Charles S. Cox, Jr., MD

Education

BA

English Plan II Honors - University of Texas at Austin, Austin, TX, 1984

MD

Doctor of Medicine - University of Texas Medical Branch, Galveston, TX, 1989

Internship

General Surgery - University of Texas Health Science Center at Houston, 1990

Residency

General Surgery - University of Texas Health Science Center at Houston, 1994

Research Fellowship

Trauma and Burns -Shriner's Burns Institute, University of Texas Medical Branch, Galveston, TX, 1992

Fellowship

Pediatric Surgery - University of Michigan, Ann Arbor, MI, 1996

Fellowship

Surgical Critical Care - University of Texas Medical School at Houston, 1997

Areas of Interest

Clinical Interests

Colorectal Diseases, Gastroesophageal Reflux Disease (GERD), Laparoscopic Hernia, Minimally Invasive Surgery, Pediatric Surgery, Trauma Surgery

Research Interests

• Pediatric Traumatic Brain Injury
  Traumatic brain injury (TBI) affects nearly 1.5 million patients each year in the U.S. with a cost of nearly 60 billion dollars associated with it.  TBI results in long-term physical and cognitive deficits. TBI is a central nervous system (CNS) injury that disrupts the normal interactions between the immune system and CNS. A CNS injury can lead to the production of inflammatory mediators or the disruption of the homeostatic signals in the circuitry of the neural-immune interactions.  Immune responses are governed by distant organs such as the spleen and thymus, which act as “bioreactors” when combined with progenitor cell therapy.  One potential target of the “bioreactors” is microglia, the resident immune-response cells of the CNS.  After injury, microglia (macrophages) differentiate into two different phenotypes.  The early phase after injury is dominated by M1 microglia that are considered pro-inflammatory.  They potentially release pro-inflammatory cytokines such as IL-1, IL-6 and TNFα. The other microglia (M2) is anti-inflammatory.  It releases cytokines such as IL-4 and IL-10.  The ratio of M1 vs M2 is potentially a critical factory in a prolonged inflammatory state.  We are currently investigating the signaling mechanisms that govern this ratio and the subsequent consequences of the changes in the ratio of M1:M2 when combined with progenitor cell therapy.  In addition, we are also examining the role of tissue (Electrospun) scaffolds as carriers for cells intended to treat TBI. Tissue scaffolds provide mechanical, geometric and chemical indicators that promote and modulate cell growth. Electrospinning is a relatively simple method of producing tissue scaffolds with geometries similar to those found in the extracellular matrix (ECM) of living tissue. The process of electrospinning involves the use of an electric field to extrude thin fibers that accumulate to create the scaffold. Electrospun scaffolds have been applied to many different areas of the body including blood vessels, bone, and nerve grafts, and can be used with either natural or synthetic biomaterials. We are attempting to use electrospun scaffolds as carriers for cells intended to treat traumatic brain injury (TBI). This requires studying the fabrication parameters that influences cell growth, and the potential for neuroprotection and neurogeneration following TBI.
• Safety of Autologous Mesenchymal Stem Cell Therapy for Spinal Cord Injury in Children
  This is a FDA approved pilot study, conducted at Children’s Memorial Hermann Hospital and sponsored in part by TIRR, to determine if bone marrow harvest and transplantation are safe in children with SCI. Ten children, ages 0-15 years of age who have suffered a SCI within 6 months to 4 years of study enrollment, will undergo bone marrow aspiration. Following cell processing, the children will then receive an Intravenous infusion of their cells. They will return at 30 days and 6 months post-procedure for follow-up to assess late functional outcome using pre-transplantation spinal cord function as the control.
• Safety of Autologous Human Cord Blood as a Treatment for Traumatic Brain Injury in Children
  This is a FDA approved pilot study, conducted at Children’s Memorial Hermann Hospital and sponsored in part by Cord Blood Registry (CBR), to determine if autologous hUCB transplantation for TBI is logistically feasible and safe. Ten children, ages 18 months -17 years who have suffered a severe to moderate TBI 6 months to 18 months prior and who have their own cord blood banked at CBR, will receive an intravenous infusion of their cord blood derived cells. Follow-up will occur at 6 months, 1 year and 2 years post-procedure to assess improvement using pre and post-TBI neuropsychological and imaging outcomes measures.

Publications

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