George & Cynthia Mitchell Distinguished Chair in Neurosciences, Department of Pediatric Surgery
Director, Program in Children's Regenerative Medicine, Department of Pediatric Surgery
Co-Director, Texas Trauma Institute
Education & Training
- English Plan II Honors - University of Texas at Austin, Austin, TX, 1984
- Doctor of Medicine - University of Texas Medical Branch, Galveston, TX, 1989
- General Surgery - University of Texas Health Science Center at Houston, 1990
- 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
- Pediatric Surgery - University of Michigan, Ann Arbor, MI, 1996
- Surgical Critical Care - University of Texas Medical School at Houston, 1997
Areas of Interests
- Clinical Interests
- Colorectal Diseases, Gastroesophageal Reflux Disease (GERD), Laparoscopic Hernia, Minimally Invasive Surgery, Pediatric Surgery, Trauma Surgery
- Research Interest
- Pediatric Traumatic Brain Injury, Safety of Autologous Mesenchymal Stem Cell Therapy for Spinal Cord Injury in Children, Safety of Autologous Human Cord Blood as a Treatment for Traumatic Brain Injury in Children
Dr. Charles S. Cox, Jr., is the George and Cynthia Mitchell Distinguished Chair in Neurosciences and directs the Pediatric Surgical Translational Laboratories and Pediatric Program in Regenerative Medicine at the UTHealth Medical School. He directs the Pediatric Trauma Program at the UTHealth Medical School/Children’s Memorial Hermann Hospital in the Texas Medical Center.
A Texas native, Dr. Cox received his undergraduate degree from the University of Texas at Austin in the Plan II Liberal Arts Honors Program. Upon graduating from the University of Texas Medical Branch, he completed his Surgery residency at the University of Texas Medical School at Houston. Further post-graduate fellowships were completed in Pediatric Surgery at the University of Michigan, an NIH T32 sponsored clinical and research fellowship in cardiopulmonary support/circulatory support devices/bio-hybrid organs at the Shriner’s Burns Institute, and Surgical Critical Care/Trauma at UTHealth Medical School. He is certified by the American Board of Surgery in Surgery, with added qualifications in Pediatric Surgery and Surgical Critical Care.
The Pediatric Translational Laboratories and Pediatric Program in Regenerative Medicine is a multi-disciplinary effort that addresses problems that originate with traumatic injury and the consequences of resuscitation and critical care. The Program focuses on progenitor cell based therapy (stem cells) for traumatic brain injury, and related neurological injuries (hypoxic-ischemic encephalopathy, stroke, spinal cord injury), recently completing the first acute, autologous cell therapy treatment Phase I study for traumatic brain injury in children.
The program also develops novel bio-hybrid organs using cell-based and tissue engineering approaches to trauma and injury related problems. These efforts have recently resulted in two IND based cell therapeutic studies, and three patents in the past two years. The program is funded through the National Institutes of Health, Texas Higher Education Coordinating Board, Industry Collaboration, and philanthropic contributions.
Dr. Cox has served on scientific study sections/review groups for the National Institutes of Health, American Heart Association, Veterans Affairs MERIT Awards, Department of Defense, Congressionally Directed Medical Research Programs, as well as National Research Programs in Canada, Singapore, and the Czech Republic. He is the author of over 100 scientific publications, 20 book chapters, and is the editor of a text in press entitled, Progenitor Cell Therapy for Neurological Injury.
- 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.
- Walker PA, Bedi SS, Shah SK, Jimenez F, Xue H, Hamilton JA, Smith P, Thomas CP, Mays RW, Pati S, Cox CS. Intravenous multipotent adult progenitor cell therapy for traumatic brain injury: Modulation of microglia/macrophages. J Neuroinflammation 9:228-240, 2012. PMID: 23020860
- Chu J, Pham NT, Olate N, Kislitsyna K, Day MC, LeTourneau P, Kots A, Stewart RH, Laine GA, Cox CS, Uray K. Biphasic regulation of myosin light chain phosphorylation by p 21 activated kinase modulates intestinal smooth muscle contractility. J Biol Chem 288:1200-1213, 2013. PMID: 23161543
- Treble A, Hasan K, Ittikhar A, Cox CS, Stuebing K, Swank P, Ewing-Cobbs L. Working memory and corpus callosum microstructural integrity following pediatric traumatic brain injury: A diffusion tensor tractography study. J Neurotrauma 30:1609-1619, 2013. PMID: 23627735.
- Olsen AB, Hetz RA, Xue H, Aroom KR, Bhattarai D, Johnson E, Bedi S, Cox CS, Uray K. Effects of traumatic brain injury on intestinal contractility. Neurogastroenterology Motil 25:593-597, 2013. PMID: 23551971
- Bedi SS, Smith P, Hetz R, Caplan H, Cox CS. Immunomagnetic enrichment and flow cytometric characterization of mouse microglia. J Neurosci Methods 219:176-182, 2013. PMID: 23928152
- Bedi SS, Hetz R, Thomas C, Olsen A, Williams S, Smith P, Xue H, Aroom K, Uray K, Hamilton T, Mays RW, Cox CS. Intravenous multipotent adult progenitor cell therapy improves spatial learning after traumatic brain injury. Stem Cells Translational Med 2:953-960, 2013. PMID: 24191266
- Bedi SS, Walker PA, Shah SK, Jimenez F, Thomas CP, Hetz RA, Xue H, Pati S, Dash PK, Cox CS. Autologous bone marrow mononuclear cell therapy attenuates activated microglia/macrophage response and improves spatial learning after traumatic brain injury. JTrauma Acute Care Surg 75:410-416, 2013. PMID: 23928737