Monday, December 15, 2003

Cell Transplants Help to Reverse Paralysis

Patients are feeling a sensation of hope

Robert Smith, 46, of Harrison Township underwent a Chinese procedure to help him regain movement. With him are his daughters Jaimie, 15, left, and Jennifer, 19.

The first American spinal cord patient to undergo a fetal cell transplant procedure -- a Harrison Township man paralyzed in a Lake St. Clair diving accident -- is regaining some movement and sensation a month after the experimental operation in China.

"I have normal sensation in parts of my body that I haven't felt in four years," said Robert Smith, 46, a one-time Chevy car salesman paralyzed from the chest down on July 4, 1999, when he dove off his boat into water that was more shallow than he thought.

He spoke at a news conference at the Rehabilitation Institute of Michigan's Novi facility Thursday.

Last month, Smith and two other Americans from New York and South Dakota went to Beijing for an experimental technique called olfactory ensheathing glia cell transplant.

It takes cells from the olfactory nerve above the ridge of the nose and injects them above and below a person's injury site. The olfactory cells are some of the only nerve cells in the body capable of continually regenerating themselves. They help coat, or ensheath, myelin that covers nerve cells, hence the name.

Dr. Hongyun Huang, the Chinese neurosurgeon who developed the technique, uses more than 1 million cells from aborted fetuses for each transplant.

A related procedure developed by Dr. Carlos Lima, a Portuguese physician, uses a person's own olfactory cells, obtained by threading a tube up the nose to extract them, then packing those cells above and below the injury site. It is known as the Lima procedure, or olfactory mucosa tissue transplant. It is much newer and appears to take longer to work.

Erica Nader, 25, whose legs were paralyzed in an auto accident two years ago while visiting her parents in Farmington Hills, was the first American to undergo the Lima procedure, performed in March. She is undergoing intense six-day-a-week rehabilitation, three to six hours a day.

"Everybody seems to be looking for the magic bullet; actually, it's a mix of things," said Nader, a San Diego resident and a California Peace Action worker at the time of her accident. She attended the news conference with her family.

Dr. Steven Hinderer, specialist-in-chief at the Rehabilitation Institute, an affiliate of the Detroit Medical Center and the Wayne State University School of Medicine, said the two procedures show that "it's very clear there's opportunity for substantial, if not full recovery."

The institute is collaborating with physicians in China and Portugal to study the procedures. It also will evaluate U.S. patients who may be eligible for the two procedures overseas and collect data in a computer registry.

At the same time, the institute is creating a new program, different from conventional spinal cord rehabilitation efforts, to be tentatively called the Neurorecovery Center for Spinal Cord Injury, to open in June. It will offer intensive rehabilitation programs focusing on nerve regeneration and sensory nerve stimulation approaches.

Neither olfactory cell procedure is likely to be offered in the United States soon, particularly the Chinese approach because of its controversial use of fetal cells.

Hongyun, a neurosurgeon at the Beijing Chaoyang Hospital, spoke at the news conference to summarize results of more than 300 patients who have undergone the technique in the past three years. He said recovery varies from slight to partial improvements in movement and sensation, including regaining bladder and bowel function, as Smith said he is beginning to do.

The procedure is appropriate for spinal cord patients without a completely severed spinal cord and some other neuromuscular disorders, including multiple sclerosis and Lou Gehrig's disease, Hongyun, said. It takes two hours, costs $20,000 and is not covered by insurance. Hongyun hopes to publish his results soon. For now, most doctors "don't believe what I'm saying," he said.

Complications have been limited to a few patients who developed problems typically associated with surgery, such as infections or leg blood clots.

Smith, a father of three and married 23 years, found out about the Chinese approach on the Internet. Hinderer and another doctor assured him he wasn't foolhardy to pursue the operation. Within hours of the procedure, Smith could wiggle toes he couldn't move before, breathed better and had a stronger lefthand grip, he said.

Smith, too, is undergoing intense rehabilitation, five days a week for six months. Asked how much recovery he expects to achieve, Smith said: "I think the sky's the limit."

BY: PATRICIA ANSTETT, FREE PRESS MEDICAL WRITER
PATRICIA BECK/DFP