Wednesday, April 14, 2004

SPINAL INJURY STRIDES: New therapy center to open in Detroit

BY PATRICIA ANSTETT - FREE PRESS MEDICAL WRITER

Detroit's Rehabilitation Institute of Michigan will open a center this summer, unlike any in the United States, that will offer new therapies to help spinal cord injury patients regain some sensation and movement after years of paralysis. It also will evaluate hundreds of spinal cord patients for two experimental operations abroad and oversee their rehabilitation in Detroit.

"We hope the center gives people open access to the latest medicines and technologies" for spinal cord treatment, said Dr. Steven Hinderer, Detroit Medical Center specialist in chief and director of the institute's Center for Spinal Cord Injury Recovery.

The center is scheduled to open in August at the Rehabilitation Institute's new Brasza Outpatient Center on the Detroit Medical Center campus, north of Detroit's downtown.

The institute generated excitement last fall among the nation's spinal cord community when it announced plans to screen patients for operations in China and Portugal. The operations are giving hope of regaining functional skills and movement to people with paralyzing spinal cord injuries -- which number up to 400,000 in the United States, according to the National Spinal Cord Injury Association.

About 100 patients already have called the Rehabilitation Institute and await screening for the procedures, Hinderer said.

Earlier plans had called for opening the center at the institute's Novi facility, but the DMC's new chief executive officer, Michael Duggan, insisted that the highly visible project be offered at the institute's headquarters.

The center will offer devices that send electrical signals into muscles, helping them move, and harnesses to hoist patients over treadmills so therapists can help them walk a step at a time.

The center will be funded with $1 million in gifts from three families of spinal cord patients. The donations include $450,000 from the Paul E. Gau Foundation; $350,000 from the Keith Shereda Foundation, and $200,000 from the Mike Wallace Research Fund.

Hinderer expects he will work almost exclusively evaluating people interested in operations in China and Portugal and following up on their care.

Hinderer is overseeing physical therapy for two metro Detroiters, Erica Nader, 26, of Farmington Hills and Bob Smith, 46, of Harrison Township, who were among the first Americans to undergo the new procedures.

"Their progress way exceeds my expectations," Hinderer said.

Both procedures are new and promising, but are not yet studied well enough to understand the benefits and risks of the operations. Fewer than 400 people have undergone the operations in the past three years.

Borrowing cells for new growth
The China and Portugal approaches vary in procedure and the type of patients eligible for them. But both use cells or tissue obtained from the olfactory bulb, above the ridge of the nose, that is capable of regenerating other cells.

These olfactory ensheathing glia (OEG) cells also release chemicals that help coat, or myelinate, connections between nerve cells. And they are attracted to growing nerve cells.

Studies have shown improved walking, weight-bearing activities and sensation in animals after OEG cells were placed into incisions made in their spinal cords.

Dr. Hongyun Huang, a neurosurgeon at Beijing's Chaoyang Hospital, has performed nearly 400 operations in the past three years using OEG cells from aborted fetuses on patients up to 30 years after an injury.

Huang injects 10 million of the cells just above and below a person's main spinal cord injury site. Anyone is eligible six months after sustaining a spinal cord injury.

Smith was Huang's first U.S. patient.

Smith paid $20,000 for the operation, including housing and travel. It was not covered by insurance, though Smith's Health Alliance Plan pays for his physical therapy.

With tissue, age is a factor
Dr. Carlos Lima, a neuropathologist at Egaz-Moniz Hospital in Lisbon, Portugal, has performed about 20 procedures in the past year -- including Nader's. The procedure uses a patient's own OEG mucosa -- the mucous membrane that lines the olfactory bulb.

After separating the tissue from other respiratory cells, Lima makes an incision at the injury site, clears scar remnants or fluid that often fills the area and packs it with 20 to 30 pieces of OEG-rich tissue before closing the incision.

The Portugese procedure is intended for younger patients, ages 18-40, preferably no more than three years after an injury. It costs about $50,000 and is not covered by insurance.

Hinderer said a patient's age may be a factor in recovery after the Portugese operation because the cell count in olfactory mucosa decreases with age. "By age 50, you have half what you once had," Hinderer said.

So far, none of the patients in China or Portugal has gotten worse as a result of surgery, Hinderer said. He also expects greater gains by U.S. patients who have the benefit of new rehabilitation therapies.

"This is such new ground," he said. The American patients, like Smith and Nader, "are the pioneers."

In a widely read Web site among the spinal cord community, Dr. Wise Young, director of the Rutgers University W.M. Keck Center for Collaborative Neuroscience, said many questions remain about the surgeries, including: When is the best time to plant the cells after an injury? How many cells should be transplanted? Which source of OEG cells are best? He tells Web visitors he expects better answers in the next few years. Thousands wait.

Hinderer said he hopes to provide patients with better answers and information on outcomes in the interim.

The center expects to begin another study in June with ProNeuron Biotechnologies to investigate the use of a white blood cell component administered within five to 14 days after injury. The Rehabilitation Institute will be one of five U.S. sites for the study.