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Thread: Summary of the First International Spinal Cord Injury Treatment and Trials Symposium

  1. #1

    Summary of the First International Spinal Cord Injury Treatment and Trials Symposium

    Let me start with a short summary from memory and fill in the details later.

    The First International Spinal Cord Injury Treatment and Trials Symposium was held on December 17-20. About 300 people registered and attended the meeting. An unknown number of guests and others from Hong Kong attended. Approximately 58 invited speakers gave talks and a total of over 70 posters were presented.

    December 17, 2005
    During the first day, the program focused on rehabilitation and surgical treatment of spinal cord injury.
    Milan Dimitrijevic from Texas gave the first talk on recovery of function after spinal cord injury. It was an elegant and brand new lecture. He reviewed the history of studies of the locomotor system and how the spinal cord is "intelligent". He pointed out that the disconnected nervous system is a new system that it operating by different rules. He showed how stimulation of the spinal cord at low frequencies can change the excitability of the circuits and can produce function, described the comprehensive motor evaluation program that he had developed to assess not only voluntary but programmed motor, sensory, and autonomic systems.
    Charles Tator from Toronto spoke about Surgical Management of spinal cord injury. In addition, he reviewed secondary injury mechanisms and other factors that influence surgical decisions.
    John Ditunno from Philadlphia spoke about predicting outcomes after spinal cord injury, covering the Amerian Spinal Cord Injury Association (ASIA) classification system. He pointed that that useful locomotor recovery from "incomplete" spinal cord injury was 50% in patients who have some preserved pinprick function below the injury site (ASIA B) and over 90% in patients who had some preserved but non-useful motor function below the injry site (ASIA C).
    Keith Luk, head of orthopedics at HKU, spoke about orthopedic management of spinal cord injury.
    John McDonald from Baltimore spoke about the importance of exercise in maximizing recovery after spinal cord injury.
    Jim Guest from Miami spoke about the surgical management of chronic spinal cord injury.
    Baoguo Jiang spoke about the application of biological chitin in spinal cord injury.
    Shao-ting Xu from Beijing is the senior orthopedic surgeon in China and he gave a talk about the treatments of spinal cord injury in China.
    Wai-Sang Poon is the head of neurosurgery at the Chinese University of Hong Kong.
    Jian Jun Li is the head of the China Rehabilitation Research Centre in Beijing and he talked about rehabilitative care of people with spinal cord injury in China. He pointed out that the average length of stay of a paraplegic is 6 months and 8-10 months for tetraplegics.
    Jizong Zhao is the head of neurosurgery for Tianjin University and one of the senior neurosurgeons in China. His department alone has 94 neurosurgeons and 155 nurses, 300 beds with 8 units. He described 15 years of experience taking care of people with spinal cord injury.
    Zhuojing Luo from the Fourth Military Medical University in Xi’an described orthopedic management of spinal cord injury in China.
    Chuanguo Xiao from Wuhan spoke about his program at Wuhan and also at NYU Medical Center in New York, reinnervating neurogenic bowel and bladder in patients with spinal cord injury.
    Keith Luk, Yat-Wa Wong, Alex Chow, John Ditunno, James Guest, and Jianjun Li Panel Discussion: How to maximize the functional outcome to spinal cord injury rehabilitation

    December 18, 2005
    The second day was devoted to various clinical trials going on in China.
    Michael Bracken from New Haven described evidence based strategies for identifying effective therapies from systematic review and large simple trials. This was a remarkably concise lecture that emphasized the importance of rigorous clinical trials and also careful review of animal results before initiating clinical trials.
    Gong Ju who is the most prominent neuroscientist in China gave a talk reviewing the major published and unpublished spinal cord injury studies going on in China. He began by reviewing the 6 major centers in China that have been funded to do spinal cord injury and stem cell research, reviewing the best studies that have been published by the groups. He apologized for not being very successful in finding a great deal of basic science in China and the fact that many of the studies came from his group in Xi'an. One of the most interesting findings was that there are a number of human embryonic stem cell lines in China and the head of the center tha produced these lines would be very happy to help produce embryonic stem cells for clinical trial.
    Hongyun Huang spoke about his experience with fetal OEG transplants, presenting data about 370 patients. Most of the information has been talked about here before. He ended his talk with a plea for more compassion and caring for the patients.
    Tian-Sheng Sun from Beijing Army General Hospital described their experience with fetal olfactory ensheathing glia, using the same method at Hongyun Huang. I am not sure but I think that he presented the results of 12 patients. His results were similar to the work of Hongyun Huang but he interpreted the motor function as "root recovery". He, however, found significant sensory recovery of 4-10 dermatomes after the fetal OEG transplants.
    Hui Zhu described her experience in Kunming doing intraspinal transplants of human fetal Schwann cell transplants. She showed how the cells were obtained, summarized the results (interestingly, conversion of patients from ASIA A to C in many cases), the aggressive rehabilitation program that they have, and the rationale for the treatment. She showed two cases, one of a young teenager who had the transplants and the other of an older adult, both of whom had recovered what she characterized as ASIA A to ASIA C.
    Yong-Fu Zhang from Zhengzhou described his experience with bone marrow stem cell transplants in spinal cord injury patients. The studies suggest that the treatment is safe although they were not able to say for sure whether the treatments improved function as a result of the transplants. The treatments were given during the first few weeks after injury.
    Shaocheng Zhang from Shanghai presented his 3-decade experience using peripheral nerves to bridge function from above the injury site muscles and bladder below the injury site. He has had improvements of bladder and bowel function, as well as restoration of penile sensation in patients.
    Henreich Cheng from Taiwan reported his experience using acidic FGF to treat paitents with chronic paraplegia and quadriplegia, including several patients who improved as a result. He also presented animal studies.
    John Steeves from Vancouver talked about clinical trial guidelines for spinal cord injury and the International group that is attempting to set such guidelines. These include a variety of standards for taking therapies to clinical trial and outcome measures.
    Adrian Nowitzke from Brisbane talked about their experience transplanting adult olfactory ensheathing glia into 3 patients and the safety of the method. He mentioned that they had made 200-500 injections into the patients. The study suggests that the patients have had no significant complications associated with the cell transplants. He was not able to comment about the neurological improvements in the patients.
    Yooh Ha from Inchon, Korea, described their clinical trial results treatment with GM-CSF and bone marrow autografts into about 10 patients with chronic spinal cord injury, including some of the positive results that they had. They found that the combination therapy was better than either one alone. This is really the first evidence (to my knowledge) of bone marrow stem cell transplants combined with a growth factor that improves recovery.
    Rutledge Ellis Behnke from MIT and now at HKU showed the technology of using self-assemblying nano materials for CNS lesion repair, mostly animal studies. This is truly amazing stuff that not only self-assembles when it comes into contact with ionic solutions but it remarkably allows and promotes axonal growth across cuts of the brain and repairs of other tissues. All the studies were done in animals so far.
    Wise Young, Michael Bracken, Henreich Cheng, James Guest, Gong Ju, Tianshen Sun Panel Discussion: What have we learnt from the first generation of spinal cord injury clinical trials?

    December 19, 2005.
    This day was devoted to experimental treatments in animals.
    Wise Young summarized various advances in spinal cord injury therapies, including some new results relating to olfactory ensheathing glia and umbilical cord blood transplants in animals. Lithium strongly stimulates proliferation and neurotrophin expression by umbilical cord blood cells. Umbilical cord blood cells plus/minus lithium is one of the treatment protocols being considered in the 2006 ChinaSCINet trials.
    Geoffrey Raisman from London presented his studies on umbilical cord blood transplants into the spinal cord. He proposed the concept of glial cells opening the path for axonal growth in the spinal cord.
    Kwok-Fai So from Hong Kong presented his work on combination therapies with chondroitinase and lithium, showing that the combination is better than either one alone for improving recovery and regeneration of the rubrospinal tract and Clarke's nucleus in hemisected rat spinal cords.
    Martin Grumet from Rutgers in New Jersey presented his work on radial glial cell transplants (these are neural stem cells), showing how the cells are both neuroprotective and possibly regenerative in contused rat spinal cords.
    Hans Keirstead from Irvine, California, reported his results using human embryonic stem cells to remyelinate contused rat spinal cords and improve locmotor recovery in rats. He pointed out that the preparation of the cells is very important and that they had a spate of difficulties replicating their own results but recently were able to do so.
    Daniel Lee from Biogen, Boston, Massachusetts, presented the work at Biogen on Nogo Receptor blockers and use of the Nogo receptor to block axonal growth inhibitors.
    Chung Hsu from Taiwan reported his work showing that methylprednisolone shuts down certain inflammatory gene expression and that the drug may have dual effects on injured spinal cords, reducing inflammation and at the same time reducing tissue repair. He was able to stop the beneficial effects of the drug with RU486 which blocks the steroid receptor, suggesting that the effects of methylprednisolone are receptor mediated.
    Tsutomo Iseda from Rutgers, New Jersey, described his results on chondroitinase injections into the spinal cord, showing that this cleared out the chondroitin-6-sulfate-proteoglycan in the spinal cord. The chondroitinase was less effective when injected in chronically injured spinal cords.
    Shiqeng Feng from Tianjin, China, reported his results of transplanting Schwann cells grown from peripheral nerves into rats and then in patients. He reported improved recovery in the patients.
    Xiaosong Gu from Nantong, China, reported his work on bridging large gaps (30-mm) of peripheral nerves using a biomaterial made from chitin and polyglucuronic acid.
    Wutian Wu from HKU described his work assessing motoneuronal death after avulsion of spinal roots and how reinsertion of the roots into the spinal cord not only allowed the motoneurons to regenerate but improved the survival of the motoneurons.
    Wutian Wu, Geoffrey Raisman, Kwok-Fai So, Xiao-Ming Xu, Wise Young Panel Discussion: The Role of Combinational Therapy in Spinal Cord Injury Therapy

    December 20, 2005
    This day was devoted to clinical trial design.
    Johan Karlberg from HKU described the impressive work being done by the HKU Clinical Trial Centre that will be running the ChinaSCINet trials, explaining the crisis in pharmaceutical trials that is occurring in the world, why it is costing over $800 million to get a drug from discovery to market, and how, despite the doubling of the investment into clinical trial research, the number of approved drugs has fallen by nearly 50%.
    Paul VanHoutte from HKU discussed the ins and outs of clinical trials, the importance of good animal studies, and providing both the industry and academic viewpoints.
    Johan Karlberg then gave a description of quality assurance programs for clinical trials.
    Edwin Hui is a philosopher from HKU gave a talk about the legal and ethical concerns relating to stem cell research (unfortunately, I had to miss the above two talks and therefore cannot comment).
    Paul VanHoutte, Andrew Blight, Edwin Hui, Jianjun Li, John Steeves, Tiansheng Sun Panel Discussion: Will China Spinal Cord Injury Clinical Trial Data be Accepted by Overseas Regulatory Authorities
    Kwok Fai So, Wise Young, Andrew Blight, Gong Ju, and Gilmore O'Neill Panel Discussion: Most Promising and Feasible Therapies for Spinal Cord Injury Clinical Trials.
    Last edited by Wise Young; 03-26-2006 at 05:19 PM.

  2. #2
    Michael Bracken from New Haven described evidence based strategies for identifying effective therapies from systematic review and large simple trials. This was a remarkably concise lecture that emphasized the importance of rigorous clinical trials and also careful review of animal results before initiating clinical trials.
    Did he also do clinical trials on methylprednisolone?

    If I remember correctly I was interested in obtaining supporting info on methylprednisolone and he said ask your own doctor.
    Don't ignore the Reeve Legacy, Remember he and Dana supported open research and fought hard for ESCR


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  3. #3
    "He pointed out that the average length of stay of a paraplegic is 6 months and 8-10 months for tetraplegics."

    psssh i was lucky to get 3, and that seems to be a lot.

  4. #4
    Thx, Wise. I did see about 40% of the presentations via the webcast, but I'm anxious to hear more, especially your interpretation. This is very exciting.

    Happy Holidays to you and your family.


  5. #5
    Senior Member lynnifer's Avatar
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    Aug 2002
    Windsor ON Canada
    I'm am **REALLY INTERESTED** in Xiao and Zhang ... For Christmas next year I would like my bladder and bowel back and the worth of having that back is priceless ... I'm tired of waiting and am not getting any younger.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  6. #6
    This is the front page of the mini-program
    Last edited by Wise Young; 12-25-2005 at 01:41 AM.

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    December 18

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    December 19

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    December 20

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