[Apparelyzed]

Legacy tests treatment for spinal injuries

Some patients in limited testing have regained some movement or feeling in paralyzed body parts
Wednesday, June 29, 2005

ANDY DWORKIN
The Oregonian

A handful of Northwest residents paralyzed by spinal injuries will get the chance to test a treatment that may restore some lost feeling or movement.

The unusual therapy involves processing samples of injured patients' blood and skin to get special immune system cells called macrophages. Doctors inject those cells at the damaged spot in the spinal cord, thinking they will release special chemicals that help repair destroyed nerve connections.

The therapy, called ProCord, is far from proven. Completed tests have treated just 16 people, according to Proneuron Biotechnologies, the company developing ProCord.

The largest finished study followed 14 patients treated in Belgium or Israel for "complete spinal cord injuries." That means the patients lost all motion and feeling in those body parts fed by nerves below the spinal wound. It does not necessarily mean the spinal cord was completely severed, though that sometimes happens.

One year after ProCord treatment, three of the 14 patients regained some ability to feel and move paralyzed body parts, including one who regained bladder control. A fourth person regained some feeling but no movement, according to Proneuron.

Doctors can't prove ProCord helped those patients. But people with complete spinal cord injuries rarely get back any feeling or movement, Portland neurosurgeon Dr. Jefferson Chen said. Chen is overseeing Portland-based Legacy Health System's participation in an expanded, "Phase II" trial of ProCord.

The patients helped by ProCord did not recover fully -- they were not suddenly walking around or feeling perfectly healthy. But Chen said regaining any movement or feeling after a complete spinal injury, even in one toe, significantly improves a patient's chances of improving with rehabilitation.

"It means that some messages are getting through" the spine's wounded zone to the brain, Chen said. "That puts the patients in a whole different category for recovery."

In the Portland area, Chen said, vehicle crashes are the main cause of complete spinal injuries, followed by sports injuries such as skiing and snowboarding accidents.

Legacy aims to enroll six or more people in the study, one-tenth of the total needed for Phase II trial. Chen estimated that would take about 18 months, given the rate of spine injuries seen locally. The trial is open to patients with complete spinal injuries to the neck or thorax who are ages 16 to 65 and meet certain other medical criteria.

Treatments in Denver

Patients who enter the trial would be treated and stabilized at a local hospital. Within two weeks of being injured, all participants would go to Craig Hospital in Denver, which specializes in spine and brain injuries. There, two-thirds of participants will be randomly assigned to get ProCord as part of their rehabilitation. The remaining one-third will get standard rehab only.

Surgeons will take blood and skin from participants getting ProCord, probably from the patients' arms. A lab will harvest macrophages from the blood and process them with the skin sample. That step helps "activate" the cells, spurring them to create more chemical factors that regulate the body's response to injury.

Doctors will inject the activated cells in six spots just below the injury. Although macrophages rush to the site of most injuries to aid in healing, a kind of biological wall called the "blood-brain barrier" keeps the cells out of the brain and spinal cord. By injecting the macrophages into the spine, researchers think they can spur cells in the spinal cord to recover.

All trial participants will have rehabilitation therapy for about a month in Denver, Chen said. Local patients will return to Legacy for more rehab and have their progress tracked by Legacy researchers.

It could take two or more years to finish the trial and determine whether ProCord genuinely helps ease spinal injuries.

Andy Dworkin: 503-221-8239; andydworkin@news.oregonian.com


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