Stem Cells for Spinal Cord Injury in China: Update on Dr. Hongyun Huang

I've blogged about Dr. Huang's work with stem cells for spinal cord injury patients before, but this is a new release on another patient who flew in from the US for therapy.

A lady by the name of Carmen Paulino from a town called Hazleton in Pennsylvania travelled halfway around the world to China for stem cell injections into her spinal cord. According to the interview, Ms. Paulino was paralyzed in both legs two years ago in an auto accident (it's a pretty tragic story about her boyfriend's estranged wife who in a fit of rage slammed into the car causing the car she was in to slam into two other cars, resulting in her severe injury and disability).

The article does not make clear whether the stem cells injected into Ms. Paulino's spine were obtained from cord blood or from an embryonic origin- Dr. Huang has worked with several sources previously. However, the results are interesting. Before the procedure, Ms. Paulino was able to stand with braces on her legs. But after the procedure, she is now able to walk from the bedroom to the bathroom with the aid of a walker. Additionally, she has also noticed sensation in her legs when she rests a cold drink against her lap and a burning sensation in her left toe.

The cost of the therapy was USD 20,000 and the procedure took place at Xishan Hospital over the course of just 3 days. Ms. Paulino also mentioned that whilst she was there receiving her injections, she met other foreigners from Canada who were also there for the same procedure. She had physiotherapy, massages and acupuncture to assist in the healing process.

Ms. Paulino is keen to return for another round of treatment in China which will cost her USD 30,000, where Dr. Huang intends to remove the screws in her back and inject stem cells into those damaged areas of her spine.


Another report tells of a 23 year old by the name of Kirk Green who was left quadriplegic after a snowmobile accident who is planning to leave for stem cell treatment in China later this month. I suspect he might be going to the same hospital as Ms. Paulino for a cord blood stem cell injection. Let's see if he also experiences the same extent of recovery.


There is a website called Stem Cells China which has information on Dr. Huang's more recent activities and charges. I can't verify its accuracy or validity but you can check it out here.

Back Surgery: Healing improvements with Adult Stem Cells

In relative discretion, articles like this one make me think that stem cell work is going on for patients all over the US and it doesn't have to be classified as a clinical trial, especially if there isn't much risk with the route of administration and the cells are the patient's own.

Hailed as a new technique, an orthopaedic spinal surgeon Dr. Robert Johnson at San Antonio's Methodist Hospital performed a surgical procedure for a 66 year old patient who suffered from disc degeneration and arthritis which has led to a narrowing of his spinal canal- leading to nerve compression and consequent debilitating back and leg pain.

The procedure involved the fusion of 3 vertebrae in the patient's back and placing in stem cells which will help the spine to fuse successfully (like a bone graft, but its constructed by stem cells). The stem cells are obtained from the patient himself, from the bone marrow where a large-bore needle is inserted into the patient's pelvis and 2 large syringes of marrow are extracted. The marrow is spun in a centrifuge to obtain the stem cells, which are then soaked into a synthetic, spongy collagen pad and placed on the vertebra to aid grafting of the cells onto the bone (which might otherwise float away).

It is already well known that stem cells originating from bone marrow have the capability to form blood, nerve and bones. The doctor is harnessing this knowledge to help his patients recover faster and hopefully, better. The doctor is optimistic that the stem cells will provide reliable and consistent fusion and reduce the chances that the patient will require future surgeries (nice!). He also notes that since it is the patient's own cells, the likelihood of problems is small and the operation itself is straightforward for him.

Given that the surgeon has already performed this procedure on more than 30 patients in the last 3 months, I think that this is interesting work and should be continued. 3 months of follow-up on the patient's condition is significant. If the healing is improved then it would be great if the doctor would share the technique and which brand of collagen pad he is using.

It would be great if we could use the collagen pads for other types of surgeries too, where stem cells need a little help to stick to the site of injury.


Dr. Johnson's Bio and Contact Details are as follows:

ROBERT G. JOHNSON, MD
DR., Orthopedic Spinal Surgery

Office:
4410 Medical Dr
Suite 610
San Antonio, Texas 78229
Phone: 210-614-2453
Fax: 210-614-4907


Status: Active
Facilities: Methodist Hospital
Organization: Neurosurgical Associates of San Antonio, P.A.
Medical school: University of Toronto, Toronto, Ontario, Canada
Internship: St Michael's Hospital, Toronto, Ontario, Canada
Residency: University of Toronto, Toronto, Ontario, Canada
Board-certified: 1986
Gender: Male
Memberships: American Academy of Orthopaedic surgery, American College of Surgeons, North American Spine Society, TMA, Bexar County Medical Association, Physicians Who Care
Special practice interests: Spine
Insurance accepted: Most Medical Insurances accepted, please call office to verify.
Additional languages spoken: English, Spanish

First Collective Interview of Adult Stem Cell Patients with Successful Outcomes

I read with great interest an announcement that a few successful adult stem cell therapy patients would be gathering in Washington to share their experiences and show how they have improved.

Many patients are tremendously shy when discussing their condition and I think its marvellous that they are willing to come forward. No doubt there may be a political slant to organizing this event (given that Senator Sam Brownback from Kansas and Dr. David Weldon who is from the House of Representatives will be giving keynote speeches), but if it is to promote awareness and funding for stem cell clinical trials and to further understanding of applications, I'm all for it.

There were 5 featured speakers:

Jacki Rabon- Stem cells used for treatment in her spinal cord (see previous entry)

Cathy Pell- Daughter Abby received cord blood treatment for cerebral palsy and used her own cord blood stem cells

Dr. David Foege- Heart failure patient who underwent Theravitae's stem cell therapy developed by Dr. Amit Patel in Pittsburgh

Mary Schneider- Son Ryan treated with his own cord blood when he was 2 for cerebral palsy at Duke University (same as Abby)

Stephen Sprague- Was diagnosed with CML 10 years ago and used cord blood stem cells for a transplant source and is well today

Apparently they shared phenomenal stories of success in their treatments and encourage more adult stem cell work to be done.

"To date, embryonic stem-cell research has failed to produce one successful treatment," said Paul Chaim Schenck, director of the national pro-life action center. "Conversely, adult and cord-blood stem-cell research has yielded over 65 successful treatments, including curing diabetes in some patients."

Interestingly, the session was organized rather innovatively as a wine-tasting session sponsored by a company called BOGO wines. Its owner, Bill Schneeberger is a Catholic from Ohio who donates $2 (USD) from every bottle sold to adult stem cell research. Check out the follow-up article here, it's got some interesting insights to the event but not much on the patients themselves.

I would have loved to be there to listen and ask them questions. If anyone reading this blog attended the session, I'd really appreciate if you'd share the information with me.

US Spinal Cord Injury Patient update from Treatment in Portugal

It looks like the Portuguese team have been able to attract a number of young spinal cord injury patients to undergo stem cell therapy with testimonial success. Here's another story of 20 year-old Paul Rudat who is paralyzed from the chest down and now has sensation in his toes. Choose whether you want to believe it or not, but I'm all for improvement in quality of life.

Try and watch the video if you have broadband, you can see the scar where he had the surgery done and the patient himself describes how he has improved. This news is most encouraging but clearly the patient had to be willing to take the necessary steps to initiate his own rehabilitation.

A Hospital in the US announces Stem Cells for Spinal Cord Injury

A very short article with barely any details tells us that a hospital in the US, Westlake Medical Centre has used autologous (person's own) stem cells for spinal cord injury.

The stem cells were extracted from the middle-aged female patient's hip (quite standard procedure) by Dr. Scott Spann, using "a special needle and other specialized equipment" from a company called Spinesmith.

An unnamed collaborator performed the cell separation and the resulting cell concentrate was implanted into the injured area of the spine. The VP of Spinesmith claims that this method has been in use in Europe for several years, but it doesn't make clear if this procedure is a replication of them, nor where they have been performed.

I looked around for Spinesmith but could only find the website of a chiropractor who definitely believes that first impressions sell, check out the huge photo on the front page. Then I looked around for VCD Medical which is said to own Spinesmith, and the website had even less information...

The only legitimate looking website was that of the hospital which looks rather posh inside. Apart from the list of expertise they have available, the website has some interesting features, aerial photos of the hospital (??), comprehensive live weather charts and space at the hospital is also advertised for lease. The credentials of the doctor who performed the procedure can be found on this page.

At this point, maybe I should just add that in Malaysia, StemLife's heart procedures has been performed at two medical centres so far. One of them is at HSC Medical Center (check out the stem cell therapy news) and the other is at Gleneagles Intan Medical Centre, both in Kuala Lumpur.

Paralysis Surgery now in China- Umbilical Cord Blood Stem Cells & Olfactory Mucosal Stem Cells?

Previously, I blogged about the use of olfactory mucosal stem cells* in an attempt to heal the injured spinal cord of Jacki Rabon. Now, another article published in the Weschester Journal describes the use of it in Beijing. Dr. Hungyun Huang will perform a similar procedure for another 23 year-old spinal cord injury patient, Christan Zaccagnino, to that conducted in Portugal.

The article states that whilst there is no success rate documented, and the surgery has not been approved in the US (hence, Lisbon, Beijing and Brisbane). But Dr. Wise Young, a Rutgers University professor and neurologist who has studied the surgery, said each of the dozen of Huang's patients he has spoken with had more sensation and some muscle strengthening after the procedure, according to a forum on the Web site of the W.M. Keck Center for Collaborative Neuroscience at Rutgers University.

According to the "Cure Paralysis Now" advocacy group website, Dr. Wise Young from Rutgers University posted some notes from Dr. Hungyun's paper:

Hungyun Huang and colleagues recently published a paper in the Chinese Medical Journal (2003, 116:1488-91) reporting the neurological results on the first 171 patients into whom they transplanted olfactory ensheathing glial (OEG). The patients ranged from 2 to 64 years of age, were mostly male (139, female 32), and were 6 months to 18 years after injury (average 2 years after injury). The cells were cultured from olfactory bulb of aborted human fetuses. The spinal cord above and below the injury site was exposed by laminectomy. Approximately a half million cells were injected into each of two sites, above and below the injury. Improvement was shown in the motor score, touch score, and pinprick score in the patients at 4-6 weeks after transplantation for each age group. Approximately 71% of the patients were ASIA A (complete spinal cord injury). There was no significant difference of recovery between the age groups.

During the surgery, Dr. Hungyun Huang of Beijing will transplant cells derived from stem cells in the lining of the nose into Zaccagnino's spinal cord above and below the spot where she was injured. Huang normally uses cells from aborted human fetuses, but Zaccagnino requested that he use cells from the frozen umbilical cord blood of her two young nephews instead (like the procedures performed in Korea by Histostem).

$$$ How much is the procedure?
USD 30, 000 for the procedure to take place in Beijing next April. Funds are now being raised by charitable donations organized by her family, friends and classmates.

It will be interesting to see the results of stem cells from umbilical cord blood versus olfactory mucosa lining, clearly there is big difference in the way that the stem cells can be obtained (cord blood does not require surgery, no controversy with aborted fetuses, no growth medium contamination problems) and if this can be repeated consistently with similar or equivalent results, will provide a lot more options for patients wishing to undergo this therapy.

*Olfactory ensheathing glia (OEG) are of particular interest because of their ability to facilitate regeneration and remyelination of the spinal cord. They are believed to be the reason why the olfactory nerve is the only central nervous system structure continuously regenerates in adults. However, umbilical cord blood derived stem cells have also produced significant recovery in patients under the same surgical procedure.

Update on Michelle Farrar's Spinal Cord Injury Procedure

The only way of knowing whether any surgery or medical procedure works is to communicate with the patient afterwards to understand whether their condition has improved or not.

In an earlier blog entry, I discussed the case of Michelle Farrar, who went to Korea for stem cell implantation into her damaged spinal cord. It was interesting to note that 4 months after the procedure, Michelle is showing signs of progress.

Upon returning back to the US from Korea, she was able to move her feet independently (apparently recorded on video but I can't seem to download it on my computer) but is for some reason unable to move them now. However, she has shown progress in a few other areas. She can do sit up crunches (good abdominal control), can use the bathroom unassisted and has feeling below the knees.

She could do none of these before the stem cell infusion.

The doctor responsible for her rehabilitation and care has called for a collaborative effort with the doctors in Korea and a large clinical trial. I think this is wonderful and spinal cord injury patients fitting the criteria should come forward to see if they may benefit as well.

Cost wise, the procedure is expensive (as are matching stem cells) for the hospitalization, medication, professional fees and although the doctors in Korea have been criticized for charging for a surgery deemed experimental, I think that unless philanthropists or a foundation would step forward to fund all the costs mentioned, the price tag is really about cost-recovery as opposed to profit (surgeries and cell therapy is expensive due to the level of care involved).

Furthermore, this procedure has to be customized according to the patient's condition and I'm really not sure if there can be "economies of scale" as this isn't a mass-produced manufactured drug.

So far, it looks like Miss Farrar is doing well and I hope that with the stem cells and rehabilitation, she's going to get back on her feet and on with life.I'm sure ABC 7 news will keep us updated in the next few months.

Olfactory Mucosa Stem Cell Surgery in Portugal for Paralysis

Spinal cord surgery for the implantation of stem cells derived from umbilical cord blood or olfactory mucosa has been performed and announced in a some countries, including Holland, Korea and Portugal. The latest article relates a story, about an 18 year-old former volleyball player from Illinois (paralyzed for 2 years from the waist down after a car accident) who went to Portugal for 12 days to have this procedure, in a fair amount of detail.

The procedure took place at a hospital called Hospital de Egas Moniz and the patient was operated on by a Portuguese neurologist, Dr. Carlos Lima. The surgery is still experimental and involved the removal of tissue from the olfactory bulb, which is thought to contain stem cells that will promote the formation of nerve cells and new neuron connections. The tissue was then inserted into the 4 centimeter damaged area of the patient's spinal cord.

The artice states:"All of Lima's approximately 80 patients - half of them Americans - who have undergone the surgery in Portugal since summer 2002 have reported some gains in sensation, and about 5 percent say they have better feeling in their bladders and bowels, Hinderer said." But according to a Dec 4 report by the Detroit Free Press, It has been noted that most patients do not see any substantial gains until 6 months post surgery.

Additionally, another website states (scroll half way down):"All of the patients recovered well from the surgery. Olfaction returned to normal by three months after the surgery. All of the patients showed improvements. One of the patients regained bladder control at fifteen months after the surgery. Regaining bladder control is extremely important to patients with spinal cord injury. All but one of the patients gained feeling in some areas of their body where they previously had no feeling. All of the patients gained the ability to move certain muscles that they could not move before the olfactory mucosa treatment."

After the operation, the patient had to undergo intensive rehabilitation program for two and a half weeks at a not for profit rehab institute operated by Dr. Steven Hinderer in Michigan. According to Dr. Hinderer, the aggressive excercises, which include crawling and walking with the help of braces for three hours each day, was to frequently stimulate for reorganizing and adapting the body to the changes that take place within.

Critics say the surgery/rehab combination is a waste of money (USD 44,000 for the surgery, USD 10,000 for the rehab, USD 10,000 for the leg brace and USD 5,000 for the work out equipment, total USD 69K) , but neither the patient nor her mother regret the pain or effort connected with the surgery. They believe that the surgery has helped the patient restore feelings in the hips and some sensation in her legs.

"Without the surgery, Jacki probably wouldn't regain any sensation," Her mother said. "There's lots of stuff going on, I'm sure she has more than she had before she went to Portugal." Although spinal cord repair with stem cells is in its experimental stages, this patient who has many years ahead of her is brave enough to accept the risks and at least show that thus far, it hasn't caused her any harm. We'll just have to wait and see if it helps her regain significant control of her muscles. Keep an open mind and support those who wish to improve their lives and help others in similar situations.

Jacki Rabon has written about her experience in Portugal, Detroit and Waverly in an online journal .