He’s a very well-spoken, able-bodied guy — comes across like a man who is used to speaking to people with money, tho’ I probably couldn’t say exactly what I mean by that. Self-assurance is part of it, along with the sense that everything he says has been very, very thoroughly thought through. He welcomes us to Vancouver, his home and place of work. Shows an image of the Blusson Spinal Cord Center, home of iCord.
I’m gonna talk about biomarkers.
Here are some examples of biomarkers … PSA is the marker for prostate cancer. Troponin means myocardial ischemia, Your CD4 count tells about whether your have HIV. (He’s talking about the presence of molecules that doctors look for in patients to find out whether they have these conditions.)
In SCI we don’t have that — we haven’t had that. We just have the clinical exam that doctors do in the ICU. (Bad flashback to the morning I watched doctors stick pins in my paralyzed husband the day after his injury. 😦 )
One problem is that 30-40% of the time, patients with new injuries are in no condition to respond to this kind of exam. The other problem is that it’s 100% subjective.
What happens to people who start out with the AIS A diagnosis? Their diagnosis changes about 40% of the time. This matters because of that statistics thing Lyn was talking about earlier. “This variability clouds the interpretation of neurological recovery …”
The idea is that if we had reliable biomarkers to capture the exact nature of an acute injury, you could design trials that actually measured whether changes are due to interventions. The plan is to measure certain proteins present in the cerebrospinal fluid … these have been about 89% accurate … they can predict with reliability who will be very, very unlikely to recover. Because these markers can be used to predict the potential for recovery, it becomes possible to discover actual therapeutic effect.
Are there also markers in the blood? Not really … these signals are very weak. The ones that are strongly predictive are in the cerebral spinal fluid. How about just using the MRI as a predictor? They did a study where they looked at 3 things: MRI, Biomarkers, and AIS exams, and tried to see which of them were predictive. The result was that the biomarkers alone were predictive. Powerfully predictive. Reliably predictive.
A few years ago they started a big screening initiative that they’re now using to produce a searchable resource for the SCI community. (this work is also being done in traumatic brain injury, and there are some markers that are present in both TBI and SCI, as you might expect).
Right now there’s a data gathering effort which will create a sort of bank, called ISCIB. It’s mission is to advance the understanding of the biology of sci ….
They’re also doing what they call spinal cord biobanking — the collecting of cords from sci-injured people after they pass. The plan is there will be very highly detailed specimens and data available to researchers.
Our dependence on functional measures in SCI is a major obstacle to translational research; understanding neurochemical biomarkers in the cerebral spinal fluid can change that.
(This seems like a very sensible and necessary project … if we don’t have data to show that a particular intervention caused a reliable response, we’re NEVER going to see therapies on the market. And we can’t gather that data if we can’t begin by showing — reliably — that the patient getting the intervention was very, very unlikely to recover. That’s what biomarkers from cerebral spinal fluid make possible.)