Paralysis pioneer

Published: June 12, 2004  |  Source: twincities.com
117

A Chinese neurosurgeon’s experimental operation using fetal cells is giving paraplegics hope but stirring medical and ethical concerns.

Strolling briskly through the dim halls of Chaoyang Hospital, neurosurgeon Huang Hongyun says his pioneering medical work using fetal cells to treat paralysis and other nervous system ailments is swamping him with attention.

The cell phone jangles. Lecture invitations mount. E-mails pour in from around the world.

Huang is causing a stir in medical circles. Many U.S. scientists and researchers have qualms about what he’s doing.

But hundreds of families of paraplegics from the United States, Japan, Singapore and elsewhere are lining up to bring loved ones to Beijing for an experimental operation that may be able to help patients sit up by themselves. Or hold a cup. Or button a shirt. Or sweat below their necks.

Huang is one of a handful of researchers around the world shattering the centuries-old idea that paralysis is irreversible.

While the Bush administration sharply limits research into embryonic stem cell and fetal tissue, citing moral and ethical considerations, nations such as China are aggressively delving into such research.

Huang, a 48-year-old with an easy smile, is taking certain kinds of fetal nerve cells, culturing them and transplanting them into patients with spinal cord injuries or other nervous system disorders. In little more than two years, he’s done the operation nearly 450 times. More than 1,000 people are on waiting lists.

“I was bowled over. They didn’t have patients who were totally paralyzed and then get up and walk. But there were people who couldn’t hold objects, and then they could after (the operation),” said Dr. Paul Cooper, a spinal surgery expert at NYU School of Medicine.

HIGH PROFILE ISSUE

The search for treatment for paralysis is at a high-profile juncture, partly because of Christopher Reeve, the renowned actor who was paralyzed after being thrown from a horse in 1995. As a quadriplegic, the strapping portrayer of the titular character in the “Superman” movies has become a forceful and blunt advocate for daring research.

Reeve blames a sluggish U.S. research establishment, lack of funding and resistance from drug companies for failure to do more for spinal cord injuries. Listening to Reeve, many of the 250,000 or so paraplegics in the United States felt their anger catalyze over the medical view that little can be done.

“My surgeons made it a point to come in my room, after about 30 days of injury, to tell me I would never walk again. There was no encouragement. It was just flat: You will never walk again,” said Don Debolt, of Stewardson, Ill., who came to Beijing to be operated on by Huang.

Debolt, who broke his neck when he rammed into a concrete wall at a water park in Missouri in 1994, said any improvement would make a huge difference.

“I cannot fasten or unfasten normal pants,” Debolt said in a hospital hallway before undergoing Huang’s procedure. “Twenty-four hours a day, seven days a week, my wife has to be with me because if I have to go to the bathroom, I can’t get my pants down.”

Debolt, 52, said he wants to move his legs at night, open a can of soda, load a paper tray of a computer printer, “things most people take for granted.”

Word of Huang’s procedure has spread through the Internet, giving hope to paraplegics and those with other nervous system disorders, such as amyotrophic lateral sclerosis, a muscle-wasting disease. So far, Huang has operated on 28 non-Chinese patients.

“I get hundreds and hundreds of people asking me, ‘Should I go to Beijing now?’ I say they should wait. But there is desperation. When you are a quadriplegic, a year is an eternity,” said Dr. Wise Young, a neuroscientist at Rutgers University in New Jersey who has visited China repeatedly and observed Huang’s work.

Even so, Young said in a telephone interview, Huang’s technique is unusual, apparently not harmful and brings “modest” improvement in Motor and sensory functions.

“There’s no one else in the world doing this,” Young said.

“HARD TO EXPLAIN”

Huang extracts certain cells, called olfactory ensheathing glial (OEG) cells, from fetuses aborted during the second trimester of pregnancy.

The OEG cells, found above the bridge of the nose at the base of the brain, are the only nerve cells in the body that regenerate throughout life. Fetal OEG cells are more potent than those taken from adults.

Huang and his team grow more fetal OEG cells in a culture, then transplant about a million of them slightly above and below the injured part of the spine. Two or three days after the operation, many paralyzed patients regain some sensation and movement.

“It’s very hard to explain. It’s too fast, too quick (for nerve Regeneration),” Huang said. “There is some mechanism. … I don’t know why it works. (But) it helps patients.”

In Portugal and Australia, researchers are also testing use of OEG cells on spinal-cord patients, reporting positive results. Researchers in both countries are extracting OEG cells from the patient, culturing them and transplanting them back, rather than using aborted fetuses.

Some U.S. spinal cord experts, including critics and supporters of Huang’s work, are troubled that he has plunged into widespread clinical use. They urge trials.

Dr. Barth Green, one of the leading U.S. spinal cord injury experts, said desperation sometimes leads U.S. patients to “discard good medical advice and common sense” in looking for treatment abroad.

“They often fly off in the wild blue yonder seeking care and a cure,” said Green, the president of the Miami Project to Cure Paralysis, a spinal-cord injury research center. He noted that the actor Steve McQueen flew to Mexico in 1980 for a dose of apricot pits before succumbing to cancer.

Huang’s patients dispute that they’re acting rashly, saying they’ve benefited from the surgery, which costs $20,000 for foreigners and about $6,000 for Chinese.

“Before, I had no sensation in my arms from my armpits down. I now have sensation in both arms down to my hands,” said Leo Per Hallan, a South Dakota man who underwent the experimental surgery in Beijing in April.

Huang said a few paraplegics have recovered limited sexual function.

His team has also treated dozens of patients suffering from ALS, Multiple Sclerosis and other nervous system ailments by transplanting OEG cells through holes in the skull.

“My husband’s tremors ceased the day after surgery. He could shave by himself. He was ecstatic,” said Toni Shoham of Granby, Conn., whose 76-year-old husband, Robert, underwent treatment for ALS in Beijing about a month ago. “My husband could barely talk, swallow or drink. Now he can do all of that.”

ETHICAL, SCIENTIFIC DOUBTS

The use of fetal tissue troubles some of the patients — to a degree.

“I’m strongly anti-abortion,” Debolt said. “But I’m also of the belief that my being here doesn’t cause the abortion. The abortion is going to occur independent of whether I use the cells or not. I equate this with organ donation.”

Huang, who did postgraduate work at Rutgers in the late 1990s, looked a little puzzled at a query about the ethics of fetal tissue use, a widespread practice in China, saying he saw no problem with it.

Chinese government support for novel medical research is growing quickly, especially in stem cells, a largely unregulated field.

Some of the findings haven’t been published in respected scientific journals because researchers — like Huang and his team — haven’t conducted rigorous clinical trials with scientific controls.

Until such trials are done, doubt may enshroud Huang’s procedure, even as advances are reported elsewhere, such as the Miami Project’s recent discovery that insulating cells from the Peripheral nervous system might help spinal cord injury.

Huang, who said he hopes to work with the Miami Project to design clinical trials, perhaps later this year, beamed as he showed videos of some of his patients from before and after their surgeries.

“Look, now he can hold the cup,” he said, showing video of a Chinese quadriplegic grasping a teacup and drinking.

Another patient, a 41-year-old quadriplegic, can be seen slowly writing Chinese characters.

Said Huang: “This is the first time after many years that he is writing.”

BY TIM JOHNSON
Knight Ridder Foreign Service