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Operation marks another step forward in stem cell research

By Miriam Falco, CNN
updated 5:14 PM EST, Mon November 21, 2011
Dr. Nicholas Boulis adjusts the device that injects stem cells into the cervical area of the spinal cord.
Dr. Nicholas Boulis adjusts the device that injects stem cells into the cervical area of the spinal cord.
STORY HIGHLIGHTS
  • For the first time, stem cells are injected into the spinal cord in the neck
  • It is part of a trial to see if the procedure can be safely done
  • "I feel like we finally arrived," says the surgeon who invented a key structure

Atlanta (CNN) -- A 50-year-old man from Trion, Georgia, is the first person to be injected with stem cells in the upper part of the spinal cord, making him yet another pioneer in the scientific quest to use stem cells to heal.

Richard Grosjean received the treatment Friday. He is part of an ongoing FDA-approved clinical trial that is testing the safety of injecting stem cells into the spinal cords of patients with amyotrophic lateral sclerosis, or ALS, also known as Lou Gehrig's disease.

ALS patient Richard Grosjean, the first patient in an approved clinical trial to have stem cells injected into the cervical area of the spinal cord.
ALS patient Richard Grosjean, the first patient in an approved clinical trial to have stem cells injected into the cervical area of the spinal cord.

Grosjean's ALS was diagnosed a little over two years ago, his wife, Tracie, told CNN. He can still walk with a cane, but he has a lot of weakness on his left side and has trouble with his speech.

"I'm pretty much his voice for him," Tracie Grosjean said.

Through his wife, Grosjean says "he has 100% confidence in Emory and Dr. (Jonathan) Glass and Dr. (Nicholas) Boulis and the good Lord that good things will come" from the trial.

While the Grosjeans know this procedure is likely to be more helpful to others in the future who have to deal with this "horrible disease," they have hope and faith that some good will come of this for them, too. In addition to praising Emory University, Tracie also praises her husband's employer, Mount Vernon Mills, which she says has "bent over backwards" to keep him employed throughout his illness giving him a sense of purpose.

The cause of ALS is unknown, but the disease is fatal because nerve cells, or neurons, in the brain and spinal cord needed to tell muscles to move, waste away or die. Early in the disease, patients have difficulty speaking and walking, both symptoms Grosjean now has. Eventually, the disease cuts off communication between the brain and chest muscles, so patients can no longer breathe.

Most people die from respiratory failure, according the National Institutes of Health, and most patients die within three to five years of diagnosis.

The team of researchers in this clinical trial is headed by University of Michigan neurologist Dr. Eva Feldman, who designed the trial; neurologist Glass, who is in charge of the clinical trial at Emory University in Atlanta, where patients are getting the injections; and Emory neurosurgeon Boulis, who invented the structure used to safely inject the stem cells into the patient.

In an operation than lasted about four hours, Grosjean received five injections into the cervical, or neck, area of his spinal cord, each delivering 100,000 cells. The cells came from Maryland-based biotech company Neuralstem, which is funding this clinical trial and devised a procedure to grow millions and millions of motor neuron cells from the donated spinal cord tissue of an 8-week-old aborted fetus.

These are not embryonic stem cells, like the ones used by California-based company Geron, which has injected cells grown from human embryonic stem cells into the spines of at least four patients with complete spinal cord injuries.

Embryonic stem cells have the ability to become any type of cell in the body. One week ago, Geron decided to stop its trial because it was too expensive to continue.

The cells in this ALS trial were taken from the spinal cord of the fetus, so they have already gone down the path of becoming nerve cells. Researchers are hoping to show that injecting neural stem cells -- the precursors to nerve cells -- into the spinal cord of ALS patients is safe.

Ultimately, the hope is that by injecting the cells into the neck, above the lungs, where the mostly deadly damage is done by ALS, these neural stem cells will reconnect communication from the brain to the muscles, keeping patients alive longer and maybe, one day, curing them.

But that is not the point of the trial at this time. At this point the goal is still to establish that injecting stem cells is safe for the patient, won't cause more damage to the patient, and won't lead to the patient reject the cells. Early data from the first 12 patients, who had injections in the lower back, shows this procedure is safe.

Injecting anything into the spinal cord is very dangerous because it can cause serious damage. To avoid injuring the spinal cord, which is always moving as the patient breathes, the needle delivering the stem cells has to move along with the body.

Boulis invented an apparatus that resembles a miniature oil rig mounted on to the patient's spine. It moves with every breath and holds a super-fine needle through which to inject the stem cells. To prepare for these surgeries, Boulis and his fellow surgeons practiced mounting the apparatus on pigs, which are close in size to humans.

The first 12 patients in this clinical trial had the "rig" mounted on their lower back, giving surgeons a flatter surface to work with.

But the injection site on Grosjean is on the neck, posing a new challenge for Boulis.

"It didn't fit exactly as I had envisioned it," he said immediately after the surgery. "In fact, I ended up applying it much in the same way that I had applied it in pigs, as opposed to how I had envisioned it in humans, and that gave us nice solid fixation."

Boulis screwed the structure to the spine on one side, but to the skull on the other side.

With the spinal cord exposed after removing part the spine and peeling back layers of muscle and membranes protecting the cord, the injections slowly began. They have to be slow -- injecting the cells too fast alone can damage the cord or the cells can spill out, never having a chance to nestle into the spinal cord.

After the third injection went smoothly, Boulis paused to note what they were accomplishing at this moment. After the surgery he said, "it is a big milestone for us. ... I think the biggest thing about this is that I feel like we finally arrived."

That's because Boulis and his colleagues have come a long way, through trial design; to testing the cells in mice to ensure they don't cause tumors, which sometimes happens with stem cells; to inventing the needle-holding oil-rig-like apparatus; to practicing on many pigs; to perfecting how attach the device to patients.

"Finally we're beginning to inject cells into the segments that control the diaphragm, and to the extent that we are able to do that safely ... this is where we keep people breathing," Boulis said.

And that's ultimately what this clinical trial is about.

Glass described Friday's surgery as being at the beginning of crossing an important threshold. "I think it's a huge step forward. I don't want anyone to think that we have a cure for this disease. We don't. But we now have a whole other way to approach it, and that's really what's exciting and important."

Feldman described the day as the most momentous in their pursuit of using stem cells in the treatment of ALS.

"I have spent over 25 years taking care of patients with ALS, and I feel today I can go back to them and give them hope," she said.

Alan Trounson, president of the California Institute for Regenerative Medicine in San Francisco, agrees, calling the progress in this clinical trial a "big step forward."

Every clinical trial that can show a stem cell procedure to be safe is important, he said.

"These are tough diseases," Trounson said. He agreed that being able to safely inject stem cells into the cervical area of the spinal cord is an important step forward for patients with ALS and potentially other neurodegenerative diseases such as multiple sclerosis.

Grosjean, Glass and Boulis are quick to point out that they have to replicate this surgery in other patients. Two more patients will receive the same cell dosages in the near future in this part of the clinical trial.

After telling Tracie Grosjean how well the surgery went, Glass was excited and cautiously optimistic.

"We're moving forward," he said. "We don't have a treatment yet, we don't have cure yet and there's no evidence yet even putting these stem cells on the spinal cord is going to either slow the disease or prevent progression or even make it better."

Three days after the surgery, Boulis said the patient was doing well. Neurologically he is where he was before the surgery. His legs and arms are moving, confirming what was monitored throughout the entire surgery. The spinal cord was not damaged.

Tracie Grosjean said her husband is still in pain, which doctors say is expected given the surgery. But she said the doctors tell them he's doing great and they hope be home in time for Thanksgiving.

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