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Stroke victims put big hopes in nerve cell transplants

Wednesday, April 12, 2000

By Ellen Mazo, Post-Gazette Staff Writer

One day last year, Sylvia Elam rode contentedly to the car in the wheelchair pushed by her husband, Ira. He had become accustomed to the task since her stroke six years earlier. As usual, he placed Sylvia's wheelchair near the passenger side, then went around to unlock the doors.

  On March 9, 1999 Sylvia Elam became the 12th person to undergo an experimental surgical procedure on her brain, performed by University of Pittsburgh neurosurgeon Douglas Kondziokla. (Joyce Mendelsohn, Post-Gazette)

Only this time, when Ira Elam walked back, Sylvia had already gotten out of her wheelchair, opened the car door herself and sat down in the passenger seat.

A miracle?

It almost seems like one to the Elams, who credit University of Pittsburgh neurosurgeon Douglas Kondziolka for injecting new nerve cells or neurons into Sylvia's brain to enable her to walk and use her hands again.

Not too long after the revolutionary surgery in March 1999, she even drove the family car near their home in Scottsdale, Ariz.

Sylvia Elam was one of Kondziolka's success stories yesterday when he presented findings from the first phase of a neuronal transplant study of 12 stroke patients at the University of Pittsburgh. He spoke to the American Association of Neurological Surgeons in San Francisco.

Nine men and three women, ranging in age from 44 to 75, received between 2 million and 6 million cells through holes that had been drilled into their skulls.

Kondziolka reported that the patients who received 6 million cells showed much more improvement than those who received 2 million. The first four received 2 million, and the remaining eight received, at random, either 2 million or 6 million cells.

  Previous article:

UPMC neurosurgeon's taste for exploration led to groundbreaking stroke research


Once injected, the unimaginably tiny neurons -- six million neurons are the size of a pinhead -- grew out like branches, reaching neurons that were still alive but unable to communicate with other parts of the brain because they were surrounded by neurons that had died during a stroke, which cuts off blood flow to parts of the brain.

Kondziolka found that the dormant neurons responded to the stimulus of new ones growing around them and regained their function. That helped some patients regain use of their limbs, and even helped some of them talk again.

Most significantly for Kondziolka's research, the procedure proved safe -- an issue that is critical before the Food and Drug Administration can allow the study to continue with more patients and more sites.

All of this has come about because doctors in New York City almost 25 years ago discovered some unusual cells in the tumor of a 22-year-old man with testicular cancer. The cancer cells were able to divide into other kinds of cells. Some were frozen for future study.

In the past few years, Layton Bioscience Inc. in Atherton, Calif., developed a chemical process to transform them into nerve cells. When injected into the brain, they develop into different types of brain cells.

The company now has developed an even more refined process for creating the cells.

Kondziolka said in an interview last week that he hopes the FDA will approve the next phase of the study by September.

Kondziolka, 38, who has performed hundreds of intricate brain surgeries at the UPMC Health System, said this pioneering procedure clearly is the one giving stroke patients everywhere a glimmer of hope.

Strokes affect more than 700,000 Americans each year, permanently disabling almost half of the survivors. The numbers hit home each day when Kondziolka's office receives telephone calls, faxes and e-mails from hopeful patients.

"The results are very exciting," Kondziolka acknowledged. "But you have to realize that there's so much that is still unknown. We don't know yet who the best patients are -- young or old? We don't have a good idea of how many cells we should use, or where we should put them, or even what our expectations should be.

"When you have all these questions circling like vultures, you can see that science is very humbling. Of course, just opening the door is significant, and we're pleased with the safety issue. We want to proceed as strongly and as soon as we can."

Sylvia Elam, 66, was the 12th and last patient to receive the brain-cell transplant in March 1999, and received the larger 6 million-cell infusion.

Elam, who came to Pittsburgh last month for a follow-up appointment with Kondziolka, said her life has changed dramatically, despite suffering a second stroke last summer.

Kondziolka said that while the second stroke set back her improvement, Sylvia has still progressed far more than he had imagined.

The Pitt professor of neurological surgery and radiation oncology tries not to get caught up in his patients' enthusiasm. He says simply that the findings are "provocative."

For example, the fourth patient's hand moves only slightly better than before his stroke. However, he now can raise it enough so that he can button his own shirt.

"In some cases, this is improving peoples' lives without really normalizing them," Kondziolka said.

In most cases, however, the patients disagree with their surgeon.

One man who is 58 said he had been incapacitated by his stroke in 1996, and that he now lifts weights and even talks understandably. He asked that his name not be used because he was afraid that he would be inundated with calls from other stroke patients.

Ira and Sylvia Elam are obviously enthusiastic boosters.

Ira Elam grins broadly every time he watches his wife walk and listens to the words she speaks, slowly, but clearly.

"Oh, if I was the FDA I would approve this operation in a flash," Ira Elam said. "I know this works. Sylvia is doing wonderfully. I want her to have more neurons. I want others to get these neurons."

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