02/11/05 - Posted from the Daily Record newsroom

New hope for spine-injured

Sparta doctor conducts trial of new treatment

By Elizabeth Hendler, Daily Record

'Finally, we may have something to offer individuals with spinal cord injuries as an early treatment,' said Dr. Karen Kepler, a Sparta physiatrist and a principal co-investigator of a spinal cord injury clinical trial. Dawn Benko / Daily Record

NEWARK -- Most people take for granted the simplest flick of the wrist or flex of their fingers. For people with a spinal cord injury, regaining even limited movement can mean the difference between feeding themselves and needing to be fed.

Dr. Karen Kepler, a Sparta physiatrist who has specialized in spinal cord injuries for six years, hopes that a clinical trial beginning at UMDNJ's University Hospital in Newark will help make that difference for patients with the most severe cases of spinal cord injury.

Every year, about 11,000 Americans suffer a spinal cord injury, adding up to 200,000 people living with the disability in the United States.

"Finally, we may have something to offer individuals with spinal cord injuries as an early treatment," Kepler said.

"Up until now, we've been able to offer the best rehabilitation, but we haven't had much to give them in the first days of an injury."

Kepler, director of the spinal cord injury program at the New Jersey Medical School, is one of two lead investigators in an experimental study using a patient's own white blood cells to promote healing within the first two weeks of a spinal cord injury.

The surgical procedure requires taking blood and skin samples from a patient's upper arm and treating the white blood cells to stimulate their regenerative powers. The cells then are implanted in the patient's spinal cord, near the point of injury.

Following most types of tissue injury, a type of white blood cells, called macrophages, work quickly to remove cell debris and produce secretions that start the healing process. But the process does not occur in the central nervous system.

This clinical trial, approved by the Food and Drug Administration, seeks to jump-start the healing process.

"We hope to give patients back a little more function," Kepler said.

"If a patient gets more arm movement, they may be able to do their daily care, such as bathing or dressing at the wheelchair level."

The procedure was first discovered in Israel, where a dozen patients have received the treatment and saw benefits, Kepler said.

University Hospital, in conjunction with the Kessler Institute for Rehabilitation, is one of six treatment sites in the United States chosen to participate in the clinical study. Since so few people have undergone the treatment, the study will measure its effectiveness and safety.

The study is funded by Proneuron Biotechnologies, a Delaware biopharmaceutical company, which developed the 36-hour procedure for activating white blood cells to promote tissue repair. A total of 60 patients will be enrolled, and about a third will be chosen at random to act as control patients and will not receive the procedure.

The study is limited in the type of patient it can accept, and, so far, University Hospital has not accepted any candidates. Patients with only the most acute injuries -- where there is no sensation or movement below the point of injury -- are eligible, Kepler said.

There also is a short window of opportunity -- candidates must be identified and accepted within the first 10 days of injury, she said. The procedure must be completed within 14 days of the injury.

Patients will see Kepler before and after the surgery, performed by Dr. Robert Heary, director of the Spine Center at the New Jersey Medical School.

Kepler oversees the screening process for potential candidates, along with Mount Olive resident Steve Koltenuk, research coordinator for the study. Together, they are responsible for performing comprehensive spinal cord exams before and after the procedure. Patients will receive standard rehabilitation at the Kessler Institute and will receive follow-up testing for one year.

Kepler said she was drawn to the spinal cord injury field because it is more than just science.

"It's science, but so much is also communication and education and support for individuals during the rehabilitation process," Kepler said.

Kepler, 45, began her career as a neuropsychologist working with people with brain injuries, but she returned to medical school to expand her area of expertise. She was attracted to the ability to create lasting relationships with her patients.

"Often, this hits young people," Kepler said. "There is a lot of art of medicine in this field because you have patients for years."

Kepler, who is raising her 3-year-old daughter, Caroline, graduated from Sparta High School. She grew up in Sparta and, after her medical training, returned because of its natural beauty, she said.