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Biomarkers for Acute Spinal Cord Injury

One of the great advances in modern medicine has been the development of biomarkers for specific human diseases. In medicine, a biomarker is typically a protein that can be measured from bodily fluid, such as blood, whose concentration levels can be used to predict the severity or presence of a diseased state. Biomarkers allow doctors to detect a disease early, monitor its progress, predict its severity, and tailor treatments to any specific patient’s problem. In the spinal cord injury (SCI) arena, early predictors of injury may have important diagnostic and prognostic significance, helping to detect the presence and severity of injury within the first few hours and to aid physicians in directing the best patient care in a timely manner. For researchers, a SCI biomarker may give early insight into the effects of experimental treatments, speeding study results and reducing the research subjects sample sizes needed. Over the past two years, a team of Miami Project and Neurosurgery Department researchers (Drs. Ross Bullock, Michael Wang, Helen Bramlett, Dalton Dietrich, Robert Keane, Pablo de Rivero Vaccari,and Stephanie Adamczak) have been investigating the use of surrogate biomarkers to predict the outcome of acute SCI in a study sponsored by Banyan Biomarkers.

In this study, blood and spinal fluid samples were obtained from 7 newly injured people who were already undergoing spinal fluid drainage as a part of their necessary clinical treatment. The presence of several breakdown products from spinal cords tissue or inflammatory mediators were found to be elevated in blood and cerebrospinal fluid at early time points after injury. Similar results were observed in a rat model of SCI. Samples indicating severe neural damage were found to be correlated with the degree of neurological impairment as well as native recovery. In other words, higher levels of these breakdown products circulating in the blood or cerebrospinal fluid were predictive of less recovery. The team’s preliminary results, and that of others, suggests that a panel of spinal tissue structural protein breakdown products have potential as promising biomarkers in an animal SCI model and in humans with SCI.

This study is still enrolling participants that are admitted to the Ryder Trauma Center at Jackson Memorial Hospital and with increasing numbers may reveal keys to early interventions for acute SCI. Ultimately, biomarkers may be used to tailor the intervention (surgical, pharmacologic, rehabilitation) to each individual person with SCI, much as cancer phenotyping is beginning to be used to target chemo- and immunotherapies, as well as to identify candidates for clinical trials targeting acute neuroprotection.