Human Hepatocyte Growth Factor Promotes Functional Recovery in Primates after Spinal Cord Injury: past achievements and perspective for clinical trial

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Human Hepatocyte Growth Factor Promotes Functional Recovery in Primates after Spinal Cord Injury: past achievements and perspective for clinical trial Eurospine 2013 Kazuya Kitamura 1,2, Kanehiro

1 Human Hepatocyte Growth Factor Promotes Functional Recovery in Primates after Spinal Cord Injury: past achievements and perspective for clinical trial Eurospine 2013 Kazuya Kitamura 1,2, Kanehiro Fujiyoshi 2, Jun-ichi Yamane 2, Akio Iwanami 2, Hideyuki Okano 3, Yoshiaki Toyama 2 and Masaya Nakamura 2 1 Department of Orthopedic Surgery, Hiratsuka City Hospital Department of Orthopaedic Surgery, 5 Physiology, Keio University School of Medicine, Tokyo, Japan

Previous report Introduction of HGF into spinal cord using HSV-1 vector in rat SCI model significantly reduced damaged area and promoted functional recovery. Kitamura et al, J.Neurosci. Res.

2 Previous report Introduction of HGF into spinal cord using HSV-1 vector in rat SCI model significantly reduced damaged area and promoted functional recovery. Kitamura et al, J.Neurosci. Res Recombinant human HGF () administration into subarachnoid space from right after SCI in rat. n > 5 20 n > d 1d 4d 7d 2w 3w 4w 5w 6w 200mg/2weeks Intrathecal administration

3 Common marmoset cervical SCI model as preclinical trial Rat (rodent) Common marmoset (New world monkey) Kitamura (Human)????????? Objective assessment of neurological hand function after cervical SCI to predict the therapeutic effects of intrathecal in human treatment.

2005) Administration of intrathecal catheter insertion right after SCI from C7 level administration of 400mg of or for 4

4 Materials and Methods Animals and SCI models adult female common marmoset (n=5 for each; and group) modified MASCIS protocol 20g weight-drop from 5cm height onto exposed dura matter at C5 level (Iwanami et al, J. Neurosci Res. 2005) Administration of intrathecal catheter insertion right after SCI from C7 level administration of 400mg of or for 4 weeks by osmotic mini pump common marmoset cervical SCI model; 400 mg / 4 weeks supply from Osmotic mini-pump Intrathecal catheter insertion

Position sense of four limbs 8 weeks after

5 Original neurological motor function scaling Highlighted points in this scaling are Extension of wrist Pronation of forearm Flexion and extension of fingers Position sense of four limbs 8 weeks after SCI reach and grasp performance hand placement in walking 1 day after SCI Kitamura et al, PLoS one, November 2011 Volume 6 Issue 11 e27706

6 Motor function analysis using original open field scoring (full score: 31 points) Intrathecal significantly promoted hand function after SCI n= n= Days after injury mg or All data are mean ± SEM. P < 0.05, P < 0.01 Mann-Whitney test Kitamura et al, PLoS one, November 2011 Volume 6 Issue 11 e27706

Intrathecal significantly reduced T2-high abnormal intensity area MR images (T2WI) at 12 weeks after SCI In vivo Diffusion tensor tractography (DTT) Spinal

7 Intrathecal significantly reduced T2-high abnormal intensity area MR images (T2WI) at 12 weeks after SCI In vivo Diffusion tensor tractography (DTT) Spinal tracts described by DTT in ventral white matter reflected spared rim of LFBpositive myelinated area at 12 weeks after SCI, suggesting the efficacy of DTT in vivo.

8 LFB staining at 12 weeks after SCI Intrathecal significantly spared rim of intact white matter rostral +1.4mm +0.7mm epicenter -0.7mm -1.4mm caudal P<0.01 P<0.05 by t-test C3 C4 C5+1.4mm C5+0.7mm C5 C5-0.7mm C5-1.4mm C6 C7

spinal cord intact spinal cord 100 90 80 70 60 50 40 30 20 10

9 Intrathecal significantly preserved corticospinal tract CaMK2a-positive corticospinal tract (CST) fibers in intact spinal cord intact spinal cord CaMK2a-positive area ratio to intact spinal cord (%) C3 C4 C5 C6 C7 T1

10 CGRP-positive fibers total length (um) Intrathecal did not give rise to abnormal sprouting of CGRP-positive fibers in laminaⅢ at 12 weeks after SCI intact spinal cord intact HGF treatment did not exacerbate allodynia 0 C3 C4 C6 C7

Exactly for clinical application What we have to do next was Determine the therapeutic time window of Determine the minimal-effective dose in rat thoracic SCI model BBB score 20 15 10 Intrathecal for

11 Exactly for clinical application What we have to do next was Determine the therapeutic time window of Determine the minimal-effective dose in rat thoracic SCI model BBB score Intrathecal for 2 weeks from 4days 8 mg of 40 mg of 200 mg of 5 time after injury 0 0d 1d 4d 7d 2w 3w 4w 5w 6w Delayed administration from 4 days after SCI also promoted functional recovery, even at much lower dose of.

12 Time to move! Therapeutic effects and mechanisms in rat SCI model Therapeutic effects of intrathecal in rat and primate SCI model Therapeutic time window and minimal effective dose Plan for clinical trial PhaseⅠ clinical trial in people with ALS PhaseⅠ clinical trial in people with SCI This work was supported by grants from Grants-in-Aid for Scientific Research from JSPS and the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT), the Project for Realization of Regenerative Medicine and Support for the Core Institutes for ips Cell Research from MEXT, a Grant-in-aid for the Global COE program from MEXT to Keio University, Research on Measures for Intractable Diseases from the Japanese Ministry of Health Labor and Welfare of Japan, and by Super Special Consortia for Supporting the Development of Cutting-edge Medical Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

3/3/2016. International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI)

3/3/2016. International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) American Spinal Injury Association International Spinal Cord Society Presented by Adam Stein, MD Chairman and Professor