Brian Kwon

He’s an emergency substitute for Richard Garr, who was on the original agenda.

I feel like an affirmative action candidate from Canada!

Biomarkers for Crossing the Translational Divide in SCI is the name of the talk.

What is a biomarker? Why do we need them? What are we doing in this area?

” . . . a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”

For example, there’s a prostrate specific antigen that tells you if you have prostrate cancer. It’s a biomarker Then there’s something called Troponin for myocardial infarction, and another one called CD4 count in HIV. We care about this in SCI  . . . because:

Showing 4 different MRIs of people who came into his hospital over a single 4-hour period. There are differences. And again, 8 MRIs from 8 people who were in the same plane crash. And 2 more, from a pair of c5 quads. The point he’s making is that they all look very different from one another.

Same injury, but not the same. How variable is the recovery cervical SCI patients with complete ASI A paralysis. There is conversion, as everybody knows. You can always find people who get recovery in the first months post-injury.

You need 480 patients who are ASIA A to find out if it’s spontaneous

You need 2200 ASIA B to find out if something is working.

That’s why you need biomarkers.

So they came up with a way to do biochemical analysis, basically looking for the proteins that were there during the inflammatory response to injury. What did they see? This stuff called IL-6. They can see chemical differences between people with A, B and C type injuries, and built a prediction model that would predict the ASIA grade.

Then they compared the actual outcomes to their predictions and found this 70% accuracy for the biochemical predictors as compared to 65% for the ASIA predictors. WHOA.

Okay, everybody knows that the doctors are often wrong, but that’s the first time I’ve ever seen a stat — they’re wrong more than a third of the time.

They’ve also looked at predictors of neuropathic pain . . . and found one called TRF-N1.

This study started in Vancouver BC and moved to Calgary, London, Ottawa, Motreal, and Halifax, and are working on getting it into the USA.

So how does this help?

He’s saying that translational medicine isn’t just bench to bedside. Translational medicine has to go both ways. It has to be bedside back to bench — meaning that doing what he is with the human beings who show up injured at his hospital has to inform the direction that research takes.

What are the obstacles to translational research in sci? (The trouble with translational medicine) There’s a feedback cycle that’s going on with not enough understanding of human pathophysiology.

Okay, describing some of the ways they’re dealing with the realization that their information is incomplete . . . and then moves on to their efforts to use minipigs in their lab work. The mini pig is a sort of intermediary in terms of the cord between rats and humans.

They’ve used these pigs to apply some translational questions, like their questions about biomarkers. They have a DOD grant to look at the ways their biomarkers show up in the minipigs (Proteomics, Genomics, Metabalomics)

The whole point of this is so that when there is a therapy to be tested, they can use the biomarkers to show that it’s working as planned. There’s a big danger, always, that scientists don’t know as much as they think they know. This work is about getting much more clarity.

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One Comment on “Brian Kwon”

  1. Biomarkers are needed for acute trials to select better cndidates to reduce the number of patient to enroll in the trial etc.
    Did people get that this is not for us?

    Brian said.
    “You need 480 patients who are ASIA A to find out if it’s spontaneous
    You need 2200 ASIA B to find out if something is working”

    That is in acute SCI. With biomarkers you can reduce these numbers etc..

    This is why you need to focus on chronics where with patients neurologically stable with just 10 patients you get a clear idea if a therapy is effective or not…

    Like


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