Brian Kwon receives a C$2.4M grant from the United States Department of Defense for SCRIBBLE clinical trial and rapid testing to predict acute spinal cord injury severity and outcome

Dr. Brian Kwon

UBC researchers, led by Dr. Brian Kwon, have identified two blood proteins—neurofilament-light chain (NF-L) and glial fibrillary acidic protein (GFAP)—that can be used to classify the severity of spinal cord injury and predict the extent of neurologic recovery of patients.   

The US Department of Defense awarded Dr. Brian Kwon a $1.89M USD (approx. 2.4M CAD) grant to conduct a clinical trial called Spinal Cord Injury Blood Biomarker Longitudinal Evaluation—or SCRIBBLE, to evaluate how well the blood proteins NF-L and GFAP perform in classifying injury severity and predicting outcome of patients with acute spinal cord injury. The funding will also go to developing rapid point-of-care testing (similar to rapid testing for COVID) that would give field clinicians a very fast read-out for an acutely injured patient, which has garnered the interest of the US military.

When someone today suffers an acute spinal cord injury (SCI), clinicians perform a standardized evaluation of muscle strength and skin sensation to classify the severity of the SCI. The evaluation, known as the International Standards for Neurologic Classification of Spinal Cord Injury—or ISNCSCI (pronounced “in-ski”)—examination, is then repeated to determine how much spinal cord function has recovered over time.

For decades, the SCI field has relied heavily on this type of neurologic examination to characterize the degree of initial injury and the extent of subsequent recovery. Researchers also depend on the ISNCSCI when conducting clinical trials of new therapies to establish how severe an injury is at the outset, and then determine how much recovery may have occurred as the result of the treatment being tested.

While the ISNCSCI is helpful, it has limitations. It is subjective and time-consuming, even for the most experienced clinicians. In acutely injured patients, it is often impossible to do, given that they may be unconscious or have other injuries that preclude any examination. Even when the ISNCSCI exam can be done, it does not allow one to precisely predict how much recovery will occur. 

Dr. Kwon has been interested in developing biomarkers of acute spinal cord injury to help diagnosis, classify, and prognosticate for neurologic recovery. For several years, Dr. Kwon and his team have been investigating specific proteins within the cerebrospinal fluid (CSF) and blood of acute SCI patients as part of the ongoing North American clinical trial CAMPER, and now CASPER.

They have recently identified two proteins—NFL and GFAP (neurofilament light chain and glial fibrillary acidic protein)—that appear to closely correlate with injury severity and can help predict who will and who will not experience recovery after an acute SCI.

“What is particularly interesting is that it appears that we can get reliable measures of these proteins in blood samples, whereas previously we have been dependent upon cerebrospinal fluid samples obtained through a lumbar puncture or ‘spinal tap’,” said Dr. Kwon, Canada Research Chair in Spinal Cord Injury, Dvorak Chair in Spine Trauma, and Professor at UBC Department of Orthopaedics.

If these findings in the serum samples are robust, we may have a very useful blood test for helping us predict neurologic outcome and recovery after acute spinal cord injury.

—Dr. Brian Kwon

A blood-based biomarker could give clinicians information about how severely the cord is damaged, even in patients who are unconscious and unable to be assessed.

These biomarkers could help clinicians provide accurate prognostic information to patients and could help researchers accelerate the testing of new treatments by more precisely predicting how much neurologic recovery is expected.

—Dr. Brian Kwon

Dr. Kwon and his research team are currently working to initiate the three-year SCRIBBLE clinical trial at Vancouver General Hospital by the end of this year.

Dr. Brian Kwon

Dr. Brian Kwon, Canada Research Chair in Spinal Cord Injury and Dvorak Chair in Spine Trauma, is an internationally recognized, award-winning surgeon-scientist and professor with the UBC Department of Orthopaedics as well as an attending spine surgeon with the Vancouver Spine Surgery Institute at Vancouver General Hospital (VGH).

He leads an active basic-science and clinical-research program in spinal cord injury and spine trauma. Dr. Kwon is the Director of Research for the Vancouver Spine Research Program, which oversees all spine-related research at VGH. He is also the Associate Director of Clinical Research at the International Collaboration on Repair Discoveries (ICORD), where the Kwon Lab for Spinal Cord Injury Research is located, and the Director at The International Spinal Cord Injury Biobank (ISCIB).

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