In 1999, a Chinese neurosurgeon named Huang Hongyun arrived at New York University School of Medicine from Beijing, wanting to work with Wise Young and learn about spinal-cord injury. Young had moved to Rutgers, so Huang followed him there. “He wanted to know what to do,” Young said. “Studies recently published had claimed that olfactory ensheathing glial cells transplanted into spinal cords would regenerate rats and improve locomotor recovery. I was skeptical about some of the results. They were mostly based on, I thought, fairly questionable behavioral outcome measures. So I suggested to him, Why don’t we do it in our spinal-cord injury model?” Huang worked with Young for several years, then moved back to Beijing, becoming chair of neurosurgery at Chaoyang Hospital.
Almost at once, Huang began operating on human patients with injured spinal cords. In March 2003, he and colleagues submitted a four-page paper to the Chinese Medical Journal, which published it in October of the same year.
The journal is something of a historical oddity. It comes out monthly, about 100 pages an issue, entirely in English except for contributors’ names. It was founded in 1887 by missionaries who wanted to bring Western medical methods and standards to China and needed an English-language publication that would present the best of modern Chinese medical research and clinical practice. In the first half of the 20th century, it was well respected; after the Communist takeover of mainland China, it declined badly. Only in the last five years or so has the journal begun to regain quality and the respect of non-Chinese scientists. But scientists do not consider the journal to be peer reviewed – at least, not to Western standards. Submitted manuscripts may be looked over by various senior medical-faculty members, but if anything, this is a liability, for a uniquely Chinese reason: Confucian tradition still inculcates profound respect for elders. To turn down a paper submitted by a senior person would be an act of disrespect.
Huang’s paper reported results of surgery on 171 patients, 139 male and 32 female, ranging in age from 2 to 64 years, with the average age just under 35. All had suffered extensive paralysis and loss of sensation. The time since injury was at least six months and as much as 18 years. All had received previous therapy of one sort or another, for example, administration of nerve-growth factors and surgery, if that had been necessary to relieve pressure on the spinal cord. A requirement was that magnetic-resonance imaging showed no gap in the spinal cord and no compression.
The surgical procedure*, which the paper described in detail, is essentially to perform a laminectomy at the site of the damage, open the dura, and inject ensheathing cells. These Huang derived from olfactory bulbs. Although the paper does not mention this, in later discussions Huang has said that the cells come from fetuses aborted in the fourth month of pregnancy. (But they are not stem cells, as has sometimes been reported.) He grows them for two weeks in cell culture, as he learned to do in Young’s lab. He then injects 50 microliters of a cell suspension, approximately half a million cells, into the spinal cord, next to the ends of the lesion.
Before the operation, patients were assessed for degree of paralysis and for sensitivity to light touch and to pinpricks, following an international standard. They were reassessed between two and eight weeks later. The paper claimed that patients made significant if relatively slight improvement in these measures. However, the data are scanty and impossible to evaluate reliably. The subjects are grouped by age but not differentiated further, not even, say, into male and female. The paper describes no individual cases. It offers no before and after scores, just degrees of improvement, and these as averages within each age group. It says nothing about possible deleterious effects, not even that there were none. It reports no long-term outcomes.