99SProceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S

first ever description of the temporal pattern of change in inflammatory cy-

tokine expression after human SCI. Additionally, our prediction model rep-

resents the first biological surrogates of cord injury that may be used to more

accurately predict injury severity and stratify patients for clinical trials.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.235

197. Predictive Value of Qualitative and Quantitative MRI

Parameters for Motor and Sensory Improvement in Patients with

Acute Cervical Traumatic Spinal Cord Injury: A Multicenter

Prospective Study

Julio Furlan, MD, MBA, MSc, PhD1, Bizhan Aarabi, MD2,

Michael Fehlings, MD, PhD, FRCSC, FACS3; 1Toronto Western Research

Institute, University Health Network, Toronto, Ontario, Canada;2University of Maryland at Baltimore, Baltimore, MD, USA; 3Krembil

Neuroscience Centre, Toronto Western Hospital, University of Toronto,

Toronto, Ontario, Canada

BACKGROUND CONTEXT: Although MRI visualizes neural tissue

with exquisite precision, this test is still not routinely employed in the clin-

ical management of patients with acute cervical spinal cord injury (SCI).

We have recently described a novel technique to assess cervical cord com-

pression and canal stenosis in patients with SCI [1-3].

PURPOSE: This multi-center prospective cohort study examines whether

quantitative and qualitative MRI parameters following SCI are predictors

of neurological recovery at long-term followup.

STUDY DESIGN/ SETTING: Prospective cohort study in two SCI cen-

ters in North America.

PATIENT SAMPLE: All consecutive patients with acute spine trauma

who were admitted to one of the participating hospitals were included.

OUTCOME MEASURES: Neurological improvement was defined as one-

grade conversion in the American Spinal Injury association Impairment Scale

(AIS). The MRI parameters included six qualitative and three quantitative pa-

rameters. The latter included maximum canal compromise (MCC) and maxi-

mum spinal cord compression (MSCC) in addition to the length of injury

within the spinal cord [1]. The qualitative parameters included edema, disc

herniation, canal stenosis, swelling, soft tissue injury and hemorrhage.

METHODS: Clinical data and MRI studies from consecutive patients

with traumatic cervical SCI were collected prospectively. An independent

observer examined MR images and assessed all nine qualitative and quan-

titative parameters. The study population was divided into patients who

had the same AIS on admission and at follow-up (Group 1) and patients

who had at least one-AIS grade conversion between admission and latest

follow-up (Group 2). Data were analyzed using Fisher’s exact test and

Mann-Whitney U test.

RESULTS: There were 46 males and 14 females with mean age of 47

years (19 to 79 years). Mean follow-up was 6.7 months (1 to 24 months).

Most patients had incomplete SCI (68.3%). Both groups were comparable

regarding age (p50.64), gender (p50.13) and follow-up (p50.46). Pa-

tients in Group 1 had more severe SCI than patients in Group 2

(p50.007). Univariate analyses indicated that there was a trend for an as-

sociation of neurological improvement with the absence of hemorrhage

(p50.09) and smaller length of lesion (p50.08). The other qualitative

(edema, disc herniation, canal stenosis, swelling, soft tissue injury) and

quantitative parameters (MCC and MSCC) did not significantly correlate

with neurological improvement.

CONCLUSIONS: MRI parameters appear to be useful in prognosticating

the potential for neurological improvement post-SCI. Smaller length of le-

sion and the absence of hemorrhage, observed at admission, might be as-

sociated with at least one-grade conversion in the AIS.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.236

198. Identification of Novel TNF-a Regulated Extracellular Matrix

and Cell-matrix Adhesion Genes in Intervertebral Disc Cells: A

Microarray Gene Profiling of Human Nucleus Pulposus Cells

Nam Vo, PhD1, Christopher Seidel, PhD2, Paulo Coelho, MS3,

Gwendolyn Sowa, PhD1, Rebecca Studer, RhD, PhD1, Joon Lee, MD1,

James Kang, MD1; 1University of Pittsburgh, Pittsburgh, PA, USA;2Stowers Institute for Medical Research, Kansas City, MO, USA;3Pittsburgh, PA, USA

BACKGROUND CONTEXT: Disc structure integrity depends on the

appropriate expression of matrix structural genes as well as those impor-

tant for cell-cell and cell-matrix interactions. Some of these genes have

been shown to be modulated by TNF-a, a cytokine implicated in disc

matrix degradation and intervertebral disc degeneration (IDD) (1-2).

While many gene products are involved in the disc structural makeup,

disc studies implicating TNF-a are limited to analysis of only a few ma-

trix genes.

PURPOSE: To identify novel genes encoding for key disc matrix and cell-

matrix structural constituents that are regulated by TNF-a. These gene can-

didates are vital for future expression and functional studies to understand

matrix compositional alternations that occur during IDD.

STUDY DESIGN/ SETTING: Gene microarray acquisition of whole-ge-

nome expression of human nucleus pulposus (NP) cells treated with and

without TNF-a.

PATIENT SAMPLE: Degenerated human disc tissues were obtained

surgically from 3 patients as approved by the University of Pittsburgh

IRB.

OUTCOME MEASURES: Genes belonging to the gene family of extra-

cellular matrix (ECM), cell-cell and cell-matrix adhesion that exhibit ex-

pression differences O2 fold between þ/-TNF-a NP cells are selected.

METHODS: Human NP cells were expanded in monolayer culture were

exposed to 0 and 5ng/ml TNF-a for 24 hours, and RNA were isolate and

hybridized to Affymetrix GeneChip Human Genome U133 Plus 2.0 Arrays

designed for analysis of 47,000 transcripts. Data from 3 independent ex-

periments were analyzed using the R statistical environment (3).

RESULTS: TNF-a modulates expression of many disc ECM structural

genes and those involved in cell-matrix adhesion. Among the ECM genes,

TNF-a suppressed expression of several different collagens (types II, VIII,

IX, XI, XV by 2–8x) and versican, aggrecan, and proteoglycan link protein

100S Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S

1 (~2x). Other notable ECM genes showing decrease expression in the

presence of TNF-a are cartilage intermediate layer protein gene (CILP),

SPARC related modular calcium binding 2 (SMOC2), and osteoglycin

(OGN, a secretory small leucine-rich proteoglycan). Surprisingly, several

cell adhesion genes were drastically up-regulated by TNF-a, including

the vascular cell adhesion molecule 1 (VCAM1, 78 fold), intercellular ad-

hesion molecule 1 (ICAM1, 34 fold), claudin 1 (14fold) and neuropilin 2

(6 fold).

CONCLUSIONS: Genome-wide gene expression profiling revealed

a number of novel and highly expressed ECM genes in untreated human

NP cells. Notably, levels of collagen types VIII, XI, and XV transcripts

are comparable to those of types I and II which are previously believed

to be most abundant in disc NP. Interestingly CILP, whose polymorphism

was recently identified as a risk factor for lumbar disc disease (4), is ex-

pressed in similar abundance as aggrecan, the major NP matrix protein.

TNF-a down regulated SMOC-2 and Claudin1 (CLDN1), a senescence-as-

sociated epithelial membrane protein. The dramatic increase of VCAM-1

and ICAM-1 expression in TNF-a treated cells suggest cell-matrix remod-

eling as the disc loses its matrix protein. These results demonstrate that

TNF-a not only suppresses matrix gene expression but also regulates

cell-cell and cell-matrix communication and cell growth in the discs. Iden-

tification of these new gene candidates is vital for future characterization

of disc matrix composition and the changes it undergoes in response to in-

flammatory cytokine in the course of IDD.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.237

199. Basic Fibroblast Growth Factor Antagonizes the Action of

BMP7 in the Intervertebral Disc

Xin Li1, Michael Ellman, MD2, Howard S. An, MD3, Frank Phillips, MD3,

Ranjith Kamal Udayakumar2, Hee-Jeong Im2; 1Department of

Biochemistry,Rush University Medical Center, Chicago, IL, USA;2Department of Biochemistry and Orthopaedic Surgery,Rush University

Medical Center, Chicago, IL, USA; 3Department of Orthopaedic Surgery,

Rush University Medical Center, Chicago, IL, USA

BACKGROUND CONTEXT: Basic fibroblast growth factor (bFGF) is

a growth factor that immediately responds to cartilage injury and plays

a pivotal catabolic and anti-anabolic role in cartilage homeostasis [1-3].

Recently, the potent inhibitory action of bFGF on the well-known anabolic

factors insulin-like growth factor-1 (IGF-1) and BMP7 (otherwise known

as OP-1) has been reported in human articular cartilage [3], suggesting that

bFGF may antagonize cartilage repair. However, the anti-anabolic effects

mediated by bFGF have not been assessed in spine cartilage.

PURPOSE: The aim of the present study is to evaluate the anti-anabolic

effects of bFGF on intervertebral disc (IVD) cells by assessing the inhib-

itory action of bFGF on BMP7 and to elucidate the biochemical pathways

by which bFGF influences BMP7 activity.

METHODS: IVD tissue was harvested from bovine coccygeal tissue (15-

18 months old) and chondrocytes were isolated from the nucleus pulposus

(NP), digested, and captured in alginate, as previously described [4]. The

beads were cultured in complete medium (DMEM/F12 supplemented with

10%FBS) for 21 days in the presence or absence of bFGF 10ng/ml and

BMP7 100ng/ml, and PG accumulation was assessed by dimethylmethy-

lene blue (DMMB) assay as previously described [3]. The cells and their

pericellular matrix were visualized using particle exclusion assay, as pre-

viously described [5]. NP cells cultured in serum-free monolayer were

treated with bFGF and IL-1 beta, a well-known antagonist of BMP7 used

as control, and noggin mRNA expression was assessed using real-time

PCR. Analysis of variance was performed using StatView 5.0 software.

P values!0.05 were considered significant.

RESULTS: PG accumulation: Incubation of bovine NP cells cultured in al-

ginate for 21 days showed a potent antagonistic effect of bFGF (10 ng/ml) on

the BMP7-mediated stimulation of PG production. When given alone, BMP7

(100 ng/ml) led to a 175% increase in PG production; however, when given

along with bFGF, this anabolic effect was abolished and reversed as PG pro-

duction decreased by 30% compared to control (no treatment).Exclusion As-

say: The bFGF-mediated antagonistic biological effect on BMP7 was further

visualized using an exclusion assay, as decreased matrix is seen with a com-

bination of bFGF and BMP7 compared to BMP7 alone.Noggin Expression:

Based on real-time PCR results, we found that stimulation of cells with bFGF

dose-dependently increased the expression of noggin, a known inhibitor of

the TGF beta /BMP family [6], suggesting that bFGF plausibly antagonizes

BMP7 via upregulation of noggin.

CONCLUSIONS: Basic FGF is anti-anabolic in bovine IVD tissue via the

antagonism of BMP7 activity, plausibly due to a bFGF-mediated upregu-

lation of noggin expression. These findings support our previous findings

from human articular cartilage, suggesting that bFGF plays a vital antag-

onistic role in cartilage repair and regeneration.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.238

200. Administration of an Engineered Zinc Finger Transcriptional

Factor which Activates FEGF-A Induces Angiogenesis Reduces Cell

Death and Promotes Neurobehavioural Recovery after Spinal Cord

Injury

Yang Liu1, S. Kaye Spratt2, Gary Lee2, Dale Ando2, Richard Surosky2,

Michael Fehlings, MD, PhD, FRCSC, FACS3; 1Toronto Western Research

Institute, Toronto, Ontario, Canada; 2Sangamo BioSciences, Pt. Richmond,

CA, USA; 3University of Toronto, Toronto, Ontario, Canada

BACKGROUND CONTEXT: Spinal cord injury (SCI) leads to local vas-

cular disruption and progressive ischemia, which contribute significantly to

secondary degeneration. Hence approaches to enhance angiogenesis by in-

duction of vascular endothelial growth factor (VEGF) expression appear

attractive. Moreover, there is emerging evidence that VEGF may also ex-

hibit neurotrophic, neuroprotective and neuroproliferative effects besides

angiogenesis.

PURPOSE: We sought to examine the therapeutic role, in the setting of

acute SCI, of an engineered zinc finger protein transcription factor

(ZFP-TF) designed to activate expression of all isoforms of endogenous

VEGF for complete biological function.

METHODS: The Ad encoding either DsRed fluorescent protein or VEGF-

ZFP transcription factor were delivered locally immediately after a clip

compression injury on rats. VEGF mRNA levels encoding for VEGF

120, 164 and 188 isoforms were measured by real-time PCR. VEGF pro-

tein, Neurofilament 200 protein (NF200) levels were determined by West-

ern blot analysis. RECA-1 antibody and TUNEL immunostaining were

used to evaluate vascularization and apoptosis, respectively. To examine

the more chronic effect, injured animals underwent microinjection with

AAV-ZFP-VEGF or AAV-GFP following by weekly behavioral assessment

for 6 weeks. Six weeks postinjury the preservation of residual tissue was

determined with morphometrical analysis.

RESULTS: Administration of VEGF-ZFP-TF with a recombinant adeno-

virus or adeno-associated virus (Ad or AAV), resulted in an increase of

VEGF mRNA and protein levels at 3 days after injury. Posttraumatic deg-

radation of neurofilament protein (NF200) was significantly attenuated in

the VEGF-ZFP-TF treated animals at 7 days and 6 weeks after SCI. More-

over, we observed a significant increase in vascularity and decreased levels

of apoptosis in the spinal cord lesions of rats treated with VEGF as com-

pared with controls. Furthermore, animals treated with VEGF- ZFP-TF

showed significant improvement in neurobehavioural outcomes and tissue

preservation up to 6 weeks after injury compared with control animals.

CONCLUSIONS: These data suggest that VEGF gene therapy using

a ZFP transcription factor holds promise as a therapy for SCI and other

forms of neurotrauma.