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From studying non-human primates in the wild to running clinical trials in humans

By Dave Marver

At the age of 10, Amanda Turner dreamed of becoming the next Jane Goodall. Her fascination with our closest animal cousins led her to study primate behavior and ecology at Central Washington University. Today she oversees the Up-LIFT clinical trial for ONWARD across as many as 15 sites in four countries, investigating the effectiveness of the ARC-EX transcutaneous device to restore strength and function of upper extremities in people with spinal cord injury (SCI). She talked to us about her unique journey in science, and the essential role she plays in ensuring the Up-LIFT train hits every milestone on its journey to change lives for the better.

“The one constant at a start-up is that plans are constantly changing.”

How did you go from studying primate behavior to running clinical trials at ONWARD?

I’ve not had the most conventional career path in science. When I was in fifth grade, I wanted to be the next Jane Goodall. I went to Central Washington University specifically for the Chimpanzee and Human Communication Institute program there. My original degrees were in primate behavior and ecology as well as anthropology. I had an amazing experience in college with chimpanzees that communicated in American Sign Language. I also spent a summer on the very hot and humid island of Bali studying interactions between tourists and wild macaques. I then worked with non-human primates for many years in biomedical research in parallel with translational studies in humans in multisensory integration. So really the story is, I went from Jane Goodall and non-human primates, to translational studies and then landed at clinical trials in humans. I've taken a lot of left and right turns, but I couldn't be happier about where I have been fortunate to end up!

What projects are you working on right now?

I’m the clinical program manager for a the Up-LIFT study, which is collecting data to confirm the efficacy of ONWARD’s ARC-EX technology to restore function in the upper extremities of people with partial tetraplegia. This is a wearable device designed to stimulate the spinal cord through the skin, as opposed to our ARC-IM device, which is surgically implanted next to the spinal cord. Each of the Up-LIFT study sites across the US, Canada, the UK and Europe has to go through many regulatory phases: ethics or IRB approval, contracts, budgets, and so on. My job is to make sure we’ve crossed all the t's and dotted all the i's so we can start doing the fun stuff, which is collecting the data. I make sure the train is constantly moving in the right direction, so we meet every milestone needed to achieve FDA clearance. 

What promise does the ARC-EX device hold for people living with SCI? What are its main advantages?

The obvious benefit of an external device is that there's no surgery involved, so it is potentially less risky, less expensive, and more accessible to more people. Our hope is that this device will restore a range of motor and sensory functions to people who have been living with SCI for years. Research and therapy development in SCI has mostly focused on the recently injured because it’s generally believed that most of the recovery takes place in the first 12 months after injury. The chronic population has received less attention in terms of recovery. 

The first indication we're pursuing is improved motor function in the upper extremities. It’s often assumed that the top priority for people living with SCI is to walk again. Though walking is an undeniable goal, many people with tetraplegia SCI say that it’s more important to regain use and function in their arms and hands so they can be more independent. Down the road, we have many other indications we hope to investigate for this device, ranging from autonomic function to blood pressure control, bowel and bladder control, and trunk control. 

You spent many years as a clinical program manager in academia before transitioning to industry. What are some key differences between these two research environments? 

During my 19 years of research experience, I've run the gamut from bench to bedside. I've experienced everything from a Petri dish and a microscope through animal models and human trials. There's a freedom in academic research that’s exciting. You get to ask lots of questions and explore them without always knowing where you're going to end up. But the reason you do all this work, the end goal, is to get the science to the population who needs it. That’s where industry comes in. My current role is focused on getting ARC-EX across the finish line and into the hands of the population that needs it. That said, there is plenty of exploratory research happening at ONWARD, which is really fascinating and exciting.

The SCI community must be watching these trials closely. Do you feel a responsibility to deliver?

People with SCI are a small and well-educated community, meaning they're very well-informed and passionate about their own rehabilitation. They don't take a back-seat approach. It’s impressive how many of them are willing to participate in research that would benefit not just themselves but others in the community. Their passion and drive are inspiring. 

I've worked with the ARC-EX device for six years now, starting in Dr. Reggie Edgerton’s lab at UCLA, when the technology was in the exploratory and pilot stages. I then left the SCI field for a couple of years, and I really missed it. When I started working with a similar but updated device at ONWARD, the work had an energized feel, in that we’re so close now to making the technology available to people. So there’s definitely more pressure to deliver this time around. 

How has working in the SCI field for so many years changed your outlook?

It recalibrates your appreciation for day-to-day ease of locomotion and independence. Many of us at ONWARD participated in a charity run a few weeks ago organized by Wings for Life, which is a wonderful organization that supports the SCI community. I love their slogan: “Run for those who can’t.” I remind myself of that a lot and try not to take for granted the fact that I can choose to walk up the stairs or take the elevator. Some people don't have that choice. 

What are some of the best things about working at ONWARD?

ONWARD has a great culture. Taking into consideration our international spread across the US and Europe, as well as the COVID-19 pandemic, the company has put a lot of effort into keeping a positive outlook. Dave is a great CEO and I think his passion for the field trickles down through the ranks. Also, science in general is a very multicultural environment, which I find fascinating. One aspect of working in such an international team is that everyone is very forgiving about differences in communication style and sense of humor. I feel like I have colleagues and former colleagues literally spread around the world, which is fun.