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  • Feasibility, Safety, and Efficacy of Directly Transplanting Autologous Adult Bone Marrow Stem Cells in Patients With Chronic Traumatic Dorsal Cord Injury

    Final Number:

    Osama Abdelaziz MD; Ahmed Marie; Mohamed Abbas; Mohamed Ibrahim; Hala Gabr

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Bone marrow is a readily accessible source for autologous adult bone marrow stem cells which can be applied therapeutically without possessing the risk of immune rejection and without raising ethical concerns. The purpose of this study is to determine the feasibility, safety, and effectiveness of direct transplantation of autologous adult bone marrow stem cells in patients with chronic cord injuries

    Methods: Thirty consecutive patients (5 females and 25 males, aged 6-64 years) having chronic traumatic dorsal spinal cord injury with durations of at least 6 months were included in the study. Twenty patients were treated with autologous adult bone marrow stem cells transplantation via open surgical intraparenchymal and intralesional injection into the site of cord injury. The treatment was continued with monthly intrathecal injection of stem cells via lumbar or cisternal punctures. Ten other patients were not treated with stem cells and served as control cases

    Results: Clinical improvement was observed in 6 (30%) out of 20 patients treated with stem cells transplantation. Short duration of injury and small cord lesions correlated with good outcome. Follow up electrophysiological studies did not show statistically significant changes. Follow up MRI did not show significant changes. Minor and temporary treatment-related morbidity were recorded

    Conclusions: The application of autologous adult bone marrow mesenchymal stem cells directly into the spinal cord is relatively safe and has clinical benefits in patients with chronic spinal cord injury. However, multicenter studies should be conducted to further elucidate the safety and efficacy of stem cells therapy in patients with spinal cord injury

    Patient Care: The results of the present research provide evidence for potential neuroregeneration and hence better rehabilitation and quality of life for patients with traumatic spinal cord injuries

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of neuroregeneration in cases of traumatic spinal cord injuries, 2) Discuss, in small groups,the surgical procedure of stem cells transplantation, 3) Identify an effective treatment for spinal cord regeneration following traumatic injuries

    References: 1. Lobosky JM. The epidemiology of spinal cord injury. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw Hill; 1996: 1049-58. 2. Lindsay KW, Bone I, Callender R. Neurology and Neurosurgery Illustrated. New York: Churchill Livingstone; 1991. 3. Berkowitz M, Harvey C, Greene C, Wilson SE. The economic consequences of traumatic spinal cord injury. New York: Demos; 1992. 4. Sekhon LHS, and Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001; 26(24 Suppl): S2–S12. 5. Himes BT, Neuhuber B, Coleman C, Kushner R, Swanger SA, Kopen GC, Wagner J, Shumsky JS, Fischer I. Recovery of function following grafting of human bone marrow-derived stromal cells into the injured spinal cord. Neurorehabil Neural Repair 2006; 20(2):278-96. 6. Sugar O, Gerard RW. Spinal cord regeneration in the rat. J Neurophysiol 1940; 3:1-19. 7. Barnard JW, Carpenter W. Lack of regeneration in the spinal cord of the rat. J Neurophysiol 1950; 13(3):223-8. 8. Feigin I, Geller EH, Wolf A. Absence of regeneration in the spinal cord of the young rat. J Neuropathol Exp Neurol 1951; 10(4):420-5. 9. Kao CC. Comparison of healing process in transected spinal cords grafted with autogenous brain tissue, sciatic nerve, and nodose ganglion. Exp Neurol 1974; 44(3):424-39. 10. Guest JD, Rao A, Olson L, Bunge MB, Bunge RP. The ability of human Schwann cell grafts to promote regeneration in the transected nude rat spinal cord. Exp Neurol 1997;148(2): 502-22. 11. Doucette R. Olfactory ensheathing cells: potential for glial cell transplantation into areas of CNS injury. Histol Histopathol 1995; 10(2):503-7. 12. Reynolds BA, Weiss S. Generation of neurons and astrocytes from isolated cells of the adult mammalian central nervous system. Science 1992; 255(5052): 1707-10. 13. Snyder EY. Grafting immortalized neurons to the CNS. Curr Opin Neurol Biol 1994; 4(5): 742-51. 14. Wilmut I, Schnieke AE, McWhir J, Kind AJ, Campbell KH. Viable offspring derived from fetal and adult mammalian cells. Nature 1997; 385(6619): 810-13. 15. Thomson JA, Itskovitz-Eldor J, Shapiro SS, Waknitz MA, Swiergiel JJ, Marshall VS, Jones JM. Embryonic stem cell lines derived from human blastocysts. Science 1998; 282(5391): 1145-7. 16. Fuchs E, Serge JA. Stem cells: a new lease on life. Cell 2000; 100(1): 143-55. 17. Sell S. Adult stem cell plasticity: introduction to the first issue of stem cell reviews. Stem Cell Rev 2005; 1(1):1-7. 18. Svendsen CN, Caldwell MA, Ostenfeld T. Human neural stem cells: isolation, expansion and transplantation. Brain Pathol 1999; 9(3): 499-513. 19. Ourednik V, Ourednik J, Park KI, Snyder EY. Neural stem cells--a versatile tool for cell replacement and gene therapy in the central nervous system. Clin Genet 1999; 56(4): 267-78. 20. Gage FH. Mammalian neural stem cells. Science 2000; 287(5457):1433-8. 21. Wickelgren I. Stem cells. Rat spinal cord function partially restored. Science 1999; 286(5446): 1826-7. 22. Liu Y, Himes BT, Solowska J, Moul J, Chow SY, Park KI, Tessler A, Murray M, Snyder EY, Fischer I. Intraspinal delivery of neurotrophin-3 using neural stem cells genetically modified by recombinant retrovirus. Exp Neurol 1999; 158(1): 9-26. 23. McDonald JW, Liu XZ, Qu Y, Liu S, Mickey SK, Turetsky D, Gottlieb DI, Choi DW. Transplanted embryonic stem cells survive, differentiate and promote recovery in injured rat spinal cord. Nat Med 1999; 5(12): 1410-12. 24. Chiu AY, Hall ZW. Stem cell research: the California experience. J Neurosci 2006; 26(25):6661-3. 25. Prentice D. Adult Stem Cells. In: Prentice D, ed. Monitoring Stem Cell Research: A Report of the President's Council on Bioethics, Appendix K. Washington, D.C.: Government Printing Office; 2004: 309-46. 26. D'Ippolito G, Diabira S, Howard GA, Menei P, Roos BA, Schiller PC. Marrow-isolated adult multilineage inducible (MIAMI) cells, a unique population of postnatal young and old human cells with extensive expansion and differentiation potential. J Cell Sci 2004;117(Pt 14):2971-81. 27. Kögler G, Sensken S, Airey JA, Trapp T, Müschen M, Feldhahn N, Liedtke S, Sorg RV, Fischer J, Rosenbaum C, Greschat S, Knipper A, Bender J, Degistirici O, Jizong Gao J, Caplan AI, Colletti EJ, Almeida-Porada G, Müller HW, Zanjani E, Wernet P. A new human somatic stem cell from placental cord blood with intrinsic pluripotent differentiation potential. J Exp Med 2004; 200(2): 123-35. 28. Jiang Y, Jahagirda BN, Reinhardt RL, Schwartz RE, Keene CD, Ortiz-Gonzalez XR, Reyes M, Lenvik T, Lund T, Blackstad M, Du J, Aldrich S, Aaron Lisberg A, Low WC, Largaespada DA, Verfaillie CM. Pluripotency of mesenchymal stem cells derived from adult marrow. Nature 2002; 418(6893):41-9. 29. Mazurier F, Doedens M, Gan OI, Dick JE. Rapid myeloerythroid repopulation after intrafemoral transplantation of NOD-SCID mice reveals a new class of human stem cells. Nat Med July 2003; 9(7):959-63. 30. Bianco P, Riminucci M, Gronthos S, Robey PG. Bone marrow stromal stem cells: nature, biology, and potential applications. Stem Cells 2001; 19(3):180-92. 31. Heissig B, Hattori K, Dias S, Friedrich M, Ferris B, Hackett NR, Crystal RG, Besmer P, Lyden D, Moore MAS, Werb Z, Rafii S. Recruitment of stem and progenitor cells from the bone marrow niche requires MMP-9 mediated release of kit-ligand. Cell 2002; 109(5): 625-37. 32. Barami K, Diaz FG. Cellular transplantation and spinal cord injury. Neurosurgery 2000; 47(3): 691-700. 33. Carvalho KA, Vialle EN, Moreira GHG, Cunha RC, Simeoni RB, Francisco JC, Guarita-Souza LC, Oliveira L, Zocche L, Olandoski M. Functional outcome of bone marrow stem cells (CD45+/CD34-) after cell therapy in chronic spinal cord injury in Wistar rats. Transplant Proc 2008; 40(3):845-6. 34. Cížková D, Rosocha J, Vanický I, Jergová S, Cížek M. Transplants of human mesenchymal stem cells improve Functional recovery after spinal cord injury in the rat. Cell Mol Neurobiol 2006; 26(7-8):1167-80. 35. Lee KH, Suh-Kim H, Choi JS, Jeun SS, Kim EJ, Kim SS, Yoon do H, Lee BH. Human mesenchymal stem cell transplantation promotes functional recovery following acute spinal cord injury in rats. Acta Neurobiol Exp (Wars) 2007; 67(1): 13–22. 36. Deng YB, Liu XG, Liu ZG; Liu XL, Liu Y, Zhou GQ. Implantation of BM mesenchymal stem cells into injured spinal cord elicits de novo neurogenesis and functional recovery: evidence from a study in rhesus monkeys. Cytotherapy 2006; 8(3):210-14. 37. Rabinovich S, Seledtsov,V, Poveschenko, O, Senuykov, V, Taraban, V, Yarochno, V, Kolosov, N, Savchenko, S, Kozlov, V. Transplantation treatment of spinal cord injury patients. Biomed Pharmacother 2003; 57(9):428-33. 38. Zhou Q, Zhang SZ, Xu RX, Xu K. Neural stem cell transplantation and postoperative management: report of 70 cases. Di Yi Jun Yi Da Xue Xue Bao 2004; 24(10):1207-9. 39. Kang KS, Kim SW, Oh YH, Yu JW, Kim KY, Park HK, Song CH, Han H. A 37-year-old spinal cord-injured female patient, transplanted of multipotent stem cells from human UC blood, with improved sensory perception and mobility, both functionally and morphologically: A case study. Cytotherapy 2005; 7(4):368-73. 40. Féron F, Perry C, Cochrane J, Licina, P, Nowitzke A, Urquhart S, Geraghty T, Mackay-Sim A. Autologous olfactory ensheathing cell transplantation in human spinal cord injury. Brain 2005; 128(Pt 12):2951-60. 41. Lima C, Pratas-Vital J, Escada P, Hasse-Ferreira A, Capucho C, Peduzzi JD. Olfactory mucosa autografts in human spinal cord injury: a pilot clinical study. J Spinal Cord Med 2006; 29(3):191-203. 42. Moviglia GA, Fernandez Viña R, Brizuela JA, Saslavsky J, Vrsalovic F, Varela G, Bastos F, Farina P, Etchegaray G, Barbieri M, Martinez G, Picasso F, Schmidt Y, Brizuela P, Gaeta CA, Costanzo H, Moviglia Brandolino MT, Merino S, Pes ME, Veloso MJ, Rugilo C, Tamer I, Shuster GS. Combined protocol of cell therapy for chronic spinal cord injury. Report on the electrical and functional recovery of two patients. Cytotherapy 2006; 8(3):202-9. 43. Deda H, Inci MC, Kurekci AE, Kayihan K, Ozgun E, Ustunsoy GE, Kocabay S. Treatment of chronic spinal cord injured patients with autologous bone marrow-derived hematopoietic stem cell transplantation:1-yearfollow-up. Cytotherapy 2008; 10(6):565-74. 44. Subbaiah G, Adavi V, Chelluri LK, Laxman S, Ratnakar K, Gopal P,. Ravindranath K. Preliminary report on the safety, efficacy and functional recovery of spinal cord injury with autologous bone marrow derived mesenchymal stem cells – a clinical trial. The Internet Journal of Spine Surgery 2009; 5(1). 45. Callera F, do Nascimento RX. Delivery of autologous bone marrow precursor cells into the spinal cord via lumbar puncture technique in patients with spinal cord injury: A preliminary safety study. Exp Hematol 2006; 34(2):130-1. 46. Takeuchi H, Natsume A, Wakabayashi T, Aoshima C, Shimato S, Ito M, Ishii J, Maeda Y, Hara M, Kim SU, Yoshida J. Intravenously transplanted human neural stem cells migrate to the injured spinal cord in adult mice in an SDF-1- and HGF-dependent manner. Neurosci Lett 2007; 426(2): 69-74. 47. Satake K, Lou J, Lenke LG. Migration of mesenchymal stem cells through cerebrospinal fluid into injured spinal cord tissue. Spine 2004; 29(18):1971-9. 48. Bakshi A, Barshinger AL, Swanger SA, Madhavani V, Shumsky JS, Neuhuber B, Fisher I. Lumbar puncture delivery of bone marrow stromal cells in spinal cord contusion: a novel method for minimally invasive cell transplantation. J Neurotrauma 2006; 23(1):55-65. 49. Huang H, Chen L, Wang H, Xiu B, Li B, Wang R, Zhang J, Zhang F, Gu Z, Li Y, Song Y, Hao W, Pang S, Sun J. Influence of patients’ age on functional recovery after transplantation of olfactory ensheathing cells into injured spinal cord injury. Chin Med J 2003; 116(10):1488-91. 50. Webber DJ, Bradbury EJ, McMahon SB, Minger SL. Transplanted neural progenitor cells survive and differentiate but achieve limited functional recovery in the lesioned adult rat spinal cord. Regen Med 2007; 2(6):929-45. 51. Saberi H, Moshayedi P, Aghayan HR, Arjmand B, Hosseini SK, Emami-Razavi SH, Rahimi-Movaghar V, Raza M, Firouzi M. Treatment of chronic thoracic spinal cord injury patients with autologous Schwann cell transplantation: an interim report on safety considerations and possible outcomes. Neurosci Lett 2008; 443(1):46-50.

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