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Autologous Bone Marrow Transplantation in Patients With Subacute and Chronic Spinal Cord Injury

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Abstract:

Stem cell transplants into spinal cord lesions may help to improve regeneration and spinal cord function. Clinical studies are necessary for transferring preclinical findings from animal experiments to humans. We investigated the transplantation of unmanipulated autologous bone marrow in patients with transversal spinal cord injury (SCI) with respect to safety, therapeutic time window, implantation strategy, method of administration, and functional improvement. We report data from 20 patients with complete SCI who received transplants 10 to 467 days postinjury. The follow-up examinations were done at 3, 6 ,and 12 months after implantation by two independent neurologists using standard neurological classification of SCI, including the ASIA protocol, the Frankel score, the recording of motor and somatosensory evoked potentials, and MRI evaluation of lesion size. We compared intra-arterial (via catheterization of a. vertebralis) versus intravenous administration of all mononuclear cells in groups of acute (10–30 days post-SCI, n = 7) and chronic patients (2–17 months postinjury, n = 13). Improvement in motor and/or sensory functions was observed within 3 months in 5 of 6 patients with intra-arterial application, in 5 of 7 acute, and in 1 of 13 chronic patients. Our case study shows that the implantation of autologous bone marrow cells appears to be safe, as there have been no complications following implantation to date (11 patients followed up for more than 2 years), but longer follow-ups are required to determine that implantation is definitively safe. Also, we cannot yet confirm that the observed beneficial effects were due to the cell therapy. However, the outcomes following transplantation in acute patients, and in one chronic patient who was in stable condition for several months prior to cell implantation, are promising. It is evident that transplantation within a therapeutic window of 3–4 weeks following injury will play an important role in any type of stem cell SCI treatment. Trials involving a larger population of patients and different cell types are needed before further conclusions can be drawn.

Keywords: Evoked potentials; Magnetic resonance imaging; Mesenchymal stem cells; Regeneration; Spinal cord injury; Stem cells

Document Type: Research Article

DOI: https://doi.org/10.3727/000000006783464381

Affiliations: 1: Center for Cell Therapy and Tissue Repair and Department of Neuroscience, 2nd Medical Faculty, Charles University, Prague, Czech Republic, Institute of Experimental Medicine, ASCR, Prague, Czech Republic 2: Department of Neurology, University Hospital Motol and 2nd Medical Faculty, Charles University, Prague, Czech Republic 3: Institute of Hematology and Blood Transfusion, Prague, Czech Republic 4: Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical Faculty, Charles University, Prague, Czech Republic 5: Department of Imaging Methods, University Hospital Motol and 2nd Medical Faculty, Charles University, Prague, Czech Republic 6: Department of Spondylosurgery, University Hospital Motol, Prague, Czech Republic

Publication date: 2006-08-01

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  • Cell Transplantation publishes original, peer-reviewed research and review articles on the subject of cell transplantation and its application to human diseases. To ensure high-quality contributions from all areas of transplantation, separate section editors and editorial boards have been established. Articles deal with a wide range of topics including physiological, medical, preclinical, tissue engineering, and device-oriented aspects of transplantation of nervous system, endocrine, growth factor-secreting, bone marrow, epithelial, endothelial, and genetically engineered cells, among others. Basic clinical studies and immunological research papers are also featured. To provide complete coverage of this revolutionary field, Cell Transplantation will report on relevant technological advances, and ethical and regulatory considerations of cell transplants. Cell Transplantation is now an Open Access journal starting with volume 18 in 2009, and therefore there will be an inexpensive publication charge, which is dependent on the number of pages, in addition to the charge for color figures. This will allow work to be disseminated to a wider audience and also entitle the corresponding author to a free PDF, as well as prepublication of an unedited version of the manuscript.
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