An attempt to treat patients who have injured spinal cords with intralesional implantation of concentrated autologous bone marrow cells
Introduction
Spinal cord trauma is most frequently suffered by young males involved in motor vehicle accidents (1,2). To date, no proper or well-accepted treatment modality for spinal cord injury (SCI) has been established because post-traumatic pathophysiologic findings have not been defined clearly (3,4). Clinical recovery from a severe SCI is not possible. However, recent animal studies have yielded encouraging results. The use of neurotrophic factors, blockade of growth inhibition factors, and transplantation of peripheral nerves, Schwann cells, embryonic central nerve tissues, stem cells and olfactory glial cells have been treatment approaches in recent studies (5,6). These studies have shown that, by using these methods in adult animals, improvement in a patient's status, to a certain extent, may be achieved (7,8).
The stem cells of the bone marrow have the ability to transform into various tissue groups and/or receiving organ cells and reproduce. Adult bone marrow contains short- and long-term hematopoietic stem cells (HSC) that can produce blood cells (9,10). While one type provides early reconstruction of the hematopoietic system, the other type provides long-term permanent hematopoiesis (11,12). Stem cells that have not been directed to a series reproduce symmetrically and renew themselves, and by asymmetrically reproducing transform into mature progenitor cells in the bone marrow (13,14). Undifferentiated stem cells comprise only 1:10 000 of the total bone marrow cells. It is possible to differentiate and reproduce HSC with the aid of proper growth factors by using specific monoclonal antibodies. In the treatment of hematologic diseases, isolation and transplantation of CD34+ stem cells have been performed widely (15,16). In recent years, the stem cells of the bone marrow have been shown to transform into hematopoietic system elements as well as neural, myocardial, chondrocyte, hepatocyte and osteocyte cells (17,18). Furthermore, the bone marrow has been shown to contain mesenchymal stromal cells (19). These findings have paved the way for studies on the regenerative use of bone marrow stem cells as part of novel treatment methods.
The aim of the current study was to implant concentrated autologous bone marrow cells into traumatized spinal cord of patients to achieve neurologic improvement where there was otherwise no chance of autologous recovery based on the degree of injury. We present the 1-year outcome of our experience.
Section snippets
Protocol
Before administration of mononuclear cells (MNC), complete neurologic functional loss [American Spinal Injury Association (ASIA) grade A] was confirmed in all patients. Neurologic status was assessed according to the International Standards of Neurologic and Functional Classification of SCI as developed by the ASIA. The five-grade ASIA impairment scale was used to determine the completeness of a patient's injury. The neurologic examinations included determination of sensory and motor scores.
Results
On day 15 post-operation, all the patients were referred to the Physical Medicine and Rehabilitation Clinic for rehabilitation. The patients were followed for 1 year by the physical medicine and rehabilitation and neurosurgery clinics. MRI of all patients were obtained 3, 6 and 12 months post-operation, and SEP and MEP were determined.
No changes were observed with the neurologic examination of the first patient. MEP and SEP evaluations at 12 months showed no activity, as observed in the
Discussion
For this study, a patient group with a minor chance of clinical recovery was included. The patients were operated on within 1 month of trauma and provided with rehabilitation. All four patients were grade A according to ASIA scoring, and at the end of the 1-year follow-up the condition of one of them remained unchanged. However, the condition of one patient had improved to ASIA grade B and of the other two to ASIA grade C. The results of this study, which was completely experimental, are
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2022, World NeurosurgeryCitation Excerpt :They reported that 3 different origins of stem cells, including bone mesenchymal stem cells (BMSCs), mononuclear cells (MNCs), and umbilical cord-derived mesenchymal stem cells (UCMSCs), were predominant in SCI treatment and had had greater efficacy than non–stem cells.9 The results from clinical studies have also indicated that BMSCs, MNCs, and UCMSCs can repair SCI and restore some spinal cord functions by repairing or regenerating damaged axons.10-16 In the literature, the therapeutic effects of stem cells are reported to manifest in 3 aspects.
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