Elsevier

Cytotherapy

Volume 13, Issue 1, January 2011, Pages 54-60
Cytotherapy

An attempt to treat patients who have injured spinal cords with intralesional implantation of concentrated autologous bone marrow cells

https://doi.org/10.3109/14653249.2010.510506Get rights and content

Abstract

Background aims

Spinal cord injury is common among young subjects involved in motor vehicle accidents. Mechanisms and attempts to reverse post-traumatic pathophysiologic consequences are still being investigated. Unfortunately no effective and well-established treatment modality has been developed so far. The regeneration capability of the human nervous system following an injury is highly limited

Methods

The study involved four patients (two male, two female) who had suffered spinal cord injury as a result of various types of trauma. On neurologic examination, all the patients were determined to be in American Spinal Injury Association (ASIA) grade A. All patients were treated with decompression, stabilization and fusion for vertebral trauma anteriorly, as well as intralesional implantation of cellular bone marrow concentrates using a posterior approach 1 month after the first operation. The patients were then treated and followed-up in the physical rehabilitation clinic

Results

At the end of the post-operative 1-year follow-up, two of the patients were classified as ASIA C while one was classified as ASIA B. One patient showed no neurologic change; none of the patients suffered from any complications or adverse effects as a result of intralesional application of bone marrow cells

Conclusions

The results of this experimental study show the potential contribution of intralesional implantation of bone marrow to neuronal regeneration in the injured spinal cord, with neuronal changes. In light of the results of this experimental study, the potential for regenerative treatment in injuries of the human spinal cord is no longer a speculation but an observation.

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

References (23)

  • CarterR.E.

    Etiology of traumatic spinal cord injury: statistics of more than 1,100 cases

    Tex Med

    (1977)
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