A method for reconstruction of severely damaged spinal cord using autologous hematopoietic stem cells and platelet-rich protein as a biological scaffold

Abstract

Introduction:There have been attempts to alter the prognosis of severe spinal cord injury in different centers, but none of which have reliably altered the outcome. Some trials use stem cells (SCs) that produced widely differing results. We hereby add our experience in our center of a surgical reconstruction of the damaged spinal cord using a mixture of SCs and Platelet-Rich Protein (PRP) with fibrin coated as a biological scaffold.Materials and Methods:Four cases of severely damaged spinal cord have been operated for neurolysis and reconstruction of the spinal cord using SCs and platelet-rich protein (PRP) with fibrin coated harvested from the peripheral circulation of the patient. PRP serves to maintain the position of the SCs. One milliliter suspension contains an average of 2.8 × 106 of autologous hematopoietic SCs. Patients were intraoperatively monitored by somatosensory evoked potential, motor evoked potentials, and delta wave. They are clinically followed postoperatively and electromyogram was repeated every 2 weeks. Magnetic resonance imaging (MRI) was repeated regularly. The patients are followed up for a period between 2 and 3 years.Results:One patient demonstrated motor and objective sensory improvement (P = 0.05), two other patients reported subjective sensory improvement, and the fourth one remained without any improvement (P = 0.1). None of these patients demonstrated any sign of deterioration or complication either on the surgery or on implanting of the SCs. MRI clearly proved that the inserted biological scaffold remained in place of reconstruction.Conclusion:SCs may play a role in restoring spinal cord functions. However, the unsolved problems of the use of SCs and related ethical issues should be addressed.

An Insight into the Prospects and Drawbacks of Stem Cell Therapy for Spinal Cord Injuries: Ongoing Trials and Future Directions

“…In a retrospective investigation, Al-Zoubi et al [36] implanted purified autologous leukapheresis-derived CD34+ and CD133+ stem cells into 19 patients with chronic full SCI; over half of the patients showed segmental sensory or motor improvement after long-term follow-up. Ammar et al [37] revealed in a pilot trial, using a biological scaffold containing autologous HSCs and platelet-rich protein for four individuals with SCI, a patient who demonstrated motor and objective sensory improvement. Some prior research found a slight neurological improvement from transplanting neural stem/progenitor cells into people with chronic SCI.…”

“…The implementation of blinding techniques is crucial to ensure the reliability of clinical trial outcomes. Many prior studies have failed to report adverse events comprehensively, potentially resulting in an overstatement of stem cell safety and efficacy [21,36,37]. Consequently, extending the follow-up period is essential to comprehensively investigate the safety profile of stem cell therapy.…”

Progress in Stem Cell Therapy for Spinal Cord Injury

“…Recent studies indicated that SCs loaded with biological scaffolds could increase the survival rate of SCs, promote differentiation into neurons, increase the growth factor release, and improve axonal and myelin sheath regeneration [ 176 ]. Numerous studies indicated that SCI mice receiving biological scaffolds combined with SC transplantation demonstrated a better outcome on motor function than those that received SCs alone [ 177 – 179 ]. A growing number of studies indicated that 3D print might be another promising and exciting technology with huge potential for SCI treatment.…”

Effect of Platelet-Rich Plasma on Intervertebral Disc Degeneration In Vivo and In Vitro: A Critical Review

“…Anatomically, the IVD comprises a central highly hydrated nucleus pulposus (NP), a peripheral thin layer of the annulus fibrosus (AF), and upper and lower cartilage endplates (CEPs) [ 5 ]. Histologically, the NP mainly comprises water and a low density of notochord and NP cells and the extracellular matrix (ECM).…”