Autologous mucosal transplant in chronic spinal cord injury: an Indian Pilot Study

Abstract

Study design: Prospective Pilot Study. Objectives: To determine the safety and feasibility of autologous olfactory mucosal transplantation into the spinal cord in chronic spinal cord injured using the technique developed by Carlos Lima et al. Setting: Spinal Injury Center, New Delhi. Methods: Five chronic, motor complete, traumatic spinal cord injury (SCI) patients with neurological level C5-T12 underwent the procedure. Participants were assessed at baseline and at 6 monthly intervals. Safety and tolerability were evaluated through monitoring for any adverse events and tests including magnetic resonance imaging (MRI) evaluation. Efficacy assessment was done through neurological, functional and psychological evaluation, electrophysiological studies and urodynamics. Results: Surgery was tolerated well by all American Spinal Injury Association (ASIA) Impairment Scale (AIS) A participants. The only AIS B participant lost sensory scores significantly after surgery but is gradually regaining it. MRI evaluation revealed a syrinx in one participant and increase in length of myelomalacia in four participants. There were no other adverse findings on MRI evaluation. There was no significant improvement in any of the neurological, electrophysiological or urodynamic efficacy variables. Statistically significant improvement was seen in functional scores as evaluated by Spinal Cord Independence Measure, Beck Depression Inventory scores and life impact scores on International Spinal Cord Injury Scale. Conclusions: The procedure is relatively safe and feasible in AIS A participants with thoracic level injuries at 18 month follow-up. No efficacy could be demonstrated which could be attributed to the procedure.

In vitro Maintenance of Olfactory Mucosa: with Enriched Olfactory Ensheathing Cells

“…However, neither they validated nor they enriched the OECs in biopsy specimens. Hence, low percentage of OECs/absence of OECs may have provided safe OM autograft transplantation, without establishment of any physiological efficacy [30,31]. Feron et al [29] cultured OECs for about 28 days and found >95% GFAP-positive and 76 to 88% p75 NTR cells which supports our study.…”

“…Following this proposition we processed our biopsy specimen without any enzymatic treatment which enabled us to obtain complete olfactory epithelium with axonal regeneration [29]. Lima et al [30] and Chabbra et al [31] utilized acutely prepared minced OM tissue in Spinal Cord Injury site without culturing them. However, neither they validated nor they enriched the OECs in biopsy specimens.…”

Safety Profile, Feasibility and Early Clinical Outcome of Cotransplantation of Olfactory Mucosa and Bone Marrow Stem Cells in Chronic Spinal Cord Injury Patients

“…Various researchers have trialed this "wonder seed" of the biological cosmos in an attempt to restore neurological functioning in paraplegics [8,9,10,11,14,15,16,17]. Stem cells may achieve spinal cord repair by one of the following processes [18]: 1) By acting as a cellular bridge, 2) By providing a source of new neurons or, 3) By secreting neurotropic substances which promote repair.…”

“…Several human studies have used autologous olfactory unsheathing cells [11,14,15,16] and bone marrow stoma cells [9,22,23] to promote spinal cord repair. Combined cellular strategies for spinal cord injury have also been evaluated in animal [8,24,25] and human [10] studies.…”

“…In the pilot study by Lima et al [11], one participant had loss of sensation, which according to the authors was due to the sensory axons getting damaged during the surgical procedure because of the difficulty of locating the site of the lesion. In the study by Chhabra et al [16], loss of sensation immediately after surgery was seen in two participants and was reported to be a complication of the myelotomy and scar removal procedure. Even though one of the participants recovered almost full sensation, these findings suggest that the procedure should be done cautiously and only by very experienced surgeons.…”