Feasibility, Safety, and Efficacy of Directly Transplanting Autologous Adult Bone Marrow Stem Cells in Patients With Chronic Traumatic Dorsal Cord Injury

Abstract

Background: Bone marrow is a readily accessible source for autologous adult bone marrow stem cells which can be applied therapeutically without possessing the risk of immune rejection and without raising ethical concerns. The purpose of this study is to determine the feasibility, safety, and effectiveness of direct transplantation of autologous adult bone marrow stem cells in patients with chronic cord injuries.Methods: Thirty consecutive patients (5 females and 25 males, aged 6 to 64 y) having chronic traumatic dorsal spinal cord injury with durations of at least 6 months were included in the study. Twenty patients were treated with autologous adult bone marrow stem cells transplantation through open surgical intraparenchymal and intralesional injection into the site of cord injury. The treatment was continued with monthly intrathecal injection of stem cells through lumbar or cisternal punctures. Ten other patients were not treated with stem cells and served as control cases.Results: Clinical improvement was observed in 6 (30%) of 20 patients treated with stem cells transplantation. Short duration of injury and small cord lesions correlated with good outcome. Follow-up electrophysiologic studies did not show statistically significant changes. Follow-up magnetic resonance imaging did not show significant changes. Minor and temporary treatmentrelated morbidity were recorded.Conclusions: The application of autologous adult bone marrow mesenchymal stem cells directly into the spinal cord is relatively safe and has clinical benefits in patients with chronic spinal cord injury. However, multicenter studies should be conducted to further elucidate the safety and efficacy of stem cells therapy in patients with spinal cord injury.

Efficacy and safety of bone marrow‐derived cell transplantation for spinal cord injury: a systematic review and meta‐analysis of clinical trials

“…Five studies (, and ) including 175 patients reported the AIS improvement rate of AIS grade A and showed significant improvement favoring BMDCs groups (OR: 6.79; 95% CI, 2.57–17.96; p < 0.001) (Fig. ).…”

“…The quality of all included 24 studies was generally low. There were three RCTs (, and ) and seven CCTs (, and ) were estimated of high quality by modified Newcastle–Ottawa scale (Table ). True randomization was used in only three RCT studies (, and ).…”

“…ASIA Impairment Scale improvement rate, which was included in seven studies (, and ) containing 275 patients, demonstrated low heterogeneity between trials (p = 0.34, I 2 = 12%) (Fig. ).…”

Stem Cell Transplantation for Traumatic Spinal Cord Injury: What Have We Learned from Previous Experience

“…The studies using OEC used open surgical intervention Lima et al (35), Mackay-Sim et al (49); while Feron et al (34) used OEC as a cellular graft injected directly into the spinal cord under microscopic guidance . However MSC or MNC implantation using surgical procedure did not report superior results justifying the invasive procedure Abdelaziz et al (40), Chernyck et al (37) , Park et al (45). The use of intra-arterial route is limited due to the technical difficulty.…”

“…Abdelaziz et al (40), in 2010 reported a controlled trial enrolling 30 chronic SCI patients divided as 20 cases and 10 control. The study used autologous bone marrow derived MSCs in a dose of 5 X10 6 /kg.…”