The effects of bone marrow mononuclear cell transplantation on the quality of life of children with cerebral palsy

Abstract

BackgroundQuality of life (QOL) is an important factor in evaluating the effectiveness of treatment in children with cerebral palsy (CP). The aim of this study was to evaluate the effects of autologous bone marrow mononuclear cells (BM MNCs) on the QOL of children with CP.MethodsFrom December 2015 to December 2016, 30 children with CP aged from 2 to 15 years received two intrathecal infusions of BM MNCs, one at baseline and the other 3 months later, at Vinmec International Hospital. The motor function and muscle tone of the patients were evaluated using the Gross Motor Function Measure (GMFM)-88 and Modified Ashworth Score, respectively. Their QOL was assessed at baseline and 6 months after the first BM MNC transplant using the Vietnamese version of the Cerebral Palsy Quality of Life Questionnaire for children (CP QOL-Child)–the parental proxy report, which comprises seven domains. Nineteen mothers (mean age: 32.9±4.9 years) and 11 fathers (mean age: 36.1±6.8 years) were invited to complete the CP QOL-Child assessment before and after the transplantations, Paired t-tests and multivariate regression analyses were used to evaluate the changes in QOL and GMFM scores and to identify the key factors correlated with the QOL score.ResultsSignificant changes were observed in the children’s gross motor function and muscle spasticity, as evidenced by the GMFM-88 total score, scores for each of its domains, the GMFM-66 percentile and the muscle tone (P < 0.001). Six months after the transplantations, the QOL scores of children with CP were markedly increased (P < 0.001) for all the domains, except for the domain of access to services. In the multivariate regression analysis, significant associations were found between higher age of children and higher QOL except for feeling about functioning and pain and impact of disability domains. Gross Motor Function Classification System (GMFCS) level was negatively correlated with the score of pain and impact of disability domain, while the GMFM-88 scores were positively correlated with the QOL in terms of feelings about functioning and family health domain (P < 0.05).ConclusionThe QOL of the children with CP was noticeably improved 6 months after BM MNC transplantation and was accompanied by improvements in gross motor function and muscle tone.Trial registrationClinicalTrials.gov Identifier: NCT02574923. Registered on October 14, 2015.

Inflamed synovial fluid induces a homeostatic response in bone marrow mononuclear cells in vitro: Implications for joint therapy

“…38,39 BMNC provide potent anti-inflammatory and pro-regenerative effects in injured tissues, including those with minimal regenerative capacity, such as the pancreas, central nervous system, and osteochondral defects. [40][41][42][43][44][45] BMNC can also induce homeostasis in chronically inflamed tissues refractory to other treatments, such as OAaffected joints and the respiratory system. 33,46 Macrophage progenitors are the primary cells in BMNC responsible for downregulating inflammation and may, through their homeostatic effects, provide therapeutic means for restoring joint homeostasis.…”

Outcomes of Bone Marrow Mononuclear Cell Transplantation for Neurological Sequelae Due to Intracranial Hemorrhage Incidence in the Neonatal Period: Report of Four Cases

“…Bone marrow was harvested through anterior iliac crest puncture under general anesthesia in the operating theater. The volume collected depended on the patients' body weight as follows: 8 ml/kg for patients under 10 kg [80 ml + (body weight in kg -10) × 7 ml] for patients above 10 kg (18).…”

“…Traditional treatments of neurological sequelae after ICH in newborns have limited effect. Recently, stem cell transplantation is being applied in the management of neurological impairment in children, resulting in promising outcomes (15)(16)(17)(18)(19)(20)(21). In 2018, Ahn et al published the first report using stem cell transplantation for severe intra-ventricular hemorrhage to reduce neurological complications (22).…”

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“…Despite the various rehabilitative, medical, and surgical interventions that help CP patients maximize functional skills, rigorous standardized assessments of multi-disciplinary outcomes for CP interventions are uncommon [20]. The traditional CP treatments of physiotherapy, pharmacologic therapies, or botulin toxin A injection, have limited effectiveness [21]. Botulinum toxin is a treatment for the controlling of excessive muscle stiffness, spasticity, and dystonia in CP patients; it inhibits the release of inflammatory mediators and peripheral neurotransmitters from sensory nerves [22].…”