Transplantation of autologous bone marrow stem cells in patients with chronic spinal cord injury
Notice bibliographique
Résumé
Stem cells are being investigated by their potential use in regenerative medicine. There is currently a lack of effective clinical therapy for a number conditions, such as severe spinal cord injury (SCI). SCI can lead to chronic paraplegia, considered an irreversible condition. The administration of stem cells has been tested as a potential therapy for SCI. In the present study we evaluated the feasibility, safety and potential efficacy of autologous mesenchymal stem cells (MSC) transplantation in patients with chronic complete SCI. We conducted a phase I/II, non-controlled study in 14 patients of both genders aging between 18-65 years, with ASIA A classified chronic traumatic SCI. Baseline somatosensory evoked potentials (SSEP), spinal magnetic resonance imaging (MRI) and urodynamics were assessed before and after treatment. Pain rating was performed using the McGill Pain Questionnaire and a visual analogue score scale. Bone marrow-derived MSC were cultured and characterized by flow cytometry, cell differentiation assays and G-band karyotyping, showing morphological and phenotypic characteristics of MSC, as well as genetic stability. MSC were injected directly into the lesion following laminectomy and durotomy. Transplantation of bone marrow derived MSC was an overall safe procedure. All of the patients were discharged within 48 hours after surgery. Only one patient developed a post-operatory complication, evolving a liquoric fistula that was treated by an additional surgical procedure. Nine patients had improvements in urologic function. All patients displayed variable improvements in sensitivity and 8 patients developed lower limbs motor functional gains, principally in the hip flexors. All patients had variable improvements in ASIA global scores. Additionally, 6 patients had changes in the AIS score to grade B and one to grade C. A direct correlation between motor gain and lesion level and an inverse correlation between light touch gain and lesion volume were found 6 months after transplantation. One patient presented changes in SSEP 3 and 6 months after MSC transplantation. Although there is an abundance of studies describing the natural history of neurologic functional gains during the first year post-SCI, there is a lack of data regarding the degree of neurological recovery that may naturally occur during prolonged follow up investigation. In the present study, we enrolled only patients with chronic and complete spinal cord injury (ASIA A) whom had previously been subjected to decompressive surgery and lengthy rehabilitation protocols without acquiring significant motor or sensory gains. Although this was not a controlled study, based on the patient profiles and the expected spontaneous gains, our study showed potential benefits of MSC transplantation treatment, in variable degrees of motor and sensory improvements, clinical pain measures and urodynamics parameters. The use of MSC presents several advantages, such as isolation from bone marrow aspirates and large-scale expansion in cell culture procedures, which are feasible to be performed in autologous transplantations. We conclude that intralesional transplantation of autologous MSC in spinal cord injury patients is safe and feasible, and may provide some progressive benefits. We are currently beginning new clinical trials based on MSC therapy for SCI.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».