Treating Spinal Cord Injury with Mesenchymal Stem Cells from Umbilical Cord

Treating Spinal Cord Injury with Mesenchymal Stem Cells from Umbilical Cord

Traumatic spinal cord injury is a potentially devastating event in which the nerves and nerves cells in the spinal cord are damaged. In the United States, more than a quarter of a million people struggle with the lifelong consequences of traumatic spinal cord injury. The consequences of spinal cord injury vary from person to person, but each person usually must deal with several complications. Many people with spinal cord injury are paralyzed. They are at risk for pressure ulcers, blood clots in the legs, urine and bowel problems, and sexual dysfunction. Despite being paralyzed, as many as two-thirds of patients with spinal cord injury experience chronic pain, which is difficult to treat. Spinal cord injury can also affect how the heart and lungs function.

There are no specific treatments for spinal cord injury. If the injury is treated early, steroids and spine surgery/neurosurgery can help reduce long-term complications. In some cases of incomplete spinal cord injury, physical therapy can help people regain some degree of function. For the most part, treatment is aimed at reducing symptoms rather than curing the injury. Treating the symptoms helps make the disease less of a burden, but is by no means the same as a cure.

Because spinal cord injury has such long-lasting and devastating effects, researchers are actively pursuing ways to heal injured spinal cord nerve cells. One possible way to do this is through the use of stem cells.

Liu and coauthors conducted a clinical trial on 22 patients with spinal cord injury. The doctors collected mesenchymal stem cells from umbilical cord tissue that would normally be discarded as medical waste after delivery. They purified the stem cells and then used them to treat the injured patients. Astoundingly, stem cell treatment was effective in 13 of 22 patients. Patients who achieved benefit from stem cells enjoyed the return of motor function, sensory function, or both. All patients who were treated with stem cells reported less pain, improved sensation, better movement, and a greater ability to provide self-care. Importantly, the treatment did not cause any notable side effects for up to three years after treatment.

These clinical trial results are truly remarkable, but it is important to note that the number of patients treated was small and further testing is needed. Nevertheless, the researchers concluded that treatment with mesenchymal stem cells derived from umbilical cells is safe, and can improve function and quality of life in most patients with spinal cord injury.

 

Reference: Liu et al. (2013). Clinical analysis of the treatment of spinal cord injury with umbilical cord mesenchymal stem cells. Cytotherapy. 2013 Feb;15(2):185-91.

Autologous Mesenchymal Stem Cell Transplantation for Spinal Cord Injury

Autologous Mesenchymal Stem Cell Transplantation for Spinal Cord Injury

Spinal cord injury is severe neurological condition in which the major mode of transmission between the brain and the body is disrupted. When higher levels of the spinal cord are injured, for example, in the neck, the injury can be immediately fatal. Those who survived spinal cord injury are often left paralyzed and at risk for a number of comorbid conditions such as pneumonia, depression, skin ulceration infection, urinary tract infections, and pain.

If patients who sustain spinal cord injury can receive medical treatment quickly, physicians may administer glucocorticoids to help reduce swelling around the injury and preserve spinal cord function. Patients may also undergo therapeutic hypothermia (a.k.a. targeted temperature management, whole body cooling), also to help reduce inflammation and prevent scar tissue from forming around the damaged spinal cord.

After the first few days to weeks after spinal cord injury, not much can be done to change the outcome of the disease. Patients may undergo intensive physical, occupational, and speech therapy to help regain function, but more often than not the neurological deficits are mostly permanent. Hence, researchers are feverishly searching for ways to treat spinal cord injury and, by extension, prevent or reduce paralysis and other chronic complications.

Mesenchymal stem cells are an intriguing potential therapy for spinal cord injury. These cells can easily be obtained from many different tissues including bone marrow and fat among others. In animals, mesenchymal stem cells have been shown to improve changes that occur during spinal cord injury, namely the regeneration and strengthening of nerve cells in the spinal cord. Research has also shown how adipose-derived stem cells are a potential option for those with neurological conditions such as spinal cord injury.

To test this possible effect in humans, researchers collected mesenchymal stromal (stem) cells from patients with spinal cord injury in their upper back (i.e. thoracic spinal cord). Researchers then prepared and administered those cells back into the cerebrospinal fluid of the same patients. Each patient received two or three injections of approximately 1,000,000 cells per kilogram body weight. There were no adverse effects of the treatment for up to two years after injection. MRI imaging showed no abnormalities resulting from stem cell infusion. While the authors write that there were too few patients to make any firm conclusions about the efficacy of the treatment, they were strongly encouraged by the safety of the procedure. In fact, they use these results to begin a placebo-controlled clinical trial.

Reference

Satti et al. (2016). Autologous mesenchymal stromal cell transplantation for spinal cord injury: A Phase I pilot study.  International Society for Cellular Therapy, 18(4),518-522.

Stem Cells Reverse Paralysis Caused by Spinal Cord Injury

Stem Cells Reverse Paralysis Caused by Spinal Cord Injury

Spinal cord injury can be one of the most devastating injuries. Long neurons that extend from the brain down the spinal cord are severed and scarred. In most cases, this damage can never be repaired. If patients survive an injury to the spinal cord, they can be permanently paralyzed. Researchers have attempted to use high-dose steroids and surgery to preserve the spinal cord, but these approaches are either controversial or largely ineffective.

Ideally, one would create an environment in which nerve cells in the spinal cord could regrow and take up their old tasks of sensation and movement. One of the most promising approaches to do just this is stem cell transplantation.

To test this concept, researchers used stem cells derived from human placenta-derived mesenchymal stem cell tissue (not embryonic stem cells) to form neural stem cells in the laboratory. These neural stem cells have the ability to become neuron-like cells, similar to those found in the spinal cord. The researchers then used these stem cells to treat rats that had experimental spinal cord injury. The results were impressive.

Rats treated with neural stem cells regained the partial ability to use their hindlimbs within one week after treatment. By three weeks after treatment, injured rats had regained substantial use of their hindlimbs. The researchers confirmed that this improvement was due to neuron growth by using various specialized tests (e.g. electrophysiology, histopathology). Rats that did not receive stem cells did not regain substantial use of their hindlimbs at any point in the study.

This work is particularly exciting because it shows that stem cells can restore movement to animals who were paralyzed after spinal cord injury. Moreover, the researchers used human stem cells derived from placenta, which suggests that this effect could be useful in human spinal cord injury patients (perhaps even more so than in rats). While additional work is needed, these results offer hope to those who may one day develop severe spinal cord injury.

Reference:

Zhi et al. (2014). Transplantation of placenta-derived mesenchymal stem cell-induced neural stem cells to treat spinal cord injury. Neural Regen Research, 9(24): 2197–2204.

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