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