title: Autologous bone marrow transplantation in patients with subacute and chronic spinal cord injury.
abstract: Stem cell transplants into spinal cord lesions may help to improve regeneration and spinal cord function. Clinical studies are necessary for transferring preclinical findings from animal experiments to humans. We investigated the transplantation of unmanipulated autologous bone marrow in patients with transversal spinal cord injury (SCI) with respect to safety, therapeutic time window, implantation strategy, method of administration, and functional improvement. We report data from 20 patients with complete SCI who received transplants 10 to 467 days postinjury. The follow-up examinations were done at 3, 6, and 12 months after implantation by two independent neurologists using standard neurological classification of SCI, including the ASIA protocol, the Frankel score, the recording of motor and somatosensory evoked potentials, and MRI evaluation of lesion size. We compared intra-arterial (via catheterization of a. vertebralis) versus intravenous administration of all mononuclear cells in groups of acute (10-30 days post-SCI, n=7) and chronic patients (2-17 months postinjury, n=13). Improvement in motor and/or sensory functions was observed within 3 months in 5 of 6 patients with intra-arterial application, in 5 of 7 acute, and in 1 of 13 chronic patients. Our case study shows that the implantation of autologous bone marrow cells appears to be safe, as there have been no complications following implantation to date (11 patients followed up for more than 2 years), but longer follow-ups are required to determine that implantation is definitively safe. Also, we cannot yet confirm that the observed beneficial effects were due to the cell therapy. However, the outcomes following transplantation in acute patients, and in one chronic patient who was in stable condition for several months prior to cell implantation, are promising. It is evident that transplantation within a therapeutic window of 3-4 weeks following injury will play an important role in any type of stem cell SCI treatment. Trials involving a larger population of patients and different cell types are needed before further conclusions can be drawn.
authors.affiliation: Center for Cell Therapy and Tissue Repair, Charles University, Prague, Czech Republic. sykova@biomed.cas.cz
authors.forename: Eva
authors.initials: E
authors.lastname: Syková
authors.forename: Ales
authors.initials: A
authors.lastname: Homola
authors.forename: Radim
authors.initials: R
authors.lastname: Mazanec
authors.forename: Hynek
authors.initials: H
authors.lastname: Lachmann
authors.forename: Simona Langkramer
authors.initials: SL
authors.lastname: Konrádová
authors.forename: Petr
authors.initials: P
authors.lastname: Kobylka
authors.forename: Radek
authors.initials: R
authors.lastname: Pádr
authors.forename: Jirí
authors.initials: J
authors.lastname: Neuwirth
authors.forename: Vladimír
authors.initials: V
authors.lastname: Komrska
authors.forename: Vladimir
authors.initials: V
authors.lastname: Vávra
authors.forename: Jan
authors.initials: J
authors.lastname: Stulík
authors.forename: Martin
authors.initials: M
authors.lastname: Bojar
mesh_terms: D000208:Acute Disease; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002908:Chronic Disease; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009416:Nerve Regeneration / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D013119:Spinal Cord Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014182:Transplantation, Autologous