Case control series of intrathecal autologous bone marrow mesenchymal stem cell therapy for chronic spinal cord injury.
BACKGROUND
Autologous bone marrow mesenchymal cells that include stem cells (MSCs) are a clinically attractive cellular therapy option to try to treat severe spinal cord injury (SCI).


OBJECTIVE
To study the possible value of MSCs injected intrathecally to enhance rehabilitation.


METHODS
This case control, convenience sample included 64 patients, at a mean of 3.6 years after SCI. Forty-four subjects received monthly intrathecal autologous MSCs for 6 months and 20 subjects, who would not agree to the procedures, served as controls. All subjects received rehabilitation therapies 3 times weekly. Subjects were evaluated at entry and at 12 months after completing the 6-months intervention. By the ASIA Impairment Scale, ASIA grading of completeness of injury, Ashworth Spasticity Scale, Functional Ambulation Classification, and bladder and bowel control questionnaire.


RESULTS
No differences were found in baseline measures and descriptors between the MSC group and control group. Although a higher percentage of the MSC group increased motor scores by 1-2 points and changed from ASIA A to B, no significant between-group improvements were found in clinical measures. Adverse effects of cells included spasticity and, in 24 out of the 43 patients developed neuropathic pain. One subject with a history of post-infectious myelitis developed encephalomyelitis after her third injection.


CONCLUSIONS
Autologus MSCs may have side effects and may be contraindicated in patients with a history of myelitis. Their utility in treating chronic traumatic SCI needs further study in pre-clinical models and in randomized controlled trials before they should be offered to patients.
Kishk
Nirmeen A
NA
Department of Neurology, Cairo University, Cairo, Egypt.
Gabr
Hala
H
Hamdy
Sherif
S
Afifi
Lamia
L
Abokresha
Noha
N
Mahmoud
Hayam
H
Wafaie
Ahmed
A
Bilal
Dalia
D
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D002908:Chronic Disease; D004679:Encephalomyelitis / Q000209:etiology; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D009437:Neuralgia / Q000209:etiology; D009473:Neuronal Plasticity; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome