title: Evaluation of clinical experience using cell-based therapies in patients with spinal cord injury: a systematic review.
abstract: OBJECTIVE
  Using a systematic approach, the authors evaluated the current utilization, safety, and effectiveness of cellular therapies for traumatic spinal cord injuries (SCIs) in humans.
  
  
  METHODS
  A systematic search and critical review of the literature published through mid-January 2012 was performed. Articles included in the search were restricted to the English language, studies with at least 10 patients, and those analyzing cellular therapies for traumatic SCI. Citations were evaluated for relevance using a priori criteria, and those that met the inclusion criteria were critically reviewed. Each article was then designated a level of evidence that was developed by the Oxford Centre for Evidence-Based Medicine.
  
  
  RESULTS
  The initial literature search identified 651 relevant articles, which decreased to 350 after excluding case reports and reviews. Evaluation of articles at the title/abstract level, and later at the full-text level, limited the final article set to 12 papers. The following cellular therapies employed in humans with SCI are reviewed: bone marrow mesenchymal and hematopoietic stem cells (8 studies), olfactory ensheathing cells (2 studies), Schwann cells (1 study), and fetal neurogenic tissue (1 study). Overall the quality of the literature was very low, with 3 Grade III levels of evidence and 9 Grade IV studies.
  
  
  CONCLUSIONS
  Several different cellular-mediated strategies for adult SCI have been reported to be relatively safe with varying degrees of neurological recovery. However, the literature is of low quality and there is a need for improved preclinical studies and prospective, controlled clinical trials.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. james.harrop@jefferson.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Robin
authors.initials: R
authors.lastname: Hashimoto
authors.forename: Dan
authors.initials: D
authors.lastname: Norvell
authors.forename: Annie
authors.initials: A
authors.lastname: Raich
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.forename: Robert G
authors.initials: RG
authors.lastname: Grossman
authors.forename: James D
authors.initials: JD
authors.lastname: Guest
authors.forename: Charles H
authors.initials: CH
authors.lastname: Tator
authors.forename: Jens
authors.initials: J
authors.lastname: Chapman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D012583:Schwann Cells / Q000637:transplantation*; D013119:Spinal Cord Injuries / Q000628:therapy*; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome