title: Human neural stem cell transplantation in ALS: initial results from a phase I trial.
abstract: BACKGROUND
  We report the initial results from a phase I clinical trial for ALS. We transplanted GMP-grade, fetal human neural stem cells from natural in utero death (hNSCs) into the anterior horns of the spinal cord to test for the safety of both cells and neurosurgical procedures in these patients. The trial was approved by the Istituto Superiore di Sanità and the competent Ethics Committees and was monitored by an external Safety Board.
  
  
  METHODS
  Six non-ambulatory patients were treated. Three of them received 3 unilateral hNSCs microinjections into the lumbar cord tract, while the remaining ones received bilateral (n = 3 + 3) microinjections. None manifested severe adverse events related to the treatment, even though nearly 5 times more cells were injected in the patients receiving bilateral implants and a much milder immune-suppression regimen was used as compared to previous trials.
  
  
  RESULTS
  No increase of disease progression due to the treatment was observed for up to18 months after surgery. Rather, two patients showed a transitory improvement of the subscore ambulation on the ALS-FRS-R scale (from 1 to 2). A third patient showed improvement of the MRC score for tibialis anterior, which persisted for as long as 7 months. The latter and two additional patients refused PEG and invasive ventilation and died 8 months after surgery due to the progression of respiratory failure. The autopsies confirmed that this was related to the evolution of the disease.
  
  
  CONCLUSIONS
  We describe a safe cell therapy approach that will allow for the treatment of larger pools of patients for later-phase ALS clinical trials, while warranting good reproducibility. These can now be carried out under more standardized conditions, based on a more homogenous repertoire of clinical grade hNSCs. The use of brain tissue from natural miscarriages eliminates the ethical concerns that may arise from the use of fetal material.
  
  
  BACKGROUND
  EudraCT:2009-014484-39 .
authors.affiliation: Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy. mazzini.l@libero.it.
authors.forename: Letizia
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authors.lastname: Mazzini
authors.affiliation: Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. m.gelati@css-mendel.it.|IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. m.gelati@css-mendel.it.
authors.forename: Maurizio
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authors.affiliation: Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. d.profico@css-mendel.it.|IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. d.profico@css-mendel.it.
authors.forename: Daniela Celeste
authors.initials: DC
authors.lastname: Profico
authors.affiliation: Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. giada.sgaravizzi@gmail.com.
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authors.affiliation: Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. gianmuzi@gmail.com.
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authors.affiliation: IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. laura.rotanodari@unimib.it.|Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy. laura.rotanodari@unimib.it.
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authors.affiliation: Department of Neuroscience, "Santa Maria" Hospital, Terni via Tristano di Joannuccio 1, 05100, Terni, Italy. sandro.carletti@virgilio.it.
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authors.affiliation: Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy. enricabersano@gmail.com.
authors.forename: Enrica
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authors.affiliation: Department of Neurology, Eastern Piedmont University, Maggiore della Carità Hospital, Corso Mazzini n. 18-28100, Novara, Italy. roberto.cantello@med.unipmn.it.
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authors.forename: Serena
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authors.forename: Annalisa
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authors.affiliation: Laboratorio Cellule Staminali, Cell Factory e Biobanca, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. vescovi@tin.it.|IRCCS Casa Sollievo della Sofferenza, viale dei Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. vescovi@tin.it.|Biotechnology and Bioscience Department Bicocca University, Piazza della Scienza 2, 20126, Milan, Italy. vescovi@tin.it.|Fondazione Cellule Staminali di Terni, Terni Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy. vescovi@tin.it.
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mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000628:therapy*; D000818:Animals; D018929:Cell Culture Techniques; D002490:Central Nervous System / Q000473:pathology; D002871:Chromosome Banding; D018450:Disease Progression; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D036341:Intercellular Signaling Peptides and Proteins; D007558:Italy; D007621:Karyotyping; D008297:Male; D051379:Mice; D008819:Mice, Nude; D008875:Middle Aged; D058953:Neural Stem Cells / Q000166:cytology*; D010865:Pilot Projects; D011446:Prospective Studies; D013116:Spinal Cord / Q000166:cytology; D033581:Stem Cell Transplantation
chemical_list: D036341:Intercellular Signaling Peptides and Proteins