title: Chronic spinal cord injury treated with transplanted autologous bone marrow-derived mesenchymal stem cells tracked by magnetic resonance imaging: a case report.
abstract: BACKGROUND
  Intrathecal transplantation is a minimally invasive method for the delivery of stem cells, however, whether the cells migrate from the lumbar to the injured cervical spinal cord has not been proved in humans. We describe an attempt to track bone marrow-derived mesenchymal stem cells in a patient with a chronic cervical spinal cord injury.
  
  
  METHODS
  A 33-year-old Thai man who sustained an incomplete spinal cord injury from the atlanto-axial subluxation was enrolled into a pilot study aiming to track bone marrow-derived mesenchymal stem cells, labeled with superparamagnetic iron oxide nanoparticles, from intrathecal transplantation in chronic cervical spinal cord injury. He had been dependent on respiratory support since 2005. There had been no improvement in his neurological function for the past 54 months. Bone marrow-derived mesenchymal stem cells were retrieved from his iliac crest and repopulated to the target number. One half of the total cells were labeled with superparamagnetic iron oxide nanoparticles before transplantation to the intrathecal space between L4 and L5. Magnetic resonance imaging studies were performed immediately after the transplantation and at 48 hours, two weeks, one month and seven months after the transplantation. His magnetic resonance imaging scan performed immediately after the transplantation showed hyposignal intensity of paramagnetic substance tagged stem cells in the subarachnoid space at the lumbar spine area. This phenomenon was observed at the surface around his cervical spinal cord at 48 hours. A focal hyposignal intensity of tagged bone marrow-derived stem cells was detected at his cervical spinal cord with magnetic resonance imaging at 48 hours, which faded after two weeks, and then disappeared after one month. No clinical improvement of the neurological function had occurred at the end of this study. However, at 48 hours after the transplantation, he presented with a fever, headache, myalgia and worsening of his motor function (by one grade of all key muscles by the American Spinal Injury Association impairment scale), which lasted for 48 hours.
  
  
  CONCLUSIONS
  Intrathecal injection of bone marrow-derived stem cells at the lumbar spine level could deliver the cells to the injured cervical spinal cord. Transient complications should be observed closely in the first 48 hours after transplantation. Further study should be carried out to evaluate the result of the treatment.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. areesak.cho@mahidol.ac.th.
authors.forename: Areesak
authors.initials: A
authors.lastname: Chotivichit
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. monchai.ortho@gmail.com.
authors.forename: Monchai
authors.initials: M
authors.lastname: Ruangchainikom
authors.affiliation: Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. pipat8999@yahoo.com.
authors.forename: Pipat
authors.initials: P
authors.lastname: Chiewvit
authors.affiliation: Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. adisak.won@mahidol.ac.th.
authors.forename: Adisak
authors.initials: A
authors.lastname: Wongkajornsilp
authors.affiliation: Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. kittipong.suj@mahidol.ac.th.
authors.forename: Kittipong
authors.initials: K
authors.lastname: Sujirattanawimol
mesh_terms: D000328:Adult; D002478:Cells, Cultured; D002574:Cervical Vertebrae / Q000473:pathology; D003911:Dextrans; D006801:Humans; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D010865:Pilot Projects; D013119:Spinal Cord Injuries / Q000473:pathology / Q000628:therapy*; D014182:Transplantation, Autologous
chemical_list: D003911:Dextrans; D058185:Magnetite Nanoparticles; C065507:ferumoxides