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Cellular Transplantation Therapies to Augment Strength and Walking Function

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Experimental animal research utilizing stems cells and other cells or tissue to treat severe spinal cord injury is now being translated to human clinical studies. Recent reports have explored the feasibility of using cellular transplantation therapies (autologous bone marrow MSCs or OMA) to help increase function and reduce impairments in people with chronic SCI, but further studies are needed to determine safety, dosage, and timing before these treatments should be offered to patients.

Table 20: Cellular Transplantation Therapies to Augment Strength and Walking Function

Discussion

One level 3 case control study investigated the effects of monthly intrathecal injections of MSCs in combination with 6 months of rehabilitation therapies on muscle strength and function (Kishk et al. 2010). There were no differences between groups for functional ambulation, but motor scores were slightly (but significantly) greater in the treatment group. Several patients experienced side effects, including increased spasticity, neuropathic pain, excessive sweating and transient hypertension. One patient withdrew from the study for severe adverse reactions to the treatment. Further studies are needed to establish safety, and controlled studies are needed to determine timing, dose and duration of this intervention.

In a pre-post study, OMA were transplanted into the site of injury in persons with chronic complete or motor-complete SCI (Lima et al. 2010). Patients then underwent locomotor training (either robotic assisted treadmill training or assisted overground walking training). Functional Independence Measure and Walking Index for Spinal Cord Injury scores improved in 13 subjects tested, and this improvement correlated with increases in leg strength. Five of twenty patients experienced adverse events, where one patient developed aseptic meningitis and another developed irritable bowel syndrome. Other adverse events were easily treated or resolved on their own. Randomized controlled trials are necessary to further show efficacy of this treatment.