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Cellular Therapies

Cellular therapy is a relatively new treatment option, which contributes to significant advancements in technology and genetic research (Vaquero, Hassan, Fernandez, Rodriguez & Zurita, 2017). Cell transplantation with mesenchymal stromal cells via injection into the site of the syrinx shows potential in the future treatment of syringomyelia without surgery (Vaquero et al. 2017).

Table 5: Cellular Therapies

Author Year

Country
Research Design

Score
Total Sample Size

MethodsOutcome
Vaquero et al., 2018a

Spain

Pre-Post

N=6

Population: Mean age: 39 yr; Gender: Males=6; Injury etiology: SCI-trauma=6; Mean time since injury: 13.7 yr; Level of severity: AISA-A=3, AISA-B=2, AISA-D=1; Lesion location: D5=2, D3=1, D4=1, D8=1, L1=1.

Intervention: Cell therapy medicament (NC1, PEI number 12-141), developed by the Spanish Agency of Medicament and Health Products. The solution was injected into the syrinx over the course of one month.

Outcome Measures: Alteration to genome of expanded cells, ASIA, SCI Functional Rating Scale of the International Association of Neurorestoratology (IANR-SCIFRS), Visual Analog Scale (VAS), Penn and modified Ashworth scale (MAS), Geffner scale, and neurogenic bowel dysfunction scale (NBD).

1.     No genome alterations were detected during the cell expansion process.

2.     Pin prick scores on the ASIA measure improved (p=0.06), this effect was only observed at 6 mo follow-up.

3.     Scores on the IANR-SCIFRS (spinal cord function) increased at 3 mo follow-up (p=0.06), and 6 mo follow-up (p=0.06).

4.     There were no significant differences in VAS score post-injection (p=0.25), although patients self-reported a decrease in neuropathic pain.

5.     There were no significant differences in levels of spasticity or spasms experienced by patients post-injection (MAS, p=0.50).

6.     The Geffner scale (bladder dysfunction) showed no significant differences post-injection (p=0.25).

7.     The NBD scale showed no significant differences post-injection (p=0.12), although four patients observed an improvement.

Discussion

To our knowledge, only one study has examined the use of cellular therapies for the treatment of syringomyelia. Vaquero et al. (2018) had a small patient sample of six, however they were able to observe strong improvements in spinal cord function at three and six months post-injection. Unfortunately, in terms of outcomes measuring bladder and bowel dysfunction no significant differences were reported. More studies are required on the use of cellular therapy as a potential non-surgical treatment for syringomyelia before any substantial conclusions can be drawn.

Conclusions

There is level 4 evidence (from one pre-post study; Vaquero et al., 2018a) that mesenchymal stromal cell therapy may be effective in improving spinal cord function post-SCI.

  • Further research is needed to determine the potential benefits of cellular therapy for the treatment of syringomyelia.