Abstract
IntroductionMultiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that leads to disability in young patients. Impaired motor function due to spasticity in such patients is significant. Umbilical cord mesenchymal stromal/stem cells (UC-MCS) are promising in the treatment of MS, in particular because they have a positive neurotrophic effect, promote remyelination, and thus, reduce spasticity.ObjectiveThe objective of the study was to investigate the effect of combined (intrathecal and intravenous) administration of UC-MCS on spasticity reduction.MethodsPatients with MS (n = 27) underwent general and neurological examinations (Ashworth Scale for spasticity). The mean age of patients was 35.25 ± 13.72 years. Patients in group 1 (n = 12) were treated with cultured UC-MSCs, which met the phenotypic and morphologic criteria of the MCS. Patients in group 1 received a total dose of UC-MSCs at the rate of 1 × 106/kg body weight, 20 × 106 of which was administered intrathecally. Intrathecal administration was performed according to the typical method of performing lumbar puncture in the operation room using local anesthesia. Patients in group 2 (n = 15) were treated according to the National Multiple Sclerosis Treatment Protocol (https://zakon.rada.gov.ua/rada/show/v0487282-07#Text). Repeated clinical examination was performed after 1, 6, and 12 months.ResultsComparing spasticity in the two groups of patients before treatment, no differences were found (P = .468). No statistically significant difference between the groups was found after 1 month (P = .426). Statistically significant spasticity reduction was observed 6 months after treatment (P = .01) and 1 year after treatment, in favor of group 1 (P = .009). The results indicate no improvement in spasticity reduction in the first month after treatment of patients with UC-MSCs. The positive effect was observed for 6 months after treatment and continued up to 1 year.DiscussionUC-MSC significantly reduce spasticity in patients with MS and contribute to the regression of movement disorders for 6 months and up to 1 year after treatment. This result is probably achieved due to the immunomodulatory and remyelination properties of MSCs. Study results suggest the need to extend the observation period and conduct larger multicenter randomized studies.
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