Abstract
This is a phase I clinical trial. Our objective was to assess the safety and feasibility of autologous mucosal olfactory ensheathing cell (OEC) and bone marrow mesenchymal stem cell (MSC) co-transplantation in people with chronic, complete (American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification A) spinal cord injury (SCI). This study was performed at Shohada Tajrish Hospital, Tehran, Iran. Three individuals with the traumatic SCI of the thoracic level were enrolled. They received the autologous OEC and MSC combination through the lumbar puncture. All adverse events and possible functional outcomes were documented performing pre- and post-operative general clinical examination, magnetic resonance imaging (MRI), neurological assessment based on the International Standard of Neurological Classification for SCI, and functional evaluation using Spinal Cord Independence Measure version III (SCIM III). No serious safety issue was recorded during the 2 years of follow-up. MRI findings remained unchanged with no neoplastic tissue formation. AIS improved from A to B in one of the participants. SCIM III evaluation also showed some degrees of progress in this participant's functional ability. The two other research participants had negligible or no improvement in their sensory scores without any changes in the AIS and SCIM III scores. No motor recovery was observed in any of the participants. Overall, this 2-year trial was not associated with any adverse findings, which may suggest the safety of autologous OEC and bone marrow MSC combination for the treatment of human SCI.
Highlights
The limited regenerative capacity of the spinal cord often confronts people affected by the Spinal Cord Injury (SCI) with permanent disability and dependency to their families and society (Mehrabi et al 2013)
All adverse events and possible functional outcomes were documented performing pre- and post-operative general clinical examination, Magnetic Resonance Imaging (MRI), neurological assessment based on the International Standard of Neurological Classification for SCI (ISNCSCI), and functional evaluation using Spinal Cord Independence Measure version III (SCIM III)
No motor recovery was observed in any of the participants. This two-year trial was not associated with any adverse findings, which may suggest the safety of autologous Olfactory Ensheathing Cell (OEC) and bone marrow Mesenchymal Stem Cell (MSC) combination for the treatment of human SCI
Summary
The limited regenerative capacity of the spinal cord often confronts people affected by the Spinal Cord Injury (SCI) with permanent disability and dependency to their families and society (Mehrabi et al 2013). The high regenerative potential of OECs like the stimulation of axonal regrowth, re-myelination, and guidance across the lesion is the rationale behind the extensive use of these cells in the experimental models of SCI (Lankford et al 2008; Gilmour et al 2020). Bone marrow MSCs possess different regenerative qualities that make them beneficial for spinal cord repair. They can differentiate into various cell types and secrete trophic factors that promote axonal growth while lacking tumorigenicity. Through their immunomodulatory, anti-inflammatory, and anti-apoptotic effects, MSCs can play a vital neuroprotective role within the injured tissue and provide axons with a permissive environment for their regeneration (Taran et al 2014)
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