Stem cells application for the treatment of traumatic brain injury

Abstract

Traumatic brain injury (TBI) is a global medical and socio-economic problem. Traumatic injuries of the skull and brain make up 30-40 % of all traumas and are the first in terms of mortality and disability among people of working age. High expectations for the treatment of TBI and its consequences are due to the use of stem cell (SCs) therapy. The present review examines the pathogenetic prerequisites for SCs application in TBI effects treatment: generalizes information about the primary and secondary changes in nerve tissue after TBI (cellular, tissue, organ, systemic level) and functional neurological disorders (physical, motor, cognitive, behavioral symptoms); emphasizes the impossibility of restoring neurological functions without restoring brain structures and functions. The paper proposes the main directions of application of SCs for the TBI effects treatment - stimulation of endogenous SCs, transplantation of exogenous SCs and a combination of these approaches. The sources and types of SCs considered for the restoration of the damaged organ and its functional parameters are characterized in detail: embryonic (ESCs), neurogenic (NSC/NPCs), stromal (SCs of bone marrow, adipose tissue, including mesenchymal (MSCs), hematopoietic (HSCs), umbilical cord blood SCs, induced pluripotent SCs (iPSCs). The results of preclinical studies of the different SCs types used in animals with TBI experimental models are summarized. The actual information regarding clinical trials on the safety and efficacy of the SCs application in the TBI effects treatment in the directions of endogenous SCs stimulation (drug administration, physical methods) and exogenous SCs transplantation (autologous SCs (bone marrow, adipose tissue) and allogeneic SCs (MSCs, bone marrow SCs, umbilical cord blood SCs) is analyzed. The gradual accumulation of clinical trial results will allow future meta-analytic studies and the development of certified standardized protocols for the treatment of TBI consequences using the benefits of SCs.