Implantation Of Autologous Stem Cells Research Articles

Ethical and Bioethical Aspects in the Use of Stem Cells in Chronic Spinal Cord Injuries

One of the fundamental dogmas maintained in neuroscience until the last century held that regeneration of the nervous system cannot occur in stages of adult life. However, it has been shown in several species during the postnatal stage and throughout life, that new neurons continue to be generated in some places in the human body. Objectives: The research was: to evaluate ethical and bioethical aspects in patients who were treated with an autologous stem cell implant in chronic spinal cord injuries. Method. An analysis is made of the ethical aspects that accompany the implantation of autologous stem cells in chronic spinal cord injuries. The results are evaluated at the "Enrique Cabrera" Surgical Clinical Teaching Hospital. Results: Ethical dilemmas are expressed and that have, among their relevant principles, the inviolability of human life. In higher animals, stem cells according to their evolutionary state can be embryonic and somatic or adult. Currently there is an extraordinary controversy about which stem cells to use from embryonic or adult ones, a debate in which both scientific, ethical, religious, social and political aspects have been included. One aspect of the scientific debate is related to the generative capacity of tumors by embryonic cells. From the ethical point of view, it has been argued that the use of human embryonic stem cells implies the destruction of embryos and it has been considered that life begins at the same moment of the union of the sperm with the ovum and that this would be equivalent to the destruction of a human life which would not be justifiable. Others do not agree with these criteria and argue that their use to save lives through research or therapy would be justified. Conclusions The physical disability produced by a chronic spinal cord injury raises an ethical dilemma about the use of stem cells, anticipating that the main controversy about this action has to do fundamentally with the way in which they are obtained.

Matične ćelije - opšti pregled - od razvojnih hemobioloških koncepata do "(auto)grafting"-a u kliničkoj praksi

Conventional hematopoietic stem cell transplantation is a well-known treatment method for numerous acquired and congenital hematopoietic disorders, disorders of the immune system, as well as certain metabolic disorders. Stem cells (SCs) can be defined as cells capable of self-renewal with a high proliferative capacity and the potential to differentiate into functionally competent mature cells. Stem cells can be divided into embryonic SCs (ESCs) and tissue-specific or adult SCs - such as bone marrow (BM) stem cells, peripheral blood (PB) stem cells, and SCs derived from umbilical cord blood (UCB), as well as other non-hematopoietic or somatic SCs. SCs in adults are characteristically considered to be restricted in their regenerative and differentiative potential, while embryonic stem cells are 'true' totipotent/pluripotent cells, due to their ability to develop into endoderm, ectoderm, or mesoderm - all three embryonic tissue types in the human body. They are the most promising, but also the most controversial type of potentially transplantable SCs. Immature hematopoietic SCs have the potential of differentiating, not only into all blood cells, but also into some somatic cell types (SC plasticity). In different clinical settings, the transplantation of immature stem cells leads to the repopulation of recipient bone marrow, with subsequent complete, stable, and long-term reconstitution of hematopoiesis. Given that immature stem cells are also capable of homing to different tissues, autologous stem cell implantation into a damaged and/or ischemic area induces their colonizing and consecutive transdifferentiating into cell lineages of the host organ, including neovascularization. Thus, they are clinically applicable in the field of regenerative medicine for the treatment of myocardial, brain, vascular, liver, pancreatic, and other tissue damage. The purpose of this overview is to recapitulate the key developments in the rapidly evolving area of stem cell research, as well as to review the use of SCs in conventional transplantations and in regenerative medicine. Additionally, a brief critical evaluation of our own stem cell research will be summarized.

Autologous stem cell implantation with core decompression for avascular necrosis of the femoral head using a new device.

Autologous stem cell progenitor implantation into necrotic lesions of the femoral head has previously been described as a potential treatment for avascular necrosis (AVN), on the basis that there is a reduced number of functioning stem cells in the marrow within the necrotic segment. We present a case series of patients with AVN that underwent core decompression with autologous stem cell implantation using a new device. The records and imaging of patients with AVN of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with core decompression and stem cell progenitor implantation, using the PerFuse system. Preoperatively, demographic information, AVN staging (as per Ficat and Arlet classification) and visual analogue pain scores (VAS) of the hips were recorded. These results were compared with postoperative VAS and imaging, with further review on the progression of AVN. We treated 14 hips in 13 patients with an average follow up of 12 months. Patients with Ficat I-II were selected for the procedure. The average preoperative VAS was 3.9. Postoperatively, this dropped to 2.6, with over half of patients reporting at least a two-point decrease in pain. Eight of the 14 treated hips showed no radiological progression of the disease, while six showed femoral head collapse requiring total hip arthroplasty (THA) at an average of ten months after treatment. Our early findings indicate that hip decompression with stem cell progenitor implantation for AVN of the femoral head provides symptomatic relief and may be beneficial in arresting progression of disease using this simple new device.

Second Autologous Stem Cell Implantation in Patients with Chronic Spinal Cord Injuries

Second Autologous Stem Cell Implantation in Patients with Chronic Spinal Cord Injuries

Implantation of Autologous Stem Cells Derived from Adipose Tissue in Rat Bone Fractures

Stem cells derived from adipose tissue (ASCs) correspond to a major advance with respect to the bone regenerative medicine, as they have the ability for self-renewal, differentiation and paracrine stimulation to various types of tissues including bone and cartilage. The hypothesis of this study considers that fractures treated with ASCs, time decreases bone regeneration and vascularization increases, aiming to histologically evaluate bone regeneration and vascularization in these fractures. To accomplish this, 24 young male Sprague Dawley rats were used. The specimens were divided into two groups: Group A (treated) and group B (control). In both groups, the rats were euthanized at 11 and 21 days post-fracture. Statistically significant difference was observed in the number of newly formed trabeculae and vascular density in the treated group compared to control group concluded that rats treated with ASCs have a higher rate and better angiogenic bone regeneration, especially given the ability to synthesize components of the extracellular matrix of these cell, and the production of angiogenic growth factors.

Cell therapy and left ventricular restoration for ischemic cardiomyopathy: long-term results of a perspective, randomized study.

Aim of this study is to verify the potential advantages and benefits of bone-marrow derived autologous stem cells implantation associated to surgical left ventricular restoration (SVR), to report a new modality of cell delivery to myocardium, and to identify possible side effects of this procedure. Between March 2007 and March 2013, 30 patients affected by ischemic dilative cardiomyopathy who received a SVR operation were enrolled in the study. The population was divided in two groups:16 patients were randomly assigned to receive stem cells therapy in addition to SVR (groupA), 14 patients received a placebo (group B). The two groups were homogeneous in respect of age, gender, preoperative NYHA class, mitral incompetence and left ventricular sizes and volumes. The patients were evaluated by echo and pet-scan before surgery and at 6 months follow-up, and by echo at subsequent follow-up. Overall 30 days-in hospital mortality was 0 for the entire cohort. At last follow-up ejection fraction increased from 25.3% before surgery to 36.3% in group A, and from 31.8% to 45.6% in group B. Reduction of LVEDD was 6% in group A, 9% in group B. ESLVV and EDLVD decreased more significantly in patients receiving stem cells (55% vs. 35%). Late cardiac mortality at 9 years follow-up was similar in the two groups of patients. No early or late adverse reaction nor cases of infections were observed. Patients affected by ischemic cardiomyopathy have a favourable outcome after SVR. A higher reduction of LVEDV and LVESV assessed by CT-Scan evaluation in patients receiving cell therapy, when compared to control group, encourages the evolution and refinement of myocardial regenerative therapy added to SVR.

Autologous stem cell implantation with core decompression for avascular necrosis of the femoral head

ObjectiveAvascular necrosis (AVN) of the femoral head is a painful, progressive disease that can lead to limited mobility and early hip replacement. Autologous stem cell implantation into the necrotic lesion of the femoral head has been described, on the basis that patients with AVN have a reduced number of stem cells in the marrow. In this study, we aim to describe our technique for decompression of the hip with autologous implantation of stem cells for AVN of the femoral head, as well as retrospectively analyze our results. MethodsThe records and imaging of patients with avascular necrosis of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with the combination of core decompression with autologous stem cell implantation from the iliac crest. Preoperatively, demographic information, stage of AVN per Association Research Circulation Osseous (ARCO) classification on magnetic resonance imaging and radiograph, and visual analogue pain scores (VAS) of the hip were recorded. Postoperatively, VAS were recorded and imaging was reviewed for progression of AVN or evidence of femoral head collapse. Statistical analysis was conducted comparing pre and postoperative VAS scores. ResultsOverall, we treated 43 hips in 28 patients with autologous stem cell implantation, with an average follow up of 16 months. Patients ranged from ARCO Ia to ARCO IIc classification of AVN. The average pre-operative visual analogue scale (VAS) of pain was 7.8. Post operatively, the average VAS score decreased to 2.5 (p < 0.0001), with 78% of patients reporting at least a 50% decrease in pain. 40 of the 43 operatively treated hips showed no radiologic progression of the disease during the follow up period, while 3 of the 43 hips had evidence of femoral head collapse and needed subsequent total hip arthroplasty at an average of 17 months after the initial decompression. ConclusionOur findings indicate that hip compression with autologous stem cell implantation for AVN of the femoral head provides significant symptomatic relief and may be beneficial in arresting progression of disease.

Autologous stem cell transplantation in refractory Asherman's syndrome: A novel cell based therapy.

BACKGROUND:There is substantial evidence that adult stem cell populations exist in human endometrium, and hence it is suggested that either endogenous endometrial stem/progenitor cells can be activated or bone marrow derived stem cells can be transplanted in the uterine cavity for endometrial regeneration in Asherman's syndrome (AS).AIMS AND OBJECTIVES:The objective was to evaluate the role of sub-endometrial autologous stem cell implantation in women with refractory AS in attaining menstruation and fertility.SETTING:Tertiary care referral center.DESIGN:Prospective case series.MATERIALS AND METHODS:Six cases of refractory AS with failed standard treatment option of hysteroscopic adhesiolysis in the past were included. Mononuclear stem cells (MNCs) were implanted in sub-endometrial zone followed by exogenous oral estrogen therapy. Endometrial thickness (ET) was assessed at 3, 6, and 9 months.RESULTS:Descriptive statistics and statistical analysis of study variables was carried out using STATA version 9.0. The mean MNC count was 103.3 × 106 (±20.45) with mean CD34+ count being 203,642 (±269,274). Mean of ET (mm) at 3 months (4.05 ± 1.40), 6 months (5.46 ± 1.36) and 9 months (5.48 ± 1.14) were significantly (P < 0.05) increased from pretreatment level (1.38 ± 0.39). Five out of six patients resumed menstruation.CONCLUSION:The autologous stem cell implantation leads to endometrial regeneration reflected by restoration of menstruation in five out of six cases. Autologous stem cell implantation is a promising novel cell based therapy for refractory AS.

Role of subendometrial autologous stem cell implantation in women with asherman's syndrome

To evaluate the efficacy of sub-endometrial autologous stem cell implantation in women with severe degree of Asherman's Syndrome. (Efficacy is defined as resumption of menstruation). Prospective, Case series. Patients with Asherman's Syndrome (n=6) where other treatment options had failed; bone marrow aspiration was done from iliac crest under local anesthesia .Bone marrow (30 ml) was aspirated using bone marrow aspiration needle (Jamshidi, 11 G). It was collected in heparinised syringes. The Isolation of Mononuclear cells was done by Ficoll density separation method at Stem cell facility.Harvested stem cells were implanted in sub-endometrial zone as identified by transvaginal scan through trans-myometrial route using ovum pick up needle (Cook,17 G) under I.V.sedation.Post implantation patients were given oral Estradiol Valerate (Progynova, Schering manufacturer) 2mg thrice a day for six weeks followed by cyclic Estrogen & progesterone therapy for 3 months(Medroxy-progesterone acetate, Serum Institute of India LTD.) 10 mg once daily from day21- day27. Women were followed up at 3, 6 and 9 month intervals by trans-vaginal ultrasound for the endometrial thickness. Descriptive statistics and statistical analysis of study variables was carried out using STATA version 9.0. Changes in endometrial thickness values due to treatment was compared using ‘t’ –Paired test to see the significant increase in ET values at 3 months, 6 months and 9 months. Mean ±Standard deviation of ET values at 3 months (4.05±1.40), 6 months(5.46±1.36) and 9 months (5.48±1.14) were significantly (P<0.05) increased from pre treatment level (1.38±0.39). The mean (±SD) of MNC counts was 103.3 (±20.45) and ranged from 76 ×10 6 to 128×10 6. Similarly the mean (±SD) of CD34 was 203642 (±269274) and ranged between 10640 and 640090 with median value 58800. Haemopoitic stem cells implantation results in endometrial regeneration in Asherman Syndrome.

Avoidance of Lower-Limb Amputation by Surgical Implantation of Autologous Stem Cells

A 69-year-old Caucasian man was referred to Baylor University Medical Center at Dallas with resting lower-extremity pain and a nonhealing sore above his right ankle (Rutherford chronic ischemia stage 5 of 6) after having failed multiple attempts at revascularization. He was enrolled in a clinical research trial using adult autologous stem cells for treatment of critical limb ischemia. Autologous stem cells from the patient's pelvic bone marrow were harvested, concentrated in the operating room, and reinjected into the lower leg along the vasculature below the level of complete occlusion of the popliteal artery and around the ulcer. After 3 months, the patient had significant improvement in his ankle brachial index, which increased from 0.10 to 0.40 (normal 0.9–1.01), and early healing. After 12 months, the ulcer was fully healed. Healing of the sore has persisted for 3 years.