Studies in neonatal mice show that if neural stem cells (NSCs) are seeded on synthetic extracellular matrix and implanted into an ischemia-damaged area, then new parenchyma composed of neurons and glia is formed and becomes vascularized. Findings by Eriksson et al indicated neurogenesis from precursors in the subventricular zone (SVZ) in vivo in humans, and precursors capable of forming neurons in human subcortical white matter. For efficient repair after stroke it may be necessary to provide NSCs with a platform so that they can reform appropriate brain structure and connections. However, NSCs are concentrated along the subventricular zone, and their migration to the zone of infarction is limited by a long migratory pathway. Bone marrow cells, being distributed throughout all tissues by the bloodstream, have easy access to the zone of infarction. Brain injury, specifically cerebral ischemia, enhances bone marrow plasticity and provides an environment that supports the differentiation of bone marrow-derived cells into endothelial cells and neurons. Neovascularization of the peripheral and coronary vasculature can be enhanced by the exogenous delivery of bone marrow-derived endothelial progenitor cells (EPCs). Some animal studies indicate intrastriatal and intravenous delivery of marrow stromal cells results in a small percentage of these cells expressing neuronal markers in ischemic brain. Considering the differentiation of bone marrow-derived progenitor cells into endothelial cells and NeuN-expressing cells , the utility of bone marrow–derived cells offers a novel potential treatment for stroke. The type of functional recovery after stroke depends on the site of implantation. Some studies report no recovery of sensorimotor function in rats with intraventricular grafts, whereas animals with intraparenchymal grafts either ipsilateral or contralateral to the lesion have shown reduced sensorimotor asymmetry.
Read full abstract