Author andyear Study design No. of patients (% male) Cells harvested Outcome measured Summary
Huang et al. 2006 [13] Case series 16 (88) Olfactory ensheathing cell (OEC) autograft.Design: Fetal olfactory mucosa grafted into cord lesion.50ulsuspension containing approx. 1×106 cells injected Phase I study: safety. Authors conclude OECs are safe in chronic SCI, conclusions limited by Phase I protocol.
Sykova et al., 2006 [15] Case series 20(80) Autologous BMSC Design: Cells harvested from posterior iliac crest.Mononuclear cells isolated and infused via transfemoral catheterization of segmental arteries (n=6) or cubital veins (n=14). One year observation.ASIA scale, Frankel score, SSEP, MEP, MRI evaluation. Safety demonstrated. Improvement in motor and sensory electrophysiologic measurements was observed within 3 months in 5 of 6 patients with intra-arterial application; Overall, improvement in 5 of 7 acutely injured patients, and in 1 of 13 chronically injured.
Chernykh et al., 2007 [10] Comparative 36 (72) Autologous BMSC harvested from iliac crest and engrafted to cord lesion bed in patients with chronic SCI. Observation time: 9.4± 4.6 months. Outcomes measurements: ASIA scale, Barthel, Ashworth score, spinal cord conduction functions, bladder control, and MRI evaluation for safety. Phase I study. No adverse effects notes clinically or radiographically. ASIA, Barthel, and Ashworth trend towards improvement. No observed effect on other measurements.
Yoon et al., 2007 [16] Comparative phase I/II trial 53 (79) Autologous BMSC taken from iliac crest.Mononuclear cells isolated.Cells injected into 6 sites surrounding SCI lesion site.GM-CSF injected subcutaneously once/day for 5 consecutive days each month for 5 months. Observation: 10.1-11.3m.Outcomes: Safety, neuropathic pain, AIS grade, MRI evaluation Safety demonstrated.Overall 30% improvement in AIS grade. Conclusions limited by small sample size.
Mehta et al., 2008 [17] Case series 180 (NR), 163 with SCI, 17 with indication for other neurological impairments. Autologous or near-relative with same blood group.Adipose tissue-derived mesenchymal cells, human embryonic stem cell-derived hematopoietic stem cells, and, autologous BM-derived stem cells.7-10ml of cells administered into subarachnoid space adjacent to injury site via lumbar puncture. Observation: 3m-2 years. Outcomes: Hauser Ambulation Index. 54 of 163(33.1%) improvement in ambulation index.No tumorigenicity. Morbidity (pain, CSF hypotension and spinal headache) from technical difficulties of lumbar catheterization.
Saberi et al., 2008 [21] Case series 33 (67) Autologous intramedullary Schwann cells Harvested from(15cm) sural nerve.Cells weremaintained for 3-5 weeks then injected into the injury site through a 3 cm durotomy. Observation: 2 years.Scales: ASIA, FIM, complications No significant changes.No complications attributed to procedure.
Cristante et al., 2009 [11] Case series pilot study 39(72) Autologous BMSC.Subcutaneous GM-CSF administered for 5 days; day 6: peripheral blood collection via hemodialysis cathether.2.5× 106 CD34 positive cells/kg isolated.Cryopreserved and stored for 1 week. Cells delivered with arteriography cathether in right femoral artery access (10ml/min rate) Observation: 2.5 years. Outcomes: SSEP. 26 patients with SSEP improvement (66%).
Kumar et al., 2009 [19] Case seriesphase I/II trial 297 (NR) Autologous BMSC harvested from iliac crest.Mononuclear cells isolated by density gradient; Administered into subarachnoid space via lumbar puncture. Observation: 3 months. Outcomes: Safety. Clinical sensory and motor Observation by neurological exam. No Adverse outcomes.Conclusions limited by Phase I design.
Pal et al., 2009 [9] Case series pilot study 30 (NR) Autologous BMSC harvested from post iliac crest.Monocytes separated by density gradient.Subarachnoid cistern delivery via Lumbar puncture at or below L3. Observation: 1 year. Outcomes: AIS grade, Barthel index, SSEP, MEP, NCV, MRI. No adverse outcomes.Unable to demonstrate improvement in outcomes measured.
Kishk et al., 2010 [14] Case-control 44(81) Autologous BMSC harvested from iliac crest.Monocytes separated by density gradient.5 × 106 to 10 × 106 cells injected via lumbar puncture monthly for 6 months into lumbar cistern. Observation: 6 months.Outcome: Trunk muscle assessment, VAS pain, Ashworth scale, ASIA scale, AIS grade, bowel and bladder control, SSEP studies No statistical improvement demonstrated. One case of encephalomyelitis after third injection.23 patients developed neuropathic pain at site of injection.
Lima et al., 2010 [19] Case series phase I/II trial 20 (85) Olfactory mucosa autograft.Mucosa grafted into injury site after laminectomy Observation: Pts followed for 2 years. Outcome: AIS grade, ASIA motor score, anal sphincter control, bladder sensation, bladder control FIM, WISCI, olfaction recovery Transient anosmia resolved in all patients.AIS grades improved in 11 of 20.
Seledtsova et al., 2010 [25] Case series 43 (26) Fetal neurogenic tissue.Hematopoietic cells harvested from 16-22 week fetal brain and liver tissue.2-2.5×106 cells given via lumbar puncture.If intramedullary cyst present, cyst drained and cells implanted into cyst cavity.Cells readministered via lumbar puncture 10-14 days after intramedullaryimplantation for pts with cyst puncture. Observation: not specified. Outcome: Clinical neurologic improvement Improvement in clinical exam in 48.9%.
Dai et al., 2013 [12] Case-control 40(70) Autologous BMSC harvested from iliac crest.Passaged cells for 5-7 days.25ul (8× 105cells/ul) injected lesion cavity. Pts followed for 6 month. AIS grade, Observation: 6 months. Outcome: ASIA motor score, EMG, paravertebral SSEP, residual urine volume Statistical improvement in all outcomes measures.
Jiang et al. 2013 [14] Case series 20 (65) Autologous BMSC (After weekly passage for 3 weeks, 1 × 108 cells injected via lumbar puncture Observation: 30 days. Outcome: ASIA scale Improvement in 15 patients (75%).
BMSC: Bone Marrow-derived Stem Cells, ASIA: American Spinal Injury Association, SSEP: Somatosensory Evoked Potentials, MEP: Motor Evoked Potentials, GM-CSF: Granulocyte Macrophage Colony-Stimulating Factor, FIM: Functional Independence Measure, NCV: nerve conduction velocity, VAS: Visual analog scale, WISCI: Walking Index for Spinal Cord Injury
Table 1: Recent published studies of human stem cell transplantation for spinal cord injury.