With respect to spinal cord injury (SCI), we have
become an interconnected global community, and, as such, what happens on
the other side of the world ultimately affects all of us. India is one
country that is playing an increasing role on the SCI world stage. Due to
its large population, combined with rapid economic growth, the country has
a huge SCI incidence, making the disorder a health-care priority.
In an attempt to develop some new solutions, Drs.
(photo) and N.K. Venkataramana, and colleagues
from Bangaloreís Manipal Hospital have initiated a pilot study evaluating
of implanting patient-derived, bone-marrow stem cells into the injured
cord. To learn more about this approach, the primary author, Corinne
Jeanmaire recently traveled to Bangalore to visit the Manipal Hospitalís
Based on animal research, the investigators chose to
transplant bone-marrow-derived mesenchymal stem cells, which are
considered jack-of-all-trades stem cell due to their therapeutic
potential. The cells are extracted from the patientís iliac crest (hip);
assessed for genetic stability, infection, and identifying markers; and
grown in culture for 14-20 days, producing 100-million cells. Because the
cells are isolated from the patient and not anyone else, there is no
About 1 million stem cells per kilogram of body
weight are injected by lumbar puncture into the spinal-cord fluid. This is
a relatively noninvasive intrathecal procedure that does not require a
laminectomy to surgically access the cord. Studies suggest that the
stem-cells migrate to the injury site when transplanted this way. The
procedure is repeated two weeks later.
The study recruited individuals who had sustained a
complete injury within one to six months of enrollment. (a complete injury
defined as the lack of sensation or motor control below the injury level
three weeks post trauma.) At the time of this report, 12 patients from
southern India had been treated, and 7 additional ones were being
recruited. Although treatment is provided without expense, subjects need
to organize their own post-transplantation rehabilitation program, often a
challenging process in India.
Recruitment was aggravated because many potential
subjects are not in good physical shape due to inadequate post-hospital
care and lack access to beneficial information. Furthermore, to be a study
participant, subjects had to be able to travel to Manipal Hospital ten
times, including visits for initial check-up, cell aspiration, two
treatment injections, and six follow-up visits.
To evaluate potential improvements accruing from the
stem-cell transplantation, various electrophysiological (measuring nerve
conduction), magnetic resonance imaging (MRI), and clinical assessments
periodically took place up to three months after transplantation.
Although still preliminary
and subjective in nature, the three-month final assessments completed in
the earliest recruited subjects indicate some recovery in sensation and
bowel-and-bladder function. After completion of this preliminary study,
the results will be published, and, if warranted, a more rigorously
designed, double-blind-clinical trial initiated.
emphasizes there is currently a lot of hype around stem-cell treatments
and, as such, we should be careful not to generate false hope. Even though
stem-cell therapies will inevitably help many in the future, there are
numerous unanswered questions. For example, in the case of his program,
What are the optimal number of cells to transplant? What is the best time
after injury to inject the cells? Another key question is, How many cells
actually reach the injury site via intrathecal implantation?
In theory, stem-cell migration and final deposition
could be assessed by tagging the cells with a marker that could be
followed. Also, the investigators would like to evaluate the potential
synergistic role of neuronal growth factors in enhancing transplantation
effectiveness. Finally, although enthusiastic about the potential of stem
cells, Venkataramana stresses that this
high-tech therapy must be considered in the context of a much greater need
to improve Indiaís acute and rehabilitative care for SCI.
Adapted from article appearing in November 2006 Paraplegia News (For subscriptions,
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