Concise Review: Bone Marrow for the Treatment of Spinal Cord Injury: Mechanisms and Clinical Applications

STEM CELLS, 2011 · DOI: 10.1002/stem.570 · Published: January 1, 2011

Spinal Cord Injury Regenerative Medicine

Simple Explanation

Transplanting bone marrow stem cells into damaged spinal cords can help repair them and improve how well they work in animal studies. There are two kinds of these stem cells: hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs). This review talks about how these cells might fix the spinal cord, focusing on how MSCs protect tissue and help it repair itself after a spinal cord injury (SCI). It also looks at problems with using HSCs and MSCs to treat SCI patients and checks out current clinical trials using bone marrow cells for SCI treatment. HSCs and MSCs represent attractive cell sources as they can be easily and reproducibly isolated from bone marrow aspirates and reintroduced into patients as autografts. In animal models of SCI, their transplantation has promoted remyelination, axonal sparing, and functional recovery.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
MSCs can modify the environment around the spinal cord injury to support the regeneration of axons, the long fibers of nerve cells. They do this by reducing inflammation and creating an environment that supports axon growth.
2
MSCs synthesize a number of neurotrophic cytokines that stimulate nerve growth, including brain-derived neurotrophic factor, NGF, and vascular endothelial growth factor (VEGF).
3
Preliminary clinical data indicates that autologous bone marrow cell transplantation and/or GM-CSF administration can be used to treat patients with SCI without any immediate serious complications.

Research Summary

Transplantation of bone marrow stem cells into spinal cord lesions enhances axonal regeneration and promotes functional recovery in animal studies. The mechanisms by which HSCs and MSCs might promote spinal cord repair following transplantation have been extensively investigated. Preliminary clinical data indicates that autologous bone marrow cell transplantation and/or GM-CSF administration can be used to treat patients with SCI without any immediate serious complications.

Practical Implications

Therapeutic Potential

Bone marrow cell transplantation may serve a number of different purposes that span various therapeutic targets in the injured CNS.

Clinical Translation

The field of SCI research is an active area close to meaningful clinical translation, as suggested by the ICCP's published guidelines for devising future clinical trials.

Further Research

Future studies must continue to establish whether bone marrow cell treatments can serve as a safe and functional autologous source for the treatment of the injured CNS.

Study Limitations

1
There is some controversy regarding the capacity of MSCs to transdifferentiate into neural cells in vitro and in vivo.
2
The biological signiﬁcance of the elevated secretion of these cytokines is difﬁcult to interpret as each factor could play a functional role in wound repair as well as a detrimental role in secondary tissue damage.
3
It is currently unclear whether cell transplantation in future SCI treatments should be limited to the acute, subacute, or chronic phase of injury.

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