Progress in clinical trials of cell transplantation for the treatment of spinal cord injury: how many questions remain unanswered?

Neural Regeneration Research, 2021 · DOI: https://doi.org/10.4103/1673-5374.293130 · Published: March 1, 2021

Spinal Cord Injury Research Methodology & Design Regenerative Medicine & Stem Cells

Simple Explanation

Spinal cord injury (SCI) lacks effective treatments, leading researchers to explore cell transplantation using neural stem cells, bone marrow mesenchymal stem cells, and other cell types. Animal studies have shown promise, but subtle changes in sensory function and pain can't be fully investigated this way. Clinical trials are needed to translate research into effective treatments. Cell transplantation aims to repair tissue damage after SCI through mechanisms like neuroprotection and axonal regeneration. While stem cell transplantation is a key approach, mature cells have also shown therapeutic effects. However, most studies are based on cell and animal models, hindering clinical translation due to lack of safety and mechanism data. Cell transplantation should be part of a comprehensive plan, combined with tissue engineering, drug delivery, and physical rehabilitation. This approach aims to improve the chances of patients returning to a normal life after spinal cord injury.

Study Duration

Not specified

Participants

Various clinical trials with different numbers of participants, ranging from single patients to larger groups. Includes descriptions such as patients with thoracic SCI, cervical SCI, chronic SCI, and subacute SCI.

Evidence Level

Review of clinical trials

Key Findings

1
Neural stem cell (NSC) transplantation has shown improvements in motor and sensory function in some patients with thoracic SCI, suggesting the potential of allogeneic NSCs.
2
Bone marrow mesenchymal stem cells (BMSCs) have demonstrated potential in improving ASIA grade, restoring walking, improving bladder control, and relieving spasms in SCI patients.
3
Olfactory ensheathing cells (OECs) have shown safety in clinical trials and some effectiveness in improving sensory and motor function in SCI patients, but cell survival limitations exist.

Research Summary

Cell transplantation holds promise for treating spinal cord injury (SCI) due to the inadequacies of current treatments. Stem cells, macrophages, and Schwann cells offer potential for nerve regeneration, neuroprotection, and immune regulation. However, clinical trials show variations in safety and efficacy based on injury severity, cell type, location, delivery system, and transplantation procedure. Key factors influencing the effectiveness of cell transplantation include obtaining cells safely, choosing between single or combined cell types, and selecting the appropriate transplantation method. Imaging-guided cell implantation may be the best solution. Combined transplantation therapy involving cells, scaffolds, nutritional factors, and drugs may optimize spinal cord regeneration. However, clinical trials require careful consideration of safety and efficacy before implementation.

Practical Implications

Standardized Protocols

Future trials should focus on standardizing the various steps in cell transplantation protocols to improve consistency and reliability.

Targeted Delivery

The development of imaging-guided techniques for precise cell implantation at the injury site could enhance efficacy and reduce risks.

Combination Therapies

Integrating cell transplantation with tissue engineering scaffolds, drug delivery systems, and rehabilitation may offer a more comprehensive approach to SCI treatment.

Study Limitations

1
Variability in cell extraction techniques.
2
Uncertainty regarding optimal cell combinations for transplantation.
3
Challenges in ensuring accurate cell localization to the injury site after lumbar puncture.

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