Stem Cell Therapy for Spinal Cord Injury

Cell Transplantation, 2021 · DOI: 10.1177/0963689721989266 · Published: January 4, 2021

Spinal Cord Injury Regenerative Medicine & Stem Cells

Simple Explanation

Traumatic spinal cord injury (SCI) results in direct and indirect damage to neural tissues, which results in motor and sensory dysfunction, dystonia, and pathological reflex that ultimately lead to paraplegia or tetraplegia. Stem cell therapy is a promising treatment for SCI due to its multiple targets and reactivity benefits. The present review focuses on SCI stem cell therapy, including bone marrow mesenchymal stem cells, umbilical mesenchymal stem cells, adipose-derived mesenchymal stem cells, neural stem cells, neural progenitor cells, embryonic stem cells, induced pluripotent stem cells, and extracellular vesicles. SCI damage is multifaceted, and there is a growing consensus that a combined treatment is needed.

Study Duration

Not specified

Participants

Numerous preclinical studies and a growing number of clinical trials

Evidence Level

Review

Key Findings

1
BM-MSC therapy is beneficial for SCI recovery by improving the microenvironment of the injury site, enhancing nutritional support, modulating the inflammatory response, and alleviating BSCB leakage.
2
U-MSCs protected neurons from apoptosis, inhibited the formation of glial scars via regulation of MMP2, attenuated ischemic compromise of the spinal cord, decreased reactive astrocytes, improved motor function, and alleviated allodynia and hyperalgesia after SCI in animal experiments.
3
AD-MSC transplantation demonstrated satisfactory effects in chronic and acute SCI. Intravenous administration of AD-MSCs activates angiogenesis and upregulates ERK and Akt, which improves hindlimb motor function.

Research Summary

Stem cells have neuroregenerative and neuroprotective effects in SCI cell therapy. Cell-based therapies in SCI have different mechanisms in functional recovery, such as immunomodulation, cell replacement nutrition, and scaffold support. Although cell therapy offers important promise for SCI treatment, there are many obstacles to clinical translation. These obstacles include suitable cell types and sources, cell survival, quality and repeatability of stem cells and optimal transplantation dosage and timing. Each type of stem cell has unique benefits. Previous studies already focused on how to enhance the efficacy of stem cells and made positive achievements. Future treatments may use a variety of novel strategies to address the problems of SCI.

Practical Implications

Enhanced Stem Cell Efficacy

The use of genetic engineering, cell coupling, combinational therapy with neuroprotective agents, trophic factors, biomaterials, and rehabilitation may improve the therapeutic effectiveness of stem cells.

Clinical Translation Challenges

Obstacles to clinical translation include identifying suitable cell types and sources, ensuring cell survival, maintaining the quality and repeatability of stem cells, and determining optimal transplantation dosage and timing.

Personalized Treatment Strategies

Future treatments may employ a variety of novel strategies to address the problems of SCI, potentially involving personalized approaches based on the unique benefits of each stem cell type.

Study Limitations

1
Cell therapy–related immunotoxicity, immunogenicity, and tumorigenicity
2
Limited cell survival and limited integration
3
Small sample size, limited supervision, and poor quality in most registered clinical trials

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