The leading edge: Emerging neuroprotective and neuroregenerative cell-based therapies for spinal cord injury

STEM CELLS Transl Med, 2020 · DOI: 10.1002/sctm.19-0135 · Published: September 1, 2020

Spinal Cord Injury Regenerative Medicine

Simple Explanation

Spinal cord injuries (SCIs) have tremendous physical, social, and financial consequences for over 1 million North Americans and their families. Rapid delivery of specialized medical and surgical care has significantly reduced mortality; however, long-term functional recovery remains limited. Cell-based therapies have emerged as an exciting strategy to neuroprotect and regenerate the injured cord through multiple mechanisms such as immunomodulation, paracrine signaling, extracellular matrix (ECM) modification, and lost cell replacement. This article summarizes the most promising preclinical and clinical cell therapies, adjunct strategies to enhance transplant success, as well as key translational considerations such as sex and age.

Study Duration

Not specified

Participants

Millions of individuals and families worldwide affected by SCI

Evidence Level

Review of preclinical and clinical data

Key Findings

1
Cell-based therapies, including mesenchymal stem cells (MSCs), neural stem cells (NSCs), oligodendrocyte progenitor cells (OPCs), Schwann cells (SCs), and olfactory ensheathing cells (OECs), show promise in promoting neuroprotection and neuroregeneration after SCI.
2
Adjunct strategies such as trophic factor support, engineered biomaterials, electrical fields, and glial scar degradation can enhance the efficacy of cell transplantation therapies.
3
Important translational considerations for clinical trials of cell therapies include clinical-grade cell line scale-up, cell storage and transportation, and the delivery of cells into humans.

Research Summary

This review summarizes the most promising preclinical and clinical cell approaches to date including transplantation of mesenchymal stem cells, neural stem cells, oligodendrocyte progenitor cells, Schwann cells, and olfactory ensheathing cells, as well as strategies to activate endogenous multipotent cell pools. We also highlight salient completed and ongoing clinical trials worldwide and the bidirectional translation of their findings. We conclude with an outlook on the future of cell-based treatments for SCI and opportunities for interdisciplinary collaboration in the field.

Practical Implications

Improved Functional Recovery

Cell-based therapies offer the potential to enhance long-term functional recovery in SCI patients by promoting neuroprotection, neuroregeneration, and immunomodulation.

Enhanced Graft Survival

Adjunct strategies such as trophic factor support and engineered biomaterials can optimize graft survival and differentiation, leading to improved outcomes.

Clinical Trial Advancement

Addressing translational considerations such as GMP-grade scale-up and delivery techniques can facilitate the development and implementation of cell-based therapies in clinical trials.

Study Limitations

1
Low transplanted cell survival in animal models of SCI
2
Understanding and overcoming potential immunorejection within the CNS
3
Effective translation of cell therapies into clinical trial requires careful planning of GMP facilities and scale-up strategies

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury