Abstract
In this supplement issue of Cell Transplantation featuring the International Association of Neurorestoratology (IANR), 10 selected articles from the contributions for the IANR IV and the 8th Global College of Neuroprotection and Neuroregeneration (GCNN) Conference are published. The conference was held in Amman, Jordan on April 27 to 30, 2011 and hosted by the IANR, GCNN, and the American Society for Neural Therapy and Repair (ASNTR). The issue focuses on clinical translational medicine in the field of Neurorestoratology, which provides further evidence for neurorestoration in humans.
Huang et al. reviewed the latest clinical study results that display the possibility of neural anatomic and functional repair in the sequelae of damages and diseases of the central nervous system (CNS). Friedrich et al. selected 20 patients with early or late spontaneous recanalization but with persistent deficits and performed intra-arterial infusion of autologous bone marrow mononuclear cells between 3 and 7 days after stroke onset. Clinical, lab, electroencephalogram, and imaging evaluations showed no procedure-related adverse events. Satisfactory clinical improvement occurred in 6/20 (30%) patients at 90 days. Eight patients (40%) showed a good outcome.
Huang et al. followed up a large sample of 108 patients with complete chronic SCI within 3.47 ± 1.12 years after olfactory ensheathing cell (OEC) therapy. No deterioration or complications were observed by clinical neurological functional evaluation, magnetic resonance imaging (MRI), electromyography (EMG), and paravertebral sensory evoked potential (PVSEP). The data definitely demonstrated OEC therapy is safe and can improve neurological functions for patients with complete chronic SCI and ameliorate their quality of life, while the active movement-target enhancement-neurore-habilitation therapy plays a critical role in enhancing functional repair after cell neurorestorotherapy. Wu et al. reported the clinical observation of OEC transplantation for complete chronic spinal cord injury. The improvement of moderate sensory, spasticity, and locomotion occurred 14 months after cell therapy. Zhou et al. transplanted autologous activated Schwann cells (AASCs) for six acute, subacute, and chronic spinal cord-injured patients [American Spinal Injury Association (ASIA) A, B, or C]. AASCs were harvested from the autologous sural nerve. The cells were implanted into the parenchyma of the cord following laminectomy. Within a 5-year follow-up, all of the patients had improvement in autonomic, motor, and sensory function. Frolov and Bryukhovetskiy elucidated the effect of autologous hematopoietic stem cells on 20 adult patients with chronic spinal cord injury at C4–C8 level using motor and somatosensory evoked potentials test. Four positive findings were observed in 1–4 years after repeated lumbar intrathecal transplantations, which included: 1) restoration of the initially absent short-latency SEP (three patients); 2) N20P23 interpeak amplitude increase in SEP elicited by median nerve stimulation (four patients); 3) P38 latency reduction in SEP elicited by tibial nerve stimulation (two patients), and 4) appearance of MEP (three patients).
Moviglia et al. report that autologous neural stem cell treatment combined with T-cell vaccination might be a feasible, minimally invasive, safe approach for the treatment of amyotrophic lateral sclerosis (ALS) patients. They treated seven ALS patients with a result of slowing or stopping disease progression. Chen et al. concluded that multiple doses of cellular therapy definitely serve as a positive role in the treatment of ALS, and the repeated and periodic cell-based therapy that the patients benefited from is strongly recommended for better controlling this progressive deterioration disorder. A total of 42 patients underwent further OEC therapy by the route of key points for neural network restoration (KPNNR) two or more times (twice in 35 patients, three times in five patients, four times in one patient, and five times in one patient). All of them achieved partial neurological functional recovery after each cell-based administration.
Sharma et al. used autologous bone marrow-derived mononuclear cells in children with muscular dystrophy, cerebral palsy, and injury to the brain and spine through intrathecal and intramuscular injection. On an average follow-up of 15 months, 97% of the muscular dystrophy cases showed subjective and functional improvement, with two of them also showing changes on MRI and three on EMG. One hundred percent of the spinal cord injury cases showed improvement with respect to muscle power, urine control, and spasticity. Eighty-five percent of the cases of cerebral palsy cases showed improvements, out of which 75% reported improvement in muscle tone and 50% in speech among other symptoms. Luan et al. used neural progenitor cells to treat children with cerebral palsy (n = 45). Motor development significantly accelerated within the first month after cell transplantation, and further developmental level of gross motor, fine motor, and cognition was higher compared with the controls after 1 year.
Taken together, the articles above show that the patients suffering from stroke, spinal cord injury, ALS, or cerebral palsy have a greater chance in further restoring their neurological functions following the new concept of cell-based neurorestorotherapy and. interestingly, over 30 different types of cells may have the potential for future clinical use. I hope more detail relating to the mechanisms of cell therapy can be elucidated and that the medical community favor, not fear, the initial clinical endeavor and pioneering research of the field of Neurorestoratology. I believe that support, encouragement, and normative research is what we should do, rather than demand perfection for this new discipline.