Written by: Mie, Southern Medical University
Expert review: Professor Li Jing, Affiliated Hospital of Jiangsu University
Recently, the journal cells published an article[1], which summarized and summarized the role of mesenchymal stem cells in spinal cord injury and the results achieved by analyzing the currently published 17 clinical trial data of mesenchymal stem cells for spinal cord injury, providing a basis for future stem cells in the treatment of spinal cord injury.
Spinal cord injury (SCI) is a relatively common disease, which generally leads to a permanent loss of muscle strength, sensation and function below the site of injury, and the patient's physical and mental health and quality of life will be greatly affected, but there is no effective treatment. As a result, many researchers are looking for new treatments.
Numerous studies have shown that stem cells can regenerate nerve cells, repair damaged nerves, and thus improve spinal cord injury in patients, and have been widely proven to be safe and beneficial in a variety of disease environments, including neurological diseases. With the blessing of corresponding policies, clinical research on stem cells for the treatment of spinal cord injury is constantly being carried out. At present, there are 63 clinical trials of stem cells for spinal cord injury registered in the clinicaltrials.gov.
Image from literature[1]
The investigators searched for keywords in multiple databases and obtained a total of 210 literature according to criteria: must be a clinical study administering mesenchymal stem cells; must be nerve injury due to spinal cord injury; each study has at least 5 participants; and ultimately a total of 17 literatures meet the criteria.
In this paper, the researchers mainly analyzed and summarized the patient's disease degree, the results obtained from follow-up and adverse events.
Point 1: The treatment effect of different stages of spinal cord injury is different
Eleven patients with chronic-stage spinal cord injury (participants) (64.7%) and four studies (23.5%) had subacute phase in their eligibility criteria. Only two studies (11.7%) included participants in the acute phase.
Image from literature[1]
The study shows that neuronal regeneration can occur in long-term injuries, and that patients who delay transplantation have a better prognosis than early transplantation, possibly because in the non-acute phase of spinal cord injury, the inflammatory response is weakened, creating a more favorable environment for transplanted cells and promoting axonal regeneration, so the treatment is better.
Point two: Stem cells improve sensory and motor nerve conduction in patients
In the included studies, the follow-up period was roughly 6 to 12 months. During follow-up, the patient's motor, sensory, and cognitive functional evolution is monitored, which is the main parameter that shows the beneficial effects of cell therapy. Overall, most patients showed improvement after receiving mesenchymal stem cell therapy.
In the follow-up process, the ASIA scale was used to evaluate the treatment effect, and it was found that the patient's motor function and sensory function had a certain degree of improvement, most patients had a weakened degree of muscle spasm and improved muscle function; through urodynamic studies, it was found that the bladder function of the vast majority of patients was restored; from a neurophysiological point of view, the patient's somatosensory evoked potential was improved, which proved that mesenchymal stem cell therapy had a positive improvement effect on the patient's sensory and motor nerve conduction. Can promote muscle nerve regeneration.
Image from literature[1]
In the included studies, the follow-up period was roughly 6 to 12 months. During follow-up, the patient's motor, sensory, and cognitive functional evolution is monitored, which is the main parameter that shows the beneficial effects of cell therapy. Overall, most patients showed improvement after receiving mesenchymal stem cell therapy.
In the follow-up process, the ASIA scale was used to evaluate the treatment effect, and it was found that the patient's motor function and sensory function had a certain degree of improvement, most patients had a weakened degree of muscle spasm and improved muscle function; through urodynamic studies, it was found that the bladder function of the vast majority of patients was restored; from a neurophysiological point of view, the patient's somatosensory evoked potential was improved, which proved that mesenchymal stem cell therapy had a positive improvement effect on the patient's sensory and motor nerve conduction. Can promote muscle nerve regeneration.
Point three: Stem cell therapy is safe
The safety of treatment is a factor that cannot be ignored, and careful analysis of adverse events is important to demonstrate the safety of mesenchymal stem cell therapy in the clinical setting of spinal cord injury. Among the data obtained, the most common adverse events were mild headache (n = 8; 62%) and pain at the site of lesion (n = 6; 46%). In the absence of the use of drugs, these adverse events often resolve gradually after 48-72 hours of treatment with mesenchymal stem cells.
At the same time, it was found that the intrathecal injection route of mesenchymal stem cells has the advantages of safety, easy to inject multiple times, and fast onset of action, which has been proved to be safe and effective for patients with spinal cord injury with various pathological characteristics.
Overall, the safety of mesenchymal stem cells in the treatment of spinal cord injury is commendable, which provides great support for the continuation of this treatment program in the future.
Viewpoint 4: Stem cell therapy has both opportunities and challenges
After systematic analysis, it was found that mesenchymal stem cell therapy is a safe and effective treatment for patients with spinal cord injury at different stages and conditions. In most studies, adverse events were mild and no long-term adverse events were recorded. In addition, after receiving treatment, the patient's movements and sensations were improved, affirming the positive effect of mesenchymal stem cells on spinal cord injury. These clinical findings provide evidence and new opportunities for further clinical research translation of mesenchymal stem cells in the treatment of spinal cord injury.
However, there are still challenges in the future, and many of the current studies include small sample sizes, numerous measurement methods, insufficient follow-up time, etc., making it difficult to observe long-term patient effects. Therefore, further relevant research needs to be carried out continuously, extending the follow-up time and further improving the follow-up content while ensuring a sufficient number of cases, so as to improve the quality of clinical research on mesenchymal stem cell therapy in spinal cord injury.
bibliography:
[1] de Araújo LT, Macêdo CT, Damasceno PKF, et al. Clinical Trials Using Mesenchymal Stem Cells for Spinal Cord Injury: Challenges in Generating Evidence. Cells. 2022;11(6):1019. Published 2022 Mar 17.