Neurological disorders are incurable! It is almost a recognized fact in the medical community.
Patients with refractory neurological disorders often face paralysis, loss of social functioning, and difficulties in life, which bring a heavy economic and mental burden to society and family.
Promoting neurological recovery and delaying disease progression are the main therapeutic goals of refractory neurological diseases.
The ability of the human nervous system to repair itself after injury or degenerative lesions is limited, and some scholars believe that the brain induces the proliferation of neural stem cells and the strength to differentiate neurons is too weak.
Stem cells have the potential for self-renewal and multidirectional differentiation and are an ideal source of cells for nerve regeneration and repair. A large number of research experiments have proved the feasibility and safety of stem cell therapy, which may become one of the important means to solve neurological diseases.
From December 2014 to March 2018, a scientific research team composed of Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Seventh Affiliated Hospital of Sun Yat-sen University evaluated a total of 37 patients with 14 diseases, including 12 cases of cerebral infarction, 1 case of traumatic brain injury, 1 case of cerebral hemorrhage, 2 cases of Alzheimer's disease, 5 cases of motor neuron disease, 4 cases of spinal cord injury, 3 cases of myelitis, 2 cases of spinocerebellar ataxia, 2 cases of multisystem atrophy, 1 case of acute disseminated cerebrospinal myelitis, and 1 case of encephalopathy syndrome. There was 1 case of hereditary spastic paraplegia, 1 case of multiple sclerosis, and 1 case of heat stroke disease.
The international stem cell academic journal Stemcell International has published new results, providing evidence that mesenchymal stem cells have the potential to treat neurological disorders.
Mesenchymal stem cells have become the most commonly used adult stem cells in regenerative medicine. Clinical studies have shown that mesenchymal stem cell therapy is a potential treatment for neurological disorders.
This study evaluated the safety and efficacy of intrathecal injection of allogeneic mesenchymal stem cells in patients with neurological disorders. Intrathecal injection has a unique characteristic that enables stem cells to migrate directly to the lesion site in patients with central nervous system diseases.
Some of the studies have been registered in the China Clinical Trials Registry (registration number: chictr-inr-16008908) under the title of "Randomized Controlled Study of Allogeneic Bone Marrow Mesenchymal Stem Cells in patients with severe cerebral infarction".
In this clinical study, eligible patients were evaluated at baseline and injected intrathecal with allogeneic bone marrow mesenchymal stem cells at a dose of 1 million cells/kg for 4 consecutive treatments with a one-week interval between each treatment. After 4 infusions, the patient was followed up for at least 6 months.
According to the data of clinical trials, researchers believe that repeated intrathecal injection of allogeneic bone marrow mesenchymal stem cells is safe and feasible for the treatment of neurological diseases, and has broad application prospects.
The following are some cases of stem cell therapy for neurological disorders:
1. Stem cells treat Parkinson's disease
Stem cell transplants were performed on 8 Parkinson's subjects, followed up for 1 month, and neurological function was assessed using the Parkinson's Disease Unified Scoring Scale (UPDRS). The results showed that the average score of updrs decreased (the lower the score, the lighter the nerve function defect) decreased from (89.38±330.92) to (75.63±27.07), mainly focusing on the improvement of muscle rigidity and tremor, indicating that stem cell therapy has a good improvement function.
Ji et al. injected stem cells intrathecally into 38 Parkinson's subjects, followed up for 1 month, and the updrs score was shown in the figure below, and all subjects had different degrees of relief in motor symptoms, and the assessment scores of spirit, behavior, and mood decreased, indicating that non-motor symptoms were also improved.
2. Stem cells for acute spinal cord injury
In February 2021, researchers from Yale University and Sapporo Medical University in Japan jointly released a study. They used patients' stem cells to repair spinal cord injuries, and in a Phase II clinical trial, all 13 patients who received intravenous infusions of their own mesenchymal stem cells improved neurological function after six months. More than half of patients experience substantial improvements in key functions, such as walking and using hands.
The trial proved the feasibility, safety and efficacy of using stem cells to treat such patients, and brought new hope to these patients.
3. Stem cells treat the sequelae of stroke
The researchers included 56 patients with ischemic stroke as subjects, of whom 28 underwent mesenchymal stem cell transplantation, and the other 28 patients used conventional therapy as a control group. After one month of stem cell therapy, the nihss score and adl rating of the two groups of patients were clinically evaluated.
The results of the study: The stroke standard (nihss) score and the quality of daily life assessment (adl) score of the two groups improved compared with the pre-transplantation, and the improvement in the transplant group was significantly better than that in the control group. The sequelae of patients in the stem cell therapy group improved their after-effects and their quality of life improved.
4. Stem cell treatment of optic neuromyelitis nmosd
The results of a one-arm trial conducted by the General Hospital of Tianjin Medical University, China, enrolled a total of 15 nmosd patients with intravenous infusion of autologous bone marrow-derived stem cells, and the results of the 2-year follow-up showed that the patient's annual recurrence rate decreased and the edss score improved, and 87% of the patients had no recurrence within 2 years after receiving stem cell transplantation.
Medical researchers used a single intravenous infusion of 11 patients for MSCS transplantation, which is easy to operate and safe, and is the main means of transplant treatment of NMOSD. None of the cell fluid leakage and adverse reactions occurred during the transplantation process, and the expected effect was achieved after 1 year of follow-up, and there were no recurrence cases.
In a large-scale multi-center randomized controlled study (National Key Research and Development Program of the Ministry of Science and Technology) carried out by Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 430 patients with nmods were recruited, using stem cells derived from the umbilical cord, using intravenous stem cell infusion (1 time /3 months, a total of 4 times), the primary endpoint index was the recurrence time, and the secondary endpoint index included edss score and the number of lesions shown by imaging.
5. Stem cells and Huntington's disease HD
Levi et al. conducted a clinical trial of brain transplantation of fetal nerve stem cells in 5 HD patients, and found that the motor and cognitive abilities of 3 patients improved within 2 years after transplantation, but the efficacy gradually decreased or even disappeared in the subsequent 4 to 6 years. Still, the study is the first to demonstrate the possibility of stem cell transplantation for the treatment of HD.
6. Stem cell treatment of als
Clinical studies: Investigators were selected as 9 patients with ALS, aged 32 to 65 years old, 6 males and 3 females, with an average (53.1±11.7) years. The history is 8 months to 3 years, with an average of 1.79 years. Stem cells are implanted in the patient through the subarachnoid space and lie flat for 3 days after surgery. All patients underwent Norris amyotrophic lateral sclerosis scale score, functional independence assessment scale (fim), barthel index rating before transplantation and in the 1st, 3rd, and 6th months after transplantation.
Results: Nine patients experienced a reduction in muscle bundle fibrillation (within 24 hours) after transplantation, which was the most obvious within 1 week, the active motor function gradually improved within 1 month, and the respiratory motility and chewing recovery were more obvious, and the self-conscious symptom improvement was the most obvious in the third month after transplantation in 2 patients. The functional scale in the first month after transplantation showed a significant improvement, and the difference in score changes was obvious. For the 3rd and 6th months of scoring, only the Norris scale showed validity. Changes in norris, fim, bathel scores 1, 3, and 6 months before and after transplantation, see Table 1.
After transplantation, the electromyography showed changes, the complex muscle action potential amplitude improved, the f-wave ejection rate increased, mainly after the 3rd month, the compound muscle action potential amplitude improvement was the most significant before transplantation and 6 months after transplantation, and the f-wave ejection rate was similar, see Table 2.
During stem cell transplantation, 3 patients developed bone pain (sternum, sacral coccyx), 1 case had fever (low-grade fever, < 38 °C), 5 cases had no obvious adverse reactions, and no intolerant patients were seen. After transplantation, four cases developed transient fever (body temperature 37.4 to 38 °C) for 24 to 36 h, did not receive special treatment, and recovered spontaneously.