A Phase III Clinical Trial Showing Limited Efficacy of Autologous Mesenchymal Stem Cell Therapy for Spinal Cord Injury

• Published in: Neurosurgery Vol. 78; no. 3; pp. 436 - 447
• Main Authors: Oh, Sun Kyu, Choi, Kyoung Hyo, Yoo, Jong Yoon, Kim, Dae Yul, Kim, Sang Joon, Jeon, Sang Ryong
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.03.2016; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Adult; Clinical trials; Diffusion Tensor Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Mesenchymal Stem Cell Transplantation - methods; Mesenchymal Stromal Cells - cytology; Middle Aged; Neurosurgery; Patients; Recovery of Function; Spinal cord injuries; Spinal Cord Injuries - therapy; Transplantation, Autologous; Clinical trial; Electrophysiological study; Intramedullary injection; Spinal cord injury; Diffusion tensor imaging; Mesenchymal stem cells
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0000000000001056

Abstract BACKGROUND: In our previous report, 3 of 10 patients with spinal cord injury who were injected with autologous mesenchymal stem cells (MSCs) showed motor improvement in the upper extremities and in activities of daily living. OBJECTIVE: To report on the results of a phase III clinical trial of autologous MSCs therapy. METHODS: Patients were selected based on the following criteria: chronic American Spinal Injury Association B status patients who had more than 12 months of cervical injury, and no neurological changes during the recent 3 months of vigorous rehabilitation. We injected 1.6 × 107 autologous MSCs into the intramedullary area at the injured level and 3.2 × 107 autologous MSCs into the subdural space. Outcome data were collected over 6 months regarding neurological examination, magnetic resonance imaging with diffusion tensor imaging, and electrophysiological analyses. RESULTS: Among the 16 patients, only 2 showed improvement in neurological status (unilateral right C8 segment from grade 1 to grade 3 in 1 patient and bilateral C6 from grade 3 to grade 4 and unilateral right C8 from grade 0 to grade 1 in 1 patient). Both patients with neurological improvement showed the appearance of continuity in the spinal cord tract by diffusion tensor imaging. There were no adverse effects associated with MSCs injection. CONCLUSION: Single MSCs application to intramedullary and intradural space is safe, but has a very weak therapeutic effect compared with multiple MSCs injection. Further clinical trials to enhance the effect of MSCs injection are necessary.