Cell transplantation therapies for spinal cord injury focusing on bone marrow mesenchymal stem cells: Advances and challenges

World Journal of Stem Cells, 2023 · DOI: 10.4252/wjsc.v15.i5.385 · Published: May 26, 2023

Spinal Cord Injury Regenerative Medicine

Simple Explanation

Spinal cord injury (SCI) is a devastating condition that disrupts sensory, motor, and autonomic functions. Currently, there's no effective treatment. Bone marrow-derived mesenchymal stem cells (BMMSCs) are being explored as a promising source for cellular therapies to treat SCI. BMMSCs may help with neuroprotection, axon growth, and myelin regeneration. This review summarizes how BMMSC therapy can repair SCI by focusing on neuroprotection, axon sprouting, myelin regeneration, managing inhibitory microenvironments and glial scar formation, immunomodulation, and angiogenesis. It also addresses challenges and future directions for stem cell therapy in SCI.

Study Duration

Not specified

Participants

1090 participants (in clinical studies reviewed)

Evidence Level

Review article

Key Findings

1
BMMSCs exhibit neuroprotective effects by releasing growth and neurotrophic factors like BDNF, VEGF, and GDNF, enhancing regeneration and repair in damaged tissues.
2
BMMSCs can modulate the inflammatory response after SCI, shifting macrophages from a pro-inflammatory to an anti-inflammatory phenotype, which promotes functional recovery.
3
BMMSC engraftment can promote revascularization, enhance blood supply and increase BSCB integrity, which will attenuate secondary injury and promote axon growth, thereby improving functional recovery following SCI.

Research Summary

This review highlights the therapeutic potential of BMMSCs in treating SCI by summarizing their applications based on mechanisms like neuroprotection, axon regeneration, myelin repair, immunomodulation, and angiogenesis. Clinical trials show BMMSC transplantation is safe for SCI patients, with some efficacy, particularly in chronic and complete injuries, but more extensive, well-designed randomized trials are needed. Combination therapies using BMMSCs with gene modulation or other factors may enhance therapeutic effects. Longer observation periods in preclinical studies are needed to address potential adverse effects.

Practical Implications

Enhanced Therapeutic Strategies

Combination therapies involving BMMSCs and other factors could lead to more effective treatments for SCI.

Improved Clinical Trial Design

Future clinical trials should incorporate larger cohorts, randomized designs, and longer follow-up periods to validate the efficacy of BMMSC transplantation.

Targeted Molecular Therapies

A better understanding of the specific mechanisms of BMMSCs in SCI repair can inform the development of targeted molecular therapies.

Study Limitations

1
Limited long-term therapeutic efficacy and effectiveness in human clinical trials.
2
The exact mechanisms of action of BMMSCs are not fully understood.
3
Most clinical studies have small sample sizes, lack control groups, and are early-stage clinical trials with the main purpose of evaluating the safety of stem cells.

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