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  4. Mesenchymal Stem Cells for Spinal Cord Injury: Current Options, Limitations, and Future of Cell Therapy

Mesenchymal Stem Cells for Spinal Cord Injury: Current Options, Limitations, and Future of Cell Therapy

International Journal of Molecular Sciences, 2019 · DOI: 10.3390/ijms20112698 · Published: May 31, 2019

Spinal Cord InjuryRegenerative Medicine

Simple Explanation

Spinal cord injury (SCI) is a significant public health problem. After the initial trauma, a secondary injury occurs involving inflammation and cellular dysfunction. Mesenchymal stem cells (MSCs) are a promising treatment because of their ease of isolation and properties. MSCs can be easily isolated from different sources and maintained, raising no ethical concerns and having a limited risk of tumor development. They can migrate to the injury site and exert paracrine effects. MSCs can release growth factors, cytokines and interleukins. They exert immunomodulatory, anti-inflammatory, neurotrophic/neuroprotective and angiogenetic effects on the host microenvironment, which is beneficial in cases of SCI.

Study Duration
Not specified
Participants
Not specified
Evidence Level
Review

Key Findings

  • 1
    MSCs from bone marrow (BM-MSCs), umbilical cord (UC-MSCs), and adipose tissue (AD-MSCs) each have different characteristics regarding availability, invasiveness of collection, proliferation, secretome, survival after grafting, immunogenicity, anti-inflammatory effect, glial scar reduction, and axonal regrowth support.
  • 2
    Preclinical studies with MSCs in animal models often show promising results, but these results have not translated well into human clinical trials.
  • 3
    MSCs, when transplanted, may show neuron-like characteristics, but it is hard to consider them as fully functional neurons. Their efficacy is primarily related to their paracrine activity rather than cellular replacement.

Research Summary

MSC therapy is a promising research area for SCI due to their immunomodulating and neuroprotective factors supporting neuron survival and axonal growth without significant side effects. Clinical trials have not met the expectations set by preclinical findings, failing to achieve functional recovery and neural circuit restoration. Further studies are needed to improve the understanding of MSC mechanisms and address factors preventing neural circuit restoration. Combinatory strategies involving stem cells, biomaterials, and cell environment modifications could translate premises into clinical practice.

Practical Implications

Optimizing therapeutic protocols

Further research is needed to determine the optimal methods for preparing, selecting the type, and determining the number of stem cells for transplantation.

Improving Clinical Translation

A better relationship between preclinical and clinical studies with a back-and-forth approach is mandatory to enhance the efficacy of cell therapy.

Patient Awareness

Patients should be aware of the poor clinical results obtained thus far in clinical trials to prevent exaggerated expectations and dramatic psychological consequences in the case of failure to obtain significant results.

Study Limitations

  • 1
    Animal model studies may not accurately reflect human SCI conditions.
  • 2
    Completed human trials have shown limited clinical results.
  • 3
    The exact mechanisms of MSCs in SCI repair are not fully understood.

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