Baek W, Kim Y S, Koh S H, Lim S W, Kim H Y, Yi H J, Kim H
Department of Neurology, University College of Medicine, Seoul, South Korea.
J Neurosurg Sci. 2012 Sep;56(3):261-3.
Stem cells have been highlighted for a possible clinical trial in amyotrophic lateral sclerosis (ALS), and have been employed in SOD1 mice and ALS patients. Human trials for stem cell transplantations have used intrathecal route by lumbar puncture. However, stem cells introduced via lumbar injection would tend to sink downwards rather than ascending to the brain and cervical and thoracic spinal cord. Therefore, we adopted for intraventricular injection via an Ommaya reservoir, and wished to test the practicality of intraventricular stem cell injection in ALS. In the case presented autologous mesenchymal stromal cells (MSCs) were isolated from the bone marrow of a male patient with ALS who underwent insertion of an Ommaya reservoir. Expanded MSCs (hBM-MSCs: dose of 1 X 106 cells/kg) were suspended in autologous CSF and directly transplanted into the ALS patient's lateral ventricle via the Ommaya reservoir. Clinical, laboratory, and radiographic evaluation of the patient revealed no serious adverse effects related to the stem cell therapy. Intraventricular injection with an optimized number of cells is safe, and is a potential route for stem cell therapy in patients with ALS. Intraventricular injection via an Ommaya reservoir makes repetitive injection of stem cells easy and reliable even in far advanced ALS patients.
干细胞因可能用于肌萎缩侧索硬化症（ALS）的临床试验而备受关注，并已应用于SOD1小鼠和ALS患者。干细胞移植的人体试验采用腰椎穿刺鞘内注射途径。然而，经腰椎注射引入的干细胞往往会向下沉降，而不是上升至大脑以及颈髓和胸髓。因此，我们采用通过奥马亚贮液器进行脑室内注射，并希望测试脑室内注射干细胞在ALS中的实用性。在该病例中，从一名接受奥马亚贮液器植入的男性ALS患者的骨髓中分离出了自体间充质基质细胞（MSC）。将扩增的MSC（hBM-MSC：剂量为1×10⁶个细胞/千克）悬浮于自体脑脊液中，并通过奥马亚贮液器直接移植到ALS患者的侧脑室。对该患者的临床、实验室和影像学评估显示，未发现与干细胞治疗相关的严重不良反应。脑室内注射优化数量的细胞是安全的，并且是ALS患者干细胞治疗的一种潜在途径。通过奥马亚贮液器进行脑室内注射，即使对于晚期ALS患者，也能轻松、可靠地重复注射干细胞。
