Duke Center for Autism and Brain Development, Duke University Medical Center.
Robertson Clinical and Translational Cell Therapy Program, Duke University Medical Center.
Stem Cells Transl Med. 2017 May;6(5):1332-1339. doi: 10.1002/sctm.16-0474. Epub 2017 Apr 5.
Despite advances in early diagnosis and behavioral therapies, more effective treatments for children with autism spectrum disorder (ASD) are needed. We hypothesized that umbilical cord blood-derived cell therapies may have potential in alleviating ASD symptoms by modulating inflammatory processes in the brain. Accordingly, we conducted a phase I, open-label trial to assess the safety and feasibility of a single intravenous infusion of autologous umbilical cord blood, as well as sensitivity to change in several ASD assessment tools, to determine suitable endpoints for future trials. Twenty-five children, median age 4.6 years (range 2.26-5.97), with a confirmed diagnosis of ASD and a qualified banked autologous umbilical cord blood unit, were enrolled. Children were evaluated with a battery of behavioral and functional tests immediately prior to cord blood infusion (baseline) and 6 and 12 months later. Assessment of adverse events across the 12-month period indicated that the treatment was safe and well tolerated. Significant improvements in children's behavior were observed on parent-report measures of social communication skills and autism symptoms, clinician ratings of overall autism symptom severity and degree of improvement, standardized measures of expressive vocabulary, and objective eye-tracking measures of children's attention to social stimuli, indicating that these measures may be useful endpoints in future studies. Behavioral improvements were observed during the first 6 months after infusion and were greater in children with higher baseline nonverbal intelligence quotients. These data will serve as the basis for future studies to determine the efficacy of umbilical cord blood infusions in children with ASD. Stem Cells Translational Medicine 2017;6:1332-1339.
尽管在早期诊断和行为疗法方面取得了进展,但仍需要更有效的治疗自闭症谱系障碍(ASD)的方法。我们假设脐带血衍生的细胞疗法可能通过调节大脑中的炎症过程,具有缓解 ASD 症状的潜力。因此,我们进行了一项 I 期、开放性试验,以评估单次静脉输注自体脐带血的安全性和可行性,以及对几种 ASD 评估工具的变化敏感性,以确定未来试验的合适终点。共有 25 名儿童入组,中位数年龄为 4.6 岁(范围为 2.26-5.97),均确诊为 ASD,且有合格的自体脐带血库血单位。在脐带血输注前(基线)和 6 个月和 12 个月后,用一系列行为和功能测试对儿童进行评估。在 12 个月的评估期间,对不良事件的评估表明该治疗安全且耐受良好。在父母报告的社交沟通技能和自闭症症状、临床医生评定的整体自闭症症状严重程度和改善程度、表达性词汇的标准化测量以及儿童对社交刺激的客观眼动测量方面,儿童的行为均有显著改善,这表明这些测量方法可能是未来研究的有用终点。输注后前 6 个月观察到行为改善,且基线非言语智商较高的儿童改善更大。这些数据将为未来的研究提供依据,以确定脐带血输注治疗 ASD 儿童的疗效。《干细胞转化医学》2017 年;6:1332-1339。