Larocca Ticiana Ferreira, Macêdo Carolina Thé, Souza Bruno Solano de Freitas, Andrade-Souza Yuri M, Villarreal Cristiane Flora, Matos André Costa, Silva Daniela Nascimento, da Silva Kátia Nunes, de Souza Clarissa Lima E Moura, Paixão Daniela da Silva, Bezerra Milena da Rocha, Alves Rodrigo Leal, Soares Milena Botelho Pereira, Dos Santos Ricardo Ribeiro
Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil.
Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil.
Cytotherapy. 2017 Oct;19(10):1189-1196. doi: 10.1016/j.jcyt.2017.06.006. Epub 2017 Jul 29.
The potential of cell therapies to improve neurological function in subjects with spinal cord injury (SCI) is currently under investigation. In this context, the choice of cell type, dose, route and administration regimen are key factors. Mesenchymal stromal cells (MSCs) can be easily obtained, expanded and are suitable for autologous transplantation. Here we conducted a pilot study that evaluated safety, feasibility and potential efficacy of intralesional MSCs transplantation performed through image-guided percutaneous injection, in subjects with chronic complete SCI.
Five subjects with chronic traumatic SCI (>6 months), at thoracic level, classified as American Spinal Cord Injury Association impairment scale (AIS) grade A, complete injury, were included. Somatosensory evoked potentials (SSEP), spinal magnetic resonance imaging (MRI) and urodynamics were assessed before and after treatment. Autologous MSCs were injected directly into the lesion site through percutaneous injection guided by computerized tomography (CT).
Tomography-guided percutaneous cell transplantation was a safe procedure without adverse effects. All subjects displayed improvements in spinal cord independence measure (SCIM) scores and functional independence measure (FIM), mainly due to improvements in bowel movements and regularity. Three subjects showed improved sensitivity to tactile stimulation. Two subjects improved AIS grade to B, incomplete injury, although this was sustained in only one of them during the study follow-up.
Autologous bone marrow MSC transplantation, performed through CT-guided percutaneous injection, was shown to be safe and feasible. Further studies are required to demonstrate efficacy of this therapeutic scheme.
目前正在研究细胞疗法改善脊髓损伤（SCI）患者神经功能的潜力。在此背景下，细胞类型、剂量、途径和给药方案的选择是关键因素。间充质基质细胞（MSCs）易于获取、扩增，适合自体移植。在此，我们进行了一项前瞻性研究，评估在慢性完全性SCI患者中通过影像引导经皮注射进行病灶内MSCs移植的安全性、可行性和潜在疗效。
纳入5例慢性创伤性SCI（>6个月）患者，损伤平面为胸段，美国脊髓损伤协会损伤分级（AIS）为A级，即完全性损伤。在治疗前后评估体感诱发电位（SSEP）、脊髓磁共振成像（MRI）和尿动力学。自体MSCs通过计算机断层扫描（CT）引导经皮直接注射到损伤部位。
CT引导下经皮细胞移植是一种安全的操作，无不良反应。所有患者的脊髓独立测量（SCIM）评分和功能独立性测量（FIM）均有改善，主要是由于排便和规律性的改善。3例患者对触觉刺激的敏感性有所提高。2例患者的AIS分级提高到B级，即不完全性损伤，尽管在研究随访期间只有1例患者维持了这一改善。
通过CT引导经皮注射进行自体骨髓MSCs移植被证明是安全可行的。需要进一步研究来证明该治疗方案的疗效。
