Hammadi Abdul Majeed Alwan, Alhimyari Fizel
From the Alyermouk Teaching Hospital, Baghdad, Iraq; and the Packy Hospital, Erbil, Iraq.
Exp Clin Transplant. 2019 Jan;17(Suppl 1):239-241. doi: 10.6002/ect.MESOT2018.P102.
This study aimed to show the positive effects of autologous bone marrow-derived mononuclear cells in the functional recovery of adult patients with subacute and chronic ischemic stroke. Stroke is a leading cause of morbidity and long-term disability in the world, with about one-third of survivors being permanently disabled. Bone marrowderived mononuclear cell concentrate is thought to improve cerebral blood flow and to speed recovery in animal models. Many types of stem cells have been used, including mesenchymal, cord blood cells, and embryonic, with different administration methods, including intrathecal, intravenous, intraarterial, and intracerebral, all with variable degrees of success. Mechanisms of action include induction of angio genesis, promotion of neurogenesis, prevention of apoptosis, and immunomodulation. The use of autologous bone marrow-derived mononuclear cells with the closed method has nearly minimal manipulation requirements and is a low-risk procedure.
We aspirated 100 cm³ (mean volume) of bone marrow from 37 (12 women/25 men) Iraqi adult patients (age range, 42-80 y). After filtration, we injected a small volume (15 cm3) intraarterially through a catheter in the internal carotid arteries. The remaining volume was injected intravenously. Mononuclear cell count was 5 to 6 × 108 per product. Time from diagnosis until transplant procedure ranged from 3 months to 5 years.
Intra-arterial administration of autologous bone marrow mononuclear cells resulted in improvements in the European Stroke Scale (from +4 to 20) in 25 of 37 patients (67.5%) over 4 to 8 weeks.
Stem cell therapy is promising in subacute and chronic stroke patients.
本研究旨在表明自体骨髓来源的单核细胞对亚急性和慢性缺血性中风成年患者功能恢复的积极作用。中风是全球发病和长期残疾的主要原因，约三分之一的幸存者会永久残疾。骨髓来源的单核细胞浓缩物被认为可改善动物模型中的脑血流量并加速恢复。已使用多种类型的干细胞，包括间充质干细胞、脐带血细胞和胚胎干细胞，采用不同的给药方法，包括鞘内注射、静脉注射、动脉内注射和脑内注射，均取得了不同程度的成功。作用机制包括诱导血管生成、促进神经发生、预防细胞凋亡和免疫调节。采用封闭方法使用自体骨髓来源的单核细胞，操作要求几乎最低，且是一种低风险程序。
我们从37名（12名女性/25名男性）伊拉克成年患者（年龄范围42 - 80岁）中抽取了100 cm³（平均体积）的骨髓。过滤后，通过颈内动脉的导管动脉内注射少量（15 cm³）。其余体积静脉注射。每个产品的单核细胞计数为5至6×10⁸。从诊断到移植手术的时间为3个月至5年。
在4至8周内，37名患者中有25名（67.5%）动脉内注射自体骨髓单核细胞后欧洲卒中量表评分有所改善（从 +4提高到20）。
干细胞疗法对亚急性和慢性中风患者很有前景。
