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脑内植入人神经干细胞与中风后运动功能恢复:多中心前瞻性单臂研究(PISCES-2)。

Intracerebral implantation of human neural stem cells and motor recovery after stroke: multicentre prospective single-arm study (PISCES-2).

机构信息

Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK

Neurosurgery, Wessex Neurological Centre, Southampton, Southampton, UK.

出版信息

J Neurol Neurosurg Psychiatry. 2020 Apr;91(4):396-401. doi: 10.1136/jnnp-2019-322515. Epub 2020 Feb 10.


DOI:10.1136/jnnp-2019-322515
PMID:32041820
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7147186/
Abstract

BACKGROUND: Human neural stem cell implantation may offer improved recovery from stroke. We investigated the feasibility of intracerebral implantation of the allogeneic human neural stem cell line CTX0E03 in the subacute-chronic recovery phase of stroke and potential measures of therapeutic response in a multicentre study. METHODS: We undertook a prospective, multicentre, single-arm, open-label study in adults aged >40 years with significant upper limb motor deficits 2-13 months after ischaemic stroke. 20 million cells were implanted by stereotaxic injection to the putamen ipsilateral to the cerebral infarct. The primary outcome was improvement by 2 or more points on the Action Research Arm Test (ARAT) subtest 2 at 3 months after implantation. FINDINGS: Twenty-three patients underwent cell implantation at eight UK hospitals a median of 7 months after stroke. One of 23 participants improved by the prespecified ARAT subtest level at 3 months, and three participants at 6 and 12 months. Improvement in ARAT was seen only in those with residual upper limb movement at baseline. Transient procedural adverse effects were seen, but no cell-related adverse events occurred up to 12 months of follow-up. Two deaths were unrelated to trial procedures. INTERPRETATION: Administration of human neural stem cells by intracerebral implantation is feasible in a multicentre study. Improvements in upper limb function occurred at 3, 6 and 12 months, but not in those with absent upper limb movement at baseline, suggesting a possible target population for future controlled trials. FUNDING: ReNeuron, Innovate UK (application no 32074-222145). TRIAL REGISTRATION NUMBER: EudraCT Number: 2012-003482-18.

摘要

背景:人神经干细胞移植可能会改善中风后的恢复情况。我们研究了在中风后亚急性期和慢性期,将异体人神经干细胞系 CTX0E03 植入大脑内的可行性,并对潜在的治疗反应进行了多中心研究。

方法:我们进行了一项前瞻性、多中心、单臂、开放标签的研究,纳入了 20 名年龄>40 岁的成年人,这些患者在缺血性中风后 2-13 个月出现了明显的上肢运动障碍。通过立体定向注射将 2000 万个细胞植入到与脑梗死同侧的壳核。主要结局是在移植后 3 个月时,行动研究上肢测试(ARAT)亚测试 2 的评分提高 2 分或更多。

结果:23 名患者在中风后 7 个月在英国的 8 家医院进行了细胞移植。23 名患者中有 1 名在 3 个月时达到了 ARAT 亚测试的预定水平,3 名患者在 6 个月和 12 个月时达到了该水平。只有在基线时上肢运动仍有残留的患者,才观察到 ARAT 的改善。有短暂的手术相关不良反应,但在 12 个月的随访中没有发生与细胞相关的不良事件。2 例死亡与试验程序无关。

解释:在多中心研究中,通过脑内移植向人体输注神经干细胞是可行的。上肢功能的改善发生在 3、6 和 12 个月时,但在基线时上肢运动完全丧失的患者中没有发生,这表明可能有一个未来对照试验的目标人群。

经费:ReNeuron,英国创新署(申请号 32074-222145)。

临床试验注册号:EudraCT 编号:2012-003482-18。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34ea/7147186/409461333c74/jnnp-2019-322515f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34ea/7147186/a3e329fbb952/jnnp-2019-322515f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34ea/7147186/409461333c74/jnnp-2019-322515f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34ea/7147186/a3e329fbb952/jnnp-2019-322515f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34ea/7147186/409461333c74/jnnp-2019-322515f02.jpg

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[1]
Intracerebral implantation of human neural stem cells and motor recovery after stroke: multicentre prospective single-arm study (PISCES-2).

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本文引用的文献

[1]
Stable Intracerebral Transplantation of Neural Stem Cells for the Treatment of Paralysis Due to Ischemic Stroke.

Stem Cells Transl Med. 2019-6-26

[2]
Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme.

J Neurol Neurosurg Psychiatry. 2019-2-15

[3]
PREP2: A biomarker-based algorithm for predicting upper limb function after stroke.

Ann Clin Transl Neurol. 2017-10-24

[4]
Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

Lancet Neurol. 2017-11

[5]
Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.

Int J Stroke. 2017-7

[6]
Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.

Int J Stroke. 2017-7

[7]
Improving the development, monitoring and reporting of stroke rehabilitation research: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.

Int J Stroke. 2017-7

[8]
Human Neural Stem Cell Therapy for Chronic Ischemic Stroke: Charting Progress from Laboratory to Patients.

Stem Cells Dev. 2017-7-1

[9]
Safety and efficacy of multipotent adult progenitor cells in acute ischaemic stroke (MASTERS): a randomised, double-blind, placebo-controlled, phase 2 trial.

Lancet Neurol. 2017-3-17

[10]
Proportional Motor Recovery After Stroke: Implications for Trial Design.

Stroke. 2017-3

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