A new study by a Wayne State University School of Medicine researcher details the outcome of adult stem cell grafts in spinal cord injuries and how the procedure led to increased mobility and quality of life for patients.
Associate Professor Jean Peduzzi-Nelson of the Department of Anatomy and Cell Biology conducted the study, “Olfactory Mucosal Autografts and Rehabilitation for Chronic Traumatic Spinal Cord Injury,” which was published online in the journal Neurorehabilitation and Neural Repair.
The process involves the use of adult stem-like progenitor cells in the patient’s own nasal tissue. The use of a person’s own stem cells, Peduzzi-Nelson said, lessens the problems of rejection, tumor formation and disease transmission.
In the study, 20 patients with severe chronic spinal cord injuries received a treatment combination of partial scar removal, transplantation of nasal tissue containing stem cells to the site of the spinal cord injury and rehabilitation. All of the patients had total paralysis below the level of their spinal cord injury before the treatment.
“This may be the first clinical study of patients with severe, chronic spinal cord injury to report considerable functional improvement in some patients with a combination treatment,” Peduzzi-Nelson said. “Normally, in people with spinal cord injuries that happened more than 18 months ago, there is little improvement.”
The injuries in the study patients were 18 months to 15 years old. The patients, ages 19 to 37, had no use of their legs before the treatment. One paraplegic treated almost three years after the injury now ambulates with two crutches and knee braces. Ten other patients ambulate with physical assistance and walkers (with and without braces). One 31-year-old male tetriplegic patient uses a walker without the help of knee braces or physical assistance. When the stem cell transplant and scar removal process was combined with an advanced form of rehabilitative training that employs brain-initiated weight-bearing movement, 13 patients improved in the standard measures used to assess functional independence and walking capabilities.
“We concluded that olfactory mucosal autograft is feasible, relatively safe and possibly beneficial in people with chronic spinal cord injury when combined with post-operative rehabilitation,” Peduzzi-Nelson said. “There are clear indications of efficacy based on neurological, functional and electrophysiological testing that justify moving forward to a larger, controlled clinical trial. In patients who are willing to commit to lots of intense rehabilitation, this combination treatment holds promise to improve their condition.”
Peduzzi-Nelson noted that there are many sources of stem cells in the body, including bone marrow, fat and the brain, but that the olfactory mucosa is the only suitable tissue that can be easily obtained with minimally invasive procedures. The stem-like progenitor cells in the olfactory mucosa are special because they normally form new neurons more rapidly than cells from any other place in the adult nervous system. When such cells are transplanted into chick embryos, she said, the cells can form mature cells of the heart, trunk muscles, liver, brain and spinal cord. This suggests that olfactory stem-like progenitor cells are very immature and capable of forming a variety of cell types.
The partial scar removal and tissue transplantation procedures were performed in Portugal. The rehabilitation of patients took place in Italy and Portugal.
“Many patients in the Detroit area have had this procedure,” she said. “Along with some colleagues, I have sent questionnaires to these local patients to find out whether or not there are any side-effects or functional improvement.”
Peduzzi-Nelson said that she and Jay Meythaler, M.D., chairman of the Department of Physical Medicine and Rehabilitation, along with other colleagues, are seeking FDA approval to perform the procedure in the United States.