Effects of bone marrow mesenchymal stromal cells on gross motor function measure scores of children with cerebral palsy: a preliminary clinical study. Cytotherapy. 2013;15:1549-1562. [PMID: 24100132 DOI: 10.1016/j.jcyt.2013.06.001]

The effects of motor and intellectual functions on the effectiveness of comprehensive rehabilitation in young children with cerebral palsy

Objective

To determine the effects of motor and intellectual functions on the effectiveness of comprehensive rehabilitation (CR) in young children with cerebral palsy (CP).

Methods

This longitudinal cohort study recruited paediatric patients with a confirmed diagnosis of CP. Baseline gross motor function was classified using the Gross Motor Function Classification System. Baseline intellectual level was evaluated using the Developmental Quotient (DQ) via the Gesell Development Scale. Children underwent CR for 3 months and then their motor and intellectual functions were assessed using the Gross Motor Function Measure, Fine Motor Function Measure and DQ. The changes from baseline were calculated.

Results

Forty-eight children with CP were recruited to this study. Greater improvements in motor function were associated with a lower baseline level of intellectual impairment. Motor and intellectual function in children with CP was significantly improved when treatment was started before 12 months of age.

Conclusion

There might be a close and reciprocal relationship between the baseline levels of impairment of motor and intellectual function with regard to the effectiveness of CR. Early intervention is important to gain a good outcome in children with CP.

The distribution of transplanted human mesenchymal stem cells in the CNS of young Macaca fascicularis

Mesenchymal stem cell (MSC)-based therapies have generated much hope and promise as a potential source of cells for cell-based therapeutic strategies in pediatric degenerative diseases. However, the distribution and migratory routes of MSCs are unknown. Here, real-time PCR and microscopy were used to observe the migration and distribution of labeled human MSCs (hMSCs) transplanted into the striatum of young Macaca fascicularis. Moreover, the differentiation of hMSCs was also detected using immunofluorescence. We found that hMSCs were mainly located near the injection site in the brain and in the anterior brain after 2 weeks. After 4 weeks, the hMSCs had dispersed and could be detected in each brain slice and were more uniformly distributed than after 2 weeks. The hMSCs showed a preference for migration towards blood vessels, which may be one of the migratory routes used by hMSCs. Additionally, hMSCs could be observed to give rise to NeuN- and GFAP-positive cells. Transplanted hMSCs also increased the expression levels of N-cadherin in the host brain tissue, which may be one factor that drives the migration and differentiation of hMSCs after transplantation. These results provide preclinical evidence that MSC-based therapies may represent an efficacious alternative to more conventional treatment regimens for a variety of pediatric neurologic disorders.

Safety and tolerability of intrathecal delivery of autologous bone marrow nucleated cells in children with cerebral palsy: an open-label phase I trial

BACKGROUND AIMS

Cerebral palsy (CP) is related to severe perinatal hypoxia with permanent brain damage in nearly 50% of surviving preterm infants. Cell therapy is a potential therapeutic option for CP by several mechanisms, including immunomodulation through cytokine and growth factor secretion.

METHODS

In this phase I open-label clinical trial, 18 pediatric patients with CP were included to assess the safety of autologous bone marrow-derived total nucleated cell (TNC) intrathecal and intravenous injection after stimulation with granulocyte colony-stimulating factor. Motor, cognitive, communication, personal-social and adaptive areas were evaluated at baseline and 1 and 6 months after the procedure through the use of the Battelle Developmental Inventory. Magnetic resonance imaging was performed at baseline and 6 months after therapy. This study was registered in ClinicaTrials.gov (NCT01019733).

RESULTS

A median of 13.12 × 10(8) TNCs (range, 4.83-53.87) including 10.02 × 10(6) CD34+ cells (range, 1.02-29.9) in a volume of 7 mL (range, 4-10.5) was infused intrathecally. The remaining cells from the bone marrow aspirate were administered intravenously; 6.01 × 10(8) TNCs (range, 1.36-17.85), with 3.39 × 10(6) cells being CD34+. Early adverse effects included headache, vomiting, fever and stiff neck occurred in three patients. No serious complications were documented. An overall 4.7-month increase in developmental age according to the Battelle Developmental Inventory, including all areas of evaluation, was observed (±SD 2.63). No MRI changes at 6 months of follow-up were found.

CONCLUSIONS

Subarachnoid placement of autologous bone marrow-derived TNC in children with CP is a safe procedure. The results suggest a possible increase in neurological function.