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Kawabori M, Kuroda S, Shichinohe H, Kahata K, Shiratori S, Ikeda S, Harada T, Hirata K, Tha KK, Aragaki M, Terasaka S, Ito YM, Nishimoto N, Ohnishi S, Yabe I, Kudo K, Houkin K, Fujimura M. Intracerebral transplantation of MRI-trackable autologous bone marrow stromal cells for patients with subacute ischemic stroke. MED 2024; 5:432-444.e4. [PMID: 38547868 DOI: 10.1016/j.medj.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/19/2023] [Accepted: 02/26/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Ischemic stroke is one of the leading causes of death and neurological disability worldwide, and stem cell therapy is highly expected to reverse the sequelae. This phase 1/2, first-in-human study evaluated the safety, feasibility, and monitoring of an intracerebral-transplanted magnetic resonance imaging (MRI)-trackable autologous bone marrow stromal cell (HUNS001-01) for patients with subacute ischemic stroke. METHODS The study included adults with severe disability due to ischemic stroke. HUNS001-01 cultured with human platelet lysates and labeled with superparamagnetic iron oxide was stereotactically transplanted into the peri-infarct area 47-64 days after ischemic stroke onset (dose: 2 or 5 × 107 cells). Neurological and radiographic evaluations were performed throughout 1 year after cell transplantation. The trial was registered at UMIN Clinical Trial Registry (number UMIN000026130). FINDINGS All seven patients who met the inclusion criteria successfully achieved cell expansion, underwent intracerebral transplantation, and completed 1 year of follow-up. No product-related adverse events were observed. The median National Institutes of Health Stroke Scale and modified Rankin scale scores before transplantation were 13 and 4, which showed improvements of 1-8 and 0-2, respectively. Cell tracking proved that the engrafted cells migrated toward the infarction border area 1-6 months after transplantation, and the quantitative susceptibility mapping revealed that cell signals at the migrated area constantly increased throughout the follow-up period up to 34% of that of the initial transplanted site. CONCLUSIONS Intracerebral transplantation of HUNS001-01 was safe and well tolerated. Cell tracking shed light on the therapeutic mechanisms of intracerebral transplantation. FUNDING This work was supported by the Japan Agency for Medical Research and Development (AMED; JP17bk0104045 and JP20bk0104011).
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Affiliation(s)
- Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan.
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Hideo Shichinohe
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Kaoru Kahata
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Souichi Shiratori
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Satoshi Ikeda
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Taisuke Harada
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Khin Khin Tha
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Masato Aragaki
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Yoichi M Ito
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Naoki Nishimoto
- Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Shunsuke Ohnishi
- Laboratory of Molecular and Cellular Medicine, Hokkaido University Graduate School of Pharmacology, Sapporo, Hokkaido 060-8638, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060-8638, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
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Barria P, Riquelme M, Reppich H, Cisnal A, Fraile JC, Pérez-Turiel J, Sierra D, Aguilar R, Andrade A, Nuñez-Espinosa C. Hand rehabilitation based on the RobHand exoskeleton in stroke patients: A case series study. Front Robot AI 2023; 10:1146018. [PMID: 37033674 PMCID: PMC10073561 DOI: 10.3389/frobt.2023.1146018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: The RobHand (Robot for Hand Rehabilitation) is a robotic neuromotor rehabilitation exoskeleton that assists in performing flexion and extension movements of the fingers. The present case study assesses changes in manual function and hand muscle strength of four selected stroke patients after completion of an established training program. In addition, safety and user satisfaction are also evaluated. Methods: The training program consisted of 16 sessions; two 60-minute training sessions per week for eight consecutive weeks. During each session, patients moved through six consecutive rehabilitation stages using the RobHand. Manual function assessments were applied before and after the training program and safety tests were carried out after each session. A user evaluation questionnaire was filled out after each patient completed the program. Results: The safety test showed the absence of significant adverse events, such as skin lesions or fatigue. An average score of 4 out of 5 was obtained on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale. Users were very satisfied with the weight, comfort, and quality of professional services. A Kruskal-Wallis test revealed that there were not statistically significant changes in the manual function tests between the beginning and the end of the training program. Discussion: It can be concluded that the RobHand is a safe rehabilitation technology and users were satisfied with the system. No statistically significant differences in manual function were found. This could be due to the high influence of the stroke stage on motor recovery since the study was performed with chronic patients. Hence, future studies should evaluate the rehabilitation effectiveness of the repetitive use of the RobHand exoskeleton on subacute patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05598892?id=NCT05598892&draw=2&rank=1, identifier NCT05598892.
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Affiliation(s)
- Patricio Barria
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
- *Correspondence: Patricio Barria,
| | - Matías Riquelme
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
| | - Hannah Reppich
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Juan-Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Javier Pérez-Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - David Sierra
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Rolando Aguilar
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Cristian Nuñez-Espinosa
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
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Jang SH, Byun DH. Delayed gait recovery by resolution of limb-kinetic apraxia in a chronic hemiparetic stroke patient: A case report. Medicine (Baltimore) 2022; 101:e28711. [PMID: 35089235 PMCID: PMC8797483 DOI: 10.1097/md.0000000000028711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE This paper reports on a chronic hemiparetic stroke patient who showed delayed gait recovery due to resolution of limb-kinetic apraxia (LKA). PATIENT CONCERNS A 49-year-old man underwent comprehensive rehabilitation at a local rehabilitation hospital since 3 weeks after spontaneous intracerebral haemorrhage. However, he could not walk independently because of severe motor weakness in his right leg until 19 months after the onset. DIAGNOSIS At the beginning of rehabilitation at our hospital (19 months after onset), we thought that he had the neurological potential to walk independently because the unaffected (right) corticospinal tract and corticoreticulospinal tract were closely related to the gait potential, representing intact integrities. As a result, we assumed that the severe motor weakness in the right leg was mainly ascribed to LKA. INTERVENTIONS At our hospital, he underwent comprehensive rehabilitation including increased doses of dopaminergic drugs (pramipexole, ropinirole, amantadine, and carbidopa/levodopa). OUTCOMES After 10 days to our hospital, he could walk independently on an even floor with verbal supervision, concurrent with motor recovery of the right leg. After 24 days after hospital admission, he could walk independently on an even floor. LESSONS We believe that the resolution of LKA in his right leg by the administration of adequate doses of dopaminergic drugs was the main reason for the delayed gait recovery in this patient. The results suggest the importance of detecting the neurological potential for gait ability of a stroke patient who cannot walk after the gait recovery phase and the causes of gait inability for individual patients.
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Jang SH, Lee HD. Late recovery of walking ability in a person with chronic stroke after an individualized rehabilitation program. Ann Phys Rehabil Med 2019; 62:386-388. [PMID: 31132507 DOI: 10.1016/j.rehab.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea.
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Alomar F, Singh J, Jang H, Rozanzki GJ, Shao CH, Padanilam BJ, Mayhan WG, Bidasee KR. Smooth muscle-generated methylglyoxal impairs endothelial cell-mediated vasodilatation of cerebral microvessels in type 1 diabetic rats. Br J Pharmacol 2016; 173:3307-3326. [PMID: 27611446 PMCID: PMC5738666 DOI: 10.1111/bph.13617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/26/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Endothelial cell-mediated vasodilatation of cerebral arterioles is impaired in individuals with Type 1 diabetes (T1D). This defect compromises haemodynamics and can lead to hypoxia, microbleeds, inflammation and exaggerated ischaemia-reperfusion injuries. The molecular causes for dysregulation of cerebral microvascular endothelial cells (cECs) in T1D remains poorly defined. This study tests the hypothesis that cECs dysregulation in T1D is triggered by increased generation of the mitochondrial toxin, methylglyoxal, by smooth muscle cells in cerebral arterioles (cSMCs). EXPERIMENTAL APPROACH Endothelial cell-mediated vasodilatation, vascular transcytosis inflammation, hypoxia and ischaemia-reperfusion injury were assessed in brains of male Sprague-Dawley rats with streptozotocin-induced diabetes and compared with those in diabetic rats with increased expression of methylglyoxal-degrading enzyme glyoxalase-I (Glo-I) in cSMCs. KEY RESULTS After 7-8 weeks of T1D, endothelial cell-mediated vasodilatation of cerebral arterioles was impaired. Microvascular leakage, gliosis, macrophage/neutrophil infiltration, NF-κB activity and TNF-α levels were increased, and density of perfused microvessels was reduced. Transient occlusion of a mid-cerebral artery exacerbated ischaemia-reperfusion injury. In cSMCs, Glo-I protein was decreased, and the methylglyoxal-synthesizing enzyme, vascular adhesion protein 1 (VAP-1) and methylglyoxal were increased. Restoring Glo-I protein in cSMCs of diabetic rats to control levels via gene transfer, blunted VAP-1 and methylglyoxal increases, cECs dysfunction, microvascular leakage, inflammation, ischaemia-reperfusion injury and increased microvessel perfusion. CONCLUSIONS AND IMPLICATIONS Methylglyoxal generated by cSMCs induced cECs dysfunction, inflammation, hypoxia and exaggerated ischaemia-reperfusion injury in diabetic rats. Lowering methylglyoxal produced by cSMCs may be a viable therapeutic strategy to preserve cECs function and blunt deleterious downstream consequences in T1D.
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Affiliation(s)
- Fadhel Alomar
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNEUSA
- Department of PharmacologyUniversity of DammamDammamSaudi Arabia
| | - Jaipaul Singh
- School of Forensic and Applied ScienceUniversity of Central LancashirePrestonUK
| | - Hee‐Seong Jang
- Department of Cellular and Integrative PhysiologyUniversity of Nebraska Medical CenterOmahaNEUSA
| | - George J Rozanzki
- Department of Cellular and Integrative PhysiologyUniversity of Nebraska Medical CenterOmahaNEUSA
- Nebraska Redox Biology CenterLincolnNEUSA
| | - Chun Hong Shao
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Babu J Padanilam
- Department of Cellular and Integrative PhysiologyUniversity of Nebraska Medical CenterOmahaNEUSA
| | - William G Mayhan
- Department of Basic Biomedical Sciences, Sanford School of MedicineUniversity of South DakotaVermillionSDUSA
| | - Keshore R Bidasee
- Department of Pharmacology and Experimental NeuroscienceUniversity of Nebraska Medical CenterOmahaNEUSA
- Department of Environmental, Agricultural and Occupational HealthUniversity of Nebraska Medical CenterOmahaNEUSA
- Nebraska Redox Biology CenterLincolnNEUSA
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Enderby P, Pandyan A, Bowen A, Hearnden D, Ashburn A, Conroy P, Logan P, Thompson C, Winter J. Accessing rehabilitation after stroke – a guessing game? Disabil Rehabil 2016; 39:709-713. [DOI: 10.3109/09638288.2016.1160448] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Pam Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anand Pandyan
- Institute for Science and Technology in Medicine & School of Health and Rehabilitation, Keele University, Keele, UK
| | - Audrey Bowen
- Stroke Research, MAHSC, University of Manchester, Salford, UK
| | - David Hearnden
- Dudley MBC Adult Care, Dudley Social Services, Dudley, UK
| | - Ann Ashburn
- Faculty of Health Science, University of Southampton, Southampton, UK
| | - Paul Conroy
- Stroke Research, MAHSC, University of Manchester, Salford, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Carl Thompson
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jacqueline Winter
- Institute for Science and Technology in Medicine & School of Health and Rehabilitation, Keele University, Keele, UK
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Cohen LK, Jensen MB. Scaffolds for Intracerebral Grafting of Neural Progenitor Cells After Cerebral Infarction: A Systematic Review. ARCHIVES OF NEUROSCIENCE 2015; 2:e25364. [PMID: 26835472 PMCID: PMC4731043 DOI: 10.5812/archneurosci.25364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Context Intracerebral grafting of neural progenitor cells is a promising potential treatment to improve recovery after stroke, but the structural disruption and cavitation of brain tissue that occurs creates an unfavorable environment for graft cell survival. To overcome this obstacle, scaffold materials have been used as extracellular matrix to provide structural support for the transplanted cells. Many materials could potentially be used as scaffolds for this application. Evidence Acquisition We performed a systematic review to determine the available evidence supporting specific scaffolds for neural progenitor cell grafting after stroke. Articles were identified with a MeSH search on PubMed. Relevant references and “related articles” of selected manuscripts were also reviewed. Full original articles published prior to May 2013 presenting unique experimental data describing intracerebral grafting of neural progenitor cells in a scaffold after cerebral infarction were included in our study. All selected articles were reviewed thoroughly by the authors for relevant data. Results We found reports of use of scaffolds composed of polyglycolic acid, poly [lactic-co-glycolic acid] particles (with and without VEGF), hyaluronan-heparin-collagen hydrogel, Matrigel, collagen and extracellular matrix derived from porcine brain and urinary bladder. While multiple beneficial effects were reported, the optimal scaffold is unclear as we found no direct comparisons. Conclusions We conclude that multiple scaffolds appear promising for neural progenitor cell grafting after stroke, but further research is needed to optimize this neurorestorative approach. Thus, we hope to provide a basic understanding of the state of scaffolds for neural progenitor cell grafting after stroke and to encourage further research. Based on the methods of the discussed studies, we propose a standardized set of outcomes that would best be used to evaluate and compare the effectiveness of a given scaffold.
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Affiliation(s)
- Laura K Cohen
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Matthew B Jensen
- Department of Neurology, University of Wisconsin, Madison, USA
- Corresponding author: Matthew B Jensen, Department of Neurology, University of Wisconsin, Madison, USA. Tel: +608-2654351, Fax: +608-2630412,
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Chow JW, Stokic DS. Variability, frequency composition, and complexity of submaximal isometric knee extension force from subacute to chronic stroke. Neuroscience 2014; 273:189-98. [PMID: 24840274 DOI: 10.1016/j.neuroscience.2014.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/09/2014] [Accepted: 05/10/2014] [Indexed: 11/27/2022]
Abstract
We examined changes in the variability, frequency composition, and complexity of force signal from subacute to chronic stage of stroke during maintenance of isometric knee extension and compared these parameters between chronic stroke and healthy subjects. The sample included 15 healthy (65±8 years) and 23 chronic stroke subjects (65±14 years, 6-112 months post-stroke) of whom 10 (64±15 years) were also examined 11-22 days post-stroke (subacute stage). The subjects performed isometric knee extension at 10%, 20%, 30%, and 50% of peak torque for 10s (two trials each). Coefficient of variation (CV) was used as a measure of force variability. The median frequency and relative power in the 0-3, 4-6, and 8-12 Hz bands were obtained through a power spectrum analysis of the force signal. The signal complexity was quantified using the sample entropy (SampEn). The longitudinal analysis revealed a significant decrease in CV from subacute to chronic stage across all contraction levels (P<0.001) but no significant changes in the frequency and entropy parameters. Comparison between the chronic stroke and control subjects revealed no significant difference in CV across the force levels (P>0.05) but significantly decreased median frequency (P<0.01), with the relative power increased in 0-3 Hz band and decreased in 4-6 and 8-12 Hz bands in both paretic and non-paretic legs (P<0.001). SampEn was also significantly decreased in chronic stroke, bilaterally (P<0.001). These results indicate a shift toward lower frequencies and a less complex physiological process underlying force control in chronic stroke. The overall results suggest the improvement in force variability from subacute to chronic stroke but without normalization in the frequency composition and complexity of the force signal. Thus, disordered structure of the force signal remains a marker of impaired motor control long after stroke occurrence despite apparent recovery in force variability.
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Affiliation(s)
- J W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA.
| | - D S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA
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Kim SJ, Moon GJ, Chang WH, Kim YH, Bang OY. Intravenous transplantation of mesenchymal stem cells preconditioned with early phase stroke serum: current evidence and study protocol for a randomized trial. Trials 2013; 14:317. [PMID: 24083670 PMCID: PMC4016561 DOI: 10.1186/1745-6215-14-317] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 09/12/2013] [Indexed: 12/19/2022] Open
Abstract
Background Recovery after a major stroke is usually limited, but cell therapy for patients with fixed neurologic deficits is emerging. Several recent clinical trials have investigated mesenchymal stem cell (MSC) therapy for patients with ischemic stroke. We previously reported the results of a controlled trial on the application of autologous MSCs in patients with ischemic stroke with a long-term follow-up of up to 5 years (the 'STem cell Application Researches and Trials In NeuroloGy’ (STARTING) study). The results from this pilot trial are challenging, but also raise important issues. In addition, there have been recent efforts to improve the safety and efficacy of MSC therapy for stroke. Methods and design The clinical and preclinical background and the STARTING-2 study protocol are provided. The trial is a prospective, randomized, open-label, blinded-endpoint (PROBE) clinical trial. Both acute and chronic stroke patients will be selected based on clinical and radiological features and followed for 3 months after MSC treatment. The subjects will be randomized into one of two groups: (A) a MSC group (n = 40) or (B) a control group (n = 20). Autologous MSCs will be intravenously administered after ex vivo culture expansion with autologous ischemic serum obtained as early as possible, to enhance the therapeutic efficacy (ischemic preconditioning). Objective outcome measurements will be performed using multimodal MRI and detailed functional assessments by blinded observers. Discussion This trial is the first to evaluate the efficacy of MSCs in patients with ischemic stroke. The results may provide better evidence for the effectiveness of MSC therapy in patients with ischemic stroke. Trial registration This trial was registered with ClinicalTrials.gov, number NCT01716481.
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Affiliation(s)
- Suk Jae Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, 135-710, Gangnam-gu, Seoul, South Korea.
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Chen L, Xi H, Huang H, Zhang F, Liu Y, Chen D, Xiao J. Multiple cell transplantation based on an intraparenchymal approach for patients with chronic phase stroke. Cell Transplant 2013; 22 Suppl 1:S83-91. [PMID: 23992950 DOI: 10.3727/096368913x672154] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Stroke is the third leading cause of death worldwide and a huge perpetrator in adult disability. This pilot clinical study investigates the possible benefits of transplanting multiple cells in chronic stroke. A total of 10 consecutive stroke patients were treated by combination cell transplantation on the basis of an intraparenchymal approach from November 2003 to April 2011. There were six males and four females. Their age ranged from 42 to 87 years, and the course of disease varied from 6 months to 20 years. Six patients suffered cerebral infarction, and four patients suffered a brain hemorrhage. The olfactory ensheathing cells, neural progenitor cells, umbilical cord mesenchymal cells, and Schwann cells were injected through selected routes including intracranial parenchymal implantation, intrathecal implantation, and intravenous administration, respectively. The clinical neurological function was assessed carefully and independently before treatment and during a long-term follow-up using the Clinic Neurologic Impairment Scale and the Barthel index. All patients were followed up successfully from 6 months to 2 years after cell transplantation. Every subject achieved neurological function amelioration including improved speech, muscle strength, muscular tension, balance, pain, and breathing; most patients had an increased Barthel index score and Clinic Neurologic Impairment Scale score. These preliminary results demonstrate the novel strategy of combined multiple cell therapy based on intraparenchymal delivery: it appears to be relatively clinically safe and at least initially beneficial for chronic stroke patients. This manuscript is published as part of the International Association of Neurorestoratology (IANR) supplement issue of Cell Transplantation.
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Zawadzka E, Domańska Ł. Assessment of select dimensions of patients' emotional functioning at different time periods after stroke. APPLIED NEUROPSYCHOLOGY. ADULT 2013; 21:87-93. [PMID: 24826501 DOI: 10.1080/09084282.2012.747959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A person's self-evaluation influences purposeful activity undertaken in the situation of illness. It is observed in neurological patients that limited self-awareness disturbs rehabilitation. The goal of the study was to investigate select dimensions of emotional state, the relationship between anxiety and emotional state, and the level of insight into emotional state in patients at different time periods after cerebral vascular accidents (CVAs). Sixty-five patients with short (n = 36) or long (n = 29) time periods following a stroke participated in this study. The patients' relatives (n = 65) evaluated their emotional functioning. The modified Neuropsychology Behavior and Affect Profile (NBAP; Nelson, Satz, & D'Elia, 1994 ) and State and Trait Anxiety Inventory were administered. Compared groups differed significantly in self-reporting and in relatives' reports on the NBAP scales. Patients with short and long time periods after stroke did not differ in terms of mania, indifference, depression, or inappropriateness. Significant positive moderate correlations between anxiety and depression were found in both groups. In the group with a long time period after CVA, ratings of depression, mania, indifference, and inappropriateness among patients with right-hemisphere damage were significantly correlated with their relatives' ratings. Biological and psychological factors determining emotional state and adequacy of patients' self-evaluations have also been discussed.
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Affiliation(s)
- Ewa Zawadzka
- a Psychology Institute, Maria Curie-Skłodowska University , Lublin , Poland
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Abstract
Acute ischemic stroke causes a disturbance of neuronal circuitry and disruption of the blood-brain barrier that can lead to functional disabilities. At present, thrombolytic therapy inducing recanalization of the occluded vessels in the cerebral infarcted area is a commonly used therapeutic strategy. However, only a minority of patients have timely access to this kind of therapy. Recently, neural stem cells (NSCs) as therapy for stroke have been developed in preclinical studies. NSCs are harbored in the subventricular zone (SVZ) as well as the subgranular zone of the brain. The microenvironment in the SVZ, including intercellular interactions, extracellular matrix proteins, and soluble factors, can promote NSC proliferation, self-renewal, and multipotency. Endogenous neurogenesis responds to insults of ischemic stroke supporting the existence of remarkable plasticity in the mammalian brain. Homing and integration of NSCs to the sites of damaged brain tissue are complex morphological and physiological processes. This review provides an update on current preclinical cell therapies for stroke, focusing on neurogenesis in the SVZ and dentate gyrus and on recruitment cues that promote NSC homing and integration to the site of the damaged brain.
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Affiliation(s)
- Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, ROC
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Mirbagheri MM, Niu X, Varoqui D. Prediction of stroke motor recovery using reflex stiffness measures at one month. IEEE Trans Neural Syst Rehabil Eng 2012; 20:762-70. [PMID: 22868634 DOI: 10.1109/tnsre.2012.2205943] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study characterizes the recovery patterns of motor impairment after stroke, and uses neuromuscular measures of the elbow joint at one month after the event to predict the ensuing recovery patterns over 12 months. Motor impairment was assessed using the Fugl-Meyer Assessment (FMA) of the upper extremity at various intervals after stroke. A parallel-cascade system identification technique characterized the intrinsic and reflex stiffness at various elbow angles. We then used "growth-mixture" modeling to identify three distinct recovery classes for FMA. While class 1 and class 3 subjects both started with low FMA, those in class 1 increased FMA significantly over 12-month recovery period, whereas those in class 3 presented no improvement. Class 2 subjects started with high FMA and also exhibited significant FMA improvement, but over a smaller range and at a slower recovery rate than class 1. Our results showed that the one-month reflex stiffness was able to distinguish between classes 1 and 3 even though both showed similarly low month-1 FMA. These findings demonstrate that, using reflex stiffness, we were able to accurately predict arm function recovery in stroke subjects over one year and beyond. This information is clinically significant and can be helpful in developing targeted therapeutic interventions.
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Affiliation(s)
- Mehdi M Mirbagheri
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611 USA.
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14
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Abstract
We reviewed the literature on walking recovery of stroke patients as it relates to the following subjects:epidemiology of walking dysfunction, recovery course of walking, and recovery mechanism of walking (neural control of normal walking, the evaluation methods for leg motor function, and motor recovery mechanism of leg).The recovery of walking is one of the primary goals in stroke patients, along with the recovery of hand function and cognition. Walking function has greater potential for recovery than hand function because motor function of the leg is less dependent on the lateral corticospinal tract than that of hand function. This suggests that detailed knowledge of walking can be used to increase the likelihood that stroke patients recover their ability to walk. Therefore, we suggest that further research should focus on these topics, especially, on the neural control mechanism of walking and motor recovery mechanisms of the leg in stroke patients.
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Sinden JD. Stem cells for stroke: translating animal models into clinical treatment. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.11.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- John D Sinden
- ReNeuron Limited, 10 Nugent Road, Guildford, Surrey GU2 7AF, UK
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16
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Anderson JFI, Augoustakis LV, Holmes RJ, Chambers BR. End-of-life decision-making in individuals with locked-in syndrome in the acute period after brainstem stroke. Intern Med J 2011; 40:61-5. [PMID: 19323701 DOI: 10.1111/j.1445-5994.2009.01957.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Locked-in syndrome (LIS) is commonly associated with a poor prognosis, particularly if the aetiology is stroke. Dealing with individuals with LIS and a poor prognosis raises the issue of introducing end-of-life discussions with the patient and/or family in the acute period of the illness. Existing literature regarding LIS provides little guidance about end-of-life decision-making in the acute management phase. We aim to provide some guidance for clinicians holding end-of-life discussions in the acute management period. We report two cases of relatively young individuals with LIS secondary to brainstem stroke. Both cases had a very poor prognosis and end-of-life discussions were commenced by the treating team in the acute phase. Despite the severity of their conditions, in neither case were end-of-life discussions well tolerated by the family in the weeks following admission. We suggest that LIS patients and their families, who have chosen to persist with full medical management after diagnosis of LIS, should be provided with sufficient time to adjust to the catastrophic changes that have occurred before further end-of-life discussions are pursued. Education and support are likely to be highly beneficial in the acute period post stroke as they allow the patient and family to develop a realistic understanding of the likely outcomes of their decisions.
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Affiliation(s)
- J F I Anderson
- Department of Psychology, University of Melbourne, Melbourne, Victoria, Australia.
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Meregalli M, Farini A, Parolini D, Maciotta S, Torrente Y. Stem cell therapies to treat muscular dystrophy: progress to date. BioDrugs 2010; 24:237-47. [PMID: 20623990 DOI: 10.2165/11534300-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Muscular dystrophies are heritable, heterogeneous neuromuscular disorders and include Duchenne and Becker muscular dystrophies (DMD and BMD, respectively). DMD patients exhibit progressive muscle weakness and atrophy followed by exhaustion of muscular regenerative capacity, fibrosis, and eventually disruption of the muscle tissue architecture. In-frame mutations in the dystrophin gene lead to expression of a partially functional protein, resulting in the milder BMD. No effective therapies are available at present. Cell-based therapies have been attempted in an effort to promote muscle regeneration, with the hope that the host cells would repopulate the muscle and improve muscle function and pathology. Injection of adult myoblasts has led to the development of new muscle fibers, but several limitations have been identified, such as poor cell survival and limited migratory ability. As an alternative to myoblasts, stem cells were considered preferable for therapeutic applications because of their capacity for self-renewal and differentiation potential. In recent years, encouraging results have been obtained with adult stem cells to treat human diseases such as leukemia, Parkinson's disease, stroke, and muscular dystrophies. Embryonic stem cells (ESCs) can be derived from mammalian embryos in the blastocyst stage, and because they can differentiate into a wide range of specialized cells, they hold potential for use in treating almost all human diseases. Several ongoing studies focus on this possibility, evaluating differentiation of specific cell lines from human ESCs (hESCs) as well as the potential tumorigenicity of hESCs. The most important limitation with using hESCs is that it requires destruction of human blastocysts or embryos. Conversely, adult stem cells have been identified in various tissues, where they serve to maintain, generate, and replace terminally differentiated cells within their specific tissue as the need arises for cell turnover or from tissue injury. Moreover, these cells can participate in regeneration of more than just their specific tissue type. Here we describe multiple types of muscle- and fetal-derived myogenic stem cells, their characterization, and their possible use in treating muscular dystrophies such as DMD and BMD. We also emphasize that the most promising possibility for the management and therapy of DMD and BMD is a combination of different approaches, such as gene and stem cell therapy.
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Affiliation(s)
- Mirella Meregalli
- Stem Cell Laboratory, Dipartimento di Scienze Neurologiche, Centro Dino Ferrari, Università di Milano, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Abstract
Stroke is a leading cause of death and disability in adults. Recovery after stroke is usually limited as there is no definite therapy to restore lost brain function. Cell therapy is an emerging paradigm in stroke therapy for patients with fixed neurologic deficits. Cell therapy for stroke may be greatly different from cell therapy for other disease conditions; the complexity of central nervous system structures and functions may limit its effectiveness. Recently, there have been several clinical trials of cell therapy for patients with ischemic stroke. In this review, the current status and limitations of cell therapy for stroke will be discussed. In addition, recent efforts and perspectives to improve therapeutic efficacy and safety of cell therapy will be summarized.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Brain and Nerve Center, Samsung Medical Center, Seoul, Korea
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Time-Course of Changes in Arm Impairment After Stroke: Variables Predicting Motor Recovery Over 12 Months. Arch Phys Med Rehabil 2008; 89:1507-13. [DOI: 10.1016/j.apmr.2008.02.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 01/21/2008] [Accepted: 02/05/2008] [Indexed: 11/20/2022]
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Meregalli M, Farini A, Torrente Y. Combining stem cells and exon skipping strategy to treat muscular dystrophy. Expert Opin Biol Ther 2008; 8:1051-61. [DOI: 10.1517/14712598.8.8.1051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mirbagheri MM, Tsao CC, Rymer WZ. Changes of elbow kinematics and kinetics during 1 year after stroke. Muscle Nerve 2008; 37:387-95. [PMID: 18236457 DOI: 10.1002/mus.20965] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A precise description of the natural history of motor recovery after stroke provides a framework for understanding the mechanisms underlying this improvement and for tracking the efficacy of rehabilitation treatments. To characterize the time course of this change in motor impairment, we examined voluntary elbow movements in hemiparetic stroke survivors over a period of 1 year after stroke. Based on the possibility that both central nervous system and muscle factors could contribute to the observed clinical state, we hypothesized that we should observe at least two major recovery patterns of motor impairment. To explore these predictions, we assessed elbow movement range, movement speed, and isometric force generation. Subjects were examined five times over the 12-month period. We used the "growth mixture" model to characterize recovery of these measures, and the Fugl-Meyer scale (FMS) of upper-extremity function at 1 month to predict the recovery. We observed two distinct recovery classes. Class 1 started with low values for the physiological measures, and these increased over time, whereas class 2 tended to start with higher values and showed widely divergent recovery patterns. Using the logistic regression model, the impact of FMS on class membership was estimated for each parameter. Based on these data, we were able to accurately predict arm impairment recovery at different time-points in the first year, information of great potential value for planning targeted therapeutic interventions.
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Affiliation(s)
- Mehdi M Mirbagheri
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 East Superior Street, Suite 1408, Chicago, IL 60611, USA.
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Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. Effects of Electric Stimulation−Assisted Cycling Training in People With Chronic Stroke. Arch Phys Med Rehabil 2008; 89:463-9. [DOI: 10.1016/j.apmr.2007.09.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 09/03/2007] [Accepted: 09/05/2007] [Indexed: 11/25/2022]
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Hama A, Sagen J. Altered antinociceptive efficacy of tramadol over time in rats with painful peripheral neuropathy. Eur J Pharmacol 2006; 559:32-7. [PMID: 17207479 PMCID: PMC1994250 DOI: 10.1016/j.ejphar.2006.11.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 11/16/2006] [Accepted: 11/21/2006] [Indexed: 11/19/2022]
Abstract
Pain due to peripheral nerve injury or disease is a dynamic process, such that the mechanism that underlies it alters over time. Tramadol has been reported to be analgesic in clinical neuropathic pain, with varying levels of efficacy due to a patient population that has had neuropathic pain for a wide range of time. In order to address and examine the issue, the antinociceptive efficacy of tramadol over time was tested in rats with a chronic constriction injury (CCI) of the left sciatic nerve. Rats developed a robust hind paw hypersensitivity to innocuous mechanical stimulation ipsilateral to CCI surgery. Subcutaneous injection of tramadol in rats two weeks after CCI surgery dose-dependently attenuated mechanical hypersensitivity, which was abolished with the mu-opioid receptor antagonist naloxone but not the alpha(2)-adrenoceptor antagonist yohimbine. Systemic tramadol also attenuated mechanical hypersensitivity four weeks after CCI surgery, but the efficacy significantly diminished at this time point. In addition, the effect of tramadol at this later time point could be reduced with yohimbine as well as naloxone. These data demonstrate that the efficacy of tramadol depends in part on the duration of nerve injury-evoked nociception, and that its antinociceptive mechanism changes over time. Alteration in antinociceptive mechanism over time may explain the inconsistency in efficacy of this and other analgesic drugs in chronic pain patients.
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Affiliation(s)
- Aldric Hama
- University of Miami Miller School of Medicine, The Miami Project to Cure Paralysis, Miami, FL 33136, USA.
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24
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Snyder EY. Special issue: the intersection of stem/progenitor cell biology and hypoxic-ischemic cerebral injury/stroke. Exp Neurol 2006; 199:1-4. [PMID: 16798271 DOI: 10.1016/j.expneurol.2006.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
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25
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Affiliation(s)
- Lawrence M Brass
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520-8018, USA.
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26
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Pollock K, Stroemer P, Patel S, Stevanato L, Hope A, Miljan E, Dong Z, Hodges H, Price J, Sinden JD. A conditionally immortal clonal stem cell line from human cortical neuroepithelium for the treatment of ischemic stroke. Exp Neurol 2006; 199:143-55. [PMID: 16464451 DOI: 10.1016/j.expneurol.2005.12.011] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 12/05/2005] [Indexed: 01/19/2023]
Abstract
Transplantation of neural stem cells into the brain is a novel approach to the treatment of chronic stroke disability. For clinical application, safety and efficacy of defined, stable cell lines produced under GMP conditions are required. To this end, a human neural stem cell line, CTX0E03, was derived from human somatic stem cells following genetic modification with a conditional immortalizing gene, c-mycER(TAM). This transgene generates a fusion protein that stimulates cell proliferation in the presence of a synthetic drug 4-hydroxy-tamoxifen (4-OHT). The cell line is clonal, expands rapidly in culture (doubling time 50-60 h) and has a normal human karyotype (46 XY). In the absence of growth factors and 4-OHT, the cells undergo growth arrest and differentiate into neurons and astrocytes. Transplantation of CTX0E03 in a rat model of stroke (MCAo) caused statistically significant improvements in both sensorimotor function and gross motor asymmetry at 6-12 weeks post-grafting. In addition, cell migration and long-term survival in vivo were not associated with significant cell proliferation. These data indicate that CTX0E03 has the appropriate biological and manufacturing characteristics necessary for development as a therapeutic cell line.
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Affiliation(s)
- Kenneth Pollock
- ReNeuron Ltd., 10 Nugent Road, Surrey Research Park, Guildford, Surrey GU2 7AF, UK
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