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Stem Cell Therapy in Neuroimmunological Diseases and Its Potential Neuroimmunological Complications. Cells 2022; 11:cells11142165. [PMID: 35883607 PMCID: PMC9318423 DOI: 10.3390/cells11142165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Since the 1990s, transplantations of hematopoietic and mesenchymal stem cells (HSCT and MSCT) and dendritic cell (DCT) have been investigated for the treatment of neurological autoimmune disorders (NADs). With the growing number of transplanted patients, awareness of neuroimmunolgical complications has increased. Therefore, an overview of SCT for the most common NADs and reports of secondary immunity after SCT is provided. Methods: For this narrative review, a literature search of the PubMed database was performed. A total of 86 articles reporting on different SCTs in NADs and 61 articles dealing with immune-mediated neurological complications after SCT were included. For multiple sclerosis (MS), only registered trials and phase I/II or II studies were considered, whereas all available articles on other disorders were included. The different transplantation procedures and efficacy and safety data are presented. Results: In MS patients, beneficial effects of HSCT, MSCT, and DCT with a decrease in disability and stabilization of disease activity have been reported. These effects were also shown in other NADs mainly in case reports. In seven of 132 reported patients with immune-mediated neurological complications, the outcome was fatal. Conclusions: Phase III trials are ongoing for MS, but the role of SCT in other NADs is currently limited to refractory patients due to occasional serious complications.
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Safety and Feasibility of Repeated Intrathecal Allogeneic Bone Marrow-Derived Mesenchymal Stromal Cells in Patients with Neurological Diseases. Stem Cells Int 2019; 2019:8421281. [PMID: 31428161 PMCID: PMC6683773 DOI: 10.1155/2019/8421281] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/10/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) have become the most commonly used adult stem cells in regenerative medicine. Preclinical studies have shown that MSCs-based therapy is a potential new treatment approach for neurological diseases. Intrathecal injection has unique feature which allows stem cells to directly migrate to the lesion site in patients with central nervous system (CNS) diseases. In this study, we evaluate the safety and feasibility of intrathecal allogeneic bone marrow-derived MSCs (BM-MSCs) in patients with neurological diseases. This open-label clinical study included 37 patients (14 diseases). Eligible patients underwent a baseline assessment and were intrathecally injected with allogeneic BM-MSCs (1 × 106 cells/kg, 4 consecutive treatments at 1-week intervals). After four infusions, the patients were followed up for at least 6 months. Adverse events, cerebrospinal fluid (CSF) test results, clinical symptoms, physical examination, and haematological and imaging examinations were used to assess the safety and feasibility of the treatment. Also, we performed a systematic review of the safety of all types of intrathecal stem cells and compared our result to previous studies. In our study, the highest adverse event was a slight ache at the injection site (4.11%), followed by fever (3.42%) and mild headache (2.05%). No severe adverse events were reported. After the intrathecal injections, the white blood cell (WBC) counts in the CSF increased in 30 patients and the protein concentration in the CSF exceeded the normal range in 26 patients, while other CSF indicators remained normal. Moreover, these patients had no suspected manifestations of CNS infection. Haematological and imaging examinations showed no abnormal changes after BM-MSCs infusion. Compared with previous studies, the incidence of adverse events was nearly consistent or even lower for headache, fever, nausea, and neck pain. In conclusion, repeated intrathecal allogeneic BM-MSCs are safe, feasible, and promising for the treatment of patients with neurological diseases.
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Zakerinia M, Kamgarpour A, Nemati H, Zare HR, Ghasemfar M, Rezvani AR, Karimi M, Nourani Khojasteh H, Dehghani M, Vojdani R, Haghighat S, Namdari N, Rekabpoor J, Tavazo M, Amirghofran S, Amirghofran Z, Yosefipour GA, Ramzi M. Intrathecal Autologous Bone Marrow-Derived Hematopoietic Stem Cell Therapy in Neurological Diseases. Int J Organ Transplant Med 2018; 9:157-167. [PMID: 30863518 PMCID: PMC6409093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cellular transplantation is a promising treatment strategy for neurological diseases. OBJECTIVE To report the results of intrathecal hematopoietic stem cell therapy in different neurological diseases in the past 6 years in a single center. METHODS From October 2011 to September 2018, 220 patients with various neurological diseases were transplanted intrathecally by their bone marrow stem cells. To have a longer follow up, we only reported the first 80 patients, transplanted up to July 2015-10 patients had spinal cord injuries and paralysis, 12 had advanced Parkinson's disease, 28 had cerebral palsy, 7 had hypoxic brain damage, 2 had autism, 4 had multiple sclerosis, 5 had progressive cerebellar atrophy, and 12 had other neurological diseases. The patients were admitted to the Bone Marrow Transplant Unit. On the first day, 50-200 (median 100) mL bone marrow was aspirated from the patients' posterior iliac crests, mixed with 120 mL culture media (RPMI), and 12 mL heparin. The samples were then transferred to immunology lab in cold box. Mononuclear cells (MNCs) were separated by a Ficoll-Hypaque gradient, washed, and suspended in ringers. Cell viability was assessed with trypan blue viability test. Transplantation was performed 3-4 hours after bone marrow collection. 5-10 mL of the cerebrospinal fluids were aspirated and about 20 mL MNCs (containing stem cells) in ringers were injected intrathecally (IT). The patients were laid down on their back for 4-5 hours. The median number of MNCs was 4×107 (range 1-450×107). The median viability of the cells was 90% (range 60%-98%). The patients received intravenous ceftriaxone every 12 hours and were discharged from the hospital few days after autologous stem cell therapy. RESULTS We noted clinical improvements in 9 of 12 patients with Parkinson's disease, 20 of 28 patients with cerebral palsy, 6 of 7 patients with hypoxic brain damage, 2 of 4 patients with multiple sclerosis, and 4 of 5 patients with cerebellar atrophy. The improvements were noted after 2-4 weeks of cell therapy. There were no improvements in patients with spinal cord injury and complete paralysis and those with autism. There were variable improvements in other patients treated. CONCLUSION Most patients with advanced Parkinson's disease, cerebral palsy, hypoxic brain damage, progressive cerebellar atrophy, and kernicterus neuropathy reported clinical effects of this safe intervention resulting in better functioning and an increased quality of life.
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Affiliation(s)
- M. Zakerinia
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Maryam Zakerinia, MD, Professor of Internal Medicine, Hematologist-Oncologist, Hematology Research Center, Department of Internal Medicine, School of Medicine, Shiraz. University of Medical Sciences, Shiraz, Iran Tel: +98-71-3647-4301, E-mail:
| | - A. Kamgarpour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Nemati
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. R. Zare
- Department of Immunology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ghasemfar
- Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A. R. Rezvani
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Karimi
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Nourani Khojasteh
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Dehghani
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R. Vojdani
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Haghighat
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N. Namdari
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - J. Rekabpoor
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Tavazo
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Amirghofran
- The International Branch, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z. Amirghofran
- Department of Immunology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - G. A. Yosefipour
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ramzi
- Bone Marrow Transplant Unit, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gharibi T, Ahmadi M, Seyfizadeh N, Jadidi-Niaragh F, Yousefi M. Immunomodulatory characteristics of mesenchymal stem cells and their role in the treatment of multiple sclerosis. Cell Immunol 2015; 293:113-21. [PMID: 25596473 DOI: 10.1016/j.cellimm.2015.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/31/2014] [Accepted: 01/02/2015] [Indexed: 12/12/2022]
Abstract
Multiple Sclerosis (MS) is a chronic inflammatory neurodegenerative disease of central nervous system (CNS). Although the main cause of MS is not clear, studies suggest that MS is an autoimmune disease which attacks myelin sheath of neurons. There are different therapeutic regimens for MS patients including interferon (IFN)-β, glatiramer acetate (GA), and natalizumab. However, such therapies are not quite effective and are associated with some side effects. So which, there is no complete therapeutic method for MS patients. Regarding the potent immunomodulatory effects of mesenchymal stem cells (MSCs) and their ameliorative effects in experimental autoimmune encephalopathy (EAE), it seems that MSCs may be a new therapeutic method in MS therapy. MSC transplantation is an approach to regulate the immune system in the region of CNS lesions. In this review, we have tried to discuss about the immunomodulatory properties of MSCs and their therapeutic mechanisms in MS patients.
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Affiliation(s)
- Tohid Gharibi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Ahmadi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Seyfizadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Jadidi-Niaragh
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yousefi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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