Olfactory (nasal) Mucosa Autografts:
In 2001, Australia reported that nasal mucosa transplantation to injured
spinal cords stimulates regeneration in rats after spinal cord injury.
Dr. Carlos Lima and his colleagues in Lisbon, Portugal, have
transplanted nasal muce recovering some
function. Unfortunately, to date, there has not been a publication of
the results so that we do not know what proportion of the people recover
function, to what extent, and for how long. It is also unclear to me how
many people have received this procedure but it is probably over 3
Adult Olfactory Ensheating Cell
• Dr. Mckay-Sims and his
colleagues in Brisbane, Australia, have managed to grow olfactory
ensheathing glia from the nasal mucosa of two patients and transplanted
these about 15 million of these cells into their spinal cords. The study
is still in its "double-blind" phase and we do not know whether there
has been recovery of function or not. In some ways, this is the most
desirable of all the options both from a scientific and clinical point
of view. The cells were grown from the nasal mucosa and have been
identified in culture as olfactory ensheathing glia. Because the cells
come from the same person, there should be less risk of immune rejection
of the cells.
Fetal Olfactory Ensheathing Glial Transplants:
• The cells
are injected into the spinal cord above and below the injury
site without cutting or removing part of the spinal cord.
cells are obtained from aborted fetuses and therefore are not
genetically matched to the person receiving it. Although there is some
evidence suggesting that fetal tissues are not rejected as adult
tissues, it is likely that these transplants will be rejected from the
spinal cord at some point, perhaps 3-4 months after transplantation.
• In Beijing, Dr. Hongyun Huang is transplanting fetal olfactory
ensheathing glia into the spinal cord of people who are 1-32 years after
injury. Over 500 people with spinal cord injury and perhaps
another 200 people with other conditions (such as ALS and
MS) have received these transplants. Reports of earlier
results in the first 171 patients that received such
transplants indicate an average of 4-8 dermatomes of sensory
recovery and 1-2 motor levels of improvement. To
my knowledge, there has been three mortalities in the series, all in
people more than 3 months after surgery and from unrelated causes.
• Animal studies suggest that
olfactory ensheathing glia will migrate from the injection site into the
injury site and surrounding cord, change the environment of the injury
site, and promote regeneration of axons. Unfortunately, only about 10%
of the patients who have been transplanted week hospitalization.
Bone Marrow Stem Cell
• Dr. Tarcisio Barros at the University of Sao Paulo in
Brazil has transplanted bone marrow mesenchymal
cells into the spinal cord of about 30 patients with chronic spinal cord
injury. Some evidence from animal studies indicate that bone marrow
cells and that these cells can be persuaded to produce neurons in
culture. The cells were apparently injected through the vascular system
into the blood vessels of the spinal cord. Dr. Barros has reported some
initial promising results in terms of somatosensory evoked potential
improvement in the patients. It is not clear how much motor improvement
the patients are getting. Because the cells are auto grafts, they are
not likely to be rejected.
• Dr. Zhang at the Henan People's Provincial Hospital in
Zhengzhou, China said that he has transplanted bone marrow
cells to dozens of people with spinal cord injury. The results are not
clear but they are looking for ways to improve the results. In January
2005, they have transplanted bone marrow
cells into over 180 patients with strokes and spinal cord injury. They
grow the cells, sort them for those that are CD-43 positive, and then
transplant them into the spinal cord.
• There is a group of surgeons in Nanjing (China) that have
transplanted bone marrow
cells into 90 patients with amyotrophic lateral sclerosis (ALS). These
cells were apparently directly transplanted into the brain and spinal
• There are also several reports of bone marrow
transplants being used in Italy to treat patients with amyotrophic
Fetal Olfactory Ensheathing Glia and Neural Stem Cell
Dr. Samuiel Rabinovich and
his colleagues in Novosibirsk have transplanted a mixture of olfactory
ensheathing glia and neural
cells into the spinal cord of patients with chronic injuries. These
cells are apparently cultured from olfactory bulbs obtained from aborted
fetuses. They report improvements in motor and sensory function in the
patients. These results were published recently. It is not clear what
cells were being injected.
Fetal Spinal Cord Transplants:
In the United States (Russia and Sweden as well), probably over 200
patients have received various fetal spinal cord transplants into the
injury site. The results have been published in a few papers but most of
the studies suggest modest recovery of function.
Adult Schwann Cell
transplanted Schwann cells grown from peripheral nerves into two
patients with multiple sclerosis. Dr. Volmer has moved to Barrows
Neurological Institute in Phoenix, Arizona. A recent email suggested
that he has finally re-organized his team and will be starting his
clinical trials again. The trial at Yale University was funded by the
Fetal Schwann Cell
China, neurosurgeons there have transplanted
fetal Schwann cells from aborted fetuses
into about 90 patients with chronic spinal
cord injury. They are reporting some
improvement in function although there is
some skepticism by visiting clinicians that
these improvements are due to the
transplants or to decompressive surgery.
Porcine Fetal Neural
At the Washington
University in St. Louis and Albany Medical Center, 10 patients have
received transplants of neural
cells obtained from fetal pig brains. This was in a clinical trial
sponsored by Diacrin. The cells are apparently grown from pig brain,
treated with antibodies to reduce the likelihood of immune rejection,
and then transplanted into the spinal cord. The results of this trial
have not yet been reported.
Human Fetal Neural
I have met several doctors
in China (Beijing and Guangzhou) who have grown human fetal neural
cells from aborted fetuses and transplanted these into the spinal cords
of people with acute or chronic spinal cord injury. Apparently, these
patients have not gotten much recovery and most of these centers are no
longer transplanting these cells.
Adult Activated Macrophage Auto-Grafts:
The company Proneuron carried out two phase 1 trials in Israel and in
Europe in patients that are within 2-3 weeks after spinal cord injury.
The cells were obtained from the blood of the patients, cultured and
activated on skin, and then transplanted into the spinal cord exposed by
laminectomy. This trial has started in the United States at three
centers: Craig Hospital in Denver, Kessler Rehabilitation Institute in
New Jersey, and Mt. Sinai Hospital in New York.
Adult Peripheral Nerve Auto-Grafts:
• Dr. Carl Kao, a neurosurgeon who operates in Quito,
Ecuador, has transplanted peripheral nerves of about 600 patients over
the past 10-15 years. He also places omentum on the spinal cord which
apparently is causing epidural cyst formations in some patients. The
peripheral nerves should contain Schwann cells.
• Dr. Henreich Cheng, a neurosurgeon in Taiwan, has used
peripheral nerves to bridge transected spinal cords and treated with
several growth factors including basic fibroblast growth factor. In
1995, he published a widely recognized paper with Lars Olson, reporting
that axons will grow across the transection site and restore function.
Since returning to Taiwan, he has apparently carried out this procedure
in some patients. He has not yet published the results.
Activated Macrophage Autografts:
• In 1998, Michal Schwartz reported that activated macrophages improves
neurological recovery of rats after spinal cord injury.
company called Proneuron initiated a phase 1 clinical trial to assess
in patients within 3 weeks after injury. Melissa Holly was the first
patient to undergo this therapy about 3 years ago. She showed
substantial improvement. Perhaps a quarter of the patients who received
showed improvement. A new phase 2 clinical trial is about ready to start.
• The omentum is a part of the vascular tissue
that surrounds the stomach and intestines. It's job is too carry blood
to and food from the gut.
• In the 1980's, Dr. Harry Goldsmith began transposing omentum to the
spinal cord of animals. Dr. Goldsmith and colleagues transferred the omentum to many patients over the past two decades.
In addition, Dr.
Carl Kao does omentum transplant.
Umbilical Cord Blood Transplants:
• There was a news report from Korea of a woman who recovered motor
function after having received an umbilical cord blood
transplant. The cells came from an umbilical cord blood bank, matched
with the recipient, and then cultured to select for certain cells. The
results have not yet been published.
• There are persistent news reports
that Biomark International, a company that was shut down by the FDA and
has now moved to London, has infused umbilical cord blood cells into
hundreds of patients, some of whom may have spinal cord injury.
are also reports that of umbilical cord blood
transplants being done in Mexico.
Young, Wise. "A summary of cell-based
therapies being tried now in people with spinal cord injury around the
world ." CareCure Community. 16 July 2004. Web. 20 April 2007.