A Randomized, Placebo-Controlled Trial of Human Umbilical Cord Blood Mesenchymal Stem Cell Infusion for Children With Cerebral Palsy

Li Huang, Che Zhang, Jiaowei Gu, Wei Wu, Zhujun Shen, Xihui Zhou, Haixia Lu, Li Huang, Che Zhang, Jiaowei Gu, Wei Wu, Zhujun Shen, Xihui Zhou, Haixia Lu

Abstract

Cerebral palsy (CP) is a common disability which results in permanent chronic motor disability appearing in early childhood. Recently human umbilical cord blood mesenchymal stem cell (hUCB-MSC) infusion has emerged as a promising therapeutic strategy for CP, and the treatment efficacy remains to be confirmed by clinical trials. All 54 patients received basic rehabilitation as a background treatment. The infusion group comprising 27 patients received 4 infusions of hUCB-MSCs (intravenous infusions at a fixed dose of 5 × 107) and basic rehabilitation treatment, whereas 27 patients in the control group received 0.9% normal saline and basic rehabilitation treatment. Several indices were tested from baseline up to 24 months posttreatment regarding efficacy and safety evaluations, including the gross motor function measurement 88 (GMFM-88) scores, the comprehensive function assessment (CFA), lab tests, electroencephalogram (EEG), routine magnetic resonance imaging (MRI), and adverse events. The changes in the total proportion of GMFM-88 and total scores of CFA in the hUCB-MSC infusion group were significantly higher than that in control group at 3, 6, 12, 24 months posttreatment. Less diffuse slow waves were noticed after hUCB-MSC infusion in patients with slowing of EEG background rhythms at baseline. Based on the routine MRI exams, improvements in cerebral structures were rare after treatment. Serious adverse events were not observed during the whole study period. The results of the study indicated that hUCB-MSC infusion with basic rehabilitation was safe and effective in improving gross motor and comprehensive functions in children with CP.

Keywords: cerebral palsy; clinical trial; human umbilical cord blood mesenchymal stem cells.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The change in gross motor function measurement 88 (GMFM-88) total score proportion in 3, 6, 12, and 24 months posttreatment.
Figure 2.
Figure 2.
The change in gross motor function measurement 88 (GMFM-88) proportion in each function area at 3, 6, 12, and 24 months posttreatment.
Figure 3.
Figure 3.
The change in comprehensive functional assessment (CFA) total score in 3, 6, 12, and 24 months posttreatment.
Figure 4.
Figure 4.
The change in comprehensive functional assessment (CFA) score in each function area in 3, 6, 12, and 24 months posttreatment.

References

    1. Jones MW, Morgan E, Shelton JE, Thorogood C. Cerebral palsy: introduction and diagnosis (part I). J Pediatr Health Care. 2007;21(3):146–152.
    1. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol Suppl. 2007;109:8–14.
    1. Nelson KB, Blair E. Prenatal factors in singletons with cerebral palsy born at or near term. N Engl J Med. 2015;373(10):946–953.
    1. Pharoah PO, Cooke T, Cooke RW, Rosenbloom L. Birthweight specific trends in cerebral palsy. Arch Dis Child. 1990;65(6):602–606.
    1. Maclennan AH, Thompson SC, Gecz J. Cerebral palsy: causes, pathways, and the role of genetic variants. Am J Obstetr Gynecol. 2015;213(6):779–788.
    1. Hasegawa J, Toyokawa S, Ikenoue T, Asano Y, Satoh S, Ikeda T, Ichizuka K, Tamiya N, Nakai A, Fujimori K, et al. ; Prevention Recurrence Committee, Japan Obstetric Compensation System for Cerebral Palsy . Relevant obstetric factors for cerebral palsy: from the nationwide obstetric compensation system in Japan. PLoS One. 2016;11(1): e0148122.
    1. He P, Chen G, Wang ZJ, Guo C, Zheng XY. Children with motor impairment related to cerebral palsy: prevalence, severity and concurrent impairments in China. J Paediatr Child Health. 2017;53(5):480–484.
    1. Bartley J, Carroll JE. Stem cell therapy for cerebral palsy. Expert Opin Biol Ther. 2003;3(4):541–549.
    1. Wang X, Cheng H, Hua R, Yang J, Dai G, Zhang Z, Wang R, Qin C, An Y. 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(12):1549–1562.
    1. Anttila H, Suoranta J, Malmivaara A, Mäkelä M, Autti-Rämä I. Effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy: a focused review. Am J Phys Med Rehabil. 2008;87(6):478–501.
    1. Ruff CA, Faulkner SD, Fehlings MG. The potential for stem cell therapies to have an impact on cerebral palsy: opportunities and limitations. Dev Med Child Neurol. 2013;55(8):689–697.
    1. Deuse T, Stubbendorff M, Tang-Quan K, Phillips N, Kay MA, Eiermann T, Phan TT, Volk HD, Reichenspurner H, Robbins RC, et al. Immunogenicity and immunomodulatory properties of umbilical cord lining mesenchymal stem cells. Cell Transplant. 2011;20(5):655–667.
    1. Wang L, Ji H, Zhou J, Xie J, Zhong Z, Li M, Bai W, Li N, Zhang Z, Wang X, et al. Therapeutic potential of umbilical cord mesenchymal stromal cells transplantation for cerebral palsy: a case report. Case Rep Transplant. 2013;2013(4):146347.
    1. Feng M, Lu A, Gao H, Qian C, Zhang J, Lin T, Zhao Y. Safety of allogeneic umbilical cord blood stem cells therapy in patients with severe cerebral palsy: a retrospective study. Stem Cells Int. 2015;2015(2):325652.
    1. Kyunghoon M, Junyoung S, Jin Young K, Jooyeon Ko PT, Ju Seok R, Myung Seo K, Su Jin J, Sang Heum K, Doyeun O, Moon Kyu K, et al. Umbilical cord blood therapy potentiated with erythropoietin for children with cerebral palsy: a double-blind, randomized, placebo-controlled trial. Stem Cells. 2013;31(3):581–591.
    1. The University of Texas Health Science Center, Houston. Safety and effectiveness of banked cord blood or bone morrow stem cells in children with cerebral palsy (CP).Clinical trials.gov.Accessed March 25, 2017 .
    1. Zhang C, Huang L, Gu J, Zhou X. Therapy for cerebral palsy by human umbilical cord blood mesenchymal stem cells transplantation combined with basic rehabilitation treatment: a case report. Glob Pediatr Health. 2015;2015(2): 1–7.
    1. Editorial Committee of Chinese Journal of Pediatrics, Neurology group of Chinese Medical Association Pediatric Society. The definition, diagnosis criteria and typing of children cerebral palsy. Chin J Pediatr. 2005;43(4):262.
    1. Dominici M, Blanc KLE, Mueller I, Slaper-Cortenbach I, Marini FC, Krause DS, Deans RJ, Keating A, Prockop DJ, Horwitz EM. Minimal criteria for defining multipotent mesenchymal stromal cells. The international society for cellular therapy position statement. Cytotherapy. 2006;8(4):315–317.
    1. Lee M, Jeong SY, Ha J, Kim M, Jin HJ, Kwon SJ, Chang JW, Choi SJ, Oh W, Yang YS, et al. Low immunogenicity of allogeneic human umbilical cord blood-derived mesenchymal stem cells in vitro and in vivo. Biochem Biophys Res Commun. 2014;446(4):983–989.
    1. Lee JK. Allogeneic transplantation of mesenchymal stem cells from human umbilical cord blood. J Appl Biol Chem. 2007;50(4):187–195.
    1. Wasielewski B, Jensen A, Roth-Härer A, Dermietzel R, Meier C. Neuroglial activation and Cx43 expression are reduced upon transplantation of human umbilical cord blood cells after perinatal hypoxic-ischemic injury. Brain Res. 2012;1487(17):39–53
    1. Lindvall O, Kokaia Z. Stem cell research in stroke: how far from the clinic? Stroke. 2011;42(8):2369–2375.
    1. Zhu H, Poon W, Liu Y, Leung GK, Wong Y, Feng Y, Ng SC, Tsang KS, Sun DT, Yeung DK, et al. Phase I-II clinical trial assessing safety and efficacy of umbilical cord blood mononuclear cell transplant therapy of chronic complete spinal cord injury. Cell Transplant. 2016;25(11):1925–1943.
    1. Eve DJ, Ehrhart J, Zesiewicz T, Jahan I, Kuzmin-Nichols N, Sanberg CD, Gooch C, Sanberg PR, Garbuzova-Davis S. Plasma derived from human umbilical cord blood modulates mitogen-induced proliferation of mononuclear cells isolated from the peripheral blood of ALS patients. Cell Transplant. 2015;25(5):963–971.
    1. Harris DT. Cord blood stem cells: a review of potential neurological applications. Stem Cell Rev. 2008;4(4):269–274.
    1. Carroll JE, Robert WM. Update on stem cell therapy for cerebral palsy. Expert Opin Biol Ther. 2011;11(4):463–471.
    1. Eapen M, Wang T, Veys PA, Boelens JJ, St Martin A, Spellman S, Bonfim CS, Brady C, Cant AJ, Dalle JH, et al. Allele-level HLA matching for umbilical cord blood transplantation for non-malignant diseases in children: a retrospective analysis. Lancet Haematol. 2017;4(7):e325–e333.
    1. Kang M, Min K, Jang J, Kim SC, Kang MS, Jang SJ, Lee JY, Kim SH, Kim MK, An SA, et al. Involvement of immune responses in the efficacy of cord blood cell therapy for cerebral palsy. Stem Cells. 2015;24(19):2259–2268.
    1. Willing AE, Garbuzova-Davis SN, Zayko O, Derasari HM, Rawls AE, James CR, Mervis RF, Sanberg CD, Kuzmin-Nichols N, Sanberg PR. Repeated administrations of human umbilical cord blood cells improve disease outcomes in a mouse model of Sanfilippo syndrome type III B. Cell Transplant. 2014;23(12):1613–1630.
    1. Rickards T, Sterling C, Taub E, Perkins-Hu C, Gauthier L, Graham M, Griffin A, Davis D, Mark VW, Uswatte G. Diffusion tensor imaging study of the response to constraint-induced movement therapy of children with hemiparetic cerebral palsy and adults with chronic stroke. Arch Phys Med Rehabil. 2014;95(3):506–514.
    1. Jin HK, Yong MK, Su MS. Motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment: a diffusion tensor imaging study. Neural Regen Res. 2015;10(4):624–630.
    1. Sharma A, Sane H, Gokulchandran N, Kulkarni P, Gandhi S, Sundaram J, Paranjape A, Shetty A, Bhagwanani K, Biju H, et al. A clinical study of autologous bone marrow mononuclear cells for cerebral palsy patients: a new frontier. Stem Cells Int. 2015;2015:905874.
    1. Hala G, Wael AE, Osama G, Mohamed EE, Yehia S. Intrathecal autologous bone marrow derived MSC therapy in cerebral palsy: safety and short term efficacy. Am J Biosci Bioeng. 2015;3(4 -1):24–29.
    1. Drobyshevsky A, Cotten CM, Shi Z, Luo K, Jiang R, Derrick M, Tracy ET, Gentry T, Goldberg RN, Kurtzberg J, et al. Human umbilical cord blood cells ameliorate motor deficits in rabbits in a cerebral palsy model. Dev Neurosci. 2015;37(4-5):349–362.
    1. Bae SH, Kong TH, Lee HS, Kim KS, Hong KS, Chopp M, Kang MS, Moon J. Long-lasting paracrine effects of human cord blood cells on damaged neocortex in an animal model of cerebral palsy. Cell Transplant. 2012;21(11):2497–2515.
    1. Rosenkranz K, Tenbusch M, May C, Marcus K, Meier C. Changes in Interleukin-1 alpha serum levels after transplantation of umbilical cord blood cells in a model of perinatal hypoxic-ischemic brain damage. Ann Anat. 2013;195(2):122–127.

Source: PubMed

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