Autologous bone marrow mononuclear cells intrathecal transplantation in chronic stroke

Alok Sharma, Hemangi Sane, Nandini Gokulchandran, Dipti Khopkar, Amruta Paranjape, Jyothi Sundaram, Sushant Gandhi, Prerna Badhe, Alok Sharma, Hemangi Sane, Nandini Gokulchandran, Dipti Khopkar, Amruta Paranjape, Jyothi Sundaram, Sushant Gandhi, Prerna Badhe

Abstract

Cell therapy is being widely explored in the management of stroke and has demonstrated great potential. It has been shown to assist in the remodeling of the central nervous system by inducing neurorestorative effect through the process of angiogenesis, neurogenesis, and reduction of glial scar formation. In this study, the effect of intrathecal administration of autologous bone marrow mononuclear cells (BMMNCs) is analyzed on the recovery process of patients with chronic stroke. 24 patients diagnosed with chronic stroke were administered cell therapy, followed by multidisciplinary neurorehabilitation. They were assessed on functional independence measure (FIM) objectively, along with assessment of standing and walking balance, ambulation, and hand functions. Out of 24 patients, 12 improved in ambulation, 10 in hand functions, 6 in standing balance, and 9 in walking balance. Further factor analysis was done. Patients of the younger groups showed higher percentage of improvement in all the areas. Patients who underwent cell therapy within 2 years after the stroke showed better changes. Ischemic type of stroke had better recovery than the hemorrhagic stroke. This study demonstrates the potential of autologous BMMNCs intrathecal transplantation in improving the prognosis of functional recovery in chronic stage of stroke. Further clinical trials are recommended. This trial is registered with NCT02065778.

Figures

Figure 1
Figure 1
Procedure for patient selection.
Figure 2
Figure 2
PET scans of 3 patients before and after cell therapy. Increased FDG uptake is seen in all 3 patients in the postintervention PET-CT scans. The blue areas represent hypometabolic areas, green areas represent normal metabolic activity, and black areas represent absent metabolic activity (primary area of stroke). All 3 images show reduction in the blue areas and increase in the green area, showing improved metabolic activity. (a) Increased FDG uptake is seen in left parietal and temporal lobes indicating increased metabolic activity. (b) Increased FDG uptake is seen in the left frontal, temporal, parietal, and occipital lobes, along with left hippocampus, parahippocampus, and left amygdale. (c) Increased FDG uptake is seen in left frontal, parietal lobes. There is also increased FDG uptake in the right parietal lobe.
Figure 3
Figure 3
Graph representing comparison of symptomatic improvement and functional improvement in patients of ≤2 and >2 years of onset of stroke.
Figure 4
Figure 4
Graph representing comparison of symptomatic improvement and functional improvement in patients with age ≤60 and >60 years.
Figure 5
Figure 5
Graph representing comparison of symptomatic improvement in patients with ischemic and hemorrhagic stroke.
Figure 6
Figure 6
Graph representing comparison of symptomatic improvement in patients with the involvement of left and right brain.

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