Autologous intravenous mononuclear stem cell therapy in chronic ischemic stroke

A Bhasin, Mv Srivastava, R Bhatia, S Mohanty, Ss Kumaran, S Bose, A Bhasin, Mv Srivastava, R Bhatia, S Mohanty, Ss Kumaran, S Bose

Abstract

Background: The regenerative potential of brain has led to emerging therapies that can cure clinico-motor deficits after neurological diseases. Bone marrow mononuclear cell therapy is a great hope to mankind as these cells are feasible, multipotent and aid in neurofunctional gains in Stroke patients.

Aims: This study evaluates safety, feasibility and efficacy of autologous mononuclear (MNC) stem cell transplantation in patients with chronic ischemic stroke (CIS) using clinical scores and functional imaging (fMRI and DTI).

Design: Non randomised controlled observational study Study: Twenty four (n=24) CIS patients were recruited with the inclusion criteria as: 3 months-2years of stroke onset, hand muscle power (MRC grade) at least 2; Brunnstrom stage of recovery: II-IV; NIHSS of 4-15, comprehendible. Fugl Meyer, modified Barthel Index (mBI) and functional imaging parameters were used for assessment at baseline, 8 weeks and at 24 weeks. Twelve patients were administered with mean 54.6 million cells intravenously followed by 8 weeks of physiotherapy. Twelve patients served as controls. All patients were followed up at 24 weeks.

Outcomes: The laboratory and radiological outcome measures were within normal limits in MNC group. Only mBI showed statistically significant improvement at 24 weeks (p<0.05) whereas the mean FM, MRC, Ashworth tone scores in the MNC group were high as compared to control group. There was an increased number of cluster activation of Brodmann areas BA 4, BA 6 post stem cell infusion compared to controls indicating neural plasticity. Cell therapy is safe and feasible which may facilitate restoration of function in CIS.

Keywords: Cell transplantation; Functional Recovery; Mononuclear Stem Cells; Neuroimaging; Stroke.

Figures

Figure 1
Figure 1
Mean FM scores between mononuclear stem cell (MNC) and control group at 0, 8 and at 24 weeks.
Figure 2
Figure 2
Mean mBI scores between mononuclear stem cell (MNC ) and control group at 0, 8 and at 24 weeks.
Figure 3
Figure 3
BOLD activation pattern between control and MNC group in right hemispheric stroke at 24 weeks overlaid on rendered images
Figure 4
Figure 4
Activation maps superimposed on whole brain T1 images for (a-c) Pretreatment activation, (d-f) Post stem cell treatment activation in sagittal (a,d), coronal (b,e) and axial (c,f) orientations.
Figure 5
Figure 5
Correlation between FM scores and FA ratio in mononuclear stem cell (MNC) and control group at 24 weeks

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