Treatment of complete spinal cord injury patients by autologous bone marrow cell transplantation and administration of granulocyte-macrophage colony stimulating factor
Treatment of complete spinal cord injury patients by autologous bone marrow cell transplantation and administration of granulocyte-macrophage colony stimulating factor
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DOI：
10.1089/ten.2005.11.913
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发表时间：
2005-05-01
影响因子：
--
通讯作者：
Park, HS
中科院分区：
文献类型：
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作者：
Park, HC;Shim, YS;Park, HS
在实验动物研究中，已发现将骨髓细胞移植到受损的脊髓中可改善神经功能。然而，目前尚不清楚骨髓细胞是否可以类似地改善人类患者完全脊髓损伤（SCI）的神经功能。为了解决这个问题，我们评估了自体骨髓细胞移植（BMT）与粒细胞巨噬细胞集落刺激因子（GMCSF）在6例完全性SCI患者的治疗效果。对5名患者进行了损伤部位BMT（1.1 x 10（6）个细胞/μ L，共1.8 mL）和皮下GM-CSF给药。1例患者仅接受GM-CSF治疗。根据患者情况，随访时间为6 ~ 18个月.术后立即观察到感觉改善。骶骨段的感觉恢复主要在术后3周至7个月。术后3 - 7个月观察到运动功能显著改善。4名患者的美国螺旋损伤协会损伤量表（AIS）分级（从A到C）显示神经功能改善。1例患者从A级改善至AIS B级，最后1例患者仍为AIS A级。没有发现神经系统症状的立即恶化。注意到GMCSF治疗的副作用，如发烧（> 38摄氏度）和肌痛。术后4 ~ 6个月随访，磁共振成像显示骨髓移植区轻度强化。骨髓移植和粒细胞集落刺激因子治疗脊髓损伤是一种安全有效的治疗方案，尤其是急性完全性损伤。为了证明该方案的全部治疗价值，需要进行长期和更全面的病例对照临床研究。
Transplantation of bone marrow cells into the injured spinal cord has been found to improve neurologic functions in experimental animal studies. However, it is unclear whether bone marrow cells can similarly improve the neurologic functions of complete spinal cord injury (SCI) in human patients. To address this issue, we evaluated the therapeutic effects of autologous bone marrow cell transplantation (BMT) in conjunction with the administration of granulocyte macrophage-colony stimulating factor (GMCSF) in six complete SCI patients. BMT in the injury site (1.1 x 10(6) cells/mu L in a total of 1.8 mL) and subcutaneous GM-CSF administration were performed on five patients. One patient was treated with GM- CSF only. The follow- up periods were from 6 to 18 months, depending on the patients. Sensory improvements were noted immediately after the operations. Sensory recovery in the sacral segment was noted mainly 3 weeks to 7 months postoperatively. Significant motor improvements were noted 3 to 7 months postoperatively. Four patients showed neurologic improvements in their American Spiral Injury Association Impairment Scale (AIS) grades (from A to C). One patient improved to AIS grade B from A and the last patient remained in AIS grade A. No immediate worsening of neurologic symptoms was found. Side effects of GMCSF treatment such as a fever (> 38 degrees C) and myalgia were noted. Serious complications increasing mortality and morbidity were not found. The follow- up study with magnetic resonance imaging 4 - 6 months after injury showed slight enhancement within the zone of BMT. Syrinx formation was not definitely found. BMT and GM-CSF administration represent a safe protocol to efficiently manage SCI patients, especially those with acute complete injury. To demonstrate the full therapeutic value of this protocol, long-term and more comprehensive case-control clinical studies are required.