Stem Cells Publications

    • Autologous Bone Marrow Mononuclear Cells in Ischemic Cerebrovascular Accident Paves Way for Neurorestoration: A Case Report

    Abstract

    In response to acute ischemic stroke, large numbers of bone marrow stem cells mobilize spontaneously in peripheral blood that home onto the site of ischemia activating the penumbra. But with chronicity, the numbers of mobilized cells decrease, reducing the degree and rate of recovery. Cellular therapy has been explored as a new avenue to restore the repair process in the chronic stage. A 67-year-old Indian male with a chronic right middle cerebral artery ischemic stroke had residual left hemiparesis despite standard management. Recovery was slow and partial resulting in dependence to carry out activities of daily living. Our aim was to enhance the speed of recovery process by providing an increased number of stem cells to the site of injury. We administered autologous bone marrow mononuclear cells intrathecally alongwith rehabilitation and regular follow up. The striking fact was that the hand functions, which are the most challenging deficits, showed significant recovery. Functional Independence Measure scores and quality of life improved. This could be attributed to the neural tissue restoration. We hypothesize that cell therapy may be safe, novel and appealing treatment for chronic ischemic stroke. Further controlled trials are indicated to advance the concept of Neurorestoration. Read more...

    • Autologous Bone Marrow Mononuclear Cells Intrathecal Transplantation in Chronic Stroke

    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. Clinical trial registration number: NCT02065778. Read more...

    • Autologous Bone Marrow Stem Cell Therapy Shows Functional Improvement in Hemorrhagic Stroke

    Abstract

    In hemorrhagic stroke, damage to the brain tissue is inevitable and no effective treatment for functional improvement is currently available except neurorehabilitation. Stem cell therapy is a rapidly growing field and has recently opened new avenues for brain repair strategies. We present a case study of a 69-year-old female treated with stem cell therapy for right-sided hemiplegia caused due to left thalamic hemorrhagic stroke. Inspite of regular physiotherapy, the patient had constant residual neurodeficit, one year after the stroke, which was severely incapacitating. In view of the same, the patient was given intrathecal autologous bone marrow derived stem cell therapy as part of the neuroregeneration and rehabilitation therapy (NRRT) along with rehabilitation. After the therapy, patient showed functional as well as neurological improvements (cognition and motor strength) without  any side effects. There is accumulating experimental data showing the benefits of cell transplantation on functional recovery  after hemorrhagic stroke. This case study supports the concept of neuroregeneration with bone marrow stem cells as a novel strategy having great therapeutic potential. However, large clinical studies are needed to further investigate autologous bone marrow stem cell therapy in addition to neurorehabilitation for treating the disability in hemorrhagic stroke. Read more...

    • Benefits of Autologous Bone Marrow Mononuclear Cell Transplantation in Chronic Ischemic Pontine Infarct - 04

    Abstract

    Introduction: Ischemic stroke is brain injury due to hypoperfusion leading to sudden neurological symptoms. Despite advances in medicine, prognosis is still grim especially with chronic residual neurodeficits. Autologous bone marrow mononuclear cells (BMMNCs) transplantation is safe and has shown positive outcomes in previous studies of ischemic stroke. Our aim was to study the effect of autologous BMMNCs transplantation in chronic ischemic stroke. Intervention and Results: We treated a case of pontine ischemic infarct three years later, with BMMNCs transplantation followed by standard rehabilitation. Seven months after transplantation he showed significant improvement in spasticity, motor function and voluntary control of upper and lower extremity, static and dynamic sitting and standing balance. Improvement was noted in the scales like Modified Ashworth scale (mAS), Motor Assessment scale (MAS), Disabilities of Shoulder, arm and hand questionnaire (DASH), Modified Rankin Scale (MRS), Berg Balance Scale (BBS) and Brunnstrom Voluntary Control Grading (BVCG). Functional Independence Measure score increased from 59 to 81.  BMMNCs exert paracrine effects, neoangiogenesis and trophic effect which facilitate various reparative and regenerative processes in the penumbral area. Conclusion: In this case, the clinical changes exhibited by BMMNCs transplantation even at a chronic stage in stroke substantiate their therapeutic potential. Although a single case report, these findings provide foundation for further research. Larger randomized controlled trials are warranted to study the safety and efficacy.

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    • Effect of Cellular Therapy Monitored on Positron Emission Tomography - Computer Tomography Scan in Chronic Hemorrhagic Stroke - 05

    Abstract

    Stroke is a major cause of complex disability and death worldwide. Stem cell therapy has improved functional status in many of the neurological disorders,

    including stroke, cerebral palsy, head injury, spinal cord injury, etc. We present a case of 58 years old male with chronic hemorrhagic stroke having right hemiplegia, who underwent intrathecal, autologous bone marrow derived mononuclear cell (BMMNC) transplantation along with neurorehabilitation. This case study is aimed at observing the efficacy of cellular therapy using Positron emission tomography computerised tomography (PET-CT) imaging as a monitoring tool in patient with chronic hemorrhagic stroke. The effects were measured on clinical and functional changes. Over 6 months, gradual improvement was noticed in the voluntary control of upper and lower limb, balance and gait. Functional Independence Measure improved from 94 to 96 and Berg Balance scale score from 44 to 48. PET-CT scan of brain was performed pre intervention and 6 months post intervention. On comparison, the scan reported improvement in the metabolism of left hemisphere of the brain in areas such as parietal and frontal lobe, basal ganglia, supplementary motor area, pre and post central gyrus. These radiological improvements correlated with the functional improvements recorded in the patient on follow up. The outcomes suggest that intrathecal autologous transplantation of BMMNCs in chronic hemorrhagic stroke along with continued neurorehabilitation may lead to significant clinical and functional improvements. There were no adverse events. This case also demonstrates the effective use of PET-CT scan brain as a radiological tool to monitor the effects of intervention at a cellular level. Read more...

    • Cellular Therapy Improves Brain Metabolism in a Case of Chronic Ischemic Stroke - 06

    Abstract

    Objective: Cellular therapy is an emerging therapeutic option for chronic stroke. The aim of this report was to study the effect of autologous bone marrow mononuclear cells followed by neurorehabilitation in the case of chronic ischemic stroke.

     

    Method and results: The patient was a 50-year old male suffering from ischemic stroke due to middle cerebral artery infarct since 4 years. The intervention included intrathecal administration of autologous bone marrow mononuclear cells followed by neurorehabilitation. He presented with right hemiparesis, dysarthria and memory deficits. He underwent cellular therapy twice at an interval of 6 months. Post cellular therapy the voluntary control, memory, ambulation and speech improved. The recovery was also marked by an improvement on Berg Balance scale (50 to 52), Beck Depression Inventory scale (23 to 9) and the Reach score. Comparative Positron Emission Tomography-Computer Tomography (PET CT) scan of brain 6 months after cellular therapy showed improvements in bilateral frontal cortex, parietal cortex, thalamus, cerebellum, medial temporal cortex, right basal ganglia, right temporal cortex, cingulate cortex which correlated with clinical improvements.

     

    Conclusion: Cellular therapy along with neurorehabilitation was safe and beneficial. Cellular therapy assisted the impaired areas of brain in recovery as demonstrated on PET CT scan even at a chronic stage. To understand the efficacy of the cellular therapy further randomised controlled clinical trials should be conducted. Read more...

Stem Cells Publications

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Scientific PUBLICATIONS ON stroke

Stem Cells Publications