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Chronic spinal cord injury treated with transplanted autologous bone marrow-derived mesenchymal stem cells tracked by magnetic resonance imaging: a case report.

Chotivichit A, Ruangchainikom M, Chiewvit P, Wongkajornsilp A, Sujirattanawimol K - J Med Case Rep (2015)

Bottom Line: There had been no improvement in his neurological function for the past 54 months.No clinical improvement of the neurological function had occurred at the end of this study.Further study should be carried out to evaluate the result of the treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. areesak.cho@mahidol.ac.th.

ABSTRACT

Introduction: Intrathecal transplantation is a minimally invasive method for the delivery of stem cells, however, whether the cells migrate from the lumbar to the injured cervical spinal cord has not been proved in humans. We describe an attempt to track bone marrow-derived mesenchymal stem cells in a patient with a chronic cervical spinal cord injury.

Case presentation: A 33-year-old Thai man who sustained an incomplete spinal cord injury from the atlanto-axial subluxation was enrolled into a pilot study aiming to track bone marrow-derived mesenchymal stem cells, labeled with superparamagnetic iron oxide nanoparticles, from intrathecal transplantation in chronic cervical spinal cord injury. He had been dependent on respiratory support since 2005. There had been no improvement in his neurological function for the past 54 months. Bone marrow-derived mesenchymal stem cells were retrieved from his iliac crest and repopulated to the target number. One half of the total cells were labeled with superparamagnetic iron oxide nanoparticles before transplantation to the intrathecal space between L4 and L5. Magnetic resonance imaging studies were performed immediately after the transplantation and at 48 hours, two weeks, one month and seven months after the transplantation. His magnetic resonance imaging scan performed immediately after the transplantation showed hyposignal intensity of paramagnetic substance tagged stem cells in the subarachnoid space at the lumbar spine area. This phenomenon was observed at the surface around his cervical spinal cord at 48 hours. A focal hyposignal intensity of tagged bone marrow-derived stem cells was detected at his cervical spinal cord with magnetic resonance imaging at 48 hours, which faded after two weeks, and then disappeared after one month. No clinical improvement of the neurological function had occurred at the end of this study. However, at 48 hours after the transplantation, he presented with a fever, headache, myalgia and worsening of his motor function (by one grade of all key muscles by the American Spinal Injury Association impairment scale), which lasted for 48 hours.

Conclusion: Intrathecal injection of bone marrow-derived stem cells at the lumbar spine level could deliver the cells to the injured cervical spinal cord. Transient complications should be observed closely in the first 48 hours after transplantation. Further study should be carried out to evaluate the result of the treatment.

No MeSH data available.


Related in: MedlinePlus

Timeline of axial T2-star echo5 magnetic resonance imaging scans of his cervical spine at the C1 level on pre-transplantation (A), two days (B), two weeks (C), one month (D) and seven months (E) after stem cell transplantation. The axial T2-star scan taken two days after stem cell transplantation (B) showed focal hyposignal intensity of tagged stem cells in the surface of the pathological upper cervical cord (arrow) at the axial T2-star scan taken two weeks after stem cell transplantation showed fading of the focal hyposignal intensity of tagged stem cells (C), which disappeared on the scans taken at one and seven months.
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Fig3: Timeline of axial T2-star echo5 magnetic resonance imaging scans of his cervical spine at the C1 level on pre-transplantation (A), two days (B), two weeks (C), one month (D) and seven months (E) after stem cell transplantation. The axial T2-star scan taken two days after stem cell transplantation (B) showed focal hyposignal intensity of tagged stem cells in the surface of the pathological upper cervical cord (arrow) at the axial T2-star scan taken two weeks after stem cell transplantation showed fading of the focal hyposignal intensity of tagged stem cells (C), which disappeared on the scans taken at one and seven months.

Mentions: A 3.0 Tesla MRI scan of his spine was performed immediately after stem cell transplantation. The T2-weighted scan of his whole spine and axial T2-weighted scan of his lumbar spine showed hyposignal intensity of paramagnetic substance tagged stem cells in the subarachnoid space and some in the area of the cauda equina, but no demonstrable hyposignal intensity at the cervical spine level (Figure 2). At 48 hours, there was focal hyposignal intensity of tagged stem cells at the injured cervical spinal cord; the focal hyposignal intensity of tagged stem cells faded at two weeks and had disappeared in the MRI scans taken at two months and seven months (Figure 3). There was no change of spinal cord structure in any follow-up MRI scans.Figure 2


Chronic spinal cord injury treated with transplanted autologous bone marrow-derived mesenchymal stem cells tracked by magnetic resonance imaging: a case report.

Chotivichit A, Ruangchainikom M, Chiewvit P, Wongkajornsilp A, Sujirattanawimol K - J Med Case Rep (2015)

Timeline of axial T2-star echo5 magnetic resonance imaging scans of his cervical spine at the C1 level on pre-transplantation (A), two days (B), two weeks (C), one month (D) and seven months (E) after stem cell transplantation. The axial T2-star scan taken two days after stem cell transplantation (B) showed focal hyposignal intensity of tagged stem cells in the surface of the pathological upper cervical cord (arrow) at the axial T2-star scan taken two weeks after stem cell transplantation showed fading of the focal hyposignal intensity of tagged stem cells (C), which disappeared on the scans taken at one and seven months.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4414006&req=5

Fig3: Timeline of axial T2-star echo5 magnetic resonance imaging scans of his cervical spine at the C1 level on pre-transplantation (A), two days (B), two weeks (C), one month (D) and seven months (E) after stem cell transplantation. The axial T2-star scan taken two days after stem cell transplantation (B) showed focal hyposignal intensity of tagged stem cells in the surface of the pathological upper cervical cord (arrow) at the axial T2-star scan taken two weeks after stem cell transplantation showed fading of the focal hyposignal intensity of tagged stem cells (C), which disappeared on the scans taken at one and seven months.
Mentions: A 3.0 Tesla MRI scan of his spine was performed immediately after stem cell transplantation. The T2-weighted scan of his whole spine and axial T2-weighted scan of his lumbar spine showed hyposignal intensity of paramagnetic substance tagged stem cells in the subarachnoid space and some in the area of the cauda equina, but no demonstrable hyposignal intensity at the cervical spine level (Figure 2). At 48 hours, there was focal hyposignal intensity of tagged stem cells at the injured cervical spinal cord; the focal hyposignal intensity of tagged stem cells faded at two weeks and had disappeared in the MRI scans taken at two months and seven months (Figure 3). There was no change of spinal cord structure in any follow-up MRI scans.Figure 2

Bottom Line: There had been no improvement in his neurological function for the past 54 months.No clinical improvement of the neurological function had occurred at the end of this study.Further study should be carried out to evaluate the result of the treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand. areesak.cho@mahidol.ac.th.

ABSTRACT

Introduction: Intrathecal transplantation is a minimally invasive method for the delivery of stem cells, however, whether the cells migrate from the lumbar to the injured cervical spinal cord has not been proved in humans. We describe an attempt to track bone marrow-derived mesenchymal stem cells in a patient with a chronic cervical spinal cord injury.

Case presentation: A 33-year-old Thai man who sustained an incomplete spinal cord injury from the atlanto-axial subluxation was enrolled into a pilot study aiming to track bone marrow-derived mesenchymal stem cells, labeled with superparamagnetic iron oxide nanoparticles, from intrathecal transplantation in chronic cervical spinal cord injury. He had been dependent on respiratory support since 2005. There had been no improvement in his neurological function for the past 54 months. Bone marrow-derived mesenchymal stem cells were retrieved from his iliac crest and repopulated to the target number. One half of the total cells were labeled with superparamagnetic iron oxide nanoparticles before transplantation to the intrathecal space between L4 and L5. Magnetic resonance imaging studies were performed immediately after the transplantation and at 48 hours, two weeks, one month and seven months after the transplantation. His magnetic resonance imaging scan performed immediately after the transplantation showed hyposignal intensity of paramagnetic substance tagged stem cells in the subarachnoid space at the lumbar spine area. This phenomenon was observed at the surface around his cervical spinal cord at 48 hours. A focal hyposignal intensity of tagged bone marrow-derived stem cells was detected at his cervical spinal cord with magnetic resonance imaging at 48 hours, which faded after two weeks, and then disappeared after one month. No clinical improvement of the neurological function had occurred at the end of this study. However, at 48 hours after the transplantation, he presented with a fever, headache, myalgia and worsening of his motor function (by one grade of all key muscles by the American Spinal Injury Association impairment scale), which lasted for 48 hours.

Conclusion: Intrathecal injection of bone marrow-derived stem cells at the lumbar spine level could deliver the cells to the injured cervical spinal cord. Transient complications should be observed closely in the first 48 hours after transplantation. Further study should be carried out to evaluate the result of the treatment.

No MeSH data available.


Related in: MedlinePlus