In practice, most clinical applications of stem cells for the treatment of SCI have involved the use of whole mononuclear cells preparations (MCPs) and culture expanded MSCs. MCPs constitute hematopoietic cells of various stages of differentiation and endothelial cells as well HSCs and MSCs. No studies have directly compared the efficacy of these various bone marrow cell preparations in the clinic, although a direct comparison was recently made between human MCPs and culture expanded MSCs transplanted into a SCI model in animals, where no differences were reported with regard to graft efficiency, spinal cord tissue sparing, or glial scar reduction. Mesenchymal stromal cells are preferred by us due to profound paracrine effect which is a well-known aspect of MSCs worldwide.
The issue of scaling up potential therapeutics is an area in SCI research that is not well documented but has important implications in the clinical setting when the lesion size in animal models and humans differ greatly. A typical injury in rat models of SCI is 1–3 mm in length into which, generally, 1–5 × 106 cells are grafted. In humans, it is perhaps intuitive to consider that more cells may be needed for larger lesions. In addition, if the acute stage of spinal cord injury proves a window of opportunity where grafting has beneficial effects then this large cell number must be generated rapidly, which has important implications clinically if MSC number is critical to the success of an MSC graft.
What kind of patients may participate in the experimental stem cell program?
1. Patients with spinal cord injury due to any cause other than malignancy or any pathology which is progressive or which may further deteriorate.
2. Injury may be acute, sub acute or chronic however, the criteria for acute, sub acute, and chronic SCI are disputable and vary greatly among the clinics.
3. ASIA A, B, C and D
4. Patients without any other significant illness which may interfere with the prognosis or which may predispose patient to adverse events.
Patients are evaluated at our end by the experts in regenerative medicine to take a final call in the suitability of the patient to participate in stem cell program.
Various methods are employed at our end to evaluate the prognosis in SCI:
ASIA score and scale, ashworth scale for spasticity, clinical signs and symptoms, quality of life index, VAS etc, various imaging like MRI, nerve conduction studies may also be employed
We have provided relevant clinical publications on MSCs from international medical journals at given below link.
Dr. Prateek Gupta