Autologous stem cells in neurology: Is there a future?

Amarna Stem Cells, Granada, Spain, .
Journal of Neural Transmission (Impact Factor: 2.4). 11/2012; 120(1). DOI: 10.1007/s00702-012-0913-9
Source: PubMed


Stem cells seem very promising in the treatment of degenerative neurological diseases for which there are currently no or limited therapeutic strategies. However, their clinical application meets many regulatory hurdles. This article gives an overview of stem cells, their potential healing capacities as well as their identified and potential risks, such as tumor formation, unwanted immune responses and the transmission of adventitious agents. As there is no clinical experience with embryonic and induced pluripotent stem cells (as the result of their unacceptable risk on tumor formation), most attention will be paid to fresh autologous adult stem cells (ASCs). To evaluate eventual clinical benefits, preclinical studies are essential, though their value is limited as in these studies, various types of stem cells, with different histories of procurement and culturing, are applied in various concentrations by various routes of administration. On top of that, in most animal studies allogenic human, thus non-autologous, stem cells are applied, which might mask the real effects. More reliable, though small-sized, clinical trials with autologous ASCs did show satisfying clinical benefits in regenerative medicine, without major health concerns. One should wonder, though, why it is so hard to get compelling evidence for the healing and renewing capacities of these stem cells when these cells indeed are really essential for tissue repair during life. Why so many hurdles have to be taken before health authorities such as the European Medicine Agency (EMA) and/or the Food and Drug Administration (FDA) approve stem cells in the treatment of (especially no-option) patients.

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Available from: Johannes de munter, May 07, 2014
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    • "Lee ST et al. found that IV administration of hNSCs migrate to the lesioned striatum as intraventricular injection (which need invasive surgical technique) thus provide us less invasive route for administration of stem cells[107], so IV administration is shown to be more attractive if it is found effective in humans[108]. This migration may be due to specific conditions of the animal model such as QA effect which cause acute inflammation in the loci serve and produce cytokines which attract NSCs into the damaged area, So further studies must be carried to ensure the migration of NSCs if systemically injected[109] "
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    • "Re-implanted adult autologous stem cells, easily harvested out of the iliac crest and whether or not expanded, as a rule, will migrate towards diseased tissue, a phenomenon called homing [17,18]. Those stem cells have the potency to modulate immune responses [19,20] and to both transdifferentiate into target cells in order to replace damaged cells [21-24], and secrete paracrine (trophic) factors relevant for cell protection and cell repair by the inhibition of apoptotic pathways [25-27]. "
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    ABSTRACT: Ischemic and traumatic insults of the central nervous system both result in definite chronic disability, only to some extent responsive to rehabilitation. Recently, the application of autologous stem cells (fresh bone marrow-derived mononuclear cells including mesenchymal and hematopoietic stem cells) was suggested to provide a strategy to further improve neurological recovery in these disorders. During the acute phase, stem cells act mainly by neuroprotection with prevention of apoptosis, whereas during the chronic situation they provide neurorestoration by transdifferentiation and/or the secretion of neurotrophic factors. To reach these goals, in the acute phase, stem cells (10 million mononuclear cells per kg body weight) might be best applied intravenously, as during the first 7 days after the lesion, the blood-brain barrier permits passage of cells from the blood into the brain or the spinal cord. In the more chronic situation, though, those cells might be applied best intrathecally by lumbar puncture. Based on the reported results so far, it seems justified to develop well-designed clinical double-blind trials in chronic spinal cord injury and ischemic stroke patients, as efficacy and safety concerns might not be answered by preclinical studies.
    No preview · Article · Jul 2012 · Journal of Neural Transmission