Stem Cell Therapy for Spinal Cord Injuries

A: Spinal cord injuries occur at a rate of 40 persons per million per year in the United States. That translates to over 12,000 new cases a year. Motor vehicle accidents account for almost half of the cases. Falls, violence such as gunshot wounds, and sports injuries make up most of the rest. Up to 80% of victims are male. This is a disorder that affects the young; the average age of victims in the US is 38.

The most obvious symptom of spinal cord injury is the paralysis in affected areas. The amount and severity of paralysis depend on several factors including the location and type of injury. Patients can experience anything from a weakness in one extremity to complete paralysis of everything below the neck.

Spinal cord injury patients also experience a number of other complications that include:
1. Bladder dysfunction including leaking and inability to empty the bladder. This can lead to further complications such as urinary infections and kidney stones.
2. Bowel dysfunction including constipation, incontinence, and retention of stool.
3. Autonomic dysfunction that can result in a number of symptoms including high blood pressure (hypertension), flushing, headaches, and rapid or slow pulse.
4. Increased incidence of coronary artery disease (heart disease).
5. Sexual dysfunction and male infertility.
6. Osteoporosis and increased bone fractures.
7. Pressure ulcers.
8. Spasticity of affected limbs and trunk.
9. Contractions and wasting of muscles in affected areas.
10. Pain syndromes in affected areas.

This is a partial list. There are a number of other complications that can occur in spinal cord injury patients. For more information see:

Home

http://www.mayoclinic.com/health/spinal-cord-injury/DS00460/DSECTION=symptoms

A: There have been important advances in recent years to the treatment of acute spinal injuries that result in less damage to the cord improved post-injury function. For further information on the acute treatment of spinal cord injuries please see:/

http://www.uptodate.com/contents/acute-traumatic-spinal-cord-injury

After the initial stabilization and interventions to preserve function, treatment of spinal cord injuries is supportive. There are no currently accepted treatments directed at repairing the damage done to the spinal cord.

Many interventions are done with spinal cord injury patients. Some of the more common include:

1. Physical therapy to increase strength and avoid contractions.
2. Occupational therapy to train daily living and occupational activities.
3. Ventilation (breathing) support for high cervical injuries.
4. Intermittent bladder catheterization commonly used with medications to help prevent urinary incontinence.
5. Routine bowel management that includes a scheduled toilet time, laxatives, and other maneuvers to maintain regular bowel movements in a controlled manner.
6. Diet high in fiber and low in dairy and fat.
7. Medications to prevent bone loss (bisphosphonate) and decrease soft tissue calcification (Non-steroidal anti-inflammatories).
8. Musculoskeletal interventions include careful positioning and repositioning, range of motion exercises, and joint splinting.
9. Careful attention to avoid pressure ulcers.
10. Medications directed at reducing muscle spasticity.
11. Interventions directed at controlling chronic. These include anti-seizure medications, antidepressant medications, narcotics, and surgical procedures. Alternative pain control methods such as hypnosis and acupuncture have also been used.

Many other interventions are available depending on the individual patient’s needs. This is a list of some of the more common treatments. The use of stem cells is directed at repairing the actual injury and restoring cord function. (see: What results can I expect after deployment of adult stem cells for spinal cord injuries?) For more information on current medical see:
http://www.mayoclinic.com/health/spinal-cord-injury/DS00460/DSECTION=treatments-and-drugs
and
http://www.ninds.nih.gov/disorders/sci/detail_sci.htm

A: Stem cells are special cells in our bodies that have two important characteristics:

1. Stem cells have the ability to replicate. In other words, they can make new copies of themselves. Because of this ability, an infinite number of copies can be made from the same cell.
2. Stem cells also have the ability to become other types of cells. A good example of this is that research labs have used fat-derived stem cells to make cartilage muscle, skin, and bone cells. This ability means that in theory the transformed can make an infinite number of the new cell type.

Stem cells can come from a number of sources including embryos, umbilical cord blood, and adult cells. Adult stem cells come from adult individuals, not embryos or umbilical cord blood. Stem cells obtained from mature adult tissues are referred to as adult stem cells. Adult stem cells are believed to have the potential to become any type of cell.

The two most commonly used sources of adult stem cells are fat and bone marrow.

Adult stem cells from fat are called adipose-derived adult stem cells. For most purposes, stem cells from fat are easier to obtain and more abundant than from other tissues. For more information read our blogs What are Stem Cells? and Understanding Adipose-Derived Stem Cells.

A: Harvesting adult stem cells from fat is very safe. The procedure has little discomfort and fairly easy recovery. First, an area such as the stomach or leg is picked to remove the fat. We then take you to the procedure room and sterilize the area. A local anesthetic is then injected into the area. Fat is suctioned using a special syringe and cannula. Typically we suction about 50 ml (about 1 1.2 oz.) of fat.

Swelling and bruising is common following the procedure at the harvest site. Swelling and bruising typically resolve within 2-3 weeks after the procedure. Most patients receive a prescription for pain medications for use as needed. We give a dose of antibiotics before the procedure but no antibiotics are needed afterward.

Nest we take the harvested cells and use a centrifuge and incubator to do some simple processing. The processing isolates the adult stem cells from the other fat cells. The final product is called Stromal Vascular Fraction (SVF). SVF obtained from fat can contain up to about 25 million adult stem cells from 50 ml of fat. SVF also contains a large amount of growth factors. Growth factors are chemical “text messages” our cells use to communicate with each other. After we have obtained the SVF, the next step is to deploy the SVF for your spinal cord injuries.

A:The process of using adult stem cells/SVF is referred to as deployment. In treating spinal cord injuries we deploy the adult stem cells/SVF into the soft tissue and epidural space around the area of the injury. This is done by an interventional radiologist using special imaging.

An IV is also started and a portion of the adult stem cells/SVF is given intravenously. We know that the damaged areas are releasing growth factors. These growth factors attract the adult stem cells/SVF to the area of the injury. Currently, injections into the spinal cord itself are not being performed. In the future, more deployment protocols may be developed (see: What is the future for adult stem cells in spinal cord injuries?)

A: Currently the treatment group is not large enough to give a conclusive answer to this question. It is important to note that the Food and Drug Administration (FDA) has NOT approved the use of adult stem cells/SVF for any disorder. This includes the use of stem cells/SVF for spinal cord injuries. Fortunately, we have enough early experience to talk about trends in therapy. The number of patients treated increases weekly, so the total depends on when you are reading this article (initial writing August 2013). Thus far, the majority of patients treated have seen an improvement in function. Most patients have seen improvement in autonomic dysfunction, bladder and bowel control. Some patients have seen an increase in muscle strength and function. Using the criteria that a satisfied patient is one that is glad they had the procedure, everyone reported so far has been satisfied.

Most patients are seeing improvements beginning 2-3 months following their adult stem cell/SVF deployment. It is reasonable to assume that a second (or more) adult stem cell/SVF deployment after 6-12 months would result in further improvement. However, the number of patients with a second deployment is too small to comment on the response. It is important to note that the great majority of patients treated had experienced a spinal cord contusion and DID NOT have a physically severed cord.

A: Most experts agree that stem cells hold the greatest potential for treating and reversing the effects of spinal cord injuries. The type of stem cells best to use (embryonic, bone marrow, or fat derived) and how to best utilize them is heavily researched and debated. Adult stem cells have a good chance of becoming the treatment of choice because of their safety, availability, and lack of controversy. It is likely that in the future, we will see further preparation done to the adult stem cells/SVF in order to prepare them to more readily become neurons. Injection techniques into the damaged spinal cord may also be developed. Over the next few years, we have some real hope in seeing therapy develop that could restore large amounts of function to spinal cord injury victims.