Spinal cord Injuries

Spinal cord injuries are known as the damage to the nerve roots inside the spinal cord which is responsible for carrying signals from the brain to any part of the body and vice versa. 
A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. Most injuries to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery; others will result in complete paralysis.

Anyone can have spinal cord injury and there are various kinds and classification for it.  At present, standard spinal cord injury care focuses on urgent emergency care that is comprised of medications designed to reduce inflammation, immobilization designed to stabilize and align the spine and surgery to remove bone fragments, foreign objects, and damaged discs or vertebrae that are compressing the spine.

More than 50% of all cases of SCI occur in persons aged 16-30 years. Traumatic SCI is more common in persons younger than 40 years, while nontraumatic SCI is more common in persons older than 40 years. Greater mortality is reported in older patients with SCI. 44.5% people suffer due to motor vehicle accidents, 18.1% due to falls, 16.6% due to violence and 12.7% due to sports injury.

Stem cells hold potential for treating spinal cord injuries. Based on the findings from a large number of animal studies, scientists are working on the ways that stem cells may contribute to spinal cord repair:

  • stem cells may be used to replace the nerve cells that have died as a result of the injury.
  • stem cells may be used to generate new supporting cells that will re-form the insulating nerve sheath (myelin) and stimulate re-growth of damaged nerves.
  • When introduced into the spinal cord shortly after injury, stem cells may protect the cells at the injury site from further damage, by releasing protective factors.
  • Bone marrow cells release a variety of factors that stimulate neuronal growth from progenitor cells.  Studies have shown that bone marrow stem cells, hematopoietic stem cells and in vitro differentiated mesenchymal stem cells possess therapeutic effects on spinal cord injury.
  • Clinical studies on patients with spinal cord injury had shown improvement in bladder function as well as motor and/or sensory functions after administration of autologous bone marrow stem cells.
  • Umbilical cord and Wharton’s jelly derived mesenchymal stem cells (MSCs) are more potent as compared to bone marrow cells. Studies have shown that Wharton’s jelly derived MSCs when administered into spinal cord transaction led to improvements in movement of hips and thighs as well as increased sensory activities




Cell therapy is a promising strategy for the treatment of spinal cord injury. Human MSC are multipotent mesenchymal adult stem cells that have a potential for autologous transplantation, obviating the need for immune suppression. Although previous studies have established that MSC can be delivered to the injured spinal cord by lumbar puncture. Recent studies have reported that MSCs promote partial functional recovery after grafting to injury, sites although mechanisms underlying this recovery have not been defined. Grafted MSCs survived in spinal cord tissue, forming cell bridges within the traumatic centromedullary cavity. Animal studies have suggested that transplantation of bone marrow stem cells into spinal cord lesions enhances axonal regeneration and promotes functional recovery. Evidences suggest that MSCs are immunosuppressive and reduces the acute inflammatory response to spinal cord injury and hence reduces cavity formation and astrocyte and macrophage reactivity. Overall findings indicate that MSC transplantation into spinal cord injury lesions attenuates acute inflammation that may be beneficial to the recovery of functions following spinal cord injury.

References:
www.eurostemcell.org/faq/what-can-stem-cells-do-spinal-cord-injuries
www.wikipedia.org
http://emedicine.medscape.com/article/322480-overview#a30

Wright el. al. Bone marrow for the treatment of spinal cord injury: Mechanism and clinical applications (2010) AlphaMed Press1066-5099

Paul et. al. Grafting of human bone marrow stromal cells into spinal cord injury: a comparison of delivery methods (2009) Spine 15;34(4):328-34.

Hofstetter et. al. Marrow stromal cells form guiding strands in the injured spinal cord and promote recovery (2002) PNAS Vol. 99, No. 4, 2199-2204

Mathai et. al. Stem cell therapy for spinal cord injury: A plea for rationality (2008), Indian Journal of Neurotrauma Vol. 5, No. 1, pp. 7-10

Sykova E, Homola A, Mazanec R, Lachmann H, Konradova SL, Kobylka P, Padr R, Neuwirth J, Komrska V, Vavra V, et al: Autologous bone marrow transplantation in patients with subacute and chronic spinal cord injury. Cell Transplant 2006, 15:675-687.

Cao FJ, Feng SQ: Human umbilical cord mesenchymal stem cells and the treatment of spinal cord injury. Chin Med J (Engl) 2009, 122:225-231.

Yang CC, Shih YH, Ko MH, Hsu SY, Cheng H, Fu YS: Transplantation of human umbilical mesenchymal stem cells from Wharton’s jelly after complete transection of the rat spinal cord. PLoS One 2008, 3:e3336.

Kang KS, Kim SW, Oh YH, Yu JW, Kim KY, Park HK, Song CH, Han H: A 37-year-old spinal cord-injured female patient, transplanted of multipotent stem cells from human UC blood, with improved sensory perception and mobility, both functionally and morphologically: a case study. Cytotherapy 2005, 7:368-373.

Zhao ZM, Li HJ, Liu HY, Lu SH, Yang RC, Zhang QJ, Han ZC: Intraspinal transplantation of CD34+ human umbilical cord blood cells after spinal cord hemisection injury improves functional recovery in adult rats. Cell Transplant 2004, 13:113-122.


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