1. Olfactory (nasal) mucosa autografts.
in 2001, Lu, et al. in Australia reported that nasal mucosa transplantation to injured spinal cords stimulates Regeneration in rats after spinal cord injury. Dr. Carlos Lima and his colleagues in Lisbon, Portugal, have transplanted nasal mucosal tissue from the same person into the spinal cord injury site. They excavate part of the spinal cord in order to make room for the transplant. Because the cells come from the same person, there should not be immune rejection of the cells. Several people on these forums who have had the surgery and appear to be recovering some function. Unfortunately, to date, there has not been a publication of the results so that we do not know what proportion of the people recover function, to what extent, and for how long. It is also unclear to me how many people have received this procedure but it is probably over 3 dozen. I have not heard of any case where there has been loss of function or death but the lack of information does not necessarily mean that these have not occurred
2. Adult olfactory ensheating cell autografts.
Dr. Mckay-Sims and his colleagues in Brisbane, Australia, have managed to grow olfactory ensheathing glia from the nasal mucosa of two patients and transplanted these about 15 million of these cells into their spinal cords. The study is still in its "double-blind" phase and we do not know whether there has been recovery of function or not. In some ways, this is the most desirable of all the options both from a scientific and clinical point of view. The cells were grown from the nasal mucosa and have been identified in culture as olfactory ensheathing glia. Because the cells come from the same person, there should be less risk of immune rejection of the cells.
3. Fetal olfactory ensheathing glial transplants.
In Beijing, Dr. Hongyun Huang is transplanting fetal olfactory ensheathing glia into the spinal cord of people who are 1-32 years after injury. I believe that over 500 people with spinal cord injury and perhaps another 200 people with other conditions (such as ALS and MS) have received these transplants. The cells are injected into the spinal cord above and below the injury site without cutting or removing part of the spinal cord. To my knowledge, there has been three mortalities in the series, all in people more than 3 months after surgery and from unrelated causes. The cells are obtained from aborted fetuses and therefore are not genetically matched to the person receiving it. Although there is some evidence suggesting that fetal tissues are not rejected as adult tissues, it is likely that these transplants will be rejected from the spinal cord at some point, perhaps 3-4 months after transplantation. Reports of earlier results in the first 171 patients that received such transplants indicate an average of 4-8 dermatomes of sensory recovery and 1-2 Motor levels of improvement. Animal studies suggest that olfactory ensheathing glia will migrate from the injection site into the injury site and surrounding cord, change the Environment of the injury site, and promote regeneration of axons. Unfortunately, only about 10% of the patients who have been transplanted have been systematically followed up beyond their 4-6 week hospitalization. Several members of these forums have received such transplants.
4. Bone marrow stem cell autografts (adult).
• Dr. Tarcisio Barros at the University of Sao Paulo in Brazil has transplanted bone marrow mesenchymal stem cells into the spinal cord of about 30 patients with chronic spinal cord injury. Some evidence from animal studies indicate that bone marrow contain stem cells and that these cells can be persuaded to produce neurons in culture. The cells were apparently injected through the vascular system into the blood vessels of the spinal cord. Dr. Barros has reported some initial promising results in terms of somatosensory evoked potential improvement in the patients. It is not clear how much motor improvement the patients are getting. Because the cells are autografts, they are not likely to be rejected.
• Zhengzhou. Dr. Zhang at the Henan People’s Provincial Hospital in Zhengzhou, China told me that he has transplanted bone marrow stem clls to dozens of people with spinal cord injury. The results are not clear but they are looking for ways to improve the results. On my last visit there in January 2005, they have transplanted bone marrow stem cells into over 180 patients with strokes and spinal cord injury. They grow the cells, sort them for those that are CD-43 positive, and then transplant them into the spinal cord.
• Nanjing. I have heard that there is a group of surgeons in Nanjing (China) that have transplanted bone marrow stem cells into 90 patients with amytrophic lateral sclerosis (ALS). These cells were apparently directly transplanted into the brain and spinal cord.
• Italy. I have also seen several reports of bone marrow stem cell transplants being used in Italy to treat patients with amyotrophic lateral sclerosis.
