5. Fetal olfactory ensheathing glia and neural stem cell transplants.
Dr. Samuiel Rabinovich and his colleagues in Novosibirsk have transplanted a mixture of olfactory ensheathing glia and neural stem cells into the spinal cord of patients with chronic injuries. These cells are apparently cultured from olfactory bulbs obtained from aborted fetuses. They report improvements in Motor and sensory function in the patients. These results were published recently. It is not clear what cells were being injected.

6. Fetal spinal cord transplants.
In the United States (Russia and Sweden as well), probably over 200 patients have received various fetal spinal cord transplants into the injury site. The results have been published in a few papers but most of the studies suggest modest recovery of function.

7. Adult Schwann cell autografts.
• Yale University. Timothy Volmer transplanted Schwann Cells grown from Peripheral nerves into two patients with Multiple Sclerosis. Dr. Volmer has moved to Barrows Neurological Institute in Phoenix, Arizona. A recent email suggested that he has finally re-organized his team and will be starting his clinical trials again. The trial was funded by the Myelin Project.

8. Fetal Schwann cell transplants.
In Kunming (Yunnan) in China, neurosurgeons there have transplanted fetal Schwann cells from aborted fetuses into about 90 patients with chronic spinal cord injury. They are reporting some improvement in function although there is some skepticism by visiting clinicians that these improvements are due to the transplants or to decompressive surgery.

9. Porcine fetal neural stem cell transplants.
At the Washington University in St. Louis and Albany Medical Center, 10 patients have received transplants of neural stem cells obtained from fetal pig brains. This was in a clinical trial sponsored by Diacrin. The cells are apparently grown from pig brain, treated with antibodies to reduce the likelihood of immune rejection, and then transplanted into the spinal cord. The results of this trial have not yet been reported.

10. Human fetal neural stem cell transplants.
I have met several doctors in China (Beijing and Guangzhou) who have grown human fetal neural stem cells from aborted fetuses and transplanted these into the spinal cords of people with acute or chronic spinal cord injury. Apparently, these patients have not gotten much recovery and most of these centers are no longer transplanting these cells.

11. Adult activated macrophage autografts.
The company Proneuron carried out two phase 1 trials in Israel and in Europe in patients that are within 2-3 weeks after spinal cord injury. The cells were obtained from the blood of the patients, cultured and activated on skin, and then transplanted into the spinal cord exposed by Laminectomy. This trial has started in the United States at three centers: Craig Hospital in Denver, Kessler Rehabilitation Institute in New Jersey, and Mt. Sinai Hospital in New York.

12. Adult peripheral nerve autografts.
• Dr. Carl Kao, a neurosurgeon who operates in Quito, Equador, has transplanted peripheral nerves of about 600 patients over the past 10-15 years. He also places Omentum on the spinal cord which apparently is causing epidural Cyst formations in some patients. The peripheral nerves should contain Schwann cells.
• Dr. Henreich Cheng, a neurosurgeon in Taiwan, has used peripheral nerves to bridge transected spinal cords and treated with several growth factors including basic fibroblast growth factor. In 1995, he published a widely recognized paper with Lars Olson, reporting that axons will grow across the transection site and restore function. Since returning to Taiwan, he has apparently carried out this procedure in some patients. He has not yet published the results.

13. Activated Macrophage Autografts.
In 1998, Michal Schwartz reported that activated macrophages improves neurological recovery of rats after spinal cord injury. An Israeli company called Proneuron initiated a phase 1 clinical trial to assess this treatment in patients within 3 weeks after injury. Melissa Holly was the first patient to undergo this therapy about 3 years ago. She showed substantial improvement. Perhaps a quarter of the patients who received the treatment showed improvement. A new phase 2 clinical trial is about read to start.

14. Omentum transplant.
In the 1980's, Dr. Harry Goldsmith began transposing omentum to the spinal cord of animals. The omentum is a part of the vascular tissue that surrounds the stomach and intestines. It's job is too carry blood to and food from the gut. Dr. Goldsmith and colleagues transferred the omentum to many patients over the past two decades. In addition, Dr. Carl Kao does omentum transplant.

15. Umbilical cord blood transplants.
There was a news report from Korea of a woman who recovered motor function after having received an umbilical cord blood stem cell transplant. The cells came from an umbilical cord blood bank, matched with the recipient, and then cultured to select for certain cells. The results have not yet been published. There are persistent news reports that Biomark International, a company that was shut down by the FDA and has now moved to London, has infused umbilical cord blood cells into hundreds of patients, some of whom may have spinal cord injury. There are also reports that of umbilical cord blood cell transplants being done in Mexico.

In short, hundreds or perhaps even thousands of patients have received cell transplants to the spinal cord and brain. Both mortality and morbidity rates of these transplant surgeries appear to be low. For example, Dr. Huang apparently has had less than 1% mortality in operations to transplant fetal olfactory ensheathing glia into patients with chronic spinal cord injury; all the mortality appear to be several months after surgery and not related to the surgery. Thus, cell transplantation therapies appear to be relatively safe and feasible in spinal cord injury. To my knowledge, however, none of these treatments have produced remarkable improvements in the patients that would warrant the word "cure". There are some reports that people do get modest improvement of function, particularly sensory function. Fetal olfactory ensheating glial transplants, for example, appear to restore 4-8 dermatomes of sensation and 1-2 motor levels, both in Thoracic and Cervical spinal cord injury.

Recent animal studies suggest that combining cell transplants with other therapies that stimulate Regeneration may be the more efficacious than either the transplants or the growth factors alone. In particular, two studies have been reported (one from Miami and the other from San Diego) that suggest that combination cell transplants (Schwann cells plus db cAMP and rolipram, bone marrow mesenchymal stem cells and cAMP) are better than the cell transplants alone or the cAMP alone. Another potential promising combination therapy is Schwann cell transplants combined with a growth factor called GDNF and chondroitinase are better than the cell transplants or the growth factor/chondroitinase alone. There will be more reports of combination therapies in the coming months. I hope that these reports will impel U.S. groups to initiate clinical trials in the United States rather than force Americans to go overseas for these therapies.

Wise Young.