Stroke

Immature (stem) cells are implanted into a subarachnoid space of a patient via a lumbar puncture. The treatment is conducted in the neurosurgical department.

The grafted cells release a variety of axonal growth-stimulating, neurotrophic factors, but also participate immediately in restoring affected nervous communications.

A donor material is subjected to 3-level testing for infection (2 immunoenzyme analyses and 1 PCR examination).

A rise in temperature until 390, meningisms, nausea and vomiting are possible during first 2 days after a cell transplantation procedure. Those effects are reduced by the appropriate drug therapy. No long-term complications are registered.

Stem cell transplantation for cerebral stroke

Cerebral stroke is one of main reasons for both mortality and disability among residents of the developed countries. Medical interventions aimed at improving a cerebral blood flow give appreciable results at acute stage of disease. Long-term consequences of brain injury are frequently refractory to medicamentous interventions, because pharmaceuticals fail to affect substantially reparative abilities of adult nervous tissue. A stem cell transplantation technology represents a feasible approach to stimulate reparative processes in the injured brain. When grafted in brain, immature (stem) cells are able to elaborate multiple growth and neurotrophic factors. Moreover, those cells, by themselves, may be implicated in forming new nervous communications. Thus, the grafted cells are capable of greatly ameliorating stroke-related, neurological defects.

In CICT 17 patients with consequences of brain stroke have received in sum 23 subarachnoidal cell graftings. Appreciable benefits from such a treatment were noted in 13 (76%) patients.

Eleven patients (5 females and 6 males) aged from 35 to 56 years were entered onto a controlled study (see Table 1). On admission, the times after cerebral stroke varied in the patients from 4 to 24 months. The following symptoms were noted: hemiparesis or hemiplegia (10 cases), high-grade sensormotor aphasia (5 cases), and coordination disorders (5 cases). Permanent dysuria was noted in 1 patient. Significant both memory and intellectual defects were observed in all patients. Before the cell-based treatment all patients were given a comprehensive rehabilitative therapy, the results of which, however, were unapparent. Fife patients have received one subarachnoidal cell transplantation, whereas the remaining 6 patients were cell-grafted twice.

The control group was formed from 11 patients aged from 45 to 65 years, who were comparable with the trial patients in clinical characteristics (see Table 2).

Table 1. Characteristics of the trial patients

N	Patient, age	Sex	Diagnosis	Neurological defect	Time (months) after stroke	Functional activity before/after CT treatment (%)
1	M., 46	f	IS in system of MCA and ACA on the left	Dement syndrome, vegetative lability, episyndrome	18	50/80
2	N., 35	f	HS in system of MCA on the left	Paresis on the right, sensormotor aphasia, dement syndrome, FPO disorder	6	40/ 80
3	S., 38	m	IS in system of MCA on the right	Left-side hemiparesis, memory disorder, vegetative lability	8	60/80
4	S., 48	m	HS in system of MCA on the right	Left-side hemiparesis, dement syndrome, FPO disorder	13	50/70
5	G., 40	f	IS in system MCA on the left	Paresis on the right, sensormotor aphasia, dement syndrome	10	40/ 70
6	I., 49	f	IS in system MCA on the left	Right-side hemiparesis, sensormotor aphasia	8	60/90
7	A., 56	m	HS in system of MCA on the right	Left-side hemiparesis, memory disorder	24	40/60
8	M., 52	f	IS in system of MCA and ACA on the right	Left-side hemiparesis, Korsakoff's syndrome, vegetative lability	18	40/50
9	L., 48	m	IS in system of MCA on the left	Right side hemiplegia, Korsakoff's syndrome, sensormotor aphasia	12	50/70
10	T., 49	m	IS in system of MCA on the left	Right-side hemiparesis, sensormotor aphasia	4	60/80
11	D., 39	>m	HI in system of MCA and ACA on the right	Left-side hemiparesis, Korsakoff's syndrome, Vegetative lability	4	50/80

The used abbreviations are: HI, hemorrhagic stroke; IB, ischemic stroke; ACA, anterior cerebral artery; MCA, medial cerebral artery; FPO, functions of pelvic organs.

Table 2. Characteristics of the controlled patients

N	Patient, age	Sex	Diagnosis	Neurological defect	Functional activity before/after CT treatment (%)
1	P., 56	f	IS in system of MCA on the right	Right-side hemiparesis, Korsakoff's syndrome	50/50
2	D., 62	f	IS in system of MCA and ACA on the right	Left-side hemiparesis, aggressive behavior, memory disorder	40/40
3	S., 58	m	IS in system of MCA on the left	Right-side hemiparesis, sensormotor aphasia, dement syndrome, FPO disorder	40/50
4	S., 67	f	IS in system of MCA on the right	Left-side hemiparesis, memory disorder	40/40
5	K., 65	m	HS in system of MCA on the left	Right-side hemiparesis, Korsakoff's syndrome	30/30
6	V., 48	f	HS in system of MCA on the left	Rright-side hemiparesis, dement syndrome, FPO disorder	30/40
7	V., 51	f	IS in system of MCA on the right	Left-side hemiparesis, aggressive behavior, memory disorder	30/50
8	D., 47	f	HS in system of MCA on the right	Left-side hemiparesis, mental and memory disorders	30/30
9	Sh., 39	f	HS in system of MCA on the lef	Right-side hemiparesis, dement syndrome, FPO disorder	40/60
10	M., 63	f	HS in system of MCA on the left	Rright-side hemiparesis, dement syndrome, sensormotor aphasia, FPO disorder	30/40
11	Ya., 45	m	IS in system of MCA on the left	Right-side hemiparesis, sensormotor aphasia, dement syndrome, FPO disorder	40/40

The abbreviations are same as those in Table 1.

Of 11 patients 10 experienced benefits from cell-based therapy in the form of appreciable improvement of mental functions, including speech. An increase of muscle strength in extremities by 1-to-2 points, as well as normalization of functioning pelvic organs, were noted in these cases. The changes appeared within the first weeks after cell-based therapy and were further accumulated during the following 4-to-8 weeks Six months after the treatment the functional activity of the trial and control patients was examined according to a Karnofsky scale. As shown in Figure 1, with the cell-based therapy the patients exhibited a significant increase in their functional activity. No noticeable functional changes were noted in the control patients.

Figure 1. Functional activity of patients before and at 6 months after the treatment.

Thus, the results suggest that cell transplantation may be an effective treatment for sequences of brain stroke.

For more information see the publications.