Background and Aim : Spinal cord injury (SCI) is a devastating medical condition and most of SCI patients suffer from profound disability and its related complications. Numerous studies in animal models of SCI and human patients have demonstrated that cellular transplantations for treatment of SCI might provide a source of neural cells and have neuroprotective and immunomodulatory effects after injury. mesenchymal stem cells (MSC) and Schwann cells (SC) have better safety and better ethical profile. Obviously no single factor accounts for the lack of axonal regeneration after SCI. Successful functional recovery in patients suffering from SCI will most likely rely on a combinatorial therapeutic strategy.Methods : We assessed the safety and feasibility of a
bone marrow mesenchymal stromal cell and Schwann cell combination for the treatment of patients with acute and subacute spinal cord injury.Six patients had complete SCI (American Spinal Injury Association Impairment Scale (AIS) grade A) and one had incomplete grade B. The patients received this autologous combination of cells into the spinal cord.We performed electromyography (EMG) and nerve conduction velocity (NCV), urodynamic study (UDS) and magnetic resonance imaging (MRI) preoperatively for all patients. In order to documenting the changes, EMG-NCV (for movement changes), UDS (for changes in bladder function or urinary sensation) and MRI (for the patients who showed significant improvement in their neurological examination) was carried out.Results : Improvement of balance in sitting position was expressed by six out of seven patients. Before transplantation, all patients had no sphincter sensation or urination, however, at the end of the study, sense of fecal and urinary excretion was reported in the first three patients Except for patient 1, UDS and EMG-NCV showed no change in the other patients (data not shown) and none of the them were under the control of the sphincter.Conclusion : The present study indicated that three patients at acute and subacute stage showed improvement in neurological function after autologous
schwann cell and
bone marrow derived mesenchymal stem
cell transplantation and in remaining patients, no progress was found in sensory or motor scores according to ISNCSCI. Almost half of patients reported sense of fecal and urinary excretion after transplantation that was not reported in previous studies.There were no systemic complications such as fever, anaphylactic shock, hypersensitivities, rush or inflammation after autologous transplantation. Also radiological pictures indicated no neoplastic overgrowth, syringomyelia, or psuedomeningocele which documents the safety of the use of this cell combination therapy.It appears that the use of this combination of cells is safe for clinical application to spinal cord regeneration.