Stem Cells and SCI: Placebo or the Next Best Thing Since Sliced Bread?
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I have gotten many emails through the years from patients who know someone who has a spinal cord injury (SCI) and who ask if we could help. My answer has always been the same. We only treat orthopedic injuries. However, a study on stem cells and spinal cord injury was just published in February that’s worth sharing. In addition, the field of using stem cells for SCI is maturing. Let’s dig in.
Spinal Cord Injury
We all have a spinal cord that runs through our vertebrae that can be injured in a traumatic event. When that happens, the patient can lose various amounts of sensation or motor function below the injury. If that injury is in the neck, then they can lose arm, trunk, and leg function. If that injury is in the low back or upper back, they usually lose either trunk and leg function or just the legs.
The reason why this issue is so hard to treat is that the spinal cord forms a scar that prevents nerve cells from regrowing and reconnecting. Hence, researchers have been trying to use stem cells to help patients recover. One of the things that’s clear from that research is that the therapy probably needs to be delivered early, before the scar forms. Or, you need to develop a way to get rid of the scar.
The New Research
The new research was performed in Japan where stem cell research on humans has fewer regulations and barriers. 13 patients with various levels of neck spinal cord injury were recruited and had their own bone marrow taken for culture, using a technique almost identical to the type of culture we use at our licensed Grand Cayman treatment site. The cells were isolated and grown to higher numbers in a lab over several weeks so that at the end there were millions of mesenchymal stem cells (MSCs). About 3-8 weeks after the spinal cord injury, culture-expanded mesenchymal stem cells from the patient were infused intravenously. 12/13 patients improved rapidly, usually one spinal cord injury grade, but several patients improved by two grades. It’s worth your time if this subject interests you to look over the MRIs and recovery stories for each patient which are detailed in the paper.
No Controls
The authors were keen to point out that they had no control group who weren’t treated or who got a placebo, so the improvements could have been due to the placebo effects. That’s easier to explain if we’re talking reports of sensation improvement, which can be subjective. However, many of the patients also regained the ability to move a body part, which would be called motor improvement. That’s pretty objective and hard to fake. Hence, while a placebo-controlled study is needed, these results are pretty amazing and compelling.
How Could This Work Via IV Injection?
One of the issues with injecting MSCs IV (in a vein) is that about 97% will end up in the lungs. While it’s possible that some of these cells will egress or leave the lungs and end up elsewhere, there has been some question about whether they can make it to the brain or spinal cord. It’s for this reason that most spinal cord injury studies using MSCs have injected them or placed them in the spinal canal.
So if few cells likely made it to the spinal cord injury site, how could this work? Likely by the cells pumping out anti-inflammatory and neuro-protective growth factors from the lungs or other sites.
What Else is Out There on Stem Cells and Treating Spinal Cord Injury?
A recent large meta-analysis reviewed the results from 18 studies on nearly a thousand patients (2). What was the conclusion?
“In SCI, MSCs transplantation generates better outcomes than rehabilitation, including improvements in movement, sensation, and quality of life. For indirect head-to-head comparisons, there were no significant differences when comparing the different cell sources and transplantation methods. Nevertheless, the treatment of SCI by IT transplantation of autologous MSCs may be a better option. However, further clinical head-to-head trials are required to confirm the effectiveness and safety of these interventions.”
So basically, MSCs to help SCI patients is now “a thing”, which is sure great to see for people suffering from this condition.
What These Treatments are NOT
I usually avoid blogs like this as vulnerable patients can get easily confused and scammed by clinics that don’t offer anything close to what’s being described in these studies. Let’s dig in on that topic.
First, these studies used cells that were cultivated in a lab incubator for weeks to isolate and grow them to higher numbers than are found in the body. Hence, this is not the same thing as taking stem cells from your bone marrow or fat and then reinfusing them into your body. While that can help many orthopedic issues, it’s very different than “culture-expanded cells”.
In addition, the reader needs to differentiate this technique with live culture-expanded cells from the dead umbilical cord cell injections being used by US clinics scamming consumers. For this to work, the MSCs must be living and functional. Hence, while we have many clinics suffering umbilical cord “stem cell” infusions, the products they are using bear ZERO resemblance to what’s being offered in these studies.
Is The Research Perfect?
NO. There are still more studies to run, so don’t expect this stuff to get covered by insurance anytime soon. However, having said that, I am encouraged enough by the state of the research that if I or a loved one had a spinal cord injury, this is what I would want done to maximize the chance of recovery. Hence, I will change my recommendation to the people who contact me about this topic from “be cautious, we don’t have any idea that this works” to “I’m cautiously optimistic that you may be able to be helped”. The caveat will be to find someone offering a legit therapy that’s like what has been studied.
The upshot? I’m so glad to see that now when people contact me, I have something positive to tell them, as the last time I did a deep dive into this body of literature was about 5-7 years ago when not much was known. In addition, there are few problems worse than spinal cord injury, so the idea that there is now some hope for these patients is fantastic.
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References:
(1) Honmou O, Yamashita T, Morita T, Oshigiri T, Hirota R, Iyama S, Kato J, Sasaki Y, Ishiai S, Ito YM, Namioka A, Namioka T, Nakazaki M, Kataoka-Sasaki Y, Onodera R, Oka S, Sasaki M, Waxman SG, Kocsis JD. Intravenous infusion of auto serum-expanded autologous mesenchymal stem cells in spinal cord injury patients: 13 case series. Clin Neurol Neurosurg. 2021 Apr;203:106565. doi: 10.1016/j.clineuro.2021.106565. Epub 2021 Feb 18. PMID: 33667953.
(2) Chen WC, Liu WF, Bai YY, et al. Transplantation of mesenchymal stem cells for spinal cord injury: a systematic review and network meta-analysis. J Transl Med. 2021;19(1):178. Published 2021 Apr 28. doi:10.1186/s12967-021-02843-0
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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.
