1. Intra-Arterial Bone Marrow Mononuclear Cells in Ischemic Stroke
- Author
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Alejandro González, Cristina Boada, Pilar Piñero, Ildefonso Espigado, Maria-Dolores Jimenez, David Garcia-Solis, Francisco Moniche, Alberto Gil-Peralta, Joan Montaner, Antonio Mayol, Magdalena Carmona, J.R. Gonzalez-Marcos, Aurelio Cayuela, and Anna Rosell
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Antigens, CD34 ,Pilot Projects ,Peripheral blood mononuclear cell ,Brain Ischemia ,Young Adult ,Granulocyte Colony-Stimulating Factor ,Nerve Growth Factor ,Intra arterial ,medicine ,Humans ,Stroke ,Aged ,Bone Marrow Transplantation ,Aged, 80 and over ,Neurologic Examination ,Advanced and Specialized Nursing ,Stroke scale ,business.industry ,Hemodynamics ,Infarction, Middle Cerebral Artery ,Middle Aged ,medicine.disease ,Surgery ,Transplantation ,Clinical trial ,Treatment Outcome ,medicine.anatomical_structure ,Ischemic stroke ,Female ,Neurology (clinical) ,Bone marrow ,Safety ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose— Bone marrow mononuclear cell (BM-MNC) intra-arterial transplantation improves recovery in experimental models of ischemic stroke. We aimed to assess the safety, feasibility, and biological effects of autologous BM-MNC transplantation in patients with stroke. Methods— A single-blind (outcomes assessor) controlled Phase I/II trial was conducted in patients with middle cerebral artery stroke. Autologous BM-MNCs were injected intra-arterially between 5 and 9 days after stroke. Follow-up was done for up to 6 months and blood samples were collected for biological markers. The primary outcome was safety and feasibility of the procedure. The secondary outcome was improvement in neurological function. Results— Ten cases (BM-MNC-treated) and 10 control subjects (BM-MNC-nontreated) were consecutively included. Mean National Institutes of Health Stroke Scale before the procedure was 15.6. Mean BM-MNCs injected were 1.59×10 8 . There was no death, stroke recurrence, or tumor formation during follow-up, although 2 cases had an isolate partial seizure at 3 months. After transplantation, higher plasma levels of beta nerve growth factor (β-nerve growth factor) were found compared with control subjects ( P =0.02). There were no significant differences in neurological function at 180 days. A trend to positive correlation between number of CD34+ cells injected and Barthel Index was found ( r =0.56, P =0.09). Conclusions— Intra-arterial BM-MNC transplantation in subacute ischemic stroke is feasible and seems to be safe. Larger randomized trials are needed to confirm the safety and elucidate the efficacy of BM-MNC transplantation. Clinical Trial Registration-URL— www.clinicaltrials.gov . Unique identifier: NCT00761982.
- Published
- 2012
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