New study from Mayo Clinic on autologous adipose derived culture expanded MSCs for Spinal Cord Injury (SCI)

As a physiatrists during residency, we trained on SCI and always wondered if there was a better way to shift the paradigm from palliative to treatment focused care. (Including most musculoskeletal conditions).

According to a phase I clinic trial published by the Mayo Clinic, this shift may be underway.

Authors from the Mayo clinic recently published a peer reviewed phase I study using autologous (ones own tissues) adipose (fat) derived mesenchymal stem cells (MSCs) for cervical & thoracic spinal cord injuries (SCI). (Medicine loves acronyms :)

MSCs have been identified by our beloved late pioneering colleague, Arnold Caplan PhD. They possess capabilities of regulating the immune system and inflammation which play critical roles in health and disease.

Patients received fat harvest of 15 ml that was then processed & cultured to a dose of 100M MSC’s & was then injected back into the same patient via lumbar intrathecal delivery w/ fluoroscopic (x-ray) guidance.

10 patients enrolled and were followed up for 2 years. No serious adverse events occurred throughout the study period, although non-serious adverse events were not infrequent.

Several patients demonstrated sensory and motor improvement based on AIS impairment grade assessments. Some participants had improvements in 2 levels of injury which is a significant achievement.

They observed an increase in the level of VEGF. This supports the proposed paracrine (cells stimulating existing cells & mechanisms in our own body w/ cross talk & cell-cell communication) mechanism of action of MSCs in SCI; however, further investigation is needed.

The research team noted 7/10 participants demonstrated improvements based on the American Spinal Injury Association (ASIA) Impairment Scale. It will be interesting to further study the non-responder characteristics for future research.

Improvements included increased sensation when tested with pinprick and light touch, increased strength in muscle motor groups, and recovery of voluntary anal contraction, which aids in bowel function.

It’s important to note that use of isolated culture expanded MSCs from fat, bone marrow, or umbilical cord tissue outside of an FDA approved clinic trial in the USA is strictly prohibited.

It’s exciting to see controlled trials emerging on MSCs that may shift away from a primary palliative and symptom management approach for some challenging conditions like SCI. More studies are needed to better understand responders & non-responders, & optimal source of tissue & donor.