Is cell transplantation a reliable therapeutic strategy for spinal cord injury in clinical practice? A systematic review and meta-analysis from 22 clinical controlled trials
It is an open question whether cell transplantation can provide safety and effective outcome to spinal cord injury (SCI) patient which has remained controversial for almost 40 years. This study aimed to evaluate the safety and efficacy of cell transplantation in SCI patients.
Studies of the cell transplantation for SCI were retrieved from PubMed, Embase, Medline, Cochrane Library and analyzed quantitative data by Review Manager 5.3.
Twenty-one clinical controlled studies with 973 patients were included. The pooled results suggested that cell transplantation significantly improved ASIA score, ASIA motor score, ASIA sensory score, Barthel Index score, residual urine volume, rehabilitative time of automatic micturition. Furthermore, subgroup analysis indicated that the stem cells exhibited more potent than the non-stem cells in spinal cord repair. Cell transplantation at more than 14 days after injury showed more significant improvements than that within 14 days from injury. The dosage of cell transplantation between 1–5 × 107 and 10–20 × 107 was the potent quantity for the patient with SCI. Intrathecal injection and intravenous + intrathecal injection showed more superior to the other method. The top 5 adverse events were febrile reaction (11.5%), neurologic pain (11.3%), headache (2.6%), neurologic deterioration (2.4%), and rigidity or spasticity (1.6%).
Cell transplantation appears to be a safe therapeutic strategy possessing substantial beneficial effects in the patients with SCI in clinic. Moreover, treating SCI with stem cell, the dosage of cells between 1–5 × 107 and 10–20 × 107, in intermediate or chronic phase, minimally invasive techniques, may bring more advantage to SCI patient.
KeywordsCell transplantation Spinal cord injury Systematic review and meta-analysis
Adipose-derived stem cells
Bone mesenchymal stem cell
Marrow mononuclear cells
Umbilical cord-derived mesenchymal stem cells
Olfactory ensheathing cells
Autologous incubated macrophage
Olfactory lamina propria
Granulocyte-macrophage colony-stimulating factor
Fetal brain-derived neural stem/progenitor cell
Central nervous system
Thank you so much for contributions made by all members of Pro. Xiu-Mei Wang`s group (School of Materials Science and Engineering, Tsinghua University). Thank you so much for contributions made by all members in department of orthopedics III (Dongzhimen Hospital, Beijing University of Chinese Medicine). Thank you so much for contributions made by Dr. Feng-He (China Academy of Chinese Medical Science), Dr. Wan-Jie Gu (Drum Tower, Medical College of Nanjing University), Dr. Yun-Tao Zhao(Aerospace Center Hospital, Peking University).
HZ, XMW, and XY designed the systematic review. HZ and QLS drafted the protocol, and LJD, YDY, YSG, and DYZ revised the manuscript. YX and HJW will independently screen the potential studies, extract data, assess the risk of bias, and finish data synthesis. JWS and KTY will arbitrate any disagreements during the review. All authors approved the publication of the manuscript.
This work was funded by the National Twelfth Five-Year Plan for Science and Technology Support (Grant No. 2012BAI18B05).
Compliance with ethical standards
Conflict of interest
Authors declare that they have no conflict of interest.
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