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Hashimoto S, Nagoshi N, Nakamura M, Okano H. Clinical application and potential pluripotent effects of hepatocyte growth factor in spinal cord injury regeneration. Expert Opin Investig Drugs 2024:1-8. [PMID: 38783527 DOI: 10.1080/13543784.2024.2360191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a condition in which the spinal cord parenchyma is damaged by various factors. The mammalian central nervous system has been considered unable to regenerate once damaged, but recent progress in basic research has gradually revealed that injured neural cells can indeed regenerate. Drug therapy using novel agents is being actively investigated as a new treatment for SCI. One notable treatment method is regeneration therapy using hepatocyte growth factors (HGF). AREA COVERED HGF has pluripotent neuroregenerative actions, as indicated by its neuroprotective and regenerative effects on the microenvironment and damaged cells, respectively. This review examines these effects in various phases of SCI, from basic research to clinical studies, and the application of this treatment to other diseases. EXPERT OPINION In regenerative medicine for SCI, drug therapies have tended to be more likely to be developed compared to cell replacement treatment. Nevertheless, there are still challenges to be addressed for these clinical applications due to a wide variety of pathology and animal experimental models of basic study, but HGF could be an effective treatment for SCI with expanded application.
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Affiliation(s)
- Shogo Hashimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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2
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Khaing ZZ, Chen JY, Safarians G, Ezubeik S, Pedroncelli N, Duquette RD, Prasse T, Seidlits SK. Clinical Trials Targeting Secondary Damage after Traumatic Spinal Cord Injury. Int J Mol Sci 2023; 24:3824. [PMID: 36835233 PMCID: PMC9960771 DOI: 10.3390/ijms24043824] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Spinal cord injury (SCI) often causes loss of sensory and motor function resulting in a significant reduction in quality of life for patients. Currently, no therapies are available that can repair spinal cord tissue. After the primary SCI, an acute inflammatory response induces further tissue damage in a process known as secondary injury. Targeting secondary injury to prevent additional tissue damage during the acute and subacute phases of SCI represents a promising strategy to improve patient outcomes. Here, we review clinical trials of neuroprotective therapeutics expected to mitigate secondary injury, focusing primarily on those in the last decade. The strategies discussed are broadly categorized as acute-phase procedural/surgical interventions, systemically delivered pharmacological agents, and cell-based therapies. In addition, we summarize the potential for combinatorial therapies and considerations.
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Affiliation(s)
- Zin Z. Khaing
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
| | - Jessica Y. Chen
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Gevick Safarians
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sohib Ezubeik
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Nicolas Pedroncelli
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rebecca D. Duquette
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Tobias Prasse
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50931 Cologne, Germany
| | - Stephanie K. Seidlits
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX 78712, USA
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3
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Fehlings MG, Pedro K, Hejrati N. Management of Acute Spinal Cord Injury: Where Have We Been? Where Are We Now? Where Are We Going? J Neurotrauma 2022; 39:1591-1602. [PMID: 35686453 DOI: 10.1089/neu.2022.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Michael G Fehlings
- Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nader Hejrati
- Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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4
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Feng Y, Peng Y, Jie J, Yang Y, Yang P. The immune microenvironment and tissue engineering strategies for spinal cord regeneration. Front Cell Neurosci 2022; 16:969002. [PMID: 35990891 PMCID: PMC9385973 DOI: 10.3389/fncel.2022.969002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Regeneration of neural tissue is limited following spinal cord injury (SCI). Successful regeneration of injured nerves requires the intrinsic regenerative capability of the neurons and a suitable microenvironment. However, the local microenvironment is damaged, including insufficient intraneural vascularization, prolonged immune responses, overactive immune responses, dysregulated bioenergetic metabolism and terminated bioelectrical conduction. Among them, the immune microenvironment formed by immune cells and cytokines plays a dual role in inflammation and regeneration. Few studies have focused on the role of the immune microenvironment in spinal cord regeneration. Here, we summarize those findings involving various immune cells (neutrophils, monocytes, microglia and T lymphocytes) after SCI. The pathological changes that occur in the local microenvironment and the function of immune cells are described. We also summarize and discuss the current strategies for treating SCI with tissue-engineered biomaterials from the perspective of the immune microenvironment.
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Affiliation(s)
- Yuan Feng
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Yong Peng
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Jing Jie
- Department of Clinical Laboratory, The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong, China
- Jing Jie,
| | - Yumin Yang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
- Yumin Yang,
| | - Pengxiang Yang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
- Institute of Cancer Prevention and Treatment, Heilongjiang Academy of Medical Science, Harbin Medical University, Harbin, China
- *Correspondence: Pengxiang Yang,
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5
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Yao XY, Xie L, Cai Y, Zhang Y, Deng Y, Gao MC, Wang YS, Xu HM, Ding J, Wu YF, Zhao N, Wang Z, Song YY, Wang LP, Xie C, Li ZZ, Wan WB, Lin Y, Jin HF, Wang K, Qiu HY, Zhuang L, Zhou Y, Jin YY, Ni LP, Yan JL, Guo Q, Xue JH, Qian BY, Guan YT. Human Umbilical Cord Mesenchymal Stem Cells to Treat Neuromyelitis Optica Spectrum Disorder (hUC-MSC-NMOSD): A Study Protocol for a Prospective, Multicenter, Randomized, Placebo-Controlled Clinical Trial. Front Neurol 2022; 13:860083. [PMID: 35547390 PMCID: PMC9082633 DOI: 10.3389/fneur.2022.860083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neuromyelitis Optica spectrum disorder (NMOSD) is severe relapsing and disabling autoimmune disease of the central nervous system. Its optimal first-line treatment to reduce relapse rate and ameliorate neurological disability remains unclear. We will conduct a prospective, multicenter, randomized, placebo-controlled clinical trial to study the safety and effectiveness of human umbilical cord mesenchymal stem cells (hUC-MSCs) in treating NMOSD. Methods The trial is planned to recruit 430 AQP4-IgG seropositive NMOSD patients. It consists of three consecutive stages. The first stage will be carried out in the leading center only and aims to evaluate the safety of hUC-MSCs. Patients will be treated with three different doses of hUC-MSCs: 1, 2, or 5 × 106 MSC/kg·weight for the low-, medium-, and high-dose group, respectively. The second and third stages will be carried out in six centers. The second stage aims to find the optimal dosage. Patients will be 1:1:1:1 randomized into the low-, medium-, high-dose group and the controlled group. The third stage aims to evaluate the effectiveness. Patients will be 1:1 randomized into the optimal dose and the controlled group. The primary endpoint is the first recurrent time and secondary endpoints are the recurrent times, EDSS scores, MRI lesion numbers, OSIS scores, Hauser walking index, and SF-36 scores. Endpoint events and side effects will be evaluated every 3 months for 2 years. Discussion Although hUC-MSC has shown promising treatment effects of NMOSD in preclinical studies, there is still a lack of well-designed clinical trials to evaluate the safety and effectiveness of hUC-MSC among NMOSD patients. As far as we know, this trial will be the first one to systematically demonstrate the clinical safety and efficacy of hUC-MSC in treating NMOSD and might be able to determine the optimal dose of hUC-MSC for NMOSD patients. Trial registration The study was registered with the Chinese Clinical Trial Registry (CHICTR.org.cn) on 2 March 2016 (registration No. ChiCTR-INR-16008037), and the revised trial protocol (Protocol version 1.2.1) was released on 16 March 2020.
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Affiliation(s)
- Xiao-Ying Yao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Xie
- Clinical Research Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Cai
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ye Deng
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei-Chun Gao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Shu Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui-Ming Xu
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med-X Clinical Stem Cell Research Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Ding
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Fan Wu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zhao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ze Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ya-Ying Song
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Ping Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong Xie
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ze-Zhi Li
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Bin Wan
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Lin
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hai-Feng Jin
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kan Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui-Ying Qiu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhuang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Yan Jin
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Ping Ni
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Li Yan
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Quan Guo
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Hui Xue
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bi-Yun Qian
- Clinical Research Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Clinical Research Promotion and Development Center, Shanghai Hospital Development Center, Shanghai, China
| | - Yang-Tai Guan
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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7
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First-in-human clinical trial of transplantation of iPSC-derived NS/PCs in subacute complete spinal cord injury: Study protocol. Regen Ther 2021; 18:321-333. [PMID: 34522725 PMCID: PMC8427225 DOI: 10.1016/j.reth.2021.08.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/07/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Our group has conducted extensive basic and preclinical studies of the use of human induced pluripotent cell (iPSC)-derived neural stem/progenitor cell (hiPSC-NS/PC) grafts in models of spinal cord injury (SCI). Evidence from animal experiments suggests this approach is safe and effective. We are preparing to initiate a first-in-human clinical study of hiPSC-NS/PC transplantation in subacute SCI. Setting NS/PCs were prepared at a Good Manufacturing Practice-grade cell processing facility at Osaka National Hospital using a clinical-grade integration-free hiPSC line established by the iPSC Stock Project organized by the Kyoto University Center for iPS Cell Research and Application. After performing all quality checks, the long-term safety and efficacy of cells were confirmed using immunodeficient mouse models. Methods The forthcoming clinical study uses an open-label, single-arm design. The initial follow-up period is 1 year. The primary objective is to assess the safety of hiPSC-NS/PC transplantation in patients with subacute SCI. The secondary objective is to obtain preliminary evidence of its impact on neurological function and quality-of-life outcomes. Four patients with C3/4-Th10 level, complete subacute (within 24 days post-injury) SCI will be recruited. After obtaining consent, cryopreserved cells will be thawed and prepared following a multi-step process including treatment with a γ-secretase inhibitor to promote cell differentiation. A total of 2 × 106 cells will be transplanted into the injured spinal cord parenchyma 14–28 days post-injury. Patients will also receive transient immunosuppression. This study protocol has been reviewed and approved by the Certified Committee for Regenerative Medicine and the Japanese Ministry of Health, Labor and Welfare (University Hospital Medical Information Network Clinical Trials Registry [UMIN-CTR] number, UMIN000035074; Japan Registry of Clinical Trials [jRCT] number, jRCTa031190228). Discussion/conclusion We plan to start recruiting a patient as soon as the COVID-19 epidemic subsides. The primary focus of this clinical study is safety, and the number of transplanted cells may be too low to confirm efficacy. After confirming safety, a dose-escalation study is planned. A first-in-human clinical study for spinal cord injury using iPSC-derived cells is about to begin. The primary objective is to assess the safety of human iPSC-derived neural stem/progenitor cells. Further clinical trials are expected to be conducted to statistically assess efficacy.
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8
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A review of emerging neuroprotective and neuroregenerative therapies in traumatic spinal cord injury. Curr Opin Pharmacol 2021; 60:331-340. [PMID: 34520943 DOI: 10.1016/j.coph.2021.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Traumatic spinal cord injuries (SCIs) have far-reaching physical, social, and financial consequences. While medical advancements have improved supportive therapeutic measures for SCI patients, no effective neuroregenerative therapeutic options exist to date. Instead, the paradigm of SCI therapy is inevitably directed towards damage control rather than the restoration of a state of functional independence. Facing a continuous increase in the prevalence of spinal cord injured patients, neuroprotective and neuroregenerative strategies have earned tremendous scientific interest. This review intends to provide a robust summary of the most promising neuroprotective and neuroregenerative therapies currently under investigation. While we highlight encouraging neuroprotective strategies as well, the focus of this review lies on neuroregenerative therapies, including neuropharmacological and cell-based approaches. We finally point to the exciting investigational areas of biomaterial scaffolds and neuromodulation therapies.
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9
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Koda M, Hanaoka H, Fujii Y, Hanawa M, Kawasaki Y, Ozawa Y, Fujiwara T, Furuya T, Ijima Y, Saito J, Kitamura M, Miyamoto T, Ohtori S, Matsumoto Y, Abe T, Takahashi H, Watanabe K, Hirano T, Ohashi M, Shoji H, Mizouchi T, Kawahara N, Kawaguchi M, Orita Y, Sasamoto T, Yoshioka M, Fujii M, Yonezawa K, Soma D, Taneichi H, Takeuchi D, Inami S, Moridaira H, Ueda H, Asano F, Shibao Y, Aita I, Takeuchi Y, Mimura M, Shimbo J, Someya Y, Ikenoue S, Sameda H, Takase K, Ikeda Y, Nakajima F, Hashimoto M, Hasue F, Fujiyoshi T, Kamiya K, Watanabe M, Katoh H, Matsuyama Y, Hasegawa T, Yoshida G, Arima H, Yamato Y, Oe S, Togawa D, Kobayashi S, Akeda K, Kawamoto E, Imai H, Sakakibara T, Sudo A, Ito Y, Kikuchi T, Takigawa T, Morita T, Tanaka N, Nakanishi K, Kamei N, Kotaka S, Baba H, Okudaira T, Konishi H, Yamaguchi T, Ito K, Katayama Y, Matsumoto T, Matsumoto T, Kanno H, Aizawa T, Hashimoto K, Eto T, Sugaya T, Matsuda M, Fushimi K, Nozawa S, Iwai C, Taguchi T, Kanchiku T, Suzuki H, Nishida N, Funaba M, Sakai T, Imajo Y, Yamazaki M. Randomized trial of granulocyte colony-stimulating factor for spinal cord injury. Brain 2021; 144:789-799. [PMID: 33764445 PMCID: PMC8041047 DOI: 10.1093/brain/awaa466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022] Open
Abstract
Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. The present trial failed to show a significant effect of G-CSF in primary end point.
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Affiliation(s)
- Masao Koda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Correspondence to: Masao Koda, MD, PhD Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City Ibaraki 305-8575 Japan E-mail:
| | - Hideki Hanaoka
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasushi Ijima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuya Miyamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukei Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kei Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Hirokazu Shoji
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Tatsuki Mizouchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Norio Kawahara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Kawaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Yugo Orita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Takeshi Sasamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Yoshioka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masafumi Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Katsutaka Yonezawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Daisuke Soma
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Hiroshi Taneichi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daisaku Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Satoshi Inami
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Moridaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Haruki Ueda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Futoshi Asano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Shibao
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Ikuo Aita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Yosuke Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Masaya Mimura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Jun Shimbo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yukio Someya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Sumio Ikenoue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Hiroaki Sameda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Kan Takase
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yoshikazu Ikeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumitake Nakajima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Mitsuhiro Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumio Hasue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takayuki Fujiyoshi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Koshiro Kamiya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Masahiko Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Katoh
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yukihiro Matsuyama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kindai University, Nara Hospital, Nara, Japan
| | - Sho Kobayashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Koji Akeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Eiji Kawamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hiroshi Imai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Toshihiko Sakakibara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Akihiro Sudo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yasuo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takeshi Kikuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Tomoyuki Takigawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takuya Morita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Nobuhiro Tanaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nihon University, Tokyo, Japan
| | - Naosuke Kamei
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hideo Baba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Tsuyoshi Okudaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Hiroaki Konishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Takayuki Yamaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Keigo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Yoshito Katayama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Taro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Tomohiro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Haruo Kanno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimi Aizawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Ko Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimitsu Eto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Takehiro Sugaya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Michiharu Matsuda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Kazunari Fushimi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Toshihiko Taguchi
- G-SPIRIT Study Group, Chiba, Japan
- Yamaguchi Rosai Hospital, Japan Organization of Occupational Health and Safety, Japan
| | - Tsukasa Kanchiku
- G-SPIRIT Study Group, Chiba, Japan
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, Japan
| | - Hidenori Suzuki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuaki Imajo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masashi Yamazaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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10
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Ozaki M, Suda K, Konomi T, Harmon SM, Komatsu M, Minami A, Matsumoto M, Nakamura M, Takahata M, Iwasaki N. Serum C-reactive protein is an early, simple and inexpensive prognostic marker for the progression of intramedullary lesion on magnetic resonance imaging from acute to subacute stage in patients with spinal cord injury. Spinal Cord 2021; 59:1155-1161. [PMID: 34045666 DOI: 10.1038/s41393-021-00640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart audit. OBJECTIVES This study aimed to identify conventional routine blood testing biomarkers associated with the progression of intramedullary injured area in patients with spinal cord injury (SCI). SETTING A spinal cord injury center in Hokkaido, Japan. METHODS We retrospectively reviewed 71 consecutive adults with acute SCI who were admitted within 24 h after injury and diagnosed as American Spinal Injury Association Impairment Scale Grade A or B at admission. Participants were divided into the progression (P group) and no progression group (NP group) based on the change of the hyperintense signal abnormality in the spinal cord on magnetic resonance imaging from the time of admission to 4 weeks after injury. Individual characteristics and blood testing data obtained in the first 4 weeks after injury were compared between groups. RESULTS The P and NP groups were comprised of 16 and 55 participants, respectively. In univariate analyses, white blood cell (WBC) count on day 3 was significantly higher in group P than group NP (P = 0.021), as was serum C-reactive protein (CRP) level on day 3 (P = 0.015) and day 7 (P = 0.047). Multivariable analysis identified serum CRP level on day 3 as a significant independent prognostic factor for the progression of secondary SCI (OR, 1.138; 95% confidence interval, 1.01-1.28; P = 0.034). CONCLUSIONS Serum CRP level on day 3 after injury was a good predictor for the progression of intramedullary signal intensity change on MRI from acute to subacute stage in patients with SCI.
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Affiliation(s)
- Masahiro Ozaki
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido, Japan. .,Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido, Japan
| | - Tsunehiko Konomi
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido, Japan.,Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan
| | | | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido, Japan
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
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11
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Huang KT, Lu Y. Traumatic Spinal Cord Disorders: Current Topics and Future Directions. Semin Neurol 2021; 41:247-255. [PMID: 34010969 DOI: 10.1055/s-0041-1725125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic spinal cord injury (tSCI) is a life-changing and potentially overwhelming event. The sudden disruption of the spinal cord's integrity necessitates rapid attention at a specialized medical center, and involves a multilateral collaboration between neurologists, spine surgeons, critical care physicians, and trauma specialists. Even with care under ideal conditions, many tSCI patients have significant disability that persists for the rest of their lives. However, recently, we have seen a proliferation in clinical and translational trials that offer the promise that new treatments may be available soon.
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Affiliation(s)
- Kevin T Huang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Baroncini A, Maffulli N, Eschweiler J, Tingart M, Migliorini F. Pharmacological management of secondary spinal cord injury. Expert Opin Pharmacother 2021; 22:1793-1800. [PMID: 33899630 DOI: 10.1080/14656566.2021.1918674] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Secondary spinal cord injury (SCI) sets on immediately after trauma and, despite prompt treatment, may become chronic. SCI is a complex condition and presents numerous challenges to patients and physicians alike, also considering the lack of an approved pharmacological therapy.Areas covered: This review describes the pathophysiological mechanisms leading to secondary SCI to highlight possible targets for pharmacological therapy. Furthermore, an extensive search of the literature on different databases (PubMed, Google scholar, Embase, and Scopus) and of the current clinical trials (clinicaltrials.gov) was performed to investigate the current outlook for the pharmacological management of SCI. Only drugs with performed or ongoing clinical trials were considered.Expert opinion: Pharmacological therapy aims to improve motor and sensory function in patients. Overall, drugs are divided into neuroprotective compounds, which aim to limit the damage induced by the pro-inflammatory and pro-apoptotic milieu of SCI, and neuroregenerative drugs, which induce neuronal and axonal regrowth. While many compounds have been trialed with promising results, none has yet completed a stage III trial and has been approved for the pharmacological management of SCI.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.,Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic Surgery, RWTH Aachen University Clinic, Aachen, Germany
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13
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Aschauer-Wallner S, Leis S, Bogdahn U, Johannesen S, Couillard-Despres S, Aigner L. Granulocyte colony-stimulating factor in traumatic spinal cord injury. Drug Discov Today 2021; 26:1642-1655. [PMID: 33781952 DOI: 10.1016/j.drudis.2021.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is a cytokine used in pharmaceutical preparations for the treatment of chemotherapy-induced neutropenia. Evidence from experimental studies indicates that G-CSF exerts relevant activities in the central nervous system (CNS) in particular after lesions. In acute, subacute, and chronic CNS lesions, G-CSF appears to have strong anti-inflammatory, antiapoptotic, antioxidative, myelin-protective, and axon-regenerative activities. Additional effects result in the stimulation of angiogenesis and neurogenesis as well as in bone marrow stem cell mobilization to the CNS. There are emerging preclinical and clinical data indicating that G-CSF is a safe and effective drug for the treatment of acute and chronic traumatic spinal cord injury (tSCI), which we summarize in this review.
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Affiliation(s)
- Stephanie Aschauer-Wallner
- Department of Orthopedics and Traumatology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Stefan Leis
- Department of Neurology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ulrich Bogdahn
- Velvio GmbH, Regensburg, Germany; Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany; Department of Neurology, BG Trauma Center Murnau, Murnau, Germany
| | - Sebastien Couillard-Despres
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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14
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Takami T, Shimokawa N, Parthiban J, Zileli M, Ali S. Pharmacologic and Regenerative Cell Therapy for Spinal Cord Injury: WFNS Spine Committee Recommendations. Neurospine 2020; 17:785-796. [PMID: 33401856 PMCID: PMC7788403 DOI: 10.14245/ns.2040408.204] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
This is a review article examining the pharmacologic and regenerative cell therapy for spinal cord injury.
A literature search during last 10 years were conducted using key words. Case reports, experimental (nonhuman) studies, papers other than English language were excluded. Up-to-date information on the pharmacologic and regenerative cell therapy for spinal cord injury was reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method.
Pharmacologic and regenerative cell therapy for spinal cord injury have long been an interest of many experimental and clinical researches. Clinical studies with methylpredinisolone have not shown clear cut benefit. Other drugs such as Rho inhibitor, minocycline, riluzole, granulocyte colony-stimulating factor have also been tried without significant benefits. Regenerative cell therapy using different types of stem cells, different inoculation techniques, and scaffolds have undergone many trials highlighting the efficacies of cells and their limitations.
This review article summarizes the current knowledge on pharmacologic and regenerative cell therapy for spinal cord injury. Unfortunately, there is a need for further experimental and human trials to recommend effective pharmacologic and regenerative cell therapy.
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Affiliation(s)
- Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Jutty Parthiban
- Department of Neurosurgery, Kovai Medical Center and Hospital Coimbatore, Tamilnadu, India
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Sheena Ali
- Department of Neurosurgery, Kovai Medical Center and Hospital Coimbatore, Tamilnadu, India
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Yang Y, Pang M, Du C, Liu ZY, Chen ZH, Wang NX, Zhang LM, Chen YY, Mo J, Dong JW, Xie PG, Wang QY, Liu B, Rong LM. Repeated subarachnoid administrations of allogeneic human umbilical cord mesenchymal stem cells for spinal cord injury: a phase 1/2 pilot study. Cytotherapy 2020; 23:57-64. [PMID: 33218835 DOI: 10.1016/j.jcyt.2020.09.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/12/2020] [Accepted: 09/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AIMS Stem cell transplantation is a potential treatment for intractable spinal cord injury (SCI), and allogeneic human umbilical cord mesenchymal stem cells (hUC-MSCs) are a promising candidate because of the advantages of immune privilege, paracrine effect, immunomodulatory function, convenient collection procedure and little ethical concern, and there is an urgent need to develop a safe and effective protocol regarding their clinical application. METHODS A prospective, single-center, single-arm study in which subjects received four subarachnoid transplantations of hUC-MSCs (1 × 106 cells/kg) monthly and were seen in follow-up four times (1, 3, 6 and 12 months after final administration) was conducted. At each scheduled time point, safety and efficacy indicators were collected and analyzed accordingly. Adverse events (AEs) were used as a safety indicator. American Spinal Injury Association (ASIA) and SCI Functional Rating Scale of the International Association of Neurorestoratology (IANR-SCIFRS) total scores at the fourth follow-up were determined as primary efficacy outcomes, whereas these two indicators at the remaining time points as well as scores of pinprick, light touch, motor and sphincter, muscle spasticity and spasm, autonomic system, bladder and bowel functions, residual urine volume (RUV) and magnetic resonance imaging (MRI) were secondary efficacy outcomes. Subgroup analysis of primary efficacy indicators was also performed. RESULTS Safety and efficacy assessments were performed on 102 and 41 subjects, respectively. Mild AEs involving fever (14.1%), headache (4.2%), transient increase in muscle tension (1.6%) and dizziness (1.3%) were observed following hUC-MSC transplantation and resolved thoroughly after conservative treatments. There was no serious AE. ASIA and IANR-SCIFRS total scores revealed statistical increases when compared with the baselines at different time points during the study, mainly reflected in the improvement of pinprick, light touch, motor and sphincter scores. Moreover, subjects showed a continuous and remarkable decrease in muscle spasticity. Regarding muscle spasm, autonomic system, bladder and bowel functions, RUV and MRI, data/imaging at final follow-up showed significant improvements compared with those at first collection. Subgroup analysis found that hUC-MSC transplantation improved neurological functions regardless of injury characteristics, including level, severity and chronicity. CONCLUSIONS The authors' present protocol demonstrates that intrathecal administration of' allogeneic hUC-MSCs at a dose of 106 cells/kg once a month for 4 months is safe and effective and leads to significant improvement in neurological dysfunction and recovery of quality of life.
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Affiliation(s)
- Yang Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Mao Pang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Cong Du
- Cell-Gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhong-Yu Liu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Zi-Hao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Nan-Xiang Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Liang-Ming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Yu-Yong Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Jian Mo
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Jian-Wen Dong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Pei-Gen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Qi-You Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China
| | - Bin Liu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China.
| | - Li-Min Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, People's Republic of China.
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16
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Yang Y, Pang M, Chen YY, Zhang LM, Liu H, Tan J, Liu B, Rong LM. Human umbilical cord mesenchymal stem cells to treat spinal cord injury in the early chronic phase: study protocol for a prospective, multicenter, randomized, placebo-controlled, single-blinded clinical trial. Neural Regen Res 2020; 15:1532-1538. [PMID: 31997819 PMCID: PMC7059580 DOI: 10.4103/1673-5374.274347] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Human umbilical cord mesenchymal stem cells (hUC-MSCs) support revascularization, inhibition of inflammation, regulation of apoptosis, and promotion of the release of beneficial factors. Thus, they are regarded as a promising candidate for the treatment of intractable spinal cord injury (SCI). Clinical studies on patients with early chronic SCI (from 2 months to 1 year post-injury), which is clinically common, are rare; therefore, we will conduct a prospective, multicenter, randomized, placebo-controlled, single-blinded clinical trial at the Third Affiliated Hospital of Sun Yat-sen University, West China Hospital of Sichuan University, and Shanghai East Hospital, Tongji University School of Medicine, China. The trial plans to recruit 66 early chronic SCI patients. Eligible patients will undergo randomization at a 2:1 ratio to two arms: the observation group and the control group. Subjects in the observation group will receive four intrathecal transplantations of stem cells, with a dosage of 1 × 106/kg, at one calendar month intervals. Subjects in the control group will receive intrathecal administrations of 10 mL sterile normal saline in place of the stem cell transplantations. Clinical safety will be assessed by the analysis of adverse events and laboratory tests. The American Spinal Injury Association (ASIA) total score will be the primary efficacy endpoint, and the secondary efficacy outcomes will be the following: ASIA impairment scale, International Association of Neural Restoration-Spinal Cord Injury Functional Rating Scale, muscle tension, electromyogram, cortical motor and cortical sensory evoked potentials, residual urine volume, magnetic resonance imaging-diffusion tensor imaging, T cell subtypes in serum, neurotrophic factors and inflammatory factors in both serum and cerebrospinal fluid. All evaluations will be performed at 1, 3, 6, and 12 months following the final intrathecal administration. During the entire study procedure, all adverse events will be reported as soon as they are noted. This trial is designed to evaluate the clinical safety and efficacy of subarachnoid transplantation of hUC-MSCs to treat early chronic SCI. Moreover, it will establish whether cytotherapy can ameliorate local hostile microenvironments, promote tracking fiber regeneration, and strengthen spinal conduction ability, thus improving overall motor, sensory, and micturition/defecation function in patients with early chronic SCI. This study was approved by the Stem Cell Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, China (approval No. [2018]-02) on March 30, 2018, and was registered with ClinicalTrials.gov (registration No. NCT03521323) on April 12, 2018. The revised trial protocol (protocol version 4.0) was approved by the Stem Cell Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, China (approval No. [2019]-10) on February 25, 2019, and released on ClinicalTrials.gov on April 29, 2019.
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Affiliation(s)
- Yang Yang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China
| | - Mao Pang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China
| | - Yu-Yong Chen
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China
| | - Liang-Ming Zhang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Liu
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China
| | - Li-Min Rong
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China
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Application of Hepatocyte Growth Factor for Acute Spinal Cord Injury: The Road from Basic Studies to Human Treatment. Int J Mol Sci 2019; 20:ijms20051054. [PMID: 30823442 PMCID: PMC6429374 DOI: 10.3390/ijms20051054] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 11/25/2022] Open
Abstract
Hepatocyte growth factor (HGF) was first identified as a potent mitogen for mature hepatocytes, and has also gained attention as a strong neurotrophic factor in the central nervous system. We found that during the acute phase of spinal cord injury (SCI) in rats, c-Met, the specific receptor for HGF, increases sharply, while the endogenous HGF up-regulation is relatively weak. Introducing exogenous HGF into the spinal cord by injecting an HGF-expressing viral vector significantly increased the neuron and oligodendrocyte survival, angiogenesis, and axonal regeneration, to reduce the area of damage and to promote functional recovery in rats after SCI. Other recent studies in rodents have shown that exogenously administered HGF during the acute phase of SCI reduces astrocyte activation to decrease glial scar formation, and exerts anti-inflammatory effects to reduce leukocyte infiltration. We also reported that the intrathecal infusion of recombinant human HGF (intrathecal rhHGF) improves neurological hand function after cervical contusive SCI in the common marmoset, a non-human primate. Based on these collective results, we conducted a phase I/II clinical trial of intrathecal rhHGF for patients with acute cervical SCI who showed a modified Frankel grade of A/B1/B2 72 h after injury onset, from June 2014 to May 2018.
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