APLICACIÓN CÉLULAS MADRE
Case study
A 39-year-old female lawyer experienced after sport accident, a sudden onset of anesthetic paraplegia. She was admitted to the hospital 5 hours after accident, maintaining flaccid paraplegia with dense sensory loss at T9 and loss of control. The patient underwent an MRI of the spine, which revealed extensive lesion of spine cord from D9, with compressive at same level (Figure 1).
The patient was immediately submitted to a D9 laminectomy surgery with fixation. Despite the surgical treatment, the patient had neurological squeal with mild postoperative improvement, but no motor improvement (ASIA A), and was discharged with a recommendation for physical therapy.
At follow-up, During and immediately following surgery, the patient underwent monitoring of somatosensory and motor evoked potentials (Figure 2), which revealed no paravertebral activity and no activity below the iliopsoas. Given that our patient did not show any sensorial o motor improvement in the year following the surgery, we opted for the use of MSCs with the goal of inducing neuroregeneration of the damaged spinal. Once the patient and her family had given their consent, and our hospital's Clinical Research Ethics committee approved the method, we submitted the patient to the protocol of MSC infusion describedblow. Preparation and inoculation of mesenchymal stem cells derived from Adipose Tissue.
Approximately 120 ml of fat were extracted from the patient's lower abdominal fat by minilipoaspiration following tumescence protocol. The patient agreed to participate in the study and signed an informed consent form. After collection, the material was immediately washed with physiological solution and collagenase digestion for 45 minuts in incubator at 37ºc, and then centrifuged at 2880 g for 9 minutes. The mononuclear cells were counted ( 130.000.000 total) Electrophysiological control Eight months after the last application of MSCs, we conducted an electrophysiological assessment with motor evoked potentials were done. Discussion Our patient is still being followed, we are now up to nine month after the first MSC infusion, and we could testify astonishing improvements. In neurological evaluation, before MSC treatment, patient had complete tactile and thermo-algesic anesthesia and abolition of voluntary motion below D9 level (ASIA A). Despite it, electrophysiological monitoring revealed residual suprasegmental electrical activity. Thus this patient was diagnosed as harboring a ¨Discomplete clinical spinal cord syndrome¨ (DCS), and the ASC was then applied. In further electrophysiological and clinical assessment, we observed an improvement in the motor potentials of both inferior limbs, with apparent normality in the bilateral paravertebral segment (which allowed our patient to maintain a seated posture with perfect equilibrium of the trunk, thus allowing him to return to his surgical work), iliopsoas improvement (he is currently able to flex the trunk in a satisfactory manner), improvement in the quadriceps (with regained tone and bilateral thigh tropism), and a bit of function below the quadriceps. Nowadays patient is able to stand alone with the aid of lower-limb orthesis and canes. Another relevant topic following the MSC transplantation was the troublesome neuropathic and myelopathic pain that affected patient since 3 months after the accident. Noteworthy was that patient has became pain medication-free after the MSC treatment, without any pain. This may be explained by the immunomodulatory efficacy of the intrathecal MSC therapy. The application of MSC over embryonic stem cells is largely justified, since it is easier to obtain, to harvest, with lower cost, and without ethical implications. Furthermore up to now there is no report of tumorigenesis using MSC transplantation. We use Adipose-derived cells since it is easy to obtain. The selection of patients eligible to MSCs therapy is still an issue of debate. This is the first report that applies MSCs therapy in Spinal cord lesion patients. Perhaps the MSC therapy in paraplegic anesthetics patients (ASIA A) with residual electrophysiological function may amplify a minimal electrical activity passing through the lesion level. Conclusion Although these are only the preliminary results from the first patient included in our MSC protocol for SCI patients, the clinical, radiological and electrophysiological improvements presented by our patient suggest that this form of therapy is promising. Further studies will provide additional data and allow us to make stronger conclusions.
