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Cellular Transplants in China: Observational Study from the Largest Human Experiment in Chronic Spinal Cord Injury
Bruce H. Dobkin, MD
Department of Neurology, Neurorehabilitation and Research Program, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, bdobkin{at}mednet.ucla.edu
Armin Curt, MD
Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland, and ICORD and Division of Neurology, the University of British Columbia, Vancouver, British Columbia, Canada
James Guest, MD, PhD
Neurological Surgery and the Miami Project to Cure Paralysis, Miller School of Medicine, Miami, FL
Background. In China, fetal brain tissue has been transplanted into the lesions of more than 400 patients with spinal cord injury (SCI). Anecdotal reports have been the only basis for assuming that the procedure is safe and effective. Objective. To compare available reports to the experiences and objective findings of patients who received pre-operative and postoperative assessments before and up to 1 year after receiving cellular implants. Methods. Independent observational study of 7 chronic SCI subjects undergoing surgery by Dr Hongyun Huang in Beijing. Assessments included lesion location by magnetic resonance imaging, protocol of the American Spinal Injury Association (ASIA), change in disability, and detailed history of the perioperative course. Results. Inclusion and exclusion criteria were not clearly defined, as subjects with myelopathies graded ASIA A through D and of diverse causes were eligible. Cell injection sites did not always correlate with the level of injury and included the frontal lobes of a subject with a high cervical lesion. Complications, including meningitis, occurred in 5 subjects. Transient postoperative hypotonicity may have accounted for some physical changes. No clinically useful sensorimotor, disability, or autonomic improvements were found. Conclusions. The phenotype and the fate of the transplanted cells, described as olfactory ensheathing cells, are unknown. Perioperative morbidity and lack of functional benefit were identified as the most serious clinical shortcomings. The procedures observed did not attempt to meet international standards for either a safety or efficacy trial. In the absence of a valid clinical trials protocol, physicians should not recommend this procedure to patients.
Key Words: Spinal cord injury • Neural transplantation • Regeneration • Rehabilitation • Neuroplasticity • Clinical trials • Fetal olfactory cells
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Neurorehabilitation and Neural Repair, Vol. 20, No. 1,
5-13 (2006)
DOI: 10.1177/1545968305284675
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