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Intra-Arterial Bone Marrow Mononuclear Cells in Ischemic Stroke

2012; Lippincott Williams & Wilkins; Volume: 43; Issue: 8 Linguagem: Inglês

10.1161/strokeaha.112.659409

1524-4628

Francisco Moniche, Alejandro González, José-Ramón González-Marcos, Magdalena Carmona, Pilar Piñero, Ildefonso Espigado, David Garcia‐Solis, Aurelio Cayuela, Joan Montaner, Cristina Boada, Anna Rosell, Maria-Dolores Jimenez, Antonio Mayol, A Gil-Peralta,

Neuroinflammation and Neurodegeneration Mechanisms

Background and Purpose— Bone marrow mononuclear cell (BM-MNC) intra-arterial transplantation improves recovery in experimental models of ischemic stroke. We aimed to assess the safety, feasibility, and biological effects of autologous BM-MNC transplantation in patients with stroke. Methods— A single-blind (outcomes assessor) controlled Phase I/II trial was conducted in patients with middle cerebral artery stroke. Autologous BM-MNCs were injected intra-arterially between 5 and 9 days after stroke. Follow-up was done for up to 6 months and blood samples were collected for biological markers. The primary outcome was safety and feasibility of the procedure. The secondary outcome was improvement in neurological function. Results— Ten cases (BM-MNC-treated) and 10 control subjects (BM-MNC-nontreated) were consecutively included. Mean National Institutes of Health Stroke Scale before the procedure was 15.6. Mean BM-MNCs injected were 1.59×10 8 . There was no death, stroke recurrence, or tumor formation during follow-up, although 2 cases had an isolate partial seizure at 3 months. After transplantation, higher plasma levels of beta nerve growth factor (β-nerve growth factor) were found compared with control subjects ( P =0.02). There were no significant differences in neurological function at 180 days. A trend to positive correlation between number of CD34+ cells injected and Barthel Index was found ( r =0.56, P =0.09). Conclusions— Intra-arterial BM-MNC transplantation in subacute ischemic stroke is feasible and seems to be safe. Larger randomized trials are needed to confirm the safety and elucidate the efficacy of BM-MNC transplantation. Clinical Trial Registration-URL— www.clinicaltrials.gov . Unique identifier: NCT00761982.