Intra-arterial infusion of autologous bone marrow mononuclear cells in patients with moderate to severe middle cerebral artery acute ischemic stroke.

Transplantation of autologous bone marrow mononuclear cells (BMMCs) has been proven safe in animal and human studies. However, there are very few studies in stroke patients. In this study, intra-arterial autologous BMMCs were infused in patients with moderate to severe acute middle cerebral artery infarcts. The subjects of this study included 20 patients with early or late spontaneous recanalization but with persistent deficits, in whom treatment could be initiated between 3 and 7 days after stroke onset. Mononuclear cells were isolated from bone marrow aspirates and infused at the proximal middle cerebral artery of the affected hemisphere. Safety analysis (primary endpoint) during the 6-month follow-up assessed death, any serious clinical events, neurological worsening with ≥ 4-point increase in National Institutes of Health Stroke Scale (NIHSS) scores, seizures, epileptogenic activity on electroencephalogram, and neuroimaging complications including new ischemic, hemorrhagic, or neoplastic lesions. Satisfactory clinical improvement (secondary endpoint) at 90 days was defined according to the pretreatment NIHSS scores as follows: modified Rankin Scale score of 0 in patients with NIHSS <8, modified Rankin Scale scores of 0-1 in patients with NIHSS 8-14, or modified Rankin Scale scores 0-2 in patients with NIHSS >14. Good clinical outcome was defined as mRS ≤2 at 90 days. Serial clinical, laboratory, electroencephalogram, and imaging evaluations showed no procedure-related adverse events. Satisfactory clinical improvement occurred in 6/20 (30%) patients at 90 days. Eight patients (40%) showed a good clinical outcome. Infusion of intra-arterial autologous BMMCs appears to be safe in patients with moderate to severe acute middle cerebral artery strokes. No cases of intrahospital mortality were seen in this pilot trial. Larger prospective randomized trials are warranted to assess the efficacy of this treatment approach.

O potencial terapêutico das células-tronco em doenças do sistema nervoso / The therapeutic potential of stem cells for nervous system disease

O presente estudo tem por objetivo apresentar as evidências científicas do transplante de células-tronco em cinco doenças do sistema nervoso: anóxia neonatal, epilepsia, acidente vascular cerebral, doença de Parkinson e lesão de nervo periférico. O método utilizado foi à revisão bibliográfica utilizando o Medline. O transplante de células-tronco é uma importante ferramenta na reparação de distúrbios do sistema nervoso. Estudos experimentais demonstram que a regeneração e a reconstrução do circuito neuronal é possível através da terapia celular. As células-tronco têm demonstrado uma capacidade de se diferenciar em neurônios e glia. Os experimentos utilizando o transplante de células-tronco em modelos animais de anóxia neonatal, isquemia cerebral, epilepsia, doença de Parkinson e lesão de nervo periférico mostraram melhora funcional nos animais tratados. Apesar das evidências científicas favoráveis ao uso de células-tronco em doenças neurológicas, consideráveis avanços necessitam ser feitos para compreender a base biológica das células-tronco, incluindo os sinais que determinam sua proliferação e diferenciação, e a caracterização de suas respostas quando transplantadas em uma área encefálica lesada.

Association of misoprostol, moebius syndrome and congenital central alveolar hypoventilation: case report

We report a case showing the association of Moebius syndrome, the use of misoprostol during pregnancy and the development of central congenital alveolar hypoventilation. Pathophysiological aspects of these three diseases are discussed and also the unfavorable prognosis of this association.