SOMATIC-CELL NUCLEAR TRANSFER: AUTOLOGOUS EMBRYONIC INTRA-SPINAL STEM CELL TRANSPLANT IN A CHRONIC COMPLETE QUADRIPLEGIC PATIENT. NEURO-ANATOMICAL OUTCOME AFTER ONE YEAR. Transferencia de núcleos de células madre: Transplante embriónico autólogo intraesp
DOI:
https://doi.org/10.31051/1852.8023.v6.n1.14096Palabras clave:
Somatic cell nuclear transfer, spinal-cord injury, stem cell transplantation, quadriplegia, Transferencia nuclear de células somáticas, lesión de médula espinal, transplante de células madre, quadriplegíaResumen
La literatura científica informa que anualmente se producen alrededor de 180.000 casos de lesiones de la médula espinal en el mundo. Publicaciones recientes han mostrado beneficios neurológicos en casos seleccionados de personas con cuadriplejía sometidas a trasplante intralesional de células madre autólogas cultivadas de médula ósea. Objetivos: Este estudio de caso presenta evidencia de nivel III de recuperación clínica neurológica parcial en un paciente de sexo masculino de 32 años, con cuadriplejia completa crónica que fue sometido a transferencia de núcleos de células somáticas (SCNT, por sus siglas en inglés) y a terapia de células embrionarias por presentar lesión traumática de la médula espinal sufrida 6 años atrás. La pregunta de investigación fue: “¿Puede la terapia celular autóloga de SCNT mejorar la discapacidad motora y sensitiva de las extremidades en la cuadriplejia crónica?" Hipótesis probada: “La terapia celular de SCNT es incapaz de mejorar la discapacidad motora y sensitiva en casos seleccionados de personas con cuadriplejia completa crónica y no puede mejorar el resultado funcional o la independencia”. Materiales y métodos: El trasplante celular se llevó a cabo mediante implantación quirúrgica en el área con daño medular cervical 6 años después de la lesión que dejó al paciente con cuadriplejía completa confirmada mediante examen neurológico y resonancia magnética. Después del procedimiento, se llevó a cabo la evaluación neurológica y fue evaluada la restauración de dermatomas y miotomas durante 12 meses, junto con la realización de resonancia magnética y clasificación de la American Spinal Injury Association (ASIA). Resultados: La mejoría neurológica se presentó en forma asimétrica en la cintura escapular y sin cambios dramáticos bilateralmente en extremidades superiores y en tronco con respecto a las funciones de las piernas evaluadas a los 12 meses. Las puntuaciones en la escala ASIA aumentaron de 29/112 a 64/112 a los 6 meses después del tratamiento y se ganó al menos un nivel de la escala ASIA. Conclusión: En comparación con los hallazgos iniciales, se documentó mejoría neurológica cuantificada en la cintura escapular y las extremidades superiores, entre 6 y 12 meses después del trasplante celular autólogo intralesional con SCNT en un caso de cuadriplejia crónica.
The scientific literature reports that about 180,000 cases of spinal-cord injuries (SCI) occur yearly in the world. Recent publications show neurological benefit in selected quadriplegics undergoing intra-lesion transplantation of autologous cultured bone-marrow mesenchymal stem cells. Objectives: This case-study reports level–III objective evidence and partial neurological clinical recovery in a 32-year old-male with chronic complete quadriplegia that underwent somatic nuclear cell transfer (SCNT) and embryonic cell therapy for traumatic spinal-cord injury (SCI) sustained 6-years previously. The research question was: “Can autologous SCNT cell-therapy improve extremity motor and sensory impairment in chronic quadriplegia?” The hypothesis tested: “SCNT cell-therapy is unable to improve severe motor and sensory impairment in selected persons with chronic complete quadriplegia and unable to improve functional outcome or independence”. Material and methods: Cell-transplantation was by neuro-surgical implantation into the damaged cervical cord 6-years after SCI that rendered the patient a complete quadriplegic confirmed on neurological examination and magnetic resonance imaging (MRI). Neurologic assessment, restoration of dermatomes and myotomes were evaluated post-procedurally for 12-months together with MRI, and American Spinal Injury Association grading (ASIA). Results: Neurological improvement was asymmetrically improved in the shoulder girdle, upper extremity bilaterally and trunk without dramatic change in leg-function at 12-months. ASIA-scales increased from 29/112 to 64/112 at 6-months after treatment and at least one ASIA-level was gained. Conclusion: Compared to baseline findings, measured neurological improvement was documented in the shoulder-girdle and upper-extremities, 6-12 months after intra-lesion autologous SCNT cell transplantation in a chronic-quadriplegic.
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