Stroke survivors who believed they would be paralysed or need a wheelchair for the rest of their lives are walking and moving again following a ground-breaking stem cell treatment.
18 patients who agreed to allow doctors to drill a hole in their skull and inject stem cells into the damaged part of their brain have made a ‘remarkable’ recovery.
Never too late to heal?
Incredibly, it worked for patients whose strokes had occurred between six months and three years previously. Historically doctors have believed that the brain will no longer regenerate after six months.
But the new therapy essentially turns the adult brain back to an infant brain so that it can rebuild itself.
Scientists at Stanford University School of Medicine believe the therapy could also work for other neurodegenerative conditions such as Alzheimer’s disease, Parkinson’s and Lou Gehrig’s Disease.
“The remarkable recovery we saw in many of these chronic stroke patients was quite surprising,” said Prof Gary Steinberg, Chair of Neurosurgery at Stanford, who has spent 15 years researching stem cells.
“This wasn’t just ‘they couldn’t move their thumb and now they can’. Patients who were in wheelchairs are walking now. Their ability to move around has recovered visibly. That’s unprecedented.
“The study changes our prior notion that patients can’t recover much more after the first six months following a stroke because the circuits are dead, or irreversibly damaged.
“Clearly the circuits can be resurrected by this treatment and we are still investigating how they are being jump-started.”
Bone marrow and the role of umbilical cord blood
The stem cells in question were taken from the bone marrow of two donors. Scientists had previously believed that stem cells could not integrate into the brain to become neurons. But it now appears they secrete powerful chemicals for growth and regeneration which the brain can use to restore function.
The Haematopoietic Stem Cells (HSCs) found in bone marrow are the same as those found in umbilical cord blood. Bone marrow collection is an unpleasant invasive process, but cord blood can be collected at birth without impact on mother or baby and can be stored for decades. What’s more, cord blood stem cells are more juvenile and pliant than their bone marrow counterparts, making them easier to match and less likely to result in graft versus host disease. Given these advantages, it seems likely that we will see stroke patients treated with the umbilical cells of their children and grandchildren in the future.
“In a simple sense, the stem cell transplant turns the adult brain in a neonatal of infant brain which recovers well after a stroke or other injury,” added Prof Steinberg.
“This could revolutionise our concept of what happens after no only stroke but traumatic brain injury and ever neurodegenerative disorders. We thought these brain circuits were dead and we’ve learned that they’re not.”
All the patients involved in the trial had suffered ischemic strokes where a clot prevents blood getting to the brain, which leads to brain cell death. The procedure involved drilling a small hole in the skull above the damaged area so that SB623 stem cells could be injected at several spots around the edge of the injury.
The patients, who had an average age of 61, only needed a local anaesthetic and were sent home the following day. Although many complained of initial headaches, because of the surgical procedure, there were no long-term side-effects.
Afterwards they were monitored with blood tests, clinical evaluations and brain imaging. Intriguingly the implanted stem cells do not survive very long in the brain, but recovery continued even after they had vanished.
There was an overall 11.4 point improvement on the Fugl-Meyer test, which gauges how well stoke pateints can move and there has been no relapse since the injection,n which was carried out up to two years ago.
Stem cells are thought to be the future of medicine because they can transform into any cell in the body depending on where they are placed.
Around 125,000 people in Britain suffer an ischemic stroke each year. Although therapies exist to prevent further damage they must be administered within four and a half hours of the event to break down blood clots and many patients do not receive treatment until it is too late and the damage has been done.
Charities said the new treatment could help fill the ‘urgent need’ for alternative treatments for stroke.
Dr Shamim Qadir, Research Communications Manager at the Stroke Assoication said: “In the UK someone has a stroke every three and a half minute and over half of all stroke survivors are left with a disability.
“There is an urgent need for alternative treatments. This trial adds to a growing body of early clinical evidence suggesting stem cell treatment could promote recover in people months, and even years after having a stroke. This is positive development and brings much needed hope for the many people living with disability. We look forward to the results of the Phase II trial which could tell us much more about this type of stem cell treatment.
“Although it is still early days these findings could potentially lead to life changing treatments for stroke patients in the future.”
The Stanford team is now moving to a phase-2 trial of 153 (check) patients to see if the results can be replicated.
“We are also starting a trial with the same cells transplanted into the brain for patients with chronic traumatic brain injury and neurologic deficits. In the future it may also work for degenerative neurologic conditions like Parkinson’s disease, ALS (Lou Gehrig’s Disease), or even Alzheimer’s.”
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