Soma Banerjee, Paul Bentley, Mohammad Hamady,Stephen Marley, John Davis, Abdul Shlebak, Joanna Nicholls, Deborah A. Williamson, Steen L. Jensen, Myrtle Gordon, Nagy Habib and Jeremy Chataway Intra-Arterial Immunoselected CD34+ Stem Cells for Acute Ischemic Stroke.Stem Cells Trans MedAugust 2014 sctm.2013-0178
Treatment with CD34+ hematopoietic stem/progenitor cells has been shown to improve functional recovery in non-human models of ischemic stroke via promotion of angiogenesis and neurogenesis. We aimed to determine the safety and feasibility of treatment with CD34+ cells delivered intra-arterially in patients with acute ischemic stroke. This was the first study in human subjects. We performed a prospective, nonrandomized, open-label, phase I study of autologous, immunoselected CD34+ stem/progenitor cell therapy in patients presenting within 7 days of onset with severe anterior circulation ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≥8). CD34+ cells were collected from the bone marrow of the subjects before being delivered by catheter angiography into the ipsilesional middle cerebral artery. Eighty-two patients with severe anterior circulation ischemic stroke were screened, of whom five proceeded to treatment. The common reasons for exclusion were age >80 years (n = 19); medical instability (n = 17), and significant carotid stenosis (n = 13). The procedure was well tolerated in all patients, and no significant treatment-related adverse effects occurred. All patients showed improvements in clinical functional scores (Modified Rankin Score and NIHSS score) and reductions in lesion volume during a 6-month follow-up period. Autologous CD34+ selected stem/progenitor cell therapy delivered intra-arterially into the infarct territory can be achieved safely in patients with acute ischemic stroke. Future studies that address eligibility criteria, dosage, delivery site, and timing and that use surrogate imaging markers of outcome are desirable before larger scale clinical trials.
Stroke is the archetypal neurodegenerative disease with neurogeneration and not so much inflammation, whereas MS is more inflammation compared to neurodegeneration. However, as we learn more it seems that there may be common processes occurring in Stroke and MS and so some of the treatment avenues may be the same.
Stroke therapeutics contain a graveyard of pharma drugs that have bitten the dust. One of the big issues is that the problems of stroke (lack of blood low to brain) happen before people get to Hospital and the damage is done and too late to influence. In MS damage accumulates slowly over time and you could start neuroprotection before the damage occurs
Sir Jermery is a working neurologist and not only has he been developing drugs for treatment of progressive MS but he has been assisting a team in London developing stem cells for stroke. In this study they got bone marrow from someone with a stroke and made CD34+ stem cells and injected into the arteries in the brain in areas around the stroke within 7 days of the stroke. They injected 5 people and it was found to be safe. This is where we should stop. However, the media report that there is some recovery and this could be better than often occurs with these strokes…Yey..
Although encouraging, we have to remember this is an unblinded non-controlled trial study. If the results are so wonderful as implied in the media
then it will only take a few people to show good results, and even the authors want to do more pilot work before large scale studies. So encouraging