Using Stem Cells For Spinal Cord Injury Biology Essay

It has been estimated that there are 2.5 million patients world-wide populating with spinal cord hurts ( 101 ) . Spinal cord hurt ( SCI ) consequences in huge personal agony due to its chronic disabling nature and has great cost deductions on society ( 102 ) . Presently there is no remedy with the acute stage therapy being limited to high doses of methylprednisolone to cut down redness and prevent farther harm. A high dosage of metylprednisolone ( 30mg/kg ) when administered in less than 8 hours after hurt reduces the formation of cytotoxic hydrops, redness and the release of glutamate and free groups. However, this intervention is still reasonably controversial since it may take to a higher rate of complications, including wound infection ( 101 ) . For chronic intervention the focal point relies chiefly on diagnostic alleviation of hurting and infection, every bit good as physical therapy ( 103 ) .

SCI wholly or partly removes the patients ‘ mobility and centripetal end product every bit good as autonomic nervous system control below the hurt, together known as uncomplete hurt ( 102 ) . The initial impact causes the vertebral to fracture which causes local segmented limited harm to the spinal column ( primary harm ) . As a effect of the impact bruise of axons, bleeding, ischaemia and oedema develops doing more harm ( secondary harm ) . The secondary harm expands within the first few hebdomads due to farther axonal devastation every bit good as glial cell loss ( 101 ) . Figure 1 below shows schematically the procedure of a spinal cord hurt in the ague and chronic stage.

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Figure 1 – Conventional presentation of the pathophysiological procedure of a spinal cord hurt in the ague and the chronic phase with the different interventions options indicated ( adapted from Ronsyn et al 2008 ) ( 109 )

Most SCI are uncomplete hurts, i.e. still neurological findings with partial loss of centripetal and/or motor map below hurt ( 105 ) . Incomplete hurts leave some spared tissue linking the spinal cord from countries above to countries below the lesion. The loss of nerve cells in the grownup, which are unable to be regenerated, consequences in an impaired map of the affected section. Demyelination normally compromises the staying axonal map. Demyelination is recognised as a cosmopolitan pathological change in SCI which involves the dislocation of medulla and the loss of myelin-forming cells, which are called olidendrocytes ( 107 ) . Without the medulla insulating sheaths, the spared axons become less efficient in their ability to carry on electrical urges ( 106 ) . The grownup spinal cord appears unable to replace the lost medulla or oligodendrocytes ( 117 ) ensuing in farther harm to the axons. The effects of axon transection, neural decease, and demyelination on overall signal transmittal are compounded by other tissue reactions to the hurt such as inflammatory and immune responses, cyst formation, and vascular alterations ( 108 ) . Nashmi and Fehlings ( 2001 ) have demonstrated that axonal demyelination contributes to functional damage of the nerve cells. This leads to an increased surface country of the open axonal membrane, increasing the resistive and capacitive burden of the nerve cells affected. Therefore, the current of the nerve cell ‘s denseness decreases ( 116 ) . Therefore, remyelinating the demyelinated axons may be a sensible curative mark for recovery of nervous map.

In 1858, Rudolph Virchow was one of the first bookmans to depict that there were other cells than neural 1s nowadays in the nervous system. Since he thought former to be connective tissue, so he named them neuroglia ( intending ‘neuron gum ‘ ) ( 114 ) . Subsequently neuroglial ( or glial ) cells were subdivided into macroglial and microglial based on size. Oligodendrocytes form portion of the macroglial cell household and are derived from root cell precursors found in the subventricular zones of the underdeveloped cardinal nervous system ( CNS ) ( 113 ) . Oligodendrocytes are the cells that produce medulla ( 112 ) , the fatty substance that provides the neural axon with insularity ( 104 ) . They are able to myelinate up to 50 axonal sections, depending on the part of the CNS ( 112 ) .

A huge figure of patients suffer from SCI, badly impacting their lives every bit good as that of their households. It is hence of import to research alternate therapies that could restrict the impact of the hurt. Recovering control over their ain intestine motions could significantly increase a patient ‘s quality of life.


Figure 2 – Curative schemes following spinal cord hurt ( adapted from Schwab et al 2006 ) ( 101 )

The figure above high spots several theoretical options to mend the spinal cord are summarised in the figure below. An obvious possible intervention of SCI is to replace the perished nerve cells and/or glial cells ( 101 ) . Using stem cells may enable the Reconstruction of some of the perished oligodendrocytes, which in bend can advance remyelination. C. Lu, Q. Shen 2009 citation grounds for three maps that nervous root cells, found in the mammalian embryonic encephalon, fulfil. First, they are capable of self-replication, easing proliferation of the absent oligodendrocytes. Second, nervous root cells secrete assorted neurotrophic factors. Finally, they differentiate into nerve cells, astrocytes and oligodendrocytes ( 110 ) .

The find of distinguishing root cells found in the encephalon has revolutionised the thought of handling SCI for several grounds. There may now be the possibility of partial or full recovery from palsy utilizing these root cells. Stem cells are defined as self-renewing cells capable of distinguishing into a cell line of descent ( 111 ) . Treating SCI with big root cells can be more advantageous than intervention with embryologic root cells, as these cells may be more similar to the cell types that require regeneration. Furthermore, grownup root cells bear greater oncogenic potency than embryologic root cells. Most significantly, nervous root cells do non usually produce cells of nonneural line of descent. Therefore, Parr et Al. see nervous root cells to be more dependable as a beginning for nervous cell regeneration ( 115 ) .

Two different theoretical schemes to use root cells for the fix of SCI. The first attack involves the organ transplant of root cells, or cells derived from root cells, to the injured spinal cord. Second, endogenous nervous root cells occupant in the grownup spinal cord could be recruited or modulated to advance recovery ( 102 ) .

In this paper, I will hence analyze how the organ transplant of root cells promotes remyelination. I will so go on by analyzing whether the activation of endogenous root cells promote remyelination. Finally, I will lucubrate on the potency of root cell-based therapies in the clinic to find the most effectual one.

Transplant of Stem cells to Promote Remyelination

Several attacks to transfer root cells to better the recovery after a SCI have been taken into clinical tests reviewed in Tator ( 118 ) . A big figure ( commendation, commendation, commendation! ! ! ) of surveies have evaluated the effects of transfering a assortment of different root cells in SCI theoretical accounts, chiefly gnawers, and a surprisingly big sum of the surveies have indicated some degree of benefit. However, there is trouble in comparing the different surveies due to the changing grade of the word picture of the cells. In add-on, they tend to utilize different hurt theoretical accounts and examine organ transplants happening at different intervals after hurt. Definitive decisions on the effects have been farther complicated by the dissimilar behavior of surveies ( 102 ) .

Surveies have shown ( commendation, commendation, commendation! ! ! ) that cell replacing is able to ease axonal remyelination every bit good as restore axonal conductive map ( 120 ) . Despite the many surveies that have indicated a good function of transplanted cells, the mechanistic penetration is still really limited ( 119 ) . The simplest account for recovery is the transplantion of cells to replace the doomed cells, thereby retracing the local circuitry. The figure below shows the mechanism proposed which includes creative activity of a permissive substance for axonal growing, remyelination and providing trophic support to cut down farther harm ( 102 ) .

Figure 3 – Mechanism by which transplanted root cells may ease regeneration ( adapted from Barnabe-Heider ) ( 102 ) .

Glial cells have been widely used for organ transplant into the encephalon and spinal cord of assorted animate beings. They are necessary for the right neural development and the maps of mature neurones. The ability of glial cells to react to the alterations in the cellular and extracellular environment is indispensable to the map of the nervous system ( 114 ) . Many surveies are concerned with the environment provided by glial cells and the suspected trophic factors expressed. These experiments have shown that glial cells play an of import function in the development, regenerative capacity and map of the spinal cord. Some of the recent probes revealed several of import characteristics of glial cells, viz. their inordinate capableness to migrate and remyelinate axons ( 121 ) . Stem cells for organ transplant include but non limited to Schwann cells, oligodendrocytes and embryologic or nervous cells ( 107 ) . A treatment of Schwann cells, oligodendrocytes and macrophages will give an overview of the potency of this method.

Schwann Cells

Schwann cells have been shown to be a really powerful cell population of the peripheral nervous system ( PNS ) . They are portion of the microglia ( 114 ) and are capable of rapid and effectual fix of demyelinated countries when transplanted into the CNS. Schwann cells have the ability to migrate towards the stripped axons and vie with less powerful host oligodendrocytes for remyelination. This ability consequences from grownup olidogendrocytes that have a limited migratory and myelinating capacity. In comparing, mature Schwann cells are able to proliferate and remyelinate more sharply.

Mature Schwann cells ‘ aggressive capacity to remyelinate the axons in the CNS may be disadvantageous to a certain extent. The forceful incursion of the host tissue may ensue in deteriorating alterations of the microenvironment at the lesion site, as they may displace both host astrocyte and oligodendrocyte cells. This uncontrolled myelinating capableness may therefore restrict their possible usage in the CNS of SCI patients ( 121 ) .


Oligodendrocytes are macroglial cells responsible for supplying and keeping the CNS axons with insulating myelin sheaths. This enables the rapid conductivity of action potencies by the axons. Any harmful influence or effects on the oligodendrocytes may ensue in an uncomplete or imperfect myelination, or gradual loss of bing medulla beds. It has become apparent ( commendation, commendation, commendation! ! ! ) that SCI induces considerable oligodendrocyte programmed cell death and hence reduces the figure of glial cells capable of remyelinating the lesion site ( 122 ) . There has been grounds ( commendation, commendation, commendation! ! ! ) to demo that oligodendrocytes are able to myelinate bare axons, both in vivo ( 123 ) and in vitro ( 124 ) . It was shown ( commendation, commendation, commendation! ! ! ) that in vivo normal oligodendrocytes transplanted into a hypomeylinated encephalon of shiverer mice, overcame the faulty shiverer oligodendrocytes and remyelinated the axons ( 125 ) . It was besides discovered ( commendation, commendation, commendation! ! ! ) through negatron microscopy that the host and transplanted oligodendrocytes were viing for the unmeylinated axons ( 126 ) .


Historically, the CNS has been regarded as a site of the organic structure where small immunological actions occur. However, more late this position has changed proposing that under specific fortunes such as infection, the immune system becomes involved in the response to these procedures ( 122 ) . Macrophages are the most of import constituents of the immunological response in the encephalon. They are known to take dust after hurt and to release cytokines that regulate mitogenic and chemotatic activities within the tissue ( 127 ) . The possible renewing abilities of the macrophages in combination with the limited inflammatory response of the CNS following an hurt suggest that grafting of these cells into a lesioned spinal column may hold good effects. When macrophages, exposed ex vivo to renewing peripheral nervousnesss, were grafted into the lesion site, some recovery in paralysed rates occurred every bit good as improved electrophysiological activity ( 128 ) . The mechanism here appears to be indirect. For case, it provides trophic support, modulates the inflammatory response or provides substrate for axonal growing ( 115 ) .

The scientific literature has to day of the month non reached a consensus on the in vivo brotherhood of the exogenic transplanted grownup root cells and the endogenous differentiated nervous cells. It has been suggested ( commendation, commendation, commendation! ! ! ) that the transplanted cells may even blend with the endogenous root cells of the spinal cord. This construct should be farther researched in the model of SCI ( 111 ) .

Activation of Endogenous Stem cells to Promote Remeylination

The presence of nervous root cells in the grownup ‘s cardinal nervous system has raised several exciting possibilities in handling SCI. This includes the possible transition of the preexistent endogenous root cells. Transition of endogenous root cells may be an attractive option to organ transplant as it is a non-invasive autologous therapy that would besiege many of the restrictions and hazards associated with organ transplant ( 102 ) . Transplant may do hurt and besides require immunosuppressant therapy ( 129 ) . The endogenous root cells can be modulated by pharmaceuticals and respond in response to different types of stressors ( 131 ) . A pharmaceutical formulated into a tablet would hold a greater entreaty than injection into the spinal column, used to transfer the cells. It is nevertheless hard to foretell today whether this is a feasible option.

Resident cells are activated in SCI and bring forth a response, but the deficiency of functional recovery after a lesion suggests that this activation and response is deficient to advance recovery ( 102 ) . It is necessary to better understand the belongingss and functional function of cells derived from endogenous root cells in order to see optimum schemes to modulate their response. As mentioned before, the chief posterities of the endogenous root cells after SCI are oligodendrocytes and astrocytes. Astrocytes are heterogeneous and it is presently ill-defined to what degree the subtypes play a function after hurt. The glial cicatrix formed after hurt is comprised of both locally present astrocytes, which become hypertrophic in response, and new astrocytes, derived from endogenous root cells that invade the lesion ( 102 ) . It is unknown whether these different astrocyte populations have different functions or maps in spinal regeneration.

As discussed above, the mortality of oligodendrocytes has a important impact on axonal decease. The thought of advancing endogenous root cells to distinguish into oligodendroctytes, and hence increase the figure of such cells at the site of hurt, seems like a sensible intervention option. However, endogenous root cell population responds to injury chiefly by proliferating and maturating into astrocytes ( 133 ) . A much smaller figure differentiate into nerve cells and oligodendrocytes. The microenviromental cues play an of import function in the development and ripening of these cells. The alteration of these microenviromental cues is hence important in order to command the distinction of these root cells ( 134 ) . Several research workers ( commendation, commendation, commendation! ! ! ) have experimented with manipulating of the spinal cord environment to teach root cells in order to follow a neural or glial destiny.

In wide footings, the type of modulating agents used by experimentation can be divided into three classs ; cytokines, growing factors and written text factors ( 132 ) . This article will merely be able to touch on some of the modulating agents that have been investigated to day of the month. Figure 4 shows some of the published experimental uses that have had an influence on endogenous root cells.

Figure 4 – Conventional pulling demoing a SCI and published experimental uses act uponing endogenous spinal cord root cells ( Taken from Obermair et al 2008 ) ( 132 )


After a SCI, the immune system responds with up-regulation of proinflammatory cytokines such as tumour mortification factor ( TNF-? ) , IL-6, IL-1? and IL-4. TNF-? has immune effects every bit good as a advancing effect on endurance and proliferation of oligodendrocytes ( 135 ) .

In a survey by ( commendation, commendation, commendation! ! ! ) where root cells were incubated with IL-6, in vitro astrocytes were the discriminatory phenotype produced. They so blocked the map of IL-6 with MR16-1 and showed that the distinction towards astrocytes was inhibited ( 136 ) . Inhibition of astrocyte distinction may be good to the remyelination procedure, because astrocytes can bring forth repressive molecules such as Jagged1. Molecules like this inhibit oligodendrocytes distinction and growing ( 143 ) .

L-1? is unusually unregulated in the grownup spinal cord instantly after hurt. It is one of the first factors to originate an immune response and therefore causes secondary neuro-damage. It was shown by Vela et Al. ( Very good done, Mader! You deserve a spine for this! : -P ) that IL-1? inhibits the proliferation of oligodendrocytes, but promotes their distinction from root cells ( 137 ) .

Growth Factors

Different growing factors have been tested by experimentation to act upon the distinction of endogenous root cells. Insulin-like Growth Factor ( IGF-1 ) was shown ( commendation, commendation, commendation! ! ! ) to hold in vivo and in vitro effects on the proliferative activity of root cells in the hippocampal part of the encephalon ( 138 ) . IGF-1 stimulates oligodendroglial distinction by suppression of bone morphogenic protein ( BMP ) , by the upregulation of BMP adversaries such as Smad6, Smad7 and Noggin ( 139 ) .

Endothelial growing factor ( EGF ) was shown ( commendation, commendation, commendation! ! ! ) to heighten the migration and scattering of cells in the environing parenchyma while Fibroblast growing factor 2 ( FGF-2 ) enhances cell proliferation ( 133 ) . The extract of these growing factors induces a 50-fold addition in neurogenesis from the root cells in response to ischemia ( 144 ) .

Transcription Factors

Retroviral-mediated overexpression of neurogenin-2 ( Ngn2 ) and Mash-1 every bit good as the mixture of growing factors ( FGF-2 and EGF ) increased the production of nerve cells and oligodendrocytes after SCI ( 140 ) . It resulted in enhanced oligodendrocyte distinction and ripening at the disbursal of astrocyte production, nevertheless the freshly generated oligodendrocytes were no longer observed one month after hurt ( 130 ) .

A written text factor called YY-1 regulates the early phases of oligodendrocyte distinction after the immature cell exits the cell rhythm. It was shown that YY-1 merely mediates these events for olidogendrocyte distinction and non for astrocytes ( 141 ) . This may be an attractive mark for the use of the endogenous root cells as distinction can be promoted cell specifically.


Recent findings indicate the methylprednisolone non merely affects the activation and proliferation of macrophages and microglia, but besides impact endogenous root cells in the spinal cord. Glucocorticoid and the mineralcorticoid receptors are found on the surface of big spinal cord root cells, proposing a direct consequence of metlyprednisolone on these cells. However, on the whole, the ascertained decrease in NG2-postive precursor cells after a SCI with methylprednisolone intervention may take to a reduced oligodensdrocyte fix ( 134 ) . These happening begs the inquiry to what extent intervention with methylprednisolone restricting the regeneration capacity of the endogenous root cells.

A bulk of SCI patients besides suffer from chronic neuropathic hurting, which greatly decreases the quality of life ( 145 ) . The organ transplant of big spinal cord nervous root cells promotes the functional recovery of the spinal column, but it can besides increase neuropathic hurting as shown in rats ( 146 ) . The rats showed marks of allodynia, where a not noxious stimulation is perceived as painful. This esthesis is likely due to the root cell-derived astrocytes advancing the germination of centripetal axons ( 102 ) . This correlativity should be established in clinical tests and methods to cut down the incidence of increased neuropathic hurting should be considered and researched. Other complications and hazards must be evaluated before a root cell-based therapy can be applied in the clinic. These hazards include tumorigenesis, immunological complications or other hazards associated with an unexpected alteration in the phenotype of the transplanted cells ( 142 ) .

A pharmaceutical therapy modulating endogenous root cells to advance recovery would be advantageous over organ transplant schemes since it is much less invasive. Transplant of donor root cells may necessitate immunosuppression which has serious side effects associated. Immuno-incompatability may ensue in rejection of transplanted cells and can either take to their loss or an inflammatory reaction fostering the secondary harm. However, there is still no grounds to propose that enlisting of endogenous root cells is good at all. It may impact the result negatively, for illustration by lending to mark formation ( 102 ) .

Possibly, the normal response to the hurt and cicatrix formation is optimum. In footings of recovering tissue unity, it prevents any farther harm and incorporating the inflammatory cells. It is possible to modulate the response of endogenous root cells to bring forth oligodendrocytes at the disbursal of astrocytes. However, this bears the hazard of diminishing the recovery of tissue unity.

For many old ages the forecast for recovery after an hurt to the spinal column was black, and this field of research was seen as a doomed cause. This has changed significantly, at least from a research worker ‘s position. Some of the new schemes to mend offer the possibility of clinically effectual therapies in the non excessively distant hereafter.