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Study design: Case report.

Objective: Report rapid neurological changes in a complete tetraplegic following a cell injection procedure.

Setting: Beijing, China.

Methods: ASIA/IMSOP neurological scale. Immunostaining of cell cultures. Cellular transplantation to effect functional restoration following spinal cord injury (SCI) has been hypothesized to cause improvements through axonal regeneration, increased plasticity, or axonal remyelination. Several human trials are in preliminary phases. We report a rapid improvement in motor and sensory functions in the segment adjacent to the level of complete SCI within days following cellular transplantation of cultured fetal olfactory bulb-derived cells. The patient was an 18-year-old C3 ASIA A complete tetraplegic 18 months post-injury who had been neurologically stable for more than 6 months.

Results: Within 48 h of cell transplantation, the patient improved one ASIA motor grade in the left elbow flexors and began to show right wrist extensor function. Descent of the sensory level occurred within 4 days and then the rate of change slowed. He is now a C5 motor and C4 sensory complete tetraplegic. Cellular cultures prepared in the same facility showed viable human cells that labeled for nestin and GFAP.

Conclusion: We hypothesize that improved transmission in intact fibers subserving the zone of partial preservation accounts for these early improvements. We emphasize the need for further independent analysis of the outcomes of this and other preliminary cell transplant studies.

Keywords: spinal cord injury, cell transplantation, olfactory ensheathing glia, stem cells

The Department of Neurological Surgery, University of Miami, Lois Pope LIFE Center, Miami, FL, USA

2The Miami Project to Cure Paralysis, University of Miami, Lois Pope LIFE Center, Miami, FL, USA

3The Miami VA Medical Center, University of Miami, Lois Pope LIFE Center, Miami, FL, USA

Correspondence: JD Guest, Department of Neurological Surgery, University of Miami, Lois Pope LIFE Center, 1095 NW 14th Terrace (D4-6), Miami, FL 33136, USA

Experimental studies have indicated that olfactory ensheathing glia (OEG) may support partial neurological recovery following spinal cord injury (SCI).1, 2, 3, 4, 5 The mechanisms of such recovery have been shown to include axonal regeneration2 and local sprouting,6 and remyelination.7 Sources for donor tissue to derive OEGs are limited in quantity8 and access to the olfactory bulb (OB) is invasive.9 Therefore, fetal allografts represent a possible alternative source from which to derive the cells. OEGs have been derived from embryonic rodent OB and characterized.10, 11 However, it is not known at what developmental stage the human OB becomes populated by OEGs although it has been proposed that this may occur as early as 6.5 weeks of embryonic development.12 Currently, a small-scale phase one clinical trial is exploring the safety and efficacy of transplanting adult nasal-derived putative OEGs into the chronically injured spinal cord,13 but the number of patients treated with fetal cell preparations in China exceeds 500. The first and third authors of this case report acted as observers of this transplant series14 over a 12-day period and wrote this report. These authors systematically examined the patient prior to surgery, observed the operative procedure, and followed the patient clinically for 8 days post-operatively.

14 Huang H et al. Influence of patients' age on functional recovery after transplantation of olfactory ensheathing cells into injured spinal cord injury. Chin Med J 2003; 116: 1488–1491.

海军总院神经外科黄红云教授关于脊髓损伤的胡编乱骗有失医德 ZT 神刀