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Neurosurgery. 2011 Mar;68(3):588-600. doi: 10.1227/NEU.0b013e318207734c.' K( c2 J0 y4 ~/ F" N3 ~& k4 U7 l
Autologous bone marrow mononuclear cell therapy for severe traumatic brain injury in children.
7 Z8 B$ @; Z' I+ e% o; UCox CS Jr, Baumgartner JE, Harting MT, Worth LL, Walker PA, Shah SK, Ewing-Cobbs L, Hasan KM, Day MC, Lee D, Jimenez F, Gee A.
6 _3 L6 s* D" [& LAuthor information
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3 R- E( C. H) |4 A s8 x: C7 NAbstract
9 z: l/ {0 s6 s- K2 ^* nBACKGROUND:
2 ^2 N8 L& |# xSevere traumatic brain injury (TBI) in children is associated with substantial long-term morbidity and mortality. Currently, there are no successful neuroprotective/neuroreparative treatments for TBI. Numerous preclinical studies suggest that bone marrow-derived mononuclear cells (BMMNCs), their derivative cells (marrow stromal cells), or similar cells (umbilical cord blood cells) offer neuroprotection. p; h, K5 k. Y0 a) t5 D6 ?/ `
OBJECTIVE:
" K, Z- l9 i b; mTo determine whether autologous BMMNCs are a safe treatment for severe TBI in children.
' q/ X* O, W% L$ c8 H% CMETHODS:
3 r+ a& O m& Q3 v0 p' y8 o6 w( j+ ?Ten children aged 5 to 14 years with a postresuscitation Glasgow Coma Scale of 5 to 8 were treated with 6×10 autologous BMMNCs/kg body weight delivered intravenously within 48 hours after TBI. To determine the safety of the procedure, systemic and cerebral hemodynamics were monitored during bone marrow harvest; infusion-related toxicity was determined by pediatric logistic organ dysfunction (PELOD) scores, hepatic enzymes, Murray lung injury scores, and renal function. Conventional magnetic resonance imaging (cMRI) data were obtained at 1 and 6 months postinjury, as were neuropsychological and functional outcome measures.. c' z' Q: a) ?2 \( D2 R3 ^* _- S, A+ |
RESULTS:
4 v/ P; G, @+ X+ M6 q i, [All patients survived. There were no episodes of harvest-related depression of systemic or cerebral hemodynamics. There was no detectable infusion-related toxicity as determined by PELOD score, hepatic enzymes, Murray lung injury scores, or renal function. cMRI imaging comparing gray matter, white matter, and CSF volumes showed no reduction from 1 to 6 months postinjury. Dichotomized Glasgow Outcome Score at 6 months showed 70% with good outcomes and 30% with moderate to severe disability. |
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