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Neurosurgery. 2011 Mar;68(3):588-600. doi: 10.1227/NEU.0b013e318207734c.& x2 |& |2 ?7 i/ v
Autologous bone marrow mononuclear cell therapy for severe traumatic brain injury in children.
8 \) i ^+ J' q2 ^& k' y! BCox 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.4 b( @8 N7 z1 T& T
Author information
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O# W q; J& L. f KAbstract4 l# e' L0 q6 q
BACKGROUND:
: ]) |% e/ z- c' {" E' @Severe 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.
5 S- Z/ {/ O" q; G2 YOBJECTIVE:
' E6 U$ t; _& C" X7 F1 KTo determine whether autologous BMMNCs are a safe treatment for severe TBI in children.
3 V N. g9 u; R$ m1 ~# |5 hMETHODS: [+ M c) [) C4 F0 c6 G
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.9 T1 P! r' B' K) }( {# a4 q
RESULTS:
& M9 H; r" W* z. Y5 zAll 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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