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Neurosurgery. 2011 Mar;68(3):588-600. doi: 10.1227/NEU.0b013e318207734c.
" w/ {9 ^# _* J$ b/ f/ l3 ^9 lAutologous bone marrow mononuclear cell therapy for severe traumatic brain injury in children.
; ?2 L. H9 W; c' vCox 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 p- V" L) U6 _& h1 F- BAuthor information* s9 Z6 _& f+ m
, D, g0 E. \: ^! Z, V! n
Abstract
9 g& y+ \9 d9 W s: l$ ^BACKGROUND:
! n7 @4 Q( G/ mSevere 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.
6 I/ [+ o* \( `- K# `& VOBJECTIVE:
7 i+ L8 b, Y4 \. u+ F$ m; kTo determine whether autologous BMMNCs are a safe treatment for severe TBI in children.# v6 w* M" [8 @, G+ f! J* s
METHODS:
8 ]' r2 E5 ?- a. R" E2 kTen 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.
$ t5 r! t+ `4 Q+ _! C' g6 ]RESULTS:; W. m+ c p' b8 d+ j% F7 D1 d% S
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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