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Neurosurgery. 2011 Mar;68(3):588-600. doi: 10.1227/NEU.0b013e318207734c.
0 t. \' h' G* n, O' H/ X, PAutologous bone marrow mononuclear cell therapy for severe traumatic brain injury in children.& w, N }) H X( j+ m
Cox 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.1 T7 p9 z t, b, t( n
Author information2 e1 H: r5 r% X8 M$ ]& H
7 z- H2 p# O3 i( t: _Abstract. }% b/ i+ h# A) ^$ d
BACKGROUND:
5 ~& F/ ~& X1 c( X6 B4 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.* I- }, j% o: |2 N: `; h G' [3 @
OBJECTIVE:8 l, Z/ r* n8 {* W! }& c: Y
To determine whether autologous BMMNCs are a safe treatment for severe TBI in children.* Q$ L, M! G+ h2 s
METHODS:+ D1 y9 \" J: m/ x+ N/ h! {
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.* [* K# v, v) o Y, }" g
RESULTS:1 N4 z; w) M1 P+ d7 i' Y
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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