However, these treatments have limited success as they cannot stimulate spinal cord regeneration.
Conventional treatment of SCI focuses on stabilizing the injured area via surgery, preventing secondary injury through pharmacological intervention, and rehabilitation to prevent loss of function and to help regain the loss functions. After injury, regeneration of spinal cord axons is very limited due to the low growth capacity of neurons, presence of inhibitory factors in central nervous system myelin, the formation of glial scar, and lack of neurotrophic factors and nerve growth factors. Although the severity of SCI and resulting disability differ from individual to individual, nonetheless, it will significantly affect the patient quality of life. SCI can affect most of the bodily functions including breathing, bowel and bladder function, hormone release, and sexual function, due to the loss of connection between the brain and the peripheral nervous system. The prevalence and incidence of SCI are ranging from 8 to 906 cases per million people according to the countries and regions and is more common in males below 30 years old. Ī spinal cord injury (SCI) is damage to the spinal cord that can lead to temporary or permanent changes to the cord’s normal motor, sensory and autonomic function, resulting in calamitous neurological deficiency and disability. Apart from serving as a conduit for the transmission of sensory input to the brain and motor output to the effector tissues, the spinal cord is also responsible for the production of spinal reflex that protects the body from harmful stimuli. Within the vertebral column, the spinal cord is covered and protected by the meninges (dura mater, arachnoid mater and pia mater) and cerebrospinal fluid (in subarachnoid space between the arachnoid and pia mater). The lumbar nerves innervate the hip and leg and the sacral nerves supply the genitals and lower digestive tract. The thoracic nerves control the motor and sensory functions of the chest and abdominal walls. The cervical nerves control the motor and sensory functions of the head, neck, shoulder, arm and hand.
Spinal nerves protruded from different segments of vertebral column innervate different body regions. These segments are grouped into 4 major regions, C1–C8 cervical, T1–T12 thoracic, L1–L5 lumbar and S1–S5 sacral vertebrae. The spinal cord connects most of the periphery nervous system to the brain and is protected by a vertebral column that is divided into multiple segments. New biological therapies including stem cell secretome therapy, immunotherapy and scaffolds can be combined with MSC therapy to enhance its therapeutic effects. These characteristics are crucial for the restoration of spinal cord function upon SCI as damaged cord has limited regenerative capacity and it is also something that cannot be achieved by pharmacological and physiotherapy interventions. Additionally, MSCs have been shown to differentiate into neuron-like cells and stimulate neural stem cell proliferation to rebuild the damaged nerve tissue. Application of MSCs may minimize secondary injury to the spinal cord and protect the neural elements that survived the initial mechanical insult by suppressing the inflammation. Bone marrow-derived MSCs (BMSCs), umbilical cord-derived MSCs (UC-MSCs) and adipose tissue-derived MSCs (ADSCs) have been trialed for the treatment of SCI. This review discusses the current status of mesenchymal stem cell (MSC) therapy for SCI, criteria to considering for the application of MSC therapy and novel biological therapies that can be applied together with MSCs to enhance its efficacy.
The SCI patients are often associated with poor quality of life. Spinal cord injury (SCI) is the damage to the spinal cord that can lead to temporary or permanent loss of function due to injury to the nerve.