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Stem cell therapy in Stroke

Brain stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, and the brain is caused to starve. On deprivation from oxygen, the brain cells begin to die and the part of the body affected becomes paralyzed. Strokes can be divided in two types. In the first, there is clotting of blood in blood vessels which in turn leads to blocking of the arteries in the brain. In the second, there is rupturing of blood vessels causing a bleeding also known as hemorrhagic stroke. In industrialised countries currently the third leading cause of death ischaemic stroke. With a huge number of stroke incidences each year around the world, approximately a third of cases are left with some form of permanent impairment. Stroke is the single largest cause of severe disability in the developed world.

When there is interruption of blood flow in a brain-supplying artery, it causes Stroke in a patient. Ischaemic stroke is also referred to as cerebral infarction medical parlance, in addition intracerebral haemorrhage causes neuronal circuitry disturbance, which leads to disruption of the functional abilities. Usually a patient loses his ability to speak and move normally.

Currently, therapy for stroke mainly revolves around prevention of recurrent (secondary) strokes and to maximize functional recovery in the initial phase Rehabilitation therapy is advised.

Still there is no known cure once the optimum recovery is achieved and to reduce brain damage and improve neurological recovery after stroke a neuro-protective therapy still remains a far cry.

Recent advancement in stem cell research for stroke has brought to light the enormous potential of cell therapy for stroke. There is documented research on the repairing of damaged cells by stem cell therapy. Stem cells increase the vascular supply by the creation of new blood vessels, they reduce inflammation, enhance the brain's repair mechanisms and reduce the ongoing death of brain cells. Stem cell therapy has been proven to be safe and a viable form of treatment in stroke patients.

Research in India has had scientists successfully use stem cells in treatment of brain damage resulting from stroke in clinical trials. Thus showing hope to stroke patients suffering from permanent paralysis, disability and dependence on others.

It has been studied that on injection of stem cells in the damaged portion of the brain, it triggered development of new brain cells without any life-threatening side-effects. It is important in successful stem cell therapy that there is positive interaction between the injected cells and host cells.

In stem cell transplantation therapy for stroke, a variety of cell types derived from humans have been tested in experimental stroke models. Following cells have been a part of the research:
  • neural stem cells cultured from foetal/embryonic tissue;
  • immortalised neural cell lines;
  • haematopoietic/endothelial progenitors and stromal cells isolated from bone marrow, umbilical cord blood or peripheral blood. Human embryonic stem cells have shown the best potential and on engineering offer an unlimited source of neural cells for structural repair in neurological disorders such as stroke, but there are ethical and safety concerns attached to its use. On the other hand, even adult stem cells (neural progenitor cells) on expansion in lab have exhibited promising therapeutic effects in several neurological disorders without causing serious side effects.

Transplanted cells may work in the following ways:

  • Increase in vascularisation: Neurological recovery is better with increased blood flow in the ischaemic area within a few days after stroke.
  • Enhancement in endogenous (inherent) repair mechanisms: there is increased sprouting of nerve fibres, with human cord blood cells in the ischaemic cortex.
  • Reduction in death of host cells: there is a neuroprotective effect with the injected cells.
  • Reduction in inflammation: Intravenous injection of human umbilical cord blood cells caused reduction in leukocyte infiltration into the brain thereby reducing the stroke-induced inflammatory/immune response.

Conclusion:

Stem cell therapy for stroke patients holds great promise. Though there are quite a few issues which needs to be addressed. Issues like:
  • optimal candidate for cell transplantation therapy (including the patient age, anatomic location and size of the infarct, and medical history),
  • the best cell type for injection,
  • the number and concentration of cells,
  • the timing of surgery with respect to the occurrence of stroke,
  • the route and site of delivery,
  • the need for immunosuppression
To determine the Longer-term nature of recovery, researchers need to undertake more clinical trails. Challenges like ensuring appropriate manufacturing, and quality control of transplanted cells should be ensured on injection. Though it is undoubted that stem cell treatment could be a major breakthrough in effecting repair of some of the damage caused by stroke.


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