Allogenic Stem Cell Therapy for Spinal Cord Injury in India

Autologous stem cell therapy for spinal cord injury (SCI) is a new treatment being offered for spinal cord injury that uses the patient’s own stem cells to help heal damaged spinal cord tissue. SCI, which may occur due to trauma, an illness, or injury to the spine, compromises the spinal cord and nerves that may result in dysfunction, sensation deficits, mobility limitations, and/or loss of function below the level of injury. Autologous stem cell therapy seeks to repair injury to the spinal cord tissue while reducing inflammation and by promoting tissue regeneration, which in turn may restore loss of function.

How Autologous Stem Cell Therapy Works for Spinal Cord Injury

Autologous stem cell therapy refers to the harvesting, processing, and reintroduction of a patient’s own stem cells into their body. It can help address the consequences of SCI in a number of ways:

1. Tissue Regeneration:

Stem cells, especially mesenchymal stem cells (MSCs), which can be obtained from bone marrow, adipose tissue (fat), or blood, can differentiate into a number of cell types, like neurons, glial cells, and other types of neural tissue. This ability to differentiate and therefore help replace damaged spinal cord cells will aid in the repair of new tissue.

2. Neuroprotection:

• After spinal cord injury, secondary damage can occur due to inflammation, free radicals, and a cascade of cell death. Stem cells are neuroprotective; they can release growth factors to decrease secondary cell death, limit inflammation, and preserve any remaining healthy spinal cord cells.

3. Immune Modulation

•  Acute spinal cord injury produces an inflammatory response, which further exacerbates tissue damage.Autologous stem cell therapy—particularly MSCs—will modulate the immune response through the release of anti-inflammatory cytokines, inhibiting damaging inflammation around the spinal cord injury and supporting healing.

4. Axon Regeneration and Synaptic Repair

•  A major impediment to rehabilitation following SCI is the damage of axonal connections between the neuron cell bodies.Stem cells can assist in axon regeneration and also develop new synapses, and possibly allow for some degree of lost function to be recovered.

5. Angiogenesis

•  Stem cells cause angiogenesis, the formation of new blood vessels, in the location of the injury.This will increase blood flow to the injury and chances of oxygen and nutrient delivery to support tissue healing and repair.

Types of stem cells used for autologous therapy for spinal cord injuries.

1. Mesenchymal Stem Cells (MSCs): -MSCs are the most widely used type of stem cell for spinal cord injury. MSCs can be isolated from bone marrow, adipose tissue, or peripheral blood. MSCs also have a greater capacity to differentiate into multiple cell types, immune modulatory functions, and tissue regenerative capabilities. 

2. Neural Stem Cells (NSCs): -NSCs produce neural cells (neurons, astrocytes, and oligodendrocytes) and are believed to be essential for the repair of a damaged spinal cord. NSCs can be harvested from the patient’s (host’s) brain or spinal cord, but overall NSC use for spinal cord injury remains a novel investigational process. 

3. Induced Pluripotent Stem Cells (iPSCs): – iPSCs are adult cells that have been “reprogrammed” to the pluripotent stage and can differentiate into virtually any cell type, including neural cells. iPSCs offer the potential to generate unlimited amounts of neural cells for repair, but like NSCs, iPSCs date back less than 10 years; still, their use in spinal cord injury is experimental.

The Procedure for Autologous Stem Cell Therapy for Spinal Cord Injury

1. The identification of stem cells:

In the beginning phase of stem cell therapies, one has to first identify stem cells from the patient. There are three general ways of identifying stem cells:

• Bone marrow aspiration: Stem cells can be identified from the patient’s bone marrow. Bone marrow is usually aspirated from the pelvis using an intraosseous aspirative technique. This is a minor invasive procedure undertaken with a local anesthetic. 

• Adipose tissue procurement: Adipose tissue can also be a source of stem cells. This could be through liposuction, again a minor invasive procedure undertaken with local anesthetic. The liposuction may be performed to remove a small amount of fat tissue from which stem cells exist.

• Peripheral blood collection: If mobilized with growth factors, stem cells can be collected from circulating peripheral blood.

2. The processing of stem cells:

After identifying stem cells, some processing will have to take place in a laboratory to separate, purify, and amplify the stem cells. Processing is required in order for stem cells to remain viable and have the ability to differentiate into neural tissue. The cells could sometimes be cultured and/or genetically modified to maximize the regenerative capabilities of the cells.

3. Stem Cell Delivery:

The isolated stem cells are ultimately reintroduced back into the patient’s body. There are some different delivery protocols for delivering stem cells:

• Intravenous infusion: The stem cells are infused into the vascular system, where the cells can travel within the body’s circulation to the injured area. When a patient has multiple target areas or their injury is more diffuse within the spinal cord, they can be infused intravenously.

• Direct injection into the spinal cord: In some cases the stem cells are injected directly into the spinal cord injury site or directly around the spinal cord injury area. This option is more suitable for local areas of injury or locations of primary trauma.

• Epidural injection: The cells can be delivered through injection to the epidural space around the spinal cord, potentially leading to healing at the spinal cord injury.

4. Ongoing Patient Monitoring:

After surgery, the patient will be monitored closely for any change in function or improvement in sensory or motor functions and side effects. All follow-up visits with the surgeon could include imaging like the MRI and CT and obtaining a physical exam if applicable.

Benefits of Autologous Stem Cell Therapy for Spinal Cord Injury

1. Tissue Repair:

Stem cells have the potential to heal damaged spinal cord tissue. This includes neurons, spinal nerve cells, and other components of the central nervous system, all of which can restore function and sensation below the injury level.

2. Enhancement of Function:

Many patients report the partial recovery of motor function and/or sensory function. Even for patients who don’t recover functioning, they often report an enhanced ability to move his or her limbs, decreased spasticity, and improved bowel and bladder control following treatment.

3. Neuroprotection:

Stem cells will also help to preserve the health of the neural tissue surrounding the injury level by providing lower chances of a secondary injury to the tissue because of inflammation, cell death, or oxidative stress, for example.

4. Diminished Inflammation:

Autologous stem cells assist in modulating the immune system and decreasing inflammation at the injury site to foster and accelerate healing. 

5. Almost No Chance of Rejection:

As the treatment utilizes the patient’s own stem cells, there is strictly no chance for immune rejection that exists in allogenic stem cell therapy (donor stem cells). 

6. Possible Long-Term Benefits:

Stem cells may provide long-term improvements in motor function, pain relief, and quality of life for SCI patients; however, this will depend on the severity of their injury as well as when they received the treatment.

Risks and Challenges of Autologous Stem Cell Therapy for Spinal Cord Injury

1. Limited Evidence:

Although autologous stem cell therapy has some potential to improve outcomes in the treatment of SCI, clinical evidence and long-term data regarding its safety and effectiveness remain limited. Autologous stem cell therapy is still investigational, and more research studies and clinical trials in SCI are warranted to establish clinical protocols and how best to administer this therapy to patients.

2. Cost:

The costs of autologous stem cell therapy in India range from INR 3,000,000 to INR 10,000,000 (approximately USD 3,500 to USD 12,000), depending on the hospital, type of stem cells harvested, and complexity of the procedure. Autologous stem cell therapy will most likely not be covered or reimbursed by most insurance companies.

3. Side Effects:

Rarely, adverse events can occur, such as infection, injury, or bleeding due to the harvesting procedure or pain in injection or harvesting sites. Post-procedure monitoring should continue, as one could dissociate or have a major adverse event.

4. Effectiveness Variation:

Results of stem cell therapy vary from patient to patient. Some patients may demonstrate amazing gains in their mobility or sensation, while others may only display marginal gains. Differences in results may be due to the specifics of the injury, the severity of the injury, the timing of the treatment, and the type of stem cells used. 

5. May Require Additional Treatments:

Patients have not yet been reported to achieve a good recovery from 1 stem cell treatment, and patients may need 2 or more stem cell treatments for a patient to achieve clinically significant improvement. This will be an appropriate question to study someday.

Leading Clinics and Hospitals Offering Autologous Stem Cell Therapy for Spinal Cord Injury in India

There are a number of hospitals and medical centers that are using stem cell therapies to treat SCI in India. Some of the best are

1. Medtravellers—Medtravellers (Gurgaon, Haryana): Medtravellers is one of the best hospitals in India with advanced regenerative therapies and has autologous stem cell treatments for spinal cord injuries. They have a stem cell therapies department and involve themselves with research and other regular breakthroughs. 

2. Dr. Stem Cell Therapy (New Delhi & Gurgaon): Dr. Stem Cell Therapy is a unique clinic in their offering of both autologous and allogenic stem cell therapy for many conditions, including spinal cord injuries. They use harvesting via bone marrow and fat as part of their methods.

3. Max Healthcare (Delhi, Gurgaon): Max Healthcare offers “comprehensive care” for spinal cord injury patients with stem cell therapies as one of their advanced service delivery options while carrying out clinical trials and research for SCIs.

4. Narayana Health (Bangalore):

• Narayana Health is partaking actively in stem cell therapies for SCI and has contributed research and clinical programs that relate to regenerative medicine.

FAQs

1. What is autologous stem cell therapy for spinal cord injury?

Autologous stem cell therapy uses the patient’s own stem cells to repair damaged spinal cord tissue. Stem cells can be gathered via bone marrow, fat, or blood, then taken into a lab where they are processed, and then the stem cells are introduced back into the patient, aimed at regeneration and/or possibly restoring some function, reducing inflammation, and healing.

2. What does the treatment procedure entail?

During the procedure stem cells are retrieved by harvesting them via bone marrow aspiration or liposuction; these stem cells will then be processed in the lab and delivered back to the patient by way of intravenous infusion, direct injection into the spinal area, or an injection into the epidural space. The patient is then monitored for improvement and side effects.

3. What are the pros and cons?

Pros: Possible tissue repair, potential improvement in motor/sensory function, potential spasticity reduction, no risk of immune rejection, and possible long-term improvements in quality of life. 

Cons: Lack of strong clinical evidence, possible infection or bleeding, possible varied responses between patients, and may require multiple treatments. 

4. What does this treatment cost in India?

The cost for this treatment in India is between INR 3-10 Lakhs (USD 3,500 – 12,000), which most of the time depends on the hospital and complexity of treatment. This is to note that most health insurance does not cover this. Some of the institutions for this Stem Cell Therapy for Arthritis in Delhi, India include Medtravellers (Gurgaon), Dr. Stem Cell Therapy (Delhi/Gurgaon), Max Healthcare, and Narayana Health (Bangalore).