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Andrea J. Mothe and Charles H. Tator

Toronto Western Research Institute and Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada.

Address correspondence to: Charles H. Tator, Toronto Western Research Institute and Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8. Phone: 416.603.5889; Fax: 416.603.5745; E-mail: charles.tator@uhn.on.ca.

Published November 1, 2012

Spinal cord injury (SCI) is a devastating condition producing great personal and societal costs and for which there is no effective treatment. Stem cell transplantation is a promising therapeutic strategy, though much preclinical and clinical research work remains. Here, we briefly describe SCI epidemiology, pathophysiology, and experimental and clinical stem cell strategies. Research in stem cell biology and cell reprogramming is rapidly advancing, with the hope of moving stem cell therapy closer to helping people with SCI. We examine issues important for clinical translation and provide a commentary on recent developments, including termination of the first human embryonic stem cell transplantation trial in human SCI.

Spinal cord injury (SCI) is a devastating condition, with sudden loss of sensory, motor, and autonomic function distal to the level of trauma. Despite major advances in the medical and surgical care of SCI patients, no effective treatment exists for the neurological deficits of major SCI (1). Current treatment includes surgery to decompress and stabilize the injury, prevention of secondary complications, management of any that do occur, and rehabilitation. Unfortunately, neurological recovery is limited, and most SCI patients still face substantial neurological dysfunction and lifelong disability. Stem cell therapy offers several highly attractive strategies for spinal cord repair, including replacement of damaged neuronal and glial cells, remyelination of spared axons, restoration of neuronal circuitry, bridging of lesion cavities, production of neurotrophic factors, antiinflammatory cytokines, and other molecules to promote tissue sparing and neovascularization, and a permissive environment for plasticity and axonal regeneration. This review builds on several excellent previous reviews (28) and discusses the incidence and pathophysiology of SCI as well as the key experimental and clinical stem cell strategies for SCI.

Worldwide, the annual incidence of SCI is 1540 cases per million people (9). In Canada, the Rick Hansen Institute estimates there are currently 85,000 people living with SCI, with more than 4,000 new cases per year (10), and in the United States, the Christopher and Dana Reeve Foundation estimates a prevalence of over 1 million patients with SCI and more than 12,000 new cases each year (11).

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JCI - Advances in stem cell therapy for spinal cord injury