Intra-Arterial Injection of Autologous Bone Marrow- Derived Mononuclear Cells in Ischemic Stroke Patients

Objectives: This study aimed to show the positive effects of autologous bone marrow-derived mononuclear cells in the functional recovery of adult patients with subacute and chronic ischemic stroke. Stroke is a leading cause of morbidity and long-term disability in the world, with about one-third of survivors being permanently disabled. Bone marrow-derived mononuclear cell concentrate is thought to improve cerebral blood flow and to speed recovery in animal models. Many types of stem cells have been used, including mesenchymal, cord blood cells, and embryonic, with different administration methods, including intrathecal, intravenous, intra-arterial, and intracerebral, all with variable degrees of success. Mechanisms of action include induction of angiogenesis, promotion of neurogenesis, prevention of apoptosis, and immunomodulation. The use of autologous bone marrow-derived mononuclear cells with the closed method has nearly minimal manipulation requirements and is a low-risk procedure. Materials and Methods: We aspirated 100 cm(3) (mean volume) of bone marrow from 37 (12 women/25 men) Iraqi adult patients (age range, 42-80 y). After filtration, we injected a small volume (15 cm 3 ) intra-arterially through a catheter in the internal carotid arteries. The remaining volume was injected intravenously. Mononuclear cell count was 5 to 6 x 10(8) per product. Time from diagnosis until transplant procedure ranged from 3 months to 5 years. Results: Intra-arterial administration of autologous bone marrow mononuclear cells resulted in improvements in the European Stroke Scale (from +4 to 20) in 25 of 37 patients (67.5%) over 4 to 8 weeks. Conclusions: Stem cell therapy is promising in subacute and chronic stroke patients.