Estudio en fase I de utilización de las células madre de médula ósea autólogas en pacientes con esclerosis lateral amiotrófica

Abstract

Objective: To assess the safety of intraspinal infusion of autologous bone marrow mononuclear cells (BMNC) and, ultimately, to look for histopathological signs of cellular neurotrophism in amyotrophic lateral sclerosis (ALS) patients. Methods: We conducted an open single arm phase I trial. After six months observation, autologous BMNC were infused into the posterior spinal cord funiculus. Safety was the primary endpoint and was defined as the absence of serious transplant-related adverse events. In addition, forced vital capacity (FVC) and ALS-FRS, MRC and Norris scales were assessed six and three months prior to the transplant and quarterly afterwards for one year. Pathological studies were performed in case of death. Results: Eleven patients were included. We did not observe any severe transplant-related adverse event but there were 43 non-severe events. Twenty-two (51%) resolved in ≤2 weeks and only four were still present at the end of follow-up. All were CTCAE grade ≤2. No acceleration in the rate of decline of FVC, ALS-FRS, Norris or MRC scales was observed. Four patients died on days 359, 378, 808 and 1058 postransplant for reasons unrelated to the procedure. Spinal cord pathological analysis showed a greater number of motoneurons in the treated compared to the untreated segments (4.2+/-0.8 mns/section and 0.9+/-0.3 mns/section, respectively). In the treated segments, motoneurons were surrounded by CD90+ cells and did not show degenerative ubiquitin deposits. Interpretation: This clinical trial confirms not only the safety of intraspinal infusion of autologous BMNC in ALS patients but also provides evidence strongly suggesting their neurotrophic activity.

Nuestro objetivo fue comprobar la seguridad de la infusión intraespinal de células mononucleadas de médula ósea autóloga (BMNCs) y buscar signos de neurotrofismo celular en pacientes con esclerosis lateral amiotrófica (ELA). Realizamos un ensayo fase I, infundiendo BMNCs en el cordón posterior medular. La seguridad se definió como la ausencia de eventos adversos severos relacionados con el tratamiento. Incluimos once pacientes. No hubo eventos adversos severos relacionados con el tratamiento. Tampoco hubo aceleración del deterioro de la capacidad vital forzada ni de las escalas ALS-FRS, Norris o MRC. Cuatro pacientes fallecieron por razones no relacionadas con el tratamiento. Se observó un mayor número de motoneuronas/sección en los segmentos tratados que en los no tratados (4.2±0.8 y 0.9±0.3 respectivamente). Estas motoneuronas estaban rodeadas por células CD90+ y no presentaban depósitos degenerativos. Este estudio confirma la seguridad de la infusión intraespinal de BMNCs en ELA y proporciona evidencias de su actividad neurotrófica.