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Young patient before transplantation. L.B., the patient, is in a persistent vegetative state 9 weeks after his cardiac arrest and before transplantation of cord blood cells. Below: young patient 2 months after autologous stem cell transplantation of his own cord blood. Credit: Arne Jensen and Eckard Hamelmann

Awoken from a persistent vegetative state

First successful treatment of paediatric cerebral palsy with autologous cord blood

“Long-held doubts about the effectiveness of the therapy dispelled”

Following a cardiac arrest that engendered severe brain damage, a 2.5 year old boy had remained in a persistent vegetative state – with minimal chances of survival. However, just two months after treatment with his own (autologous) cord blood containing stem cells, his symptoms improved significantly; over the following months, he learned to speak simple sentences and to move.

“Our findings, along with those from a Korean study, dispel the long-held doubts about the effectiveness of this new therapy,” said Dr. Arne Jensen of the Campus Gynaecology Clinic. Together with his colleague Prof. Dr. Eckard Hamelmann of the Department of Paediatrics at the Catholic Hospital Bochum (University Clinic of the RUB), Dr. Jensen reported their results in the journal Case Reports in Transplantation.

The parents searched the literature for treatment options

At the end of November 2008, the little boy had suffered a cardiac arrest followed with severe brain damage and was subsequently in a persistent vegetative state, his body paralysed. Up to then, there had been no treatment for the cause of what is known as infantile cerebral palsy. “In their desperate situation, the parents searched the literature for alternative therapies,” Arne Jensen explains. “They contacted us and asked about the possibilities of using their son’s own cord blood, frozen at his birth.”

“Threatened, if not hopeless prognosis”

Nine weeks after the brain damage, on 27 January 2009, doctors administered the prepared cord blood intravenously. They followed his progress of recovery at 2, 5, 12, 24, 30, and 40 months after the injury. Usually, the chances of survival from such severe brain damage, with more than 25 minutes of resuscitation, are six per cent. Months after severe brain damage, surviving children usually only exhibit minimal signs of consciousness. “The prognosis for the little patient was threatened if not hopeless,” the Bochum doctors said.

Rapid recovery after cord blood therapy

After the cord blood therapy, the patient, however, recovered relatively quickly. Within two months, his spasticity decreased significantly. He was able to see, sit, smile, and to speak simple words again. Forty months after treatment, he was able to eat independently, walk with assistance, and form four-word sentences.

“Of course, on the basis of these results, we cannot clearly say what the cause of the recovery is,” Jensen says. “It is, however, very difficult to explain these remarkable effects by purely symptomatic treatment during active rehabilitation.”

In animal studies, stem cells migrate to damaged brain tissue

In animal studies, scientists have been researching the therapeutic potential of cord blood for some time. In a previous study with rats, RUB researchers found that cord blood cells migrate to the damaged area of the brain in large numbers within 24 hours of introducttion. In March 2013, in a controlled study of one hundred children, Korean doctors reported for the first time that they had successfully treated cerebral palsy with allogeneic cord blood.

Conclusion drawn from the published work:
"Thus, given the severity of brain damage and persistent vegetative state he suffered from, the patient has recovered to an extent, that is difficult to explain by intense active rehabilitation alone. Taking the evidence together, it appears that autologous transplantation of cord blood cells may in part have contributed to the remarkable functional neuroregeneration observed in this patient. If true, this would be the first account of a successful causative cell therapy of pediatric cerebral palsy, a condition for which there is no cure at present."

Bibliographic record
A. Jensen and E. Hamelmann (2013): First autologous cell therapy of cerebral palsy caused by hypoxic-ischemic brain damage in a child after cardiac arrest—individual treatment with cord blood, Case Reports in Transplantation, DOI: 10.1155/2013/951827

Original article: http://aktuell.ruhr-uni-bochum.de/pm2013/pm00151.html.en