| Dr Himanshu Bansal and his team used stem cell therapy successfully to treat a young male patient with traumatic brain injury |
Traumatic brain injury (TBI) affects nearly 1.6 million individuals annually in India. Most of them are victims of road traffic accidents, others get TBI due to falls, violence or unintentional injuries. Most often TBI leaves the patient disabled and most of these patients are either young or the only breadwinner of the family or both. This creates a significant financial and social burden for the caretaker and the patient.
However, most of the existing treatment for traumatic brain injury are limited to restricting further damage. Rehabilitation is required for the patient to relearn basic skills such as walking or talking to improve their ability to perform daily activities.
Stem cell therapy to repair or replace damaged brain tissue is a new area of research. In numerous studies, stem cell implantation has substantially improved brain function in experimental animals with brain trauma. A study published by Dr Toshiya Osanai of Hokkaido University Graduate School of Medicine, Sapporo, Japan has shown that stem cells were injected in brain-injured rats via the carotid artery travel directly to the brain, where they greatly enhanced functional recovery. The therapy shows preclinical promise and its application is being researched around the world.
Dr Himanshu Bansal Founder Director, Institute of Spinal Cord Injury, Rudrapur and Mother Cell Stem Cell Research & Solutions Uttarakhand |
Recently, Dr Himanshu Bansal and his team from The Institute of Spinal Injury & Stem Cell Research, Uttarakhand reported encouraging results of a young male patient with TBI. The patient, suffering from severe disability for the past one and half year following an accident, has successfully undergone non-invasive autologous stem cell transplantation and is the first successful case reported from North India. The patient was bed ridden, suffering from altered sensorium with complete visual loss, severe cognitive dysfunction and lack of movement in limbs. He regained full consciousness, reasonable memory, communication abilities and purposive movements in limbs after stem cell therapy.
The case
| 20-year-old Ram Choudhary from Pune |
A 20-year-old, Ram Choudhary hailing from Pune had a road accident in 2012 and suffered severe brain injury. He was admitted at a prestigious private hospital in Pune and was on ventilator with tracheostomy. Doctors gave him only guarded prognosis even for survival and he remained unconscious for three months in the hospital where he underwent two neurosurgical procedures.
He had marginal recovery but he was now in altered sensorium. He had to be on Ryle’s Tube feeding and urinary catheter with no useful limb movements and no verbal response. He had no vision, hearing or speech. Choudhary needed to be assisted in his daily activities. He did not show any improvement despite all available treatment in the last one year and ultimately the possibility of stem cell therapy was considered after discussions with his family.
At this stage the parents had no hope for the patient and were left with no choice. They consulted Dr Bansal and he agreed to treat the patient with stem cell therapy. “Research has shown clearly that stem cell after transplantation migrate to the injury sites, transdifferentiate into new neurons and hence replace lost cells. It also prevents further axonal injury in fresh injuries and promotes axonal regrowth by secretion of growth factors, induction of angiogenesis and by modulation of the systemic immunologic response. Many studies have also shown that implanted stem cells have substantially improved cerebral function with brain trauma,” informs Dr Bansal.
This treatment was chosen as a last resort for the patient on compassionate grounds. Glasgow Coma Scale (GCS) score of the patient when he reported to Dr Bansal was E2 M4 V1. “We evaluated him clinically on MRI and found right fronto parietal craniectomy with moderate to severe gliosis in right frontal and right temporal region and dilation of lateral ventricle old contusion in right frontal parietal cortical region,” he explains.
The process
The stem cells were processed at Dr Bansal’s lab and the patient received the transplant at the Apollo Hospital, Noida. Approximately 240 ml of bone marrow was harvested from iliac crest. This bone marrow is processed in a closed system for volume reduction. Volume reduced sample is processed to have rich 5 ml fraction of mononuclear cells (haemopoetic stem cells and mesenchymal stem cells and endothelial progenitor cells) and adjoining supernatant plasma which is rich in platelets and growth factors. The sample is further processed to recover lost Very small embryonic like stem cells (VSELS) the most useful and powerful cells. Finally, 0.5 ml of this end product is sent to the lab for expansion of mesenchymal cells in human grade media at 4 degree Celsius.
These cells are then injected to the patent on a monthly basis by retrobulbar/intrathecal and intrarterial route for six months. “The typical yield, on an average, per 60 ml of bone marrow varies from 320-380 million MNC, 15 to 18 million Cd 34+ve o.5 million MSCs and 1 million VSEls. Further, 40 ml of the bone marrow sample which was sent to lab is expanded for Mscs. These mscs are expanded at four per cent oxygen only upto three passages normally we get 50-75 millions at end of three passage,” Dr Bansal says.
Support therapy in terms of Ayurevda and supplements of Vitamin B1 and Vitamin B12, Vitamin B3 nicotinic acid were also started along with vigorous rehabilitation and intensive physiotherapy.
Prognosis
After the third treatment sitting, patient started showing improvement in his brain functions. He became oriented, was gradually able to recognise family and friends and started moving his hands and legs purposefully. By the fifth month, patient started showing considerable improvement, started verbalising, was able to communicate with his parents and able to walk with support. He could perform semi-assisted activities of daily living, and his memory recovered significantly. Vision improved to finger counting in the right eye and good perception of light in the left eye by sixth month. “It may take him a couple of months to be more active,” Dr Bansal opines.
Outlook
The belief that brain injuries aren’t curable has been proved wrong as stem cell therapy has become one of the means to tackle the situation. “The need to help accident victims led us to work on compassionate grounds for the option of stem cell therapy,” says Dr Bansal. “There has been a pressing need to help the rising number of people who were disabled following road accidents. Most of the people who manage to escape from death after a road accident find it very difficult to lead a normal life as their neurological functions get disturbed to a large extent. According to Institute of Road Traffic Education, the numbers of these are mind boggling. About 1.4 million people in India face road accidents out of which 40 per cent die and the other 60 per cent are left with serious injuries, most of them related to head. Till now there wasn’t a treatment which could claim its ability to address these concerns. Stem cells transplant have raised a hope for the millions who are left with the aftermath of these accidents,” he adds.
“This is an eye opener that there is a possibility of reactivating brain cells following injury with very gratifying clinical results. To our knowledge few attempts like this have been made across the world. This is the first reported successful case from India,” he adds. “These stem cells are non-invasive, display contact inhibition and are non-malignant. These are safe for transplant,” explains Dr Bansal.
Till date seven patients across Delhi at various private hospitals like Rockland and Karla have received this therapy. The cost per sitting is about a lakh rupees followed with other expenses making this an expensive treatment option. However, Dr Bansal says that poor patients who need the transplant are also treated at substantially low rates.
However, a lot more need to be understood about stem cell therapy in head injuries including the time of intervention and quantity of cells to be used depending upon the injury. “We’re planning to carry out a pilot study in treating head injuries with stem cells,” says Dr Bansal.
“Stem cell therapy has a reasonable perspective for a clinical application in traumatic brain injury, the translation of the existing findings requires extensive additional experimental studies,” he concludes.