Cerebral palsy (CP) in adults bioengineering of the damaged brain and spinal cord

What is cerebral palsy (CP) and where are we now? Currently, the term cerebral palsy refers to a group of diseases caused by residual organic damage to the brain and spinal cord that have been obtained in the prenatal and early postnatal period. The residual organic changes in the brain could be induced by hypoxic disorders or asphyxia in the prenatal, birth and postnatal period, a head injury received before birth in the womb and during delivery, or during obstetric care (forceps delivery, falls during childbirth, etc.). However, in adulthood, we observe a classic disease of the damaged brain, which is manifested by cysts, scars or atrophy of the nervous tissue, as well as a violation of cerebrospinal fluid (CSF) flow. Therefore, the treatment of these patients should follow the algorithm for the treatment of the patients with severe brin injury and spinal cord injury.

Types of patients: the individuals with cerebral palsy (CP) aged over 18 with residual neurological disorders after severe birth brin and/or spinal cord injury and/or hypoxia, independent on the type of disease.

The principle of therapy: Trauma-induced death of cells that constitute the normal structure of the tissues of the spinal cord, leads to the damage of the function of the corresponding parts of the spinal cord and disability of the patient. At the site of injury, the conditions are unfavorable for tissue regeneration, which is associated with the disruption of vascular trophism (provision), the formation of glial scars, which leads to local production of inflammation supporting tissue factors and cytokines. As a rule, specialized blood circulating cells, which under normal conditions provide tissue repair after damage, do not penetrate the blood-brain barrier that separates the brain and spinal cord from the vascular bed, and thus they do not participate in regeneration. Figuratively, one can imagine that the damaged areas lack «building» personalised material. As a result, the lost functions do not recover or they restore extremely slowly, even despite active drug treatment and modern rehabilitation programs.

The administration of autologous CD34+ fraction of the patient's peripheral blood mononuclear cells (PBMCs), including progenitor cells, bypassing the blood-brain barrier, allows not only to provide the damaged areas with the necessary "building" material, but also to affect the local personalised repair mechanisms of regulation. The administration of autologous (patient’s own) cells of an adult type does not carry any risks of developing tumors, immunological rejection reactions or transmission of viral and other latent (hidden) infections.

Method: At the first stage, the CD34+ fraction of the peripheral blood mononuclear cells (PBMCs) is harvested from the patient on a cell separator, using a disposable system. One séance provides the material that is sufficient for the long-term restorative therapy for 12 to 18 months. The obtained cell material is preserved at low temperature. Before administration, the cells are thawed and are introduced by spinal tap behind the blood-brain barrier with an interval of 1 to 2 weeks. The cells migrate in the cerebrospinal fluid to the sites of injury and brain tissue to the central neurons of the brain and spinal cord to provide axonal transport and neural restoration.

Result. Active specialized rehabilitation aimed at the development of new function provides for even better functional results against the therapy of CP and improves the neurological functions in 61.2% of the CP patients depending on the type and duration of injury; Over 500 patients with CP from 15 countries of the world have been treated in our hospital.