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Functional regeneration of supraspinal connections in a patient with transected spinal cord following transplantation of bulbar olfactory ensheathing cells with peripheral nerve bridging


Treatment of patients sustaining a complete spinal cord injury remains an unsolved
clinical problem because of the lack of spontaneous regeneration of injured central
axons. A 38-year-old man sustained traumatic transection of the thoracic spinal cord at
upper vertebral level Th9. At 21 months after injury the patient presented symptoms of
a clinically complete spinal cord injury (American Spinal Injury Association class AASIA
A). One of the patient‟s olfactory bulbs was removed and used to derive a culture
containing olfactory ensheathing cells and olfactory nerve fibroblasts. Following
resection of the glial scar the cultured cells were transplanted into the spinal cord
stumps above and below the injury, and the 8 mm gap bridged by 4 strips of autologous
sural nerve. The patient underwent an intense pre- and post-operative
neurorehabilitation program. No adverse effects were seen at 19 months
postoperatively, and unexpectedly, the removal of the olfactory bulb did not lead to
persistent unilateral anosmia. The patient improved from ASIA A to ASIA C. There
was improved trunk stability, partial recovery of the voluntary movements of the lower
extremities, and an increase of the muscle mass in the left thigh, as well as partial
recovery of superficial and deep sensation. There was also some indication of improved
visceral sensation and improved vascular autoregulation in the left lower limb. The
pattern of recovery suggests functional regeneration of both efferent and afferent longdistance
fibers. Imaging confirmed that the grafts had bridged the left side of the spinal
cord, where the majority of the nerve grafts were implanted, and neurophysiological
examinations confirmed the restitution of the integrity of the corticospinal tracts and the
voluntary character of recorded muscle contractions. To our knowledge, this is the first
clinical indication of beneficial effects of transplanted autologous bulbar cells.