Workshop on intraspinal transplantation and clinical application.
The following general conclusions were reached at the workshop: 1. Laboratory studies suggest a potential benefit of cellular transplant therapy for SCI. 2. Some evidence supporting the safety of human fetal transplants is available from clinical studies of transplants in Parkinson's disease and SCI. 3. Assessment criteria and methodology are available, including imaging approaches, validated neurologic scoring systems, detailed electrophysiologic studies of conduction and spinal cord reflexes, and functional scoring approaches. 4. More controlled animal studies are needed (a) to demonstrate efficacy and to evaluate the necessity for immunosuppressive therapy and the overall safety of intraspinal transplantation, (b) to obtain more supporting evidence (e.g., electrophysiologic, histopathologic, MRI, molecular) that would provide insights into ways that transplanted tissue could mediate function, (c) to provide guidance for the procurement, harvesting, preparation, storage, and other logistics related to the use of human cells for transplantation into the spinal cord, (d) to define more thoroughly the cell type(s) that would be most likely to have benefit and the conditions that affect their viability, migration, gene expressions, and proliferation after transplantation, (e) to determine the most optimal time after injury for transplantation, and (f) to clarify patient selection characteristics that might optimize success (i.e., complete vs incomplete injuries, spinal level involved, age of recipient).