Name of journal: World Journal of Transplantation esps manuscript no: 18452 Manuscript Type: Original Article Retrospective Study

Evaluation of motor function repair: The efficacy of the intrathecal transplantation of HSCs and HPs was evaluated with the help of the assessment of neurologic condition that included 5-point test of muscle strength, active movements and pace of movements of the extremities on both sides. Total score for no neurologic disorder is 300 points. As seen from Figure 3A, 56.9% of the cases demonstrated improvement of neurologic symptoms, accompanied by muscle strength and muscle tone build-up, visual contractions of some groups of muscles, frequently unilateral, and further development of movements in lightweight positions. Largely, the active movements appeared 12-18 mo later during exercises on press machines. Accordingly, in 50% of the patients the motor restoration began after the first HSCs and HPs transplantation, which is confirmed in average by 9.9 points improvement in neurologic impairment as compared to the baseline (P < 0.05) (Figure 3B). Repeated HSCs and HPs transplantations further enhanced neurologic improvement, that made 142.5 ± 9.7 points (P < 0.05, as compared to baseline and first HSCs and HPs transplantation results). Usually, intensive exercise led to strengthening of extremities’ muscles, increase of range and pace of the movements, stabilization of the knee joints, ability to stand independently in the knee supporting position and development of the elements of walking with assisting devices (walkers). It should be noted that 91.2% reported no restoration of motor functions for several years, and development of the first controllable movements was extremely important for the patients and served an incentive for further training. However, the improvement of the muscle strength was often admitted by the patient no earlier than in 6-12 mo and became objective reality by the end of the second or even third year. By the sixth year, the patients are deeply convinced in the effectiveness and practicability of the therapy.

As our research demonstrated, the intrathecal transplantations of HSCs and HPs led to gradual recovery of the lost movements in chronic SCI patients, only being accompanied by specific rehabilitation. Still, rehabilitation without HSCs and HPs transplantation before enrollment into the program produced only limited effect.