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

Post HSCs and HPs transplantation changes of motor activity depending on the level of injury

The motor improvement was mostly observed at Th3-Th8 level of injury, specifically in 81.3% of the cases (Figure 3C). Meanwhile, cervical and lumbar SCI cases showed lesser benefit from the therapy, and functional restoration was less illustrative (Figure 4). However, the level Th3-Th8 cases demonstrated considerable repair.

Due to baseline diversity, the comparison of the clinical data between the levels of injury was done in per cent and showed maximal improvement of Th3-Th8 SCI cases after the second and consequent HSCs and HPs transplantations. After the first HSCs and HPs transplantation neurologic improvement was observed only in the cases of cervical injury, which can be explained by the fact that the first feeling of the slight changes in motor functionality (mostly of upper limbs) was much brighter in this category of the patients. By 5-8-th transplantations the quadriplegics were able to turn in their beds independently, the strength in upper extremities and back increased, and they did not require fixation to a wheelchair with the belts or any other devices. However, three years after the first transplantation, the most positive results were observed in lumbosacral cases and, strangely enough, in cervical SCI. At least, the improvement of life quality was more obvious in quadriplegics, both for the patient and for their relatives.

Accordingly, these data report more vigorous repair of motor functions at Th3-Th8 level of SCI after HSCs and HPs transplantations. Although, the represented data show limited opportunity for the restoration at the level of cervical and lumbar enlargement, we observed the benefits of cell transplantations at these levels. Follow-up of the SCI patients after the HSCs and HPs transplantations demonstrated neurologic progress in 61.1%, and it was associated with strengthening of the muscles, development and/or increase of motor activity, regress of sensitive disorders, and improvement of bowel and bladder functions. The most notable clinical effect was achieved in locomotion. In most cases, the changes in motor functions were minimal after the first HSCs and HPs transplantation and manifested in lightweight positions. Further intensive rehabilitation led to strengthening of extremities muscles, increase of pace and range of movements during exercise tests. After the second HSCs and HPs transplantation 33 patients were able to stabilize knee joints, to stand in knee supporting position independently and developed some elements of walking with assisting devices (walkers). It should be noted that 96% of the patients demonstrated no signs of neurologic restoration for several years before HSCs and HPs therapy. One of the patients from the United States restored independent automatic walk in a month of the therapy that included 4 administrations of the HSCs and HPs, and left the hospital on their own feet, although their previous treatment in the US lasted 5 years. The similar recovery was observed in the patient from Bosnia and Herzegovina, when two administrations were enough to restore the walking function after 6 years of ineffective therapies in various clinics of the world.