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 years post injury

The increase of motor activity increase (Figure 6) after HSCs and HPs transplantation was observed only in the cases of 2-5 years post SCI; it was manifested in the motor activity increase from baseline 134.5 ± 7.3 points to 144.5 ± 8.6 points after the first transplantation and to 173.4 ± 10.7 after the second P < 0.05 between baseline and transplantations, respectively). Neither cases of 1-2 years post SCI, nor the cases over 5 years post injury showed statistically significant changes of clinical symptoms. These results seem to be conditioned by the inability of HSCs and HPs to realize their regeneration potential, due to residual inflammation and apoptosis in the patients with the period post SCI, varying from 1 to 2 years and due to degenerative changes in spinal cord in over 5 years old SCI cases. Still, regress of motor neurologic symptoms was observed in some of the patients with such SCI, so that in one of the cases the motor functions were considerably repaired 29 years post injury.

Testing muscle strength repair in SCI patients after HSCS AND HPS transplantation with Medical Research Council Scale

The Medical Research Council Scale was used to confirm the obtained results of motor progress after the HSCs and HPs transplantation in chronic SCI patients. The scale seems to be one of the most convenient and clear measurements of the strength of separate muscles, and originally was meant to detect locomotion deficit in the injuries of peripheral nerves. Total score for the absence of neurologic impairment makes 100 points.

As seen in Figure 7, the HSCs and HPs transplantation, accompanied by intensive rehabilitation, resulted in the increase of the muscle strength at all stages of research (P < 0.05). The second HSCs and HPs transplantation did not lead to muscle strength increase in damaged extremities. These data can be explained by insensitivity of the measurement tool to paresis improvements, the so called ceiling effect, that agrees with the data of Belova^[11]. It is also confirmed by the analysis of muscle strength, the patients being distributed according to the level and type of injury (Figures 8A and B). Strengthening of the muscles was observed in the cases of more severe injuries: at the level of cervical intumescence and with complete SCI.

On the other hand, recovery of the muscle strength after HSCs and HPs transplantation repeated the pattern of the progress of motor functions, depending on the years post injury. This manifested in the slight score increase in the cases of 2-5 years post SCI after the first HSCs and HPs transplantation (from baseline 63.8 ± 4.6 points to 78 ± 7.1 points after HSCs and HPs transplantation, P < 0.05, respectively). However, after the second HSCs and HPs transplantation, muscle strength increase was registered only in the patients with 1-2 years old injury. The cases of over 5 years old SCI demonstrated no statistically valid increase of muscle strength, herewith, confirming the hypothesis of hindered motor restoration, due to degenerative changes in spinal cord in these cases. Hence, the changes in muscle strength, measured by Medical Research Council Scale, demonstrated improvement of locomotion after HSCs and HPs transplantation despite low sensitivity of the tool and consequent low increase of the score (Figure 9).