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

Sensation repair in SCI patients after HSCs and HPs transplantation

Sensation repair after the intrathecal transplantation of HSCs and HPs was evaluated in 71 patients by the assessment of neurologic condition that included 2-point tests of pain, temperature, deep sensation on dermatomes on both sides, as well as the assessment of the feeling of muscle “heaviness” in rest and after exercise in upper and lower extremities, abdomen and back. Total score, denoting absence of neurologic motor disorders, made 312 points.

As different from the locomotion, the repair of sensation was registered in a much fewer number of chronic SCI cases (Figure 10), the reason as yet remaining unclear. At the same time, the analysis of the obtained clinical data showed (Figure 11A) that the cell therapy led to the increase of sensitivity from baseline 124.3 points to 138.4 after the first and to 153.5 points after the second transplantations of HSCs and HPs (P < 0.05, between the stages of research).

Clinically, the repair manifested in the expansion of sensation areas, accompanied by gradual involvement of new dermatomes. Major part of the patients observed the elements of deep sensation after the first transplantation and characterized them as the “heaviness” of muscles in rest and after physical training. Further, it was noted that development of the feeling of the position of lower extremities in space preceded stabilization of knee joints and development of the first elements of walking.

Expansion of the areas of surface sensation did not depend on the level of injury, i.e. the sensation could manifest with separate dermatomes of lower and/or upper extremities, anterior chest or abdomen walls. In most of the cases the dermatomes did not restore in full, but only partially the sensation seldom restored unilaterally. Having received 5-7 HSCs and HPs transplantations, some of the patients restored sensation in all or almost all dermatomes of extremities and body. Hence, after the transplantation of HSCs and HPs, the sensation restores in chronic SCI cases, but in fewer cases than locomotion.

Case distribution, depending on the level or type of injury, demonstrated restoration of sensation in the most severe cases (complete SCI of cervical intumescence) (Figures 11B and C). These results are likely to be conditioned by low sensitivity of the measurement scale, i.e., “ceiling effect”. However, gradation of the sensation disorders was copied from widely applied measurement scales, including ISCSCI-92, and, hence, demonstrated the inefficiency of applied evaluation methods that demand upgrade.

No clinical changes were observed in the distribution of the cases, depending on the years post injury. This can be explained by lesser damage of posterolateral parts of spinal cord that agrees with the multiple data of pathomorphological tests. However, additional tests are necessary to confirm this hypothesis. Obtained clinical data of sensation repair were objectified with somatosensory evoked potentials^[12].