Cellular Therapy for Chronic Traumatic Brachial Plexus Injury

Document Type : CASE REPORT


1 Department of Medical Services and Clinical Research, NeuroGen Brain and Spine Institute, New Mumbai, Maharashtra, India

2 Department of Research and Development, NeuroGen Brain and Spine Institute, New Mumbai, Maharashtra, India

3 Department of Neurorehabilitation, NeuroGen Brain and Spine Institute, New Mumbai, Maharashtra, India


Cellular therapy is being actively pursued as a therapeutic modality in many of the neurological diseases. A variety of stem cells from diverse sources have been studied in detail and have been shown to exhibit angiogenetic and immunomodulatory properties in addition to other neuroprotective effects. Published clinical data have shown bone marrow mononuclear cell (BMMNC) injection in neurological disorders is safe and possesses regenerative potential. We illustrate a case of 27-year-old male with traumatic brachial plexus injury, administered with autologous BMMNCs intrathecally and intramuscularly, followed by multidisciplinary rehabilitation. At the follow-up assessment of 3 and 7 months after first cell transplantation, improvements were recorded in muscle strength and movements. Electromyography (EMG) performed after the intervention showed a response in biceps and deltoid muscles suggesting the process of reinnervation at the site of injury. In view of the improvements observed after the treatment, the patient underwent second cell transplantation 8 months after the first transplantation. Muscle wasting had completely stopped with an increase in the muscle girth. No adverse effects were noted. Improvements were maintained for 4 years. A comprehensive randomized study for this type of injury is needed to establish the therapeutic benefits of cellular therapy.


Snell RS. Clinical Anatomy by Regions. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2007.  Back to cited text no. 1
Moran SL, Steinmann SP, Shin AY. Adult brachial plexus injuries: Mechanism, patterns of injury, and physical diagnosis. Hand Clin 2005;21:13-24.  Back to cited text no. 2
Rovak JM, Tung TH. Traumatic brachial plexus injuries. Mo Med 2006;103:632-6.  Back to cited text no. 3
MacDonald SC, Fleetwood IG, Hochman S, Dodd JG, Cheng GK, Jordan LM, et al. Functional motor neurons differentiating from mouse multipotent spinal cord precursor cells in culture and after transplantation into transected sciatic nerve. J Neurosurg 2003;98:1094-103.  Back to cited text no. 4
Heine W, Conant K, Griffin JW, Höke A. Transplanted neural stem cells promote axonal regeneration through chronically denervated peripheral nerves. Exp Neurol 2004;189:231-40.  Back to cited text no. 5
Ren Z, Wang Y, Peng J, Zhao Q, Lu S. Role of stem cells in the regeneration and repair of peripheral nerves. Rev Neurosci 2012;23:135-43.  Back to cited text no. 6
Carlson RV, Boyd KM, Webb DJ. The revision of the declaration of Helsinki: Past, present and future. Br J Clin Pharmacol 2004;57:695-713.  Back to cited text no. 7
Miyan JA, Zendah M, Mashayekhi F, Owen-Lynch PJ. Cerebrospinal fluid supports viability and proliferation of cortical cells in vitro, mirroring in vivo development. Cerebrospinal Fluid Res 2006;3:2.  Back to cited text no. 8
Dubuisson AS, Kline DG. Brachial plexus injury: A survey of 100 consecutive cases from a single service. Neurosurgery 2002;51:673-82.  Back to cited text no. 9
Nandedkar SD. Objective EMG: Quantitation and documentation in the routine needle electromyographic examination. In: Pease WS, Johnson EW, editors. Practical Electromyography. 3rd ed. Baltimore: Williams and Wilkins; 1997.  Back to cited text no. 10
Saliba S, Saliba EN, Pugh KF, Chhabra A, Diduch D. Rehabilitation considerations of a brachial plexus injury with complete avulsion of C5 and C6 nerve roots in a college football player: A case study. Sports Health 2009;1:370-5.  Back to cited text no. 11
Jin H, Yang Q, Ji F, Zhang YJ, Zhao Y, Luo M. Human amniotic epithelial cell transplantation for the repair of injured brachial plexus nerve: Evaluation of nerve viscoelastic properties. Neural Regen Res 2015;10:260-5.  Back to cited text no. 12
[PUBMED]  [Full text]  
Glover LE, Tajiri N, Weinbren NL, Ishikawa H, Shinozuka K, Kaneko Y, et al. A step-up approach for cell therapy in stroke: Translational hurdles of bone marrow-derived stem cells. Transl Stroke Res 2012;3:90-8.  Back to cited text no. 13
Meng J, Muntoni F, Morgan JE. Stem cells to treat muscular dystrophies – Where are we? Neuromuscul Disord 2011;21:4-12.  Back to cited text no. 14
Geffner LF, Santacruz P, Izurieta M, Flor L, Maldonado B, Auad AH, et al. Administration of autologous bone marrow stem cells into spinal cord injury patients via multiple routes is safe and improves their quality of life: Comprehensive case studies. Cell Transplant 2008;17:1277-93.  Back to cited text no. 15
Sharma A, Gokulchandran N, Chopra G, Kulkarni P, Lohia M, Badhe P, et al. Administration of autologous bone marrow-derived mononuclear cells in children with incurable neurological disorders and injury is safe and improves their quality of life. Cell Transplant 2012;21 Suppl 1:S79-90.  Back to cited text no. 16
Lazerges C, Daussin PA, Coulet B, Boubaker el Andalousi R, Micallef JP, Chammas M, et al. Transplantation of primary satellite cells improves properties of reinnervated skeletal muscles. Muscle Nerve 2004;29:218-26.  Back to cited text no. 17
Skuk D. Myoblast transplantation for inherited myopathies: A clinical approach. Expert Opin Biol Ther 2004;4:1871-85.  Back to cited text no. 18
Sharma A, Kulkarni P, Chopra G, Gokulchandran N, Lohia M, Badhe P. Autologous bone marrow derived mononuclear cell transplantation in Duchenne muscular dystrophy-a case report. Indian J Clin Pract 2012;23:169-72.  Back to cited text no. 19
Callera F, do Nascimento RX. Delivery of autologous bone marrow precursor cells into the spinal cord via lumbar puncture technique in patients with spinal cord injury: A preliminary safety study. Exp Hematol 2006;34:130-1.  Back to cited text no. 20
Chen G, Wang Y, Xu Z, Fang F, Xu R, Wang Y, et al. Neural stem cell-like cells derived from autologous bone mesenchymal stem cells for the treatment of patients with cerebral palsy. J Transl Med 2013;11:21.  Back to cited text no. 21
Siniscalco D. Stem cell research: An opportunity for autism spectrum disorders treatment. Autism 2012;2:2.  Back to cited text no. 22
Teng YD, Liao WL, Choi H, Konya D, Sabharwal S, Langer R, et al. Physical activity-mediated functional recovery after spinal cord injury: Potential roles of neural stem cells. Regen Med 2006;1:763-76.  Back to cited text no. 23
Hsu YC, Chen SL, Wang DY, Chiu IM. Stem cell-based therapy in neural repair. Biomed J 2013;36:98-105.  Back to cited text no. 24
[PUBMED]  [Full text]  
Hawke TJ, Garry DJ. Myogenic satellite cells: Physiology to molecular biology. J Appl Physiol 2001;91:534-51.  Back to cited text no. 25
Abedi M, Greer DA, Colvin GA, Demers DA, Dooner MS, Harpel JA, et al. Robust conversion of marrow cells to skeletal muscle with formation of marrow-derived muscle cell colonies: A multifactorial process. Exp Hematol 2004;32:426-34.  Back to cited text no. 26
Maclean S, Khan WS, Malik AA, Anand S, Snow M. The potential of stem cells in the treatment of skeletal muscle injury and disease. Stem Cells Int 2012;2012:282348.  Back to cited text no. 27
Pratt SJ, Shah SB, Ward CW, Inacio MP, Stains JP, Lovering RM. Effects of in vivo injury on the neuromuscular junction in healthy and dystrophic muscles. J Physiol 2013;591:559-70.  Back to cited text no. 28
Hogendoorn S, Duijnisveld BJ, van Duinen SG, Stoel BC, van Dijk JG, Fibbe WE, et al. Local injection of autologous bone marrow cells to regenerate muscle in patients with traumatic brachial plexus injury: A pilot study. Bone Joint Res 2014;3:38-47.  Back to cited text no. 29
Bakshi A, Hunter C, Swanger S, Lepore A, Fischer I. Minimally invasive delivery of stem cells for spinal cord injury: Advantages of the lumbar puncture technique. J Neurosurg Spine 2004;1:330-7.  Back to cited text no. 30
Kilmer DD, Abresch RT, Fowler WM Jr. Serial manual muscle testing in Duchenne muscular dystrophy. Arch Phys Med Rehabil 1993;74:1168-71.  Back to cited text no. 31
Lue YJ, Jong YJ, Lin YT, Chen SS. The strength and functional performance of patients with Duchenne muscular dystrophy based on natural history. Gaoxiong Yi Xue Ke Xue Za Zhi 1992;8:597-604.  Back to cited text no. 32
Fabel K, Wolf SA, Ehninger D, Babu H, Leal-Galicia P, Kempermann G. Additive effects of physical exercise and environmental enrichment on adult hippocampal neurogenesis in mice. Front Neurosci 2009;3:50.  Back to cited text no. 33