Translational Stroke Research

, Volume 9, Issue 4, pp 321–332 | Cite as

Cell Therapy in Stroke—Cautious Steps Towards a Clinical Treatment

  • Olivier Detante
  • Keith Muir
  • Jukka JolkkonenEmail author


In the future, stroke patients may receive stem cell therapy as this has the potential to restore lost functions. However, the development of clinically deliverable therapy has been slower and more challenging than expected. Despite recommendations by STAIR and STEPS consortiums, there remain flaws in experimental studies such as lack of animals with comorbidities, inconsistent approaches to experimental design, and concurrent rehabilitation that might lead to a bias towards positive results. Clinical studies have typically been small, lacking control groups as well as often without clear biological hypotheses to guide patient selection. Furthermore, they have used a wide range of cell types, doses, and delivery methods, and outcome measures. Although some ongoing and recent trial programs offer hints that these obstacles are now being tackled, the Horizon2020 funded RESSTORE trial will be given as an example of inconsistent regulatory requirements and challenges in harmonized cell production, logistic, and clinical criteria in an international multicenter study. The PISCES trials highlight the complex issues around intracerebral cell transplantation. Therefore, a better understanding of translational challenges is expected to pave the way to more successful help for stroke patients.


Cell therapy Cerebrovascular diseases Experimental studies Clinical trials Translation 


Funding Information

This work was supported by RESSTORE project ( funded by the European Commission under the H2020 program (grant number 681044).

Compliance with Ethical Standards

Conflict of Interest

Dr. Keith Muir is chief Investigator for PISCES 1 and PISCES 2 trials, funded by ReNeuron Ltd. He participated in advisory boards for ReNeuron. No other authors have a conflict of interest.


  1. 1.
    Hankey GJ. Stroke. Lancet Lond Engl. 2017;389(10069):641–54. Scholar
  2. 2.
    Wei L, Wei ZZ, Jiang MQ, Mohamad O, Yu SP. Stem cell transplantation therapy for multifaceted therapeutic benefits after stroke. Prog Neurobiol. 2017;157:49–78. Scholar
  3. 3.
    Hicks A, Jolkkonen J. Challenges and possibilities of intravascular cell therapy in stroke. Acta Neurobiol Exp (Wars). 2009;69(1):1–11.Google Scholar
  4. 4.
    Auriat AM, Rosenblum S, Smith TN, Guzman R. Intravascular stem cell transplantation for stroke. Transl Stroke Res. 2011;2(3):250–65. Scholar
  5. 5.
    Janowski M, Wagner D-C, Boltze J. Stem cell-based tissue replacement after stroke: factual necessity or notorious fiction? Stroke. 2015;46(8):2354–63. Scholar
  6. 6.
    Pendharkar AV, Chua JY, Andres RH, Wang N, Gaeta X, Wang H, et al. Biodistribution of neural stem cells after intravascular therapy for hypoxic-ischemia. Stroke. 2010;41(9):2064–70. Scholar
  7. 7.
    Detante O, Valable S, de Fraipont F, Grillon E, Barbier EL, Moisan A, et al. Magnetic resonance imaging and fluorescence labeling of clinical-grade mesenchymal stem cells without impacting their phenotype: study in a rat model of stroke. Stem Cells Transl Med. 2012;1(4):333–41. Scholar
  8. 8.
    Rosado-de-Castro PH, Schmidt F d R, Battistella V, Lopes de Souza SA, Gutfilen B, Goldenberg RC, et al. Biodistribution of bone marrow mononuclear cells after intra-arterial or intravenous transplantation in subacute stroke patients. Regen Med. 2013;8(2):145–55. Scholar
  9. 9.
    Rosenblum S, Wang N, Smith TN, Pendharkar AV, Chua JY, Birk H, et al. Timing of intra-arterial neural stem cell transplantation after hypoxia-ischemia influences cell engraftment, survival, and differentiation. Stroke. 2012;43(6):1624–31. Scholar
  10. 10.
    Mitkari B, Kerkelä E, Nystedt J, Korhonen M, Mikkonen V, Huhtala T, et al. Intra-arterial infusion of human bone marrow-derived mesenchymal stem cells results in transient localization in the brain after cerebral ischemia in rats. Exp Neurol. 2013;239:158–62. Scholar
  11. 11.
    Nagpal A, Choy FC, Howell S, Hillier S, Chan F, Hamilton-Bruce MA, et al. Safety and effectiveness of stem cell therapies in early-phase clinical trials in stroke: a systematic review and meta-analysis. Stem Cell Res Ther. 2017;8(1):191. Scholar
  12. 12.
    Boltze J, Arnold A, Walczak P, Jolkkonen J, Cui L, Wagner D-C. The dark side of the force - constraints and complications of cell therapies for stroke. Front Neurol. 2015;6:155. Scholar
  13. 13.
    Lees JS, Sena ES, Egan KJ, Antonic A, Koblar SA, Howells DW, et al. Stem cell-based therapy for experimental stroke: a systematic review and meta-analysis. Int J Stroke. 2012;7(7):582–8. Scholar
  14. 14.
    Vu Q, Xie K, Eckert M, Zhao W, Cramer SC. Meta-analysis of preclinical studies of mesenchymal stromal cells for ischemic stroke. Neurology. 2014;82(14):1277–86. Scholar
  15. 15.
    Chen L, Zhang G, Gu Y, Guo X. Meta-analysis and systematic review of neural stem cells therapy for experimental ischemia stroke in preclinical studies. Sci Rep. 2016;6(1):32291. Scholar
  16. 16.
    Wu Q, Wang Y, Demaerschalk BM, Ghimire S, Wellik KE, Qu W. Bone marrow stromal cell therapy for ischemic stroke: a meta-analysis of randomized control animal trials. Int J Stroke. 2016;1:1747493016676617.Google Scholar
  17. 17.
    Vahidy FS, Rahbar MH, Zhu H, Rowan PJ, Bambhroliya AB, Savitz SI. Systematic review and meta-analysis of bone marrow-derived mononuclear cells in animal models of ischemic stroke. Stroke J Cereb Circ. 2016;47(6):1632–9. Scholar
  18. 18.
    Rosado-de-Castro PH, Pimentel-Coelho PM, da Fonseca LMB, de Freitas GR, Mendez-Otero R. The rise of cell therapy trials for stroke: review of published and registered studies. Stem Cells Dev. 2013;22(15):2095–111. Scholar
  19. 19.
    Jolkkonen J, Kwakkel G. Translational hurdles in stroke recovery studies. Transl Stroke Res. 2016;7(4):331–42. Scholar
  20. 20.
    Detante O, Moisan A, Hommel M, Jaillard A. Controlled clinical trials of cell therapy in stroke: meta-analysis at six months after treatment. Int J Stroke. 2017;12(7):748–51. Scholar
  21. 21.
    Boltze J, Nitzsche F, Jolkkonen J, Weise G, Pösel C, Nitzsche B, et al. Concise review: increasing the validity of cerebrovascular disease models and experimental methods for translational stem cell research. Stem Cells Dayt Ohio. 2017;35(5):1141–53.
  22. 22.
    O’Collins VE, Macleod MR, Donnan GA, Horky LL, van der Worp BH, Howells DW. 1,026 experimental treatments in acute stroke. Ann Neurol. 2006;59(3):467–77. Scholar
  23. 23.
    Sena E, van der Worp HB, Howells D, Macleod M. How can we improve the pre-clinical development of drugs for stroke? Trends Neurosci. 2007;30(9):433–9. Scholar
  24. 24.
    Minnerup J, Zentsch V, Schmidt A, Fisher M, Schäbitz W-R. Methodological quality of experimental stroke studies published in the stroke journal: time trends and effect of the basic science checklist. Stroke. 2016;47(1):267–72. Scholar
  25. 25.
    Thomas A, Detilleux J, Flecknell P, Sandersen C. Impact of stroke therapy academic industry roundtable (STAIR) guidelines on peri-anesthesia care for rat models of stroke: a meta-analysis comparing the years 2005 and 2015. PLoS One. 2017;12(1):e0170243. Scholar
  26. 26.
    Fisher M, Feuerstein G, Howells DW, Hurn PD, Kent TA, Savitz SI, et al. Update of the stroke therapy academic industry roundtable preclinical recommendations. Stroke J Cereb Circ. 2009;40(6):2244–50. Scholar
  27. 27.
    Savitz SI, Chopp M, Deans R, Carmichael T, Phinney D, Wechsler L, et al. Stem cell therapy as an emerging paradigm for stroke (STEPS) II. Stroke J Cereb Circ. 2011;42(3):825–9. Scholar
  28. 28.
    Macleod MR, van der Worp HB, Sena ES, Howells DW, Dirnagl U, Donnan GA. Evidence for the efficacy of NXY-059 in experimental focal cerebral ischaemia is confounded by study quality. Stroke. 2008;39(10):2824–9. Scholar
  29. 29.
    Chen J, Sanberg PR, Li Y, Wang L, Lu M, Willing AE, et al. Intravenous administration of human umbilical cord blood reduces behavioral deficits after stroke in rats. Stroke. 2001;32(11):2682–8. Scholar
  30. 30.
    Zacharek A, Chen J, Cui X, Li A, Li Y, Roberts C, et al. Angiopoietin1/Tie2 and VEGF/Flk1 induced by MSC treatment amplifies angiogenesis and vascular stabilization after stroke. J Cereb Blood Flow Metab. 2007;27(10):1684–91. Scholar
  31. 31.
    Chen J, Ye X, Yan T, Zhang C, Yang X-P, Cui X, et al. Adverse effects of bone marrow stromal cell treatment of stroke in diabetic rats. Stroke J Cereb Circ. 2011;42(12):3551–8. Scholar
  32. 32.
    Yan T, Venkat P, Chopp M, Zacharek A, Ning R, Roberts C, et al. Neurorestorative responses to delayed human mesenchymal stromal cells treatment of stroke in type 2 diabetic rats. Stroke. 2016;47(11):2850–8. Scholar
  33. 33.
    Rewell SSJ, Fernandez JA, Cox SF, Spratt NJ, Hogan L, Aleksoska E, et al. Inducing stroke in aged, hypertensive, diabetic rats. J Cereb Blood Flow Metab. 2010;30(4):729–33. Scholar
  34. 34.
    Boltze J, Wagner D-C, Barthel H, Gounis MJ. Academic-industry collaborations in translational stroke research. Transl Stroke Res. 2016;7(4):343–53. Scholar
  35. 35.
    Llovera G, Hofmann K, Roth S, Salas-Pérdomo A, Ferrer-Ferrer M, Perego C, et al. Results of a preclinical randomized controlled multicenter trial (pRCT): anti-CD49d treatment for acute brain ischemia. Sci Transl Med. 2015;7(299):299ra121. Scholar
  36. 36.
    Savitz SI, Cramer SC, Wechsler L. STEPS 3 consortium. Stem cells as an emerging paradigm in stroke 3: enhancing the development of clinical trials. Stroke J Cereb Circ. 2014;45(2):634–9. Scholar
  37. 37.
    Biernaskie J, Corbett D. Enriched rehabilitative training promotes improved forelimb motor function and enhanced dendritic growth after focal ischemic injury. J Neurosci. 2001;21(14):5272–80.PubMedCrossRefGoogle Scholar
  38. 38.
    Zhao S, Zhao M, Xiao T, Jolkkonen J, Zhao C. Constraint-induced movement therapy overcomes the intrinsic axonal growth-inhibitory signals in stroke rats. Stroke J Cereb Circ. 2013;44(6):1698–705. Scholar
  39. 39.
    Jones TA, Chu CJ, Grande LA, Gregory AD. Motor skills training enhances lesion-induced structural plasticity in the motor cortex of adult rats. J Neurosci. 1999;19(22):10153–63.PubMedCrossRefGoogle Scholar
  40. 40.
    Kwakkel G, Veerbeek JM, van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14(2):224–34. Scholar
  41. 41.
    Mering S, Jolkkonen J. Proper housing conditions in experimental stroke studies-special emphasis on environmental enrichment. Front Neurosci. 2015;9:106. Scholar
  42. 42.
    Karelina K, Norman GJ, Zhang N, DeVries AC. Social contact influences histological and behavioral outcomes following cerebral ischemia. Exp Neurol. 2009;220(2):276–82. Scholar
  43. 43.
    Venna VR, Xu Y, Doran SJ, Patrizz A, McCullough LD. Social interaction plays a critical role in neurogenesis and recovery after stroke. Transl Psychiatry. 2014;4(1):e351. Scholar
  44. 44.
    Venna VR, McCullough LD. Role of social factors on cell death, cerebral plasticity and recovery after stroke. Metab Brain Dis. 2015;30(2):497–506. Scholar
  45. 45.
    Kilkenny C, Browne W, Cuthill IC, Emerson M, Altman DG, National Centre for the Replacement, Refinement and Reduction of Animals in Research. Animal research: reporting in vivo experiments—the ARRIVE guidelines. J Cereb Blood Flow Metab. 2011;31(4):991–3. Scholar
  46. 46.
    Hicks AU, Hewlett K, Windle V, Chernenko G, Ploughman M, Jolkkonen J, et al. Enriched environment enhances transplanted subventricular zone stem cell migration and functional recovery after stroke. Neuroscience. 2007;146(1):31–40. Scholar
  47. 47.
    Hicks AU, Lappalainen RS, Narkilahti S, Suuronen R, Corbett D, Sivenius J, et al. Transplantation of human embryonic stem cell-derived neural precursor cells and enriched environment after cortical stroke in rats: cell survival and functional recovery. Eur J Neurosci. 2009;29(3):562–74. Scholar
  48. 48.
    Zhang Y-X, Yuan M-Z, Cheng L, Lin L-Z, Du H-W, Chen R-H, et al. Treadmill exercise enhances therapeutic potency of transplanted bone mesenchymal stem cells in cerebral ischemic rats via anti-apoptotic effects. BMC Neurosci. 2015;16(1):56. Scholar
  49. 49.
    Sasaki Y, Sasaki M, Kataoka-Sasaki Y, Nakazaki M, Nagahama H, Suzuki J, et al. Synergic effects of rehabilitation and intravenous infusion of mesenchymal stem cells after stroke in rats. Phys Ther. 2016;96(11):1791–8. Scholar
  50. 50.
    Boltze J, Lukomska B, Jolkkonen J, MEMS–IRBI consortium. Mesenchymal stromal cells in stroke: improvement of motor recovery or functional compensation? J Cereb Blood Flow Metab. 2014;34(8):1420–1. Scholar
  51. 51.
    Knieling M, Metz GA, Antonow-Schlorke I, Witte OW. Enriched environment promotes efficiency of compensatory movements after cerebral ischemia in rats. Neuroscience. 2009;163(3):759–69. Scholar
  52. 52.
    Kitago T, Liang J, Huang VS, Hayes S, Simon P, Tenteromano L, et al. Improvement after constraint-induced movement therapy: recovery of normal motor control or task-specific compensation? Neurorehabil Neural Repair. 2013;27(2):99–109. Scholar
  53. 53.
    Braun RG, Andrews EM, Kartje GL. Kinematic analysis of motor recovery with human adult bone marrow-derived somatic cell therapy in a rat model of stroke. Neurorehabil Neural Repair. 2012;26(7):898–906. Scholar
  54. 54.
    Muir KW. Clinical trial design for stem cell therapies in stroke: what have we learned? Neurochem Int. 2016;106:108–13. Scholar
  55. 55.
    Kondziolka D, Wechsler L, Goldstein S, Meltzer C, Thulborn KR, Gebel J, et al. Transplantation of cultured human neuronal cells for patients with stroke. Neurology. 2000;55(4):565–9. Scholar
  56. 56.
    Kondziolka D, Steinberg GK, Wechsler L, Meltzer CC, Elder E, Gebel J, et al. Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial. J Neurosurg. 2005;103(1):38–45. Scholar
  57. 57.
    Savitz SI, Dinsmore J, Wu J, Henderson GV, Stieg P, Caplan LR. Neurotransplantation of fetal porcine cells in patients with basal ganglia infarcts: a preliminary safety and feasibility study. Cerebrovasc Dis Basel Switz. 2005;20(2):101–7. Scholar
  58. 58.
    Rabinovich SS, Seledtsov VI, Banul NV, Poveshchenko OV, Senyukov VV, Astrakov SV, et al. Cell therapy of brain stroke. Bull Exp Biol Med. 2005;139(1):126–8. Scholar
  59. 59.
    Bang OY, Lee JS, Lee PH, Lee G. Autologous mesenchymal stem cell transplantation in stroke patients. Ann Neurol. 2005;57(6):874–82. Scholar
  60. 60.
    Lee JS, Hong JM, Moon GJ, Lee PH, Ahn YH, Bang OY, et al. A long-term follow-up study of intravenous autologous mesenchymal stem cell transplantation in patients with ischemic stroke. Stem Cells Dayt Ohio. 2010;28(6):1099–106. Scholar
  61. 61.
    Mendonça MLF, Freitas GR, Silva SA, Manfrim A, Falcão CH, Gonzáles C, et al. Safety of intra-arterial autologous bone marrow mononuclear cell transplantation for acute ischemic stroke. Arq Bras Cardiol. 2006;86(1):52–5.Google Scholar
  62. 62.
    Suárez-Monteagudo C, Hernández-Ramírez P, Alvarez-González L, García-Maeso I, de la Cuétara-Bernal K, Castillo-Díaz L, et al. Autologous bone marrow stem cell neurotransplantation in stroke patients. An open study. Restor Neurol Neurosci. 2009;27(3):151–61. Scholar
  63. 63.
    Barbosa da Fonseca LM, Gutfilen B, Rosado de Castro PH, Battistella V, Goldenberg RCS, Kasai-Brunswick T, et al. Migration and homing of bone-marrow mononuclear cells in chronic ischemic stroke after intra-arterial injection. Exp Neurol. 2010;221(1):122–8. Scholar
  64. 64.
    Battistella V, de Freitas GR, da Fonseca LMB, Mercante D, Gutfilen B, Goldenberg RCS, et al. Safety of autologous bone marrow mononuclear cell transplantation in patients with nonacute ischemic stroke. Regen Med. 2011;6(1):45–52. Scholar
  65. 65.
    Savitz SI, Misra V, Kasam M, Juneja H, Cox CS, Alderman S, et al. Intravenous autologous bone marrow mononuclear cells for ischemic stroke. Ann Neurol. 2011;70(1):59–69. Scholar
  66. 66.
    Honmou O, Houkin K, Matsunaga T, Niitsu Y, Ishiai S, Onodera R, et al. Intravenous administration of auto serum-expanded autologous mesenchymal stem cells in stroke. Brain J Neurol. 2011;134(Pt 6):1790–807. Scholar
  67. 67.
    Bhasin A, Srivastava MVP, Kumaran SS, Mohanty S, Bhatia R, Bose S, et al. Autologous mesenchymal stem cells in chronic stroke. Cerebrovasc Dis Extra. 2011;1(1):93–104. Scholar
  68. 68.
    Bhasin A, Srivastava MVP, Mohanty S, Bhatia R, Kumaran SS, Bose S. Stem cell therapy: a clinical trial of stroke. Clin Neurol Neurosurg. 2013;115(7):1003–8. Scholar
  69. 69.
    Prasad K, Mohanty S, Bhatia R, Srivastava MVP, Garg A, Srivastava A, et al. Autologous intravenous bone marrow mononuclear cell therapy for patients with subacute ischaemic stroke: a pilot study. Indian J Med Res. 2012;136(2):221–8.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Moniche F, Montaner J, Gonzalez-Marcos J-R, Carmona M, Piñero P, Espigado I, et al. Intra-arterial bone marrow mononuclear cell transplantation correlates with GM-CSF, PDGF-BB, and MMP-2 serum levels in stroke patients: results from a clinical trial. Cell Transplant. 2014;23(Suppl 1):S57–64.PubMedCrossRefGoogle Scholar
  71. 71.
    Friedrich MAG, Martins MP, Araújo MD, Klamt C, Vedolin L, Garicochea B, et al. Intra-arterial infusion of autologous bone marrow mononuclear cells in patients with moderate to severe middle cerebral artery acute ischemic stroke. Cell Transplant. 2012;21(Suppl 1):S13–21.PubMedCrossRefGoogle Scholar
  72. 72.
    Li Z-M, Zhang Z-T, Guo C-J, Geng F-Y, Qiang F, Wang L-X. Autologous bone marrow mononuclear cell implantation for intracerebral hemorrhage-a prospective clinical observation. Clin Neurol Neurosurg. 2013;115(1):72–6. Scholar
  73. 73.
    Chen D-C, Lin S-Z, Fan J-R, Lin C-H, Lee W, Lin C-C, et al. Intracerebral implantation of autologous peripheral blood stem cells in stroke patients: a randomized phase II study. Cell Transplant. 2014;23(12):1599–612. Scholar
  74. 74.
    Prasad K, Sharma A, Garg A, Mohanty S, Bhatnagar S, Johri S, et al. Intravenous autologous bone marrow mononuclear stem cell therapy for ischemic stroke: a multicentric, randomized trial. Stroke. 2014;45(12):3618–24. Scholar
  75. 75.
    Banerjee S, Bentley P, Hamady M, Marley S, Davis J, Shlebak A, et al. Intra-arterial immunoselected CD34+ stem cells for acute ischemic stroke. Stem Cells Transl Med. 2014;3(11):1322–30. Scholar
  76. 76.
    Sharma A, Sane H, Nagrajan A, Gokulchandran N, Badhe P, Paranjape A, et al. Autologous bone marrow mononuclear cells in ischemic cerebrovascular accident paves way for neurorestoration: a case report. Case Rep Med. 2014;2014:530239. Scholar
  77. 77.
    Taguchi A, Sakai C, Soma T, Kasahara Y, Stern DM, Kajimoto K, et al. Intravenous autologous bone marrow mononuclear cell transplantation for stroke: phase1/2a clinical trial in a homogeneous group of stroke patients. Stem Cells Dev. 2015;24(19):2207–18. Scholar
  78. 78.
    Steinberg GK, Kondziolka D, Wechsler LR, Lunsford LD, Coburn ML, Billigen JB, et al. Clinical outcomes of transplanted modified bone marrow-derived mesenchymal stem cells in stroke: a phase 1/2a study. Stroke. 2016;47(7):1817–24. Scholar
  79. 79.
    Kalladka D, Sinden J, Pollock K, Haig C, McLean J, Smith W, et al. Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study. Lancet Lond Engl. 2016;388(10046):787–96. Scholar
  80. 80.
    Hess DC, Wechsler LR, Clark WM, Savitz SI, Ford GA, Chiu D, et al. Safety and efficacy of multipotent adult progenitor cells in acute ischaemic stroke (MASTERS): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2017;16(5):360–8. Scholar
  81. 81.
    Pollock K, Stroemer P, Patel S, Stevanato L, Hope A, Miljan E, et al. A conditionally immortal clonal stem cell line from human cortical neuroepithelium for the treatment of ischemic stroke. Exp Neurol. 2006;199(1):143–55. Scholar
  82. 82.
    Kalladka D, Muir KW. Stem cell therapy in stroke: designing clinical trials. Neurochem Int. 2011;59(3):367–70. Scholar
  83. 83.
    George AJT, Collet C, Carr AJ, Holm S, Bale C, Burton S, et al. When should placebo surgery as a control in clinical trials be carried out. Bull R Coll Surg Engl. 2016;98(2):75–9. Scholar
  84. 84.
    Hommel M, Detante O, Favre I, Touzé E, Jaillard A. How to measure recovery? Revisiting concepts and methods for stroke studies. Transl Stroke Res. 2016;7(5):388–94. Scholar
  85. 85.
    Kidwell CS, Liebeskind DS, Starkman S, Saver JL. Trends in acute ischemic stroke trials through the 20th century. Stroke. 2001;32(6):1349–59. Scholar
  86. 86.
    Muir KW, Teal PA. Why have neuro-protectants failed?: lessons learned from stroke trials. J Neurol. 2005;252(9):1011–20. Scholar
  87. 87.
    Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, et al. Standardized measurement of sensorimotor recovery in stroke trials: consensus-based core recommendations from the stroke recovery and rehabilitation roundtable. Int J Stroke. 2017;12(5):451–61. Scholar
  88. 88.
    Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA. 2006;296(17):2095–104. Scholar
  89. 89.
    Wilson JTL, Hareendran A, Grant M, Baird T, Schulz UGR, Muir KW, et al. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke. 2002;33(9):2243–6. Scholar
  90. 90.
    Wilson JTL, Hareendran A, Hendry A, Potter J, Bone I, Muir KW. Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke. 2005;36(4):777–81. Scholar
  91. 91.
    Quinn TJ, McArthur K, Dawson J, Walters MR, Lees KR. Reliability of structured modified Rankin scale assessment. Stroke. 2010;41(12):e602; author reply e603. Scholar
  92. 92.
    McArthur K, Fan Y, Pei Z, Quinn T. Optimising outcome assessment to improve quality and efficiency of stroke trials. Expert Rev Pharmacoecon Outcomes Res. 2014;14(1):101–11. Scholar
  93. 93.
    McArthur KS, Johnson PCD, Quinn TJ, Higgins P, Langhorne P, Walters MR, et al. Improving the efficiency of stroke trials: feasibility and efficacy of group adjudication of functional end points. Stroke. 2013;44(12):3422–8. Scholar
  94. 94.
    Bushnell C, Bettger JP, Cockroft KM, Cramer SC, Edelen MO, Hanley D, et al. Chronic stroke outcome measures for motor function intervention trials: expert panel recommendations. Circ Cardiovasc Qual Outcomes. 2015;8(6 Suppl 3):S163–9. Scholar
  95. 95.
    Svensson J, Ghatnekar O, Lindgren A, Lindvall O, Norrving B, Persson U, et al. Societal value of stem cell therapy in stroke—a modeling study. Cerebrovasc Dis Basel Switz. 2012;33(6):532–9. Scholar
  96. 96.
    Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, et al. Effect of a task-oriented rehabilitation program on upper extremity recovery following motor stroke: the ICARE randomized clinical trial. JAMA. 2016;315(6):571–81. Scholar
  97. 97.
    AVERT Trial Collaboration Group, Bernhardt J, Langhorne P, Lindley RI, Thrift AG, Ellery F, et al. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet Lond Engl. 2015;386(9988):46–55.CrossRefGoogle Scholar
  98. 98.
    Favre I, Zeffiro TA, Detante O, Krainik A, Hommel M, Jaillard A. Upper limb recovery after stroke is associated with ipsilesional primary motor cortical activity: a meta-analysis. Stroke. 2014;45(4):1077–83. Scholar
  99. 99.
    Feydy A, Carlier R, Roby-Brami A, Bussel B, Cazalis F, Pierot L, et al. Longitudinal study of motor recovery after stroke: recruitment and focusing of brain activation. Stroke. 2002;33(6):1610–7. Scholar
  100. 100.
    Mitkari B, Kerkelä E, Nystedt J, Korhonen M, Jolkkonen J. Unexpected complication in a rat stroke model: exacerbation of secondary pathology in the thalamus by subacute intraarterial administration of human bone marrow-derived mesenchymal stem cells. J Cereb Blood Flow Metab. 2015;35(3):363–6. Scholar
  101. 101.
    Stinear CM, Barber PA, Petoe M, Anwar S, Byblow WD. The PREP algorithm predicts potential for upper limb recovery after stroke. Brain J Neurol. 2012;135(Pt 8):2527–35. Scholar
  102. 102.
    Stinear CM, Byblow WD, Ackerley SJ, Smith M-C, Borges VM, Barber PA. Proportional motor recovery after stroke: implications for trial design. Stroke. 2017;48(3):795–8. Scholar
  103. 103.
    Stinear CM, Byblow WD, Ackerley SJ, Barber PA, Smith M-C. Predicting recovery potential for individual stroke patients increases rehabilitation efficiency. Stroke. 2017;48(4):1011–9. Scholar
  104. 104.
    Nagpal A, Juttner C, Hamilton-Bruce MA, Rolan P, Koblar SA. Stem cell therapy clinical research: a regulatory conundrum for academia. Adv Drug Deliv Rev. 2016;
  105. 105.
    Delavaran H, Aked J, Sjunnesson H, Lindvall O, Norrving B, Kokaia Z, et al. Spontaneous recovery of upper extremity motor impairment after ischemic stroke: implications for stem cell-based therapeutic approaches. Transl Stroke Res. 2017;8(4):351–61. Scholar

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Authors and Affiliations

  1. 1.Stroke Unit, Neurology DepartmentGrenoble HospitalGrenobleFrance
  2. 2.Grenoble Institute of Neurosciences, Inserm U1216Université Grenoble AlpesGrenobleFrance
  3. 3.Institute of Neuroscience & Psychology, University of GlasgowUniversity of GlasgowGlasgowUK
  4. 4.Queen Elizabeth University HospitalGlasgowUK
  5. 5.Department of NeurologyUniversity of Eastern FinlandKuopioFinland
  6. 6.NeuroCenterKuopio University HospitalKuopioFinland

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