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Effects of transplantation of olfactory ensheathing cells in chronic spinal cord injury: a systematic review and meta-analysis

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Abstract

Purpose

The debate on the effects and outcome of olfactory ensheathing cell (OEC) transplantation for the treatment of spinal cord injury (SCI) has remained unresolved for nearly 20 years. This study aimed to evaluate the safety and efficacy of OEC transplantation in chronic SCI patients.

Method

Electronic databases, including PubMed, the Cochrane Library, EMBASE, and MEDLINE, were searched to identify clinical therapeutic trials studying the use of OEC transplantation for SCI in humans. Each trial was analyzed in accordance with the criteria of the Cochrane Handbook 5.1.0 and MOOSE. Data were analyzed with Review Manager 5.2 and Meta-Analyst Beta 3.13 software.

Results

Eleven articles concerning 10 studies of 1,193 patients with chronic SCI treated with OEC transplantation were selected for review. All the articles had low methodological quality. Studies reported their outcomes using the American Spinal Injury Association (ASIA) Impairment Scale; the AISA motor, light touch, pinprick score; the Functional Independence Measure and (or) other measure methods. According to the available relevant data, the incidences of total adverse events and mortality were 7.68 % (n = 742) and 0.35 % (n = 566), respectively. The most frequently reported adverse events were fever, mild anemia, and syringomyelia; however, the statistical adverse events occurring in different studies were cerebrospinal fluid leakage (7.00 %, n = 586, 2 trials), sensory deterioration (0.70 %, n = 573, 2 trials), and both motor and sensory deterioration (0.68 %, n = 586, 2 trials).

Conclusions

Given the results from our study, we conclude that OEC transplantation appears to be safe, although the evidence for efficacy is modest and requires the support of prospective, randomized trials in larger cohorts of patients. Further randomized controlled trials utilizing strict therapy programs and implanted cell selections are needed to confirm these findings.

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Abbreviations

SCI:

Spinal cord injury

OECs:

Olfactory ensheathing cells

LP:

Lamina propria

OM:

Olfactory mucosa

OB:

Olfactory bulb

ASIA:

American Spinal Injury Association

MOOSE:

Meta-analysis of Observational Studies in Epidemiology

AIS:

American Spinal Injury Association (ASIA) Impairment Scale

FIM:

Functional independence measure

PVSEP:

Paravertebral sensory evoked potential

IANR-SCIFRS:

International Association of Neurorestoratology Spinal Cord Injury Functional Rating Scale

MRI:

Magnetic resonance imaging

EMG:

Electromyography

MAS:

Modified Ashworth Scale

SSEP:

Somatosensory evoked potentials

TMS:

Transcranial magnetic stimulation

WISCI:

Walking Index for Spinal Cord Injury

ISNCSCI:

International Standards for Neurological Classification of Spinal Cord Injury

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. First Affliated Hospital of Dalian Medical University, Zhong shan road no. 222, Dalian, 116011, Liaoning, People’s Republic of China

    Lei Li, Hafeez Adnan, Benchen Xu, Jianmin Wang, Chengke Wang, Fang Li & Kai Tang

  2. Kaifeng Central Hospital, River street no. 85, Kaifeng, 475000, Henan, People’s Republic of China

    Lei Li

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  1. Lei Li
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  2. Hafeez Adnan
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Correspondence to Kai Tang.

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Li, L., Adnan, H., Xu, B. et al. Effects of transplantation of olfactory ensheathing cells in chronic spinal cord injury: a systematic review and meta-analysis. Eur Spine J 24, 919–930 (2015). https://doi.org/10.1007/s00586-014-3416-6

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  • DOI: https://doi.org/10.1007/s00586-014-3416-6

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