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Friday, 15 November 2013

Stem cell scaffold for stroke treatment 09 Mar 2009 | 16:21 GMT | Posted by Daniel Cressey | Category: Health and medicine

  1. Professor Pranab Kumar Bhattacharya said:
    Title-A more attractive option is to mobilize endogenous progenitor cells, an approach that may beutilized in stroke and multiple sclerosis treatment
    The out come of treatment of the ischemic stroke depends in West Bengal, India, on several factors like 1) how quick the patient could be shifted in a primary stroke center ( for class I and level of evidence A or B stroke) or in a comprehensive stroke center(for class 2 and class 3 strokes, level of evidence- C) from patients house[ more then 65% patients of ischemic stroke comes to hospital on average > 6-8 hours late],2) Proper evaluation of vascular area involvement[ commonly MCA] and extent of damage by infract by a CT or by multimodal CT or MRI imaging when available and extensive neurological examination by competent neurophysicians 3)whether judicial use of intravenious rtPA within3 hours, [preferably within 90 minutes], used or not [except NIHS score60% pt with acute ischemic stroke & nurological detoriation are seen when SBP above 160mmHg and DBP>110mm Hg) 5)To care whether drug induced hypotension happened [SBP60% pt with acute ischemic stroke & nurological detoriation are seen when SBP above 160mmHg and DBP>110mm Hg) 5)To care whether drug induced hypotension happened [SBP<100mmHg or DBP<70 mmHg] or not, increases chances of further ischemia and increase stroke 6) Treatment of hyperglycemia particularly when patient is a diabetic one, which is again a negative prognostic factor[desired level of blood glucose 80-140 mg/dl] ,7) Use of anti platelet agents like clopidogrel and aspirin 8) use of Vasodilators like Pentoxifyline/propentofyline by constant intravenous infusions in Class III and level of evidence-A stroke], use of platelet Glycoprotein II b inhibitors 9) control of nutrition, hydration, pneumonia, UTI, ,sepsis, deep vein thrombosis[use low mol.wt heparin to prevent] pulmonary embolism. Care for ischemic brain swelling particularly in Middle cerebral artery[MCA] infraction [use of mannitol] and palliative cares like bed/pressure sore care[source of sepsis often]
    The surgical interventions recommended today are 1) Carotid end arterectomy[ one must be care full about sudden development of brain edema and brain stem herniation] even emergency consideration for atherosclerotic plaque at carotid artery bifurcation,2) emergency angioplasty and stenting[when carotid artery dissection is the cause],3) mechanical clot disruption in MCA by intra-arterial thrombolysis and clot extraction [MERCI device trial, PROACT ii trial]
    Despite extensive and very costly management sudden death rate of acute ischemic stroke patients is still high 50-70% usually in 3rd-5th weeks of treatment and probably the cause lies in brain stem herniation from sudden oedema of brain or from infections like sepsis or pneumonia or deep vein thrombosis
    Those who however survives from the acute stroke insult, the questions of future stem cell therapy then only comes to them.
    Neurons[nestin positive cells] can however be generated from skin, skeletal muscle, hematopoietic stem cells (HSC), mesenchymal stem cell or teratocarcinoma cells l or can be generated as immortalized human neural crest stem cell lines from a 15 week gestational embryo which is termed as HNC10 cell lines. HCN10 cells when grown in serum containing medium produced neurons, Schwann cells, adrenal chromaffin cells and skeletal muscle cells . Neurons can be grown from neurosphere- blastocyst derived EC pluripotent stem cells are also capable of generating 3 types of cells found in CNS and also cells of other tissues. Other sources of neuronal stem cells are subventricular zone lining forebrain and ventricle, Dentate gyrus of hippocampus, olfactory epithelium, olfactory bulb
    Neural progenitor cells (NPC) improve motor behavior and task learning in rodent models of stroke has been proved.
    Stem cell therapy from exogenious stem cell cultured stem cell may develop a tumor. In may 2001, a 9-year-old boy who was suffering from ataxia telangiectasia was taken to Russia for the first of three injections of stem cells from fetal brain cells. In February 2005, the boy, suffere d from recurring headaches, was examined by neurologists at Sheba Medical Center in Israel. MRI scans showed lesions at the base of the brain (near the cerebellum) and in the spinal cord. The latter tumor was surgically removed. Analysis of the DNA from tumor cells and the patient’s blood cells indicated that the tumor cells did not originate in the patient. The tumor cells must have grown from the transplanted stem cells. (Many tumor cells possessed two X chromosomes, indicating that they are female, but the patient is male.) One theory is that stem cells acquire mutations that lead to unchecked growth; this small population of cells multiplies and forms a tumor. The results of this study suggest it is possible that brain tumors could come from stem cells. A more attractive option will be to mobilise endogenous progenitor cells, an approach that has been utilized in stroke and multiple sclerosis. Colony stimulating factors such as erythropoietin (EPO) and granulocyte colony stimulating factor (G-CSF) improve outcome in experimental models of stroke and, although a number of small clinical trials have tested them in stroke, to date there is insufficient evidence to justify use, with several randomized controlled trials ongoing.
    References
    • Ninette Amariglio, Abraham Hirshberg, Bernd W. Scheithauer, Yoram Cohen, Ron Loewenthal, Luba Trakhtenbrot, Nurit Paz, Maya Koren-Michowitz, Dalia Waldman, Leonor Leider-Trejo, Amos Toren, Shlomi Constantini, Gideon Rechavi, “Donor-Derived Brain Tumor Following Neural Stem Cell Transplantation in an Ataxia Telangiectasia Patient published in the February 2009 issue of PLoS Medicine(doi:10.1371/journal.pmed.1000029

    Copy Right- Copy Right of this letter-A more attractive option is to mobilize endogenous progenitor cells, an approach that may be utilized in stroke and multiple sclerosis treatment Published in Nature News is intellectual Property & Copy Right belongs to Professor Pranab kumar Bhattacharya and his first degree relatives only as per copy right act & rules of Intellectual Property Right Rules 3D/107/1201a,b/ RDF Copy Right rules/ SPARC copy Right rules-2006/ and Protect intellectual Property Right(PIP) copy right rules of USA-2012.Please do not Infringe and be enough carefull for your own safety if you are not direct Blood relation to prof Pranab Kumar Bhattacharya.  . No person, No NGOS no pharmaceutical companypersons [ except the authors& first degree relatives]  in the state of West Bengal or in any other states of India or in any abroad countries are authorized to use this article ever, with any meaning full,  scientific sentences or with scientific and meaning full words laid out in this article either in the class room/  or in mass teaching programme including CME  or  in any form what so ever it is with any content of this article or while in writing any book or for his/her personal/ home use, or collective works or for any future Research or implementation as a policy matter or,[ except the authors ]or  by Xeroxing and distributing the article/ or by printing/saving/broadcasting the article from any website of internet services,displayed without proper copy right clearance from the authors or from his family members or future copy right owner by written forms.