CAUSES OF NEURO-DEVELOPMENTAL AND NEURO-DEGENERATIVE DISEASES

Synaptic plasticity is an important neurophysiological process which refers to the ability of the brain to regenerate & neurons to modify the connections and is an activity involved in brain networks development and reorganization after damage from various neuro degenerative diseases and neuro developmental diseases like Autism, Parkinsons disease,  Alzheimer’s disease and schizophrenia. Synaptic plasticity is of two types, namely, anti-homeostatic (i.e., Hebbian) and homeostatic plasticity (i.e., synaptic scaling). A delicate and intricate  balance between these two forms of synaptic plasticity is important to regulate & maintain a physiological brain network functioning and architecture. 

HOW DOES A CHILD PRESENT

Autism is in fact Autism spectrum disorder with children presenting in different clinical presentations for example some children may not speak but some may speak very well. In common children have difficulty in speaking, social communication and social interactions, deficits in cognitive development,   repetitive behaviour, hyper-activity, attention deficit, repetition of words or phrases. There are many theories of cause of autism though not proven like genetic factors, environmental factors and perinatal causes .

TREATMENT AND THERAPY

Intervention can be non-pharmacological, pharmacological, life style modification and neurodevelopment through cell based therapies.

Non-pharmacological interventions includes special education, psychoeducational programmes, speech therapy which focusses on psychological, behavioural education. skill-building training may modulate autistic children to learn life skills necessary for living independently and sustain them, as well as to learn social, communication, and language skills. Therapy also aims to reduce challenging behaviors and build upon strengths.

Pharmacological interventions include prescription of drugs like risperidone, aripiperazole and anti-epileptic drugs.

Casein free and gluten free diet is helpful.

Out of all these strategies neurodevelopment through cell based therapies is the most promising way of treatment of such children as other interventions are time consuming and have limited scope and outcome. After cell based therapy like autologous stem cell transplant, non pharmacological and pharmacological approach  may be more beneficial.

AUTOLOGOUS STEM CELL THERAPY

Autologous stem cell therapy is quite safe and can be done through autologous bone marrow which is rich in growth factors and haematopoietic cells and

Body  fat which is rich in mesenchymal cells.

Both the tissues can be harvested by minimally invasive stitch-less & scarless surgeries with mild anesthesia.  After processing in tissue culture labs without manipulating the stem cells, they can be given by IV, intra arterial and intrathecal route. Intrathecal route means giving by spinal route.

This procedure (autologous stem cell therapy) is a day care procedure and the child (including parents) can resume his/her schedule next day. Post transfusion analgesics are also not required. Omega 3 fatty acids given subsequently reduces the pro-inflammatory environment in brain. Stem cell therapy is a ray of hope for all parents who suffers a lot psychologically (fear psychosis) that what would happen to their child after them. This technique had translated from petri dishes to bedside and to a new paradigm. This is the tipping point where race against time for parents and patients stop.  

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CELL BASED THERAPY

There are many ways by which neuro regeneration and other tissue regeneration can take place like cell-based therapies (stem cells), growth factors, bio-peptides, omega 3 fatty acids but out of these cell-based therapies (stem cells) have very promising results.  Cell based therapies (stem cells) can be syngeneic (twins) autologous (same person), allogenic (different person), xenogeneic (different species). Out of all these cell-based therapies, autologous stem cell therapy is safe and is yielding good & promising results without any complications .

AUTOLOGUS STEM CELL THERAPY

Autologous stem cell therapy means that cells would be taken from patients own body so there is no question of graft rejection or reaction and its absolutely safe. Autologous stem cells can be harvested from bone marrow, body fat, tooth germ, menstrual blood and can be given without culturing in lab because culturing of cells leads to mutations.

BONE MARROW HARVESTING

Out of these sources of autologous stem cells, bone marrow is a very rich source of haematopoietic stem cells, mesenchymal stem cells, growth factors and ligands. Harvesting a marrow is a high precision surgery and normally its harvested from posterior superior iliac spine (fan shaped bone of pelvis) but only by aspiration as breaking the bone trabeculae’s are difficult.

NEW TECHNIQUE

The newer technique aims at harvesting the bone marrow from femur under C arm/flat panel/cine loop control with just 1/2 cm incision which is minimally invasive and harvesting the marrow by rasping the femur with specially designed cannula called as MJ cannula. Rasping movements helps in breaking bone trabeculae’s in entire length of femur and the quality of harvest is very good. One can harvest large volumes of marrow app 600 ml. In addition one can processes the marrow fat also  as marrow fat is obtained  because of breaking of yellow marrow.

ADVANTAGES

This revolutionary technique has many advantages as the yield of hematopoietic stem cells and growth factor is very high as marrow is harvested through rasping, reaming and marrow mining. This would prevent graft failure in allogenic transplants because of inadequacy of cells and growth factors and better outcomes in autologous transplants and reduce the number of sittings. This is a paradigm shift in stem cell harvesting techniques and would become gold standard for harvesting bone marrow stem cells and growth factors.

The post INDIAN DOCTOR INNOVATES NEW TECHNIQUE FOR BONE MARROW HARVEST first appeared on Pragati Stem Cells.

TREATMENT

There are many drugs under trial for pulmonary fibrosis with poor outcome and  most of the patients are advised lung transplant which is a costly procedure, high rates of mortality and morbidity because of graft rejection, and long cues for graft match.

MODERN APPROACH FOR TREATMENT

With extensive research & development in the field of cell based therapy (like stem cell therapy), it has become a  promising and safe technique for reducing the fibrosis and improving the transport of gases along the alveolar membrane and hence the oxygen saturation.

In present case the patient was suffering from post covid fibrosis with oxygen saturation of 90% at rest and 83-84% during walking which forced her to take rest in between. Patient was on oxygen for 12 hours a day @ 4 litres/minute.

LIPOSUCTION

Liposuction was done under local anesthesia and 100 ml of fat was aspirated and after thorough washing it was processed in tissue culture lab and 10 ml stromal vascular fraction prepared. Stromal vascular fraction is rich in mesenchymal cells which have a powerful anti-inflammatory effect and promotes the conversion of alveolar stem cells into alveolar cells which in turn reduces the fibrosis and improves transport of oxygen.

ROUTE OF AUTOLOGOUS MESENCHYMAL CELLS INFUSION

Stem cells were given by IV route diluted in normal saline in non plastic infusion bags as plastic bottles make the mesenchymal cells adhere to the walls of bottle. Infusion was given slowly over 6 hours and oxygen saturation was observed during the entire process.  

OUTCOME & RESULT

Patient was followed up on day to day basis and from 4^th day patient said that she is feeling better and then rate of oxygen flow was reduced from 4 liters /minute to 2 liters /minute. Patient tolerated well this reduction in @ of oxygen delivery and it was continued for 3 days. Then duration of oxygen therapy  was reduced to 8 hours instead of 12 hours and patient tolerated well for 3 days. Then duration was further reduced to 6 hours for 3 days then 4 hours for 3 days then 2 hours for 3 days. Every day oxygen was give for 2 hours @ 1 litre/minute for 7 days. Then oxygen therapy was with drawn.

Patient is doing very well with 95% saturation at rest and 90% saturation during day to day activities (3 months follow up).

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