Prospect of Stem Cells as Promising Therapy for Brachial Plexus Injury: A Systematic Review

Abstract

Tito Sumarwoto,1,2 Heri Suroto,3 Ferdiansyah Mahyudin,3 Dwikora Novembri Utomo,3 FNU Romaniyanto,2 Andhi Prijosedjati,2 Hari Basuki Notobroto,4 Damayanti Tinduh,5 Cita Rosita Sigit Prakoeswa,6 Fedik Abdul Rantam,7,8 Sholahuddin Rhatomy9,10 1Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia; 2Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia; 3Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia; 4Faculty of Public Health, Airlangga University, Surabaya, Indonesia; 5Physical Medicine and Rehabilitation Department, Universitas Airlangga, Surabaya, Indonesia; 6Department of Dermatology and Venereology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia; 7Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia; 8Stem Cell Research and Development Center, Airlangga University, Surabaya, Indonesia; 9Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; 10Faculty of medicine, public health and nursing, Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Sholahuddin Rhatomy, Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia, Email [email protected]: Brachial plexus injury is an advanced and devastating neurological injury, for which both nerve surgery and tendon transfers sometimes remain insufficient in restoring normal movement. Stem cell therapy may be applicable to rescue the injured motor neurons from degeneration which potentially improves muscle strength.Study Design: Systematic Review; Level of evidence V.Data Sources: A systematic literature search was conducted on PubMed (MEDLINE), EMBASE, the Cochrane Library, and Scopus using the terms (“stem cell”) AND (“brachial plexus”) as search keywords.Methods: The process of study selection was summarized by PRISMA flow diagram. The study included in vivo and in vitro studies with English language, humans or animals with some brachial plexus injuries, interventions, some applications of stem cells to the groups of study, with functional, biomechanical, or safety outcomes.Results: In total, there were 199 studies identified from the literature sources where 75 articles were qualified for forward evaluation following selecting the titles and abstracts. Ten studies were finally included in this systematic review after full-text assessment. Stem cells can produce neurotrophic factors in vitro and in vivo in rats, and their level was increased after injury. Electrophysiological measurement showed that the intervention group had distinctly higher CMAP amplitude and evidently shorter CMAP latency than the model group. Application of bone marrow stem cells (BMSCs) showed an elevation in the numbers of axons and density of myelinated fibers, the density of nerve fibers, the diameter of regenerating axons, and a decrease in axonal degeneration. A study in humans indicated an improvement of the movements in a patient with traumatic total BPI after injection of Ad-MSC. It is associated with increased muscle mass and sensory recovery and also suggested that mononuclear cell injection enhances muscle regeneration and reinnervation in the partly denervated muscle of brachial plexus injury. Various muscle groups had obtained strength together with restoration, the muscle strength attained after the previous transplantation were preserved. The results of this review support stem cell treatment in brachial plexus injury.Conclusion: This review provides evidence of the positive effects of stem cell treatment in brachial plexus injury.Keywords: stem cell, brachial plexus injury, promising therapy

Keywords

• stem cell
• brachial plexus injury
• promising therapy