Effects of neural stem cell transplantation on the motor function of rats with contusion spinal cord injuries: a meta-analysis

OBJECTIVE: To judge the efficacies of neural stem cell (NSC) transplantation on functional recovery following contusion spinal cord injuries (SCIs). DATA SOURCES: Studies in which NSCs were transplanted into a clinically relevant, standardized rat model of contusion SCI were identified by searching the PubMed, Embase and Cochrane databases, and the extracted data were analyzed by Stata 14.0. DATA SELECTION: Inclusion criteria were that NSCs were used in in vivo animal studies to treat contusion SCIs and that behavioral assessment of locomotor functional recovery was performed using the Basso, Beattie, and Bresnahan lo-comotor rating scale. Exclusion criteria included a follow-up of less than 4 weeks and the lack of control groups. OUTCOME MEASURES: The restoration of motor function was assessed by the Basso, Beattie, and Bresnahan locomotor rating scale. RESULTS: We identified 1756 non-duplicated papers by searching the aforementioned electronic databases, and 30 full-text articles met the inclusion criteria. A total of 37 studies reported in the 30 articles were included in the meta-analysis. The meta-analysis results showed that transplanted NSCs could improve the motor function recovery of rats following contusion SCIs, to a moderate extent (pooled standardized mean difference (SMD) = 0.73; 95% confidence interval (CI): 0.47–1.00; P < 0.001). NSCs obtained from different donor species (rat: SMD = 0.74; 95% CI: 0.36–1.13; human: SMD = 0.78; 95% CI: 0.31–1.25), at different donor ages (fetal: SMD = 0.67; 95% CI: 0.43–0.92; adult: SMD = 0.86; 95% CI: 0.50–1.22) and from different origins (brain-derived: SMD = 0.59; 95% CI: 0.27–0.91; spinal cord-derived: SMD = 0.51; 95% CI: 0.22–0.79) had similar efficacies on improved functional recovery; however, adult induced pluripotent stem cell-derived NSCs showed no significant efficacies. Furthermore, the use of higher doses of transplanted NSCs or the administration of immunosuppressive agents did not promote better locomotor function recovery (SMD = 0.45; 95% CI: 0.21–0.70). However, shorter periods between the contusion induction and the NSC transplantation showed slightly higher efficacies (acute: SMD = 1.22; 95% CI: 0.81–1.63; subacute: SMD = 0.75; 95% CI: 0.42–1.09). For chronic injuries, NSC implantation did not significantly improve functional recovery (SMD = 0.25; 95% CI: –0.16 to 0.65). CONCLUSION: NSC transplantation alone appears to be a positive yet limited method for the treatment of contusion SCIs.