Review Article

Review of Preclinical and Clinical Studies of Bone Marrow-Derived Cell Therapies for Intracerebral Hemorrhage

Table 1

Preclinical studies.

ReferenceCell typeRouteDose, infusion volume, rate, and timingAnimalsModelEngraftmentFunctional outcomeCellular/molecular effects

Zhang et al., 2006 [30]Rat BM-MSCIA (carotid artery), IV (cervical vein), or ICV2 × 106 cells in 20 µL saline, slowly injected on days 1, 3, 5, and 7 after ICHSprague-Dawley rats weighing 270–300 gInjection of 0.5 U collagenase VII into the left striatum (caudate nucleus)BrdU-labeled cells found around the bleeding focus, in the ipsilateral cortex and ipsilateral hippocampus (except in the IV group), on days 1, 3, 5 and 7 after injectionImproved (beam balance test), on days 1, 3, 5, and 7 after injection (IA and ICV groups only).NA

Seyfried et al., 2006 [27]Human BM-MSCIV (tail vein)3 ×  106, 5 × 106, or 8 × 106 cells in 1 mL PBS, slowly injected 1 day after ICHMale Wistar rats weighing 270–320 gInjection of 100 µL autologous whole blood into the right striatumHuman cells were detected by the mAb 1281; cells were found in the injured region (14 days after ICH)Improved in all groups (NSS and corner turn test), 7 and 14 days after ICHDecreased striatal tissue loss (all tested doses); increased neurogenesis and synaptogenesis

Seyfried et al., 2008 [28]Human BM-MSCIA (internal carotid artery);
IV injection of mannitol (1.5 g/kg) alone or 10 min before IA injection of BM-MSC
1 × 106 cells in 100 μL PBS, 1 day after ICHMale Wistar rats weighing 270–320 gInjection of 100 µL autologous whole blood into the right striatumHuman cells were detected by the mAb 1281; more cells were found in the injured region in the IA BM-MSC + IV mannitol group (14 days after ICH)Improved only in the IA BM-MSC + IV mannitol group (NSS and corner turn test), up to 14 days after ICHDecreased striatal tissue loss; increased neurogenesis and synaptogenesis; improvements occurred only in the IA BM-MSC + IV mannitol group

Otero et al., 2010 [36]Rat BM-MSCIC (into the injured zone)2 × 106 cells in 10 μL of saline, 3 days after ICHFemale Wistar rats weighing 200–250 gInjection of 0.5 U collagenase IV into the striatumBrdU-labeled cells and male (donor-derived) cells found near the lesion (1 month after transplantation)Improved (Rotarod and mNSS), 3 and 4 weeks after ICHIncreased number of proliferating cells (Ki67+) in the SVZ

Seyfried et al., 2010 [29]Rat BM-MSCIV (tail vein)0.5 × 106 or 1 × 106 cells in 1 mL PBS, 1 day after ICHFemale Wistar rats weighing 270–320 gInjection of 0.1 cc of blood into the right striatumY chromosome-positive cells (donor-derived) found in the ipsilateral hemisphere (14 days after ICH)Improved only in the group that received the higher dose (NSS and corner turn test), 7 and 14 days after ICHDecreased striatal tissue loss (2 weeks after ICH); increased neurogenesis and synaptogenesis; improvements occurred only in the high-dose group

Yang et al., 2011 [61]Rat BM-MSC or rat BM-MSC overexpressing GDNFIC (into the right striatum)5 × 105 cells in 20 μL saline, injected at 2 mL/min, 3 days after ICHWistar rats weighing 270–320 gInjection of 0.25 U collagenase I into the right striatumGFP-positive cells found mainly in the area surrounding the injection site (up to 2 weeks after transplantation)Improved in both groups, but GDNF-BM-MSC improved further (mNSS), up to 2 weeks after ICHDecreased lesion volume and decreased number of apoptotic cells in the striatum in both groups, but better results were obtained in the GDNF-MSC group; increased GDNF protein levels in the ipsilateral striatum (only in the GDNF-MSC group)

Otero et al., 2011 [34]Rat BM-MSCIC (into the injured zone)5 × 106 cells in 15 μL of saline, 2 months after ICHAdult female Wistar ratsInjection of 0.5 U collagenase IV into the striatumY chromosome-positive cells found in the vicinity of the lesion (six months after cell transplantation)Improved (mNSS, Rotarod, and locomotor activity), up to 6 months after treatmentNo change in the number of proliferating cells (Ki67+) in the SVZ

Feng et al., 2011 [32]Human BM-MSCIC (into 9 points near the hematoma)1–5 ×  106 cells in 250 µL of vehicle, 1 or 4 weeks after ICHMale Macaca fascicularis monkeys weighing 4.2 ± 0.2 kg (4–6 y old)Injection of 1.5 mL of blood between the right cortex and the basal ganglia (outside the right putamen)NAImproved in both the early and late treatment groups (neurologic deficit score), up to 8 weeks after treatment Increased 18F-fluorodeoxyglucose uptake (better results were obtained in the early treatment group); increased microvessel density in the region surrounding the hematoma in both groups

Otero et al., 2012 [33]Rat BM-MSCIC (into the injured zone)2 ×  106 cells in 15 μL of saline, 2 hours after ICHFemale Wistar rats, weighing 200–250 gInjection of 0.5 U collagenase IV into the striatumY chromosome-positive cells found in the vicinity of the lesion (up to 28 days after ICH)NAIncreased number of proliferating cells (Ki67+) in the SVZ; decreased number of apoptotic cells in the lesion zone

Khalili et al., 2012 [22]Rat BM-MSCIV (tail vein)3 ×  106 cells in 1 mL PBS, 1 day after SAHFemale Wistar rats weighing 275–300 gInjection of 0.3 mL of blood into subarachnoid spaceBrdU-positive cells were detected in the parietal lobe (14 days after SAH)Improved (NSS), 14 days after SAHDecreased number of apoptotic cells in the brain

Wang et al., 2012 [23]Rat BM-MSCIV (tail vein)1 ×  106 cells in 1 mL PBS, 1 hour after ICHMale Sprague-Dawley rats weighing 270–320 g (12 weeks old)Injection of 0.4 U collagenase VII into the striatumNAImproved (mNSS), 7, 14, 21, and 28 days after ICHDecreased hemorrhage volume; increased number of proliferating cells and decreased number of apoptotic cells in the perihematomal region; upregulated the expression of antiapoptotic molecules, G-CSF, and BDNF

Liang et al., 2013 [62]Rat BM-MSCIC (into 3 injection sites)3 injections of 1 ×  106 cells in 10 µL PBS each, 1 day after ICHMale Wistar rats weighing 250–300 g (4 months old)Injection of 0.8 U collagenase IV into the striatumPKH26-labeled cells found in the lesion site, corpus callosum, and hippocampus (35 days after ICH)Improved (modified limb placing test and vibrissae-elicited forelimb placing test), up to 28 days after ICHNo change in hemispheric atrophy; increased density of fibers crossing the midline; increased neuronal plasticity

Vaquero et al. 2013 [35]Rat BM-MSCIC (into the injured zone); one group received the cells embedded in a PRP scaffold5 ×  106 cells in 30 µL vehicle, injected over 5 min, 2 months after ICHFemale Wistar rats weighing 200–250 gInjection of 0.5 U collagenase IV into the right striatumY chromosome-positive cells were found near the lesion and next to the SVZ; more cells were detected in the BM-MSC + scaffold group (6 months after cell transplantation)Improved in both groups, but better results were obtained in the BM-MSC + scaffold group (Rotarod and locomotor activity test), up to six months after treatmentNo significant change in lesion volume; increased number of proliferating cells (Ki67+) in the lesion zone (only in the BM-MSC + scaffold group) and in the SVZ (in both groups: BM-MSC alone or BM-MSC + scaffold)

Bao et al., 2013 [24]Flk-1+ human BM-MSCIC (into 3 injection sites)2 ×  105 cells in 15 μL of saline, 1 day after ICHMale Sprague-Dawley rats weighing 190–210 gInjection of 0.4 U collagenase VII into the striatumHuman cells were detected by the mAb 1281; cells were found close to the hemorrhagic boundary zone (55 days after transplantation)Improved (mNSS), up to 56 days after ICHDecreased brain water content; no significant change in hemorrhage volume; decreased number of microglia/macrophages and neutrophils in the hemorrhagic boundary; induced angiogenesis in the hemorrhagic boundary; decreased number of apoptotic cells and increased number of neurons in the hemorrhagic boundary; downregulated expression of several cytokines in the brain

Khalili et al., 2014 [67]Rat BM-MSCIV (tail vein)3 ×  106 cells in 1 mL PBS, 1 day after SAHFemale Wistar rats weighing 275–300 gInjection of 0.3 mL of blood into subarachnoid spaceNANAImproved ultrastructural morphology

Wang et al., 2015 [31]Rat BM-MSCIV (tail vein)1 ×  106 cells in 100 μL vehicleMale spontaneously hypertensive ratsInjection of 50 μL of blood into the striatumPKH26-labeled cells were found in the brain (up to 42 days after ICH, although the number of cells decreased over time)Improved (mNSS and modified limb placing test), up to 42 days after ICHIncreased expression of occludin in the brain

Sun et al., 2015 [37]Hypoxia-preconditioned rat BM-MSCIntranasal (30 min after the intranasal administration of 100 U hyaluronidase dissolved in PBS)1 ×  106 cells in 100 μL vehicle, 3 and 7 days after ICHMale C57BL/6 mice weighing 25–28 g (8–10 weeks)Injection of 0.15 U collagenase
IV into the striatum
Hoechst 33342-labeled cells found in the olfactory bulb, ipsilateral cortex, perivascular spaces, and perihematomal regions (6 hours after transplantation)Improved (mNSS, open field behavioral monitoring, Rotarod, and adhesive removal test), 14–21 days after ICHDecreased tissue loss and ventricle enlargement; increased expression of GDNF, VEGF, and BDNF in the brain; increased SVZ neurogenesis

Chen et al., 2015 [25]Rat BM-MSCIV (jugular vein)5 ×  106 in 200 μL PBS injected over 10 min, 2 hours after ICHMale Sprague-Dawley rats weighing 250–300 gInjection of 0.5 U collagenase
IV into the striatum
NAImproved (mNSS), 3 days after ICHDecreased brain water content; decreased number of apoptotic cells in the cortical hemorrhagic boundary; decreased number of microglia/macrophages and neutrophils in the brain; decreased blood-brain barrier dysfunction; decreased the expression of proinflammatory cytokines, MMP9, iNOS, and 3-nitrotyrosine in the brain; increased expression of anti-inflammatory cytokines and TSG-6 in the brain; suppressed activation of the NF-κB signaling pathway

Suda et al., 2015 [26]Autologous rat BM-MNCIV (tail vein)1 ×  107 cells/kg in 1 mL PBS infused over 5 min, 1 day after ICHMale Long Evans rats weighing 275–325 g or retired breeder aged rats weighing 600–650 gInjection of 70 μL of blood into the striatumQtracker-labeled cells found in the brain, spleen, lungs, liver, and kidney (6 and 24 hours after transplantation)Improved both in young and in aged rats (Staircase test, 28 days after ICH, and Morris water maze test, 4 weeks after ICH)Decreased brain water content and brain atrophy both in young and in aged rats; stimulated angiogenesis and SVZ neurogenesis; decreased number of degenerating neurons, iNOS-positive cells, and neutrophils in the perihematomal area; decreased expression of HMGB1, MMP9, S100β, and aquaporin 4 in the brain; decreased levels of the proinflammatory cytokine interleukin-1β in the serum

BDNF: brain-derived neurotrophic factor; BM-MNC: bone marrow-derived mononuclear cells; BM-MSC: bone marrow-derived mesenchymal stem cells; BrdU: 5-bromo-2′-deoxyuridine; G-CSF: granulocyte-colony stimulating factor; GDNF: glial cell line-derived neurotrophic factor; GFAP: glial-fibrillary acidic protein; HMGB1: high mobility group box 1 protein; IA: intra-arterial; ICH: intracerebral hemorrhage; ICV: intracerebroventricular; iNOS: inducible nitric oxide synthase; IP: intraperitoneal; IV: intravenous; mAb: monoclonal antibody; MMP9: matrix metallopeptidase 9; mNSS: modified neurological stroke scale; NA: not available; NSS: neurological stroke scale; PRP: platelet-rich plasma; SAH: subarachnoid hemorrhage; SVZ: subventricular zone; TSG-6: tumor necrosis factor- (TNF-) stimulated gene 6 protein; VEGF: vascular endothelial growth factor.