Critical measures were taken to optimize the delivery of the grafts, such as the use of the reverse Trendelenburg position (operative table tilted in a 30 degrees angle, head upwards) to keep cerebrospinal fluid away from the lesion during the grafting procedure. This action, coupled to increased concentrations of fibrin-thrombin, and an immunosuppression protocol with three drugs (tacrolimus, mycophenolate mofetil, and prednisone), resulted in increased survival of the grafts, which reached at least 9 months. By combining intracortical injections with biotinylated dextran amine (BDA), and immunofluorescence for neuron-specific and glial-specific cytoskeletal markers (class III β-tubulin, NF70, NF200, SMI32, and GFAP) and the postsynaptic marker HOMER, the researchers identified that transplanted grafts were able to develop long-distance axons within the host spinal cord (mostly of immature nature as evidenced by lack of NF200 immunoreactivity), promote host axonal regeneration, and demonstrated for the first time the regeneration primate corticospinal axons into human NPC grafts. Ultimately, surviving grafts led to significant improvements in object manipulation tasks, locomotor recovery, and peak performance.
The present study represents a massive leap in SCI research, moving from rodents to primates, offering significant translational value and understanding of interspecies differences in stem cell biology and regenerative mechanisms. Future studies will look to verify these exciting results and optimize the grafting of human NPCs by improving delivery, immunosuppressive therapy, and selection of more fitting NPCs and NCs.
April 10 2018