Recovery After Thoracic Spinal Cord Injury: Walking Rehabilitation in Humans and Stem Cell Therapy with Rehabilitation in Non-Human Primates

The therapeutic effects of single interventions for spinal cord injury are limited by significant inter-individual variability. We evaluated one year of locomotor rehabilitation in 15 patients with complete thoracic SCI, observing moderate improvements in AIS grades, L2 motor scores, WISCI, and SCIM, but no notable changes in Ashworth or sensory scores. To explore a feasible combination therapy, we developed a monkey contusion SCI model, which induced hind limb paralysis and electrophysiological deficits. Subacute transplantation of human adipose tissue-derived mesenchymal stem cells (ADMSCs) combined with body-supported walking training significantly improved functional recovery, as evidenced by gait analysis, von Frey tests, and electrophysiology. ADMSC transplantation reduced inflammatory markers, lesion cavity volume, neuronal loss, and axon demyelination, while enhancing corticospinal axon preservation and spinal motor network connectivity. Rehabilitation and ADMSC transplantation synergistically improved gait parameters, including knee stability, suggesting this combined approach may be a promising therapeutic strategy for SCI patients.