The Effect of Serum from Acute Traumatic Brain or Spinal Cord Injury Patients on the Growth of Bone Marrow-Derived Mesenchymal Stem Cells (Atcc-USA)

Research Article

Austin J Orthopade & Rheumatol. 2015; 2(3): 1024.

The Effect of Serum from Acute Traumatic Brain or Spinal Cord Injury Patients on the Growth of Bone Marrow-Derived Mesenchymal Stem Cells (Atcc-USA)

Khallaf FG1 and Kehinde EO2*

1Department of Orthopaedic Surgery, Jahra Hospital, Kuwait

2Department of Surgery, Kuwait University, Kuwait

*Corresponding author: Khallaf FG, Department of Orthopaedic Surgery, Jahra Hospital, Ministry of Health, Kuwait

Received: September 27, 2015; Accepted: December 18, 2015; Published: December 23, 2015


Accelerated osteogenesis associated with traumatic brain injury BTI or spinal cord injury SCI is inconclusive and its cause remains obscured. The purpose of this study was to ensure a clinical evidence of its presence and to reveal the possible underlying mechanism. Healing indicators of diaphyseal femoral fractures in 20 patients with BTI and 20 patients with SCI were compared to 20 patients with femoral fracture only. The effect of sera of blood samples withdrawn from these patients on cell count proliferation rate of bone marrowderived Mesenchymal Stem Cells MSCs (ATCC-USA) were measured and compared to sera from 20 patients with BTI only, 20 patients with SCI only, and a control group. The results showed that femoral fractures with BTI or SCI heal more expectedly, faster with exuberant callus (p<0.001) and showed statistically significant increased cell count and growth rate of MSCs with sera from BTI and SCI patients with or without femoral fractures, 82.34%, 83.90%, 81.46%, and 81.50% respectively versus 52.96% in the control and 59.77% in patients with femoral fractures only (p<0.005). These results suggested enhancement of fracture-healing secondary to TBI and SCI due to the presence of factors in the serum that have a mitogenic effect on MSCs.

Keywords: Traumatic brain injury; Spinal cord injury; Long bone fractures; Acceleration of bone healing; Undifferentiated mesenchymal stem cells


TBI: Traumatic Brain Injury; SCI: Spinal Cord Injury; MSCs: Undifferentiated Mesenchymal Stem Cells; ATCC: American Type Culture Collection; SPSS: Statistical Package for the Social Sciences; GCS: Glasgow Coma Scale; RTA: Road Traffic Accident


There is some clinical evidence to suggest that fractures of long bones heal more rapidly in patients with severe head injury or acute traumatic spinal cord injury. The mechanism underlying this orthopedic phenomenon is not well understood. Early clinical reports that researched the correlation between accelerated bone healing and acute traumatic nervous tissue damage in head or spinal cord injuries were inconclusive and demonstrated no evidence of accelerated union or increased callus formation [1-10].

The current understanding of bone healing event showed that the process involves the participation of orchestra of many growth factors and cytokine molecules and cells, primarily Undifferentiated Mesenchymal Stem Cells (MSCs) and blood inflammatory cells to induce formation of union callus at the fracture site [11-25].

The primary objective of this prospective controlled study was to ensure the accelerating effect of severe acute traumatic head injuries and spinal cord injuries on the healing of concomitant diaphyseal femoral fractures and the secondary objective was to test the effect of sera taken from patients with severe head or spinal cord injuries with concomitant long bone femoral diaphyseal on the growth rate of bone marrow derived mesenchymal stem cells on stem cells culture to elucidate the mechanism of accelerated bone healing in such patients.

Patients and Methods

Recruited patients in this current study, were non-smokers, between 18 and 60 years old, and had no history of chronic illness or systemic diseases. Patients on permanent medications and therapy for chronic disease such as diabetes mellitus, ischemic heart diseases, chronic renal failure, or endocrine diseases, or patients on corticosteroids for bronchial asthma, rheumatoid arthritis, other inflammatory arthritis, and autoimmune diseases were excluded from the study

The patients were divided into five groups: Group A consisted of 20 patients with acute severe post-traumatic head (brain) injuries who were admitted to the Intensive Care Unit (ICU) with a Glasgow Coma Scale (GCS) of 8 or less(to define severe injury), Group B consisted of 20 patients with severe head injury and concomitant long bone diaphyseal femoral fractures, Group C consisted of 20 patients with acute post- traumatic spinal cord injuries with complete quadriplegia or paraplegia, Group D consisted of 20 patients with spinal cord injury and femoral shaft fractures, and Group E consisted of 20 patients with femoral diaphyseal fractures only. All femoral fractures in patients of group (B), (D), and (E) were treated surgically, by closed static reamed intra-medullary locking nail and followed -up weekly for three month and then, every three weeks for another three months (end-point of the study of fracture union, delayed union, or non-union), and every two months for another six to eight months. The patients’ biodata and characteristics of injuries of all groups were shown in (Table 1).