A Review of Stem Cell Therapy in Ischemic Stroke - Free Essay Example

ABSTRACT Stroke is a leading cause of death and disability. Effecting over 15 million people worldwide. Of those 15 million cases 5 million will die and a further 5 million will be left disabled. Currently there is little to no treatment for stroke, this leaves patients with a large deficit of treatment. Thus, there is a pressing need for new and effective treatment option. Stem cell therapy (SCT) is a well-established treatment method that has proved its self in other hematological diseases. This fact coupled with some promising results shown from animal models that show significant functional benefits have led research to the bedside. This review provides a brief history and scientific background to the stem cell therapy of ischemic stroke (IS). This will then be followed up with evidence of current clinical trials including a discussion of the various route of delivery, cell type, timing of treatment and number of cells used. Finally, the review will end with a discussion of what will become of stem cell therapy in the distant future. INTRODUCTION Stroke is a major cause of serious disability and the second largest cause of death in the world. Stroke is also very expensive taking up to 2-4% of all healthcare costs. Even if the age specific strokes stay constant or decrees slightly the number of new cases of stroke will rise each year with the advent of the ageing era. Stroke has been categorized as 1) ischemic (obstruction); 2) hemorrhagic (bleeding); 3) transient (transient ischemic attack) by the American Heart assertion, with ischemic stroke accounting for 85% of all stroke cases [3] it will be focus of this review. An ischemic stroke results from artery occlusion in the brain, which if left untreated will lead to cell death in the affected part of the brain. Current treatment of (IS) Is to use tissue plasminogen activator (t-PA) a medication that can help remove the clot in the brain. Unfortunately, this medication is only useful if administered within 3-4.5 hours after the stroke [5]. Aspirin can also be used as a deter rent to stroke but only provides a 1% absolute reduction in death and recurrent (IS) [1]. Most patients over time show some spontaneous recovery after stroke. This recovery can be attributed to cell regeneration in the brain, this regeneration until recently was thought to be impossible. This process of cell recovery has been named neurogenesis [2,3]. However, this recovery is often incomplete. Creating a need for further cell recovery in the brain. This with the evidence of neurogenesis have sparked the creation of experimental work investigation cell transplantation therapy in (IS). Background and developments in Stem Cell therapy for Ischemic stroke The clinic approaches of (SCT) can be divided into endogenous and exogenous approaches. The endogenous approach aims to stimulate the stem cells already present within the induvial. This uses a granulocyte-colony stimulating factor (G-CSF) which is used to mobilize stem cells for transplantation in hematological damaged areas [5,6]. This has shown promising results in animal studies showing direct benefits in cognitive regeneration. Several phase II trials are currently underway to investigate its efficacy in (IS). The exogenous approach involves the transplantation of stem cells directly into the damage area. This involve in vitro culture of cells and cell expansion prior to admission. This review will focus on the studies using exogenous approaches to (SCT) in (IS), as it is seeing a lot more focus from the stem cell community. Following a stroke, both neural and supportive brain tissue elements are lost, unlike other neurogenerative disease that target a specific neuronal type. SCT for IS, therefore focuses on regenerative strategies to restore both neurol elements but supportive elements as well such as blood vessels. Many stem cells have been tested and evaluated in humans for their potentials in this use. Neural stem cells (NSC) It now generally accepted that neurogenesis originated from neural stem cells (NSC) that are located in specific regions of the adult mammalian brain. Throughout life creating new populations of neurons [17]. NSC can be isolated for fetal and adult mammalian brains. Multiply studies have shown isolation of NCS from adult rodent brains [18,19], and also a newer study has moved on to isolation in the human brain [20,21]. Preclinical studies explore the feasibility of using NSCs to treat IS. When giving NSC through intravenous or stereotactically route the NSC have been shown to survive, migrate towards the lesion and differentiate, while promoting tissue repair, consequently improved neurological function and recovery in ischemic rodent [15,16]. Studies have shown that delayed intravenous transplantation of NSC at 3 days after ischemic stroke exhibited delayed neuroprotection by suppressing inflammation and focal glial scar formation, suggesting that NSCs had the potential to extend t he therapeutic time window for ischemic stroke treatment [21]. There is currently a phase trial planned using commercial derived NSC named CTX to be delivered by stereotactic injection in patients with IS. While NSC show promise the practicability of routine brain biopsies for isolation of adult human NSC is not, leading many researchers to exploring other methods of SCT with cells that are more accessible. Bone marrow derived stem cells Bone marrow derived stem cells consist of both hematopoietic stem cells (HSC) and mesenchymal stem cells (MSC). HSCs are the precursors of all the blood and lymphoid cell lineages. MSCs give rise the stromal cells of the bone marrow. The stromal cells consist of chondrocytes, adipocytes and osteoblasts. Bone marrow is an attractive choice for isolating stem cells for being easily accessible, autologous (coming from the same individual) meaning there would be no need for immunosuppressant medication. Bone marrow cells have been shown to migrate to the brain a dissociate into cells the express neuron-specific markers [37]. Both populations of bone marrow cells have been studied extensively on their potential for neuronal differentiation and possible use in neuroregenerative therapy.

Top 5 Financial Considerations When Selecting Childcare

Childcare costs, just like college tuition, are reaching record highs. According to the nonprofit organization Child Care Awareï ¿ ½s 2014 Parents and the High Cost of Childcare report, todayï ¿ ½s families spend more on childcare than housing, college tuition, food and transportation. Just how much are we talking about? The experts at Babycenter.com say itï ¿ ½s just over $11,000 a year for the average family. So how has this high cost of childcare affected family budgets and savings goals, and what can families do to soften the blow? We asked Brooke Napiwocki, Family Wealth Advisor with Bronfman E.L. Rothschild in Wisconsin, for her expert advice: ï ¿ ½Most families face the reality of childcare as a non-discretionary expense item within their familyï ¿ ½s budget. The cost of childcare varies greatly depending upon the type of care, specific provider chosen, and geographic location. Before having children, many couples dream of fully funding their childï ¿ ½s college education. The current reality is often that every year of full-time childcare paid per child is often equal to a year of in-state college tuition! For example, in my household, we could purchase a new car every year based on our childcare expenses. This shocking reality often leads to essential reassessments of current work arrangements, household expenses, and short- and long-term savings goals. RELATED: The top 10 financial mistakes millennial parents make For dual-income families, the first questions are often (1) do both spouses want to continue working outside of the home, and (2) does each spouseï ¿ ½s income offset the cost of childcare? In the case of the latter question, sometimes a deficit of expense-to-income may still warrant a spouse staying in the workforce for financial reasons like employee benefits and gaining Social Security credits and for non-financial reasons like the difficulty in regaining employment and the need to keep technical skills current. For dual-income couples who have the benefit of excess discretionary income, I often recommend that families make childcare choices that help instill the familyï ¿ ½s values and provide necessary flexibility. One way for families with excess discretionary income to increase flexibility is to consider outsourcing common household tasks like meal preparation, general household cleaning, and running errands. By allocating a portion of the familyï ¿ ½s budget to cover these day-to-day duties, families might find that they have increased quality time to spend together, strengthening the family unit. If childcare becomes a necessity for a particular family, discretionary expenses will most likely need to be minimized, and savings goals will likely need to be adjusted. Discretionary or unnecessary expenses can be found by tracking spending and are commonly found in cable bills, restaurant expenditures, and big box store impulse buys. RELATED: 7 Money Management Tips to Save More for College Each familyï ¿ ½s situation is different, and there is no ï ¿ ½one-size-fits-allï ¿ ½; there are a variety of financial and non-financial considerations that go into childcare decisions. Families should consider the following before deciding whatï ¿ ½s right for their situations: Evaluate the use of flexible spending accounts for dependent care expense at your workplace and utilizing the Child and Dependent Care tax credit with your tax preparer to help offset child care costs. Be careful about completely exiting the workplace if your sole reason is financial. Workplace flexibility is gaining momentum, and several online resources and templates are available to propose flexible and part-time work scheduling with your employer. Weigh financial and non-financial reasons when picking the right childcare provider and reevaluate your childcare situation as your children grow. Some families change childcare providers or exit/re-enter the workplace as children age and as income levels change. Remember that your childcare provider can be a family asset and not just an expense. The intellectual, social, and life skills taught by childcare providers can be a great advantage for children entering the next stage of their education. Review family financial goals and budgets together and prioritize savings goals once you understand the big picture and your current financial realities." RELATED: Should I pay for private elementary school or save for college Brooke Napiwocki joined Bronfman E.L. Rothschild in March 2014. She has worked with individuals, small businesses, and institutional clients in the financial services industry for the past 15 years. Childcare costs, just like college tuition, are reaching record highs. According to the nonprofit organization Child Care Awareï ¿ ½s 2014 Parents and the High Cost of Childcare report, todayï ¿ ½s families spend more on childcare than housing, college tuition, food and transportation. Just how much are we talking about? The experts at Babycenter.com say itï ¿ ½s just over $11,000 a year for the average family. So how has this high cost of childcare affected family budgets and savings goals, and what can families do to soften the blow? We asked Brooke Napiwocki, Family Wealth Advisor with Bronfman E.L. Rothschild in Wisconsin, for her expert advice: ï ¿ ½Most families face the reality of childcare as a non-discretionary expense item within their familyï ¿ ½s budget. The cost of childcare varies greatly depending upon the type of care, specific provider chosen, and geographic location. Before having children, many couples dream of fully funding their childï ¿ ½s college education. The current reality is often that every year of full-time childcare paid per child is often equal to a year of in-state college tuition! For example, in my household, we could purchase a new car every year based on our childcare expenses. This shocking reality often leads to essential reassessments of current work arrangements, household expenses, and short- and long-term savings goals. RELATED: The top 10 financial mistakes millennial parents make For dual-income families, the first questions are often (1) do both spouses want to continue working outside of the home, and (2) does each spouseï ¿ ½s income offset the cost of childcare? In the case of the latter question, sometimes a deficit of expense-to-income may still warrant a spouse staying in the workforce for financial reasons like employee benefits and gaining Social Security credits and for non-financial reasons like the difficulty in regaining employment and the need to keep technical skills current. For dual-income couples who have the benefit of excess discretionary income, I often recommend that families make childcare choices that help instill the familyï ¿ ½s values and provide necessary flexibility. One way for families with excess discretionary income to increase flexibility is to consider outsourcing common household tasks like meal preparation, general household cleaning, and running errands. By allocating a portion of the familyï ¿ ½s budget to cover these day-to-day duties, families might find that they have increased quality time to spend together, strengthening the family unit. If childcare becomes a necessity for a particular family, discretionary expenses will most likely need to be minimized, and savings goals will likely need to be adjusted. Discretionary or unnecessary expenses can be found by tracking spending and are commonly found in cable bills, restaurant expenditures, and big box store impulse buys. RELATED: 7 Money Management Tips to Save More for College Each familyï ¿ ½s situation is different, and there is no ï ¿ ½one-size-fits-allï ¿ ½; there are a variety of financial and non-financial considerations that go into childcare decisions. Families should consider the following before deciding whatï ¿ ½s right for their situations: Evaluate the use of flexible spending accounts for dependent care expense at your workplace and utilizing the Child and Dependent Care tax credit with your tax preparer to help offset child care costs. Be careful about completely exiting the workplace if your sole reason is financial. Workplace flexibility is gaining momentum, and several online resources and templates are available to propose flexible and part-time work scheduling with your employer. Weigh financial and non-financial reasons when picking the right childcare provider and reevaluate your childcare situation as your children grow. Some families change childcare providers or exit/re-enter the workplace as children age and as income levels change. Remember that your childcare provider can be a family asset and not just an expense. The intellectual, social, and life skills taught by childcare providers can be a great advantage for children entering the next stage of their education. Review family financial goals and budgets together and prioritize savings goals once you understand the big picture and your current financial realities." RELATED: Should I pay for private elementary school or save for college Brooke Napiwocki joined Bronfman E.L. Rothschild in March 2014. She has worked with individuals, small businesses, and institutional clients in the financial services industry for the past 15 years.