Human umbilical cord mesenchymal stem cells for severe neurological sequelae due to anti-N-methyl-d-aspartate receptor encephalitis: First case report

Abstract

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis results from altered immune responses and can lead to severe neurological sequelae. This study presents the first case of a patient with significant neurological impairment following NMDA receptor encephalitis who was treated with allogeneic umbilical cord-derived mesenchymal stem/stromal cells (UC-MSCs).

The patient, a 5-year-old girl, was diagnosed with NMDA receptor encephalitis and initially received immunosuppressive therapy along with intravenous immunoglobulin (IVIG). Despite aggressive treatment, her condition deteriorated, prompting consideration of UC-MSC therapy. She subsequently underwent three intrathecal infusions of xeno- and serum-free cultured UC-MSCs at a dose of 10^6 cells/kg.

The patient’s progress was assessed using several scales, including the German Coma Recovery Scale (CRS), Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure–88 (GMFM-88), Manual Ability Classification System (MACS), Modified Ashworth Scale, and Denver II test. Initially, she was in a permanent vegetative state with extensive cerebral atrophy. However, following the UC-MSC infusions, her cognitive and motor functions improved progressively. By the final evaluation, she was able to walk, write, and count. Additionally, she fully regained control over urinary and bowel functions, and brain MRI showed a reduction in cerebral atrophy.

These outcomes suggest that UC-MSC therapy may hold promise for treating autoimmune encephalitis and its associated neurological complications.