{"doi":"10.1016/j.xjon.2021.06.022","title":"Commentary: Revival of motor and sensory functions: Is this a catholicon or hollow promise for paraplegia?","abstract":"Central MessagePreconditioning of mesenchymal stem cells and using mesenchymal-stem-cell–derived extracellular vesicles or exosomes via intravascular route improve recovery in spinal cord ischemia–reperfusion injury.See Article page 23. Spinal cord ischemic-reperfusion injury (SIRI) during thoracoabdominal aneurysm repair can lead to changes in motor, sensory, and autonomic functions resulting in neurological deficiency and disability. Minimally invasive surgical procedures limit the ischemic injury, but SIRI remains a distressing complication manifested by paraplegia or paraparesis.1Bisdas T. Panuccio G. Sugimoto M. Torsello G. Austermann M. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms.J Vasc Surg. 2015; 61: 1408-1416Google Scholar The changing microenvironment after SIRI inhibits axonal regeneration. Bone-marrow–derived mesenchymal stem cells (BM-MSCs), due to their plasticity, can be used as potential therapeutics by modulating the microenvironment. Therapeutic role of MSCs in spinal cord injury is via regulating gliosis, antiapoptosis, inflammation, oxidative stress, angiogenesis, differentiation to neural and glial cells, axonal regeneration, and secretion of growth factors, cytokines, and chemokines.2Liau L.L. Looi Q.H. Chia W.C. Subramaniam T. Ng M.H. Law J.X. Treatment of spinal cord injury with mesenchymal stem cells.Cell Biosci. 2020; 10: 1-17Google Scholar,3Yin F. Meng C. Lu R. Li L. Zhang Y. Chen H. et al.Bone marrow mesenchymal stem cells repair spinal cord ischemia/reperfusion injury by promoting axonal growth and anti-autophagy.Neural Regen Res. 2014; 9: 1665-1671Google Scholar MSCs are administered intracranially/intrathecally or intravascularly with better results for larger lesions via the intravascular route.4Bliss T.M. Andres R.H. Steinberg G.K. Optimizing the success of cell transplantation therapy for stroke.Neurobiol Dis. 2010; 37: 275-283Google Scholar Retro-orbital injection of MSCs after ischemic injury plays a protective role in repairing SIRI in rats by preventing autophagy and promoting neurite growth and regeneration.3Yin F. Meng C. Lu R. Li L. Zhang Y. Chen H. et al.Bone marrow mesenchymal stem cells repair spinal cord ischemia/reperfusion injury by promoting axonal growth and anti-autophagy.Neural Regen Res. 2014; 9: 1665-1671Google Scholar Preemptive intrathecal injection of MSCs also plays a protective role by stabilizing the blood–spinal cord barrier integrity after SIRI via matrix metallopeptidase 9 and tumor necrosis factor-α inhibition.5Fang B. Wang H. Sun X.J. Li X.Q. Ai C.Y. Tan W.F. et al.Intrathecal transplantation of bone marrow stromal cells attenuates blood-spinal cord barrier disruption induced by spinal cord ischemia-reperfusion injury in rabbits.J Vasc Surg. 2013; 58: 1043-1052Google Scholar Increased number of neurons and decreased damage to neurons in animal models and mixed results of improvement in motor activity and sphincter control in some patients, whereas no improvement in others, support the notion of therapeutic use of MSCs; however, warrants an in-depth understanding of the repair mechanisms to enhance therapeutic efficacy, efficiency, reproducibility, and to promote clinical use of MSCs.2Liau L.L. Looi Q.H. Chia W.C. Subramaniam T. Ng M.H. Law J.X. Treatment of spinal cord injury with mesenchymal stem cells.Cell Biosci. 2020; 10: 1-17Google Scholar,6Qu J. Zhang H. Roles of mesenchymal stem cells in spinal cord injury.Stem Cells Int. 2017; 2017: 5251313Google Scholar,7Zhou Y. Wen L.L. Li Y.F. Wu K.M. Duan R.R. Yao Y.B. et al.Exosomes derived from bone marrow mesenchymal stem cells protect the injured spinal cord by inhibiting pericyte pyroptosis.Neural Regen Res. 2022; 17: 194-202Google Scholar Nakai and colleagues8Nakai H. Fujita Y. Masuda S. Komatsu M. Tani A. Okita Y. et al.Intravenous injection of adult human bone marrow mesenchymal stromal cells attenuates spinal cord ischemia/reperfusion injury in a murine ","journal":"JTCVS Open","year":2021,"id":221262,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9522,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":288569,"name":"Vikrant Rai","orcid":"0000-0001-6286-2341","position":1,"is_corresponding":false},{"id":363513,"name":"Devendra K. 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