Challenges and promises in optimising a non-clinical protocol of intracerebroventricular human neural stem cell transplantation in ALS

Background and aimsNeural stem cell (NSC) transplantation holds promising therapeutic potential for neurodegenerative disorders like amyotrophic lateral sclerosis (ALS). However, pre-clinical studies and early-phase clinical trials have faced challenges hindering the effective clinical translation of this approach. Crucial hurdles include the side-effects of prolonged immunosuppression, concerns regarding cell origin and transplantation dosage, identification of the most appropriate therapeutic window, and invasiveness of surgical procedures. Here, we show challenges and promises in optimizing a non-clinical protocol to assess safety and efficacy of human NSC (hNSC) intracerebroventricular (ICV) transplantation for ALS. MethodsWe evaluated the safety of administering up to 1x106 hNSCs in immunodeficient mice and assessed their potential efficacy in reducing ALS hallmarks employing the SOD1G93A mouse model. Both, transient (15 days) and prolonged immunosuppression regimens, at low (15 mg/kg) and high (30 mg/kg) doses, were tested along with two different cell dosages (3x105 and 1x106). ResultsBilateral ICV injection of up to 1x106 hNSCs proved to be safe, with no evidence of tumor formation. At 40 days post-transplantation, hNSCs induced a trend toward delaying motor decline and reducing spinal cord (SC) microgliosis when transplanted under prolonged high-dose (30 mg/kg) immunosuppression. ConclusionsOur study suggests that: (i) a bilateral ICV transplantation of 1x106 hNSCs is safe and non-tumorigenic in immunodeficient hosts; (ii) sustained high-dose immunosuppression is essential for ensuring cell survival in immunocompetent mice; and (iii) hNSC transplantation may provide therapeutic benefits in ALS by delaying motor decline and reducing microgliosis. This study also highlights persisting hurdles that need to be further addressed, such as the aggressive murine immune response to exogenous cells.