Pediatric Stroke and Cell-Based Treatment – Pivotal Role of Brain Plasticity

Pediatric cerebrovascular disorders like stroke are among the top 10 causes of death in children, with rates highest in the first year of life, while survivors may face lifelong sequelae, disability, and/or cerebral palsy for which there is no cure at present. Individual treatments using human autologous cord blood Mononuclear Cells (hucbMNC) containing stem cells have yielded promising results. However, stroke is an entity with heterogenic etiologies including arterial ischemic stroke, hemorrhagic stroke, hemorrhagic infarction, and sinus venous thrombosis in newborns, infants, children, and adults. Hence, any attempt to examine care, non-cellular or cell-based therapies has to merit the specific characteristics of this heterogeneity as far as age, symptoms, diagnostics, pathophysiology, histopathology, clinical course and prevalence are concerned. This review describes the various etiologies of stroke for the Neonatal/Perinatal and childhood subsets of the pediatric population as a basis for established non-cellular and novel cell-based therapeutic approaches using cord blood mononuclear cells in the preclinical and clinical setting. In addition, due to its fundamental importance for cell-based therapeutic strategies for stroke, an account of brain plasticity along with blood-brain barrier function and the distinctions between the developing brain and the adult brain is provided. It is concluded that on the present balance of evidence the pathophysiological characteristics associated with plasticity of the developing brain are closely linked to the pharmacological action of hucbMNC in such a way that cell-based treatment might be more efficacious in pediatric stroke than in adult stroke.