Dimethyl Sulfoxide-Induced Tonic-Clonic Seizure and Cardiac Arrest During Infusion of Autologous Peripheral Blood Stem Cells

Abstract

Various side effects associated with dimethyl sulfoxide (DMSO) which is used for cryopreservation of bone marrow or peripheral blood progenitor cells (PBPCs) have been reported. Among the central nervous system side effects the epileptic seizures, stroke, transient and temporary leucoencephalopathy, and global amnesia are well known. Herein we report a 52-year-old man who experienced tonic-clonic seizure within minutes after the initiation of DMSO cryopreserved autologous PBPC infusion. Unfortunately, he also developed cardiac arrest and required intubation for ventilation after the seizure. Pathophysiology of acute neurological and cardiac toxicity is unclear, but may also be idiosyncratic. Clinicians should be aware of the toxicity of cryoprotectant agents during PBSC infusion. Determining the risk factors associated with increased DMSO toxicity and taking preventive actions is utmost important.

Low DMSO Cryopreservation of Stem Cells Enabled by Macromolecular Cryoprotectants

“… 4 More critically, DMSO is known to cause adverse side effects in patients receiving cell therapies, ranging from mild symptoms, such as nausea, 5 to seizures and cardiac arrest. 6 A study reported one in 70 transfusions result in DMSO-related side effects. 7 …”

Principles and Protocols For Post-Cryopreservation Quality Evaluation of Stem Cells in Novel Biomedicine

“…Adverse drug reaction monitoring following stem cell implantation procedures has documented some unwanted reactions including symptoms like abdominal cramps, diarrhea, nausea, flushing, and life-threatening events such as acute renal failure, respiratory depression and cardiac arrhythmias ( Shu et al, 2014 ). Some of the observed adverse effects has been linked to toxicity caused by traces of DMSO retained in the infusion ( Ataseven et al, 2017 ; Maral et al, 2018 ). Although the mechanisms underlying the adverse effects from infusing cryopreserved stem cell products are not completely unraveled, other contributing factors besides the toxicity of DMSO include cell aggregation and presence of apoptotic debris ( Schlegel et al, 2009 ), volume of infused suspension and presence of unnucleated cells ( Rohner et al, 2019 ), hypothermic condition of the cell suspension, and electrolyte imbalance ( Calmels et al, 2003 ).…”

“…The combination of cryoprotectants can reduce the concentration of a single CPA used, thus reducing cytotoxicity ( Elliott et al, 2017 ). The addition of trehalose ( Yamatoya et al, 2022 ), sucrose ( Shu et al, 2014 ), polyampholytes ( Maral et al, 2018 ) and antifreeze proteins ( Shaliutina-Kolešová et al, 2019 ) during cryopreservation can greatly minimize the required amount of DMSO, thereby reducing cytotoxicity.…”

Curcumin nanoparticles are a promising anti-bacterial and anti-inflammatory agent for treating periprosthetic joint infections

“…Unfortunately, DMSO is toxic toward normal cells and been rarely used as a solvent in clinical applications. [35][36][37][38] In recent years, nanoparticle formations have been developed to improve the solubility of CUR to increase its bioavailability and pharmacological effects. 27,28,34,39 A polyvinylpyrrolidone (PVP)-based novel curcumin nanoparticle (CURN) system was developed in our previous study.…”