Potential Beneficial Effects of Granulocyte Colony-Stimulating Factor Therapy for Spastic Paraparesis in a Patient with Kyphoscoliosis: A Case Report

Abstract

Congenital kyphosis and kyphoscoliosis are much less common than congenital scoliosis and more serious because these curves can progress rapidly and can lead to spinal cord compression and paraplegia. A 15-year-old boy presented with congenital kyphoscoliosis along with spastic paraparesis (American Spinal Injury Association Impairment Scale grade C). We examined the safety and effectiveness of a low dose of analog granulocyte colony-stimulating factor (G-CSF) in this patient. G-CSF 5 µg/kg was given subcutaneously, daily for 5 days per month for 3 months. Laboratory tests, including blood, biochemical tests, and CD34+ cells (marker hematopoietic progenitor cells) were performed, in addition to clinical examination. Clinical examination revealed an increase of muscle strength in the upper limbs and decrease spasticity in the lower limbs between baseline and day 90 and day 180. We found no serious adverse event, drug-related platelet reduction, or splenomegaly. Leukocyte levels remained below 21,000/µL. CD34+ increased significantly at day 5 of G-CSF administration. Low-dose G-CSF was safe and well tolerated by the patient. A significant increase in muscle strength in this patient with spastic paraparesis after 3 months of treatment may indicate beneficial effects of G-CSF factor in this disorder. These results are inspiring and warrant further studies.

Effects of granulocyte colony-stimulating factor therapy for osteogenesis imperfecta: a case report

“…No serious adverse events were reported. In this report, the increase of white blood cells after G-CSF was similar to that of other clinical studies using G-CSF [11,12].…”

“…It enhances muscle proliferation of skeletal muscle injury in animals and promotes vessel formation [8,10]. In our patient, G-CSF was administered for five consecutive days as in similar studies [11,12]. The results indicated improvements in muscle strength and motor functions after three months of therapy and, a 7.1% increase in skeletal bone mass per year was reported in the study of bone densitometry system.…”

“…Recent studies have indicated that G-CSF can potentially be used for the treatment of spinal cord injuries and neurodegenerative diseases [11,12]. Scientific articles indicating the use of G-CSF for children with OI have not yet been found.…”

Granulocyte Colony-Stimulating Factor and Its Potential Application for Skeletal Muscle Repair and Regeneration

“…Furthermore, improved functional outcomes and independence after treatment with low-dose G-CSF were observed in a single patient with a cervical spinal injury resulting in tetraplegia [ 86 ]. Finally, improved upper limb muscle strength and reduced lower limb spasticity were observed in a patient with kyphoscoliosis [ 87 ]. It is promising to consider that G-CSF may actually be affecting the skeletal muscle and thus leading to functional improvements.…”

Effects of granulocyte colony-stimulating factor treatment in children and patients with cerebral palsy: a preliminary report

“…In our previous case reports [16,17], we evaluated the safety and effectiveness of G-CSF in a patient with tetraplegia caused by a cervical hyperextension injury and in a patient with spastic paraparesis due to kyphoscoliosis. In the patient with spastic tetraplegia, G-CSF 5 μg/kg was administered subcutaneously daily for 5 days per month for 3 months, again after 6 months, and again after 10 months.…”