Recovery from Severe Neurological Sequelae due to Anti-N-methyl D-aspartate Receptor Encephalitis after Three Infusions of Allogeneic Umbilical Cord-derived Mesenchymal Stem Cells: A First Case Report

PurposeAnti-N-methyl D-aspartate (NMDA) receptor encephalitis is caused by altered patients’ immune reactions. This study reports the first patient with severe neurologic sequelae after NMDA receptor encephalitis treated with allogeneic umbilical cord-derived mesenchymal stem/stromal cells (UC-MSCs) via intrathecal route.MethodsUC-MSCs were obtained from a healthy donor and expanded under a xeno- and serum-free condition. The patient received three intrathecal UC-MSC infusions at the dose of 106 cells/Kg. The outcome was accessed using the German Coma Recovery Scale (CRS), the Gross Motor Function Classification System (GMFCS), the Gross Motor Function Measure–88 (GMFM-88), Manual Ability Classification System (MACS), Modified Ashworth Scale, and the Denver II test.ResultsA 5-year-old girl suffered from a permanent vegetative state with diffuse cerebral atrophy due to NMDA receptor encephalitis despite intensive treatment of immunosuppressive medicaments and IVIG. After three UC-MSC infusions, her cognition and motoric functions improved progressively. In the last visits, she could walk, practice writing, and count numbers. Urinary and bowel functions were completely controlled. Cerebral atrophy reduced on brain MRI.ConclusionsThe outcomes of this patient suggest a potential cell therapy for autoimmune encephalitis and its neurological consequences.