Enhanced Mesenchymal Stromal Cells or Erythropoietin Provide Long-Term Functional Benefit After Neonatal Stroke

Stroke. 2021 Jan;52(1):284-293. doi: 10.1161/STROKEAHA.120.031191. Epub 2020 Dec 22.


Background and purpose: Perinatal stroke is a common cause of life-long neurobehavioral compromise. Mesenchymal stromal cells (MSCs) and EPO (erythropoietin) have each demonstrated short-term benefit with delayed administration after stroke, and combination therapy may provide the most benefit. The purpose of this study is to determine the long-term histological and functional efficacy of enhanced, intranasal stem cell therapy (MSC preexposed to EPO) compared with standard MSC or multidose systemic EPO.

Methods: Transient middle cerebral artery occlusion or sham surgery was performed in postnatal day (P) 10 Sprague-Dawley rats, who were treated with single-dose intranasal MSC, MSC preexposed to EPO (MSC/EPO), multidose systemic EPO (EPO3; 1000 u/kg per dose×3 every 72 hours), or cell-conditioned media on P13 (day 3 [P13-P19] for EPO), or on P17 (day 7 [P17-P23] for EPO). At 2 months of age, animals underwent novel object recognition, cylinder rearing, and open field testing to assess recognition memory, sensorimotor function, and anxiety in adulthood.

Results: MSC, MSC/EPO, and EPO3 improved brain volume when administered at 3 or 7 days after middle cerebral artery occlusion. MSC/EPO also enhanced long-term recognition memory with either day 3 or day 7 treatment, but EPO3 had the most long-term benefit, improving recognition memory and exploratory behavior and reducing anxiety.

Conclusions: These data suggest that single-dose MSC/EPO and multidose systemic EPO improve long-term neurobehavioral outcomes even when administration is delayed, although EPO was the most effective treatment overall. It is possible that EPO represents a final common pathway for improved long-term repair, although the specific mechanisms remain to be determined.

Keywords: anxiety; erythropoietin; infarction, middle cerebral artery; mesenchymal stem cell; treatment outcome.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Intranasal
  • Animals
  • Animals, Newborn
  • Anxiety / psychology
  • Behavior, Animal
  • Brain / diagnostic imaging
  • Culture Media, Conditioned
  • Epoetin Alfa / therapeutic use
  • Female
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / etiology
  • Memory / drug effects
  • Mesenchymal Stem Cell Transplantation / methods*
  • Motor Activity / drug effects
  • Pregnancy
  • Psychomotor Performance
  • Rats
  • Rats, Sprague-Dawley
  • Stroke / drug therapy
  • Stroke / psychology
  • Stroke / therapy*
  • Treatment Outcome


  • Culture Media, Conditioned
  • Epoetin Alfa