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Liu X, Liu J, Zhao S, Zhang H, Cai W, Cai M, Ji X, Leak RK, Gao Y, Chen J, Hu X. Interleukin-4 Is Essential for Microglia/Macrophage M2 Polarization and Long-Term Recovery After Cerebral Ischemia. Stroke 2016; 47:498-504. [PMID: 26732561 DOI: 10.1161/strokeaha.115.012079] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/25/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Interleukin-4 (IL-4) is a unique cytokine that may contribute to brain repair by regulating microglia/macrophage functions. Thus, we examined the effect of IL-4 on long-term recovery and microglia/macrophage polarization in 2 well-established stroke models. METHODS Transient middle cerebral artery occlusion or permanent distal middle cerebral artery occlusion was induced in wild-type and IL-4 knockout C57/BL6 mice. In a separate cohort of wild-type animals, IL-4 (60 ng/d for 7 days) or vehicle was infused into the cerebroventricle after transient middle cerebral artery occlusion. Behavioral outcomes were assessed by the Rotarod, corner, foot fault, and Morris water maze tests. Neuronal tissue loss was verified by 2 independent neuron markers. Markers of classically activated (M1) and alternatively activated (M2) microglia were assessed by real-time polymerase chain reaction, immunofluorescence, and flow cytometry. RESULTS Loss of IL-4 exacerbated sensorimotor deficits and impaired cognitive functions ≤21 days post injury. In contrast to the delayed deterioration of neurological functions, IL-4 deficiency increased neuronal tissue loss only in the acute phase (5 days) after stroke and had no impact on neuronal tissue loss 14 or 21 days post injury. Loss of IL-4 promoted expression of M1 microglia/macrophage markers and impaired expression of M2 markers at 5 and 14 days post injury. Administration of IL-4 into the ischemic brain also enhanced long-term functional recovery. CONCLUSIONS The cytokine IL-4 improves long-term neurological outcomes after stroke, perhaps through M2 phenotype induction in microglia/macrophages. These results are the first to suggest that immunomodulation with IL-4 is a promising approach to promote long-term functional recovery after stroke.
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Affiliation(s)
- Xiangrong Liu
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Jia Liu
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Shangfeng Zhao
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Haiyue Zhang
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Wei Cai
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Mengfei Cai
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Xunming Ji
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Rehana K Leak
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Yanqin Gao
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Jun Chen
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.)
| | - Xiaoming Hu
- From the Department of Neurology, University of Pittsburgh School of Medicine, PA (X.L., S.Z., H.Z., W.C., J.C., X.H.); Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing, P.R. China (X.L., X.J.); State Key Laboratory of Medical Neurobiology, Institute of Brain Sciences, Fudan University, Shanghai, China (J.L., M.C., Y.G., J.C., X.H.); Division of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA (R.K.L.); and Geriatric Research, Educational and Clinical Center, Veterans Affairs Pittsburgh Health Care System, PA (J.C., X.H.).
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152
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Zhou BC, Liu LJ, Liu B. Neuroprotection of hyperbaric oxygen therapy in sub-acute traumatic brain injury: not by immediately improving cerebral oxygen saturation and oxygen partial pressure. Neural Regen Res 2016; 11:1445-1449. [PMID: 27857747 PMCID: PMC5090846 DOI: 10.4103/1673-5374.191218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Although hyperbaric oxygen (HBO) therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury (TBI), the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation (rSO2) and oxygen partial pressure (PaO2). To test this idea, we compared two groups: a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment. rSO2 levels in the patients did not differ significantly after treatment, but levels before and after treatment were significantly lower than those in the control group. PaO2 levels were significantly decreased after the 30-minute HBO treatment. Our findings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.
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Affiliation(s)
- Bao-Chun Zhou
- Department of Emergency and Intensive Care Unit, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Li-Jun Liu
- Department of Emergency and Intensive Care Unit, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Bing Liu
- Department of Neurosurgery, High-tech District Branch of the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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153
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Yan F, Yue W, Zhang YL, Mao GC, Gao K, Zuo ZX, Zhang YJ, Lu H. Chitosan-collagen porous scaffold and bone marrow mesenchymal stem cell transplantation for ischemic stroke. Neural Regen Res 2015; 10:1421-6. [PMID: 26604902 PMCID: PMC4625507 DOI: 10.4103/1673-5374.163466] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In this study, we successfully constructed a composite of bone marrow mesenchymal stem cells and a chitosan-collagen scaffold in vitro, transplanted either the composite or bone marrow mesenchymal stem cells alone into the ischemic area in animal models, and compared their effects. At 14 days after co-transplantation of bone marrow mesenchymal stem cells and the hitosan-collagen scaffold, neurological function recovered noticeably. Vascular endothelial growth factor expression and nestin-labeled neural precursor cells were detected in the ischemic area, surrounding tissue, hippocampal dentate gyrus and subventricular zone. Simultaneously, a high level of expression of glial fibrillary acidic protein and a low level of expression of neuron-specific enolase were visible in BrdU-labeled bone marrow mesenchymal stem cells. These findings suggest that transplantation of a composite of bone marrow mesenchymal stem cells and a chitosan-collagen scaffold has a neuroprotective effect following ischemic stroke.
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Affiliation(s)
- Feng Yan
- Department of Neurosurgery, the Third Affiliated Hospital of Xi'an Jiaotong University; Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China ; Department of Neurosurgery, the Fourth People's Hospital of Shaanxi, Xi'an, Shaanxi Province, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yue-Lin Zhang
- Department of Neurosurgery, the Third Affiliated Hospital of Xi'an Jiaotong University; Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
| | - Guo-Chao Mao
- Department of Neurosurgery, the Third Affiliated Hospital of Xi'an Jiaotong University; Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
| | - Ke Gao
- Department of Neurosurgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zhen-Xing Zuo
- Department of Neurosurgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Ya-Jing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Hui Lu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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154
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Gao X, Zhao Y, Stemmer-Rachamimov AO, Liu H, Huang P, Chin S, Selig MK, Plotkin SR, Jain RK, Xu L. Anti-VEGF treatment improves neurological function and augments radiation response in NF2 schwannoma model. Proc Natl Acad Sci U S A 2015; 112:14676-81. [PMID: 26554010 DOI: 10.1073/pnas.1512570112] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Hearing loss is the main limitation of radiation therapy for vestibular schwannoma (VS), and identifying treatment options that minimize hearing loss are urgently needed. Treatment with bevacizumab is associated with tumor control and hearing improvement in neurofibromatosis type 2 (NF2) patients; however, its effect is not durable and its mechanism of action on nerve function is unknown. We modeled the effect anti-VEGF therapy on neurological function in the sciatic nerve model and found that it improves neurological function by alleviating tumor edema, which may further improve results by decreasing muscle atrophy and increasing nerve regeneration. Using a cranial window model, we showed that anti-VEGF treatment may achieve these effects via normalizing the tumor vasculature, improving vessel perfusion, and delivery of oxygenation. It is known that oxygen is a potent radiosensitizer; therefore, we further demonstrated that combining anti-VEGF with radiation therapy can achieve a better tumor control and help lower the radiation dose and, thus, minimize radiation-related neurological toxicity. Our results provide compelling rationale for testing combined therapy in human VS.
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155
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Xiang YX, Wang WX, Xue Z, Zhu L, Wang SB, Sun ZH. Electrical stimulation of the vagus nerve protects against cerebral ischemic injury through an anti-infammatory mechanism. Neural Regen Res 2015; 10:576-82. [PMID: 26170817 PMCID: PMC4424749 DOI: 10.4103/1673-5374.155430] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/17/2022] Open
Abstract
Vagus nerve stimulation exerts protective effects against ischemic brain injury; however, the underlying mechanisms remain unclear. In this study, a rat model of focal cerebral ischemia was established using the occlusion method, and the right vagus nerve was given electrical stimulation (constant current of 0.5 mA; pulse width, 0.5 ms; frequency, 20 Hz; duration, 30 seconds; every 5 minutes for a total of 60 minutes) 30 minutes, 12 hours, and 1, 2, 3, 7 and 14 days after surgery. Electrical stimulation of the vagus nerve substantially reduced infarct volume, improved neurological function, and decreased the expression levels of tumor necrosis factor-α and interleukin-6 in rats with focal cerebral ischemia. The experimental findings indicate that the neuroprotective effect of vagus nerve stimulation following cerebral ischemia may be associated with the inhibition of tumor necrosis factor-α and interleukin-6 expression.
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Affiliation(s)
- Yao-Xian Xiang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Wen-Xin Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhe Xue
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Lei Zhu
- Department of Radiology, Beijing Electric Power Hospit, Beijng, China
| | - Sheng-Bao Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zheng-Hui Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
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156
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Smits A, Zetterling M, Lundin M, Melin B, Fahlström M, Grabowska A, Larsson EM, Berntsson SG. Neurological Impairment Linked with Cortico-Subcortical Infiltration of Diffuse Low-Grade Gliomas at Initial Diagnosis Supports Early Brain Plasticity. Front Neurol 2015. [PMID: 26113841 DOI: 10.3389/fneur.2015.00137.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diffuse low-grade gliomas (DLGG) are slow-growing brain tumors that in spite of an indolent behavior at onset show a continuous expansion over time and inevitably transform into malignant gliomas. Extensive tumor resections may be performed with preservation of neurological function due to neuroplasticity that is induced by the slow tumor growth. However, DLGG prefer to migrate along subcortical pathways, and white matter plasticity is considerably more limited than gray matter plasticity. Whether signs of functional decompensating white matter that may be found as early as at disease presentation has not been systematically studied. Here, we examined 52 patients who presented with a DLGG at the time of radiological diagnosis. We found a significant correlation between neurological impairment and eloquent cortico-subcortical tumor localization, but not between neurological function and tumor volume. These results suggest that even small tumors invading white matter pathways may lack compensatory mechanisms for functional reorganization already at disease presentation.
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Affiliation(s)
- Anja Smits
- Department of Neuroscience, Neurology, University Hospital , Uppsala , Sweden ; Department of Neurology, Danish Epilepsy Center , Dianalund , Denmark
| | - Maria Zetterling
- Department of Neuroscience, Neurosurgery, University Hospital , Uppsala , Sweden
| | - Margareta Lundin
- Department of Neuroradiology, University Hospital , Örebro , Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Umeå University , Umeå , Sweden
| | - Markus Fahlström
- Department of Radiology, Oncology and Radiotherapy, Radiology, University Hospital , Uppsala , Sweden
| | - Anna Grabowska
- Department of Radiology, Oncology and Radiotherapy, Radiology, University Hospital , Uppsala , Sweden
| | - Elna-Marie Larsson
- Department of Radiology, Oncology and Radiotherapy, Radiology, University Hospital , Uppsala , Sweden
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157
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Smits A, Zetterling M, Lundin M, Melin B, Fahlström M, Grabowska A, Larsson EM, Berntsson SG. Neurological Impairment Linked with Cortico-Subcortical Infiltration of Diffuse Low-Grade Gliomas at Initial Diagnosis Supports Early Brain Plasticity. Front Neurol 2015; 6:137. [PMID: 26113841 PMCID: PMC4462100 DOI: 10.3389/fneur.2015.00137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/28/2015] [Indexed: 11/18/2022] Open
Abstract
Diffuse low-grade gliomas (DLGG) are slow-growing brain tumors that in spite of an indolent behavior at onset show a continuous expansion over time and inevitably transform into malignant gliomas. Extensive tumor resections may be performed with preservation of neurological function due to neuroplasticity that is induced by the slow tumor growth. However, DLGG prefer to migrate along subcortical pathways, and white matter plasticity is considerably more limited than gray matter plasticity. Whether signs of functional decompensating white matter that may be found as early as at disease presentation has not been systematically studied. Here, we examined 52 patients who presented with a DLGG at the time of radiological diagnosis. We found a significant correlation between neurological impairment and eloquent cortico-subcortical tumor localization, but not between neurological function and tumor volume. These results suggest that even small tumors invading white matter pathways may lack compensatory mechanisms for functional reorganization already at disease presentation.
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Affiliation(s)
- Anja Smits
- Department of Neuroscience, Neurology, University Hospital , Uppsala , Sweden ; Department of Neurology, Danish Epilepsy Center , Dianalund , Denmark
| | - Maria Zetterling
- Department of Neuroscience, Neurosurgery, University Hospital , Uppsala , Sweden
| | - Margareta Lundin
- Department of Neuroradiology, University Hospital , Örebro , Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Umeå University , Umeå , Sweden
| | - Markus Fahlström
- Department of Radiology, Oncology and Radiotherapy, Radiology, University Hospital , Uppsala , Sweden
| | - Anna Grabowska
- Department of Radiology, Oncology and Radiotherapy, Radiology, University Hospital , Uppsala , Sweden
| | - Elna-Marie Larsson
- Department of Radiology, Oncology and Radiotherapy, Radiology, University Hospital , Uppsala , Sweden
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158
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Vinik EJ, Vinik AI, Paulson JF, Merkies ISJ, Packman J, Grogan DR, Coelho T. Norfolk QOL-DN: validation of a patient reported outcome measure in transthyretin familial amyloid polyneuropathy. J Peripher Nerv Syst 2015; 19:104-14. [PMID: 24738700 DOI: 10.1111/jns5.12059] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/27/2014] [Accepted: 03/19/2014] [Indexed: 11/30/2022]
Abstract
The Norfolk Quality of Life-Diabetic Neuropathy (QOL-DN) questionnaire is an instrument to assess QOL in diabetic polyneuropathy. The objective of this observational, cross-sectional study in 61 patients with V30M transthyretin familial amyloid polyneuropathy (TTR-FAP) and 16 healthy volunteers was to validate the Norfolk QOL-DN for assessment of QOL in TTR-FAP. Comparisons were conducted to identify the best items to discriminate disease stages and assess which individual Norfolk domains (symptoms, large fiber, small fiber, autonomic, and activities of daily living) would be most affected by disease stage. Analysis of individual items revealed a significant pattern of discrimination among disease stages (p < 0.001). Total QOL scores increased (indicating worsening) with duration of symptoms, with a steeper increase observed earlier in the course of disease. Significant correlations were observed between each Norfolk domain and other measures of neurological function. Limitations include cross-sectional study design, low patient numbers in this rare disease, and the ordinal-based character of the metric used; future areas to explore include item response theory approaches such as Rasch analysis. These results suggest the Norfolk QOL-DN is a reliable indicator of the impact of disease severity on QOL in patients with TTR-FAP.
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Affiliation(s)
- Etta J Vinik
- Eastern Virginia Medical School, Strelitz Diabetes Center, Norfolk, VA, USA
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159
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Wang C, Fei Y, Xu C, Zhao Y, Pan Y. Bone marrow mesenchymal stem cells ameliorate neurological deficits and blood-brain barrier dysfunction after intracerebral hemorrhage in spontaneously hypertensive rats. Int J Clin Exp Pathol 2015; 8:4715-4724. [PMID: 26191161 PMCID: PMC4503033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is a common and fatal subtype of stroke, with hypertension the most common cause of this disorder. Bone marrow derived mesenchymal stem cells (BM-MSCs) have been shown to elicit protective properties in stroke models. In the present study, male spontaneously hypertensive rats (SHR) were subjected to ICH by intracerebral injection with autologous blood, Wistar-Kyoto (WKY) rats were employed as control. The neurological function outcomes and blood-brain barrier (BBB) were assessed after BM-MSCs transplantation. Our results showed that BM-MSCs grafts via the tail vein significantly decreased the modified neurological severity score (mNSS) and the modified limb placing test (MLPT) score at 14 days after ICH, and the scores were gradually lowered till the end of test. Furthermore, BM-MSCs transplantation effectively attenuated the BBB permeability compared with the vehicle only group, as evidenced by the low level of Evans blue leakage in the BM-MSC group. In addition, we found that BM-MSCs grafts elevated the levels of tight junction associated protein occludin, and type IV collagen. Taken together, our results suggest that intravenously transplanted BM-MSCs exert therapeutic effects on ICH in spontaneously hypertensive rats. The underlying mechanisms are associated with the enhanced neurological function recovery and increased integrity of BBB. Our results provide the increased understanding of the underlying mechanisms and perspective of BMSCs in treatment for stroke.
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Affiliation(s)
- Chunyan Wang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical UniversityHarbin 150001, People’s Republic of China
| | - Yiping Fei
- Hematologic Cancer Center, The First Affiliated Hospital of Harbin Medical UniversityHarbin 150001, People’s Republic of China
| | - Congshu Xu
- Department of Neurology, The First Affiliated Hospital of Harbin Medical UniversityHarbin 150001, People’s Republic of China
| | - Yue Zhao
- Department of Neurology, Harbin Second HospitalHarbin 150026, People’s Republic of China
| | - Yujun Pan
- Department of Neurology, The First Affiliated Hospital of Harbin Medical UniversityHarbin 150001, People’s Republic of China
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160
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Xie JB, Zhang X, Li QH, Xu ZJ. Inhibition of inflammatory cytokines after early decompression may mediate recovery of neurological function in rats with spinal cord injury. Neural Regen Res 2015; 10:219-24. [PMID: 25883619 PMCID: PMC4392668 DOI: 10.4103/1673-5374.152374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/04/2022] Open
Abstract
A variety of inflammatory cytokines are involved in spinal cord injury and influence the recovery of neuronal function. In the present study, we established a rat model of acute spinal cord injury by cerclage. The cerclage suture was released 8 or 72 hours later, to simulate decompression surgery. Neurological function was evaluated behaviorally for 3 weeks after surgery, and tumor necrosis factor α immunoreactivity and apoptosis were quantified in the region of injury. Rats that underwent decompression surgery had significantly weaker immunoreactivity of tumor necrosis factor α and significantly fewer apoptotic cells, and showed faster improvement of locomotor function than animals in which decompression surgery was not performed. Decompression at 8 hours resulted in significantly faster recovery than that at 72 hours. These data indicate that early decompression may improve neurological function after spinal cord injury by inhibiting the expression of tumor necrosis factor α.
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Affiliation(s)
- Jia-Bing Xie
- Department of Trauma Orthopedics, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu, Anhui Province, China
| | - Xin Zhang
- Department of Trauma Orthopedics, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu, Anhui Province, China
| | - Quan-Hui Li
- Department of Trauma Orthopedics, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu, Anhui Province, China
| | - Zhu-Jun Xu
- Department of Trauma Orthopedics, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu, Anhui Province, China
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161
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Bai L, Wang TB, Wang X, Zhang WW, Xu JH, Cai XM, Zhou DY, Cai LB, Pan JD, Tian MT, Chen H, Zhang DY, Fu ZG, Zhang PX, Jiang BG. Use of nerve elongator to repair short-distance peripheral nerve defects: a prospective randomized study. Neural Regen Res 2015; 10:79-83. [PMID: 25788924 PMCID: PMC4357122 DOI: 10.4103/1673-5374.150710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/04/2022] Open
Abstract
Repair techniques for short-distance peripheral nerve defects, including adjacent joint flexion to reduce the distance between the nerve stump defects, "nerve splint" suturing, and nerve sleeve connection, have some disadvantages. Therefore, we designed a repair technique involving intraoperative tension-free application of a nerve elongator and obtained good outcomes in the repair of short-distance peripheral nerve defects in a previous animal study. The present study compared the clinical outcomes between the use of this nerve elongator and performance of the conventional method in the repair of short-distance transection injuries in human elbows. The 3-, 6-, and 12-month postoperative follow-up results demonstrated that early neurological function recovery was better in the nerve elongation group than in the conventional group, but no significant difference in long-term neurological function recovery was detected between the two groups. In the nerve elongation group, the nerves were sutured without tension, and the duration of postoperative immobilization of the elbow was decreased. Elbow function rehabilitation was significantly better in the nerve elongation group than in the control group. Moreover, there were no security risks. The results of this study confirm that the use of this nerve elongator for repair of short-distance peripheral nerve defects is safe and effective.
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Affiliation(s)
- Lu Bai
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Tian-Bing Wang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Xin Wang
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Wei-Wen Zhang
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Ji-Hai Xu
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Xiao-Ming Cai
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Dan-Ya Zhou
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Li-Bing Cai
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Jia-Dong Pan
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Min-Tao Tian
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Hong Chen
- Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Dian-Ying Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Zhong-Guo Fu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
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Lee S, Shin J, Lee M, Hong Y, Lee SK, Lee Y, Lkhagvasuren T, Kim DW, Yang YA, Chang KT, Hong Y. Melatonin combined with exercise cannot alleviate cerebral injury in a rat model of focal cerebral ischemia/reperfusion injury. Neural Regen Res 2015; 7:993-9. [PMID: 25722687 PMCID: PMC4341280 DOI: 10.3969/j.issn.1673-5374.2012.13.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/30/2012] [Indexed: 11/18/2022] Open
Abstract
Previous studies have demonstrated that melatonin combined with exercise can alleviate secondary damage after spinal cord injury in rats. Therefore, it is hypothesized that melatonin combined with exercise can also alleviate ischemic brain damage. In this study, adult rats were subjected to right middle cerebral artery occlusion after receiving 10 mg/kg melatonin or vehicle subcutaneously twice daily for 14 days. Forced exercise using an animal treadmill was performed at 20 m/min for 30 minutes per day for 6 days prior to middle cerebral artery occlusion. After middle cerebral artery occlusion, each rat received melatonin combined with exercise, melatonin or exercise alone equally for 7 days until sacrifice. Interestingly, rats receiving melatonin combined with exercise exhibited more severe neurological deficits than those receiving melatonin or exercise alone. Hypoxia-inducible factor 1α mRNA in the brain tissue was upregulated in rats receiving melatonin combined with exercise. Similarly, microtubule associated protein-2 mRNA expression was significantly upregulated in rats receiving melatonin alone. Chondroitin sulfate proteoglycan 4 (NG2) mRNA expression was significantly decreased in rats receiving melatonin combined with exercise as well as in rats receiving exercise alone. Furthermore, neural cell loss in the primary motor cortex was significantly reduced in rats receiving melatonin or exercise alone, but the change was not observed in rats receiving melatonin combined with exercise. These findings suggest that excessive intervention with melatonin, exercise or their combination may lead to negative effects on ischemia/reperfusion-induced brain damage.
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Affiliation(s)
- Seunghoon Lee
- Department of Rehabilitation Science in Interdisciplinary Ph.D. Program, Inje University, Gimhae 621-749, Republic of Korea
| | - Jinhee Shin
- Cardiovascular & Metabolic Disease Center, College of Biomedical Science & Engineering, Gimhae 621-749, Republic of Korea
| | - Minkyung Lee
- Department of Rehabilitation Science in Interdisciplinary Ph.D. Program, Inje University, Gimhae 621-749, Republic of Korea
| | - Yunkyung Hong
- Department of Rehabilitation Science in Interdisciplinary Ph.D. Program, Inje University, Gimhae 621-749, Republic of Korea
| | - Sang-Kil Lee
- Cardiovascular & Metabolic Disease Center, College of Biomedical Science & Engineering, Gimhae 621-749, Republic of Korea
| | - Youngjeon Lee
- Department of Rehabilitation Science in Interdisciplinary Ph.D. Program, Inje University, Gimhae 621-749, Republic of Korea
| | - Tserentogtokh Lkhagvasuren
- Department of Smart Foods & Drugs, School of Food & Life Sciences, Inje University, Gimhae 621-749, Republic of Korea
| | - Dong-Wook Kim
- Department of Pharmaceutical Engineering, College of Engineering, Inje University, Gimhae 621-749, Republic of Korea
| | - Young-Ae Yang
- Department of Rehabilitation Science in Interdisciplinary Ph.D. Program, Inje University, Gimhae 621-749, Republic of Korea
| | - Kyu-Tae Chang
- National Primate Research Center, Korea Research Institute of Biotechnology, Ochang 363-883, Republic of Korea
| | - Yonggeun Hong
- Department of Rehabilitation Science in Interdisciplinary Ph.D. Program, Inje University, Gimhae 621-749, Republic of Korea ; Cardiovascular & Metabolic Disease Center, College of Biomedical Science & Engineering, Gimhae 621-749, Republic of Korea ; National Primate Research Center, Korea Research Institute of Biotechnology, Ochang 363-883, Republic of Korea
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163
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Wang D, Liang J, Zhang J, Liu S, Sun W. Mild hypothermia combined with a scaffold of NgR-silenced neural stem cells/Schwann cells to treat spinal cord injury. Neural Regen Res 2015; 9:2189-96. [PMID: 25657741 PMCID: PMC4316453 DOI: 10.4103/1673-5374.147952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/24/2022] Open
Abstract
Because the inhibition of Nogo proteins can promote neurite growth and nerve cell differentiation, a cell-scaffold complex seeded with Nogo receptor (NgR)-silenced neural stem cells and Schwann cells may be able to improve the microenvironment for spinal cord injury repair. Previous studies have found that mild hypothermia helps to attenuate secondary damage in the spinal cord and exerts a neuroprotective effect. Here, we constructed a cell-scaffold complex consisting of a poly(D,L-lactide-co-glycolic acid) (PLGA) scaffold seeded with NgR-silenced neural stem cells and Schwann cells, and determined the effects of mild hypothermia combined with the cell-scaffold complexes on the spinal cord hemi-transection injury in the T9 segment in rats. Compared with the PLGA group and the NgR-silencing cells + PLGA group, hindlimb motor function and nerve electrophysiological function were clearly improved, pathological changes in the injured spinal cord were attenuated, and the number of surviving cells and nerve fibers were increased in the group treated with the NgR-silenced cell scaffold + mild hypothermia at 34°C for 6 hours. Furthermore, fewer pathological changes to the injured spinal cord and more surviving cells and nerve fibers were found after mild hypothermia therapy than in injuries not treated with mild hypothermia. These experimental results indicate that mild hypothermia combined with NgR gene-silenced cells in a PLGA scaffold may be an effective therapy for treating spinal cord injury.
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Affiliation(s)
- Dong Wang
- Department of Neurosurgery, the Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Central Hospital, Tianjin, China
| | - Jinhua Liang
- Department of Clinical Detection, Hongqi Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang Province, China
| | - Jianjun Zhang
- Department of Neurosurgery, the Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Central Hospital, Tianjin, China
| | - Shuhong Liu
- Department of Epidemiology, Logistics University of People's Armed Police Force, Tianjin, China
| | - Wenwen Sun
- Department of Neurosurgery, the Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Central Hospital, Tianjin, China
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164
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Que J, Cao Q, Sui T, Du S, Zhang A, Kong D, Cao X. Tacrolimus reduces scar formation and promotes sciatic nerve regeneration. Neural Regen Res 2014; 7:2500-6. [PMID: 25337101 PMCID: PMC4200705 DOI: 10.3969/j.issn.1673-5374.2012.32.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/20/2012] [Indexed: 01/01/2023] Open
Abstract
A sciatic nerve transection and repair model was established in Sprague-Dawley rats by transecting the tendon of obturator internus muscle in the greater sciatic foramen and suturing with nylon sutures. The models were treated with tacrolimus gavage (4 mg/kg per day) for 0, 2, 4 and 6 weeks. Specimens were harvested at 6 weeks of intragastric administration. Masson staining revealed that the collagen fiber content and scar area in the nerve anastomosis of the sciatic nerve injury rats were significantly reduced after tacrolimus administration. Hematoxylin-eosin staining showed that tacrolimus significantly increased myelinated nerve fiber density, average axon diameter and myelin sheath thickness. Intragastric administration of tacrolimus also led to a significant increase in the recovery rate of gastrocnemius muscle wet weight and the sciatic functional index after sciatic nerve injury. The above indices were most significantly improved at 6 weeks after of tacrolimus gavage. The myelinated nerve fiber density in the nerve anastomosis and the sciatic nerve functions had a significant negative correlation with the scar area, as detected by Spearman’s rank correlation analysis. These findings indicate that tacrolimus can promote peripheral nerve regeneration and accelerate the recovery of neurological function through the reduction of scar formation.
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Affiliation(s)
- Jun Que
- Intensive Care Unit, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Quan Cao
- Intensive Care Unit, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Shihao Du
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ailiang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Dechao Kong
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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165
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Hu W, Liu D, Zhang Y, Shen Z, Gu T, Gu X, Gu J. Neurological function following intra-neural injection of fluorescent neuronal tracers in rats. Neural Regen Res 2014; 8:1253-61. [PMID: 25206419 PMCID: PMC4107650 DOI: 10.3969/j.issn.1673-5374.2013.14.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/22/2013] [Indexed: 12/18/2022] Open
Abstract
Fluorescent neuronal tracers should not be toxic to the nervous system when used in long-term labeling. Previous studies have addressed tracer toxicity, but whether tracers injected into an intact nerve result in functional impairment remains to be elucidated. In the present study, we examined the functions of motor, sensory and autonomic nerves following the application of 5% Fluoro-Gold, 4% True Blue and 10% Fluoro-Ruby (5 μL) to rat tibial nerves via pressure injection. A set of evaluation methods including walking track analysis, plantar test and laser Doppler perfusion imaging was used to determine the action of the fluorescent neuronal tracers. Additionally, nerve pathology and ratio of muscle wet weight were also observed. Results showed that injection of Fluoro-Gold significantly resulted in loss of motor nerve function, lower plantar sensibility, increasing blood flow volume and higher neurogenic vasodilatation. Myelinated nerve fiber degeneration, unclear boundaries in nerve fibers and high retrograde labeling efficacy were observed in the Fluoro-Gold group. The True Blue group also showed obvious neurogenic vasodilatation, but less severe loss of motor function and degeneration, and fewer labeled motor neurons were found compared with the Fluoro-Gold group. No anomalies of motor and sensory nerve function and no myelinated nerve fiber degeneration were observed in the Fluoro-Ruby group. Experimental findings indicate that Fluoro-Gold tracing could lead to significant functional impairment of motor, sensory and autonomic nerves, while functional impairment was less severe following True Blue tracing. Fluoro-Ruby injection appears to have no effect on neurological function.
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Affiliation(s)
- Wen Hu
- School of Biology and Basic Medical Sciences, Soochow University, Suzhou 215123, Jiangsu Province, China ; Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Dan Liu
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China ; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yanping Zhang
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China ; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhongyi Shen
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China ; School of Medicine, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Tianwen Gu
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China ; School of Medicine, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Xiaosong Gu
- School of Biology and Basic Medical Sciences, Soochow University, Suzhou 215123, Jiangsu Province, China ; Jiangsu Key Laboratory of Neuroregeneration, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jianhui Gu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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166
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Yao L, He C, Zhao Y, Wang J, Tang M, Li J, Wu Y, Ao L, Hu X. Human umbilical cord blood stem cell transplantation for the treatment of chronic spinal cord injury: Electrophysiological changes and long-term efficacy. Neural Regen Res 2014; 8:397-403. [PMID: 25206680 PMCID: PMC4146127 DOI: 10.3969/j.issn.1673-5374.2013.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/08/2013] [Indexed: 02/06/2023] Open
Abstract
Stem cell transplantation can promote functional restoration following acute spinal cord injury (injury time < 3 months), but the safety and long-term efficacy of this treatment need further exploration. In this study, 25 patients with traumatic spinal cord injury (injury time > 6 months) were treated with human umbilical cord blood stem cells via intravenous and intrathecal injection. The follow-up period was 12 months after transplantation. Results found that autonomic nerve functions were restored and the latent period of somatosensory evoked potentials was reduced. There were no severe adverse reactions in patients following stem cell transplantation. These experimental findings suggest that the transplantation of human umbilical cord blood stem cells is a safe and effective treatment for patients with traumatic spinal cord injury.
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Affiliation(s)
- Liqing Yao
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Chuan He
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Ying Zhao
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Jirong Wang
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Mei Tang
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Jun Li
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Ying Wu
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Lijuan Ao
- Department of Rehabilitation, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Xiang Hu
- Shenzhen Beike Cell Engineering Research Institute, Shenzhen 518057, Guangdong Province, China
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167
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Zheng Z, Liu G, Chen Y, Wei S. Olfactory ensheathing cell transplantation improves sympathetic skin responses in chronic spinal cord injury. Neural Regen Res 2014; 8:2849-55. [PMID: 25206606 PMCID: PMC4146016 DOI: 10.3969/j.issn.1673-5374.2013.30.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/20/2013] [Indexed: 12/14/2022] Open
Abstract
Forty-three patients with chronic spinal cord injury for over 6 months were transplanted with bryonic olfactory ensheathing cells, 2-4 × 10(6), into multiple sites in the injured area under the surgical microscope. The sympathetic skin response in patients was measured with an electromyography/evoked potential instrument 1 day before transplantation and 3-8 weeks after transtion. Spinal nerve function of patients was assessed using the American Spinal Injury Association impairment scale. The sympathetic skin response was elicited in 32 cases before olfactory ensheathing cell transplantation, while it was observed in 34 cases after transplantation. tantly, sympathetic skin response latency decreased significantly and amplitude increased cantly after transplantation. Transplantation of olfactory ensheathing cells also improved American Spinal Injury Association scores for movement, pain and light touch. Our findings indicate that factory ensheathing cell transplantation improves motor, sensory and autonomic nerve functions in patients with chronic spinal cord injury.
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Affiliation(s)
- Zuncheng Zheng
- Department of Orthopedics, Taian Central Hospital, Taian 271000, Shandong Province, China
| | - Guifeng Liu
- Department of Orthopedics, Taian Central Hospital, Taian 271000, Shandong Province, China
| | - Yuexia Chen
- Department of Orthopedics, Taian Central Hospital, Taian 271000, Shandong Province, China
| | - Shugang Wei
- Department of Spine and Spinal Cord, Taian Rongjun Hospital, Taian 271000, Shandong Province, China
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168
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Zhang Z, Li F, Sun T. An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China. Neural Regen Res 2014; 8:3077-86. [PMID: 25206628 PMCID: PMC4158704 DOI: 10.3969/j.issn.1673-5374.2013.33.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/01/2013] [Indexed: 11/20/2022] Open
Abstract
This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, established from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview (one item); pre-hospital care (one item); evaluation and diagnosis (13 items); treatment (23 items); prevention and treatment of major complications (12 items); and rehabilitation (four items). This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the recommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with “1” corresponding to neutrality and “5” representing maximum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recommendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thoracolumbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.
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Affiliation(s)
- Zhicheng Zhang
- PLA Institute of Orthopedics, Beijing Army General Hospital of Chinese PLA, Beijing 100700, China
| | - Fang Li
- PLA Institute of Orthopedics, Beijing Army General Hospital of Chinese PLA, Beijing 100700, China
| | - Tiansheng Sun
- PLA Institute of Orthopedics, Beijing Army General Hospital of Chinese PLA, Beijing 100700, China
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169
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Gao H, Li X, Gao X, Ma B. Contralateral needling at unblocked collaterals for hemiplegia following acute ischemic stroke. Neural Regen Res 2014; 8:2914-22. [PMID: 25206612 PMCID: PMC4146169 DOI: 10.3969/j.issn.1673-5374.2013.31.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/06/2013] [Indexed: 11/18/2022] Open
Abstract
Hemiplegia caused by stroke indicates dysfunction of the network between the brain and limbs, namely collateral shock in the brain. Contralateral needling is the insertion of needles into acupoints on the relative healthy side of the body to treat diseases such as apoplexy. However, there is little well-designed and controlled clinical evidence for this practice. This study investigated whether contralateral needling could treat hemiplegia after acute ischemic stroke in 106 randomly selected patients with acute ischemic stroke. These patients were randomly assigned to three groups: 45 in the contralateral needling group, receiving acupuncture on the unaffected limbs; 45 in the tional acupuncture group, receiving acupuncture on the hemiplegic limbs; and 16 in the control group, receiving routine treatments without acupuncture. Acupuncture at acupoints Chize (LU5) in the upper limb and Jianliao (TE14) in the lower limb was performed for 45 minutes daily for 30 consecutive days. The therapeutic effective rate, Neurological Deficit Score, Modified Barthel Index and Fugl-Meyer Assessment were evaluated. The therapeutic effective rate of contralateral needling was higher than that of conventional acupuncture (46.67% vs. 31.11%, P < 0.05). The neurological deficit score of contralateral needling was significantly decreased compared with conventional acupuncture (P < 0.01). The Modified Barthel Index and Fugl-Meyer Assessment score of contralateral needling increased more significantly than those of conventional acupuncture (both P < 0.01). The present findings suggest that contralateral needling unblocks collaterals and might be more effective than conventional acupuncture in the treatment of hemiplegia following acute ischemic stroke.
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Affiliation(s)
- Huanmin Gao
- Department of Neurology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Xugang Li
- Department of Intensive Care Unit, People's Hospital of Rizhao City, Rizhao 276826, Shandong Province, China
| | - Xia Gao
- Department of Rehabilitation, the Second Affiliated Hospital of Qingdao University Medical College, Qingdao 266042, Shandong Province, China
| | - Benxu Ma
- Department of Rehabilitation, the Second Affiliated Hospital of Qingdao University Medical College, Qingdao 266042, Shandong Province, China
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170
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Wang D, Huang X, Fu G, Gu L, Liu X, Wang H, Hu J, Yi J, Niu X, Zhu Q. A simple model of radial nerve injury in the rhesus monkey to evaluate peripheral nerve repair. Neural Regen Res 2014; 9:1041-6. [PMID: 25206757 PMCID: PMC4146303 DOI: 10.4103/1673-5374.133166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/04/2022] Open
Abstract
Current research on bone marrow stem cell transplantation and autologous or xenogenic nerve transplantation for peripheral nerve regeneration has mainly focused on the repair of peripheral nerve defects in rodents. In this study, we established a standardized experimental model of radial nerve defects in primates and evaluated the effect of repair on peripheral nerve injury. We repaired 2.5-cm lesions in the radial nerve of rhesus monkeys by transplantation of autografts, acellular allografts, or acellular allografts seeded with autologous bone marrow stem cells. Five months after surgery, regenerated nerve tissue was assessed for function, electrophysiology, and histomorphometry. Postoperative functional recovery was evaluated by the wrist-extension test. Compared with the simple autografts, the acellular allografts and allografts seeded with bone marrow stem cells facilitated remarkable recovery of the wrist-extension functions in the rhesus monkeys. This functional improvement was coupled with radial nerve distal axon growth, a higher percentage of neuron survival, increased nerve fiber density and diameter, increased myelin sheath thickness, and increased nerve conduction velocities and peak amplitudes of compound motor action potentials. Furthermore, the quality of nerve regeneration in the bone marrow stem cells-laden allografts group was comparable to that achieved with autografts. The wrist-extension test is a simple behavioral method for objective quantification of peripheral nerve regeneration.
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Affiliation(s)
- Dong Wang
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xijun Huang
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Guo Fu
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Liqiang Gu
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xiaolin Liu
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Honggang Wang
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jun Hu
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jianhua Yi
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xiaofeng Niu
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Qingtang Zhu
- Department of Orthopedics and Microsurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Yin Y, Gu Z, Pan L, Gan L, Qin D, Yang B, Guo J, Hu X, Wang T, Feng Z. How does the motor relearning program improve neurological function of brain ischemia monkeys? Neural Regen Res 2014; 8:1445-54. [PMID: 25206440 PMCID: PMC4107808 DOI: 10.3969/j.issn.1673-5374.2013.16.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/07/2013] [Indexed: 02/05/2023] Open
Abstract
The motor relearning program can significantly improve various functional disturbance induced by ischemic cerebrovascular diseases. However, its mechanism of action remains poorly understood. In injured brain tissues, glial fibrillary acidic protein and neurofilament protein changes can reflect the condition of injured neurons and astrocytes, while vascular endothelial growth factor and basic fibroblast growth factor changes can indicate angiogenesis. In the present study, we induced ischemic brain injury in the rhesus macaque by electrocoagulation of the M1 segment of the right middle cerebral artery. The motor relearning program was conducted for 60 days from the third day after model establishment. Immunohistochemistry and single-photon emission CT showed that the numbers of glial fibrillary acidic protein-, neurofilament protein-, vascular endothelial growth factor- and basic fibroblast growth factor-positive cells were significantly increased in the infarcted side compared with the contralateral hemisphere following the motor relearning program. Moreover, cerebral blood flow in the infarcted side was significantly improved. The clinical rating scale for stroke was used to assess neurological function changes in the rhesus macaque following the motor relearning program. Results showed that motor function was improved, and problems with consciousness, self-care ability and balance function were significantly ameliorated. These findings indicate that the motor relearning program significantly promoted neuronal regeneration, repair and angiogenesis in the surroundings of the infarcted hemisphere, and improve neurological function in the rhesus macaque following brain ischemia.
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Affiliation(s)
- Yong Yin
- Department of Rehabilitation Medicine, Fourth Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China
| | - Zhen Gu
- Department of Neurosurgery, Fourth Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China
| | - Lei Pan
- Department of Rehabilitation Medicine, Fourth Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China
| | - Lu Gan
- Department of Rehabilitation Medicine, Fourth Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China
| | - Dongdong Qin
- Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan Province, China
| | - Bo Yang
- Department of Nuclear Medicine, Fourth Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China
| | - Jin Guo
- Department of Pathology, Fourth Hospital of Kunming Medical University, Kunming 650021, Yunnan Province, China
| | - Xintian Hu
- Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan Province, China
| | - Tinghua Wang
- Institute of Neuroscience, Kunming Medical University, Kunming 650500, Yunnan Province, China
| | - Zhongtang Feng
- Institute of Neuroscience, Kunming Medical University, Kunming 650500, Yunnan Province, China
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172
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Si D, Li J, Liu J, Wang X, Wei Z, Tian Q, Wang H, Liu G. Progesterone protects blood-brain barrier function and improves neurological outcome following traumatic brain injury in rats. Exp Ther Med 2014; 8:1010-1014. [PMID: 25120639 PMCID: PMC4113529 DOI: 10.3892/etm.2014.1840] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/16/2014] [Indexed: 01/01/2023] Open
Abstract
Inflammatory responses are associated with blood-brain barrier (BBB) dysfunction and neurological deficits following traumatic brain injury (TBI). The aim of the present study was to investigate the effects of progesterone on the expression of the inflammatory mediators prostaglandin E2 (PGE2), cyclooxygenase-2 (COX-2), nuclear factor κB (NF-κB) and tumor necrosis factor-α (TNF-α) in the brain, BBB permeability, cerebral edema and neurological outcome, as well as to explore the mechanism of its neuroprotective effect. In this study, male rats were randomly divided into three groups: a sham-operated group (SHAM), a TBI group (TBI) and a progesterone treatment group (TBI-PROG). The TBI model was established using a modified Feeney’s weight-dropping method. Brain samples were extracted 24 h following injury. The expression levels of COX-2 and NF-κB were examined using immunohistochemistry, whilst the expression levels of PGE2 and TNF-α were detected by enzyme-linked immunosorbent assay. BBB permeability was analyzed using Evans blue and cerebral edema was determined using the dry-wet method. The neurological outcome was evaluated using the modified neurological severity score test. The results revealed that progesterone treatment significantly reduced post-injury inflammatory response, brain edema and Evans blue dye extravasation, and improved neurological scores compared with those in the TBI group. In conclusion, the inhibition of inflammation may be an important mechanism by which progesterone protects the BBB and improves neurological outcome.
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Affiliation(s)
- Daowen Si
- School of Basic Medical Sciences, Hebei United University, Tangshan, Hebei 063000, P.R. China
| | - Juan Li
- School of Basic Medical Sciences, Hebei United University, Tangshan, Hebei 063000, P.R. China
| | - Jiang Liu
- School of Basic Medical Sciences, Hebei United University, Tangshan, Hebei 063000, P.R. China
| | - Xiaoyin Wang
- Department of Biochemistry and Molecular Biology, Xinxiang Medical College, Xinxiang, Henan 453000, P.R. China
| | - Zifeng Wei
- School of Basic Medical Sciences, Hebei United University, Tangshan, Hebei 063000, P.R. China
| | - Qingyou Tian
- School of Basic Medical Sciences, Hebei United University, Tangshan, Hebei 063000, P.R. China
| | - Haitao Wang
- School of Basic Medical Sciences, Hebei United University, Tangshan, Hebei 063000, P.R. China
| | - Gang Liu
- Department of Neurosurgery, Affiliated Hospital of Hebei United University, Tangshan, Hebei 063000, P.R. China
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173
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Li Z, Wang B, Kan Z, Zhang B, Yang Z, Chen J, Wang D, Wei H, Zhang JN, Jiang R. Progesterone increases circulating endothelial progenitor cells and induces neural regeneration after traumatic brain injury in aged rats. J Neurotrauma 2012; 29:343-53. [PMID: 21534727 PMCID: PMC3261789 DOI: 10.1089/neu.2011.1807] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Vascular remodeling plays a key role in neural regeneration in the injured brain. Circulating endothelial progenitor cells (EPCs) are a mediator of the vascular remodeling process. Previous studies have found that progesterone treatment of traumatic brain injury (TBI) decreases cerebral edema and cellular apoptosis and inhibits inflammation, which in concert promote neuroprotective effects in young adult rats. However, whether progesterone treatment regulates circulating EPC level and fosters vascular remodeling after TBI have not been investigated. In this study, we hypothesize that progesterone treatment following TBI increases circulating EPC levels and promotes vascular remodeling in the injured brain in aged rats. Male Wistar 20-month-old rats were subjected to a moderate unilateral parietal cortical contusion injury and were treated with or without progesterone (n=54/group). Progesterone was administered intraperitoneally at a dose of 16mg/kg at 1 h post-TBI and was subsequently injected subcutaneously daily for 14 days. Neurological functional tests and immnunostaining were performed. Circulating EPCs were measured by flow cytometry. Progesterone treatment significantly improved neurological outcome after TBI measured by the modified neurological severity score, Morris Water Maze and the long term potentiation in the hippocampus as well as increased the circulating EPC levels compared to TBI controls (p<0.05). Progesterone treatment also significantly increased CD34 and CD31 positive cell number and vessel density in the injured brain compared to TBI controls (p<0.05). These data indicate that progesterone treatment of TBI improves multiple neurological functional outcomes, increases the circulating EPC level, and facilitates vascular remodeling in the injured brain after TBI in aged rats.
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Affiliation(s)
- Zhanying Li
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
- Department of Neurosurgery, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Bin Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
| | - Zhisheng Kan
- Department of Neurosurgery, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Baoliang Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
| | - Zhuo Yang
- School of Medicine, Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Science, Nankai University, Tianjin, China
| | - Jieli Chen
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
| | - Huijie Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
| | - Jian-ning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital; Tianjin Neurological Institute; Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education; Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin, China
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174
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Abstract
Believe nothing that you see in the newspapers—they have done more to create dissatisfaction than all other agencies. If you see anything in them that you know is true, begin to doubt it at once (Sir William Osler).
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Affiliation(s)
- P Winstanley
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
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175
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Davis TM, Dembo LG, Kaye-Eddie SA, Hewitt BJ, Hislop RG, Batty KT. Neurological, cardiovascular and metabolic effects of mefloquine in healthy volunteers: a double-blind, placebo-controlled trial. Br J Clin Pharmacol 1996; 42:415-21. [PMID: 8904612 PMCID: PMC2042694 DOI: 10.1046/j.1365-2125.1996.04745.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
1. To assess neurological, cardiovascular, metabolic and other side-effects of mefloquine given in conventional prophylactic dose to healthy volunteers, a double-blind, randomized, placebo-controlled trial was conducted. In addition, the identity of the active drug was concealed until the end of the trial. 2. A total of 106 healthy adults were recruited, of whom 95 (mean age 24 years; 45% males) completed the full study protocol. 3. Subjects had a baseline assessment, received placebo as first dose, were randomized to mefloquine 250 mg or placebo weekly for 4 weeks starting a week later, and were reassessed after the 2nd and 4th active/placebo doses. Subjects kept a daily symptom diary from 2 weeks before until 2 weeks after the dosing period. 4. Plasma mefloquine assay suggested compliance in all 46 subjects allocated active treatment (week 5 mean +/- s.d.; 2.35 +/- 0.94 mumol l-1. Mefloquine did not alter calcium homoeostasis but produced a mean 0.5 mmol l-1 fall in serum glucose over the study period (P < 0.001) and relative hyperinsulinaemia. Symbol digit modalities, and digit forwards and backwards test scores, were similar in active and placebo groups across the three assessments, as were lying/standing blood pressure and high-tone hearing loss. Electrocardiographic QTc interval prolongation and diarrhoea were mild but transient side-effects of mefloquine (P < 0.01). Neurological symptoms were comparable in the two groups throughout the study. There was no evidence of drug toxicity in 11 subjects who withdrew. 5. Mefloquine prophylaxis does not appear to produce low-grade but debilitating neurological symptoms or to alter the results of sensitive tests of cerebral function. However, there may be situations in which mefloquine might contribute to hypoglycaemia and cardiac dysrhythmias.
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Affiliation(s)
- T M Davis
- University of Western Australia, Department of Medicine, Fremantle Hospital, Western Australia
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