Nanotechnology approaches for the regeneration and neuroprotection of the central nervous system

Nanotechnology is the science and engineering concerned with the design, synthesis, and characterization of materials and devices that have a functional organization in at least 1 dimension on the nanometer (ie, one-billionth of a meter) scale. The ability to manipulate and control engineered self-assembling (ie, self-organizing) substrates at these scales produces macroscopic physical and/or chemical properties in the bulk material not possessed by the constituent building block molecules alone. This in turn results in a degree of functional integration between the engineered substrates and cellular or physiological systems not previously attainable. Applied nanotechnology aimed at the regeneration and neuroprotection of the central nervous system (CNS) will significantly benefit from basic nanotechnology research conducted in parallel with advances in cell biology, neurophysiology, and neuropathology. Ultimately the goal is to develop novel technologies that directly or indirectly aid in providing neuroprotection and/or a permissive environment and active signaling cues for guided axon growth. In some cases, it is expected that the neurosurgeon will be required to administer these substrates to the patient. As such, in order for nanotechnology applications directed toward neurological disorders to develop to their fullest potential, it will be important for neuroscientists, neurosurgeons, and neurologists to participate and contribute to the scientific process alongside physical science and engineering colleagues. This review will focus on emerging clinical applications aimed at the regeneration and neuroprotection of the injured CNS, and discuss other platform technologies that have a significant potential for being adapted for clinical neuroscience applications.

Neurological complications in renal failure: a review

Neurological complications whether due to the uremic state or its treatment, contribute largely to the morbidity and mortality in patients with renal failure. Despite continuous therapeutic advances, many neurological complications of uremia, like uremic encephalopathy, atherosclerosis, neuropathy and myopathy fail to fully respond to dialysis. Moreover, dialytic therapy or kidney transplantation may even induce neurological complications. Dialysis can directly or indirectly be associated with dialysis dementia, dysequilibrium syndrome, aggravation of atherosclerosis, cerebrovascular accidents due to ultrafiltration-related arterial hypotension, hypertensive encephalopathy, Wernicke's encephalopathy, hemorrhagic stroke, subdural hematoma, osmotic myelinolysis, opportunistic infections, intracranial hypertension and mononeuropathy. Renal transplantation itself can give rise to acute femoral neuropathy, rejection encephalopathy and neuropathy in graft versus host disease. The use of immunosuppressive drugs after renal transplantation can cause encephalopathy, movement disorders, opportunistic infections, neoplasms, myopathy and progression of atherosclerosis. We address the clinical, pathophysiological and therapeutical aspects of both central and peripheral nervous system complications in uremia.

Detection and prevention of neurologic injury in the intensive care unit

Survivors of repairs of complex congenital cardiac malformations in infancy have an increased risk of permanent abnormalities in motor, cognitive, expressive, and behavioral functioning. These functional deficits are expressions of complex interactions of environment, including prolonged hospitalization and conditioned child–parental behaviours, alterations of social environment, the effects of physical limitations, biological influences including genetic determinants, prenatal injury, and acquired reversible and irreversible neuronal injury.1,2 The magnitude of the problem is large, with incidence dependent upon the measures used for assessment. Overt postoperative neurologic signs have been recorded in up to one-tenth of postoperative infants and children, with double that rate found in those with abnormalities of the aortic arch.3 A decreased potential for development, based upon parent-sibling models, has been estimated to occur in one-third of survivors.4,5 Evidence of injury is provided by magnetic resonance imaging in up to one-third of patients preoperatively, and between half and nine-tenths postoperatively, although most of these early postoperative changes will disappear.5 Although recent changes in perioperative management are likely to reduce such neurologic injury, their significance remains high.

Mild intraoperative hypothermia during surgery for intracranial aneurysm

BACKGROUND

Surgery for intracranial aneurysm often results in postoperative neurologic deficits. We conducted a randomized trial at 30 centers to determine whether intraoperative cooling during open craniotomy would improve the outcome among patients with acute aneurysmal subarachnoid hemorrhage.

METHODS

A total of 1001 patients with a preoperative World Federation of Neurological Surgeons score of I, II, or III ("good-grade patients"), who had had a subarachnoid hemorrhage no more than 14 days before planned surgical aneurysm clipping, were randomly assigned to intraoperative hypothermia (target temperature, 33 degrees C, with the use of surface cooling techniques) or normothermia (target temperature, 36.5 degrees C). Patients were followed closely postoperatively and examined approximately 90 days after surgery, at which time a Glasgow Outcome Score was assigned.

RESULTS

There were no significant differences between the group assigned to intraoperative hypothermia and the group assigned to normothermia in the duration of stay in the intensive care unit, the total length of hospitalization, the rates of death at follow-up (6 percent in both groups), or the destination at discharge (home or another hospital, among surviving patients). At the final follow-up, 329 of 499 patients in the hypothermia group had a Glasgow Outcome Score of 1 (good outcome), as compared with 314 of 501 patients in the normothermia group (66 percent vs. 63 percent; odds ratio, 1.14; 95 percent confidence interval, 0.88 to 1.48; P=0.32). Postoperative bacteremia was more common in the hypothermia group than in the normothermia group (5 percent vs. 3 percent, P=0.05).

CONCLUSIONS

Intraoperative hypothermia did not improve the neurologic outcome after craniotomy among good-grade patients with aneurysmal subarachnoid hemorrhage.

Calculation of magnetic field-induced current densities for humans from EAS countertop activation/deactivation devices that use ferromagnetic cores

Compliance testing of electronic article surveillance (EAS) devices requires that induced current densities in central nervous system (CNS) tissues, i.e. brain and the spinal cord, be less than the prescribed safety limits. Even though ferromagnetic cores are mostly used for activation/deactivation of embedded magnetic tags, assumed equivalent air-core coils with guessed increased number of ampere turns have always been used to calculate the magnetic fields for the proximal region to which a customer is exposed. We show that at low frequencies up to several kilohertz, duality of electric and magnetic circuits may be exploited such that the shaped high reluctance core is modelled as though it was a higher conductivity electric circuit of the corresponding shape. The proposed procedure is tested by examples of two magnetic cores typical of countertop activation/deactivation devices. The equivalent exposure magnetic fields obtained from the dual electric fields are shown to be in excellent agreement (within +/-5%) with those measured for these ferromagnetic EAS devices. The previously proposed impedance method is then used to calculate the induced current densities for a 1.974 x 1.974 x 2.93 mm resolution anatomic model of a human. For the two considered EAS systems using excitation currents of 5000 A turns at 200 Hz, the maximum 1 cm2 area-averaged induced current densities in the CNS tissues are calculated and found to be less than the ICNIRP safety limits.

Metallothionein reduces central nervous system inflammation, neurodegeneration, and cell death following kainic acid-induced epileptic seizures

We examined metallothionein (MT)-induced neuroprotection during kainic acid (KA)-induced excitotoxicity by studying transgenic mice with MT-I overexpression (TgMT mice). KA induces epileptic seizures and hippocampal excitotoxicity, followed by inflammation and delayed brain damage. We show for the first time that even though TgMT mice were more susceptible to KA, the cerebral MT-I overexpression decreases the hippocampal inflammation and delayed neuronal degeneration and cell death as measured 3 days after KA administration. Hence, the proinflammatory responses of microglia/macrophages and lymphocytes and their expression of interleukin (IL)-1, IL-6, IL-12, tumor necrosis factor-alpha and matrix metalloproteinases (MMP-3, MMP-9) were significantly reduced in hippocampi of TgMT mice relative to wild-type mice. Also by 3 days after KA, the TgMT mice showed significantly less delayed damage, such as oxidative stress (formation of nitrotyrosine, malondialdehyde, and 8-oxoguanine), neurodegeneration (neuronal accumulation of abnormal proteins), and apoptotic cell death (judged by TUNEL and activated caspase-3). This reduced bystander damage in TgMT mice could be due to antiinflammatory and antioxidant actions of MT-I but also to direct MT-I effects on the neurons, in that significant extracellular MT presence was detected. Furthermore, MT-I overexpression stimulated astroglia and increased immunostaining of antiinflammatory IL-10, growth factors, and neurotrophins (basic fibroblastic growth factor, transforming growth factor-beta, nerve growth factor, brain-derived neurotrophic factor, glial-derived neurotrophic factor) in hippocampus. Accordingly, MT-I has different functions that likely contribute to the increased neuron survival and improved CNS condition of TgMT mice. The data presented here add new insight into MT-induced neuroprotection and indicate that MT-I therapy could be used against neurological disorders.

Infectious diseases of the central nervous system

Neurologic disease is seen commonly in cats, with infectious causes accounting for 30-45% of cases. However, since a specific infection cannot be identified in 12-40% of these cases, it is essential that we try to understand these cases better in the hope that we can eventually identify the cause(s), and so determine how best to treat and/or prevent them.

Oxygen therapy for CO poisoning: rationale and recommendations

CO poisoning remains a serious public health problem. Oxygen is the basis of its treatment and HBO has been proven more effective to prevent cognitive sequelae than NBO. Most commonly accepted criteria for HBO treatment are: comatose patient, loss of consciousness, neuropsychological and cardiac symptoms and pregnancy. However, patients not requiring HBO, have to be treated by a correct NBO regimen.

Prevention of radiation-induced central nervous system toxicity: a role for amifostine?

PURPOSE

To review the role of amifostine (WR-2721) in ameliorating radiation-induced central nervous system (CNS) toxicity.

MATERIALS AND METHODS

Literature review and presentation of preliminary animal experiments designed to test the efficacy of both intrathecal and subcutaneous application of amifostine.

RESULTS

Despite its inability to cross the blood-brain barrier, amifostine appears promising because it protects blood vessels against radiation-induced damage. Vascular damage is one of the most important components in the development of CNS toxicity after radiotherapy. Furthermore, the increased permeability of the blood-brain barrier during fractionated radiotherapy might allow penetration of amifostine. Three animal studies with systemic administration found positive results after brain irradiation with different fractionation schedules, total doses and amifostine doses. One study where amifostine was given after radiotherapy showed no protection, suggesting that the timing of the drug application is crucial. Further data suggest that either intrathecal or systemic administration might protect the spinal cord as well. In our experience with spinal cord irradiation, systemic administration was more effective than intrathecal. Regarding CNS protection, the optimum dose of amifostine has yet to be determined.

CONCLUSION

Several independent experiments provided preliminary evidence that modulation of the radiation response of the CNS in vivo by systemic administration of amifostine is possible and feasible. Additional studies are warranted to investigate the protective effect with differing regimens of administration, more clinically relevant fractionation regimens and longer follow-up.

Rise and fall of minocycline in neuroprotection: need to promote publication of negative results

Initial studies conducted on the neuroprotective effects of minocycline, a second-generation tetracycline, in experimental models of neurodegeneration gave promising results. However, more recently, minocycline has clearly been shown to have variable and even contradictory (beneficial or detrimental) effects in different species and models of neurological disorders, and its "neuroprotective" mechanisms remain to be clarified. Although its anti-inflammatory properties are likely to contribute to its neuroprotective effects observed in several animal models, a body of recent evidence indicates that our community should proceed with caution in the clinical use of minocycline for central nervous system disorders.

Parelaphostrongylus tenuis and other parasitic diseases of the ruminant nervous system

There are many parasites that affect the ruminant central nervous system. Clinical signs can vary dramatically based on the location and mobility of the parasite. Clinical disease can occur due to the physical presence of the parasite and the resulting host immune response or the toxin produced by the parasite. Differentiating the cause of disease is particularly important because prognosis,treatment, and subsequent control measures vary dramatically depending on the disease process. This article focuses on the pathogenesis,treatment, and control of some of the more common parasitic diseases of the ruminant central nervous system.

Resolution and prevention of feline immunodeficiency virus-induced neurological deficits by treatment with the protease inhibitor TL-3

In vivo tests were performed to assess the influence of the protease inhibitor TL-3 on feline immunodeficiency virus (FIV)-induced central nervous system (CNS) deficits. Twenty cats were divided into four groups of five animals each. Group 1 received no treatment, group 2 received TL-3 only, group 3 received FIV strain PPR (FIV-PPR) only, and group 4 received FIV-PPR and TL-3. Animals were monitored for immunological and virological status, along with measurements of brain stem auditory evoked potential (BAEP) changes. Groups 1 and 2 remained FIV negative, and groups 3 and 4 became virus positive and seroconverted by 3 to 5 weeks postinoculation. No adverse effects were noted with TL-3 only. The average peak viral load for the virus-only group 3 animals was 1.32 x 10(6) RNA copies/ml, compared to 6.9 x 10(4) copies/ml for TL-3-treated group 4 cats. Group 3 (virus-only) cats exhibited marked progressive delays in BAEPs starting at 2 weeks post virus exposure, which is typical of infection with FIV-PPR. In contrast, TL-3-treated cats of group 4 exhibited BAEPs similar to those of control and drug-only cats. At 97 days postinfection, treatments were switched; i.e., group 4 animals were taken off TL-3 and group 3 animals were treated with TL-3. BAEPs in group 3 animals returned to control levels, while BAEPs in group 4 animals remained at control levels. After 70 days on TL-3, group 3 was removed from the drug treatment regimen. Delays in BAEPs immediately increased to levels observed prior to TL-3 treatment. The findings show that early TL-3 treatment can effectively eliminate FIV-induced changes in the CNS. Furthermore, TL-3 can counteract FIV effects on the CNS of infected cats, although continued treatment is required to maintain unimpaired CNS function.

[Prevention and treatment of bacterial infection by the recombinant human granulocytic colony-stimulating factor in newborns]

An impact on the immune system is a principally new trend in optimizing the prevention and treatment of neonatal sepsis. The purpose of the case study was to investigate the clinical efficiency of neipogene. The study comprised 33 mature newborns with respiratory pathology and perinatal CNS lesion, who were at the artificial lung ventilation (ALV). Neipogene was found to increase for a short time period the absolute number of neutrophils, monocytes and the pool of stem cells (predecessors of the myeloid row) in peripheral blood, which cut the rate of sepsis, lethality, ALV time and treatment costs. The conclusion is that neipogene is safe and effective for the prevention and treatment of bacterial complications.

[Colforsin daropate does not affect the cerebral blood-flow in cardiac surgery patients under cardiopulmonary bypass]

BACKGROUND

Cerebral blood flow partly plays a pivotal role in cerebral complications among cardiac surgery patients. We evaluated the effect of colforsin daropate (colforsin) on cerebral blood flow in cardiac surgery patients under cardiopulmonary bypass (CPB) by transcranial Doppler sonography (TCD).

METHODS

Eighteen patients scheduled for coronary artery bypass surgery under CPB were assigned randomly to two groups:colforsin group (n=9) and control group (n=9). We assessed cardiac function by measuring cardiac index (CI) and systemic vascular resistance index (SVRI). Cerebral blood flow was evaluated by measuring the peak systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd) together with mean blood flow velocity (Vm), and calculated the pulsatility index (PI) in the left carotid siphon by TCD. After baseline measurement, the colforsin loading dosage was increased from 0.25 to 0.5 microg x kg(-1) x min(-1) in colforsin group every 60 minutes.

RESULTS

Colforsin significantly increased CI and decreased SVRI compared with pre-levels. In both groups there were no significant changes in Vs, Vd, Vm and PI.

CONCLUSIONS

We have demonstrated that colforsin is effective for hemodynamics without cerebral blood flow change in cardiac surgery patients under cardiopulmonary bypass.

Early activation of microglia as antigen-presenting cells correlates with T cell-mediated protection and repair of the injured central nervous system

After an injury to the central nervous system (CNS), activated microglia have been shown to contribute to the ongoing destructive processes leading to secondary neuronal degeneration. They can, however, also express neuroprotective activity. Studies from our laboratory point to the existence of a physiological T cell-mediated neuroprotective mechanism (adaptive immunity) that is amenable to boosting. We postulate that the beneficial or destructive outcome of the local microglial (innate) response is determined by a well-controlled dialog between the innate and the adaptive immune players. Here, we show that spontaneous or exogenously boosted T cell-mediated neuroprotection is correlated with early activation of microglia as antigen-presenting cells. We suggest that such microglial activity, if well controlled, is a crucial step in determining the fate of the neurons in a hostile environment.

Cerebral dysfunction following cardiopulmonary bypass is a fact: what are the solutions?

Focal and diffuse cerebral dysfunction following cardiopulmonary bypass are multifactorial complications that occur with coronary artery bypass grafting. Controversy exists regarding quantification and duration of diffuse cerebral dysfunction. Multiple measures can be undertaken from preoperative screening to intraoperative and postoperative management to decrease the most common complication occurring after coronary artery bypass surgery.

Relationship between oxidative stress, pathology, and behavioral signs of lead poisoning in mallards

Some of the adverse effects of lead (Pb) may be associated with oxidative damage of lipids, proteins, or DNA. In a previous study a linkage was observed between the susceptibilities of waterfowl species to Pb poisoning with oxidative stress. To investigate this relationship among the individuals of a single species, for 3 wk 4 groups of 12 mallards were fed diets containing high or low levels of vitamin E (20 or 220 UI/kg) and high or low levels of Pb (0 or 2 g/kg). During the first week of Pb exposure, mallards developed hemolytic anemia, and during the second week, signs of neurological impairment. Histological findings in the Pb-exposed mallards were hemosiderosis, demyelinization of sciatic and brachial nerves, and tumefaction of renal tubular epithelium with the presence of intranuclear inclusion bodies. Lipid peroxidation increased with Pb exposure in blood, liver, bile, and brain, but decreased in nerves. Glutathione (GSH) increased with Pb exposure in liver and bile, and its oxidized/reduced ratio only increased in bile. Pb exposure inhibited GSH peroxidase activity (GPX) in plasma, liver, and brain, and decreased protein thiols (PSH) in blood and liver. Vitamin E resulted in significantly lower lipid peroxidation in nerves of control birds relative to unsupplemented controls, but did not alleviate any sign of lead posioning. Pb-induced pathological changes associated with hepatic and nervous functions were significantly correlated with lower GPX activity and PSH concentrations in these tissues rather than lipid peroxidation. Data suggest that inhibition of antioxidant enzymes and interaction with sulfhydryl groups of proteins may play a more important role in Pb poisoning of waterfowl than lipid peroxidation.

[Countermeasures to neurological adverse reactions of chemotherapy]

Anti-tumor drugs often cause adverse reactions on both central and peripheral nervous systems. Prevention and early detection is essential, since proper treatment scarcely protects against adverse reactions once appeared in the nervous system. Precise neurological examination at bed side must be done before starting the chemotherapy and along the course periodically. Radiological diagnosis (including CT and MRI) and electrophysiological evaluation (including electroencephalogram and nerve conduction study) are informative as supplemental tools. Neurological and psychiatric symptoms and signs resulting from the major adverse reactions are reviewed, taken notice of prevention and countermeasures. Inclusive of amifostine there exist no neuroprotectants proving clinical utility at present. Some neuroprotectants are briefly introduced, of which efficacy animal experiments have demonstrated.