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Canavero S, Ren X, Kim CY, Rosati E. Neurologic foundations of spinal cord fusion (GEMINI). Surgery 2016; 160:11-19. [PMID: 27180142 DOI: 10.1016/j.surg.2016.01.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/08/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Abstract
Cephalosomatic anastomosis has been carried out in both monkeys and mice with preservation of brain function. Nonetheless the spinal cord was not reconstructed, leaving the animals unable to move voluntarily. Here we review the details of the GEMINI spinal cord fusion protocol, which aims at restoring electrophysiologic conduction across an acutely transected spinal cord. The existence of the cortico-truncoreticulo-propriospinal pathway, a little-known anatomic entity, is described, and its importance concerning spinal cord fusion emphasized. The use of fusogens and electrical stimulation as adjuvants for nerve fusion is addressed. The possibility of achieving cephalosomatic anastomosis in humans has become reality in principle.
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Affiliation(s)
| | - XiaoPing Ren
- Hand and Microsurgical Center, the Second Affiliated Hospital of Harbin Medical University; State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China; Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - C-Yoon Kim
- Department of Bioengineering, College of Life Science, CHA University, Seoul, Korea; Department of Laboratory Animal Medicine, College of Veterinary Medicine, Seoul National University, Seoul, Korea
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Kearney H, Miszkiel KA, Yiannakas MC, Altmann DR, Ciccarelli O, Miller DH. Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis. Mult Scler 2015; 22:910-20. [DOI: 10.1177/1352458515604905] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/17/2015] [Indexed: 11/17/2022]
Abstract
Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined. Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability. Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing–remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM). Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS ( p = 0.03) and PPMS ( p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 ( p = 0.002) and 5.7 ( p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability ( p < 0.001). Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.
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Affiliation(s)
- Hugh Kearney
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK
| | - Katherine A Miszkiel
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK
| | - Daniel R Altmann
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK/Medical Statistics Department, London School of Hygiene & Tropical Medicine, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK/NIHR University College London Hospitals Biomedical Research Centre, UK
| | - David H Miller
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK/NIHR University College London Hospitals Biomedical Research Centre, UK
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Trifunović D, Djedović N, Lavrnja I, Wendrich KS, Paquet-Durand F, Miljković D. Cell death of spinal cord ED1(+) cells in a rat model of multiple sclerosis. PeerJ 2015; 3:e1189. [PMID: 26413432 PMCID: PMC4581773 DOI: 10.7717/peerj.1189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
Infiltration of macrophages into the central nervous system and activation of microglia are hallmarks of multiple sclerosis and its animal model—experimental autoimmune encephalomyelitis (EAE). Cell death in EAE has been demonstrated as an essential mechanism in the local regulation of the inflammatory reaction, but also as one of the major factors contributing to the destruction of the nervous tissue. The focus of this study was on detection of cell death among ED1+ cells (macrophages/activated microglia) in the spinal cord of Dark Agouti rats at the peak of EAE. Cell death was assessed using the TUNEL assay and immunostaining for cleaved caspase 3, as markers for cell death in general and “classical” apoptosis, respectively. Major infiltrates of immune cells were detected both in white matter and gray matter of spinal cords in rats at the disease peak. ED1, TUNEL, and caspase 3 positive cells were detected within, but also outside the infiltrates. There were more dying ED1+ cells in white matter than in gray matter, both in the general population and in infiltrated regions. The observed discrepancy in the proportion of dying ED1+ cells in spinal cord gray and white matter indicated that in EAE rat macrophages/microglia within gray matter are less prone to cell death induction. This is of special interest in the context of the increasingly appreciated contribution of spinal cord gray matter inflammation to multiple sclerosis pathogenesis. Our findings suggest that activated macrophages/microglia of gray matter are less susceptible to cell death induction. Alternatively, it can be assumed that intrinsic cell death-inductive mechanisms of nervous tissue differ in white and gray matter. Thus, further research on the gray matter macrophages/microglia cell death during EAE is warranted. They should be aimed at identification of the reasons for the observed differences and finding suitable ways to stimulate gray matter activated macrophages/microglia death.
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Affiliation(s)
- Dragana Trifunović
- Institute for Ophthalmic Research, University of Tuebingen , Tuebingen , Germany
| | - Neda Djedović
- Department of Immunology, Institute for Biological Research "Siniša Stanković", University of Belgrade , Belgrade , Serbia
| | - Irena Lavrnja
- Department of Neurobiology, Institute for Biological Research "Siniša Stanković", University of Belgrade , Belgrade , Serbia
| | | | | | - Djordje Miljković
- Department of Immunology, Institute for Biological Research "Siniša Stanković", University of Belgrade , Belgrade , Serbia
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Schlaeger R, Papinutto ND, Zhu AH, Lobach IV, Bevan CJ, Bucci M, Castellano A, Gelfand JM, Graves JS, Green AJ, Jordan KM, Keshavan A, Panara V, Stern WA, von Büdingen HC, Waubant E, Goodin DS, Cree BAC, Hauser SL, Henry RG. Association Between Thoracic Spinal Cord Gray Matter Atrophy and Disability in Multiple Sclerosis. JAMA Neurol 2015; 72:897-904. [PMID: 26053119 PMCID: PMC6002864 DOI: 10.1001/jamaneurol.2015.0993] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE In multiple sclerosis (MS), upper cervical cord gray matter (GM) atrophy correlates more strongly with disability than does brain or cord white matter (WM) atrophy. The corresponding relationships in the thoracic cord are unknown owing to technical difficulties in assessing GM and WM compartments by conventional magnetic resonance imaging techniques. OBJECTIVES To investigate the associations between MS disability and disease type with lower thoracic cord GM and WM areas using phase-sensitive inversion recovery magnetic resonance imaging at 3 T, as well as to compare these relationships with those obtained at upper cervical levels. DESIGN, SETTING, AND PARTICIPANTS Between July 2013 and March 2014, a total of 142 patients with MS (aged 25-75 years; 86 women) and 20 healthy control individuals were included in this cross-sectional observational study conducted at an academic university hospital. MAIN OUTCOMES AND MEASURES Total cord areas (TCAs), GM areas, and WM areas at the disc levels C2/C3, C3/C4, T8/9, and T9/10. Area differences between groups were assessed, with age and sex as covariates. RESULTS Patients with relapsing MS (RMS) had smaller thoracic cord GM areas than did age- and sex-matched control individuals (mean differences [coefficient of variation (COV)]: 0.98 mm2 [9.2%]; P = .003 at T8/T9 and 0.93 mm2 [8.0%]; P = .01 at T9/T10); however, there were no significant differences in either the WM area or TCA. Patients with progressive MS showed smaller GM areas (mean differences [COV]: 1.02 mm2 [10.6%]; P < .001 at T8/T9 and 1.37 mm2 [13.2%]; P < .001 at T9/T10) and TCAs (mean differences [COV]: 3.66 mm2 [9.0%]; P < .001 at T8/T9 and 3.04 mm2 [7.2%]; P = .004 at T9/T10) compared with patients with RMS. All measurements (GM, WM, and TCA) were inversely correlated with Expanded Disability Status Scale score. Thoracic cord GM areas were correlated with lower limb function. In multivariable models (which also included cord WM areas and T2 lesion number, brain WM volumes, brain T1 and fluid-attenuated inversion recovery lesion loads, age, sex, and disease duration), cervical cord GM areas had the strongest correlation with Expanded Disability Status Scale score followed by thoracic cord GM area and brain GM volume. CONCLUSIONS AND RELEVANCE Thoracic cord GM atrophy can be detected in vivo in the absence of WM atrophy in RMS. This atrophy is more pronounced in progressive MS than RMS and correlates with disability and lower limb function. Our results indicate that remarkable cord GM atrophy is present at multiple cervical and lower thoracic levels and, therefore, may reflect widespread cord GM degeneration.
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Affiliation(s)
- Regina Schlaeger
- Department of Neurology, University of California San Francisco, USA
- Department of Neurology, University Hospital Basel, University of Basel, Switzerland
| | - Nico D. Papinutto
- Department of Neurology, University of California San Francisco, USA
| | - Alyssa H. Zhu
- Department of Neurology, University of California San Francisco, USA
| | - Iryna V. Lobach
- Department of Neurology, University of California San Francisco, USA
- Departments of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Carolyn J. Bevan
- Department of Neurology, University of California San Francisco, USA
| | - Monica Bucci
- Department of Neurology, University of California San Francisco, USA
| | | | | | | | - Ari J. Green
- Department of Neurology, University of California San Francisco, USA
- Department of Ophthalmology, University of California San Francisco, USA
| | - Kesshi M. Jordan
- Department of Neurology, University of California San Francisco, USA
- Bioengineering Graduate Group, University of California San Francisco & Berkeley, USA
| | - Anisha Keshavan
- Department of Neurology, University of California San Francisco, USA
- Bioengineering Graduate Group, University of California San Francisco & Berkeley, USA
| | - Valentina Panara
- Department of Neurology, University of California San Francisco, USA
| | - William A. Stern
- Department of Neurology, University of California San Francisco, USA
| | | | | | - Douglas S. Goodin
- Department of Neurology, University of California San Francisco, USA
| | - Bruce A. C. Cree
- Department of Neurology, University of California San Francisco, USA
| | - Stephen L. Hauser
- Department of Neurology, University of California San Francisco, USA
| | - Roland G. Henry
- Department of Neurology, University of California San Francisco, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
- Bioengineering Graduate Group, University of California San Francisco & Berkeley, USA
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Abstract
Multiple sclerosis (MS) is an inflammatory disorder of the CNS that affects both the brain and the spinal cord. MRI studies in MS focus more often on the brain than on the spinal cord, owing to the technical challenges in imaging this smaller, mobile structure. However, spinal cord abnormalities at disease onset have important implications for diagnosis and prognosis. Furthermore, later in the disease course, in progressive MS, myelopathy becomes the primary characteristic of the clinical presentation, and extensive spinal cord pathology--including atrophy, diffuse abnormalities and numerous focal lesions--is common. Recent spinal cord imaging studies have employed increasingly sophisticated techniques to improve detection and quantification of spinal cord lesions, and to elucidate their relationship with physical disability. Quantitative MRI measures of cord size and tissue integrity could be more sensitive to the axonal loss and other pathological processes in the spinal cord than is conventional MRI, putting quantitative MRI in a key role to elucidate the association between disability and spinal cord abnormalities seen in people with MS. In this Review, we summarize the most recent MS spinal cord imaging studies and discuss the new insights they have provided into the mechanisms of neurological impairment. Finally, we suggest directions for further and future research.
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Papinutto N, Schlaeger R, Panara V, Caverzasi E, Ahn S, Johnson KJ, Zhu AH, Stern WA, Laub G, Hauser SL, Henry RG. 2D phase-sensitive inversion recovery imaging to measure in vivo spinal cord gray and white matter areas in clinically feasible acquisition times. J Magn Reson Imaging 2014; 42:698-708. [PMID: 25483607 DOI: 10.1002/jmri.24819] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/17/2014] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To present and assess a procedure for measurement of spinal cord total cross-sectional areas (TCA) and gray matter (GM) areas based on phase-sensitive inversion recovery imaging (PSIR). In vivo assessment of spinal cord GM and white matter (WM) could become pivotal to study various neurological diseases, but it is challenging because of insufficient GM/WM contrast provided by conventional magnetic resonance imaging (MRI). MATERIALS AND METHODS We acquired 2D PSIR images at 3T at each disc level of the spinal axis in 10 healthy subjects and measured TCA, cord diameters, WM and GM areas, and GM area/TCA ratios. Second, we investigated 32 healthy subjects at four selected levels (C2-C3, C3-C4, T8-T9, T9-T10, total acquisition time <8 min) and generated normative reference values of TCA and GM areas. We assessed test-retest, intra- and interoperator reliability of the acquisition strategy, and measurement steps. RESULTS The measurement procedure based on 2D PSIR imaging allowed TCA and GM area assessments along the entire spinal cord axis. The tests we performed revealed high test-retest/intraoperator reliability (mean coefficient of variation [COV] at C2-C3: TCA = 0.41%, GM area = 2.75%) and interoperator reliability of the measurements (mean COV on the 4 levels: TCA = 0.44%, GM area = 4.20%; mean intraclass correlation coefficient: TCA = 0.998, GM area = 0.906). CONCLUSION 2D PSIR allows reliable in vivo assessment of spinal cord TCA, GM, and WM areas in clinically feasible acquisition times. The area measurements presented here are in agreement with previous MRI and postmortem studies.
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Affiliation(s)
- Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Regina Schlaeger
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Department of Neurology, University of Basel, Basel, Switzerland
| | - Valentina Panara
- ITAB - Institute of Advanced Biomedical Technologies, University "G. D'Annunzio,", Chieti, Italy
| | - Eduardo Caverzasi
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Sinyeob Ahn
- Siemens Healthcare USA, San Francisco, California, USA
| | | | - Alyssa H Zhu
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - William A Stern
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Gerhard Laub
- Siemens Healthcare USA, San Francisco, California, USA
| | - Stephen L Hauser
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Roland G Henry
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Bioengineering Graduate Group, University of California San Francisco, San Francisco and University of California Berkeley, Berkeley, California, USA.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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57
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Malkki H. Multiple sclerosis: Spinal cord grey matter loss correlates with disability in MS. Nat Rev Neurol 2014; 10:546. [PMID: 25155437 DOI: 10.1038/nrneurol.2014.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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