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Epidemiological State, Predictors of Early Mortality, and Predictive Models for Traumatic Spinal Cord Injury: A Multicenter Nationwide Cohort Study. Spine (Phila Pa 1976) 2019; 44:479-487. [PMID: 30234810 DOI: 10.1097/brs.0000000000002871] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multi-center, retrospective cohort study. OBJECTIVE To determine the epidemiology, identify predictors of early mortality, and develop predictive models for traumatic spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA Despite improved initial care and management strategies, traumatic SCI remains a devastating event. Knowledge of the epidemiological state and predictive factors for mortality is important for developing strategies and counseling; however, they have not been adequately investigated, and predictive modeling regarding outcomes remains an underused modality for patients with traumatic SCI. METHODS Using a nationwide trauma registry-the Japan Trauma Data Bank-we identified adult (≥18 yrs) patients with SCI between 2004 and 2015. The endpoint was in-hospital mortality. Characteristics of each patient were described. Multivariate logistic regression analyses were performed to identify factors significantly associated with in-hospital mortality and develop a predictive model. RESULTS In total, 236,698 patients were registered in the database. Of the 215,835 adult patients, 8069 (3.7%) had SCI. The majority had SCI at the cervical level with falls at ground level being the primary etiology. Over the study period, median age, the proportion of cervical SCI, and the etiology of falls at ground level increased. The mortality rate was 5.6%. The following eight factors, age, sex, Glasgow Coma Scale on arrival (GCS), hypotension on arrival, bradycardia on arrival, severe head injury, Injury Severity Score (ISS), and neurological severity of SCI, were independently associated with mortality. A predictive model consisting of these variables predicted mortality with area under the receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.86-0.90). CONCLUSION Over the 12-year period, patient characteristics, etiology, and post-SCI outcomes significantly changed. We identified eight prognostic factors of early mortality. A predictive model including these factors showed excellent performance and may improve treatment strategies, healthcare resource allocation, and counseling. LEVEL OF EVIDENCE 3.
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102
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Guercio JR, Kralic JE, Marrotte EJ, James ML. Spinal cord injury pharmacotherapy: Current research & development and competitive commercial landscape as of 2015. J Spinal Cord Med 2019; 42:102-122. [PMID: 29485334 PMCID: PMC6340271 DOI: 10.1080/10790268.2018.1439803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
CONTEXT Current treatment of spinal cord injury (SCI) focuses on cord stabilization to prevent further injury, rehabilitation, management of non-motor symptoms, and prevention of complications. Currently, no approved treatments are available, and limited treatment options exist for symptoms and complications associated with chronic SCI. This review describes the pharmacotherapy landscape in SCI from both commercial and research and development (R&D) standpoints through March 2015. METHODS Information about specific compounds has been obtained through drug pipeline monographs in the Pharmaprojects® (Citeline, Inc., New York, New York, USA) drug database (current as of a search on May 30, 2014), websites of individual companies with compounds in development for SCI (current as of March 24, 2015), and a literature search of published R&D studies to validate the Pharmaprojects® source for selected compounds (current as of March 24, 2015). RESULTS Types of studies conducted and outcomes measured in earlier phases of development are described for compounds in clinical development Currently four primary mechanisms are under investigation and may yield promising therapeutic targets: 1) neuronal regeneration; 2) neuroprotection (including anti-inflammation); 3) axonal reconnection; and 4) neuromodulation and signal enhancement. Many other compounds are no longer under investigation for SCI are mentioned; however, in most cases, the reason for terminating their development is not clear. CONCLUSION There is urgent need to develop disease-modifying therapy for SCI, yet the commercial landscape remains small and highly fragmented with a paucity of novel late-stage compounds in R&D.
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Affiliation(s)
- Jason R. Guercio
- North American Partners in Anesthesiology, New Britain, Connecticuit, USA,Correspondence to: Michael L. James, MD, Associate Professor, Brain Injury Translational Research Center, Duke University DUMC 3094, Durham, NC 27710, USA.
| | - Jason E. Kralic
- Innervate BD Solutions, LLC, Hillsborough, North Carolina, USA
| | - Eric J. Marrotte
- Department of Neurology, Brain Injury Translational Research Center, Duke University, Durham, North Carolina, USA
| | - Michael L. James
- Department of Neurology, Brain Injury Translational Research Center, Duke University, Durham, North Carolina, USA,Department of Anesthesiology, Brain Injury Translational Research Center, Duke University, Durham, North Carolina, USA,Correspondence to: Michael L. James, MD, Associate Professor, Brain Injury Translational Research Center, Duke University DUMC 3094, Durham, NC 27710, USA.
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Squair JW, Ruiz I, Phillips AA, Zheng MM, Sarafis ZK, Sachdeva R, Gopaul R, Liu J, Tetzlaff W, West CR, Krassioukov AV. Minocycline Reduces the Severity of Autonomic Dysreflexia after Experimental Spinal Cord Injury. J Neurotrauma 2018; 35:2861-2871. [DOI: 10.1089/neu.2018.5703] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jordan W. Squair
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- MD/PhD Training Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Ruiz
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron A. Phillips
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mei M.Z. Zheng
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zoe K. Sarafis
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rayshad Gopaul
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jie Liu
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wolfram Tetzlaff
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher R. West
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Health Authority, Vancouver, British Columbia, Canada
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Cowan RE, Anderson KD. Replication and novel analysis of age and sex effects on the neurologic and functional value of each spinal segment in the US healthcare setting. Spinal Cord 2018; 57:156-164. [DOI: 10.1038/s41393-018-0206-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
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105
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Squair JW, Tigchelaar S, Moon KM, Liu J, Tetzlaff W, Kwon BK, Krassioukov AV, West CR, Foster LJ, Skinnider MA. Integrated systems analysis reveals conserved gene networks underlying response to spinal cord injury. eLife 2018; 7:39188. [PMID: 30277459 PMCID: PMC6173583 DOI: 10.7554/elife.39188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/24/2018] [Indexed: 12/20/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating neurological condition for which there are currently no effective treatment options to restore function. A major obstacle to the development of new therapies is our fragmentary understanding of the coordinated pathophysiological processes triggered by damage to the human spinal cord. Here, we describe a systems biology approach to integrate decades of small-scale experiments with unbiased, genome-wide gene expression from the human spinal cord, revealing a gene regulatory network signature of the pathophysiological response to SCI. Our integrative analyses converge on an evolutionarily conserved gene subnetwork enriched for genes associated with the response to SCI by small-scale experiments, and whose expression is upregulated in a severity-dependent manner following injury and downregulated in functional recovery. We validate the severity-dependent upregulation of this subnetwork in rodents in primary transcriptomic and proteomic studies. Our analysis provides systems-level view of the coordinated molecular processes activated in response to SCI.
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Affiliation(s)
- Jordan W Squair
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Seth Tigchelaar
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Kyung-Mee Moon
- Centre for High-Throughput Biology, University of British Columbia, Vancouver, Canada
| | - Jie Liu
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Wolfram Tetzlaff
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada.,GF Strong Rehabilitation Centre, Vancouver Health Authority, Vancouver, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Christopher R West
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada.,School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Leonard J Foster
- Centre for High-Throughput Biology, University of British Columbia, Vancouver, Canada.,Department of Biochemistry and Molecular Biology and Michael Smith Laboratories, University of British Columbia, Vancouver, Canada
| | - Michael A Skinnider
- Centre for High-Throughput Biology, University of British Columbia, Vancouver, Canada
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Arnold PM, Anderson PA, Chi JH, Dailey AT, Dhall SS, Eichholz KM, Harrop JS, Hoh DJ, Qureshi S, Rabb CH, Raksin PB, Kaiser MG, O’Toole JE. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Pharmacological Treatment. Neurosurgery 2018; 84:E36-E38. [DOI: 10.1093/neuros/nyy371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/16/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paul M Arnold
- Department of Neurosurgery, University of Kansas School of Medicine, Kansas City, Kansas
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin
| | - John H Chi
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew T Dailey
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Kurt M Eichholz
- St. Louis Minimally Invasive Spine Center, St. Louis, Missouri
| | - James S Harrop
- Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel J Hoh
- Lillian S. Wells Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York
| | - Craig H Rabb
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - P B Raksin
- Division of Neurosurgery, John H. Stroger, Jr Hospital of Cook County and Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael G Kaiser
- Department of Neurosurgery, Columbia University, New York, New York
| | - John E O’Toole
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
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107
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Kim M, Hong SK, Jeon SR, Roh SW, Lee S. Early (≤48 Hours) versus Late (>48 Hours) Surgery in Spinal Cord Injury: Treatment Outcomes and Risk Factors for Spinal Cord Injury. World Neurosurg 2018; 118:e513-e525. [PMID: 30257304 DOI: 10.1016/j.wneu.2018.06.225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Surgical management of spinal cord injury (SCI) is challenging. There is no standard guideline regarding the timing of surgery, although physicians have prioritized early surgery over the past decades. Although better outcomes have been observed from these studies, the definition of early surgery has been controversial, although mostly limited to 24-hours after injury. For some hospitals, this early surgery could be difficult to implement in practice. Hence, we re-evaluated the timing of early surgery as surgery within 48 hours and investigated the surgical outcomes of SCI depending on whether surgery was performed early (≤48 hours) or late (>48 hours). The primary outcomes were improvement in the American Spinal Injury Association Impairment Scale (AIS) grade in early and late surgery groups. METHODS This study was a retrospective cohort study in individuals aged 15-85 years, who underwent surgery for SCI between 2005 and 2016. The rate of AIS grade improvements was measured at 6 months after injury. Of the 86 enrolled patients, 31 (mean, 40.9 ± 12.64 hours) and 55 (mean, 168.25 ± 93.01 hours) patients were assigned to the early and late surgery groups, respectively. RESULTS AIS grade improvement was significantly greater in the early than in the late group (P = 0.039). In the early group, there was no significant difference in neurologic improvements among the AIS B, C, and D groups, but the AIS A group showed a significant improvement (P = 0.015). This finding was not observed in the late group (P = 0.060). AIS grade improvement was also significantly greater in the incomplete SCI group than in the complete SCI group, for all measurements (early, P = 0.007, late, P = 0.009). Other factors that significantly affected clinical outcomes were AIS grade on admission and the level of the injury.
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Affiliation(s)
- Moinay Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Neurosurgical Critical Care, Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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108
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Abstract
Traumatic spinal cord injury (SCI) results in impaired neurologic function that for many individuals is permanent and significantly impacts health, function, quality of life, and life expectancy. Many efforts have been taken to develop effective treatments for SCI; nevertheless, proven therapies targeting neurologic regeneration and functional recovery have been limited. Existing therapeutic approaches, including early surgery, strict blood pressure control, and consideration of treatment with steroids, remain debated and largely focus on mitigating secondary injury after the primary trauma has occurred. Today, there is more research being performed in SCI than ever before. Current clinical trials are exploring pharmacologic, cell-based, physiologic, and rehabilitation approaches to reduce secondary injury and also overcome barriers to neurorecovery. In the future, it is likely that tailored treatments combining many of these strategies will offer significant benefits for persons with SCI. This article aims to review key past, current and emerging neurologic and rehabilitation therapeutic approaches for adults with traumatic SCI.
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Affiliation(s)
- Jayne Donovan
- Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, New Jersey, 07052, USA.
- Rutgers New Jersey Medical School, 183 South Orange Avenue, Newark, New Jersey, 07101, USA.
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, New Jersey, 07052, USA
- Rutgers New Jersey Medical School, 183 South Orange Avenue, Newark, New Jersey, 07101, USA
- The Kessler Foundation, 1199 Pleasant Valley Way, West Orange, New Jersey, 07052, USA
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109
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El Tecle NE, Dahdaleh NS, Bydon M, Ray WZ, Torner JC, Hitchon PW. The natural history of complete spinal cord injury: a pooled analysis of 1162 patients and a meta-analysis of modern data. J Neurosurg Spine 2018; 28:436-443. [DOI: 10.3171/2017.7.spine17107] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVEThe natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease.METHODSThe authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis.RESULTSEleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03).CONCLUSIONSThe overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.
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Affiliation(s)
| | - Nader S. Dahdaleh
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mohamad Bydon
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Wilson Z. Ray
- 4Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Patrick W. Hitchon
- 6Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Stem Cells Therapy for Spinal Cord Injury. Int J Mol Sci 2018; 19:ijms19041039. [PMID: 29601528 PMCID: PMC5979319 DOI: 10.3390/ijms19041039] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 12/26/2022] Open
Abstract
Spinal cord injury (SCI), a serious public health issue, most likely occurs in previously healthy young adults. Current therapeutic strategies for SCI includes surgical decompression and pharmacotherapy, however, there is still no gold standard for the treatment of this devastating condition. Inefficiency and adverse effects of standard therapy indicate that novel therapeutic strategies are required. Because of their neuroregenerative and neuroprotective properties, stem cells are a promising tool for the treatment of SCI. Herein, we summarize and discuss the promising therapeutic potential of human embryonic stem cells (hESC), induced pluripotent stem cells (iPSC) and ependymal stem/progenitor cells (epSPC) for SCI.
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111
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Huang H, Sharma HS, Chen L, Otom A, Al Zoubi ZM, Saberi H, Muresanu DF, He X. Review of clinical neurorestorative strategies for spinal cord injury: Exploring history and latest progresses. JOURNAL OF NEURORESTORATOLOGY 2018. [DOI: 10.26599/jnr.2018.9040013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Clinical neurorestorative therapies recently made great progress for patients with spinal cord injury (SCI). This paper systemically reviews historical perspectives, recent advancements and achievements in SCI through key neurorestorative strategies. In this study, a search was performed in the PubMed, Scopus, and Scholar Google search engines using the keywords “neurorestorative strategies”, “spinal cord injury”, “cell therapy”, “neuromodulation”, and “nerve bridges”. Clinical studies published in the English language were included. It is paramount for academic community involved in this field to take the initiative of a multicenter randomized, double-blind, and placebo-control clinical study with high level of evidence-based treatments for most SCI neurorestorative strategies in patient management. It is of utmost need to establish standard therapeutic methods for patients with SCI as early as possible.
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112
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Lopez PH, Báez BB. Gangliosides in Axon Stability and Regeneration. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2018; 156:383-412. [DOI: 10.1016/bs.pmbts.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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113
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Tong B, Jutzeler CR, Cragg JJ, Grassner L, Schwab JM, Casha S, Geisler F, Kramer JLK. Serum Albumin Predicts Long-Term Neurological Outcomes After Acute Spinal Cord Injury. Neurorehabil Neural Repair 2017; 32:7-17. [DOI: 10.1177/1545968317746781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. There is a need to identify reliable biomarkers of spinal cord injury recovery for clinical practice and clinical trials. Objective. Our objective was to correlate serum albumin levels with spinal cord injury neurological outcomes. Methods. We performed a secondary analysis of patients with traumatic spinal cord injury (n = 591) participating in the Sygen clinical trial. Serum albumin concentrations were obtained as part of routine blood chemistry analysis, at trial entry (24-72 hours), 1, 2, and 4 weeks after injury. The primary outcomes were “marked recovery” and lower extremity motor scores, derived from the International Standards for the Neurological Classification of Spinal Cord Injury. Data were analyzed with multivariable logistic and linear regression to adjust for potential confounders. Results. Serum albumin was significantly associated with spinal cord injury neurological outcomes. Higher serum albumin concentrations at 1, 2, and 4 weeks were associated with higher 52-week lower extremity motor score. Similarly, the odds of achieving “marked neurological recovery” was greater for individuals with higher serum albumin concentrations. The association between serum albumin concentrations and neurological outcomes was independent of initial injury severity, treatment with GM-1, and polytrauma. Conclusions. In spinal cord injury, serum albumin is an independent marker of long-term neurological outcomes. Serum albumin could serve as a feasible biomarker for prognosis at the time of injury and stratification in clinical trials.
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Affiliation(s)
- Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine R. Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Grassner
- Center for Spinal Cord Injuries and Department of Neurosurgery, Trauma Center, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jan M. Schwab
- Wexner Medical Center, The Ohio State University, Spinal Cord Injury Medicine, Columbus, OH, USA
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Mattiassich G, Gollwitzer M, Gaderer F, Blocher M, Osti M, Lill M, Ortmaier R, Haider T, Hitzl W, Resch H, Aschauer-Wallner S. Functional Outcomes in Individuals Undergoing Very Early (< 5 h) and Early (5–24 h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study. J Neurotrauma 2017; 34:3362-3371. [DOI: 10.1089/neu.2017.5132] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Georg Mattiassich
- Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Maria Gollwitzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Linz, Linz, Austria
| | - Franz Gaderer
- Department of Trauma Surgery, Medcampus III, Kepler University Linz, Linz, Austria
| | - Martina Blocher
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Osti
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria
| | - Markkus Lill
- Trauma Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, ISAG/UMIT, Hall in Tyrol, Austria
| | - Thomas Haider
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hitzl
- Research Office of Biostatistics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Herbert Resch
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stephanie Aschauer-Wallner
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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115
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Ma DN, Zhang XQ, Ying J, Chen ZJ, Li LX. Efficacy and safety of 9 nonoperative regimens for the treatment of spinal cord injury: A network meta-analysis. Medicine (Baltimore) 2017; 96:e8679. [PMID: 29381946 PMCID: PMC5708945 DOI: 10.1097/md.0000000000008679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This network meta-analysis aims to compare the efficacy and safety of 9 nonoperative regimens (placebo, pregabalin, GM-1 ganglioside, venlafaxine extended-release [venlafaxine XR], fampridine, conventional over-ground training [OT], body-weight-supported treadmill training [BWSTT], robotic-assisted gait training [RAGT] + OT and body-weight-supported over-ground training [BWSOT]) in treating spinal cord injury (SCI). METHODS Clinical controlled trials of 9 nonoperative regimens for SCI were retrieved in the electronic database. Traditional pairwise and Bayesian network meta-analyses were performed to compare the efficacy and safety of 9 nonoperative regimens for the treatment of SCI. Weighted mean difference (WMD), odds ratios (OR), and surface under the cumulative ranking curve (SUCRA) were calculated using the Markov Chain Monte Carlo engine Open BUGS (V.3.4.0) and R (V.3.2.1) package gemtc (V.0.6). RESULTS A total of 9 clinical controlled trials meeting the inclusion criteria were selected in this meta-analysis. On the aspect of efficacy, the results of pairwise meta-analysis indicated that the RAGT + OT and BWSOT might have the best efficacy in SCI patients in terms of a lower extremity motor score (LEMS) compared with conventional OT; the efficacy of RAGT + OT on SCI patients was relatively better than that of conventional OT in terms of walking index for spinal cord injury (WISCI). With the aspect of safety, the constipation rate of placebo on SCI patients was relatively higher than that of venlafaxine XR; however, with respect to headache and urinary tract infection, there was no significant difference in the safety of placebo, pregabalin, GM-1 ganglioside, venlafaxine XR, and fampridine on SCI patients. The results of SUCRA values suggested that BWSOT had the highest SUCRA value (75.25%) of LEMS; RAGT + OT had the highest SUCRA value (88.50%) of WISCI; venlafaxine XR had the highest SUCRA value (94.00%) of constipation; venlafaxine XR had the highest SUCRA value (80.00%) of headache; GM-1 ganglioside had the highest SUCRA value (87.75%) of urinary tract infection. CONCLUSION Our results provide evidence that the RAGT + OT and BWSOT might have the best efficacy in the treatment of SCI, and the venlafaxine XR and GM-1 ganglioside showed adequate safety for SCI.
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Affiliation(s)
| | | | - Jie Ying
- Department of Clinical Research Center, Xuyi People's Hospital, Huaian
| | - Zhong-Jun Chen
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
| | - Li-Xin Li
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, P.R. China
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Abstract
Spinal cord injury (SCI) is a common medical condition with a poor prognosis for recovery and catastrophic effects on a patient's quality of life. Available treatments for SCI are limited, and the evidence suggesting their harmful side effects is more consistent than any suggestion of clinical benefit. Developing novel safe and effective therapeutic options for SCI is crucial. Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine with known multifaceted effects on the central nervous system. Herein, we review the accumulating preclinical evidence for the beneficial effects of G-CSF on functional and structural outcomes after SCI. Meanwhile we present and discuss multiple mechanisms for G-CSF's neuroprotective and neuroregenerative actions through the results of these studies. In addition, we present the available clinical evidence indicating the efficacy and safety of G-CSF administration for the treatment of acute and chronic traumatic SCI, compression myelopathy, and SCI-associated neuropathic pain. Our review indicates that although the quality of clinical evidence regarding the use of G-CSF in SCI is inadequate, the encouraging available preclinical and clinical data warrant its further clinical development, and bring new hope to the longstanding challenge that is treatment of SCI.
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117
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Wilson JR, Tetreault LA, Kwon BK, Arnold PM, Mroz TE, Shaffrey C, Harrop JS, Chapman JR, Casha S, Skelly AC, Holmer HK, Brodt ED, Fehlings MG. Timing of Decompression in Patients With Acute Spinal Cord Injury: A Systematic Review. Global Spine J 2017; 7:95S-115S. [PMID: 29164038 PMCID: PMC5684838 DOI: 10.1177/2192568217701716] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To conduct a systematic review and synthesis of the literature to assess the comparative effectiveness, safety, and cost-effectiveness of early (≤24 hours) versus late decompression (>24 hours) in adults with acute spinal cord injury (SCI). METHODS A systematic search was conducted of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar to identify studies published through November 6, 2014. Studies published in any language, in humans, and with an abstract were considered for inclusion. Included studies were critically appraised and the overall strength of evidence was determined using methods proposed by the Grading of Recommendation Assessment, Development and Evaluation working group. RESULTS The search yielded 449 potentially relevant citations. Sixteen additional primary studies were identified through other sources. Six studies met inclusion criteria. All but 2 studies were considered to have moderately high risk of bias. Across studies and injury levels, the impact of early surgical decompression (≤24 hours) on clinically important improvement in neurological status was variable. Isolated studies reported statistically significant and clinically important improvements at 6 months (cervical injury, low strength of evidence) and following discharge from inpatient rehabilitation (all levels, very low strength of evidence) but not at other time points; another study observed a statistically significant 6 point improvement in ASIA Impairment Scale (AIS) among patients with AIS B, C, or D, but not for those with AIS A (very low strength of evidence). In one study of acute central cord syndrome without instability, a clinically and statistically meaningful improvement in total motor scores was reported at 6 and 12 months in patients treated early (versus late). There were, however, no significant differences in AIS improvement between early and late surgical groups at 6- or 12-months (very low strength of evidence). One of 3 studies found a shorter length of hospital stay associated with early surgical decompression. Of 3 studies reporting on safety, no significant differences in rates of complications (including mortality, neurologic deterioration, pneumonia or pressure ulcers) were noted between early and late decompression groups. CONCLUSIONS Results surrounding the efficacy of early versus late decompressive surgery, as well as the quality of evidence available, were variable depending on the level of SCI, timing of follow-up, and specific outcome considered. Existing evidence supports improved neurological recovery among cervical SCI patients undergoing early surgery; however, evidence regarding remaining SCI populations and clinical outcomes was inconsistent.
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Affiliation(s)
- Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University College Cork, Cork, Ireland
| | - Brian K. Kwon
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | | | | | | | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Michael G. Fehlings
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
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118
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Rouanet C, Reges D, Rocha E, Gagliardi V, Silva GS. Traumatic spinal cord injury: current concepts and treatment update. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:387-393. [DOI: 10.1590/0004-282x20170048] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/14/2017] [Indexed: 01/03/2023]
Abstract
ABSTRACT Spinal cord injury (SCI) affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising.
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Affiliation(s)
| | | | - Eva Rocha
- Universidade Federal de São Paulo, Brasil
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119
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Generating level-dependent models of cervical and thoracic spinal cord injury: Exploring the interplay of neuroanatomy, physiology, and function. Neurobiol Dis 2017; 105:194-212. [PMID: 28578003 DOI: 10.1016/j.nbd.2017.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/10/2017] [Accepted: 05/29/2017] [Indexed: 01/01/2023] Open
Abstract
The majority of spinal cord injuries (SCI) occur at the cervical level, which results in significant impairment. Neurologic level and severity of injury are primary endpoints in clinical trials; however, how level-specific damages relate to behavioural performance in cervical injury is incompletely understood. We hypothesized that ascending level of injury leads to worsening forelimb performance, and correlates with loss of neural tissue and muscle-specific neuron pools. A direct comparison of multiple models was made with injury realized at the C5, C6, C7 and T7 vertebral levels using clip compression with sham-operated controls. Animals were assessed for 10weeks post-injury with numerous (40) outcome measures, including: classic behavioural tests, CatWalk, non-invasive MRI, electrophysiology, histologic lesion morphometry, neuron counts, and motor compartment quantification, and multivariate statistics on the total dataset. Histologic staining and T1-weighted MR imaging revealed similar structural changes and distinct tissue loss with cystic cavitation across all injuries. Forelimb tests, including grip strength, F-WARP motor scale, Inclined Plane, and forelimb ladder walk, exhibited stratification between all groups and marked impairment with C5 and C6 injuries. Classic hindlimb tests including BBB, hindlimb ladder walk, bladder recovery, and mortality were not different between cervical and thoracic injuries. CatWalk multivariate gait analysis showed reciprocal and progressive changes forelimb and hindlimb function with ascending level of injury. Electrophysiology revealed poor forelimb axonal conduction in cervical C5 and C6 groups alone. The cervical enlargement (C5-T2) showed progressive ventral horn atrophy and loss of specific motor neuron populations with ascending injury. Multivariate statistics revealed a robust dataset, rank-order contribution of outcomes, and allowed prediction of injury level with single-level discrimination using forelimb performance and neuron counts. Level-dependent models were generated using clip-compression SCI, with marked and reliable differences in forelimb performance and specific neuron pool loss.
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120
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Serum MicroRNAs Reflect Injury Severity in a Large Animal Model of Thoracic Spinal Cord Injury. Sci Rep 2017; 7:1376. [PMID: 28469141 PMCID: PMC5431108 DOI: 10.1038/s41598-017-01299-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022] Open
Abstract
Therapeutic development for spinal cord injury is hindered by the difficulty in conducting clinical trials, which to date have relied solely on functional outcome measures for patient enrollment, stratification, and evaluation. Biological biomarkers that accurately classify injury severity and predict neurologic outcome would represent a paradigm shift in the way spinal cord injury clinical trials could be conducted. MicroRNAs have emerged as attractive biomarker candidates due to their stability in biological fluids, their phylogenetic similarities, and their tissue specificity. Here we characterized a porcine model of spinal cord injury using a combined behavioural, histological, and molecular approach. We performed next-generation sequencing on microRNAs in serum samples collected before injury and then at 1, 3, and 5 days post injury. We identified 58, 21, 9, and 7 altered miRNA after severe, moderate, and mild spinal cord injury, and SHAM surgery, respectively. These data were combined with behavioural and histological analysis. Overall miRNA expression at 1 and 3 days post injury strongly correlates with outcome measures at 12 weeks post injury. The data presented here indicate that serum miRNAs are promising candidates as biomarkers for the evaluation of injury severity for spinal cord injury or other forms of traumatic, acute, neurologic injury.
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121
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Abstract
Spinal cord injury (SCI) has been considered an incurable condition and it often causes devastating sequelae. In terms of the pathophysiology of SCI, reducing secondary damage is the key to its treatment. Various researches and clinical trials have been performed, and some of them showed promising results; however, there is still no gold standard treatment with sufficient evidence. Two therapeutic concepts for SCI are neuroprotective and neuroregenerative strategies. The neuroprotective strategy modulates the pathomechanism of SCI. The purpose of neuroprotective treatment is to minimize secondary damage following direct injury. The aim of neuroregenerative treatment is to enhance the endogenous regeneration process and to alter the intrinsic barrier. With advancement in biotechnology, cell therapy using cell transplantation is currently under investigation. This review discusses the pathophysiology of SCI and introduces the therapeutic candidates that have been developed so far.
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Affiliation(s)
- Young-Hoon Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Il Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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122
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Thibault-Halman G, Rivers CS, Bailey CS, Tsai EC, Drew B, Noonan VK, Fehlings MG, Dvorak MF, Kuerban D, Kwon BK, Christie SD. Predicting Recruitment Feasibility for Acute Spinal Cord Injury Clinical Trials in Canada Using National Registry Data. J Neurotrauma 2017; 34:599-606. [DOI: 10.1089/neu.2016.4568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Eve C. Tsai
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Drew
- Hamilton General, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa K. Noonan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Brian K. Kwon
- Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Sean D. Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
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123
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Kramer JLK, Geisler F, Ramer L, Plunet W, Cragg JJ. Open Access Platforms in Spinal Cord Injury: Existing Clinical Trial Data to Predict and Improve Outcomes. Neurorehabil Neural Repair 2017; 31:399-401. [PMID: 28107789 DOI: 10.1177/1545968316688801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recovery from acute spinal cord injury (SCI) is characterized by extensive heterogeneity, resulting in uncertain prognosis. Reliable prediction of recovery in the acute phase benefits patients and their families directly, as well as improves the likelihood of detecting efficacy in clinical trials. This issue of heterogeneity is not unique to SCI. In fields such as traumatic brain injury, Parkinson's disease, and amyotrophic lateral sclerosis, one approach to understand variability in recovery has been to make clinical trial data widely available to the greater research community. We contend that the SCI community should adopt a similar approach in providing open access clinical trial data.
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Affiliation(s)
- John L K Kramer
- 1 University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Leanne Ramer
- 3 Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Ward Plunet
- 1 University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J Cragg
- 1 University of British Columbia, Vancouver, British Columbia, Canada
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124
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Shank CD, Walters BC, Hadley MN. Management of acute traumatic spinal cord injuries. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:275-298. [PMID: 28187803 DOI: 10.1016/b978-0-444-63600-3.00015-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute traumatic spinal cord injury (SCI) is a devastating disease process affecting tens of thousands of people across the USA each year. Despite the increase in primary prevention measures, such as educational programs, motor vehicle speed limits, automobile running lights, and safety technology that includes automobile passive restraint systems and airbags, SCIs continue to carry substantial permanent morbidity and mortality. Medical measures implemented following the initial injury are designed to limit secondary insult to the spinal cord and to stabilize the spinal column in an attempt to decrease devastating sequelae. This chapter is an overview of the contemporary management of an acute traumatic SCI patient from the time of injury through the stay in the intensive care unit. We discuss initial triage, immobilization, and transportation of the patient by emergency medical services personnel to a definitive treatment facility. Upon arrival at the emergency department, we review initial trauma protocols and the evidence-based recommendations for radiographic evaluation of the patient's vertebral column. Finally, we outline closed cervical spine reduction and various aggressive medical therapies aimed at improving neurologic outcome.
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Affiliation(s)
- C D Shank
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - B C Walters
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA
| | - M N Hadley
- Department of Neurosurgery, University of Alabama, Birmingham, AL, USA.
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125
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126
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Tanadini LG, Steeves JD, Curt A, Hothorn T. Autoregressive transitional ordinal model to test for treatment effect in neurological trials with complex endpoints. BMC Med Res Methodol 2016; 16:149. [PMID: 27821067 PMCID: PMC5100172 DOI: 10.1186/s12874-016-0251-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/19/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A number of potential therapeutic approaches for neurological disorders have failed to provide convincing evidence of efficacy, prompting pharmaceutical and health companies to discontinue their involvement in drug development. Limitations in the statistical analysis of complex endpoints have very likely had a negative impact on the translational process. METHODS We propose a transitional ordinal model with an autoregressive component to overcome previous limitations in the analysis of Upper Extremity Motor Scores, a relevant endpoint in the field of Spinal Cord Injury. Statistical power and clinical interpretation of estimated treatment effects of the proposed model were compared to routinely employed approaches in a large simulation study of two-arm randomized clinical trials. A revisitation of a key historical trial provides further comparison between the different analysis approaches. RESULTS The proposed model outperformed all other approaches in virtually all simulation settings, achieving on average 14 % higher statistical power than the respective second-best performing approach (range: -1 %, +34 %). Only the transitional model allows treatment effect estimates to be interpreted as conditional odds ratios, providing clear interpretation and visualization. CONCLUSION The proposed model takes into account the complex ordinal nature of the endpoint under investigation and explicitly accounts for relevant prognostic factors such as lesion level and baseline information. Superior statistical power, combined with clear clinical interpretation of estimated treatment effects and widespread availability in commercial software, are strong arguments for clinicians and trial scientists to adopt, and further extend, the proposed approach.
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Affiliation(s)
- Lorenzo G Tanadini
- Department of Biostatistics; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland.
| | - John D Steeves
- ICORD, University of British Columbia and Vancouver Coastal Health, Vancouver, Canada
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Torsten Hothorn
- Department of Biostatistics; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland
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127
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Donati ARC, Shokur S, Morya E, Campos DSF, Moioli RC, Gitti CM, Augusto PB, Tripodi S, Pires CG, Pereira GA, Brasil FL, Gallo S, Lin AA, Takigami AK, Aratanha MA, Joshi S, Bleuler H, Cheng G, Rudolph A, Nicolelis MAL. Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients. Sci Rep 2016; 6:30383. [PMID: 27513629 PMCID: PMC4980986 DOI: 10.1038/srep30383] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/04/2016] [Indexed: 12/04/2022] Open
Abstract
Brain-machine interfaces (BMIs) provide a new assistive strategy aimed at restoring mobility in severely paralyzed patients. Yet, no study in animals or in human subjects has indicated that long-term BMI training could induce any type of clinical recovery. Eight chronic (3–13 years) spinal cord injury (SCI) paraplegics were subjected to long-term training (12 months) with a multi-stage BMI-based gait neurorehabilitation paradigm aimed at restoring locomotion. This paradigm combined intense immersive virtual reality training, enriched visual-tactile feedback, and walking with two EEG-controlled robotic actuators, including a custom-designed lower limb exoskeleton capable of delivering tactile feedback to subjects. Following 12 months of training with this paradigm, all eight patients experienced neurological improvements in somatic sensation (pain localization, fine/crude touch, and proprioceptive sensing) in multiple dermatomes. Patients also regained voluntary motor control in key muscles below the SCI level, as measured by EMGs, resulting in marked improvement in their walking index. As a result, 50% of these patients were upgraded to an incomplete paraplegia classification. Neurological recovery was paralleled by the reemergence of lower limb motor imagery at cortical level. We hypothesize that this unprecedented neurological recovery results from both cortical and spinal cord plasticity triggered by long-term BMI usage.
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Affiliation(s)
- Ana R C Donati
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Solaiman Shokur
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil
| | - Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Alberto Santos Dumont Education and Research Institute, Sao Paulo, Brazil
| | - Debora S F Campos
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Renan C Moioli
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Alberto Santos Dumont Education and Research Institute, Sao Paulo, Brazil
| | - Claudia M Gitti
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Patricia B Augusto
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Sandra Tripodi
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Cristhiane G Pires
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Gislaine A Pereira
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Fabricio L Brasil
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Alberto Santos Dumont Education and Research Institute, Sao Paulo, Brazil
| | - Simone Gallo
- STI IMT, Ecole Polytechnique Federal de Lausanne, Lausanne, Switzerland
| | - Anthony A Lin
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Angelo K Takigami
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil
| | - Maria A Aratanha
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil
| | - Sanjay Joshi
- Mechanical and Aerospace Engineering, University of California, Davis, CA, USA
| | - Hannes Bleuler
- STI IMT, Ecole Polytechnique Federal de Lausanne, Lausanne, Switzerland
| | - Gordon Cheng
- Institute for Cognitive Systems, Technical University of Munich (TUM), Munich, Germany, Germany
| | - Alan Rudolph
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Colorado State University, Fort Collins, CO, USA
| | - Miguel A L Nicolelis
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), Sâo Paulo, Brazil.,Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Neurobiology, Duke University, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Center for Neuroengineering, Duke University, Durham, NC, USA
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128
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Park DH, Wang L, Pittock P, Lajoie G, Whitehead SN. Increased Expression of GM1 Detected by Electrospray Mass Spectrometry in Rat Primary Embryonic Cortical Neurons Exposed to Glutamate Toxicity. Anal Chem 2016; 88:7844-52. [PMID: 27376483 DOI: 10.1021/acs.analchem.6b01940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neurons within different brain regions have varying levels of vulnerability to external stress and respond differently to injury. A potential reason to explain this may lie within a key lipid class of the cell's plasma membrane called gangliosides. These glycosphingolipid species have been shown to play various roles in the maintenance of neuronal viability. The purpose of this study is to use electrospray ionization mass spectrometry (ESI-MS) and immunohistochemistry to evaluate the temporal expression profiles of gangliosides during the course of neurodegeneration in rat primary cortical neurons exposed to glutamate toxicity. Primary embryonic (E18) rat cortical neurons were cultured to DIV (days in vitro) 14. Glutamate toxicity was induced for 1, 3, 6, and 24 h to injure and kill neurons. Immunofluorescence was used to stain for GM1 and GM3 species, and ESI-MS was used to quantify the ganglioside species expressed within these injured neurons. ESI-MS data revealed that GM1, GM2, and GM3 were up-regulated in neurons exposed to glutamate. Interestingly, using immunofluorescence, we demonstrated that the GM1 increase following glutamate exposure occurred in viable neurons, possibly indicating a potential intrinsic neuroprotective response. To test this potential neuroprotective property, neurons were pretreated with GM1 for 24 h prior to glutamate exposure. Pretreatment with GM1 conferred significant neuroprotection against glutamate-induced cell death. Overall, work from this study validates the use of ESI-MS for cell-derived gangliosides and supports the further development of lipid based strategies to protect against neuron cell death.
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Affiliation(s)
| | | | | | | | - Shawn Narain Whitehead
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario , London, Ontario N6A 5A5, Canada
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129
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Marcon RM, Cristante AF, de Barros Filho TEP, Ferreira R, dos Santos GB. Effects of ganglioside G(M1) and erythropoietin on spinal cord lesions in rats: functional and histological evaluations. Clinics (Sao Paulo) 2016; 71:351-60. [PMID: 27438570 PMCID: PMC4930661 DOI: 10.6061/clinics/2016(06)11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/21/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the functional and histological effects of ganglioside G(M1) and erythropoietin after experimental spinal cord contusion injury. METHODS Fifty male Wistar rats underwent experimental spinal cord lesioning using an NYU-Impactor device and were randomly divided into the following groups, which received treatment intraperitoneally. The G(M1) group received ganglioside G(M1) (30 mg/kg); the erythropoietin group received erythropoietin (1000 IU/kg); the combined group received both drugs; and the saline group received saline (0.9%) as a control. A fifth group was the laminectomy group, in which the animals were subjected to laminectomy alone, without spinal lesioning or treatment. The animals were evaluated according to the Basso, Beattie and Bresnahan (BBB) scale, motor evoked potential recordings and, after euthanasia, histological analysis of spinal cord tissue. RESULTS The erythropoietin group had higher BBB scores than the G(M1) group. The combined group had the highest BBB scores, and the saline group had the lowest BBB scores. No significant difference in latency was observed between the three groups that underwent spinal cord lesioning and intervention. However, the combined group showed a significantly higher signal amplitude than the other treatment groups or the saline group (p<0.01). Histological tissue analysis showed no significant difference between the groups. Axonal index was significantly enhanced in the combined group than any other intervention (p<0.01). CONCLUSION G(M1) and erythropoietin exert therapeutic effects on axonal regeneration and electrophysiological and motor functions in rats subjected to experimental spinal cord lesioning and administering these two substances in combination potentiates their effects.
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Affiliation(s)
- Raphael Martus Marcon
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Divisão de Cirurgia de Coluna Vertebral, Laboratório de Investigação Médica (LIM 41), São Paulo/SP, Brazil
- E-mail: .
| | - Alexandre Fogaça Cristante
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Divisão de Cirurgia de Coluna Vertebral, Laboratório de Investigação Médica (LIM 41), São Paulo/SP, Brazil
| | - Tarcísio Eloy Pessoa de Barros Filho
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Divisão de Cirurgia de Coluna Vertebral, Laboratório de Investigação Médica (LIM 41), São Paulo/SP, Brazil
| | - Ricardo Ferreira
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Divisão de Cirurgia de Coluna Vertebral, Laboratório de Investigação Médica (LIM 41), São Paulo/SP, Brazil
| | - Gustavo Bispo dos Santos
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), Divisão de Cirurgia de Coluna Vertebral, Laboratório de Investigação Médica (LIM 41), São Paulo/SP, Brazil
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Anthonymuthu TS, Kenny EM, Bayır H. Therapies targeting lipid peroxidation in traumatic brain injury. Brain Res 2016; 1640:57-76. [PMID: 26872597 PMCID: PMC4870119 DOI: 10.1016/j.brainres.2016.02.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 02/06/2023]
Abstract
Lipid peroxidation can be broadly defined as the process of inserting a hydroperoxy group into a lipid. Polyunsaturated fatty acids present in the phospholipids are often the targets for peroxidation. Phospholipids are indispensable for normal structure of membranes. The other important function of phospholipids stems from their role as a source of lipid mediators - oxygenated free fatty acids that are derived from lipid peroxidation. In the CNS, excessive accumulation of either oxidized phospholipids or oxygenated free fatty acids may be associated with damage occurring during acute brain injury and subsequent inflammatory responses. There is a growing body of evidence that lipid peroxidation occurs after severe traumatic brain injury in humans and correlates with the injury severity and mortality. Identification of the products and sources of lipid peroxidation and its enzymatic or non-enzymatic nature is essential for the design of mechanism-based therapies. Recent progress in mass spectrometry-based lipidomics/oxidative lipidomics offers remarkable opportunities for quantitative characterization of lipid peroxidation products, providing guidance for targeted development of specific therapeutic modalities. In this review, we critically evaluate previous attempts to use non-specific antioxidants as neuroprotectors and emphasize new approaches based on recent breakthroughs in understanding of enzymatic mechanisms of lipid peroxidation associated with specific death pathways, particularly apoptosis. We also emphasize the role of different phospholipases (calcium-dependent and -independent) in hydrolysis of peroxidized phospholipids and generation of pro- and anti-inflammatory lipid mediators. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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Affiliation(s)
- Tamil Selvan Anthonymuthu
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Free Radical and Antioxidant Health, University of Pittsburgh, Pittsburgh, PA 15219, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Elizabeth Megan Kenny
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Free Radical and Antioxidant Health, University of Pittsburgh, Pittsburgh, PA 15219, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Hülya Bayır
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15219, USA; Center for Free Radical and Antioxidant Health, University of Pittsburgh, Pittsburgh, PA 15219, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15260, USA; Childrens׳s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 15224, USA.
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Liu D, Jiang T, Cai W, Chen J, Zhang H, Hietala S, Santos HA, Yin G, Fan J. An In Situ Gelling Drug Delivery System for Improved Recovery after Spinal Cord Injury. Adv Healthc Mater 2016; 5:1513-21. [PMID: 27113454 DOI: 10.1002/adhm.201600055] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/02/2016] [Indexed: 12/11/2022]
Abstract
Therapeutic strategies for the spinal cord injury (SCI) are limited by the current available drug delivery techniques. Here, an in situ gelling drug delivery system (DDS), composed of a Poloxamer-407, a 188 mixture-based thermoresponsive hydrogel matrix and, an incorporated therapeutic compound (monosialoganglioside, GM1), is developed for SCI therapy. A low-thoracic hemisection in rats is used as SCI model to evaluate therapeutic efficiency. The GM1-incorporating Poloxamer-407 and 188 polymer solution is converted to a hydrogel (GM1-hydrogel) upon instillation to the injured spinal cord, due to the increased temperature. At body temperature, the thermoresponsive hydrogel prolongs the release of GM1 for about 1 month, due to the superposition of dissolution and swelling (anomalous transport) of the hydrogel matrix. The sustained release of the GM1-hydrogel enables the prolonged residence time of GM1 at the injured spinal cord, decreases the frequency of administration and, consequently, may improve patient compliance. After SCI, the administration of GM1-hydrogel to the lesion site inhibits the apoptotic cell death and glial scar formation, enhances the neuron regeneration, provides neuroprotection to the injured spinal cord, and improves the locomotor recovery. Overall, this study opens future perspectives for the treatment of SCI with a prolonged drug release DDS.
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Affiliation(s)
- Dongfei Liu
- Division of Pharmaceutical Chemistry and Technology Faculty of Pharmacy University of Helsinki FI‐00014 Helsinki Finland
| | - Tao Jiang
- Department of Orthopaedics The First Affiliated Hospital of Nanjing Medical University Jiangsu 210029 China
| | - Weihua Cai
- Department of Orthopaedics The First Affiliated Hospital of Nanjing Medical University Jiangsu 210029 China
| | - Jian Chen
- Department of Orthopaedics The First Affiliated Hospital of Nanjing Medical University Jiangsu 210029 China
| | - Hongbo Zhang
- Division of Pharmaceutical Chemistry and Technology Faculty of Pharmacy University of Helsinki FI‐00014 Helsinki Finland
| | - Sami Hietala
- Laboratory of Polymer Chemistry Department of Chemistry University of Helsinki FI‐00014 Helsinki Finland
| | - Hélder A. Santos
- Division of Pharmaceutical Chemistry and Technology Faculty of Pharmacy University of Helsinki FI‐00014 Helsinki Finland
| | - Guoyong Yin
- Department of Orthopaedics The First Affiliated Hospital of Nanjing Medical University Jiangsu 210029 China
| | - Jin Fan
- Department of Orthopaedics The First Affiliated Hospital of Nanjing Medical University Jiangsu 210029 China
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BARROS FILHO TARCÍSIOELOYPESSOA, ARAUJO FERNANDOFLORESDE, HIGINO LUCASDAPAZ, MARCON RAPHAELMARTUS, CRISTANTE ALEXANDREFOGAÇA. THE EFFECT OF MONOSIALOGANGLYOSIDE (GM-1) ADMINISTRATION IN SPINAL CORD INJURY. ACTA ORTOPEDICA BRASILEIRA 2016; 24:123-6. [PMID: 27217811 PMCID: PMC4863858 DOI: 10.1590/1413-785220162403160032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of monosialoganglioside (GM-1) in spinal cord trauma patients seen in our service who have not been treated with methylprednisolone. METHODS Thirty patients with acute spinal cord trauma were randomly divided into two groups. In Group 1, patients received 200 mg GM-1 in the initial assessment and thereafter received 100 mg intravenous per day for 30 days and Group 2 (control) received saline. Patients were evaluated periodically (at 6 weeks, 6 months, one year and two years), using a standardized neurological assessment of the American Spinal Injury Association / International Spinal Cord Society. RESULTS The comparative statistical analysis of motor indices, sensitive indices for pain and touch according to the standardization of ASIA / ISCOS showed that the assessments at 6 weeks, 6 months and 2 years, GM-Group 1 patients had higher rates than the control group regarding sensitivity to pain and touch, with no statistically significant difference from the motor index. CONCLUSION The functional assessment showed improvement in the sensitive indices of patients treated with GM1 after post-traumatic spinal cord injury compared to patients who received placebo. Level of Evidence IV, Prospective Case Studies Series.
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133
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Diagnostic accuracy of evoked potentials for functional impairment after contusive spinal cord injury in adult rats. J Clin Neurosci 2016; 25:122-6. [DOI: 10.1016/j.jocn.2015.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/11/2015] [Indexed: 11/17/2022]
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Rogers WK, Todd M. Acute spinal cord injury. Best Pract Res Clin Anaesthesiol 2016; 30:27-39. [DOI: 10.1016/j.bpa.2015.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022]
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Martin AR, Aleksanderek I, Fehlings MG. Diagnosis and Acute Management of Spinal Cord Injury: Current Best Practices and Emerging Therapies. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-015-0020-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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136
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Rationale, design and critical end points for the Riluzole in Acute Spinal Cord Injury Study (RISCIS): a randomized, double-blinded, placebo-controlled parallel multi-center trial. Spinal Cord 2015; 54:8-15. [PMID: 26099215 PMCID: PMC5399137 DOI: 10.1038/sc.2015.95] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/28/2015] [Accepted: 05/01/2015] [Indexed: 01/08/2023]
Abstract
Background: Riluzole is a sodium channel-blocking agent used in treating amyotrophic lateral sclerosis. It has been approved by the U.S. Food and Drug Administration, Canadian and Australian authorities, and in many other countries. A phase I trial of riluzole for acute spinal cord injury (SCI) provided safety and pharmacokinetic data and suggested neuroprotective benefits. A phase IIB/III double-blinded randomized controlled trial (RCT) started in January 2014 (https://clinicaltrials.gov, NCT01597518). This article describes the pathophysiological rationale, preclinical experience and design of the phase IIB/III RCT of Riluzole in Acute Spinal Cord Injury Study (RISCIS). Objectives: The primary objective of the trial is to evaluate the superiority of riluzole, at a dose of 100 mg BID in the first 24 h followed by 50 mg BID for the following 13 days post injury, compared with placebo in improving neurological motor outcomes in patients with C4–C8 level, International Standards for Neurological Classification of Spinal Cord Injury Examination (ISNCSCI) grade A, B or C acute (within 12 h post injury) SCI. Setting: Acute trauma centers worldwide Methods: A double-blind, multi-center, placebo-controlled RCT will enroll 351 participants randomized 1:1 to riluzole and placebo. The primary end point is the change between 180 days and baseline in ISNCSCI Motor Score. This study has 90% power to detect a change of nine points in ISNCSCI Motor Score at one-sided α=0.025. Results: Currently enrolling in 11 centers. Conclusion: This study will provide class I evidence regarding the safety and neuroprotective efficacy of riluzole in patients with acute cervical SCI.
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Ling ZM, Tang Y, Li YQ, Luo HX, Liu LL, Tu QQ, Zhou LH. Evaluation of Avulsion-Induced Neuropathology in Rat Spinal Cords with 18F-FDG Micro-PET/CT. PLoS One 2015; 10:e0127685. [PMID: 26010770 PMCID: PMC4444271 DOI: 10.1371/journal.pone.0127685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 04/17/2015] [Indexed: 01/10/2023] Open
Abstract
Brachial plexus root avulsion (BPRA) leads to dramatic motoneuron death and glial reactions in the corresponding spinal segments at the late stage of injury. To protect spinal motoneurons, assessment of the affected spinal segments should be done at an earlier stage of the injury. In this study, we employed 18F-FDG small-animal PET/CT to assess the severity of BPRA-induced cervical spinal cord injuries. Adult Sprague-Dawley rats were randomly treated and divided into three groups: Av+NS (brachial plexus root avulsion (Av) treated with normal saline), Av+GM1 (treated with monosialoganglioside), and control. At time points of 3 day (d), 1 week (w), 2 w, 4 w and 8 w post-injury, 18F-FDG micro-PET/CT scans and neuropathology assessments of the injured spinal roots, as well as the spinal cord, were performed. The outcomes of the different treatments were compared. The results showed that BPRA induced local bleeding and typical Wallerian degeneration of the avulsed roots accompanied by 18F-FDG accumulations at the ipsilateral cervical intervertebral foramen. BPRA-induced astrocyte reactions and overexpression of neuronal nitric oxide synthase in the motoneurons correlated with higher 18F-FDG uptake in the ipsilateral cervical spinal cord during the first 2 w post-injury. The GM1 treatment reduced BPRA-induced astrocyte reactions and inhibited the de novo nNOS expressions in spinal motoneurons. The GM1 treatment also protected spinal motoneurons from avulsion within the first 4 w post-injury. The data from this study suggest that 18F-FDG PET/CT could be used to assess the severity of BPRA-induced primary and secondary injuries in the spinal cord. Furthermore, GM1 is an effective drug for reducing primary and secondary spinal cord injuries following BPRA.
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Affiliation(s)
- Ze-Min Ling
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
| | - Ying Tang
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
| | - Ying-Qin Li
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
| | - Hao-Xuan Luo
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
| | - Lin-Lin Liu
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
| | - Qing-Qiang Tu
- Small Animal Molecular Imaging Center, Laboratories of Translational Medicine and Clinical Research, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
| | - Li-Hua Zhou
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, P.R. China
- * E-mail:
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Ledeen RW, Wu G. The multi-tasked life of GM1 ganglioside, a true factotum of nature. Trends Biochem Sci 2015; 40:407-18. [PMID: 26024958 DOI: 10.1016/j.tibs.2015.04.005] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022]
Abstract
GM1 ganglioside occurs widely in vertebrate tissues, where it exhibits many essential functions, both in the plasma membrane and intracellular loci. Its essentiality is revealed in the dire consequences resulting from genetic deletion. This derives from its key roles in several signalosome systems, characteristically located in membrane rafts, where it associates with specific proteins that have glycolipid-binding domains. Thus, GM1 interacts with proteins that modulate mechanisms such as ion transport, neuronal differentiation, G protein-coupled receptors (GPCRs), immune system reactivities, and neuroprotective signaling. The latter occurs through intimate association with neurotrophin receptors, which has relevance to the etiopathogenesis of neurodegenerative diseases and potential therapies. Here, we review the current state of knowledge of these GM1-associated mechanisms.
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Affiliation(s)
- Robert W Ledeen
- Department of Neurology and Neurosciences, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ 07103, USA.
| | - Gusheng Wu
- Department of Neurology and Neurosciences, New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ 07103, USA
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Palmano K, Rowan A, Guillermo R, Guan J, McJarrow P. The role of gangliosides in neurodevelopment. Nutrients 2015; 7:3891-913. [PMID: 26007338 PMCID: PMC4446785 DOI: 10.3390/nu7053891] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 11/18/2022] Open
Abstract
Gangliosides are important components of neuronal cell membranes and it is widely accepted that they play a critical role in neuronal and brain development. They are functionally involved in neurotransmission and are thought to support the formation and stabilization of functional synapses and neural circuits required as the structural basis of memory and learning. Available evidence, as reviewed herein, suggests that dietary gangliosides may impact positively on cognitive functions, particularly in the early postnatal period when the brain is still growing. Further, new evidence suggests that the mechanism of action may be through an effect on the neuroplasticity of the brain, mediated through enhanced synaptic plasticity in the hippocampus and nigro-striatal dopaminergic pathway.
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Affiliation(s)
| | - Angela Rowan
- Fonterra Co-operative Group Ltd., Private Bag 11029, Palmerston North 4442, New Zealand.
| | - Rozey Guillermo
- Centre for Brain Research, Auckland University, Private Bag 92019, Auckland 1142, New Zealand.
| | - Jian Guan
- Centre for Brain Research, Auckland University, Private Bag 92019, Auckland 1142, New Zealand.
| | - Paul McJarrow
- Fonterra Co-operative Group Ltd., Private Bag 11029, Palmerston North 4442, New Zealand.
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Jug M, Kejžar N, Vesel M, Al Mawed S, Dobravec M, Herman S, Bajrović FF. Neurological Recovery after Traumatic Cervical Spinal Cord Injury Is Superior if Surgical Decompression and Instrumented Fusion Are Performed within 8 Hours versus 8 to 24 Hours after Injury: A Single Center Experience. J Neurotrauma 2015; 32:1385-92. [PMID: 25658291 DOI: 10.1089/neu.2014.3767] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A prospective study was performed to evaluate the impact of surgical decompression (SD) and instrumented fusion within 8 h versus 8-24 h after injury on neurological recovery after cervical traumatic spinal cord injury (tSCI) in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the 6-month follow-up. Of the 48 enrolled patients, 22 patients who underwent surgery within 8 h (group 8 h) and 20 patients who underwent surgery between 8 and 24 h (Group 8-24 h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the 6-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in group 8 h and in 10% of patients in group 8-24 h (p=0.017). The median improvement in the ASIA motor score was 38.5 (10.0-61.0) motor points in group 8 h and 15.0 (8.8-34.0) motor points in group 8-24 h (p=0.0468). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in group 8 h than for patients in group 8-24 h (odds ratio=11.08, p=0.004). No statistically significant difference was found in the rate of perioperative complications, pneumonia, and the number of ventilator-dependent days or the mortality between the groups. Our results suggest that the patients with tSCI who undergo SD within 8 h after injury have superior neurological outcomes than patients who undergo SD 8-24 h after injury, without any increase in the rate of adverse effects.
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Affiliation(s)
- Marko Jug
- 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Nataša Kejžar
- 2 Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana , Slovenia
| | - Miloš Vesel
- 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Said Al Mawed
- 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Marko Dobravec
- 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Simon Herman
- 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Fajko F Bajrović
- 3 Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia .,4 Department of Neurology, University Medical Centre Ljubljana , Ljubljana, Slovenia
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Dietrich WD. Protection and Repair After Spinal Cord Injury: Accomplishments and Future Directions. Top Spinal Cord Inj Rehabil 2015; 21:174-87. [PMID: 26364287 DOI: 10.1310/sci2102-174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It was an honor for me to present the 2014 G. Heiner Sell Memorial Lecture at the annual American Spinal Injury Association (ASIA) meeting in San Antonio. For this purpose, I provided a comprehensive review of the scope of research targeting discovery and translational and clinical investigations into spinal cord injury (SCI) research. Indeed, these are exciting times in the area of spinal cord research and clinical initiatives. Many laboratories and clinical programs throughout the world are publishing data related to the pathophysiology of SCI and new strategies for protecting and promoting recovery in both animal models and humans. For this lecture, several topics were discussed including neuroprotective and reparative strategies, neurorehabilitation, quality of life issues, and future directions. In the area of neuroprotection, pathophysiological events that may be targeted with therapeutic strategies, including pharmacological and targeted temperature management were reviewed. For reparative approaches, the importance of both intrinsic and extrinsic mechanisms of axonal regeneration was highlighted. Various cell therapies currently being tested in preclinical and clinical arenas were reviewed as well as ongoing US Food and Drug Administration approved trials for SCI patients. Neurorehabilitation is an evolving research field with locomotive training strategies, electrical stimulation, and brain-machine interface programs targeting various types of SCI. The importance of testing combination approaches including neuroprotective, reparative, and rehabilitative strategies to maximize recovery mechanisms was therefore emphasized. Finally, quality of life issues that affect thousands of individuals living with paralysis were also presented. Future directions and specific obstacles that require attention as we continue to move the SCI field forward were discussed.
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Affiliation(s)
- W Dalton Dietrich
- The Miami Project to Cure Paralysis and the Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Cox A, Varma A, Banik N. Recent advances in the pharmacologic treatment of spinal cord injury. Metab Brain Dis 2015; 30:473-82. [PMID: 24833553 PMCID: PMC4233197 DOI: 10.1007/s11011-014-9547-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/10/2014] [Indexed: 12/16/2022]
Abstract
A need exists for the effective treatment of individuals suffering from spinal cord injury (SCI). Recent advances in the understanding of the pathophysiological mechanisms occurring in SCI have resulted in an expansion of new therapeutic targets. This review summarizes both preclinical and clinical findings investigating the mechanisms and cognate pharmacologic therapeutics targeted to modulate hypoxia, ischemia, excitotoxicity, inflammation, apoptosis, epigenetic alterations, myelin regeneration and scar remodeling. Successful modulation of these targets has been demonstrated in both preclinical and clinical studies with agents such as Oxycyte, Minocycline, Riluzole, Premarin, Cethrin, and ATI-355. The translation of these agents into clinical studies highlights the progress the field has made in the past decade. SCI proves to be a complex condition; the numerous pathophysiological mechanisms occurring at varying time points suggests that a single agent approach to the treatment of SCI may not be optimal. As the field continues to mature, the hope is that the knowledge gained from these studies will be applied to the development of an effective multi-pronged treatment strategy for SCI.
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Affiliation(s)
- April Cox
- Department of Neurosciences, Medical University of South Carolina, 96 Jonathan Lucas ST. MSC606, Charleston, SC, 29425, USA,
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Kuhle J, Gaiottino J, Leppert D, Petzold A, Bestwick JP, Malaspina A, Lu CH, Dobson R, Disanto G, Norgren N, Nissim A, Kappos L, Hurlbert J, Yong VW, Giovannoni G, Casha S. Serum neurofilament light chain is a biomarker of human spinal cord injury severity and outcome. J Neurol Neurosurg Psychiatry 2015; 86:273-9. [PMID: 24935984 DOI: 10.1136/jnnp-2013-307454] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Neurofilaments (Nf) are major structural proteins that occur exclusively in neurons. In spinal cord injury (SCI), the severity of disease is quantified by clinical measures that have limited sensitivity and reliability, and no blood-based biomarker has been established to further stratify the degree of injury. We aimed to examine a serum-based NfL immunoassay as predictor of the clinical outcome in SCI. METHODS Longitudinal measurement of serum NfL was performed in patients with central cord syndrome (CCS, n=4), motor-incomplete SCI (iSCI, n=10), motor-complete SCI (cSCI, n=13) and healthy controls (HC, n=67), and correlated with clinical severity, neurological outcome, and neuroprotective effect of the drug minocycline. RESULTS Baseline NfL levels were higher in iSCI (21 pg/mL) and cSCI (70 pg/mL) than in HC (5 pg/mL, p=0.006 and p<0.001) and CCS (6 pg/mL, p=0.025 and p=0.010). Levels increased over time (p<0.001) and remained higher in cSCI versus iSCI (p=0.011) and than in CCS (p<0.001). NfL levels correlated with American Spinal Injury Association (ASIA) motor score at baseline (r=-0.53, p=0.004) and after 24 h (r=-0.69, p<0.001) and 3-12-month motor outcome (baseline NfL: r=-0.43, p=0.026 and 24 h NfL: r=-0.72, p<0.001). Minocycline treatment showed decreased NfL levels in the subgroup of cSCI patients. CONCLUSIONS Serum NfL concentrations in SCI patients show a close correlation with acute severity and neurological outcome. Our data provide evidence that serum NfL is of prognostic value in SCI patients for the first time. Further, blood NfL levels may qualify as drug response markers in SCI.
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Affiliation(s)
- Jens Kuhle
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK Neurology, University Hospital Basel, Basel, Switzerland
| | - Johanna Gaiottino
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David Leppert
- Neurology, University Hospital Basel, Basel, Switzerland
| | - Axel Petzold
- Department of Molecular Neurosciences, UCL Institute of Neurology, London, UK
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea Malaspina
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK North-East London and Essex Regional MND Care Centre, London, UK
| | - Ching-Hua Lu
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ruth Dobson
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Giulio Disanto
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Ahuva Nissim
- Biochemical Pharmacology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Ludwig Kappos
- Neurology, University Hospital Basel, Basel, Switzerland
| | - John Hurlbert
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - V Wee Yong
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steven Casha
- Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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144
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Tanadini LG, Hothorn T, Jones LAT, Lammertse DP, Abel R, Maier D, Rupp R, Weidner N, Curt A, Steeves JD. Toward Inclusive Trial Protocols in Heterogeneous Neurological Disorders. Neurorehabil Neural Repair 2015; 29:867-77. [DOI: 10.1177/1545968315570322] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Several novel drug- and cell-based potential therapies for spinal cord injury (SCI) have either been applied or will be considered for future clinical trials. Limitations on the number of eligible patients require trials be undertaken in a highly efficient and effective manner. However, this is particularly challenging when people living with incomplete SCI (iSCI) represent a very heterogeneous population in terms of recovery patterns and can improve spontaneously over the first year after injury. Objective. The current study addresses 2 requirements for designing SCI trials: first, enrollment of as many eligible participants as possible; second, refined stratification of participants into homogeneous cohorts from a heterogeneous iSCI population. Methods. This is a retrospective, longitudinal analysis of prospectively collected SCI data from the European Multicenter study about Spinal Cord Injury (EMSCI). We applied conditional inference trees to provide a prediction-based stratification algorithm that could be used to generate decision rules for the appropriate inclusion of iSCI participants to a trial. Results. Based on baseline clinical assessments and a defined subsequent clinical endpoint, conditional inference trees partitioned iSCI participants into more homogeneous groups with regard to the illustrative endpoint, upper extremity motor score. Assuming a continuous endpoint, the conditional inference tree was validated both internally as well as externally, providing stable and generalizable results. Conclusion. The application of conditional inference trees is feasible for iSCI participants and provides easily implementable, prediction-based decision rules for inclusion and stratification. This algorithm could be utilized to model various trial endpoints and outcome thresholds.
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Affiliation(s)
- Lorenzo G. Tanadini
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Torsten Hothorn
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Daniel P. Lammertse
- Craig Hospital, Englewood, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO, USA
| | - Rainer Abel
- Trauma Center Bayreuth, Bayreuth, Germany
- EMSCI Study Group
| | - Doris Maier
- EMSCI Study Group
- Trauma Center Murnau, Murnau, Germany
| | - Rüdiger Rupp
- EMSCI Study Group
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- EMSCI Study Group
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- EMSCI Study Group
| | - John D. Steeves
- ICORD, University of British Columbia and Vancouver Coastal Health, Vancouver, Canada
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145
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Yılmaz T, Kaptanoğlu E. Current and future medical therapeutic strategies for the functional repair of spinal cord injury. World J Orthop 2015; 6:42-55. [PMID: 25621210 PMCID: PMC4303789 DOI: 10.5312/wjo.v6.i1.42] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Spinal cord injury (SCI) leads to social and psychological problems in patients and requires costly treatment and care. In recent years, various pharmacological agents have been tested for acute SCI. Large scale, prospective, randomized, controlled clinical trials have failed to demonstrate marked neurological benefit in contrast to their success in the laboratory. Today, the most important problem is ineffectiveness of nonsurgical treatment choices in human SCI that showed neuroprotective effects in animal studies. Recently, attempted cellular therapy and transplantations are promising. A better understanding of the pathophysiology of SCI started in the early 1980s. Research had been looking at neuroprotection in the 1980s and the first half of 1990s and regeneration studies started in the second half of the 1990s. A number of studies on surgical timing suggest that early surgical intervention is safe and feasible, can improve clinical and neurological outcomes and reduce health care costs, and minimize the secondary damage caused by compression of the spinal cord after trauma. This article reviews current evidence for early surgical decompression and nonsurgical treatment options, including pharmacological and cellular therapy, as the treatment choices for SCI.
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146
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Dvorak MF, Noonan VK, Fallah N, Fisher CG, Finkelstein J, Kwon BK, Rivers CS, Ahn H, Paquet J, Tsai EC, Townson A, Attabib N, Bailey CS, Christie SD, Drew B, Fourney DR, Fox R, Hurlbert RJ, Johnson MG, Linassi AG, Parent S, Fehlings MG. The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study. J Neurotrauma 2014; 32:645-54. [PMID: 25333195 DOI: 10.1089/neu.2014.3632] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To determine the influence of time from injury to surgery on neurological recovery and length of stay (LOS) in an observational cohort of individuals with traumatic spinal cord injury (tSCI), we analyzed the baseline and follow-up motor scores of participants in the Rick Hansen Spinal Cord Injury Registry to specifically assess the effect of an early (less than 24 h from injury) surgical procedure on motor recovery and on LOS. One thousand four hundred and ten patients who sustained acute tSCIs with baseline American Spinal Injury Association Impairment Scale (AIS) grades A, B, C, or D and were treated surgically were analyzed to determine the effect of the timing of surgery (24, 48, or 72 h from injury) on motor recovery and LOS. Depending on the distribution of data, we used different types of generalized linear models, including multiple linear regression, gamma regression, and negative binomial regression. Persons with incomplete AIS B, C, and D injuries from C2 to L2 demonstrated motor recovery improvement of an additional 6.3 motor points (SE=2.8 p<0.03) when they underwent surgical treatment within 24 h from the time of injury, compared with those who had surgery later than 24 h post-injury. This beneficial effect of early surgery on motor recovery was not seen in the patients with AIS A complete SCI. AIS A and B patients who received early surgery experienced shorter hospital LOS. While the issues of when to perform surgery and what specific operation to perform remain controversial, this work provides evidence that for an incomplete acute tSCI in the cervical, thoracic, or thoracolumbar spine, surgery performed within 24 h from injury improves motor neurological recovery. Early surgery also reduces LOS.
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Affiliation(s)
- Marcel F Dvorak
- 1 Division of Spine, Department of Orthopedics, University of British Columbia , Vancouver, British Columbia, Canada
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147
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Zakharova IO, Sokolova TV, Vlasova YA, Furaev VV, Rychkova MP, Avrova NF. GM1 ganglioside activates ERK1/2 and Akt downstream of Trk tyrosine kinase and protects PC12 cells against hydrogen peroxide toxicity. Neurochem Res 2014; 39:2262-75. [PMID: 25216715 DOI: 10.1007/s11064-014-1428-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/29/2014] [Accepted: 08/30/2014] [Indexed: 12/14/2022]
Abstract
Ganglioside GM1 at micro- and nanomolar concentrations was shown to increase the viability of pheochromocytoma PC12 cells exposed to hydrogen peroxide and diminish the accumulation of reactive oxygen species and oxidative inactivation of Na(+),K(+)-ATPase, the effects of micromolar GM1 being more pronounced than those of nanomolar GM1. These effects of GM1 were abolished by Trk receptor tyrosine kinase inhibitor and diminished by MEK1/2, phosphoinositide 3-kinase and protein kinase C inhibitors. Hydrogen peroxide activates Trk tyrosine kinase; Akt and ERK1/2 are activated downstream of this protein kinase. GM1 was found to activate Trk receptor tyrosine kinase in PC12 cells. GM1 (100 nM and 10 µM) increased the basal activity of Akt, but did not change Akt activity in cells exposed to hydrogen peroxide. Basal ERK1/2 activity in PC12 cells was increased by GM1 at a concentration of 10 µM, but not at nanomolar concentrations. Activation of ERK1/2 by hydrogen peroxide was enhanced by GM1 at a concentration of 10 µM and to a lesser extent at a concentration of 100 nM. Thus, the protective and metabolic effects of GM1 ganglioside on PC12 cells exposed to hydrogen peroxide appear to depend on the activation of Trk receptor tyrosine kinase and downstream activation of Akt and ERK1/2.
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Affiliation(s)
- Irina O Zakharova
- Department of Comparative Neurochemistry, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, Thorez Avenue, 44, Saint Petersburg, 194223, Russian Federation
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148
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Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma. Asian Spine J 2014; 8:427-34. [PMID: 25187859 PMCID: PMC4149985 DOI: 10.4184/asj.2014.8.4.427] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/11/2013] [Accepted: 10/11/2013] [Indexed: 11/08/2022] Open
Abstract
Study Design Prospective observational study. Purpose To assess the clinical outcome after early versus late decompression for traumatic cervical cord injury. Overview of Literature Traumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established. Methods Study on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up. Results The patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS. Conclusions The results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.
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149
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Dvorak MF, Noonan VK, Fallah N, Fisher CG, Rivers CS, Ahn H, Tsai EC, Linassi AG, Christie SD, Attabib N, Hurlbert RJ, Fourney DR, Johnson MG, Fehlings MG, Drew B, Bailey CS, Paquet J, Parent S, Townson A, Ho C, Craven BC, Gagnon D, Tsui D, Fox R, Mac-Thiong JM, Kwon BK. Minimizing errors in acute traumatic spinal cord injury trials by acknowledging the heterogeneity of spinal cord anatomy and injury severity: an observational Canadian cohort analysis. J Neurotrauma 2014; 31:1540-7. [PMID: 24811484 DOI: 10.1089/neu.2013.3278] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Clinical trials of therapies for acute traumatic spinal cord injury (tSCI) have failed to convincingly demonstrate efficacy in improving neurologic function. Failing to acknowledge the heterogeneity of these injuries and under-appreciating the impact of the most important baseline prognostic variables likely contributes to this translational failure. Our hypothesis was that neurological level and severity of initial injury (measured by the American Spinal Injury Association Impairment Scale [AIS]) act jointly and are the major determinants of motor recovery. Our objective was to quantify the influence of these variables when considered together on early motor score recovery following acute tSCI. Eight hundred thirty-six participants from the Rick Hansen Spinal Cord Injury Registry were analyzed for motor score improvement from baseline to follow-up. In AIS A, B, and C patients, cervical and thoracic injuries displayed significantly different motor score recovery. AIS A patients with thoracic (T2-T10) and thoracolumbar (T11-L2) injuries had significantly different motor improvement. High (C1-C4) and low (C5-T1) cervical injuries demonstrated differences in upper extremity motor recovery in AIS B, C, and D. A hypothetical clinical trial example demonstrated the benefits of stratifying on neurological level and severity of injury. Clinically meaningful motor score recovery is predictably related to the neurological level of injury and the severity of the baseline neurological impairment. Stratifying clinical trial cohorts using a joint distribution of these two variables will enhance a study's chance of identifying a true treatment effect and minimize the risk of misattributed treatment effects. Clinical studies should stratify participants based on these factors and record the number of participants and their mean baseline motor scores for each category of this joint distribution as part of the reporting of participant characteristics. Improved clinical trial design is a high priority as new therapies and interventions for tSCI emerge.
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Affiliation(s)
- Marcel F Dvorak
- 1 Department of Orthopedics, University of British Columbia , Vancouver, British Columbia, Canada
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150
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Joaquim AF, Ghizoni E, Tedeschi H, da Cruz HYF, Patel AA. Clinical results of patients with subaxial cervical spine trauma treated according to the SLIC score. J Spinal Cord Med 2014; 37:420-4. [PMID: 24090539 PMCID: PMC4116726 DOI: 10.1179/2045772313y.0000000143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The Subaxial Injury Classification (SLIC) system has been developed to improve injury classification and guide surgical decision making yet clinical validation remains necessary. METHODS We evaluated the validity and safety of the SLIC system prospectively in patients treated for subaxial cervical spine trauma (SCST) between 2009 and 2012. Patients with four or more points were surgically treated, whereas patients with less than 4 points were conservatively managed. OUTCOME MEASURES Neurological status was assessed as the primary outcome of successful treatment. RESULTS Non-surgical group - Twenty-three patients were treated non-surgically, 14 (61%) of them with some follow-up at our institution. Follow-up ranged from 3 to 5 months (mean of 4.42; median 4). The SLIC score ranged from 0 to 6 points (mean and median of 1). One patient with a SLIC of 6 points refused surgery. Surgical group: Twenty-five patients were operated, but follow-up after hospital discharge was obtained in 23 (92%) patients (range from 1 to 24 months, mean of 5.82 months). The SLIC score in this group ranged from 4 to 9 points (mean and median of 7). No patients had neurological worsening. Eight of 13 patients with incomplete deficits had some improvement in American Spinal Injury Association score. CONCLUSIONS This is the first prospective application of the SLIC system. With regard to our primary outcome, neurological status, the SLIC system was found to be a safe and effective guide in the surgical treatment of SCST.
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Affiliation(s)
- Andrei F. Joaquim
- Neurosurgery Division, State University of Campinas (UNICAMP), Campinas, SP, Brazil,Correspondence to: Andrei F. Joaquim, State University of Campinas, UNICAMP, Rua Antônio Lapa 280, S 506, Cambuí, Campinas-SP 13025-240, Brazil.
| | - Enrico Ghizoni
- Neurosurgery Division, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Helder Tedeschi
- Head of the Neurosurgery Division, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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