Norepinephrine levels in traumatized spinal cord of catecholamine-depleted cats

Role of Descending Serotonergic Fibers in the Development of Pathophysiology after Spinal Cord Injury (SCI): Contribution to Chronic Pain, Spasticity, and Autonomic Dysreflexia

As the nervous system develops, nerve fibers from the brain form descending tracts that regulate the execution of motor behavior within the spinal cord, incoming sensory signals, and capacity to change (plasticity). How these fibers affect function depends upon the transmitter released, the receptor system engaged, and the pattern of neural innervation. The current review focuses upon the neurotransmitter serotonin (5-HT) and its capacity to dampen (inhibit) neural excitation. A brief review of key anatomical details, receptor types, and pharmacology is provided. The paper then considers how damage to descending serotonergic fibers contributes to pathophysiology after spinal cord injury (SCI). The loss of serotonergic fibers removes an inhibitory brake that enables plasticity and neural excitation. In this state, noxious stimulation can induce a form of over-excitation that sensitizes pain (nociceptive) circuits, a modification that can contribute to the development of chronic pain. Over time, the loss of serotonergic fibers allows prolonged motor drive (spasticity) to develop and removes a regulatory brake on autonomic function, which enables bouts of unregulated sympathetic activity (autonomic dysreflexia). Recent research has shown that the loss of descending serotonergic activity is accompanied by a shift in how the neurotransmitter GABA affects neural activity, reducing its inhibitory effect. Treatments that target the loss of inhibition could have therapeutic benefit.

Spinal cord contusion models

Most human spinal cord injuries involve contusions of the spinal cord. Many investigators have long used weight-drop contusion animal models to study the pathophysiology and genetic responses of spinal cord injury. All spinal cord injury therapies tested to date in clinical trial were validated in such models. In recent years, the trend has been towards use of rats for spinal cord injury studies. The MASCIS Impactor is a well-standardized rat spinal cord contusion model that produces very consistent graded spinal cord damage that linearly predicts 24-h lesion volumes, 6-week white matter sparing, and locomotor recovery in rats. All aspects of the model, including anesthesia for male and female rats, age rather than body weight criteria, and arterial blood gases were empirically selected to enhance the consistency of injury.

Role of glycemia in acute spinal cord injury. Data from a rat experimental model and clinical experience

While experimental and clinical evidence indicates that in brain injury blood glucose increases with injury severity and hyperglycemia worsens neurological outcome, the role of blood glucose in secondary mechanisms of neuronal damage after acute spinal cord injury has not yet been investigated. Data from spinal cord ischemia models suggests a deleterious effect of hyperglycemia, likely due to enhanced lactic acidosis, which is primarily dependent on the amount of glucose available to be metabolized. The purpose of this study is to summarize preliminary experimental and clinical observations on the role of blood glucose in acute spinal cord injury. Between 1995 and 1996 we used the New York University (NYU) rat spinal cord injury model to test the following hypotheses: 1) Blood glucose levels increase with injury severity. 2) Fasting protects from hyperglycemia and prevents secondary damage to the spinal cord. 3) Postinjury-induced hyperglycemia (dextrose 5% 2 gm/Kg) enhances spinal lesion volume. From a clinical perspective, we reviewed blood glucose records of 47 patients admitted to the Department of Neurosrgery in Verona, between 1991 and 1995, within 24 hours of acute spinal cord injury in order to determine: a) the incidence of hyperglycemia (> 140 mg/dl); b) the correlation between blood glucose and injury severity; and c) the role of methylprednisolone in affecting blood glucose. Results indicate that in a graded spinal cord injury model: 1) Early after injury, more severe contusions support significantly higher blood glucose levels. 2) Fasting overnight does not directly affect spinal cord lesion volume but influences blood gases, and we observed that a slightly systemic acidosis plays a minor neuroprotective role. Fasting also ensures more consistent normoglycemic baseline blood glucose values. 3) Postinjury-induced moderate hyperglycemia (160-190 mg/dl) does not significantly affect spinal cord injury. In the clinical study, we observed that during the first 24 hours after spinal cord injury: a) Glycemia ranges between 90 and 243 mg/dl (mean value 143 mg/dl), and close to 50% of the patients present blood glucose values higher than normal. b) Methylprednisolone administration is not associated to significantly higher blood glucose levels. c) There is a trend for larger glucose rises with more severe injury.

Biochemical markers of cerebral injury in patients with minor head trauma and ethanol intoxication

OBJECTIVE

To determine whether biochemical markers can selectively identify those intoxicated patients with presumed minor head injuries who are likely to have CT evidence of intracranial injury.

METHODS

Patients presenting to the ED with simultaneous presumed minor head trauma and ethanol intoxication were prospectively entered into this cross-sectional study. Following phlebotomy, all patients received cranial CT. Associations between the presence of an abnormal CT scan for injury and serum levels of the following biochemical markers were sought: serum catecholamines, creatine kinase-brain band (CK-BB), and serum amylase. Serum levels are reported as mean +/- SEM.

RESULTS

Nine of the 107 patients (8.4%; 95% CI 3.9-15.4%) had evidence of intracranial injury on CT. Mean serum CK-BB (16.1 +/- 3.7 vs 13.2 +/- 9.6 ng/mL), serum norepinephrine (913 +/- 117 vs 1,089 +/- 76 pg/mL), and serum amylase (64.9 +/- 14.8 vs 84 +/- 4.7 U/L) levels were not significantly different in patients with and without CT evidence of intracranial injury, respectively. Mean serum epinephrine (298 +/- 54 vs 167 +/- 18 pg/mL; p = 0.03) and serum dopamine (218 +/- 50 vs 130 +/- 9 pg/mL; p = 0.014) levels were significantly elevated in the group with intracranial injury on CT. A threshold level of serum dopamine > or = 140 pg/mL yields a sensitivity of 89% (95% CI 52-100%) and a specificity of 80% (95% CI 70-87%) for CT-evident injury. A threshold level of serum epinephrine > or = 218 pg/mL yields a sensitivity of 89% (95% CI 52-100%) and a specificity of 80% (95% CI 70-87%) for CT-evident injury.

CONCLUSION

Elevated serum epinephrine and dopamine levels are associated with intracranial CT-evident injury for ethanol-intoxicated patients with presumed minor head injuries. The potential use of these biochemical markers to guide a more selective approach to cranial CT scanning warrants further evaluation.

Norepinephrine modulates excitability of neonatal rat optic nerves through calcium-mediated mechanisms

We report that norepinephrine markedly increases excitability of neonatal rat optic nerves. To investigate the mechanisms of the norepinephrine-induced excitability increase, we studied isolated optic nerves from 42 neonatal (< three days old) and five adult (> three months old) Long-Evan's hooded rats. Norepinephrine (10(-6), 10(-5) and 10(-4) M) rapidly and reversibly increased the amplitude (mean +/- S.D.: 3.5 +/- 1.7%, 12.1 +/- 2.8% and 35.6 +/- 8.4%) of compound action potentials elicited by submaximal stimulation of neonatal optic nerves. The beta-1 adrenoceptor antagonist atenolol (10(-5) M) blocked the norepinephrine-induced increase in excitability but the alpha antagonist phentolamine (10(-5) M) did not. The beta agonist isoproterenol (10(-5) and 10(-4) M) increased response amplitudes (8.7 +/- 4.1% and 25.8 +/- 4.6%) but the alpha-1 agonist methoxamine and alpha-2 agonist clonidine did not. The beta antagonist propranolol blocked the isoproterenol effect. Replacing Ca2+ with Mg2+ or adding 0.8 mM of Cd2+ reversibly blocked the norepinephrine effects. Extracellular K+ concentrations did not change in optic nerves during norepinephrine application. Blockade of K+ channels with apamin (10(-6) M) or tetraethylammonium (10(-3) M) did not prevent the excitatory effects of norepinephrine. Adult rat optic nerves were insensitive to both norepinephrine (10(-4) M) and isoproterenol (10(-4) M). Our results indicate that norepinephrine increases neonatal optic axonal excitability through Ca(2+)-dependent mechanisms. The data suggest that the adrenoceptors are situated on the axons, that the excitability changes are not due to changes in extracellular K+ concentration or K+ channels sensitive to apamin or tetraethylammonium. The sensitivity of rat optic nerves to norepinephrine declined with age. Axonal adrenoceptors may play a role in optic axonal development and injury.

Central nervous system bioaminergic responses to mechanical trauma. An experimental study

Changes in biogenic amines in the brain and spinal cord following penetrating injury were studied in male Wistar rats using high-performance liquid chromatography with electrochemical detection. Rapid increase in hemispheric concentration of these substances was noted beginning shortly after trauma. This trend continued until they were about three to four times control levels by about 24 to 48 hours postinjury. In the spinal cord, however, there was an initial sharp reduction in regional concentrations 2 hours postinjury followed by a slow rise thereafter. By 48 hours postinjury, levels of norepinephrine, dopamine, and serotonin of the cords of injured animals were still less than those of nontraumatized controls. This variation in the central nervous system bioaminergic response with the level of injury raises questions as to its precise role in neurological damage following mechanical insult.

Effect of transection on the blood-spinal cord barrier of the rat after isolation from descending sources

The disruption of descending pathways and subsequent release of vasoactive neurotransmitters may contribute to the abnormal vascular permeability observed after spinal cord injury. Therefore, the relationship between disruption of long descending fiber tracts in the rat spinal cord and the development of blood-spinal cord barrier breakdown to the protein horseradish peroxidase (HRP) was evaluated. This was accomplished by first transecting the cord in order to deplete transmitter stores in the distal (caudal) segments. One month after this isolation procedure, a second transection was made several segments distal to the first transection. The axial distribution of barrier permeability to HRP was evaluated at both the light and electron microscopic levels in this 'isolated cord' preparation. Camera lucida drawings, delineating the distribution of tracer leakage in the spinal cord, were used to quantify the extent of protein extravasation. Vascular leakage of the tracer was identified as early as 1 h postinjury but was restricted to segments adjacent to the second transection. By 1 day after injury, protein extravasation was more marked, as compared to the earlier time points, and axial spread of barrier breakdown occurred along more distal vascular sites. Abnormal permeability to HRP was confirmed at the ultrastructural level where the protein was present within vesicles in the endothelium and the surrounding smooth muscle layer and basal lamina. The tracer was also identified in the cytoplasmic compartment of neurons and glia and within the adjacent extracellular space.

Monoaminergic responses to spinal trauma. Participation of serotonin in posttraumatic progression of neural damage

The monoamines norepinephrine (NE), dopamine (DA), and serotonin (5-HT) and their major metabolites were measured in the spinal cord of rabbits following laminectomy or impact injury to the thoracic cord. Samples were taken 30 minutes, 60 minutes, 4 hours, and 6 weeks after injury. Utilization ratios (metabolite/transmitter) were calculated from the data. Turnover rates for NE and DA were also calculated at 30 minutes using the alpha-methylparatyrosine method. Trauma resulted in rapid and sustained elevations in 5-HT concentration at and around the injury site. The catecholamines were depleted slightly at the injury site. Levels of 5-hydroxyindole-3-acetic acid were elevated at 30 minutes but fell to baseline by 4 hours, resulting in a decrease in the 5-HT utilization ratio. The utilization and turnover of NE was increased at the injury site, while DA function was not affected. The large short-term increase in 5-HT levels may have been due to extravasation of platelet 5-HT stores into spinal tissue, rather than due to changes in neuronal 5-HT metabolism. At 6 weeks after injury, each monoamine and metabolite appeared to accumulate in spinal cord tissue proximal to the insult. Distal to the injury, depleted amine stores displayed augmented utilization. The data are discussed in terms of a serotonergic hypothesis of the progression of neural damage after trauma, with the interaction of 5-HT with raphe-spinal nerve terminals as a principal event.

The post-injury responses in trauma and ischemia: secondary injury or protective mechanisms?

Transient injuries to the central nervous system, whether due to trauma or ischemia, often produce long lasting metabolic derangements, lipid peroxidation, edema, and falls in blood flow at the lesion site. Because these post-injury responses are believed to be causes of secondary injury, much research effort has been devoted to developing therapies that prevent them. Recent studies suggest that excessive Ca entry into injured cells instigates these post-injury responses. A new theory is proposed to explain these post-injury responses. This theory posits that Ca ions entering dying cells activate phospholipases that break down membranes to release phosphates. The phosphates then bind and precipitate Ca ions, producing the profound and prolonged decreases in extracellular Ca activity that have been observed in traumatized spinal cords and ischemic brains. The phospholipase activity also facilitates release of lipid peroxides which enhance edema and reduce blood flow. Both of these in turn decrease Ca diffusion to the lesion site and slow the recovery of extracellular Ca activity, giving the tissue time to recover and avoiding the consequences of rapid restoration of extracellular Ca activity. The theory suggests that central nervous tissues evolved these Ca-activated responses as a general mechanism to protect neurons against excessive Ca entry. Brain and spinal cord tissues contain very high concentrations of phosphates, many times greater than is necessary to bind all the Ca ions in the tissues. This excessive Ca buffering capacity enables the tissue to sacrifice a small proportion of severely injured cells to reduce Ca entry into less severely injured neurons. This process will also rapidly eliminate moribund cells that may otherwise linger and consume oxygen and metabolic substrates better utilized by the remaining cells. If confirmed, this theory raises serious questions concerning the current experimental therapeutic approaches to CNS trauma and stroke. Therapy should perhaps be designed to optimize rather than to abort the post-injury responses.

Monoamine and tissue fluid levels in contused spinal cord of sheep

Methods are described for the determination of sheep spinal cord tissue fluid content and norepinephrine, serotonin, and dopamine concentrations after experimental injury. The amount of tissue fluid varied in different regions of sheep spinal cord following injury. Norepinephrine and serotonin wet weight concentrations were corrected for this variation in tissue fluid. Corrected norepinephrine wet weight cord concentrations did not change up to 3 hr after injury. Levels of serotonin at 60 min after injury were similar to controls. Dopamine was not detected in sheep spinal cord. alpha-Methyl tyrosine significantly reduced fluid in the spinal cord at 75 min after injury.

Norepinephrine, dopamine and serotonin in experimental spinal cord trauma: current status

The status and function of monoamines in experimental spinal cord trauma remains a subject of controversy and continued debate. The norepinephrine hypothesis has been severely weakened by its lack of reproducibility. Dopamine results are too variable to draw meaningful conclusions. The role of serotonin, particularly with reference to its vasoactive properties and the physiological importance of its effects, remains to be determined.

Microscopic analysis of early histopathological spinal cord alterations following trauma in normal and cathecholamine-depleted cats

The progressive histopathological sequence over the first 3 hr after a 400 g-cm blunt injury to the spinal cord of catecholamine (CA)-intact and CA-depleted cats is described. Norepinephrine levels were measured in all animals. The experiments were designed to determine the role of CA in progressive hemorrhagic necrosis of the spinal cord by removing CA from one group of animals prior to trauma. A second group of CA-intact animals was subjected to identical experimentally-induced trauma. Upon analysis of the histopathological changes, it appears that the sequential nature of the development of hemorrhagic necrosis is both qualitatively and quantitatively similar in both experimental groups. The general conclusion is drawn that catecholamines in greater than normal amounts are present at the lesion site after trauma, but these catecholamines are probably not involved in the process of central hemorrhagic necrosis.