Prevention of damage in acute spinal cord injury by peptides and pharmacologic agents

"Radio-Protective Effect of Aminocaproic Acid in Human Spermatozoa"

BACKGROUND

The negative effects of ionizing radiation on organs and the reproductive system are well known and documented. Exposure to gamma radiation can lead to oligospermia, azoospermia and DNA damage. Up to date, there is no effective pharmaceutical compound for protecting the male reproductive system and sperm.

OBJECTIVE

This study aimed at investigating the ability of Ɛ-aminocaproic acid (EACA) to prevent the damage of human spermatozoa and DNA induced by ionizing radiation.

MATERIALS AND METHODS

Sperm samples were obtained from healthy volunteers (35 men; 31.50 ± 7.34 years old). There were 4 experimental groups: 1) control group (CG), 2) group exposed to maximal radiation dose 67.88 mGy (RMAX), 3) low-dose radiation (minimal) 22.62 mGy (RMIN), and 4) group treated with radiation (67.88 mGy) and EACA (dose 50 ng/ml). Sperm motility, viability, and DNA damage were assessed.

RESULTS

We observed a significant decrease in total sperm motility of the RMAX group compared to CG (p < 0.05). Sperm viability in the RMAX group was also reduced in comparison to the control (p < 0.05). A significant increase in DNA fragmentation was detected in the RMAX group. The results demonstrated that the treatment of sperm with EACA led to a decrease in the fragmentation of the sperm DNA (compared to the RMAX group) (p < 0.05).

CONCLUSION

The results indicate that EACA effectively protects human spermatozoa from DNA damage induced by ionizing radiation. Treatment of spermatozoa with EACA led to the preservation of cell motility, viability, and DNA integrity upon radiation exposure.

Therapeutic approaches of trophic factors in animal models and in patients with spinal cord injury

Trophic factors are naturally produced by different tissues that participate in several functions such as the intercellular communication, in the development, stability, differentiation and regeneration at the cellular level. Specifically, in the case of spinal injuries, these factors can stimulate neuronal recovery. They are applied both in experimental models and in clinical trials in patients. The trophic factors analysed in this review include gonadotropin-releasing hormone (GnRH), thyrotropin-releasing hormone (TRH), growth hormone (GH), melatonin, oestrogens, the family of fibroblast growth factors (FGFs), the family of neurotrophins and the glial cell-derived neurotrophic factor (GDNF). There are some trophic (neurotrophic) factors that already been tested in patients with spinal cord injury (SCI), but only shown partial recovery effect. It is possible that, the administration of these trophic factors together with physical rehabilitation, act synergistically and, therefore, significantly improve the quality of life of patients with SCI.

Spinal cord injury: a review of current therapy, future treatments, and basic science frontiers

The incidence of acute and chronic spinal cord injury (SCI) in the United States is more than 10,000 per year, resulting in 720 cases per million persons enduring permanent disability each year. The economic impact of SCI is estimated to be more than 4 billion dollars annually. Preclinical studies, case reports, and small clinical trials suggest that early treatment may improve neurological recovery. To date, no proven therapeutic modality exists that has demonstrated a positive effect on neurological outcome. Emerging data from recent preclinical and clinical studies offer hope for this devastating condition. This review gives an overview of current basic research and clinical studies for the treatment of SCI.

Kinin receptor antagonists as potential neuroprotective agents in central nervous system injury

Injury to the central nervous system initiates complex physiological, cellular and molecular processes that can result in neuronal cell death. Of interest to this review is the activation of the kinin family of neuropeptides, in particular bradykinin and substance P. These neuropeptides are known to have a potent pro-inflammatory role and can initiate neurogenic inflammation resulting in vasodilation, plasma extravasation and the subsequent development of edema. As inflammation and edema play an integral role in the progressive secondary injury that causes neurological deficits, this review critically examines kinin receptor antagonists as a potential neuroprotective intervention for acute brain injury, and more specifically, traumatic brain and spinal cord injury and stroke.

Current status of clinical trials for acute spinal cord injury

Acute spinal cord injury (ASCI) occurs as a result of physical disruption of spinal cord axons through the epicenter of injury leading to deficits in motor, sensory, and autonomic function. This is a debilitating neurological disorder common in young adults that often requires life-long therapy and rehabilitative care, placing a significant burden on our healthcare system. While no cure exists, research has identified various pharmacological compounds that specifically antagonize primary and secondary mechanisms contributing to the etiology of ASCI. Several compounds including methylprednisolone (MPSS), GM-1 ganglio-side, thyrotropin releasing hormone (TRH), nimodipine, and gacyclidine have been tested in prospective randomized clinical trials of ASCI. MPSS and GM-1 ganglioside have shown evidence of modest benefits. Clearly trials of improved neuroprotective agents are required. Promising potential therapies for ASCI include riluzole, minocycline, erythropoietin, and the fusogen polyethylene glycol, as well as mild hypothermia.

Effects of naloxone on sodium- and potassium-activated and magnesium-dependent adenosine-5'-triphosphatase activity and lipid peroxidation and early ultrastructural findings after experimental spinal cord injury

Endorphins have been implicated in the pathophysiology of spinal cord injury. The effect of naloxone on the sodium- and potassium-activated and magnesium-dependent adenosine-5'-triphosphatase (Na(+)-K+/Mg+2 ATPase, EC.3.6.1.3.) activity, lipid peroxidation, and early ultrastructural findings were studied in rats at the early stage of spinal cord injury, produced with an aneurysm clip on the T2-T7 segments. The rats were divided into four groups. The 10 rats in Group I, which had no injury and received no medication, were used for determining Na(+)-K+/Mg+2 ATPase activity, the extent of lipid peroxidation (by measuring the level of thiobarbituric acid-reactive substances as malondialdehyde), and normal ultrastructural findings. On the 15 rats in Group II, without spinal cord injury, only laminectomy was performed to determine the effect of surgery on the biochemical indices and findings. In the 15 rats in Group III, physiological saline was administered intraperitoneally in an amount equivalent to that of the naloxone administered immediately after spinal cord injury. In the 15 rats in Group IV, 0.5 mg of naloxone was administered intraperitoneally as a single dose immediately after injury and again 60 minutes after injury. The Na(+)-K+/Mg+2 ATPase activity was promptly reduced after spinal cord injury and remained in a lower level than the levels of Groups I and II during 120 minutes after injury. Naloxone treatment, immediately after trauma, attenuated the inactivation of Na(+)-K+/Mg+2 ATPase. On the other hand, there was a significant difference in the malondialdehyde content between animals in Groups I and III. Naloxone treatment reduced the malondialdehyde content in Group IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of mammalian spinal cord injury with antioxidants

After spinal cord injury, two groups of cats were treated with a combination of methylprednisolone sodium succinate (MP, 35 mg/kg) and epsilon-aminocaproic acid (EACA, 350 mg/kg), and guanabenz acetate (0.65 mg/kg). Guanabenz acetate was administered twice daily for 8 weeks. In the first group, the treatment significantly increased blood flow in the abdominal aorta. All cats treated with guanabenz acetate 3 hr after spinal cord contusion had return of micturition and none suffered complete paraplegia. Four animals had partial and the other four had complete motor recovery. A superoxide (O2-.) generating system, horseradish peroxidase, decreased [14C]gamma amino butyric acid uptake by mouse cortical slices by 33% but when superoxide dismutase was added to the medium, the uptake was reduced by only 9%. The nerve endings were also protected by superoxide dismutase from morphologic damage by O2-. as observed by electron microscopy. The agents used in these studies produce their ameliorating effects by virtue of their anti-inflammatory, antioxidant, and membrane stabilizing properties, and enhancing the regional microcirculation. In addition to having these properties, guanabenz acetate is also an alpha 2 adrenoceptor agonist.

The effect of an alpha-2 agonist on bladder function and cord histology after spinal cord injury

Spinal injury in cats is accompanied by urinary bladder and hind limb dysfunction. Ten cats subjected to spinal contusion at the ninth thoracic segment were treated with guanabenz (an alpha-2 agonist) intraperitoneally (0.65 mg./kg.) three hours after injury, and twice daily for eight weeks. An additional six spinal cats were untreated and served as controls. Urodynamic studies were performed on a weekly basis on all animals. Guanabenz modified the vesico-somatic reflex: detrusor-sphincter dyssynergia was either ablated or abolished. In contrast, the controls demonstrated detrusor-sphincter dyssynergia, high residual urine, and spasticity below the lesion. Histological evaluations of the spinal cords revealed that the six paraplegic animals (untreated) suffered marked cavitation of the cord and complete destruction of the grey matter. The five incomplete paraplegic animals (treated) showed minimal cavitation with some preservation of the grey matter. The five ambulators (treated) demonstrated some distortion of grey matter with preservation of white matter. Treatment with guanabenz post traumatic cord injury results in decreased cord cavitation. Detrusor-sphincter dyssynergia is diminished and hind limb function is improved in treated animals.

Oxygen radicals in CNS damage

The products of univalent reduction of oxygen, superoxide anion radical, hydrogen peroxide, and the hydroxyl radical, are capable of causing cellular damage and death. They are, therefore, logical candidates as mediators of vascular and parenchymal injury in the central nervous system (CNS). This paper reviews the sources of oxygen radicals in the CNS, their effects on cerebral vessels and on brain and spinal cord parenchyma, and the evidence which implicates oxygen radicals in various pathological conditions of the CNS.

Thyrotropin releasing hormone augments growth of spinal cord transplants in oculo

The effects of thyrotropin releasing hormone (TRH) on spinal cord growth were evaluated using the in oculo transplant model. The growth of fetal spinal cord allografts, placed into the anterior eye chamber of Sprague-Dawley rats, was markedly augmented by acute exposure of the graft and host animal to TRH at the time of transplantation. No significant growth augmentation was seen after equimolar administration of a mixture of the amino acids that comprise the TRH molecule. It is concluded that acutely administered TRH, at the time of grafting, elicits a significant stimulation of the growth of spinal cord tissue. Our data strengthen the rationale for continued clinical trials of this peptide in spinal cord injury.

Superoxide radical-mediated alteration of synaptosome membrane structure and high-affinity gamma-[14C]aminobutyric acid uptake

Mouse cortical synaptosomal structure and function are altered when exposed to hypoxanthine/xanthine oxidase (HPX/XOD)-generated active oxygen/free radical species. The structure of both the synaptic vesicle and plasma membrane systems are altered by HPX/XOD treatment. The alteration of synaptic vesicle structure is exhibited by a significant increase in the cumulative length of nonsynaptic vesicle membrane per nerve terminal. With respect to the nerve terminal plasma membrane, the length of the perimeter of the synaptosome is increased as the membrane pulls away from portions of the terminal in blebs. The functional lesion generated by HPX/XOD treatment results in a reduction in selective high-affinity gamma-[14C]aminobutyric acid (GABA) uptake. Kinetic analysis of the reduction in high-affinity uptake reveals that the Vmax is significantly altered whereas the Km is not. Preincubation with specific active oxygen/free radical scavengers indicates that the super-oxide radical is directly involved. This radical, most probably in the protonated perhydroxyl form, initiates lipid peroxidative damage of the synaptosomal membrane systems. Low-affinity [14C]GABA transport is unaltered by the HPX/XOD treatment. The apparent ineffectiveness of free radical exposure on low-affinity [14C]GABA transport coupled with its effectiveness in reducing high-affinity transport supports the idea that two separate and different amino acid uptake systems exist in CNS tissue, with the high-affinity being more sensitive (lipid-dependent) and/or more energy-dependent (Na+,K+-ATPase) than the low-affinity system.

Effect of low intravenous doses of TRH, acid-TRH and cyclo(His-Pro) on cerebral and peripheral blood flows

Local cerebral and peripheral blood flow in conscious and anaesthetized rabbits were investigated with the microsphere method, before and after the i.v. administration of 25 or 50 micrograms kg-1 thyrotropin-releasing hormone (TRH). Before the experiment, the cervical sympathetic chain was sectioned on one side in order to evaluate the possible effect of the sympathetic nerves on cranial and extracranial blood flows. Blood flow was also determined in anaesthetized rabbits before and after the administration of the TRH metabolites cyclo(His-Pro) and acid-TRH and after subsequent administration of 50 micrograms kg-1 TRH. TRH caused an increase in mean arterial blood pressure (MAP) of about 1 to 2 kPa whereas cyclo(His-Pro) and acid-TRH had no effect on MAP. In the anaesthetized animal an increase in total cerebral blood flow (CBFtot), from 71 +/- 7 to 107 +/- 12 g min-1 100 g-1 (P less than 0.05) was observed on the sympathetic intact side after 25 micrograms kg-1 TRH and a further increase to 130 +/- 9 g min-1 100g-1 (P less than 0.01) after 50 micrograms kg-1 TRH. A similar effect was observed on the sympathotomized side. An effect on CBF in the conscious animal was not detected. The control CBFtot (104 +/- 8 g min-1 100g-1) was higher in these animals than in the anaesthetized animals (P less than 0.02). Neither cyclo(His-Pro) nor acid-TRH mimicked the effect of TRH on CBF. In several peripheral tissues, e.g. skin, pancreas and gastric mucosa, a reduction in blood flow was noted after the administration of TRH in both anaesthetized and conscious rabbits. It was concluded that TRH can induce cerebral vasodilatation in animals with a depressed CBF, whereas the vasoconstrictor effect of TRH in peripheral organs is not markedly affected by the state of consciousness.

Effects of raised intracranial pressure on regional cerebral blood flow: a comparison of effects of naloxone and TRH on the microcirculation in partial cerebral ischaemia

The effects on regional cerebral blood flow (rCBF) of raised intracranial pressure (ICP) and of naloxone and thyrotropin releasing hormone (TRH) during this condition were studied in anaesthetized rabbits. The ICP was elevated until a central ischaemic response was observed. The regional blood flow was determined with the microsphere technique before and during elevation of the ICP (ICPe) and after drug treatment. Total CBF was reduced by about 70% during ICPe while the uveal blood flow increased slightly and some other peripheral tissue blood flows remained unaffected. The administration of TRH caused an increase in mean arterial blood pressure (MAP) from 11.9 +/- 0.6 to 14.6 +/- 0.7 kPa and a normalization of the rCBF. In some peripheral tissues, e.g. gastric mucosa and spleen, TRH reduced the blood flow by 53% and 76%, respectively. In blood pressure stabilized animals no effect on rCBF was seen after TRH. Naloxone had no consistent effect on MAP or local blood flow. It was concluded that in the range of cerebral perfusion pressure studied there was a passive relationship between cerebral blood flow and perfusion pressure. The lack of effect of naloxone and the marked effect of TRH during cerebral ischaemia are consistent with a mechanism of action of TRH not related to a 'physiological' antagonism of opioids.

Improvement in injury induced hypocalcia by high-dose naloxone intervention

Naloxone hydrochloride was used to re-establish normal calcium activities in the extracellular space of the injured spinal cord. The micromolar levels of calcium which occur immediately after injury were improved above control values by 1 h 30 min post-injury; normal activities occurred at 2 h 45 min. Such a restitution of ionic levels after injury may contribute to the beneficial effects of naloxone in traumatic injury.

Functional restoration of the traumatically injured spinal cord in cats by clonidine

The long-term, chronic, paralysis resulting from spinal cord injury in the cat has been reversed by the use of an alpha 2-adrenergic receptor agonist, clonidine. Administration of this drug resulted in "normalization" of sensory-motor and autonomic dysfunctions. Preliminary studies of the clonidine in humans with traumatically injured spinal cord indicate that autonomic dysreflexia can be controlled and spasticity minimized. The data suggest that biochemical and pharmacologic manipulation of receptors may ameliorate paralysis following traumatic injury to the spinal cord as well as to the brain and brainstem.