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Jiang K, Sun Y, Chen X. Mechanism Underlying Acupuncture Therapy in Spinal Cord Injury: A Narrative Overview of Preclinical Studies. Front Pharmacol 2022; 13:875103. [PMID: 35462893 PMCID: PMC9021644 DOI: 10.3389/fphar.2022.875103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 12/29/2022] Open
Abstract
Spinal cord injury (SCI) results from various pathogenic factors that destroy the normal structure and function of the spinal cord, subsequently causing sensory, motor, and autonomic nerve dysfunction. SCI is one of the most common causes of disability and death globally. It leads to severe physical and mental injury to patients and causes a substantial economic burden on families and the society. The pathological changes and underlying mechanisms within SCI involve oxidative stress, apoptosis, inflammation, etc. As a traditional therapy, acupuncture has a positive effect promoting the recovery of SCI. Acupuncture-induced neuroprotection includes several mechanisms such as reducing oxidative stress, inhibiting the inflammatory response and neuronal apoptosis, alleviating glial scar formation, promoting neural stem cell differentiation, and improving microcirculation within the injured area. Therefore, the recent studies exploring the mechanism of acupuncture therapy in SCI will help provide a theoretical basis for applying acupuncture and seeking a better treatment target and acupuncture approach for SCI patients.
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Affiliation(s)
- Kunpeng Jiang
- Department of Hand and Foot Surgery, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Yulin Sun
- Department of Neurosurgery, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Xinle Chen
- Department of Neurosurgery, Zhejiang Rongjun Hospital, Jiaxing, China
- *Correspondence: Xinle Chen,
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Gurcay E, Karaahmet OZ, Cankurtaran D, Nazlı F, Umay E, Güzel Ş, Gurcay AG. Functional electrical stimulation cycling in patients with chronic spinal cord injury: a pilot study. Int J Neurosci 2021; 132:421-427. [PMID: 33998960 DOI: 10.1080/00207454.2021.1929212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the therapeutic value of lower extremity functional electrical stimulation (FES) - evoked cycling on functional independence, health status, gait parameters, pulmonary functions, and biochemical values in patients with chronic complete/incomplete spinal cord injury (SCI). MATERIALS AND METHODS Fifteen patients with SCI (duration of more than 6 months) who were able to stand up and walk with long leg braces or assistive devices and had stable neurological status and trunk balance undertook FES cycling for 6 weeks (three times per week). The main outcomes were: Functional Independence Measure (FIM), Nottingham Health Profile (NHP), 6-minute walk test (6MWT), and 20-meter walk test (20MWT). Secondary outcomes include measurements of pulmonary function tests and biochemical values. All parameters were evaluated at the beginning and end of the program. RESULTS Improvements were seen in motor and total scores of FIM (p = 0.007), physical mobility subscale of NHP (p = 0.011), 6MWT (p = 0.001), and 20MWT (p = 0.011). In pulmonary functions, only forced vital capacity (FVC) levels demonstrated a significant increase compared with baseline (p = 0.011). Biochemical values reached no significant level. CONCLUSION The results of this study showed that the FES cycling exercise program improves motor and total FIM scores, gait parameters, and FVC values of pulmonary functions in patients with chronic SCI experience. The FES cycle might be a valuable and well-tolerated intervention in clinical rehabilitation.
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Affiliation(s)
- Eda Gurcay
- Gaziler Physical Therapy and Rehabilitation Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ozgur Zeliha Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Fatma Nazlı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Şükran Güzel
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Baskent University, Ankara, Turkey
| | - Ahmet Gurhan Gurcay
- School of Medicine, Department of Neurosurgery, Yıldırım Beyazıt University, Ankara, Turkey
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Baltin ME, Sabirova DE, Kiseleva EI, Kamalov MI, Abdullin TI, Petrova NV, Ahmetov NF, Sachenkov OA, Baltina TV, Lavrov IA. Comparison of systemic and localized carrier-mediated delivery of methylprednisolone succinate for treatment of acute spinal cord injury. Exp Brain Res 2021; 239:627-638. [PMID: 33388811 DOI: 10.1007/s00221-020-05974-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Localized carrier-mediated administration of drugs is a promising approach to treatment of acute phase of spinal cord injury (SCI) as it allows enhanced and/or sustained drug delivery to damaged tissues along with minimization of systemic side effects. We studied the effect of locally applied self-assembling micellar formulation of methylprednisolone succinate (MPS) with trifunctional block copolymer of ethylene oxide and propylene oxide (TBC) on functional recovery and tissue drug content after SCI in rats in comparison with local and systemic administration of MPS alone. Variations in the amplitude of motor evoked responses in the hindlimb muscles induced by epidural stimulation during acute phase of SCI and restoration of movements during chronic period after local vs. systemic application of MPS were evaluated in this study. Results demonstrate that local delivery of MPS in combination with TBC facilitates spinal cord sensorimotor circuitry, increasing the excitability. In addition, this formulation was found to be more effective in improvement of locomotion after SCI compared to systemic administration. LC-MS/MS data shows that the use of TBC carrier increases the glucocorticoid content in treated spinal cord by more than four times over other modes of treatment. The results of this study demonstrate that the local treatment of acute SCI with MPS in the form of mixed micelles with TBC can provide improved therapeutic outcome by promoting drug accumulation and functional restoration of the spinal cord.
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Affiliation(s)
- Maxim E Baltin
- Rehabilitation in Movement Disorders Laboratory, Kazan Federal University, 18 Kremlyovskaya Str., Kazan, 420008, Russian Federation
| | - Diana E Sabirova
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, 18 Kremlyovskaya Str., Kazan, 420008, Russian Federation
| | - Elvira I Kiseleva
- Rehabilitation in Movement Disorders Laboratory, Kazan Federal University, 18 Kremlyovskaya Str., Kazan, 420008, Russian Federation
| | - Marat I Kamalov
- Laboratory of Bioactive Polymers and Peptides, Institute of Fundamental Medicine and Biology, Kazan Federal University, 9 Parizhskoy Kommuny Str, Kazan, 420021, Russian Federation
| | - Timur I Abdullin
- Laboratory of Bioactive Polymers and Peptides, Institute of Fundamental Medicine and Biology, Kazan Federal University, 9 Parizhskoy Kommuny Str, Kazan, 420021, Russian Federation
| | - Natalia V Petrova
- Kazan Institute of Biochemistry and Biophysics, FRC Kazan Scientific Center of RAS, Lobachevsky Str., 2/31, Kazan, 420111, Russian Federation
| | - Nafis F Ahmetov
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, 18 Kremlyovskaya Str., Kazan, 420008, Russian Federation
| | - Oscar A Sachenkov
- Department of Theoretical Mechanics, Institute of Mathematics and Mechanics, Kazan Federal University, 18 Kremlyovskaya Str, Kazan, 420008, Russian Federation
| | - Tatiana V Baltina
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, 18 Kremlyovskaya Str., Kazan, 420008, Russian Federation.
| | - Igor A Lavrov
- Rehabilitation in Movement Disorders Laboratory, Kazan Federal University, 18 Kremlyovskaya Str., Kazan, 420008, Russian Federation
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Cragg JJ, Tong B, Jutzeler CR, Warner FM, Cashman N, Geisler F, Kramer JLK. A Longitudinal Study of the Neurologic Safety of Acute Baclofen Use After Spinal Cord Injury. Neurotherapeutics 2019; 16:858-867. [PMID: 30725362 PMCID: PMC6694358 DOI: 10.1007/s13311-019-00713-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The objective of our study was to determine whether treatment with baclofen is neurologically safe with respect to exposure during recovery from spinal cord injury. We performed a secondary longitudinal analysis of a cohort of adult patients with traumatic acute spinal cord injury. Cumulative baclofen dose was computed over the first 4 weeks following injury from concomitant medication information from a completed clinical trial. The main outcome measure was neurologic status, which was assessed over 52 weeks with "marked recovery" defined as the conversion to higher sensory and motor function. To complete the drug safety profile, drug toxicity was assessed with assays from standard blood work. Multivariable Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Of the cohort (n = 651), 18% (n = 115) received baclofen within 4 weeks post injury. Baclofen use was associated with higher rates of marked neurologic recovery, even after adjustment for injury severity (HR = 2.1, 95% CI 1.5-3.0 for high dose vs none). Baclofen exposure was not associated with liver or renal side effects. The use of other medications indicated for spasticity was not associated with neurological outcomes. Overall, this longitudinal analysis provides level 3 evidence on the neurologic safety of baclofen and potential beneficial effects on recovery in the early days after acute traumatic spinal cord injury. The usefulness of concomitant medication files from completed clinical trials is highlighted. We also highlight the importance of incorporating logical patient questions and neurological outcomes into research addressing drug safety.
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Affiliation(s)
- Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Catherine R Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Freda M Warner
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil Cashman
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Kilcoyne M, Patil V, O’Grady C, Bradley C, McMahon SS. Differential Glycosylation Expression in Injured Rat Spinal Cord Treated with Immunosuppressive Drug Cyclosporin-A. ACS OMEGA 2019; 4:3083-3097. [PMID: 30868109 PMCID: PMC6407839 DOI: 10.1021/acsomega.8b02524] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
Glycosylation is ubiquitous throughout the central nervous system and altered following spinal cord injury (SCI). The glial scar that forms following SCI is composed of several chondroitin sulfate proteoglycans, which inhibit axonal regrowth. Cyclosporin-A (CsA), an immunosuppressive therapeutic, has been proposed as a potential treatment after SCI. We investigated CsA treatment in the spinal cord of healthy, contusion injured, and injured CsA-treated rats. Lectin histochemistry using fluorescently labeled lectins, SBA, MAA, SNA-I, and WFA, was performed to identify the terminal carbohydrate residues of glycoconjugates within the spinal cord. SBA staining decreased in gray and white matter following spinal cord injury, whereas staining was increased at the lesion site in CsA-treated animals, indicating an increase in galactose and N-acetylgalactosamine terminal structures. No significant changes in MAA were observed. WFA staining was abundant in gray matter and observed to increase at the lesion site, in agreement with increased expression of chondroitin sulfate proteoglycans. SNA-I-stained blood vessels in all spinal cord regions and dual staining identified a subpopulation of astrocytes in the lesion site, which expressed α-(2,6)-sialic acid. Glycosylation were altered in injured spinal cord treated with CsA, indicating that glycosylation and alteration of particular carbohydrate structures are important factors to consider in the examination of the environment of the spinal cord after injury.
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Affiliation(s)
- Michelle Kilcoyne
- Carbohydrate
Signalling Group, Discipline of Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway H91 W2TY, Ireland
| | - Vaibhav Patil
- Centre
for Research in Medical Devices (CÚRAM), National University of Ireland, Galway H91 W2TY, Ireland
| | - Claire O’Grady
- Discipline
of Anatomy and NCBES Galway Neuroscience Centre, College of Medicine
Nursing and Health Sciences, National University
of Ireland Galway, Galway H91 W5P7, Ireland
| | - Ciara Bradley
- Discipline
of Anatomy and NCBES Galway Neuroscience Centre, College of Medicine
Nursing and Health Sciences, National University
of Ireland Galway, Galway H91 W5P7, Ireland
| | - Siobhan S. McMahon
- Discipline
of Anatomy and NCBES Galway Neuroscience Centre, College of Medicine
Nursing and Health Sciences, National University
of Ireland Galway, Galway H91 W5P7, Ireland
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Li Q, Houdayer T, Liu S, Belegu V. Induced Neural Activity Promotes an Oligodendroglia Regenerative Response in the Injured Spinal Cord and Improves Motor Function after Spinal Cord Injury. J Neurotrauma 2017; 34:3351-3361. [PMID: 28474539 DOI: 10.1089/neu.2016.4913] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Myelination in the central nervous system (CNS) is a dynamic process that includes birth of oligodendrocyte progenitor cells (OPCs), their differentiation into oligodendrocytes, and ensheathment of axons. Regulation of myelination by neuronal activity has emerged as a new mechanism of CNS plasticity. Activity-dependent myelination has been shown to regulate sensory, motor, and cognitive functions. In this work, we aimed to employ this mechanism of CNS plasticity by utilizing induced neuronal activity to promote remyelination and functional recovery in a subchronic model of spinal cord injury (SCI). We used a mild contusive SCI at T10, which demyelinates surviving axons of the dorsal corticospinal tract (dCST), to investigate the effects of induced neuronal activity on oligodendrogenesis, remyelination, and motor function after SCI. Neuronal activity was induced through epidural electrodes that were implanted over the primary motor (M1) cortex. Induced neuronal activity increased the number of proliferating OPCs. Additionally, induced neuronal activity in the subchronic stages of SCI increased the number of oligodendrocytes, and enhanced myelin basic protein (MBP) expression and myelin sheath formation in dCST. The oligodendroglia regenerative response could have been mediated by axon-OPC synapses, the number of which increased after induced neuronal activity. Further, M1-induced neuronal activation promoted recovery of hindlimb motor function after SCI. Our work is a proof of principle demonstration that epidural electrical stimulation as a mode of inducing neuronal activity throughout white matter tracts of the CNS could be used to promote remyelination and functional recovery after CNS injuries and demyelination disorders.
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Affiliation(s)
- Qun Li
- 1 The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger , Baltimore, Maryland
| | - Thierry Houdayer
- 1 The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger , Baltimore, Maryland
| | - Su Liu
- 1 The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger , Baltimore, Maryland
| | - Visar Belegu
- 1 The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger , Baltimore, Maryland.,2 Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, Maryland.,3 Department of Pathology, Johns Hopkins University School of Medicine , Baltimore, Maryland
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Choe AS. Advances in Spinal Functional Magnetic Resonance Imaging in the Healthy and Injured Spinal Cords. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017; 5:143-150. [PMID: 29255645 DOI: 10.1007/s40141-017-0161-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose of Review This review provides an overview of the current spinal functional magnetic resonance imaging (fMRI) studies that investigate the healthy and injured spinal cords. Recent Findings Spinal fMRI-derived outcome measures have previously been suggested to be sensitive to changes in neurological function in the spinal cord. A body of recent task-activated fMRI studies seems to confirm that detecting neural activity in the spinal cord using spinal fMRI may be feasible as well as reliable. Furthermore, a growing number of studies has shown that resting state fMRI in the spinal cord is also feasible, demonstrating that the investigation of changes in neural activity can also be performed in the absence of explicit tasks. Summary Current task-activated and resting state fMRI studies suggest that spinal fMRI has a strong potential to provide novel imaging biomarkers that can be used to investigate plastic changes in the injured spinal cord.
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Affiliation(s)
- Ann S Choe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205 USA
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Local versus distal transplantation of human neural stem cells following chronic spinal cord injury. Spine J 2016; 16:764-9. [PMID: 26698654 DOI: 10.1016/j.spinee.2015.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/10/2015] [Accepted: 12/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have demonstrated functional recovery of rats with spinal cord contusions after transplantation of neural stem cells adjacent to the site of acute injury. PURPOSE The purpose of the study was to determine if the local or distal injection of neural stem cells can cause functional difference in recovery after chronic spinal cord injury. STUDY DESIGN/SETTING Twenty-four adult female Long-Evans hooded rats were randomized into four groups, with six animals in each group: two experimental and two control groups. Functional assessment was measured after injury and then weekly for 6 weeks using the Basso, Beattie, and Bresnahan locomotor rating score. Data were analyzed using two-sample t test and linear mixed-effects model analysis. METHODS Posterior exposure and laminectomy at the T10 level was used. Moderate spinal cord contusion was induced by the Multicenter Animal Spinal Cord Injury Study Impactor with 10-g weight dropped from a height of 25 mm. Experimental subjects received either a subdural injection of human neural stem cells (hNSCs) locally at the injury site or intrathecal injection of hNSCs through a separate distal laminotomy 4 weeks after injury. Controls received control media injection either locally or distally. RESULTS A statistically significant functional improvement in subjects that received hNSCs injected distally to the site of injury was observed when compared with the control (p=.042). The difference between subjects that received hNSCs locally and the control did not reach statistical significance (p=.085). CONCLUSIONS The transplantation of hNSCs into the contused spinal cord of a rat led to significant functional recovery of the spinal cord when injected distally but not locally to the site of chronic spinal cord injury.
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Choe AS, Jones CK, Joel SE, Muschelli J, Belegu V, Caffo BS, Lindquist MA, van Zijl PCM, Pekar JJ. Reproducibility and Temporal Structure in Weekly Resting-State fMRI over a Period of 3.5 Years. PLoS One 2015; 10:e0140134. [PMID: 26517540 PMCID: PMC4627782 DOI: 10.1371/journal.pone.0140134] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/22/2015] [Indexed: 11/18/2022] Open
Abstract
Resting-state functional MRI (rs-fMRI) permits study of the brain’s functional networks without requiring participants to perform tasks. Robust changes in such resting state networks (RSNs) have been observed in neurologic disorders, and rs-fMRI outcome measures are candidate biomarkers for monitoring clinical trials, including trials of extended therapeutic interventions for rehabilitation of patients with chronic conditions. In this study, we aim to present a unique longitudinal dataset reporting on a healthy adult subject scanned weekly over 3.5 years and identify rs-fMRI outcome measures appropriate for clinical trials. Accordingly, we assessed the reproducibility, and characterized the temporal structure of, rs-fMRI outcome measures derived using independent component analysis (ICA). Data was compared to a 21-person dataset acquired on the same scanner in order to confirm that the values of the single-subject RSN measures were within the expected range as assessed from the multi-participant dataset. Fourteen RSNs were identified, and the inter-session reproducibility of outcome measures—network spatial map, temporal signal fluctuation magnitude, and between-network connectivity (BNC)–was high, with executive RSNs showing the highest reproducibility. Analysis of the weekly outcome measures also showed that many rs-fMRI outcome measures had a significant linear trend, annual periodicity, and persistence. Such temporal structure was most prominent in spatial map similarity, and least prominent in BNC. High reproducibility supports the candidacy of rs-fMRI outcome measures as biomarkers, but the presence of significant temporal structure needs to be taken into account when such outcome measures are considered as biomarkers for rehabilitation-style therapeutic interventions in chronic conditions.
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Affiliation(s)
- Ann S. Choe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States of America
- * E-mail:
| | - Craig K. Jones
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - Suresh E. Joel
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - John Muschelli
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Visar Belegu
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Brian S. Caffo
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Martin A. Lindquist
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Peter C. M. van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - James J. Pekar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
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Park HS, Liu S, McDonald J, Thakor N, Yang IH. Neuromuscular junction in a microfluidic device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:2833-5. [PMID: 24110317 DOI: 10.1109/embc.2013.6610130] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malfunctions at the site of neuromuscular junction (NMJ) of post-injuries or diseases are major barriers to recovery of function. The ability to efficiently derive motor neurons (MN) from embryonic stem cells has indicated promise toward the development of new therapies in increasing functional outcomes post injury. Recent advances in micro-technologies have provided advanced culture platforms allowing compartmentalization of sub-cellular components of neurons. In this study, we combined these advances in science and technology to develop a compartmentalized in vitro NMJ model. The developed NMJ system is between mouse embryonic stem cell (mESC)-derived MNs and c2c12 myotubes cultured in a compartmentalized polydimethylsiloxane (PDMS) microfluidic device. While some functional in vitro NMJ systems have been reported, this system would further contribute to research in NMJ-related diseases by providing a system to study the site of action of NMJ aimed at improving promoting better functional recovery.
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Jones ML, Evans N, Tefertiller C, Backus D, Sweatman M, Tansey K, Morrison S. Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial. Arch Phys Med Rehabil 2014; 95:2239-46.e2. [PMID: 25102384 DOI: 10.1016/j.apmr.2014.07.400] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/03/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DESIGN Randomized controlled trial with delayed treatment design. SETTING Outpatient program in a private, nonprofit rehabilitation hospital. PARTICIPANTS Volunteer sample of adults (N=48; 37 men and 11 women; age, 18-66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). INTERVENTIONS A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. MAIN OUTCOME MEASURES Neurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). RESULTS Significant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs -0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002). CONCLUSIONS ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.
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Affiliation(s)
- Michael L Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
| | - Nicholas Evans
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | | | - Deborah Backus
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Mark Sweatman
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Keith Tansey
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
| | - Sarah Morrison
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA
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Sadowsky CL, Hammond ER, Strohl AB, Commean PK, Eby SA, Damiano DL, Wingert JR, Bae KT, McDonald JW. Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury. J Spinal Cord Med 2013; 36:623-31. [PMID: 24094120 PMCID: PMC3831323 DOI: 10.1179/2045772313y.0000000101] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To examine the effect of long-term lower extremity functional electrical stimulation (FES) cycling on the physical integrity and functional recovery in people with chronic spinal cord injury (SCI). DESIGN Retrospective cohort, mean follow-up 29.1 months, and cross-sectional evaluation. SETTING Washington University Spinal Cord Injury Neurorehabilitation Center, referral center. PARTICIPANTS Twenty-five people with chronic SCI who received FES during cycling were matched by age, gender, injury level, and severity, and duration of injury to 20 people with SCI who received range of motion and stretching. INTERVENTION Lower extremity FES during cycling as part of an activity-based restorative treatment regimen. MAIN OUTCOME MEASURE Change in neurological function: motor, sensory, and combined motor-sensory scores (CMSS) assessed by the American Spinal Injury Association Impairment scale. Response was defined as ≥ 1 point improvement. RESULTS FES was associated with an 80% CMSS responder rate compared to 40% in controls. An average 9.6 CMSS point loss among controls was offset by an average 20-point gain among FES subjects. Quadriceps muscle mass was on average 36% higher and intra/inter-muscular fat 44% lower, in the FES group. Hamstring and quadriceps muscle strength was 30 and 35% greater, respectively, in the FES group. Quality of life and daily function measures were significantly higher in FES group. CONCLUSION FES during cycling in chronic SCI may provide substantial physical integrity benefits, including enhanced neurological and functional performance, increased muscle size and force-generation potential, reduced spasticity, and improved quality of life.
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Affiliation(s)
- Cristina L. Sadowsky
- The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA; and Department of Physical Medicine and Rehabilitation, Department of Neurology (JWM), John Hopkins, Baltimore, MD USA
| | - Edward R. Hammond
- The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA
| | - Adam B. Strohl
- Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, NY, USA
| | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Sarah A. Eby
- Department of Physical Medicine and Rehabilitation, Sinai Hospital, Baltimore, MD, USA
| | | | - Jason R. Wingert
- Department of Health and Wellness, University of North Carolina, Asheville, NC, USA
| | - Kyongtae T. Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John W. McDonald
- The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA; and Department of Neurology, Neurological Surgery, Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO, USA
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13
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Choe AS, Belegu V, Yoshida S, Joel S, Sadowsky CL, Smith SA, van Zijl PCM, Pekar JJ, McDonald JW. Extensive neurological recovery from a complete spinal cord injury: a case report and hypothesis on the role of cortical plasticity. Front Hum Neurosci 2013; 7:290. [PMID: 23805087 PMCID: PMC3691521 DOI: 10.3389/fnhum.2013.00290] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/03/2013] [Indexed: 12/14/2022] Open
Abstract
Neurological recovery in patients with severe spinal cord injury (SCI) is extremely rare. We have identified a patient with chronic cervical traumatic SCI, who suffered a complete loss of motor and sensory function below the injury for 6 weeks after the injury, but experienced a progressive neurological recovery that continued for 17 years. The extent of the patient's recovery from the severe trauma-induced paralysis is rare and remarkable. A detailed study of this patient using diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), and resting state fMRI (rs-fMRI) revealed structural and functional changes in the central nervous system that may be associated with the neurological recovery. Sixty-two percent cervical cord white matter atrophy was observed. DTI-derived quantities, more sensitive to axons, demonstrated focal changes, while MTI-derived quantity, more sensitive to myelin, showed a diffuse change. No significant cortical structural changes were observed, while rs-fMRI revealed increased brain functional connectivity between sensorimotor and visual networks. The study provides comprehensive description of the structural and functional changes in the patient using advanced MR imaging technique. This multimodal MR imaging study also shows the potential of rs-fMRI to measure the extent of cortical plasticity.
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Affiliation(s)
- Ann S Choe
- Department of Neurology, Johns Hopkins University School of Medicine Baltimore, MD, USA ; International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger, Inc. Baltimore, MD, USA ; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute Baltimore, MD, USA
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14
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Sadowsky CL, Hammond ER, Strohl AB, Commean PK, Eby SA, Damiano DL, Wingert JR, Bae KT, McDonald JW. Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury. J Spinal Cord Med 2013. [PMID: 24094120 DOI: 10.1179/2045772313y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine the effect of long-term lower extremity functional electrical stimulation (FES) cycling on the physical integrity and functional recovery in people with chronic spinal cord injury (SCI). DESIGN Retrospective cohort, mean follow-up 29.1 months, and cross-sectional evaluation. SETTING Washington University Spinal Cord Injury Neurorehabilitation Center, referral center. PARTICIPANTS Twenty-five people with chronic SCI who received FES during cycling were matched by age, gender, injury level, and severity, and duration of injury to 20 people with SCI who received range of motion and stretching. INTERVENTION Lower extremity FES during cycling as part of an activity-based restorative treatment regimen. MAIN OUTCOME MEASURE Change in neurological function: motor, sensory, and combined motor-sensory scores (CMSS) assessed by the American Spinal Injury Association Impairment scale. Response was defined as ≥ 1 point improvement. RESULTS FES was associated with an 80% CMSS responder rate compared to 40% in controls. An average 9.6 CMSS point loss among controls was offset by an average 20-point gain among FES subjects. Quadriceps muscle mass was on average 36% higher and intra/inter-muscular fat 44% lower, in the FES group. Hamstring and quadriceps muscle strength was 30 and 35% greater, respectively, in the FES group. Quality of life and daily function measures were significantly higher in FES group. CONCLUSION FES during cycling in chronic SCI may provide substantial physical integrity benefits, including enhanced neurological and functional performance, increased muscle size and force-generation potential, reduced spasticity, and improved quality of life.
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Affiliation(s)
- Cristina L Sadowsky
- The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA; and Department of Physical Medicine and Rehabilitation, Department of Neurology (JWM), John Hopkins, Baltimore, MD USA
| | - Edward R Hammond
- The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA
| | - Adam B Strohl
- Division of Plastic and Reconstructive Surgery, Mount Sinai Medical Center, NY, USA
| | - Paul K Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Sarah A Eby
- Department of Physical Medicine and Rehabilitation, Sinai Hospital, Baltimore, MD, USA
| | | | - Jason R Wingert
- Department of Health and Wellness, University of North Carolina, Asheville, NC, USA
| | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John W McDonald
- The International Center for Spinal Cord Injury and the Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA; and Department of Neurology, Neurological Surgery, Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO, USA
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15
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Inflammatory, vascular, and infectious myelopathies in children. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:999-1017. [PMID: 23622308 DOI: 10.1016/b978-0-444-52910-7.00020-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute nontraumatic myelopathies of childhood include inflammatory, infectious, and vascular etiologies. Inflammatory immune-mediated disorders of the spinal cord can be categorized as idiopathic isolated transverse myelitis, neuromyelitis optica, and multiple sclerosis. In recent years, human T-cell lymphotropic virus type 1, West Nile virus, enterovirus-71, and Lyme disease have been increasingly recognized as infectious etiologies of myelopathy, and poliomyelitis remains an important etiology in world regions where vaccination programs have not been universally available. Vascular etiologies include vasculopathies (systemic lupus erythematosus, small vessel primary angiitis of the central nervous system), arteriovenous malformations, and spinal cord infarction (fibrocartilaginous embolism, diffuse hypoxic ischemia-mediated infarction). Vascular myelopathies are less common than inflammatory and infectious myelopathies, but are more likely to lead to devastating clinical deficits. Current therapeutic strategies include acute anti-inflammatory treatment and rehabilitation. Stem cell transplantation, nerve graft implantation, and stimulation of endogenous repair mechanisms represent promising strategies for spinal cord repair.
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16
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Larson CA, Dension PM. Effectiveness of intense, activity-based physical therapy for individuals with spinal cord injury in promoting motor and sensory recovery: is olfactory mucosa autograft a factor? J Spinal Cord Med 2013; 36:44-57. [PMID: 23433335 PMCID: PMC3555107 DOI: 10.1179/2045772312y.0000000026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/OBJECTIVES Rehabilitation for individuals with spinal cord injury (SCI) is expanding to include intense, activity-based, out-patient physical therapy (PT). The study's primary purposes were to (i) examine the effectiveness of intense PT in promoting motor and sensory recovery in individuals with SCI and (ii) compare recovery for individuals who had an olfactory mucosa autograft (OMA) with individuals who did not have the OMA while both groups participated in the intense PT program. METHODS Prospective, non-randomized, non-blinded, intervention study. Using the American Spinal Injury Association examination, motor and sensory scores for 23 (7 OMA, 6 matched control and 10 other) participants were recorded. RESULTS Mean therapy dosage was 137.3 total hours. The participants' total, upper and lower extremity motor scores improved significantly while sensory scores did not improve during the first 60 days and from initial to discharge examination. Incomplete SCI or paraplegia was associated with greater motor recovery. Five of 14 participants converted from motor-complete to motor-incomplete SCI. Individuals who had the OMA and participated in intense PT did not have greater sensory or greater magnitude or rate of motor recovery as compared with participants who had intense PT alone. CONCLUSION This study provides encouraging evidence as to the effectiveness of intense PT for individuals with SCI. Future research is needed to identify the optimal therapy dosage and specific therapeutic activities required to generate clinically meaningful recovery for individuals with SCI including those who elect to undergo a neural recovery/regenerative surgical procedure and those that elect intense therapy alone.
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Affiliation(s)
- Cathy A. Larson
- Rehabilitation Institute of Michigan, Center for Spinal Cord Injury Recovery, Detroit, MI, USA; and Oakland University Physical Therapy program, Rochester, MI, USA,Correspondence to: Cathy A. Larson PT, PhD, University of Michigan-Flint, Physical Therapy Program, 303 E. Kearsley Street, 2157 WSW, Flint, MI 48502, USA.
| | - Paula M. Dension
- Rehabilitation Institute of Michigan, Center for Spinal Cord Injury Recovery, Detroit, MI, USA
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17
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Tail nerve electrical stimulation combined with scar ablation and neural transplantation promotes locomotor recovery in rats with chronically contused spinal cord. Brain Res 2012; 1456:22-35. [DOI: 10.1016/j.brainres.2012.03.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 01/28/2023]
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18
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Becker D, McDonald JW. Approaches to repairing the damaged spinal cord: overview. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:445-61. [PMID: 23098730 DOI: 10.1016/b978-0-444-52137-8.00028-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Affecting young people during the most productive period of their lives, spinal cord injury (SCI) is a devastating problem for modern society. In the past, treating SCI seemed frustrating and hopeless because of the tremendous morbidity and mortality, life-shattering impact, and limited therapeutic options associated with the condition. Today, however, an understanding of the underlying pathophysiological mechanisms, the development of neuroprotective interventions, and progress toward regenerative interventions are increasing hope for functional restoration. In this chapter, we provide an overview of various repair strategies for the injured spinal cord. Special attention will be paid to strategies that promote spontaneous regeneration, including functional electrical stimulation, cell replacement, neuroprotection, and remyelination. The concept that limited rebuilding can provide a disproportionate improvement in quality of life is emphasized throughout. New surgical procedures, pharmacological treatments, and functional neuromuscular stimulation methods have evolved over the last decades and can improve functional outcomes after spinal cord injury; however, limiting secondary injury remains the primary goal. Tissue replacement strategies, including the use of embryonic stem cells, become an important tool and can restore function in animal models. Controlled clinical trials are now required to confirm these observations. The ultimate goal is to harness the body's own potential to replace lost central nervous system cells by activation of endogenous progenitor cell repair mechanisms.
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Affiliation(s)
- Daniel Becker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Wegener ST, Adams LL, Rohe D. Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:297-314. [PMID: 23098721 DOI: 10.1016/b978-0-444-52137-8.00019-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.
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Affiliation(s)
- Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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20
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Gary DS, Malone M, Capestany P, Houdayer T, McDonald JW. Electrical stimulation promotes the survival of oligodendrocytes in mixed cortical cultures. J Neurosci Res 2011; 90:72-83. [PMID: 21932370 DOI: 10.1002/jnr.22717] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/09/2011] [Accepted: 05/19/2011] [Indexed: 11/07/2022]
Abstract
Oligodendrocyte (OLG) death plays a major role in white matter dysfunction and demyelination following injury to the CNS. Axonal contact, communication, and neuronal activity appear to promote OLG survival and function in cell culture and during development. The application of electrical stimulation to mixed neural cultures has been shown to promote OLG differentiation and the formation of myelin in vitro. Here we show that OLG viability can be significantly enhanced in mixed cortical cultures by applying biphasic pulses of electrical stimulation (ESTIM). Enhanced survival via ESTIM requires the presence of neurons and is suppressed by inhibition of voltage-gated sodium channels. Additionally, contact between the axon and OLG is necessary for ESTIM to promote OLG survival. This report suggests that patterned neuronal activity could repress delayed progression of white matter injury and promote CNS repair in neurological conditions that involve white matter damage.
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Affiliation(s)
- Devin S Gary
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland 21205, USA.
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21
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Xu JC, Bernreuther C, Cui YF, Jakovcevski I, Hargus G, Xiao MF, Schachner M. Transplanted L1 expressing radial glia and astrocytes enhance recovery after spinal cord injury. J Neurotrauma 2011; 28:1921-37. [PMID: 21671795 DOI: 10.1089/neu.2011.1783] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A major obstacle for the transplantation of neural stem cells (NSCs) into the lesioned spinal cord is their predominant astrocytic differentiation after transplantation. We took advantage of this predominant astrocytic differentiation of NSCs and expressed the paradigmatic beneficial neural cell adhesion molecule L1 in radial glial cells and reactive and nonreactive astrocytes as novel cellular vehicles to express L1 under the control of the promoter for the human glial fibrillary acidic protein (GFAP-L1 NSCs). Behavioral analysis and electrophysiological H-reflex recordings revealed that mice transplanted with GFAP-L1 NSCs showed enhanced locomotor recovery in comparison to mice injected with wild type (WT) NSCs or control mice injected with phosphate-buffered saline (PBS). This functional recovery was further accelerated in mice transplanted with L1-expressing radial glial cells that had been immunoisolated from GFAP-L1 NSCs (GFAP-L1-i cells). Morphological analysis revealed that mice grafted with GFAP-L1 NSCs exhibited increased neuronal differentiation and migration of transplanted cells, as well as increased soma size and cholinergic synaptic coverage of host motoneurons and increased numbers of endogenous catecholaminergic nerve fibers caudal to the lesion site. These findings show that L1-expressing astrocytes and radial glial cells isolated from GFAP-L1 NSC cultures represent a novel strategy for improving functional recovery after spinal cord injury, encouraging the use of the human GFAP promoter to target beneficial transgene expression in transplanted stem cells.
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Affiliation(s)
- Jin-Chong Xu
- Zentrum für Molekulare Neurobiologie Hamburg, Hamburg, Germany
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22
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Zhang SX, Huang F, Gates M, Holmberg EG. Scar ablation combined with LP/OEC transplantation promotes anatomical recovery and P0-positive myelination in chronically contused spinal cord of rats. Brain Res 2011; 1399:1-14. [DOI: 10.1016/j.brainres.2011.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 04/30/2011] [Accepted: 05/02/2011] [Indexed: 01/27/2023]
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23
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Stroh A, Tsai HC, Wang LP, Zhang F, Kressel J, Aravanis A, Santhanam N, Deisseroth K, Konnerth A, Schneider MB. Tracking stem cell differentiation in the setting of automated optogenetic stimulation. Stem Cells 2011; 29:78-88. [PMID: 21280159 DOI: 10.1002/stem.558] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Membrane depolarization has been shown to play an important role in the neural differentiation of stem cells and in the survival and function of mature neurons. Here, we introduce a microbial opsin into ESCs and develop optogenetic technology for stem cell engineering applications, with an automated system for noninvasive modulation of ESC differentiation employing fast optogenetic control of ion flux. Mouse ESCs were stably transduced with channelrhodopsin-2 (ChR2)-yellow fluorescent protein and purified by fluorescence activated cell sorting (FACS). Illumination of resulting ChR2-ESCs with pulses of blue light triggered inward currents. These labeled ESCs retained the capability to differentiate into functional mature neurons, assessed by the presence of voltage-gated sodium currents, action potentials, fast excitatory synaptic transmission, and expression of mature neuronal proteins and neuronal morphology. We designed and tested an apparatus for optically stimulating ChR2-ESCs during chronic neuronal differentiation, with high-speed optical switching on a custom robotic stage with environmental chamber for automated stimulation and imaging over days, with tracking for increased expression of neural and neuronal markers. These data point to potential uses of ChR2 technology for chronic and temporally precise noninvasive optical control of ESCs both in vitro and in vivo, ranging from noninvasive control of stem cell differentiation to causal assessment of the specific contribution of transplanted cells to tissue and network function.
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Affiliation(s)
- Albrecht Stroh
- Department of Bioengineering, Behavioral Sciences, Stanford University, Stanford, USA.
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24
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Cui YF, Xu JC, Hargus G, Jakovcevski I, Schachner M, Bernreuther C. Embryonic stem cell-derived L1 overexpressing neural aggregates enhance recovery after spinal cord injury in mice. PLoS One 2011; 6:e17126. [PMID: 21445247 PMCID: PMC3060805 DOI: 10.1371/journal.pone.0017126] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/21/2011] [Indexed: 12/26/2022] Open
Abstract
An obstacle to early stem cell transplantation into the acutely injured spinal cord is poor survival of transplanted cells. Transplantation of embryonic stem cells as substrate adherent embryonic stem cell-derived neural aggregates (SENAs) consisting mainly of neurons and radial glial cells has been shown to enhance survival of grafted cells in the injured mouse brain. In the attempt to promote the beneficial function of these SENAs, murine embryonic stem cells constitutively overexpressing the neural cell adhesion molecule L1 which favors axonal growth and survival of grafted and imperiled cells in the inhibitory environment of the adult mammalian central nervous system were differentiated into SENAs and transplanted into the spinal cord three days after compression lesion. Mice transplanted with L1 overexpressing SENAs showed improved locomotor function when compared to mice injected with wild-type SENAs. L1 overexpressing SENAs showed an increased number of surviving cells, enhanced neuronal differentiation and reduced glial differentiation after transplantation when compared to SENAs not engineered to overexpress L1. Furthermore, L1 overexpressing SENAs rescued imperiled host motoneurons and parvalbumin-positive interneurons and increased numbers of catecholaminergic nerve fibers distal to the lesion. In addition to encouraging the use of embryonic stem cells for early therapy after spinal cord injury L1 overexpression in the microenvironment of the lesioned spinal cord is a novel finding in its functions that would make it more attractive for pre-clinical studies in spinal cord regeneration and most likely other diseases of the nervous system.
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Affiliation(s)
- Yi-Fang Cui
- Zentrum für Molekulare Neurobiologie Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Universität Hamburg, Hamburg, Germany
- Clinical Neurobiology Laboratory, German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany
| | - Jin-Chong Xu
- Zentrum für Molekulare Neurobiologie Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Universität Hamburg, Hamburg, Germany
| | - Gunnar Hargus
- Zentrum für Molekulare Neurobiologie Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Universität Hamburg, Hamburg, Germany
| | - Igor Jakovcevski
- Zentrum für Molekulare Neurobiologie Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Universität Hamburg, Hamburg, Germany
| | - Melitta Schachner
- Zentrum für Molekulare Neurobiologie Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Universität Hamburg, Hamburg, Germany
- W. M. Keck Center for Collaborative Neuroscience and Department of Cell Biology and Neuroscience, Rutgers University, New Jersey, United States of America
- * E-mail: (MS); (CB)
| | - Christian Bernreuther
- Zentrum für Molekulare Neurobiologie Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Universität Hamburg, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail: (MS); (CB)
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25
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Bonner JF, Blesch A, Neuhuber B, Fischer I. Promoting directional axon growth from neural progenitors grafted into the injured spinal cord. J Neurosci Res 2010; 88:1182-92. [PMID: 19908250 DOI: 10.1002/jnr.22288] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal cord injury (SCI) is a devastating condition characterized by disruption of axonal connections, failure of axonal regeneration, and loss of motor and sensory function. The therapeutic promise of neural stem cells has been focused on cell replacement, but many obstacles remain in obtaining neuronal integration following transplantation into the injured CNS. This study investigated the neurotransmitter identity and axonal growth potential of neural progenitors following grafting into adult rats with a dorsal column lesion. We found that using a combination of neuronal and glial restricted progenitors (NRP and GRP) produced graft-derived glutamatergic and GABAergic neurons within the injury site, with minimal axonal extension. Administration of brain-derived neurotrophic factor (BDNF) with the graft promoted modest axonal growth from grafted cells. In contrast, injecting a lentiviral vector expressing BDNF rostral into the injured area generated a neurotrophin gradient and promoted directional growth of axons for up to 9 mm. Animals injected with BDNF lentivirus (at 2.5 and 5.0 mm) showed significantly more axons and significantly longer axons than control animals injected with GFP lentivirus. However, only the 5.0-mm-BDNF group showed a preference for extension in the rostral direction. We concluded that NRP/GRP grafts can be used to produce excitatory and inhibitory neurons, and neurotrophin gradients can guide axonal growth from graft-derived neurons toward putative targets. Together they can serve as a building block for neuronal cell replacement of local circuits and formation of neuronal relays.
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Affiliation(s)
- Joseph F Bonner
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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26
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Hooshmand MJ, Sontag CJ, Uchida N, Tamaki S, Anderson AJ, Cummings BJ. Analysis of host-mediated repair mechanisms after human CNS-stem cell transplantation for spinal cord injury: correlation of engraftment with recovery. PLoS One 2009; 4:e5871. [PMID: 19517014 PMCID: PMC2690693 DOI: 10.1371/journal.pone.0005871] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Accepted: 04/22/2009] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human central nervous system-stem cells grown as neurospheres (hCNS-SCns) self-renew, are multipotent, and have potential therapeutic applications following trauma to the spinal cord. We have previously shown locomotor recovery in immunodeficient mice that received a moderate contusion spinal cord injury (SCI) and hCNS-SCns transplantation 9 days post-injury (dpi). Engrafted hCNS-SCns exhibited terminal differentiation to myelinating oligodendrocytes and synapse-forming neurons. Further, selective ablation of human cells using Diphtheria toxin (DT) abolished locomotor recovery in this paradigm, suggesting integration of human cells within the mouse host as a possible mechanism for the locomotor improvement. However, the hypothesis that hCNS-SCns could alter the host microenvironment as an additional or alternative mechanism of recovery remained unexplored; we tested that hypothesis in the present study. METHODS AND FINDINGS Stereological quantification of human cells using a human-specific cytoplasmic marker demonstrated successful cell engraftment, survival, migration and limited proliferation in all hCNS-SCns transplanted animals. DT administration at 16 weeks post-transplant ablated 80.5% of hCNS-SCns. Stereological quantification for lesion volume, tissue sparing, descending serotonergic host fiber sprouting, chondroitin sulfate proteoglycan deposition, glial scarring, and angiogenesis demonstrated no evidence of host modification within the mouse spinal cord as a result of hCNS-SCns transplantation. Biochemical analyses supplemented stereological data supporting the absence of neural stem-cell mediated host repair. However, linear regression analysis of the number of engrafted hCNS-SCns vs. the number of errors on a horizontal ladder beam task revealed a strong correlation between these variables (r = -0.78, p<0.05), suggesting that survival and engraftment were directly related to a quantitative measure of recovery. CONCLUSIONS Altogether, the data suggest that the locomotor improvements associated with hCNS-SCns transplantation were not due to modifications within the host microenvironment, supporting the hypothesis that human cell integration within the host circuitry mediates functional recovery following a 9 day delayed transplant.
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Affiliation(s)
- Mitra J. Hooshmand
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, California, United States of America
| | - Christopher J. Sontag
- Department of Anatomy and Neurobiology, University of California Irvine, Irvine, California, United States of America
| | - Nobuko Uchida
- StemCells, Inc., Palo Alto, California, United States of America
| | - Stan Tamaki
- StemCells, Inc., Palo Alto, California, United States of America
| | - Aileen J. Anderson
- Department of Physical Medicine and Rehabilitation, Reeve-Irvine Research Center, University of California Irvine, Irvine, California, United States of America
| | - Brian J. Cummings
- Department of Physical Medicine and Rehabilitation, Reeve-Irvine Research Center, University of California Irvine, Irvine, California, United States of America
- * E-mail:
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Alexander JJ, Anderson AJ, Barnum SR, Stevens B, Tenner AJ. The complement cascade: Yin-Yang in neuroinflammation--neuro-protection and -degeneration. J Neurochem 2008; 107:1169-87. [PMID: 18786171 DOI: 10.1111/j.1471-4159.2008.05668.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The complement cascade has long been recognized to play a key role in inflammatory and degenerative diseases. It is a 'double edged' sword as it is necessary to maintain health, yet can have adverse effects when unregulated, often exacerbating disease. The contrasting effects of complement, depending on whether in a setting of health or disease, is the price paid to achieve flexibility in scope and degree of a protective response for the host from infection and injury. Loss or even decreased efficiency of critical regulatory control mechanisms can result in aggravated inflammation and destruction of self-tissue. The role of the complement cascade is poorly understood in the nervous system and neurological disorders. Novel studies have demonstrated that the expression of complement proteins in brain varies in different cell types and the effects of complement activation in various disease settings appear to differ. Understanding the functioning of this cascade is essential, as it has therapeutic implications. In this review, we will attempt to provide insight into how this complex cascade functions and to identify potential strategic targets for therapeutic intervention in chronic diseases as well as acute injury in the CNS.
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Åkesson E, Sandelin M, Kanaykina N, Aldskogius H, Kozlova EN. Long-Term Survival, Robust Neuronal Differentiation, and Extensive Migration of Human Forebrain Stem/Progenitor Cells Transplanted to the Adult Rat Dorsal Root Ganglion Cavity. Cell Transplant 2008; 17:1115-23. [DOI: 10.3727/096368908787236585] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neurons in dorsal root ganglia (DRGs) transmit sensory information from peripheral tissues to the spinal cord. This pathway can be interrupted, for example, as the result of physical violence, traffic accidents, or complications during child delivery. As a consequence, the patient permanently loses sensation and often develops intractable neuropathic pain in the denervated area. Here we investigate whether human neural stem/progenitor cells (hNSPCs) transplanted to the DRG cavity can serve as a source for repairing lost peripheral sensory connections. We found that hNSPCs robustly differentiate to neurons, which survive long-term transplantation. The neuronal population in the transplants was tightly surrounded by astrocytes, suggesting their active role in neuron survival. Furthermore, 3 months after grafting hNSPCs were found in the dorsal root transitional zone (DRTZ) and within the spinal cord. The level of differentiation of transplanted cells was high in the core of the transplants whereas cells that migrated to the DRTZ and spinal cord were undifferentiated, nestin-expressing precursors. These data indicate that peripherally transplanted hNPSCs can be used for repair of dorsal root avulsion or spinal cord injuries; however, additional factors are required to guide their differentiation to the desired type of neurons. Furthermore, hNPSCs that migrate from the DRG cavity graft site to the DRTZ and spinal cord may provide trophic support for regenerating dorsal root axons, thereby allowing them to reenter the host spinal cord.
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Affiliation(s)
- Elisabet Åkesson
- Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Martin Sandelin
- Department of Neuroscience, Neuroanatomy, Uppsala University Biomedical Center, Uppsala, Sweden
| | - Nadezda Kanaykina
- Department of Neuroscience, Neuroanatomy, Uppsala University Biomedical Center, Uppsala, Sweden
| | - Hákan Aldskogius
- Department of Neuroscience, Neuroanatomy, Uppsala University Biomedical Center, Uppsala, Sweden
| | - Elena N. Kozlova
- Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Grumbles RM, Almeida VW, Thomas CK. Embryonic neurons transplanted into the tibial nerve reinnervate muscle and reduce atrophy but NCAM expression persists. Neurol Res 2008; 30:183-9. [PMID: 18397611 DOI: 10.1179/174313208x281073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to use the glycogen depletion technique to determine whether reinnervated muscle fibers could be distinguished from denervated muscle fibers by their size or by neural cell adhesion molecule (NCAM) expression. METHODS Medial gastrocnemius muscles of five adult Fischer rats were reinnervated from embryonic neurons transplanted into the distal stump of the tibial nerve. Ten weeks later, the transplants were stimulated repeatedly to deplete reinnervated muscle fibers of glycogen. Areas of reinnervated (glycogen-depleted) muscle fibers were measured and assessed for NCAM expression. The areas of muscle fibers from reinnervated, denervated (n=5) and unoperated control muscles (n=5) were compared. RESULTS Mean reinnervated muscle fiber area was significantly larger than the mean for denervated fibers (mean +/- SE: 40 +/- 6 and 10 +/- 1% of unoperated control fibers, respectively). NCAM was expressed in 55 +/- 7% of reinnervated fibers (mean +/- SE; range: 42-77%). The mean areas of reinnervated fibers that did or did not express NCAM were similar. NCAM was only expressed in some fibers in completely denervated muscles. DISCUSSION Our data show that NCAM expression does not differentiate muscle denervation or reinnervation. Quantifying the area of large fibers did distinguish reinnervated muscle fibers from denervated fibers and showed that reinnervation of muscle from neurons placed in peripheral nerve is a strategy to rescue muscle from atrophy.
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Affiliation(s)
- Robert M Grumbles
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, 1095 NW 14th Terrace (R48), Miami, FL 33136, USA
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30
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Konya D, Liao WL, Choi H, Yu D, Woodard MC, Newton KM, King AM, Pamir NM, Black PM, Frontera WR, Sabharwal S, Teng YD. Functional recovery in T13–L1 hemisected rats resulting from peripheral nerve rerouting: role of central neuroplasticity. Regen Med 2008; 3:309-27. [DOI: 10.2217/17460751.3.3.309] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Functional improvements after spinal cord injury (SCI) have been reported anecdotally following neurotization, in other words, rerouting nerves proximal to injured cord segments to distal neuromuscular targets, although the underlying mechanisms remain largely unknown. Aim: To test our hypothesis that neurotization-mediated recovery is primarily attributable to CNS neuroplasticity that therefore manifests optimal response during particular therapeutic windows, we anastomosed the T12 intercostal nerve to the ipsilateral L3 nerve root 1–4 weeks after T13–L1 midline hemisection in rats. Results: While axonal tracing and electromyography revealed limited reinnervation in the target muscles, neurobehavioral function, as assessed by locomotion, extensor postural thrust and sciatic functional index of SCI rats receiving neurotization 7–10 days postinjury (n = 11), recovered to levels close to non-SCI controls with neurotization only (n = 3), beginning 3–5 weeks postanastomosis. Conversely, hindlimb deficits were unchanged in hemisected controls with sham neurotization (n = 7) or 4 weeks-delayed neurotization (n = 3) and in rats that had undergone T13–L1 transection plus bilateral anastomoses (n = 6). Conclusion: Neurotized SCI animals demonstrated multiparameters of neural reorganization in the distal lumbar cord, including enhanced proliferation of endogenous neural stem cells, increased immunoreactivity of serotonin and synaptophysin, and neurite growth/sprouting, suggesting that anastomosing functional nerves with the nerve stump emerging distal to the hemisection stimulates neuroplasticity in the dysfunctional spinal cord. Our conclusion is validated by the fact that severance of the T13–L1 contralateral cord abolished the postanastomosis functional recovery. Neurotization and its neuroplastic sequelae need to be explored further to optimize clinical strategies of post-SCI functional repair.
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Affiliation(s)
- Deniz Konya
- Division of SCI Research, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
- Department of Neurosurgery, Marmara University, Istanbul, Turkey
| | - Wei-Lee Liao
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
| | - Howard Choi
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
| | - Dou Yu
- Division of SCI Research, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
| | - Matthew C Woodard
- Division of SCI Research, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
| | - Kimberly M Newton
- Division of SCI Research, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
| | - Allyson M King
- Division of SCI Research, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
| | | | - Peter M Black
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
| | - Walter R Frontera
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
- School of Medicine, University of Puerto Rico, San Juan, PR, USA
| | - Sunil Sabharwal
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
| | - Yang D Teng
- Division of SCI Research, VA Boston Healthcare System, Boston, MA 02132, USA
- Department of Neurosurgery, Harvard Medical School, the Brigham and Women's Hospital and Children's Hospital Boston, Boston, MA 02115, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA
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Hutchinson D, Weinik M, Betz R. Utility of Electrophysiological Studies in Assessing Peripheral Sensory and Motor Nerve Involvement in the Upper Limb After Traumatic Tetraplegia. Top Spinal Cord Inj Rehabil 2008. [DOI: 10.1310/sci1304-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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