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Macêdo CT, de Freitas Souza BS, Villarreal CF, Silva DN, da Silva KN, de Souza CLEM, da Silva Paixão D, da Rocha Bezerra M, da Silva Moura Costa AO, Brazão ES, Marins Filho JP, Matos AC, dos Santos RR, Soares MBP. Transplantation of autologous mesenchymal stromal cells in complete cervical spinal cord injury: a pilot study. Front Med (Lausanne) 2024; 11:1451297. [PMID: 39328312 PMCID: PMC11424397 DOI: 10.3389/fmed.2024.1451297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/29/2024] [Indexed: 09/28/2024] Open
Abstract
Objective Spinal cord injury (SCI) is a serious condition that can lead to partial or complete paraplegia or tetraplegia. Currently, there are few therapeutic options for these conditions, which are mainly directed toward the acute phase, such as surgical intervention and high-dose steroid administration. Mesenchymal stromal cells (MSC) have been shown to improve neurological function following spinal cord injury. The aim of the study was to evaluate the safety, feasibility, and potential efficacy of MSC transplantation in patients with cervical traumatic SCI. Methods We included seven subjects with chronic traumatic SCI (> 1 year) at the cervical level, classified as American Spinal Cord Injury Association impairment scale (AIS) grade A. Subjects received two doses of autologous bone marrow derived MSC, the first by direct injection into the lesion site after hemilaminectomy and the second three months later by intrathecal injection. Neurologic evaluation, spinal magnetic resonance imaging (MRI), urodynamics, and life quality questionnaires were assessed before and after treatment. Results Cell transplantation was safe without severe or moderate adverse effects, and the procedures were well tolerated. Neurological evaluation revealed discrete improvements in sensitivity below the lesion level, following treatment. Five subjects showed some degree of bilateral sensory improvement for both superficial and deep mechanical stimuli compared to the pretreatment profile. No significant alterations in bladder function were observed during this study. Conclusion Transplantation of autologous MSC in patients with chronic cervical SCI is a safe and feasible procedure. Further studies are required to confirm the efficacy of this therapeutic approach. Clinical trial registration https://clinicaltrials.gov/study/NCT02574572, identifier NCT02574572.
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Affiliation(s)
- Carolina Thé Macêdo
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Hospital São Rafael, Salvador, Bahia, Brazil
- SENAI Institute for Innovation in Advanced Health Systems, SENAI CIMATEC, Salvador, Bahia, Brazil
| | - Bruno Solano de Freitas Souza
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Hospital São Rafael, Salvador, Bahia, Brazil
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Cristiane Flora Villarreal
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Faculty of Pharmacy, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Daniela Nascimento Silva
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- SENAI Institute for Innovation in Advanced Health Systems, SENAI CIMATEC, Salvador, Bahia, Brazil
| | - Kátia Nunes da Silva
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Clarissa Lima e Moura de Souza
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Hospital São Rafael, Salvador, Bahia, Brazil
| | | | | | | | | | | | | | - Ricardo Ribeiro dos Santos
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- SENAI Institute for Innovation in Advanced Health Systems, SENAI CIMATEC, Salvador, Bahia, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Milena Botelho Pereira Soares
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- SENAI Institute for Innovation in Advanced Health Systems, SENAI CIMATEC, Salvador, Bahia, Brazil
- National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
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Zhang YY, Xue RR, Yao M, Li ZY, Hu CW, Dai YX, Fang YD, Ding X, Xu JH, Cui XJ, Mo W. A systematic review and meta-analysis of chondroitinase ABC promotes functional recovery in rat models of spinal cord injury. Nutr Neurosci 2024; 27:917-933. [PMID: 37950873 DOI: 10.1080/1028415x.2023.2278867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
BACKGROUND To comprehensively assess the neurologic recovery potential of chondroitinase ABC (ChABC) in rats after spinal cord injury (SCI). METHODS The PubMed, Embase, ScienceDirect, Web of Science, and China National Knowledge Infrastructure databases were searched for animal experiments that evaluated the use of ChABC in the treatment of SCI up to November 2022. Studies reporting neurological function using the Basso, Beattie, and Bresnahan (BBB) scale, as well as assessments of cavity area, lesion area, and glial fibrillary acidic protein (GFAP) levels, were included in the analysis. RESULTS A total of 46 studies were ultimately selected for inclusion. The results of the study showed that rats with SCI that received ChABC therapy exhibited a significant improvement in locomotor function after 7 days compared with controls (32 studies, weighted mean difference (WMD) = 0.58, [0.33, 0.83], p < 0.00001). Furthermore, the benefits of ChABC therapy were maintained for up to 28 days according to BBB scale. The lesion area was reduced by ChABC (5 studies, WMD = -20.94, [-28.42, -13.46], p < 0.00001). Meanwhile, GFAP levels were reduced in the ChABC treatment group (8 studies, WMD = -29.15, [-41.57, -16.72], p < 0.00001). Cavity area is not statistically significant. The subgroup analysis recommended that a single injection of 10 μL (8 studies, WMD = 2.82, [1.99, 3.65], p < 0.00001) or 20 U/mL (4 studies, WMD = 2.21, [0.73, 3.70], p = 0.003) had a better effect on improving the function. The funnel plot of the BBB scale was found to be essentially symmetrical, indicating a low risk of publication bias. CONCLUSIONS This systematic review and meta-analysis has indicated that ChABC could improve functional recovery in rats after SCI.
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Affiliation(s)
- Ya-Yun Zhang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Traditional Chinese Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, People's Republic of China
| | - Rui-Rui Xue
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Min Yao
- Department of Orthopaedics, Longhua Hospital, Spine Disease Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Zhuo-Yao Li
- Department of Orthopaedics, Longhua Hospital, Spine Disease Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Cai-Wei Hu
- Department of Orthopaedics, Longhua Hospital, Spine Disease Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yu-Xiang Dai
- Department of Orthopaedics, Longhua Hospital, Spine Disease Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yi-de Fang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xing Ding
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jin-Hai Xu
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xue-Jun Cui
- Department of Orthopaedics, Longhua Hospital, Spine Disease Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Wen Mo
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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Zhou R, Li J, Wang R, Chen Z, Zhou F. Moderate systemic therapeutic hypothermia is insufficient to protect blood-spinal cord barrier in spinal cord injury. Front Neurol 2022; 13:1041099. [DOI: 10.3389/fneur.2022.1041099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Blood–spinal cord barrier (BSCB) disruption is a pivotal event in spinal cord injury (SCI) that aggravates secondary injury but has no specific treatment. Previous reports have shown that systemic therapeutic hypothermia (TH) can protect the blood–brain barrier after brain injury. To verify whether a similar effect exists on the BSCB after SCI, moderate systemic TH at 32°C was induced for 4 h on the mice with contusion-SCI. In vivo two-photon microscopy was utilized to dynamically monitor the BSCB leakage 1 h after SCI, combined with immunohistochemistry to detect BSCB leakage at 1 and 4 h after SCI. The BSCB leakage was not different between the normothermia (NT) and TH groups at both the in vivo and postmortem levels. The expression of endothelial tight junctions was not significantly different between the NT and TH groups 4 h after SCI, as detected by capillary western blotting. The structural damage of the BSCB was examined with immunofluorescence, but the occurrence of junctional gaps was not changed by TH 4 h after SCI. Our results have shown that moderate systemic TH induced for 4 h does not have a protective effect on the disrupted BSCB in early SCI. This treatment method has a low value and is not recommended for BSCB disruption therapy in early SCI.
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Zhang YY, Yao M, Zhu K, Xue RR, Xu JH, Cui XJ, Mo W. Neurological recovery and antioxidant effect of erythropoietin for spinal cord injury: A systematic review and meta-analysis. Front Neurol 2022; 13:925696. [PMID: 35928137 PMCID: PMC9343731 DOI: 10.3389/fneur.2022.925696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTo critically evaluate the neurological recovery effects and antioxidant effects of erythropoietin (EPO) in rat models of spinal cord injury (SCI).MethodsThe PubMed, EMBASE, MEDLINE, ScienceDirect, and Web of Science were searched for animal experiments applying EPO to treat SCI to January 2022. We included studies which examined neurological function by the Basso, Beattie, and Bresnahan (BBB) scale, as well as cavity area and spared area, and determining the molecular-biological analysis of antioxidative effects by malondialdehyde (MDA) levels in spinal cord tissues. Meta-analysis were performed with Review Manager 5.4 software.ResultsA total of 33 studies were included in this review. The results of the meta-analysis showed that SCI rats receiving EPO therapy showed a significant locomotor function recovery after 14 days compared with control, then the superiority of EPO therapy maintained to 28 days from BBB scale. Compared with the control group, the cavity area was reduced [4 studies, weighted mean difference (WMD) = −16.65, 95% CI (−30.74 to −2.55), P = 0.02] and spared area was increased [3 studies, WMD =11.53, 95% CI (1.34 to 21.72), P = 0.03] by EPO. Meanwhile, MDA levels [2 studies, WMD = −0.63 (−1.09 to −0.18), P = 0.007] were improved in the EPO treatment group compared with control, which indicated its antioxidant effect. The subgroup analysis recommended 5,000 UI/kg is the most effective dose [WMD = 4.05 (2.23, 5.88), P < 0.0001], although its effect was not statistically different from that of 1,000 UI/kg. Meanwhile, the different rat strains (Sprague-Dawley vs. Wistar), and models of animals, as well as administration method (single or multiple administration) of EPO did not affect the neuroprotective effect of EPO for SCI.ConclusionsThis systematic review indicated that EPO can promote the recovery of the locomotor function of SCI rats. The mechanism exploration of EPO needs to be verified by experiments, and then carefully designed randomized controlled trials are needed to explore its neural recovery effects.
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Affiliation(s)
- Ya-yun Zhang
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Yao
- Department of Orthopaedics, Spine Disease Institute, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zhu
- Department of Orthopaedics, Spine Disease Institute, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui-rui Xue
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jin-hai Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xue-jun Cui
| | - Xue-jun Cui
- Department of Orthopaedics, Spine Disease Institute, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jin-hai Xu
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Wen Mo
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Li T, Jing P, Yang L, Wan Y, Du X, Wei J, Zhou M, Liu Z, Lin Y, Zhong Z. CAQK modification enhances the targeted accumulation of metformin-loaded nanoparticles in rats with spinal cord injury. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 41:102526. [PMID: 35104674 DOI: 10.1016/j.nano.2022.102526] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/11/2022]
Abstract
Spinal cord injury (SCI) often causes neuronal membrane rupture and immediate death of neurons, followed by complicated secondary injuries. Treatment of SCI still remains a major challenge in clinical practice; thus, a great advance is urgently needed in this field. Metformin (MET) has anti-oxidant, anti-inflammatory, anti-apoptotic and neuroprotective properties, which may exert a potential therapeutic effect on SCI. In this study, we established a zein-based MET-loaded nanodrug system (CAQK-MET-NPs) for the targeted drug delivery for SCI. The results showed that MET could be effectively encapsulated into zein to obtain the zein-based spherical nanoparticles. Pharmacokinetic analysis indicated that CAQK-MET-NPs exhibited sustained-release and long-term therapeutic effects. The fluorescence imaging and tissue distribution experiments showed that CAQK-MET-NPs could efficiently accumulate at the lesion site of SCI rats. In conclusion, CAQK-MET-NPs may be a promising nanodrug for the treatment of SCI.
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Affiliation(s)
- Ting Li
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; The Second Hospital of Traditional Chinese Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Pei Jing
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lingling Yang
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Yujie Wan
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Xingjie Du
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Jun Wei
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Meiling Zhou
- Department of Pharmacy, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Zhongbing Liu
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Yan Lin
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China.
| | - Zhirong Zhong
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China.
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Sharif H, Alexander H, Azam A, Martin JH. Dual motor cortex and spinal cord neuromodulation improves rehabilitation efficacy and restores skilled locomotor function in a rat cervical contusion injury model. Exp Neurol 2021; 341:113715. [PMID: 33819448 PMCID: PMC10150584 DOI: 10.1016/j.expneurol.2021.113715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/14/2021] [Accepted: 03/31/2021] [Indexed: 01/11/2023]
Abstract
Motor recovery after spinal cord injury is limited due to sparse descending pathway axons caudal to the injury. Rehabilitation is the primary treatment for paralysis in humans with SCI, but only produces modest functional recovery. Here, we determined if dual epidural motor cortex (M1) intermittent theta burst stimulation (iTBS) and cathodal transcutaneous spinal direct stimulation (tsDCS) enhances the efficacy of rehabilitation in improving motor function after cervical SCI. iTBS produces CST axon sprouting and tsDCS enhances M1-evoked spinal activity and muscle contractions after SCI. Rats were trained to perform the horizontal ladder task. Animals received a moderate midline C4 contusion, producing bilateral forelimb impairments. After 2 weeks, animals either received 10 days of iTBS+tsDCS or no stimulation; subsequently, all animals received 6 weeks of daily rehabilitation on the horizontal ladder task. Lesion size was not different in the two animal groups. Rehabilitation alone improved performance by a 22% reduction in skilled locomotion error rate, whereas stimulation+rehabilitation was markedly more effective (52%), and restored error rate to pre-injury levels. Stimulation+rehabilitation significantly increased CST axon length caudal to the injury and the amount of ventral horn label was positively correlated with functional improvement. The stimulation+rehabilitation group had significantly less proprioceptive afferent terminal labelling in the intermediate zone and fewer synapses on motoneurons . Afferent fiber terminal labeling was negatively correlated with motor recovery. Thus, the dual neuromodulation protocol promotes adaptive plasticity in corticospinal and proprioceptive afferents networks after contusion SCI, leading to enhanced rehabilitation efficacy and recovery of skilled locomotion.
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Affiliation(s)
- Hisham Sharif
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA
| | - Heather Alexander
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA
| | - Anika Azam
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA
| | - John H Martin
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA; Neuroscience Program, Graduate Center of the City University of New York, New York, NY, USA.
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Inanici F, Brighton LN, Samejima S, Hofstetter CP, Moritz CT. Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury. IEEE Trans Neural Syst Rehabil Eng 2021; 29:310-319. [DOI: 10.1109/tnsre.2021.3049133] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Li Y, Wang H, Ding X, Shen J, Zhou H, Jiang D, Jin C, Li K. Human Brain-Derived Neurotrophic Factor Gene-Modified Bone Marrow Mesenchymal Stem Cells Combined With Erythropoietin Can Improve Acute Spinal Cord Injury. Dose Response 2020; 18:1559325820910930. [PMID: 32284696 PMCID: PMC7119236 DOI: 10.1177/1559325820910930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/17/2020] [Accepted: 02/01/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: To assess the effect as well as mechanism of bone marrow mesenchymal stem cells (BMSCs) modified by the human brain–derived neurotrophic factor gene combined with erythropoietin (EPO) in the treatment of acute spinal cord injury (SCI) in rats. Methods: The Brain-derived neurotrophic factor (BDNF) gene was transected by a virus vector. Rats with SCI were randomly split into following groups: The normal saline (NS) group, the EPO group, The Basso, Beattie, and Bresnahan scores, messenger RNA BDNF expression, and apoptosis rates were compared between the 4 groups at 1, 3, 7, 14, and 21 days after SCI. Results: At 7, 14, and 21 days after operation, the expression of the BDNF gene in the other 3 groups was higher than that of the NS group, and the difference was statistically significant (P < .05). The apoptosis rate in the combined group was less than that of NS, EPO, and BDNF/BMSC groups, and the differences were statistically significant (P < .05). Conclusion: Brain-derived neurotrophic factor gene-modified BMSC transplantation combined with EPO can promote the repair of nerve function after SCI in rats.
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Affiliation(s)
- YongLei Li
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Hongchen Wang
- Beijing Daxing District Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Xiaofang Ding
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Jiancheng Shen
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Haitao Zhou
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Dengxue Jiang
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Chen Jin
- Pediatric Surgery Department, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong, China
| | - Kuang Li
- Pediatric Surgery Department, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong, China
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Cao BH, Wu ZM, Liang JW. Risk Factors for Poor Prognosis of Cervical Spinal Cord Injury with Subaxial Cervical Spine Fracture-Dislocation After Surgical Treatment: A CONSORT Study. Med Sci Monit 2019; 25:1970-1975. [PMID: 30877267 PMCID: PMC6433098 DOI: 10.12659/msm.915700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The objective of the study was to identify risk factors for poor prognosis of cervical spinal cord injury (SCI) with subaxial cervical fracture-dislocation after surgical treatment. MATERIAL AND METHODS A total of 60 cervical SCI patients with subaxial cervical fracture-dislocation were primarily included in the study from April 2013 to April 2018. All the enrolled subjects received surgical treatment. The enrolled patients with complete follow-up record were divided into 2 groups based on the neural function prognosis: a non-functional restoration group and a functional restoration group. Multivariate regression analysis was performed to identify independent risk factors for poor prognosis of SCI after surgical treatment. RESULTS Fifty-five subjects were included in this study, and the follow-up time ranged from 8.5 to 44.5 months. A total of 25 subjects were categorized into the non-functional restoration group and 30 subjects into the functional restoration group. According to the results of multivariate regression analysis, time from injury to operation (more than 3.8 days), subaxial cervical injury classification (SLIC, score more than 7.5), and maximum spinal cord compression (MSCC, more than 55.8%) are independent risk factors for poor prognosis of SCI after surgical treatment (p<0.05), with AUCs of 0.95 (time from injury to operation), 0.91 (SLIC score), and 0.96 (MSCC). CONCLUSIONS Time from injury to operation (more than 3.8 days), SLIC score (more than 7.5), and MSCC (more than 55.8%) are independent risk factors for poor prognosis of SCI with subaxial cervical fracture-dislocation after surgical treatment.
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Affiliation(s)
- Bin-Hao Cao
- Department of Orthopedics, Taizhou First People’s Hospital, Taizhou, Zhejiang, P.R. China
| | - Zhi-Ming Wu
- Department of Orthopedics, Xiangyang No. 1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei, P.R. China
| | - Jian-Wei Liang
- Department of Orthopedics, Taizhou First People’s Hospital, Taizhou, Zhejiang, P.R. China
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Abstract
Spinal cord injury is associated with chronic sensorimotor deficits due to the interruption of ascending and descending tracts between the brain and spinal cord. Functional recovery after anatomically complete spinal cord injury is limited due to the lack of long-distance axonal regeneration of severed fibers in the adult central nervous system. Most spinal cord injuries in humans, however, are anatomically incomplete. Although restorative treatment options for spinal cord injury remain currently limited, research from experimental models of spinal cord injury have revealed a tremendous capability for both spontaneous and treatment-induced plasticity of the corticospinal system that supports functional recovery. We review recent advances in the understanding of corticospinal circuit plasticity after spinal cord injury and concentrate mainly on the hindlimb motor cortex, its corticospinal projections, and the role of spinal mechanisms that support locomotor recovery. First, we discuss plasticity that occurs at the level of motor cortex and the reorganization of cortical movement representations. Next, we explore downstream plasticity in corticospinal projections. We then review the role of spinal mechanisms in locomotor recovery. We conclude with a perspective on harnessing neuroplasticity with therapeutic interventions to promote functional recovery.
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Affiliation(s)
- Andrew R Brown
- Département de Neurosciences, Faculté de Médecine, Université de Montréal; Hôpital du Sacré-Coeur de Montréal (CIUSS-NIM), Montréal, Québec, Canada
| | - Marina Martinez
- Département de Neurosciences, Faculté de Médecine, Université de Montréal; Hôpital du Sacré-Coeur de Montréal (CIUSS-NIM), Montréal; Groupe de Recherche sur le Système Nerveux Central, Université de Montréal, Montréal, Québec, Canada
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Krueger E, Magri LMS, Botelho AS, Bach FS, Rebellato CLK, Fracaro L, Fragoso FYI, Villanova JA, Brofman PRS, Popović-Maneski L. Effects of low-intensity electrical stimulation and adipose derived stem cells transplantation on the time-domain analysis-based electromyographic signals in dogs with SCI. Neurosci Lett 2018; 696:38-45. [PMID: 30528708 DOI: 10.1016/j.neulet.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The application of low-intensity electrical stimulation (LIES) to neural tissue increases neurochemical factors responsible for regeneration as nerve growth factor. Stem cell (SC) therapy for patients with Spinal cord injury (SCI) promote some increase functional improvement. OBJECTIVE Investigate the electromyographic response in paraplegic dogs undergoing LIES and SC transplantation. METHODS 27 dogs paraplegics with SCI were divided into three groups with different types of therapy. GADSC: two SC transplants (n = 9); GLIES: LIES (n = 8); GCOMB: two SC transplants and LIES (n = 10). Adipose derived mesenchymal stem cells (ADSCs) were transplanted by lumbar puncture in the amount of 1.2 × 106 cells/50 μL. Acupuncture needles positioned in the interspinous space were used for stimulation. The electrical stimulation was applied with a mean voltage ∼30 mV and four consecutive modulated frequencies (5 Hz, 10 Hz, 15 Hz and 20 Hz) within 5 min each. The patients motor performance was evaluated before (Pre) the procedure and after 30 (Post30) and 60 (Post60) days, from electromyography root mean square (EMGRMS) registered with subcutaneous electrodes in the vastus lateralis muscle, while the animals were in quadrupedal position. RESULTS All three groups showed a significant intra-group increase of EMGRMS (Pre vs. Post30 or Pre vs. Post60). However, there were no statistically significant differences between Post30 and Post60. The inter-group test (GADSC X GLIES X GCOMB) did not present significance when compared the instants Pre (p = 0.34), Post30 (p = 0.78) and Post60 (p = 0.64). CONCLUSION Some dogs recovered motor activity, expressed by the EMGRMS, in all groups, in pre vs. post (30 or 60 days) comparisons.
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Affiliation(s)
- E Krueger
- Neural Engineering and Rehabilitation Laboratory, Master and Doctoral Program in Rehabilitation Sciences UEL-UNOPAR, Anatomy Department, State University of Londrina, Londrina, Brazil; Graduate Program in Biomedical Engineering, Technological Federal University - Paraná, Curitiba, Brazil.
| | - L M S Magri
- Graduate Program in Biomedical Engineering, Technological Federal University - Paraná, Curitiba, Brazil
| | | | - F S Bach
- Pontificial Catholical University of Paraná, Curitiba, Brazil
| | - C L K Rebellato
- Pontificial Catholical University of Paraná, Curitiba, Brazil
| | - L Fracaro
- Pontificial Catholical University of Paraná, Curitiba, Brazil
| | - F Y I Fragoso
- Pontificial Catholical University of Paraná, Curitiba, Brazil
| | - J A Villanova
- Pontificial Catholical University of Paraná, Curitiba, Brazil
| | - P R S Brofman
- Pontificial Catholical University of Paraná, Curitiba, Brazil
| | - L Popović-Maneski
- Institute of Technical Sciences of the Serbian Academy of Sciences and Arts, Belgrade, Serbia
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12
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Larocca TF, Macêdo CT, Souza BSDF, Andrade-Souza YM, Villarreal CF, Matos AC, Silva DN, da Silva KN, de Souza CLEM, Paixão DDS, Bezerra MDR, Alves RL, Soares MBP, Dos Santos RR. Image-guided percutaneous intralesional administration of mesenchymal stromal cells in subjects with chronic complete spinal cord injury: a pilot study. Cytotherapy 2017; 19:1189-1196. [PMID: 28760352 DOI: 10.1016/j.jcyt.2017.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/13/2017] [Accepted: 06/22/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AIMS The potential of cell therapies to improve neurological function in subjects with spinal cord injury (SCI) is currently under investigation. In this context, the choice of cell type, dose, route and administration regimen are key factors. Mesenchymal stromal cells (MSCs) can be easily obtained, expanded and are suitable for autologous transplantation. Here we conducted a pilot study that evaluated safety, feasibility and potential efficacy of intralesional MSCs transplantation performed through image-guided percutaneous injection, in subjects with chronic complete SCI. METHODS Five subjects with chronic traumatic SCI (>6 months), at thoracic level, classified as American Spinal Cord Injury Association impairment scale (AIS) grade A, complete injury, were included. Somatosensory evoked potentials (SSEP), spinal magnetic resonance imaging (MRI) and urodynamics were assessed before and after treatment. Autologous MSCs were injected directly into the lesion site through percutaneous injection guided by computerized tomography (CT). RESULTS Tomography-guided percutaneous cell transplantation was a safe procedure without adverse effects. All subjects displayed improvements in spinal cord independence measure (SCIM) scores and functional independence measure (FIM), mainly due to improvements in bowel movements and regularity. Three subjects showed improved sensitivity to tactile stimulation. Two subjects improved AIS grade to B, incomplete injury, although this was sustained in only one of them during the study follow-up. CONCLUSION Autologous bone marrow MSC transplantation, performed through CT-guided percutaneous injection, was shown to be safe and feasible. Further studies are required to demonstrate efficacy of this therapeutic scheme.
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Affiliation(s)
- Ticiana Ferreira Larocca
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil
| | - Carolina Thé Macêdo
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil
| | - Bruno Solano de Freitas Souza
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil
| | | | - Cristiane Flora Villarreal
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil; Faculty of Pharmacy, Federal University of Bahia, Salvador, BA, Brazil
| | | | - Daniela Nascimento Silva
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil
| | - Kátia Nunes da Silva
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil
| | - Clarissa Lima E Moura de Souza
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Hospital São Rafael, Salvador, BA, Brazil
| | | | | | | | - Milena Botelho Pereira Soares
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; Gonçalo Moniz Institute, IGM-Fiocruz/BA, Salvador, BA, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil.
| | - Ricardo Ribeiro Dos Santos
- Center for Biotechnology and Cell Therapy, Hospital São Rafael, Salvador, BA, Brazil; National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, RJ, Brazil
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