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Singh G, Sharma P, Forrest GF, Harkema SJ, Behrman A, Gerasimenko Y. Spinal cord transcutaneous stimulation in cervical spinal cord injury: A review examining upper extremity neuromotor control, recovery mechanisms, and future directions. J Neurotrauma 2024. [PMID: 38874496 DOI: 10.1089/neu.2023.0438] [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: 06/15/2024] Open
Abstract
Cervical spinal cord injury (SCI) results in significant sensorimotor impairments below the injury level, notably in the upper extremities (UE), impacting daily activities and quality of life. Regaining UE function remains the top priority for individuals post cervical SCI. Recent advances in understanding adaptive plasticity within the sensorimotor system have led to the development of novel non-invasive neurostimulation strategies, such as spinal cord transcutaneous stimulation (scTS), to facilitate UE motor recovery after SCI. This comprehensive review investigates the neuromotor control of UE, the typical recovery trajectories following SCI, and the therapeutic potential of scTS to enhance UE motor function in individuals with cervical SCI. Although limited in number with smaller sample sizes, the included research articles consistently suggest that scTS, when combined with task-specific training, improves voluntary control of arm and hand function and sensation. Furthermore, the reported improvements translate to recovery of various UE functional tasks and positively impact the quality of life in individuals with cervical SCI. Several methodological limitations, including stimulation site selection and parameters, training strategies and sensitive outcome measures, require further advancements to allow successful translation of scTS from research to clinical settings. This review also summarizes the current literature and proposes future directions to support establishing approaches for scTS as a viable neuro-rehabilitative tool.
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Affiliation(s)
- Goutam Singh
- Spalding University, 901 S 3rs Street, Louisville, Kentucky, United States, 40203
- University of Louisville School of Medicine, Neurological Surgery, Louisville, Kentucky, United States, 40292;
| | - Pawan Sharma
- University of Louisville School of Medicine, Neurological Surgery, Louisville, Kentucky, United States;
| | - Gail F Forrest
- Kessler Foundation, Human Performance and Engineering Research, West Orange, New Jersey, United States
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation, Newark, New Jersey, United States;
| | - Susan J Harkema
- University of Louisville School of Medicine, Neurological Surgery, Louisville, Kentucky, United States
- Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky, United States
- UofL Health Frazier Rehabilitation Institute, Louisville, Kentucky, United States
- University of Louisville, Department of Bioengineering, Louisville, Kentucky, United States;
| | - Andrea Behrman
- Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky, United States
- UofL Health Frazier Rehabilitation Institute, Louisville, Kentucky, United States
- University of Louisville School of Medicine, Neurological Surgery, Louisville, Kentucky, United States;
| | - Yury Gerasimenko
- University of Louisville, Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky, United States
- University of Louisville, Physiology, Louisville, Kentucky, United States
- Pavlov Institute of Physiology of the Russian Academy of Sciences, Sankt-Peterburg, Sankt-Peterburg, Russian Federation;
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Zhai C, Wang Z, Cai J, Fang L, Li X, Jiang K, Shen Y, Wang Y, Xu X, Liu W, Wang T, Wu Q. Repeated trans-spinal magnetic stimulation promotes microglial phagocytosis of myelin debris after spinal cord injury through LRP-1. Exp Neurol 2024; 379:114844. [PMID: 38830500 DOI: 10.1016/j.expneurol.2024.114844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
Spinal cord injury (SCI) is a serious trauma of the central nervous system. The clearance of myelin debris is a critical step in the functional recovery following spinal cord injury (SCI). Recent studies have begun to reveal critical roles for professional phagocytes in the central nervous system, microglia, and their receptors in the control of myelin debris in neurodegenerative disease. Repeated trans-spinal magnetic stimulation (rTSMS) has been demonstrated as a noninvasive SCI treatment that enhances tissue repair and functional recovery. In this study, we investigated the role and molecular mechanism of rTSMS on microglial phagocytosis of myelin debris in a rat SCI model. In our studies, we found that rTSMS significantly promoted the motor function recovery of SCI rats associated with the inhibition the neuroinflammation and glia scar formation. Immunofluorescence results further showed that the rTSMS promotes the clearance of myelin debris by microglia in vivo and in vitro. Additionally, receptor-associated protein (RAP), a Low-density lipoprotein receptor-related protein-1 (LRP-1) inhibitor, could cancel the accelerated microglial phagocytosis of myelin debris after rTSMS in vitro experiments. Simultaneously, Elisa's results and western blotting respectively showed that rTSMS significantly decreased the levels of soluble LRP-1(sLRP-1) and the LRP-1 splicing enzyme of ADAM17. In conclusion, rTSMS could promote the clearance of myelin debris by microglia through LRP-1 to improve the functional recovery of SCI rats.
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Affiliation(s)
- Chenyuan Zhai
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zun Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Rehabilitation medicine department, School of Acupuncture and Tuina, School of Health and Rehabilitation, Nanjing university of Chinese medicine, Nanjing 210023, China
| | - Jili Cai
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lu Fang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangzhe Li
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Rehabilitation Medicine Center, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, Jiangsu 215153, China
| | - Kunmao Jiang
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yu Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xingjun Xu
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wentao Liu
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, Jiangsu 211166, China.
| | - Tong Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Qi Wu
- Department of Rehabilitation, Hengyang Medical School, The First Affiliated Hospital, University of South China, Hengyang 421000, China.
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Yadav T, Lokuge B, Jackson MA, Austin EK, Fitzgerald PB, Brown AL, Paton B, Sequeira M, Nean M, Mills L, Dunlop AJ. Pilot study with randomised control of dual site theta burst transcranial magnetic stimulation (TMS) for methamphetamine use disorder: a protocol for the TARTAN study. Pilot Feasibility Stud 2024; 10:74. [PMID: 38725088 PMCID: PMC11080215 DOI: 10.1186/s40814-024-01498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) (including the theta burst stimulation (TBS) form of TMS used in this study) is a non-invasive means to stimulate nerve cells in superficial areas of the brain. In recent years, there has been a growth in the application of TMS to investigate the modulation of neural networks involved in substance use disorders. This study examines the feasibility of novel TMS protocols for the treatment of methamphetamine (MA) use disorder in an ambulatory drug and alcohol treatment setting. METHODS Thirty participants meeting the criteria for moderate to severe MA use disorder will be recruited in community drug and alcohol treatment settings and randomised to receive active TMS or sham (control) intervention. The treatment is intermittent TBS (iTBS) applied to the left dorsolateral prefrontal cortex (DLPFC), then continuous TBS (cTBS) to the left orbitofrontal cortex (OFC). Twelve sessions are administered over 4 weeks with opt-in weekly standardized cognitive behaviour therapy (CBT) counselling and a neuroimaging sub-study offered to participants. Primary outcomes are feasibility measures including recruitment, retention and acceptability of the intervention. Secondary outcomes include monitoring of safety and preliminary efficacy data including changes in substance use, cravings (cue reactivity) and cognition (response inhibition). DISCUSSION This study examines shorter TBS protocols of TMS for MA use disorder in real-world drug and alcohol outpatient settings where withdrawal and abstinence from MA, or other substances, are not eligibility requirements. TMS is a relatively affordable treatment and staff of ambulatory health settings can be trained to administer TMS. It is a potentially scalable and translatable treatment for existing drug and alcohol clinical settings. TMS has the potential to provide a much-needed adjuvant treatment to existing psychosocial interventions for MA use disorder. A limitation of this protocol is that the feasibility of follow-up is only examined at the end of treatment (4 weeks). TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12622000762752. Registered on May 27, 2022, and retrospectively registered (first participant enrolled) on May 23, 2022, with protocol version 7 on February 24, 2023.
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Affiliation(s)
- Tarun Yadav
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Buddhima Lokuge
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Melissa A Jackson
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Emma K Austin
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Paul B Fitzgerald
- School of Medicine and Psychology, College of Health & Medicine, Australian National University, Canberra, Australia
- Monarch Mental Health Group, Sydney, Australia
| | - Amanda L Brown
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Bryan Paton
- School of Psychology, Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - Marcia Sequeira
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Martin Nean
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - Llewllyn Mills
- Discipline of Addiction Medicine, Central Clinical School, University of Sydney, Camperdown, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Camperdown, Australia
- The Langton Centre, Surry Hills, Australia
| | - Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- NSW Drug & Alcohol Clinical Research & Improvement Network, St Leonards, Australia
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Nepomuceno P, Souza WH, Pakosh M, Musselman KE, Craven BC. Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters. J Neuroeng Rehabil 2024; 21:73. [PMID: 38705999 PMCID: PMC11070073 DOI: 10.1186/s12984-024-01365-2] [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] [Received: 11/28/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Exoskeletons are increasingly applied during overground gait and balance rehabilitation following neurological impairment, although optimal parameters for specific indications are yet to be established. OBJECTIVE This systematic review aimed to identify dose and dosage of exoskeleton-based therapy protocols for overground locomotor training in spinal cord injury/disease. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses guidelines. A literature search was performed using the CINAHL Complete, Embase, Emcare Nursing, Medline ALL, and Web of Science databases. Studies in adults with subacute and/or chronic spinal cord injury/disease were included if they reported (1) dose (e.g., single session duration and total number of sessions) and dosage (e.g., frequency of sessions/week and total duration of intervention) parameters, and (2) at least one gait and/or balance outcome measure. RESULTS Of 2,108 studies identified, after removing duplicates and filtering for inclusion, 19 were selected and dose, dosage and efficacy were abstracted. Data revealed a great heterogeneity in dose, dosage, and indications, with overall recommendation of 60-min sessions delivered 3 times a week, for 9 weeks in 27 sessions. Specific protocols were also identified for functional restoration (60-min, 3 times a week, for 8 weeks/24 sessions) and cardiorespiratory rehabilitation (60-min, 3 times a week, for 12 weeks/36 sessions). CONCLUSION This review provides evidence-based best practice recommendations for overground exoskeleton training among individuals with spinal cord injury/disease based on individual therapeutic goals - functional restoration or cardiorespiratory rehabilitation. There is a need for structured exoskeleton clinical translation studies based on standardized methods and common therapeutic outcomes.
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Affiliation(s)
- Patrik Nepomuceno
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Graduate Program in Health Promotion, Department of Health Sciences, University of Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Wagner H Souza
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - B Catharine Craven
- KITE Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Klamruen P, Suttiwong J, Aneksan B, Muangngoen M, Denduang C, Klomjai W. Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:857-867. [PMID: 37926224 DOI: 10.1016/j.apmr.2023.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit-to-stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI). DESIGN Double-blind sham-controlled trial with a matched-pair design. SETTING Sirindhorn National Medical Rehabilitation Institute, Thailand. PARTICIPANTS Individuals with iSCI (n=34) were allocated to the anodal or sham groups. INTERVENTION Anodal tDCS was administered over the M1 lower-limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions. MAIN OUTCOME MEASURES The 10-meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five-Time Sit-to-Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post-intervention, and at 1-month (1M) and 2-month (2M) follow-ups. RESULT Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between-group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post-intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post-intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post-intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between-group differences were found for other outcomes. CONCLUSION Five-session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post-intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit-to-stand), and quality of life were unaffected compared with overground gait training.
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Affiliation(s)
- Pipat Klamruen
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand; Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Jatuporn Suttiwong
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Benchaporn Aneksan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand
| | - Monticha Muangngoen
- Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Chanapass Denduang
- Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Wanalee Klomjai
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand
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Yao S, Yang Y, Li C, Yang K, Song X, Li C, Cao Z, Zhao H, Yu X, Wang X, Wang LN. Axon-like aligned conductive CNT/GelMA hydrogel fibers combined with electrical stimulation for spinal cord injury recovery. Bioact Mater 2024; 35:534-548. [PMID: 38414842 PMCID: PMC10897856 DOI: 10.1016/j.bioactmat.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/18/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
Rehabilitation and regenerative medicine are two promising approaches for spinal cord injury (SCI) recovery, but their combination has been limited. Conductive biomaterials could bridge regenerative scaffolds with electrical stimulation by inducing axon regeneration and supporting physiological electrical signal transmission. Here, we developed aligned conductive hydrogel fibers by incorporating carbon nanotubes (CNTs) into methacrylate acylated gelatin (GelMA) hydrogel via rotating liquid bath electrospinning. The electrospun CNT/GelMA hydrogel fibers mimicked the micro-scale aligned structure, conductivity, and soft mechanical properties of neural axons. For in vitro studies, CNT/GelMA hydrogel fibers supported PC12 cell proliferation and aligned adhesion, which was enhanced by electrical stimulation (ES). Similarly, the combination of aligned CNT/GelMA hydrogel fibers and ES promoted neuronal differentiation and axon-like neurite sprouting in neural stem cells (NSCs). Furthermore, CNT/GelMA hydrogel fibers were transplanted into a T9 transection rat spinal cord injury model for in vivo studies. The results showed that the incorporating CNTs could remain at the injury site with the GelMA fibers biodegraded and improve the conductivity of regenerative tissue. The aligned structure of the hydrogel could induce the neural fibers regeneration, and the ES enhanced the remyelination and axonal regeneration. Behavioral assessments and electrophysiological results suggest that the combination of aligned CNT/GelMA hydrogel fibers and ES could significantly restore motor function in rats. This study demonstrates that conductive aligned CNT/GelMA hydrogel fibers can not only induce neural regeneration as a scaffold but also support ESto promote spinal cord injury recovery. The conductive hydrogel fibers enable merging regenerative medicine and rehabilitation, showing great potential for satisfactory locomotor recovery after SCI.
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Affiliation(s)
- Shenglian Yao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yongdong Yang
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Chenyu Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Kaitan Yang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Xin Song
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Chuanhong Li
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Zheng Cao
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - He Zhao
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Hai Yun Cang, Beijing, 100700, China
| | - Xiumei Wang
- Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, China
| | - Lu-Ning Wang
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
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Sun Y, Xiao Z, Chen B, Zhao Y, Dai J. Advances in Material-Assisted Electromagnetic Neural Stimulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2400346. [PMID: 38594598 DOI: 10.1002/adma.202400346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/26/2024] [Indexed: 04/11/2024]
Abstract
Bioelectricity plays a crucial role in organisms, being closely connected to neural activity and physiological processes. Disruptions in the nervous system can lead to chaotic ionic currents at the injured site, causing disturbances in the local cellular microenvironment, impairing biological pathways, and resulting in a loss of neural functions. Electromagnetic stimulation has the ability to generate internal currents, which can be utilized to counter tissue damage and aid in the restoration of movement in paralyzed limbs. By incorporating implanted materials, electromagnetic stimulation can be targeted more accurately, thereby significantly improving the effectiveness and safety of such interventions. Currently, there have been significant advancements in the development of numerous promising electromagnetic stimulation strategies with diverse materials. This review provides a comprehensive summary of the fundamental theories, neural stimulation modulating materials, material application strategies, and pre-clinical therapeutic effects associated with electromagnetic stimulation for neural repair. It offers a thorough analysis of current techniques that employ materials to enhance electromagnetic stimulation, as well as potential therapeutic strategies for future applications.
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Affiliation(s)
- Yuting Sun
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zhifeng Xiao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Bing Chen
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yannan Zhao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Jianwu Dai
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and developmental Biology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
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Wang Y, Chai YQ, Cai J, Huang SS, Wang YF, Yuan SS, Wang JL, Shi KQ, Deng JJ. Human Adipose Tissue Lysate-Based Hydrogel for Lasting Immunomodulation to Effectively Improve Spinal Cord Injury Repair. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2304318. [PMID: 38018305 DOI: 10.1002/smll.202304318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/22/2023] [Indexed: 11/30/2023]
Abstract
The long-term inflammatory microenvironment is one of the main obstacles to inhibit acute spinal cord injury (SCI) repair. The natural adipose tissue-derived extracellular matrix hydrogel shows effective anti-inflammatory regulation because of its unique protein components. However, the rapid degradation rate and removal of functional proteins during the decellularization process impair the lasting anti-inflammation function of the adipose tissue-derived hydrogel. To address this problem, adipose tissue lysate provides an effective way for SCI repair due to its abundance of anti-inflammatory and nerve regeneration-related proteins. Thereby, human adipose tissue lysate-based hydrogel (HATLH) with an appropriate degradation rate is developed, which aims to in situ long-term recruit and induce anti-inflammatory M2 macrophages through sustainedly released proteins. HATLH can recruit and polarize M2 macrophages while inhibiting pro-inflammatory M1 macrophages regardless of human or mouse-originated. The axonal growth of neuronal cells also can be effectively improved by HATLH and HATLH-induced M2 macrophages. In vivo experiments reveal that HATLH promotes endogenous M2 macrophages infiltration in large numbers (3.5 × 105/100 µL hydrogel) and maintains a long duration for over a month. In a mouse SCI model, HATLH significantly inhibits local inflammatory response, improves neuron and oligodendrocyte differentiation, enhances axonal growth and remyelination, as well as accelerates neurological function restoration.
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Affiliation(s)
- Yu Wang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, Wenzhou, Zhejiang, 325000, China
- Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, Wenzhou, Zhejiang, 325000, China
| | - Ying-Qian Chai
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
| | - Jie Cai
- Department of Orthopedics, Xiaoshan Hospital Affiliated to Wenzhou Medical University, Hangzhou, Zhejiang, 310000, China
| | - Shan-Shan Huang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
| | - Ye-Feng Wang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Shan-Shan Yuan
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
| | - Ji-Long Wang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
| | - Ke-Qing Shi
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
| | - Jun-Jie Deng
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Joint Centre of Translational Medicine, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325000, China
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Zhang D, Xiao B, Liu B, Cui W, Duan S, Wu B, Wang L, Zhu D, Rong T. Influence of Blood Pressure on Acute Cervical Spinal Cord Injury Without Fracture and Dislocation: Results From a Retrospective Analysis. World Neurosurg 2024; 184:e530-e536. [PMID: 38316177 DOI: 10.1016/j.wneu.2024.01.164] [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] [Received: 01/24/2024] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The objective of this study was to investigate the influence of blood pressure on the severity and functional recovery of patients with acute cervical spinal cord injury (SCI) without fracture and dislocation. METHODS A retrospective case control study analyzed the data of 40 patients admitted to our orthopedics department (Beijing Tiantan Hospital, Capital Medical University) from January 2013 to February 2021. They were diagnosed as acute cervical SCI without fracture and dislocation. Gender, age, height, weight, history of hypertension, postinjury American Spinal Injury Association grade, postinjury modified Japanese Orthopaedic Association (mJOA) score, postoperative mJOA score, 1-year follow-up mJOA score, preoperative mean arterial pressure (MAP), intramedullary T2 hyperintensity, and hyponatremia were collected. The patients were divided into groups and subgroups based on their history of hypertension and preoperative MAP. The effects of history of hypertension and preoperative MAP on the incidence of T2 hyperintensity, hyponatremia, the improvement rate of the postoperative mJOA and 1-year follow-up mJOA scores were analyzed. RESULTS Patients with history of hypertension had a lower incidence of intramedullary T2 hyperintensity than patients without history of hypertension (P < 0.05). Patients with history of hypertension and patients with a higher preoperative MAP had better neurological recovery at 1 year of follow-up (P < 0.05). CONCLUSIONS Blood pressure has great influence on acute cervical SCI without fracture and dislocation. Maintaining a higher preoperative MAP is advantageous for better recovery after SCI. Attention should be paid to the dynamic management of blood pressure to avoid the adverse effects of hypotension after SCI.
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Affiliation(s)
- Duo Zhang
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bowei Xiao
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application Capital Medical University, Beijing, China.
| | - Wei Cui
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Duan
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bingxuan Wu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application Capital Medical University, Beijing, China
| | - Lei Wang
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Di Zhu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianhua Rong
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application Capital Medical University, Beijing, China
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10
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Liu J, Chen Z, Wu R, Yu H, Yang S, Xu J, Wu C, Guo Y, Hua N, Zeng X, Ma Y, Li G, Zhang L, Chen Y, Zeng Y, Ding Y, Lai B. Effects of tail nerve electrical stimulation on the activation and plasticity of the lumbar locomotor circuits and the prevention of skeletal muscle atrophy after spinal cord transection in rats. CNS Neurosci Ther 2024; 30:e14445. [PMID: 37752787 PMCID: PMC10916423 DOI: 10.1111/cns.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Severe spinal cord injury results in the loss of neurons in the relatively intact spinal cord below the injury area and skeletal muscle atrophy in the paralyzed limbs. These pathological processes are significant obstacles for motor function reconstruction. OBJECTIVE We performed tail nerve electrical stimulation (TNES) to activate the motor neural circuits below the injury site of the spinal cord to elucidate the regulatory mechanisms of the excitatory afferent neurons in promoting the reconstruction of locomotor function. METHODS Eight days after T10 spinal cord transection in rats, TNES was performed for 7 weeks. Behavioral scores were assessed weekly. Electrophysiological tests and double retrograde tracings were performed at week 8. RESULTS After 7 weeks of TNES treatment, there was restoration in innervation, the number of stem cells, and mitochondrial metabolism in the rats' hindlimb muscles. Double retrograde tracings of the tail nerve and sciatic nerve further confirmed the presence of synaptic connections between the tail nerve and central pattern generator (CPG) neurons in the lumbar spinal cord, as well as motor neurons innervating the hindlimb muscles. CONCLUSION The mechanisms of TNES induced by the stimulation of primary afferent nerve fibers involves efficient activation of the motor neural circuits in the lumbosacral segment, alterations of synaptic plasticity, and the improvement of muscle and nerve regeneration, which provides the structural and functional foundation for the future use of cutting-edge biological treatment strategies to restore voluntary movement of paralyzed hindlimbs.
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Affiliation(s)
- Jia‐Lin Liu
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
| | - Zheng‐Hong Chen
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Rehabilitation Medicine DepartmentThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Rong‐Jie Wu
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Shantou University Medical CollegeShantouGuangdongChina
- Department of OrthopedicsGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Hai‐Yang Yu
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of OrthopedicsGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Shang‐Bin Yang
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Jing Xu
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Chuang‐Ran Wu
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of OrthopedicsGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Yi‐Nan Guo
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Nan Hua
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
| | - Xiang Zeng
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Yuan‐Huan Ma
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Guangzhou First People's Hospital, Guangzhou Institute of Clinical Medicine, South China University of TechnologyGuangzhouGuangdongChina
| | - Ge Li
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Pathogenesis, Targeted Prevention and Treatment of Heart DiseaseGuangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangzhouGuangdongChina
| | - Ling Zhang
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Rehabilitation Medicine DepartmentThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Yuan‐Feng Chen
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of OrthopedicsGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhouGuangdongChina
| | - Yuan‐Shan Zeng
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Co‐innovation Center of NeuroregenerationNantong UniversityNantongJiangsuChina
| | - Ying Ding
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Bi‐Qin Lai
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat‐sen University), Ministry of EducationGuangzhouGuangdongChina
- Department of Histology and EmbryologyZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Guangdong Provincial Key Laboratory of Brain Function and DiseaseZhongshan School of Medicine, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Co‐innovation Center of NeuroregenerationNantong UniversityNantongJiangsuChina
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11
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Wang Y, Fang N, Wang Y, Geng Y, Li Y. Activating MC4R Promotes Functional Recovery by Repressing Oxidative Stress-Mediated AIM2 Activation Post-spinal Cord Injury. Mol Neurobiol 2024:10.1007/s12035-024-03936-9. [PMID: 38277117 DOI: 10.1007/s12035-024-03936-9] [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: 09/22/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
Spinal cord injury (SCI) is a destructive neurological trauma that induces permanent sensory and motor impairment as well as a deficit in autonomic physiological function. Melanocortin receptor 4 (MC4R) is a G protein-linked receptor that is extensively expressed in the neural system and contributes to inhibiting inflammation, regulating mitochondrial function, and inducing programmed cell death. However, the effect of MC4R in the modulation of oxidative stress and whether this mechanism is related to the role of absent in melanoma 2 (AIM2) in SCI are not confirmed yet. In the current study, we demonstrated that MC4R is significantly increased in the neurons of spinal cords after trauma and oxidative stimulation of cells. Further, activation of MC4R by RO27-3225 effectively improved functional recovery, inhibited AIM2 activation, maintained mitochondrial homeostasis, repressed oxidative stress, and prevented Drp1 translocation to the mitochondria. Meanwhile, treating Drp1 inhibitors would be beneficial in reducing AIM2 activation, and activating AIM2 could abolish the protective effect of MC4R on neuron homeostasis. In conclusion, we demonstrated that MC4R protects against neural injury through a novel process by inhibiting mitochondrial dysfunction, oxidative stress, as well as AIM2 activation, which may serve as an available candidate for SCI therapy.
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Affiliation(s)
- Yongli Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Orthopaedics, Huzhou Central Hospital, Huzhou Basic and Clinical Translation of Orthopaedics Key Laboratory, Huzhou, Zhejiang, China
| | - Nongtao Fang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yikang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yibo Geng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yao Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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12
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Ghosh M, Pearse DD. Schwann Cell-Derived Exosomal Vesicles: A Promising Therapy for the Injured Spinal Cord. Int J Mol Sci 2023; 24:17317. [PMID: 38139147 PMCID: PMC10743801 DOI: 10.3390/ijms242417317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Exosomes are nanoscale-sized membrane vesicles released by cells into their extracellular milieu. Within these nanovesicles reside a multitude of bioactive molecules, which orchestrate essential biological processes, including cell differentiation, proliferation, and survival, in the recipient cells. These bioactive properties of exosomes render them a promising choice for therapeutic use in the realm of tissue regeneration and repair. Exosomes possess notable positive attributes, including a high bioavailability, inherent safety, and stability, as well as the capacity to be functionalized so that drugs or biological agents can be encapsulated within them or to have their surface modified with ligands and receptors to imbue them with selective cell or tissue targeting. Remarkably, their small size and capacity for receptor-mediated transcytosis enable exosomes to cross the blood-brain barrier (BBB) and access the central nervous system (CNS). Unlike cell-based therapies, exosomes present fewer ethical constraints in their collection and direct use as a therapeutic approach in the human body. These advantageous qualities underscore the vast potential of exosomes as a treatment option for neurological injuries and diseases, setting them apart from other cell-based biological agents. Considering the therapeutic potential of exosomes, the current review seeks to specifically examine an area of investigation that encompasses the development of Schwann cell (SC)-derived exosomal vesicles (SCEVs) as an approach to spinal cord injury (SCI) protection and repair. SCs, the myelinating glia of the peripheral nervous system, have a long history of demonstrated benefit in repair of the injured spinal cord and peripheral nerves when transplanted, including their recent advancement to clinical investigations for feasibility and safety in humans. This review delves into the potential of utilizing SCEVs as a therapy for SCI, explores promising engineering strategies to customize SCEVs for specific actions, and examines how SCEVs may offer unique clinical advantages over SC transplantation for repair of the injured spinal cord.
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Affiliation(s)
- Mousumi Ghosh
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- The Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Veterans Affairs, Veterans Affairs Medical Center, Miami, FL 33136, USA
| | - Damien D. Pearse
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- The Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Veterans Affairs, Veterans Affairs Medical Center, Miami, FL 33136, USA
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- The Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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13
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Hodkinson DJ, Drabek MM, Jung J, Lankappa ST, Auer DP. Theta Burst Stimulation of the Human Motor Cortex Modulates Secondary Hyperalgesia to Punctate Mechanical Stimuli. Neuromodulation 2023:S1094-7159(23)00755-9. [PMID: 37952136 DOI: 10.1016/j.neurom.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Many chronic pain conditions show evidence of dysregulated synaptic plasticity, including the development and maintenance of central sensitization. This provides a strong rationale for neuromodulation therapies for the relief of chronic pain. However, variability in responses and low fidelity across studies remain an issue for both clinical trials and pain management, demonstrating insufficient mechanistic understanding of effective treatment protocols. MATERIALS AND METHODS In a randomized counterbalanced crossover designed study, we evaluated two forms of patterned repetitive transcranial magnetic stimulation, known as continuous theta burst stimulation (TBS) and intermittent TBS, during normal and central sensitization states. Secondary hyperalgesia (a form of use-dependent central sensitization) was induced using a well-established injury-free pain model and assessed by standardized quantitative sensory testing involving light touch and pinprick pain thresholds in addition to stimulus-response functions. RESULTS We found that continuous TBS of the human motor cortex has a facilitatory (pronociceptive) effect on the magnitude of perceived pain to secondary hyperalgesia, which may rely on induction and expression of neural plasticity through heterosynaptic long-term potentiation-like mechanisms. CONCLUSIONS By defining the underlying mechanisms of TBS-driven synaptic plasticity in the nociceptive system, we offer new insight into disease mechanisms and provide targets for promoting functional recovery and repair in chronic pain. For clinical applications, this knowledge is critical for development of more efficacious and mechanisms-based neuromodulation protocols, which are urgently needed to address the chronic pain and opioid epidemics.
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Affiliation(s)
- Duncan J Hodkinson
- Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research, Nottingham Biomedical Research Center, Queens Medical Center, Nottingham, UK.
| | - Marianne M Drabek
- Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research, Nottingham Biomedical Research Center, Queens Medical Center, Nottingham, UK
| | - JeYoung Jung
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Sudheer T Lankappa
- Nottinghamshire Healthcare National Health Service Foundation Trust, Nottingham, UK
| | - Dorothee P Auer
- Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Center, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research, Nottingham Biomedical Research Center, Queens Medical Center, Nottingham, UK
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14
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Fontana S, Caramazza L, Marracino P, Cuenca Ortolá I, Colella M, Dolciotti N, Paffi A, Gisbert Roca F, Ivashchenko S, Más Estellés J, Consales C, Balucani M, Apollonio F, Liberti M. Electric field bridging-effect in electrified microfibrils' scaffolds. Front Bioeng Biotechnol 2023; 11:1264406. [PMID: 37954020 PMCID: PMC10634785 DOI: 10.3389/fbioe.2023.1264406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction: The use of biocompatible scaffolds combined with the implantation of neural stem cells, is increasingly being investigated to promote the regeneration of damaged neural tissue, for instance, after a Spinal Cord Injury (SCI). In particular, aligned Polylactic Acid (PLA) microfibrils' scaffolds are capable of supporting cells, promoting their survival and guiding their differentiation in neural lineage to repair the lesion. Despite its biocompatible nature, PLA is an electrically insulating material and thus it could be detrimental for increasingly common scaffolds' electric functionalization, aimed at accelerating the cellular processes. In this context, the European RISEUP project aims to combine high intense microseconds pulses and DC stimulation with neurogenesis, supported by a PLA microfibrils' scaffold. Methods: In this paper a numerical study on the effect of microfibrils' scaffolds on the E-field distribution, in planar interdigitated electrodes, is presented. Realistic microfibrils' 3D CAD models have been built to carry out a numerical dosimetry study, through Comsol Multiphysics software. Results: Under a voltage of 10 V, microfibrils redistribute the E-field values focalizing the field streamlines in the spaces between the fibers, allowing the field to pass and reach maximum values up to 100 kV/m and values comparable with the bare electrodes' device (without fibers). Discussion: Globally the median E-field inside the scaffolded electrodes is the 90% of the nominal field, allowing an adequate cells' exposure.
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Affiliation(s)
- Sara Fontana
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
- Center for Life Nano- & Neuro-Science, Fondazione Istituto Italiano di Tecnologia (IIT), Rome, Italy
| | - Laura Caramazza
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
- Center for Life Nano- & Neuro-Science, Fondazione Istituto Italiano di Tecnologia (IIT), Rome, Italy
| | | | - Irene Cuenca Ortolá
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Micol Colella
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Noemi Dolciotti
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Alessandra Paffi
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
| | - Fernando Gisbert Roca
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Sergiy Ivashchenko
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Jorge Más Estellés
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Claudia Consales
- Division of Health Protection Technologies, ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy
| | | | - Francesca Apollonio
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
- Center for Life Nano- & Neuro-Science, Fondazione Istituto Italiano di Tecnologia (IIT), Rome, Italy
| | - Micaela Liberti
- BioEM Lab, Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Rome, Italy
- Center for Life Nano- & Neuro-Science, Fondazione Istituto Italiano di Tecnologia (IIT), Rome, Italy
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15
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Furlan JC, Furlan DT, Marquez-Chin C. Progress Report on the Spinal Cord Rehabilitation Research Initiatives Based on Registered Clinical Studies From 2000 to 2022. Am J Phys Med Rehabil 2023; 102:755-763. [PMID: 36928768 DOI: 10.1097/phm.0000000000002207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Identify the most common trends and features of research studies on spinal cord rehabilitation, which were registered in the ClinicalTrials.gov Website between 2000 and 2022; (2) Discuss the main limitations of research on spinal cord rehabilitation, based on the protocols published on the ClinicalTrials.gov Website; and (3) Recognize important knowledge gaps in clinical studies on spinal cord rehabilitation that were registered in the ClinicalTrials.gov Website. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Julio C Furlan
- From the Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada (JCF); KITE Research Institute, University Health Network, Toronto, Canada (JCF, CM-C); Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada (JCF); Institute of Medical Science, University of Toronto, Toronto, Canada (JCF); Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada (JCF); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (JCF); Faculty of Arts and Science, University of Toronto, Toronto, Canada (DTF); and Institute of Biomedical Engineering, University of Toronto, Toronto, Canada (CM-C)
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16
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Wang Y, Dong T, Li X, Zhao H, Yang L, Xu R, Fu Y, Li L, Gai X, Qin D. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review. Front Neurol 2023; 14:1219590. [PMID: 37533475 PMCID: PMC10392830 DOI: 10.3389/fneur.2023.1219590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Traumatic or non-traumatic spinal cord injury (SCI) can lead to severe disability and complications. The incidence of SCI is high, and the rehabilitation cycle is long, which increases the economic burden on patients and the health care system. However, there is no practical method of SCI treatment. Recently, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has been shown to induce changes in plasticity in specific areas of the brain by regulating the activity of neurons in the stimulation site and its functionally connected networks. TMS is a new potential method for the rehabilitation of SCI and its complications. In addition, TMS can detect the activity of neural circuits in the central nervous system and supplement the physiological evaluation of SCI severity. This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.
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Affiliation(s)
- Yuhong Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tingting Dong
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiahuang Li
- Department of Neurosurgery, Mengzi People’s Hospital, Mengzi, China
| | - Huiyun Zhao
- Department of Rehabilitation Medicine, Dongchuan District People’s Hospital, Kunming, China
| | - Lili Yang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Rui Xu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Li Li
- Department of Emergency Trauma Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xuesong Gai
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming, China
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17
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Chandrasekaran S, Bhagat NA, Ramdeo R, Ebrahimi S, Sharma PD, Griffin DG, Stein A, Harkema SJ, Bouton CE. Targeted transcutaneous spinal cord stimulation promotes persistent recovery of upper limb strength and tactile sensation in spinal cord injury: a pilot study. Front Neurosci 2023; 17:1210328. [PMID: 37483349 PMCID: PMC10360050 DOI: 10.3389/fnins.2023.1210328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Long-term recovery of limb function is a significant unmet need in people with paralysis. Neuromodulation of the spinal cord through epidural stimulation, when paired with intense activity-based training, has shown promising results toward restoring volitional limb control in people with spinal cord injury. Non-invasive neuromodulation of the cervical spinal cord using transcutaneous spinal cord stimulation (tSCS) has shown similar improvements in upper-limb motor control rehabilitation. However, the motor and sensory rehabilitative effects of activating specific cervical spinal segments using tSCS have largely remained unexplored. We show in two individuals with motor-complete SCI that targeted stimulation of the cervical spinal cord resulted in up to a 1,136% increase in exerted force, with weekly activity-based training. Furthermore, this is the first study to document up to a 2-point improvement in clinical assessment of tactile sensation in SCI after receiving tSCS. Lastly, participant gains persisted after a one-month period void of stimulation, suggesting that targeted tSCS may lead to persistent recovery of motor and sensory function.
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Affiliation(s)
- Santosh Chandrasekaran
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Nikunj A. Bhagat
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, United States
| | - Richard Ramdeo
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Sadegh Ebrahimi
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Pawan D. Sharma
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Doug G. Griffin
- Northwell Health STARS Rehabilitation, East Meadow, NY, United States
| | - Adam Stein
- Department of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of Bioengineering, University of Louisville, Louisville, KY, United States
- Frazier Rehabilitation Institute, University of Louisville Health, Louisville, KY, United States
- Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Chad E. Bouton
- Neural Bypass and Brain Computer Interface Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Brihmat N, Bayram MB, Ravi M, Bheemreddy A, Anjaria M, Momeni K, Saleh S, Forrest GF. Differential Corticospinal Excitability and Cortical Functional Connectivity Modulation by Spinal Cord Transcutaneous Stimulation-based Motor Training versus Motor Training alone in Able-bodied and SCI participants: A Multiple Case Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083293 DOI: 10.1109/embc40787.2023.10340957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Spinal cord transcutaneous stimulation (scTS) has shown its potential for boosting motor, sensory, and autonomic function recovery after a spinal cord injury. Despite the demonstrated benefits, little is known about the exact neuromodulatory mechanisms triggered by scTS and the cortex involvement in the beneficial effects observed. Here, we examine the effects of scTS-based motor training and motor training alone on sensorimotor cortical functional connectivity and corticospinal excitability in able-bodied and SCI participants.Clinical Relevance- The results show preliminary evidence of differential cortical involvement and modulation by scTS-based motor training in uninjured and spinal-cord injured individuals. A better understanding of scTS mechanisms of action could help optimize the intervention design and potentiate its benefits.
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Shahemi NH, Mahat MM, Asri NAN, Amir MA, Ab Rahim S, Kasri MA. Application of Conductive Hydrogels on Spinal Cord Injury Repair: A Review. ACS Biomater Sci Eng 2023. [PMID: 37364251 DOI: 10.1021/acsbiomaterials.3c00194] [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: 06/28/2023]
Abstract
Spinal cord injury (SCI) causes severe motor or sensory damage that leads to long-term disabilities due to disruption of electrical conduction in neuronal pathways. Despite current clinical therapies being used to limit the propagation of cell or tissue damage, the need for neuroregenerative therapies remains. Conductive hydrogels have been considered a promising neuroregenerative therapy due to their ability to provide a pro-regenerative microenvironment and flexible structure, which conforms to a complex SCI lesion. Furthermore, their conductivity can be utilized for noninvasive electrical signaling in dictating neuronal cell behavior. However, the ability of hydrogels to guide directional axon growth to reach the distal end for complete nerve reconnection remains a critical challenge. In this Review, we highlight recent advances in conductive hydrogels, including the incorporation of conductive materials, fabrication techniques, and cross-linking interactions. We also discuss important characteristics for designing conductive hydrogels for directional growth and regenerative therapy. We propose insights into electrical conductivity properties in a hydrogel that could be implemented as guidance for directional cell growth for SCI applications. Specifically, we highlight the practical implications of recent findings in the field, including the potential for conductive hydrogels to be used in clinical applications. We conclude that conductive hydrogels are a promising neuroregenerative therapy for SCI and that further research is needed to optimize their design and application.
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Affiliation(s)
- Nur Hidayah Shahemi
- Faculty of Applied Sciences, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
| | - Mohd Muzamir Mahat
- Faculty of Applied Sciences, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
| | - Nurul Ain Najihah Asri
- Faculty of Applied Sciences, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
| | - Muhammad Abid Amir
- Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, 47000 Sungai Buloh, Selangor, Malaysia
| | - Sharaniza Ab Rahim
- Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, 47000 Sungai Buloh, Selangor, Malaysia
| | - Mohamad Arif Kasri
- Kulliyyah of Science, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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20
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Pradat PF, Hayon D, Blancho S, Neveu P, Khamaysa M, Guerout N. Advances in Spinal Cord Neuromodulation: The Integration of Neuroengineering, Computational Approaches, and Innovative Conceptual Frameworks. J Pers Med 2023; 13:993. [PMID: 37373982 DOI: 10.3390/jpm13060993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Spinal cord stimulation (SCS) is an approved treatment for intractable pain and has recently emerged as a promising area of research for restoring function after spinal cord lesion. This review will focus on the historical evolution of this transition and the path that remains to be taken for these methods to be rigorously evaluated for application in clinical practice. New developments in SCS are being driven by advances in the understanding of spinal cord lesions at the molecular, cellular, and neuronal levels, as well as the understanding of compensatory mechanisms. Advances in neuroengineering and the computational neurosciences have enabled the development of new conceptual SCS strategies, such as spatiotemporal neuromodulation, which allows spatially selective stimulation at precise time points during anticipated movement. It has also become increasingly clear that these methods are only effective when combined with intensive rehabilitation techniques, such as new task-oriented methods and robotic aids. The emergence of innovative approaches to spinal cord neuromodulation has sparked significant enthusiasm among patients and in the media. Non-invasive methods are perceived to offer improved safety, patient acceptance, and cost-effectiveness. There is an immediate need for well-designed clinical trials involving consumer or advocacy groups to evaluate and compare the effectiveness of various treatment modalities, assess safety considerations, and establish outcome priorities.
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Affiliation(s)
- Pierre-François Pradat
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75013 Paris, France
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre Référent SLA, 75013 Paris, France
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Derry/Londonderry BT47 6SB, UK
- Institut Pour la Recherche Sur la Moelle Epiniere et l'Encéphale (IRME), 25 Rue Duranton, 75015 Paris, France
| | - David Hayon
- Clinique Saint-Roch, Service d'Anesthésie, 56 Rue de Lille, 59223 Roncq, France
| | - Sophie Blancho
- Institut Pour la Recherche Sur la Moelle Epiniere et l'Encéphale (IRME), 25 Rue Duranton, 75015 Paris, France
| | - Pauline Neveu
- Saints Pères Paris Institute for the Neurosciences, Université Paris Cité, CNRS UMR8003, 75006 Paris, France
| | - Mohammed Khamaysa
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75013 Paris, France
| | - Nicolas Guerout
- Saints Pères Paris Institute for the Neurosciences, Université Paris Cité, CNRS UMR8003, 75006 Paris, France
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21
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Thorogood NP, Waheed Z, Chernesky J, Burkhart I, Smith J, Sweeney S, Wudlick R, Douglas S, Wang D, Noonan VK. Spinal Cord Injury Community Personal Opinions and Perspectives on Spinal Cord Stimulation. Top Spinal Cord Inj Rehabil 2023; 29:1-11. [PMID: 37235197 PMCID: PMC10208255 DOI: 10.46292/sci22-00057] [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: 05/28/2023]
Abstract
Background Spinal cord stimulation (SCS) clinical trials are evaluating its efficacy and safety for motor, sensory, and autonomic recovery following spinal cord injury (SCI). The perspectives of people living with SCI are not well known and can inform the planning, delivery, and translation of SCS. Objectives To obtain input from people living with SCI on the top priorities for recovery, expected meaningful benefits, risk tolerance, clinical trial design, and overall interest in SCS. Methods Data were collected anonymously from an online survey between February and May 2020. Results A total of 223 respondents living with SCI completed the survey. The majority of respondents identified their gender as male (64%), were 10+ years post SCI (63%), and had a mean age of 50.8 years. Most individuals had a traumatic SCI (81%), and 45% classified themselves as having tetraplegia. Priorities for improved outcome for those with complete or incomplete tetraplegia included fine motor skills and upper body function, whereas priorities for complete or incomplete paraplegia included standing and walking, and bowel function. The meaningful benefits that are important to achieve are bowel and bladder care, less reliance on caregivers, and maintaining physical health. Perceived potential risks include further loss of function, neuropathic pain, and complications. Barriers to participation in clinical trials include inability to relocate, out-of-pocket expenses, and awareness of therapy. Respondents were more interested in transcutaneous SCS than epidural SCS (80% and 61%, respectively). Conclusion SCS clinical trial design, participant recruitment, and translation of the technology can be improved by better reflecting the priorities and preferences of those living with SCI identified from this study.
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Affiliation(s)
| | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - John Chernesky
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Ian Burkhart
- North American Spinal Cord Injury Consortium, Niagara Falls, New York
| | - Judith Smith
- North American Spinal Cord Injury Consortium, Niagara Falls, New York
| | - Shannon Sweeney
- North American Spinal Cord Injury Consortium, Niagara Falls, New York
| | - Rob Wudlick
- North American Spinal Cord Injury Consortium, Niagara Falls, New York
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sam Douglas
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
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22
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Henea ME, Șindilar EV, Burtan LC, Mihai I, Grecu M, Anton A, Solcan G. Recovery of Spinal Walking in Paraplegic Dogs Using Physiotherapy and Supportive Devices to Maintain the Standing Position. Animals (Basel) 2023; 13:ani13081398. [PMID: 37106961 PMCID: PMC10135265 DOI: 10.3390/ani13081398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Paraplegic patients have always been ideal candidates for physiotherapy due to their body's inability to recover on its own. Regardless of the cause that led to the onset of paraplegia (traumatic or degenerative), physiotherapy helps these patients with devices and methods designed to restore the proper functioning of their motility, as well as their quality of life. A total of 60 paraplegic dogs without deep pain in the hindlimbs caused by intervertebral disc extrusion or thoracolumbar fractures underwent physiotherapy sessions: manual therapy (massage), electrostimulation (10-20 min with possible repetition on the same day), ultrasound therapy, laser therapy, hydrotherapy, and assisted gait in supportive devices or on treadmills to stimulate and relearn walking, which was the main focus of the study. To maintain the standing position over time, we developed different devices adapted for each patient depending on the degree of damage and the possible associated pathologies: harnesses, trolleys, straps, exercise rollers, balancing platforms and mattresses, physio balls and rollers for recovery of proprioception. The main objective of our study was to demonstrate that physiotherapy and assisted gait in supportive devices to maintain the standing position may help paraplegic dogs to develop spinal walking. Concurrent pathologies (skin wounds, urinary infections, etc.) were managed concomitantly. Recovery of SW was evaluated by progression in regaining the reflectivity, nociception, gait score, and quality of life. After 125 to 320 physiotherapy sessions (25 to 64 weeks), 35 dogs (58.33%) developed spinal walking and were able to walk without falling or falling only sometimes in the case of a quick look (gait score 11.6 ± 1.57, with 14 considered normal), with a lack of coordination between the thoracic and pelvic limbs or difficulties in turning, especially when changing direction, but with the recovery of the quadrupedal position in less than 30 s. The majority of dogs recovering SW were of small size, with a median weight of 6.83 kg (range: 1.5-15.7), mixed breed (n = 9; 25.71%), Teckel (n = 4; 11.43%), Bichon (n = 5; 14.28%), Pekingese (n = 4; 11.43%), and Caniche (n = 2; 5.71%), while those who did not recover SW were larger in size, 15.59 kg (range: 5.5-45.2), and mixed breed (n = 16; 64%).
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Affiliation(s)
- Mădălina Elena Henea
- Phisiotherapy Unit, Clinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
| | - Eusebiu Viorel Șindilar
- Surgery Unit, Clinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
| | - Liviu Cătălin Burtan
- Surgery Unit, Clinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
| | - Iuliana Mihai
- Surgery Unit, Clinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
| | - Mariana Grecu
- Pharmacy Unit, Preclinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
| | - Alina Anton
- Internal Medicine Unit, Clinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
| | - Gheorghe Solcan
- Internal Medicine Unit, Clinics Department, Faculty of Veterinary Medicine, Iasi University of Life Sciences, Ion Ionescu de la Brad, 700490 Iasi, Romania
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23
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Radeleczki B, Mravcsik M, Bozheim L, Laczko J. Prediction of leg muscle activities from arm muscle activities in arm and leg cycling. Anat Rec (Hoboken) 2023; 306:710-719. [PMID: 35712823 DOI: 10.1002/ar.25004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/31/2022] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Functional electrical stimulation (FES) driven leg cycling is usually controlled by previously established stimulation patterns. We investigated the potential utilization of a particular computational method for controlling electrical stimulation of lower limb muscles by real-time electromyography (EMG) signals of arm muscles during hybrid arm and leg cycling. In hybrid arm and leg cycling, arm cranking is performed voluntarily, while leg cycling is driven by FES. In this study, we investigate arm and leg cycling movements of able-bodied persons when both arm and leg cycling is performed voluntarily without FES. We present a neural network-based model in which the input of the neural network is given by a time series of upper limb muscle activities (EMG), and the output provides potential lower limb muscle activities. The particular neural network was a nonlinear autoregressive exogen (NARX) neural network. The measured EMG signals of the lower limb muscles were compared to the signals that were predicted by the neural network. The neural network was trained with data recorded from four participants. Our preliminary results show notable differences between the predicted and the experimentally measured lower limb muscle activities. The prediction was good only for 60% of the movement time. We conclude that-while including arm cycling in the movement-simpler control modalities or further consideration of applying machine-learning techniques has to be taken into account to improve voluntary upper limb-controlled FES assisted leg cycling.
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Affiliation(s)
- Balazs Radeleczki
- Pázmány Péter Catholic University, Faculty of Information Technology and Bionics, Budapest, Hungary
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
| | - Mariann Mravcsik
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
- Department of Information Technology and Biorobotics, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Lilla Bozheim
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
- Department of Information Technology and Biorobotics, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | - Jozsef Laczko
- Pázmány Péter Catholic University, Faculty of Information Technology and Bionics, Budapest, Hungary
- Department of Computational Sciences, Wigner Research Centre for Physics, Budapest, Hungary
- Department of Information Technology and Biorobotics, Faculty of Sciences, University of Pécs, Pécs, Hungary
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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24
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Barroso FO, Torricelli D, Moreno JC. Neurorobotics and neuroprostheses: Towards a new anatomy. Anat Rec (Hoboken) 2023; 306:706-709. [PMID: 36715240 DOI: 10.1002/ar.25157] [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] [Received: 08/15/2022] [Revised: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/31/2023]
Abstract
The idea of this Special Issue arose from the technological advances in bionic, robotic, and neural rehabilitation systems and the common need to comprehend in detail how human anatomical structures can be replicated or controlled. Motor control theories, among others, include the generalized control program theory, the equilibrium point hypothesis, or the optimal control approach in which neural commands to the muscles are a result of the central nervous system solving an optimization problem for a specific cost function. No matter the alternative interpretation selected to replicate biological control of human movements, artificial "anatomies" should consider not only motor capabilities from the central nervous system but integrate bioinspired mechanical features (such as compliance) in artificial limbs. The development of wearable robotics and neuroprosthetic systems for human movement compensation and control is naturally inspired by human anatomy and biology. Cutting-edge technological advances in the field of biomedical and neural engineering are bringing us more and more close to a new artificial anatomy with which humans could augment their motor capabilities or replace them after they are compromised. Either augmentative/assistive or rehabilitation technologies in the near future will require engineering solutions based on novel approaches to create usable neurorobotic and neuroprosthetic systems for the most relevant societal needs.
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Affiliation(s)
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, CSIC, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, CSIC, Madrid, Spain
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25
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Yu H, Yang S, Li H, Wu R, Lai B, Zheng Q. Activating Endogenous Neurogenesis for Spinal Cord Injury Repair: Recent Advances and Future Prospects. Neurospine 2023; 20:164-180. [PMID: 37016865 PMCID: PMC10080446 DOI: 10.14245/ns.2245184.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/29/2022] [Indexed: 04/03/2023] Open
Abstract
After spinal cord injury (SCI), endogenous neural stem cells are activated and migrate to the injury site where they differentiate into astrocytes, but they rarely differentiate into neurons. It is difficult for brain-derived information to be transmitted through the injury site after SCI because of the lack of neurons that can relay neural information through the injury site, and the functional recovery of adult mammals is difficult to achieve. The development of bioactive materials, tissue engineering, stem cell therapy, and physiotherapy has provided new strategies for the treatment of SCI and shown broad application prospects, such as promoting endogenous neurogenesis after SCI. In this review, we focus on novel approaches including tissue engineering, stem cell technology, and physiotherapy to promote endogenous neurogenesis and their therapeutic effects on SCI. Moreover, we explore the mechanisms and challenges of endogenous neurogenesis for the repair of SCI.
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Affiliation(s)
- Haiyang Yu
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shangbin Yang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haotao Li
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Rongjie Wu
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Biqin Lai
- Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat-sen University), Ministry of Education, Guangzhou, China
- Co-corresponding Author Biqin Lai Key Laboratory for Stem Cells and Tissue Engineering (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Southern Medical University, Guangzhou, China
- Corresponding Author Qiujian Zheng Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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26
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Leszczyńska K, Huber J. The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury. Biomedicines 2023; 11:biomedicines11041035. [PMID: 37189653 DOI: 10.3390/biomedicines11041035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Efforts to find therapeutic methods that support spinal cord functional regeneration continue to be desirable. Natural recovery is limited, so high hopes are being placed on neuromodulation methods which promote neuroplasticity, such as repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation used as treatment options for managing incomplete spinal cord injury (iSCI) apart from kinesiotherapy. However, there is still no agreement on the methodology and algorithms for treatment with these methods. The search for effective therapy is also hampered by the use of different, often subjective in nature, evaluation methods and difficulties in assessing the actual results of the therapy versus the phenomenon of spontaneous spinal cord regeneration. In this study, an analysis was performed on the database of five trials, and the cumulative data are presented. Participants (iSCI patients) were divided into five groups on the basis of the treatment they had received: rTMS and kinesiotherapy (N = 36), peripheral electrotherapy and kinesiotherapy (N = 65), kinesiotherapy alone (N = 55), rTMS only (N = 34), and peripheral electrotherapy mainly (N = 53). We present changes in amplitudes and frequencies of the motor units’ action potentials recorded by surface electromyography (sEMG) from the tibialis anterior—the index muscle for the lower extremity and the percentage of improvement in sEMG results before and after the applied therapies. The increase in values in sEMG parameters represents the better ability of motor units to recruit and, thus, improvement of neural efferent transmission. Our results indicate that peripheral electrotherapy provides a higher percentage of neurophysiological improvement than rTMS; however, the use of any of these additional stimulation methods (rTMS or peripheral electrotherapy) provided better results than the use of kinesiotherapy alone. The best improvement of tibialis anterior motor units’ activity in iSCI patients provided the application of electrotherapy conjoined with kinesiotherapy and rTMS conjoined with kinesiotherapy. We also undertook a review of the current literature to identify and summarise available works which address the use of rTMS or peripheral electrotherapy as neuromodulation treatment options in patients after iSCI. Our goal is to encourage other clinicians to implement both types of stimulation into the neurorehabilitation program for subjects after iSCI and evaluate their effectiveness with neurophysiological tests such as sEMG so further results and algorithms can be compared across studies. Facilitating the motor rehabilitation process by combining two rehabilitation procedures together was confirmed.
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27
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Lai BQ, Wu RJ, Han WT, Bai YR, Liu JL, Yu HY, Yang SB, Wang LJ, Ren JL, Ding Y, Li G, Zeng X, Ma YH, Quan Q, Xing LY, Jiang B, Wang YQ, Zhang L, Chen ZH, Zhang HB, Chen YF, Zheng QJ, Zeng YS. Tail nerve electrical stimulation promoted the efficiency of transplanted spinal cord-like tissue as a neuronal relay to repair the motor function of rats with transected spinal cord injury. Biomaterials 2023; 297:122103. [PMID: 37028111 DOI: 10.1016/j.biomaterials.2023.122103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
Following transected spinal cord injury (SCI), there is a critical need to restore nerve conduction at the injury site and activate the silent neural circuits caudal to the injury to promote the recovery of voluntary movement. In this study, we generated a rat model of SCI, constructed neural stem cell (NSC)-derived spinal cord-like tissue (SCLT), and evaluated its ability to replace injured spinal cord and repair nerve conduction in the spinal cord as a neuronal relay. The lumbosacral spinal cord was further activated with tail nerve electrical stimulation (TNES) as a synergistic electrical stimulation to better receive the neural information transmitted by the SCLT. Next, we investigated the neuromodulatory mechanism underlying the action of TNES and its synergism with SCLT in SCI repair. TNES promoted the regeneration and remyelination of axons and increased the proportion of glutamatergic neurons in SCLT to transmit brain-derived neural information more efficiently to the caudal spinal cord. TNES also increased the innervation of motor neurons to hindlimb muscle and improved the microenvironment of muscle tissue, resulting in effective prevention of hindlimb muscle atrophy and enhanced muscle mitochondrial energy metabolism. Tracing of the neural circuits of the sciatic nerve and tail nerve identified the mechanisms responsible for the synergistic effects of SCLT transplantation and TNES in activating central pattern generator (CPG) neural circuits and promoting voluntary motor function recovery in rats. The combination of SCLT and TNES is expected to provide a new breakthrough for patients with SCI to restore voluntary movement and control their muscles.
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Affiliation(s)
- Bi-Qin Lai
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China; Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Rong-Jie Wu
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510100, China; Shantou University Medical College, Shantou, 515041, China
| | - Wei-Tao Han
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China
| | - Yu-Rong Bai
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China
| | - Jia-Lin Liu
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China
| | - Hai-Yang Yu
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510100, China
| | - Shang-Bin Yang
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China
| | - Lai-Jian Wang
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jia-Le Ren
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ying Ding
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China; Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ge Li
- Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, 510100, China
| | - Xiang Zeng
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China; Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuan-Huan Ma
- Guangzhou Institute of Clinical Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, 510180, China
| | - Qi Quan
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, the 4th Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
| | - Ling-Yan Xing
- Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bin Jiang
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ya-Qiong Wang
- Department of Electron Microscope, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ling Zhang
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zheng-Hong Chen
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Hong-Bo Zhang
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China
| | - Yuan-Feng Chen
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510100, China.
| | - Qiu-Jian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510100, China.
| | - Yuan-Shan Zeng
- Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, 510080, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226001, China; Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China; Institute of Spinal Cord Injury, Sun Yat-sen University, Guangzhou, 510800, China.
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Ge X, Ye W, Zhu Y, Cui M, Zhou J, Xiao C, Jiang D, Tang P, Wang J, Wang Z, Ji C, Zhou X, Cao X, Liu W, Cai W. USP1/UAF1-Stabilized METTL3 Promotes Reactive Astrogliosis and Improves Functional Recovery after Spinal Cord Injury through m 6A Modification of YAP1 mRNA. J Neurosci 2023; 43:1456-1474. [PMID: 36653190 PMCID: PMC10008067 DOI: 10.1523/jneurosci.1209-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/01/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
RNA N6-methyladenosine (m6A) modification is involved in diverse biological processes. However, its role in spinal cord injury (SCI) is poorly understood. The m6A level increases in injured spinal cord, and METTL3, which is the core subunit of methyltransferase complex, is upregulated in reactive astrocytes and further stabilized by the USP1/UAF1 complex after SCI. The USP1/UAF1 complex specifically binds to and subsequently removes K48-linked ubiquitination of the METTL3 protein to maintain its stability after SCI. Moreover, conditional knockout of astrocytic METTL3 in both sexes of mice significantly suppressed reactive astrogliosis after SCI, thus resulting in widespread infiltration of inflammatory cells, aggravated neuronal loss, hampered axonal regeneration, and impaired functional recovery. Mechanistically, the YAP1 transcript was identified as a potential target of METTL3 in astrocytes. METTL3 could selectively methylate the 3'-UTR region of the YAP1 transcript, which subsequently maintains its stability in an IGF2BP2-dependent manner. In vivo, YAP1 overexpression by adeno-associated virus injection remarkably contributed to reactive astrogliosis and partly reversed the detrimental effects of METTL3 knockout on functional recovery after SCI. Furthermore, we found that the methyltransferase activity of METTL3 plays an essential role in reactive astrogliosis and motor repair, whereas METTL3 mutant without methyltransferase function failed to promote functional recovery after SCI. Our study reveals the previously unreported role of METTL3-mediated m6A modification in SCI and might provide a potential therapy for SCI.SIGNIFICANCE STATEMENT Spinal cord injury is a devastating trauma of the CNS involving motor and sensory impairments. However, epigenetic modification in spinal cord injury is still unclear. Here, we propose an m6A regulation effect of astrocytic METTL3 following spinal cord injury, and we further characterize its underlying mechanism, which might provide promising strategies for spinal cord injury treatment.
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Affiliation(s)
- Xuhui Ge
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Wu Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yufeng Zhu
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Min Cui
- Department of Human Anatomy, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Jiawen Zhou
- Department of Pharmacology, China Pharmaceutical University, Nanjing 211198, China
| | - Chenyu Xiao
- Department of Human Anatomy, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Dongdong Jiang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Pengyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jiaxing Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhuanghui Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chengyue Ji
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xuhui Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Xiaojian Cao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Wei Liu
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
| | - Weihua Cai
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Dorrian RM, Berryman CF, Lauto A, Leonard AV. Electrical stimulation for the treatment of spinal cord injuries: A review of the cellular and molecular mechanisms that drive functional improvements. Front Cell Neurosci 2023; 17:1095259. [PMID: 36816852 PMCID: PMC9936196 DOI: 10.3389/fncel.2023.1095259] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that causes severe loss of motor, sensory and autonomic functions. Additionally, many individuals experience chronic neuropathic pain that is often refractory to interventions. While treatment options to improve outcomes for individuals with SCI remain limited, significant research efforts in the field of electrical stimulation have made promising advancements. Epidural electrical stimulation, peripheral nerve stimulation, and functional electrical stimulation have shown promising improvements for individuals with SCI, ranging from complete weight-bearing locomotion to the recovery of sexual function. Despite this, there is a paucity of mechanistic understanding, limiting our ability to optimize stimulation devices and parameters, or utilize combinatorial treatments to maximize efficacy. This review provides a background into SCI pathophysiology and electrical stimulation methods, before exploring cellular and molecular mechanisms suggested in the literature. We highlight several key mechanisms that contribute to functional improvements from electrical stimulation, identify gaps in current knowledge and highlight potential research avenues for future studies.
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Affiliation(s)
- Ryan M. Dorrian
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia,*Correspondence: Ryan M. Dorrian,
| | | | - Antonio Lauto
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Anna V. Leonard
- Spinal Cord Injury Research Group, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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Neuromodulation with transcutaneous spinal stimulation reveals different groups of motor profiles during robot-guided stepping in humans with incomplete spinal cord injury. Exp Brain Res 2023; 241:365-382. [PMID: 36534141 PMCID: PMC10278039 DOI: 10.1007/s00221-022-06521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
Neuromodulation via spinal stimulation has been investigated for improving motor function and reducing spasticity after spinal cord injury (SCI) in humans. Despite the reported heterogeneity of outcomes, few investigations have attempted to discern commonalities among individual responses to neuromodulation, especially the impact of stimulation frequencies. Here, we examined how exposure to continuous lumbosacral transcutaneous spinal stimulation (TSS) across a range of frequencies affects robotic torques and EMG patterns during stepping in a robotic gait orthosis on a motorized treadmill. We studied nine chronic motor-incomplete SCI individuals (8/1 AIS-C/D, 8 men) during robot-guided stepping with body-weight support without and with TSS applied at random frequencies between 1 and up to 100 Hz at a constant, individually selected stimulation intensity below the common motor threshold for posterior root reflexes. The hip and knee robotic torques needed to maintain the predefined stepping trajectory and EMG in eight bilateral leg muscles were recorded. We calculated the standardized mean difference between the stimulation conditions grouped into frequency bins and the no stimulation condition to determine changes in the normalized torques and the average EMG envelopes. We found heterogeneous changes in robotic torques across individuals. Agglomerative clustering of robotic torques identified four groups wherein the patterns of changes differed in magnitude and direction depending mainly on the stimulation frequency and stance/swing phase. On one end of the spectrum, the changes in robotic torques were greater with increasing stimulation frequencies (four participants), which coincided with a decrease in EMG, mainly due to the reduction of clonogenic motor output in the lower leg muscles. On the other end, we found an inverted u-shape change in torque over the mid-frequency range along with an increase in EMG, reflecting the augmentation of gait-related physiological (two participants) or pathophysiological (one participant) output. We conclude that TSS during robot-guided stepping reveals different frequency-dependent motor profiles among individuals with chronic motor incomplete SCI. This suggests the need for a better understanding and characterization of motor control profiles in SCI when applying TSS as a therapeutic intervention for improving gait.
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Lemos N, Fernandes GL, Ribeiro AM, Maia-Lemos PS, Contiero W, Croos-Bezerra V, Tomlison G, Faber J, Oliveira ASB, Girão MJBC. Rehabilitation of People With Chronic Spinal Cord Injury Using a Laparoscopically Implanted Neurostimulator: Impact on Mobility and Urinary, Anorectal, and Sexual Functions. Neuromodulation 2023; 26:233-245. [PMID: 35248460 DOI: 10.1016/j.neurom.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to assess the impact of the laparoscopic implantation of neuromodulation electrodes (Possover-LION procedure) on mobility and on sexual, urinary, and anorectal functions of people with chronic spinal cord injury (SCI). MATERIAL AND METHODS Longitudinal analysis of 30 patients with chronic SCI (21 ASIA impairment scale (AIS) A, eight AIS B, and one AIS C) submitted to the Possover-LION procedure for bilateral neuromodulation of femoral, sciatic, and pudendal nerves. Assessments were performed before the surgical procedure and at 3, 6, and 12 months postoperatively. The primary outcome was evolution in walking, measured by the Walking Index for Spinal Cord Injury score, preoperatively and at 12 months. Secondary outcomes were changes in overall mobility (Mobility Assessment Tool for Evaluation of Rehabilitation score), urinary function and quality of life (Qualiveen questionnaire), and bowel (time for bowel emptying proceedings and Wexner's Fecal Incontinence Severity Index [FISI]) and sexual functions (International Index of Erectile Function for men and Female Sexual Function Index for women). Surgical time, intraoperative bleeding, and perioperative complications were also recorded. RESULTS Qualitatively, 18 of 25 (72%) patients with thoracic injury and 3 of 5 (60%) patients with cervical injury managed to establish a walker-assisted gait at one-year follow-up (p < 0.0001). A total of 11 (47.8%) have improved in their urinary incontinence (p < 0.0001), and seven (30.4%) improved their enuresis (p = 0.0156). The FISI improved from a median of 9 points preoperatively to 5.5 at 12 months (p = 0.0056). Of note, 20 of 28 (71.4%) patients reported an improvement on genital sensitivity at 12 months postoperatively (p < 0.0001), but this was not reflected in sexual quality-of-life questionnaires. CONCLUSIONS Patients experienced improved mobility and genital sensitivity and a reduction in the number of urinary and fecal incontinence episodes. By demonstrating reproducible outcomes and safety, this study helps establish the Possover-LION procedure as an addition to the therapeutic armamentarium for the rehabilitation of patients with chronic SCI. CLINICAL TRIAL REGISTRATION This study was registered at the WHO Clinical Trials Database through the Brazilian Registry of Clinical Trials-REBEC (Universal Tracking Number: U1111-1261-4428).
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Affiliation(s)
- Nucelio Lemos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil.
| | - Gustavo L Fernandes
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil; Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Augusta M Ribeiro
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Priscila S Maia-Lemos
- Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Wellington Contiero
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - Victor Croos-Bezerra
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil; Department of Gynecology and Neuropelveology, Increasing-Institute of Care and Rehabilitation in Neuropelveology and Gynecology, São Paulo, Brazil
| | - George Tomlison
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jean Faber
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Manoel J B C Girão
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil
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Ahmed RU, Knibbe CA, Wilkins F, Sherwood LC, Howland DR, Boakye M. Porcine spinal cord injury model for translational research across multiple functional systems. Exp Neurol 2023; 359:114267. [PMID: 36356636 DOI: 10.1016/j.expneurol.2022.114267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Animal models are necessary to identify pathological changes and help assess therapeutic outcomes following spinal cord injury (SCI). Small animal models offer value in research in terms of their easily managed size, minimal maintenance requirements, lower cost, well-characterized genomes, and ability to power research studies. However, despite these benefits, small animal models have neurologic and anatomical differences that may influence translation of results to humans and thus limiting the success of their use in preclinical studies as a direct pipeline to clinical studies. Large animal models, offer an attractive intermediary translation model that may be more successful in translating to the clinic for SCI research. This is largely due to their greater neurologic and anatomical similarities to humans. The physical characteristics of pig spinal cord, gut microbiome, metabolism, proportions of white to grey matter, bowel anatomy and function, and urinary system are strikingly similar and provide great insight into human SCI conditions. In this review, we address the variety of existing porcine injury models and their translational relevance, benefits, and drawbacks in modeling human systems and functions for neurophysiology, cardiovascular, gastrointestinal and urodynamic functions.
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Affiliation(s)
- Rakib Uddin Ahmed
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | - Chase A Knibbe
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Felicia Wilkins
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Leslie C Sherwood
- Comparative Medicine Research Unit, University of Louisville, Louisville, KY, USA
| | - Dena R Howland
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Robley Rex VA Medical Center, Louisville, KY 40202, USA
| | - Maxwell Boakye
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
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33
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Singla RK, Guimarães AG, Zengin G. Editorial: Application of plant secondary metabolites to pain neuromodulation, volume III. Front Pharmacol 2023; 14:1166272. [PMID: 36895948 PMCID: PMC9990135 DOI: 10.3389/fphar.2023.1166272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Rajeev K Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China.,iGlobal Research and Publishing Foundation, New Delhi, India
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Fehlings MG, Pedro K, Hejrati N. Management of Acute Spinal Cord Injury: Where Have We Been? Where Are We Now? Where Are We Going? J Neurotrauma 2022; 39:1591-1602. [PMID: 35686453 DOI: 10.1089/neu.2022.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Michael G Fehlings
- Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nader Hejrati
- Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Hodkinson DJ, Jackson SR, Jung J. Task-dependent plasticity in distributed neural circuits after transcranial direct current stimulation of the human motor cortex: A proof-of-concept study. FRONTIERS IN PAIN RESEARCH 2022; 3:1005634. [PMID: 36506269 PMCID: PMC9732378 DOI: 10.3389/fpain.2022.1005634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
The ability of non-invasive brain stimulation to induce neuroplasticity and cause long-lasting functional changes is of considerable interest for the reversal of chronic pain and disability. Stimulation of the primary motor cortex (M1) has provided some of the most encouraging after-effects for therapeutic purposes, but little is known about its underlying mechanisms. In this study we combined transcranial Direct Current Stimulation (tDCS) and fMRI to measure changes in task-specific activity and interregional functional connectivity between M1 and the whole brain. Using a randomized counterbalanced sham-controlled design, we applied anodal and cathodal tDCS stimulation over the left M1. In agreement with previous studies, we demonstrate that tDCS applied to the target region induces task-specific facilitation of local brain activity after anodal tDCS, with the stimulation effects having a negative relationship to the resting motor threshold. Beyond the local effects, tDCS also induced changes in multiple downstream regions distinct from the motor system that may be important for therapeutic efficacy, including the operculo-insular and cingulate cortex. These results offer opportunities to improve outcomes of tDCS for the individual patient based on the degree of presumed neuroplasticity. Further research is still warranted to address the optimal stimulation targets and parameters for those with disease-specific symptoms of chronic pain.
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Affiliation(s)
- Duncan J. Hodkinson
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Queens Medical Center, Nottingham, United Kingdom
- Versus Arthritis Pain Centre, University of Nottingham, Nottingham, United Kingdom
| | - Stephen R. Jackson
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Queens Medical Center, Nottingham, United Kingdom
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - JeYoung Jung
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
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36
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Hashemizadeh S, Hosseindoost S, Omidi A, Aminianfar H, Ebrahimi-Barough S, Ai J, Arjmand B, Hadjighassem M. Novel therapeutic approach to slow down the inflammatory cascade in acute/subacute spinal cord injury: Early immune therapy with lipopolysaccharide enhanced neuroprotective effect of combinational therapy of granulocyte colony-stimulating factor and bone-marrow mesenchymal stem cell in spinal cord injury. Front Cell Neurosci 2022; 16:993019. [PMID: 36505513 PMCID: PMC9727083 DOI: 10.3389/fncel.2022.993019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Bone-marrow mesenchymal stem cells (BM-MSCs) have not yet proven any significant therapeutic efficacy in spinal cord injury (SCI) clinical trials, due to the hostile microenvironment of the injured spinal cord at the acute phase. This study aims to modulate the inflammatory milieu by lipopolysaccharide (LPS) and granulocyte colony-stimulating factor (G-CSF) to improve the BM-MSCs therapy. For this purpose, we determined the optimum injection time and sub-toxic dosage of LPS following a T10 contusion injury. Medium-dose LPS administration may result in a local anti-inflammatory beneficial role. This regulatory role is associated with an increase in NF-200-positive cells, significant tissue sparing, and improvement in functional recovery compared to the SCI control group. The second aim was to examine the potential ability of LPS and LPS + G-CSF combination therapy to modulate the lesion site before BM-MSC (1 × 105 cells) intra-spinal injection. Our results demonstrated combination therapy increased potency to enhance the anti-inflammatory response (IL-10 and Arg-1) and decrease inflammatory markers (TNF-α and CD86) and caspase-3 compared to BM-MSC monotherapy. Histological analysis revealed that combination groups displayed better structural remodeling than BM-MSC monotherapy. In addition, Basso-Beattie-Bresnahan (BBB) scores show an increase in motor recovery in all treatment groups. Moreover, drug therapy shows faster recovery than BM-MSC monotherapy. Our results suggest that a sub-toxic dose of LPS provides neuroprotection to SCI and can promote the beneficial effect of BM-MSC in SCI. These findings suggest that a combination of LPS or LPS + G-CSF prior BM-MSC transplantation is a promising approach for optimizing BM-MSC-based strategies to treat SCI. However, because of the lack of some methodological limitations to examine the survival rate and ultimate fate of transplanted BM-MSCs followed by LPS administration in this study, further research needs to be done in this area. The presence of only one-time point for evaluating the inflammatory response (1 week) after SCI can be considered as one of the limitations of this study. We believed that the inclusion of additional time points would provide more information about the effect of our combination therapy on the microglia/macrophage polarization dynamic at the injured spinal cord.
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Affiliation(s)
- Shiva Hashemizadeh
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saereh Hosseindoost
- Pain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Omidi
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Somayeh Ebrahimi-Barough
- Department of Tissue Engineering and Applied Cell Sciences, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jafar Ai
- Department of Tissue Engineering and Applied Cell Sciences, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran,Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoudreza Hadjighassem
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran,Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran,*Correspondence: Mahmoudreza Hadjighassem,
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Pavlov VA, Tracey KJ. Bioelectronic medicine: Preclinical insights and clinical advances. Neuron 2022; 110:3627-3644. [PMID: 36174571 PMCID: PMC10155266 DOI: 10.1016/j.neuron.2022.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/28/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
The nervous system maintains homeostasis and health. Homeostatic disruptions underlying the pathobiology of many diseases can be controlled by bioelectronic devices targeting CNS and peripheral neural circuits. New insights into the regulatory functions of the nervous system and technological developments in bioelectronics drive progress in the emerging field of bioelectronic medicine. Here, we provide an overview of key aspects of preclinical research, translation, and clinical advances in bioelectronic medicine.
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Affiliation(s)
- Valentin A Pavlov
- Institute of Bioelectronic Medicine, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, the Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Govindarajan LN, Calvert JS, Parker SR, Jung M, Darie R, Miranda P, Shaaya E, Borton DA, Serre T. Fast inference of spinal neuromodulation for motor control using amortized neural networks. J Neural Eng 2022; 19:10.1088/1741-2552/ac9646. [PMID: 36174534 PMCID: PMC9668352 DOI: 10.1088/1741-2552/ac9646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022]
Abstract
Objective.Epidural electrical stimulation (EES) has emerged as an approach to restore motor function following spinal cord injury (SCI). However, identifying optimal EES parameters presents a significant challenge due to the complex and stochastic nature of muscle control and the combinatorial explosion of possible parameter configurations. Here, we describe a machine-learning approach that leverages modern deep neural networks to learn bidirectional mappings between the space of permissible EES parameters and target motor outputs.Approach.We collected data from four sheep implanted with two 24-contact EES electrode arrays on the lumbosacral spinal cord. Muscle activity was recorded from four bilateral hindlimb electromyography (EMG) sensors. We introduce a general learning framework to identify EES parameters capable of generating desired patterns of EMG activity. Specifically, we first amortize spinal sensorimotor computations in a forward neural network model that learns to predict motor outputs based on EES parameters. Then, we employ a second neural network as an inverse model, which reuses the amortized knowledge learned by the forward model to guide the selection of EES parameters.Main results.We found that neural networks can functionally approximate spinal sensorimotor computations by accurately predicting EMG outputs based on EES parameters. The generalization capability of the forward model critically benefited our inverse model. We successfully identified novel EES parameters, in under 20 min, capable of producing desired target EMG recruitment duringin vivotesting. Furthermore, we discovered potential functional redundancies within the spinal sensorimotor networks by identifying unique EES parameters that result in similar motor outcomes. Together, these results suggest that our framework is well-suited to probe spinal circuitry and control muscle recruitment in a completely data-driven manner.Significance.We successfully identify novel EES parameters within minutes, capable of producing desired EMG recruitment. Our approach is data-driven, subject-agnostic, automated, and orders of magnitude faster than manual approaches.
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Affiliation(s)
- Lakshmi Narasimhan Govindarajan
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence RI USA
- Carney Institute for Brain Science, Brown University, Providence RI USA
| | | | | | - Minju Jung
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence RI USA
- Carney Institute for Brain Science, Brown University, Providence RI USA
| | - Radu Darie
- School of Engineering, Brown University, Providence RI USA
| | | | - Elias Shaaya
- Department of Neurosurgery, Brown University and Rhode Island Hospital, Providence RI USA
| | - David A. Borton
- Carney Institute for Brain Science, Brown University, Providence RI USA
- School of Engineering, Brown University, Providence RI USA
- Center for Neurorestoration and Neurotechnology, Department of Veterans Affairs, Providence RI USA
| | - Thomas Serre
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence RI USA
- Carney Institute for Brain Science, Brown University, Providence RI USA
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Leemhuis E, Favieri F, Forte G, Pazzaglia M. Integrated Neuroregenerative Techniques for Plasticity of the Injured Spinal Cord. Biomedicines 2022; 10:biomedicines10102563. [PMID: 36289825 PMCID: PMC9599452 DOI: 10.3390/biomedicines10102563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
On the slow path to improving the life expectancy and quality of life of patients post spinal cord injury (SCI), recovery remains controversial. The potential role of the regenerative capacity of the nervous system has led to numerous attempts to stimulate the SCI to re-establish the interrupted sensorimotor loop and to understand its potential in the recovery process. Numerous resources are now available, from pharmacological to biomolecular approaches and from neuromodulation to sensorimotor rehabilitation interventions based on the use of various neural interfaces, exoskeletons, and virtual reality applications. The integration of existing resources seems to be a promising field of research, especially from the perspective of improving living conditions in the short to medium term. Goals such as reducing chronic forms of neuropathic pain, regaining control over certain physiological activities, and enhancing residual abilities are often more urgent than complete functional recovery. In this perspective article, we provide an overview of the latest interventions for the treatment of SCI through broad phases of injury rehabilitation. The underlying intention of this work is to introduce a spinal cord neuroplasticity-based multimodal approach to promote functional recovery and improve quality of life after SCI. Nonetheless, when used separately, biomolecular therapeutic approaches have been shown to have modest outcomes.
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Affiliation(s)
- Erik Leemhuis
- Dipartimento di Psicologia, Sapienza Università di Roma, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Correspondence: (E.L.); (M.P.)
| | - Francesca Favieri
- Dipartimento di Psicologia, Sapienza Università di Roma, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Giuseppe Forte
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Sapienza Università di Roma, 00185 Roma, Italy
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, Sapienza Università di Roma, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Correspondence: (E.L.); (M.P.)
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Filippone A, Esposito E, Mannino D, Lyssenko N, Praticò D. The contribution of altered neuronal autophagy to neurodegeneration. Pharmacol Ther 2022; 238:108178. [PMID: 35351465 PMCID: PMC9510148 DOI: 10.1016/j.pharmthera.2022.108178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/21/2022]
Abstract
Defects in cellular functions related to altered protein homeostasis and associated progressive accumulation of pathological intracellular material is a critical process involved in the pathogenesis of many neurodegenerative disorders, including Alzheimer's disease and Parkinson's disease. Autophagy is an essential mechanism that ensures neuronal health by removing long-lived proteins or defective organelles and by doing so prevents cell toxicity and death within the central nervous system. Abundant evidence has shown that neuronal autophagy pathways are altered in Alzheimer's disease, Parkinson's disease and traumas of the central nervous system including Spinal Cord Injury and Traumatic Brain Injury. In this review, we aimed to summarize the latest studies on the role that altered neuronal autophagy plays in brain health and these pathological conditions, and how this knowledge can be leveraged for the development of novel therapeutics against them.
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Affiliation(s)
- Alessia Filippone
- Alzheimer's Center at Temple, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D' Alcontres 31. 98166 Messina, Italy
| | - Emanuela Esposito
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D' Alcontres 31. 98166 Messina, Italy
| | - Deborah Mannino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D' Alcontres 31. 98166 Messina, Italy
| | - Nicholas Lyssenko
- Alzheimer's Center at Temple, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Domenico Praticò
- Alzheimer's Center at Temple, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
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Girão AF, Serrano MC, Completo A, Marques PAAP. Is Graphene Shortening the Path toward Spinal Cord Regeneration? ACS NANO 2022; 16:13430-13467. [PMID: 36000717 PMCID: PMC9776589 DOI: 10.1021/acsnano.2c04756] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Along with the development of the next generation of biomedical platforms, the inclusion of graphene-based materials (GBMs) into therapeutics for spinal cord injury (SCI) has potential to nourish topmost neuroprotective and neuroregenerative strategies for enhancing neural structural and physiological recovery. In the context of SCI, contemplated as one of the most convoluted challenges of modern medicine, this review first provides an overview of its characteristics and pathophysiological features. Then, the most relevant ongoing clinical trials targeting SCI, including pharmaceutical, robotics/neuromodulation, and scaffolding approaches, are introduced and discussed in sequence with the most important insights brought by GBMs into each particular topic. The current role of these nanomaterials on restoring the spinal cord microenvironment after injury is critically contextualized, while proposing future concepts and desirable outputs for graphene-based technologies aiming to reach clinical significance for SCI.
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Affiliation(s)
- André F. Girão
- Centre
for Mechanical Technology and Automation (TEMA), Department of Mechanical
Engineering, University of Aveiro (UA), Aveiro, 3810-193, Portugal
- Instituto
de Ciencia de Materiales de Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Calle Sor Juana Inés de la
Cruz 3, Madrid, 28049, Spain
- (A.F.G.)
| | - María Concepcion Serrano
- Instituto
de Ciencia de Materiales de Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Calle Sor Juana Inés de la
Cruz 3, Madrid, 28049, Spain
- (M.C.S.)
| | - António Completo
- Centre
for Mechanical Technology and Automation (TEMA), Department of Mechanical
Engineering, University of Aveiro (UA), Aveiro, 3810-193, Portugal
| | - Paula A. A. P. Marques
- Centre
for Mechanical Technology and Automation (TEMA), Department of Mechanical
Engineering, University of Aveiro (UA), Aveiro, 3810-193, Portugal
- (P.A.A.P.M.)
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Singla RK, Guimarães AG, Zengin G. Editorial: Application of plant secondary metabolites to pain neuromodulation, volume II. Front Pharmacol 2022; 13:1013063. [PMID: 36225584 PMCID: PMC9549320 DOI: 10.3389/fphar.2022.1013063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
- *Correspondence: Rajeev K. Singla, ; Adriana Gibara Guimarães, ; Gokhan Zengin,
| | - Adriana Gibara Guimarães
- Federal University of Sergipe, São Cristóvão, Brazil
- *Correspondence: Rajeev K. Singla, ; Adriana Gibara Guimarães, ; Gokhan Zengin,
| | - Gokhan Zengin
- Selçuk University, Konya, Turkey
- *Correspondence: Rajeev K. Singla, ; Adriana Gibara Guimarães, ; Gokhan Zengin,
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Dietz VA, Roberts N, Knox K, Moore S, Pitonak M, Barr C, Centeno J, Leininger S, New KC, Nowell P, Rodreick M, Geoffroy CG, Stampas A, Dulin JN. Fighting for recovery on multiple fronts: The past, present, and future of clinical trials for spinal cord injury. Front Cell Neurosci 2022; 16:977679. [PMID: 36212690 PMCID: PMC9533868 DOI: 10.3389/fncel.2022.977679] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Through many decades of preclinical research, great progress has been achieved in understanding the complex nature of spinal cord injury (SCI). Preclinical research efforts have guided and shaped clinical trials, which are growing in number by the year. Currently, 1,149 clinical trials focused on improving outcomes after SCI are registered in the U.S. National Library of Medicine at ClinicalTrials.gov. We conducted a systematic analysis of these SCI clinical trials, using publicly accessible data downloaded from ClinicalTrials.gov. After extracting all available data for these trials, we categorized each trial according to the types of interventions being tested and the types of outcomes assessed. We then evaluated clinical trial characteristics, both globally and by year, in order to understand the areas of growth and change over time. With regard to clinical trial attributes, we found that most trials have low enrollment, only test single interventions, and have limited numbers of primary outcomes. Some gaps in reporting are apparent; for instance, over 75% of clinical trials with "Completed" status do not have results posted, and the Phase of some trials is incorrectly classified as "Not applicable" despite testing a drug or biological compound. When analyzing trials based on types of interventions assessed, we identified the largest representation in trials testing rehab/training/exercise, neuromodulation, and behavioral modifications. Most highly represented primary outcomes include motor function of the upper and lower extremities, safety, and pain. The most highly represented secondary outcomes include quality of life and pain. Over the past 15 years, we identified increased representation of neuromodulation and rehabilitation trials, and decreased representation of drug trials. Overall, the number of new clinical trials initiated each year continues to grow, signifying a hopeful future for the clinical treatment of SCI. Together, our work provides a comprehensive glimpse into the past, present, and future of SCI clinical trials, and suggests areas for improvement in clinical trial reporting.
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Affiliation(s)
- Valerie A. Dietz
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Nolan Roberts
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Katelyn Knox
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Sherilynne Moore
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Michael Pitonak
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Chris Barr
- Unite 2 Fight Paralysis, Minneapolis, MN, United States
| | - Jesus Centeno
- Unite 2 Fight Paralysis, Minneapolis, MN, United States
| | | | - Kent C. New
- Unite 2 Fight Paralysis, Minneapolis, MN, United States
| | - Peter Nowell
- Unite 2 Fight Paralysis, Minneapolis, MN, United States
| | | | - Cedric G. Geoffroy
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University, College Station, TX, United States
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, United States
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, UTHealth Houston McGovern Medical School, Houston, TX, United States
| | - Jennifer N. Dulin
- Department of Biology, Texas A&M University, College Station, TX, United States
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, United States
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Yan L, Fu J, Dong X, Chen B, Hong H, Cui Z. Identification of hub genes in the subacute spinal cord injury in rats. BMC Neurosci 2022; 23:51. [PMID: 36030234 PMCID: PMC9419366 DOI: 10.1186/s12868-022-00737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Spinal cord injury (SCI) is a common trauma in clinical practices. Subacute SCI is mainly characterized by neuronal apoptosis, axonal demyelination, Wallerian degeneration, axonal remodeling, and glial scar formation. It has been discovered in recent years that inflammatory responses are particularly important in subacute SCI. However, the mechanisms mediating inflammation are not completely clear. Methods The gene expression profiles of GSE20907, GSE45006, and GSE45550 were downloaded from the GEO database. The models of the three gene expression profiles were all for SCI to the thoracic segment of the rat. The differentially expressed genes (DEGs) and weighted correlation network analysis (WGCNA) were performed using R software, and functional enrichment analysis and protein–protein interaction (PPI) network were performed using Metascape. Module analysis was performed using Cytoscape. Finally, the relative mRNA expression level of central genes was verified by RT-PCR. Results A total of 206 candidate genes were identified, including 164 up-regulated genes and 42 down-regulated genes. The PPI network was evaluated, and the candidate genes enrichment results were mainly related to the production of tumor necrosis factors and innate immune regulatory response. Twelve core genes were identified, including 10 up-regulated genes and 2 down-regulated genes. Finally, seven hub genes with statistical significance in both the RT-PCR results and expression matrix were identified, namely Itgb1, Ptprc, Cd63, Lgals3, Vav1, Shc1, and Casp4. They are all related to the activation process of microglia. Conclusion In this study, we identified the hub genes and signaling pathways involved in subacute SCI using bioinformatics methods, which may provide a molecular basis for the future treatment of SCI.
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Affiliation(s)
- Lei Yan
- The Second Affiliated Hospital of Nantong University, No.6, North Road, 226000, Haierxiang, Nantong, Jiangsu, People's Republic of China
| | - Jiawei Fu
- The Second Affiliated Hospital of Nantong University, No.6, North Road, 226000, Haierxiang, Nantong, Jiangsu, People's Republic of China
| | - Xiong Dong
- The Second Affiliated Hospital of Nantong University, No.6, North Road, 226000, Haierxiang, Nantong, Jiangsu, People's Republic of China
| | - Baishen Chen
- The Second Affiliated Hospital of Nantong University, No.6, North Road, 226000, Haierxiang, Nantong, Jiangsu, People's Republic of China
| | - Hongxiang Hong
- The Second Affiliated Hospital of Nantong University, No.6, North Road, 226000, Haierxiang, Nantong, Jiangsu, People's Republic of China
| | - Zhiming Cui
- The Second Affiliated Hospital of Nantong University, No.6, North Road, 226000, Haierxiang, Nantong, Jiangsu, People's Republic of China.
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45
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Chen M, Chen Z, Xiao X, Zhou L, Fu R, Jiang X, Pang M, Xia J. Corticospinal circuit neuroplasticity may involve silent synapses: Implications for functional recovery facilitated by neuromodulation after spinal cord injury. IBRO Neurosci Rep 2022; 14:185-194. [PMID: 36824667 PMCID: PMC9941655 DOI: 10.1016/j.ibneur.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
Abstract
Spinal cord injury (SCI) leads to devastating physical consequences, such as severe sensorimotor dysfunction even lifetime disability, by damaging the corticospinal system. The conventional opinion that SCI is intractable due to the poor regeneration of neurons in the adult central nervous system (CNS) needs to be revisited as the CNS is capable of considerable plasticity, which underlie recovery from neural injury. Substantial spontaneous neuroplasticity has been demonstrated in the corticospinal motor circuitry following SCI. Some of these plastic changes appear to be beneficial while others are detrimental toward locomotor function recovery after SCI. The beneficial corticospinal plasticity in the spared corticospinal circuits can be harnessed therapeutically by multiple contemporary neuromodulatory approaches, especially the electrical stimulation-based modalities, in an activity-dependent manner to improve functional outcomes in post-SCI rehabilitation. Silent synapse generation and unsilencing contribute to profound neuroplasticity that is implicated in a variety of neurological disorders, thus they may be involved in the corticospinal motor circuit neuroplasticity following SCI. Exploring the underlying mechanisms of silent synapse-mediated neuroplasticity in the corticospinal motor circuitry that may be exploited by neuromodulation will inform a novel direction for optimizing therapeutic repair strategies and rehabilitative interventions in SCI patients.
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Key Words
- AMPARs, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors
- BDNF, brain-derived neurotrophic factor
- BMIs, brain-machine interfaces
- CPG, central pattern generator
- CST, corticospinal tract
- Corticospinal motor circuitry
- DBS, deep brain stimulation
- ESS, epidural spinal stimulation
- MEPs, motor-evoked potentials
- NHPs, non-human primates
- NMDARs, N-methyl-d-aspartate receptors
- Neuromodulation
- Neuroplasticity
- PSNs, propriospinal neurons
- Rehabilitation
- SCI, spinal cord injury
- STDP, spike timing-dependent plasticity
- Silent synapses
- Spinal cord injury
- TBS, theta burst stimulation
- TMS, transcranial magnetic stimulation
- TrkB, tropomyosin-related kinase B
- cTBS, continuous TBS
- iTBS, intermittent TBS
- mTOR, mammalian target of rapamycin
- rTMS, repetitive TMS
- tDCS, transcranial direct current stimulation
- tcSCS, transcutaneous spinal cord stimulation
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Affiliation(s)
- Mingcong Chen
- Department of Orthopedics and Traumatology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, China
| | - Zuxin Chen
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Neher Neural Plasticity Laboratory, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS); Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong 518055, China
| | - Xiao Xiao
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education; Behavioral and Cognitive Neuroscience Center, Institute of Science and Technology for Brain-Inspired Intelligence; MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200433, China
| | - Libing Zhou
- Guangdong-Hongkong-Macau CNS Regeneration Institute of Jinan University, Key Laboratory of CNS Regeneration (Jinan University)-Ministry of Education, Guangzhou, Guangdong 510632, China
| | - Rao Fu
- Department of Anatomy, School of Medicine, Sun Yat-sen University, Shenzhen, Guangdong 518100, China
| | - Xian Jiang
- Institute of Neurological and Psychiatric Disorder, Shenzhen Bay laboratory, Shenzhen, Guangdong 518000, China
| | - Mao Pang
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong 510630, China
| | - Jianxun Xia
- Department of Basic Medical Sciences, Yunkang School of Medicine and Health, Nanfang College, Guangzhou, Guangdong 510970, China,Corresponding author.
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Sinopoulou E, Spejo AB, Roopnarine N, Burnside ER, Bartus K, De Winter F, McMahon SB, Bradbury EJ. Chronic muscle recordings reveal recovery of forelimb function in spinal injured female rats after cortical epidural stimulation combined with rehabilitation and chondroitinase ABC. J Neurosci Res 2022; 100:2055-2076. [PMID: 35916483 PMCID: PMC9544922 DOI: 10.1002/jnr.25111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 06/23/2022] [Accepted: 07/09/2022] [Indexed: 11/11/2022]
Abstract
Cervical level spinal cord injury (SCI) can severely impact upper limb muscle function, which is typically assessed in the clinic using electromyography (EMG). Here, we established novel preclinical methodology for EMG assessments of muscle function after SCI in awake freely moving animals. Adult female rats were implanted with EMG recording electrodes in bicep muscles and received bilateral cervical (C7) contusion injuries. Forelimb muscle activity was assessed by recording maximum voluntary contractions during a grip strength task and cortical motor evoked potentials in the biceps. We demonstrate that longitudinal recordings of muscle activity in the same animal are feasible over a chronic post-injury time course and provide a sensitive method for revealing post-injury changes in muscle activity. This methodology was utilized to investigate recovery of muscle function after a novel combination therapy. Cervical contused animals received intraspinal injections of a neuroplasticity-promoting agent (lentiviral-chondroitinase ABC) plus 11 weeks of cortical epidural electrical stimulation (3 h daily, 5 days/week) and behavioral rehabilitation (15 min daily, 5 days/week). Longitudinal monitoring of voluntary and evoked muscle activity revealed significantly increased muscle activity and upper limb dexterity with the combination treatment, compared to a single treatment or no treatment. Retrograde mapping of motor neurons innervating the biceps showed a predominant distribution across spinal segments C5-C8, indicating that treatment effects were likely due to neuroplastic changes in a mixture of intact and injured motor neurons. Thus, longitudinal assessments of muscle function after SCI correlate with skilled reach and grasp performance and reveal functional benefits of a novel combination therapy.
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Affiliation(s)
- Eleni Sinopoulou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK.,Department of Neuroscience, The Center for Neural Repair, University of California, San Diego, California, USA
| | - Aline Barroso Spejo
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Naomi Roopnarine
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Emily R Burnside
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Katalin Bartus
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Fred De Winter
- Laboratory for Neuroregeneration, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Stephen B McMahon
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Elizabeth J Bradbury
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
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Samejima S, Henderson R, Pradarelli J, Mondello SE, Moritz CT. Activity-dependent plasticity and spinal cord stimulation for motor recovery following spinal cord injury. Exp Neurol 2022; 357:114178. [PMID: 35878817 DOI: 10.1016/j.expneurol.2022.114178] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023]
Abstract
Spinal cord injuries lead to permanent physical impairment despite most often being anatomically incomplete disruptions of the spinal cord. Remaining connections between the brain and spinal cord create the potential for inducing neural plasticity to improve sensorimotor function, even many years after injury. This narrative review provides an overview of the current evidence for spontaneous motor recovery, activity-dependent plasticity, and interventions for restoring motor control to residual brain and spinal cord networks via spinal cord stimulation. In addition to open-loop spinal cord stimulation to promote long-term neuroplasticity, we also review a more targeted approach: closed-loop stimulation. Lastly, we review mechanisms of spinal cord neuromodulation to promote sensorimotor recovery, with the goal of advancing the field of rehabilitation for physical impairments following spinal cord injury.
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Affiliation(s)
- Soshi Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Henderson
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jared Pradarelli
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah E Mondello
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Chet T Moritz
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Center for Neurotechnology, Seattle, WA, USA; Department of Physiology and Biophysics, University of Washington, Seattle, WA, USA.
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48
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Luo L, Hina BW, McFarland BW, Saunders JC, Smolin N, von Reyn CR. An optogenetics device with smartphone video capture to introduce neurotechnology and systems neuroscience to high school students. PLoS One 2022; 17:e0267834. [PMID: 35522662 PMCID: PMC9075642 DOI: 10.1371/journal.pone.0267834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/16/2022] [Indexed: 11/22/2022] Open
Abstract
Although neurotechnology careers are on the rise, and neuroscience curriculums have significantly grown at the undergraduate and graduate levels, increasing neuroscience and neurotechnology exposure in high school curricula has been an ongoing challenge. This is due, in part, to difficulties in converting cutting-edge neuroscience research into hands-on activities that are accessible for high school students and affordable for high school educators. Here, we describe and characterize a low-cost, easy-to-construct device to enable students to record rapid Drosophila melanogaster (fruit fly) behaviors during optogenetics experiments. The device is generated from inexpensive Arduino kits and utilizes a smartphone for video capture, making it easy to adopt in a standard biology laboratory. We validate this device is capable of replicating optogenetics experiments performed with more sophisticated setups at leading universities and institutes. We incorporate the device into a high school neuroengineering summer workshop. We find student participation in the workshop significantly enhances their understanding of key neuroscience and neurotechnology concepts, demonstrating how this device can be utilized in high school settings and undergraduate research laboratories seeking low-cost alternatives.
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Affiliation(s)
- Liudi Luo
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Bryce W. Hina
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Brennan W. McFarland
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Jillian C. Saunders
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Natalie Smolin
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Catherine R. von Reyn
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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49
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Kim CK, Won JS, An JY, Lee HJ, Nam AJ, Nam H, Lee JY, Lee KH, Lee SH, Joo KM. Significant Therapeutic Effects of Adult Human Neural Stem Cells for Spinal Cord Injury Are Mediated by Monocyte Chemoattractant Protein-1 (MCP-1). Int J Mol Sci 2022; 23:ijms23084267. [PMID: 35457084 PMCID: PMC9029183 DOI: 10.3390/ijms23084267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 12/11/2022] Open
Abstract
The limited capability of regeneration in the human central nervous system leads to severe and permanent disabilities following spinal cord injury (SCI) while patients suffer from no viable treatment option. Adult human neural stem cells (ahNSCs) are unique cells derived from the adult human brain, which have the essential characteristics of NSCs. The objective of this study was to characterize the therapeutic effects of ahNSCs isolated from the temporal lobes of focal cortical dysplasia type IIIa for SCI and to elucidate their treatment mechanisms. Results showed that the recovery of motor functions was significantly improved in groups transplanted with ahNSCs, where, in damaged regions of spinal cords, the numbers of both spread and regenerated nerve fibers were observed to be higher than the vehicle group. In addition, the distance between neuronal nuclei in damaged spinal cord tissue was significantly closer in treatment groups than the vehicle group. Based on an immunohistochemistry analysis, those neuroprotective effects of ahNSCs in SCI were found to be mediated by inhibiting apoptosis of spinal cord neurons. Moreover, the analysis of the conditioned medium (CM) of ahNSCs revealed that such neuroprotective effects were mediated by paracrine effects with various types of cytokines released from ahNSCs, where monocyte chemoattractant protein-1 (MCP-1, also known as CCL2) was identified as a key paracrine mediator. These results of ahNSCs could be utilized further in the preclinical and clinical development of effective and safe cell therapeutics for SCI, with no available therapeutic options at present.
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Affiliation(s)
- Chung Kwon Kim
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, Korea
| | - Jeong-Seob Won
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
| | - Jae Yeol An
- Department of Anatomy, Seoul National University College of Medicine, Seoul 03880, Korea; (J.Y.A.); (J.Y.L.)
- Healthcare Division, Partners Investment Co., Ltd., Seoul 06152, Korea
| | - Ho Jin Lee
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Ah-Jin Nam
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Hyun Nam
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ji Yeoun Lee
- Department of Anatomy, Seoul National University College of Medicine, Seoul 03880, Korea; (J.Y.A.); (J.Y.L.)
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul 03080, Korea
| | - Kyung-Hoon Lee
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Sun-Ho Lee
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: (S.-H.L.); (K.M.J.); Tel.: +82-2-3410-2457 (S.-H.L.); +82-31-299-6073 (K.M.J.); Fax: +82-2-3410-0048 (S.-H.L.); +82-31-299-6029 (K.M.J.)
| | - Kyeung Min Joo
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, Korea
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
- Correspondence: (S.-H.L.); (K.M.J.); Tel.: +82-2-3410-2457 (S.-H.L.); +82-31-299-6073 (K.M.J.); Fax: +82-2-3410-0048 (S.-H.L.); +82-31-299-6029 (K.M.J.)
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50
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Rahman MA, Tharu NS, Gustin SM, Zheng YP, Alam M. Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review. J Clin Med 2022; 11:jcm11061550. [PMID: 35329875 PMCID: PMC8954138 DOI: 10.3390/jcm11061550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.
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Affiliation(s)
- Md. Akhlasur Rahman
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- Centre for the Rehabilitation of the Paralysed (CRP), Savar Union 1343, Bangladesh
| | - Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Sylvia M. Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- Correspondence: ; Tel.: +852-6213-5054
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