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Liu Y, Luo X, Le J, Wang C, Xu C. Prognostic Value of Magnetic Resonance Imaging Variables Combined with Neutrophil-to-Lymphocyte Ratio in Patients with Cervical Traumatic Spinal Cord Injury. World Neurosurg 2024:S1878-8750(24)01345-7. [PMID: 39111659 DOI: 10.1016/j.wneu.2024.07.204] [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: 07/21/2024] [Accepted: 07/29/2024] [Indexed: 09/02/2024]
Abstract
OBJECTIVE We aimed to explore the prognostic significance of preoperative magnetic resonance imaging (MRI) variables and novel inflammatory indicators in predicting neurological recovery post-cervical traumatic spinal cord injury (TSCI) in the study. METHODS We enrolled a total of 244 patients diagnosed with acute cervical TSCI from 2 hospitals and evaluated the prognostic value of MRI variables (intramedullary hemorrhage, intramedullary lesion length [IMLL], maximum spinal cord compression, and maximum canal compromise [MCC]) and novel inflammatory indicators (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and systemic immune-inflammatory index) in patients with acute cervical TSCI. RESULTS Among the 244 patients, 140 (57.38%) exhibited improved AIS grade conversion at 1-year follow-up. The results revealed intramedullary hemorrhage, IMLL, MCC, neutrophils, and NLR were significantly different compared with follow-up AIS grade. Furthermore, IMLL, MCC, white blood cells, neutrophils, NLR, and lymphocyte-to-monocyte ratio correlated with the follow-up AIS grade by Spearman's correlation analysis. Multivariate analysis showed IMLL, intramedullary hemorrhage, NLR, and admission AIS grade emerged as independent predictors of AIS grade conversion. The receiver operating characteristic curve analysis showed that the novel model (combination of MRI variables, NLR, and admission AIS grade) produced a larger area under the curve compared with using only intramedullary hemorrhage, IMLL, NLR, or admission AIS grade individually. CONCLUSION Intramedullary hemorrhage and IMLL and NLR are predictors of AIS grade conversion after cervical TSCI. Therefore, we suggest the combination of MRI variables and NLR for the prognostic prediction of AIS grade conversion in patients with cervical TSCI.
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Affiliation(s)
- Yihao Liu
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiaojuan Luo
- Department of Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jinggang Le
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Chengyun Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Cong Xu
- Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
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Hatami-Fard G, Anastasova-Ivanova S. Advancements in Cerebrospinal Fluid Biosensors: Bridging the Gap from Early Diagnosis to the Detection of Rare Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:3294. [PMID: 38894085 PMCID: PMC11174891 DOI: 10.3390/s24113294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024]
Abstract
Cerebrospinal fluid (CSF) is a body fluid that can be used for the diagnosis of various diseases. However, CSF collection requires an invasive and painful procedure called a lumbar puncture (LP). This procedure is applied to any patient with a known risk of central nervous system (CNS) damage or neurodegenerative disease, regardless of their age range. Hence, this can be a very painful procedure, especially in infants and elderly patients. On the other hand, the detection of disease biomarkers in CSF makes diagnoses as accurate as possible. This review aims to explore novel electrochemical biosensing platforms that have impacted biomedical science. Biosensors have emerged as techniques to accelerate the detection of known biomarkers in body fluids such as CSF. Biosensors can be designed and modified in various ways and shapes according to their ultimate applications to detect and quantify biomarkers of interest. This process can also significantly influence the detection and diagnosis of CSF. Hence, it is important to understand the role of this technology in the rapidly progressing field of biomedical science.
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Affiliation(s)
- Ghazal Hatami-Fard
- The Hamlyn Centre, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
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Yuan W, Sun J, Li Q, Zheng R, Guan B, Chen Z, Ding J, Sun Q, Fu R, Wang W, Fan Y, Kang Y, Sun C, Li A, Wu D, Wang D, Qi L, Chen L, Feng S, Zhou H. Protocol for the Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study: a prospective, observational, multicentre cohort study of acute spinal cord injury. BMJ Open 2024; 14:e080358. [PMID: 38749680 PMCID: PMC11097860 DOI: 10.1136/bmjopen-2023-080358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a catastrophic event with devastating physical, social and occupational consequences for patients and their families. The number of patients with acute SCI in China continues to grow rapidly, but there have been no large prospective cohort studies of patients with acute SCI. This proposed study aims to establish a multicentre, extensive sample cohort of clinical data and biological samples of patients in China, which would aid the systematisation and standardisation of clinical research and treatment of acute SCI, thus reducing the heavy burden of acute SCI on patients and society. METHODS AND ANALYSIS The Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study is an observational, multicentre cohort study of patients with acute SCI admitted to the Qilu Hospital of Shandong University and other participating centres with prospective collection of their clinical data and biological samples. We aim to recruit 2097 patients in this study. Demographics, disease history, emergency intervention information, motor and sensory examinations, surgical information, medication information and rehabilitation evaluation will be recorded. This will facilitate the development of a prediction model for complications and prognosis of patients with acute SCI and an evaluation of the current management of acute SCI. Among these variables, detailed information on surgical treatment will also be used to assess procedures for acute SCI treatment. Outcome measurements, including the International Standard for Neurological Classification of Spinal Cord Injury examinations, the occurrence of complications and death, will be performed repeatedly during follow-up. We will analyse imaging data and blood samples to develop SCI imaging markers and biomarkers. ETHICS AND DISSEMINATION This study protocol has been approved by the Medical Ethics Committee of the Qilu Hospital of Shandong University and all other participating centres. The findings will be disseminated in peer-reviewed journals and academic conferences.
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Affiliation(s)
- Wenjian Yuan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiuxiao Sun
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qingyang Li
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ruiyuan Zheng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Bin Guan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhuo Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiaming Ding
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qingyu Sun
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Runhan Fu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wei Wang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuxuan Fan
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Yi Kang
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Chao Sun
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Ang Li
- Department of Orthopaedics, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Dongjin Wu
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Dachuan Wang
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lei Qi
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lingxiao Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hengxing Zhou
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
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Huang Y, Ye K, He A, Wan S, Wu M, Hu D, Xu K, Wei P, Yin J. Dual-layer conduit containing VEGF-A - Transfected Schwann cells promotes peripheral nerve regeneration via angiogenesis. Acta Biomater 2024; 180:323-336. [PMID: 38561075 DOI: 10.1016/j.actbio.2024.03.029] [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: 11/20/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
Peripheral nerve injuries (PNIs) can cause neuropathies and significantly affect the patient's quality of life. Autograft transplantation is the gold standard for conventional treatment; however, its application is limited by nerve unavailability, size mismatch, and local tissue adhesion. Tissue engineering, such as nerve guidance conduits, is an alternative and promising strategy to guide nerve regeneration for peripheral nerve repair; however, only a few conduits could reach the high repair efficiency of autografts. The healing process of PNI is frequently accompanied by not only axonal and myelination regeneration but also angiogenesis, which initializes nerve regeneration through vascular endothelial growth factor A (VEGF-A). In this study, a composite nerve conduit with a poly (lactic-co-glycolic acid) (PLGA) hollow tube as the outer layer and gelatin methacryloyl (GelMA) encapsulated with VEGF-A transfected Schwann cells (SCs) as the inner layer was established to evaluate its promising ability for peripheral nerve repair. A rat model of peripheral nerve defect was used to examine the efficiency of PLGA/GelMA-SC (VA) conduits, whereas autograft, PLGA, PLGA/GelMA, and PLGA/GelMA-SC (NC) were used as controls. VEGF-A-transfected SCs can provide a stable source for VEGF-A secretion. Furthermore, encapsulation in GelMA cannot only promote proliferation and tube formation of human umbilical vein endothelial cells but also enhance dorsal root ganglia and neuronal cell extension. Previous animal studies have demonstrated that the regenerative effects of PLGA/GelMA-SC (VA) nerve conduit were similar to those of autografts and much better than those of other conduits. These findings indicate that combination of VEGF-A-overexpressing SCs and PLGA/GelMA conduit-guided peripheral nerve repair provides a promising method that enhances angiogenesis and regeneration during nerve repair. STATEMENT OF SIGNIFICANCE: Nerve guidance conduits shows promise for peripheral nerve repair, while achieving the repair efficiency of autografts remains a challenge. In this study, a composite nerve conduit with a PLGA hollow tube as the outer layer and gelatin methacryloyl (GelMA) encapsulated with vascular endothelial growth factor A (VEGF-A)-transfected Schwann cells (SCs) as the inner layer was established to evaluate its potential ability for peripheral nerve repair. This approach preserves growth factor bioactivity and enhances material properties. GelMA insertion promotes Schwann cell proliferation and morphology extension. Moreover, transfected SCs serve as a stable VEGF-A source and fostering angiogenesis. This study offers a method preserving growth factor efficacy and safeguarding SCs, providing a comprehensive solution for enhanced angiogenesis and nerve regeneration.
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Affiliation(s)
- Yuye Huang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
| | - Kai Ye
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
| | - Andong He
- Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
| | - Shaobo Wan
- Yuyao Traditional Chinese Medicine Hospital, Ningbo 315010, China
| | - Miaoben Wu
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China
| | - Donghao Hu
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Kailei Xu
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo 315010, China.
| | - Peng Wei
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315010, China.
| | - Jun Yin
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou 310027, China.
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Shool S, Rahmani S, Habibi MA, Piri SM, Lotfinia M, Jashnani D, Asaadi S. Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review. Spinal Cord Ser Cases 2024; 10:21. [PMID: 38615029 PMCID: PMC11016077 DOI: 10.1038/s41394-024-00636-3] [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: 03/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Scoping systematic review. OBJECTIVES To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models. SETTING Tehran, Iran. METHODS In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models. RESULTS A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures. CONCLUSIONS The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.
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Affiliation(s)
- Sina Shool
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Saeed Rahmani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Mahmoud Lotfinia
- Resident of Neurosurgery, Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Germany
| | - Delara Jashnani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Department of Surgery, Division of Acute Care Surgery, Loma Linda University, Loma Linda, CA, USA.
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Chen H, Wu L, Zhang Y, Ding W, Xiaofan Y. Steroid inhibited Serpina3n expression which was positively correlated with the degrees of spinal cord injury. Heliyon 2024; 10:e26649. [PMID: 38449654 PMCID: PMC10915347 DOI: 10.1016/j.heliyon.2024.e26649] [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: 06/23/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
Aims The aim of our project was to identify proteins associated with the extent of spinal cord injury (SCI) and subsequent long-term neurological recovery. Methods Through proteomic analysis, we identified proteins that are differentially expressed specifically in the acute phase of injury. We analyzed the concentrations of differentially expressed proteins in serum and the injured spinal cord segment by ELISA. Results Serpina3n protein expression in the injured spinal cord segment was increased 101-fold at 12 h after severe SCI and 89-fold at 12 h after mild SCI, as determined by LC‒MS/MS. In the mild and severe SCI groups, serum Serpina3n levels began to increase at 12 h and peaked at 24 h. At 12 h, 24 h and 3 d after injury, serum Serpina3n protein levels were significantly correlated with the severity of injury (12 h: r = 0.6034, P = 0.008; 24 h: r = 0.7542, P = 0.0003; 3 d: r = 0.862, P < 0.001). Serum Serpina3n levels at 2 h, 24 h and 3 d post injury were significantly correlated with long-term neurological recovery at 28 d after SCI (2 h: r = -0.5781, P = 0.012; 24 h: r = -0.5912, P = 0.0098; 3 d: r = -0.7792, P < 0.0001). Methylprednisolone treatment would decrease the serum Serpina3n levels in mice with mild and severe SCI compared with those in placebo-group mice at 12 h and 24 h after SCI. The serum Serpina3n concentration in the severe SCI group was significantly reduced on the third day after steroid treatment. Conclusion Taken together, these data suggest that serpina3n may be a circulating biomarker of acute SCI and may be closely associated with injury severity and long-term motor function recovery.
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Affiliation(s)
- Haihong Chen
- Orthopaedic Department, Minhang Hospital, Fudan University, Shanghai, 201199, China
| | - Liang Wu
- Orthopaedic Department, Minhang Hospital, Fudan University, Shanghai, 201199, China
| | - Yue Zhang
- Rehabilitation Department, Minhang Hospital, Fudan University, Shanghai, 201199, China
| | - Wang Ding
- Orthopaedic Department, Minhang Hospital, Fudan University, Shanghai, 201199, China
| | - Yin Xiaofan
- Orthopaedic Department, Minhang Hospital, Fudan University, Shanghai, 201199, China
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Yu E, Chen Z, Huang Y, Wu Y, Wang Z, Wang F, Wu M, Xu K, Peng W. A grooved conduit combined with decellularized tissues for peripheral nerve regeneration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:35. [PMID: 37477830 PMCID: PMC10361901 DOI: 10.1007/s10856-023-06737-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 07/01/2023] [Indexed: 07/22/2023]
Abstract
Peripheral nerve injury (PNI) is a common and severe clinical disease worldwide, which leads to a poor prognosis because of the complicated treatments and high morbidity. Autologous nerve grafting as the gold standard still cannot meet the needs of clinical nerve transplantation because of its low availability and limited size. The development of artificial nerve conduits was led to a novel direction for PNI treatment, while most of the currently developed artificial nerve conduits was lack biochemical cues to promote nerve regeneration. In this study, we designed a novel composite neural conduit by inserting decellularized the rat sciatic nerve or kidney in a poly (lactic-co-glycolic acid) (PLGA) grooved conduit. The nerve regeneration effect of all samples was analyzed using rat sciatic nerve defect model, where decellularized tissues and grooved PLGA conduit alone were used as controls. The degree of nerve regeneration was evaluated using the motor function, gastrocnemius recovery, and morphological and histological assessments suggested that the combination of a grooved conduit with decellularized tissues significantly promoted nerve regeneration compared with decellularized tissues and PLGA conduit alone. It is worth to note that the grooved conduits containing decellularized nerves have a promotive effect similar to that of autologous nerve grafting, suggesting that it could be an artificial nerve conduit used for clinical practice in the future.
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Affiliation(s)
- Enxing Yu
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Zhiwu Chen
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Yuye Huang
- Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Yibing Wu
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Zonghuan Wang
- Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Fangfang Wang
- Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Miaoben Wu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, China
| | - Kailei Xu
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China.
- Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, 315010, China.
| | - Wei Peng
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China.
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Zhang P, Zhang J, Kou W, Gu G, Zhang Y, Shi W, Chu P, Liang D, Sun G, Shang J. Comprehensive analysis of a pyroptosis-related gene signature of clinical and biological values in spinal cord injury. Front Neurol 2023; 14:1141939. [PMID: 37273699 PMCID: PMC10237016 DOI: 10.3389/fneur.2023.1141939] [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: 01/13/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Background Since some of the clinical examinations are not suitable for patients with severe spinal cord injury (SCI), blood biomarkers have been reported to reflect the severity of SCI. The objective of this study was to screen out the potential biomarkers associated with the diagnosis of SCI by bioinformatics analysis. Methods The microarray expression profiles of SCI were obtained from the Gene Expression Omnibus (GEO) database. Core genes correlated to pyroptosis were obtained by crossing the differential genes, and module genes were obtained by WGCNA analysis and lasso regression. The immune infiltration analysis and GSEA analysis revealed the essential effect of immune cells in the progression of SCI. In addition, the accuracy of the biomarkers in diagnosing SCI was subsequently evaluated and verified using the receiver operating characteristic curve (ROC) and qRT-PCR. Results A total of 423 DEGs were identified, among which 319 genes were upregulated and 104 genes were downregulated. Based on the WGCNA analysis, six potential biomarkers were screened out, including LIN7A, FCGR1A, FGD4, GPR27, BLOC1S1, and GALNT4. The results of ROC curves demonstrated the accurate value of biomarkers related to SCI. The immune infiltration analysis and GSEA analysis revealed the essential effect of immune cells in the progression of SCI, including macrophages, natural killer cells, and neutrophils. The qRT-PCR results verified that FGD4, FCAR1A, LIN7A, BLOC1S1, and GPR27 were significantly upregulated in SCI patients. Conclusion In this study, we identified and verified five immune pyroptosis-related hub genes by WGCNA and biological experiments. It is expected that the five identified potential biomarkers in peripheral white blood cells may provide a novel strategy for early diagnosis.
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Affiliation(s)
- Pingping Zhang
- Department of Orthopedics, Seventh Affiliated Hospital of Shanxi Medical University, Linfen People's Hospital, Linfen, Shanxi, China
| | - Jianping Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjuan Kou
- School of Pharmaceutical Sciences and Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
- Department of Disinfection Monitoring, Yongji Disease Control and Prevention Center, Yongji, Shanxi, China
| | - Guangjin Gu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yaning Zhang
- Department of Orthopedics, Seventh Affiliated Hospital of Shanxi Medical University, Linfen People's Hospital, Linfen, Shanxi, China
| | - Weihan Shi
- Department of Orthopedics, Seventh Affiliated Hospital of Shanxi Medical University, Linfen People's Hospital, Linfen, Shanxi, China
| | - Pengcheng Chu
- Department of Orthopedics, Seventh Affiliated Hospital of Shanxi Medical University, Linfen People's Hospital, Linfen, Shanxi, China
| | - Dachuan Liang
- Department of Scientific Research Management, Shanxi Medical College Seventh Affiliated Hospital, Linfen People's Hospital, Linfen, Shanxi, China
| | - Guangwei Sun
- Department of Orthopedics, Seventh Affiliated Hospital of Shanxi Medical University, Linfen People's Hospital, Linfen, Shanxi, China
| | - Jun Shang
- Department of Orthopedics, Seventh Affiliated Hospital of Shanxi Medical University, Linfen People's Hospital, Linfen, Shanxi, China
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
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Sotir A, Klopf J, Brostjan C, Neumayer C, Eilenberg W. Biomarkers of Spinal Cord Injury in Patients Undergoing Complex Endovascular Aortic Repair Procedures-A Narrative Review of Current Literature. Biomedicines 2023; 11:biomedicines11051317. [PMID: 37238988 DOI: 10.3390/biomedicines11051317] [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: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Complex endovascular aortic repair (coEVAR) of thoracoabdominal aortic aneurysms (TAAA) has greatly evolved in the past decades. Despite substantial improvements of postoperative care, spinal cord injury (SCI) remains the most devastating complication of coEVAR being associated with impaired patient outcome and having an impact on long-term survival. The rising number of challenges of coEVAR, essentially associated with an extensive coverage of critical blood vessels supplying the spinal cord, resulted in the implementation of dedicated SCI prevention protocols. In addition to maintenance of adequate spinal cord perfusion pressure (SCPP), early detection of SCI plays an integral role in intra- and postoperative patient care. However, this is challenging due to difficulties with clinical neurological examinations during patient sedation in the postoperative setting. There is a rising amount of evidence, suggesting that subclinical forms of SCI might be accompanied by an elevation of biochemical markers, specific to neuronal tissue damage. Addressing this hypothesis, several studies have attempted to assess the potential of selected biomarkers with regard to early SCI diagnosis. In this review, we discuss biomarkers measured in patients undergoing coEVAR. Once validated in future prospective clinical studies, biomarkers of neuronal tissue damage may potentially add to the armamentarium of modalities for early SCI diagnosis and risk stratification.
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Affiliation(s)
- Anna Sotir
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Klopf
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Bailey CS, Dhall S, Mac-Thiong JM, Wilson JR, Christie S, Dvorak MF, Wellington CL, Kwon BK. Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury. Neurology 2023; 100:e1221-e1233. [PMID: 36599698 PMCID: PMC10033160 DOI: 10.1212/wnl.0000000000206744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic spinal cord injury (SCI) is highly heterogeneous, and tools to better delineate pathophysiology and recovery are needed. Our objective was to profile the response of 2 biomarkers, neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP), in the serum and CSF of patients with acute SCI to evaluate their ability to objectively characterize injury severity and predict neurologic recovery. METHODS Blood and CSF samples were obtained from prospectively enrolled patients with acute SCI through days 1-4 postinjury, and the concentration of NF-L and GFAP was quantified using Simoa technology. Neurologic assessments defined the ASIA Impairment Scale (AIS) grade and motor score (MS) at presentation and 6 months postinjury. RESULTS One hundred eighteen patients with acute SCI (78 AIS A, 20 AIS B, and 20 AIS C) were enrolled, with 113 (96%) completing 6-month follow-up. NF-L and GFAP levels were strongly associated between paired serum and CSF specimens, were both increased with injury severity, and distinguished among baseline AIS grades. Serum NF-L and GFAP were significantly (p = 0.02 to <0.0001) higher in AIS A patients who did not improve at 6 months, predicting AIS grade conversion with a sensitivity and specificity (95% CI) of 76% (61, 87) and 77% (55, 92) using NF-L and 72% (57, 84) and 77% (55, 92) using GFAP at 72 hours, respectively. Independent of clinical baseline assessment, a serum NF-L threshold of 170 pg/mL at 72 hours predicted those patients who would be classified as motor complete (AIS A/B) compared with motor incomplete (AIS C/D) at 6 months with a sensitivity of 87% (76, 94) and specificity of 84% (69, 94); a serum GFAP threshold of 13,180 pg/mL at 72 hours yielded a sensitivity of 90% (80, 96) and specificity of 84% (69, 94). DISCUSSION The potential for NF-L and GFAP to classify injury severity and predict outcome after acute SCI will be useful for patient stratification and prognostication in clinical trials and inform communication of prognosis. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that higher serum NF-L and GFAP are associated with worse neurological outcome after acute SCI. TRIAL REGISTRATION INFORMATION Registered on ClinicalTrials.gov: NCT00135278 (March 2006) and NCT01279811 (January 2012).
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Affiliation(s)
- Sophie Stukas
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jennifer Cooper
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jasmine Gill
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Nader Fallah
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Michael A Skinnider
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Lise Belanger
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Leanna Ritchie
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Angela Tsang
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Kevin Dong
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Femke Streijger
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - John Street
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Scott Paquette
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Tamir Ailon
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Nicolas Dea
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Raphaele Charest-Morin
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Charles G Fisher
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Christopher S Bailey
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Sanjay Dhall
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jean-Marc Mac-Thiong
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jefferson R Wilson
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Sean Christie
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Marcel F Dvorak
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Cheryl L Wellington
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Brian K Kwon
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada.
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11
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Specific Blood RNA Profiles in Individuals with Acute Spinal Cord Injury as Compared with Trauma Controls. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:1485135. [PMID: 36686379 PMCID: PMC9851797 DOI: 10.1155/2023/1485135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/30/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023]
Abstract
Background Spinal cord injury (SCI) is known to cause a more robust systemic inflammatory response than general trauma without CNS injury, inducing severe secondary organ damage, especially the lung and liver. Related studies are principally focused on the mechanisms underlying repair and regeneration in the injured spinal cord tissue. However, the specific mechanism of secondary injury after acute SCI is widely overlooked, compared with general trauma. Methods Two datasets of GSE151371 and GSE45376 related to the blood samples and spinal cord after acute SCI were selected to identify the differentially expressed genes (DEGs). In GSE151371, functional enrichment analysis on specific DEGs of blood samples was performed. And the top 15 specific hub genes were identified from intersectional genes between the specific upregulated DEGs of blood samples in GSE151371 and the upregulated DEGs of the spinal cord in GSE45376. The specific functional enrichment analysis and the drug candidates of the hub genes and the miRNAs-targeted hub genes were also analyzed and predicted. Results DEGs were identified, and a total of 64 specific genes were the intersection of upregulated genes of the spinal cord in GSE45376 and upregulated genes of human blood samples in GSE151371. The top 15 hub genes including HP, LCN2, DLGAP5, CEP55, HMMR, CDKN3, PRTN3, SKA3, MPO, LTF, CDC25C, MMP9, NEIL3, NUSAP1, and CD163 were calculated from the 64 specific genes. Functional enrichment analysis of the top 15 hub genes revealed inflammation-related pathways. The predicted miRNAs-targeted hub genes and drug candidates of hub genes were also performed to put forward reasonable treatment strategies. Conclusion The specific hub genes of acute SCI as compared with trauma without CNS injury were identified. The functional enrichment analysis of hub genes showed a specific immune response. Several predicted drugs of hub genes were also obtained. The hub genes and the predicted miRNAs may be potential biomarkers and therapeutic targets and require further validation.
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12
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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: 7] [Impact Index Per Article: 3.5] [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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13
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Li C, Wu C, Xu G, Liu Y, Chen J, Zhang J, Hong H, Ji C, Cui Z. CCR7-mediated T follicular helper cell differentiation is associated with the pathogenesis and immune microenvironment of spinal cord injury-induced immune deficiency syndrome. Front Neurosci 2022; 16:1019406. [PMCID: PMC9615471 DOI: 10.3389/fnins.2022.1019406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury-induced immune deficiency syndrome (SCI-IDS) is a disorder characterized by systemic immunosuppression secondary to SCI that dramatically increases the likelihood of infection and is difficult to treat. T follicular helper (Tfh) cells regulated by chemokine receptor CCR7 are associated with SCI-IDS after acute SCI. The present study explored the roles of CCR7 in SCI-IDS occurrence and immune microenvironment composition. Gene expression profile data of peripheral blood leukocytes from SCI and non-SCI subjects were collected from the Gene Expression Omnibus database. According to differential gene expression analysis, a protein-protein interaction (PPI) network, and risk model construction, the CCR7 expression level was prominently related to acute SCI and CCR7 expression was significantly downregulated after acute SCI. Next, we constructed a clinical prediction model and used it to identify patients with acute SCI. Using Gene Ontology (GO) analysis and gene set enrichment analysis (GSEA), we discovered that immune-related biological processes, such as T cell receptor signaling pathway, were suppressed, whereas chemokine-related signaling pathways were activated after acute SCI. Immune infiltration analysis performed using single sample GSEA and CIBERSORT suggested that Tfh cell function was significantly correlated with the CCR7 expression levels and was considerably reduced after acute SCI. Acute SCI was divided into two subtypes, and we integrated multiple classifiers to analyze and elucidate the immunomodulatory relationships in both subtypes jointly. The results suggested that CCR7 suppresses the immunodeficiency phenotype by activating the chemokine signaling pathway in Tfh cells. In conclusion, CCR7 exhibits potential as a diagnostic marker for acute SCI.
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Affiliation(s)
- Chaochen Li
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
- Key Laboratory for Restoration Mechanism and Clinical Translation of Spinal Cord Injury, Nantong, China
- Research Institute for Spine and Spinal Cord Disease of Nantong University, Nantong, China
| | - Chunshuai Wu
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
- Key Laboratory for Restoration Mechanism and Clinical Translation of Spinal Cord Injury, Nantong, China
- Research Institute for Spine and Spinal Cord Disease of Nantong University, Nantong, China
| | - Guanhua Xu
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Yang Liu
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Jiajia Chen
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Jinlong Zhang
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Hongxiang Hong
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
| | - Chunyan Ji
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
- Key Laboratory for Restoration Mechanism and Clinical Translation of Spinal Cord Injury, Nantong, China
- Research Institute for Spine and Spinal Cord Disease of Nantong University, Nantong, China
| | - Zhiming Cui
- The First People’s Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong University, Nantong, China
- Key Laboratory for Restoration Mechanism and Clinical Translation of Spinal Cord Injury, Nantong, China
- Research Institute for Spine and Spinal Cord Disease of Nantong University, Nantong, China
- *Correspondence: Zhiming Cui,
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14
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MiRNAs as Promising Translational Strategies for Neuronal Repair and Regeneration in Spinal Cord Injury. Cells 2022; 11:cells11142177. [PMID: 35883621 PMCID: PMC9318426 DOI: 10.3390/cells11142177] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/10/2022] Open
Abstract
Spinal cord injury (SCI) represents a devastating injury to the central nervous system (CNS) that is responsible for impaired mobility and sensory function in SCI patients. The hallmarks of SCI include neuroinflammation, axonal degeneration, neuronal loss, and reactive gliosis. Current strategies, including stem cell transplantation, have not led to successful clinical therapy. MiRNAs are crucial for the differentiation of neural cell types during CNS development, as well as for pathological processes after neural injury including SCI. This makes them ideal candidates for therapy in this condition. Indeed, several studies have demonstrated the involvement of miRNAs that are expressed differently in CNS injury. In this context, the purpose of the review is to provide an overview of the pre-clinical evidence evaluating the use of miRNA therapy in SCI. Specifically, we have focused our attention on miRNAs that are widely associated with neuronal and axon regeneration. “MiRNA replacement therapy” aims to transfer miRNAs to diseased cells and improve targeting efficacy in the cells, and this new therapeutic tool could provide a promising technique to promote SCI repair and reduce functional deficits.
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15
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Hulme CH, Fuller HR, Riddell J, Shirran SL, Botting CH, Osman A, Wright KT. Investigation of the blood proteome in response to spinal cord injury in rodent models. Spinal Cord 2022; 60:320-325. [PMID: 34601498 PMCID: PMC8989679 DOI: 10.1038/s41393-021-00692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022]
Abstract
STUDY DESIGN Explanatory and mechanistic study. OBJECTIVES A better understanding of the 'whole-body' response following spinal cord injury (SCI) is needed to guide future research aimed at developing novel therapeutic interventions and identifying prognostic indicators for SCI. This study aimed to characterise the blood proteome following contusion or complete SCI compared to a sham injury in rat models. SETTING United Kingdom. METHODS Pooled blood samples from one and seven days after a contusion (serum; n = 5) or from 14 days and 112 days post-complete transection SCI (plasma; n = 8) and their sham-injured counterparts were subjected to independent iTRAQ nanoflow liquid chromatography tandem mass-spectrometry proteomic analyses. Pathway analyses of the proteins that were differentially abundant between SCI and their matched sham injured counterparts were completed to indicate biological pathways that may be changed in response to SCI. RESULTS Eleven and 42 proteins were differentially abundant (≥±2.0 FC; p ≤ 0.05) between the contusion SCI and sham injured animals at 24 h and seven days post-injury, respectively. Seven and tweleve proteins were differentially abundant between complete and sham injured rats at 14 and 112 days post-injury, respectively. Acute-phase response signalling and Liver X Receptor/Retinoic X Receptor activation were identified as differentially regulated pathways in both models of SCI. CONCLUSIONS We have utilised longitudinal preclinical SCI models to provide an insight into the blood proteome changes that result following SCI and to highlight a number of biological pathways of interest for future studies.
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Affiliation(s)
- Charlotte H Hulme
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK
- Midlands Centre for Spinal Injuries, RJAH Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Heidi R Fuller
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK
| | - John Riddell
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Sally L Shirran
- BSRC Mass Spectrometry and Proteomics Facility, University of St Andrews, North Haugh, St Andrews, UK
| | - Catherine H Botting
- BSRC Mass Spectrometry and Proteomics Facility, University of St Andrews, North Haugh, St Andrews, UK
| | - Aheed Osman
- Midlands Centre for Spinal Injuries, RJAH Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Karina T Wright
- School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK.
- Midlands Centre for Spinal Injuries, RJAH Orthopaedic Hospital, Oswestry, Shropshire, UK.
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16
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Wang HD, Wei ZJ, Li JJ, Feng SQ. Application value of biofluid-based biomarkers for the diagnosis and treatment of spinal cord injury. Neural Regen Res 2021; 17:963-971. [PMID: 34558509 PMCID: PMC8552873 DOI: 10.4103/1673-5374.324823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recent studies in patients with spinal cord injuries (SCIs) have confirmed the diagnostic potential of biofluid-based biomarkers, as a topic of increasing interest in relation to SCI diagnosis and treatment. This paper reviews the research progress and application prospects of recently identified SCI-related biomarkers. Many structural proteins, such as glial fibrillary acidic protein, S100-β, ubiquitin carboxy-terminal hydrolase-L1, neurofilament light, and tau protein were correlated with the diagnosis, American Spinal Injury Association Impairment Scale, and prognosis of SCI to different degrees. Inflammatory factors, including interleukin-6, interleukin-8, and tumor necrosis factor α, are also good biomarkers for the diagnosis of acute and chronic SCI, while non-coding RNAs (microRNAs and long non-coding RNAs) also show diagnostic potential for SCI. Trace elements (Mg, Se, Cu, Zn) have been shown to be related to motor recovery and can predict motor function after SCI, while humoral markers can reflect the pathophysiological changes after SCI. These factors have the advantages of low cost, convenient sampling, and ease of dynamic tracking, but are also associated with disadvantages, including diverse influencing factors and complex level changes. Although various proteins have been verified as potential biomarkers for SCI, more convincing evidence from large clinical and prospective studies is thus required to identify the most valuable diagnostic and prognostic biomarkers for SCI.
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Affiliation(s)
- Hong-Da Wang
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhi-Jian Wei
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin; Department of Orthopedics, Qilu Hospital; Shandong University Center for Orthopedics, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Jun-Jin Li
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Shi-Qing Feng
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin; Department of Orthopedics, Qilu Hospital; Shandong University Center for Orthopedics, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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17
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Mousa AH, Agha Mohammad S, Rezk HM, Muzaffar KH, Alshanberi AM, Ansari SA. Nanoparticles in traumatic spinal cord injury: therapy and diagnosis. F1000Res 2021. [DOI: 10.12688/f1000research.55472.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Nanotechnology has been previously employed for constructing drug delivery vehicles, biosensors, solar cells, lubricants and as antimicrobial agents. The advancement in synthesis procedure makes it possible to formulate nanoparticles (NPs) with precise control over physico-chemical and optical properties that are desired for specific clinical or biological applications. The surface modification technology has further added impetus to the specific applications of NPs by providing them with desirable characteristics. Hence, nanotechnology is of paramount importance in numerous biomedical and industrial applications due to their biocompatibility and stability even in harsh environments. Traumatic spinal cord injuries (TSCIs) are one of the major traumatic injuries that are commonly associated with severe consequences to the patient that may reach to the point of paralysis. Several processes occurring at a biochemical level which exacerbate the injury may be targeted using nanotechnology. This review discusses possible nanotechnology-based approaches for the diagnosis and therapy of TSCI, which have a bright future in clinical practice.
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18
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Xie Y, Wang Y, Zhou Y, Liu M, Li S, Bao Y, Jiang W, Tang S, Li F, Xue H, Li L, Gong X, Liu Y, Wang W, Li T. A Nomogram for Predicting Acute Respiratory Failure After Cervical Traumatic Spinal Cord Injury Based on Admission Clinical Findings. Neurocrit Care 2021; 36:421-433. [PMID: 34346037 PMCID: PMC8964578 DOI: 10.1007/s12028-021-01302-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Acute respiratory failure (ARF) is a common medical complication in patients with cervical traumatic spinal cord injury (TSCI). To identify independent predictors for ARF onset in patients who underwent cervical TSCI without premorbid respiratory diseases and to apply appropriate medical supports based on accurate prediction, a nomogram relating admission clinical information was developed for predicting ARF during acute care period. METHODS We retrospectively reviewed clinical profiles of patients who suffered cervical TSCI and were emergently admitted to Qingdao Municipal Hospital from 2014 to 2020 as the training cohort. Univariate analysis was performed using admission clinical variables to estimate associated factors and a nomogram for predicting ARF occurrence was generated based on the independent predictors from multivariate logistic regression analysis. This nomogram was assessed by concordance index for discrimination and calibration curve with internal-validated bootstrap strategy. Receiver operating characteristic curve was conducted to compare the predictive accuracy between the nomogram and the traditional gold standard, which combines neuroimaging and neurological measurements by using area under the receiver operating characteristic curve (AUC). An additional 56-patient cohort from another medical center was retrospectively reviewed as the test cohort for external validation of the nomogram. RESULTS 162 patients were eligible for this study and were included in the training cohort, among which 25 individuals developed ARF and were recorded to endure more complications. Despite the aggressive treatments and prolonged intensive care unit cares, 14 patients insulted with ARF died. Injury level, American Spinal Injury Association Impairment Scale (AIS) grade, admission hemoglobin (Hb), platelet to lymphocyte ratio, and neutrophil percentage to albumin ratio (NPAR) were independently associated with ARF onset. The concordance index of the nomogram incorporating these predictors was 0.933 in the training cohort and 0.955 in the test cohort, although both calibrations were good. The AUC of the nomogram was equal to concordance index, which presented better predictive accuracy compared with previous measurements using neuroimaging and AIS grade (AUC 0.933 versus 0.821, Delong's test p < 0.001). Similar significant results were also found in the test cohort (AUC 0.955 versus 0.765, Delong's test p = 0.034). In addition, this nomogram was translated to a Web-based calculator that could generate individual probability for ARF in a visualized form. CONCLUSIONS The nomogram incorporating the injury level, AIS grade, admission Hb, platelet to lymphocyte ratio, and NPAR is a promising model to predict ARF in patients with cervical TSCI who are absent from previous respiratory dysfunction. This nomogram can be offered to clinicians to stratify patients, strengthen evidence-based decision-making, and apply appropriate individualized treatment in the field of acute clinical care.
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Affiliation(s)
- Yongfan Xie
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China.,School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Yongyi Wang
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China.,School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Yong Zhou
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Mingxing Liu
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Shengli Li
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China
| | - Yue Bao
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China.,Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Wenbo Jiang
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China.,Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Siwei Tang
- Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Fangbao Li
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Hao Xue
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, No.107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
| | - Luo Li
- School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China.,Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China
| | - Xingyuan Gong
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - Yongliang Liu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China.
| | - Weimin Wang
- Department of Neurosurgery, Qingdao Municipal Hospital (Headquarters), No. 1 Jiaozhou Road, Qingdao, 266011, Shandong, People's Republic of China. .,School of Medicine, Qingdao University, No. 308 Ningxia Road, Qingdao, 266011, Shandong, People's Republic of China.
| | - Tong Li
- Department of Neurosurgery, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China. .,Department of Neurosurgery, Neuro Intensive Care Unit, Qingdao Municipal Hospital, No. 5 Donghai Zhong Road, Qingdao, 266071, Shandong, People's Republic of China.
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19
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Bourguignon L, Vo AK, Tong B, Geisler F, Mach O, Maier D, Kramer JL, Grassner L, Jutzeler CR. Natural Progression of Routine Laboratory Markers after Spinal Trauma: A Longitudinal, Multi-Cohort Study. J Neurotrauma 2021; 38:2151-2161. [PMID: 33882712 PMCID: PMC8309438 DOI: 10.1089/neu.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Our objective was to track and quantify the natural course of serological markers over the 1st year following spinal cord injury. For that purpose, data on serological markers, demographics, and injury characteristics were extracted from medical records of a clinical trial (Sygen) and an ongoing observational cohort study (Murnau study). The primary outcomes were concentration/levels/amount of commonly collected serological markers at multiple time points. Two-way analysis of variance (ANOVA) and mixed-effects regression techniques were used to account for the longitudinal data and adjust for potential confounders. Trajectories of serological markers contained in both data sources were compared using the slope of progression. Our results show that, at baseline (≤ 2 weeks post-injury), most serological markers were at pathological levels, but returned to normal values over the course of 6-12 months post-injury. The baseline levels and longitudinal trajectories were dependent on injury severity. More complete injuries were associated with more pathological values (e.g., hematocrit, ANOVA test; χ2 = 68.93, df = 3, adjusted p value <0.001, and χ2 = 73.80, df = 3, adjusted p value <0.001, in the Sygen and Murnau studies, respectively). Comparing the two databases revealed some differences in the serological markers, which are likely attributable to differences in study design, sample size, and standard of care. We conclude that because of trauma-induced physiological perturbations, serological markers undergo marked changes over the course of recovery, from initial pathological levels that normalize within a year. The findings from this study are important, as they provide a benchmark for clinical decision making and prospective clinical trials. All results can be interactively explored on the Haemosurveillance web site (https://jutzelec.shinyapps.io/Haemosurveillance/) and GitHub repository (https://github.com/jutzca/Systemic-effects-of-Spinal-Cord-Injury).
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Affiliation(s)
- Lucie Bourguignon
- Department of Biosystems Science and Engineering, ETH Zurich and SIB Swiss Institute of Bioinformatics, Zurich, Switzerland
| | - Anh Khoa Vo
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Fred Geisler
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Orpheus Mach
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - John L.K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, and University of British Columbia, Vancouver, British Columbia, Canada
- Hugill Centre for Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Catherine R. Jutzeler
- Department of Biosystems Science and Engineering, ETH Zurich and SIB Swiss Institute of Bioinformatics, Zurich, Switzerland
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20
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Stukas S, Gill J, Cooper J, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Dhall S, Mac-Thiong JM, Wilson JR, Bailey C, Christie S, Dvorak MF, Wellington C, Kwon BK. Characterization of Cerebrospinal Fluid Ubiquitin C-Terminal Hydrolase L1 as a Biomarker of Human Acute Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:2055-2064. [PMID: 33504255 DOI: 10.1089/neu.2020.7352] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A major obstacle for translational research in acute spinal cord injury (SCI) is the lack of biomarkers that can objectively stratify injury severity and predict outcome. Ubiquitin C-terminal hydrolase L1 (UCH-L1) is a neuron-specific enzyme that shows promise as a diagnostic biomarker in traumatic brain injury (TBI), but has not been studied in SCI. In this study, cerebrospinal fluid (CSF) and serum samples were collected over the first 72-96 h post-injury from 32 acute SCI patients who were followed prospectively to determine neurological outcomes at 6 months post-injury. UCH-L1 concentration was measured using the Quanterix Simoa platform (Quanterix, Billerica, MA) and correlated to injury severity, time, and neurological recovery. We found that CSF UCH-L1 was significantly elevated by 10- to 100-fold over laminectomy controls in an injury severity- and time-dependent manner. Twenty-four-hour post-injury CSF UCH-L1 concentrations distinguished between American Spinal Injury Association Impairment Scale (AIS) A and AIS B, and AIS A and AIS C patients in the acute setting, and predicted who would remain "motor complete" (AIS A/B) at 6 months with a sensitivity of 100% and a specificity of 86%. AIS A patients who did not improve their AIS grade at 6 months post-injury were characterized by sustained elevations in CSF UCH-L1 up to 96 h. Similarly, the failure to gain >8 points on the total motor score at 6 months post-injury was associated with higher 24-h CSF UCH-L1. Unfortunately, serum UCH-L1 levels were not informative about injury severity or outcome. In conclusion, CSF UCH-L1 in acute SCI shows promise as a biomarker to reflect injury severity and predict outcome.
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Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Gill
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lise Belanger
- Vancouver Spine Research Program, Vancouver General Hospital, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leanna Ritchie
- Vancouver Spine Research Program, Vancouver General Hospital, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Tsang
- Vancouver Spine Research Program, Vancouver General Hospital, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Dong
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Paquette
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamir Ailon
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphaële Charest-Morin
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Dhall
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Jean-Marc Mac-Thiong
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Department of Surgery, Chu Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher Bailey
- Division of Orthopaedic Surgery, Schulich Medicine & Dentistry, Victoria Hospital, London, Ontario, Canada
| | - Sean Christie
- Division of Neurosurgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcel F Dvorak
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Jónsson GG, Marklund N, Blennow K, Zetterberg H, Wanhainen A, Lindström D, Eriksson J, Mani K. Dynamics of Selected Biomarkers in Cerebrospinal Fluid During Complex Endovascular Aortic Repair - A Pilot Study. Ann Vasc Surg 2021; 78:141-151. [PMID: 34175417 DOI: 10.1016/j.avsg.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ischemic spinal cord injury (SCI) is a serious complication of complex aortic repair. Prophylactic cerebrospinal fluid (CSF) drainage, used to decrease lumbar cerebrospinal fluid (CSF) pressure, enables monitoring of CSF biomarkers that may aid in detecting impending SCI. We hypothesized that biomarkers, previously evaluated in traumatic SCI and brain injury, would be altered in CSF over time following complex endovascular aortic repair (cEVAR). OBJECTIVES To examine if a chosen cohort of CSF biomarker correlates to SCI and warrants further research. METHODS A prospective observational study on patients undergoing cEVAR with extensive aortic coverage. Vital parameters and CSF samples were collected on ten occasions during 72 hours post-surgery. A panel of ten biomarkers were analyzed (Neurofilament Light Polypeptide (NFL), Tau, Glial Fibrillary Acidic Protein (GFAP), Soluble Amyloid Precursos Protein (APP) α and β, Amyloid β 38, 40 and 42 (Aβ38, 40 and 42), Chitinase-3-like protein 1 (CHI3LI or YKL-40), Heart-type fatty acid binding protein (H-FABP).). RESULTS Nine patients (mean age 69, 7 males) were included. Median total aortic coverage was 68% [33, 98]. One patient died during the 30-day post-operative period. After an initial stable phase for the first few postoperative hours, most biomarkers showed an upward trend compared with baseline in all patients with >50% increase in value for NFL in 5/9 patients, in 7/9 patients for Tau and in 5/9 patients for GFAP. One patient developed spinal cord and supratentorial brain ischemia, confirmed with MRI. In this case, NF-L, GFAP and tau were markedly elevated compared with non-SCI patients (maximum increase compared with baseline in the SCI patient versus mean value of the maximal increase for all other patients: NF-L 367% vs 79%%, GFAP 95608% versus 3433%, tau 1020% vs 192%). CONCLUSION This study suggests an increase in all ten studied CSF biomarkers after coverage of spinal arteries during endovascular aortic repair. However, the pilot study was not able to establish a specific correlation between spinal fluid biomarker elevation and clinical symptoms of SCI due to small sample size and event rate.
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Affiliation(s)
- Gísli Gunnar Jónsson
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - Niklas Marklund
- Department of Neuroscience, Section of Neurosurgery, Uppsala University and Uppsala University Hospital; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Sweden
| | - David Lindström
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Jacob Eriksson
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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22
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Proteomic Portraits Reveal Evolutionarily Conserved and Divergent Responses to Spinal Cord Injury. Mol Cell Proteomics 2021; 20:100096. [PMID: 34129941 PMCID: PMC8260874 DOI: 10.1016/j.mcpro.2021.100096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/14/2021] [Accepted: 05/11/2021] [Indexed: 01/16/2023] Open
Abstract
Despite the emergence of promising therapeutic approaches in preclinical studies, the failure of large-scale clinical trials leaves clinicians without effective treatments for acute spinal cord injury (SCI). These trials are hindered by their reliance on detailed neurological examinations to establish outcomes, which inflate the time and resources required for completion. Moreover, therapeutic development takes place in animal models whose relevance to human injury remains unclear. Here, we address these challenges through targeted proteomic analyses of cerebrospinal fluid and serum samples from 111 patients with acute SCI and, in parallel, a large animal (porcine) model of SCI. We develop protein biomarkers of injury severity and recovery, including a prognostic model of neurological improvement at 6 months with an area under the receiver operating characteristic curve of 0.91, and validate these in an independent cohort. Through cross-species proteomic analyses, we dissect evolutionarily conserved and divergent aspects of the SCI response and establish the cerebrospinal fluid abundance of glial fibrillary acidic protein as a biochemical outcome measure in both humans and pigs. Our work opens up new avenues to catalyze translation by facilitating the evaluation of novel SCI therapies, while also providing a resource from which to direct future preclinical efforts. • Targeted proteomic analysis of CSF and serum samples from 111 acute SCI patients. • Single- and multiprotein biomarkers of injury severity and recovery. • Parallel proteomic analysis in a large animal model identifies conserved biomarkers. • Evolutionary conservation and divergence of the proteomic response to SCI.
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23
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Kyritsis N, Torres-Espín A, Schupp PG, Huie JR, Chou A, Duong-Fernandez X, Thomas LH, Tsolinas RE, Hemmerle DD, Pascual LU, Singh V, Pan JZ, Talbott JF, Whetstone WD, Burke JF, DiGiorgio AM, Weinstein PR, Manley GT, Dhall SS, Ferguson AR, Oldham MC, Bresnahan JC, Beattie MS. Diagnostic blood RNA profiles for human acute spinal cord injury. J Exp Med 2021; 218:e20201795. [PMID: 33512429 PMCID: PMC7852457 DOI: 10.1084/jem.20201795] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/18/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
Diagnosis of spinal cord injury (SCI) severity at the ultra-acute stage is of great importance for emergency clinical care of patients as well as for potential enrollment into clinical trials. The lack of a diagnostic biomarker for SCI has played a major role in the poor results of clinical trials. We analyzed global gene expression in peripheral white blood cells during the acute injury phase and identified 197 genes whose expression changed after SCI compared with healthy and trauma controls and in direct relation to SCI severity. Unsupervised coexpression network analysis identified several gene modules that predicted injury severity (AIS grades) with an overall accuracy of 72.7% and included signatures of immune cell subtypes. Specifically, for complete SCIs (AIS A), ROC analysis showed impressive specificity and sensitivity (AUC: 0.865). Similar precision was also shown for AIS D SCIs (AUC: 0.938). Our findings indicate that global transcriptomic changes in peripheral blood cells have diagnostic and potentially prognostic value for SCI severity.
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Affiliation(s)
- Nikos Kyritsis
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Abel Torres-Espín
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Patrick G. Schupp
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Brain Tumor Center, University of California, San Francisco, San Francisco, CA
| | - J. Russell Huie
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Austin Chou
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Xuan Duong-Fernandez
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Leigh H. Thomas
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Rachel E. Tsolinas
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Debra D. Hemmerle
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Lisa U. Pascual
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Vineeta Singh
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Jonathan Z. Pan
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Jason F. Talbott
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - William D. Whetstone
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA
| | - John F. Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Anthony M. DiGiorgio
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Philip R. Weinstein
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
- Weill Institute for Neurosciences, Institute for Neurodegenerative Diseases, Spine Center, University of California, San Francisco, San Francisco, CA
| | - Geoffrey T. Manley
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Sanjay S. Dhall
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Adam R. Ferguson
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Michael C. Oldham
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Brain Tumor Center, University of California, San Francisco, San Francisco, CA
| | - Jacqueline C. Bresnahan
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Michael S. Beattie
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA
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24
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Leister I, Linde LD, Vo AK, Haider T, Mattiassich G, Grassner L, Schaden W, Resch H, Jutzeler CR, Geisler FH, Kramer JLK, Aigner L. Routine Blood Chemistry Predicts Functional Recovery After Traumatic Spinal Cord Injury: A Post Hoc Analysis. Neurorehabil Neural Repair 2021; 35:321-333. [PMID: 33615895 DOI: 10.1177/1545968321992328] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) leads to various degrees of lifelong functional deficits. Most individuals with incomplete SCI experience a certain degree of functional recovery, especially within the first-year postinjury. However, this is difficult to predict, and surrogate biomarkers are urgently needed. OBJECTIVE We aimed to (1) determine if routine blood chemistry parameters are related to neurological recovery after SCI, (2) evaluate if such parameters could predict functional recovery, and (3) establish cutoff values that could inform clinical decision-making. METHODS We performed a post hoc analysis of routine blood chemistry parameters in patients with traumatic SCI (n = 676). Blood samples were collected between 24 and 72 hours as well as at 1, 2, 4, 8, and 52 weeks postinjury. Linear mixed models, regression analysis, and unbiased recursive partitioning (URP) of blood chemistry data were used to relate to and predict walking recovery 1 year postinjury. RESULTS The temporal profile of platelet counts and serum levels of albumin, alkaline phosphatase, and creatinine differentiated patients who recovered walking from those who remained wheelchair bound. The 4 blood chemistry parameters from the sample collection 8 weeks postinjury predicted functional recovery observed 1 year after incomplete SCI. Finally, URP defined a cutoff for serum albumin at 3.7 g/dL, which in combination with baseline injury severity differentiates individuals who regain ambulation from those not able to walk. Specifically, about 80% of those with albumin >3.7 g/dL recovered walking. CONCLUSIONS Routine blood chemistry data from the postacute phase, together with baseline injury severity, predict functional outcome after incomplete SCI.
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Affiliation(s)
- Iris Leister
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), and ParaMove, Paracelsus Medical University, Salzburg, Austria.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas D Linde
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Anh Khoa Vo
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Mattiassich
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,Traumacenter Graz, Teaching Hospital of the Medical University Graz, Graz, Austria
| | - Lukas Grassner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), and ParaMove, Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.,Department of Paraplegiology, BG Trauma Center Murnau, Murnau, Germany.,ParaMove, Paracelsus Medical University Salzburg, Austria, and Department of Paraplegiology, BG Trauma Center Murnau, Murnau, Germany
| | - Wolfgang Schaden
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
| | - Herbert Resch
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), and ParaMove, Paracelsus Medical University, Salzburg, Austria
| | - Catherine R Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Department of Biosystems Science and Engineering, Swiss Federal Institute, Basel, Switzerland
| | - Fred H Geisler
- College of Medicine at the University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Shared senior-authorship
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), and ParaMove, Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration.,ParaMove, Paracelsus Medical University Salzburg, Austria, and Department of Paraplegiology, BG Trauma Center Murnau, Murnau, Germany.,Shared senior-authorship
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25
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Harrington GMB, Cool P, Hulme C, Osman A, Chowdhury JR, Kumar N, Budithi S, Wright K. Routinely Measured Hematological Markers Can Help to Predict American Spinal Injury Association Impairment Scale Scores after Spinal Cord Injury. J Neurotrauma 2021; 38:301-308. [PMID: 32703074 PMCID: PMC7826437 DOI: 10.1089/neu.2020.7144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Neurological outcomes following spinal cord injury (SCI) are currently difficult to predict. While the initial American Spinal Injury Association Impairment Scale (AIS) grade can give an estimate of outcome, the high remaining degree of uncertainty has stoked recent interest in biomarkers for SCI. This study aimed to assess the prognostic value of routinely measured blood biomarkers by developing prognostic models of AIS scores at discharge and 12 months post-injury. Routine blood and clinical data were collected from SCI patients (n = 417), and blood measures that had been assessed in less than 50% of patients were excluded. Outcome neurology was obtained from AIS and Spinal Cord Independence Measure III (SCIM-III) scores at discharge and 12 months post-injury, with motor (AIS) and sensory (AIS, touch and prick) abilities being assessed individually. Linear regression models with and without elastic net penalization were created for all outcome measures. Blood measures associated with liver function, such as alanine transaminase, were found to add value to predictions of SCIM-III at discharge and 12 months post-injury. Further, components of a total blood count, including hemoglobin, were found to add value to predictions of AIS motor and sensory scores at discharge and 12 months post-injury. These findings corroborate the results of our previous preliminary study and thus provide further evidence that routine blood measures can add prognostic value in SCI and that markers of liver function are of particular interest.
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Affiliation(s)
| | - Paul Cool
- Keele University, Staffordshire, United Kingdom
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Charlotte Hulme
- Keele University, Staffordshire, United Kingdom
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Aheed Osman
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Joy Roy Chowdhury
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Naveen Kumar
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Srinivasa Budithi
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Karina Wright
- Keele University, Staffordshire, United Kingdom
- Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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26
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Khachatryan Z, Haunschild J, von Aspern K, Borger MA, Etz CD. Ischemic spinal cord injury - experimental evidence and evolution of protective measures. Ann Thorac Surg 2021; 113:1692-1702. [PMID: 33434541 DOI: 10.1016/j.athoracsur.2020.12.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Paraplegia remains one of the most devastating complications of descending and thoracoabdominal aortic repair. The aim of this review is to outline the current state of art in the rapidly developing field of spinal cord injury (SCI) research. METHODS A review of PubMed and Web of Science databases was performed using the following terms and their combinations: spinal cord, injury, ischemia, ischemia-reperfusion, ischemic spinal cord injury, paraplegia, paraparesis. Articles published before July 2019 were screened and included if considered relevant. RESULTS The review focuses on the topic of SCI and the developments concerning methods of monitoring, diagnostics and prevention of SCI. CONCLUSIONS Translation of novel technologies from bench to bedside and into everyday clinical practice is challenging, however each of the developing areas hold great promise in SCI prevention.
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Affiliation(s)
- Zara Khachatryan
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Konstantin von Aspern
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany.
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27
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Early CSF Biomarkers and Late Functional Outcomes in Spinal Cord Injury. A Pilot Study. Int J Mol Sci 2020; 21:ijms21239037. [PMID: 33261156 PMCID: PMC7729583 DOI: 10.3390/ijms21239037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
Although, biomarkers are regarded as an important tool for monitoring injury severity and treatment efficacy, and for predicting clinical evolution in many neurological diseases and disorders including spinal cord injury, there is still a lack of reliable biomarkers for the assessment of clinical course and patient outcome. In this study, a biological dataset of 60 cytokines/chemokines, growth factorsm and intracellular and extracellular matrix proteins, analyzed in CSF within 24 h of injury, was used for correlation analysis with the clinical dataset of the same patients. A heat map was generated of positive and negative correlations between biomarkers and clinical rating scale scores at discharge, and between biomarkers and changes in clinical scores during the observation period. Using very stringent statistical criteria, we found 10 molecules which correlated with clinical scores at discharge, and five molecules, which correlated with changes in clinical scores. The proposed methodology may be useful for generating hypotheses regarding "predictive" and "treatment effectiveness" biomarkers, thereby suggesting potential candidates for disease-modifying therapies using a "bed-to-bench" approach.
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28
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Recent progress in therapeutic drug delivery systems for treatment of traumatic CNS injuries. Future Med Chem 2020; 12:1759-1778. [PMID: 33028091 DOI: 10.4155/fmc-2020-0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Most therapeutics for the treatment of traumatic central nervous system injuries, such as traumatic brain injury and spinal cord injury, encounter various obstacles in reaching the target tissue and exerting pharmacological effects, including physiological barriers like the blood-brain barrier and blood-spinal cord barrier, instability rapid elimination from the injured tissue or cerebrospinal fluid and off-target toxicity. For central nervous system delivery, nano- and microdrug delivery systems are regarded as the most suitable and promising carriers. In this review, the pathophysiology and biomarkers of traumatic central nervous system injuries (traumatic brain injury and spinal cord injury) are introduced. Furthermore, various drug delivery systems, novel combinatorial therapies and advanced therapies for the treatment of traumatic brain injury and spinal cord injury are emphasized.
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29
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Yeh JZ, Wang DH, Cherng JH, Wang YW, Fan GY, Liou NH, Liu JC, Chou CH. A Collagen-Based Scaffold for Promoting Neural Plasticity in a Rat Model of Spinal Cord Injury. Polymers (Basel) 2020; 12:E2245. [PMID: 33003601 PMCID: PMC7600216 DOI: 10.3390/polym12102245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
In spinal cord injury (SCI) therapy, glial scarring formed by activated astrocytes is a primary problem that needs to be solved to enhance axonal regeneration. In this study, we developed and used a collagen scaffold for glial scar replacement to create an appropriate environment in an SCI rat model and determined whether neural plasticity can be manipulated using this approach. We used four experimental groups, as follows: SCI-collagen scaffold, SCI control, normal spinal cord-collagen scaffold, and normal control. The collagen scaffold showed excellent in vitro and in vivo biocompatibility. Immunofluorescence staining revealed increased expression of neurofilament and fibronectin and reduced expression of glial fibrillary acidic protein and anti-chondroitin sulfate in the collagen scaffold-treated SCI rats at 1 and 4 weeks post-implantation compared with that in untreated SCI control. This indicates that the collagen scaffold implantation promoted neuronal survival and axonal growth within the injured site and prevented glial scar formation by controlling astrocyte production for their normal functioning. Our study highlights the feasibility of using the collagen scaffold in SCI repair. The collagen scaffold was found to exert beneficial effects on neuronal activity and may help in manipulating synaptic plasticity, implying its great potential for clinical application in SCI.
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Affiliation(s)
- Jue-Zong Yeh
- Department of Pharmacy, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Ding-Han Wang
- School of Dentistry, National Yang-Ming University, Taipei 112, Taiwan;
| | - Juin-Hong Cherng
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan; (J.-H.C.); (Y.-W.W.); (N.-H.L.); (J.-C.L.)
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Yi-Wen Wang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan; (J.-H.C.); (Y.-W.W.); (N.-H.L.); (J.-C.L.)
| | - Gang-Yi Fan
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - Nien-Hsien Liou
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan; (J.-H.C.); (Y.-W.W.); (N.-H.L.); (J.-C.L.)
| | - Jiang-Chuan Liu
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan; (J.-H.C.); (Y.-W.W.); (N.-H.L.); (J.-C.L.)
| | - Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
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30
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Ward H, West SJ. Microglia: sculptors of neuropathic pain? ROYAL SOCIETY OPEN SCIENCE 2020; 7:200260. [PMID: 32742693 PMCID: PMC7353970 DOI: 10.1098/rsos.200260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/01/2020] [Indexed: 05/02/2023]
Abstract
Neuropathic pain presents a huge societal and individual burden. The limited efficacy of current analgesics, diagnostic markers and clinical trial outcome measures arises from an incomplete understanding of the underlying mechanisms. A large and growing body of evidence has established the important role of microglia in the onset and possible maintenance of neuropathic pain, and these cells may represent an important target for future therapy. Microglial research has further revealed their important role in structural remodelling of the nervous system. In this review, we aim to explore the evidence for microglia in sculpting nervous system structure and function, as well as their important role in neuropathic pain, and finally integrate these studies to synthesize a new model for microglia in somatosensory circuit remodelling, composed of six key and inter-related mechanisms. Summarizing the mechanisms through which microglia modulate nervous system structure and function helps to frame a better understanding of neuropathic pain, and provide a clear roadmap for future research.
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Affiliation(s)
- Harry Ward
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Steven J. West
- Sainsbury Wellcome Centre, University College London, 25 Howland St, London WC1E 6BT, UK
- Author for correspondence: Steven J. West e-mail:
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31
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Zhang L, Zhuang X, Chen Y, Niu Z, Xia H. Plasma Erythropoietin, IL-17A, and IFNγ as Potential Biomarkers of Motor Function Recovery in a Canine Model of Spinal Cord Injury. J Mol Neurosci 2020; 70:1821-1828. [PMID: 32418163 PMCID: PMC7561571 DOI: 10.1007/s12031-020-01575-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/30/2020] [Indexed: 02/15/2023]
Abstract
Traumatic spinal cord injury (SCI) is a devastating neurological disease for which an accurate, cost-effective prediction of motor function recovery is in pressing need. A plethora of neurochemical changes involved in the pathophysiological process of SCI may serve as a new source of biomarkers for patient outcomes. Five dogs were included in this study. We characterized the plasma cytokine profiles in acute phase (0, 1, and 3 days after SCI) and subacute phase (7, 14, and 21 days after SCI) with microarray analysis. The motor function recovery following SCI was monitored by Olby scores. The expression level of differentially expressed proteins (DEPs) was measured with enzyme-linked immunosorbent assay (ELISA). Then, correlations with the Olby scores and receiver operating characteristic curve (ROC) analysis were performed. We identified 12 DEPs including 10 pro-inflammatory and 2 anti-inflammatory cytokines during the 21-day study period. Among those, the expression levels of erythropoietin (EPO), IL-17A, and IFNγ significantly correlated with the Olby scores with R2 values of 0.870, 0.740, and 0.616, respectively. The results of the ROC analysis suggested that plasma EPO, IL-17A, and IFNγ exhibited a significant predictive power with an area under the curve (AUC) of 0.656, 0.848, and 0.800 for EPO, IL-17A, and IFNγ, respectively. Our results provide a longitudinal description of the changes in plasma cytokine expression in the acute and subacute stages of canine SCI. These data reveal novel panels of inflammation-related cytokines which have the potential to be evaluated as biomarkers for predicting motor function prognosis after SCI.
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Affiliation(s)
- Lijian Zhang
- School of Clincial Medicine, Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Neurosurgery, General Hospital of Ningxia Medical University, No. 804, Shengli Street, Xingqing District, Yinchuan, Ningxia, China.,Ningxia Human Stem Cell Research Institute, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaoqing Zhuang
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, No. 804, Shengli Street, Xingqing District, Yinchuan, Ningxia, China.
| | - Yao Chen
- School of Clincial Medicine, Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Neurosurgery, General Hospital of Ningxia Medical University, No. 804, Shengli Street, Xingqing District, Yinchuan, Ningxia, China.,Ningxia Human Stem Cell Research Institute, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhanfeng Niu
- Department of Neurosurgery, General Hospital of Ningxia Medical University, No. 804, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Hechun Xia
- Department of Neurosurgery, General Hospital of Ningxia Medical University, No. 804, Shengli Street, Xingqing District, Yinchuan, Ningxia, China. .,Ningxia Human Stem Cell Research Institute, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
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32
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Leister I, Haider T, Mattiassich G, Kramer JLK, Linde LD, Pajalic A, Grassner L, Altendorfer B, Resch H, Aschauer-Wallner S, Aigner L. Biomarkers in Traumatic Spinal Cord Injury—Technical and Clinical Considerations: A Systematic Review. Neurorehabil Neural Repair 2020; 34:95-110. [DOI: 10.1177/1545968319899920] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective. To examine (1) if serological or cerebrospinal fluid (CSF) biomarkers can be used as diagnostic and/or prognostic tools in patients with spinal cord injury (SCI) and (2) if literature provides recommendations regarding timing and source of biomarker evaluation. Data Sources. A systematic literature search to identify studies reporting on diagnostic and prognostic blood and/or CSF biomarkers in SCI was conducted in PubMed/MEDLINE, CINAHL, Science Direct, The Cochrane Library, ISI Web of Science, and PEDro. Study Selection. Clinical trials, cohort, and pilot studies on patients with traumatic SCI investigating at least one blood or CSF biomarker were included. Following systematic screening, 19 articles were included in the final analysis. PRISMA guidelines were followed to conduct this review. Data Extraction. Independent extraction of articles was completed by 2 authors using predefined inclusion criteria and study quality indicators. Data Synthesis. Nineteen studies published between 2002 and April 2019 with 1596 patients were included in the systematic review. In 14 studies, blood biomarkers were measured, 4 studies investigated CSF biomarkers, and 1 study used both blood and CSF samples. Conclusions. Serum/CSF concentrations of several biomarkers (S100b, IL-6, GFAP, NSE, tau, TNF-α, IL-8, MCP-1, pNF-H, and IP-10) following SCI are highly time dependent and related to injury severity. Future studies need to validate these markers as true biomarkers and should control for secondary complications associated with SCI. A deeper understanding of secondary pathophysiological events after SCI and their effect on biomarker dynamics may improve their clinical significance as surrogate parameters in future clinical studies.
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Affiliation(s)
- Iris Leister
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Austrian Spinal Cord Injury Study, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Mattiassich
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Traumacenter Graz, Teaching Hospital of the Medical University Graz, Graz, Austria
| | - John L. K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas D. Linde
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan Pajalic
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Department of Cardiology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Lukas Grassner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- University Clinic of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Center for Spinal Cord Injuries, Trauma Center Murnau, Germany
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Herbert Resch
- Austrian Spinal Cord Injury Study, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Stephanie Aschauer-Wallner
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Austrian Cluster for Tissue Regeneration
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33
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Neurochemical biomarkers in spinal cord injury. Spinal Cord 2019; 57:819-831. [PMID: 31273298 DOI: 10.1038/s41393-019-0319-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/02/2019] [Accepted: 06/11/2019] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN This is a narrative review of the literature on neurochemical biomarkers in spinal cord injury (SCI). OBJECTIVES The objective was to summarize the literature on neurochemical biomarkers in SCI and describe their use in facilitating clinical trials for SCI. Clinical trials in spinal cord injury (SCI) have been notoriously difficult to conduct, as exemplified by the paucity of definitive prospective randomized trials that have been completed, to date. This is related to the relatively low incidence and the complexity and heterogeneity of the human SCI condition. Given the increasing number of promising approaches that are emerging from the laboratory which are vying for clinical evaluation, novel strategies to help facilitate clinical trials are needed. METHODS A literature review was conducted, with a focus on neurochemical biomarkers that have been described in human neurotrauma. RESULTS We describe advances in our understanding of neurochemical biomarkers as they pertain to human SCI. The application of biomarkers from serum and cerebrospinal fluid (CSF) has been led by efforts in the human traumatic brain injury (TBI) literature. A number of promising biomarkers have been described in human SCI whereby they may assist in stratifying injury severity and predicting outcome. CONCLUSIONS Several time-specific biomarkers have been described for acute SCI and for chronic SCI. These appear promising for stratifying injury severity and potentially predicting outcome. The subsequent application within a clinical trial will help to demonstrate their utility in facilitating the study of novel approaches for SCI.
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Hepner A, Porter J, Hare F, Nasir SS, Zetterberg H, Blennow K, Martin MG. Serum Neurofilament Light, Glial Fibrillary Acidic Protein and Tau Are Possible Serum Biomarkers for Activity of Brain Metastases and Gliomas. World J Oncol 2019; 10:169-175. [PMID: 31636790 PMCID: PMC6785270 DOI: 10.14740/wjon1228] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background Primary central nervous system (CNS) tumors and brain metastases (BMs) are major causes of morbidity and mortality, accompanied by low survival rates. Efforts to early discovery of CNS malignancies are critical. However, to date, there are no biomarkers approved for detection of cancer activity in the brain. Blood levels of neurofilament light (NfL) and tau, as well as glial fibrillary acidic protein (GFAp), show promise as biomarkers for brain injury in previous studies. Therefore, we performed a cross-sectional study to investigate correlations of those biomarkers with CNS activity of gliomas and BMs. Methods Serum samples of 36 participants of a single centered institution were tested for NfL, GFAp and tau with Simoa immunoassay, and correlated with clinical and radiological data. Results NfL and GFAp levels were significantly associated with the state of intracranial disease (analysis of variance (ANOVA), PsNfL = 0.03; ANOVA, PGFAp = 0.03). Although statistically significant (P = 0.04), differences in concentrations were not clinically meaningful for tau levels. Serum NfL (sNfL) and GFAp concentrations were higher in the group of patients with CNS tumors with disease in progression versus CNS with stable disease (P = 0.03 and P = 0.01, respectively). In addition, sNfL were higher in patients with metastatic solid tumors with known BMs than in those with metastatic tumors with no BM (P = 0.0004). Conclusion sNfL and GFAp both apparently vary closely with presence and activity of gliomas and BMs. Further studies in larger populations are needed to expand these findings.
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Affiliation(s)
- Adriana Hepner
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jason Porter
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
| | - Felicia Hare
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
| | - Syed Sameer Nasir
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Molndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Molndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Molndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Molndal, Sweden
| | - Michael Gary Martin
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
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35
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Brown SJ, Harrington GMB, Hulme CH, Morris R, Bennett A, Tsang WH, Osman A, Chowdhury J, Kumar N, Wright KT. A Preliminary Cohort Study Assessing Routine Blood Analyte Levels and Neurological Outcome after Spinal Cord Injury. J Neurotrauma 2019; 37:466-480. [PMID: 31310157 PMCID: PMC6978787 DOI: 10.1089/neu.2019.6495] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
There is increasing interest in the identification of biomarkers that could predict neurological outcome following a spinal cord injury (SCI). Although initial American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade is a good indicator of neurological outcome, for the patient and clinicians, an element of uncertainty remains. This preliminary study aimed to assess the additive potential of routine blood analytes following principal component analysis (PCA) to develop prognostic models for neurological outcome following SCI. Routine blood and clinical data were collected from SCI patients (n = 82) and PCA used to reduce the number of blood analytes into related factors. Outcome neurology was obtained from AIS scores at 3 and 12 months post-injury, with motor (AIS and total including all myotomes) and sensory (AIS, touch and pain) abilities being assessed individually. Multiple regression models were created for all outcome measures. Blood analytes relating to “liver function” and “acute inflammation and liver function” factors were found to significantly increase prediction of neurological outcome at both 3 months (touch, pain, and AIS sensory) and at 1 year (pain, R2 increased by 0.025 and total motor, R2 increased by 0.016). For some models “liver function” and “acute inflammation and liver function” factors were both significantly predictive, with the greatest combined R2 improvement of 0.043 occurring for 3 month pain prediction. These preliminary findings support ongoing research into the use of routine blood analytes in the prediction of neurological outcome in SCI patients.
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Affiliation(s)
- Sharon J Brown
- Institute of Science and Technology in Medicine (ISTM), Keele University, Keele, United Kingdom.,Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Gabriel M B Harrington
- Institute of Science and Technology in Medicine (ISTM), Keele University, Keele, United Kingdom.,Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Charlotte H Hulme
- Institute of Science and Technology in Medicine (ISTM), Keele University, Keele, United Kingdom.,Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Rachel Morris
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Anna Bennett
- Life Sciences, University of Chester, Chester, Cheshire, United Kingdom
| | - Wai-Hung Tsang
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Aheed Osman
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Joy Chowdhury
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Naveen Kumar
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
| | - Karina T Wright
- Institute of Science and Technology in Medicine (ISTM), Keele University, Keele, United Kingdom.,Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom
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36
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Fernández M, Baldassarro VA, Capirossi R, Montevecchi R, Bonavita J, Cescatti M, Giovannini T, Giovannini G, Uneddu M, Giovanni G, Giardino L, Calzà L. Possible Strategies to Optimize a Biomarker Discovery Approach to Correlate with Neurological Outcome in Patients with Spinal Cord Injury: A Pilot Study. J Neurotrauma 2019; 37:431-440. [PMID: 31215324 DOI: 10.1089/neu.2018.6362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The lack of reliable diagnostic and prognostic markers for spinal cord injured (SCI) patients is a severe obstacle in development and testing of new therapies, and it also impairs appropriate rehabilitation care. The sparse available data on the biochemical composition of cerebrospinal fluid (CSF) during the acute and/or chronic phase of the lesion provide, up until now, inconsistent results. In this pilot study, we then explored the possibility of combining a multi-parametric and bioinformatic analysis of CSF for its biological properties tested on different cells types, suitable for investigating inflammation and re-myelination. The patient enrollment was based on stringent inclusion criteria; that is, cervical and thoracic SCI trauma, CSF collection within 24 h of trauma, type of surgical approach for spine stabilization, and absence of steroid therapy before CSF collection. Eleven SCI patients and four healthy controls were included, and in three patients, CSF was also collected at 3 months after lesion. We identified 19 proteins among the 60 investigated cytokines, chemokines, growth factors, and structural biomarkers, which are transiently regulated 24 h after SCI. A bioinformatic analysis indicated that interleukin (IL)-6 and IL-10 are in the core of the interconnected net of activated proteins. Cell-based experiments indicate that CSF from SCI patients stimulates astroglia derivation from neural precursor cells, and an inverse correlation between IL-8 CSF level and oligodendrocyte precursor cells generated from neural stem cells was also observed. Results from this pilot study suggest that using a combined bioanalytic and biological approach to analyze SCI CSF at different times after injury could be a useful approach for identifying reliable diagnostic and prognostic markers in SCI.
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Affiliation(s)
- Mercedes Fernández
- Department of Veterinary Medical Sciences-DIMEVET, University of Bologna, Bologna, Italy
| | - Vito Antonio Baldassarro
- Department of Health Sciences and Technologies - Interdepartmental Center for Industrial Research-CIRI-SDV, University of Bologna, Bologna, Italy.,Department of Pharmacy and Biotechnology-Fabit, University of Bologna, Bologna, Italy
| | - Rita Capirossi
- Montecatone Rehabilitation Institute SpA, Imola, Bologna, Italy
| | - Roberto Montevecchi
- Bologna Local Health Authority - Intensive Care Unit, EMS and Trauma Centre, Maggiore Hospital, Bologna, Italy
| | - Jacopo Bonavita
- Montecatone Rehabilitation Institute SpA, Imola, Bologna, Italy
| | | | | | | | - Mariella Uneddu
- Montecatone Rehabilitation Institute SpA, Imola, Bologna, Italy
| | - Gordini Giovanni
- Bologna Local Health Authority - Intensive Care Unit, EMS and Trauma Centre, Maggiore Hospital, Bologna, Italy
| | - Luciana Giardino
- Department of Veterinary Medical Sciences-DIMEVET, University of Bologna, Bologna, Italy.,Department of Health Sciences and Technologies - Interdepartmental Center for Industrial Research-CIRI-SDV, University of Bologna, Bologna, Italy.,IRET Foundation, Ozzano Emilia, Italy
| | - Laura Calzà
- Department of Health Sciences and Technologies - Interdepartmental Center for Industrial Research-CIRI-SDV, University of Bologna, Bologna, Italy.,Department of Pharmacy and Biotechnology-Fabit, University of Bologna, Bologna, Italy.,IRET Foundation, Ozzano Emilia, Italy
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37
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van Lieverloo GGA, Wieske L, Verhamme C, Vrancken AFJ, van Doorn PA, Michalak Z, Barro C, van Schaik IN, Kuhle J, Eftimov F. Serum neurofilament light chain in chronic inflammatory demyelinating polyneuropathy. J Peripher Nerv Syst 2019; 24:187-194. [PMID: 30973667 DOI: 10.1111/jns.12319] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Axonal damage in chronic inflammatory demyelinating polyneuropathy (CIDP) is the main predictor of poor outcome. We hypothesized that serum neurofilament light chain (sNfL) reflects disease activity by detecting ongoing neuro-axonal damage in CIDP. Three prospective cohorts of CIDP patients were studied: (a) patients starting induction treatment (IT cohort, N = 29) measured at baseline and 6 months after starting treatment; (b) patients on maintenance treatment (MT) starting intravenous immunoglobuline (IVIg) withdrawal (MT cohort, N = 24) measured at baseline and 6 months after IVIg withdrawal or at time of relapse; and (c) patients in long-term remission without treatment (N = 27). A single molecule array assay was used to measure sNfL. Age-matched healthy controls (N = 30) and age-specific reference values were used for comparison. At baseline, sNfL was higher in patients starting IT compared to healthy controls. Ten out of 29 IT (34%) patients have sNfL levels above the 95th percentile of age-specific cut-off values. In the MT and remission cohort, elevated sNfL levels were infrequent and not different from healthy controls. sNfL levels were correlated with electrophysiological markers of axonal damage. At follow-up assessment, patients with active disease (non-responders and patients who relapsed after IVIg withdrawal) had higher sNfL levels compared with patients with stable disease (responders and patients who were successfully withdrawn from IVIg treatment). sNfL levels were increased in a third of CIDP patients starting IT and reflected axonal damage. sNfL levels might be usable as biomarker of disease activity in a subset of CIDP patients.
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Affiliation(s)
- Gwen G A van Lieverloo
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Alexander F J Vrancken
- Brain Centre Rudolf Magnus, Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Zuzanna Michalak
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Filip Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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38
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Albayar AA, Roche A, Swiatkowski P, Antar S, Ouda N, Emara E, Smith DH, Ozturk AK, Awad BI. Biomarkers in Spinal Cord Injury: Prognostic Insights and Future Potentials. Front Neurol 2019; 10:27. [PMID: 30761068 PMCID: PMC6361789 DOI: 10.3389/fneur.2019.00027] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/10/2019] [Indexed: 12/17/2022] Open
Abstract
Spinal Cord Injury (SCI) is a major challenge in Neurotrauma research. Complex pathophysiological processes take place immediately after the injury and later on as the chronic injury develops. Moreover, SCI is usually accompanied by traumatic injuries because the most common modality of injury is road traffic accidents and falls. Patients develop significant permanent neurological deficits that depend on the extent and the location of the injury itself and in time they develop further neurological and body changes that may risk their mere survival. In our review, we explored the recent updates with regards to SCI biomarkers. We observed two methods that may lead to the appearance of biomarkers for SCI. First, during the first few weeks following the injury the Blood Spinal Cord Barrier (BSCB) disruption that releases several neurologic structure components from the injured tissue. These components find their way to Cerebrospinal Fluid (CSF) and the systemic circulation. Also, as the injury develops several components of the pathological process are expressed or released such as in neuroinflammation, apoptosis, reactive oxygen species, and excitotoxicity sequences. Therefore, there is a growing interest in examining any correlations between these components and the degrees or the outcomes of the injury. Additionally, some of the candidate biomarkers are theorized to track the progressive changes of SCI which offers an insight on the patients' prognoses, potential-treatments-outcomes assessment, and monitoring the progression of the complications of chronic SCI such as Pressure Ulcers and urinary dysfunction. An extensive literature review was performed covering literature, published in English, until February 2018 using the Medline/PubMed database. Experimental and human studies were included and titles, PMID, publication year, authors, biomarkers studies, the method of validation, relationship to SCI pathophysiology, and concluded correlation were reported. Potential SCI biomarkers need further validation using clinical studies. The selection of the appropriate biomarker group should be made based on the stage of the injuries, the accompanying trauma and with regards to any surgical, or medical interference that might have been done. Additionally, we suggest testing multiple biomarkers related to the several pathological changes coinciding to offer a more precise prediction of the outcome.
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Affiliation(s)
- Ahmed A. Albayar
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Abigail Roche
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Przemyslaw Swiatkowski
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah Antar
- Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nouran Ouda
- Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman Emara
- Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Douglas H. Smith
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Ali K. Ozturk
- Department of Neurosurgery, Penn Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Basem I. Awad
- Department of Neurosurgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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39
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Du XJ, Chen YX, Zheng ZC, Wang N, Wang XY, Kong FE. Neural stem cell transplantation inhibits glial cell proliferation and P2X receptor-mediated neuropathic pain in spinal cord injury rats. Neural Regen Res 2019; 14:876-885. [PMID: 30688274 PMCID: PMC6375052 DOI: 10.4103/1673-5374.249236] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
P2X4 and P2X7 receptors play an important role in neuropathic pain after spinal cord injury. Regulation of P2X4 and P2X7 receptors can obviously reduce pain hypersensitivity after injury. To investigate the role of neural stem cell transplantation on P2X receptor-mediated neuropathic pain and explore related mechanisms, a rat model of spinal cord injury was prepared using the free-falling heavy body method with spinal cord segment 10 as the center. Neural stem cells were injected into the injured spinal cord segment using a micro-syringe. Expression levels of P2X4 and P2X7 receptors, neurofilament protein, and glial fibrillary acidic protein were determined by immunohistochemistry and western blot assay. In addition, sensory function was quantitatively assessed by current perception threshold. The Basso-Beattie-Bresnahan locomotor rating scale was used to assess neuropathological pain. The results showed that 4 weeks after neural stem cell transplantation, expression of neurofilament protein in the injured segment was markedly increased, while expression of glial fibrillary acidic protein and P2X4 and P2X7 receptors was decreased. At this time point, motor and sensory functions of rats were obviously improved, and neuropathic pain was alleviated. These findings demonstrated that neural stem cell transplantation reduced overexpression of P2X4 and P2X7 receptors, activated locomotor and sensory function reconstruction, and played an important role in neuropathic pain regulation after spinal cord injury. Therefore, neural stem cell transplantation is one potential option for relieving neuropathic pain mediated by P2X receptors.
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Affiliation(s)
- Xiao-Jing Du
- Department of Rehabilitation Medicine, the Central Hospital of Taian, Taian, Shandong Province, China
| | - Yue-Xia Chen
- Department of Rehabilitation Medicine, the Central Hospital of Taian, Taian, Shandong Province, China
| | - Zun-Cheng Zheng
- Department of Rehabilitation Medicine, the Central Hospital of Taian, Taian, Shandong Province, China
| | - Nan Wang
- Graduate School, Taishan Medical University, Taian, Shandong Province, China
| | - Xiao-Yu Wang
- Department of Rehabilitation Medicine, the Central Hospital of Taian, Taian, Shandong Province, China
| | - Fan-E Kong
- Graduate School, Taishan Medical University, Taian, Shandong Province, China
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40
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Tang Y, Liu HL, Min LX, Yuan HS, Guo L, Han PB, Lu YX, Zhong JF, Wang DL. Serum and cerebrospinal fluid tau protein level as biomarkers for evaluating acute spinal cord injury severity and motor function outcome. Neural Regen Res 2019; 14:896-902. [PMID: 30688276 PMCID: PMC6375043 DOI: 10.4103/1673-5374.249238] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tau protein, a microtubule-associated protein, has a high specific expression in neurons and axons. Because traumatic spinal cord injury mainly affects neurons and axons, we speculated that tau protein may be a promising biomarker to reflect the degree of spinal cord injury and prognosis of motor function. In this study, 160 female Sprague-Dawley rats were randomly divided into a sham group, and mild, moderate, and severe spinal cord injury groups. A laminectomy was performed at the T8 level to expose the spinal cord in all groups. A contusion lesion was made with the NYU-MASCIS impactor by dropping a 10 g rod from heights of 12.5 mm (mild), 25 mm (moderate) and 50 mm (severe) upon the exposed dorsal surface of the spinal cord. Tau protein levels were measured in serum and cerebrospinal fluid samples at 1, 6, 12, 24 hours, 3, 7, 14 and 28 days after operation. Locomotor function of all rats was assessed using the Basso, Beattie and Bresnahan locomotor rating scale. Tau protein concentration in the three spinal cord injury groups (both in serum and cerebrospinal fluid) rapidly increased and peaked at 12 hours after spinal cord injury. Statistically significant positive linear correlations were found between tau protein level and spinal cord injury severity in the three spinal cord injury groups, and between the tau protein level and Basso, Beattie, and Bresnahan locomotor rating scale scores. The tau protein level at 12 hours in the three spinal cord injury groups was negatively correlated with Basso, Beattie, and Bresnahan locomotor rating scale scores at 28 days (serum: r = −0.94; cerebrospinal fluid: r = −0.95). Our data suggest that tau protein levels in serum and cerebrospinal fluid might be a promising biomarker for predicting the severity and functional outcome of traumatic spinal cord injury.
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Affiliation(s)
- Ying Tang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
| | - Hong-Liang Liu
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ling-Xia Min
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hao-Shi Yuan
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Lei Guo
- Department of Orthopedics, Chinese PLA Beijing Army General Hospital, Beijing, China
| | - Peng-Bo Han
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Yu-Xin Lu
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Jian-Feng Zhong
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Dong-Lin Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
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41
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Casha S, Rice T, Stirling DP, Silva C, Gnanapavan S, Giovannoni G, Hurlbert RJ, Yong VW. Cerebrospinal Fluid Biomarkers in Human Spinal Cord Injury from a Phase II Minocycline Trial. J Neurotrauma 2018; 35:1918-1928. [DOI: 10.1089/neu.2018.5899] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Steve Casha
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Tiffany Rice
- Department of Anesthesia, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David P. Stirling
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- KY Spinal Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Claudia Silva
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Sharmilee Gnanapavan
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Gavin Giovannoni
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - R. John Hurlbert
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Division of Neurosurgery, University of Arizona, Tucson, Arizona
| | - V. Wee Yong
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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42
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Caprelli MT, Mothe AJ, Tator CH. Hyperphosphorylated Tau as a Novel Biomarker for Traumatic Axonal Injury in the Spinal Cord. J Neurotrauma 2018; 35:1929-1941. [DOI: 10.1089/neu.2017.5495] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Mitchell T. Caprelli
- University of Toronto, Institute of Medical Science, Toronto, Ontario, Canada
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
| | - Andrea J. Mothe
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
| | - Charles H. Tator
- University of Toronto, Institute of Medical Science, Toronto, Ontario, Canada
- Division of Genetics and Development, Krembil Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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43
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Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, Birk HS, Chan AK, Dhall SS. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus 2018; 43:E19. [PMID: 29088951 DOI: 10.3171/2017.7.focus17396] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during immediate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. Venous thromboembolism prophylaxis using low-molecular-weight heparin is recommended by current guidelines for SCI. For these patients, titration of tidal volumes is important to balance the association of earlier weaning off the ventilator, with its risk of atelectasis, against the risk for lung damage from mechanical overinflation that can occur with prolonged ventilation. Careful evaluation of infection risk is a priority following multisystem trauma for patients with relative immunosuppression or compromise. Although patients with polytrauma may experience longer rehabilitation courses, long-term neurological recovery is generally comparable to that in patients with isolated SCI after controlling for demographics. Bowel and bladder disorders are common following SCI, significantly reduce quality of life, and constitute a focus of targeted therapies. Emerging biomarkers including glial fibrillary acidic protein, S100β, and microRNAs for traumatic SCIs are presented. Systematic management approaches to minimize sources of secondary injury are discussed, and areas requiring further research, implementation, and validation are identified.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
| | - Jonathan W Rick
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
| | - Carlene P Partow
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Diego, California
| | - Harjus S Birk
- Department of Neurological Surgery, University of California, San Diego, California
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and
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Tong B, Jutzeler CR, Cragg JJ, Grassner L, Schwab JM, Casha S, Geisler F, Kramer JLK. Serum Albumin Predicts Long-Term Neurological Outcomes After Acute Spinal Cord Injury. Neurorehabil Neural Repair 2017; 32:7-17. [DOI: 10.1177/1545968317746781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. There is a need to identify reliable biomarkers of spinal cord injury recovery for clinical practice and clinical trials. Objective. Our objective was to correlate serum albumin levels with spinal cord injury neurological outcomes. Methods. We performed a secondary analysis of patients with traumatic spinal cord injury (n = 591) participating in the Sygen clinical trial. Serum albumin concentrations were obtained as part of routine blood chemistry analysis, at trial entry (24-72 hours), 1, 2, and 4 weeks after injury. The primary outcomes were “marked recovery” and lower extremity motor scores, derived from the International Standards for the Neurological Classification of Spinal Cord Injury. Data were analyzed with multivariable logistic and linear regression to adjust for potential confounders. Results. Serum albumin was significantly associated with spinal cord injury neurological outcomes. Higher serum albumin concentrations at 1, 2, and 4 weeks were associated with higher 52-week lower extremity motor score. Similarly, the odds of achieving “marked neurological recovery” was greater for individuals with higher serum albumin concentrations. The association between serum albumin concentrations and neurological outcomes was independent of initial injury severity, treatment with GM-1, and polytrauma. Conclusions. In spinal cord injury, serum albumin is an independent marker of long-term neurological outcomes. Serum albumin could serve as a feasible biomarker for prognosis at the time of injury and stratification in clinical trials.
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Affiliation(s)
- Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine R. Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Grassner
- Center for Spinal Cord Injuries and Department of Neurosurgery, Trauma Center, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jan M. Schwab
- Wexner Medical Center, The Ohio State University, Spinal Cord Injury Medicine, Columbus, OH, USA
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Olfactory ensheathing cell transplantation inhibits P2X4 receptor overexpression in spinal cord injury rats with neuropathic pain. Neurosci Lett 2017; 651:171-176. [DOI: 10.1016/j.neulet.2017.04.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 12/13/2022]
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