1
|
Lohitaksha K, Kumari D, Shukla M, Byagari L, Ashireddygari VR, Tammineni P, Reddanna P, Gorla M. Eicosanoid signaling in neuroinflammation associated with Alzheimer's disease. Eur J Pharmacol 2024; 976:176694. [PMID: 38821162 DOI: 10.1016/j.ejphar.2024.176694] [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: 02/29/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
Alzheimer's disease (AD) is a prevalent neurodegenerative condition affecting a substantial portion of the global population. It is marked by a complex interplay of factors, including the accumulation of amyloid plaques and tau tangles within the brain, leading to neuroinflammation and neuronal damage. Recent studies have underscored the role of free lipids and their derivatives in the initiation and progression of AD. Eicosanoids, metabolites of polyunsaturated fatty acids like arachidonic acid (AA), emerge as key players in this scenario. Remarkably, eicosanoids can either promote or inhibit the development of AD, and this multifaceted role is determined by how eicosanoid signaling influences the immune responses within the brain. However, the precise molecular mechanisms dictating the dual role of eicosanoids in AD remain elusive. In this comprehensive review, we explore the intricate involvement of eicosanoids in neuronal function and dysfunction. Furthermore, we assess the therapeutic potential of targeting eicosanoid signaling pathways as a viable strategy for mitigating or halting the progression of AD.
Collapse
Affiliation(s)
| | - Deepika Kumari
- Department of Biochemistry, Central University of Rajasthan, Bandarsindri, Ajmer, Rajasthan, India
| | - Manas Shukla
- Department of Animal Biology, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Lavanya Byagari
- Department of Animal Biology, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | | | - Prasad Tammineni
- Department of Animal Biology, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Pallu Reddanna
- Department of Animal Biology, School of Life Sciences, University of Hyderabad, Hyderabad, India; Brane Enterprises Private Limited, Hyderabad, India.
| | - Madhavi Gorla
- National Institute of Animal Biotechnology, Hyderabad, India.
| |
Collapse
|
2
|
Lin X, Wang X, Zhang Y, Chu G, Liang J, Zhang B, Lu Y, Steward O, Luo J. Synergistic effect of chemogenetic activation of corticospinal motoneurons and physical exercise in promoting functional recovery after spinal cord injury. Exp Neurol 2023; 370:114549. [PMID: 37774765 DOI: 10.1016/j.expneurol.2023.114549] [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: 03/19/2023] [Revised: 09/06/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Single therapeutic interventions have not yet been successful in restoring function after spinal cord injury. Accordingly, combinatorial interventions targeting multiple factors may hold greater promise for achieving maximal functional recovery. In this study, we applied a combinatorial approach of chronic chemogenetic neuronal activation and physical exercise including treadmill running and forelimb training tasks to promote functional recovery. In a mouse model of cervical (C5) dorsal hemisection of the spinal cord, which transects almost all descending corticospinal tract axons, combining selective activation of corticospinal motoneurons (CMNs) by intersectional chemogenetics with physical exercise significantly promoted functional recovery evaluated by the grid walking test, grid hanging test, rotarod test, and single pellet-reaching tasks. Electromyography and histological analysis showed increased activation of forelimb muscles via chemogenetic stimuli, and a greater density of vGlut1+ innervation in spinal cord grey matter rostral to the injury, suggesting enhanced neuroplasticity and connectivity. Combined therapy also enhanced activation of mTOR signaling and reduced apoptosis in spinal motoneurons, Counts revealed increased numbers of detectable choline acetyltransferase-positive motoneurons in the ventral horn. Taken together, the findings from this study validate a novel combinatorial approach to enhance motor function after spinal cord injury.
Collapse
Affiliation(s)
- Xueling Lin
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiuping Wang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuejin Zhang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guangpin Chu
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jingwen Liang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bin Zhang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yisheng Lu
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Oswald Steward
- Reeve-Irvine Research Center, University of California Irvine School of Medicine, USA; Department of Anatomy & Neurobiology, University of California Irvine School of Medicine, USA; Department of Neurobiology & Behavior, University of California Irvine, USA; Department of Neurosurgery, University of California Irvine School of Medicine, USA.
| | - Juan Luo
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| |
Collapse
|
3
|
Zhang H, Chen Y, Li F, Wu C, Cai W, Ye H, Su H, He M, Yang L, Wang X, Zhou K, Ni W. Elamipretide alleviates pyroptosis in traumatically injured spinal cord by inhibiting cPLA2-induced lysosomal membrane permeabilization. J Neuroinflammation 2023; 20:6. [PMID: 36609266 PMCID: PMC9825014 DOI: 10.1186/s12974-023-02690-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating injury that may result in permanent motor impairment. The active ingredients of medications are unable to reach the affected area due to the blood‒brain barrier. Elamipretide (SS-31) is a new and innovative aromatic cationic peptide. Because of its alternating aromatic and cationic groups, it freely crosses the blood‒brain barrier. It is also believed to decrease inflammation and protect against a variety of neurological illnesses. This study explored the therapeutic value of SS-31 in functional recovery after SCI and its possible underlying mechanism. A spinal cord contusion injury model as well as the Basso Mouse Scale, footprint assessment, and inclined plane test were employed to assess how well individuals could function following SCI. The area of glial scarring, the number of dendrites, and the number of synapses after SCI were confirmed by HE, Masson, MAP2, and Syn staining. Western blotting, immunofluorescence, and enzyme-linked immunosorbent assays were employed to examine the expression levels of pyroptosis-, autophagy-, lysosomal membrane permeabilization (LMP)- and MAPK signalling-related proteins. The outcomes showed that SS-31 inhibited pyroptosis, enhanced autophagy and attenuated LMP in SCI. Mechanistically, we applied AAV vectors to upregulate Pla2g4A in vivo and found that SS-31 enhanced autophagy and attenuated pyroptosis and LMP by inhibiting phosphorylation of cPLA2. Ultimately, we applied asiatic acid (a p38-MAPK agonist) to test whether SS-31 regulated cPLA2 partially through the MAPK-P38 signalling pathway. Our group is the first to suggest that SS-31 promotes functional recovery partially by inhibiting cPLA2-mediated autophagy impairment and preventing LMP and pyroptosis after SCI, which may have potential clinical application value.
Collapse
Affiliation(s)
- Haojie Zhang
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Yituo Chen
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Feida Li
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Chenyu Wu
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Wanta Cai
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Hantao Ye
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Haohan Su
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Mingjun He
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Liangliang Yang
- grid.268099.c0000 0001 0348 3990School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, 325035 Zhejiang China
| | - Xiangyang Wang
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Kailiang Zhou
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| | - Wenfei Ni
- grid.417384.d0000 0004 1764 2632Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000 Zhejiang China ,grid.268099.c0000 0001 0348 3990Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, 325000 Zhejiang China
| |
Collapse
|
4
|
Liu S, Song L, Dai W, Liu M, Zhang H, Zhang X, Li H, Liu X, Lv Y, Hu Y. Worldwide productivity and research trend of publications concerning electroactive materials and spinal cord injury: A bibliometric study. Front Bioeng Biotechnol 2023; 11:1094059. [PMID: 36923456 PMCID: PMC10009169 DOI: 10.3389/fbioe.2023.1094059] [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: 11/09/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
Purpose: We investigated the current state and trends in the area during the previous 10 years using bibliometric approaches to evaluate the global scientific output of research on electroactive materials and spinal cord injury. Methods: Studies on spinal cord injury in electroactive materials that were published between 2012 and 2022 were located using the Web of science (WOS) datebase. The software programs bibliometrix R-package and CiteSpace were used to do quantitative analyses of annual publications, nation, author, institution, journal source, co-cited references, and keywords. The studies were categorized by the research's main points using a qualitative analysis, and publications having more than 10 citations each year. Results: In the final analysis, 1,330 relevant papers or reviews were included. There is an increased tendency in both the average annual citation rate and the number of publications in the discipline. The United States and the University of Toronto are the countries and institutions that have contributed the most to this discipline, respectively. The majority of authors are from the China and United States. Zhang Y is the author with the most published articles and holds the top position in the cited author h-index species. The journal with the highest number of published articles is "Disability and rehabilitation"; the journal is divided into four main areas including physics, materials, chemistry, molecular, and biology. The keyword analysis revealed a shift in research hotspots from schwann cell, fracture, and urinary disorders to carbon-based materials, functional recovery, and surgery. Analysis of qualitative data revealed that the role and mechanism of injectable conductive hydrogels in spinal cord healing after damage is a hot topic of current study, with the mechanism primarily focusing on the inhibition of oxidative stress (Nrf2) and apoptosis (Casepase 3). Conclusion: Our bibliometric analysis indicates that research on electroactive materials for spinal cord injury remains an active field of study. Moreover, contemporary research is concentrated on carbon-based materials, functional rehabilitation, and surgery.
Collapse
Affiliation(s)
- Sirui Liu
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Lin Song
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.,Department of Periodontology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Weishu Dai
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Mengdie Liu
- The Third Medical Center of PLA General Hospital, Beijing, China.,The First Medical Center of PLA General Hospital, Beijing, China
| | - Huijing Zhang
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.,Department of Periodontology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xueyan Zhang
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Hongyu Li
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xiu Liu
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Yan Lv
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Ying Hu
- Beijing Institute of Dental Research, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Bi J, Jing H, Zhou C, Gao P, Han F, Li G, Zhang S. Regulation of skeletal myogenesis in C2C12 cells through modulation of Pax7, MyoD, and myogenin via different low-frequency electromagnetic field energies. Technol Health Care 2022; 30:371-382. [PMID: 35124612 PMCID: PMC9028610 DOI: 10.3233/thc-thc228034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND: A low-frequency electromagnetic field (LF-EMF) exerts important biological effects on the human body. OBJECTIVE: We previously studied the immunity and atrophy of gastrocnemius muscles in rats with spinal cord injuries and found that LF-EMF with a magnetic flux density of 1.5 mT exerted excellent therapeutic and preventive effects on reducing myotubes and increasing spatium intermusculare. However, the effects of LF-EMF on all stages of skeletal myogenesis, such as activation, proliferation, differentiation, and fusion of satellite cells to myotubes as stimulated by myogenic regulatoryfactors (MRFs), have not been fully elucidated. METHODS: This study investigated the optimal LF-EMF magnetic flux density that exerted maximal effects on all stages of C2C12 cell skeletal myogenesis as well as its impact on regulatory MRFs. RESULTS: The results showed that an LF-EMF with a magnetic flux density of 2.0 mT could activate C2C12 cells and upregulate the proliferation-promoting transcription factor PAX7. On the other hand, 1.5 mT EMF could upregulate the expression of MyoD and myogenin. CONCLUSION: LF-EMF could prevent the disappearance of myotubes, with different magnetic flux densities of LF-EMF exerting independent and positive effects on skeletal myogenesis such as satellite cell activation and proliferation, muscle cell differentiation, and myocyte fusion.
Collapse
Affiliation(s)
- Jiaqi Bi
- Harbin Children’s Hospital, Harbin, Heilongjiang, China
- Emergency Department, SongBei Hospital of The Fourth Hospital Affiliated of Harbin Medical University, Harbin, Heilongjiang, China
- Harbin Children’s Hospital, Harbin, Heilongjiang, China
| | - Hong Jing
- Harbin Children’s Hospital, Harbin, Heilongjiang, China
- Harbin Children’s Hospital, Harbin, Heilongjiang, China
| | - ChenLiang Zhou
- Emergency Department, SongBei Hospital of The Fourth Hospital Affiliated of Harbin Medical University, Harbin, Heilongjiang, China
| | - Peng Gao
- The First Department of General Surgery, Harbin Children’s Hospital, Harbin, Heilongjiang, China
| | - Fujun Han
- Emergency Department, SongBei Hospital of The Fourth Hospital Affiliated of Harbin Medical University, Harbin, Heilongjiang, China
| | - Gang Li
- The Second Department of Orthopedics, The First Hospital of Yichun, Yichun, Heilongjiang, China
| | - Shiwei Zhang
- Harbin Children’s Hospital, Harbin, Heilongjiang, China
| |
Collapse
|
6
|
Huang H, Xue J, Zheng J, Tian H, Fang Y, Wang W, Wang G, Hou D, Lin J. Bioinformatic analysis of the gene expression profile in muscle atrophy after spinal cord injury. Sci Rep 2021; 11:21903. [PMID: 34754020 PMCID: PMC8578571 DOI: 10.1038/s41598-021-01302-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
Spinal cord injury (SCI) is often accompanied by muscle atrophy; however, its underlying mechanisms remain unclear. Here, the molecular mechanisms of muscle atrophy following SCI were investigated. The GSE45550 gene expression profile of control (before SCI) and experimental (14 days following SCI) groups, consisting of Sprague–Dawley rat soleus muscle (n = 6 per group), was downloaded from the Gene Expression Omnibus database, and then differentially expressed gene (DEG) identification and Gene Ontology, pathway, pathway network, and gene signal network analyses were performed. A total of 925 differentially expressed genes, 149 biological processes, and 55 pathways were screened. In the pathway network analysis, the 10 most important pathways were citrate cycle (TCA cycle), pyruvate metabolism, MAPK signalling pathway, fatty acid degradation, propanoate metabolism, apoptosis, focal adhesion, synthesis and degradation of ketone bodies, Wnt signalling, and cancer pathways. In the gene signal network analysis, the 10 most important genes were Acat1, Acadvl, Acaa2, Hadhb, Acss1, Oxct1, Hadha, Hadh, Acaca, and Cpt1b. Thus, we screened the key genes and pathways that may be involved in muscle atrophy after SCI and provided support for finding valuable markers for this disease.
Collapse
Affiliation(s)
- Hui Huang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Jinju Xue
- Department of Geriatrics, Affiliated Haikou Hospital, Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China
| | - Jiaxuan Zheng
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Haiquan Tian
- Department of Orthopaedic Surgery, The Second People's Hospital of Changzhi, Changzhi, 046000, Shanxi, China
| | - Yehan Fang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Wei Wang
- Department of Emergency, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Guangji Wang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Dan Hou
- Department of Neurology, Affiliated Haikou Hospital, Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China.
| | - Jianping Lin
- Department of Joint Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China.
| |
Collapse
|
7
|
Abbaszadeh F, Fakhri S, Khan H. Targeting apoptosis and autophagy following spinal cord injury: Therapeutic approaches to polyphenols and candidate phytochemicals. Pharmacol Res 2020; 160:105069. [PMID: 32652198 DOI: 10.1016/j.phrs.2020.105069] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
Spinal cord injury (SCI) is a neurological disorder associated with the loss of sensory and motor function. Understanding the precise dysregulated signaling pathways, especially apoptosis and autophagy following SCI, is of vital importance in developing innovative therapeutic targets and treatments. The present study lies in the fact that it reveals the precise dysregulated signaling mediators of apoptotic and autophagic pathways following SCI and also examines the effects of polyphenols and other candidate phytochemicals. It provides new insights to develop new treatments for post-SCI complications. Accordingly, a comprehensive review was conducted using electronic databases including, Scopus, Web of Science, PubMed, and Medline, along with the authors' expertise in apoptosis and autophagy as well as their knowledge about the effects of polyphenols and other phytochemicals on SCI pathogenesis. The primary mechanical injury to spinal cord is followed by a secondary cascade of apoptosis and autophagy that play critical roles during SCI. In terms of pharmacological mechanisms, caspases, Bax/Bcl-2, TNF-α, and JAK/STAT in apoptosis along with LC3 and Beclin-1 in autophagy have shown a close interconnection with the inflammatory pathways mainly glutamatergic, PI3K/Akt/mTOR, ERK/MAPK, and other cross-linked mediators. Besides, apoptotic pathways have been shown to regulate autophagy mediators and vice versa. Prevailing evidence has highlighted the importance of modulating these signaling mediators/pathways by polyphenols and other candidate phytochemicals post-SCI. The present review provides dysregulated signaling mediators and therapeutic targets of apoptotic and autophagic pathways following SCI, focusing on the modulatory effects of polyphenols and other potential phytochemical candidates.
Collapse
Affiliation(s)
- Fatemeh Abbaszadeh
- Department of Neuroscience, Faculty of Advanced Technologies in Medical Sciences, Iran University of Medical Sciences, Tehran, Iran; Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran.
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, 23200, Pakistan.
| |
Collapse
|
8
|
Gallegos C, Carey M, Zheng Y, He X, Cao QL. Reaching and Grasping Training Improves Functional Recovery After Chronic Cervical Spinal Cord Injury. Front Cell Neurosci 2020; 14:110. [PMID: 32536855 PMCID: PMC7266985 DOI: 10.3389/fncel.2020.00110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/08/2020] [Indexed: 12/31/2022] Open
Abstract
Previous studies suggest locomotion training could be an effective non-invasive therapy after spinal cord injury (SCI) using primarily acute thoracic injuries. However, the majority of SCI patients have chronic cervical injuries. Regaining hand function could significantly increase their quality of life. In this study, we used a clinically relevant chronic cervical contusion to study the therapeutic efficacy of rehabilitation in forelimb functional recovery. Nude rats received a moderate C5 unilateral contusive injury and were then divided into two groups with or without Modified Montoya Staircase (MMS) rehabilitation. For the rehabilitation group, rats were trained 5 days a week starting at 8 weeks post-injury (PI) for 6 weeks. All rats were assessed for skilled forelimb functions with MMS test weekly and for untrained gross forelimb locomotion with grooming and horizontal ladder (HL) tests biweekly. Our results showed that MMS rehabilitation significantly increased the number of pellets taken at 13 and 14 weeks PI and the accuracy rates at 12 to 14 weeks PI. However, there were no significant differences in the grooming scores or the percentage of HL missteps at any time point. Histological analyses revealed that MMS rehabilitation significantly increased the number of serotonergic fibers and the amount of presynaptic terminals around motor neurons in the cervical ventral horns caudal to the injury and reduced glial fibrillary acidic protein (GFAP)-immunoreactive astrogliosis in spinal cords caudal to the lesion. This study shows that MMS rehabilitation can modify the injury environment, promote axonal sprouting and synaptic plasticity, and importantly, improve reaching and grasping functions in the forelimb, supporting the therapeutic potential of task-specific rehabilitation for functional recovery after chronic SCI.
Collapse
Affiliation(s)
- Chrystine Gallegos
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Center for Stem Cell and Regenerative Medicine, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Matthew Carey
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Center for Stem Cell and Regenerative Medicine, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Summer Undergraduate Research Program, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yiyan Zheng
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Center for Stem Cell and Regenerative Medicine, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiuquan He
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Center for Stem Cell and Regenerative Medicine, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Anatomy and Histoembryology, School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Qi Lin Cao
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, United States.,Center for Stem Cell and Regenerative Medicine, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
9
|
Ungerer G, Cui J, Ndam T, Bekemeier M, Song H, Li R, Siedhoff HR, Yang B, Appenteng MK, Greenlief CM, Miller DK, Sun GY, Folk WR, Gu Z. Harpagophytum procumbens Extract Ameliorates Allodynia and Modulates Oxidative and Antioxidant Stress Pathways in a Rat Model of Spinal Cord Injury. Neuromolecular Med 2020; 22:278-292. [PMID: 31900786 DOI: 10.1007/s12017-019-08585-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
Spinal cord injury (SCI) is a deliberating disorder with impairments in locomotor deficits and incapacitating sensory abnormalities. Harpagophytum procumbens (Hp) is a botanical widely used for treating inflammation and pain related to various inflammatory and musculoskeletal conditions. Using a modified rodent contusion model of SCI, we explored the effects of this botanical on locomotor function and responses to mechanical stimuli, and examined possible neurochemical changes associated with SCI-induced allodynia. Following spinal cord contusion at T10 level, Hp (300 mg/kg, p.o.) or vehicle (water) was administered daily starting 24 h post-surgery, and behavioral measurements made every-other day until sacrifice (Day 21). Hp treatment markedly ameliorated the contusion-induced decrease in locomotor function and increased sensitivity to mechanical stimuli. Determination of Iba1 expression in spinal cord tissues indicated microglial infiltration starting 3 days post-injury. SCI results in increased levels of 4-hydroxynonenal, an oxidative stress product and proalgesic, which was diminished at 7 days by treatment with Hp. SCI also enhanced antioxidant heme oxygenase-1 (HO-1) expression. Concurrent studies of cultured murine BV-2 microglial cells revealed that Hp suppressed oxidative/nitrosative stress and inflammatory responses, including production of nitric oxide and reactive oxygen species, phosphorylation of cytosolic phospholipases A2, and upregulation of the antioxidative stress pathway involving the nuclear factor erythroid 2-related factor 2 and HO-1. These results support the use of Hp for management of allodynia by providing resilience against the neuroinflammation and pain associated with SCI and other neuropathological conditions.
Collapse
Affiliation(s)
- Garrett Ungerer
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Jiankun Cui
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Tina Ndam
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Mikeala Bekemeier
- Department of Psychological Sciences, College of Arts & Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Hailong Song
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Runting Li
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Heather R Siedhoff
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA
| | - Bo Yang
- Department of Chemistry, College of Arts & Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Michael K Appenteng
- Department of Chemistry, College of Arts & Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - C Michael Greenlief
- Department of Chemistry, College of Arts & Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Dennis K Miller
- Department of Psychological Sciences, College of Arts & Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Grace Y Sun
- Biochemistry Department, School of Medicine and College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, MO, 65211, USA
| | - William R Folk
- Biochemistry Department, School of Medicine and College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, MO, 65211, USA
| | - Zezong Gu
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, 65212, USA.
| |
Collapse
|
10
|
Seif M, David G, Huber E, Vallotton K, Curt A, Freund P. Cervical Cord Neurodegeneration in Traumatic and Non-Traumatic Spinal Cord Injury. J Neurotrauma 2019; 37:860-867. [PMID: 31544628 PMCID: PMC7071087 DOI: 10.1089/neu.2019.6694] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare macrostructural and microstructural neurodegenerative changes remote from a cervical spinal cord injury in traumatic spinal cord injury (tSCI) and degenerative cervical myelopathy (DCM) patients using quantitative magnetic resonance imaging (MRI). Twenty-nine tSCI patients, 20 mild/moderate DCM patients, and 22 healthy controls underwent a high-resolution MRI protocol at the cervical cord (C2/C3). High-resolution T2*-weighted and diffusion-weighted scans provided data to calculate tissue-specific cross-sectional areas of the spinal cord and tract-specific diffusion indices of cord white matter, respectively. Regression analysis determined associations between neurodegeneration and clinical impairment. tSCI patients showed more impairment in upper limb strength and manual dexterity when compared with DCM patients. While macrostructural MRI measures revealed a similar extent of remote cord atrophy at cervical level, microstructural measures (diffusion indices) were able to distinguish more pronounced tract-specific neurodegeneration in tSCI patients when compared with DCM patients. Tract-specific neurodegeneration was associated with upper limb impairment. Despite clinical differences between severely impaired tSCI compared with mildly affected DCM patient, extensive cord atrophy is present remotely from the focal spinal cord injury. Diffusion indices revealed greater tract-specific alterations in tSCI patients. Therefore, diffusion indices are more sensitive than macrostructural MRI measures as these are able to distinguish between traumatic and non-traumatic spinal cord injury. Neuroimaging biomarkers of cervical cord integrity hold potential as predictors of recovery and might be suitable biomarkers for interventional trials both in traumatic and non-traumatic SCI.
Collapse
Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gergely David
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eveline Huber
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kevin Vallotton
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Xu Y. Targeting Lysophosphatidic Acid in Cancer: The Issues in Moving from Bench to Bedside. Cancers (Basel) 2019; 11:cancers11101523. [PMID: 31658655 PMCID: PMC6826372 DOI: 10.3390/cancers11101523] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 12/16/2022] Open
Abstract
Since the clear demonstration of lysophosphatidic acid (LPA)'s pathological roles in cancer in the mid-1990s, more than 1000 papers relating LPA to various types of cancer were published. Through these studies, LPA was established as a target for cancer. Although LPA-related inhibitors entered clinical trials for fibrosis, the concept of targeting LPA is yet to be moved to clinical cancer treatment. The major challenges that we are facing in moving LPA application from bench to bedside include the intrinsic and complicated metabolic, functional, and signaling properties of LPA, as well as technical issues, which are discussed in this review. Potential strategies and perspectives to improve the translational progress are suggested. Despite these challenges, we are optimistic that LPA blockage, particularly in combination with other agents, is on the horizon to be incorporated into clinical applications.
Collapse
Affiliation(s)
- Yan Xu
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, 950 W. Walnut Street R2-E380, Indianapolis, IN 46202, USA.
| |
Collapse
|
12
|
cPLA2 activation contributes to lysosomal defects leading to impairment of autophagy after spinal cord injury. Cell Death Dis 2019; 10:531. [PMID: 31296844 PMCID: PMC6624263 DOI: 10.1038/s41419-019-1764-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/02/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022]
Abstract
The autophagy–lysosomal pathway plays an essential role in cellular homeostasis as well as a protective function against a variety of diseases including neurodegeneration. Conversely, inhibition of autophagy, for example due to lysosomal dysfunction, can lead to pathological accumulation of dysfunctional autophagosomes and consequent neuronal cell death. We previously reported that autophagy is inhibited and contributes to neuronal cell death following spinal cord injury (SCI). In this study, we examined lysosomal function and explored the mechanism of lysosomal defects following SCI. Our data demonstrated that expression levels and processing of the lysosomal enzyme cathepsin D (CTSD) are decreased by 2 h after SCI. Enzymatic activity levels of CTSD and another lysosomal enzyme, N-acetyl-alpha-glucosaminidase, are both decreased 24 h post injury, indicating general lysosomal dysfunction. Subcellular fractionation and immunohistochemistry analysis demonstrated that this dysfunction is due to lysosomal membrane permeabilization and leakage of lysosomal contents into the cytosol. To directly assess extent and mechanisms of damage to lysosomal membranes, we performed mass spectrometry-based lipidomic analysis of lysosomes purified from SCI and control spinal cord. At 2 h post injury our data demonstrated increase in several classes of lysosophospholipids, the products of phospholipases (PLAs), as well as accumulation of PLA activators, ceramides. Phospholipase cPLA2, the main PLA species expressed in the CNS, has been previously implicated in mediation of secondary injury after SCI, but the mechanisms of its involvement remain unclear. Our data demonstrate that cPLA2 is activated within 2 h after SCI preferentially in the lysosomal fraction, where it colocalizes with lysosomal-associated membrane protein 2 in neurons. Inhibition of cPLA2 in vivo decreased lysosomal damage, restored autophagy flux, and reduced neuronal cell damage. Taken together our data implicate lysosomal defects in pathophysiology of SCI and for the first time indicate that cPLA2 activation leads to lysosomal damage causing neuronal autophagosome accumulation associated with neuronal cell death.
Collapse
|
13
|
Chew C, Kiley BJ, Sengelaub DR. Neuroprotective Effects on the Morphology of Somatic Motoneurons Following the Death of Neighboring Motoneurons: A Role for Microglia? Dev Neurobiol 2019; 79:131-154. [PMID: 30430756 DOI: 10.1002/dneu.22652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 11/08/2022]
Abstract
Partial depletion of spinal motoneuron populations induces dendritic atrophy in neighboring motoneurons, and treatment with testosterone protects motoneurons from induced dendritic atrophy. We explored a potential mechanism for this induced atrophy and protection by testosterone, examining the microglial response to partial depletion of motoneurons. Motoneurons innervating the vastus medialis muscles of adult male rats were killed by intramuscular injection of cholera toxin-conjugated saporin; some saporin-injected rats were treated with testosterone. Microglia were later visualized via immunohistochemical staining, classified as monitoring or activated, and counted stereologically. Partial motoneuron depletion increased the number of activated microglia in the quadriceps motor pool, and this increase was attenuated with testosterone treatment. The attenuation in microglial response could reflect an effect of testosterone on suppressing microglia activation, potentially sparing motoneuron dendrites. Alternatively, testosterone could be neuroprotective, sparing motoneuron dendrites, secondarily resulting in reduced microglial activation. To discriminate between these hypotheses, following partial motoneuron depletion, rats were treated with minocycline to inhibit microglial activation. Motoneurons innervating the ipsilateral vastus lateralis muscle were later labeled with cholera toxin-conjugated horseradish peroxidase, and dendritic arbors were reconstructed. Reduction of microglial activation by minocycline did not prevent induced dendritic atrophy following partial motoneuron depletion. Further, reduction of microglial activation by minocycline treatment resulted in dendritic atrophy in intact animals. Together, these findings indicate that the neuroprotective effect of testosterone on dendrites following motoneuron death is not due to inhibiting microglial activation, and that microglial activity contributes to the normal maintenance of dendritic arbors.
Collapse
Affiliation(s)
- Cory Chew
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| | - Brandon J Kiley
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| | - Dale R Sengelaub
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| |
Collapse
|
14
|
Wang Y, Wu W, Wu X, Sun Y, Zhang YP, Deng LX, Walker MJ, Qu W, Chen C, Liu NK, Han Q, Dai H, Shields LB, Shields CB, Sengelaub DR, Jones KJ, Smith GM, Xu XM. Remodeling of lumbar motor circuitry remote to a thoracic spinal cord injury promotes locomotor recovery. eLife 2018; 7:39016. [PMID: 30207538 PMCID: PMC6170189 DOI: 10.7554/elife.39016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/09/2018] [Indexed: 12/18/2022] Open
Abstract
Retrogradely-transported neurotrophin signaling plays an important role in regulating neural circuit specificity. Here we investigated whether targeted delivery of neurotrophin-3 (NT-3) to lumbar motoneurons (MNs) caudal to a thoracic (T10) contusive spinal cord injury (SCI) could modulate dendritic patterning and synapse formation of the lumbar MNs. In vitro, Adeno-associated virus serotype two overexpressing NT-3 (AAV-NT-3) induced NT-3 expression and neurite outgrowth in cultured spinal cord neurons. In vivo, targeted delivery of AAV-NT-3 into transiently demyelinated adult mouse sciatic nerves led to the retrograde transportation of NT-3 to the lumbar MNs, significantly attenuating SCI-induced lumbar MN dendritic atrophy. NT-3 enhanced sprouting and synaptic formation of descending serotonergic, dopaminergic, and propriospinal axons on lumbar MNs, parallel to improved behavioral recovery. Thus, retrogradely transported NT-3 stimulated remodeling of lumbar neural circuitry and synaptic connectivity remote to a thoracic SCI, supporting a role for retrograde transport of NT-3 as a potential therapeutic strategy for SCI.
Collapse
Affiliation(s)
- Ying Wang
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States.,Neural Tissue Engineering Research Institute, Mudanjiang College of Medicine, Mudanjiang, China
| | - Wei Wu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Xiangbing Wu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Yan Sun
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States.,Department of Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yi P Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, United States
| | - Ling-Xiao Deng
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Melissa Jane Walker
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Wenrui Qu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Chen Chen
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States.,Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indiana, United States
| | - Nai-Kui Liu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Qi Han
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Heqiao Dai
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States
| | - Lisa Be Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, United States
| | | | - Dale R Sengelaub
- Program in Neuroscience, Department of Psychological and Brain Sciences, Indiana University, Bloomington, United States
| | - Kathryn J Jones
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, United States
| | - George M Smith
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, United States
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, United States.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, United States.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, United States
| |
Collapse
|
15
|
Sengelaub DR, Xu XM. Protective effects of gonadal hormones on spinal motoneurons following spinal cord injury. Neural Regen Res 2018; 13:971-976. [PMID: 29926818 PMCID: PMC6022470 DOI: 10.4103/1673-5374.233434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/29/2022] Open
Abstract
Spinal cord injury (SCI) results in lesions that destroy tissue and disrupt spinal tracts, producing deficits in locomotor and autonomic function. The majority of treatment strategies after SCI have concentrated on the damaged spinal cord, for example working to reduce lesion size or spread, or encouraging regrowth of severed descending axonal projections through the lesion, hoping to re-establish synaptic connectivity with caudal targets. In our work, we have focused on a novel target for treatment after SCI, surviving spinal motoneurons and their target musculature, with the hope of developing effective treatments to preserve or restore lost function following SCI. We previously demonstrated that motoneurons, and the muscles they innervate, show pronounced atrophy after SCI. Importantly, SCI-induced atrophy of motoneuron dendrites can be attenuated by treatment with gonadal hormones, testosterone and its active metabolites, estradiol and dihydrotestosterone. Similarly, SCI-induced reductions in muscle fiber cross-sectional areas can be prevented by treatment with androgens. Together, these findings suggest that regressive changes in motoneuron and muscle morphology seen after SCI can be ameliorated by treatment with gonadal hormones, further supporting a role for steroid hormones as neurotherapeutic agents in the injured nervous system.
Collapse
Affiliation(s)
- Dale R. Sengelaub
- Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
16
|
Sengelaub DR, Han Q, Liu NK, Maczuga MA, Szalavari V, Valencia SA, Xu XM. Protective Effects of Estradiol and Dihydrotestosterone following Spinal Cord Injury. J Neurotrauma 2018; 35:825-841. [PMID: 29132243 PMCID: PMC5863086 DOI: 10.1089/neu.2017.5329] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Spinal cord injury (SCI) results in lesions that destroy tissue and disrupt spinal tracts, producing deficits in locomotor and autonomic function. We previously demonstrated that motoneurons and the muscles they innervate show pronounced atrophy after SCI, and these changes are prevented by treatment with testosterone. Here, we assessed whether the testosterone active metabolites estradiol and dihydrotestosterone have similar protective effects after SCI. Young adult female rats received either sham or T9 spinal cord contusion injuries and were treated with estradiol, dihydrotestosterone, both, or nothing via Silastic capsules. Basso-Beattie-Bresnahan locomotor testing was performed weekly and voiding behavior was assessed at 3 weeks post-injury. Four weeks after SCI, lesion volume and tissue sparing, quadriceps muscle fiber cross-sectional area, and motoneuron dendritic morphology were assessed. Spontaneous locomotor behavior improved after SCI, but hormone treatments had no effect. Voiding behavior was disrupted after SCI, but was significantly improved by treatment with either estradiol or dihydrotestosterone; combined treatment was maximally effective. Treatment with estradiol reduced lesion volume, but dihydrotestosterone alone and estradiol combined with dihydrotestosterone were ineffective. SCI-induced decreases in motoneuron dendritic length were attenuated by all hormone treatments. SCI-induced reductions in muscle fiber cross-sectional areas were prevented by treatment with either dihydrotestosterone or estradiol combined with dihydrotestosterone, but estradiol treatment was ineffective. These findings suggest that deficits in micturition and regressive changes in motoneuron and muscle morphology seen after SCI are ameliorated by treatment with estradiol or dihydrotestosterone, further supporting a role for steroid hormones as neurotherapeutic agents in the injured nervous system.
Collapse
Affiliation(s)
- Dale R. Sengelaub
- Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Qi Han
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nai-Kui Liu
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Melissa A. Maczuga
- Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Violetta Szalavari
- Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | | | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
17
|
Tail Nerve Electrical Stimulation and Electro-Acupuncture Can Protect Spinal Motor Neurons and Alleviate Muscle Atrophy after Spinal Cord Transection in Rats. Neural Plast 2017; 2017:7351238. [PMID: 28744378 PMCID: PMC5506460 DOI: 10.1155/2017/7351238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/08/2017] [Accepted: 03/19/2017] [Indexed: 01/12/2023] Open
Abstract
Spinal cord injury (SCI) often results in death of spinal neurons and atrophy of muscles which they govern. Thus, following SCI, reorganizing the lumbar spinal sensorimotor pathways is crucial to alleviate muscle atrophy. Tail nerve electrical stimulation (TANES) has been shown to activate the central pattern generator (CPG) and improve the locomotion recovery of spinal contused rats. Electroacupuncture (EA) is a traditional Chinese medical practice which has been proven to have a neural protective effect. Here, we examined the effects of TANES and EA on lumbar motor neurons and hindlimb muscle in spinal transected rats, respectively. From the third day postsurgery, rats in the TANES group were treated 5 times a week and those in the EA group were treated once every other day. Four weeks later, both TANES and EA showed a significant impact in promoting survival of lumbar motor neurons and expression of choline acetyltransferase (ChAT) and ameliorating atrophy of hindlimb muscle after SCI. Meanwhile, the expression of neurotrophin-3 (NT-3) in the same spinal cord segment was significantly increased. These findings suggest that TANES and EA can augment the expression of NT-3 in the lumbar spinal cord that appears to protect the motor neurons as well as alleviate muscle atrophy.
Collapse
|
18
|
Cai Y, Chew C, Muñoz F, Sengelaub DR. Neuroprotective effects of testosterone metabolites and dependency on receptor action on the morphology of somatic motoneurons following the death of neighboring motoneurons. Dev Neurobiol 2016; 77:691-707. [PMID: 27569375 DOI: 10.1002/dneu.22445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/11/2022]
Abstract
Partial depletion of spinal motoneuron populations induces dendritic atrophy in neighboring motoneurons, and treatment with testosterone is neuroprotective, attenuating induced dendritic atrophy. In this study we examined whether the protective effects of testosterone could be mediated via its androgenic or estrogenic metabolites. Furthermore, to assess whether these neuroprotective effects were mediated through steroid hormone receptors, we used receptor antagonists to attempt to prevent the neuroprotective effects of hormones after partial motoneuron depletion. Motoneurons innervating the vastus medialis muscles of adult male rats were selectively killed by intramuscular injection of cholera toxin-conjugated saporin. Simultaneously, some saporin-injected rats were treated with either dihydrotestosterone or estradiol, alone or in combination with their respective receptor antagonists, or left untreated. Four weeks later, motoneurons innervating the ipsilateral vastus lateralis muscle were labeled with cholera toxin-conjugated horseradish peroxidase, and dendritic arbors were reconstructed in three dimensions. Compared with intact normal animals, partial motoneuron depletion resulted in decreased dendritic length in remaining quadriceps motoneurons. Dendritic atrophy was attenuated with both dihydrotestosterone and estradiol treatment to a degree similar to that seen with testosterone, and attenuation of atrophy was prevented by receptor blockade. Together, these findings suggest that neuroprotective effects on motoneurons can be mediated by either androgenic or estrogenic hormones and require action via steroid hormone receptors, further supporting a role for hormones as neurotherapeutic agents in the injured nervous system. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 691-707, 2017.
Collapse
Affiliation(s)
- Yi Cai
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| | - Cory Chew
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| | - Fernando Muñoz
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| | - Dale R Sengelaub
- Program in Neuroscience and Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405
| |
Collapse
|
19
|
Jones ZB, Ren Y. Sphingolipids in spinal cord injury. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2016; 8:52-69. [PMID: 27570580 PMCID: PMC4981650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Abstract
Spinal cord injury (SCI) is a debilitating condition that affects millions of individuals worldwide. Despite progress over the last few decades, the molecular mechanisms of secondary SCI that continue to occur days and weeks after the original trauma remain poorly understood. As a result, current therapies for SCI are only marginally effective. Sphingolipids, a diverse class of bioactive lipids, have been shown to regulate SCI repair and key secondary injury processes such as apoptosis, ischemia and inflammation. This review will discuss the numerous roles of sphingolipids and highlight the potential of sphingolipid-targeted therapies for SCI.
Collapse
Affiliation(s)
- Zachary B Jones
- Department of Biomedical Sciences, Florida State UniversityTallahassee, FL, USA
| | - Yi Ren
- Department of Biomedical Sciences, Florida State UniversityTallahassee, FL, USA
- Institute of Inflammation and Diseases, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| |
Collapse
|
20
|
Agarwal R, Thornton ME, Fonteh AN, Harrington MG, Chmait RH, Grubbs BH. Amniotic fluid levels of phospholipase A2 in fetal rats with retinoic acid induced myelomeningocele: the potential "second hit" in neurologic damage. J Matern Fetal Neonatal Med 2015; 29:3003-8. [PMID: 26513600 DOI: 10.3109/14767058.2015.1112373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES There is growing evidence of ongoing, in utero neurological damage in fetuses with myelomeningocele (MMC). Phospholipase A2 (PLA2) has known neurotoxic properties and is predominantly present in its secretory isoform (sPLA2) in meconium, the passage of which is increased in MMC fetuses. The objective of this study was to determine if amniotic fluid (AF) levels of PLA2 are elevated in a rat model of MMC. METHODS Timed pregnant Sprague-Dawley rats were gavage fed 60 mg/kg/bodyweight retinoic acid (RA) in olive oil at embryonic day 10 (E10). Amniocentesis was performed at multiple gestational time points on MMC fetuses, RA-exposed fetuses without MMC and control fetuses. AF PLA2 levels were analyzed by a fluorescent enzyme activity assay. PLA2 isoforms were determined by measuring activity in the presence of specific inhibitors. RESULTS There was no difference in AF PLA2 activity between groups on E15. PLA2 activity was significantly increased in MMC fetuses on E17, E19 and E21 (p < 0.001). Secretory PLA2 primarily accounted for the overall greater activity. CONCLUSIONS PLA2 levels are elevated in the AF of fetal rats with MMC and may contribute to ongoing neural injury. This pathway may be a useful drug target to limit ongoing damage and better preserve neurologic function.
Collapse
Affiliation(s)
- R Agarwal
- a Keck School of Medicine of the University of Southern California , Los Angeles , CA , USA
| | - M E Thornton
- b Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Los Angeles County-University of Southern California Medical Center , Los Angeles , CA , USA , and
| | - A N Fonteh
- c Molecular Neurology Program, Huntington Medical Research Institutes , Pasadena , CA , USA
| | - M G Harrington
- c Molecular Neurology Program, Huntington Medical Research Institutes , Pasadena , CA , USA
| | - R H Chmait
- b Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Los Angeles County-University of Southern California Medical Center , Los Angeles , CA , USA , and
| | - B H Grubbs
- b Division of Maternal-Fetal Medicine , Department of Obstetrics and Gynecology, Los Angeles County-University of Southern California Medical Center , Los Angeles , CA , USA , and
| |
Collapse
|
21
|
Bittner GD, Sengelaub DR, Trevino RC, Peduzzi JD, Mikesh M, Ghergherehchi CL, Schallert T, Thayer WP. The curious ability of polyethylene glycol fusion technologies to restore lost behaviors after nerve severance. J Neurosci Res 2015; 94:207-30. [PMID: 26525605 DOI: 10.1002/jnr.23685] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/17/2015] [Accepted: 10/12/2015] [Indexed: 01/09/2023]
Abstract
Traumatic injuries to PNS and CNS axons are not uncommon. Restoration of lost behaviors following severance of mammalian peripheral nerve axons (PNAs) relies on regeneration by slow outgrowths and is typically poor or nonexistent when after ablation or injuries close to the soma. Behavioral recovery after severing spinal tract axons (STAs) is poor because STAs do not naturally regenerate. Current techniques to enhance PNA and/or STA regeneration have had limited success and do not prevent the onset of Wallerian degeneration of severed distal segments. This Review describes the use of a recently developed polyethylene glycol (PEG) fusion technology combining concepts from biochemical engineering, cell biology, and clinical microsurgery. Within minutes after microsuturing carefully trimmed cut ends and applying a well-specified sequence of solutions, PEG-fused axons exhibit morphological continuity (assessed by intra-axonal dye diffusion) and electrophysiological continuity (assessed by conduction of action potentials) across the lesion site. Wallerian degeneration of PEG-fused PNAs is greatly reduced as measured by counts of sensory and/or motor axons and maintenance of axonal diameters and neuromuscular synapses. After PEG-fusion repair, cut-severed, crush-severed, or ablated PNAs or crush-severed STAs rapidly (within days to weeks), more completely, and permanently restore PNA- or STA-mediated behaviors compared with nontreated or conventionally treated animals. PEG-fusion success is enhanced or decreased by applying antioxidants or oxidants, trimming cut ends or stretching axons, and exposure to Ca(2+) -free or Ca(2+) -containing solutions, respectively. PEG-fusion technology employs surgical techniques and chemicals already used by clinicians and has the potential to produce a paradigm shift in the treatment of traumatic injuries to PNAs and STAs.
Collapse
Affiliation(s)
- G D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - D R Sengelaub
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - R C Trevino
- Department of Orthopedic Surgery, Wellspan Health, York, Pennsylvania
| | - J D Peduzzi
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, Michigan
| | - M Mikesh
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - C L Ghergherehchi
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - T Schallert
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - W P Thayer
- Department of Plastic Surgery, Vanderbilt School of Medicine, Nashville, Tennessee
| |
Collapse
|
22
|
Wang H, Liu NK, Zhang YP, Deng L, Lu QB, Shields CB, Walker MJ, Li J, Xu XM. Treadmill training induced lumbar motoneuron dendritic plasticity and behavior recovery in adult rats after a thoracic contusive spinal cord injury. Exp Neurol 2015; 271:368-78. [PMID: 26164199 DOI: 10.1016/j.expneurol.2015.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 07/01/2015] [Accepted: 07/04/2015] [Indexed: 12/17/2022]
Abstract
Spinal cord injury (SCI) is devastating, causing sensorimotor impairments and paralysis. Persisting functional limitations on physical activity negatively affect overall health in individuals with SCI. Physical training may improve motor function by affecting cellular and molecular responses of motor pathways in the central nervous system (CNS) after SCI. Although motoneurons form the final common path for motor output from the CNS, little is known concerning the effect of exercise training on spared motoneurons below the level of injury. Here we examined the effect of treadmill training on morphological, trophic, and synaptic changes in the lumbar motoneuron pool and on behavior recovery after a moderate contusive SCI inflicted at the 9th thoracic vertebral level (T9) using an Infinite Horizon (IH, 200 kDyne) impactor. We found that treadmill training significantly improved locomotor function, assessed by Basso-Beattie-Bresnahan (BBB) locomotor rating scale, and reduced foot drops, assessed by grid walking performance, as compared with non-training. Additionally, treadmill training significantly increased the total neurite length per lumbar motoneuron innervating the soleus and tibialis anterior muscles of the hindlimbs as compared to non-training. Moreover, treadmill training significantly increased the expression of a neurotrophin brain-derived neurotrophic factor (BDNF) in the lumbar motoneurons as compared to non-training. Finally, treadmill training significantly increased synaptic density, identified by synaptophysin immunoreactivity, in the lumbar motoneuron pool as compared to non-training. However, the density of serotonergic terminals in the same regions did not show a significant difference between treadmill training and non-training. Thus, our study provides a biological basis for exercise training as an effective medical practice to improve recovery after SCI. Such an effect may be mediated by synaptic plasticity, and neurotrophic modification in the spared lumbar motoneuron pool caudal to a thoracic contusive SCI.
Collapse
Affiliation(s)
- Hongxing Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, PR China; Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Nai-Kui Liu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States
| | - Lingxiao Deng
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Qing-Bo Lu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States
| | - Melissa J Walker
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Jianan Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, PR China.
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
| |
Collapse
|