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Barber SM, Wolfe T, Steele AG, Hoffman K, Hogan MK, Frazier A, Tang X, Sayenko DG, Horner PJ. A novel minimally invasive and versatile kyphoplasty balloon-based model of porcine spinal cord injury. Front Neurol 2024; 15:1422357. [PMID: 39087009 PMCID: PMC11289774 DOI: 10.3389/fneur.2024.1422357] [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: 04/24/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Spinal cord injury (SCI) animal models often utilize an open surgical laminectomy, which results in animal morbidity and also leads to changes in spinal canal diameter, spinal cord perfusion, cerebrospinal fluid flow dynamics, and spinal stability which may confound SCI research. Moreover, the use of open surgical laminectomy for injury creation lacks realism when considering human SCI scenarios. Methods We developed a novel, image-guided, minimally invasive, large animal model of SCI which utilizes a kyphoplasty balloon inserted into the epidural space via an interlaminar approach without the need for open surgery. Results The model was validated in 5 Yucatán pigs with imaging, neurofunctional, histologic, and electrophysiologic findings consistent with a mild compression injury. Discussion Few large animal models exist that have the potential to reproduce the mechanisms of spinal cord injury (SCI) commonly seen in humans, which in turn limits the relevance and applicability of SCI translational research. SCI research relies heavily on animal models, which typically involve an open surgical, dorsal laminectomy which is inherently invasive and may have untoward consequences on animal morbidity and spinal physiology that limit translational impact. We developed a minimally invasive, large animal model of spinal cord injury which utilizes a kyphoplasty balloon inserted percutaneously into the spinal epidural space. Balloon inflation results in a targeted, compressive spinal cord injury with histological and electrophysiological features directly relevant to human spinal cord injury cases without the need for invasive surgery. Balloon inflation pressure, length of time that balloon remains inflated, and speed of inflation may be modified to achieve variations in injury severity and subtype.
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Affiliation(s)
- Sean M. Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, United States
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Tatiana Wolfe
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
- University of Arkansas for Medical Sciences, Psychiatric Research Institute, Brain Imaging Research Center, Little Rock, AR, United States
| | - Alexander G. Steele
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Kris Hoffman
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Matthew K. Hogan
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Allison Frazier
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Xiufeng Tang
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Dimitry G. Sayenko
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Philip J. Horner
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
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Nielsen TGNDS, Dancause N, Janjua TAM, Andreis FR, Kjærgaard B, Jensen W. Porcine Model of Cerebral Ischemic Stroke Utilizing Intracortical Recordings for the Continuous Monitoring of the Ischemic Area. SENSORS (BASEL, SWITZERLAND) 2024; 24:2967. [PMID: 38793822 PMCID: PMC11124877 DOI: 10.3390/s24102967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE Our aim was to use intracortical recording to enable the tracking of ischemic infarct development over the first few critical hours of ischemia with a high time resolution in pigs. We employed electrophysiological measurements to obtain quick feedback on neural function, which might be useful for screening, e.g., for the optimal dosage and timing of agents prior to further pre-clinical evaluation. METHODS Micro-electrode arrays containing 16 (animal 1) or 32 electrodes (animal 2-7) were implanted in the primary somatosensory cortex of seven female pigs, and continuous electrical stimulation was applied at 0.2 Hz to a cuff electrode implanted on the ulnar nerve. Ischemic stroke was induced after 30 min of baseline recording by injection of endothelin-1 onto the cortex adjacent to the micro-electrode array. Evoked responses were extracted over a moving window of 180 s and averaged across channels as a measure of cortical excitability. RESULTS Across the animals, the cortical excitability was significantly reduced in all seven 30 min segments following endothelin-1 injection, as compared to the 30 min preceding this intervention. This difference was not explained by changes in the anesthesia, ventilation, end-tidal CO2, mean blood pressure, heart rate, blood oxygenation, or core temperature, which all remained stable throughout the experiment. CONCLUSIONS The animal model may assist in maturing neuroprotective approaches by testing them in an accessible model of resemblance to human neural and cardiovascular physiology and body size. This would constitute an intermediate step for translating positive results from rodent studies into human application, by more efficiently enabling effective optimization prior to chronic pre-clinical studies in large animals.
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Affiliation(s)
| | - Numa Dancause
- Département de Neurosciences, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada
| | - Taha Al Muhammadee Janjua
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
| | - Felipe Rettore Andreis
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
| | - Benedict Kjærgaard
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Winnie Jensen
- Bevica Center, Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260 Gistrup, Denmark
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Ahmed RU, Medina‐Aguinaga D, Adams S, Knibbe CA, Morgan M, Gibson D, Kim J, Sharma M, Chopra M, Davison S, Sherwood LC, Negahdar M, Bert R, Ugiliweneza B, Hubscher C, Budde MD, Xu J, Boakye M. Predictive values of spinal cord diffusion magnetic resonance imaging to characterize outcomes after contusion injury. Ann Clin Transl Neurol 2023; 10:1647-1661. [PMID: 37501362 PMCID: PMC10502634 DOI: 10.1002/acn3.51855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/21/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVES To explore filtered diffusion-weighted imaging (fDWI), in comparison with conventional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI), as a predictor for long-term locomotor and urodynamic (UD) outcomes in Yucatan minipig model of spinal cord injury (SCI). Additionally, electrical conductivity of neural tissue using D-waves above and below the injury was measured to assess correlations between fDWI and D-waves data. METHODS Eleven minipigs with contusion SCI at T8-T10 level underwent MRI at 3T 4 h. post-SCI. Parameters extracted from region of interest analysis included Daxial from fDWI at injury site, fractional anisotropy and radial diffusivity from DTI above the injury site along with measures of edema length and cord width at injury site from T2 -weighted images. Locomotor recovery was assessed pre- and weekly post-SCI through porcine thoracic injury behavior scale (PTIBS) and UD were performed pre- and at 12 weeks of SCI. D-waves latency and amplitude differences were recorded before and immediately after SCI. RESULTS Two groups of pigs were found based on the PTIBS at week 12 (p < 0.0001) post-SCI and were labeled "poor" and "good" recovery. D-waves amplitude decreased below injury and increased above injury. UD outcomes pre/post SCI changed significantly. Conventional MRI metrics from T2 -weighted images were significantly correlated with diffusion MRI metrics. Daxial at injury epicenter was diminished by over 50% shortly after SCI, and it differentiated between good and poor locomotor recovery and UD outcomes. INTERPRETATION Similar to small animal studies, fDWI from acute imaging after SCI is a promising predictor for functional outcomes in large animals.
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Affiliation(s)
- Rakib Uddin Ahmed
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Daniel Medina‐Aguinaga
- Department of Anatomical Sciences and NeurobiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Shawns Adams
- Department of NeurosurgeryDuke UniversityRaleighNorth CarolinaUSA
| | - Chase A. Knibbe
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Monique Morgan
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Destiny Gibson
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Joo‐won Kim
- Department of RadiologyBaylor College of MedicineHoustonTexasUSA
- Department of PsychiatryBaylor College of MedicineHoustonTexasUSA
| | - Mayur Sharma
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Manpreet Chopra
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Steven Davison
- Comparative Medicine Research UnitUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Leslie C. Sherwood
- Comparative Medicine Research UnitUniversity of LouisvilleLouisvilleKentuckyUSA
| | - M.J. Negahdar
- Department of RadiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Robert Bert
- Department of RadiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Charles Hubscher
- Department of Anatomical Sciences and NeurobiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Matthew D. Budde
- Department of NeurosurgeryMedical College of WisconsinMilwaukeeWisconsinUSA
- Clement J. Zablocki Veterans Affairs Medical CenterMilwaukeeWisconsinUSA
| | - Junqian Xu
- Department of RadiologyBaylor College of MedicineHoustonTexasUSA
- Department of PsychiatryBaylor College of MedicineHoustonTexasUSA
| | - Maxwell Boakye
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research CenterUniversity of LouisvilleLouisvilleKentuckyUSA
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Hilgart DR, Iversen MM, Peters AY, Zabriskie MS, Hoareau GL, Vapniarsky N, Clark GA, Shah LM, Rieke V. Non-invasive central nervous system assessment of a porcine model of neuropathic pain demonstrates increased latency of somatosensory-evoked potentials. J Neurosci Methods 2023; 396:109934. [PMID: 37524248 PMCID: PMC10530261 DOI: 10.1016/j.jneumeth.2023.109934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/01/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The study of chronic pain and its treatments requires a robust animal model with objective and quantifiable metrics. Porcine neuropathic pain models have been assessed with peripheral pain recordings and behavioral responses, but thus far central nervous system electrophysiology has not been investigated. This work aimed to record non-invasive, somatosensory-evoked potentials (SEPs) via electroencephalography in order to quantitatively assess chronic neuropathic pain induced in a porcine model. NEW METHOD Peripheral neuritis trauma (PNT) was induced unilaterally in the common peroneal nerve of domestic farm pigs, with the contralateral leg serving as the control for each animal. SEPs were generated by stimulation of the peripheral nerves distal to the PNT and were recorded non-invasively using transcranial electroencephalography (EEG). The P30 wave of the SEP was analyzed for latency changes. RESULTS P30 SEPs were successfully recorded with non-invasive EEG. PNT resulted in significantly longer P30 SEP latencies (p < 0.01 [n = 8]) with a median latency increase of 14.3 [IQR 5.0 - 17.5] ms. Histological results confirmed perineural inflammatory response and nerve damage around the PNT nerves. COMPARISON WITH EXISTING METHOD(S) Control P30 SEPs were similar in latency and amplitude to those previously recorded invasively in healthy pigs. Non-invasive recordings have numerous advantages over invasive measures. CONCLUSIONS P30 SEP latency can serve as a quantifiable neurological measure that reflects central nervous system processing in a porcine model of chronic pain. Advancing the development of a porcine chronic pain model will facilitate the translation of experimental therapies into human clinical trials.
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Affiliation(s)
- David R Hilgart
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Marta M Iversen
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Angela Y Peters
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Matthew S Zabriskie
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Guillaume L Hoareau
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT, USA
| | - Natalia Vapniarsky
- Department of Pathology Microbiology and Immunology, University of California Davis, Davis, CA, USA
| | - Gregory A Clark
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Viola Rieke
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
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Ahmed RU, Knibbe CA, Wilkins F, Sherwood LC, Howland DR, Boakye M. Porcine spinal cord injury model for translational research across multiple functional systems. Exp Neurol 2023; 359:114267. [PMID: 36356636 DOI: 10.1016/j.expneurol.2022.114267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Animal models are necessary to identify pathological changes and help assess therapeutic outcomes following spinal cord injury (SCI). Small animal models offer value in research in terms of their easily managed size, minimal maintenance requirements, lower cost, well-characterized genomes, and ability to power research studies. However, despite these benefits, small animal models have neurologic and anatomical differences that may influence translation of results to humans and thus limiting the success of their use in preclinical studies as a direct pipeline to clinical studies. Large animal models, offer an attractive intermediary translation model that may be more successful in translating to the clinic for SCI research. This is largely due to their greater neurologic and anatomical similarities to humans. The physical characteristics of pig spinal cord, gut microbiome, metabolism, proportions of white to grey matter, bowel anatomy and function, and urinary system are strikingly similar and provide great insight into human SCI conditions. In this review, we address the variety of existing porcine injury models and their translational relevance, benefits, and drawbacks in modeling human systems and functions for neurophysiology, cardiovascular, gastrointestinal and urodynamic functions.
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Affiliation(s)
- Rakib Uddin Ahmed
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
| | - Chase A Knibbe
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Felicia Wilkins
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Leslie C Sherwood
- Comparative Medicine Research Unit, University of Louisville, Louisville, KY, USA
| | - Dena R Howland
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA; Robley Rex VA Medical Center, Louisville, KY 40202, USA
| | - Maxwell Boakye
- Department of Neurological Surgery and Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
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Hoareau GL, Peters A, Hilgart D, Iversen M, Clark G, Zabriskie M, Rieke V, Floyd C, Shah L. Feasibility of non-invasive recording of somatosensory evoked potential in pigs. Lab Anim Res 2022; 38:9. [PMID: 35331342 PMCID: PMC8943992 DOI: 10.1186/s42826-022-00118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-invasive measurement of somatosensory-evoked potentials (SEP) in a large animal model is important to translational cognitive research. We sought to develop a methodology for neurophysiological recording via a transcranial electroencephalography (EEG) cap under an effective sedative regimen with dexmedetomidine, midazolam, and butorphanol that will produce sedation instead of anesthesia while not compromising data quality. RESULTS Pigs received intramuscular dexmedetomidine, midazolam, and butorphanol for SEP assessment with peroneal nerve stimulation. Semi-quantitative sedation assessment was performed after the animal was sufficiently sedated and 30 min later, during the transcranial SEP recording. SEP data were analyzed with commercial software. Binary qualitative analysis of the recording was categorized by an experienced neurophysiologist. All four animals had adequate surface SEP recordings. Animals received 43 [21-47] mcg/kg of dexmedetomidine, 0.3 [0.2-0.3] mg/kg of midazolam, and 0.3 [0.3-0.3] mg/kg of butorphanol IM. All treatments resulted in moderate to deep sedation (Baseline median sedation score 11.5 [11-12]; median score at 30 min: 11.5 [10.5-12]). Heart rate (median [range]) (55 [49-71] beats per minute), respiratory rate (24 [21-30] breaths per minute), and hemoglobin oxygen saturation (99 [98-100]%) and body temperature (37.7 [37.4-37.9] °C) remained within clinically acceptable ranges. There were no undesirable recovery incidents. CONCLUSIONS In this pilot study, we demonstrate the feasibility of SEP recording via a transcranial EEG cap under an effective sedative regimen in pigs. Our approach will expand the use of a large animal model in neurotranslational research.
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Affiliation(s)
- Guillaume L Hoareau
- Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Angela Peters
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - David Hilgart
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Marta Iversen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Gregory Clark
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Matthew Zabriskie
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Viola Rieke
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Candace Floyd
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Lubdha Shah
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Palma M, Khoshnevis M, Lion M, Zenga C, Kefs S, Fallegger F, Schiavone G, Flandin IG, Lacour S, Yvert B. Chronic recording of cortical activity underlying vocalization in awake minipigs. J Neurosci Methods 2022; 366:109427. [PMID: 34852254 DOI: 10.1016/j.jneumeth.2021.109427] [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: 05/19/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Investigating brain dynamics underlying vocal production in animals is a powerful way to inform on the neural bases of human speech. In particular, brain networks underlying vocal production in non-human primates show striking similarities with the human speech production network. However, despite increasing findings also in birds and more recently in rodents, the extent to which the primate vocal cortical network model generalizes to other non-primate mammals remains unclear. Especially, no domestic species has yet been proposed to investigate vocal brain activity using electrophysiological approaches. NEW METHOD In the present study, we introduce a novel experimental paradigm to identify the cortical dynamics underlying vocal production in behaving minipigs. A key problem to chronically implant cortical probes in pigs is the presence and growth of frontal sinuses extending caudally to the parietal bone and preventing safe access to neural structures with conventional craniotomy in adult animals. RESULTS Here we first show that implantations of soft ECoG grids can be done safely using conventional craniotomy in minipigs younger than 5 months, a period when sinuses are not yet well developed. Using wireless recordings in behaving animals, we further show activation of the motor and premotor cortex around the onset of vocal production of grunts, the most common vocalization of pigs. CONCLUSION These results suggest that minipigs, which are very loquacious and social animals, can be a good experimental large animal model to study the cortical bases of vocal production.
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Affiliation(s)
- Marie Palma
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Mehrdad Khoshnevis
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Marie Lion
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Cyril Zenga
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Samy Kefs
- CHU Grenoble Alpes, Clinique Universitaire de Cancérologie-Radiothérapie, 38000 Grenoble, France
| | - Florian Fallegger
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory for Soft Bioelectronic Interfaces, Geneva, Switzerland
| | - Giuseppe Schiavone
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory for Soft Bioelectronic Interfaces, Geneva, Switzerland
| | - Isabelle Gabelle Flandin
- CHU Grenoble Alpes, Clinique Universitaire de Cancérologie-Radiothérapie, 38000 Grenoble, France
| | - Stéphanie Lacour
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory for Soft Bioelectronic Interfaces, Geneva, Switzerland
| | - Blaise Yvert
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.
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Noga BR, Guest JD. Combined neuromodulatory approaches in the central nervous system for treatment of spinal cord injury. Curr Opin Neurol 2021; 34:804-811. [PMID: 34593718 PMCID: PMC8595808 DOI: 10.1097/wco.0000000000000999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To report progress in neuromodulation following spinal cord injury (SCI) using combined brain and spinal neuromodulation.Neuromodulation refers to alterations in neuronal activity for therapeutic purposes. Beneficial effects are established in disease states such as Parkinson's Disease (PD), chronic pain, epilepsy, and SCI. The repertoire of neuromodulation and bioelectric medicine is rapidly expanding. After SCI, cohort studies have reported the benefits of epidural stimulation (ES) combined with training. Recently, we have explored combining ES with deep brain stimulation (DBS) to increase activation of descending motor systems to address limitations of ES in severe SCI. In this review, we describe the types of applied neuromodulation that could be combined in SCI to amplify efficacy to enable movement. These include ES, mesencephalic locomotor region (MLR) - DBS, noninvasive transcutaneous stimulation, transcranial magnetic stimulation, paired-pulse paradigms, and neuromodulatory drugs. We examine immediate and longer-term effects and what is known about: (1) induced neuroplastic changes, (2) potential safety concerns; (3) relevant outcome measures; (4) optimization of stimulation; (5) therapeutic limitations and prospects to overcome these. RECENT FINDINGS DBS of the mesencephalic locomotor region is emerging as a potential clinical target to amplify supraspinal command circuits for locomotion. SUMMARY Combinations of neuromodulatory methods may have additive value for restoration of function after spinal cord injury.
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Affiliation(s)
- Brian R Noga
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Del Cerro P, Rodríguez-De-Lope Á, Collazos-Castro JE. The Cortical Motor System in the Domestic Pig: Origin and Termination of the Corticospinal Tract and Cortico-Brainstem Projections. Front Neuroanat 2021; 15:748050. [PMID: 34790101 PMCID: PMC8591036 DOI: 10.3389/fnana.2021.748050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
The anatomy of the cortical motor system and its relationship to motor repertoire in artiodactyls is for the most part unknown. We studied the origin and termination of the corticospinal tract (CST) and cortico-brainstem projections in domestic pigs. Pyramidal neurons were retrogradely labeled by injecting aminostilbamidine in the spinal segment C1. After identifying the dual origin of the porcine CST in the primary motor cortex (M1) and premotor cortex (PM), the axons descending from those regions to the spinal cord and brainstem were anterogradely labeled by unilateral injections of dextran alexa-594 in M1 and dextran alexa-488 in PM. Numerous corticospinal projections from M1 and PM were detected up to T6 spinal segment and showed a similar pattern of decussation and distribution in the white matter funiculi and the gray matter laminae. They terminated mostly on dendrites of the lateral intermediate laminae and the internal basilar nucleus, and some innervated the ventromedial laminae, but were essentially absent in lateral laminae IX. Corticofugal axons terminated predominantly ipsilaterally in the midbrain and bilaterally in the medulla oblongata. Most corticorubral projections arose from M1, whereas the mesencephalic reticular formation, superior colliculus, lateral reticular nucleus, gigantocellular reticular nucleus, and raphe received abundant axonal contacts from both M1 and PM. Our data suggest that the porcine cortical motor system has some common features with that of primates and humans and may control posture and movement through parallel motor descending pathways. However, less cortical regions project to the spinal cord in pigs, and the CST neither seems to reach the lumbar enlargement nor to have a significant direct innervation of cervical, foreleg motoneurons.
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Affiliation(s)
- Patricia Del Cerro
- Neural Repair and Biomaterials Laboratory, Hospital Nacional de Parapléjicos, Toledo, Spain.,Ph.D. Program in Neuroscience, Autonoma de Madrid University, Madrid, Spain
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Invasive and Non-Invasive Approaches of Electrical Stimulation to Improve Physical Functioning after Spinal Cord Injury. J Clin Med 2021; 10:jcm10225356. [PMID: 34830637 PMCID: PMC8625266 DOI: 10.3390/jcm10225356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/13/2022] Open
Abstract
This review of literature provides the latest evidence involving invasive and non-invasive uses of electrical stimulation therapies that assist in restoring functional abilities and the enhancement of quality of life in those with spinal cord injuries. The review includes neuromuscular electrical stimulation and functional electrical stimulation activities that promote improved body composition changes and increased muscular strength, which have been shown to improve abilities in activities of daily living. Recommendations for optimizing electrical stimulation parameters are also reported. Electrical stimulation is also used to enhance the skills of reaching, grasping, standing, and walking, among other activities of daily living. Additionally, we report on the use of invasive and non-invasive neuromodulation techniques targeting improved mobility, including standing, postural control, and assisted walking. We attempt to summarize the effects of epidural stimulation on cardiovascular performance and provide a mechanistic explanation to the current research findings. Future trends such as the combination of epidural stimulation and exoskeletal-assisted walking are also discussed.
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Züchner M, Escalona MJ, Teige LH, Balafas E, Zhang L, Kostomitsopoulos N, Boulland JL. How to generate graded spinal cord injuries in swine - tools and procedures. Dis Model Mech 2021; 14:dmm049053. [PMID: 34464444 PMCID: PMC8419714 DOI: 10.1242/dmm.049053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
Spinal cord injury (SCI) is a medically, psychologically and socially disabling condition. A large body of our knowledge on the basic mechanisms of SCI has been gathered in rodents. For preclinical validation of promising therapies, the use of animal models that are closer to humans has several advantages. This has promoted the more-intensive development of large-animal models for SCI during the past decade. We recently developed a multimodal SCI apparatus for large animals that generated biomechanically reproducible impacts in vivo. It is composed of a spring-load impactor and support systems for the spinal cord and the vertebral column. We now present the functional outcome of farm pigs and minipigs injured with different lesion strengths. There was a correlation between the biomechanical characteristics of the impact, the functional outcome and the tissue damage observed several weeks after injury. We also provide a detailed description of the procedure to generate such a SCI in both farm pigs and minipigs, in the hope to ease the adoption of the swine model by other research groups.
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Affiliation(s)
- Mark Züchner
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Manuel J. Escalona
- Department for Immunology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Lena Hammerlund Teige
- Department for Immunology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Evangelos Balafas
- Center of Clinical Experimental Surgery and Translational Research, Biomedical Research Foundation of Academy of Athens, 11527 Athens, Greece
| | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
| | - Nikolaos Kostomitsopoulos
- Center of Clinical Experimental Surgery and Translational Research, Biomedical Research Foundation of Academy of Athens, 11527 Athens, Greece
| | - Jean-Luc Boulland
- Department for Immunology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
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12
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Cerro PD, Barriga-Martín A, Vara H, Romero-Muñoz LM, Rodríguez-De-Lope Á, Collazos-Castro JE. Neuropathological and Motor Impairments after Incomplete Cervical Spinal Cord Injury in Pigs. J Neurotrauma 2021; 38:2956-2977. [PMID: 34121450 DOI: 10.1089/neu.2020.7587] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Humans, primates, and rodents with cervical spinal cord injury (SCI) show permanent sensorimotor dysfunction of the upper/forelimb as consequence of axonal damage and local neuronal death. This work aimed at characterizing a model of cervical SCI in domestic pigs in which hemisection with excision of 1 cm of spinal cord was performed to reproduce the loss of neural tissue observed in human neuropathology. Posture and motor control were assessed over 3 months by scales and kinematics of treadmill locomotion. Histological measurements included lesion length, atrophy of the adjacent spinal cord segments, and neuronal death. In some animals, the retrograde neural tracer aminostilbamidine was injected in segments caudal to the lesion to visualize propriospinal projection neurons. Neuronal loss extended for 4-6 mm from the lesion borders and was more severe in the ipsilateral, caudal spinal cord stump. Axonal Wallerian degeneration was observed caudally and rostrally, associated with marked atrophy of the white matter in the spinal cord segments adjacent to the lesion. The pigs showed chronic monoplegia or severe monoparesis of the foreleg ipsilateral to the lesion, whereas the trunk and the other legs had postural and motor impairments that substantially improved during the first month post-lesion. Adaptations of the walking cycle such as those reported for rats and humans ameliorated the negative impact of focal neurological deficits on locomotor performance. These results provide a baseline of behavior and histology in a porcine model of cervical spinal cord hemisection that can be used for translational research in SCI therapeutics.
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Affiliation(s)
- Patricia Del Cerro
- Neural Repair Laboratory, Hospital Nacional de Parapléjicos, Toledo, Spain.,Program in Neuroscience, Autonoma de Madrid University, Madrid, Spain
| | - Andrés Barriga-Martín
- Orthopedic Surgery and Traumatology, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Hugo Vara
- Neural Repair Laboratory, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Luis M Romero-Muñoz
- Orthopedic Surgery and Traumatology, Hospital Nacional de Parapléjicos, Toledo, Spain
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13
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Asimakidou E, Abut PA, Raabe A, Seidel K. Motor Evoked Potential Warning Criteria in Supratentorial Surgery: A Scoping Review. Cancers (Basel) 2021; 13:2803. [PMID: 34199853 PMCID: PMC8200078 DOI: 10.3390/cancers13112803] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/31/2022] Open
Abstract
During intraoperative monitoring of motor evoked potentials (MEP), heterogeneity across studies in terms of study populations, intraoperative settings, applied warning criteria, and outcome reporting exists. A scoping review of MEP warning criteria in supratentorial surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sixty-eight studies fulfilled the eligibility criteria. The most commonly used alarm criteria were MEP signal loss, which was always a major warning sign, followed by amplitude reduction and threshold elevation. Irreversible MEP alterations were associated with a higher number of transient and persisting motor deficits compared with the reversible changes. In almost all studies, specificity and Negative Predictive Value (NPV) were high, while in most of them, sensitivity and Positive Predictive Value (PPV) were rather low or modest. Thus, the absence of an irreversible alteration may reassure the neurosurgeon that the patient will not suffer a motor deficit in the short-term and long-term follow-up. Further, MEPs perform well as surrogate markers, and reversible MEP deteriorations after successful intervention indicate motor function preservation postoperatively. However, in future studies, a consensus regarding the definitions of MEP alteration, critical duration of alterations, and outcome reporting should be determined.
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Affiliation(s)
- Evridiki Asimakidou
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Pablo Alvarez Abut
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
- Department of Neurosurgery, Clínica 25 de Mayo, 7600 Mar del Plata, Argentina
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
| | - Kathleen Seidel
- Department of Neurosurgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; (E.A.); (P.A.A.); (A.R.)
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14
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Santamaria AJ, Benavides FD, Saraiva PM, Anderson KD, Khan A, Levi AD, Dietrich WD, Guest JD. Neurophysiological Changes in the First Year After Cell Transplantation in Sub-acute Complete Paraplegia. Front Neurol 2021; 11:514181. [PMID: 33536992 PMCID: PMC7848788 DOI: 10.3389/fneur.2020.514181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Neurophysiological testing can provide quantitative information about motor, sensory, and autonomic system connectivity following spinal cord injury (SCI). The clinical examination may be insufficiently sensitive and specific to reveal evolving changes in neural circuits after severe injury. Neurophysiologic data may provide otherwise imperceptible circuit information that has rarely been acquired in biologics clinical trials in SCI. We reported a Phase 1 study of autologous purified Schwann cell suspension transplantation into the injury epicenter of participants with complete subacute thoracic SCI, observing no clinical improvements. Here, we report longitudinal electrophysiological assessments conducted during the trial. Six participants underwent neurophysiology screening pre-transplantation with three post-transplantation neurophysiological assessments, focused on the thoracoabdominal region and lower limbs, including MEPs, SSEPs, voluntarily triggered EMG, and changes in GSR. We found several notable signals not detectable by clinical exam. In all six participants, thoracoabdominal motor connectivity was detected below the clinically assigned neurological level defined by sensory preservation. Additionally, small voluntary activations of leg and foot muscles or positive lower extremity MEPs were detected in all participants. Voluntary EMG was most sensitive to detect leg motor function. The recorded MEP amplitudes and latencies indicated a more caudal thoracic level above which amplitude recovery over time was observed. In contrast, further below, amplitudes showed less improvement, and latencies were increased. Intercostal spasms observed with EMG may also indicate this thoracic “motor level.” Galvanic skin testing revealed autonomic dysfunction in the hands above the injury levels. As an open-label study, we can establish no clear link between these observations and cell transplantation. This neurophysiological characterization may be of value to detect therapeutic effects in future controlled studies.
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Affiliation(s)
- Andrea J Santamaria
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Francisco D Benavides
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Pedro M Saraiva
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Kimberly D Anderson
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Aisha Khan
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,Miller School of Medicine, The Interdisciplinary Stem Cell Institute, The University of Miami, Miami, FL, United States
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - James D Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
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15
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Mukhamedshina Y, Shulman I, Ogurcov S, Kostennikov A, Zakirova E, Akhmetzyanova E, Rogozhin A, Masgutova G, James V, Masgutov R, Lavrov I, Rizvanov A. Mesenchymal Stem Cell Therapy for Spinal Cord Contusion: A Comparative Study on Small and Large Animal Models. Biomolecules 2019; 9:E811. [PMID: 31805639 PMCID: PMC6995633 DOI: 10.3390/biom9120811] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/05/2019] [Accepted: 11/26/2019] [Indexed: 12/19/2022] Open
Abstract
Here, we provide a first comparative study of the therapeutic potential of allogeneic mesenchymal stem cells derived from bone marrow (BM-MSCs), adipose tissue (AD-MSCs), and dental pulp (DP-MSCs) embedded in fibrin matrix, in small (rat) and large (pig) spinal cord injury (SCI) models during subacute period of spinal contusion. Results of behavioral, electrophysiological, and histological assessment as well as immunohistochemistry and real-time polymerase chain reaction analysis suggest that application of AD-MSCs combined with a fibrin matrix within the subacute period in rats (2 weeks after injury), provides significantly higher post-traumatic regeneration compared to a similar application of BM-MSCs or DP-MSCs. Within the rat model, use of AD-MSCs resulted in a marked change in: (1) restoration of locomotor activity and conduction along spinal axons; (2) reduction of post-traumatic cavitation and enhancing tissue retention; and (3) modulation of microglial and astroglial activation. The effect of an autologous application of AD-MSCs during the subacute period after spinal contusion was also confirmed in pigs (6 weeks after injury). Effects included: (1) partial restoration of the somatosensory spinal pathways; (2) reduction of post-traumatic cavitation and enhancing tissue retention; and (3) modulation of astroglial activation in dorsal root entry zone. However, pigs only partially replicated the findings observed in rats. Together, these results indicate application of AD-MSCs embedded in fibrin matrix at the site of SCI during the subacute period can facilitate regeneration of nervous tissue in rats and pigs. These results, for the first time, provide robust support for the use of AD-MSC to treat subacute SCI.
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Affiliation(s)
- Yana Mukhamedshina
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
- Department of Histology, Cytology, and Embryology, Kazan State Medical University, 420012 Kazan, Russia
| | - Iliya Shulman
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
- Republic Clinical Hospital, 420138 Kazan, Russia
| | - Sergei Ogurcov
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
- Republic Clinical Hospital, 420138 Kazan, Russia
| | - Alexander Kostennikov
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
| | - Elena Zakirova
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
| | - Elvira Akhmetzyanova
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
| | - Alexander Rogozhin
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
- Department of Neurology, Kazan State Medical Academy–Branch Campus of the Federal State Budgetary Edicational Institution of Father Professional Education «Russian Medical Academy of Continuous Professional Education», 420012 Kazan, Russia
| | - Galina Masgutova
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
| | - Victoria James
- Division of Biomedical Science, School of Veterinary Medicine and Science, Faculty of Medicine and Health Sciences, University of Nottingham Biodiscovery Institute, University Park, Nottingham NG7 2RD, UK;
| | - Ruslan Masgutov
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
- Republic Clinical Hospital, 420138 Kazan, Russia
| | - Igor Lavrov
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Albert Rizvanov
- Clinical Research Center for Precision and Regenerative Medicine, Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia; (I.S.); (S.O.); (A.K.); (E.Z.); (E.A.); (A.R.); (G.M.); (R.M.); (I.L.); (A.R.)
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16
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Calvert JS, Manson GA, Grahn PJ, Sayenko DG. Preferential activation of spinal sensorimotor networks via lateralized transcutaneous spinal stimulation in neurologically intact humans. J Neurophysiol 2019; 122:2111-2118. [PMID: 31553681 DOI: 10.1152/jn.00454.2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcutaneous spinal stimulation (TSS), a noninvasive technique to modulate sensorimotor circuitry within the spinal cord, has been shown to enable a wide range of functions that were thought to be permanently impaired in humans with spinal cord injury. However, the extent to which TSS can be used to target specific mediolateral spinal cord circuitry remains undefined. We tested the hypothesis that TSS applied unilaterally to the skin ~2 cm lateral to the midline of the lumbosacral spine selectively activates ipsilateral spinal sensorimotor circuitry, resulting in ipsilateral activation of downstream lower extremity neuromusculature. TSS cathodes and anodes were positioned lateral from the midline of the spine in 15 healthy subjects while supine, and the timing of TSS pulses was synchronized to recordings of lower extremity muscle activity and force. At motor threshold, left and right TSS-evoked muscle activity was significantly higher in the ipsilateral leg compared with contralateral recordings from the same muscles. Similarly, we observed a significant increase in force production in the ipsilateral leg compared with the contralateral leg. Delivery of paired TSS pulses, during which an initial stimulus was applied to one side of the spinal cord and 50 ms later a second stimulus was applied to the contralateral side, revealed that ipsilateral leg muscle responses decreased following the initial stimulus, whereas contralateral muscle responses did not decrease, indicating side-specific activation of lateral spinal sensorimotor circuitry. Our results indicate TSS can selectively engage ipsilateral neuromusculature via lumbosacral sensorimotor networks responsible for lower extremity function in healthy humans.NEW & NOTEWORTHY We demonstrate the selectivity of transcutaneous spinal stimulation (TSS), which has been shown to enable function in humans with chronic paralysis. Specifically, we demonstrate that TSS applied to locations lateral to the spinal cord can selectively activate ipsilateral spinal sensorimotor networks. We quantified lumbosacral spinal network activity by recording lower extremity muscle electromyography and force. Our results suggest lumbosacral TSS engages side-specific spinal sensorimotor networks associated with ipsilateral lower extremity function in humans.
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Affiliation(s)
- Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Gerome A Manson
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - Peter J Grahn
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
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17
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Züchner M, Lervik A, Kondratskaya E, Bettembourg V, Zhang L, Haga HA, Boulland JL. Development of a Multimodal Apparatus to Generate Biomechanically Reproducible Spinal Cord Injuries in Large Animals. Front Neurol 2019; 10:223. [PMID: 30941086 PMCID: PMC6433700 DOI: 10.3389/fneur.2019.00223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/21/2019] [Indexed: 01/08/2023] Open
Abstract
Rodents are widespread animal models in spinal cord injury (SCI) research. They have contributed to obtaining important information. However, some treatments only tested in rodents did not prove efficient in clinical trials. This is probably a result of significant differences in the physiology, anatomy, and complexity between humans and rodents. To bridge this gap in a better way, a few research groups use pig models for SCI. Here we report the development of an apparatus to perform biomechanically reproducible SCI in large animals, including pigs. We present the iterative process of engineering, starting with a weight-drop system to ultimately produce a spring-load impactor. This device allows a graded combination of a contusion and a compression injury. We further engineered a device to entrap the spinal cord and prevent it from escaping at the moment of the impact. In addition, it provides identical resistance around the cord, thereby, optimizing the inter-animal reproducibility. We also present other tools to straighten the vertebral column and to ease the surgery. Sensors mounted on the impactor provide information to assess the inter-animal reproducibility of the impacts. Further evaluation of the injury strength using neurophysiological recordings, MRI scans, and histology shows consistency between impacts. We conclude that this apparatus provides biomechanically reproducible spinal cord injuries in pigs.
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Affiliation(s)
- Mark Züchner
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Norwegian Center for Stem Cell Research, Oslo University Hospital, Oslo, Norway
| | - Andreas Lervik
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Elena Kondratskaya
- Norwegian Center for Stem Cell Research, Oslo University Hospital, Oslo, Norway
| | - Vanessa Bettembourg
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Henning A Haga
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Jean-Luc Boulland
- Norwegian Center for Stem Cell Research, Oslo University Hospital, Oslo, Norway
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18
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Toossi A, Everaert DG, Uwiera RRE, Hu DS, Robinson K, Gragasin FS, Mushahwar VK. Effect of anesthesia on motor responses evoked by spinal neural prostheses during intraoperative procedures. J Neural Eng 2019; 16:036003. [PMID: 30790787 DOI: 10.1088/1741-2552/ab0938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The overall goal of this study was to investigate the effects of various anesthetic protocols on the intraoperative responses to intraspinal microstimulation (ISMS). ISMS is a neuroprosthetic approach that targets the motor networks in the ventral horns of the spinal cord to restore function after spinal cord injury. In preclinical studies, ISMS in the lumbosacral enlargement produced standing and walking by activating networks controlling the hindlimb muscles. ISMS implants are placed surgically under anesthesia, and refinements in placement are made based on the evoked responses. Anesthesia can have a significant effect on the responses evoked by spinal neuroprostheses; therefore, in preparation for clinical testing of ISMS, we compared the evoked responses under a common clinical neurosurgical anesthetic protocol with those evoked under protocols commonly used in preclinical studies. APPROACH Experiments were conducted in seven pigs. An ISMS microelectrode array was implanted in the lumbar enlargement and responses to ISMS were measured under three anesthetic protocols: (1) isoflurane, an agent used pre-clinically and clinically, (2) total intravenous anesthesia (TIVA) with propofol as the main agent commonly used in clinical neurosurgical procedures, (3) TIVA with sodium pentobarbital, an anesthetic agent used mostly preclinically. Responses to ISMS were evaluated based on stimulation thresholds, movement kinematics, and joint torques. Motor evoked potentials (MEP) and plasma concentrations of propofol were also measured. MAIN RESULTS ISMS under propofol anesthesia produced large and functional responses that were not statistically different from those produced under pentobarbital anesthesia. Isoflurane, however, significantly suppressed the ISMS-evoked responses. SIGNIFICANCE This study demonstrated that the choice of anesthesia is critical for intraoperative assessments of motor responses evoked by spinal neuroprostheses. Propofol and pentobarbital anesthesia did not overly suppress the effects of ISMS; therefore, propofol is expected to be a suitable anesthetic agent for clinical intraoperative testing of an intraspinal neuroprosthetic system.
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Affiliation(s)
- Amirali Toossi
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada. Sensory Motor Adaptive Rehabilitative Technology (SMART) Network, University of Alberta, Edmonton, AB, Canada
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19
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Guest JD, Moore SW, Aimetti AA, Kutikov AB, Santamaria AJ, Hofstetter CP, Ropper AE, Theodore N, Ulich TR, Layer RT. Internal decompression of the acutely contused spinal cord: Differential effects of irrigation only versus biodegradable scaffold implantation. Biomaterials 2018; 185:284-300. [DOI: 10.1016/j.biomaterials.2018.09.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/04/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
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20
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Somatosensory and transcranial motor evoked potential monitoring in a porcine model for experimental procedures. PLoS One 2018; 13:e0205410. [PMID: 30296297 PMCID: PMC6175523 DOI: 10.1371/journal.pone.0205410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
Evoked potential monitoring has evolved as an essential tool not only for elaborate neurological diagnostics, but also for general clinical practice. Moreover, it is increasingly used to guide surgical procedures and prognosticate neurological outcome in the critical care unit, e.g. after cardiac arrest. Experimental animal models aim to simulate a human-like scenario to deduct relevant clinical information for patient treatment and to test novel therapeutic opportunities. Porcine models are particularly ideal due to a comparable cardiovascular system and size. However, certain anatomic disparities have to be taken into consideration when evoked potential monitoring is used in animal models. We describe a non-invasive and reproducible set-up useful for different modalities in porcine models. We further illustrate hints to overcome multi-faceted problems commonly occurring while using this sophisticated technique. Our descriptions can be used to answer a plethora of experimental questions, and help to further facilitate experimental therapeutic innovation.
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21
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Islamov RR, Sokolov ME, Bashirov FV, Fadeev FO, Shmarov MM, Naroditskiy BS, Povysheva TV, Shaymardanova GF, Yakupov RA, Chelyshev YA, Lavrov IA. A pilot study of cell-mediated gene therapy for spinal cord injury in mini pigs. Neurosci Lett 2017; 644:67-75. [PMID: 28213069 DOI: 10.1016/j.neulet.2017.02.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/24/2016] [Accepted: 02/12/2017] [Indexed: 11/26/2022]
Abstract
Currently, in clinical practice there is no efficient way to overcome the sequences of neurodegeneration after spinal cord traumatic injury. Using a new experimental model of spinal cord contusion injury on miniature pigs, we proposed to deliver therapeutic genes encoding vascular endothelial growth factor (VEGF), glial cell line-derived neurotrophic factor (GDNF) and neural cell adhesion molecule (NCAM) to the damaged area, using umbilical cord blood mononuclear cells (UCBC). In this study, genetically engineered UCBC (2×106 cells in 200 ml of saline) were injected intrathecally to mini-pigs 10days after SCI. Control and experimental mini pigs were observed for 60days after surgery. Histological, electrophysiological, and clinical evaluation demonstrated significant improvement in animal treated with genetically engineered UCBCs. Difference in recovery of the somatosensory evoked potentials and in histological findings in control and treated animals support the positive effect of the gene-cell constriction for recovery after spinal cord injury. Results of this study suggest that transplantation of UCBCs simultaneously transduced with three recombinant adenoviruses Ad5-VEGF, Ad5-GDNF and Ad5-NCAM represent a novel potentially successful approach for treatment of spinal cord injury.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Igor Aleksandrovich Lavrov
- Kazan Federal University, Kazan, Russia; Departments of Neurologic Surgery and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States.
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