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Al-Nashash H, Wong KL, ALL AH. Hypothermia effects on neuronal plasticity post spinal cord injury. PLoS One 2024; 19:e0301430. [PMID: 38578715 PMCID: PMC10997101 DOI: 10.1371/journal.pone.0301430] [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: 12/26/2023] [Accepted: 03/15/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND SCI is a time-sensitive debilitating neurological condition without treatment options. Although the central nervous system is not programmed for effective endogenous repairs or regeneration, neuroplasticity partially compensates for the dysfunction consequences of SCI. OBJECTIVE AND HYPOTHESIS The purpose of our study is to investigate whether early induction of hypothermia impacts neuronal tissue compensatory mechanisms. Our hypothesis is that although neuroplasticity happens within the neuropathways, both above (forelimbs) and below (hindlimbs) the site of spinal cord injury (SCI), hypothermia further influences the upper limbs' SSEP signals, even when the SCI is mid-thoracic. STUDY DESIGN A total of 30 male and female adult rats are randomly assigned to four groups (n = 7): sham group, control group undergoing only laminectomy, injury group with normothermia (37°C), and injury group with hypothermia (32°C +/-0.5°C). METHODS The NYU-Impactor is used to induce mid-thoracic (T8) moderate (12.5 mm) midline contusive injury in rats. Somatosensory evoked potential (SSEP) is an objective and non-invasive procedure to assess the functionality of selective neuropathways. SSEP monitoring of baseline, and on days 4 and 7 post-SCI are performed. RESULTS Statistical analysis shows that there are significant differences between the SSEP signal amplitudes recorded when stimulating either forelimb in the group of rats with normothermia compared to the rats treated with 2h of hypothermia on day 4 (left forelimb, p = 0.0417 and right forelimb, p = 0.0012) and on day 7 (left forelimb, p = 0.0332 and right forelimb, p = 0.0133) post-SCI. CONCLUSION Our results show that the forelimbs SSEP signals from the two groups of injuries with and without hypothermia have statistically significant differences on days 4 and 7. This indicates the neuroprotective effect of early hypothermia and its influences on stimulating further the neuroplasticity within the upper limbs neural network post-SCI. Timely detection of neuroplasticity and identifying the endogenous and exogenous factors have clinical applications in planning a more effective rehabilitation and functional electrical stimulation (FES) interventions in SCI patients.
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Affiliation(s)
- Hasan Al-Nashash
- Department of Electrical Engineering, College of Engineering, American University of Sharjah, Sharjah, United Arab Emirates
| | - Ka-Leung Wong
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
| | - Angelo H. ALL
- Department of Chemistry, Faculty of Science, Hong Kong Baptist University, Hong Kong, China
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Patel SP, Michael FM, Arif Khan M, Duggan B, Wyse S, Darby DR, Chaudhuri K, Pham JT, Gollihue J, DeRouchey JE, Sullivan PG, Dziubla TD, Rabchevsky AG. Erodible thermogelling hydrogels for localized mitochondrial transplantation to the spinal cord. Mitochondrion 2022; 64:145-155. [DOI: 10.1016/j.mito.2022.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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Marzoog BA. Systemic and Local Hypothermia in the Context of Cell Regeneration. CRYOLETTERS 2022; 43:66-73. [PMID: 36626147 DOI: 10.54680/fr22210110112] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2024]
Abstract
Local and systemic cooling is an inducer of cell proliferation. Cell proliferation and transdifferentiation or stem cells differentiation involves microenvironment regulation such as temperature. Mild hypothermia downregulates the production of pro-inflammatory cytokines and reduces the immune response against pathogens. In addition, mild tissue cooling improves endothelial cell function. Endothelial cells are involved in angiogenesis during regeneration strategies; therefore, their death is catastrophic and affects regeneration, but not cell proliferation. The potential mechanism underlying the effects of local or systemic hypothermia on cell regeneration has not yet been elucidated. Hypothermia reduces the production of reactive oxygen species and organelle activity. Hypothermia therapeutic effects depends on the targeted organ, exposure duration, and hypothermia degree. Therefore, determining these factors may enhance the usage of hypothermia more effectively in regenerative medicine. The paper introduces the hypothermia role in paracrine/endocrine cell secretion, reception, and the immune state after local and systemic hypothermia application.
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Neuroprotective Role of Hypothermia in Acute Spinal Cord Injury. Biomedicines 2022; 10:biomedicines10010104. [PMID: 35052784 PMCID: PMC8773047 DOI: 10.3390/biomedicines10010104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Even nowadays, the question of whether hypothermia can genuinely be considered therapeutic care for patients with traumatic spinal cord injury (SCI) remains unanswered. Although the mechanisms of hypothermia action are yet to be fully explored, early hypothermia for patients suffering from acute SCI has already been implemented in clinical settings. This article discusses measures for inducing various forms of hypothermia and summarizes several hypotheses describing the likelihood of hypothermia mechanisms of action. We present our objective neuro-electrophysiological results and demonstrate that early hypothermia manifests neuroprotective effects mainly during the first- and second-month post-SCI, depending on the severity of the injury, time of intervening, duration, degree, and modality of inducing hypothermia. Nevertheless, eventually, its beneficial effects gradually but consistently diminish. In addition, we report potential complications and side effects for the administration of general hypothermia with a unique referment to the local hypothermia. We also provide evidence that instead of considering early hypothermia post-SCI a therapeutic approach, it is more a neuroprotective strategy in acute and sub-acute phases of SCI that mostly delay, but not entirely avoid, the natural history of the pathophysiological events. Indeed, the most crucial rationale for inducing early hypothermia is to halt these devastating inflammatory and apoptotic events as early and as much as possible. This, in turn, creates a larger time-window of opportunity for physicians to formulate and administer a well-designed personalized treatment for patients suffering from acute traumatic SCI.
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All AH, Al-Nashash H. Comparative analysis of functional assessment for contusion and transection models of spinal cord injury. Spinal Cord 2021; 59:1206-1209. [PMID: 34493803 DOI: 10.1038/s41393-021-00698-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Descriptive secondary analysis of two spinal cord injury (SCI) animal models. OBJECTIVES To compare the somatosensory evoked potential (SSEP) and motor behavioral (BBB) assessments of the two most used rodent SCI models (contusion and transection), to elucidate their functional similarity and differences over the acute phase of 3 weeks. SETTING Neuro-electrophysiology SSEP and motor behavioral BBB assessments are used to provide a comparative analysis of the functional changes among various severities of contusion and transection SCI. METHODS Adult male and female rats randomly grouped (n = 5) as following: mild (6.25 mm), moderate (12.5 mm), severe (25 mm), and very severe (50 mm) contusion as well as right T10 hemi-transection (RxI), left T8 and right T10 double hemi-transection (DxI), and T8 complete transection (CxI) injuries, plus the control group (laminectomy with no injury). Animal weight, body temperature, anesthesia, surgical procedures, electrophysiological SSEP monitoring, locomotion BBB scoring, and statistical analysis were identical among all animal groups. RESULTS Statistical analysis of the SSEP and BBB data from both contusion and transection injury models indicate significant differences (P < 0.05). The results also show remarkable similarity for the severe and very severe contusion injuries to the complete transection, the moderate contusion injury to the double hemi-transection, and the mild contusion injury to the T10 hemi-transection injury. CONCLUSION Although contusion and transection spinal cord injuries have two completely different pathophysiologies, their injury progress during acute phase follow a similar trend.
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Affiliation(s)
- Angelo H All
- Department of Chemistry, Faculty of Science, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
| | - Hasan Al-Nashash
- Department of Electrical Engineering, College of Engineering, American University of Sharjah, University City, Sharjah, UAE.
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All AH, Luo S, Liu X, Al-Nashash H. Effect of thoracic spinal cord injury on forelimb somatosensory evoked potential. Brain Res Bull 2021; 173:22-27. [PMID: 33991605 DOI: 10.1016/j.brainresbull.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
In this paper, we investigate the forelimbs somatosensory evoked potential (SSEP) signals, which are representative of the integrity of ascending sensory pathways and their stability as well as function, recorded from corresponding cortices, post thoracic spinal cord injury (SCI). We designed a series of distinctive transection SCI to investigate whether forelimbs SSEPs change after right T10 hemi-transection, T8 and T10 double hemi-transection and T8 complete transection in rat model of SCI. We used electrical stimuli to stimulate median nerves and recorded SSEPs from left and right somatosensory areas of both cortices. We monitored pre-injury baseline and verified changes in forelimbs SSEP signals on Days 4, 7, 14, and 21 post-injury. We previously characterized hindlimb SSEP changes for the abovementioned transection injuries. The focus of this article is to investigate the quality and quantity of changes that may occur in the forelimb somatosensory pathways post-thoracic transection SCI. It is important to test the stability of forelimb SSEPs following thoracic SCI because of their potential utility as a proxy baseline for the traumatic SCIs in clinical cases wherein there is no opportunity to gather baseline of the lower extremities. We observed that the forelimb SSEP amplitudes increased following thoracic SCI but gradually returned to the baseline. Despite changes found in the raw signals, statistical analysis found forelimb SSEP signals become stable relatively soon. In summary, though there are changes in value (with p > 0.05), they are not statistically significant. Therefore, the null hypothesis that the mean of the forelimb SSEP signals are the same across multiple days after injury onset cannot be rejected during the acute phase.
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Affiliation(s)
- Angelo H All
- Department of Chemistry, Faculty of Science, Hong Kong Baptist University, Room RRS844, Sir Run Run Shaw Building, Ho Sin Hang Campus, Hong Kong.
| | - Shiyu Luo
- Department of Biomedical Engineering, Johns Hopkins University, Traylor Building, 720 Rutland Ave., Baltimore, MD, 21205, USA.
| | - Xiaogang Liu
- Department of Chemistry, Faculty of Science, National University of Singapore, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore.
| | - Hasan Al-Nashash
- Department of Electrical Engineering, College of Engineering, American University of Sharjah, ESB-2018, Engineering Science Building, American University of Sharjah, University City, Sharjah, 26666, United Arab Emirates.
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Kafka J, Lukacova N, Sulla I, Maloveska M, Vikartovska Z, Cizkova D. Hypothermia in the course of acute traumatic spinal cord injury. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sun YJ, Zhang ZY, Fan B, Li GY. Neuroprotection by Therapeutic Hypothermia. Front Neurosci 2019; 13:586. [PMID: 31244597 PMCID: PMC6579927 DOI: 10.3389/fnins.2019.00586] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022] Open
Abstract
Hypothermia therapy is an old and important method of neuroprotection. Until now, many neurological diseases such as stroke, traumatic brain injury, intracranial pressure elevation, subarachnoid hemorrhage, spinal cord injury, hepatic encephalopathy, and neonatal peripartum encephalopathy have proven to be suppressed by therapeutic hypothermia. Beneficial effects of therapeutic hypothermia have also been discovered, and progress has been made toward improving the benefits of therapeutic hypothermia further through combination with other neuroprotective treatments and by probing the mechanism of hypothermia neuroprotection. In this review, we compare different hypothermia induction methods and provide a summarized account of the synergistic effect of hypothermia therapy with other neuroprotective treatments, along with an overview of hypothermia neuroprotection mechanisms and cold/hypothermia-induced proteins.
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Affiliation(s)
- Ying-Jian Sun
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Zi-Yuan Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Bin Fan
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Guang-Yu Li
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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Jorge A, Fish EJ, Dixon CE, Hamilton KD, Balzer J, Thirumala P. The Effect of Prophylactic Hypothermia on Neurophysiological and Functional Measures in the Setting of Iatrogenic Spinal Cord Impact Injury. World Neurosurg 2019; 129:e607-e613. [PMID: 31158549 DOI: 10.1016/j.wneu.2019.05.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Iatrogenic spinal cord injury (iSCI) during spinal corrective surgery can result in devastating complications, such as paraplegia or paraparesis. Perioperatively, iSCI often occurs as a direct injury during spinal cord instrumentation placement. Currently, treatment of iSCI remains limited to posttraumatic hypothermia, which has demonstrated some value in recent clinical trials. Here we report the outcomes of preinjury hypothermia initiated preprocedurally and maintained for a considerable time after iSCI. METHODS Twenty-six female Sprague-Dawley rats were assigned at random to either a normothermic group (36 °C) or a hypothermic group (32 °C) and then underwent a laminectomy procedure at the T8 level. Each group was further divided at random to receive a 200-kdyn force contusive spinal cord injury or a sham impact. Hypothermic rats were then rewarmed after 2 hours of hypothermic treatment. Behavioral scores, temperature profiles, weights, and somatosensory evoked potentials were obtained at baseline and at specified time points after the procedure. RESULTS The median survival was 42 days for the iSCI hypothermic group and 11 days for the iSCI normothermic group (hazard ratio, 3.82; 95% confidence interval, 1.52-9.57). The probability of survival was significantly higher in the iSCI hypothermic group compared with the iSCI normothermic group (χ2 = 4.18; P = 0.040). The hypothermic group exhibited a higher Basso, Beattie and Bresnahan (BBB) locomotor rating scale score (17 vs. 14; P < 0.01), lower normalized latencies (1.06 ± 0.16 seconds vs. 1.34 ± 0.17 seconds; P = 0.04), and higher peak-to-peak amplitudes (0.32 ± 0.10 μV vs. 0.12 ± 0.09 μV; P = 0.005). CONCLUSIONS The use of prophylactic hypothermia before iSCI was significantly associated with an increased survival rate, higher BBB scores, and improved neurophysiological measures.
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Affiliation(s)
- Ahmed Jorge
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Erika J Fish
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - C Edward Dixon
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kojo D Hamilton
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Balzer
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parthasarathy Thirumala
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Teh DBL, Chua SM, Prasad A, Kakkos I, Jiang W, Yue M, Liu X, All AH. Neuroprotective assessment of prolonged local hypothermia post contusive spinal cord injury in rodent model. Spine J 2018; 18:507-514. [PMID: 29074466 DOI: 10.1016/j.spinee.2017.10.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/26/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although general hypothermia is recognized as a clinically applicable neuroprotective intervention, acute moderate local hypothermia post contusive spinal cord injury (SCI) is being considered a more effective approach. Previously, we have investigated the feasibility and safety of inducing prolonged local hypothermia in the central nervous system of a rodent model. PURPOSE Here, we aimed to verify the efficacy and neuroprotective effects of 5 and 8 hours of local moderate hypothermia (30±0.5°C) induced 2 hours after moderate thoracic contusive SCI in rats. STUDY DESIGN Rats were induced with moderate SCI (12.5 mm) at its T8 section. Local hypothermia (30±0.5°C) was induced 2 hours after injury induction with an M-shaped copper tube with flow of cold water (12°C), from the T6 to the T10 region. Experiment groups were divided into 5-hour and 8-hour hypothermia treatment groups, respectively, whereas the normothermia control group underwent no hypothermia treatment. METHODS The neuroprotective effects were assessed through objective weekly somatosensory evoked potential (SSEP) and motor behavior (basso, beattie and bresnahan Basso, Beattie and Bresnahan (BBB) scoring) monitoring. Histology on spinal cord was performed until at the end of day 56. All authors declared no conflict of interest. This work was supported by the Singapore Institute for Neurotechnology Seed Fund (R-175-000-121-733), National University of Singapore, Ministry of Education, Tier 1 (R-172-000-414-112.). RESULTS Our results show significant SSEP amplitudes recovery in local hypothermia groups starting from day 14 post-injury onward for the 8-hour treatment group, which persisted up to days 28 and 42, whereas the 5-hour group showed significant improvement only at day 42. The functional improvement plateaued after day 42 as compared with control group of SCI with normothermia. This was supported by both 5-hour and 8-hour improvement in locomotion as measured by BBB scores. Local hypothermia also observed insignificant changes in its SSEP latency, as compared with the control. In addition, 5- and 8-hour hypothermia rats' spinal cord showed higher percentage of parenchyma preservation. CONCLUSIONS Early local moderate hypothermia can be induced for extended periods of time post SCI in the rodent model. Such intervention improves functional electrophysiological outcome and motor behavior recovery for a long time, lasting until 8 weeks.
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Affiliation(s)
- Daniel Boon Loong Teh
- Department of Medicine & Singapore Institute of Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Dr, 5-COR, Singapore 117456, Singapore
| | - Soo Min Chua
- Department of Medicine & Singapore Institute of Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Dr, 5-COR, Singapore 117456, Singapore
| | - Ankshita Prasad
- Department of Medicine & Singapore Institute of Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Dr, 5-COR, Singapore 117456, Singapore; Department of Biomedical Engineering, National University of Singapore, E4, 4 Engineering Dr 3, Singapore 117583, Singapore
| | - Ioannis Kakkos
- Department of Electrical and Computing Engineering, National Technical University of Athens, Zografos, 15773, Athens, Greece
| | - Wenxuan Jiang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Mu Yue
- Department of Statistics and Applied Probability, National University of Singapore, Level 7, Block S16,6 Science Dr 2, Singapore 117546, Singapore
| | - Xiaogang Liu
- Department of Chemistry, National University of Singapore, 3 Science Dr 3, Singapore 117543, Singapore
| | - Angelo Homayoun All
- Department of Medicine & Singapore Institute of Neurotechnology (SINAPSE), National University of Singapore, 28 Medical Dr, 5-COR, Singapore 117456, Singapore; Department of Biomedical Engineering and Department of Neurology, John Hopkins School of Medicine, 701C Rutland Ave 720, Baltimore, MD 21205, USA.
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Chen X, Li L, Hu J, Zhang C, Pan Y, Tian D, Tang Z. Anti-inflammatory effect of dexmedetomidine combined with hypothermia on acute respiratory distress syndrome in rats. J Surg Res 2017; 216:179-184. [PMID: 28807204 DOI: 10.1016/j.jss.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND To investigate the protective effect of combination of dexmedetomidine and hypothermia on lipopolysaccharide (LPS) induced acute respiratory distress syndrome in rats. METHODS Fifty male Wistar rats were randomly divided into five groups, with 10 rats in each group. The acute respiratory distress syndrome model was reproduced by LPS injected into the right external jugular vein (L group); only saline was injected into the right external jugular vein for control group (C group). In hypothermia group (T group), the body temperature was lowered to 32.5°C-33.0°C after 1 h of LPS injection, and 10 rats were sacrificed at 8 h. Group dexmedetomidine (D group) and dexmedetomidine combined with hypothermia group (DT group) received intraperitoneal dexmedetomidine 30 min before LPS was injected. The arterial blood gas was determined in all the groups before and 8 h after instillation of saline or LPS, and the oxygenation index (PaO2/FiO2) was calculated. The pro-inflammatory cytokines TNF-alpha (TNF-α) and interleukin- 6 (IL-6) levels were determined by enzyme-linked immunosorbent assay. The expression of inflammatory signaling proteins in bronchial alveolar lavage fluid was determined by Western blot. RESULTS Compared with group L, TNF-α and IL-6 levels in serum of rats were significantly lower (P < 0.05), the expression of toll-like receptors 4 and phosphorylated c-Jun N-terminal kinase was significantly lower (P < 0.05), and the p-Akt level was significantly higher (P < 0.05). Moreover, the dexmedetomidine combined with hypothermia treated was superior to the single method. CONCLUSIONS The combination of dexmedetomidine and hypothermia could alleviate acute lung injury in rats.
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Affiliation(s)
- Xianfeng Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Lili Li
- Department of Dermatology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, PR China
| | - Juntao Hu
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Chi Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Yiping Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Diansheng Tian
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China
| | - Zhanhong Tang
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, PR China.
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Martirosyan NL, Patel AA, Carotenuto A, Kalani MYS, Bohl MA, Preul MC, Theodore N. The role of therapeutic hypothermia in the management of acute spinal cord injury. Clin Neurol Neurosurg 2017; 154:79-88. [PMID: 28131967 DOI: 10.1016/j.clineuro.2017.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 12/18/2022]
Abstract
This review paper investigates the history, efficacy, and administration of systemic and local hypothermia for spinal cord injury (SCI). It summarizes the published experimental and clinical evidence on hypothermia for SCI and analyzes the potential for further research. Early experimental animal research showed that local hypothermia improved recovery and gain of function after acute SCI. However, in the early 1970s, clinical research findings did not coincide with results of these animal trials, which led to a loss of interest in local hypothermia. Since the 1980s, systemic hypothermia has been successfully used to treat SCI in both animals and humans. An abundance of positive evidence suggests that clinical trials are needed to determine the effectiveness of hypothermia for SCI. As a first step, we investigated the published clinical and experimental evidence on the use of hypothermia for SCI patients, who have few available treatment options. We searched PubMed for English-language reports published from 1940 to 2016 containing terms related to SCI treatment using hypothermia. We reviewed all articles on local hypothermia and acute SCI or on systemic hypothermia and acute SCI. Bibliographies of retrieved publications were also screened for additional citations. Ninety-six papers were selected. The clinical use of hypothermia is most successful if applied according to certain optimized parameters (e.g., duration, temperature, time from injury to initiation of cooling, and rewarming time). Preliminary data suggest that modest systemic hypothermia applied for 48h provides the best therapeutic value, but the parameters for use of local hypothermia vary greatly. Experimental evidence and some clinical evidence suggest that both local hypothermia and systemic hypothermia are beneficial for acute SCI. Future research should focus on defining the optimal levels of parameters. Large, multicenter, controlled clinical trials are needed to investigate its therapeutic potential.
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Affiliation(s)
- Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States; Division of Neurosurgery, University of Arizona, Tucson, AZ, United States
| | - Arpan A Patel
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | | | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States; Division of Neurosurgery, University of Arizona, Tucson, AZ, United States; College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.
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Abstract
Spinal cord injury (SCI) is a major health problem and is associated with a diversity of neurological symptoms. Pathophysiologically, dysfunction after SCI results from the culmination of tissue damage produced both by the primary insult and a range of secondary injury mechanisms. The application of hypothermia has been demonstrated to be neuroprotective after SCI in both experimental and human studies. The myriad of protective mechanisms of hypothermia include the slowing down of metabolism, decreasing free radical generation, inhibiting excitotoxicity and apoptosis, ameliorating inflammation, preserving the blood spinal cord barrier, inhibiting astrogliosis, promoting angiogenesis, as well as decreasing axonal damage and encouraging neurogenesis. Hypothermia has also been combined with other interventions, such as antioxidants, anesthetics, alkalinization and cell transplantation for additional benefit. Although a large body of work has reported on the effectiveness of hypothermia as a neuroprotective approach after SCI and its application has been translated to the clinic, a number of questions still remain regarding its use, including the identification of hypothermia's therapeutic window, optimal duration and the most appropriate rewarming rate. In addition, it is necessary to investigate the neuroprotective effect of combining therapeutic hypothermia with other treatment strategies for putative synergies, particularly those involving neurorepair.
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Affiliation(s)
- Jiaqiong Wang
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA.
| | - Damien D Pearse
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA.
- The Department of Neurological Surgery, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA.
- The Neuroscience Program, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA.
- The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA.
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Vipin A, Kortelainen J, Al-Nashash H, Chua SM, Thow X, Manivannan J, Astrid, Thakor NV, Kerr CL, All AH. Prolonged Local Hypothermia Has No Long-Term Adverse Effect on the Spinal Cord. Ther Hypothermia Temp Manag 2015; 5:152-62. [PMID: 26057714 DOI: 10.1089/ther.2015.0005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hypothermia is known to be neuroprotective and is one of the most effective and promising first-line treatments for central nervous system (CNS) trauma. At present, induction of local hypothermia, as opposed to general hypothermia, is more desired because of its ease of application and safety; fewer side effects and an absence of severe complications have been noted. Local hypothermia involves temperature reduction of a small and specific segment of the spinal cord. Our group has previously shown the neuroprotective effect of short-term, acute moderate general hypothermia through improvements in electrophysiological and motor behavioral assessments, as well as histological examination following contusive spinal cord injury (SCI) in rats. We have also shown the benefit of using short-term local hypothermia versus short-term general hypothermia post-acute SCI. The overall neuroprotective benefit of hypothermia can be categorized into three main components: (1) induction modality, general versus local, (2) invasive, semi-invasive or noninvasive, and (3) duration of hypothermia induction. In this study, a series of experiments were designed to investigate the feasibility, long-term safety, as well as eventual complications and side effects of prolonged, semi-invasive, moderate local hypothermia (30°C±0.5°C for 5 and 8 hours) in rats with uninjured spinal cord while maintaining their core temperature at 37°C±0.5°C. The weekly somatosensory evoked potential and motor behavioral (Basso, Beattie and Bresnahan) assessments of rats that underwent 5 and 8 hours of semi-invasive local hypothermia, which revealed no statistically significant changes in electrical conductivity and behavioral outcomes. In addition, 4 weeks after local hypothermia induction, histological examination showed no anatomical damages or morphological changes in their spinal cord structure and parenchyma. We concluded that this method of prolonged local hypothermia is feasible, safe, and has the potential for clinical translation.
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Affiliation(s)
- Ashwati Vipin
- 1 Singapore Institute for Neurotechnology, National University of Singapore , Singapore, Singapore
| | - Jukka Kortelainen
- 2 Biomedical Engineering Research Group, Department of Computer Science and Engineering, University of Oulu , Oulu, Finland
| | - Hasan Al-Nashash
- 3 Department of Electrical Engineering, American University of Sharjah , Sharjah, United Arab Emirates
| | - Soo Min Chua
- 1 Singapore Institute for Neurotechnology, National University of Singapore , Singapore, Singapore
| | - Xinyuan Thow
- 1 Singapore Institute for Neurotechnology, National University of Singapore , Singapore, Singapore
| | - Janani Manivannan
- 4 Department of Orthopedic Surgery, National University of Singapore , Singapore, Singapore
| | - Astrid
- 1 Singapore Institute for Neurotechnology, National University of Singapore , Singapore, Singapore
| | - Nitish V Thakor
- 1 Singapore Institute for Neurotechnology, National University of Singapore , Singapore, Singapore .,5 Department of Biomedical Engineering, Johns Hopkins School of Medicine , Baltimore, Maryland
| | - Candace L Kerr
- 6 Department of Biochemistry and Molecular Biology, University of Maryland , Baltimore, Maryland
| | - Angelo H All
- 1 Singapore Institute for Neurotechnology, National University of Singapore , Singapore, Singapore .,4 Department of Orthopedic Surgery, National University of Singapore , Singapore, Singapore .,5 Department of Biomedical Engineering, Johns Hopkins School of Medicine , Baltimore, Maryland.,7 Department of Biomedical Engineering, National University of Singapore , Singapore, Singapore .,8 Division of Neurology, Department of Medicine, National University of Singapore , Singapore, Singapore .,9 Department of Neurology, Johns Hopkins School of Medicine , Baltimore, Maryland
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15
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Wang D, Liang J, Zhang J, Liu S, Sun W. Mild hypothermia combined with a scaffold of NgR-silenced neural stem cells/Schwann cells to treat spinal cord injury. Neural Regen Res 2015; 9:2189-96. [PMID: 25657741 PMCID: PMC4316453 DOI: 10.4103/1673-5374.147952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/24/2022] Open
Abstract
Because the inhibition of Nogo proteins can promote neurite growth and nerve cell differentiation, a cell-scaffold complex seeded with Nogo receptor (NgR)-silenced neural stem cells and Schwann cells may be able to improve the microenvironment for spinal cord injury repair. Previous studies have found that mild hypothermia helps to attenuate secondary damage in the spinal cord and exerts a neuroprotective effect. Here, we constructed a cell-scaffold complex consisting of a poly(D,L-lactide-co-glycolic acid) (PLGA) scaffold seeded with NgR-silenced neural stem cells and Schwann cells, and determined the effects of mild hypothermia combined with the cell-scaffold complexes on the spinal cord hemi-transection injury in the T9 segment in rats. Compared with the PLGA group and the NgR-silencing cells + PLGA group, hindlimb motor function and nerve electrophysiological function were clearly improved, pathological changes in the injured spinal cord were attenuated, and the number of surviving cells and nerve fibers were increased in the group treated with the NgR-silenced cell scaffold + mild hypothermia at 34°C for 6 hours. Furthermore, fewer pathological changes to the injured spinal cord and more surviving cells and nerve fibers were found after mild hypothermia therapy than in injuries not treated with mild hypothermia. These experimental results indicate that mild hypothermia combined with NgR gene-silenced cells in a PLGA scaffold may be an effective therapy for treating spinal cord injury.
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Affiliation(s)
- Dong Wang
- Department of Neurosurgery, the Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Central Hospital, Tianjin, China
| | - Jinhua Liang
- Department of Clinical Detection, Hongqi Hospital of Mudanjiang Medical College, Mudanjiang, Heilongjiang Province, China
| | - Jianjun Zhang
- Department of Neurosurgery, the Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Central Hospital, Tianjin, China
| | - Shuhong Liu
- Department of Epidemiology, Logistics University of People's Armed Police Force, Tianjin, China
| | - Wenwen Sun
- Department of Neurosurgery, the Fourth Center Clinical College of Tianjin Medical University, Tianjin Fourth Central Hospital, Tianjin, China
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16
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All AH, Gharibani P, Gupta S, Bazley FA, Pashai N, Chou BK, Shah S, Resar LM, Cheng L, Gearhart JD, Kerr CL. Early intervention for spinal cord injury with human induced pluripotent stem cells oligodendrocyte progenitors. PLoS One 2015; 10:e0116933. [PMID: 25635918 PMCID: PMC4311989 DOI: 10.1371/journal.pone.0116933] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/16/2014] [Indexed: 12/16/2022] Open
Abstract
Induced pluripotent stem (iPS) cells are at the forefront of research in regenerative medicine and are envisaged as a source for personalized tissue repair and cell replacement therapy. Here, we demonstrate for the first time that oligodendrocyte progenitors (OPs) can be derived from iPS cells generated using either an episomal, non-integrating plasmid approach or standard integrating retroviruses that survive and differentiate into mature oligodendrocytes after early transplantation into the injured spinal cord. The efficiency of OP differentiation in all 3 lines tested ranged from 40% to 60% of total cells, comparable to those derived from human embryonic stem cells. iPS cell lines derived using episomal vectors or retroviruses generated a similar number of early neural progenitors and glial progenitors while the episomal plasmid-derived iPS line generated more OPs expressing late markers O1 and RIP. Moreover, we discovered that iPS-derived OPs (iPS-OPs) engrafted 24 hours following a moderate contusive spinal cord injury (SCI) in rats survived for approximately two months and that more than 70% of the transplanted cells differentiated into mature oligodendrocytes that expressed myelin associated proteins. Transplanted OPs resulted in a significant increase in the number of myelinated axons in animals that received a transplantation 24 h after injury. In addition, nearly a 5-fold reduction in cavity size and reduced glial scarring was seen in iPS-treated groups compared to the control group, which was injected with heat-killed iPS-OPs. Although further investigation is needed to understand the mechanisms involved, these results provide evidence that patient-specific, iPS-derived OPs can survive for three months and improve behavioral assessment (BBB) after acute transplantation into SCI. This is significant as determining the time in which stem cells are injected after SCI may influence their survival and differentiation capacity.
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Affiliation(s)
- Angelo H. All
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore
- Departments of Orthopedic Surgery, Biomedical Engineering and Medicine, Division of Neurology, National University of Singapore, Singapore, Singapore
| | - Payam Gharibani
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Siddharth Gupta
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Faith A. Bazley
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Singapore Institute for Neurotechnology, National University of Singapore, Singapore, Singapore
| | - Nikta Pashai
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Bin-Kuan Chou
- Graduate Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sandeep Shah
- Division of Hematology in Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Linda M. Resar
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Hematology in Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Linzhao Cheng
- Graduate Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Hematology in Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - John D. Gearhart
- Department of Cell and Developmental Biology in the School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Animal Biology in the School of Veterinary Medicine; University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Candace L. Kerr
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Biochemistry and Molecular Biology, Unversity of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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