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Zhao W, Jia Z, Bauman WA, Qin Y, Peng Y, Chen Z, Cardozo CP, Wang D, Qin W. Targeted-delivery of nanomedicine-enabled methylprednisolone to injured spinal cord promotes neuroprotection and functional recovery after acute spinal cord injury in rats. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2024; 60:102761. [PMID: 38871068 DOI: 10.1016/j.nano.2024.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
To date, no therapy has been proven to be efficacious in fully restoring neurological functions after spinal cord injury (SCI). Systemic high-dose methylprednisolone (MP) improves neurological recovery after acute SCI in both animal and human. MP therapy remains controversial due to its modest effect on functional recovery and significant adverse effects. To overcome the limitation of MP therapy, we have developed a N-(2-hydroxypropyl) methacrylamide copolymer-based MP prodrug nanomedicine (Nano-MP) that can selectively deliver MP to the SCI lesion when administered systemically in a rat model of acute SCI. Our in vivo data reveal that Nano-MP is significantly more effective than free MP in attenuating secondary injuries and neuronal apoptosis. Nano-MP is superior to free MP in improving functional recovery after acute SCI in rats. These data support Nano-MP as a promising neurotherapeutic candidate, which may provide potent neuroprotection and accelerate functional recovery with improved safety for patients with acute SCI.
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Affiliation(s)
- Wei Zhao
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zhenshan Jia
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - William A Bauman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA; Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yiwen Qin
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; GCM Grosvenor, New York, USA
| | - Yuanzhen Peng
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Zihao Chen
- Departments of Biotechnology, Brown University, Providence, RI, USA
| | - Christopher P Cardozo
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA; Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dong Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Weiping Qin
- Spinal Cord Damage Research Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
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Ji R, Hao Z, Wang H, Li X, Duan L, Guan F, Ma S. Application of Injectable Hydrogels as Delivery Systems in Spinal Cord Injury. Gels 2023; 9:907. [PMID: 37998998 PMCID: PMC10670785 DOI: 10.3390/gels9110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Spinal cord injury (SCI) is a severe neurological injury caused by traffic accidents, trauma, or falls, which leads to significant loss of sensory, motor, and autonomous functions and seriously affects the patient's life quality. Although considerable progress has been made in mitigating secondary injury and promoting the regeneration/repair of SCI, the therapeutic effects need to be improved due to drug availability. Given their good biocompatibility, biodegradability, and low immunogenicity, injectable hydrogels can be used as delivery systems to achieve controlled release of drugs and other substances (cells and proteins, etc.), offering new hope for SCI repair. In this article, we summarized the types of injectable hydrogels, analyzed their application as delivery systems in SCI, and further discussed the mechanisms of hydrogels in the treatment of SCI, such as anti-inflammatory, antioxidant, anti-apoptosis, and pro-neurogenesis. Moreover, we highlighted the potential benefits of hydrogels in the treatment of SCI in combination with therapies, including the recent advances and achievements of these promising tools. Our review may offer new strategies for the development of SCI treatments based on injectable hydrogels as delivery systems.
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Affiliation(s)
| | | | | | | | | | - Fangxia Guan
- School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China; (R.J.); (Z.H.); (H.W.); (X.L.); (L.D.)
| | - Shanshan Ma
- School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China; (R.J.); (Z.H.); (H.W.); (X.L.); (L.D.)
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Sadeghi-Naini M, Yousefifard M, Ghodsi Z, Azarhomayoun A, Kermanian F, Golpayegani M, Alizadeh SD, Hosseini M, Shokraneh F, Komlakh K, Vaccaro AR, Jiang F, Fehlings MG, Rahimi-Movaghar V. In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis. Acta Neurochir (Wien) 2023; 165:2675-2688. [PMID: 37480505 DOI: 10.1007/s00701-023-05720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. METHODS We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries). RESULTS Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028). CONCLUSION A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.
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Affiliation(s)
- Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kermanian
- Department of Anatomy, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Golpayegani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Danial Alizadeh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran
- Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shokraneh
- King's Technology Evaluation Centre (KiTEC), School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, London Institute of Healthcare Engineering, King's College London, London, UK
| | - Khalil Komlakh
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alexander R Vaccaro
- Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA
| | - Fan Jiang
- Department of Surgery and Spine Program, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Department of Surgery, University of Toronto, Toronto, Canada
- Krembil Brain Institute and McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
- Visiting Professor, Spine Program, University of Toronto, Toronto, Canada.
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, Tehran, 11365-3876, Iran.
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Lu D, Wu JP, Yang QW, Wang HY, Yang JJ, Zhang GG, Wang C, Yang YL, Zhu L, Sun XZ. Recent advances in lipid nanovesicles for targeted treatment of spinal cord injury. Front Bioeng Biotechnol 2023; 11:1261288. [PMID: 37691909 PMCID: PMC10486273 DOI: 10.3389/fbioe.2023.1261288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
The effective regeneration and functional restoration of damaged spinal cord tissue have been a long-standing concern in regenerative medicine. Treatment of spinal cord injury (SCI) is challenging due to the obstruction of the blood-spinal cord barrier (BSCB), the lack of targeting of drugs, and the complex pathophysiology of injury sites. Lipid nanovesicles, including cell-derived nanovesicles and synthetic lipid nanovesicles, are highly biocompatible and can penetrate BSCB, and are therefore effective delivery systems for targeted treatment of SCI. We summarize the progress of lipid nanovesicles for the targeted treatment of SCI, discuss their advantages and challenges, and provide a perspective on the application of lipid nanovesicles for SCI treatment. Although most of the lipid nanovesicle-based therapy of SCI is still in preclinical studies, this low immunogenicity, low toxicity, and highly engineerable nanovesicles will hold great promise for future spinal cord injury treatments.
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Affiliation(s)
- Di Lu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nano-science and Technology, Beijing, China
| | - Jiu-Ping Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi-Wei Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nano-science and Technology, Beijing, China
| | - Hua-Yi Wang
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nano-science and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jun-Jie Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang-Gang Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen Wang
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nano-science and Technology, Beijing, China
- CAS Key Laboratory of Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing, China
| | - Yan-Lian Yang
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nano-science and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Ling Zhu
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nano-science and Technology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xin-Zhi Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Onder C, Onder C, Akesen S, Yumusak E, Akesen B. Riluzole is Effective on Spinal Decompression for Treating Acute Spinal Injury When Compared With Methylprednisolone and the Combination of Two Drugs: In Vivo Rat Model. Global Spine J 2023:21925682231159068. [PMID: 36812057 DOI: 10.1177/21925682231159068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
STUDY DESIGN Randomized controlled animal experiment. OBJECTIVES To determine and compare the efficacy of riluzole, MPS and the combination of two drugs in a rat model with acute spinal trauma, electrophysiologically and histopathologically. METHODS 59 rats were divided into 4 groups as control, riluzole (6 mg/kg, every 12 hours for 7 days), MPS (30 mg/kg, 2nd and 4th hours after injury) and riluzole + MPS. Spinal trauma was created and the subjects were followed for 7 days. Electrophysiological recordings were made via neuromonitoring. The subjects were sacrificed and histopathological examination was made. RESULTS For the amplitude values, mean alteration in the period from the spinal cord injury to the end of the 7th day is 15.89 ± 20.00%, 210.93 ± 199.44%, 24.75% ± 10.13% increase and 18.91 ± 30.01% decrease for the control, riluzole, riluzole + MPS and MPS groups, respectively. Although the riluzole treatment group produced the greatest increase in amplitude, it was observed that no treatment provided a significant improvement compared to the control group, in terms of latency and amplitude. It was observed that there was significantly less cavitation area in the riluzole treatment group compared to the control group (P = .020). (P < .05). CONCLUSIONS Electrophysiologically, no treatment was found to provide significant improvement. Histopathologically, it was observed that riluzole provided significant neural tissue protection.
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Affiliation(s)
- Cem Onder
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Uludağ University, Bursa, Turkey
| | - Cigdem Onder
- Department of Physical Therapy and Rehabilitation, Sehitkamil Hospital, Gaziantep, Turkey
| | - Selcan Akesen
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Uludağ University, Bursa, Turkey
| | - Ezgi Yumusak
- Faculty of Veterinary Medicine, Department of Pathology, Uludağ University, Bursa, Turkey
| | - Burak Akesen
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Uludağ University, Bursa, Turkey
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Sterner RC, Sterner RM. Immune response following traumatic spinal cord injury: Pathophysiology and therapies. Front Immunol 2023; 13:1084101. [PMID: 36685598 PMCID: PMC9853461 DOI: 10.3389/fimmu.2022.1084101] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, the mechanical damage from the trauma causes immediate acute cell dysfunction and cell death. Then, secondary mechanisms of injury further propagate the cell dysfunction and cell death over the course of days, weeks, or even months. Among the secondary injury mechanisms, inflammation has been shown to be a key determinant of the secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in addition to surgical management of SCI, selectively targeting the immune response following SCI could substantially decrease the progression of secondary injury and improve patient outcomes. In order to develop such therapies, a detailed molecular understanding of the timing of the immune response following SCI is necessary. Recently, several studies have mapped the cytokine/chemokine and cell proliferation patterns following SCI. In this review, we examine the immune response underlying the pathophysiology of SCI and assess both current and future therapies including pharmaceutical therapies, stem cell therapy, and the exciting potential of extracellular vesicle therapy.
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Affiliation(s)
- Robert C. Sterner
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rosalie M. Sterner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States,*Correspondence: Rosalie M. Sterner,
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Feng C, Deng L, Yong YY, Wu JM, Qin DL, Yu L, Zhou XG, Wu AG. The Application of Biomaterials in Spinal Cord Injury. Int J Mol Sci 2023; 24:816. [PMID: 36614259 PMCID: PMC9821025 DOI: 10.3390/ijms24010816] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
The spinal cord and the brain form the central nervous system (CNS), which is the most important part of the body. However, spinal cord injury (SCI) caused by external forces is one of the most difficult types of neurological injury to treat, resulting in reduced or even absent motor, sensory and autonomic functions. It leads to the reduction or even disappearance of motor, sensory and self-organizing nerve functions. Currently, its incidence is increasing each year worldwide. Therefore, the development of treatments for SCI is urgently needed in the clinic. To date, surgery, drug therapy, stem cell transplantation, regenerative medicine, and rehabilitation therapy have been developed for the treatment of SCI. Among them, regenerative biomaterials that use tissue engineering and bioscaffolds to transport cells or drugs to the injured site are considered the most promising option. In this review, we briefly introduce SCI and its molecular mechanism and summarize the application of biomaterials in the repair and regeneration of tissue in various models of SCI. However, there is still limited evidence about the treatment of SCI with biomaterials in the clinic. Finally, this review will provide inspiration and direction for the future study and application of biomaterials in the treatment of SCI.
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Affiliation(s)
| | | | | | | | | | | | - Xiao-Gang Zhou
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of Education, School of Pharmacy, Southwest Medical University, Luzhou 646000, China
| | - An-Guo Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Drugability Evaluation, Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, Key Laboratory of Medical Electrophysiology of Ministry of Education, School of Pharmacy, Southwest Medical University, Luzhou 646000, China
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8
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Zhang Y, Li AA, Xiao SN, Zhong NS, Tong WL, Wang SJ, Liu JM, Liu ZL. A Bibliometric Analysis of Publications on Spinal Cord Injury Treatment With Glucocorticoids Using VOSviewer. Front Public Health 2022; 10:907372. [PMID: 36003626 PMCID: PMC9393342 DOI: 10.3389/fpubh.2022.907372] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/20/2022] [Indexed: 01/03/2023] Open
Abstract
Background Spinal cord injury (SCI) has devastating physical and social consequences for patients. Systemic administration of methylprednisolone (MP) at a higher dosage though can reduce neurological deficits following acute SCI. Still, this treatment regimen is controversial, owing to the apparent dose-related side effects and relatively minor improvement in neurological function. Therefore, this study aimed at the bibliometric analysis of published literature related to SCI treatment, which may lead to future research trends. Methods The literature published relating to SCI and using glucocorticoids for its treatment between 1982 and 2022 was collected and scanned in the Web of Science collection database using the keywords glucocorticoid, dexamethasone, MP, corticosteroids, and SCI, followed by using VOSviewer for bibliometric analysis of these articles. Results A total of 1,848 published articles and 7,448 authors on SCI and glucocorticoid usage were identified. The SCI total link strength accounts for 1,341, and MP for 762 has a strong link to neuroprotection and inflammation. The mean citation count for the top 20 most-cited articles was 682 (range: 358–1,828), where most of these were descriptive studies having focused on clinical features. The Journal of Neurotrauma was the highest-ranked journal with 6,010 citations. A total of 69 articles were published by Michael G Fehlings from the University of Toronto with 6,092 citations. The University of Toronto has published 90-related manuscripts with 7,632 citations. In contrast, 800 articles were published in the United States, with 39,633 citations and total link strength of 5,714. The second-ranked country was China, with 241 published articles and 3,403 citations. Conclusions The research published on applying MP in treating SCI has increased with time. Although the United States has made a significant global contribution to this important field of research, it requires rigorous clinical trials designed to verify the therapeutic role of MP in SCI and its appropriate dosage to find solutions for neurological recovery.
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Affiliation(s)
- Yu Zhang
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - An-An Li
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Shi-Ning Xiao
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Nan-Shan Zhong
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Wei-Lai Tong
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Shi-Jiang Wang
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Jia-Ming Liu
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Zhi-Li Liu
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- *Correspondence: Zhi-Li Liu
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Peng Y, Zhao W, Hu Y, Guo XE, Wang J, Hao K, He Z, Toro C, Bauman WA, Qin W. Administration of High-Dose Methylprednisolone Worsens Bone Loss after Acute Spinal Cord Injury in Rats. Neurotrauma Rep 2022; 2:592-602. [PMID: 35018361 PMCID: PMC8742306 DOI: 10.1089/neur.2021.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The administration of high-dose methylprednisolone (MP) for 24–48 h after traumatic spinal cord injury (SCI) has been shown to improve functional recovery. The known adverse effects of MP on skeletal muscle and the immune system, though, have raised clinically relevant safety concerns. However, the effect of MP administration on SCI-induced bone loss has not been evaluated to date. This study examined the adverse effects of high-dose MP administration on skeletal bone after acute SCI in rodents. Male rats underwent spinal cord transection at T3–T4, which was followed by an intravenous injection of MP and subsequent infusion of MP for 24 h. At 2 days, animals were euthanized and hindlimb bone samples were collected. MP significantly reduced bone mineral density (−6.7%) and induced deterioration of bone microstructure (trabecular bone volume/tissue volume, −18.4%; trabecular number, −19.4%) in the distal femur of SCI rats. MP significantly increased expression in the hindlimb bones of osteoclastic genes receptor activator of nuclear factor-κB ligand (RANKL; +402%), triiodothyronine receptor auxiliary protein (+32%), calcitonin receptor (+41%), and reduced osteoprotegerin/RANKL ratio (−72%) compared to those of SCI-vehicle animals. Collectively, 1 day of high-dose MP at a dose comparable to the dosing regimen prescribed to patients who qualify to receive this treatment approach with acute SCI increased loss of bone mass and integrity below the level of lesion than that of animals that had SCI alone, and was associated with further elevation in the expression of genes involved in pathways associated with osteoclastic bone resorption than that observed in SCI animals.
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Affiliation(s)
- Yuanzhen Peng
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Wei Zhao
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yizhong Hu
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - X. Edward Guo
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Jun Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhiming He
- College of Dentistry, New York University, New York, New York, USA
| | - Carlos Toro
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
| | - William A. Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Departments of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Weiping Qin
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York, USA
- Departments of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- *Address correspondence to: Weiping Qin, MD, PhD, James J. Peters Veteran Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA;
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10
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Walsh CM, Wychowaniec JK, Brougham DF, Dooley D. Functional hydrogels as therapeutic tools for spinal cord injury: New perspectives on immunopharmacological interventions. Pharmacol Ther 2021; 234:108043. [PMID: 34813862 DOI: 10.1016/j.pharmthera.2021.108043] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) is a complex medical and psychological challenge for which there is no curative therapy currently available. Despite major progress in pharmacological and surgical approaches, clinical trials for SCI patients have been uniformly disappointing thus far as there are many practical and biological issues yet to be resolved. Neuroinflammation is a critical event of the secondary injury phase after SCI, and recent research strategies have focused on modulating the immune response after injury to provide a more favorable recovery environment. Biomaterials can serve this purpose by providing physical and trophic support to the injured spinal cord after SCI. Of all potential biomaterials, functional hydrogels are emerging as a key component in novel treatment strategies for SCI, including controlled and localized delivery of immunomodulatory therapies to drive polarization of immune cells towards a pro-regenerative phenotype. Here, we extensively review recent developments in the use of functional hydrogels as immunomodulatory therapies for SCI. We briefly describe physicochemical properties of hydrogels and demonstrate how advanced fabrication methods lead to the required heterogeneity and hierarchical arrangements that increasingly mimic complex spinal cord tissue. We then summarize potential SCI therapeutic modalities including: (i) hydrogels alone; (ii) hydrogels as cellular or (iii) bioactive molecule delivery vehicles, and; (iv) combinatorial approaches. By linking the structural properties of hydrogels to their functions in treatment with particular focus on immunopharmacological stimuli, this may accelerate further development of functional hydrogels for SCI, and indeed next-generation central nervous system regenerative therapies.
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Affiliation(s)
- Ciara M Walsh
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland; UCD Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
| | - Jacek K Wychowaniec
- School of Chemistry, University College Dublin, Belfield, Dublin 4, Ireland; AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Dermot F Brougham
- School of Chemistry, University College Dublin, Belfield, Dublin 4, Ireland
| | - Dearbhaile Dooley
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland; UCD Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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11
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Sefiani A, Geoffroy CG. The Potential Role of Inflammation in Modulating Endogenous Hippocampal Neurogenesis After Spinal Cord Injury. Front Neurosci 2021; 15:682259. [PMID: 34220440 PMCID: PMC8249862 DOI: 10.3389/fnins.2021.682259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Currently there are approximately 291,000 people suffering from a spinal cord injury (SCI) in the United States. SCI is associated with traumatic changes in mobility and neuralgia, as well as many other long-term chronic health complications, including metabolic disorders, diabetes mellitus, non-alcoholic steatohepatitis, osteoporosis, and elevated inflammatory markers. Due to medical advances, patients with SCI survive much longer than previously. This increase in life expectancy exposes them to novel neurological complications such as memory loss, cognitive decline, depression, and Alzheimer's disease. In fact, these usually age-associated disorders are more prevalent in people living with SCI. A common factor of these disorders is the reduction in hippocampal neurogenesis. Inflammation, which is elevated after SCI, plays a major role in modulating hippocampal neurogenesis. While there is no clear consensus on the mechanism of the decline in hippocampal neurogenesis and cognition after SCI, we will examine in this review how SCI-induced inflammation could modulate hippocampal neurogenesis and provoke age-associated neurological disorders. Thereafter, we will discuss possible therapeutic options which may mitigate the influence of SCI associated complications on hippocampal neurogenesis.
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12
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Ko WK, Lee SJ, Kim SJ, Han GH, Han IB, Hong JB, Sheen SH, Sohn S. Direct Injection of Hydrogels Embedding Gold Nanoparticles for Local Therapy after Spinal Cord Injury. Biomacromolecules 2021; 22:2887-2901. [PMID: 34097404 DOI: 10.1021/acs.biomac.1c00281] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, we created a hydrogel composed of glycol chitosan (gC) and oxidized hyaluronate (oHA). Gold nanoparticles (GNPs) were conjugated with ursodeoxycholic acid (UDCA). The GNP-UDCA complex was embedded into gC-oHA (CHA) hydrogels to form a CHA-GNP-UDCA gel. This CHA-GNP-UDCA gel was injected once into an epicenter of an injured region in SCI rats. Near-infrared (NIR) irradiation was then applied to the lesion as a means of local therapy. To optimize the viscosity for injection into a lesion, several volume ratios of gC and oHA were investigated using scanning electron microscopy and a rotating rheometer. The optimally synthesized CHA-GNP-UDCA gel under NIR irradiation suppressed the production of inflammatory cytokines in vitro. In addition, the optimized CHA-GNP-UDCA gel under NIR irradiation inhibited the cystic cavity of the lesion and significantly improved the hindlimb function. The production of inflammatory cytokines following SCI was significantly inhibited in the CHA-GNP-UDCA gel + NIR group. CHA-GNP-UDCA gels with NIR irradiation can therefore have therapeutic effects for those with spinal cord injuries.
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Affiliation(s)
- Wan-Kyu Ko
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea.,Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Sang Jin Lee
- Department of Dental Materials, School of Dentistry, Kyung Hee University, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Seong Jun Kim
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea.,Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - Gong Ho Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea.,Department of Biomedical Science, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do 13488, Republic of Korea
| | - In-Bo Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - Seung Hun Sheen
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea
| | - Seil Sohn
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Republic of Korea
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13
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Injectable Hydrogel Containing Tauroursodeoxycholic Acid for Anti-neuroinflammatory Therapy After Spinal Cord Injury in Rats. Mol Neurobiol 2020; 57:4007-4017. [PMID: 32647974 DOI: 10.1007/s12035-020-02010-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
We investigate the anti-inflammatory effects of injectable hydrogel containing tauroursodeoxycholic acid (TUDCA) in a spinal cord injury (SCI) model. To this end, TUDCA-hydrogel (TC gel) is created by immersing the synthesized hydrogel in a TUDCA solution for 1 h. A mechanical SCI was imposed on rats, after which we injected the TC gel. After the SCI and injections, motor functions and lesions were significantly improved in the TC gel group compared with those in the saline group. The TC gel significantly decreased pro-inflammatory cytokine levels compared with the saline; TUDCA and glycol chitosan-oxidized hyaluronate were mixed at a ratio of 9:1 (CHA) gel independently. In addition, the TC gel significantly suppressed the phosphorylation of extracellular signal-regulated kinase (p-ERK) and c-Jun N-terminal kinase (p-JNK) in the mitogen-activated protein kinase (MAPK) pathway compared with the saline, TUDCA, and CHA gel independently. It also decreased tumor necrosis factor-α (TNF-α) and glial fibrillary acidic protein (GFAP), inflammatory marker, at the injured sites more than those in the saline, TUDCA, and CHA gel groups. In conclusion, the results of this study demonstrate the neuroinflammatory inhibition effects of TC gel in SCI and suggest that TC gel can be an alternative drug system for SCI cases.
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14
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The role of hepatocyte growth factor in mesenchymal stem cell-induced recovery in spinal cord injured rats. Stem Cell Res Ther 2020; 11:178. [PMID: 32410702 PMCID: PMC7227078 DOI: 10.1186/s13287-020-01691-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background Mesenchymal stem cells (MSCs) have become a promising treatment for spinal cord injury (SCI) due to the fact that they provide a favorable environment. Treatment using MSCs results in a better neurological functional improvement through the promotion of nerve cell regeneration and the modulation of inflammation. Many studies have highlighted that the beneficial effects of MSCs are more likely associated with their secreted factors. However, the identity of the factor that plays a key role in the MSC-induced neurological functional recovery following SCI as well as its molecular mechanism still remains unclear. Methods A conditioned medium (collected from the MSCs) and hepatocyte growth factor (HGF) were used to test the effects on the differentiation of neural stem cells (NSCS) in the presence of BMP4 with or without a c-Met antibody. In SCI rats, Western blot, ELISA, immunohistochemistry, and hematoxylin-eosin staining were used to investigate the biological effects of MSC-conditioned medium and HGF on nerve cell regeneration and inflammation with or without the pre-treatment using a c-Met antibody. In addition, the possible molecular mechanism (cross-talk between HGF/c-Met and the BMP/Smad 1/5/8 signaling pathway) was also detected by Western blot both in vivo and in vitro. Results The conditioned medium from bone marrow-derived MSCs (BMSCs) was able to promote the NSC differentiation into neurons in vitro and the neurite outgrowth in the scar boundary of SCI rats by inhibiting the BMP/Smad signaling pathway as well as reduces the secondary damage through the modulation of the inflammatory process. The supplementation of HGF showed similar biological effects to those of BMSC-CM, whereas a functional blocking of the c-Met antibody or HGF knockdown in BMSCs significantly reversed the functional improvement mediated by the BMSC-CM. Conclusions The MSC-associated biological effects on the recovery of SCI rats mainly depend on the secretion of HGF.
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15
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The safety and efficacy of steroid treatment for acute spinal cord injury: A Systematic Review and meta-analysis. Heliyon 2020; 6:e03414. [PMID: 32095652 PMCID: PMC7033344 DOI: 10.1016/j.heliyon.2020.e03414] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/17/2019] [Accepted: 02/12/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction The role for steroids in acute spinal cord injury (ASCI) remains unclear; while some studies have demonstrated the risks of steroids outweigh the benefits,a meta-analyses conducted on heterogeneous patient populations have shown significant motor improvement at short-term but not at long-term follow-up. Given the heterogeneity of the patient population in previous meta-analyses and the publication of a recent trial not included in these meta-analyses, we sought to re-assess and update the safety and short-term and long-term efficacy of steroid treatment following ASCI in a more homogeneous patient population. Materials and methods A literature search was conducted on PubMed, EMBASE and Cochrane Library through June 2019 for studies evaluating the utility of steroids within the first 8 h following ASCI. Neurological and safety outcomes were extracted for patients treated and not treated with steroids. Pooled effect estimates were calculated using the random-effects model. Results Twelve studies, including five randomized controlled trials (RCTs) and seven observational studies (OBSs), were meta-analyzed. Overall, methylprednisolone was not associated with significant short-term or long-term improvements in motor or neurological scores based on RCTs or OBSs. An increased risk of hyperglycemia was shown in both RCTs (RR: 13.7; 95% CI: 1.93, 97.4; 1 study) and OBSs (RR: 2.9; 95% CI: 1.55, 5.41; 1 study). Risk for pneumonia was increased with steroids; while this increase was not statistically significant in the RCTs (pooled RR: 1.16; 95% C.I: 0.59, 2.29; 3 studies), it reached statistical significance in the OBSs (pooled RR: 2.00; 95% C.I: 1.32, 3.02; 6 studies). There was no statistically significant increased risk of gastrointestinal bleeding, decubitus ulcers, surgical site infections, sepsis, atelectasis, venous thromboembolism, urinary tract infections, or mortality among steroid-treated ASCI patients compared to untreated controls in either RCTs or OBSs. Conclusions Methylprednisolone therapy within the first 8 h following ASCI failed to show a statistically significant short-term or long-term improvement in patients' overall motor or neurological scores compared to controls who were not administered steroids. For the same comparison, there was an increased risk of pneumonia and hyperglycemia compared to controls. Routine use of methylprednisone following ASCI should be carefully considered in the context of these results.
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16
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Choi SH, Sung CH, Heo DR, Jeong SY, Kang CN. Incidence of acute spinal cord injury and associated complications of methylprednisolone therapy: a national population-based study in South Korea. Spinal Cord 2019; 58:232-237. [DOI: 10.1038/s41393-019-0357-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/25/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
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17
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Song YH, Agrawal NK, Griffin JM, Schmidt CE. Recent advances in nanotherapeutic strategies for spinal cord injury repair. Adv Drug Deliv Rev 2019; 148:38-59. [PMID: 30582938 PMCID: PMC6959132 DOI: 10.1016/j.addr.2018.12.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022]
Abstract
Spinal cord injury (SCI) is a devastating and complicated condition with no cure available. The initial mechanical trauma is followed by a secondary injury characterized by inflammatory cell infiltration and inhibitory glial scar formation. Due to the limitations posed by the blood-spinal cord barrier, systemic delivery of therapeutics is challenging. Recent development of various nanoscale strategies provides exciting and promising new means of treating SCI by crossing the blood-spinal cord barrier and delivering therapeutics. As such, we discuss different nanomaterial fabrication methods and provide an overview of recent studies where nanomaterials were developed to modulate inflammatory signals, target inhibitory factors in the lesion, and promote axonal regeneration after SCI. We also review emerging areas of research such as optogenetics, immunotherapy and CRISPR-mediated genome editing where nanomaterials can provide synergistic effects in developing novel SCI therapy regimens, as well as current efforts and barriers to clinical translation of nanomaterials.
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Affiliation(s)
- Young Hye Song
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Nikunj K Agrawal
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jonathan M Griffin
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Christine E Schmidt
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
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18
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Liu Z, Yang Y, He L, Pang M, Luo C, Liu B, Rong L. High-dose methylprednisolone for acute traumatic spinal cord injury: A meta-analysis. Neurology 2019; 93:e841-e850. [PMID: 31358617 DOI: 10.1212/wnl.0000000000007998] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Due to the continuing debates on the utility of high-dose methylprednisolone (MP) early after acute spinal cord injury (ASCI), we aimed to evaluate the therapeutic and adverse effects of high-dose MP according to the second National Acute Spinal Cord Injury Study (NASCIS-2) dosing protocol in comparison to no steroids in patients with ASCI by performing a meta-analysis on the basis of the current available clinical trials. METHODS We searched PubMed and Cochrane Library (to May 22, 2018) for studies comparing neurologic recoveries, adverse events, and in-hospital costs between ASCI patients who underwent high-dose MP treatment or not. Data were synthesized with corresponding statistical models according to the degree of heterogeneity. RESULTS = 0.78). CONCLUSIONS Based on the current evidence, high-dose MP treatment, in comparison to controls, does not contribute to better neurologic recoveries but may increase the risk of adverse events in patients with ASCI. Therefore, we recommend against routine use of high-dose MP early after ASCI.
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Affiliation(s)
- Zhongyu Liu
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Yang Yang
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Lei He
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Mao Pang
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Chunxiao Luo
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Bin Liu
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Limin Rong
- From the Department of Spine Surgery, Institute of Drug Clinical Trial for Orthopedic Diseases, The Third Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.
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19
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Warner FM, Tong B, Jutzeler CR, Cragg JJ, Scheuren PS, Kramer JLK. Journal Club: Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology 2019; 89:e76-e78. [PMID: 28808174 DOI: 10.1212/wnl.0000000000004241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Freda M Warner
- From International Collaboration on Repair Discoveries (ICORD) (F.M.W., B.T., C.R.J., J.J.C., P.S.S., J.L.K.K.) and School of Kinesiology (F.M.W., C.R.J., J.L.K.K.), University of British Columbia, Vancouver, Canada.
| | - Bobo Tong
- From International Collaboration on Repair Discoveries (ICORD) (F.M.W., B.T., C.R.J., J.J.C., P.S.S., J.L.K.K.) and School of Kinesiology (F.M.W., C.R.J., J.L.K.K.), University of British Columbia, Vancouver, Canada
| | - Catherine R Jutzeler
- From International Collaboration on Repair Discoveries (ICORD) (F.M.W., B.T., C.R.J., J.J.C., P.S.S., J.L.K.K.) and School of Kinesiology (F.M.W., C.R.J., J.L.K.K.), University of British Columbia, Vancouver, Canada
| | - Jacquelyn J Cragg
- From International Collaboration on Repair Discoveries (ICORD) (F.M.W., B.T., C.R.J., J.J.C., P.S.S., J.L.K.K.) and School of Kinesiology (F.M.W., C.R.J., J.L.K.K.), University of British Columbia, Vancouver, Canada
| | - Paulina S Scheuren
- From International Collaboration on Repair Discoveries (ICORD) (F.M.W., B.T., C.R.J., J.J.C., P.S.S., J.L.K.K.) and School of Kinesiology (F.M.W., C.R.J., J.L.K.K.), University of British Columbia, Vancouver, Canada
| | - John L K Kramer
- From International Collaboration on Repair Discoveries (ICORD) (F.M.W., B.T., C.R.J., J.J.C., P.S.S., J.L.K.K.) and School of Kinesiology (F.M.W., C.R.J., J.L.K.K.), University of British Columbia, Vancouver, Canada
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20
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Divi SN, Schroeder GD, Mangan JJ, Tadley M, Ramey WL, Badhiwala JH, Fehlings MG, Oner FC, Kandziora F, Benneker LM, Vialle EN, Rajasekaran S, Chapman JR, Vaccaro AR. Management of Acute Traumatic Central Cord Syndrome: A Narrative Review. Global Spine J 2019; 9:89S-97S. [PMID: 31157150 PMCID: PMC6512200 DOI: 10.1177/2192568219830943] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To provide an updated overview of the management of acute traumatic central cord syndrome (ATCCS). METHODS A comprehensive narrative review of the literature was done to identify evidence-based treatment strategies for patients diagnosed with ATCCS. RESULTS ATCCS is the most commonly encountered subtype of incomplete spinal cord injury and is characterized by worse sensory and motor function in the upper extremities compared with the lower extremities. It is most commonly seen in the setting of trauma such as motor vehicles or falls in elderly patients. The operative management of this injury has been historically variable as it can be seen in the setting of mechanical instability or preexisting cervical stenosis alone. While each patient should be evaluated on an individual basis, based on the current literature, the authors' preferred treatment is to perform early decompression and stabilization in patients that have any instability or significant neurologic deficit. Surgical intervention, in the appropriate patient, is associated with an earlier improvement in neurologic status, shorter hospital stay, and shorter intensive care unit stay. CONCLUSIONS While there is limited evidence regarding management of ATCCS, in the presence of mechanical instability or ongoing cord compression, surgical management is the treatment of choice. Further research needs to be conducted regarding treatment strategies and patient outcomes.
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Affiliation(s)
- Srikanth N Divi
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John J Mangan
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Madeline Tadley
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Wyatt L Ramey
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Alexander R Vaccaro
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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21
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Zuidema JM, Gilbert RJ, Gottipati MK. Biomaterial Approaches to Modulate Reactive Astroglial Response. Cells Tissues Organs 2018; 205:372-395. [PMID: 30517922 PMCID: PMC6397084 DOI: 10.1159/000494667] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/18/2018] [Indexed: 11/19/2022] Open
Abstract
Over several decades, biomaterial scientists have developed materials to spur axonal regeneration and limit secondary injury and tested these materials within preclinical animal models. Rarely, though, are astrocytes examined comprehensively when biomaterials are placed into the injury site. Astrocytes support neuronal function in the central nervous system. Following an injury, astrocytes undergo reactive gliosis and create a glial scar. The astrocytic glial scar forms a dense barrier which restricts the extension of regenerating axons through the injury site. However, there are several beneficial effects of the glial scar, including helping to reform the blood-brain barrier, limiting the extent of secondary injury, and supporting the health of regenerating axons near the injury site. This review provides a brief introduction to the role of astrocytes in the spinal cord, discusses astrocyte phenotypic changes that occur following injury, and highlights studies that explored astrocyte changes in response to biomaterials tested within in vitro or in vivo environments. Overall, we suggest that in order to improve biomaterial designs for spinal cord injury applications, investigators should more thoroughly consider the astrocyte response to such designs.
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Affiliation(s)
- Jonathan M Zuidema
- Department of Chemistry and Biochemistry, University of California, San Diego, California, USA
| | - Ryan J Gilbert
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Manoj K Gottipati
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA,
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA,
- Center for Brain and Spinal Cord Repair, Department of Neuroscience, The Ohio State University, Columbus, Ohio, USA,
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22
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Halsey AM, Conner AC, Bill RM, Logan A, Ahmed Z. Aquaporins and Their Regulation after Spinal Cord Injury. Cells 2018; 7:E174. [PMID: 30340399 PMCID: PMC6210264 DOI: 10.3390/cells7100174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022] Open
Abstract
After injury to the spinal cord, edema contributes to the underlying detrimental pathophysiological outcomes that lead to worsening of function. Several related membrane proteins called aquaporins (AQPs) regulate water movement in fluid transporting tissues including the spinal cord. Within the cord, AQP1, 4 and 9 contribute to spinal cord injury (SCI)-induced edema. AQP1, 4 and 9 are expressed in a variety of cells including astrocytes, neurons, ependymal cells, and endothelial cells. This review discusses some of the recent findings of the involvement of AQP in SCI and highlights the need for further study of these proteins to develop effective therapies to counteract the negative effects of SCI-induced edema.
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Affiliation(s)
- Andrea M Halsey
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Alex C Conner
- Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Roslyn M Bill
- School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.
| | - Ann Logan
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
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23
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Doyle C, Cristofaro V, Sullivan MP, Adam RM. Inosine - a Multifunctional Treatment for Complications of Neurologic Injury. Cell Physiol Biochem 2018; 49:2293-2303. [PMID: 30261493 DOI: 10.1159/000493831] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/18/2018] [Indexed: 01/31/2023] Open
Abstract
Spinal cord injury (SCI) caused by trauma or disease leads to motor and sensory abnormalities that depend on the level, severity and duration of the lesion. The most obvious consequence of SCI is paralysis affecting lower and upper limbs. SCI also leads to loss of bladder and bowel control, both of which have a deleterious, life-long impact on the social, psychological, functional, medical and economic well being of affected individuals. Currently, there is neither a cure for SCI nor is there adequate management of its consequences. Although medications provide symptomatic relief for the complications of SCI including muscle spasms, lower urinary tract dysfunction and hyperreflexic bowel, strategies for repair of spinal injuries and recovery of normal limb and organ function are still to be realized. In this review, we discuss experimental evidence supporting the use of the naturally occurring purine nucleoside inosine to improve the devastating sequelae of SCI. Evidence suggests inosine is a safe, novel agent with multifunctional properties that is effective in treating complications of SCI and other neuropathies.
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Affiliation(s)
- Claire Doyle
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Urology, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maryrose P Sullivan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Urology, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rosalyn M Adam
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Ko WK, Kim SJ, Jo MJ, Choi H, Lee D, Kwon IK, Lee SH, Han IB, Sohn S. Ursodeoxycholic Acid Inhibits Inflammatory Responses and Promotes Functional Recovery After Spinal Cord Injury in Rats. Mol Neurobiol 2018; 56:267-277. [DOI: 10.1007/s12035-018-0994-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/07/2018] [Indexed: 12/15/2022]
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Yuksel U, Bakar B, Dincel GC, Budak Yildiran FA, Ogden M, Kisa U. The Investigation of the Cox-2 Selective Inhibitor Parecoxib Effects in Spinal Cord Injury in Rat. J INVEST SURG 2018; 32:402-413. [PMID: 29355394 DOI: 10.1080/08941939.2017.1423423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aim: Today, spinal cord injury (SCI) can be rehabilitated but cannot be treated adequately. This experimental study was conducted to investigate possible beneficial effects of methylprednisolone and parecoxib in treatment of SCI. Materials and methods: Forty-eight male Wistar albino rats were assigned into CONTROL, acute (MP-A, PX-A, and PXMP-A), and subacute (MP-S, PX-S, and PXMP-S) stage groups. Then, to induce SCI, a temporary aneurysm clip was applied to the spinal cord following T7-8 laminectomy, except in the CONTROL group. Four hours later parecoxib, methylprednisolone, or their combination was administered to rats intraperitoneally except CONTROL, SHAM-A, and SHAM-S groups. Rats in the acute stage group were sacrificed 72 h later, and whereas rats in the subacute stage were sacrificed 7 days later for histopathological and biochemical investigation and for gene-expression analyses. Results: Parecoxib and methylprednisolone and their combination could not improve histopathological grades in any stage. They also could not decrease malondialdehyde or caspase-3, myeloperoxidase levels in any stage. Parecoxib and methylprednisolone could decrease the TNF-α gene expression in subacute stage. Methylprednisolone could increase TGF-1β gene-expression level in acute stage. Conclusion: Neither of the experimental drugs, either alone or in combination, did not show any beneficial effects in SCI model in rats.
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Affiliation(s)
- Ulas Yuksel
- a Department of Neurosurgery, Sanliurfa Training and Research Hospital , Sanliurfa , Turkey
| | - Bulent Bakar
- b Department of Neurosurgery, Faculty of Medicine, Kirikkale University , Kirikkale , Turkey
| | - Gungor Cagdas Dincel
- c Laboratory and Veterinary Science, Eskil Vocational High School, Aksaray University , Aksaray , Turkey
| | | | - Mustafa Ogden
- b Department of Neurosurgery, Faculty of Medicine, Kirikkale University , Kirikkale , Turkey
| | - Ucler Kisa
- e Department of Biochemistry, Faculty of Medicine, Kirikkale University , Kirikkale , Turkey
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Nejati-Koshki K, Mortazavi Y, Pilehvar-Soltanahmadi Y, Sheoran S, Zarghami N. An update on application of nanotechnology and stem cells in spinal cord injury regeneration. Biomed Pharmacother 2017; 90:85-92. [DOI: 10.1016/j.biopha.2017.03.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 02/08/2023] Open
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Ziemba AM, Gilbert RJ. Biomaterials for Local, Controlled Drug Delivery to the Injured Spinal Cord. Front Pharmacol 2017; 8:245. [PMID: 28539887 PMCID: PMC5423911 DOI: 10.3389/fphar.2017.00245] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Affecting approximately 17,000 new people each year, spinal cord injury (SCI) is a devastating injury that leads to permanent paraplegia or tetraplegia. Current pharmacological approaches are limited in their ability to ameliorate this injury pathophysiology, as many are not delivered locally, for a sustained duration, or at the correct injury time point. With this review, we aim to communicate the importance of combinatorial biomaterial and pharmacological approaches that target certain aspects of the dynamically changing pathophysiology of SCI. After reviewing the pathophysiology timeline, we present experimental biomaterial approaches to provide local sustained doses of drug. In this review, we present studies using a variety of biomaterials, including hydrogels, particles, and fibers/conduits for drug delivery. Subsequently, we discuss how each may be manipulated to optimize drug release during a specific time frame following SCI. Developing polymer biomaterials that can effectively release drug to target specific aspects of SCI pathophysiology will result in more efficacious approaches leading to better regeneration and recovery following SCI.
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Affiliation(s)
| | - Ryan J. Gilbert
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Sciences, Rensselaer Polytechnic Institute, TroyNY, USA
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Abstract
Traumatic spine injuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant health care costs from associated medical needs following injury. For these reasons, TSI was chosen as an ENLS protocol. This article offers a comprehensive review on the management of spinal column injuries using the best available evidence. Alhough the review focuses primarily on cervical spinal column injuries, thoracolumbar injuries are briefly discussed as well. The initial emergency department clinical evaluation of possible spinal fractures and cord injuries, along with the definitive early management of confirmed injuries, is also covered.
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Mbori NJR, Chuan XY, Feng QX, Alizada M, Zhan J. Evaluation of the Combination of Methylprednisolone and Tranilast after Spinal Cord Injury in Rat Models. J Korean Neurosurg Soc 2016; 59:334-40. [PMID: 27446512 PMCID: PMC4954879 DOI: 10.3340/jkns.2016.59.4.334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/04/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of our study was to evaluate the neuroprotective functions of the combination therapy using methylprednisolone (MP) and tranilast (TR) after spinal cord injury (SCI) in adult rats. Methods Spinal cord compression injury model was achieved using Yasargil aneurysm clip. Rats were divided into control group, MP group, TR group, and combination therapy group using TR and MP. Rat models were assessed for locomotor functional recovery using Basso, Beattie, and Bresnahan (BBB) score, spinal cord water content and myeloperoxidase (MPO) activity 24 hours post SCI, haematoxylin and eosin staining and glial fibrillary acid protein (GFAP) staining at 7 and 14 days post SCI. Results The spinal cord water content and MPO activity in the combination therapy group was significantly lower than the control group and the individual therapy groups p<0.05. The combination therapy group had significantly higher BBB scores than control group and individual therapy groups (p<0.05). At one week after SCI, GFAP expression in the combination group was significantly lower than the control group (p<0.05) but there was no significant difference compared to the individual therapy groups (p>0.05). At 2 weeks after SCI there was a slight decrease in GFAP expression compared to the first week but the difference was not statistically significant (p>0.05), GFAP expression between the groups was not statistically significant p>0.05. Conclusion Combining MP and TR is therapeutically more effective in improving functional recovery, inhibiting inflammation and glial scar formation after acute SCI.
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Affiliation(s)
- Ngwayi James Reeves Mbori
- Department of Orthopedic Surgery (Unit III), First Affiliated Hospital of Jiamusi University, Heilongjiang Province, Jiamusi City, China
| | - Xie Yun Chuan
- Department of Orthopedic Surgery (Unit III), First Affiliated Hospital of Jiamusi University, Heilongjiang Province, Jiamusi City, China
| | - Qiao Xiao Feng
- Department of Orthopedic Surgery (Unit III), First Affiliated Hospital of Jiamusi University, Heilongjiang Province, Jiamusi City, China
| | - Mujahid Alizada
- Department of Neurosurgery, First Affiliated Hospital of Jiamusi University, Heilongjiang Province, Jiamusi City, China
| | - Jing Zhan
- Department of Orthopedic Surgery (Unit III), First Affiliated Hospital of Jiamusi University, Heilongjiang Province, Jiamusi City, China
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Local versus distal transplantation of human neural stem cells following chronic spinal cord injury. Spine J 2016; 16:764-9. [PMID: 26698654 DOI: 10.1016/j.spinee.2015.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/10/2015] [Accepted: 12/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have demonstrated functional recovery of rats with spinal cord contusions after transplantation of neural stem cells adjacent to the site of acute injury. PURPOSE The purpose of the study was to determine if the local or distal injection of neural stem cells can cause functional difference in recovery after chronic spinal cord injury. STUDY DESIGN/SETTING Twenty-four adult female Long-Evans hooded rats were randomized into four groups, with six animals in each group: two experimental and two control groups. Functional assessment was measured after injury and then weekly for 6 weeks using the Basso, Beattie, and Bresnahan locomotor rating score. Data were analyzed using two-sample t test and linear mixed-effects model analysis. METHODS Posterior exposure and laminectomy at the T10 level was used. Moderate spinal cord contusion was induced by the Multicenter Animal Spinal Cord Injury Study Impactor with 10-g weight dropped from a height of 25 mm. Experimental subjects received either a subdural injection of human neural stem cells (hNSCs) locally at the injury site or intrathecal injection of hNSCs through a separate distal laminotomy 4 weeks after injury. Controls received control media injection either locally or distally. RESULTS A statistically significant functional improvement in subjects that received hNSCs injected distally to the site of injury was observed when compared with the control (p=.042). The difference between subjects that received hNSCs locally and the control did not reach statistical significance (p=.085). CONCLUSIONS The transplantation of hNSCs into the contused spinal cord of a rat led to significant functional recovery of the spinal cord when injected distally but not locally to the site of chronic spinal cord injury.
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Analysis of prehospital care and emergency room treatment of patients with acute traumatic spinal cord injury: a retrospective cohort study on the implementation of current guidelines. Spinal Cord 2016; 55:16-19. [DOI: 10.1038/sc.2016.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 11/08/2022]
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Karabey-Akyurek Y, Gurcay AG, Gurcan O, Turkoglu OF, Yabanoglu-Ciftci S, Eroglu H, Sargon MF, Bilensoy E, Oner L. Localized delivery of methylprednisolone sodium succinate with polymeric nanoparticles in experimental injured spinal cord model. Pharm Dev Technol 2016; 22:972-981. [PMID: 26895158 DOI: 10.3109/10837450.2016.1143002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With important social and economic consequences, spinal cord injuries (SCIs) still exist among major health problems. Although many therapeutic agents and methods investigated for the treatment of acute SCI, only high dose methylprednisolone (MP) is being used currently in practice. Due to the serious side effects, high dose systemic MP administration after SCI is a critical issue that is mostly considered controversial. In our study, it is aimed to develop a nanoparticle-gel combined drug delivery system for localization of MP on trauma site and eliminating dose-dependent side effects by lowering the administered dose. For this purpose, methyl prednisolone sodium succinate (MPSS) loaded polycaprolactone based nanoparticles were developed and embedded in an implantable fibrin gel. The effects of MPSS delivery system are evaluated on an acute SCI rat model, by quantification the levels of three inflammatory cytokines (interleukin-1β, interleukin-6 and caspase-3) and assessment of the damage on ultrastructural level by transmission electron microscopy. Developed NP-gel system showed very similar results with systemic high dose of MPSS. It is believed that developed system may be used as a tool for the safe and effective localized delivery of several other therapeutic molecules on injured spinal cord cases.
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Affiliation(s)
- Yasemin Karabey-Akyurek
- a Department of Pharmaceutical Technology , Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Ahmet Gurhan Gurcay
- b Department of Neurosurgery , Ankara Ataturk Research & Education Hospital , Ankara , Turkey
| | - Oktay Gurcan
- b Department of Neurosurgery , Ankara Ataturk Research & Education Hospital , Ankara , Turkey
| | - Omer Faruk Turkoglu
- b Department of Neurosurgery , Ankara Ataturk Research & Education Hospital , Ankara , Turkey
| | - Samiye Yabanoglu-Ciftci
- c Department of Biochemistry , Faculty of Pharmacy, Hacettepe University , Ankara , Turkey , and
| | - Hakan Eroglu
- a Department of Pharmaceutical Technology , Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Mustafa Fevzi Sargon
- d Department of Anatomy , Faculty of Medicine, Hacettepe University , Ankara , Turkey
| | - Erem Bilensoy
- a Department of Pharmaceutical Technology , Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Levent Oner
- a Department of Pharmaceutical Technology , Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
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Evaniew N, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J Neurotrauma 2015; 33:468-81. [PMID: 26529320 PMCID: PMC4779323 DOI: 10.1089/neu.2015.4192] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Previous meta-analyses of methylprednisolone (MPS) for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in the quality of evidence used for pooled effect estimates, and new primary studies have been recently published. We aimed to determine whether MPS improves motor recovery and is associated with increased risks for adverse events. We searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from randomized, controlled trials (RCTs) and controlled observational studies separately and used the Grades of Recommendation, Assessment, Development, and Evaluation approach to evaluate confidence. We included four RCTs and 17 observational studies. MPS was not associated with an increase in long-term motor score recovery (two RCTs: 335 participants; mean difference [MD], −1.11; 95% confidence interval [CI], −4.75 to 2.53; p = 0.55, low confidence; two observational studies: 528 participants; MD, 1.37; 95% CI, −3.08 to 5.83; p = 0.55, very low confidence) or improvement by at least one motor grade (three observational studies: 383 participants; risk ratio [RR], 0.84; 95% CI, 0.53–1.33; p = 0.46, very low confidence). Evidence from two RCTs demonstrated superior short-term motor score improvement if MPS was administered within 8 h of injury (two RCTs: 250 participants; MD, 4.46; 95% CI, 0.97–7.94; p = 0.01, low confidence), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (nine studies: 2857 participants; RR, 2.18; 95% CI, 1.13–4.19; p = 0.02, very low confidence), but RCTs did not. Pooled evidence does not demonstrate a significant long-term benefit for MPS in patients with acute TSCIs and suggests it may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited.
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Affiliation(s)
- Nathan Evaniew
- 1 Department of Surgery, McMaster University , Hamilton, Ontario, Canada
| | - Emilie P Belley-Côté
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Ontario, Canada
| | - Nader Fallah
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Carly S Rivers
- 3 Rick Hansen Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 4 Department of Orthopedics, Blusson Spinal Cord Center, University of British Columbia , Vancouver, British Columbia, Canada
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Cheung V, Hoshide R, Bansal V, Kasper E, Chen CC. Methylprednisolone in the management of spinal cord injuries: Lessons from randomized, controlled trials. Surg Neurol Int 2015; 6:142. [PMID: 26392918 PMCID: PMC4553662 DOI: 10.4103/2152-7806.163452] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/02/2015] [Indexed: 11/23/2022] Open
Abstract
The efficacy of glucocorticoid for treatment of acute spinal cord injuries remains a controversial topic. Differing medical societies have issued conflicting recommendations in this regard. Here we review the available randomized, controlled trial (RCT) data on this subject and offer a synthesis of these data sets.
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Affiliation(s)
- Vincent Cheung
- Division of Neurosurgery, University of California, San Diego, CA, USA
| | - Reid Hoshide
- Division of Neurosurgery, University of California, San Diego, CA, USA
| | - Vishal Bansal
- Department of Surgery, University of California, San Diego, CA, USA
| | - Ekkehard Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Clark C Chen
- Division of Neurosurgery, University of California, San Diego, CA, USA
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Gwak SJ, Koo H, Yun Y, Yhee JY, Lee HY, Yoon DH, Kim K, Ha Y. Multifunctional nanoparticles for gene delivery and spinal cord injury. J Biomed Mater Res A 2015; 103:3474-82. [DOI: 10.1002/jbm.a.35489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 01/23/2023]
Affiliation(s)
- So-Jung Gwak
- Department of Neurosurgery; Spine and Spinal Cord Institute; Yonsei University College of Medicine; 134 Shinchon-dong Seodaemoon-gu Seoul South Korea
| | - Heebeom Koo
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology; Hwarangno 14-Gil 6 Seongbuk-Gu Seoul 136-791 South Korea
| | - Yeomin Yun
- Department of Neurosurgery; Spine and Spinal Cord Institute; Yonsei University College of Medicine; 134 Shinchon-dong Seodaemoon-gu Seoul South Korea
| | - Ji Young Yhee
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology; Hwarangno 14-Gil 6 Seongbuk-Gu Seoul 136-791 South Korea
| | - Hye Yeong Lee
- Department of Neurosurgery; Spine and Spinal Cord Institute; Yonsei University College of Medicine; 134 Shinchon-dong Seodaemoon-gu Seoul South Korea
| | - Do Heum Yoon
- Department of Neurosurgery; Spine and Spinal Cord Institute; Yonsei University College of Medicine; 134 Shinchon-dong Seodaemoon-gu Seoul South Korea
| | - Kwangmeyung Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology; Hwarangno 14-Gil 6 Seongbuk-Gu Seoul 136-791 South Korea
| | - Yoon Ha
- Department of Neurosurgery; Spine and Spinal Cord Institute; Yonsei University College of Medicine; 134 Shinchon-dong Seodaemoon-gu Seoul South Korea
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Papastefanaki F, Matsas R. From demyelination to remyelination: the road toward therapies for spinal cord injury. Glia 2015; 63:1101-25. [PMID: 25731941 DOI: 10.1002/glia.22809] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/14/2022]
Abstract
Myelin integrity is crucial for central nervous system (CNS) physiology while its preservation and regeneration after spinal cord injury (SCI) is key to functional restoration. Disturbance of nodal organization acutely after SCI exposes the axon and triggers conduction block in the absence of overt demyelination. Oligodendrocyte (OL) loss and myelin degradation follow as a consequence of secondary damage. Here, we provide an overview of the major biological events and underlying mechanisms leading to OL death and demyelination and discuss strategies to restrain these processes. Another aspect which is critical for SCI repair is the enhancement of endogenously occurring spontaneous remyelination. Recent findings have unveiled the complex roles of innate and adaptive immune responses in remyelination and the immunoregulatory potential of the glial scar. Moreover, the intimate crosstalk between neuronal activity, oligodendrogenesis and myelination emphasizes the contribution of rehabilitation to functional recovery. With a view toward clinical applications, several therapeutic strategies have been devised to target SCI pathology, including genetic manipulation, administration of small therapeutic molecules, immunomodulation, manipulation of the glial scar and cell transplantation. The implementation of new tools such as cellular reprogramming for conversion of one somatic cell type to another or the use of nanotechnology and tissue engineering products provides additional opportunities for SCI repair. Given the complexity of the spinal cord tissue after injury, it is becoming apparent that combinatorial strategies are needed to rescue OLs and myelin at early stages after SCI and support remyelination, paving the way toward clinical translation.
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Affiliation(s)
- Florentia Papastefanaki
- Laboratory of Cellular and Molecular Neurobiology, Hellenic Pasteur Institute, Athens, 11521, Greece
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Hurlbert RJ, Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE, Rozzelle CJ, Ryken TC, Theodore N. Pharmacological Therapy for Acute Spinal Cord Injury. Neurosurgery 2015; 76 Suppl 1:S71-83. [DOI: 10.1227/01.neu.0000462080.04196.f7] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Liu D, Huang Y, Li B, Jia C, Liang F, Fu Q. Carvedilol promotes neurological function, reduces bone loss and attenuates cell damage after acute spinal cord injury in rats. Clin Exp Pharmacol Physiol 2015; 42:202-12. [PMID: 25424914 DOI: 10.1111/1440-1681.12345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/04/2014] [Accepted: 11/11/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Da Liu
- Department of Orthopaedic Surgery; Shengjing Hospital of China Medical University; Shenyang China
| | - Ying Huang
- Department of Ultrasound; Shengjing Hospital of China Medical University; Shenyang China
| | - Bin Li
- Department of Orthopaedic Surgery; Shengjing Hospital of China Medical University; Shenyang China
| | - Changqing Jia
- Department of Orthopaedic Surgery; Shengjing Hospital of China Medical University; Shenyang China
| | - Feng Liang
- Department of Orthopaedic Surgery; Shengjing Hospital of China Medical University; Shenyang China
| | - Qin Fu
- Department of Orthopaedic Surgery; Shengjing Hospital of China Medical University; Shenyang China
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Zhang L, Li Y, Wang C, Li G, Zhao Y, Yang Y. Synthesis of methylprednisolone loaded ibuprofen modified inulin based nanoparticles and their application for drug delivery. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 42:111-5. [DOI: 10.1016/j.msec.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/08/2014] [Accepted: 05/06/2014] [Indexed: 12/13/2022]
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Hurlbert RJ. Methylprednisolone for the Treatment of Acute Spinal Cord Injury. Neurosurgery 2014; 61 Suppl 1:32-5. [DOI: 10.1227/neu.0000000000000393] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Yu P, Ma H, Shang Y, Wu J, Shen S. Polyethylene glycol modified magnetic carbon nanotubes as nanosorbents for the determination of methylprednisolone in rat plasma by high performance liquid chromatography. J Chromatogr A 2014; 1348:27-33. [DOI: 10.1016/j.chroma.2014.04.065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/18/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Treatment of a Spinal Cord Hemitransection Injury with Keratin Biomaterial Hydrogel Elicits Recovery and Tissue Repair. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/426047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Medical care costs can reach an estimated value of $4 billion for spinal cord injuries (SCI) each year in the USA alone. With no viable treatment options available, care remains palliative and aims to minimize lifelong disabilities and complications, such as immobility, bladder and bowel dysfunction, breathing problems, and blood clots. Human hair keratin biomaterials have demonstrated efficacy in peripheral nerve injury models and were shown to improve conduction delay and increase axon number and density. In this study, a keratin hydrogel was tested in a central nervous system (CNS) application of spinal cord hemisection injury. Keratin-treated rats showed increased survival rates as well as a better functional recovery of gait properties and bladder function. Histological results demonstrated reduced glial scar formation with keratin treatment and suggested a greater degree of beneficial remodeling and cellular influx. The data provided in this pilot study suggest the possibility of using a keratin-based treatment for SCI and warrant further investigation.
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McLean MM, Vert C, Dutcher M, Kollar R, Tilney PV. A 41-year-old man with an incomplete spinal cord injury. Air Med J 2014; 33:6-9. [PMID: 24373468 DOI: 10.1016/j.amj.2013.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/17/2013] [Indexed: 11/25/2022]
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Abstract
Spinal cord injury results in significant mortality and morbidity, lifestyle changes, and difficult rehabilitation. Treatment of spinal cord injury is challenging because the spinal cord is both complex to treat acutely and difficult to regenerate. Nanomaterials can be used to provide effective treatments; their unique properties can facilitate drug delivery to the injury site, enact as neuroprotective agents, or provide platforms to stimulate regrowth of damaged tissues. We review recent uses of nanomaterials including nanowires, micelles, nanoparticles, liposomes, and carbon-based nanomaterials for neuroprotection in the acute phase. We also review the design and neural regenerative application of electrospun scaffolds, conduits, and self-assembling peptide scaffolds.
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Affiliation(s)
- Jacqueline Y. Tyler
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute and Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Ji-Xin Cheng
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907
- Department of Chemistry, Purdue University, West Lafayette, IN 47907
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Hurlbert RJ, Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE, Rozzelle CJ, Ryken TC, Theodore N. Pharmacological therapy for acute spinal cord injury. Neurosurgery 2013; 72 Suppl 2:93-105. [PMID: 23417182 DOI: 10.1227/neu.0b013e31827765c6] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- R John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bharne AP, Upadhya MA, Shelkar GP, Singru PS, Subhedar NK, Kokare DM. Neuroprotective effect of cocaine- and amphetamine-regulated transcript peptide in spinal cord injury in mice. Neuropharmacology 2013; 67:126-35. [DOI: 10.1016/j.neuropharm.2012.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 10/13/2012] [Accepted: 10/20/2012] [Indexed: 10/27/2022]
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Park DY, Mayle RE, Smith RL, Corcoran-Schwartz I, Kharazi AI, Cheng I. Combined Transplantation of Human Neuronal and Mesenchymal Stem Cells following Spinal Cord Injury. Global Spine J 2013; 3:1-6. [PMID: 24436845 PMCID: PMC3854610 DOI: 10.1055/s-0033-1337118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022] Open
Abstract
Transplantation of human fetal neural stem cells (hNSCs) previously demonstrated significant functional recovery after spinal cord contusion in rats. Other studies indicated that human mesenchymal stem cells (hMSCs) can home to areas of damage and cross the blood-brain barrier. The purpose of this article is to determine if combined administration of mesenchymal stem cells and neuronal stem cells improves functional outcomes in rats. The study design was a randomized controlled animal trial. Female adult Long-Evans hooded rats underwent laminectomy at T10 level. Moderate spinal cord contusion at T10 level was induced by the MASCIS Impactor. Four groups were identified. The MSC + NSC group received hMSCs intravenously (IV) immediately after spinal cord injury (acute) and returned 1 week later (subacute) for injection of hNSC directly at site of injury. The MSC-only group received hMSC IV acutely and cell media subacutely. The NSC-only group received cell media IV acutely and hNSC subacutely. The control group received cell media IV acutely and subacutely. Subjects were assessed for 6 weeks using Basso, Beattie, Bresnahan Locomotor Rating Score. Twenty-four subjects were utilized, six subjects in each group. Statistically significant functional improvement was seen in the MSC + NSC group and the NSC-only group versus controls (p = 0.027, 0.042, respectively). The MSC-only group did not demonstrate a significant improvement over control (p = 0.145). Comparing the MSC + NSC group and the NSC-only group, there was no significant difference (p = 0.357). Subacute transplantation of hNSCs into contused spinal cord of rats led to significant functional recovery when injected either with or without acute IV administration of hMSCs. Neither hMSCs nor addition of hMSC to hNSC resulted in significant improvement.
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Affiliation(s)
- D. Y. Park
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - R. E. Mayle
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - R. L. Smith
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - I. Corcoran-Schwartz
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | | | - I. Cheng
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
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Chikuda H, Yasunaga H, Takeshita K, Horiguchi H, Kawaguchi H, Ohe K, Fushimi K, Tanaka S. Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database. Emerg Med J 2013; 31:201-6. [PMID: 23449889 PMCID: PMC3932981 DOI: 10.1136/emermed-2012-202058] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective To examine the magnitude of the adverse impact of high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury (SCI). Methods We examined the abstracted data from the Japanese Diagnosis Procedure Combination database, and included patients with ICD-10 code S141 who were admitted on an emergency basis between 1 July and 31 December in 2007–2009. The investigation evaluated the patients’ sex, age, comorbidities, Japan Coma Scale, hospital volume and the amount of methylprednisolone administered. One-to-one propensity-score matching between high-dose methylprednisolone group (>5000 mg) and control group was performed to compare the rates of in-hospital death and major complications (sepsis; pneumonia; urinary tract infection; gastrointestinal ulcer/bleeding; and pulmonary embolism). Results We identified 3508 cervical SCI patients (2652 men and 856 women; mean age, 60.8±18.7 years) including 824 (23.5%) patients who received high-dose methylprednisolone. A propensity-matched analysis with 824 pairs of patients showed a significant increase in the occurrence of gastrointestinal ulcer/bleeding (68/812 vs 31/812; p<0.001) in the high-dose methylprednisolone group. Overall, the high-dose methylprednisolone group demonstrated a significantly higher risk of complications (144/812 vs 96/812;OR, 1.66; 95% CI 1.23 to 2.24; p=0.001) than the control group. There was no significant difference in in-hospital mortality between the high-dose methylprednisolone group and the control group (p=0.884). Conclusions Patients receiving high-dose methylprednisolone had a significantly increased risk of major complications, in particular, gastrointestinal ulcer/bleeding. However, high-dose methylprednisolone treatment was not associated with any increase in mortality.
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Affiliation(s)
- Hirotaka Chikuda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, , Tokyo, Japan
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