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Kempe PRG, de Castro MV, Khuriyeh VC, Barraviera B, Ferreira RS, de Oliveira ALR. Ultrastructural Evidence of Synapse Preservation and Axonal Regeneration Following Spinal Root Repair with Fibrin Biopolymer and Therapy with Dimethyl Fumarate. Polymers (Basel) 2023; 15:3171. [PMID: 37571065 PMCID: PMC10421511 DOI: 10.3390/polym15153171] [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: 06/28/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
Spinal cord injury causes critical loss in motor and sensory function. Ventral root avulsion is an experimental model in which there is the tearing of the ventral (motor) roots from the surface of the spinal cord, resulting in several morphological changes, including motoneuron degeneration and local spinal cord circuitry rearrangements. Therefore, our goal was to test the combination of surgical repair of lesioned roots with a fibrin biopolymer and the pharmacological treatment with dimethyl fumarate, an immunomodulatory drug. Thus, adult female Lewis rats were subjected to unilateral ventral root avulsion of L4-L6 roots followed by repair with fibrin biopolymer and daily treatment with dimethyl fumarate (15 mg/Kg; gavage) for 4 weeks, the survival time post-surgery being 12 weeks; n = 5/group/technique. Treatments were evaluated by immunofluorescence and transmission electron microscopy, morphometry of the sciatic nerve, and motor function recovery. Our results indicate that the combination between fibrin biopolymer and dimethyl fumarate is neuroprotective since most of the synapses apposed to alfa motoneurons were preserved in clusters. Also, nerve sprouting occurred, and the restoration of the 'g' ratio and large axon diameter was achieved with the combined treatment. Such parameters were combined with up to 50% of gait recovery, observed by the walking track test. Altogether, our results indicate that combining root restoration with fibrin biopolymer and dimethyl fumarate administration can enhance motoneuron survival and regeneration after proximal lesions.
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Affiliation(s)
- Paula Regina Gelinski Kempe
- Laboratory of Nerve Regeneration, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas 13083-862, SP, Brazil; (P.R.G.K.); (M.V.d.C.); (V.C.K.)
| | - Mateus Vidigal de Castro
- Laboratory of Nerve Regeneration, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas 13083-862, SP, Brazil; (P.R.G.K.); (M.V.d.C.); (V.C.K.)
| | - Victor Campos Khuriyeh
- Laboratory of Nerve Regeneration, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas 13083-862, SP, Brazil; (P.R.G.K.); (M.V.d.C.); (V.C.K.)
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu 18610-307, SP, Brazil; (B.B.); (R.S.F.J.)
| | - Rui Seabra Ferreira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu 18610-307, SP, Brazil; (B.B.); (R.S.F.J.)
| | - Alexandre Leite Rodrigues de Oliveira
- Laboratory of Nerve Regeneration, Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas 13083-862, SP, Brazil; (P.R.G.K.); (M.V.d.C.); (V.C.K.)
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Bai Y, Han S, Guan JY, Lin J, Zhao MG, Liang GB. Contralateral C7 nerve transfer in the treatment of upper-extremity paralysis: a review of anatomical basis, surgical approaches, and neurobiological mechanisms. Rev Neurosci 2022; 33:491-514. [PMID: 34979068 DOI: 10.1515/revneuro-2021-0122] [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: 09/09/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022]
Abstract
The previous three decades have witnessed a prosperity of contralateral C7 nerve (CC7) transfer in the treatment of upper-extremity paralysis induced by both brachial plexus avulsion injury and central hemiplegia. From the initial subcutaneous route to the pre-spinal route and the newly-established post-spinal route, this surgical operation underwent a series of innovations and refinements, with the aim of shortening the regeneration distance and even achieving direct neurorrhaphy. Apart from surgical efforts for better peripheral nerve regeneration, brain involvement in functional improvements after CC7 transfer also stimulated scientific interest. This review summarizes recent advances of CC7 transfer in the treatment of upper-extremity paralysis of both peripheral and central causes, which covers the neuroanatomical basis, the evolution of surgical approach, and central mechanisms. In addition, motor cortex stimulation is discussed as a viable rehabilitation treatment in boosting functional recovery after CC7 transfer. This knowledge will be beneficial towards improving clinical effects of CC7 transfer.
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Affiliation(s)
- Yang Bai
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Song Han
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Jing-Yu Guan
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Jun Lin
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Ming-Guang Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
| | - Guo-Biao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, Shenyang 110015, China
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Collins A, Li D, Liadi M, Tabakow P, Fortuna W, Raisman G, Li Y. Partial Recovery of Proprioception in Rats with Dorsal Root Injury after Human Olfactory Bulb Cell Transplantation. J Neurotrauma 2018; 35:1367-1378. [PMID: 29285976 DOI: 10.1089/neu.2017.5273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Transplanted human olfactory ensheathing cells (hOECs) were mixed with collagen into a unilateral transection of four dorsal roots (C6-T1) in a rat model. By mixing with collagen, the limited numbers of hOEC were maximized from an olfactory bulb biopsy and optimize cavity filling. Cyclosporine was administered daily to prevent immune rejection. Forelimb proprioception was assessed weekly in a vertical climb task. Half of the rats receiving hOEC transplants showed some functional improvement ("responders") over six weeks of the study while the other half did not ("nonresponders") and performed similarly to "injured only" rats. Transplanted cells were seen at both one week and six weeks after the surgical procedure; many were concentrated within the lesion cavity, but others were found with elongated processes in the overlying connective tissue. There were some fibers in the injury area associated with transplanted cells that were immunostained for neurofilament and TUJ1. Responder and nonresponder rats were compared with regard to microglial activation within the deep dorsal horn of cervical levels C7, C8 and also axon loss within the cuneate fasciculus at cervical level C3. Little difference was seen in microglial activation or axonal loss that could account for the improved proprioception in the responders group. This preliminary study is the first to transplant human olfactory bulb cells into a rat model of dorsal root injury; by refining each component part of the procedure, the repair potential of OECs can be maximized in a clinical setting.
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Affiliation(s)
- Andrew Collins
- 1 Spinal Repair Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology , Queen Square, London, United Kingdom
| | - Daqing Li
- 1 Spinal Repair Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology , Queen Square, London, United Kingdom
| | - Modinat Liadi
- 1 Spinal Repair Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology , Queen Square, London, United Kingdom
| | - Pawel Tabakow
- 2 Department of Neurosurgery, Wroclaw Medical University , Wroclaw, Poland
| | - Wojciech Fortuna
- 2 Department of Neurosurgery, Wroclaw Medical University , Wroclaw, Poland
| | - Geoffrey Raisman
- 1 Spinal Repair Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology , Queen Square, London, United Kingdom
| | - Ying Li
- 1 Spinal Repair Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology , Queen Square, London, United Kingdom
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Kachramanoglou C, Carlstedt T, Koltzenburg M, Choi D. Long-Term Outcome of Brachial Plexus Reimplantation After Complete Brachial Plexus Avulsion Injury. World Neurosurg 2017; 103:28-36. [PMID: 28365432 PMCID: PMC5756545 DOI: 10.1016/j.wneu.2017.03.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 12/04/2022]
Abstract
Background Complete brachial plexus avulsion injury is a severe disabling injury due to traction to the brachial plexus. Brachial plexus reimplantation is an emerging surgical technique for the management of complete brachial plexus avulsion injury. Objective We assessed the functional recovery in 15 patients who underwent brachial plexus reimplantation surgery after complete brachial plexus avulsion injury with clinical examination and electrophysiological testing. Methods We included all patients who underwent brachial plexus reimplantation in our institution between 1997 and 2010. Patients were assessed with detailed motor and sensory clinical examination and motor and sensory electrophysiological tests. Results We found that patients who had reimplantation surgery demonstrated an improvement in Medical Research Council power in the deltoid, pectoralis, and infraspinatous muscles and global Medical Research Council score. Eight patients achieved at least grade 3 MRC power in at least one muscle group of the arm. Improved reinnervation by electromyelography criteria was found in infraspinatous, biceps, and triceps muscles. There was evidence of ongoing innervation in 3 patients. Sensory testing in affected dermatomes also showed better recovery at C5, C6, and T1 dermatomes. The best recovery was seen in the C5 dermatome. Conclusions Our results demonstrate a definite but limited improvement in motor and sensory recovery after reimplantation surgery in patients with complete brachial plexus injury. We hypothesize that further improvement may be achieved by using regenerative cell technologies at the time of repair.
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Affiliation(s)
| | - Thomas Carlstedt
- Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom
| | - Martin Koltzenburg
- Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom
| | - David Choi
- Spinal Repair Unit, UCL Institute of Neurology, London, England, United Kingdom
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Perussi Biscola N, Politti Cartarozzi L, Ferreira Junior RS, Barraviera B, Leite Rodrigues de Oliveira A. Long-Standing Motor and Sensory Recovery following Acute Fibrin Sealant Based Neonatal Sciatic Nerve Repair. Neural Plast 2016; 2016:9028126. [PMID: 27446617 PMCID: PMC4942656 DOI: 10.1155/2016/9028126] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/03/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022] Open
Abstract
Brachial plexus lesion results in loss of motor and sensory function, being more harmful in the neonate. Therefore, this study evaluated neuroprotection and regeneration after neonatal peripheral nerve coaptation with fibrin sealant. Thus, P2 neonatal Lewis rats were divided into three groups: AX: sciatic nerve axotomy (SNA) without treatment; AX+FS: SNA followed by end-to-end coaptation with fibrin sealant derived from snake venom; AX+CFS: SNA followed by end-to-end coaptation with commercial fibrin sealant. Results were analyzed 4, 8, and 12 weeks after lesion. Astrogliosis, microglial reaction, and synapse preservation were evaluated by immunohistochemistry. Neuronal survival, axonal regeneration, and ultrastructural changes at ventral spinal cord were also investigated. Sensory-motor recovery was behaviorally studied. Coaptation preserved synaptic covering on lesioned motoneurons and led to neuronal survival. Reactive gliosis and microglial reaction decreased in the same groups (AX+FS, AX+CFS) at 4 weeks. Regarding axonal regeneration, coaptation allowed recovery of greater number of myelinated fibers, with improved morphometric parameters. Preservation of inhibitory synaptic terminals was accompanied by significant improvement in the motor as well as in the nociceptive recovery. Overall, the present data suggest that acute repair of neonatal peripheral nerves with fibrin sealant results in neuroprotection and regeneration of motor and sensory axons.
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Affiliation(s)
- Natalia Perussi Biscola
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), 18618-000 Botucatu, SP, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), 18610-307 Botucatu, SP, Brazil
| | - Luciana Politti Cartarozzi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, 13083-970 Campinas, SP, Brazil
| | - Rui Seabra Ferreira Junior
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), 18618-000 Botucatu, SP, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), 18610-307 Botucatu, SP, Brazil
| | - Benedito Barraviera
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), 18618-000 Botucatu, SP, Brazil
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), 18610-307 Botucatu, SP, Brazil
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Affiliation(s)
- Jan Hoeber
- Uppsala University, Department of Neuroscience, Uppsala, Sweden
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Human Embryonic Stem Cell-Derived Progenitors Assist Functional Sensory Axon Regeneration after Dorsal Root Avulsion Injury. Sci Rep 2015; 5:10666. [PMID: 26053681 PMCID: PMC4459081 DOI: 10.1038/srep10666] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/24/2015] [Indexed: 12/29/2022] Open
Abstract
Dorsal root avulsion results in permanent impairment of sensory functions due to disconnection between the peripheral and central nervous system. Improved strategies are therefore needed to reconnect injured sensory neurons with their spinal cord targets in order to achieve functional repair after brachial and lumbosacral plexus avulsion injuries. Here, we show that sensory functions can be restored in the adult mouse if avulsed sensory fibers are bridged with the spinal cord by human neural progenitor (hNP) transplants. Responses to peripheral mechanical sensory stimulation were significantly improved in transplanted animals. Transganglionic tracing showed host sensory axons only in the spinal cord dorsal horn of treated animals. Immunohistochemical analysis confirmed that sensory fibers had grown through the bridge and showed robust survival and differentiation of the transplants. Section of the repaired dorsal roots distal to the transplant completely abolished the behavioral improvement. This demonstrates that hNP transplants promote recovery of sensorimotor functions after dorsal root avulsion, and that these effects are mediated by spinal ingrowth of host sensory axons. These results provide a rationale for the development of novel stem cell-based strategies for functionally useful bridging of the peripheral and central nervous system.
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Kou YH, Zhang PX, Wang YH, Chen B, Han N, Xue F, Zhang HB, Yin XF, Jiang BG. Sleeve bridging of the rhesus monkey ulnar nerve with muscular branches of the pronator teres: multiple amplification of axonal regeneration. Neural Regen Res 2015; 10:53-9. [PMID: 25788920 PMCID: PMC4357117 DOI: 10.4103/1673-5374.150706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/09/2023] Open
Abstract
Multiple-bud regeneration, i.e., multiple amplification, has been shown to exist in peripheral nerve regeneration. Multiple buds grow towards the distal nerve stump during proximal nerve fiber regeneration. Our previous studies have verified the limit and validity of multiple amplification of peripheral nerve regeneration using small gap sleeve bridging of small donor nerves to repair large receptor nerves in rodents. The present study sought to observe multiple amplification of myelinated nerve fiber regeneration in the primate peripheral nerve. Rhesus monkey models of distal ulnar nerve defects were established and repaired using muscular branches of the right forearm pronator teres. Proximal muscular branches of the pronator teres were sutured into the distal ulnar nerve using the small gap sleeve bridging method. At 6 months after suture, two-finger flexion and mild wrist flexion were restored in the ulnar-sided injured limbs of rhesus monkey. Neurophysiological examination showed that motor nerve conduction velocity reached 22.63 ± 6.34 m/s on the affected side of rhesus monkey. Osmium tetroxide staining demonstrated that the number of myelinated nerve fibers was 1,657 ± 652 in the branches of pronator teres of donor, and 2,661 ± 843 in the repaired ulnar nerve. The rate of multiple amplification of regenerating myelinated nerve fibers was 1.61. These data showed that when muscular branches of the pronator teres were used to repair ulnar nerve in primates, effective regeneration was observed in regenerating nerve fibers, and functions of the injured ulnar nerve were restored to a certain extent. Moreover, multiple amplification was subsequently detected in ulnar nerve axons.
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Affiliation(s)
- Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Yan-Hua Wang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Bo Chen
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Na Han
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Feng Xue
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Hong-Bo Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Xiao-Feng Yin
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
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Czyz M, Tabakow P, Hernandez-Sanchez I, Jarmundowicz W, Raisman G. Obtaining the olfactory bulb as a source of olfactory ensheathing cells with the use of minimally invasive neuroendoscopy-assisted supraorbital keyhole approach—cadaveric feasibility study. Br J Neurosurg 2015; 29:362-70. [DOI: 10.3109/02688697.2015.1006170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Barbizan R, Castro MV, Ferreira RS, Barraviera B, Oliveira ALR. Long-term spinal ventral root reimplantation, but not bone marrow mononuclear cell treatment, positively influences ultrastructural synapse recovery and motor axonal regrowth. Int J Mol Sci 2014; 15:19535-51. [PMID: 25353176 PMCID: PMC4264127 DOI: 10.3390/ijms151119535] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/27/2014] [Accepted: 10/11/2014] [Indexed: 12/13/2022] Open
Abstract
We recently proposed a new surgical approach to treat ventral root avulsion, resulting in motoneuron protection. The present work combined such a surgical approach with bone marrow mononuclear cells (MC) therapy. Therefore, MC were added to the site of reimplantation. Female Lewis rats (seven weeks old) were subjected to unilateral ventral root avulsion (VRA) at L4, L5 and L6 levels and divided into the following groups (n = 5 for each group): Avulsion, sealant reimplanted roots and sealant reimplanted roots plus MC. After four weeks and 12 weeks post-surgery, the lumbar intumescences were processed by transmission electron microscopy, to analyze synaptic inputs to the repaired α motoneurons. Also, the ipsi and contralateral sciatic nerves were processed for axon counting and morphometry. The ultrastructural results indicated a significant preservation of inhibitory pre-synaptic boutons in the groups repaired with sealant alone and associated with MC therapy. Moreover, the average number of axons was higher in treated groups when compared to avulsion only. Complementary to the fiber counting, the morphometric analysis of axonal diameter and “g” ratio demonstrated that root reimplantation improved the motor component recovery. In conclusion, the data herein demonstrate that root reimplantation at the lesion site may be considered a therapeutic approach, following proximal lesions in the interface of central nervous system (CNS) and peripheral nervous system (PNS), and that MC therapy does not further improve the regenerative recovery, up to 12 weeks post lesion.
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Affiliation(s)
- Roberta Barbizan
- Department of Structural and Functional Biology, University of Campinas (UNICAMP), PO Box 6109, Campinas 13083-970, São Paulo, Brazil.
| | - Mateus V Castro
- Department of Structural and Functional Biology, University of Campinas (UNICAMP), PO Box 6109, Campinas 13083-970, São Paulo, Brazil.
| | - Rui Seabra Ferreira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu 18610-307, São Paulo, Brazil.
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu 18610-307, São Paulo, Brazil.
| | - Alexandre L R Oliveira
- Department of Structural and Functional Biology, University of Campinas (UNICAMP), PO Box 6109, Campinas 13083-970, São Paulo, Brazil.
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Conovaloff AW, Beier BL, Irazoqui PP, Panitch A. Effects of a synthetic bioactive peptide on neurite growth and nerve growth factor release in chondroitin sulfate hydrogels. BIOMATTER 2014; 1:165-73. [PMID: 23507745 PMCID: PMC3549887 DOI: 10.4161/biom.17849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Previous work has revealed robust dorsal root ganglia neurite growth in hydrogels of chondroitin sulfate. In the current work, it was determined whether addition of a synthetic bioactive peptide could augment neurite growth in these matrices via enhanced binding and sequestering of growth factors. Fluorescence recovery after photobleaching studies revealed that addition of peptide slowed nerve growth factor diffusivity in chondroitin sulfate gels, but not in control gels of hyaluronic acid. Furthermore, cultures of chick dorsal root ganglia in gels of hyaluronic acid or chondroitin sulfate revealed enhanced growth in chondroitin sulfate gels only upon addition of peptide. Taken together, these results suggest a synergistic nerve growth factor-binding activity between this peptide and chondroitin sulfate.
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Affiliation(s)
- Aaron W Conovaloff
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Kachramanoglou C, Law S, Andrews P, Li D, Choi D. Culture of olfactory ensheathing cells for central nerve repair: the limitations and potential of endoscopic olfactory mucosal biopsy. Neurosurgery 2013; 72:170-8; discussion 178-9. [PMID: 23149968 DOI: 10.1227/neu.0b013e31827b99be] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Autotransplantation of olfactory ensheathing cells (OECs) into the damaged central nervous system is a potential therapeutic strategy for spinal cord and root cord injuries. One limiting factor has been the poor OEC yields from human mucosal biopsies. Previous studies have only commented on their success in obtaining mucosal specimens containing olfactory mucosa, but have not commented on the yield of OECs from those specimens. OBJECTIVE To describe a reproducible and safe surgical technique for obtaining human olfactory mucosa and identify patient factors that possibly affect the yield of OEC cultures from the human olfactory mucosa. METHODS We obtained mucosal biopsies from 43 consecutive patients by using a novel reproducible surgical technique and our laboratory culture protocol. The Spearman rank correlation coefficient was used to assess the relationship between OECs and fibroblast yield with patient characteristics and specimen factors. RESULTS A greater yield of OECs was obtained from patients of younger age. In addition, patients with worse mucosal disease yielded poorer cell cultures. Greatest yields were found in patients with absence of mucosal disease. Furthermore, a higher yield of OECs was obtained from specimens harvested from the more caudal portions of the superior turbinate, and OEC yield did not correlate with the ventroposterior location of the biopsy. CONCLUSION We have provided evidence that biopsies closer to the cribriform plate can produce larger yields of OECs, and that patient factors like age and mucosal disease adversely affect the culture yield.
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Affiliation(s)
- Carolina Kachramanoglou
- Spinal Repair Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom.
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Choi D, Gladwin K. Olfactory ensheathing cells: Part II--source of cells and application to patients. World Neurosurg 2013; 83:251-6. [PMID: 23891878 DOI: 10.1016/j.wneu.2013.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/22/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess clinical methods of sourcing human olfactory ensheathing cells (OECs), and the results of present day clinical studies in OEC transplantation. METHODS Review of literature. RESULTS Present clinical studies of OEC transplantation have demonstrated the feasibility and safety of the technique, and no significant complications have occurred from harvest of the olfactory mucosa to culture OECs. These reported studies have not been designed to determine whether clinical outcome is improved by transplantation. CONCLUSIONS OEC transplantation strategies need to be studied further. At present clinical models for testing OECs vary in methodology and quality, and until high-quality, well-designed, and sufficiently powered studies have been performed, the true effect of OEC treatment for patients will remain unclear.
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Affiliation(s)
- David Choi
- Department of Brain, Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London, United Kingdom; National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Karen Gladwin
- Department of Brain, Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London, United Kingdom
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Czyż M, Tabakow P, Gheek D, Miś M, Jarmundowicz W, Raisman G. The supraorbital keyhole approach via an eyebrow incision applied to obtain the olfactory bulb as a source of olfactory ensheathing cells – radiological feasibility study. Br J Neurosurg 2013; 28:234-40. [DOI: 10.3109/02688697.2013.817534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kachramanoglou C, De Vita E, Thomas DL, Wheeler-Kingshott CAM, Balteau E, Carlstedt T, Choi D, Thompson AJ, Ciccarelli O. Metabolic changes in the spinal cord after brachial plexus root re-implantation. Neurorehabil Neural Repair 2012; 27:118-24. [PMID: 22961264 PMCID: PMC4107801 DOI: 10.1177/1545968312457825] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective. To investigate metabolic changes within the spinal cord using
proton magnetic resonance spectroscopy (1H-MRS) and determine their
relationship with clinical function in patients with complete brachial plexus avulsion who
underwent reimplantation of the ventral roots. Methods. Single-voxel
1H-MRS of the cord between C1 and C3 was performed in 10 patients with normal
spinal cord on MRI, who underwent reimplantation of C5 to T1 ventral roots on average 5.5
years earlier, and 19 healthy controls. The ratios of the concentrations of the following
main metabolites, with respect to total creatine levels, were obtained: total
N-acetyl-aspartate, choline-containing compounds, creatine and phosphocreatine (Cr), and
myo-inositol (m-Ins). Patient disability was assessed using upper limb scales. Differences
in metabolite concentration ratios and their correlations with disability were
investigated. Results. Patients showed increased m-Ins/Cr ratio compared
with controls, which was associated with the level of function of the affected arm and
time from injury. Conclusions. The finding of increased m-Ins/Cr in
patients suggests that reactive gliosis, perhaps in response to the degeneration of
avulsed fibers, may occur in the spinal cord above the site of injury and be relevant to
motor dysfunction. However, this pathological process appears to diminish with time. These
insights underline the need to integrate metabolic imaging with structural and functional
magnetic resonance imaging to obtain a complete view of spinal cord plasticity. Last, this
study provides the first steps toward identifying markers to serve as outcome measures for
trials comparing strategies of plexus repair following avulsion injury.
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Vanderhave KL, Bovid K, Alpert H, Chang KWC, Quint DJ, Leonard JA, Yang LJS. Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy. J Neurosurg Pediatr 2012; 9:283-9. [PMID: 22380957 DOI: 10.3171/2011.12.peds11416] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The rate of neonatal brachial plexus palsy (NBPP) remains 0.4%-4% despite improvements in perinatal care. Among affected children, the extent of brachial plexus palsy differs greatly, as does the prognosis. Controversial elements in management include indications and timing of nerve repair as well as type of reconstruction in patients in whom function will ultimately not be recovered without surgical intervention. Differentiating preganglionic (avulsion) from postganglionic (rupture) lesions is critical because preganglionic lesions cannot spontaneously recover motor function. Distinguishing between these lesions at initial presentation based on clinical examination alone can be difficult in infants. The purpose of the present study was to determine the sensitivity of preoperative electrodiagnostic studies (EDSs) and CT myelography (CTM) in determining the presence of nerve root rupture and avulsions in infants with NBPP. METHODS After receiving institutional review board approval, the authors conducted a retrospective review of patients referred to the Neonatal Brachial Plexus Program between 2007 and 2010. Inclusion criteria included children who underwent brachial plexus exploration following preoperative EDSs and CTM. The CTM scans were interpreted by a staff neuroradiologist, EDSs were conducted by a single physiatrist, and intraoperative findings were recorded by the operating neurosurgeon. The findings from the preoperative EDSs and CTM were then compared with intraoperative findings. The sensitivities and 95% confidence intervals were determined to evaluate performance accuracy of each preoperative measure. RESULTS Twenty-one patients (8 male amd 13 female) met inclusion criteria for this study. The sensitivity of EDSs and CTM for detecting a postganglionic rupture was 92.8% (CI 0.841-0.969) and 58.3% (CI 0.420-0.729), respectively. The sensitivity for EDSs and CTM for preganglionic nerve root avulsion was 27.8% (CI 0.125-0.509) and 72.2% (CI 0.491-0.875), respectively. In cases in which both CTM and EDSs gave concordant results, the sensitivity for both modalities combined was 50.0% (CI 0.237-0.763) for avulsion and 80.8% (CI 0.621-0.915) for rupture. Overall, EDSs were most useful in identifying ruptures, particularly in the upper plexus, whereas CTM was most sensitive in identifying avulsions in the lower plexus. CONCLUSIONS Knowledge of the spinal nerve integrity is critical for early management of patients with NBPP. Surgical management, in the form of nerve repair/reconstruction, and optimal prognostication of NBPP depend on the accurate diagnosis of the level and type of lesion. Both EDSs and CTM scans must always be interpreted in the context of a comprehensive evaluation of the patient. They provide supplemental information (in addition to the physical examination) for early detection of nerve root rupture and avulsion injuries, aiding surgical decision making and preoperative planning for NBPP. Continued advances in imaging, EDSs, and microsurgical nerve repair techniques will allow surgeons to achieve greater success for functional recovery in management of NBPP.
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Affiliation(s)
- Kelly L Vanderhave
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
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Conovaloff A, Panitch A. Characterization of a chondroitin sulfate hydrogel for nerve root regeneration. J Neural Eng 2011; 8:056003. [PMID: 21804177 DOI: 10.1088/1741-2560/8/5/056003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Brachial plexus injury is a serious medical problem that affects many patients annually, with most cases involving damage to the nerve roots. Therefore, a chondroitin sulfate hydrogel was designed to both serve as a scaffold for regenerating root neurons and deliver neurotrophic signals. Capillary electrophoresis showed that chondroitin sulfate has a dissociation constant in the micromolar range with several common neurotrophins, and this was determined to be approximately tenfold stronger than with heparin. It was also revealed that nerve growth factor exhibits a slightly stronger affinity for hyaluronic acid than for chondroitin sulfate. However, E8 chick dorsal root ganglia cultured in the presence of nerve growth factor revealed that ganglia cultured in chondroitin sulfate scaffolds showed more robust growth than those cultured in control gels of hyaluronic acid. It is hypothesized that, despite the stronger affinity of nerve growth factor for hyaluronic acid, chondroitin sulfate serves as a better scaffold for neurite outgrowth, possibly due to inhibition of growth by hyaluronic acid chains.
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Affiliation(s)
- Aaron Conovaloff
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907-2032, USA
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