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Zhao T, Wei N, Li T, Chen K, Cui W, Wang Z, Wang F, Lin Y, Zhu J. Transplantation of glutamatergic neuronal precursor cells in the paraventricular thalamus and claustrum facilitates awakening with recovery of consciousness. CNS Neurosci Ther 2023; 29:1785-1804. [PMID: 36880283 PMCID: PMC10324366 DOI: 10.1111/cns.14137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/09/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Stem cells offer a promising therapeutic strategy for patients with disorders of consciousness (DOC) after severe traumatic brain injury (TBI), but the optimal transplantation sites and cells are not clear. Although the paraventricular thalamus (PVT) and claustrum (CLA) are associated with consciousness and are candidate transplantation targets, few studies have been designed to investigate this possibility. METHODS Controlled cortical injury (CCI) was performed to establish a mouse model of DOC. CCI-DOC paradigm was established to investigate the role of excitatory neurons of PVT and CLA in disorders of consciousness. The role of excitatory neuron transplantation in promoting arousal and recovery of consciousness was determined by optogenetics, chemogenetics, electrophysiology, Western blot, RT-PCR, double immunofluorescence labeling, and neurobehavioral experiments. RESULTS After CCI-DOC, neuronal apoptosis was found to be concentrated in the PVT and CLA. Prolonged awaking latency and cognitive decline were also seen after destruction of the PVT and CLA, suggesting that the PVT and CLA may be key nuclei in DOC. Awaking latency and cognitive performance could be altered by inhibiting or activating excitatory neurons, implying that excitatory neurons may play an important role in DOC. Furthermore, we found that the PVT and CLA function differently, with the PVT mainly involved in arousal maintenance while the CLA plays a role mainly in the generation of conscious content. Finally, we found that by transplanting excitatory neuron precursor cells in the PVT and CLA, respectively, we could facilitate awakening with recovery of consciousness, which was mainly manifested by shortened awaking latency, reduced duration of loss of consciousness (LOC), enhanced cognitive ability, enhanced memory, and improved limb sensation. CONCLUSION In this study, we found that the deterioration in the level and content of consciousness after TBI was associated with a large reduction in glutamatergic neurons within the PVT and CLA. Transplantation of glutamatergic neuronal precursor cells could play a beneficial role in promoting arousal and recovery of consciousness. Thus, these findings have the potential to provide a favorable basis for promoting awakening and recovery in patients with DOC.
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Affiliation(s)
- Tong Zhao
- Department of Neurosurgery, The First Affiliated Hospital, Neurosurgery Research InstituteFujian Medical UniversityFuzhouFujianChina
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Naili Wei
- Department of NeurosurgeryThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Tianwen Li
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Kezhu Chen
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Wenqiang Cui
- Department of NeurologyAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanShandongChina
| | - Zhifu Wang
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
| | - Fan Wang
- Department of NeurologyPeking University Third HospitalBeijingChina
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital, Neurosurgery Research InstituteFujian Medical UniversityFuzhouFujianChina
| | - Jianhong Zhu
- Department of Neurosurgery, State Key laboratory of Medical Neurobiology, Shanghai Key Laboratory of Brain Function and Regeneration, Shanghai Medical College, Fudan University Huashan Hospital, Institute of Brain ScienceFudan UniversityShanghaiChina
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Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions. Neurocrit Care 2021; 35:68-85. [PMID: 34236624 PMCID: PMC8266715 DOI: 10.1007/s12028-021-01227-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023]
Abstract
Background/Objective For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients with DoC have been limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies have strong evidence to support their use; amantadine is the only therapy recommended by current clinical guidelines, specifically for patients with DoC caused by severe traumatic brain injury. To foster and advance development of consciousness-promoting therapies for patients with DoC, the Curing Coma Campaign convened a Coma Science Work Group to perform a gap analysis. Methods We consider five classes of therapies: (1) pharmacologic; (2) electromagnetic; (3) mechanical; (4) sensory; and (5) regenerative. For each class of therapy, we summarize the state of the science, identify gaps in knowledge, and suggest future directions for therapy development. Results Knowledge gaps in all five therapeutic classes can be attributed to the lack of: (1) a unifying conceptual framework for evaluating therapeutic mechanisms of action; (2) large-scale randomized controlled trials; and (3) pharmacodynamic biomarkers that measure subclinical therapeutic effects in early-phase trials. To address these gaps, we propose a precision medicine approach in which clinical trials selectively enroll patients based upon their physiological receptivity to targeted therapies, and therapeutic effects are measured by complementary behavioral, neuroimaging, and electrophysiologic endpoints. Conclusions This personalized approach can be realized through rigorous clinical trial design and international collaboration, both of which will be essential for advancing the development of new therapies and ultimately improving the lives of patients with DoC. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01227-y.
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Cinamon U, Albukrek D, Dvir D, Marom T. Reversible conductive hearing impediments among patients with severe brain injury. Disabil Rehabil 2019; 42:3199-3202. [PMID: 30950659 DOI: 10.1080/09638288.2019.1588923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Rehabilitation of patients with severe traumatic brain injury may include auditory stimuli. Hampering the function of the external, middle ear or Eustachian tube generates a conductive auditory deficit up to 35 dB that may potentially hinder auditory rehabilitation. The objective was to evaluate the incidence of conductive hearing impediments among patients with severe brain injury.Methods: The cross-section study included adults with severe brain injury hospitalized in a rehabilitation center. The patients presented with a prolonged vegetative state, were dependent on mechanical ventilation and gastrostomy tube feeding. Assessment of external, middle ear and Eustachian tube included otoscopy, tympanometry, nasopharyngoscopy, gag reflex and soft palate evaluations.Results: Nineteen patients (38 ears) were evaluated: 14 males and 5 females, aged 18-93 years (average 59). All patients had a normal nasopharynx, lacked a gag reflex, palatal movements or supraglottic sensation. Eighteen ears (47%) had middle ear effusion, 26 (68%) ears had cerumen impaction, and 14 (37%) had both.Conclusions: Many patients with severe brain injury have reversible and treatable impairments that cause potential conductive hearing loss. Routine otoscopic examination and treatment if required, that is, removal of impacted cerumen or middle ear drainage, have rehabilitating and general health benefits.Implications for rehabilitationAuditory stimulation was suggested for rehabilitation in patients with severe traumatic brain injury.Many patients have cerumen and/or otitis media with effusion causing conductive hearing impairment as well as general health issues.Both aural impediments are diagnosed by routine otoscopy, are easily treated, and may affect rehabilitation.
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Affiliation(s)
- Udi Cinamon
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon, Israel
| | - Dov Albukrek
- Reuth Rehabilitation Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Dvir
- Reuth Rehabilitation Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Sackler School of Medicine, Tel Aviv University, Assuta Ashdod University Hospital, Ashdod, Israel
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Tang Q, Zhang C, Wu X, Duan W, Weng W, Feng J, Mao Q, Chen S, Jiang J, Gao G. Comprehensive Proteomic Profiling of Patients' Tears Identifies Potential Biomarkers for the Traumatic Vegetative State. Neurosci Bull 2018; 34:626-638. [PMID: 30019218 DOI: 10.1007/s12264-018-0259-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 01/03/2023] Open
Abstract
The vegetative state is a complex condition with unclear mechanisms and limited diagnostic, prognostic, and therapeutic methods. In this study, we aimed to explore the proteomic profile of tears from patients in a traumatic vegetative state and identify potential diagnostic markers using tears-a body fluid that can be collected non-invasively. Using iTRAQ quantitative proteomic technology, in the discovery phase, tear samples collected from 16 patients in a traumatic vegetative state and 16 normal individuals were analyzed. Among 1080 identified tear proteins, 57 were upregulated and 15 were downregulated in the patients compared to the controls. Bioinformatics analysis revealed that the differentially-expressed proteins were mainly involved in the wound response and immune response signaling pathways. Furthermore, we verified the levels of 7 differentially-expressed proteins in tears from 50 traumatic vegetative state patients and 50 normal controls (including the samples used in the discovery phase) using ELISA. The results showed that this 7-protein panel had a high discrimination ability for traumatic vegetative state (area under the curve = 0.999). In summary, the altered tear proteomic profile identified in this study provides a basis for potential tear protein markers for diagnosis and prognosis of the traumatic vegetative state and also provides novel insights into the mechanisms of traumatic vegetative state.
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Affiliation(s)
- Qilin Tang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Chao Zhang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Xiang Wu
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Wenbin Duan
- Department of Neurosurgery, Baoshan People's Hospital, Baoshan, 678000, China
| | - Weiji Weng
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Junfeng Feng
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Qing Mao
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Shubin Chen
- Department of Neurology, Anda Hospital, Shanghai, 201204, China
| | - Jiyao Jiang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
- Shanghai Head Trauma Institute, Shanghai, 200127, China
| | - Guoyi Gao
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
- Shanghai Head Trauma Institute, Shanghai, 200127, China.
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