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Huang Y, Mai Y, Ye W, Lv S, Zhou Y, Wu P, Zhou L, Li Y, Zhong K. Brachial Plexus Root Avulsion Injury-Induced Endothelin-Converting Enzyme-Like 1 Overexpression Is Associated with Injured Motor Neurons Survival. Mol Neurobiol 2024:10.1007/s12035-023-03887-7. [PMID: 38170441 DOI: 10.1007/s12035-023-03887-7] [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: 07/18/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
Brachial plexus root avulsion (BPRA) injury arises from challenging delivery during childbirth, sports-related incidents, or car accidents, leading to extensive loss of motor neurons (MNs) and subsequent paralysis, including both motor and sensory impairment. Surgical nerve re-implantation cannot effectively restore motor function, and the survival of injured MNs is vital for axon regeneration and re-innervating the target muscles. Therefore, identifying novel molecular targets to improve injured MNs survival is of great significance in the treatment of BPRA injuries. Endothelin-converting enzyme-like 1 (ECEL1), a membrane-bound metallopeptidase, was initially identified as a molecule associated with nerve injuries. Damaged neurons exhibit a significant increase in the expression of ECEL1 following various types of nerve injuries, such as optic nerve injury and sciatic nerve injury. This study aimed to investigate the relationship between ECEL1 overexpression and the survival of injured MNs following BPRA injury. Our results observed a significant elevation in ECEL1 expression in injured MNs and positively correlated with MNs survival following BPRA injury. The transcription of ECEL1 is regulated by the transcription factors c-Jun and ATF3 in the context of BPRA injury, which is consistent with previous other nerve injuries study. In addition, the expression of TrkA gradually decreases in ECEL1-positive MNs and ECEL1 possibly preserves the activity of downstream AKT-GSK3β pathway of TrkA in injured MNs. In conclusion, our results introduce a promising therapeutic molecular target to assist re-implantation surgery for the treatment of BPRA injury.
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Affiliation(s)
- Yu Huang
- Department of Anatomy, School of Medicine (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yunlin Mai
- Department of Anatomy, School of Medicine (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Weijian Ye
- Center of Cyclotron and PET Radiopharmaceuticals, Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Shiqin Lv
- Department of Anatomy, School of Medicine (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yingying Zhou
- Department of Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pingzhen Wu
- Department of Anatomy, School of Medicine (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Lihua Zhou
- Department of Anatomy, School of Medicine (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yingqin Li
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Mei Hua East Road, Zhuhai, 519000, Guangdong, China.
| | - Ke Zhong
- Department of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, China.
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Sumarwoto T, Suroto H, Mahyudin F, Utomo DN, Romaniyanto FNU, Prijosedjati A, Notobroto HB, Tinduh D, Prakoeswa CRS, Rantam FA, Rhatomy S. Prospect of Stem Cells as Promising Therapy for Brachial Plexus Injury: A Systematic Review. Stem Cells Cloning 2022; 15:29-42. [PMID: 35770243 PMCID: PMC9234311 DOI: 10.2147/sccaa.s363415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 12/09/2022] Open
Abstract
Background Brachial plexus injury is an advanced and devastating neurological injury, for which both nerve surgery and tendon transfers sometimes remain insufficient in restoring normal movement. Stem cell therapy may be applicable to rescue the injured motor neurons from degeneration which potentially improves muscle strength. Study Design Systematic Review; Level of evidence V. Data Sources A systematic literature search was conducted on PubMed (MEDLINE), EMBASE, the Cochrane Library, and Scopus using the terms ("stem cell") AND ("brachial plexus") as search keywords. Methods The process of study selection was summarized by PRISMA flow diagram. The study included in vivo and in vitro studies with English language, humans or animals with some brachial plexus injuries, interventions, some applications of stem cells to the groups of study, with functional, biomechanical, or safety outcomes. Results In total, there were 199 studies identified from the literature sources where 75 articles were qualified for forward evaluation following selecting the titles and abstracts. Ten studies were finally included in this systematic review after full-text assessment. Stem cells can produce neurotrophic factors in vitro and in vivo in rats, and their level was increased after injury. Electrophysiological measurement showed that the intervention group had distinctly higher CMAP amplitude and evidently shorter CMAP latency than the model group. Application of bone marrow stem cells (BMSCs) showed an elevation in the numbers of axons and density of myelinated fibers, the density of nerve fibers, the diameter of regenerating axons, and a decrease in axonal degeneration. A study in humans indicated an improvement of the movements in a patient with traumatic total BPI after injection of Ad-MSC. It is associated with increased muscle mass and sensory recovery and also suggested that mononuclear cell injection enhances muscle regeneration and reinnervation in the partly denervated muscle of brachial plexus injury. Various muscle groups had obtained strength together with restoration, the muscle strength attained after the previous transplantation were preserved. The results of this review support stem cell treatment in brachial plexus injury. Conclusion This review provides evidence of the positive effects of stem cell treatment in brachial plexus injury.
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Affiliation(s)
- Tito Sumarwoto
- Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Heri Suroto
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - F N U Romaniyanto
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Andhi Prijosedjati
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | | | - Damayanti Tinduh
- Physical Medicine and Rehabilitation Department, Universitas Airlangga, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
- Stem Cell Research and Development Center, Airlangga University, Surabaya, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
- Faculty of medicine, public health and nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Ali ZS, Johnson VE, Stewart W, Zager EL, Xiao R, Heuer GG, Weber MT, Mallela AN, Smith DH. Neuropathological Characteristics of Brachial Plexus Avulsion Injury With and Without Concomitant Spinal Cord Injury. J Neuropathol Exp Neurol 2016; 75:69-85. [PMID: 26671984 PMCID: PMC6322589 DOI: 10.1093/jnen/nlv002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Neonatal brachial plexus avulsion injury (BPAI) commonly occurs as a consequence of birth trauma and can result in lifetime morbidity; however, little is known regarding the evolving neuropathological processes it induces. In particular, mechanical forces during BPAI can concomittantly damage the spinal cord and may contribute to outcome. Here, we describe the functional and neuropathological outcome following BPAI, with or without spinal cord injury, in a novel pediatric animal model. Twenty-eight-day-old piglets underwent unilateral C5–C7 BPAI with and without limited myelotomy. Following avulsion, all animals demonstrated right forelimb monoparesis. Injury extending into the spinal cord conferred greater motor deficit, including long tract signs. Consistent with clinical observations, avulsion with myelotomy resulted in more severe neuropathological changes with greater motor neuron death, progressive axonopathy, and persistent glial activation. These data demonstrate neuropathological features of BPAI associated with poor functional outcome. Interestingly, in contrast to adult small animal models of BPAI, a degree of motor neuron survival was observed, even following severe injury in this neonatal model. If this is also the case in human neonatal BPAI, repair may permit functional restoration. This model also provides a clinically relevant platform for exploring the complex postavulsion neuropathological responses that may inform therapeutic strategies.
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Affiliation(s)
- Zarina S. Ali
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Victoria E. Johnson
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - William Stewart
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Eric L. Zager
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Rui Xiao
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Gregory G. Heuer
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Maura T. Weber
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Arka N. Mallela
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
| | - Douglas H. Smith
- From the Department of Neurosurgery (ZAS, VEJ, WS, ELZ, MTW, ANM, DHS), Penn Center for Brain Injury and Repair (ZAS, VEJ, WS, MTW, ANM, DHS), Department of Biostatistics and Epidemiology (RX), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow, UK (WS); Division of Neurosurgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (GGH)
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