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Doncel-Pérez E, Guízar-Sahagún G, Grijalva-Otero I. From single to combinatorial therapies in spinal cord injuries for structural and functional restoration. Neural Regen Res 2025; 20:660-670. [PMID: 38886932 DOI: 10.4103/nrr.nrr-d-23-01928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/20/2024] [Indexed: 06/20/2024] Open
Abstract
Spinal cord injury results in paralysis, sensory disturbances, sphincter dysfunction, and multiple systemic secondary conditions, most arising from autonomic dysregulation. All this produces profound negative psychosocial implications for affected people, their families, and their communities; the financial costs can be challenging for their families and health institutions. Treatments aimed at restoring the spinal cord after spinal cord injury, which have been tested in animal models or clinical trials, generally seek to counteract one or more of the secondary mechanisms of injury to limit the extent of the initial damage. Most published works on structural/functional restoration in acute and chronic spinal cord injury stages use a single type of treatment: a drug or trophic factor, transplant of a cell type, and implantation of a biomaterial. Despite the significant benefits reported in animal models, when translating these successful therapeutic strategies to humans, the result in clinical trials has been considered of little relevance because the improvement, when present, is usually insufficient. Until now, most studies designed to promote neuroprotection or regeneration at different stages after spinal cord injury have used single treatments. Considering the occurrence of various secondary mechanisms of injury in the acute and sub-acute phases of spinal cord injury, it is reasonable to speculate that more than one therapeutic agent could be required to promote structural and functional restoration of the damaged spinal cord. Treatments that combine several therapeutic agents, targeting different mechanisms of injury, which, when used as a single therapy, have shown some benefits, allow us to assume that they will have synergistic beneficial effects. Thus, this narrative review article aims to summarize current trends in the use of strategies that combine therapeutic agents administered simultaneously or sequentially, seeking structural and functional restoration of the injured spinal cord.
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Affiliation(s)
- Ernesto Doncel-Pérez
- Hospital Nacional de Parapléjicos de Toledo, Servicio de Salud de Castilla La Mancha (SESCAM), Toledo, Spain
| | - Gabriel Guízar-Sahagún
- Medical Research Unit for Neurological Diseases, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - Israel Grijalva-Otero
- Medical Research Unit for Neurological Diseases, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
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Li X, Deng YF, Xiang P, Du JY, Liang JF. Intrathecal liproxstatin-1 delivery inhibits ferroptosis and attenuates mechanical and thermal hypersensitivities in rats with complete Freund’s adjuvant-induced inflammatory pain. Neural Regen Res 2023; 18:456-462. [PMID: 35900446 PMCID: PMC9396519 DOI: 10.4103/1673-5374.346547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Previous studies have confirmed the relationship between iron-dependent ferroptosis and a peripheral nerve injury-induced neuropathic pain model. However, the role of ferroptosis in inflammatory pain remains inconclusive. Therefore, we aimed to explore whether ferroptosis in the spinal cord and dorsal root ganglion contributes to complete Freund’s adjuvant (CFA)-induced painful behaviors in rats. Our results revealed that various biochemical and morphological changes were associated with ferroptosis in the spinal cord and dorsal root ganglion tissues of CFA rats. These changes included iron overload, enhanced lipid peroxidation, disorders of anti-acyl-coenzyme A synthetase long-chain family member 4 and glutathione peroxidase 4 levels, and abnormal morphological changes in mitochondria. Intrathecal treatment of liproxstatin-1 (a ferroptosis inhibitor) reversed these ferroptosis-related changes and alleviated mechanical and thermal hypersensitivities in CFA rats. Our study demonstrated the occurrence of ferroptosis in the spinal cord and dorsal root ganglion tissues in a rodent model of inflammatory pain and indicated that intrathecal administration of ferroptosis inhibitors, such as liproxstatin-1, is a potential therapeutic strategy for treating inflammatory pain.
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Hashemizadeh S, Gharaylou Z, Hosseindoost S, Sardari M, Omidi A, Hosseini ravandi H, Hadjighassem M. Long-term administration of bumetanide improve functional recovery after spinal cord injury in rats. Front Pharmacol 2022; 13:932487. [PMID: 36339604 PMCID: PMC9628211 DOI: 10.3389/fphar.2022.932487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Ion disturbances are among the most remarkable deficits in spinal cord injury (SCI). GABA is an integral part of neural interaction. Action of the GABAA receptor depends on the amount of intracellular chloride. Homeostasis of chloride is controlled by two co-transporters, NKCC1 and KCC2. Previous studies revealed that NKCC1 are disturbed in SCI. In this study, NKCC1 is highly expressed in the epicenter of the lesioned spinal cord at 3 hours after induction of the lesion and reached the peak around 6 hours after SCI. Bumetanide (2 and 4 mg/day), as a specific NKCC1 inhibitor, was used at 3 hours post SCI for 28 days. The functional recovery outcomes were measured by the Basso–Beattie–Bresnahan (BBB) locomotor rating scale, ladder walking test, and hot plate test. The rats that received bumetanide 4 mg/day exhibited improved recovery of locomotor function, reduction of NKCC1 gene expression, and upregulation of GAP protein levels 28 days post SCI. Histological tissue evaluations confirmed bumetanide’s neuroprotective and regenerative effects. This study provides novel evidence for the benefits of bumetanide in early administration after SCI.
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Affiliation(s)
- Shiva Hashemizadeh
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saereh Hosseindoost
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pain Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sardari
- Department of Animal Biology, School of Biology, College of Science, University of Tehran, Tehran, Iran
| | - Ameneh Omidi
- Department of Anatomical Sciences, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | | | - Mahmoudreza Hadjighassem
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Mahmoudreza Hadjighassem,
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GABAergic Mechanisms Can Redress the Tilted Balance between Excitation and Inhibition in Damaged Spinal Networks. Mol Neurobiol 2021; 58:3769-3786. [PMID: 33826070 PMCID: PMC8279998 DOI: 10.1007/s12035-021-02370-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
Correct operation of neuronal networks depends on the interplay between synaptic excitation and inhibition processes leading to a dynamic state termed balanced network. In the spinal cord, balanced network activity is fundamental for the expression of locomotor patterns necessary for rhythmic activation of limb extensor and flexor muscles. After spinal cord lesion, paralysis ensues often followed by spasticity. These conditions imply that, below the damaged site, the state of balanced networks has been disrupted and that restoration might be attempted by modulating the excitability of sublesional spinal neurons. Because of the widespread expression of inhibitory GABAergic neurons in the spinal cord, their role in the early and late phases of spinal cord injury deserves full attention. Thus, an early surge in extracellular GABA might be involved in the onset of spinal shock while a relative deficit of GABAergic mechanisms may be a contributor to spasticity. We discuss the role of GABA A receptors at synaptic and extrasynaptic level to modulate network excitability and to offer a pharmacological target for symptom control. In particular, it is proposed that activation of GABA A receptors with synthetic GABA agonists may downregulate motoneuron hyperexcitability (due to enhanced persistent ionic currents) and, therefore, diminish spasticity. This approach might constitute a complementary strategy to regulate network excitability after injury so that reconstruction of damaged spinal networks with new materials or cell transplants might proceed more successfully.
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Shen XY, Tao CL, Ma L, Shen JH, Li ZL, Wang ZG, Lü XY. Influence of spinal cord injury on core regions of motor function. Neural Regen Res 2021; 16:567-572. [PMID: 32985489 PMCID: PMC7996037 DOI: 10.4103/1673-5374.293158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Functional electrical stimulation is an effective way to rebuild hindlimb motor function after spinal cord injury. However, no site map exists to serve as a reference for implanting stimulator electrodes. In this study, rat models of thoracic spinal nerve 9 contusion were established by a heavy-impact method and rat models of T6/8/9 spinal cord injury were established by a transection method. Intraspinal microstimulation was performed to record motion types, site coordinates, and threshold currents induced by stimulation. After transection (complete injury), the core region of hip flexion migrated from the T13 to T12 vertebral segment, and the core region of hip extension migrated from the L1 to T13 vertebral segment. Migration was affected by post-transection time, but not transection segment. Moreover, the longer the post-transection time, the longer the distance of migration. This study provides a reference for spinal electrode implantation after spinal cord injury. This study was approved by the Institutional Animal Care and Use Committee of Nantong University, China (approval No. 20190225-008) on February 26, 2019.
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Affiliation(s)
- Xiao-Yan Shen
- School of Information Science and Technology; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Chun-Ling Tao
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu Province, China
| | - Lei Ma
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu Province, China
| | - Jia-Huan Shen
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu Province, China
| | - Zhi-Ling Li
- School of Information Science and Technology, Nantong University, Nantong, Jiangsu Province, China
| | - Zhi-Gong Wang
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong; Institute of RF and OE-ICs, Southeast University, Nanjing, Jiangsu Province, China
| | - Xiao-Ying Lü
- State Key Laboratory of Bioelectronics, Southeast University, Nanjing, Jiangsu Province, China
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Liang YH, Chen GW, Li XS, Jia S, Meng CY. Guanosine-5'-triphosphate cyclohydrolase 1 regulated long noncoding RNAs are potential targets for microglial activation in neuropathic pain. Neural Regen Res 2021; 16:596-600. [PMID: 32985494 PMCID: PMC7996028 DOI: 10.4103/1673-5374.290914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several studies have confirmed that microglia are involved in neuropathic pain. Inhibition of guanosine-5'-triphosphate cyclohydrolase 1 (GTPCH1) can reduce the inflammation of microglia. However, the precise mechanism by which GTPCH1 regulates neuropathic pain remains unclear. In this study, BV2 microglia were transfected with adenovirus to knockdown GTPCH1 expression. High throughput sequencing analysis revealed that the mitogen-activated protein kinase (MAPK) related pathways and proteins were the most significantly down-regulated molecular function. Co-expression network analysis of Mapk14 mRNA and five long noncoding RNAs (lncRNAs) revealed their correlation. Quantitative reverse transcription-polymerase chain reaction revealed that among five lncRNAs, ENSMUST00000205634, ENSMUST00000218450 and ENSMUST00000156079 were related to the downregulation of Mapk14 mRNA expression. These provide some new potential targets for the involvement of GTPCH1 in neuropathic pain. This study is the first to note the differential expression of lncRNAs and mRNA in GTPCH1 knockdown BV2 microglia. Findings from this study reveal the mechanism by which GTPCH1 activates microglia and provide new potential targets for microglial activation in neuropathic pain.
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Affiliation(s)
- Yan-Hu Liang
- Department of Clinical Medical College, Jining Medical University; Neuropathic Pain Institute for Spinal Nerve of Jining Medical University, Jining, Shandong Province, China
| | - Guo-Wu Chen
- Neuropathic Pain Institute for Spinal Nerve of Jining Medical University; Department of Spine Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Xue-Song Li
- Department of Joint Surgery, Yanzhou Campus, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Shu Jia
- Neuropathic Pain Institute for Spinal Nerve of Jining Medical University, Jining, Shandong Province, China
| | - Chun-Yang Meng
- Neuropathic Pain Institute for Spinal Nerve of Jining Medical University; Department of Spine Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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Hellman A, Maietta T, Byraju K, Linda Park Y, Shao M, Liss A, Neubauer P, Burdette C, Ghoshal G, Qian J, Nalwalk J, Pilitsis JG. Low Intensity Focused Ultrasound Modulation of Vincristine Induced Neuropathy. Neuroscience 2020; 430:82-93. [DOI: 10.1016/j.neuroscience.2020.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/01/2023]
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Abstract
Adrenomedullin, a peptide with multiple physiological functions in nervous system injury and disease, has aroused the interest of researchers. This review summarizes the role of adrenomedullin in neuropathological disorders, including pathological pain, brain injury and nerve regeneration, and their treatment. As a newly characterized pronociceptive mediator, adrenomedullin has been shown to act as an upstream factor in the transmission of noxious information for various types of pathological pain including acute and chronic inflammatory pain, cancer pain, neuropathic pain induced by spinal nerve injury and diabetic neuropathy. Initiation of glia-neuron signaling networks in the peripheral and central nervous system by adrenomedullin is involved in the formation and maintenance of morphine tolerance. Adrenomedullin has been shown to exert a facilitated or neuroprotective effect against brain injury including hemorrhagic or ischemic stroke and traumatic brain injury. Additionally, adrenomedullin can serve as a regulator to promote nerve regeneration in pathological conditions. Therefore, adrenomedullin is an important participant in nervous system diseases.
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Affiliation(s)
- Feng-Jiao Li
- College of Life Sciences, Laboratory of Neuroendocrinology, Provincial Key Laboratory of Developmental Biology and Neuroscience, Fujian Normal University, Fuzhou, Fujian Province, China
| | - Si-Ru Zheng
- College of Life Sciences, Laboratory of Neuroendocrinology, Provincial Key Laboratory of Developmental Biology and Neuroscience, Fujian Normal University, Fuzhou, Fujian Province, China
| | - Dong-Mei Wang
- College of Life Sciences, Laboratory of Neuroendocrinology, Provincial Key Laboratory of Developmental Biology and Neuroscience, Fujian Normal University, Fuzhou, Fujian Province, China
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