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Pan JZ, Wang Z, Sun W, Pan P, Li W, Sun Y, Chen S, Lin A, Tan W, He L, Greene J, Yao V, An L, Liang R, Li Q, Yu J, Zhang L, Kyritsis N, Fernandez XD, Moncivais S, Mendoza E, Fung P, Wang G, Niu X, Du Q, Xiao Z, Chang Y, Lv P, Huie JR, Torres‐Espin A, Ferguson AR, Hemmerle DD, Talbott JF, Weinstein PR, Pascual LU, Singh V, DiGiorgio AM, Saigal R, Whetstone WD, Manley GT, Dhall SS, Bresnahan JC, Maze M, Jiang X, Singhal NS, Beattie MS, Su H, Guan Z. ATF3 is a neuron-specific biomarker for spinal cord injury and ischaemic stroke. Clin Transl Med 2024; 14:e1650. [PMID: 38649772 PMCID: PMC11035380 DOI: 10.1002/ctm2.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Although many molecules have been investigated as biomarkers for spinal cord injury (SCI) or ischemic stroke, none of them are specifically induced in central nervous system (CNS) neurons following injuries with low baseline expression. However, neuronal injury constitutes a major pathology associated with SCI or stroke and strongly correlates with neurological outcomes. Biomarkers characterized by low baseline expression and specific induction in neurons post-injury are likely to better correlate with injury severity and recovery, demonstrating higher sensitivity and specificity for CNS injuries compared to non-neuronal markers or pan-neuronal markers with constitutive expressions. METHODS In animal studies, young adult wildtype and global Atf3 knockout mice underwent unilateral cervical 5 (C5) SCI or permanent distal middle cerebral artery occlusion (pMCAO). Gene expression was assessed using RNA-sequencing and qRT-PCR, while protein expression was detected through immunostaining. Serum ATF3 levels in animal models and clinical human samples were measured using commercially available enzyme-linked immune-sorbent assay (ELISA) kits. RESULTS Activating transcription factor 3 (ATF3), a molecular marker for injured dorsal root ganglion sensory neurons in the peripheral nervous system, was not expressed in spinal cord or cortex of naïve mice but was induced specifically in neurons of the spinal cord or cortex within 1 day after SCI or ischemic stroke, respectively. Additionally, ATF3 protein levels in mouse blood significantly increased 1 day after SCI or ischemic stroke. Importantly, ATF3 protein levels in human serum were elevated in clinical patients within 24 hours after SCI or ischemic stroke. Moreover, Atf3 knockout mice, compared to the wildtype mice, exhibited worse neurological outcomes and larger damage regions after SCI or ischemic stroke, indicating that ATF3 has a neuroprotective function. CONCLUSIONS ATF3 is an easily measurable, neuron-specific biomarker for clinical SCI and ischemic stroke, with neuroprotective properties. HIGHLIGHTS ATF3 was induced specifically in neurons of the spinal cord or cortex within 1 day after SCI or ischemic stroke, respectively. Serum ATF3 protein levels are elevated in clinical patients within 24 hours after SCI or ischemic stroke. ATF3 exhibits neuroprotective properties, as evidenced by the worse neurological outcomes and larger damage regions observed in Atf3 knockout mice compared to wildtype mice following SCI or ischemic stroke.
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Affiliation(s)
- Jonathan Z. Pan
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Zhanqiang Wang
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for Cerebrovascular ResearchUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of NeurologyCangzhou People's HospitalCangzhouChina
| | - Wei Sun
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyShandong Provincial Hospital, Shandong UniversityJinanChina
| | - Peipei Pan
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for Cerebrovascular ResearchUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Wei Li
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyShandong Provincial Hospital, Shandong UniversityJinanChina
| | - Yongtao Sun
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyQianfoshan Hospital, Shandong UniversityJinanChina
| | - Shoulin Chen
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyThe Second Affiliated Hospital, Nanchang UniversityNanchangChina
| | - Amity Lin
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Wulin Tan
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyGuangzhou Medical UniversityGuangzhouChina
| | - Liangliang He
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of Pain ManagementXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Jacob Greene
- Medical SchoolUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Virginia Yao
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lijun An
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyNo. 1 People's HospitalHuaianChina
| | - Rich Liang
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for Cerebrovascular ResearchUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Qifeng Li
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for Cerebrovascular ResearchUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of NeurosurgeryTianjin Medical University General HospitalTianjinChina
| | - Jessica Yu
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lingyi Zhang
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Nikolaos Kyritsis
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Xuan Duong Fernandez
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sara Moncivais
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Esmeralda Mendoza
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Pamela Fung
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Gongming Wang
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyShandong Provincial Hospital, Shandong UniversityJinanChina
| | - Xinhuan Niu
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyShandong Provincial Hospital, Shandong UniversityJinanChina
| | - Qihang Du
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyShandong Provincial Hospital, Shandong UniversityJinanChina
| | - Zhaoyang Xiao
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of AnesthesiologyThe Second Affiliated Hospital, Dalian Medical UniversityDalianChina
| | - Yuwen Chang
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Peiyuan Lv
- Department of AnesthesiologyThe Second Affiliated Hospital, Dalian Medical UniversityDalianChina
- Department of NeurologyHebei Medical UniversityShijiazhuangChina
| | - J. Russell Huie
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Abel Torres‐Espin
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Adam R. Ferguson
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Debra D. Hemmerle
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jason F. Talbott
- Department of RadiologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Philip R. Weinstein
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lisa U. Pascual
- Department of Orthopedic SurgeryOrthopaedic Trauma InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Vineeta Singh
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Anthony M. DiGiorgio
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Rajiv Saigal
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - William D. Whetstone
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Geoffrey T. Manley
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sanjay S. Dhall
- Department of NeurosurgeryHarbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Jacqueline C. Bresnahan
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Mervyn Maze
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for Cerebrovascular ResearchUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Xiangning Jiang
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Neel S. Singhal
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Michael S. Beattie
- Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Brain and Spinal Injury CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Hua Su
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for Cerebrovascular ResearchUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Zhonghui Guan
- Department of Anesthesia and Perioperative CareUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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2
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Chou A, Torres-Espin A, Kyritsis N, Huie JR, Khatry S, Funk J, Hay J, Lofgreen A, Shah R, McCann C, Pascual LU, Amorim E, Weinstein PR, Manley GT, Dhall SS, Pan JZ, Bresnahan JC, Beattie MS, Whetstone WD, Ferguson AR. Correction: Expert-augmented automated machine learning optimizes hemodynamic predictors of spinal cord injury outcome. PLoS One 2023; 18:e0294081. [PMID: 37917637 PMCID: PMC10621810 DOI: 10.1371/journal.pone.0294081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0265254.].
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3
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Lui A, Park C, Chryssikos T, Radabaugh H, Patel A, Aabedi AA, Ferguson AR, Torres Espin A, Mummaneni PV, Dhall SS, Duong-Fernandez X, Saigal R, Chou A, Pan J, Singh V, Hemmerle DD, Kyritsis N, Talbott JF, Pascual LU, Huie JR, Whetstone WD, Bresnahan JC, Beattie MS, Weinstein PR, Manley GT, DiGiorgio AM. Safety and comparative efficacy of initiating low-molecular-weight heparin within 24 hours of injury or surgery for venous thromboembolism prophylaxis in patients with spinal cord injury: a prospective TRACK-SCI registry study. Neurosurg Focus 2023; 55:E17. [PMID: 37778033 DOI: 10.3171/2023.7.focus23362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Venous thromboembolism (VTE) following traumatic spinal cord injury (SCI) is a significant clinical concern. This study sought to determine the incidence of VTE and hemorrhagic complications among patients with SCI who received low-molecular-weight heparin (LMWH) within 24 hours of injury or surgery and identify variables that predict VTE using the prospective Transforming Research and Clinical Knowledge in SCI (TRACK-SCI) database. METHODS The TRACK-SCI database was queried for individuals with traumatic SCI from 2015 to 2022. Primary outcomes of interest included rates of VTE (including deep vein thrombosis [DVT] and pulmonary embolism [PE]) and in-hospital hemorrhagic complications that occurred after LWMH administration. Secondary outcomes included intensive care unit and hospital length of stay, discharge location type, and in-hospital mortality. RESULTS The study cohort consisted of 162 patients with SCI. Fifteen of the 162 patients withdrew from the study, leading to loss of data for certain variables for these patients. One hundred thirty patients (87.8%) underwent decompression and/or fusion surgery for SCI. DVT occurred in 11 (7.4%) of 148 patients, PE in 9 (6.1%) of 148, and any VTE in 18 (12.2%) of 148 patients. The analysis showed that admission lower-extremity motor score (p = 0.0408), injury at the thoracic level (p = 0.0086), admission American Spinal Injury Association grade (p = 0.0070), and younger age (p = 0.0372) were significantly associated with VTE. There were 3 instances of postoperative spine surgery-related bleeding (2.4%) in the 127 patients who had spine surgery with bleeding complication data available, with one requiring return to surgery (0.8%). Thirteen (8.8%) of 147 patients had a bleeding complication not related to spine surgery. There were 2 gastrointestinal bleeds associated with nasogastric tube placement, 3 cases of postoperative non-spine-related surgery bleeding, and 8 cases of other bleeding complications (5.4%) not related to any surgery. CONCLUSIONS Initiation of LMWH within 24 hours was associated with a low rate of spine surgery-related bleeding. Bleeding complications unrelated to SCI surgery still occur with LMWH administration. Because neurosurgical intervention is typically the limiting factor in initializing chemical DVT prophylaxis, many of these bleeding complications would have likely occurred regardless of the protocol.
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Affiliation(s)
- Austin Lui
- 1College of Osteopathic Medicine, Touro University California, Vallejo
| | | | | | | | | | | | - Adam R Ferguson
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
- 5San Francisco Veterans Affairs Healthcare System, San Francisco, California
| | - Abel Torres Espin
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Praveen V Mummaneni
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Sanjay S Dhall
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Xuan Duong-Fernandez
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Rajiv Saigal
- 6Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Austin Chou
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Jonathan Pan
- Departments of2Neurological Surgery
- 7Anesthesia and Perioperative Care
| | | | - Debra D Hemmerle
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Nikos Kyritsis
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Jason F Talbott
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
- 9Radiology and Biomedical Imaging, and
| | - Lisa U Pascual
- 10Department of Orthopedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco
| | - J Russell Huie
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | - Jacqueline C Bresnahan
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Michael S Beattie
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
- 5San Francisco Veterans Affairs Healthcare System, San Francisco, California
| | - Philip R Weinstein
- Departments of2Neurological Surgery
- 8Neurology
- 12Weill Institute for Neurosciences, Institute for Neurodegenerative Diseases, Spine Center, University of California, San Francisco; and
| | - Geoffrey T Manley
- Departments of2Neurological Surgery
- 13Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Anthony M DiGiorgio
- Departments of2Neurological Surgery
- 3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
- 13Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
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4
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Wai G, Zdunowski S, Zhong H, Nielson JL, Ferguson AR, Strand SC, Moseanko R, Hawbecker S, Nout-Lomas YS, Rosenzweig ES, Beattie MS, Bresnahan JC, Tuszynski MH, Roy RR, Edgerton VR. Emergence of functionally aberrant and subsequent reduction of neuromuscular connectivity and improved motor performance after cervical spinal cord injury in Rhesus. Front Rehabil Sci 2023; 4:1205456. [PMID: 37378049 PMCID: PMC10291623 DOI: 10.3389/fresc.2023.1205456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Introduction The paralysis that occurs after a spinal cord injury, particularly during the early stages of post-lesion recovery (∼6 weeks), appears to be attributable to the inability to activate motor pools well beyond their motor threshold. In the later stages of recovery, however, the inability to perform a motor task effectively can be attributed to abnormal activation patterns among motor pools, resulting in poor coordination. Method We have tested this hypothesis on four adult male Rhesus monkeys (Macaca mulatta), ages 6-10 years, by recording the EMG activity levels and patterns of multiple proximal and distal muscles controlling the upper limb of the Rhesus when performing three tasks requiring different levels of skill before and up to 24 weeks after a lateral hemisection at C7. During the recovery period the animals were provided routine daily care, including access to a large exercise cage (5' × 7' × 10') and tested every 3-4 weeks for each of the three motor tasks. Results At approximately 6-8 weeks the animals were able to begin to step on a treadmill, perform a spring-loaded task with the upper limb, and reaching, grasping, and eating a grape placed on a vertical stick. The predominant changes that occurred, beginning at ∼6-8 weeks of the recovery of these tasks was an elevated level of activation of most motor pools well beyond the pre-lesion level. Discussion As the chronic phase progressed there was a slight reduction in the EMG burst amplitudes of some muscles and less incidence of co-contraction of agonists and antagonists, probably contributing to an improved ability to selectively activate motor pools in a more effective temporal pattern. Relative to pre-lesion, however, the EMG patterns even at the initial stages of recovery of successfully performing the different motor tasks, the level of activity of most muscle remained higher. Perhaps the most important concept that emerges from these data is the large combinations of adaptive strategies in the relative level of recruitment and the timing of the peak levels of activation of different motor pools can progressively provide different stages to regain a motor skill.
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Affiliation(s)
- Gregory Wai
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sharon Zdunowski
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hui Zhong
- Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, CA, United States
| | - Jessica L Nielson
- Department of Psychiatry & Behavioral Sciences and the Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Sarah C Strand
- California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Rod Moseanko
- California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Stephanie Hawbecker
- California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Yvette S Nout-Lomas
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Michael S Beattie
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Mark H Tuszynski
- Veterans Administration Medical Center, La Jolla, CA, United States
- Department of Neuroscience, University of California, San Diego, La Jolla, CA, United States
| | - Roland R Roy
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - V Reggie Edgerton
- Rancho Los Amigos National Rehabilitation Center, Rancho Research Institute, Downey, CA, United States
- Institut Guttmann, Hospital de Neurorehabilitacio, Universitat Autonoma de Barcelona, Badalona, Spain
- Neurorestoration Center, University of Southern California, Los Angeles, CA, United States
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5
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Obaid N, Morioka K, Sinopoulou E, Lomas YN, Salegio E, Bresnahan JC, Beattie MS, Sparrey CJ. The biomechanical implications of neck position in cervical contusion animal models of SCI. Front Neurol 2023; 14:1152472. [PMID: 37346165 PMCID: PMC10280737 DOI: 10.3389/fneur.2023.1152472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Large animal contusion models of spinal cord injury are an essential precursor to developing and evaluating treatment options for human spinal cord injury. Reducing variability in these experiments has been a recent focus as it increases the sensitivity with which treatment effects can be detected while simultaneously decreasing the number of animals required in a study. Here, we conducted a detailed review to explore if head and neck positioning in a cervical contusion model of spinal cord injury could be a factor impacting the biomechanics of a spinal cord injury, and thus, the resulting outcomes. By reviewing existing literature, we found evidence that animal head/neck positioning affects the exposed level of the spinal cord, morphology of the spinal cord, tissue mechanics and as a result the biomechanics of a cervical spinal cord injury. We posited that neck position could be a hidden factor contributing to variability. Our results indicate that neck positioning is an important factor in studying biomechanics, and that reporting these values can improve inter-study consistency and comparability and that further work needs to be done to standardize positioning for cervical spinal cord contusion injury models.
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Affiliation(s)
- Numaira Obaid
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Kazuhito Morioka
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Eleni Sinopoulou
- Center for Neural Repair, University of California, San Diego, San Diego, CA, United States
| | - Yvette-Nout Lomas
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Jacqueline C. Bresnahan
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Michael S. Beattie
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Carolyn J. Sparrey
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
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6
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Agarwal N, Blitstein J, Lui A, Torres-Espin A, Vasnarungruengkul C, Burke J, Mummaneni PV, Dhall SS, Weinstein PR, Duong-Fernandez X, Chou A, Pan J, Singh V, Ferguson AR, Hemmerle DD, Kyritsis N, Talbott JF, Whetstone WD, Bresnahan JC, Beattie MS, Manley GT, DiGiorgio A. Hypotension requiring vasopressor treatment and increased cardiac complications in elderly spinal cord injury patients: a prospective TRACK-SCI registry study. J Neurosurg Spine 2023:1-9. [PMID: 36933260 DOI: 10.3171/2023.2.spine221043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/10/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Increasing life expectancy has led to an older population. In this study, the authors analyzed complications and outcomes in elderly patients following spinal cord injury (SCI) using the established multi-institutional prospective study Transforming Research and Clinical Knowledge in SCI (TRACK-SCI) database collected in the Department of Neurosurgical Surgery at the University of California, San Francisco. METHODS TRACK-SCI was queried for elderly individuals (≥ 65 years of age) with traumatic SCI from 2015 to 2019. Primary outcomes of interest included total hospital length of stay, perioperative complications, postoperative complications, and in-hospital mortality. Secondary outcomes included disposition location, and neurological improvement based on the American Spinal Injury Association Impairment Scale (AIS) grade at discharge. Descriptive analysis, Fisher's exact test, univariate analysis, and multivariable regression analysis were performed. RESULTS The study cohort consisted of 40 elderly patients. The in-hospital mortality rate was 10%. Every patient in this cohort experienced at least 1 complication, with a mean of 6.6 separate complications (median 6, mode 4). The most common complication categories were cardiovascular, with a mean of 1.6 complications (median 1, mode 1), and pulmonary, with a mean of 1.3 (median 1, mode 0) complications, with 35 patients (87.5%) having at least 1 cardiovascular complication and 25 (62.5%) having at least 1 pulmonary complication. Overall, 32 patients (80%) required vasopressor treatment for mean arterial pressure (MAP) maintenance goals. The use of norepinephrine correlated with increased cardiovascular complications. Only 3 patients (7.5%) of the total cohort had an improved AIS grade compared with their acute level at admission. CONCLUSIONS Given the increased frequency of cardiovascular complications associated with vasopressor use in elderly SCI patients, caution is warranted when targeting MAP goals in these patients. A downward adjustment of blood pressure maintenance goals and prophylactic cardiology consultation to select the most appropriate vasopressor agent may be advisable for SCI patients ≥ 65 years of age.
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Affiliation(s)
| | - Jacob Blitstein
- 2College of Osteopathic Medicine, Touro University California, Vallejo
| | - Austin Lui
- 2College of Osteopathic Medicine, Touro University California, Vallejo
| | - Abel Torres-Espin
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | | | | | - Praveen V Mummaneni
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Sanjay S Dhall
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Philip R Weinstein
- 1Departments of Neurological Surgery.,5Radiology and Biomedical Imaging.,6Neurology
| | - Xuan Duong-Fernandez
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Austin Chou
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Jonathan Pan
- 1Departments of Neurological Surgery.,7Anesthesia and Perioperative Care, and
| | | | - Adam R Ferguson
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.,8San Francisco Veterans Affairs Healthcare System, San Francisco, California; and
| | - Debra D Hemmerle
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Nikos Kyritsis
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Jason F Talbott
- 4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.,5Radiology and Biomedical Imaging
| | | | - Jacqueline C Bresnahan
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Michael S Beattie
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.,8San Francisco Veterans Affairs Healthcare System, San Francisco, California; and
| | - Geoffrey T Manley
- 1Departments of Neurological Surgery.,10Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Anthony DiGiorgio
- 1Departments of Neurological Surgery.,3Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco.,4Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.,10Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
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7
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Sinopoulou E, Rosenzweig ES, Conner JM, Gibbs D, Weinholtz CA, Weber JL, Brock JH, Nout-Lomas YS, Ovruchesky E, Takashima Y, Biane JS, Kumamaru H, Havton LA, Beattie MS, Bresnahan JC, Tuszynski MH. Rhesus macaque versus rat divergence in the corticospinal projectome. Neuron 2022; 110:2970-2983.e4. [PMID: 35917818 PMCID: PMC9509478 DOI: 10.1016/j.neuron.2022.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 04/14/2022] [Accepted: 07/06/2022] [Indexed: 01/14/2023]
Abstract
We used viral intersectional tools to map the entire projectome of corticospinal neurons associated with fine distal forelimb control in Fischer 344 rats and rhesus macaques. In rats, we found an extraordinarily diverse set of collateral projections from corticospinal neurons to 23 different brain and spinal regions. Remarkably, the vast weighting of this "motor" projection was to sensory systems in both the brain and spinal cord, confirmed by optogenetic and transsynaptic viral intersectional tools. In contrast, rhesus macaques exhibited far heavier and narrower weighting of corticospinal outputs toward spinal and brainstem motor systems. Thus, corticospinal systems in macaques primarily constitute a final output system for fine motor control, whereas this projection in rats exerts a multi-modal integrative role that accesses far broader CNS regions. Unique structural-functional correlations can be achieved by mapping and quantifying a single neuronal system's total axonal output and its relative weighting across CNS targets.
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Affiliation(s)
- Eleni Sinopoulou
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Ephron S Rosenzweig
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - James M Conner
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Daniel Gibbs
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Chase A Weinholtz
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Janet L Weber
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - John H Brock
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Veterans Administration Medical Center, La Jolla, CA, USA
| | - Yvette S Nout-Lomas
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Eric Ovruchesky
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Yoshio Takashima
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Jeremy S Biane
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Hiromi Kumamaru
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Leif A Havton
- Departments of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Veterans Administration Medical Center, Bronx, NY, USA
| | - Michael S Beattie
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | | | - Mark H Tuszynski
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Veterans Administration Medical Center, La Jolla, CA, USA.
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8
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Chou A, Torres-Espin A, Kyritsis N, Huie JR, Khatry S, Funk J, Hay J, Lofgreen A, Shah R, McCann C, Pascual LU, Amorim E, Weinstein PR, Manley GT, Dhall SS, Pan JZ, Bresnahan JC, Beattie MS, Whetstone WD, Ferguson AR. Expert-augmented automated machine learning optimizes hemodynamic predictors of spinal cord injury outcome. PLoS One 2022; 17:e0265254. [PMID: 35390006 PMCID: PMC8989303 DOI: 10.1371/journal.pone.0265254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Artificial intelligence and machine learning (AI/ML) is becoming increasingly more accessible to biomedical researchers with significant potential to transform biomedicine through optimization of highly-accurate predictive models and enabling better understanding of disease biology. Automated machine learning (AutoML) in particular is positioned to democratize artificial intelligence (AI) by reducing the amount of human input and ML expertise needed. However, successful translation of AI/ML in biomedicine requires moving beyond optimizing only for prediction accuracy and towards establishing reproducible clinical and biological inferences. This is especially challenging for clinical studies on rare disorders where the smaller patient cohorts and corresponding sample size is an obstacle for reproducible modeling results. Here, we present a model-agnostic framework to reinforce AutoML using strategies and tools of explainable and reproducible AI, including novel metrics to assess model reproducibility. The framework enables clinicians to interpret AutoML-generated models for clinical and biological verifiability and consequently integrate domain expertise during model development. We applied the framework towards spinal cord injury prognostication to optimize the intraoperative hemodynamic range during injury-related surgery and additionally identified a strong detrimental relationship between intraoperative hypertension and patient outcome. Furthermore, our analysis captured how evolving clinical practices such as faster time-to-surgery and blood pressure management affect clinical model development. Altogether, we illustrate how expert-augmented AutoML improves inferential reproducibility for biomedical discovery and can ultimately build trust in AI processes towards effective clinical integration.
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Affiliation(s)
- Austin Chou
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Abel Torres-Espin
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Nikos Kyritsis
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - J. Russell Huie
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Sarah Khatry
- DataRobot, Inc., Boston, Massachusetts, United States of America
| | - Jeremy Funk
- DataRobot, Inc., Boston, Massachusetts, United States of America
| | - Jennifer Hay
- DataRobot, Inc., Boston, Massachusetts, United States of America
| | - Andrew Lofgreen
- DataRobot, Inc., Boston, Massachusetts, United States of America
| | - Rajiv Shah
- DataRobot, Inc., Boston, Massachusetts, United States of America
| | - Chandler McCann
- DataRobot, Inc., Boston, Massachusetts, United States of America
| | - Lisa U. Pascual
- Orthopedic Trauma Institute, Department of Orthopedic Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Edilberto Amorim
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Philip R. Weinstein
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Weill Institute for Neurosciences, Institute for Neurodegenerative Diseases, Spine Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Geoffrey T. Manley
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Sanjay S. Dhall
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Jonathan Z. Pan
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Anesthesia and Perioperative Care, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Jacqueline C. Bresnahan
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Michael S. Beattie
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - William D. Whetstone
- Department of Emergency Medicine, University of California, San Francisco (UCSF), San Francisco, California, United States of America
| | - Adam R. Ferguson
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
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9
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Chou A, Torres-Espín A, Huie JR, Krukowski K, Lee S, Nolan A, Guglielmetti C, Hawkins BE, Chaumeil MM, Manley GT, Beattie MS, Bresnahan JC, Martone ME, Grethe JS, Rosi S, Ferguson AR. Empowering Data Sharing and Analytics through the Open Data Commons for Traumatic Brain Injury Research. Neurotrauma Rep 2022; 3:139-157. [PMID: 35403104 PMCID: PMC8985540 DOI: 10.1089/neur.2021.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Traumatic brain injury (TBI) is a major public health problem. Despite considerable research deciphering injury pathophysiology, precision therapies remain elusive. Here, we present large-scale data sharing and machine intelligence approaches to leverage TBI complexity. The Open Data Commons for TBI (ODC-TBI) is a community-centered repository emphasizing Findable, Accessible, Interoperable, and Reusable data sharing and publication with persistent identifiers. Importantly, the ODC-TBI implements data sharing of individual subject data, enabling pooling for high-sample-size, feature-rich data sets for machine learning analytics. We demonstrate pooled ODC-TBI data analyses, starting with descriptive analytics of subject-level data from 11 previously published articles (N = 1250 subjects) representing six distinct pre-clinical TBI models. Second, we perform unsupervised machine learning on multi-cohort data to identify persistent inflammatory patterns across different studies, improving experimental sensitivity for pro- versus anti-inflammation effects. As funders and journals increasingly mandate open data practices, ODC-TBI will create new scientific opportunities for researchers and facilitate multi-data-set, multi-dimensional analytics toward effective translation.
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Affiliation(s)
- Austin Chou
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Abel Torres-Espín
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - J Russell Huie
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
| | - Karen Krukowski
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
| | - Sangmi Lee
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Amber Nolan
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
| | - Caroline Guglielmetti
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Bridget E Hawkins
- Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Moody Project for Traumatic Brain Injury Research, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Myriam M Chaumeil
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael S Beattie
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
- Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California, USA
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California, USA
| | - Maryann E Martone
- Department of Neuroscience, University of California San Diego, San Diego, California, USA
| | - Jeffrey S Grethe
- Department of Neuroscience, University of California San Diego, San Diego, California, USA
| | - Susanna Rosi
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California, USA
- Kavli Institute of Fundamental Neuroscience, University of California San Francisco, San Francisco, California, USA
| | - Adam R Ferguson
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Healthcare System, San Francisco, California, USA
- Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California, USA
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10
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Agarwal N, Aabedi AA, Torres-Espin A, Chou A, Wozny TA, Mummaneni PV, Burke JF, Ferguson AR, Kyritsis N, Dhall SS, Weinstein PR, Duong-Fernandez X, Pan J, Singh V, Hemmerle DD, Talbott JF, Whetstone WD, Bresnahan JC, Manley GT, Beattie MS, DiGiorgio AM. Decision tree–based machine learning analysis of intraoperative vasopressor use to optimize neurological improvement in acute spinal cord injury. Neurosurg Focus 2022; 52:E9. [DOI: 10.3171/2022.1.focus21743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Previous work has shown that maintaining mean arterial pressures (MAPs) between 76 and 104 mm Hg intraoperatively is associated with improved neurological function at discharge in patients with acute spinal cord injury (SCI). However, whether temporary fluctuations in MAPs outside of this range can be tolerated without impairment of recovery is unknown. This retrospective study builds on previous work by implementing machine learning to derive clinically actionable thresholds for intraoperative MAP management guided by neurological outcomes.
METHODS
Seventy-four surgically treated patients were retrospectively analyzed as part of a longitudinal study assessing outcomes following SCI. Each patient underwent intraoperative hemodynamic monitoring with recordings at 5-minute intervals for a cumulative 28,594 minutes, resulting in 5718 unique data points for each parameter. The type of vasopressor used, dose, drug-related complications, average intraoperative MAP, and time spent in an extreme MAP range (< 76 mm Hg or > 104 mm Hg) were collected. Outcomes were evaluated by measuring the change in American Spinal Injury Association Impairment Scale (AIS) grade over the course of acute hospitalization. Features most predictive of an improvement in AIS grade were determined statistically by generating random forests with 10,000 iterations. Recursive partitioning was used to establish clinically intuitive thresholds for the top features.
RESULTS
At discharge, a significant improvement in AIS grade was noted by an average of 0.71 levels (p = 0.002). The hemodynamic parameters most important in predicting improvement were the amount of time intraoperative MAPs were in extreme ranges and the average intraoperative MAP. Patients with average intraoperative MAPs between 80 and 96 mm Hg throughout surgery had improved AIS grades at discharge. All patients with average intraoperative MAP > 96.3 mm Hg had no improvement. A threshold of 93 minutes spent in an extreme MAP range was identified after which the chance of neurological improvement significantly declined. Finally, the use of dopamine as compared to norepinephrine was associated with higher rates of significant cardiovascular complications (50% vs 25%, p < 0.001).
CONCLUSIONS
An average intraoperative MAP value between 80 and 96 mm Hg was associated with improved outcome, corroborating previous results and supporting the clinical verifiability of the model. Additionally, an accumulated time of 93 minutes or longer outside of the MAP range of 76–104 mm Hg is associated with worse neurological function at discharge among patients undergoing emergency surgical intervention for acute SCI.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Abel Torres-Espin
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Austin Chou
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Thomas A. Wozny
- Department of Neurological Surgery, University of California, San Francisco
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
| | - John F. Burke
- Department of Neurological Surgery, University of California, San Francisco
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- San Francisco Veterans Affairs Healthcare System, San Francisco; and
| | - Nikos Kyritsis
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Sanjay S. Dhall
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Philip R. Weinstein
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
| | - Xuan Duong-Fernandez
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Jonathan Pan
- Department of Neurological Surgery, University of California, San Francisco
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - Vineeta Singh
- Department of Neurological Surgery, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
| | - Debra D. Hemmerle
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Jason F. Talbott
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - William D. Whetstone
- Department of Emergency Medicine, University of California, San Francisco, California
| | - Jacqueline C. Bresnahan
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Michael S. Beattie
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- San Francisco Veterans Affairs Healthcare System, San Francisco; and
| | - Anthony M. DiGiorgio
- Department of Neurological Surgery, University of California, San Francisco
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
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11
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Miclau TA, Torres-Espín A, Morshed S, Morioka K, Huie JR, El Naga A, Chou A, Pascual L, Duong Fernandez X, Kuo YH, Weinstein P, Dhall S, Bresnahan JC, Beattie MS, DiGiorgio AM, Ferguson AR. Appendicular fracture and polytrauma correlate with outcome of spinal cord injury (SCI): A TRACK-SCI study. J Neurotrauma 2022; 39:1030-1038. [PMID: 35255740 PMCID: PMC9536347 DOI: 10.1089/neu.2021.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injuries (SCIs) frequently occur in combination with other major organ injuries, such as traumatic brain injury (TBI) and injuries to the chest, abdomen, and musculoskeletal system (e.g., extremity, pelvic, and spine fractures). However, the effects of appendicular fractures on SCI recovery are poorly understood. We investigated whether the presence of SCI-concurrent appendicular fractures is predictive of a less robust SCI recovery. Patients enrolled in the Transforming Research And Clinical Knowledge in SCI (TRACK-SCI) prospective cohort study were identified and included in this secondary analysis study. Inclusion criteria resulted in 147 patients consisting of 120 isolated SCIs and 27 with concomitant appendicular fracture. The primary outcome was ASIA Impairment Scale (AIS) neurological grades at hospital discharge. Secondary outcomes included hospital length of stay, ICU length of stay, and AIS grade improvement during hospitalization. Multivariable binomial logistic regression analyses assessed whether SCI-concomitant appendicular fractures associate with SCI function and secondary outcomes. These analyses were adjusted for age, gender, injury severity, and non-fracture polytrauma. Appendicular fractures were associated with more severe AIS grades at hospital discharge, though covariate adjustments diminished statistical significance of this effect. Notably, non-fracture injuries to the chest and abdomen were influential covariates. Secondary analyses suggested that appendicular fractures also increased hospital length of stay. Our study indicated that SCI-associated polytrauma is important for predicting SCI functional outcomes. Further statistical evaluation is required to disentangle the effects of appendicular fractures, non-fracture solid organ injury, and SCI physiology to improve health outcomes amongst SCI patients.
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Affiliation(s)
- Theodore Andrew Miclau
- UCSF School of Medicine, 533 Parnassus Ave, San Francisco, California, United States, 94143;
| | - Abel Torres-Espín
- Universitat Autonoma de Barcelona, Cell Biology, Physiology and Immunology, and Institute of Neuroscience, Campus UAB, Campus UAB, Bellaterra, Barcelona, Spain, 082193;
| | - Saam Morshed
- University of California San Francisco, 8785, Orthopaedic Surgery, San Francisco, California, United States;
| | - Kazuhito Morioka
- University of California San Francisco, 8785, Orthopaedic Surgery, 2550 23rd Street, Bldg. 9, 3rd Floor, Room 346, San Francisco, California, United States, 941110.,University of California San Francisco, 8785, Neurological SUrgery, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, California, United States, 94143;
| | - J Russell Huie
- University of California San Francisco, Brain and Spinal Injury Center, Dept. of Neurological Surgery, 1001 Potrero Ave, San Francisco, California, United States, 94110.,United States;
| | - Ashraf El Naga
- University of California San Francisco, 8785, Orthopaedic Surgery, San Francisco, California, United States;
| | - Austin Chou
- University of California, San Francisco, 1001 Potrero Ave, Building 1, San Francisco, California, United States, 94110;
| | - Lisa Pascual
- University of California San Francisco, 8785, Orthopedic Surgery, 2550 23rd Street, Bldg. 9, 2nd Floor, San Francisco, California, United States, 94110;
| | - Xuan Duong Fernandez
- University of California San Francisco, 8785, Neurological Surgery, San Francisco, California, United States;
| | - Yu-Hung Kuo
- UCSF Fresno, 589388, Department of Neurological Surgery, Fresno, California, United States;
| | - Philip Weinstein
- University of California San Francisco, 8785, Neurological Surgery, San Francisco, California, United States;
| | - Sanjay Dhall
- University of California San Francisco, Neurological Surgery, San Francisco, California, United States;
| | - Jacqueline C Bresnahan
- UCSF, Neurological Surgery, 1001 Potrero Ave, San Francisco, California, United States, 94110;
| | - Michael S Beattie
- UCSF, BASIC, 1001 Potrero Ave, San Francisco, California, United States, 94110;
| | - Anthony Michael DiGiorgio
- University of California San Francisco, 8785, Neurological Surgery, 505 Parnassus Ave, San Francisco, San Francisco, California, United States, 94143;
| | - Adam R Ferguson
- UCSF, Brain and Spinal Injury Center, Dept Neurosurgery, 1001 Potrero Ave, 1001 Potrero Ave, San Francisco, California, United States, 94110;
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12
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Almeida CA, Torres-Espin A, Huie JR, Sun D, Noble-Haeusslein LJ, Young W, Beattie MS, Bresnahan JC, Nielson JL, Ferguson AR. Excavating FAIR Data: the Case of the Multicenter Animal Spinal Cord Injury Study (MASCIS), Blood Pressure, and Neuro-Recovery. Neuroinformatics 2022; 20:39-52. [PMID: 33651310 PMCID: PMC9015816 DOI: 10.1007/s12021-021-09512-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 01/07/2023]
Abstract
Meta-analyses suggest that the published literature represents only a small minority of the total data collected in biomedical research, with most becoming 'dark data' unreported in the literature. Dark data is due to publication bias toward novel results that confirm investigator hypotheses and omission of data that do not. Publication bias contributes to scientific irreproducibility and failures in bench-to-bedside translation. Sharing dark data by making it Findable, Accessible, Interoperable, and Reusable (FAIR) may reduce the burden of irreproducible science by increasing transparency and support data-driven discoveries beyond the lifecycle of the original study. We illustrate feasibility of dark data sharing by recovering original raw data from the Multicenter Animal Spinal Cord Injury Study (MASCIS), an NIH-funded multi-site preclinical drug trial conducted in the 1990s that tested efficacy of several therapies after a spinal cord injury (SCI). The original drug treatments did not produce clear positive results and MASCIS data were stored in boxes for more than two decades. The goal of the present study was to independently confirm published machine learning findings that perioperative blood pressure is a major predictor of SCI neuromotor outcome (Nielson et al., 2015). We recovered, digitized, and curated the data from 1125 rats from MASCIS. Analyses indicated that high perioperative blood pressure at the time of SCI is associated with poorer health and worse neuromotor outcomes in more severe SCI, whereas low perioperative blood pressure is associated with poorer health and worse neuromotor outcome in moderate SCI. These findings confirm and expand prior results that a narrow window of blood-pressure control optimizes outcome, and demonstrate the value of recovering dark data for assessing reproducibility of findings with implications for precision therapeutic approaches.
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Affiliation(s)
- Carlos A Almeida
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, USA
| | - Abel Torres-Espin
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, USA
| | - J Russell Huie
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, USA
| | - Dongming Sun
- W.M. Keck Center for Collaborative Neuroscience, Rutgers University, New Brunswick, NJ, USA
| | - Linda J Noble-Haeusslein
- Department of Neurology, University of Texas, Austin, TX, USA
- Department of Psychology, University of Texas, Austin, TX, USA
| | - Wise Young
- W.M. Keck Center for Collaborative Neuroscience, Rutgers University, New Brunswick, NJ, USA
| | - Michael S Beattie
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, USA
| | - Jacqueline C Bresnahan
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, USA
| | - Jessica L Nielson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA.
| | - Adam R Ferguson
- Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California San Francisco, San Francisco, CA, USA.
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
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13
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Torres-Espín A, Haefeli J, Ehsanian R, Torres D, Almeida CA, Huie JR, Chou A, Morozov D, Sanderson N, Dirlikov B, Suen CG, Nielson JL, Kyritsis N, Hemmerle DD, Talbott JF, Manley GT, Dhall SS, Whetstone WD, Bresnahan JC, Beattie MS, McKenna SL, Pan JZ, Ferguson AR. Topological network analysis of patient similarity for precision management of acute blood pressure in spinal cord injury. eLife 2021; 10:68015. [PMID: 34783309 PMCID: PMC8639149 DOI: 10.7554/elife.68015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Predicting neurological recovery after spinal cord injury (SCI) is challenging. Using topological data analysis, we have previously shown that mean arterial pressure (MAP) during SCI surgery predicts long-term functional recovery in rodent models, motivating the present multicenter study in patients. Methods: Intra-operative monitoring records and neurological outcome data were extracted (n = 118 patients). We built a similarity network of patients from a low-dimensional space embedded using a non-linear algorithm, Isomap, and ensured topological extraction using persistent homology metrics. Confirmatory analysis was conducted through regression methods. Results: Network analysis suggested that time outside of an optimum MAP range (hypotension or hypertension) during surgery was associated with lower likelihood of neurological recovery at hospital discharge. Logistic and LASSO (least absolute shrinkage and selection operator) regression confirmed these findings, revealing an optimal MAP range of 76–[104-117] mmHg associated with neurological recovery. Conclusions: We show that deviation from this optimal MAP range during SCI surgery predicts lower probability of neurological recovery and suggest new targets for therapeutic intervention. Funding: NIH/NINDS: R01NS088475 (ARF); R01NS122888 (ARF); UH3NS106899 (ARF); Department of Veterans Affairs: 1I01RX002245 (ARF), I01RX002787 (ARF); Wings for Life Foundation (ATE, ARF); Craig H. Neilsen Foundation (ARF); and DOD: SC150198 (MSB); SC190233 (MSB); DOE: DE-AC02-05CH11231 (DM). Spinal cord injury is a devastating condition that involves damage to the nerve fibers connecting the brain with the spinal cord, often leading to permanent changes in strength, sensation and body functions, and in severe cases paralysis. Scientists around the world work hard to find ways to treat or even repair spinal cord injuries but few patients with complete immediate paralysis recover fully. Immediate paralysis is caused by direct damage to neurons and their extension in the spinal cord. Previous research has shown that blood pressure regulation may be key in saving these damaged neurons, as spinal cord injuries can break the communication between nerves that is involved in controlling blood pressure. This can lead to a vicious cycle of dysregulation of blood pressure and limit the supply of blood and oxygen to the damaged spinal cord tissue, exacerbating the death of spinal neurons. Management of blood pressure is therefore a key target for spinal cord injury care, but so far, the precise thresholds to enable neurons to recover are poorly understood. To find out more, Torres-Espin, Haefeli et al. used machine learning software to analyze previously recorded blood pressure and heart rate data obtained from 118 patients that underwent spinal cord surgery after acute spinal cord injury. The analyses revealed that patients who suffered from either low or high blood pressure during surgery had poorer prospects of recovery. Statistical models confirming these findings showed that the optimal blood pressure range to ensure recovery lies between 76 to 104-117 mmHg. Any deviation from this narrow window would dramatically worsen the ability to recover. These findings suggests that dysregulated blood pressure during surgery affects to odds of recovery in patients with a spinal cord injury. Torres-Espin, Haefeli et al. provide specific information that could improve current clinical practice in trauma centers. In the future, such machine learning tools and models could help develop real-time models that could predict the likelihood of a patient’s recovery following spinal cord injury and related neurological conditions.
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Affiliation(s)
- Abel Torres-Espín
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Jenny Haefeli
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Reza Ehsanian
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, United States
| | - Dolores Torres
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Carlos A Almeida
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - J Russell Huie
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States.,San Francisco Veterans Affairs Healthcare System, San Francisco, United States
| | - Austin Chou
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Dmitriy Morozov
- Computational Research Division, Lawrence Berkeley National Laboratory, Berkeley, United States
| | | | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, United States
| | - Catherine G Suen
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Jessica L Nielson
- Department of Psychiatry and Behavioral Science, and University of Minnesota, Minneapolis, United States.,Institute for Health Informatics, University of Minnesota, Minneapolis, United States
| | - Nikos Kyritsis
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Debra D Hemmerle
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Jason F Talbott
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, United States
| | - Geoffrey T Manley
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Sanjay S Dhall
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - William D Whetstone
- Department of Emergency Medicine, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Jacqueline C Bresnahan
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States.,San Francisco Veterans Affairs Healthcare System, San Francisco, United States
| | - Michael S Beattie
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States.,San Francisco Veterans Affairs Healthcare System, San Francisco, United States
| | - Stephen L McKenna
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, United States.,Department of Neurosurgery, Stanford University, Stanford, United States
| | - Jonathan Z Pan
- Department of Anesthesia and Perioperative Care, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States
| | - Adam R Ferguson
- Weill Institute for Neurosciences; Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, United States.,San Francisco Veterans Affairs Healthcare System, San Francisco, United States
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14
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North R, Wurr R, Macon R, Mannion C, Hyde J, Torres-Espin A, Rosenzweig ES, Ferguson AR, Tuszynski MH, Beattie MS, Bresnahan JC, Joiner WM. Quantifying the kinematic features of dexterous finger movements in nonhuman primates with markerless tracking. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:6110-6115. [PMID: 34892511 DOI: 10.1109/embc46164.2021.9630018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research using nonhuman primate models for human disease frequently requires behavioral observational techniques to quantify functional outcomes. The ability to assess reaching and grasping patterns is of particular interest in clinical conditions that affect the motor system (e.g., spinal cord injury, SCI). Here we explored the use of DeepLabCut, an open-source deep learning toolset, in combination with a standard behavioral task (Brinkman Board) to quantify nonhuman primate performance in precision grasping. We examined one male rhesus macaque (Macaca mulatta) in the task which involved retrieving rewards from variously-oriented shallow wells. Simultaneous recordings were made using GoPro Hero7 Black cameras (resolution 1920 x 1080 at 120 fps) from two different angles (from the side and top of the hand motion). The task/device design necessitates use of the right hand to complete the task. Two neural networks (corresponding to the top and side view cameras) were trained using 400 manually annotated images, tracking 19 unique landmarks each. Based on previous reports, this produced sufficient tracking (Side: trained pixel error of 2.15, test pixel error of 11.25; Top: trained pixel error of 2.06, test pixel error of 30.31) so that landmarks could be tracked on the remaining frames. Landmarks included in the tracking were the spatial location of the knuckles and the fingernails of each digit, and three different behavioral measures were quantified for assessment of hand movement (finger separation, middle digit extension and preshaping distance). Together, our preliminary results suggest that this markerless approach is a possible method to examine specific kinematic features of dexterous function.Clinical Relevance- The methodology presented below allows for the markerless tracking of kinematic features of dexterous finger movement by non-human primates. This method could allow for direct comparisons between human patients and non-human primate models of clinical conditions (e.g., spinal cord injury). This would provide objective quantitative metrics and crucial information for assessing movement impairments across populations and the potential translation of treatments, interventions and their outcomes.
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15
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Tsolinas RE, Burke JF, DiGiorgio AM, Thomas LH, Duong-Fernandez X, Harris MH, Yue JK, Winkler EA, Suen CG, Pascual LU, Ferguson AR, Huie JR, Pan JZ, Hemmerle DD, Singh V, Torres-Espin A, Omondi C, Kyritsis N, Haefeli J, Weinstein PR, de Almeida Neto CA, Kuo YH, Taggard D, Talbott JF, Whetstone WD, Manley GT, Bresnahan JC, Beattie MS, Dhall SS. Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI): an overview of initial enrollment and demographics. Neurosurg Focus 2021; 48:E6. [PMID: 32357323 DOI: 10.3171/2020.2.focus191030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/14/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Traumatic spinal cord injury (SCI) is a dreaded condition that can lead to paralysis and severe disability. With few treatment options available for patients who have suffered from SCI, it is important to develop prospective databases to standardize data collection in order to develop new therapeutic approaches and guidelines. Here, the authors present an overview of their multicenter, prospective, observational patient registry, Transforming Research and Clinical Knowledge in SCI (TRACK-SCI). METHODS Data were collected using the National Institute of Neurological Disorders and Stroke (NINDS) common data elements (CDEs). Highly granular clinical information, in addition to standardized imaging, biospecimen, and follow-up data, were included in the registry. Surgical approaches were determined by the surgeon treating each patient; however, they were carefully documented and compared within and across study sites. Follow-up visits were scheduled for 6 and 12 months after injury. RESULTS One hundred sixty patients were enrolled in the TRACK-SCI study. In this overview, basic clinical, imaging, neurological severity, and follow-up data on these patients are presented. Overall, 78.8% of the patients were determined to be surgical candidates and underwent spinal decompression and/or stabilization. Follow-up rates to date at 6 and 12 months are 45% and 36.3%, respectively. Overall resources required for clinical research coordination are also discussed. CONCLUSIONS The authors established the feasibility of SCI CDE implementation in a multicenter, prospective observational study. Through the application of standardized SCI CDEs and expansion of future multicenter collaborations, they hope to advance SCI research and improve treatment.
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Affiliation(s)
- Rachel E Tsolinas
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of
| | - John F Burke
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Anthony M DiGiorgio
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Leigh H Thomas
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Xuan Duong-Fernandez
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Mark H Harris
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - John K Yue
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Ethan A Winkler
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Catherine G Suen
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Lisa U Pascual
- 4Orthopaedic Surgery and Orthopedic Trauma Institute, Zuckerberg San Francisco General Hospital.,5Orthopedic Surgery
| | - Adam R Ferguson
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience.,6San Francisco Veterans Affairs Healthcare System
| | - J Russell Huie
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Jonathan Z Pan
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,7Anesthesia and Perioperative Care
| | - Debra D Hemmerle
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Vineeta Singh
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,3Weill Institutes for Neuroscience.,8Neurology, and
| | - Abel Torres-Espin
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Cleopa Omondi
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Nikos Kyritsis
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Jenny Haefeli
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Philip R Weinstein
- 2Neurological Surgery.,3Weill Institutes for Neuroscience.,9Institute for Neurodegenerative Diseases, Spine Center, University of California San Francisco
| | - Carlos A de Almeida Neto
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Yu-Hung Kuo
- 12Department of Neurological Surgery, University of California San Francisco-Fresno, Fresno, California
| | - Derek Taggard
- 12Department of Neurological Surgery, University of California San Francisco-Fresno, Fresno, California
| | - Jason F Talbott
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,10Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; and
| | | | - Geoffrey T Manley
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Jacqueline C Bresnahan
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Michael S Beattie
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Sanjay S Dhall
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
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16
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Kyritsis N, Torres-Espín A, Schupp PG, Huie JR, Chou A, Duong-Fernandez X, Thomas LH, Tsolinas RE, Hemmerle DD, Pascual LU, Singh V, Pan JZ, Talbott JF, Whetstone WD, Burke JF, DiGiorgio AM, Weinstein PR, Manley GT, Dhall SS, Ferguson AR, Oldham MC, Bresnahan JC, Beattie MS. Diagnostic blood RNA profiles for human acute spinal cord injury. J Exp Med 2021; 218:e20201795. [PMID: 33512429 PMCID: PMC7852457 DOI: 10.1084/jem.20201795] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/18/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
Diagnosis of spinal cord injury (SCI) severity at the ultra-acute stage is of great importance for emergency clinical care of patients as well as for potential enrollment into clinical trials. The lack of a diagnostic biomarker for SCI has played a major role in the poor results of clinical trials. We analyzed global gene expression in peripheral white blood cells during the acute injury phase and identified 197 genes whose expression changed after SCI compared with healthy and trauma controls and in direct relation to SCI severity. Unsupervised coexpression network analysis identified several gene modules that predicted injury severity (AIS grades) with an overall accuracy of 72.7% and included signatures of immune cell subtypes. Specifically, for complete SCIs (AIS A), ROC analysis showed impressive specificity and sensitivity (AUC: 0.865). Similar precision was also shown for AIS D SCIs (AUC: 0.938). Our findings indicate that global transcriptomic changes in peripheral blood cells have diagnostic and potentially prognostic value for SCI severity.
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Affiliation(s)
- Nikos Kyritsis
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Abel Torres-Espín
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Patrick G. Schupp
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Brain Tumor Center, University of California, San Francisco, San Francisco, CA
| | - J. Russell Huie
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Austin Chou
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Xuan Duong-Fernandez
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Leigh H. Thomas
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Rachel E. Tsolinas
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Debra D. Hemmerle
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Lisa U. Pascual
- Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA
| | - Vineeta Singh
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Jonathan Z. Pan
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Jason F. Talbott
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - William D. Whetstone
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA
| | - John F. Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Anthony M. DiGiorgio
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Philip R. Weinstein
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
- Weill Institute for Neurosciences, Institute for Neurodegenerative Diseases, Spine Center, University of California, San Francisco, San Francisco, CA
| | - Geoffrey T. Manley
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Sanjay S. Dhall
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Adam R. Ferguson
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Michael C. Oldham
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Brain Tumor Center, University of California, San Francisco, San Francisco, CA
| | - Jacqueline C. Bresnahan
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Michael S. Beattie
- Weill Institute for Neurosciences, Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA
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17
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Huie JR, Ferguson AR, Kyritsis N, Pan JZ, Irvine KA, Nielson JL, Schupp PG, Oldham MC, Gensel JC, Lin A, Segal MR, Ratan RR, Bresnahan JC, Beattie MS. Machine intelligence identifies soluble TNFa as a therapeutic target for spinal cord injury. Sci Rep 2021; 11:3442. [PMID: 33564058 PMCID: PMC7873211 DOI: 10.1038/s41598-021-82951-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Traumatic spinal cord injury (SCI) produces a complex syndrome that is expressed across multiple endpoints ranging from molecular and cellular changes to functional behavioral deficits. Effective therapeutic strategies for CNS injury are therefore likely to manifest multi-factorial effects across a broad range of biological and functional outcome measures. Thus, multivariate analytic approaches are needed to capture the linkage between biological and neurobehavioral outcomes. Injury-induced neuroinflammation (NI) presents a particularly challenging therapeutic target, since NI is involved in both degeneration and repair. Here, we used big-data integration and large-scale analytics to examine a large dataset of preclinical efficacy tests combining five different blinded, fully counter-balanced treatment trials for different acute anti-inflammatory treatments for cervical spinal cord injury in rats. Multi-dimensional discovery, using topological data analysis (TDA) and principal components analysis (PCA) revealed that only one showed consistent multidimensional syndromic benefit: intrathecal application of recombinant soluble TNFα receptor 1 (sTNFR1), which showed an inverse-U dose response efficacy. Using the optimal acute dose, we showed that clinically-relevant 90 min delayed treatment profoundly affected multiple biological indices of NI in the first 48 h after injury, including reduction in pro-inflammatory cytokines and gene expression of a coherent complex of acute inflammatory mediators and receptors. Further, a 90 min delayed bolus dose of sTNFR1 reduced the expression of NI markers in the chronic perilesional spinal cord, and consistently improved neurological function over 6 weeks post SCI. These results provide validation of a novel strategy for precision preclinical drug discovery that is likely to improve translation in the difficult landscape of CNS trauma, and confirm the importance of TNFα signaling as a therapeutic target.
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Affiliation(s)
- J R Huie
- Department of Neurological Surgery, Brain and Spinal Injury Center (BASIC), University of California, San Francisco, CA, USA
| | - A R Ferguson
- Department of Neurological Surgery, Brain and Spinal Injury Center (BASIC), University of California, San Francisco, CA, USA.
- San Francisco Veterans Affairs Medical Center, San Francisco, USA.
| | - N Kyritsis
- Department of Neurological Surgery, Brain and Spinal Injury Center (BASIC), University of California, San Francisco, CA, USA
| | - J Z Pan
- Department of Anesthesiology, University of California San Francisco, San Francisco, USA
| | - K-A Irvine
- Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Anesthesia, Perioperative Medicine and Pain, Stanford University, Stanford, CA, USA
| | - J L Nielson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
- Institute for Health Informatics, University of Minnesota, Minneapolis, USA
| | - P G Schupp
- Brain Tumor Research Center, University of California, San Francisco, USA
| | - M C Oldham
- Brain Tumor Research Center, University of California, San Francisco, USA
| | - J C Gensel
- SCoBIRC, University of Kentucky, Lexington, USA
| | - A Lin
- Department of Neurological Surgery, Brain and Spinal Injury Center (BASIC), University of California, San Francisco, CA, USA
| | - M R Segal
- Department of Epidemiology and Biostatistics, Center for Bioinformatics and Molecular Biostatistics, University of California San Francisco, San Francisco, USA
| | - R R Ratan
- Department of Neurology and Neuroscience, Burke-Cornell Medical Research Institute, Weill Medical College of Cornell University, New York, USA
| | - J C Bresnahan
- Department of Neurological Surgery, Brain and Spinal Injury Center (BASIC), University of California, San Francisco, CA, USA
| | - M S Beattie
- Department of Neurological Surgery, Brain and Spinal Injury Center (BASIC), University of California, San Francisco, CA, USA.
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18
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Mummaneni N, Burke JF, DiGiorgio AM, Thomas LH, Duong-Fernandez X, Harris M, Pascual LU, Ferguson AR, Russell Huie J, Pan JZ, Hemmerle DD, Singh V, Torres-Espin A, Omondi C, Kyritsis N, Weinstein PR, Whetstone WD, Manley GT, Bresnahan JC, Beattie MS, Cohen-Adad J, Dhall SS, Talbott JF. Injury volume extracted from MRI predicts neurologic outcome in acute spinal cord injury: A prospective TRACK-SCI pilot study. J Clin Neurosci 2020; 82:231-236. [PMID: 33248950 DOI: 10.1016/j.jocn.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Abstract
Conventional MRI measures of traumatic spinal cord injury severity largely rely on 2-dimensional injury characteristics such as intramedullary lesion length and cord compression. Recent advances in spinal cord (SC) analysis have led to the development of a robust anatomic atlas incorporated into an open-source platform called the Spinal Cord Toolbox (SCT) that allows for quantitative volumetric injury analysis. In the current study, we evaluate the prognostic value of volumetric measures of spinal cord injury on MRI following registration of T2-weighted (T2w) images and segmented lesions from acute SCI patients with a standardized atlas. This IRB-approved prospective cohort study involved the image analysis of 60 blunt cervical SCI patients enrolled in the TRACK-SCI clinical research protocol. Axial T2w MRI data obtained within 24 h of injury were processed using the SCT. Briefly, SC MRIs were automatically segmented using the sct_deepseg_sc tool in the SCT and segmentations were manually corrected by a neuro-radiologist. Lesion volume data were used as predictor variables for correlation with lower extremity motor scores at discharge. Volumetric MRI measures of T2w signal abnormality comprising the SCI lesion accurately predict lower extremity motor scores at time of patient discharge. Similarly, MRI measures of injury volume significantly correlated with motor scores to a greater degree than conventional 2-D metrics of lesion size. The volume of total injury and of injured spinal cord motor regions on T2w MRI is significantly and independently associated with neurologic outcome at discharge after injury.
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Affiliation(s)
- Nikhil Mummaneni
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John F Burke
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Anthony M DiGiorgio
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Leigh H Thomas
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Xuan Duong-Fernandez
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Mark Harris
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Lisa U Pascual
- Orthopedic Trauma Institute, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA; San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - J Russell Huie
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Jonathan Z Pan
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Debra D Hemmerle
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Vineeta Singh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Abel Torres-Espin
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Cleopa Omondi
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Nikos Kyritsis
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Phillip R Weinstein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, Spine Center, University of California San Francisco, San Francisco, CA, USA
| | - William D Whetstone
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Michael S Beattie
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; Weill Institutes for Neuroscience, San Francisco, CA, USA
| | - Julien Cohen-Adad
- Polytechnique Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Sanjay S Dhall
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jason F Talbott
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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19
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Jannesar S, Salegio EA, Beattie MS, Bresnahan JC, Sparrey CJ. Correlating Tissue Mechanics and Spinal Cord Injury: Patient-Specific Finite Element Models of Unilateral Cervical Contusion Spinal Cord Injury in Non-Human Primates. J Neurotrauma 2020; 38:698-717. [PMID: 33066716 DOI: 10.1089/neu.2019.6840] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Non-human primate (NHP) models are the closest approximation of human spinal cord injury (SCI) available for pre-clinical trials. The NHP models, however, include broader morphological variability that can confound experimental outcomes. We developed subject-specific finite element (FE) models to quantify the relationship between impact mechanics and SCI, including the correlations between FE outcomes and tissue damage. Subject-specific models of cervical unilateral contusion SCI were generated from pre-injury MRIs of six NHPs. Stress and strain outcomes were compared with lesion histology using logit analysis. A parallel generic model was constructed to compare the outcomes of subject-specific and generic models. The FE outcomes were correlated more strongly with gray matter damage (0.29 < R2 < 0.76) than white matter (0.18 < R2 < 0.58). Maximum/minimum principal strain, Von-Mises and Tresca stresses showed the strongest correlations (0.31 < R2 < 0.76) with tissue damage in the gray matter while minimum principal strain, Von-Mises stress, and Tresca stress best predicted white matter damage (0.23 < R2 < 0.58). Tissue damage thresholds varied for each subject. The generic FE model captured the impact biomechanics in two of the four models; however, the correlations between FE outcomes and tissue damage were weaker than the subject-specific models (gray matter [0.25 < R2 < 0.69] and white matter [R2 < 0.06] except for one subject [0.26 < R2 < 0.48]). The FE mechanical outputs correlated with tissue damage in spinal cord white and gray matters, and the subject-specific models accurately mimicked the biomechanics of NHP cervical contusion impacts.
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Affiliation(s)
- Shervin Jannesar
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
| | - Ernesto A Salegio
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
| | - Michael S Beattie
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center, University of California San Francisco, San Francisco, California, USA
| | - Carolyn J Sparrey
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
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20
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Gao J, Sun Z, Xiao Z, Du Q, Niu X, Wang G, Chang YW, Sun Y, Sun W, Lin A, Bresnahan JC, Maze M, Beattie MS, Pan JZ. Dexmedetomidine modulates neuroinflammation and improves outcome via alpha2-adrenergic receptor signaling after rat spinal cord injury. Br J Anaesth 2019; 123:827-838. [PMID: 31623841 DOI: 10.1016/j.bja.2019.08.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/17/2019] [Accepted: 08/17/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spinal cord injury induces inflammatory responses that include the release of cytokines and the recruitment and activation of macrophages and microglia. Neuroinflammation at the lesion site contributes to secondary tissue injury and permanent locomotor dysfunction. Dexmedetomidine (DEX), a highly selective α2-adrenergic receptor agonist, is anti-inflammatory and neuroprotective in both preclinical and clinical trials. We investigated the effect of DEX on the microglial response, and histological and neurological outcomes in a rat model of cervical spinal cord injury. METHODS Anaesthetised rats underwent unilateral (right) C5 spinal cord contusion (75 kdyne) using an impactor device. The locomotor function, injury size, and inflammatory responses were assessed. The effect of DEX was also studied in a microglial cell culture model. RESULTS DEX significantly improved the ipsilateral upper-limb motor dysfunction (grooming and paw placement; P<0.0001 and P=0.0012), decreased the injury size (P<0.05), spared white matter (P<0.05), and reduced the number of activated macrophages (P<0.05) at the injury site 4 weeks post-SCI. In DEX-treated rats after injury, tissue RNA expression indicated a significant downregulation of pro-inflammatory markers (e.g. interleukin [IL]-1β, tumour necrosis factor-α, interleukin (IL)-6, and CD11b) and an upregulation of anti-inflammatory and pro-resolving M2 responses (e.g. IL-4, arginase-1, and CD206) (P<0.05). In lipopolysaccharide-stimulated cultured microglia, DEX produced a similar inflammation-modulatory effect as was seen in spinal cord injury. The benefits of DEX on these outcomes were mostly reversed by an α2-adrenergic receptor antagonist. CONCLUSIONS DEX significantly improves neurological outcomes and decreases tissue damage after spinal cord injury, which is associated with modulation of neuroinflammation and is partially mediated via α2-adrenergic receptor signaling.
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Affiliation(s)
- Jiandong Gao
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhihua Sun
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaoyang Xiao
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, The Second Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China
| | - Qihang Du
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xinhuan Niu
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Gongming Wang
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yu-Wen Chang
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA
| | - Yongtao Sun
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Shandong Provincial Qianfoshan Hospital, the First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Wei Sun
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Department of Anaesthesiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Amity Lin
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mervyn Maze
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Michael S Beattie
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Jonathan Z Pan
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA.
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21
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Yue JK, Hemmerle DD, Winkler EA, Thomas LH, Fernandez XD, Kyritsis N, Pan JZ, Pascual LU, Singh V, Weinstein PR, Talbott JF, Huie JR, Ferguson AR, Whetstone WD, Manley GT, Beattie MS, Bresnahan JC, Mummaneni PV, Dhall SS. Clinical Implementation of Novel Spinal Cord Perfusion Pressure Protocol in Acute Traumatic Spinal Cord Injury at U.S. Level I Trauma Center: TRACK-SCI Study. World Neurosurg 2019; 133:e391-e396. [PMID: 31526882 DOI: 10.1016/j.wneu.2019.09.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to report the safety of implementation of a novel standard of care protocol using spinal cord perfusion pressure (SCPP) maintenance for managing traumatic spinal cord injury (SCI) in lieu of mean arterial pressure goals at a U.S. Level I trauma center. METHODS Starting in December 2017, blunt SCI patients presenting <24 hours after injury with admission American Spinal Injury Association Impairment Scale (AIS) A-C (or AIS D at neurosurgeon discretion) received lumbar subarachnoid drain (LSAD) placement for SCPP monitoring in the intensive care unit and were included in the TRACK-SCI (Transforming Research and Clinical Knowledge in Spinal Cord Injury) data registry. This SCPP protocol comprises standard care at our institution. SCPPs were monitored for 5 days (goal ≥65 mm Hg) achieved through intravenous fluids and vasopressor support. AISs were assessed at admission and day 7. RESULTS Fifteen patients enrolled to date were aged 60.5 ± 17 years. Injury levels were 93.3% (cervical) and 6.7% (thoracic). Admission AIS was 20.0%/20.0%/26.7%/33.3% for A/B/C/D. All patients maintained mean SCPP ≥65 mm Hg during monitoring. Fourteen of 15 cases required surgical decompression and stabilization with time to surgery 8.8 ± 7.1 hours (71.4% <12 hours). At day 7, 33.3% overall and 50% of initial AIS A-C had an improved AIS. Length of stay was 14.7 ± 8.3 days. None had LSAD-related complications. There were 7 respiratory complications. One patient expired after transfer to comfort care. CONCLUSIONS In our initial experience of 15 patients with acute SCI, standardized SCPP goal-directed care based on LSAD monitoring for 5 days was feasible. There were no SCPP-related complications. This is the first report of SCPP implementation as clinical standard of care in acute SCI.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Debra D Hemmerle
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Leigh H Thomas
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Xuan Duong Fernandez
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Nikolaos Kyritsis
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Jonathan Z Pan
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Lisa U Pascual
- Department of Rehabilitation Medicine, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Vineeta Singh
- Department of Neurology, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Philip R Weinstein
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Jason F Talbott
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - J Russell Huie
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - William D Whetstone
- Department of Emergency Medicine, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Michael S Beattie
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Jacqueline C Bresnahan
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
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22
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Dhall SS, Haefeli J, Talbott JF, Ferguson AR, Readdy WJ, Bresnahan JC, Beattie MS, Pan JZ, Manley GT, Whetstone WD. Motor Evoked Potentials Correlate With Magnetic Resonance Imaging and Early Recovery After Acute Spinal Cord Injury. Neurosurgery 2019; 82:870-876. [PMID: 28973360 DOI: 10.1093/neuros/nyx320] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While the utilization of neurophysiologic intraoperative monitoring with motor evoked potentials (MEPs) has become widespread in surgery for traumatic spine fractures and spinal cord injury (SCI), clinical validation of its diagnostic and therapeutic benefit has been limited. OBJECTIVE To describe the use of intraoperative MEP at a large level I trauma center and assess the prognostic capability of this technology. METHODS The SCI REDCap database at our institution, a level I trauma center, was queried for acute cervical SCI patients who underwent surgery with intraoperative monitoring between 2005 and 2011, yielding 32 patients. Of these, 23 patients had severe SCI (association impairment scale [AIS] A, B, C). We assessed preoperative and postoperative SCI severity (AIS grade), surgical data, use of steroids, and early magnetic resonance imaging (MRI) findings (preoperatively in 27 patients), including axial T2 MRI grade (Brain and Spinal Injury Center score). RESULTS The presence of MEPs significantly predicted AIS at discharge (P< .001). In the group of severe SCI (ie, AIS A, B, C) patients with elicitable MEPs, AIS improved by an average of 1.5 grades (median = 1), as compared to the patients without elicitable MEP who improved on average 0.5 grades (median = 0, P< .05). In addition, axial MRI grade significantly correlated with MEP status. Patients without MEPs had a significantly higher axial MRI grade in comparison to the patients with MEPs (P< .001). CONCLUSION In patients with severe SCI, MEPs predicted neurological improvement and correlated with axial MRI grade. These significant findings warrant future prospective studies of MEPs as a prognostic tool in SCI.
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Affiliation(s)
- Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California
| | - Jenny Haefeli
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California
| | - Jason F Talbott
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California.,Department of Neurological Surgery, SF-VA Medical Center, San Francisco, California
| | - William J Readdy
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California
| | - Jacqueline C Bresnahan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California
| | - Michael S Beattie
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California
| | - Jonathan Z Pan
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California.,Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California
| | - William D Whetstone
- Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) Investigators, San Francisco, California.,Department of Emergency Medicine, ZSFGH Emergency Center for Neuro-Critical Emergencies, San Francisco, California
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23
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Burke JF, Yue JK, Ngwenya LB, Winkler EA, Talbott JF, Pan JZ, Ferguson AR, Beattie MS, Bresnahan JC, Haefeli J, Whetstone WD, Suen CG, Huang MC, Manley GT, Tarapore PE, Dhall SS. In Reply: Ultra-Early (<12 Hours) Surgery Correlates With Higher Rate of American Spinal Injury Association Impairment Scale Conversion After Cervical Spinal Cord Injury. Neurosurgery 2019; 85:E401-E402. [PMID: 31173137 DOI: 10.1093/neuros/nyz156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- John F Burke
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - John K Yue
- School of Medicine University of California, San Francisco San Francisco, California
| | - Laura B Ngwenya
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Ethan A Winkler
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Jason F Talbott
- Department of Radiology University of California, San Francisco San Francisco, California
| | - Jonathan Z Pan
- Department of Anesthesia and Perioperative Care University of California, San Francisco San Francisco, California
| | - Adam R Ferguson
- Department of Neurological Surgery University of California, San Francisco San Francisco, California.,San Francisco Veterans Affairs Medical Center San Francisco, California
| | - Michael S Beattie
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Jacqueline C Bresnahan
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Jenny Haefeli
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - William D Whetstone
- Department of Emergency Medicine University of California, San Francisco San Francisco, California
| | - Catherine G Suen
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Michael C Huang
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Geoffrey T Manley
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Phiroz E Tarapore
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
| | - Sanjay S Dhall
- Department of Neurological Surgery University of California, San Francisco San Francisco, California
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24
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Rosenzweig ES, Salegio EA, Liang JJ, Weber JL, Weinholtz CA, Brock JH, Moseanko R, Hawbecker S, Pender R, Cruzen CL, Iaci JF, Caggiano AO, Blight AR, Haenzi B, Huie JR, Havton LA, Nout-Lomas YS, Fawcett JW, Ferguson AR, Beattie MS, Bresnahan JC, Tuszynski MH. Chondroitinase improves anatomical and functional outcomes after primate spinal cord injury. Nat Neurosci 2019; 22:1269-1275. [PMID: 31235933 PMCID: PMC6693679 DOI: 10.1038/s41593-019-0424-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/10/2019] [Indexed: 01/07/2023]
Abstract
Inhibitory extracellular matrices form around mature neurons as perineuronal nets containing chondroitin sulfate proteoglycans (CSPGs) that limit axonal sprouting after CNS injury. The enzyme chondroitinase (Chase) degrades the inhibitory CSPGs and improves axonal sprouting and functional recovery after spinal cord injury (SCI) in rodents. We evaluated the effects of Chase in Rhesus monkeys that had undergone C7 spinal cord hemisection. Four weeks after hemisection, multiple intraparenchymal Chase injections targeted spinal cord circuits controlling hand function below the lesion. Hand function improved significantly in Chase-treated monkeys relative to vehicle-injected controls. Moreover, Chase significantly increased corticospinal axon growth and the number of synapses formed by corticospinal terminals in gray matter caudal to the lesion. No detrimental effects were detected. This approach appears to merit clinical translation in SCI.
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Affiliation(s)
- Ephron S Rosenzweig
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Ernesto A Salegio
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Justine J Liang
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Janet L Weber
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Chase A Weinholtz
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - John H Brock
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Veterans Administration Medical Center, La Jolla, CA, USA
| | - Rod Moseanko
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Stephanie Hawbecker
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Roger Pender
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Christina L Cruzen
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | | | | | | | | | - J Russell Huie
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Leif A Havton
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yvette S Nout-Lomas
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Adam R Ferguson
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Michael S Beattie
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jacqueline C Bresnahan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mark H Tuszynski
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA. .,Veterans Administration Medical Center, La Jolla, CA, USA.
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25
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McCoy DB, Dupont SM, Gros C, Cohen-Adad J, Huie RJ, Ferguson A, Duong-Fernandez X, Thomas LH, Singh V, Narvid J, Pascual L, Kyritsis N, Beattie MS, Bresnahan JC, Dhall S, Whetstone W, Talbott JF. Convolutional Neural Network-Based Automated Segmentation of the Spinal Cord and Contusion Injury: Deep Learning Biomarker Correlates of Motor Impairment in Acute Spinal Cord Injury. AJNR Am J Neuroradiol 2019; 40:737-744. [PMID: 30923086 DOI: 10.3174/ajnr.a6020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to use 2D convolutional neural networks for automatic segmentation of the spinal cord and traumatic contusion injury from axial T2-weighted MR imaging in a cohort of patients with acute spinal cord injury. MATERIALS AND METHODS Forty-seven patients who underwent 3T MR imaging within 24 hours of spinal cord injury were included. We developed an image-analysis pipeline integrating 2D convolutional neural networks for whole spinal cord and intramedullary spinal cord lesion segmentation. Linear mixed modeling was used to compare test segmentation results between our spinal cord injury convolutional neural network (Brain and Spinal Cord Injury Center segmentation) and current state-of-the-art methods. Volumes of segmented lesions were then used in a linear regression analysis to determine associations with motor scores. RESULTS Compared with manual labeling, the average test set Dice coefficient for the Brain and Spinal Cord Injury Center segmentation model was 0.93 for spinal cord segmentation versus 0.80 for PropSeg and 0.90 for DeepSeg (both components of the Spinal Cord Toolbox). Linear mixed modeling showed a significant difference between Brain and Spinal Cord Injury Center segmentation compared with PropSeg (P < .001) and DeepSeg (P < .05). Brain and Spinal Cord Injury Center segmentation showed significantly better adaptability to damaged areas compared with PropSeg (P < .001) and DeepSeg (P < .02). The contusion injury volumes based on automated segmentation were significantly associated with motor scores at admission (P = .002) and discharge (P = .009). CONCLUSIONS Brain and Spinal Cord Injury Center segmentation of the spinal cord compares favorably with available segmentation tools in a population with acute spinal cord injury. Volumes of injury derived from automated lesion segmentation with Brain and Spinal Cord Injury Center segmentation correlate with measures of motor impairment in the acute phase. Targeted convolutional neural network training in acute spinal cord injury enhances algorithm performance for this patient population and provides clinically relevant metrics of cord injury.
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Affiliation(s)
- D B McCoy
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - S M Dupont
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.)
| | - C Gros
- NeuroPoly Lab (C.G., J.C.-A.), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - J Cohen-Adad
- NeuroPoly Lab (C.G., J.C.-A.), Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada
| | - R J Huie
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - A Ferguson
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - X Duong-Fernandez
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - L H Thomas
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - V Singh
- Departments of Neurology (V.S.)
| | - J Narvid
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.)
| | - L Pascual
- Orthopedic Surgery (L.P.), Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | - N Kyritsis
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - M S Beattie
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - J C Bresnahan
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - S Dhall
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - W Whetstone
- Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.).,Brain and Spinal Injury Center (D.B.M., R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W.)
| | - J F Talbott
- From the Departments of Radiology and Biomedical Imaging (D.B.M., S.M.D., J.N., J.F.T.) .,Neurological Surgery (R.J.H., A.F., X.D.-F., L.H.T., N.K., M.S.B., J.C.B., S.D., W.W., J.F.T.)
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26
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Burke JF, Yue JK, Ngwenya LB, Winkler EA, Talbott JF, Pan JZ, Ferguson AR, Beattie MS, Bresnahan JC, Haefeli J, Whetstone WD, Suen CG, Huang MC, Manley GT, Tarapore PE, Dhall SS. Ultra-Early (<12 Hours) Surgery Correlates With Higher Rate of American Spinal Injury Association Impairment Scale Conversion After Cervical Spinal Cord Injury. Neurosurgery 2018; 85:199-203. [DOI: 10.1093/neuros/nyy537] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022] Open
Abstract
Abstract
BACKGROUND
Cervical spinal cord injury (SCI) is a devastating condition with very few treatment options. It remains unclear if early surgery correlated with conversion of American Spinal Injury Association Impairment Scale (AIS) grade A injuries to higher grades.
OBJECTIVE
To determine the optimal time to surgery after cervical SCI through retrospective analysis.
METHODS
We collected data from 48 patients with cervical SCI. Based on the time from Emergency Department (ED) presentation to surgical decompression, we grouped patients into ultra-early (decompression within 12 h of presentation), early (within 12-24 h), and late groups (>24 h). We compared the improvement in AIS grade from admission to discharge, controlling for confounding factors such as AIS grade on admission, injury severity, and age. The mean time from injury to ED for this group of patients was 17 min.
RESULTS
Patients who received surgery within 12 h after presentation had a relative improvement in AIS grade from admission to discharge: the ultra-early group improved on average 1.3. AIS grades compared to 0.5 in the early group (P = .02). In addition, 88.8% of patients with an AIS grade A converted to a higher grade (AIS B or better) in the ultra-early group, compared to 38.4% in the early and late groups (P = .054).
CONCLUSION
These data suggest that surgical decompression after SCI that takes place within 12 h may lead to a relative improved neurological recovery compared to surgery that takes place after 12 h.
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Affiliation(s)
- John F Burke
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Jason F Talbott
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Jonathan Z Pan
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Neurological Surgery, Veterans Affairs Medical Center, San Francisco, California
| | - Michael S Beattie
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Jacqueline C Bresnahan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Jenny Haefeli
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - William D Whetstone
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Catherine G Suen
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Michael C Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
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27
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Rosenzweig ES, Brock JH, Lu P, Kumamaru H, Salegio EA, Kadoya K, Weber JL, Liang JJ, Moseanko R, Hawbecker S, Huie JR, Havton LA, Nout-Lomas YS, Ferguson AR, Beattie MS, Bresnahan JC, Tuszynski MH. Restorative effects of human neural stem cell grafts on the primate spinal cord. Nat Med 2018; 24:484-490. [PMID: 29480894 DOI: 10.1038/nm.4502] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 01/26/2018] [Indexed: 12/14/2022]
Abstract
We grafted human spinal cord-derived neural progenitor cells (NPCs) into sites of cervical spinal cord injury in rhesus monkeys (Macaca mulatta). Under three-drug immunosuppression, grafts survived at least 9 months postinjury and expressed both neuronal and glial markers. Monkey axons regenerated into grafts and formed synapses. Hundreds of thousands of human axons extended out from grafts through monkey white matter and synapsed in distal gray matter. Grafts gradually matured over 9 months and improved forelimb function beginning several months after grafting. These findings in a 'preclinical trial' support translation of NPC graft therapy to humans with the objective of reconstituting both a neuronal and glial milieu in the site of spinal cord injury.
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Affiliation(s)
- Ephron S Rosenzweig
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - John H Brock
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Veterans Administration Medical Center, La Jolla, California, USA
| | - Paul Lu
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Veterans Administration Medical Center, La Jolla, California, USA
| | - Hiromi Kumamaru
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Ernesto A Salegio
- California National Primate Research Center, University of California, Davis, Davis, California, USA
| | - Ken Kadoya
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Janet L Weber
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Justine J Liang
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Rod Moseanko
- California National Primate Research Center, University of California, Davis, Davis, California, USA
| | - Stephanie Hawbecker
- California National Primate Research Center, University of California, Davis, Davis, California, USA
| | - J Russell Huie
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Leif A Havton
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Yvette S Nout-Lomas
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Adam R Ferguson
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA.,Veterans Administration Medical Center, San Francisco, California, USA
| | - Michael S Beattie
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline C Bresnahan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Mark H Tuszynski
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA.,Veterans Administration Medical Center, La Jolla, California, USA
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28
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DiGiorgio AM, Tsolinas R, Alazzeh M, Haefeli J, Talbott JF, Ferguson AR, Bresnahan JC, Beattie MS, Manley GT, Whetstone WD, Mummaneni PV, Dhall SS. Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data. Neurosurg Focus 2017; 43:E21. [DOI: 10.3171/2017.8.focus17437] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal cord injuries (SCIs) occur in approximately 17,000 people in the US each year. The average length of hospital stay is 11 days, and deep venous thrombosis (DVT) rates as high as 65% are reported in these patients. There is no consensus on the appropriate timing of chemical DVT prophylaxis for this critically injured patient cohort. The object of this study was to determine if low-molecular-weight heparin (LMWH) was safe and effective if given within 24 hours of SCI.METHODSThe Transforming Research and Clinical Knowledge in SCIs study is a prospective observational study conducted by the UCSF Brain and Spinal Injury Center. Protocol at this center includes administration of LMWH within 24 hours of SCI. Data were retrospectively reviewed to determine DVT rate, pulmonary embolism (PE) rate, and hemorrhagic complications.RESULTSForty-nine patients were enrolled in the study. There were 3 DVTs (6.1%), 2 PEs (4.1%), and no hemorrhagic complications. Regression modeling did not find an association between DVT and/or PE and age, American Spinal Injury Association grade, sex, race, or having undergone a neurosurgical procedure.CONCLUSIONSA standardized protocol in which LMWH is given to patients with SCI within 24 hours of injury is effective in keeping venous thromboembolism at the lower end of the reported range, and is safe, with a zero rate of adverse bleeding events.
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Affiliation(s)
- Anthony M. DiGiorgio
- 1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Departments of 5Neurological Surgery and
| | | | - Mohanad Alazzeh
- 3David Geffen School of Medicine, University of California, Los Angeles; and
| | | | - Jason F. Talbott
- 4Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco
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29
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Haefeli J, Mabray MC, Whetstone WD, Dhall SS, Pan JZ, Upadhyayula P, Manley GT, Bresnahan JC, Beattie MS, Ferguson AR, Talbott JF. Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury. AJNR Am J Neuroradiol 2017; 38:648-655. [PMID: 28007771 PMCID: PMC5671488 DOI: 10.3174/ajnr.a5021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Acute markers of spinal cord injury are essential for both diagnostic and prognostic purposes. The goal of this study was to assess the relationship between early MR imaging biomarkers after acute cervical spinal cord injury and to evaluate their predictive validity of neurologic impairment. MATERIALS AND METHODS We performed a retrospective cohort study of 95 patients with acute spinal cord injury and preoperative MR imaging within 24 hours of injury. The American Spinal Injury Association Impairment Scale was used as our primary outcome measure to define neurologic impairment. We assessed several MR imaging features of injury, including axial grade (Brain and Spinal Injury Center score), sagittal grade, length of injury, maximum canal compromise, and maximum spinal cord compression. Data-driven nonlinear principal component analysis was followed by correlation and optimal-scaled multiple variable regression to predict neurologic impairment. RESULTS Nonlinear principal component analysis identified 2 clusters of MR imaging variables related to 1) measures of intrinsic cord signal abnormality and 2) measures of extrinsic cord compression. Neurologic impairment was best accounted for by MR imaging measures of intrinsic cord signal abnormality, with axial grade representing the most accurate predictor of short-term impairment, even when correcting for surgical decompression and degree of cord compression. CONCLUSIONS This study demonstrates the utility of applying nonlinear principal component analysis for defining the relationship between MR imaging biomarkers in a complex clinical syndrome of cervical spinal cord injury. Of the assessed imaging biomarkers, the intrinsic measures of cord signal abnormality were most predictive of neurologic impairment in acute spinal cord injury, highlighting the value of axial T2 MR imaging.
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Affiliation(s)
- J Haefeli
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - M C Mabray
- Radiology and Biomedical Imaging (M.C.M., J.F.T.)
| | - W D Whetstone
- Emergency Medicine (W.D.W.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - S S Dhall
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - J Z Pan
- Anesthesia and Perioperative Care (J.Z.P.), University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California.,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - P Upadhyayula
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - G T Manley
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - J C Bresnahan
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - M S Beattie
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
| | - A R Ferguson
- From the Departments of Neurological Surgery (J.H., S.S.D., P.U., G.T.M., J.C.B., M.S.B., A.R.F.) .,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.).,San Francisco VA Medical Center (A.R.F.), San Francisco, California
| | - J F Talbott
- Radiology and Biomedical Imaging (M.C.M., J.F.T.).,Weill Institute for Neurosciences, Brain and Spinal Injury Center (J.H., W.D.W., S.S.D., J.Z.P., P.U., G.T.M., J.C.B., M.S.B., A.R.F., J.F.T.)
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Abstract
Apoptosis is the morphological counterpart of active, genetically programmed cell death and is important in development, immune function, and carcinogenesis. Recent data suggest that apoptosis may be important in neurodegenerative disorders, ischemic brain injury, and neurotrauma as well. Here we review very recent data from our laboratory and others that show that at least some of the pronounced secondary injury that follows spinal cord injury (SCI) may be caused by apoptosis and associated intracellular death pathways. Both neurons and glia seem to die by apoptosis; the response of oligodendrocytes in long tracts undergoing Wallerian degeneration is particularly long lived and may be responsible for chronic demyelination and some of the dysfunction in chronic SCI. These findings suggest that the therapeutic window for treatment of acute SCI may extend into the chronic phase. In addition, proliferation of ependymal cells occurs in concert with cell death, suggesting that both degeneration and repair may occur at the same time. Therapies aimed at altering the balance between these cellular events may be useful for future treatments of SCI. NEURO SCIENTIST 4:163-171, 1998
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Affiliation(s)
- Michael S. Beattie
- Department of Cell Biology, Neurobiology, and Anatomy (MSB, SLS, JCB) and Division of Neurosurgery (MSB) The Ohio State University College of Medicine and Public Health Columbus, Ohio
| | - Sheri L. Shuman
- Department of Cell Biology, Neurobiology, and Anatomy (MSB, SLS, JCB) and Division of Neurosurgery (MSB) The Ohio State University College of Medicine and Public Health Columbus, Ohio
| | - Jacqueline C. Bresnahan
- Department of Cell Biology, Neurobiology, and Anatomy (MSB, SLS, JCB) and Division of Neurosurgery (MSB) The Ohio State University College of Medicine and Public Health Columbus, Ohio
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Friedli L, Rosenzweig ES, Barraud Q, Schubert M, Dominici N, Awai L, Nielson JL, Musienko P, Nout-Lomas Y, Zhong H, Zdunowski S, Roy RR, Strand SC, van den Brand R, Havton LA, Beattie MS, Bresnahan JC, Bézard E, Bloch J, Edgerton VR, Ferguson AR, Curt A, Tuszynski MH, Courtine G. Pronounced species divergence in corticospinal tract reorganization and functional recovery after lateralized spinal cord injury favors primates. Sci Transl Med 2016; 7:302ra134. [PMID: 26311729 DOI: 10.1126/scitranslmed.aac5811] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Experimental and clinical studies suggest that primate species exhibit greater recovery after lateralized compared to symmetrical spinal cord injuries. Although this observation has major implications for designing clinical trials and translational therapies, advantages in recovery of nonhuman primates over other species have not been shown statistically to date, nor have the associated repair mechanisms been identified. We monitored recovery in more than 400 quadriplegic patients and found that functional gains increased with the laterality of spinal cord damage. Electrophysiological analyses suggested that corticospinal tract reorganization contributes to the greater recovery after lateralized compared with symmetrical injuries. To investigate underlying mechanisms, we modeled lateralized injuries in rats and monkeys using a lateral hemisection, and compared anatomical and functional outcomes with patients who suffered similar lesions. Standardized assessments revealed that monkeys and humans showed greater recovery of locomotion and hand function than did rats. Recovery correlated with the formation of corticospinal detour circuits below the injury, which were extensive in monkeys but nearly absent in rats. Our results uncover pronounced interspecies differences in the nature and extent of spinal cord repair mechanisms, likely resulting from fundamental differences in the anatomical and functional characteristics of the motor systems in primates versus rodents. Although rodents remain essential for advancing regenerative therapies, the unique response of the primate corticospinal tract after injury reemphasizes the importance of primate models for designing clinically relevant treatments.
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Affiliation(s)
- Lucia Friedli
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Ephron S Rosenzweig
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093-0662, USA
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Nadia Dominici
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland. MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, 1081 BT Amsterdam, Netherlands
| | - Lea Awai
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jessica L Nielson
- Department of Neurosurgery, University of California, San Francisco (UCSF), San Francisco, CA 94122, USA
| | - Pavel Musienko
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland. Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
| | - Yvette Nout-Lomas
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Hui Zhong
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Sharon Zdunowski
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Roland R Roy
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Sarah C Strand
- California National Primate Research Center, University of California, Davis, Davis, CA 95616-8542, USA
| | - Rubia van den Brand
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Leif A Havton
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095-1769, USA
| | | | | | - Erwan Bézard
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France. CNRS, Institut des Maladies Neurodégénératives, UMR 5293, F-33000 Bordeaux, France
| | - Jocelyne Bloch
- Clinical Neuroscience, University Hospital of Vaud (CHUV), 1011 Lausanne, Switzerland
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology and Brain Research Center, University of California, Los Angeles (UCLA), Los Angeles, CA 900095-7246, USA
| | - Adam R Ferguson
- Department of Neurosurgery, University of California, San Francisco (UCSF), San Francisco, CA 94122, USA
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mark H Tuszynski
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093-0662, USA. Veterans Administration Medical Center, San Diego, CA 92161, USA
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland. Clinical Neuroscience, University Hospital of Vaud (CHUV), 1011 Lausanne, Switzerland.
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Mabray MC, Talbott JF, Whetstone WD, Dhall SS, Phillips DB, Pan JZ, Manley GT, Bresnahan JC, Beattie MS, Haefeli J, Ferguson AR. Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury. J Neurotrauma 2016; 33:954-62. [PMID: 26414451 PMCID: PMC4876497 DOI: 10.1089/neu.2015.4093] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Literature examining magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) has focused on cervical SCI. Reproducible systems have been developed for MRI-based grading; however, it is unclear how they apply to thoracic SCI. Our hypothesis is that MRI measures will group as coherent multivariate principal component (PC) ensembles, and that distinct PCs and individual variables will show discriminant validity for predicting early impairment in thoracic SCI. We undertook a retrospective cohort study of 25 patients with acute thoracic SCI who underwent MRI on admission and had American Spinal Injury Association Impairment Scale (AIS) assessment at hospital discharge. Imaging variables of axial grade, sagittal grade, length of injury, thoracolumbar injury classification system (TLICS), maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were collected. We performed an analytical workflow to detect multivariate PC patterns followed by explicit hypothesis testing to predict AIS at discharge. All imaging variables loaded positively on PC1 (64.3% of variance), which was highly related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively correlated with AIS at discharge with the highest level of correlation for axial grade as assessed with the Brain and Spinal Injury Center (BASIC) score. A multiple variable model identified BASIC as the only statistically significant predictor of AIS at discharge, signifying that BASIC best captured the variance in AIS within our study population. Our study provides evidence of convergent validity, construct validity, and clinical predictive validity for the sampled MRI measures of SCI when applied in acute thoracic and thoracolumbar SCI.
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Affiliation(s)
- Marc C. Mabray
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco General Hospital, San Francisco, California
| | - Jason F. Talbott
- Department of Radiology and Biomedical Imaging, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - William D. Whetstone
- Department of Emergency Medicine, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Sanjay S. Dhall
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - David B. Phillips
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jonathan Z. Pan
- Department of Anesthesia and Perioperative Care, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jacqueline C. Bresnahan
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Michael S. Beattie
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jenny Haefeli
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California San Francisco and San Francisco General Hospital, San Francisco, California
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
- San Francisco Veteran's Affairs Medical Center, San Francisco, California
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Readdy WJ, Saigal R, Whetstone WD, Mefford AN, Ferguson AR, Talbott JF, Inoue T, Bresnahan JC, Beattie MS, Pan J, Manley GT, Dhall SS. Failure of Mean Arterial Pressure Goals to Improve Outcomes Following Penetrating Spinal Cord Injury. Neurosurgery 2016; 79:708-714. [DOI: 10.1227/neu.0000000000001249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Increased spinal cord perfusion and blood pressure goals have been recommended for spinal cord injury (SCI). Penetrating SCI is associated with poor prognosis, but there is a paucity of literature examining the role of vasopressor administration for the maintenance of mean arterial pressure (MAP) goals in this patient population.
OBJECTIVE:
To elucidate this topic and to determine the efficacy of vasopressor administration in penetrating SCI by examining a case series of consecutive penetrating SCIs.
METHODS:
We reviewed consecutive patients with complete penetrating SCI who met inclusion and exclusion criteria, including the administration of vasopressors to maintain MAP goals. We identified 14 patients with complete penetrating SCIs with an admission American Spinal Injury Association grade of A from 2005 to 2011. The neurological recovery, complications, interventions, and vasopressor administration strategies were reviewed and compared with those of a cohort with complete blunt SCI.
RESULTS:
In our patient population, only 1 patient with penetrating SCI (7.1%) experienced neurological recovery, as determined by improvement in the American Spinal Injury Association grade, despite the administration of vasopressors for supraphysiological MAP goals for an average of 101.07 ± 34.96 hours. Furthermore, 71.43% of patients with penetrating SCI treated with vasopressors experienced associated cardiogenic complications.
CONCLUSION:
Given the decreased likelihood of neurological improvement in penetrating injuries, it may be important to re-examine intervention strategies in this population. Specifically, the use of vasopressors, in particular dopamine, with their associated complications is more likely to cause complications than to result in neurological improvement. Our experience shows that patients with acute penetrating SCI are unlikely to recover, despite aggressive cardiopulmonary management.
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Affiliation(s)
- William J. Readdy
- Brain and Spinal Injury Center, Departments of Neurological Surgery, San Francisco, San Francisco, California
- Emergency Medicine, San Francisco, California
| | - Rajiv Saigal
- Brain and Spinal Injury Center, Departments of Neurological Surgery, San Francisco, San Francisco, California
- Emergency Medicine, San Francisco, California
| | - William D. Whetstone
- Emergency Medicine, San Francisco, California
- Radiology and Biomedical Imaging, San Francisco, California
| | | | | | - Jason F. Talbott
- Emergency Medicine, San Francisco, California
- Anesthesia, University of California, San Francisco, San Francisco, California
| | - Tomoo Inoue
- Emergency Medicine, San Francisco, California
| | | | | | - Jonathan Pan
- Emergency Medicine, San Francisco, California
- Anesthesia, University of California, San Francisco, San Francisco, California
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Lee S, Mattingly A, Lin A, Sacramento J, Mannent L, Castel MN, Canolle B, Delbary-Gossart S, Ferzaz B, Morganti JM, Rosi S, Ferguson AR, Manley GT, Bresnahan JC, Beattie MS. A novel antagonist of p75NTR reduces peripheral expansion and CNS trafficking of pro-inflammatory monocytes and spares function after traumatic brain injury. J Neuroinflammation 2016; 13:88. [PMID: 27102880 PMCID: PMC4840857 DOI: 10.1186/s12974-016-0544-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/10/2016] [Indexed: 12/17/2022] Open
Abstract
Background Traumatic brain injury (TBI) results in long-term neurological deficits, which may be mediated in part by pro-inflammatory responses in both the injured brain and the circulation. Inflammation may be involved in the subsequent development of neurodegenerative diseases and post-injury seizures. The p75 neurotrophin receptor (p75NTR) has multiple biological functions, affecting cell survival, apoptotic cell death, axonal growth, and degeneration in pathological conditions. We recently found that EVT901, a novel piperazine derivative that inhibits p75NTR oligomerization, is neuroprotective, reduces microglial activation, and improves outcomes in two models of TBI in rats. Since TBI elicits both CNS and peripheral inflammation, we used a mouse model of TBI to examine whether EVT901 would affect peripheral immune responses and trafficking to the injured brain. Methods Cortical contusion injury (CCI)-TBI of the sensory/motor cortex was induced in C57Bl/6 wild-type mice and CCR2+/RFP heterozygote transgenic mice, followed by treatment with EVT901, a selective antagonist of p75NTR, or vehicle by i.p. injection at 4 h after injury and then daily for 7 days. Brain and blood were collected at 1 and 6 weeks after injury. Flow cytometry and histological analysis were used to determine peripheral immune responses and trafficking of peripheral immune cells into the lesion site at 1 and 6 weeks after TBI. A battery of behavioral tests administered over 6 weeks was used to evaluate neurological outcome, and stereological estimation of brain tissue volume at 6 weeks was used to assess tissue damage. Finally, multivariate principal components analysis (PCA) was used to evaluate the relationships between inflammatory events, EVT901 treatment, and neurological outcomes. Results EVT901 is neuroprotective in mouse CCI-TBI and dramatically reduced the early trafficking of CCR2+ and pro-inflammatory monocytes into the lesion site. EVT901 reduced the number of CD45highCD11b+ and CD45highF4/80+ cells in the injured brain at 6 weeks. TBI produced a significant increase in peripheral pro-inflammatory monocytes (Ly6Cint-high pro-inflammatory monocytes), and this peripheral effect was also blocked by EVT901 treatment. Further, we found that blocking p75NTR with EVT901 reduces the expansion of pro-inflammatory monocytes, and their response to LPS in vitro, supporting the idea that there is a peripheral EVT901 effect that blunts inflammation. Further, 1 week of EVT901 blocks the expansion of pro-inflammatory monocytes in the circulation after TBI, reduces the number of multiple subsets of pro-inflammatory monocytes that enter the injury site at 1 and 6 weeks post-injury, and is neuroprotective, as it was in the rat. Conclusions Together, these findings suggest that p75NTR signaling participates in the production of the peripheral pro-inflammatory response to CNS injury and implicates p75NTR as a part of the pro-inflammatory cascade. Thus, the neuroprotective effects of p75NTR antagonists might be due to a combination of central and peripheral effects, and p75NTR may play a role in the production of peripheral inflammation in addition to its many other biological roles. Thus, p75NTR may be a therapeutic target in human TBI. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0544-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sangmi Lee
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA
| | - Aaron Mattingly
- Biomedical Science Graduate Program, University of California at San Francisco, San Francisco, CA, 94143-0899, USA
| | - Amity Lin
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA
| | - Jeffrey Sacramento
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA
| | - Leda Mannent
- Early to Candidate, Sanofi Research, 195 route d'Espagne, Chilly-Mazarin, France
| | - Marie-Noelle Castel
- Early to Candidate, Sanofi Research, 195 route d'Espagne, Chilly-Mazarin, France
| | - Benoit Canolle
- Early to Candidate, Sanofi Research, 195 route d'Espagne, Chilly-Mazarin, France
| | | | - Badia Ferzaz
- Early to Candidate, Sanofi Research, 195 route d'Espagne, Chilly-Mazarin, France
| | - Josh M Morganti
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA
| | - Susanna Rosi
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA.,Biomedical Science Graduate Program, University of California at San Francisco, San Francisco, CA, 94143-0899, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA.,Biomedical Science Graduate Program, University of California at San Francisco, San Francisco, CA, 94143-0899, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA
| | - Jacqueline C Bresnahan
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA
| | - Michael S Beattie
- Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco, Box 0899, 1001 Potrero Ave, Bldg 1, Rm 101, San Francisco, CA, 94143-0899, USA. .,Biomedical Science Graduate Program, University of California at San Francisco, San Francisco, CA, 94143-0899, USA.
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Sparrey CJ, Salegio EA, Camisa W, Tam H, Beattie MS, Bresnahan JC. Mechanical Design and Analysis of a Unilateral Cervical Spinal Cord Contusion Injury Model in Non-Human Primates. J Neurotrauma 2016; 33:1136-49. [PMID: 26670940 DOI: 10.1089/neu.2015.3974] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Non-human primate (NHP) models of spinal cord injury better reflect human injury and provide a better foundation to evaluate potential treatments and functional outcomes. We combined finite element (FE) and surrogate models with impact data derived from in vivo experiments to define the impact mechanics needed to generate a moderate severity unilateral cervical contusion injury in NHPs (Macaca mulatta). Three independent variables (impactor displacement, alignment, and pre-load) were examined to determine their effects on tissue level stresses and strains. Mechanical measures of peak force, peak displacement, peak energy, and tissue stiffness were analyzed as potential determinants of injury severity. Data generated from FE simulations predicted a lateral shift of the spinal cord at high levels of compression (>64%) during impact. Submillimeter changes in mediolateral impactor position over the midline increased peak impact forces (>50%). Surrogate cords established a 0.5 N pre-load protocol for positioning the impactor tip onto the dural surface to define a consistent dorsoventral baseline position before impact, which corresponded with cerebrospinal fluid displacement and entrapment of the spinal cord against the vertebral canal. Based on our simulations, impactor alignment and pre-load were strong contributors to the variable mechanical and functional outcomes observed in in vivo experiments. Peak displacement of 4 mm after a 0.5N pre-load aligned 0.5-1.0 mm over the midline should result in a moderate severity injury; however, the observed peak force and calculated peak energy and tissue stiffness are required to properly characterize the severity and variability of in vivo NHP contusion injuries.
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Affiliation(s)
- Carolyn J Sparrey
- 1 Mechatronic Systems Engineering, Simon Fraser University , Surrey, British Columbia, Canada .,2 International Collaboration on Repair Discoveries (ICORD) , Vancouver, British Columbia, Canada
| | - Ernesto A Salegio
- 3 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - William Camisa
- 4 Taylor Collaboration, St Mary's Medical Center , San Francisco, California
| | - Horace Tam
- 1 Mechatronic Systems Engineering, Simon Fraser University , Surrey, British Columbia, Canada
| | - Michael S Beattie
- 3 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Jacqueline C Bresnahan
- 3 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
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36
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Delbary-Gossart S, Lee S, Baroni M, Lamarche I, Arnone M, Canolle B, Lin A, Sacramento J, Salegio EA, Castel MN, Delesque-Touchard N, Alam A, Laboudie P, Ferzaz B, Savi P, Herbert JM, Manley GT, Ferguson AR, Bresnahan JC, Bono F, Beattie MS. A novel inhibitor of p75-neurotrophin receptor improves functional outcomes in two models of traumatic brain injury. Brain 2016; 139:1762-82. [PMID: 27084575 PMCID: PMC4892754 DOI: 10.1093/brain/aww074] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/20/2016] [Indexed: 11/14/2022] Open
Abstract
The p75 neurotrophin receptor is important in multiple physiological actions including neuronal survival and neurite outgrowth during development, and after central nervous system injury. We have discovered a novel piperazine-derived compound, EVT901, which interferes with p75 neurotrophin receptor oligomerization through direct interaction with the first cysteine-rich domain of the extracellular region. Using ligand binding assays with cysteine-rich domains-fused p75 neurotrophin receptor, we confirmed that EVT901 interferes with oligomerization of full-length p75 neurotrophin receptor in a dose-dependent manner. Here we report that EVT901 reduces binding of pro-nerve growth factor to p75 neurotrophin receptor, blocks pro-nerve growth factor induced apoptosis in cells expressing p75 neurotrophin receptor, and enhances neurite outgrowth in vitro. Furthermore, we demonstrate that EVT901 abrogates p75 neurotrophin receptor signalling by other ligands, such as prion peptide and amyloid-β. To test the efficacy of EVT901 in vivo, we evaluated the outcome in two models of traumatic brain injury. We generated controlled cortical impacts in adult rats. Using unbiased stereological analysis, we found that EVT901 delivered intravenously daily for 1 week after injury, reduced lesion size, protected cortical neurons and oligodendrocytes, and had a positive effect on neurological function. After lateral fluid percussion injury in adult rats, oral treatment with EVT901 reduced neuronal death in the hippocampus and thalamus, reduced long-term cognitive deficits, and reduced the occurrence of post-traumatic seizure activity. Together, these studies provide a new reagent for altering p75 neurotrophin receptor actions after injury and suggest that EVT901 may be useful in treatment of central nervous system trauma and other neurological disorders where p75 neurotrophin receptor signalling is affected.
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Affiliation(s)
| | - Sangmi Lee
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Marco Baroni
- 3 Sanofi Research, Exploratory Unit, Via Gaetano Sbodio 2, 20134 Milano, Italy
| | - Isabelle Lamarche
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Michele Arnone
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Benoit Canolle
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Amity Lin
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Jeffrey Sacramento
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Ernesto A Salegio
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Marie-Noelle Castel
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | | | - Antoine Alam
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Patricia Laboudie
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Badia Ferzaz
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Pierre Savi
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Jean-Marc Herbert
- 4 From Sanofi Research, Early to Candidate, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Geoffrey T Manley
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Adam R Ferguson
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Jacqueline C Bresnahan
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Françoise Bono
- 1 Evotec, 195 route d'Espagne, 31036 Toulouse cedex, France
| | - Michael S Beattie
- 2 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
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Talbott JF, Nout-Lomas YS, Wendland MF, Mukherjee P, Huie JR, Hess CP, Mabray MC, Bresnahan JC, Beattie MS. Diffusion-Weighted Magnetic Resonance Imaging Characterization of White Matter Injury Produced by Axon-Sparing Demyelination and Severe Contusion Spinal Cord Injury in Rats. J Neurotrauma 2016; 33:929-42. [PMID: 26483094 DOI: 10.1089/neu.2015.4102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Alterations in magnetic resonance imaging (MRI)-derived measurements of water diffusion parallel (D∥) and perpendicular (D⊥) to white matter tracts have been specifically attributed to pathology of axons and myelin, respectively. We test the hypothesis that directional diffusion measurements can distinguish between axon-sparing chemical demyelination and severe contusion spinal cord white matter injury. Adult rats received either unilateral ethidium bromide (EB) microinjections (chemical demyelination) into the lateral funiculus of the spinal cord at C5 or were subjected to unilateral severe contusion spinal cord injury (SCI). Diffusion MRI metrics in the lateral funiculus were analyzed at early and late time-points following injury and correlated with histology. Early EB-demyelination resulted in a significant elevation in D⊥ and significant reduction in D∥ at the injury epicenter, with histological evidence of uniform axon preservation. Alterations in D⊥ and D∥ at the epicenter of early EB-demyelination were not significantly different from those observed with severe contusion at the epicenter, where histology demonstrated severe combined axonal and myelin injury. Diffusion abnormalities away from the injury epicenter were seen with contusion injury, but not with EB-demyelination. Chronic EB lesions underwent endogenous remyelination with normalization of diffusion metrics, whereas chronic contusion resulted in persistently altered diffusivities. In the early setting, directional diffusion measurements at the injury epicenter associated with chemical demyelination are indistinguishable from those seen with severe contusive SCI, despite dramatic pathologic differences between injury models. Caution is advised in interpretation of diffusion metrics with respect to specific white matter structural alterations. Diffusion analysis should not be limited to the epicenter of focal spinal lesions as alterations marginal to the epicenter are useful for assessing the nature of focal white matter injury.
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Affiliation(s)
- Jason F Talbott
- 1 Department of Radiology and Biomedical Imaging, San Francisco General Hospital and University of California , San Francisco, San Francisco, California.,4 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Yvette S Nout-Lomas
- 2 College of Veterinary Medicine and Biomedical Sciences, Colorado State University , Fort Collins, Colorado
| | - Michael F Wendland
- 1 Department of Radiology and Biomedical Imaging, San Francisco General Hospital and University of California , San Francisco, San Francisco, California
| | - Pratik Mukherjee
- 1 Department of Radiology and Biomedical Imaging, San Francisco General Hospital and University of California , San Francisco, San Francisco, California.,4 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - J Russell Huie
- 3 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,4 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Christopher P Hess
- 1 Department of Radiology and Biomedical Imaging, San Francisco General Hospital and University of California , San Francisco, San Francisco, California
| | - Marc C Mabray
- 1 Department of Radiology and Biomedical Imaging, San Francisco General Hospital and University of California , San Francisco, San Francisco, California
| | - Jacqueline C Bresnahan
- 3 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,4 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
| | - Michael S Beattie
- 3 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,4 Brain and Spinal Injury Center, San Francisco General Hospital , San Francisco, California
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Salegio EA, Bresnahan JC, Sparrey CJ, Camisa W, Fischer J, Leasure J, Buckley J, Nout-Lomas YS, Rosenzweig ES, Moseanko R, Strand S, Hawbecker S, Lemoy MJ, Haefeli J, Ma X, Nielson JL, Edgerton VR, Ferguson AR, Tuszynski MH, Beattie MS. A Unilateral Cervical Spinal Cord Contusion Injury Model in Non-Human Primates (Macaca mulatta). J Neurotrauma 2016; 33:439-59. [PMID: 26788611 PMCID: PMC4799702 DOI: 10.1089/neu.2015.3956] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The development of a non-human primate (NHP) model of spinal cord injury (SCI) based on mechanical and computational modeling is described. We scaled up from a rodent model to a larger primate model using a highly controllable, friction-free, electronically-driven actuator to generate unilateral C6-C7 spinal cord injuries. Graded contusion lesions with varying degrees of functional recovery, depending upon pre-set impact parameters, were produced in nine NHPs. Protocols and pre-operative magnetic resonance imaging (MRI) were used to optimize the predictability of outcomes by matching impact protocols to the size of each animal's spinal canal, cord, and cerebrospinal fluid space. Post-operative MRI confirmed lesion placement and provided information on lesion volume and spread for comparison with histological measures. We evaluated the relationships between impact parameters, lesion measures, and behavioral outcomes, and confirmed that these relationships were consistent with our previous studies in the rat. In addition to providing multiple univariate outcome measures, we also developed an integrated outcome metric describing the multivariate cervical SCI syndrome. Impacts at the higher ranges of peak force produced highly lateralized and enduring deficits in multiple measures of forelimb and hand function, while lower energy impacts produced early weakness followed by substantial recovery but enduring deficits in fine digital control (e.g., pincer grasp). This model provides a clinically relevant system in which to evaluate the safety and, potentially, the efficacy of candidate translational therapies.
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Affiliation(s)
- Ernesto A Salegio
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Jacqueline C Bresnahan
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Carolyn J Sparrey
- 2 School of Engineering Science, Simon Fraser University , Surrey, British Columbia, Canada
| | - William Camisa
- 3 Taylor Collaboration, St. Mary's Medical Center , San Francisco, California
| | - Jason Fischer
- 3 Taylor Collaboration, St. Mary's Medical Center , San Francisco, California
| | - Jeremi Leasure
- 3 Taylor Collaboration, St. Mary's Medical Center , San Francisco, California
| | - Jennifer Buckley
- 4 Department of Mechanical Engineering, University of Delaware , Newark, Delaware
| | - Yvette S Nout-Lomas
- 5 College of Veterinary Medicine and Biomedical Sciences, Colorado State University , Fort Collins, Colorado
| | - Ephron S Rosenzweig
- 6 Department of Neurosciences, University of California at San Diego , San Diego, California; Veterans Administration Medical Center, La Jolla, California
| | - Rod Moseanko
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Sarah Strand
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Stephanie Hawbecker
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Marie-Josee Lemoy
- 7 California National Primate Research Center, University of California at Davis , Davis, California
| | - Jenny Haefeli
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Xiaokui Ma
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Jessica L Nielson
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - V R Edgerton
- 8 Departments of Physiological Science and Neurology, University of California at Los Angeles , Los Angeles, California
| | - Adam R Ferguson
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
| | - Mark H Tuszynski
- 6 Department of Neurosciences, University of California at San Diego , San Diego, California; Veterans Administration Medical Center, La Jolla, California
| | - Michael S Beattie
- 1 Department of Neurological Surgery, Brain and Spinal Injury Center, University of California at San Francisco , San Francisco, California
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39
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Readdy WJ, Whetstone WD, Ferguson AR, Talbott JF, Inoue T, Saigal R, Bresnahan JC, Beattie MS, Pan JZ, Manley GT, Dhall SS. Complications and outcomes of vasopressor usage in acute traumatic central cord syndrome. J Neurosurg Spine 2015; 23:574-580. [DOI: 10.3171/2015.2.spine14746] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The optimal mean arterial pressure (MAP) for spinal cord perfusion after trauma remains unclear. Although there are published data on MAP goals after spinal cord injury (SCI), the specific blood pressure management for acute traumatic central cord syndrome (ATCCS) and the implications of these interventions have yet to be elucidated. Additionally, the complications of specific vasopressors have not been fully explored in this injury condition.
METHODS
The present study is a retrospective cohort analysis of 34 patients with ATCCS who received any vasopressor to maintain blood pressure above predetermined MAP goals at a single Level 1 trauma center. The collected variables were American Spinal Injury Association (ASIA) grades at admission and discharge, administered vasopressor and associated complications, other interventions and complications, and timing of surgery. The relationship between the 2 most common vasopressors—dopamine and phenylephrine—and complications within the cohort as a whole were explored, and again after stratification by age.
RESULTS
The mean age of the ATCCS patients was 62 years. Dopamine was the most commonly used primary vasopressor (91% of patients), followed by phenylephrine (65%). Vasopressors were administered to maintain MAP goals fora mean of 101 hours. Neurological status improved by a median of 1 ASIA grade in all patients, regardless of the choice of vasopressor. Sixty-four percent of surgical patients underwent decompression within 24 hours. There was no observed relationship between the timing of surgical intervention and the complication rate. Cardiogenic complications associated with vasopressor usage were notable in 68% of patients who received dopamine and 46% of patients who received phenylephrine. These differences were not statistically significant (OR with dopamine 2.50 [95% CI 0.82–7.78], p = 0.105). However, in the subgroup of patients > 55 years, dopamine produced statistically significant increases in the complication rates when compared with phenylephrine (83% vs 50% for dopamine and phenylephrine, respectively; OR with dopamine 5.0 [95% CI 0.99–25.34], p = 0.044).
CONCLUSIONS
Vasopressor usage in ATCCS patients is associated with complication rates that are similar to the reported literature for SCI. Dopamine was associated with a higher risk of complications in patients > 55 years. Given the increased incidence of ATCCS in older populations, determination of MAP goals and vasopressor administration should be carefully considered in these patients. While a randomized control trial on this topic may not be practical, a multiinstitutional prospective study for SCI that includes ATCCS patients as a subpopulation would be useful for examining MAP goals in this population.
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Affiliation(s)
- William J. Readdy
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
| | - William D. Whetstone
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
- Departments of 2Emergency Medicine,
| | - Adam R. Ferguson
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
| | - Jason F. Talbott
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
- 3Radiology and Biomedical Imaging, and
| | - Tomoo Inoue
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
| | - Rajiv Saigal
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
| | | | - Michael S. Beattie
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
| | - Jonathan Z. Pan
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
- 4Anesthesia, University of California, San Francisco, California
| | - Geoffrey T. Manley
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
| | - Sanjay S. Dhall
- 1Department of Neurological Surgery, Brain and Spinal Injury Center; and
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Nielson JL, Paquette J, Liu AW, Guandique CF, Tovar CA, Inoue T, Irvine KA, Gensel JC, Kloke J, Petrossian TC, Lum PY, Carlsson GE, Manley GT, Young W, Beattie MS, Bresnahan JC, Ferguson AR. Topological data analysis for discovery in preclinical spinal cord injury and traumatic brain injury. Nat Commun 2015; 6:8581. [PMID: 26466022 PMCID: PMC4634208 DOI: 10.1038/ncomms9581] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/06/2015] [Indexed: 02/06/2023] Open
Abstract
Data-driven discovery in complex neurological disorders has potential to extract meaningful syndromic knowledge from large, heterogeneous data sets to enhance potential for precision medicine. Here we describe the application of topological data analysis (TDA) for data-driven discovery in preclinical traumatic brain injury (TBI) and spinal cord injury (SCI) data sets mined from the Visualized Syndromic Information and Outcomes for Neurotrauma-SCI (VISION-SCI) repository. Through direct visualization of inter-related histopathological, functional and health outcomes, TDA detected novel patterns across the syndromic network, uncovering interactions between SCI and co-occurring TBI, as well as detrimental drug effects in unpublished multicentre preclinical drug trial data in SCI. TDA also revealed that perioperative hypertension predicted long-term recovery better than any tested drug after thoracic SCI in rats. TDA-based data-driven discovery has great potential application for decision-support for basic research and clinical problems such as outcome assessment, neurocritical care, treatment planning and rapid, precision-diagnosis.
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Affiliation(s)
- Jessica L Nielson
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA
| | - Jesse Paquette
- Tagb.io, 1 Quartz Way, San Francisco, California 94131, USA
| | - Aiwen W Liu
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA
| | - Cristian F Guandique
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA
| | - C Amy Tovar
- Department of Neuroscience, Ohio State University, 460 West 12th Avenue, 670 Biomedical Research Tower, Columbus, Ohio 43210, USA
| | - Tomoo Inoue
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai city, Miyagi prefecture 980-0856, Japan
| | - Karen-Amanda Irvine
- Department of Neurology, San Francisco VA Medical Center, University of California San Francisco, San Francisco, California 94110, USA
| | - John C Gensel
- Department of Physiology, Spinal Cord and Brain Injury Research Center, Chandler Medical Center, University of Kentucky Lexington, B463 Biomedical &Biological Sciences Research Building, 741 South Limestone Street, Kentucky 40536, USA
| | - Jennifer Kloke
- Ayasdi Inc., 4400 Bohannon Drive Suite #200, Menlo Park, California 94025, USA
| | - Tanya C Petrossian
- GenePeeks, Inc., 777 Avenue of the Americas, New York, New York 10001, USA
| | - Pek Y Lum
- Capella Biosciences, 550 Hamilton Avenue, Palo Alto, California 94301, USA
| | - Gunnar E Carlsson
- Ayasdi Inc., 4400 Bohannon Drive Suite #200, Menlo Park, California 94025, USA.,Department of Mathematics, Stanford University, Building 380, Stanford, California, 94305, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA
| | - Wise Young
- Department of Cell Biology and Neuroscience, W.M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, New Jersey 08854, USA
| | - Michael S Beattie
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA
| | - Jacqueline C Bresnahan
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA
| | - Adam R Ferguson
- Department of Neurosurgery, Brain and Spinal Injury Center, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, California 94143, USA.,Department of Neurosurgery, San Francisco VA Medical Center, University of California San Francisco, San Francisco, California 94110, USA
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Talbott JF, Whetstone WD, Readdy WJ, Ferguson AR, Bresnahan JC, Saigal R, Hawryluk GWJ, Beattie MS, Mabray MC, Pan JZ, Manley GT, Dhall SS. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine 2015; 23:495-504. [DOI: 10.3171/2015.1.spine141033] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Previous studies that have evaluated the prognostic value of abnormal changes in signals on T2-weighted MRI scans of an injured spinal cord have focused on the longitudinal extent of this signal abnormality in the sagittal plane. Although the transverse extent of injury and the degree of spared spinal cord white matter have been shown to be important for predicting outcomes in preclinical animal models of spinal cord injury (SCI), surprisingly little is known about the prognostic value of altered T2 relaxivity in humans in the axial plane.
METHODS
The authors undertook a retrospective chart review of 60 patients who met the inclusion criteria of this study and presented to the authors’ Level I trauma center with an acute blunt traumatic cervical SCI. Within 48 hours of admission, all patients underwent MRI examination, which included axial and sagittal T2 images. Neurological symptoms, evaluated with the grades according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS), at the time of admission and at hospital discharge were correlated with MRI findings. Five distinct patterns of intramedullary spinal cord T2 signal abnormality were defined in the axial plane at the injury epicenter. These patterns were assigned ordinal values ranging from 0 to 4, referred to as the Brain and Spinal Injury Center (BASIC) scores, which encompassed the spectrum of SCI severity.
RESULTS
The BASIC score strongly correlated with neurological symptoms at the time of both hospital admission and discharge. It also distinguished patients initially presenting with complete injury who improved by at least one AIS grade by the time of discharge from those whose injury did not improve. The authors’ proposed score was rapid to apply and showed excellent interrater reliability.
CONCLUSIONS
The authors describe a novel 5-point ordinal MRI score for classifying acute SCIs on the basis of axial T2-weighted imaging. The proposed BASIC score stratifies the SCIs according to the extent of transverse T2 signal abnormality during the acute phase of the injury. The new score improves on current MRI-based prognostic descriptions for SCI by reflecting functionally and anatomically significant patterns of intramedullary T2 signal abnormality in the axial plane.
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Affiliation(s)
- Jason F. Talbott
- Departments of 1Radiology and Biomedical Imaging,
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | | | | | - Adam R. Ferguson
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Jacqueline C. Bresnahan
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Rajiv Saigal
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Gregory W. J. Hawryluk
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Michael S. Beattie
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | | | - Jonathan Z. Pan
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
- 5Anesthesia and Perioperative Care, University of California; and
| | - Geoffrey T. Manley
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Sanjay S. Dhall
- 3Neurological Surgery, and
- 4Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
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Wang A, Brown EG, Lankford L, Keller BA, Pivetti CD, Sitkin NA, Beattie MS, Bresnahan JC, Farmer DL. Placental mesenchymal stromal cells rescue ambulation in ovine myelomeningocele. Stem Cells Transl Med 2015; 4:659-69. [PMID: 25911465 PMCID: PMC4449103 DOI: 10.5966/sctm.2014-0296] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/27/2015] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Myelomeningocele (MMC)-commonly known as spina bifida-is a congenital birth defect that causes lifelong paralysis, incontinence, musculoskeletal deformities, and severe cognitive disabilities. The recent landmark Management of Myelomeningocele Study (MOMS) demonstrated for the first time in humans that in utero surgical repair of the MMC defect improves lower limb motor function, suggesting a capacity for improved neurologic outcomes in this disorder. However, functional recovery was incomplete, and 58% of the treated children were unable to walk independently at 30 months of age. In the present study, we demonstrate that using early gestation human placenta-derived mesenchymal stromal cells (PMSCs) to augment in utero repair of MMC results in significant and consistent improvement in neurologic function at birth in the rigorous fetal ovine model of MMC. In vitro, human PMSCs express characteristic MSC markers and trilineage differentiation potential. Protein array assays and enzyme-linked immunosorbent assay show that PMSCs secrete a variety of immunomodulatory and angiogenic cytokines. Compared with adult bone marrow MSCs, PMSCs secrete significantly higher levels of brain-derived neurotrophic factor and hepatocyte growth factor, both of which have known neuroprotective capabilities. In vivo, functional and histopathologic analysis demonstrated that human PMSCs mediate a significant, clinically relevant improvement in motor function in MMC lambs and increase the preservation of large neurons within the spinal cord. These preclinical results in the well-established fetal ovine model of MMC provide promising early support for translating in utero stem cell therapy for MMC into clinical application for patients. SIGNIFICANCE This study presents placenta-derived mesenchymal stromal cell (PMSC) treatment as a potential therapy for myelomeningocele (MMC). Application of PMSCs can augment current in utero surgical repair in the well-established and rigorously applied fetal lamb model of MMC. Treatment with human PMSCs significantly and dramatically improved neurologic function and preserved spinal cord neuron density in experimental animals. Sixty-seven percent of the PMSC-treated lambs were able to ambulate independently, with two exhibiting no motor deficits whatsoever. In contrast, none of the lambs treated with the vehicle alone were capable of ambulation. The locomotor rescue demonstrated in PMSC-treated lambs indicates great promise for future clinical trials to improve paralysis in children afflicted with MMC.
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Affiliation(s)
- Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Erin G Brown
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Lee Lankford
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Benjamin A Keller
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher D Pivetti
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Nicole A Sitkin
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael S Beattie
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline C Bresnahan
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Diana L Farmer
- Surgical Bioengineering Laboratory, Department of Surgery, University of California, Davis, Health System, Sacramento, California, USA; Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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Song Y, Sretavan D, Salegio EA, Berg J, Huang X, Cheng T, Xiong X, Meltzer S, Han C, Nguyen TT, Bresnahan JC, Beattie MS, Jan LY, Jan YN. Regulation of axon regeneration by the RNA repair and splicing pathway. Nat Neurosci 2015; 18:817-25. [PMID: 25961792 PMCID: PMC4446171 DOI: 10.1038/nn.4019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/07/2015] [Indexed: 12/15/2022]
Abstract
Mechanisms governing a neuron’s regenerative ability are important but not well understood. We identified Rtca, RNA 3′-terminal phosphate cyclase, as an inhibitor for axon regeneration. Removal of dRtca cell-autonomously enhanced axon regrowth in the Drosophila central nervous system, whereas its overexpression reduced axon regeneration in the periphery. Rtca along with the RNA ligase Rtcb and its catalyst Archease operate in the RNA repair/splicing pathway important for stress induced mRNA splicing, including that of Xbp1, a cellular stress sensor. dRtca and dArchease had opposing effects on Xbp1 splicing, and deficiency of dArchease or Xbp1 impeded axon regeneration in Drosophila. Moreover, overexpressing mammalian Rtca in cultured rodent neurons reduced axonal complexity in vitro, whereas reducing its function promoted retinal ganglion cell axon regeneration after optic nerve crush in mice. Our study thus links axon regeneration to cellular stress and RNA metabolism, revealing new potential therapeutic targets for treating nervous system trauma.
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Affiliation(s)
- Yuanquan Song
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - David Sretavan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Ernesto A Salegio
- Brain and Spinal Injury Center, University of California, San Francisco, California, USA
| | - Jim Berg
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - Xi Huang
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - Tong Cheng
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - Xin Xiong
- Howard Hughes Medical Institute, University of California, San Francisco, California, USA
| | - Shan Meltzer
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - Chun Han
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - Trong-Tuong Nguyen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center, University of California, San Francisco, California, USA
| | - Michael S Beattie
- Brain and Spinal Injury Center, University of California, San Francisco, California, USA
| | - Lily Yeh Jan
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
| | - Yuh Nung Jan
- 1] Howard Hughes Medical Institute, University of California, San Francisco, California, USA. [2] Department of Physiology, University of California, San Francisco, California, USA
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Kwon BK, Streijger F, Hill CE, Anderson AJ, Bacon M, Beattie MS, Blesch A, Bradbury EJ, Brown A, Bresnahan JC, Case CC, Colburn RW, David S, Fawcett JW, Ferguson AR, Fischer I, Floyd CL, Gensel JC, Houle JD, Jakeman LB, Jeffery ND, Jones LAT, Kleitman N, Kocsis J, Lu P, Magnuson DSK, Marsala M, Moore SW, Mothe AJ, Oudega M, Plant GW, Rabchevsky AS, Schwab JM, Silver J, Steward O, Xu XM, Guest JD, Tetzlaff W. Large animal and primate models of spinal cord injury for the testing of novel therapies. Exp Neurol 2015; 269:154-68. [PMID: 25902036 DOI: 10.1016/j.expneurol.2015.04.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 12/28/2022]
Abstract
Large animal and primate models of spinal cord injury (SCI) are being increasingly utilized for the testing of novel therapies. While these represent intermediary animal species between rodents and humans and offer the opportunity to pose unique research questions prior to clinical trials, the role that such large animal and primate models should play in the translational pipeline is unclear. In this initiative we engaged members of the SCI research community in a questionnaire and round-table focus group discussion around the use of such models. Forty-one SCI researchers from academia, industry, and granting agencies were asked to complete a questionnaire about their opinion regarding the use of large animal and primate models in the context of testing novel therapeutics. The questions centered around how large animal and primate models of SCI would be best utilized in the spectrum of preclinical testing, and how much testing in rodent models was warranted before employing these models. Further questions were posed at a focus group meeting attended by the respondents. The group generally felt that large animal and primate models of SCI serve a potentially useful role in the translational pipeline for novel therapies, and that the rational use of these models would depend on the type of therapy and specific research question being addressed. While testing within these models should not be mandatory, the detection of beneficial effects using these models lends additional support for translating a therapy to humans. These models provides an opportunity to evaluate and refine surgical procedures prior to use in humans, and safety and bio-distribution in a spinal cord more similar in size and anatomy to that of humans. Our results reveal that while many feel that these models are valuable in the testing of novel therapies, important questions remain unanswered about how they should be used and how data derived from them should be interpreted.
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Affiliation(s)
- Brian K Kwon
- University of British Columbia, ICORD, Room 6196, Blusson Spinal Cord Centre, 818 West 10th Avenue, Vancouver, BC V5Z 1 M9, Canada.
| | - Femke Streijger
- University of British Columbia, ICORD, Room 6196, Blusson Spinal Cord Centre, 818 West 10th Avenue, Vancouver, BC V5Z 1 M9, Canada.
| | - Caitlin E Hill
- Burke Medical Research Institute/Weill Cornell Medical College, 785 Mamaroneck Ave., White Plains, NY 10605, USA.
| | | | - Mark Bacon
- International Spinal Research Trust, International Spinal Research Trust, Bramley Business Centre, Station Road, Bramley, Guildford, Surrey GU5 0AZ, UK.
| | - Michael S Beattie
- University of California at San Francisco, 1001 Potrero Ave., Bldg 1 Rm 101, San Francisco, CA 94110, USA.
| | - Armin Blesch
- Heidelberg University Hospital, Spinal Cord Injury Center, Germany.
| | - Elizabeth J Bradbury
- King's College London, The Wolfson Centre for Age-Related Diseases, Wolfson Wing, Hodgkin Building, Guy's Campus, London Bridge, London SE1 1UL, UK.
| | - Arthur Brown
- University of Western Ontario, Robarts Research Institute, University of Western Ontario, Department of Anatomy and Cell Biology, 1151 Richmond Street, North, N6A 5B7, Canada.
| | - Jacqueline C Bresnahan
- University of California at San Francisco, 1001 Potrero Ave., Bldg 1 Rm 101, San Francisco, CA 94110, USA.
| | - Casey C Case
- Asterias Biotherapeutics, 230 Constitution Drive, Menlo Park, CA 94025, USA.
| | - Raymond W Colburn
- Acorda Therapeutics, Acorda Therapeutics, Inc., 420 Saw Mill River Road, Ardsley, NY 10502, USA.
| | - Samuel David
- Centre for Research in Neuroscience, Research Institute of the McGill University Health Centre, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada.
| | - James W Fawcett
- University of Cambridge, John van Geest Centre for Brain Repair, Robinson Way, Cambridge CB2 0PY, UK.
| | - Adam R Ferguson
- University of California, San Francisco (UCSF), Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, USA.
| | - Itzhak Fischer
- Drexel University College of Medicine, Dept. of Neurobiology and Anatomy, 2900 Queen Lane, Philadelphia, PA 19129, USA.
| | - Candace L Floyd
- University of Alabama at Birmingham, 529C Spain Rehabilitation Center, 1717 6th Avenue South, Birmingham, AL 35249, USA.
| | - John C Gensel
- University of Kentucky, Spinal Cord and Brain Injury Research Center, B463 Biomedical & Biological Sciences Research Building (BBSRB), 741 S. Limestone, Lexington, KY 40536, USA.
| | - John D Houle
- Drexel University College of Medicine, Spinal Cord Research Center, Philadelphia, PA 19129, USA.
| | - Lyn B Jakeman
- National Institutes of Health/NINDS, 6001 Executive Blvd. North, Bethesda, MD 20852, USA.
| | - Nick D Jeffery
- Iowa State University, Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA.
| | | | - Naomi Kleitman
- Craig H. Neilsen Foundation, 16830 Ventura Blvd. Suite 352, Encino, CA 91436, USA.
| | - Jeffery Kocsis
- Yale University and VA CT Healthcare System, Neuroscience Center (127A), VA CT Healthcare Center, 950 Campbell Ave., West Haven, CT 06516, USA.
| | - Paul Lu
- VA-San Diego Healthcare System, University of California at San Diego, BMF2, Room 2126, 9500 Gilman Dr., La Jolla, CA 92093-0626, USA.
| | - David S K Magnuson
- University of Louisville School of Medicine, 511 S. Floyd St., MDR Rm 616, USA.
| | - Martin Marsala
- University of California, San Diego, Department of Anesthesiology SCRM, Room 4009, 2880 Torrey Pines Scenic Dr., La Jolla, CA 92037, USA.
| | - Simon W Moore
- InVivo Therapeutics Corporation, One Kendall Square, Suite B14402, Cambridge, MA 02139, USA.
| | - Andrea J Mothe
- Toronto Western Research Institute, Krembil Discovery Tower, 60 Leonard Ave. , 7KD-406, Toronto ON M5T 2S8, Canada.
| | - Martin Oudega
- University of Miami Miller School of Medicine, LPLC, 1095 NW 14 Terrace, Miami, FL 33136, USA.
| | - Giles W Plant
- Stanford University, Lorry I. Lokey Stem Cell Research Building, Stanford University, 265 Campus Drive, Stanford, CA 94305, USA.
| | | | | | - Jerry Silver
- Case Western Reserve University, Dept. of Neurosciences, School of Medicine, 2109 Adelbert Rd., Cleveland, OH 44106, USA.
| | - Oswald Steward
- University of California Irvine, Reeve-Irvine Research Center, Department of Anatomy & Neurobiology, University of California Irvine School of Medicine, Irvine, CA 92697, USA.
| | - Xiao-Ming Xu
- Indiana University School of Medicine, 320 W. 15th St., Indianapolis, IN 46202, USA.
| | | | - Wolfram Tetzlaff
- University of British Columbia, ICORD, Room 6196, Blusson Spinal Cord Centre, 818 West 10th Avenue, Vancouver, BC V5Z 1 M9, Canada.
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Abstract
BACKGROUND/PURPOSE Research to cure paralysis associated with myelomeningocele (MMC) is ongoing using the fetal sheep model of MMC. Despite decades of research using this model, no standardized motor function assessment exists. The purpose of this study is to develop a sensitive and reliable locomotor scale for assessing the functional status of sheep. METHODS Twenty lambs were used to develop and validate the locomotor scale. Lambs (n=15) underwent a surgically created MMC defect at gestational age (GA) 75 days, followed by repair with various methods at GA 100. One lamb underwent a sham operation (n=1). Normal lambs (n=4) served as controls. All lambs were born via spontaneous vaginal delivery, and motor function was assessed for 24 hours. A locomotor rating scale was developed based on behavioral observations of lambs. Inter-rater reliability testing was performed to determine if the scale could be reliably applied by different raters. RESULTS Observations led to the definition of 7 categories of locomotor recovery. A scoring system was developed to rank these categories. The scale captured a wide variety of neurologic outcomes. Inter-rater reliability revealed minimal variability between examiners (average standard deviation ±0.431). The average score for all raters was within 1 point of the consensus score 100% of the time. CONCLUSIONS The sheep locomotor rating scale is capable of capturing subtle differences in neurologic function with minimal inter-rater variability. We propose a standardized rating scale for neurologic outcomes and believe this is a critical component for assessing the validity of experimental treatments to cure paralysis in MMC.
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Affiliation(s)
- Erin G Brown
- University of California, Davis Health System, Sacramento, CA, USA.
| | | | | | - Nicole A Sitkin
- University of California, Davis Health System, Sacramento, CA, USA
| | - Aijun Wang
- University of California, Davis Health System, Sacramento, CA, USA
| | - Diana L Farmer
- University of California, Davis Health System, Sacramento, CA, USA
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46
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Nielson JL, Haefeli J, Salegio EA, Liu AW, Guandique CF, Stück ED, Hawbecker S, Moseanko R, Strand SC, Zdunowski S, Brock JH, Roy RR, Rosenzweig ES, Nout-Lomas YS, Courtine G, Havton LA, Steward O, Reggie Edgerton V, Tuszynski MH, Beattie MS, Bresnahan JC, Ferguson AR. Leveraging biomedical informatics for assessing plasticity and repair in primate spinal cord injury. Brain Res 2014; 1619:124-38. [PMID: 25451131 DOI: 10.1016/j.brainres.2014.10.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/18/2022]
Abstract
Recent preclinical advances highlight the therapeutic potential of treatments aimed at boosting regeneration and plasticity of spinal circuitry damaged by spinal cord injury (SCI). With several promising candidates being considered for translation into clinical trials, the SCI community has called for a non-human primate model as a crucial validation step to test efficacy and validity of these therapies prior to human testing. The present paper reviews the previous and ongoing efforts of the California Spinal Cord Consortium (CSCC), a multidisciplinary team of experts from 5 University of California medical and research centers, to develop this crucial translational SCI model. We focus on the growing volumes of high resolution data collected by the CSCC, and our efforts to develop a biomedical informatics framework aimed at leveraging multidimensional data to monitor plasticity and repair targeting recovery of hand and arm function. Although the main focus of many researchers is the restoration of voluntary motor control, we also describe our ongoing efforts to add assessments of sensory function, including pain, vital signs during surgery, and recovery of bladder and bowel function. By pooling our multidimensional data resources and building a unified database infrastructure for this clinically relevant translational model of SCI, we are now in a unique position to test promising therapeutic strategies' efficacy on the entire syndrome of SCI. We review analyses highlighting the intersection between motor, sensory, autonomic and pathological contributions to the overall restoration of function. This article is part of a Special Issue entitled SI: Spinal cord injury.
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Affiliation(s)
- Jessica L Nielson
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Jenny Haefeli
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Ernesto A Salegio
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Aiwen W Liu
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Cristian F Guandique
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Ellen D Stück
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Stephanie Hawbecker
- California National Primate Research Center (CNPRC), University of California, Davis, CA (UCD), United States
| | - Rod Moseanko
- California National Primate Research Center (CNPRC), University of California, Davis, CA (UCD), United States
| | - Sarah C Strand
- California National Primate Research Center (CNPRC), University of California, Davis, CA (UCD), United States
| | - Sharon Zdunowski
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA (UCLA), United States
| | - John H Brock
- Center for Neural Repair, Department of Neurosciences, University of California, San Diego, La Jolla, CA (UCSD), United States
| | - Roland R Roy
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA (UCLA), United States
| | - Ephron S Rosenzweig
- Center for Neural Repair, Department of Neurosciences, University of California, San Diego, La Jolla, CA (UCSD), United States
| | - Yvette S Nout-Lomas
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, United States
| | - Gregoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), United States
| | - Leif A Havton
- Reeve-Irvine Research Center (RIRC), University of California, Irvine, CA (UCI), United States; Departments of Anesthesiology & Perioperative Care, Neurology, and Anatomy & Neurobiology, University of California, Irvine, CA, United States
| | - Oswald Steward
- Reeve-Irvine Research Center (RIRC), University of California, Irvine, CA (UCI), United States; Departments of Anatomy & Neurobiology, Neurobiology & Behavior, and Neurosurgery, University of California, Irvine, CA, United States
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA (UCLA), United States
| | - Mark H Tuszynski
- Departments of Anesthesiology & Perioperative Care, Neurology, and Anatomy & Neurobiology, University of California, Irvine, CA, United States; Veterans Administration Medical Center, La Jolla, CA, United States
| | - Michael S Beattie
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Adam R Ferguson
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States.
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47
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Nielson JL, Guandique CF, Liu AW, Burke DA, Lash AT, Moseanko R, Hawbecker S, Strand SC, Zdunowski S, Irvine KA, Brock JH, Nout-Lomas YS, Gensel JC, Anderson KD, Segal MR, Rosenzweig ES, Magnuson DSK, Whittemore SR, McTigue DM, Popovich PG, Rabchevsky AG, Scheff SW, Steward O, Courtine G, Edgerton VR, Tuszynski MH, Beattie MS, Bresnahan JC, Ferguson AR. Development of a database for translational spinal cord injury research. J Neurotrauma 2014; 31:1789-99. [PMID: 25077610 DOI: 10.1089/neu.2014.3399] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Efforts to understand spinal cord injury (SCI) and other complex neurotrauma disorders at the pre-clinical level have shown progress in recent years. However, successful translation of basic research into clinical practice has been slow, partly because of the large, heterogeneous data sets involved. In this sense, translational neurological research represents a "big data" problem. In an effort to expedite translation of pre-clinical knowledge into standards of patient care for SCI, we describe the development of a novel database for translational neurotrauma research known as Visualized Syndromic Information and Outcomes for Neurotrauma-SCI (VISION-SCI). We present demographics, descriptive statistics, and translational syndromic outcomes derived from our ongoing efforts to build a multi-center, multi-species pre-clinical database for SCI models. We leveraged archived surgical records, postoperative care logs, behavioral outcome measures, and histopathology from approximately 3000 mice, rats, and monkeys from pre-clinical SCI studies published between 1993 and 2013. The majority of animals in the database have measures collected for health monitoring, such as weight loss/gain, heart rate, blood pressure, postoperative monitoring of bladder function and drug/fluid administration, behavioral outcome measures of locomotion, and tissue sparing postmortem. Attempts to align these variables with currently accepted common data elements highlighted the need for more translational outcomes to be identified as clinical endpoints for therapeutic testing. Last, we use syndromic analysis to identify conserved biological mechanisms of recovery after cervical SCI between rats and monkeys that will allow for more-efficient testing of therapeutics that will need to be translated toward future clinical trials.
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Affiliation(s)
- Jessica L Nielson
- 1 Brain and Spinal Injury Center, Department of Neurological Surgery, University of California San Francisco , San Francisco, California
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48
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Irvine KA, Ferguson AR, Mitchell KD, Beattie SB, Lin A, Stuck ED, Huie JR, Nielson JL, Talbott JF, Inoue T, Beattie MS, Bresnahan JC. The Irvine, Beatties, and Bresnahan (IBB) Forelimb Recovery Scale: An Assessment of Reliability and Validity. Front Neurol 2014; 5:116. [PMID: 25071704 PMCID: PMC4083223 DOI: 10.3389/fneur.2014.00116] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/20/2014] [Indexed: 12/24/2022] Open
Abstract
The IBB scale is a recently developed forelimb scale for the assessment of fine control of the forelimb and digits after cervical spinal cord injury [SCI; (1)]. The present paper describes the assessment of inter-rater reliability and face, concurrent and construct validity of this scale following SCI. It demonstrates that the IBB is a reliable and valid scale that is sensitive to severity of SCI and to recovery over time. In addition, the IBB correlates with other outcome measures and is highly predictive of biological measures of tissue pathology. Multivariate analysis using principal component analysis (PCA) demonstrates that the IBB is highly predictive of the syndromic outcome after SCI (2), and is among the best predictors of bio-behavioral function, based on strong construct validity. Altogether, the data suggest that the IBB, especially in concert with other measures, is a reliable and valid tool for assessing neurological deficits in fine motor control of the distal forelimb, and represents a powerful addition to multivariate outcome batteries aimed at documenting recovery of function after cervical SCI in rats.
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Affiliation(s)
- Karen-Amanda Irvine
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Adam R. Ferguson
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen D. Mitchell
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie B. Beattie
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Amity Lin
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ellen D. Stuck
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - J. Russell Huie
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jessica L. Nielson
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jason F. Talbott
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Tomoo Inoue
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Michael S. Beattie
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jacqueline C. Bresnahan
- Brain and Spinal Cord Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
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Brown EG, Saadai P, Pivetti CD, Beattie MS, Bresnahan JC, Wang A, Farmer DL. In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model. J Pediatr Surg 2014; 49:133-7; discussion 137-8. [PMID: 24439597 DOI: 10.1016/j.jpedsurg.2013.09.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite advances in prenatal repair, myelomeningocele (MMC) still produces devastating neurologic deficits. The amniotic membranes (AM) are a biologically active tissue that has been used anecdotally for human fetal MMC repair. This study evaluated the use of autologous AM compared to skin closure in an established fetal MMC model. METHODS Seven fetal lambs underwent surgical creation of MMC at gestational age of 75days followed by in utero repair at gestational age of 100days. Lambs were repaired with an autologous AM patch followed by skin closure (n=4) or skin closure alone (n=3). Gross necropsy and histopathology of the spinal cords were performed at term to assess neuronal preservation at the lesion. RESULTS An increase in preserved motor neurons and a larger area of spinal cord tissue were seen in AM-repaired lambs, as was decreased wound healing of the overlying skin. Loss of nearly all spinal cord tissue with limited motor neuron preservation was seen in skin only-repaired lambs. CONCLUSIONS AM-repaired lambs showed increased protection of spinal cord tissue compared to skin only-repaired lambs, but the overlying skin failed to close in AM-repaired lambs. These results suggest a potential role for AM in fetal MMC repair that warrants further study.
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Affiliation(s)
- Erin G Brown
- University of California, Davis Health System, Sacramento, CA, USA.
| | - Payam Saadai
- University of California, Davis Health System, Sacramento, CA, USA
| | | | | | | | - Aijun Wang
- University of California, Davis Health System, Sacramento, CA, USA
| | - Diana L Farmer
- University of California, Davis Health System, Sacramento, CA, USA
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Kwon BK, Soril LJ, Bacon M, Beattie MS, Blesch A, Bresnahan JC, Bunge MB, Dunlop SA, Fehlings MG, Ferguson AR, Hill CE, Karimi-Abdolrezaee S, Lu P, McDonald JW, Müller HW, Oudega M, Rosenzweig ES, Reier PJ, Silver J, Sykova E, Xu XM, Guest JD, Tetzlaff W. Corrigendum to “Demonstrating efficacy in preclinical studies of cellular therapies for spinal cord injury — How much is enough?” [Exp. Neurol. 248 (2013) 30–44]. Exp Neurol 2013. [DOI: 10.1016/j.expneurol.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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