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Guo XJ, Zhao Z, Chang JQ, He LW, Su WN, Feng T, Zhao C, Xu M, Rao JS. Epidural combined optical and electrical stimulation induces high-specificity activation of target muscles in spinal cord injured rats. Front Neurosci 2023; 17:1282558. [PMID: 38027482 PMCID: PMC10667474 DOI: 10.3389/fnins.2023.1282558] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Epidural electrical stimulation (EES) has been shown to improve motor dysfunction after spinal cord injury (SCI) by activating residual locomotor neural networks. However, the stimulation current often spreads excessively, leading to activation of non-target muscles and reducing the accuracy of stimulation regulation. Objectives Near-infrared nerve stimulation (nINS) was combined with EES to explore its regulatory effect on lower limb muscle activity in spinal-cord-transected rats. Methods In this study, stimulation electrodes were implanted into the rats' L3-L6 spinal cord segment with T8 cord transected. Firstly, a series of EES parameters (0.2-0.6 mA and 20-60 Hz) were tested to determine those that specifically regulate the tibialis anterior (TA) and medial gastrocnemius (MG). Subsequently, to determine the effect of combined optical and electrical stimulation, near-infrared laser with a wavelength of 808 nm was used to irradiate the L3-L6 spinal cord segment while EES was performed. The amplitude of electromyography (EMG), the specific activation intensity of the target muscle, and the minimum stimulus current intensity to induce joint movement (motor threshold) under a series of optical stimulation parameters (power: 0.0-2.0 W; pulse width: 0-10 ms) were investigated and analyzed. Results EES stimulation with 40 Hz at the L3 and L6 spinal cord segments specifically activated TA and MG, respectively. High stimulation intensity (>2 × motor threshold) activated non-target muscles, while low stimulation frequency (<20 Hz) produced intermittent contraction. Compared to electrical stimulation alone (0.577 ± 0.081 mV), the combined stimulation strategy could induce stronger EMG amplitude of MG (1.426 ± 0.365 mV) after spinal cord injury (p < 0.01). The combined application of nINS effectively decreased the EES-induced motor threshold of MG (from 0.237 ± 0.001 mA to 0.166 ± 0.028 mA, p < 0.001). Additionally, the pulse width (PW) of nINS had a slight impact on the regulation of muscle activity. The EMG amplitude of MG only increased by ~70% (from 3.978 ± 0.240 mV to 6.753 ± 0.263 mV) when the PW increased by 10-fold (from 1 to 10 ms). Conclusion The study demonstrates the feasibility of epidural combined electrical and optical stimulation for highly specific regulation of muscle activity after SCI, and provides a new strategy for improving motor dysfunction caused by SCI.
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Affiliation(s)
- Xiao-Jun Guo
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ziyi Zhao
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jia-Qi Chang
- Smart Fluid Equipment and Manufacture Lab, School of Automation Science and Electrical Engineering, Beihang Univeristy, Beijing, China
| | - Le-Wei He
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Wen-Nan Su
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ting Feng
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Can Zhao
- Institute of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, China
| | - Meng Xu
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Lin D, Lee JM, Wang C, Park HG, Lieber CM. Injectable Ventral Spinal Stimulator Evokes Programmable and Biomimetic Hindlimb Motion. Nano Lett 2023. [PMID: 37338198 DOI: 10.1021/acs.nanolett.3c01806] [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] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Spinal cord neuromodulation can restore partial to complete loss of motor functions associated with neuromotor disease and trauma. Current technologies have made substantial progress but have limitations as dorsal epidural or intraspinal devices that are either remote to ventral motor neurons or subject to surgical intervention in the spinal tissue. Here, we describe a flexible and stretchable spinal stimulator design with nanoscale thickness that can be implanted by minimally invasive injection through a polymeric catheter to target the ventral spinal space of mice. Ventrolaterally implanted devices exhibited substantially lower stimulation threshold currents and more precise recruitment of motor pools than did comparable dorsal epidural implants. Functionally relevant and novel hindlimb movements were achieved via specific stimulation patterns of the electrodes. This approach holds translational potential for improving controllable limb function following spinal cord injury or neuromotor disease.
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Affiliation(s)
- Dingchang Lin
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Center for Cell Dynamics, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, United States
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Jung Min Lee
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
- Department of Physics, Korea University, Seoul 02841, Republic of Korea
| | - Chonghe Wang
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Hong-Gyu Park
- Department of Physics, Korea University, Seoul 02841, Republic of Korea
| | - Charles M Lieber
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
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Govindarajan LN, Calvert JS, Parker SR, Jung M, Darie R, Miranda P, Shaaya E, Borton DA, Serre T. Fast inference of spinal neuromodulation for motor control using amortized neural networks. J Neural Eng 2022; 19:10.1088/1741-2552/ac9646. [PMID: 36174534 PMCID: PMC9668352 DOI: 10.1088/1741-2552/ac9646] [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: 05/31/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022]
Abstract
Objective.Epidural electrical stimulation (EES) has emerged as an approach to restore motor function following spinal cord injury (SCI). However, identifying optimal EES parameters presents a significant challenge due to the complex and stochastic nature of muscle control and the combinatorial explosion of possible parameter configurations. Here, we describe a machine-learning approach that leverages modern deep neural networks to learn bidirectional mappings between the space of permissible EES parameters and target motor outputs.Approach.We collected data from four sheep implanted with two 24-contact EES electrode arrays on the lumbosacral spinal cord. Muscle activity was recorded from four bilateral hindlimb electromyography (EMG) sensors. We introduce a general learning framework to identify EES parameters capable of generating desired patterns of EMG activity. Specifically, we first amortize spinal sensorimotor computations in a forward neural network model that learns to predict motor outputs based on EES parameters. Then, we employ a second neural network as an inverse model, which reuses the amortized knowledge learned by the forward model to guide the selection of EES parameters.Main results.We found that neural networks can functionally approximate spinal sensorimotor computations by accurately predicting EMG outputs based on EES parameters. The generalization capability of the forward model critically benefited our inverse model. We successfully identified novel EES parameters, in under 20 min, capable of producing desired target EMG recruitment duringin vivotesting. Furthermore, we discovered potential functional redundancies within the spinal sensorimotor networks by identifying unique EES parameters that result in similar motor outcomes. Together, these results suggest that our framework is well-suited to probe spinal circuitry and control muscle recruitment in a completely data-driven manner.Significance.We successfully identify novel EES parameters within minutes, capable of producing desired EMG recruitment. Our approach is data-driven, subject-agnostic, automated, and orders of magnitude faster than manual approaches.
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Affiliation(s)
- Lakshmi Narasimhan Govindarajan
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence RI USA
- Carney Institute for Brain Science, Brown University, Providence RI USA
| | | | | | - Minju Jung
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence RI USA
- Carney Institute for Brain Science, Brown University, Providence RI USA
| | - Radu Darie
- School of Engineering, Brown University, Providence RI USA
| | | | - Elias Shaaya
- Department of Neurosurgery, Brown University and Rhode Island Hospital, Providence RI USA
| | - David A. Borton
- Carney Institute for Brain Science, Brown University, Providence RI USA
- School of Engineering, Brown University, Providence RI USA
- Center for Neurorestoration and Neurotechnology, Department of Veterans Affairs, Providence RI USA
| | - Thomas Serre
- Cognitive, Linguistic & Psychological Sciences, Brown University, Providence RI USA
- Carney Institute for Brain Science, Brown University, Providence RI USA
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4
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Lee S, Park J, Choi DS, Lim S, Kwak Y, Jang DP, Kim DH, Ji HB, Choy YB, Im CH. Feasibility of epidural temporal interference stimulation for minimally invasive electrical deep brain stimulation: simulation and phantom experimental studies. J Neural Eng 2022; 19. [PMID: 36066021 DOI: 10.1088/1741-2552/ac8503] [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: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 11/11/2022]
Abstract
Objective. Temporal interference stimulation (TIS) has shown the potential as a new method for selective stimulation of deep brain structures in small animal experiments. However, it is challenging to deliver a sufficient temporal interference (TI) current to directly induce an action potential in the deep area of the human brain when electrodes are attached to the scalp because the amount of injection current is generally limited due to safety issues. Thus, we propose a novel method called epidural TIS (eTIS) to address this issue; in this method, the electrodes are attached to the epidural surface under the skull.Approach. We employed finite element method (FEM)-based electric field simulations to demonstrate the feasibility of eTIS. We first optimized the electrode conditions to deliver maximum TI currents to each of the three different targets (anterior hippocampus, subthalamic nucleus, and ventral intermediate nucleus) based on FEM, and compared the stimulation focality between eTIS and transcranial TIS (tTIS). Moreover, we conducted realistic skull-phantom experiments for validating the accuracy of the computational simulation for eTIS.Main results. Our simulation results showed that eTIS has the advantage of avoiding the delivery of TI currents over unwanted neocortical regions compared with tTIS for all three targets. It was shown that the optimized eTIS could induce neural action potentials at each of the three targets when a sufficiently large current equivalent to that for epidural cortical stimulation is injected. Additionally, the simulated results and measured results via the phantom experiments were in good agreement.Significance. We demonstrated the feasibility of eTIS, facilitating more focalized and stronger electrical stimulation of deep brain regions than tTIS, with the relatively less invasive placement of electrodes than conventional deep brain stimulation via computational simulation and realistic skull phantom experiments.
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Affiliation(s)
- Sangjun Lee
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jimin Park
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Da Som Choi
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
| | - Seokbeen Lim
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Youngjong Kwak
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Dong Pyo Jang
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Center for Intelligent and Interactive Robotics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Han Bi Ji
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Young Bin Choy
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea.,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Chang-Hwan Im
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea.,Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
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5
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Islamov R, Bashirov F, Izmailov A, Fadeev F, Markosyan V, Sokolov M, Shmarov M, Logunov D, Naroditsky B, Lavrov I. New Therapy for Spinal Cord Injury: Autologous Genetically-Enriched Leucoconcentrate Integrated with Epidural Electrical Stimulation. Cells 2022; 11:144. [PMID: 35011706 DOI: 10.3390/cells11010144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 12/17/2022] Open
Abstract
The contemporary strategy for spinal cord injury (SCI) therapy aims to combine multiple approaches to control pathogenic mechanisms of neurodegeneration and stimulate neuroregeneration. In this study, a novel regenerative approach using an autologous leucoconcentrate enriched with transgenes encoding vascular endothelial growth factor (VEGF), glial cell line-derived neurotrophic factor (GDNF), and neural cell adhesion molecule (NCAM) combined with supra- and sub-lesional epidural electrical stimulation (EES) was tested on mini-pigs similar in morpho-physiological scale to humans. The complex analysis of the spinal cord recovery after a moderate contusion injury in treated mini-pigs compared to control animals revealed: better performance in behavioural and joint kinematics, restoration of electromyography characteristics, and improvement in selected immunohistology features related to cell survivability, synaptic protein expression, and glial reorganization above and below the injury. These results for the first time demonstrate the positive effect of intravenous infusion of autologous genetically-enriched leucoconcentrate producing recombinant molecules stimulating neuroregeneration combined with neuromodulation by translesional multisite EES on the restoration of the post-traumatic spinal cord in mini-pigs and suggest the high translational potential of this novel regenerative therapy for SCI patients.
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Abstract
Tonic or phasic electrical epidural stimulation of the lumbosacral region of the spinal cord facilitates locomotion and standing in a variety of preclinical models with severe spinal cord injury. However, the mechanisms of epidural electrical stimulation that facilitate sensorimotor functions remain largely unknown. This review aims to address how epidural electrical stimulation interacts with spinal sensorimotor circuits and discusses the limitations that currently restrict the clinical implementation of this promising therapeutic approach.
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Affiliation(s)
- Johannie Audet
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Charly G Lecomte
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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7
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Fadeev FO, Bashirov FV, Markosyan VA, Izmailov AA, Povysheva TV, Sokolov ME, Kuznetsov MS, Eremeev AA, Salafutdinov II, Rizvanov AA, Lee HJ, Islamov RR. Combination of epidural electrical stimulation with ex vivo triple gene therapy for spinal cord injury: a proof of principle study. Neural Regen Res 2021; 16:550-560. [PMID: 32985487 PMCID: PMC7996027 DOI: 10.4103/1673-5374.293150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/15/2019] [Revised: 11/03/2019] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
Despite emerging contemporary biotechnological methods such as gene- and stem cell-based therapy, there are no clinically established therapeutic strategies for neural regeneration after spinal cord injury. Our previous studies have demonstrated that transplantation of genetically engineered human umbilical cord blood mononuclear cells producing three recombinant therapeutic molecules, including vascular endothelial growth factor (VEGF), glial cell-line derived neurotrophic factor (GDNF), and neural cell adhesion molecule (NCAM) can improve morpho-functional recovery of injured spinal cord in rats and mini-pigs. To investigate the efficacy of human umbilical cord blood mononuclear cells-mediated triple-gene therapy combined with epidural electrical stimulation in the treatment of spinal cord injury, in this study, rats with moderate spinal cord contusion injury were intrathecally infused with human umbilical cord blood mononuclear cells expressing recombinant genes VEGF165, GDNF, NCAM1 at 4 hours after spinal cord injury. Three days after injury, epidural stimulations were given simultaneously above the lesion site at C5 (to stimulate the cervical network related to forelimb functions) and below the lesion site at L2 (to activate the central pattern generators) every other day for 4 weeks. Rats subjected to the combined treatment showed a limited functional improvement of the knee joint, high preservation of muscle fiber area in tibialis anterior muscle and increased H/M ratio in gastrocnemius muscle 30 days after spinal cord injury. However, beneficial cellular outcomes such as reduced apoptosis and increased sparing of the gray and white matters, and enhanced expression of heat shock and synaptic proteins were found in rats with spinal cord injury subjected to the combined epidural electrical stimulation with gene therapy. This study presents the first proof of principle study of combination of the multisite epidural electrical stimulation with ex vivo triple gene therapy (VEGF, GDNF and NCAM) for treatment of spinal cord injury in rat models. The animal protocols were approved by the Kazan State Medical University Animal Care and Use Committee (approval No. 2.20.02.18) on February 20, 2018.
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Affiliation(s)
- Filip Olegovich Fadeev
- Department of Medical Biology and Genetics, Kazan State Medical University, Kazan, Russia
| | | | | | | | | | | | | | | | | | | | - Hyun Joon Lee
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
- Research Service, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
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8
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Hofstoetter US, Danner SM, Freundl B, Binder H, Lackner P, Minassian K. Ipsi- and Contralateral Oligo- and Polysynaptic Reflexes in Humans Revealed by Low-Frequency Epidural Electrical Stimulation of the Lumbar Spinal Cord. Brain Sci 2021; 11:brainsci11010112. [PMID: 33467053 PMCID: PMC7830402 DOI: 10.3390/brainsci11010112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/22/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/16/2023] Open
Abstract
Epidural electrical stimulation (EES) applied over the human lumbosacral spinal cord provides access to afferent fibers from virtually all lower-extremity nerves. These afferents connect to spinal networks that play a pivotal role in the control of locomotion. Studying EES-evoked responses mediated through these networks can identify some of their functional components. We here analyzed electromyographic (EMG) responses evoked by low-frequency (2–6 Hz) EES derived from eight individuals with chronic, motor complete spinal cord injury. We identified and separately analyzed three previously undescribed response types: first, crossed reflexes with onset latencies of ~55 ms evoked in the hamstrings; second, oligosynaptic reflexes within 50 ms post-stimulus superimposed on the monosynaptic posterior root-muscle reflexes in the flexor muscle tibialis anterior, but with higher thresholds and no rate-sensitive depression; third, polysynaptic responses with variable EMG shapes within 50–450 ms post-stimulus evoked in the tibialis anterior and triceps surae, some of which demonstrated consistent changes in latencies with graded EES. Our observations suggest the activation of commissural neurons, lumbar propriospinal interneurons, and components of the late flexion reflex circuits through group I and II proprioceptive afferent inputs. These potential neural underpinnings have all been related to spinal locomotion in experimental studies.
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Affiliation(s)
- Ursula S. Hofstoetter
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria;
| | - Simon M. Danner
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA 19129, USA;
| | - Brigitta Freundl
- Neurological Center, Klinik Penzing—Wiener Gesundheitsverbund, 1140 Vienna, Austria; (B.F.); (H.B.); (P.L.)
| | - Heinrich Binder
- Neurological Center, Klinik Penzing—Wiener Gesundheitsverbund, 1140 Vienna, Austria; (B.F.); (H.B.); (P.L.)
| | - Peter Lackner
- Neurological Center, Klinik Penzing—Wiener Gesundheitsverbund, 1140 Vienna, Austria; (B.F.); (H.B.); (P.L.)
| | - Karen Minassian
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence:
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Abstract
A long-standing goal of spinal cord injury research is to develop effective repair strategies, which can restore motor and sensory functions to near-normal levels. Recent advances in clinical management of spinal cord injury have significantly improved the prognosis, survival rate and quality of life in patients with spinal cord injury. In addition, a significant progress in basic science research has unraveled the underlying cellular and molecular events of spinal cord injury. Such efforts enabled the development of pharmacologic agents, biomaterials and stem-cell based therapy. Despite these efforts, there is still no standard care to regenerate axons or restore function of silent axons in the injured spinal cord. These challenges led to an increased focus on another therapeutic approach, namely neuromodulation. In multiple animal models of spinal cord injury, epidural electrical stimulation of the spinal cord has demonstrated a recovery of motor function. Emerging evidence regarding the efficacy of epidural electrical stimulation has further expanded the potential of epidural electrical stimulation for treating patients with spinal cord injury. However, most clinical studies were conducted on a very small number of patients with a wide range of spinal cord injury. Thus, subsequent studies are essential to evaluate the therapeutic potential of epidural electrical stimulation for spinal cord injury and to optimize stimulation parameters. Here, we discuss cellular and molecular events that continue to damage the injured spinal cord and impede neurological recovery following spinal cord injury. We also discuss and summarize the animal and human studies that evaluated epidural electrical stimulation in spinal cord injury.
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Affiliation(s)
- Elliot H Choi
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Ophthalmology, Gavin Herbert Eye Institute, School of Medicine; Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Sandra Gattas
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - John D Hong
- Department of Ophthalmology, Gavin Herbert Eye Institute, School of Medicine, University of California, Irvine, CA, USA
| | - Joshua N Limbo
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Alvin Y Chan
- Department of Neurosurgery, University of California, Irvine, CA, USA
| | - Michael Y Oh
- Department of Neurosurgery, University of California, Irvine, CA, USA
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10
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Islamov R, Bashirov F, Fadeev F, Shevchenko R, Izmailov A, Markosyan V, Sokolov M, Kuznetsov M, Davleeva M, Garifulin R, Salafutdinov I, Nurullin L, Chelyshev Y, Lavrov I. Epidural Stimulation Combined with Triple Gene Therapy for Spinal Cord Injury Treatment. Int J Mol Sci 2020; 21:E8896. [PMID: 33255323 DOI: 10.3390/ijms21238896] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022] Open
Abstract
The translation of new therapies for spinal cord injury to clinical trials can be facilitated with large animal models close in morpho-physiological scale to humans. Here, we report functional restoration and morphological reorganization after spinal contusion in pigs, following a combined treatment of locomotor training facilitated with epidural electrical stimulation (EES) and cell-mediated triple gene therapy with umbilical cord blood mononuclear cells overexpressing recombinant vascular endothelial growth factor, glial-derived neurotrophic factor, and neural cell adhesion molecule. Preliminary results obtained on a small sample of pigs 2 months after spinal contusion revealed the difference in post-traumatic spinal cord outcomes in control and treated animals. In treated pigs, motor performance was enabled by EES and the corresponding morpho-functional changes in hind limb skeletal muscles were accompanied by the reorganization of the glial cell, the reaction of stress cell, and synaptic proteins. Our data demonstrate effects of combined EES-facilitated motor training and cell-mediated triple gene therapy after spinal contusion in large animals, informing a background for further animal studies and clinical translation.
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11
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Fadeev F, Eremeev A, Bashirov F, Shevchenko R, Izmailov A, Markosyan V, Sokolov M, Kalistratova J, Khalitova A, Garifulin R, Islamov R, Lavrov I. Combined Supra- and Sub-Lesional Epidural Electrical Stimulation for Restoration of the Motor Functions after Spinal Cord Injury in Mini Pigs. Brain Sci 2020; 10:brainsci10100744. [PMID: 33081405 PMCID: PMC7650717 DOI: 10.3390/brainsci10100744] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/11/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022] Open
Abstract
This study evaluates the effect of combined epidural electrical stimulation (EES) applied above (C5) and below (L2) the spinal cord injury (SCI) at T8–9 combined with motor training on the restoration of sensorimotor function in mini pigs. The motor evoked potentials (MEP) induced by EES applied at C5 and L2 levels were recorded in soleus muscles before and two weeks after SCI. EES treatment started two weeks after SCI and continued for 6 weeks led to improvement in multiple metrics, including behavioral, electrophysiological, and joint kinematics outcomes. In control animals after SCI a multiphasic M-response was observed during M/H-response testing, while animals received EES-enable training demonstrated the restoration of the M-response and H-reflex, although at a lower amplitude. The joint kinematic and assessment with Porcine Thoracic Injury Behavior scale (PTIBS) motor recovery scale demonstrated improvement in animals that received EES-enable training compared to animals with no treatment. The positive effect of two-level (cervical and lumbar) epidural electrical stimulation on functional restoration in mini pigs following spinal cord contusion injury in mini pigs could be related with facilitation of spinal circuitry at both levels and activation of multisegmental coordination. This approach can be taken as a basis for the future development of neuromodulation and neurorehabilitation therapy for patients with spinal cord injury.
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Affiliation(s)
- Filip Fadeev
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Anton Eremeev
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
| | - Farid Bashirov
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Roman Shevchenko
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Andrei Izmailov
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Vage Markosyan
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Mikhail Sokolov
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Julia Kalistratova
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Anastasiia Khalitova
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Ravil Garifulin
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
| | - Rustem Islamov
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia; (F.F.); (F.B.); (R.S.); (A.I.); (V.M.); (M.S.); (J.K.); (A.K.); (R.G.)
- Correspondence: (R.I.); (I.L.)
| | - Igor Lavrov
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: (R.I.); (I.L.)
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Calvert JS, Grahn PJ, Zhao KD, Lee KH. Emergence of Epidural Electrical Stimulation to Facilitate Sensorimotor Network Functionality After Spinal Cord Injury. Neuromodulation 2019; 22:244-252. [PMID: 30840354 DOI: 10.1111/ner.12938] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 07/05/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). METHODS This review provides a historical account of the translational research efforts that led to the emergence of EES of the spinal cord to enable intentional control of motor functions that were lost after SCI. We also highlight the major limitations associated with EES after SCI and propose future directions of spinal neuromodulation research. RESULTS Multiple, independent studies have demonstrated return of motor function via EES in individuals with chronic SCI. These enabled motor functions include intentional, controlled movement of previously paralyzed extremities, independent standing and stepping, and increased grip strength. In addition, improvements in cardiovascular health, respiratory function, body composition, and urologic function have been reported. CONCLUSIONS EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.
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Affiliation(s)
| | - Peter J Grahn
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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