Time course of dorsal root axon regeneration into transplants of fetal spinal cord: I. A light microscopic study

Transplanting neural progenitor cells to restore connectivity after spinal cord injury

Spinal cord injury remains a scientific and therapeutic challenge with great cost to individuals and society. The goal of research in this field is to find a means of restoring lost function. Recently we have seen considerable progress in understanding the injury process and the capacity of CNS neurons to regenerate, as well as innovations in stem cell biology. This presents an opportunity to develop effective transplantation strategies to provide new neural cells to promote the formation of new neuronal networks and functional connectivity. Past and ongoing clinical studies have demonstrated the safety of cell therapy, and preclinical research has used models of spinal cord injury to better elucidate the underlying mechanisms through which donor cells interact with the host and thus increase long-term efficacy. While a variety of cell therapies have been explored, we focus here on the use of neural progenitor cells obtained or derived from different sources to promote connectivity in sensory, motor and autonomic systems.

Putative Inhibitory Extracellular Matrix Molecules Do Not Prevent Dorsal Root Regeneration into Fetal Spinal Cord Transplants

We examined the distribution of several extracellular matrix molecules (ECM) and their relationship to regenerating axons in embryonic day 14 spinal cord transplants 1 to 12 weeks after transplantation into adult rats. We used immunocytochemical tech niques to label chondroitin sulfate proteoglycans (CSPGs) and tenascin-C in adjacent sections. Synthesis of these molecules by astrocytes is thought to be one mechanism by which astrocytes inhibit regeneration in the central nervous system (CNS); glial fibrillary acidic protein antibody was used to label astrocytes and examine their rela tionship to both the ECM molecules and regenerating calcitonin gene-related pep tide (CORP)-contammg dorsal roots. We also compared the expression and distribu tion of these five markers in transplants with normal spinal cord development.

Olfactory ensheathing cell grafts have minimal influence on regeneration at the dorsal root entry zone following rhizotomy

The effectiveness of grafts of olfactory ensheathing cells (OECs) as a means of promoting functional reconnection of regenerating primary afferent fibers was investigated following dorsal root injury. Adult rats were subjected to dorsal root section and reanastomosis and at the same operation a suspension of purified OECs was injected at the dorsal root entry zone and/or into the sectioned dorsal root. Regeneration of dorsal root fibers was then assessed after a survival period ranging from 1 to 6 months. In 11 animals, electrophysiology was used to look for evidence of functional reconnection of regenerating dorsal root fibers. However, electrical stimulation of lesioned dorsal roots failed to evoke detectable cord dorsum or field potentials within the spinal cord of any of the animals examined, indicating that reconnection of regenerating fibers with spinal cord neurones had not occurred. In a further 11 rats, immunocytochemical labeling and biotin dextran tracing of afferent fibers in the lesioned roots was used to determine whether regenerating fibers were able to grow into the spinal cord in the presence of an OEC graft. Although a few afferent fibers could be seen to extend for a limited distance into the spinal cord, similar minimal in-growth was seen in control animals that had not been injected with OECs. We therefore conclude that OEC grafts are of little or no advantage in promoting the in-growth of regenerating afferent fibers at the dorsal root entry zone following rhizotomy.

Stimulating regeneration in the damaged spinal cord

Great progress has been made in recent years in experimental strategies for spinal cord repair. In this review we describe two of these strategies, namely the use of neurotrophic factors to promote functional regeneration across the dorsal root entry zone (DREZ), and the use of synthetic fibronectin conduits to support directed axonal growth. The junction between the peripheral nervous system (PNS) and central nervous system (CNS) is marked by a specialized region, the DREZ, where sensory axons enter the spinal cord from the dorsal roots. After injury to dorsal roots, axons will regenerate as far as the DREZ but no further. However, recent studies have shown that this barrier can be overcome and function restored. In animals treated with neurotrophic factors, regenerating axons cross the DREZ and establish functional connections with dorsal horn cells. For example, intrathecal delivery of neurotrophin 3 (NT3) supports ingrowth of A fibres into the dorsal horn. This ingrowth is revealed using a transganglionic anatomical tracer (cholera toxin subunit B) and analysis at light and electron microscopic level. In addition to promoting axonal growth, spinal cord repair is likely to require strategies for supporting long-distance regeneration. Synthetic fibronectin conduits may be useful for this purpose. Experimental studies indicate that fibronectin mats implanted into the spinal cord will integrate with the host tissue and support extensive and directional axonal growth. Growth of both PNS and CNS axons is supported by the fibronectin, and axons become myelinated by Schwann cells. Ongoing studies are aimed at developing composite conduits and promoting axonal growth from the fibronectin back into the spinal cord.

Olfactory ensheathing cells: bridging the gap in spinal cord injury

Spinal cord injury (SCI) continues to be an insidious and challenging problem for scientists and clinicians. Recent neuroscientific advances have changed the pessimistic notion that axons are not capable of significant extension after transection. The challenges of recovering from SCI have been broadly divided into four areas: 1) cell survival; 2) axon regeneration (growth); 3) correct targeting by growing axons; and 4) establishment of correct and functional synaptic appositions. After acute SCI, there seems to be a therapeutic window of opportunity within which the devastating consequences of the secondary injury can be ameliorated. This is supported by several observations in which apoptotic glial cells have been identified up to 1 week after acute SCI. Moreover, autopsy studies have identified anatomically preserved but unmyelinated axons that could potentially subserve normal physiological properties. These observations suggest that therapeutic strategies after SCI can be directed into two broad modalities: 1) prevention or amelioration of the secondary injury, and 2) restorative or regenerative interventions. Intraspinal transplants have been used after SCI as a means for restoring the severed neuraxis. Fetal cell transplants and, more recently, progenitor cells have been used to restore intraspinal circuitry or to serve as relay for damaged axons. In an attempt to remyelinate anatomically preserved but physiologically disrupted axons, newer therapeutic interventions have incorporated the transplantation of myelinating cells, such as Schwann cells, oligodendrocytes, and olfactory ensheathing cells. Of these cells, the olfactory ensheathing cells have become a more favorable candidate for extensive remyelination and axonal regeneration. Olfactory ensheathing cells are found along the full length of the olfactory nerve, from the basal lamina of the epithelium to the olfactory bulb, crossing the peripheral nervous system-central nervous system junction. In vitro, these cells promote robust axonal growth, in part through cell adhesion molecules and possibly by secretion of neurotrophic growth factors that support axonal elongation and extension. In animal models of SCI, transplantation of ensheathing cells supports axonal remyelination and extensive migration throughout the length of the spinal cord. Although the specific properties of these cells that govern enhanced axon regeneration remain to be elucidated, it seems certain that they will contribute to the establishment of new horizons in SCI research.

Embryonic central nervous system transplants mediate adult dorsal root regeneration into host spinal cord

OBJECTIVE

The aim of this study was to determine whether embryonic central nervous system transplants assisted cut dorsal root axons of adult rats to regenerate into the spinal cord.

METHODS

Rats received transplants of embryonic spinal cord, hippocampus, or neocortex into dorsal quadrant cavities aspirated in the lumbar enlargement. The transected L5 dorsal root stump was secured between the transplant and the spinal cord. Regenerated dorsal roots were subsequently labeled by using immunohistochemical methods to detect calcitonin gene-related peptide.

RESULTS

Calcitonin gene-related peptide-immunoreactive axons extended into all host spinal cords examined, but the patterns of regrowth differed in rats that had received embryonic spinal cord and brain transplants. In rats with embryonic spinal cord transplants, regenerated axons traversed the dorsal root/spinal cord interface, entered the spinal cord, and frequently formed plexuses with arborizations in motoneuron pools; some of these axons established synapses on spinal cord neurons. In rats with embryonic brain transplants, regenerated axons were diffusely distributed in the spinal cord but did not form plexuses. Few axons regenerated into the spinal cords of lesion-only animals. The results of quantitative analyses confirmed these findings.

CONCLUSION

These findings suggest that transplants of embryonic spinal cord and brain supply cues that enable cut dorsal roots to regenerate into the host spinal cord and that the cues provided by spinal cord transplants favor more extensive growth than do those provided by brain transplants. These cues are likely to depend in part on neurotrophic effects of embryonic central nervous system tissues. Therefore, embryonic central nervous system transplants, especially spinal cord grafts, may contribute to techniques for restoring interrupted spinal reflex arcs.

Neurotrophic agents in fibrin glue mediate adult dorsal root regeneration into spinal cord

OBJECTIVE

The aim of the present study was to determine whether neurotrophic factors (NTFs) exogenously administered in fibrin glue assisted cut dorsal root axons of adult rats to regenerate into the spinal cord.

METHODS

Rats received intraspinal implants of fibrin glue containing neurotrophin-3, brain-derived NTF, ciliary NTF, or Dulbecco's modified Eagle's medium (control) into left dorsal quadrant cavities aspirated in the lumbar enlargement. The transected L5 dorsal root stump was placed at the bottom of the lesion cavity and was secured between the fibrin glue and the spinal cord. Regenerated dorsal root axons were subsequently labeled with immunohistochemical methods to demonstrate those that contained calcitonin gene-related peptide.

RESULTS

Calcitonin gene-related peptide-immunoreactive dorsal root axons regenerated across the dorsal root-spinal cord interface of rats with fibrin glue containing neurotrophin-3, brain-derived NTF, or ciliary NTF, entered the spinal cord, and frequently arborized within clusters of motoneuronal cell bodies. Only a few axons regenerated into the spinal cord of animals with fibrin glue implants that lacked NTF, and their growth within the spinal cord was extremely limited. The results of quantitative studies confirmed these observations.

CONCLUSION

Our results indicate that neurotrophin-3, brain-derived NTF, and ciliary NTF enhance dorsal root regeneration into spinal cord and that fibrin glue is an effective medium for intraspinal delivery of NTF. This method of delivering NTF may therefore provide a strategy for restoring injured spinal reflex arcs.

Ensheathing glia transplants promote dorsal root regeneration and spinal reflex restitution after multiple lumbar rhizotomy

Previously, we have shown that transplants of olfactory bulb ensheathing cells promoted regeneration of transected dorsal roots into the spinal cord. In this study, we assessed the ability of regenerating axons to make functional connections in the cord. Dorsal roots L3 to L6 were sectioned close to their entrance into the spinal cord and reapposed after injecting a suspension of ensheathing cells into each dorsal root entry zone (Group G). Afferent regeneration into the cord and recovery of spinal reflexes were compared with animals that received no injection (Group S) or culture medium without cells (Group C). Electrophysiological tests, to measure nerve conduction and spinal reflexes (H response and withdrawal reflex) evoked by stimulation of afferents of the sciatic nerve, were performed. At 14 days after surgery, H response was found in only 1 of 7 rats of Group G, and withdrawal reflexes were absent from all animals. At 60 days, the H response reappeared in 7 of 10 rats of Group G, and 1 of 5 of each of Groups C and S. The withdrawal reflex recovered in 4 of 10 rats of Group G, but in none of Groups C and S. Immunohistochemical labeling for calcitonin gene-related peptide (CGRP) in rats of Group G showed immunoreactive fibers entering the dorsal horn from sectioned roots, although at lower density than in the contralateral side. In conclusion, transplanted ensheathing cells promoted central regeneration and functional reconnection of regenerating sensory afferents.

Electrophysiological responses in foetal spinal cord transplants evoked by regenerated dorsal root axons

Cut dorsal root axons regenerate into intraspinal transplants of foetal spinal cord (FSC) and establish synaptic connections there. The aim of the present study was to determine whether transplant neurons are driven synaptically in response to electrical stimulation of regenerated dorsal root axons. Adult Sprague-Dawley rats received FSC transplants (E14) into dorsal quadrant cavities at the lumbar enlargement. The cut L4 or L5 dorsal root stump was placed at the bottom of the lesion cavity and secured between the transplant and host spinal cord. Four to ten weeks later the animals were prepared for electrical stimulation and recording. We stimulated regenerated dorsal roots and recorded extracellular single unit post-synaptic activities which were evoked close to the dorsal root-transplant interface. We used intracellular recording to observe several examples of monosynaptic EPSPs in transplant neurons evoked by dorsal root stimulation. These results indicate that the regenerated dorsal root axons establish functional connections with neurons within the transplants and suggest that FSC transplants can be used to reconstruct functional connections between neurons that have been interrupted by spinal cord injury.

Regeneration of adult dorsal root axons into transplants of dorsal or ventral half of foetal spinal cord

Several dorsal root axons regenerate into the transplants of foetal spinal cord (FSC) and form synapses there. It is unknown whether the growth is specific to transplants of dorsal half FSC, a normal target of most dorsal root axons, or whether it is due to properties shared by transplants of ventral half FSC. We used calcitonin gene-related peptide immunohistochemistry to label subsets of regenerated host dorsal root axons, and morphometric analysis to compared neuronal populations within both transplants. Adult Sprague-Dawley rats received intraspinal grafts of dorsal or ventral half FSC (E14), and the L4 or L5 dorsal root was cut and juxtaposed to the grafts. Three months later sagittal sections were prepared for immunohistochemistry and Nissl-Myelin stain. Histograms of the perikaryal area showed that the transplants of dorsal half FSC consisted of small neurons predominantly, whereas transplants of ventral half FSC consisted of neurons of variable sizes. Dorsal root axons regenerated into both transplants, but growth into dorsal half FSC was more robust. These results indicate that both transplants provide an environment that supports dorsal root regeneration, but that the environment provided by dorsal half FSC is more favorable. Transplants of dorsal half FSC may offer advantages for the long-term goal of repairing of damaged spinal cord circuits.