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Hellenbrand DJ, Quinn CM, Piper ZJ, Elder RT, Mishra RR, Marti TL, Omuro PM, Roddick RM, Lee JS, Murphy WL, Hanna AS. The secondary injury cascade after spinal cord injury: an analysis of local cytokine/chemokine regulation. Neural Regen Res 2024; 19:1308-1317. [PMID: 37905880 DOI: 10.4103/1673-5374.385849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/04/2023] [Indexed: 11/02/2023] Open
Abstract
Abstract
JOURNAL/nrgr/04.03/01300535-202406000-00035/inline-graphic1/v/2023-10-30T152229Z/r/image-tiff
After spinal cord injury, there is an extensive infiltration of immune cells, which exacerbates the injury and leads to further neural degeneration. Therefore, a major aim of current research involves targeting the immune response as a treatment for spinal cord injury. Although much research has been performed analyzing the complex inflammatory process following spinal cord injury, there remain major discrepancies within previous literature regarding the timeline of local cytokine regulation. The objectives of this study were to establish an overview of the timeline of cytokine regulation for 2 weeks after spinal cord injury, identify sexual dimorphisms in terms of cytokine levels, and determine local cytokines that significantly change based on the severity of spinal cord injury. Rats were inflicted with either a mild contusion, moderate contusion, severe contusion, or complete transection, 7 mm of spinal cord centered on the injury was harvested at varying times post-injury, and tissue homogenates were analyzed with a Cytokine/Chemokine 27-Plex assay. Results demonstrated pro-inflammatory cytokines including tumor necrosis factor α, interleukin-1β, and interleukin-6 were all upregulated after spinal cord injury, but returned to uninjured levels within approximately 24 hours post-injury, while chemokines including monocyte chemoattractant protein-1 remained upregulated for days post-injury. In contrast, several anti-inflammatory cytokines and growth factors including interleukin-10 and vascular endothelial growth factor were downregulated by 7 days post-injury. After spinal cord injury, tissue inhibitor of metalloproteinase-1, which specifically affects astrocytes involved in glial scar development, increased more than all other cytokines tested, reaching 26.9-fold higher than uninjured rats. After a mild injury, 11 cytokines demonstrated sexual dimorphisms; however, after a severe contusion only leptin levels were different between female and male rats. In conclusion, pro-inflammatory cytokines initiate the inflammatory process and return to baseline within hours post-injury, chemokines continue to recruit immune cells for days post-injury, while anti-inflammatory cytokines are downregulated by a week post-injury, and sexual dimorphisms observed after mild injury subsided with more severe injuries. Results from this work define critical chemokines that influence immune cell infiltration and important cytokines involved in glial scar development after spinal cord injury, which are essential for researchers developing treatments targeting secondary damage after spinal cord injury.
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Affiliation(s)
- Daniel J Hellenbrand
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Charles M Quinn
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Zachariah J Piper
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ryan T Elder
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Raveena R Mishra
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Taylor L Marti
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Phoebe M Omuro
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Rylie M Roddick
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jae Sung Lee
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - William L Murphy
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Forward BIO Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - Amgad S Hanna
- Department of Neurosurgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Lana JF, Navani A, Jeyaraman M, Santos N, Pires L, Santos GS, Rodrigues IJ, Santos D, Mosaner T, Azzini G, da Fonseca LF, de Macedo AP, Huber SC, de Moraes Ferreira Jorge D, Purita J. Sacral Bioneuromodulation: The Role of Bone Marrow Aspirate in Spinal Cord Injuries. Bioengineering (Basel) 2024; 11:461. [PMID: 38790327 PMCID: PMC11118755 DOI: 10.3390/bioengineering11050461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Spinal cord injury (SCI) represents a severe trauma to the nervous system, leading to significant neurological damage, chronic inflammation, and persistent neuropathic pain. Current treatments, including pharmacotherapy, immobilization, physical therapy, and surgical interventions, often fall short in fully addressing the underlying pathophysiology and resultant disabilities. Emerging research in the field of regenerative medicine has introduced innovative approaches such as autologous orthobiologic therapies, with bone marrow aspirate (BMA) being particularly notable for its regenerative and anti-inflammatory properties. This review focuses on the potential of BMA to modulate inflammatory pathways, enhance tissue regeneration, and restore neurological function disrupted by SCI. We hypothesize that BMA's bioactive components may stimulate reparative processes at the cellular level, particularly when applied at strategic sites like the sacral hiatus to influence lumbar centers and higher neurological structures. By exploring the mechanisms through which BMA influences spinal repair, this review aims to establish a foundation for its application in clinical settings, potentially offering a transformative approach to SCI management that extends beyond symptomatic relief to promoting functional recovery.
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Affiliation(s)
- José Fábio Lana
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
- Clinical Research, Anna Vitória Lana Institute (IAVL), Indaiatuba 13334-170, SP, Brazil
- Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, SP, Brazil
| | - Annu Navani
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
- Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, SP, Brazil
- Comprehensive Spine & Sports Center, Campbell, CA 95008, USA
| | - Madhan Jeyaraman
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
- Department of Orthopaedics, ACS Medical College and Hospital, Chennai 600077, Tamil Nadu, India
| | - Napoliane Santos
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Luyddy Pires
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Gabriel Silva Santos
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Izair Jefthé Rodrigues
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Douglas Santos
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Tomas Mosaner
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Gabriel Azzini
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Lucas Furtado da Fonseca
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
- Medical School, Federal University of São Paulo (UNIFESP), São Paulo 04024-002, SP, Brazil
| | - Alex Pontes de Macedo
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Stephany Cares Huber
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Daniel de Moraes Ferreira Jorge
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, SP, Brazil; (J.F.L.); (N.S.); (L.P.); (I.J.R.); (D.S.); (T.M.); (G.A.); (L.F.d.F.); (A.P.d.M.); (S.C.H.); (D.d.M.F.J.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
| | - Joseph Purita
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, SP, Brazil; (A.N.); (J.P.)
- Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, SP, Brazil
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Shool S, Rahmani S, Habibi MA, Piri SM, Lotfinia M, Jashnani D, Asaadi S. Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review. Spinal Cord Ser Cases 2024; 10:21. [PMID: 38615029 PMCID: PMC11016077 DOI: 10.1038/s41394-024-00636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Scoping systematic review. OBJECTIVES To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models. SETTING Tehran, Iran. METHODS In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models. RESULTS A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures. CONCLUSIONS The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.
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Affiliation(s)
- Sina Shool
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Saeed Rahmani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Mahmoud Lotfinia
- Resident of Neurosurgery, Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Germany
| | - Delara Jashnani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Department of Surgery, Division of Acute Care Surgery, Loma Linda University, Loma Linda, CA, USA.
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Paragond S, Dhatt SS, Kumar V, Zohmangaihi D, Gaurav A, Neradi D, Pal A. Prognosticating acute traumatic spinal cord injury using Neurofilament (NF), Neuron Specific Enolase (NSE), Matrix Metalloproteinases (MMPs), and S-100B as biomarkers. Ir J Med Sci 2024; 193:769-775. [PMID: 37528246 DOI: 10.1007/s11845-023-03476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Spinal cord injury (SCI) can result in lifelong disability. Currently, the literature suggests that biomarkers are helpful in prognosticating SCI, but there is no specific biomarker to date. This is the first study that predicted the prognosis dynamically using biomarkers. AIM To elucidate the role of biomarkers in prognosticating acute traumatic SCI. METHODS Blood samples were obtained from 35 patients of acute traumatic SCI at presentation, immediate post-op, and at 6 weeks. At 6 months follow-up, patients were divided into two groups, i.e, improved and non-improved based on the improvement in the ASIA grade compared to presentation. A non-parametric test was used for comparing mean NSE, MMP-2, S100-B, and NF serum levels at presentation, immediate post-op, and 6 weeks post-op follow-up between the two groups. RESULTS There was a significant difference (p = 0.03) in the NF values at presentation between the two groups. The difference of NSE values at 6 weeks was also significant (p = 0.016) between the two groups. S-100B levels were also significantly different between both groups at presentation (p=0.016), and at the immediate post-op stage (p=0.007). MMP-2 levels neither displayed any specific trend nor any significant difference between the two groups. CONCLUSION Higher NF values at presentation, and higher S-100B levels at presentation and immediate post-operative period correlated with poor outcome. Also, increased NSE values after surgery are indicative of no improvement. These levels can be used at various stages to predict the prognosis. However, further studies are required on this topic extensively to know the exact cut-off values of these markers to predict the prognosis accurately. CLINICAL TRIALS REGISTRY NUMBER REF/2020/01/030616.
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Affiliation(s)
- Sachin Paragond
- Department of Orthopaedics, ESIC Medical College and Hospital, Kalaburagi, Karnataka, India
| | | | - Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India.
| | | | - Ankit Gaurav
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Deepak Neradi
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, PGIMER, Chandigarh, India
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He B, Niu L, Li S, Li H, Hou Y, Li A, Zhang X, Hao H, Song H, Cai R, Zhou Y, Wang Y, Wang Y. Sustainable inflammatory activation following spinal cord injury is driven by thrombin-mediated dynamic expression of astrocytic chemokines. Brain Behav Immun 2024; 116:85-100. [PMID: 38042209 DOI: 10.1016/j.bbi.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/30/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023] Open
Abstract
Acute spinal cord injury (SCI) always results in sustainable recruitment of inflammatory cells driven by sequentially generated chemokines, thereby eliciting excessive neuroinflammation. However, the underlying mechanism of temporally produced chemokines remains elusive. Reactive astrocytes are known to be the main sources of chemokines at the lesion site, which can be immediately activated by thrombin following SCI. In the present study, SCI was shown to induce a sequential production of chemokines CCL2 and CCL5 from astrocytes, which were associated with a persistent infiltration of macrophages/microglia. The rapidly induced CCL2 and later induced CCL5 from astrocytes were regulated by thrombin at the damaged tissues. Investigation of the regulatory mechanism revealed that thrombin facilitated astrocytic CCL2 production through activation of ERK/JNK/NFκB pathway, whereas promoted CCL5 production through PLCβ3/NFκB and ERK/JNK/NFκB signal pathway. Inhibition of thrombin activity significantly decreased production of astrocytic CCL2 and CCL5, and reduced the accumulation of macrophages/microglia at the lesion site. Accordingly, the locomotor function of rats was remarkably improved. The present study has provided a new regulatory mechanism on thrombin-mediated sequential production of astrocytic chemokines, which might be beneficial for clinical therapy of CNS neuroinflammation.
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Affiliation(s)
- Bingqiang He
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China; Medical School of Nantong University, Nantong, Jiangsu Province, China
| | - Li Niu
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Shaolan Li
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Hui Li
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Yuxuan Hou
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Aicheng Li
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Xingyuan Zhang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Huifei Hao
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Honghua Song
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Rixin Cai
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Yue Zhou
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Yingjie Wang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
| | - Yongjun Wang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China.
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Kobeissy F, Arja RD, Munoz JC, Shear DA, Gilsdorf J, Zhu J, Yadikar H, Haskins W, Tyndall JA, Wang KK. The game changer: UCH-L1 and GFAP-based blood test as the first marketed in vitro diagnostic test for mild traumatic brain injury. Expert Rev Mol Diagn 2024; 24:67-77. [PMID: 38275158 DOI: 10.1080/14737159.2024.2306876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Major organ-based in vitro diagnostic (IVD) tests like ALT/AST for the liver and cardiac troponins for the heart are established, but an approved IVD blood test for the brain has been missing, highlighting a gap in medical diagnostics. AREAS COVERED In response to this need, Abbott Diagnostics secured FDA clearance in 2021 for the i-STAT Alinity™, a point-of-care plasma blood test for mild traumatic brain injury (TBI). BioMerieux VIDAS, also approved in Europe, utilizes two brain-derived protein biomarkers: neuronal ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP). These biomarkers, which are typically present in minimal amounts in healthy individuals, are instrumental in diagnosing mild TBI with potential brain lesions. The study explores how UCH-L1 and GFAP levels increase significantly in the bloodstream following traumatic brain injury, aiding in early and accurate diagnosis. EXPERT OPINION The introduction of the i-STAT Alinity™ and the Biomerieux VIDAS TBI blood tests mark a groundbreaking development in TBI diagnosis. It paves the way for the integration of TBI biomarker tools into clinical practice and therapeutic trials, enhancing the precision medicine approach by generating valuable data. This advancement is a critical step in addressing the long-standing gap in brain-related diagnostics and promises to revolutionize the management and treatment of mild TBI.
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Affiliation(s)
- Firas Kobeissy
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Rawad Daniel Arja
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jennifer C Munoz
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah A Shear
- Brain Trauma Neuroprotection & Neurorestoration (BTNN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Janice Gilsdorf
- Brain Trauma Neuroprotection & Neurorestoration (BTNN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jiepei Zhu
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Hamad Yadikar
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Biological Sciences, Kuwait University, Safat, Kuwait
| | | | | | - Kevin K Wang
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
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Morrison D, Pinpin C, Lee A, Sison C, Chory A, Gregersen PK, Forrest G, Kirshblum S, Harkema SJ, Boakye M, Harrop JS, Bryce TN, Schwab JM, Kwon BK, Stein AB, Bank MA, Bloom O. Profiling Immunological Phenotypes in Individuals During the First Year After Traumatic Spinal Cord Injury: A Longitudinal Analysis. J Neurotrauma 2023; 40:2621-2637. [PMID: 37221869 PMCID: PMC10722895 DOI: 10.1089/neu.2022.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Abstract Individuals with SCI are severely affected by immune system changes, resulting in increased risk of infections and persistent systemic inflammation. While recent data support that immunological changes after SCI differ in the acute and chronic phases of living with SCI, only limited immunological phenotyping in humans is available. To characterize dynamic molecular and cellular immune phenotypes over the first year, we assess RNA (bulk-RNA sequencing), protein, and flow cytometry (FACS) profiles of blood samples from 12 individuals with SCI at 0-3 days and at 3, 6, and 12 months post injury (MPI) compared to 23 uninjured individuals (controls). We identified 967 differentially expressed (DE) genes in individuals with SCI (FDR <0.001) compared to controls. Within the first 6 MPI we detected a reduced expression of NK cell genes, consistent with reduced frequencies of CD56bright, CD56dim NK cells present at 12 MPI. Over 6MPI, we observed increased and prolonged expression of genes associated with inflammation (e.g. HMGB1, Toll-like receptor signaling) and expanded frequencies of monocytes acutely. Canonical T-cell related DE genes (e.g. FOXP3, TCF7, CD4) were upregulated during the first 6 MPI and increased frequencies of activated T cells at 3-12 MPI. Neurological injury severity was reflected in distinct whole blood gene expression profiles at any time after SCI, verifying a persistent 'neurogenic' imprint. Overall, 2876 DE genes emerge when comparing motor complete to motor incomplete SCI (ANOVA, FDR <0.05), including those related to neutrophils, inflammation, and infection. In summary, we identify a dynamic immunological phenotype in humans, including molecular and cellular changes which may provide potential targets to reduce inflammation, improve immunity, or serve as candidate biomarkers of injury severity.
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Affiliation(s)
- Debra Morrison
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Camille Pinpin
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Annette Lee
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Cristina Sison
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Ashley Chory
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Peter K. Gregersen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Gail Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Center for Mobility and Human Engineering Research, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Steven Kirshblum
- Tim and Caroline Reynolds Center for Spinal Stimulation, Center for Mobility and Human Engineering Research, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Institute for Rehabilitation. West Orange, New Jersey, USA
| | - Susan J. Harkema
- Kentucky Spinal Injury Research Center, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Neurosurgery, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Kentucky Spinal Injury Research Center, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Neurosurgery, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - James S. Harrop
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Jan M. Schwab
- The Belford Center for Spinal Cord Injury, Spinal Cord Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Department of Neurology, Spinal Cord Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Brian K. Kwon
- International Collaboration on Repair Discoveries (ICORD), Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam B. Stein
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Matthew A. Bank
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
- North Shore University Hospital, Manhasset, New York, USA
| | - Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
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8
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Azad TD, Ran KR, Liu J, Vattipally VN, Khela H, Leite E, Materi JD, Davidar AD, Bettegowda C, Theodore N. A future blood test for acute traumatic spinal cord injury. Biomarkers 2023; 28:703-713. [PMID: 38126897 DOI: 10.1080/1354750x.2023.2298650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
Acute spinal cord injury (SCI) requires prompt diagnosis and intervention to minimize the risk of permanent neurologic deficit. Presently, SCI diagnosis and interventional planning rely on magnetic resonance imaging (MRI), which is not always available or feasible for severely injured patients. Detection of disease-specific biomarkers in biofluids via liquid biopsy may provide a more accessible and objective means of evaluating patients with suspected SCI. Cell-free DNA, which has been used for diagnosing and monitoring oncologic disease, may detect damage to spinal cord neurons via tissue-specific methylation patterns. Other types of biomarkers, including proteins and RNA species, have also been found to reflect neuronal injury and may be included as part of a multi-analyte assay to improve liquid biopsy performance. The feasibility of implementing liquid biopsy into current practices of SCI management is supported by the relative ease of blood sample collection as well as recent advancements in droplet digital polymerase chain reaction technology. In this review, we detail the current landscape of biofluid biomarkers for acute SCI and propose a framework for the incorporation of a putative blood test into the clinical management of SCI.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jiaqi Liu
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Harmon Khela
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Enzo Leite
- Faculdade Pernambucana de Saúde (FPS), Recife, PE, Brazil
| | - Joshua D Materi
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
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9
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Sabirov D, Ogurcov S, Shulman I, Kabdesh I, Garanina E, Sufianov A, Rizvanov A, Mukhamedshina Y. Comparative Analysis of Cytokine Profiles in Cerebrospinal Fluid and Blood Serum in Patients with Acute and Subacute Spinal Cord Injury. Biomedicines 2023; 11:2641. [PMID: 37893015 PMCID: PMC10604120 DOI: 10.3390/biomedicines11102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Cytokines are actively involved in the regulation of the inflammatory and immune responses and have crucial importance in the outcome of spinal cord injuries (SCIs). Examining more objective and representative indicators of the patient's condition is still required to reveal the fundamental patterns of the abovementioned posttraumatic processes, including the identification of changes in the expression of cytokines. METHODS We performed a dynamic (3, 7, and 14 days post-injury (dpi)) extended multiplex analysis of cytokine profiles in both CSF and blood serum of SCI patients with baseline American Spinal Injury Association Impairment Scale grades of A. RESULTS The data obtained showed a large elevation of IL6 (>58 fold) in CSF and IFN-γ (>14 fold) in blood serum at 3 dpi with a downward trend as the post-traumatic period increases. The level of cytokine CCL26 was significantly elevated in both CSF and blood serum at 3 days post-SCI, while other cytokines did not show the same trend in the different biosamples. CONCLUSIONS The dynamic changes in cytokine levels observed in our study can explore the relationships with the SCI region and injury severity, paving the way for a better understanding of the pathophysiology of SCI and potentially more targeted and personalized therapeutic interventions.
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Affiliation(s)
- Davran Sabirov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Sergei Ogurcov
- Neurosurgical Department No. 2, Republic Clinical Hospital, 420138 Kazan, Russia
| | - Ilya Shulman
- Neurosurgical Department No. 2, Republic Clinical Hospital, 420138 Kazan, Russia
| | - Ilyas Kabdesh
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Ekaterina Garanina
- Department of Genetics, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Albert Sufianov
- Department of Neurosurgery, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
- The Research and Educational Institute of Neurosurgery, Peoples’ Friendship University of Russia (RUDN), 117198 Moscow, Russia
| | - Albert Rizvanov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Yana Mukhamedshina
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
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10
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Yang J, Wang M, Zheng S, Huang R, Wen G, Zhou P, Wang W, Zhou S, Jiang X, Liu S, Li Z, Ma D, Jiao G. Mesoporous polydopamine delivering 8-gingerol for the target and synergistic treatment to the spinal cord injury. J Nanobiotechnology 2023; 21:192. [PMID: 37316835 DOI: 10.1186/s12951-023-01896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/15/2023] [Indexed: 06/16/2023] Open
Abstract
In the treatment of spinal cord injury (SCI), the complex process of secondary injury is mainly responsible for preventing SCI repair or even exacerbating the injury. In this experiment, we constructed the 8-gingerol (8G)-loaded mesoporous polydopamine (M-PDA), M@8G, as the in vivo targeting nano-delivery platform, and investigated the therapeutic effects of M@8G in secondary SCI and its related mechanisms. The results indicated that M@8G could penetrate the blood-spinal cord barrier to enrich the spinal cord injury site. Mechanism research has shown that all of the M-PDA,8G and M@8G displayed the anti-lipid peroxidation effect, and then M@8G can inhibit the secondary SCI by suppressing the ferroptosis and inflammation. In vivo assays showed that M@8G significantly diminished the local injury area, reduced axonal and myelin loss, thus improving the neurological and motor recovery in rats. Based on the analysis of cerebrospinal fluid samples from patients, ferroptosis occurred locally in SCI and continued to progress in patients during the acute phase of SCI as well as the stage after their clinical surgery. This study showcases effective treatment of SCI through the aggregation and synergistic effect of M@8G in focal areas, providing a safe and promising strategy for the clinical treatment of SCI.
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Affiliation(s)
- Jinpei Yang
- Department of Orthopaedics, the First Affiliated Hospital of Jinan University, Jinan University, 613 Huangpu Avenue West Road, Guangzhou, 510630, Guangdong, China
- Department of Orthopaedics, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, 516002, Guangdong, China
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523573, Guangdong, China
| | - Meng Wang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Engineering Technology Research Center of Drug Carrier of Guangdong, Department of Biomedical Engineering, Jinan University Guangzhou, Guangzhou, 510632, China
| | - Shuai Zheng
- Department of Orthopaedics, the First Affiliated Hospital of Jinan University, Jinan University, 613 Huangpu Avenue West Road, Guangzhou, 510630, Guangdong, China
| | - Ruodong Huang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Engineering Technology Research Center of Drug Carrier of Guangdong, Department of Biomedical Engineering, Jinan University Guangzhou, Guangzhou, 510632, China
| | - Ganjun Wen
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523573, Guangdong, China
| | - Pan Zhou
- Department of Orthopaedics, the First Affiliated Hospital of Jinan University, Jinan University, 613 Huangpu Avenue West Road, Guangzhou, 510630, Guangdong, China
| | - Wenbo Wang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Engineering Technology Research Center of Drug Carrier of Guangdong, Department of Biomedical Engineering, Jinan University Guangzhou, Guangzhou, 510632, China
| | - Shihao Zhou
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Engineering Technology Research Center of Drug Carrier of Guangdong, Department of Biomedical Engineering, Jinan University Guangzhou, Guangzhou, 510632, China
| | - Xinlin Jiang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Engineering Technology Research Center of Drug Carrier of Guangdong, Department of Biomedical Engineering, Jinan University Guangzhou, Guangzhou, 510632, China
| | - Shuangjiang Liu
- Department of Orthopaedics, the First Affiliated Hospital of Jinan University, Jinan University, 613 Huangpu Avenue West Road, Guangzhou, 510630, Guangdong, China
| | - Zhizhong Li
- Department of Orthopaedics, the First Affiliated Hospital of Jinan University, Jinan University, 613 Huangpu Avenue West Road, Guangzhou, 510630, Guangdong, China.
- The Fifth Affiliated Hospital of Jinan University, Jinan University, Heyuan, 51700, Guangdong, China.
| | - Dong Ma
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Engineering Technology Research Center of Drug Carrier of Guangdong, Department of Biomedical Engineering, Jinan University Guangzhou, Guangzhou, 510632, China.
- MOE Key Laboratory of Tumor Molecular Biology, Jinan University, Guangzhou, 510632, China.
| | - Genlong Jiao
- Department of Orthopaedics, the First Affiliated Hospital of Jinan University, Jinan University, 613 Huangpu Avenue West Road, Guangzhou, 510630, Guangdong, China.
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523573, Guangdong, China.
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11
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Yang Z, Apiliogullari S, Fu Y, Istanbouli A, Kaur S, Jabbal IS, Moghieb A, Irfan Z, Patterson RL, Kurup M, Morrow L, Cohn M, Zhang Z, Zhu J, Hayes RL, Bramlett HM, Bullock MR, Dietrich WD, Wang MY, Kobeissy F, Wang KW. Association between Cerebrospinal Fluid and Serum Biomarker Levels and Diagnosis, Injury Severity, and Short-Term Outcomes in Patients with Acute Traumatic Spinal Cord Injury. Diagnostics (Basel) 2023; 13:diagnostics13101814. [PMID: 37238298 DOI: 10.3390/diagnostics13101814] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Acute traumatic spinal cord injury (SCI) is recognized as a global problem that can lead to a range of acute and secondary complications impacting morbidity and mortality. There is still a lack of reliable diagnostic and prognostic biomarkers in patients with SCI that could help guide clinical care and identify novel therapeutic targets for future drug discovery. The aim of this prospective controlled study was to determine the cerebral spinal fluid (CSF) and serum profiles of 10 biomarkers as indicators of SCI diagnosis, severity, and prognosis to aid in assessing appropriate treatment modalities. CSF and serum samples of 15 SCI and ten healthy participants were included in the study. The neurological assessments were scored on admission and at discharge from the hospital using the American Spinal Injury Association Impairment Score (AIS) grades. The CSF and serum concentrations of SBDP150, S100B, GFAP, NF-L, UCHL-1, Tau, and IL-6 were significantly higher in SCI patients when compared with the control group. The CSF GBDP 38/44K, UCHL-L1, S100B, GFAP, and Tau levels were significantly higher in the AIS A patients. This study demonstrated a strong correlation between biomarker levels in the diagnosis and injury severity of SCI but no association with short-term outcomes. Future prospective controlled studies need to be done to support the results of this study.
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Affiliation(s)
- Zhihui Yang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Seza Apiliogullari
- Department of Neurobiology, Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, USA
| | - Yueqiang Fu
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Ayah Istanbouli
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Sehajpreet Kaur
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Iktej Singh Jabbal
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Ahmed Moghieb
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Zoha Irfan
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Robert Logan Patterson
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Milin Kurup
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Lindsey Morrow
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Michael Cohn
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Zhiqun Zhang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Jiepei Zhu
- Department of Neurobiology, Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, USA
| | - Ronald L Hayes
- Banyan Biomarkers, Inc., 16470 West Bernardo Drive, Suite 100, San Diego, CA 92127, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - M Ross Bullock
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - W Dalton Dietrich
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Michael Y Wang
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Firas Kobeissy
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
- Department of Neurobiology, Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, USA
| | - Kevin W Wang
- Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Department of Emergency Medicine, University of Florida, Gainesville, FL 32611, USA
- Department of Neurobiology, Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, USA
- Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center (VAMC), 1601, The Archer Rd., Gainesville, FL 32608, USA
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12
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Sargent L, Smitherman J, Sorenson M, Brown R, Starkweather A. Cognitive and physical impairment in spinal cord injury: A scoping review and call for new understanding. J Spinal Cord Med 2023; 46:343-366. [PMID: 36441038 PMCID: PMC10114976 DOI: 10.1080/10790268.2022.2134634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Study Design: Scoping review.Objective: To examine potential underlying mechanisms of cognitive and physical impairment in patients with spinal cord injury and identify current research gaps.Methods: A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews to identify primary studies that explored mechanisms of cognitive and/or physical impairment after spinal cord injury. The databases searched were PubMed/MEDLINE, EMBASE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), Web of Science, Scopus, and PsycInfo. These databases were searched from inception through December 20, 2021.Results: Accumulating research suggests that neuroinflammation and neurodegeneration after a traumatic event may be possible mechanisms for cognitive impairment among patients with SCI. In addition, lack of physical activity due to impaired mobility is associated with an increased risk of cognitive impairment.Conclusion: While the results establish a foundation for understanding how cognitive impairment, mental health, and physical function independently affect patients with SCI, further research is warranted to understand how these factors systemically impact the patient and discover refined targets for future rehabilitation therapies. Studies should also explore potential predisposing factors for the relationship between cognitive and physical impairment among patients with SCI.
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Affiliation(s)
- Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, USA
- Geriatric Pharmacotherapy Program, Virginia Commonwealth University, Richmond, USA
- Institute for Inclusion, Inquiry & Innovation iCubed Health and Wellness in Aging Transdisciplinary Core, Richmond, USA
| | - Jonice Smitherman
- Institute for Inclusion, Inquiry & Innovation iCubed Health and Wellness in Aging Transdisciplinary Core, Richmond, USA
| | | | - Roy Brown
- Health Sciences Library, VCU Libraries, Richmond, USA
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13
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The Role of Tumor Necrosis Factor Following Spinal Cord Injury: A Systematic Review. Cell Mol Neurobiol 2023; 43:925-950. [PMID: 35604578 DOI: 10.1007/s10571-022-01229-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/03/2022] [Indexed: 11/03/2022]
Abstract
Pre-clinical studies place tumor necrosis factor (TNF) as a central player in the inflammatory response after spinal cord injury (SCI), and blocking its production and/or activity has been proposed as a possible treatment option after SCI. This systematic review provides an overview of the literature on the temporal and cellular expression of TNF after SCI and clarifies the potential for its therapeutic manipulation in SCI. A systematic search was performed in EMBASE (Ovid), MEDLINE (Ovid), and Web of Science (Core Collection). The search terms were the MeSH forms of tumor necrosis factor and spinal cord injury in the different databases, and the last search was performed on February 3, 2021. We found twenty-four articles examining the expression of TNF, with most using a thoracic contusive SCI model in rodents. Two articles described the expression of TNF receptors in the acute phase after SCI. Twenty-one articles described the manipulation of TNF signaling using genetic knock-out, pharmaceutical inhibition, or gain-of-function approaches. Overall, TNF expression increased rapidly after SCI, within the first hours, in resident cells (neurons, astrocytes, oligodendrocytes, and microglia) and again in macrophages in the chronic phase after injury. The review underscores the complexity of TNF's role after SCI and indicates that TNF inhibition is a promising therapeutic option. This review concludes that TNF plays a significant role in the inflammatory response after SCI and suggests that targeting TNF signaling is a feasible therapeutic approach.
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14
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Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Bailey CS, Dhall S, Mac-Thiong JM, Wilson JR, Christie S, Dvorak MF, Wellington CL, Kwon BK. Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury. Neurology 2023; 100:e1221-e1233. [PMID: 36599698 PMCID: PMC10033160 DOI: 10.1212/wnl.0000000000206744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic spinal cord injury (SCI) is highly heterogeneous, and tools to better delineate pathophysiology and recovery are needed. Our objective was to profile the response of 2 biomarkers, neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP), in the serum and CSF of patients with acute SCI to evaluate their ability to objectively characterize injury severity and predict neurologic recovery. METHODS Blood and CSF samples were obtained from prospectively enrolled patients with acute SCI through days 1-4 postinjury, and the concentration of NF-L and GFAP was quantified using Simoa technology. Neurologic assessments defined the ASIA Impairment Scale (AIS) grade and motor score (MS) at presentation and 6 months postinjury. RESULTS One hundred eighteen patients with acute SCI (78 AIS A, 20 AIS B, and 20 AIS C) were enrolled, with 113 (96%) completing 6-month follow-up. NF-L and GFAP levels were strongly associated between paired serum and CSF specimens, were both increased with injury severity, and distinguished among baseline AIS grades. Serum NF-L and GFAP were significantly (p = 0.02 to <0.0001) higher in AIS A patients who did not improve at 6 months, predicting AIS grade conversion with a sensitivity and specificity (95% CI) of 76% (61, 87) and 77% (55, 92) using NF-L and 72% (57, 84) and 77% (55, 92) using GFAP at 72 hours, respectively. Independent of clinical baseline assessment, a serum NF-L threshold of 170 pg/mL at 72 hours predicted those patients who would be classified as motor complete (AIS A/B) compared with motor incomplete (AIS C/D) at 6 months with a sensitivity of 87% (76, 94) and specificity of 84% (69, 94); a serum GFAP threshold of 13,180 pg/mL at 72 hours yielded a sensitivity of 90% (80, 96) and specificity of 84% (69, 94). DISCUSSION The potential for NF-L and GFAP to classify injury severity and predict outcome after acute SCI will be useful for patient stratification and prognostication in clinical trials and inform communication of prognosis. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that higher serum NF-L and GFAP are associated with worse neurological outcome after acute SCI. TRIAL REGISTRATION INFORMATION Registered on ClinicalTrials.gov: NCT00135278 (March 2006) and NCT01279811 (January 2012).
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Affiliation(s)
- Sophie Stukas
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jennifer Cooper
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jasmine Gill
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Nader Fallah
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Michael A Skinnider
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Lise Belanger
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Leanna Ritchie
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Angela Tsang
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Kevin Dong
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Femke Streijger
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - John Street
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Scott Paquette
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Tamir Ailon
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Nicolas Dea
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Raphaele Charest-Morin
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Charles G Fisher
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Christopher S Bailey
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Sanjay Dhall
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jean-Marc Mac-Thiong
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jefferson R Wilson
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Sean Christie
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Marcel F Dvorak
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Cheryl L Wellington
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Brian K Kwon
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada.
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15
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Yifan H, Peng G, Tao Q, Bo C, Tao X, Jiang Y, Qian W, Zhenqi Y, Tao J, Jin F, Shujie Z, Wei Z, Jian C, Guoyong Y. Delayed inhibition of collagen deposition by targeting bone morphogenetic protein 1 promotes recovery after spinal cord injury. Matrix Biol 2023; 118:69-91. [PMID: 36918086 DOI: 10.1016/j.matbio.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/13/2023]
Abstract
Fibrotic scars appear after spinal cord injury (SCI) and are mainly composed of fibroblasts and excess extracellular matrix (ECM), including different types of collagen. The temporal and spatial distribution and role of excess collagens and ECM after SCI are not yet fully understood. Here, we identified that the procollagen type I C-terminal propeptide (PICP), a marker of collagen type I deposition, and bone morphogenetic protein 1 (BMP1), a secreted procollagen c-proteinase (PCP) for type I collagen maturation, were significantly elevatedin cerebrospinal fluid of patients with SCI compared with healthy controls, and were associated with spinal cord compression and neurological symptoms. We revealed the deposition of type I collagen in the area damaged by SCI in mice and confirmed that BMP1 was the only expressed PCP and induced collagen deposition. Furthermore, transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) can activate the expression of BMP1. However, inhibition of BMP1 at the acute phase eliminated fibrotic scars in the damaged area and inhibited activation and enrichment of astrocytes, which made the damage difficult to repair and increased hematoma. Unexpectedly, knockdown of Bmp1 by adeno-associated virus or the inhibition of BMP1 biological function by specific inhibitors and monoclonal antibodies at different time points after injury led to distinct therapeutic effects. Only delayed inhibition of BMP1 improved axonal regeneration and myelin repair at the subacute stage post-injury, and led to the recovery of motor function, suggesting that scarring had a dual effect. Early inhibition of the scarring was not conducive to limiting inflammation, while excessive scar formation inhibited the growth of axons. After SCI, the collagen deposition indicators increased in both human cerebrospinal fluid and mouse spinal cord. Therefore, suppression of BMP1 during the subacute phase improves nerve function after SCI and is a potential target for scar reduction.
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Affiliation(s)
- Huang Yifan
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Gao Peng
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Qin Tao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Chu Bo
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Xu Tao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Yi Jiang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Wang Qian
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Yang Zhenqi
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Jiang Tao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Fan Jin
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Zhao Shujie
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
| | - Zhou Wei
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
| | - Chen Jian
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
| | - Yin Guoyong
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
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16
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Rahimi B, Behroozi Z, Motamednezhad A, Jafarpour M, Hamblin MR, Moshiri A, Janzadeh A, Ramezani F. Study of nerve cell regeneration on nanofibers containing cerium oxide nanoparticles in a spinal cord injury model in rats. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:9. [PMID: 36809518 PMCID: PMC9944598 DOI: 10.1007/s10856-023-06711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/15/2023] [Indexed: 05/17/2023]
Abstract
Since the CNS is unable to repair itself via neuronal regeneration in adult mammals, alternative therapies need to be found. The use of cerium oxide nanoparticles to repair nerve damage could be a promising approach for spinal cord reconstruction. In this study, we constructed a scaffold containing cerium oxide nanoparticles (Scaffold-CeO2) and investigated the rate of nerve cell regeneration in a rat model of spinal cord injury. The scaffold of gelatin and polycaprolactone was synthesized, and a gelatin solution containing cerium oxide nanoparticles was attached to the scaffold. For the animal study, 40 male Wistar rats were randomly divided into 4 groups (n = 10): (a) Control; (b) Spinal cord injury (SCI); (c) Scaffold (SCI + scaffold without CeO2 nanoparticles); (d) Scaffold-CeO2 (SCI + scaffold containing CeO2 nanoparticles). After creation of a hemisection SCI, scaffolds were placed at the site of injury in groups c and d, and after 7 weeks the rats were subjected to behavioral tests and then sacrificed for preparation of the spinal cord tissue to measure the expression of G-CSF, Tau and Mag proteins by Western blotting and Iba-1 protein by immunohistochemistry. The result of behavioral tests confirmed motor improvement and pain reduction in the Scaffold-CeO2 group compared to the SCI group. Decreased expression of Iba-1 and higher expression of Tau and Mag in the Scaffold-CeO2 group compared to the SCI group could be the result of nerve regeneration caused by the scaffold containing CeONPs as well as relief of pain symptoms.
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Affiliation(s)
- Behnaz Rahimi
- Department of basic sciences, Saveh University of Medical Sciences, Saveh, Iran
| | - Zahra Behroozi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Science, Kerman, Iran
| | - Ali Motamednezhad
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maral Jafarpour
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, 2028, South Africa
| | | | - Atousa Janzadeh
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Ramezani
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
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17
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Erens C, Van Broeckhoven J, Bronckaers A, Lemmens S, Hendrix S. The Dark Side of an Essential Amino Acid: L-Arginine in Spinal Cord Injury. J Neurotrauma 2023; 40:820-832. [PMID: 36503258 DOI: 10.1089/neu.2022.0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
L-arginine is a semi-essential amino acid involved in a variety of physiological processes in the central nervous system (CNS). It is essential in the survival and functionality of neuronal cells. Nonetheless, L-arginine also has a dark side; it potentiates neuroinflammation and nitric oxide (NO) production, leading to secondary damage. Therefore, modulating the L-arginine metabolism is challenging because both detrimental and beneficial effects are dependent on this semi-essential amino acid. After spinal cord injury (SCI), L-arginine plays a crucial role in trauma-induced neuroinflammation and regenerative processes via the two key enzymes: nitric oxide synthase (NOS) and arginase (ARG). Studies on L-arginine metabolism using ARG and NOS inhibitors highlighted the conflicting role of this semi-essential amino acid. Similarly, L-arginine supplementation resulted in both negative and positive outcomes after SCI. However, new data indicate that arginine depletion substantially improves spinal cord regeneration after injury. Here, we review the challenging characteristics of L-arginine metabolism as a therapeutic target after SCI.
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Affiliation(s)
- Céline Erens
- Department of Immunology and Infection, Hasselt University, Biomedical Research Institute BIOMED, Diepenbeek, Belgium
| | - Jana Van Broeckhoven
- Department of Immunology and Infection, Hasselt University, Biomedical Research Institute BIOMED, Diepenbeek, Belgium
| | - Annelies Bronckaers
- Department of Cardio and Organ Systems, Hasselt University, Biomedical Research Institute BIOMED, Diepenbeek, Belgium
| | - Stefanie Lemmens
- Department of Immunology and Infection, Hasselt University, Biomedical Research Institute BIOMED, Diepenbeek, Belgium
| | - Sven Hendrix
- Department of Immunology and Infection, Hasselt University, Biomedical Research Institute BIOMED, Diepenbeek, Belgium.,Medical School Hamburg, Hamburg, Germany
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18
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Glial fibrillary acidic protein is a robust biomarker in cerebrospinal fluid and peripheral blood after traumatic spinal cord injury: a prospective pilot study. Acta Neurochir (Wien) 2023; 165:1417-1425. [PMID: 36790588 DOI: 10.1007/s00701-023-05520-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Biochemical biomarkers to determine the injury severity and the potential for functional recovery of traumatic spinal cord injury (TSCI) are highly warranted; however, it remains to be clarified whether cerebrospinal fluid (CSF) or peripheral blood (PB) is the ideal sample media. This study aims to measure and compare biomarker concentrations in CSF and PB and to explore associations between biomarker concentrations and injury severity, i.e., American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade, and biomarker concentrations and clinical outcome, i.e., AIS grade improvement and Spinal Cord Independent Measure version III (SCIM-III) score. METHODS From 2018 to 2020, we conducted a single-center prospective pilot study of TSCI patients (n=15) and healthy controls (n=15). Sample collection and clinical outcome assessment were performed at median 13 h [IQR: 19], 9 days [IQR: 2], and 148 days [IQR: 49] after TSCI. Concentrations of neuron-specific enolase (NSE); glial fibrillary acid protein (GFAP); neurofilament light chain (NfL); interferon-γ (IFN-γ); interleukin (IL)-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and IL-13; and tumor necrosis factor α (TNF-α) were measured and associated to clinical outcomes. RESULTS The biomarker concentrations were higher in CSF than PB. CSF concentrations of GFAP, NSE, IFN-y, TNF-a, IL-2, IL-12p70, IL-4, IL-10, and IL-13 and PB concentrations of GFAP and IFN-y were significantly associated with AIS grade, but not with AIS grade improvement or SCIM-III score. CONCLUSIONS Our results support GFAP as a potential diagnostic biomarker that may be measured in CSF as well as PB.
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19
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Zhang C, Talifu Z, Xu X, Liu W, Ke H, Pan Y, Li Y, Bai F, Jing Y, Li Z, Li Z, Yang D, Gao F, Du L, Li J, Yu Y. MicroRNAs in spinal cord injury: A narrative review. Front Mol Neurosci 2023; 16:1099256. [PMID: 36818651 PMCID: PMC9931912 DOI: 10.3389/fnmol.2023.1099256] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injury (SCI) is a global medical problem with high disability and mortality rates. At present, the diagnosis and treatment of SCI are still lacking. Spinal cord injury has a complex etiology, lack of diagnostic methods, poor treatment effect and other problems, which lead to the difficulty of spinal cord regeneration and repair, and poor functional recovery. Recent studies have shown that gene expression plays an important role in the regulation of SCI repair. MicroRNAs (miRNAs) are non-coding RNA molecules that target mRNA expression in order to silence, translate, or interfere with protein synthesis. Secondary damage, such as oxidative stress, apoptosis, autophagy, and inflammation, occurs after SCI, and differentially expressed miRNAs contribute to these events. This article reviews the pathophysiological mechanism of miRNAs in secondary injury after SCI, focusing on the mechanism of miRNAs in secondary neuroinflammation after SCI, so as to provide new ideas and basis for the clinical diagnosis and treatment of miRNAs in SCI. The mechanisms of miRNAs in neurological diseases may also make them potential biomarkers and therapeutic targets for spinal cord injuries.
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Affiliation(s)
- Chunjia Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Zuliyaer Talifu
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China,School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong Province, China
| | - Xin Xu
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Wubo Liu
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China,Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China,Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Han Ke
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China,Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China,Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yunzhu Pan
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China,School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong Province, China
| | - Yan Li
- China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Fan Bai
- China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Yingli Jing
- China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Zihan Li
- China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Zehui Li
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Degang Yang
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Feng Gao
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Liangjie Du
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Jianjun Li
- School of Rehabilitation, Capital Medical University, Beijing, China,,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China,School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, Shandong Province, China,Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China,*Correspondence: Jianjun Li,
| | - Yan Yu
- School of Rehabilitation, Capital Medical University, Beijing, China,,China Rehabilitation Science Institute, Beijing, China,Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China,Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China,Yan Yu,
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20
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Sterner RC, Sterner RM. Immune response following traumatic spinal cord injury: Pathophysiology and therapies. Front Immunol 2023; 13:1084101. [PMID: 36685598 PMCID: PMC9853461 DOI: 10.3389/fimmu.2022.1084101] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, the mechanical damage from the trauma causes immediate acute cell dysfunction and cell death. Then, secondary mechanisms of injury further propagate the cell dysfunction and cell death over the course of days, weeks, or even months. Among the secondary injury mechanisms, inflammation has been shown to be a key determinant of the secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in addition to surgical management of SCI, selectively targeting the immune response following SCI could substantially decrease the progression of secondary injury and improve patient outcomes. In order to develop such therapies, a detailed molecular understanding of the timing of the immune response following SCI is necessary. Recently, several studies have mapped the cytokine/chemokine and cell proliferation patterns following SCI. In this review, we examine the immune response underlying the pathophysiology of SCI and assess both current and future therapies including pharmaceutical therapies, stem cell therapy, and the exciting potential of extracellular vesicle therapy.
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Affiliation(s)
- Robert C. Sterner
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rosalie M. Sterner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States,*Correspondence: Rosalie M. Sterner,
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21
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Hu Y, Li R, Li HL, Cui HY, Huang YC. Identification of injury type using somatosensory and motor evoked potentials in a rat spinal cord injury model. Neural Regen Res 2023; 18:422-427. [PMID: 35900440 PMCID: PMC9396501 DOI: 10.4103/1673-5374.346458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The spinal cord is at risk of injury during spinal surgery. If intraoperative spinal cord injury is identified early, irreversible impairment or loss of neurological function can be prevented. Different types of spinal cord injury result in damage to different spinal cord regions, which may cause different somatosensory and motor evoked potential signal responses. In this study, we examined electrophysiological and histopathological changes between contusion, distraction, and dislocation spinal cord injuries in a rat model. We found that contusion led to the most severe dorsal white matter injury and caused considerable attenuation of both somatosensory and motor evoked potentials. Dislocation resulted in loss of myelinated axons in the lateral region of the injured spinal cord along the rostrocaudal axis. The amplitude of attenuation in motor evoked potential responses caused by dislocation was greater than that caused by contusion. After distraction injury, extracellular spaces were slightly but not significantly enlarged; somatosensory evoked potential responses slightly decreased and motor evoked potential responses were lost. Correlation analysis showed that histological and electrophysiological findings were significantly correlated and related to injury type. Intraoperative monitoring of both somatosensory and motor evoked potentials has the potential to identify iatrogenic spinal cord injury type during surgery.
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22
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Verma S, Perry K, Razdan R, Howell JC, Dawson AL, Hu WT. CSF IL-8 Associated with Response to Gene Therapy in a Case Series of Spinal Muscular Atrophy. Neurotherapeutics 2023; 20:245-253. [PMID: 36289175 PMCID: PMC9607706 DOI: 10.1007/s13311-022-01305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/27/2022] Open
Abstract
Gene therapies have greatly changed the outlook in spinal muscular atrophy (SMA), and this disorder provides a rare opportunity to study longitudinal biomarker changes correlated with reduced disease burden and improved clinical outcomes. Recent work suggests clinical response to correlate with declining cerebrospinal fluid (CSF) levels of the neurodegenerative marker neurofilament light chain (NfL) in children receiving serial anti-sense oligonucleotide therapy. However, change in CSF NfL levels is no longer a practical biomarker as more children undergo single-dose gene replacement therapy. Here we leverage serial CSF samples (median of 4 per child) collected in 13 children with SMA undergoing anti-sense oligonucleotide therapy to characterize the longitudinal profiles of NfL as well as inflammatory and neuronal proteins. In contrast to neurodegeneration in adults, we found NfL levels to first decrease following initiation of treatment but then increase upon further treatment and improved motor functions. We then examined additional CSF inflammatory and neuronal markers for linear association with motor function during SMA treatment. We identified longitudinal IL-8 levels to inversely correlate with motor functions determined by clinical examination (F(1, 47) = 12.903, p = 0.001) or electromyography in the abductor pollicis brevis muscle (p = 0.064). In keeping with this, lower baseline IL-8 levels were associated with better longitudinal outcomes, even though this difference diminished over 2 years in the younger group. We thus propose CSF IL-8 as a biomarker for baseline function and short-term treatment response in SMA, and a candidate biomarker for future treatment trials in other neurodegenerative disorders.
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Affiliation(s)
- Sumit Verma
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
- Department of Neurology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
- Department of Neurosciences, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
| | - Kelsey Perry
- Department of Neurology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
| | - Raj Razdan
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
| | - J Christina Howell
- Department of Neurology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
| | - Alice L Dawson
- Department of Neurology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA
- Health Care Policy, and Aging Research, Rutgers-Robert Wood Johnson Medical School and Rutgers Institute for Health, New Brunswick, NJ, 08901, USA
- Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
| | - William T Hu
- Department of Neurology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, 30324, USA.
- Health Care Policy, and Aging Research, Rutgers-Robert Wood Johnson Medical School and Rutgers Institute for Health, New Brunswick, NJ, 08901, USA.
- Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA.
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23
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Transplantation of olfactory ensheathing cells decreases local and serological monocyte chemoattractant protein 1 level during the acute phase of rat spinal cord injury. Neuroreport 2022; 33:729-741. [PMID: 36250430 DOI: 10.1097/wnr.0000000000001839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Monocyte chemoattractant protein 1 (MCP1) is one of the most upregulated cytokines in the spinal cord and serum throughout acute spinal cord injury (SCI). Olfactory ensheathing cells (OECs) transplantation improves SCI through multiple mechanisms, including immunomodulation. Our study aimed to investigate whether OECs ameliorate acute inflammation after SCI by modulating MCP1 expression. METHODS We established a standardized clinically relevant contusion model using the NYU impactor. OECs were administered to the injured spinal cord via microinjection 30 minutes after injury. Rat locomotor functions were assessed by the Basso-Beattie-Bresnahan scale score. Time-course histopathological (H&E and IHC) analyses were performed to record rapid changes in acute inflammation at lesion epicenters. Serum MCP1 level was detected by ELISA assay. RESULTS BBB scores showed improved locomotor functional recoveries in the OECs transplantation group after SCI ( P < 0.05). Staining of H&E and CD68 illustrated that OECs transplantation attenuated inflammatory response by reducing lesion areas and infiltrating myeloid cell numbers. We further revealed significantly decreased MCP1 levels in the spinal cord and serum after OECs transplantation ( P < 0.05). Noteworthily, distinct expression levels of MCP1 were found in rats undergoing a mild injury (cord impacted from a 10-mm height) compared to the moderate injury (25-mm) group. CONCLUSION Our study reports that transplantation of OECs promotes locomotor functional recovery after SCI and alleviates acute inflammation by decreasing local and serological MCP1 levels. We provide preliminary evidence that MCP1 might serve as a potential biomarker to reflect the severity of SCI, which is of great interest in future studies.
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24
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Wichmann TO, Kasch H, Dyrskog S, Høy K, Møller BK, Krog J, Hviid CVB, Hoffmann HJ, Rasmussen MM. The inflammatory response and blood-spinal cord barrier integrity in traumatic spinal cord injury: a prospective pilot study. Acta Neurochir (Wien) 2022; 164:3143-3153. [PMID: 36190569 DOI: 10.1007/s00701-022-05369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/07/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Triggering of inflammatory responses and disruption of blood-spinal cord barrier (BSCB) integrity are considered pivotal events in the pathophysiology of traumatic spinal cord injury (TSCI). Yet, these events are poorly understood and described in humans. This study aims to describe inflammatory responses and BSCB integrity in human TSCI. METHODS Fifteen TSCI patients and fifteen non-TSCI patients were prospectively recruited from Aarhus University Hospital, Denmark. Peripheral blood (PB) and cerebrospinal fluid (CSF) were collected at median day 0 [IQR: 1], median day 9 [IQR: 2], and median day 148 [IQR: 49] after injury. PB and CSF were analyzed for immune cells by flow cytometry, cytokines by multiplex immunoassay, and BSCB integrity by IgG Index. RESULTS Eleven TSCI patients completed follow-up. Results showed alterations in innate and adaptive immune cell counts over time. TSCI patients had significantly increased cytokine concentrations in CSF at the first and second follow-up, while only concentrations of interleukin (IL)-4, IL-8, and tumor necrosis factor-α remained significantly increased at the third follow-up. In PB, TSCI patients had significantly increased IL-6, IL-8, and IL-10 concentrations and significantly decreased interferon-γ concentrations at the first follow-up. Results further showed increased IgG Index indicative of BSCB disruption in seven TSCI patients at the first follow-up, five TSCI patients at the second follow-up, and two patients at the third follow-up. CONCLUSIONS Our results suggest that TSCI mainly triggers innate inflammatory responses that resolves over time, although with some degree of non-resolving inflammation, particularly in CSF. Our results cannot confirm BSCB disruption in all TSCI patients.
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Affiliation(s)
- Thea Overgaard Wichmann
- Dept. Neurosurgery, Cense-Spine, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 165 8200 Aarhus N, Aarhus, Denmark.
| | - Helge Kasch
- Dept. Neurology, Aarhus University Hospital, Aarhus, Denmark.,Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig Dyrskog
- Dept. Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian Høy
- Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Dept. Orthopaedic Surgery - Spine section, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne Kuno Møller
- Dept. of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Krog
- Dept. Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Dept. Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Dept. Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Hans Jürgen Hoffmann
- Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Dept. Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Mylius Rasmussen
- Dept. Neurosurgery, Cense-Spine, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 165 8200 Aarhus N, Aarhus, Denmark.,Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
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25
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Leister I, Altendorfer B, Maier D, Mach O, Wutte C, Grillhösl A, Arevalo-Martin A, Garcia-Ovejero D, Aigner L, Grassner L. The trajectory of serum levels of glial fibrillary acidic protein within four weeks post-injury is related to neurological recovery during the transition from acute to chronic spinal cord injury. J Neurotrauma 2022; 40:999-1006. [PMID: 36200629 DOI: 10.1089/neu.2022.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The use of biomarkers in spinal cord injury (SCI) research has evolved rapidly in recent years whereby most studies focused on the acute post-injury phase. Since SCI is characterized by persisting neurological impairments, the question arises whether blood biomarkers remain altered during the subacute post-injury time. Sample collection in the subacute phase might provide a better insight in the ongoing SCI specific molecular mechanism with fewer confounding factors compared to the acute phase where, amongst other complications, individuals receive a substantial amount of medication. This study aimed to determine if the temporal dynamics of serum biomarkers of neurodegeneration differ between individuals depending on their extent of neurological recovery in the transition phase between acute and chronic SCI. We performed a secondary analysis of biomarkers in patients with SCI (n=41) who were treated at a level I trauma center in Germany. Patients with cervical or thoracic SCI regardless of injury severity were included. Blood samples were collected in the acute phase (1-4 days post-injury), and after 30- and 120-days post-injury. Serum protein levels of Glial Fibrillary Acidic Protein (GFAP), and Neurofilament light protein (NfL) were determined for each time point of sample collection using R-Plex Assays (Meso Scale Discovery). Linear mixed models were used to evaluate the trajectory of GFAP and NfL over time. Fixed effects of time, neurological recovery, and injury severity along with the recovery-by-time interaction were included in models with random slopes and intercepts. GFAP levels increase during the first days after SCI and decrease in subacute to chronic stages. Notably, the trajectory of GFAP over time is significantly associated with the extent of neurological recovery during the transition from acute to chronic SCI with a steeper decline in individuals who recovered better. Serum levels of NfL continue to rise significantly until day 30 followed by a decrease afterwards, independent of neurological recovery. The trajectory of serum GFAP levels qualifies as a prognostic biomarker for neurological recovery, and facilitates monitoring of disease progression in the sub-acute post-injury phase.
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Affiliation(s)
- Iris Leister
- BG Trauma Center Murnau, Spinal Cord Injury Center, Prof.-Küntscher-Str. 8, Murnau am Staffelsee, Germany, 82418;
| | - Barbara Altendorfer
- Paracelsus Medical University Salzburg, Institute of Molecular Regenerative Medicine, Salzburg, Salzburg, Austria;
| | - Doris Maier
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Orpheus Mach
- Trauma Center Murnau, Center for Spinal Cord Injuries, Prof.-Kuentscher-Str. 8, Murnau, Germany, 82418;
| | - Christof Wutte
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Andreas Grillhösl
- Trauma Center Murnau, Department of Neuroradiology, Professor-Kuentscher-Strasse 8, Murnau, Germany, 82418;
| | - Angel Arevalo-Martin
- Hospital Nacional de Paraplejicos, Laboratory of Neuroinflammation, Finca la Peraleda, s/n, Toledo, Spain, 45071;
| | - Daniel Garcia-Ovejero
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda, Toledo, Spain, 45071;
| | - Ludwig Aigner
- Paracelsus Medical University Salzburg, Institute of Molecular Regenerative Medicine, Salzburg, Salzburg, Austria;
| | - Lukas Grassner
- University Hospital Salzburg - Christian Doppler Hospital, Department of Neurosurgery, Salzburg, Salzburg, Austria.,Paracelsus Medical University Salzburg, Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Salzburg, Austria;
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26
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Astaxanthin ameliorates serum level and spinal expression of macrophage migration inhibitory factor following spinal cord injury. Behav Pharmacol 2022; 33:505-512. [PMID: 36148838 DOI: 10.1097/fbp.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Astaxanthin (AST) is a lipid-soluble carotenoid with antioxidant and anti-inflammatory properties. Previous reports demonstrated the promising effects of AST on spinal cord injury (SCI)-induced inflammation and sensory-motor dysfunction. Macrophage migration inhibitory factor (MIF), as a cytokine, plays a critical role in the inflammatory phase of SCI. The aim of this study was to evaluate the effects of AST on post-SCI levels of MIF in serum and spinal cord. The possible correlation between MIF and mechanical pain threshold was also assessed. Adult male rats were subjected to a severe compression spinal injury and 30 min later were treated with AST (Intrathecal, 2 nmol) or vehicle. Neuropathic pain was assessed by von Frey filaments before the surgery, and then on days 7, 14, 21, and 28 post-SCI. Western blot and ELISA were used to measure the serum level and spinal expression of MIF following SCI in the same time points. AST treatment significantly attenuated the SCI-induced dysregulations in the serum levels and tissue expression of MIF. A negative correlation was observed between mechanical pain threshold and serum MIF level (r = -0.5463, P < 0.001), as well as mechanical pain threshold and spinal level of MIF (r = -0.9562; P < 0.001). AST ameliorates SCI-induced sensory dysfunction, probably through inhibiting MIF-regulated inflammatory pathways.
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27
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Sabirov D, Ogurcov S, Baichurina I, Blatt N, Rizvanov A, Mukhamedshina Y. Molecular diagnostics in neurotrauma: Are there reliable biomarkers and effective methods for their detection? Front Mol Biosci 2022; 9:1017916. [PMID: 36250009 PMCID: PMC9557129 DOI: 10.3389/fmolb.2022.1017916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
To date, a large number of studies are being carried out in the field of neurotrauma, researchers not only establish the molecular mechanisms of the course of the disorders, but are also involved in the search for effective biomarkers for early prediction of the outcome and therapeutic intervention. Particular attention is paid to traumatic brain injury and spinal cord injury, due to the complex cascade of reactions in primary and secondary injury that affect pathophysiological processes and regenerative potential of the central nervous system. Despite a wide range of methods available methods to study biomarkers that correlate with the severity and degree of recovery in traumatic brain injury and spinal cord injury, development of reliable test systems for clinical use continues. In this review, we evaluate the results of recent studies looking for various molecules acting as biomarkers in the abovementioned neurotrauma. We also summarize the current knowledge of new methods for studying biological molecules, analyzing their sensitivity and limitations, as well as reproducibility of results. In this review, we also highlight the importance of developing reliable and reproducible protocols to identify diagnostic and prognostic biomolecules.
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Affiliation(s)
- Davran Sabirov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Sergei Ogurcov
- Neurosurgical Department No. 2, Republic Clinical Hospital, Kazan, Russia
| | - Irina Baichurina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- *Correspondence: Irina Baichurina,
| | - Nataliya Blatt
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Albert Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Yana Mukhamedshina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
- Department of Histology, Cytology, and Embryology, Kazan State Medical University, Kazan, Russia
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28
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Behroozi Z, Rahimi B, Hamblin MR, Nasirinezhad F, Janzadeh A, Ramezani F. Injection of Cerium Oxide Nanoparticles to Treat Spinal Cord Injury in Rats. J Neuropathol Exp Neurol 2022; 81:635-642. [PMID: 35472142 PMCID: PMC9297098 DOI: 10.1093/jnen/nlac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This study investigated the effects of local injection of cerium oxide nanoparticles (CeONPs) in a rat spinal cord injury (SCI) model. Thirty-six adult male Wistar rats were divided into 4 groups: controls (healthy animals), sham (laminectomy), SCI (laminectomy+SCI induction), and treatment (laminectomy+SCI induction+intrathecal injection of CeONPs immediately after injury). SCI was induced using an aneurysm clip at the T12-T13 vertebral region. Motor performance and pain threshold tests were performed weekly; H&E staining and measurement of cavity sizes were performed 6 weeks after injury. The expression of granulocyte colony-stimulating factor (GCSF), P44/42 MAPK, P-P44/42 MAPK, Tau, myelin-associated glycoprotein(MAG) was evaluated after 6 weeks by Western blot. The Basso, Beattie, and Bresnahan locomotor scoring scales improved in animals receiving CeONPs compared with SCI animals. The cavity sizes were less in the treatment group. GCSF expression was similar in the animals receiving CeONPs compared with the SCI group but the expression of ERK1/ERK2 and phospho-ERK was lower than in the SCI group. Expression levels of Tau and MAG were significantly increased in treated animals compared to the SCI group. These data indicate that the use of CeONPs may improve motor functional recovery in SCI.
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Affiliation(s)
- Zahra Behroozi
- From the Physiology Research Center, Institute of Neuropharmaclogy, Kerman University of Medical Sciences. Kerman, Iran
- Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnaz Rahimi
- Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Farinaz Nasirinezhad
- Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Atousa Janzadeh
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ramezani
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
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29
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Mothe AJ, Jacobson PB, Caprelli M, Ulndreaj A, Rahemipour R, Huang L, Monnier PP, Fehlings MG, Tator CH. Delayed administration of elezanumab, a human anti-RGMa neutralizing monoclonal antibody, promotes recovery following cervical spinal cord injury. Neurobiol Dis 2022; 172:105812. [PMID: 35810963 DOI: 10.1016/j.nbd.2022.105812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Spinal cord injury (SCI) elicits a cascade of degenerative events including cell death, axonal degeneration, and the upregulation of inhibitory molecules which limit repair. Repulsive guidance molecule A (RGMa) is an axon growth inhibitor which is also involved in neuronal cell death and differentiation. SCI causes upregulation of RGMa in the injured rodent, non-human primate, and human spinal cord. Recently, we showed that delayed administration of elezanumab, a high affinity human RGMa-specific monoclonal antibody, promoted neuroprotective and regenerative effects following thoracic SCI. Since most human traumatic SCI is at the cervical level, and level-dependent anatomical and molecular differences may influence pathophysiological responses to injury and treatment, we examined the efficacy of elezanumab and its therapeutic time window of administration in a clinically relevant rat model of cervical impact-compression SCI. Pharmacokinetic analysis of plasma and spinal cord tissue lysate showed comparable levels of RGMa antibodies with delayed administration following cervical SCI. At 12w after SCI, elezanumab promoted long term benefits including perilesional sparing of motoneurons and increased neuroplasticity of key descending pathways involved in locomotion and fine motor function. Elezanumab also promoted growth of corticospinal axons into spinal cord gray matter and enhanced serotonergic innervation of the ventral horn to form synaptic connections caudal to the cervical lesion. Significant recovery in grip and trunk/core strength, locomotion and gait, and spontaneous voiding ability was found in rats treated with elezanumab either immediately post-injury or at 3 h post-SCI, and improvements in specific gait parameters were found when elezanumab was delayed to 24 h post-injury. We also developed a new locomotor score, the Cervical Locomotor Score, a simple and sensitive measure of trunk/core and limb strength and stability during dynamic locomotion.
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Affiliation(s)
- Andrea J Mothe
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada.
| | - Peer B Jacobson
- Department of Translational Sciences, AbbVie Inc., North Chicago, IL 60064, USA
| | - Mitchell Caprelli
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada
| | - Antigona Ulndreaj
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada
| | - Radmehr Rahemipour
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada
| | - Lili Huang
- AbbVie Biologics, AbbVie Bioresearch Center, Worcester, MA 01605, USA
| | - Philippe P Monnier
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada; Department of Ophthalmology and Vision Science, University of Toronto, Toronto, M5S 3H6, ON, Canada
| | - Michael G Fehlings
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, M5T 2S8, ON, Canada
| | - Charles H Tator
- Division of Experimental and Translational Neuroscience, Krembil Brain Institute & University Health Network, Toronto, M5T 0S8, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, M5T 2S8, ON, Canada.
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30
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Azzam M, Fahmi A, Utomo B, Faris M, Parenrengi MA, Sudiana IK, Bajamal AH, Subagio EA. The Effect of ACTH(4–10) PRO8-GLY9-PRO10 Administration on the Expression of IL-6 and IL-8 in Sprague Dawley Mice with Spinal Cord Injury. J Neurosci Rural Pract 2022; 13:370-375. [PMID: 35946003 PMCID: PMC9357503 DOI: 10.1055/s-0042-1744468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Abstract
Background Spinal cord injury (SCI) is a significant cause of morbidity since it results in the inflammation process which leads to necrosis or apoptosis. Inflammatory response to the tissue damage increases IL-6 and IL-8 levels. ACTH4–10Pro8-Gly9-Pro10 is a peptide community that has been shown to have a beneficial effect on minimizing the morbidity and increasing the recovery time.
Methods This study is a true experimental laboratory research with a totally randomized method. The subjects were animal models with light and extreme compression of spinal cord, respectively.
Results The administration of ACTH 4–10 in mild SCI in the 3-hour observation group did not show a significant difference in IL-6 expression compared with the 6-hour observation group. The administration of ACTH 4–10 in severe SCI showed a significantly lower expression level of IL-6 in the 3-hour observation group compared with the 6-hour one. The administration of ACTH 4–10 in severe SCI led to a significantly lower IL-8 expression in the 3-hour observation group compared with the 6-hour one. However, there was no significant difference in IL-8 expression in the group receiving ACTH 4–10 in 3 hours observation compared with that in 6 hours observation.
Conclusion The administration of ACTH4–10Pro8-Gly9-Pro10 can reduce the expression of IL-6 and IL-8 at 3-hour and 6-hour observation after mild and severe SCI in animal models. Future research works are recommended.
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Affiliation(s)
- Muhammad Azzam
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Achmad Fahmi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health-Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - I. Ketut Sudiana
- Department of Pathological Anatomy, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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31
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Serum glial fibrillary acidic protein is a body fluid biomarker: A valuable prognostic for neurological disease – A systematic review. Int Immunopharmacol 2022; 107:108624. [DOI: 10.1016/j.intimp.2022.108624] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
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32
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Bloom O, Tracey KJ, Pavlov VA. Exploring the vagus nerve and the inflammatory reflex for therapeutic benefit in chronic spinal cord injury. Curr Opin Neurol 2022; 35:249-257. [PMID: 35102123 PMCID: PMC9258775 DOI: 10.1097/wco.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe features and implications of chronic systemic inflammation in individuals with spinal cord injury (SCI) and to summarize the growing therapeutic possibilities to explore the vagus nerve-mediated inflammatory reflex in this context. RECENT FINDINGS The discovery of the inflammatory reflex provides a rationale to explore neuromodulation modalities, that is, electrical vagus nerve stimulation and pharmacological cholinergic modalities to regulate inflammation after SCI. SUMMARY Inflammation in individuals with SCI may negatively impact functional recovery and medical consequences after SCI. Exploring the potential of the vagus nerve-based inflammatory reflex to restore autonomic regulation and control inflammation may provide a novel approach for functional improvement in SCI.
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Affiliation(s)
- Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| | - Valentin A. Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
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33
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Blood GFAP as an emerging biomarker in brain and spinal cord disorders. Nat Rev Neurol 2022; 18:158-172. [PMID: 35115728 DOI: 10.1038/s41582-021-00616-3] [Citation(s) in RCA: 191] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
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Wichmann TO, Kasch H, Dyrskog S, Høy K, Møller BK, Krog J, Hoffmann HJ, Hviid CVB, Rasmussen MM. Cerebrospinal fluid and peripheral blood proteomics in Traumatic Spinal Cord Injury: A prospective pilot study. BRAIN AND SPINE 2022; 2:100906. [PMID: 36248130 PMCID: PMC9560581 DOI: 10.1016/j.bas.2022.100906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/12/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022]
Abstract
Proteomics enable profiling of inflammatory responses after spinal cord injury. Proteins are differentially expressed over time. Proteins are differentially expressed in cerebrospinal fluid and peripheral blood. A poor relationship exists between protein expression and neurological outcome.
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Affiliation(s)
- Thea Overgaard Wichmann
- Dept. Neurosurgery, Cense-Spine, Aarhus University Hospital, Aarhus, Denmark
- Corresponding author. Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Helge Kasch
- Dept. Neurology, Viborg Regional Hospital, Toldbodgade 12, 8800, Viborg, Denmark
- Dept. of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Stig Dyrskog
- Dept. Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kristian Høy
- Dept. of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Dept. Orthopaedic Surgery – Spine Section, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Bjarne Kuno Møller
- Dept. of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jan Krog
- Dept. Anaesthesiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Hans Jürgen Hoffmann
- Dept. of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Dept. Respiratory Diseases and Allergy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 93, 8200, Aarhus N, Denmark
| | - Claus Vinter Bødker Hviid
- Dept. Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mikkel Mylius Rasmussen
- Dept. Neurosurgery, Cense-Spine, Aarhus University Hospital, Aarhus, Denmark
- Dept. of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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35
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Hellenbrand DJ, Quinn CM, Piper ZJ, Morehouse CN, Fixel JA, Hanna AS. Inflammation after spinal cord injury: a review of the critical timeline of signaling cues and cellular infiltration. J Neuroinflammation 2021; 18:284. [PMID: 34876174 PMCID: PMC8653609 DOI: 10.1186/s12974-021-02337-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/30/2021] [Indexed: 03/02/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating neurological condition that results in a loss of motor and sensory function. Although extensive research to develop treatments for SCI has been performed, to date, none of these treatments have produced a meaningful amount of functional recovery after injury. The primary injury is caused by the initial trauma to the spinal cord and results in ischemia, oxidative damage, edema, and glutamate excitotoxicity. This process initiates a secondary injury cascade, which starts just a few hours post-injury and may continue for more than 6 months, leading to additional cell death and spinal cord damage. Inflammation after SCI is complex and driven by a diverse set of cells and signaling molecules. In this review, we utilize an extensive literature survey to develop the timeline of local immune cell and cytokine behavior after SCI in rodent models. We discuss the precise functional roles of several key cytokines and their effects on a variety of cell types involved in the secondary injury cascade. Furthermore, variations in the inflammatory response between rats and mice are highlighted. Since current SCI treatment options do not successfully initiate functional recovery or axonal regeneration, identifying the specific mechanisms attributed to secondary injury is critical. With a more thorough understanding of the complex SCI pathophysiology, effective therapeutic targets with realistic timelines for intervention may be established to successfully attenuate secondary damage.
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Affiliation(s)
- Daniel J Hellenbrand
- Department of Neurological Surgery, School of Medicine and Public Health (UWSMPH), University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Charles M Quinn
- Department of Neurological Surgery, School of Medicine and Public Health (UWSMPH), University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Zachariah J Piper
- Department of Neurological Surgery, School of Medicine and Public Health (UWSMPH), University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Carolyn N Morehouse
- Department of Neurological Surgery, School of Medicine and Public Health (UWSMPH), University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Jordyn A Fixel
- Department of Neurological Surgery, School of Medicine and Public Health (UWSMPH), University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Amgad S Hanna
- Department of Neurological Surgery, School of Medicine and Public Health (UWSMPH), University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA.
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36
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Jogia T, Kopp MA, Schwab JM, Ruitenberg MJ. Peripheral white blood cell responses as emerging biomarkers for patient stratification and prognosis in acute spinal cord injury. Curr Opin Neurol 2021; 34:796-803. [PMID: 34608075 PMCID: PMC8631147 DOI: 10.1097/wco.0000000000000995] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To date, prognostication of patients after acute traumatic spinal cord injury (SCI) mostly relies on the neurological assessment of residual function attributed to lesion characteristics. With emerging treatment candidates awaiting to be tested in early clinical trials, there is a need for wholistic high-yield prognostic biomarkers that integrate both neurogenic and nonneurogenic SCI pathophysiology as well as premorbid patient characteristics. RECENT FINDINGS It is becoming clearer that effective prognostication after acute SCI would benefit from integrating an assessment of pathophysiological changes on a systemic level, and with that, extend from a lesion-centric approach. Immunological markers mirror tissue injury as well as host immune function and are easily accessible through routine blood sampling. New studies have highlighted the value of circulating white blood cells, neutrophils and lymphocytes in particular, as prognostic systemic indicators of SCI severity and outcomes. SUMMARY We survey recent advances in methods and approaches that may allow for a more refined diagnosis and better prognostication after acute SCI, discuss how these may help deepen our understanding of SCI pathophysiology, and be of use in clinical trials.
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Affiliation(s)
- Trisha Jogia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Marcel A. Kopp
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan M. Schwab
- Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Belford Center for Spinal Cord Injury, Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Marc J. Ruitenberg
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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37
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Wang HD, Wei ZJ, Li JJ, Feng SQ. Application value of biofluid-based biomarkers for the diagnosis and treatment of spinal cord injury. Neural Regen Res 2021; 17:963-971. [PMID: 34558509 PMCID: PMC8552873 DOI: 10.4103/1673-5374.324823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recent studies in patients with spinal cord injuries (SCIs) have confirmed the diagnostic potential of biofluid-based biomarkers, as a topic of increasing interest in relation to SCI diagnosis and treatment. This paper reviews the research progress and application prospects of recently identified SCI-related biomarkers. Many structural proteins, such as glial fibrillary acidic protein, S100-β, ubiquitin carboxy-terminal hydrolase-L1, neurofilament light, and tau protein were correlated with the diagnosis, American Spinal Injury Association Impairment Scale, and prognosis of SCI to different degrees. Inflammatory factors, including interleukin-6, interleukin-8, and tumor necrosis factor α, are also good biomarkers for the diagnosis of acute and chronic SCI, while non-coding RNAs (microRNAs and long non-coding RNAs) also show diagnostic potential for SCI. Trace elements (Mg, Se, Cu, Zn) have been shown to be related to motor recovery and can predict motor function after SCI, while humoral markers can reflect the pathophysiological changes after SCI. These factors have the advantages of low cost, convenient sampling, and ease of dynamic tracking, but are also associated with disadvantages, including diverse influencing factors and complex level changes. Although various proteins have been verified as potential biomarkers for SCI, more convincing evidence from large clinical and prospective studies is thus required to identify the most valuable diagnostic and prognostic biomarkers for SCI.
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Affiliation(s)
- Hong-Da Wang
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhi-Jian Wei
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin; Department of Orthopedics, Qilu Hospital; Shandong University Center for Orthopedics, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Jun-Jin Li
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Shi-Qing Feng
- Department of Orthopedics; International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin; Department of Orthopedics, Qilu Hospital; Shandong University Center for Orthopedics, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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38
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Leister I, Altendorfer B, Maier D, Mach O, Wutte C, Grillhösl A, Arevalo-Martin A, Garcia-Ovejero D, Aigner L, Grassner L. Serum Levels of Glial Fibrillary Acidic Protein and Neurofilament Light Protein Are Related to the Neurological Impairment and Spinal Edema after Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:3431-3439. [PMID: 34541888 DOI: 10.1089/neu.2021.0264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neurological examination in the acute phase after spinal cord injury (SCI) is often impossible and severely confounded by pharmacological sedation or concomitant injuries. Therefore, diagnostic biomarkers that objectively characterize severity or the presence of SCI are urgently needed to facilitate clinical decision-making. This study aimed to determine if serum markers of neural origin are related to: 1) presence and severity of SCI, and 2) magnetic resonance imaging (MRI) parameters in the very acute post-injury phase. We performed a secondary analysis of serological parameters, as well as MRI findings in patients with acute SCI (n = 38). Blood samples were collected between Days 1-4 post-injury. Serum protein levels of glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and neurofilament light protein (NfL) were determined. A group of 41 age- and sex-matched healthy individuals served as control group. In the group of individuals with SCI, pre-operative sagittal and axial T2-weighted and sagittal T1-weighted MRI scans were available for 21 patients. Serum markers of neural origin are different among individuals who sustained traumatic SCI depending on injury severity, and the extent of the lesion according to MRI in the acute injury phase. Unbiased Recursive Partitioning regression with Conditional Inference Trees (URP-CTREE) produced preliminary cut-off values for NfL (75.217 pg/mL) and GFAP (73.121 pg/mL), allowing a differentiation between individuals with SCI and healthy controls within the first 4 days after SCI. Serum proteins NfL and GFAP qualify as diagnostic biomarkers for the presence and severity of SCI in the acute post-injury phase, where the reliability of clinical exams is limited.
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Affiliation(s)
- Iris Leister
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Doris Maier
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria
| | - Orpheus Mach
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany
| | - Christof Wutte
- Department of Neurosurgery, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Biomechanics, BG Trauma Center Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria
| | - Andreas Grillhösl
- Department of Radiology, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany
| | - Angel Arevalo-Martin
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain
| | - Daniel Garcia-Ovejero
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain
| | - Ludwig Aigner
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Lukas Grassner
- ParaMove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury Center, Clinical Research Unit, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Neuroradiology and Interventional Radiology, BG Trauma Center Murnau, Murnau, Germany.,Institute of Biomechanics, BG Trauma Center Murnau, Germany, and Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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39
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A Review of the Clinical and Therapeutic Implications of Neuropathic Pain. Biomedicines 2021; 9:biomedicines9091239. [PMID: 34572423 PMCID: PMC8465811 DOI: 10.3390/biomedicines9091239] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023] Open
Abstract
Understanding neuropathic pain presents several challenges, given the various mechanisms underlying its pathophysiological classification and the lack of suitable tools to assess its diagnosis. Furthermore, the response of this pathology to available drugs is still often unpredictable, leaving the treatment of neuropathic pain still questionable. In addition, the rise of personalized treatments further extends the ramified classification of neuropathic pain. While a few authors have focused on neuropathic pain clustering, by analyzing, for example, the presence of specific TRP channels, others have evaluated the presence of alterations in microRNAs to find tailored therapies. Thus, this review aims to synthesize the available evidence on the topic from a clinical perspective and provide a list of current demonstrations on the treatment of this disease.
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40
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Stukas S, Gill J, Cooper J, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Dhall S, Mac-Thiong JM, Wilson JR, Bailey C, Christie S, Dvorak MF, Wellington C, Kwon BK. Characterization of Cerebrospinal Fluid Ubiquitin C-Terminal Hydrolase L1 as a Biomarker of Human Acute Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:2055-2064. [PMID: 33504255 DOI: 10.1089/neu.2020.7352] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A major obstacle for translational research in acute spinal cord injury (SCI) is the lack of biomarkers that can objectively stratify injury severity and predict outcome. Ubiquitin C-terminal hydrolase L1 (UCH-L1) is a neuron-specific enzyme that shows promise as a diagnostic biomarker in traumatic brain injury (TBI), but has not been studied in SCI. In this study, cerebrospinal fluid (CSF) and serum samples were collected over the first 72-96 h post-injury from 32 acute SCI patients who were followed prospectively to determine neurological outcomes at 6 months post-injury. UCH-L1 concentration was measured using the Quanterix Simoa platform (Quanterix, Billerica, MA) and correlated to injury severity, time, and neurological recovery. We found that CSF UCH-L1 was significantly elevated by 10- to 100-fold over laminectomy controls in an injury severity- and time-dependent manner. Twenty-four-hour post-injury CSF UCH-L1 concentrations distinguished between American Spinal Injury Association Impairment Scale (AIS) A and AIS B, and AIS A and AIS C patients in the acute setting, and predicted who would remain "motor complete" (AIS A/B) at 6 months with a sensitivity of 100% and a specificity of 86%. AIS A patients who did not improve their AIS grade at 6 months post-injury were characterized by sustained elevations in CSF UCH-L1 up to 96 h. Similarly, the failure to gain >8 points on the total motor score at 6 months post-injury was associated with higher 24-h CSF UCH-L1. Unfortunately, serum UCH-L1 levels were not informative about injury severity or outcome. In conclusion, CSF UCH-L1 in acute SCI shows promise as a biomarker to reflect injury severity and predict outcome.
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Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Gill
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lise Belanger
- Vancouver Spine Research Program, Vancouver General Hospital, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leanna Ritchie
- Vancouver Spine Research Program, Vancouver General Hospital, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Tsang
- Vancouver Spine Research Program, Vancouver General Hospital, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Dong
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Paquette
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamir Ailon
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphaële Charest-Morin
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Dhall
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Jean-Marc Mac-Thiong
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Department of Surgery, Chu Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher Bailey
- Division of Orthopaedic Surgery, Schulich Medicine & Dentistry, Victoria Hospital, London, Ontario, Canada
| | - Sean Christie
- Division of Neurosurgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcel F Dvorak
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Spine Surgery Institute, Department of Orthopaedics, Blusson Spinal Cord Center, University of British Columbia, Vancouver, British Columbia, Canada
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41
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Bohren Y, Timbolschi DI, Muller A, Barrot M, Yalcin I, Salvat E. Platelet-rich plasma and cytokines in neuropathic pain: A narrative review and a clinical perspective. Eur J Pain 2021; 26:43-60. [PMID: 34288258 DOI: 10.1002/ejp.1846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/18/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. A number of preclinical studies have provided evidence for the involvement of cytokines, predominantly secreted by a variety of immune cells and by glial cells from the nervous system, in neuropathic pain conditions. Clinical trials and the use of anti-cytokine drugs in different neuropathic aetiologies support the relevance of cytokines as treatment targets. However, the use of such drugs, in particularly biotherapies, can provoke notable adverse effects. Moreover, it is challenging to select one given cytokine as a target, among the various neuropathic pain conditions. It could thus be of interest to target other proteins, such as growth factors, in order to act more widely on the neuroinflammation network. Thus, platelet-rich plasma (PRP), an autologous blood concentrate, is known to contain a natural concentration of growth factors and immune system messengers and is widely used in the clinical setting for tissue regeneration and repair. DATABASE AND DATA TREATMENT In the present review, we critically assess the current knowledge on cytokines in neuropathic pain by taking into consideration both human studies and animal models. RESULTS This analysis of the literature highlights the pathophysiological importance of cytokines. We particularly highlight the concept of time- and tissue-dependent cytokine activation during neuropathic pain conditions. RESULTS Conclusion: Thus, direct or indirect cytokines modulation with biotherapies or growth factors appears relevant. In addition, we discuss the therapeutic potential of localized injection of PRP as neuropathic pain treatment by pointing out the possible link between cytokines and the action of PRP. SIGNIFICANCE Preclinical and clinical studies highlight the idea of a cytokine imbalance in the development and maintenance of neuropathic pain. Clinical trials with anticytokine drugs are encouraging but are limited by a 'cytokine candidate approach' and adverse effect of biotherapies. PRP, containing various growth factors, is a new therapeutic used in regenerative medicine. Growth factors can be also considered as modulators of cytokine balance. Here, we emphasize a potential therapeutic effect of PRP on cytokine imbalance in neuropathic pain. We also underline the clinical interest of the use of PRP, not only for its therapeutic effect but also for its safety of use.
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Affiliation(s)
- Yohann Bohren
- Centre d'Evaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Daniel Ionut Timbolschi
- Centre d'Evaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - André Muller
- Centre d'Evaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Michel Barrot
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Ipek Yalcin
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Eric Salvat
- Centre d'Evaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
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Wu C, Yu J, Xu G, Gao H, Sun Y, Huang J, Sun L, Zhang X, Cui Z. Bioinformatic Analysis of the Proteome in Exosomes Derived From Plasma: Exosomes Involved in Cholesterol Metabolism Process of Patients With Spinal Cord Injury in the Acute Phase. Front Neuroinform 2021; 15:662967. [PMID: 34305563 PMCID: PMC8299276 DOI: 10.3389/fninf.2021.662967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Spinal cord injury (SCI) is a common but severe disease caused by traffic accidents. Coronary atherosclerotic heart disease (CHD) caused by dyslipidemia is known as the leading cause of death in patients with SCI. However, the quantitative analysis showed that the cholesterol and lipoprotein concentrations in peripheral blood (PB) did not change significantly within 48 h after SCI. Due to the presence of the Blood spinal cord barrier (BSCB), there are only few studies concerning the plasma cholesterol metabolism in the acute phase of SCI. Exosomes have a smaller particle size, which enables them relatively less limitation of BSCB. This study uses exosomes derived from the plasma of 43 patients in the acute phase of SCI and 71 patients in the control group as samples. MS proteomics and bioinformatics analysis found 590 quantifiable proteins, in which 75 proteins were upregulated and 153 proteins were downregulated, and the top 10 differentially expressed proteins are those including downregulating proteins: HIST1H4A, HIST2H3A, HIST2H2BE, HCLS1, S100A9, HIST1H2BM, S100A8, CALM3, YWHAH, and SFN, and upregulating proteins: SERPIND1, C1QB, SPTLC3, IGHV4-28, C4A, IGHV4-38-2, IGHV4-30-2, SLC15A1, C4B, and ACTG2. Enrichment analysis showed that the largest part of proteins was related to cholesterol metabolism among the downregulated proteins. The main components of cholesterol [ApoB-48 and ApoB-100 increased, ApoA-I, ApoA-II, ApoA-IV, ApoC, ApoE, and Apo(a) decreased] were changed in exosomes derived from plasma of patients. ELISA analysis showed that some components were disordered in the acute phase of SCI. These results suggested that the exosomes might be involved in cholesterol metabolism regulation in the acute phase of SCI.
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Affiliation(s)
- Chunshuai Wu
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Jinjuan Yu
- Department of Administrative Office, The Third People's Hospital of Nantong, Nantong, China
| | - Guanhua Xu
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Hong Gao
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Yue Sun
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Jiayi Huang
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Li Sun
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Xu Zhang
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
| | - Zhiming Cui
- Department of Spine Surgery, Nantong First People's Hospital, The Affiliated Hospital 2 of Nantong University, Nantong, China
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Proteomic Portraits Reveal Evolutionarily Conserved and Divergent Responses to Spinal Cord Injury. Mol Cell Proteomics 2021; 20:100096. [PMID: 34129941 PMCID: PMC8260874 DOI: 10.1016/j.mcpro.2021.100096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/14/2021] [Accepted: 05/11/2021] [Indexed: 01/16/2023] Open
Abstract
Despite the emergence of promising therapeutic approaches in preclinical studies, the failure of large-scale clinical trials leaves clinicians without effective treatments for acute spinal cord injury (SCI). These trials are hindered by their reliance on detailed neurological examinations to establish outcomes, which inflate the time and resources required for completion. Moreover, therapeutic development takes place in animal models whose relevance to human injury remains unclear. Here, we address these challenges through targeted proteomic analyses of cerebrospinal fluid and serum samples from 111 patients with acute SCI and, in parallel, a large animal (porcine) model of SCI. We develop protein biomarkers of injury severity and recovery, including a prognostic model of neurological improvement at 6 months with an area under the receiver operating characteristic curve of 0.91, and validate these in an independent cohort. Through cross-species proteomic analyses, we dissect evolutionarily conserved and divergent aspects of the SCI response and establish the cerebrospinal fluid abundance of glial fibrillary acidic protein as a biochemical outcome measure in both humans and pigs. Our work opens up new avenues to catalyze translation by facilitating the evaluation of novel SCI therapies, while also providing a resource from which to direct future preclinical efforts. • Targeted proteomic analysis of CSF and serum samples from 111 acute SCI patients. • Single- and multiprotein biomarkers of injury severity and recovery. • Parallel proteomic analysis in a large animal model identifies conserved biomarkers. • Evolutionary conservation and divergence of the proteomic response to SCI.
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Mahmoudi E, Lin P, Peterson MD, Meade MA, Tate DG, Kamdar N. Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study. Arch Phys Med Rehabil 2021; 102:1147-1154. [PMID: 33508336 PMCID: PMC10536758 DOI: 10.1016/j.apmr.2020.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/12/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed. DESIGN Cohort study. SETTING Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD. PARTICIPANTS Adults with and without TSCI (N=6083). INTERVENTION Not applicable. MAIN OUTCOMES MEASURES Diagnosis of ADRD. RESULTS Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]). CONCLUSIONS Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle A Meade
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Lin M, Huang W, Kabbani N, Theiss MM, Hamilton JF, Ecklund JM, Conley YP, Vodovotz Y, Brienza D, Wagner AK, Robbins E, Sowa GA, Lipsky RH. Effect of CHRFAM7A Δ2bp gene variant on secondary inflammation after spinal cord injury. PLoS One 2021; 16:e0251110. [PMID: 33956875 PMCID: PMC8101719 DOI: 10.1371/journal.pone.0251110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
The α7 neuronal nicotinic acetylcholine receptors (α7nAChRs) are essential for anti-inflammatory responses. The human-specific CHRFAM7A gene and its 2bp deletion polymorphism (Δ2bp variant) encodes a structurally-deficient α7nAChRs that may impact the anti-inflammatory function. We studied 45 spinal cord injury (SCI) patients for up to six weeks post SCI to investigate the role of the Δ2bp variant on multiple circulating inflammatory mediators and two outcome measures (neuropathic pain and risk of pressure ulcers). The patient's SCI were classified as either severe or mild. Missing values were imputed. Overall genetic effect was conducted with independent sample t-test and corrected with false discovery rate (FDR). Univariate analysis and regression analysis were applied to evaluate the Δ2bp effects on temporal variation of inflammatory mediators post SCI and their interaction with outcome measures. In severe SCI, the Δ2bp carriers showed higher levels of circulating inflammatory mediators than the Δ2bp non-carriers in TNF-α (FDR = 9.6x10-4), IFN-γ (FDR = 1.3x10-3), IL-13 (FDR = 1.6x10-3), CCL11 (FDR = 2.1x10-3), IL-12p70 (FDR = 2.2x10-3), IL-8 (FDR = 2.2x10-3), CXCL10 (FDR = 3.1x10-3), CCL4 (FDR = 5.7x10-3), IL-12p40 (FDR = 7.1x10-3), IL-1b (FDR = 0.014), IL-15 (FDR = 0.024), and IL-2 (FDR = 0.037). IL-8 and CCL2 were negatively associated with days post injury (DPI) for the Δ2bp carriers (P = 2x10-7 and P = 2x10-8, respectively) and IL-5 was positively associated with DPI for the Δ2bp non-carriers (P = 0.015). Neuropathic pain was marginally positively associated with IL-13 for the Δ2bp carriers (P = 0.056). In mild SCI, the Δ2bp carriers had lower circulating levels of IL-15 (FDR = 0.04) than the Δ2bp non-carriers. Temporal variation of inflammatory mediators post SCI was not associated with the Δ2bp variant. For the mild SCI Δ2bp carriers, risk of pressure ulcers was positively associated with circulating levels of IFN-γ, CXCL10, and CCL4 and negatively associated with circulating levels of IL-12p70. These findings support an important role for the human-specific CHRFAM7A Δ2bp gene variant in modifying anti-inflammatory function of α7nAChRs following SCI.
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Affiliation(s)
- Mingkuan Lin
- School of Systems Biology, George Mason University, Fairfax, Virginia, United States of America
- Inova Neuroscience and Spine Institute, Inova Health System, Falls Church, Virginia, United States of America
- * E-mail:
| | - Wan Huang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Nadine Kabbani
- School of Systems Biology, George Mason University, Fairfax, Virginia, United States of America
| | - Mark M. Theiss
- Department of Orthopedic Services, Inova Health System, Falls Church, Virginia, United States of America
| | - John F. Hamilton
- Inova Neuroscience and Spine Institute, Inova Health System, Falls Church, Virginia, United States of America
| | - James M. Ecklund
- Inova Neuroscience and Spine Institute, Inova Health System, Falls Church, Virginia, United States of America
| | - Yvette P. Conley
- School of Nursing and Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yoram Vodovotz
- Department of Surgery, Center for Inflammation & Regenerative Modeling in McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - David Brienza
- Rehabilitation Science &Technology, Bioengineering, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Amy K. Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Emily Robbins
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Gwendolyn A. Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Robert H. Lipsky
- School of Systems Biology, George Mason University, Fairfax, Virginia, United States of America
- Inova Neuroscience and Spine Institute, Inova Health System, Falls Church, Virginia, United States of America
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Blood Serum Cytokines in Patients with Subacute Spinal Cord Injury: A Pilot Study to Search for Biomarkers of Injury Severity. Brain Sci 2021; 11:brainsci11030322. [PMID: 33806460 PMCID: PMC8000354 DOI: 10.3390/brainsci11030322] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background. Despite considerable interest in the search for a spinal cord injury (SCI) therapy, there is a critical need to develop a panel of diagnostic biomarkers to determine injury severity. In this regard, there is a requirement for continuing research into the fundamental processes of neuroinflammatory and autoimmune reactions in SCI, identifying changes in the expression of cytokines. Methods. In this pilot study, an extended multiplex analysis of the cytokine profiles in the serum of patients at 2 weeks post-SCI (n = 28) was carried out, together with an additional assessment of neuron-specific enolase (NSE) and vascular endothelial growth factor (VEGF) levels by enzyme-linked immunosorbent assay. A total of 16 uninjured subjects were enrolled as controls. Results. The data obtained showed a large elevation of IFNγ (>52 fold), CCL27 (>13 fold), and CCL26 (>8 fold) 2 weeks after SCI. The levels of cytokines CXCL5, CCL11, CXCL11, IL10, TNFα, and MIF were different between patients with baseline American Spinal Injury Association Impairment Scale (AIS) grades of A or B, whilst IL2 (>2 fold) and MIP-3a (>6 fold) were significantly expressed in the cervical and thoracic regions. There was a trend towards increasing levels of NSE. However, the difference in NSE was lost when the patient set was segregated based on AIS group. Conclusions. Our pilot research demonstrates that serum concentrations of cytokines can be used as an affordable and rapid detection tool to accurately stratify SCI severity in patients.
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Xu J, Ji J, Wang Z, Xu T. Effects of minocycline on motor function recovery and expression of glial fibrillary acidic protein and brain-derived neurotrophic factor after spinal cord injury in rats. J Pharm Pharmacol 2021; 73:332-337. [PMID: 33793886 DOI: 10.1093/jpp/rgaa041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/16/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Study explore the effects of minocycline on the expression of glial fibrillary acidic protein and brain-derived neurotrophic factor after spinal cord injury and its possible mechanism of action. METHODS The model of acute spinal cord injury was established by Allen's method. The rats in each group were assessed with Basso Beattie Bresnahan score of hindlimb motor function and inclined plate test score. Serum malondialdehyde and superoxide dismutase, glial fibrillary acidic protein and brain-derived neurotrophic factor in spinal cord were compared. KEY FINDINGS Basso Beattie Bresnahan scores, Tiltboard experiment max angles, and Serum superoxide dismutase activity of the minocycline group were higher than those of the model group after surgery (P < 0.05). Serum malondialdehyde content, and expression of the minocycline group was lower than that of the model group (P < 0.05), and brain-derived neurotrophic factorexpression of minocycline group was significantly higher in the model group after surgery (P < 0.05). Minocycline can promote the recovery of motor function after spinal cord injury in rats. CONCLUSIONS The mechanism of action may be that it inhibits local free radical generation, reduces lipid peroxidation and glial fibrillary acidic protein expression in spinal cord tissue after spinal cord injury, and promotes the synthesis of endogenous brain-derived neurotrophic factor, thus improving the microenvironment of spinal cord regeneration after spinal cord injury in rats.
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Affiliation(s)
- Jiancheng Xu
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Jing Ji
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Zhan Wang
- Department of Orthopaedics, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Department of Orthopaedics, People's Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Tao Xu
- Department of Rehabilitation Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
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Tsitsopoulos PP, Holmström U, Blennow K, Zetterberg H, Marklund N. Cerebrospinal fluid biomarkers of glial and axonal injury in cervical spondylotic myelopathy. J Neurosurg Spine 2021; 34:632-641. [PMID: 33513577 DOI: 10.3171/2020.8.spine20965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical spondylotic myelopathy (CSM) is a major cause of spinal cord dysfunction with an unpredictable prognosis. Βiomarkers reflecting pathophysiological processes in CSM have been insufficiently investigated. It was hypothesized that preoperative cerebrospinal fluid (CSF) biomarker levels are altered in patients with CSM and correlate with neurological status and outcome. METHODS CSF biomarkers from patients with CSM and controls were analyzed with immunoassays. Spinal cord changes were evaluated with MRI. The American Spinal Cord Injury Association Impairment Scale, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the EQ-5D questionnaire were applied prior to and 3 months after surgery. A p value < 0.05 was considered statistically significant. RESULTS Twenty consecutive CSM patients with a mean age of 67.7 ± 13 years and 63 controls with a mean age of 65.2 ± 14.5 years (p > 0.05) were included in the study. In the CSM subjects, CSF neurofilament light subunit (NF-L) and glial fibrillary acidic protein (GFAP) concentrations were higher (p < 0.05), whereas fatty acid-binding protein 3 (FABP3), soluble amyloid precursor proteins (sAPPα and sAPPβ), and amyloid β (Aβ) peptide (Aβ38, Aβ40, and Aβ42) concentrations were lower than in controls (p < 0.05). Aβ peptide levels correlated positively with symptom duration. Preoperative JOACMEQ lower extremity function and CSF NF-L levels correlated positively, and the JOACMEQ bladder function correlated negatively with sAPPα and sAPPβ (p < 0.05). CSF NF-L and FABP3 levels were higher in patients with improved outcome (EQ-5D visual analog scale difference > 20). CONCLUSIONS CSF biomarkers of glial and axonal damage, inflammation, and synaptic changes are altered in symptomatic CSM patients, indicating that axonal injury, astroglial activation, and Aβ dysmetabolism may be present in these individuals. These findings reflect CSM pathophysiology and may aid in prognostication. However, future studies including larger patient cohorts, postoperative biomarker data and imaging, and longer follow-up times are required to validate the present findings.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- 1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.,2Department of Neurosurgery, Hippokratio General Hospital, Aristotle University School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Ulrika Holmström
- 1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- 3Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal.,4Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- 3Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal.,4Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,5Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London.,6UK Dementia Research Institute at University College of London, United Kingdom; and
| | - Niklas Marklund
- 1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.,7Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden
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Systemic Inflammation and the Breakdown of Intestinal Homeostasis Are Key Events in Chronic Spinal Cord Injury Patients. Int J Mol Sci 2021; 22:ijms22020744. [PMID: 33451043 PMCID: PMC7828526 DOI: 10.3390/ijms22020744] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/27/2020] [Accepted: 01/10/2021] [Indexed: 12/20/2022] Open
Abstract
Our aim was to investigate the subset distribution and function of circulating monocytes, proinflammatory cytokine levels, gut barrier damage, and bacterial translocation in chronic spinal cord injury (SCI) patients. Thus, 56 SCI patients and 28 healthy donors were studied. The levels of circulating CD14+highCD16-, CD14+highCD16+, and CD14+lowCD16+ monocytes, membrane TLR2, TLR4, and TLR9, phagocytic activity, ROS generation, and intracytoplasmic TNF-α, IL-1, IL-6, and IL-10 after lipopolysaccharide (LPS) stimulation were analyzed by polychromatic flow cytometry. Serum TNF-α, IL-1, IL-6 and IL-10 levels were measured by Luminex and LPS-binding protein (LBP), intestinal fatty acid-binding protein (I-FABP) and zonulin by ELISA. SCI patients had normal monocyte counts and subset distribution. CD14+highCD16- and CD14+highCD16+ monocytes exhibited decreased TLR4, normal TLR2 and increased TLR9 expression. CD14+highCD16- monocytes had increased LPS-induced TNF-α but normal IL-1, IL-6, and IL-10 production. Monocytes exhibited defective phagocytosis but normal ROS production. Patients had enhanced serum TNF-α and IL-6 levels, normal IL-1 and IL-10 levels, and increased circulating LBP, I-FABP, and zonulin levels. Chronic SCI patients displayed impaired circulating monocyte function. These patients exhibited a systemic proinflammatory state characterized by enhanced serum TNF-α and IL-6 levels. These patients also had increased bacterial translocation and gut barrier damage.
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Bannerman CA, Douchant K, Sheth PM, Ghasemlou N. The gut-brain axis and beyond: Microbiome control of spinal cord injury pain in humans and rodents. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2021; 9:100059. [PMID: 33426367 PMCID: PMC7779861 DOI: 10.1016/j.ynpai.2020.100059] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
Spinal cord injury (SCI) is a devastating injury to the central nervous system in which 60 to 80% of patients experience chronic pain. Unfortunately, this pain is notoriously difficult to treat, with few effective options currently available. Patients are also commonly faced with various compounding injuries and medical challenges, often requiring frequent hospitalization and antibiotic treatment. Change in the gut microbiome from the "normal" state to one of imbalance, referred to as gut dysbiosis, has been found in both patients and rodent models following SCI. Similarities exist in the bacterial changes observed after SCI and other diseases with chronic pain as an outcome. These changes cause a shift in the regulation of inflammation, causing immune cell activation and secretion of inflammatory mediators that likely contribute to the generation/maintenance of SCI pain. Therefore, correcting gut dysbiosis may be used as a tool towards providing patients with effective pain management and improved quality of life.
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Affiliation(s)
- Courtney A. Bannerman
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Katya Douchant
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Prameet M. Sheth
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
- Division of Microbiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Nader Ghasemlou
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
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