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Nguyen QT, Thanh LN, Hoang VT, Phan TTK, Heke M, Hoang DM. Bone Marrow-Derived Mononuclear Cells in the Treatment of Neurological Diseases: Knowns and Unknowns. Cell Mol Neurobiol 2023; 43:3211-3250. [PMID: 37356043 DOI: 10.1007/s10571-023-01377-x] [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: 01/30/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
Bone marrow-derived mononuclear cells (BMMNCs) have been used for decades in preclinical and clinical studies to treat various neurological diseases. However, there is still a knowledge gap in the understanding of the underlying mechanisms of BMMNCs in the treatment of neurological diseases. In addition, prerequisite factors for the efficacy of BMMNC administration, such as the optimal route, dose, and number of administrations, remain unclear. In this review, we discuss known and unknown aspects of BMMNCs, including the cell harvesting, administration route and dose; mechanisms of action; and their applications in neurological diseases, including stroke, cerebral palsy, spinal cord injury, traumatic brain injury, amyotrophic lateral sclerosis, autism spectrum disorder, and epilepsy. Furthermore, recommendations on indications for BMMNC administration and the advantages and limitations of BMMNC applications for neurological diseases are discussed. BMMNCs in the treatment of neurological diseases. BMMNCs have been applied in several neurological diseases. Proposed mechanisms for the action of BMMNCs include homing, differentiation and paracrine effects (angiogenesis, neuroprotection, and anti-inflammation). Further studies should be performed to determine the optimal cell dose and administration route, the roles of BMMNC subtypes, and the indications for the use of BMMNCs in neurological conditions with and without genetic abnormalities.
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Affiliation(s)
- Quyen Thi Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hai Ba Trung, Hanoi, 11622, Vietnam
| | - Liem Nguyen Thanh
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hai Ba Trung, Hanoi, 11622, Vietnam.
- College of Health Science, Vin University, Vinhomes Ocean Park, Gia Lam District, Hanoi, 12400, Vietnam.
- Vinmec International Hospital-Times City, Vinmec Healthcare System, 458 Minh Khai, Hanoi, 11622, Vietnam.
| | - Van T Hoang
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hai Ba Trung, Hanoi, 11622, Vietnam
| | - Trang T K Phan
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hai Ba Trung, Hanoi, 11622, Vietnam
| | - Michael Heke
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Duc M Hoang
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hai Ba Trung, Hanoi, 11622, Vietnam
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Babadjouni RM, Walcott BP, Liu Q, Tenser MS, Amar AP, Mack WJ. Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy. Neurosurg Focus 2017; 42:E4. [PMID: 28366053 DOI: 10.3171/2017.1.focus16514] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite the success of numerous neuroprotective strategies in animal and preclinical stroke models, none have effectively translated to clinical medicine. A multitude of influences are likely responsible. Two such factors are inefficient recanalization strategies for large vessel occlusions and suboptimal delivery methods/platforms for neuroprotective agents. The recent endovascular stroke trials have established a new paradigm for large vessel stroke treatment. The associated advent of advanced mechanical revascularization devices and new stroke technologies help address each of these existing gaps. A strategy combining effective endovascular revascularization with administration of neuroprotective therapies is now practical and could have additive, if not synergistic, effects. This review outlines past and current neuroprotective strategies assessed in acute stroke trials. The discussion focuses on delivery platforms and their potential applicability to endovascular stoke treatment.
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Affiliation(s)
| | - Brian P Walcott
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Matthew S Tenser
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arun P Amar
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - William J Mack
- Zilkha Neurogenetic Institute and.,Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Amar AP, Griffin JH, Zlokovic BV. Combined neurothrombectomy or thrombolysis with adjunctive delivery of 3K3A-activated protein C in acute ischemic stroke. Front Cell Neurosci 2015; 9:344. [PMID: 26388732 PMCID: PMC4556986 DOI: 10.3389/fncel.2015.00344] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/18/2015] [Indexed: 01/19/2023] Open
Abstract
In the treatment of acute ischemic stroke (AIS), vessel recanalization correlates with improved functional status and reduced mortality. Mechanical neurothrombectomy achieves a higher likelihood of revascularization than intravenous thrombolysis (IVT), but there remains significant discrepancy between rates of recanalization and rates of favorable outcome. The poor neurological recovery among some stroke patients despite successful recanalization confirms the need for adjuvant therapy, such as pharmacological neuroprotection. Prior clinical trials of neuroprotectant drugs failed perhaps due to inability of the agent to reach the ischemic tissue beyond the occluded artery. A protocol that couples mechanical neurothrombectomy with concurrent delivery of a neuroprotectant overcomes this pitfall. Activated protein C (APC) exerts pleiotropic anti-inflammatory, anti-apoptotic, antithrombotic, cytoprotective, and neuroregenerative effects in stroke and appears a compelling candidate for this novel approach.
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Affiliation(s)
- Arun Paul Amar
- Department of Neurosurgery, Keck School of Medicine of the University of Southern California, University of Southern California Los Angeles, CA, USA
| | - John H Griffin
- Department of Molecular and Experimental Medicine, Scripps Research Institute La Jolla, CA, USA ; Department of Medicine, Division of Hematology/Oncology, University of California, San Diego San Diego, CA, USA
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, Keck School of Medicine of the University of Southern California, University of Southern California Los Angeles, CA, USA
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Horie N, Hiu T, Nagata I. Stem cell transplantation enhances endogenous brain repair after experimental stroke. Neurol Med Chir (Tokyo) 2015; 55:107-12. [PMID: 25746304 PMCID: PMC4533406 DOI: 10.2176/nmc.ra.2014-0271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Stem cell transplantation for stroke treatment has been a promising therapy in small and large animal models, and many clinical trials are ongoing to establish this strategy in a clinical setting. However, the mechanism underlying functional recovery after stem cell transplantation has not been fully established and there is still a need to determine the ideal subset of stem cells for such therapy. We herein reviewed the recent evidences showing the underlying mechanism of functional recovery after cell transplantation, focusing on endogenous brain repair. First, angiogenesis/neovascularization is promoted by trophic factors including vascular endothelial growth factor secreted from stem cells, and stem cells migrated to the lesion along with the vessels. Second, axonal sprouting, dendritic branching, and synaptogenesis were enhanced altogether in the both ipsilateral and contralateral hemisphere remapping the pyramidal tract across the board. Finally, endogenous neurogenesis was also enhanced although little is known how much these neurogenesis contribute to the functional recovery. Taken together, it is clear that stem cell transplantation provides functional recovery via endogenous repair enhancement from multiple ways. This is important to maximize the effect of stem cell therapy after stroke, although it is still undetermined which repair mechanism is mostly contributed.
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Affiliation(s)
- Nobutaka Horie
- Department of Neurosurgery, Nagasaki University School of Medicine
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Fukuda Y, Horie N, Satoh K, Yamaguchi S, Morofuji Y, Hiu T, Izumo T, Hayashi K, Nishida N, Nagata I. Intra-arterial transplantation of low-dose stem cells provides functional recovery without adverse effects after stroke. Cell Mol Neurobiol 2014; 35:399-406. [PMID: 25398358 DOI: 10.1007/s10571-014-0135-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
Cell transplantation therapy for cerebral infarction has emerged as a promising treatment to reduce brain damage and enhance functional recovery. We previously reported that intra-arterial delivery of bone marrow mesenchymal stem cells (MSCs) enables superselective cell administration to the infarct area and results in significant functional recovery after ischemic stroke in a rat model. However, to reduce the risk of embolism caused by the transplanted cells, an optimal cell number should be determined. At 24 h after middle cerebral artery occlusion and reperfusion, we administered human MSCs (low dose: 1 × 10(4) cells; high dose: 1 × 10(6) cells) and then assessed functional recovery, inflammatory responses, cell distribution, and mortality. Rats treated with high- or low-dose MSCs showed behavioral recovery. At day 8 post-stroke, microglial activation was suppressed significantly, and interleukin (IL)-1β and IL-12p70 were reduced in both groups. Although high-dose MSCs were more widely distributed in the cortex and striatum of rats, the degree of intravascular cell aggregation and mortality was significantly higher in the high-dose group. In conclusion, selective intra-arterial transplantation of low-dose MSCs has anti-inflammatory effects and reduces the adverse effects of embolic complication, resulting in sufficient functional recovery of the affected brain.
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Affiliation(s)
- Yuhtaka Fukuda
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan.
| | - Katsuya Satoh
- Department of Molecular Microbiology and Immunology, School of Medicine, Nagasaki University, Nagasaki, Japan
| | - Susumu Yamaguchi
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Youichi Morofuji
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Kentaro Hayashi
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Noriyuki Nishida
- Department of Molecular Microbiology and Immunology, School of Medicine, Nagasaki University, Nagasaki, Japan
| | - Izumi Nagata
- Department of Neurosurgery, School of Medicine, Nagasaki University, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
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Treatment of aganglionic megacolon mice via neural stem cell transplantation. Mol Neurobiol 2013; 48:429-37. [PMID: 23512482 DOI: 10.1007/s12035-013-8430-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
Abstract
To explore a potential methodology for treating aganglionic megacolon, neural stem cells (NSCs) expressing engineered endothelin receptor type B (EDNRB) and glial cell-derived neurotrophic factor (GDNF) genes were transplanted into the aganglionic megacolon mice. After transplantation, the regeneration of neurons in the colon tissue was observed, and expression levels of differentiation-related genes were determined. Primary culture of NSCs was obtained from the cortex of postnatal mouse brain and infected with recombinant adenovirus expressing EDNRB and GDNF genes. The mouse model of aganglionic megacolon was developed by treating the colon tissue with 0.5 % benzalkonium chloride (BAC) to selectively remove the myenteric nerve plexus that resembles the pathological changes in the human congenital megacolon. The NSCs stably expressing the EDNRB and GDNF genes were transplanted into the benzalkonium chloride-induced mouse aganglionic colon. Survival and differentiation of the implanted stem cells were assessed after transplantation. Results showed that the EDNRB and GDNF genes were able to be expressed in primary culture of NSCs by adenovirus infection. One week after implantation, grafted NSCs survived and differentiated into neurons. Compared to the controls, elevated expression of EDNRB and GDNF was determined in BAC-induced aganglionic megacolon mice with partially improved intestinal function. Those founding indicated that the genes transfected into NSCs were expressed in vivo after transplantation. Also, this study provided favorable support for the therapeutic potential of multiple gene-modified NSC transplantation to treat Hirschsprung's disease, a congenital disorder of the colon in which ganglion cells are absent.
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Apuzzo MLJ, Pagán VM, Faccio R, Liu CY. A Bosphorus submarine passage and the reinvention of neurosurgery. World Neurosurg 2012. [PMID: 23177761 DOI: 10.1016/j.wneu.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.
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Affiliation(s)
- Michael L J Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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8
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[Rhesus monkey embryonic stem cells differentiation, proliferation and allotransplantation]. DONG WU XUE YAN JIU = ZOOLOGICAL RESEARCH 2012; 33:43-8. [PMID: 22345007 DOI: 10.3724/sp.j.1141.2012.01043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate the characteristics of rhesus monkey embryonic stem cells and to promote their clinical application, the differentiation and proliferation of rosettes neural stem cells from GFP marked rhesus monkey embryonic stem cells were studied The results showed that: 1) A stable and high-efficient neural differentiation system was established. More than 95% of the embryonic stem cells were differentiated into neural stem cells on the 12(th) days of differentiation; 2) the rosettes neural stem cells differentiated from the rhesus monkey embryonic stem cells could maintain their rosettes-shape by proliferating with bFGF/EGF; 3) the neural stem cells could differentiate into neurons after transplanted into the rhesus monkey brain. In conclusion, the rosettes neural stem cells differentiated from rhesus monkey embryonic stem cells could maintain their characteristics after proliferation with bFGF/EGF and they could survive and differentiate into neurons after transplanted into the rhesus monkey brain, which strongly supports the clinical application of neural stem cells in the future.
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Lundberg J, Södersten E, Sundström E, Le Blanc K, Andersson T, Hermanson O, Holmin S. Targeted Intra-arterial Transplantation of Stem Cells to the Injured CNS is more Effective than Intravenous Administration: Engraftment is Dependent on Cell Type and Adhesion Molecule Expression. Cell Transplant 2012; 21:333-43. [DOI: 10.3727/096368911x576036] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Stem cell transplantation procedures using intraparenchymal injections cause tissue injury in addition to associated surgical risks. Intravenous cell administration give engraftment in parenchymal lesions although the method has low efficacy and specificity. In pathological conditions with inflammation, such as traumatic brain injury, there is a transient up-regulation of ICAM-1 and VCAM-1 which might provide environmental cues for migration of stem cells from blood to parenchyma. The aim of this study was to i) analyze the effect of intra-arterial administration on cellular engraftment, ii) compare engraftment and side effects between three different stem cell systems, and iii) analyze gene expression in these three systems. We performed specific intra-arterial transplantations with human mesenchymal stem cells (hMSCs), human neural progenitor cells (hNPCs), and rat neural progenitor cells (rNPCs) in a rat model of traumatic brain injury. These results were compared to the intravenous route for each cell type, respectively. Analysis of engraftment and recipient characterization was performed by immunohistochemistry. We further characterized the different types of cells by microarray and RT-qPCR analysis. Specific intra-arterial transplantations produced significantly higher engraftment compared to intravenous transplantation with hMSCs and rNPCs. No engraftment was detected after intra-arterial or intravenous administration of hNPCs. Characterization of integrin expression indicated that CD49dVCAM-1 and possibly ICAM-1 interactions through CD18 and CD11a, respectively, are important for engraftment after intravascular cell administration. No side effects, such as thromboembolic complications, were detected. When translating stem cell therapies to clinical practice, the route of transplantation and the properties of the cell lines (homing, diapedesis, and migration) become important. This study supports the use of selective intra-arterial transplantation for improving engraftment after traumatic brain injury. In addition, we conclude that careful analysis of cells intended for local, intra-arterial transplantation with respect to integrin expression is important.
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Affiliation(s)
- Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Södersten
- DBRM, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Sundström
- Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stiftelsen Stockholms Sjukhem, Stockholm, Sweden
| | - Katarina Le Blanc
- Department of Laboratory Medicine, Division of Clinical Immunology, Karolinska Institutet, Stockholm, Sweden
- Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Hermanson
- DBRM, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Abstract
The major efforts to selectively deliver drugs to the brain in the past decade have relied on smart molecular techniques to penetrate the blood-brain barrier, whereas intraarterial drug delivery has drawn relatively little attention. Meanwhile, rapid progress has been made in the field of endovascular surgery. Modern endovascular procedures can permit highly targeted drug delivery by the intracarotid route. Intracarotid drug delivery can be the primary route of drug delivery or it could be used to facilitate the delivery of smart neuropharmaceuticals. There have been few attempts to systematically understand the kinetics of intracarotid drugs. Anecdotal data suggest that intracarotid drug delivery is effective in the treatment of cerebral vasospasm, thromboembolic strokes, and neoplasms. Neuroanesthesiologists are frequently involved in the care of such high-risk patients. Therefore, it is necessary to understand the applications of intracarotid drug delivery and the unusual kinetics of intracarotid drugs.
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Affiliation(s)
- Shailendra Joshi
- Department of Anesthesiology, PH 505, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, New York 10032, USA.
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11
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Tao K, Chen J, Wang G, Shu X. Culture and identification of monoclonal neural stem cells derived from cerebral cortex. ACTA ACUST UNITED AC 2008; 26:451-4. [PMID: 17120746 DOI: 10.1007/s11596-006-0419-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To isolate and culture the purified monoclonal neural stem cells from the cerebral cortex of new born mice, new-born mice cerebral cortex was isolated and dissociated to single-cell suspension by mechanical trituration. The dissociated single cells were cultured in serum-free medium. After the formation of neurospheres, single-cell clone culture was performed by limiting dilution and the proliferated single-cell clones were harvested for subculture. Immunocytochemistry was used to detect the specific marker of neuroepithelial stem cells (Nestin) of the primary and monoclonal neurospheres. In the differentiated cells we detected the specific antigen of NF-200 and GFAP. Our results showed that the primary neurospheres expressed Nestin antigen positively. By limiting dilution, we cultured the cell lines from single-cell clone and the monoclonal neurospheres expressed Nestin and had capabilities of self-renewal, proliferation and the potentiality of differentiation into neurons and glial cells. It is concluded that monoclonal neural stem cells which have the ability of proliferation and multi-directional differentiation can be isolated and cultured from the cerebral cortex of new-born mice by limiting dilution.
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Affiliation(s)
- Kaixiong Tao
- Department of Laparoscopic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Elder JB, Hoh DJ, Oh BC, Heller AC, Liu CY, Apuzzo ML. THE FUTURE OF CEREBRAL SURGERY. Neurosurgery 2008; 62:1555-79; discussion 1579-82. [DOI: 10.1227/01.neu.0000333820.33143.0d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Elder JB, Liu CY, Apuzzo MLJ. Neurosurgery in the realm of 10(-9), part 1: stardust and nanotechnology in neuroscience. Neurosurgery 2008; 62:1-20. [PMID: 18300888 DOI: 10.1227/01.neu.0000311058.80249.6b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nanotechnology as a science has evolved from notions and speculation to emerge as a prominent combination of science and engineering that stands to impact innumerable aspects of technology. Medicine in general and neurosurgery in particular will benefit greatly in terms of improved diagnostic and therapeutic capabilities. The recent explosion in nanotechnology products, including diverse applications such as beauty products and medical contrast agents, has been accompanied by an ever increasing volume of literature. Recent articles from our institution provided an historical and scientific background of nanotechnology, with a purposeful focus on nanomedicine. Future applications of nanotechnology to neuroscience and neurosurgery were briefly addressed. The present article is the first of two that will further this discussion by providing specific details of current nanotechnology applications and research related to neuroscience and clinical neurosurgery. This article also provides relevant perspective in scale, history, economics, and toxicology. Topics of specific importance to developments or advances of technologies used by neuroscientists and neurosurgeons are presented. In addition, advances in the field of microelectromechanical systems technology are discussed. Although larger than nanoscale, microelectromechanical systems technologies will play an important role in the future of medicine and neurosurgery. The second article will discuss current nanotechnologies that are being, or will be in the near future, incorporated into the armamentarium of the neurosurgeon. The goal of these articles is to keep the neuroscience community abreast of current developments in nanotechnology, nanomedicine, and, in particular, nanoneurosurgery, and to present possibilities for future applications of nanotechnology. As applications of nanotechnology permeate all forms of scientific and medical research, clinical applications will continue to emerge. Physicians of the present and future must take an active role in shaping the design and research of nanotechnologies to ensure maximal clinical relevance and patient benefit.
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Affiliation(s)
- James B Elder
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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15
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Jeon YI, Kwon DH. Current status and future prospect of endovascular neurosurgery. J Korean Neurosurg Soc 2008; 43:69-78. [PMID: 19096608 DOI: 10.3340/jkns.2008.43.2.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 01/21/2008] [Indexed: 12/22/2022] Open
Abstract
Recently, due to the evolution of technology, the field of neurosurgery is receiving spotlight. In particular endovascular neurosurgery has gained a great interest along with the advancement of the modern neurosurgery. The most remarkable advances were made in embolization of the cerebral aneurysms, arteriovenous malformations and intracranial stenosis during the past 10 years. These advances will further change the role of neurosurgeons in treating cerebrovascular disease. Because interventional neuroradiologists have performed most of procedures in the past, neurosurgeons have been deprived of chances to learn endovascular procedure. This article discusses the development of technological aspect of endovascular neurosurgery in chronological order. By understanding the history and current status of the endovascular surgery, the future of neurosurgery will be promising.
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Affiliation(s)
- Young Il Jeon
- Department of Neurosurgery , Gil Hospital, Gachon University of Science and Medicine, Incheon, Korea
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16
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Lee PH, Kim JW, Bang OY, Ahn YH, Joo IS, Huh K. Autologous mesenchymal stem cell therapy delays the progression of neurological deficits in patients with multiple system atrophy. Clin Pharmacol Ther 2007; 83:723-30. [PMID: 17898702 DOI: 10.1038/sj.clpt.6100386] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We evaluated the feasibility and safety of therapy with mesenchymal stem cells (MSCs) through consecutively intra-arterial and three repeated intravenous injections and compared the long-term prognosis between MSC-treated (n=11) and control multiple system atrophy (MSA) patients (n=18). The MSC-treated patients showed significantly greater improvement on the unified MSA rating scale (UMSARS) than the control patients at all visits throughout the 12-month study period. Orthostasis in UMSARS I items and cerebellar dysfunction-related items of UMSARS II items were significantly different in favor of MSC treatment compared to controls. Serial positron emission tomography scan in the MSC-treated group showed that increased fluorodeoxyglucose uptake from baseline was noted in cerebellum and frontal white matters. No serious adverse effects related to MSC therapy occurred. This study demonstrated that MSC therapy in patients with MSA was safe and delayed the progression of neurological deficits with achievement of functional improvement in the follow-up period.
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Affiliation(s)
- P H Lee
- Department of Neurology, Ajou University College of Medicine, Suwon, South Korea.
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Mukhida K, Shilpakar SK, Sharma MR, Bagan M. Neurosurgery at Tribhuvan University Teaching Hospital, Nepal. Neurosurgery 2005; 57:172-80; discussion 172-80. [PMID: 15987553 DOI: 10.1227/01.neu.0000163429.92507.d4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 02/16/2005] [Indexed: 11/19/2022] Open
Abstract
February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.
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Affiliation(s)
- Karim Mukhida
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
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18
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Liu CY, Wang MY, Apuzzo MLJ. The evolution and future of minimalism in neurological surgery. Childs Nerv Syst 2004; 20:783-9. [PMID: 15503058 DOI: 10.1007/s00381-004-0931-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The evolution of the field of neurological surgery has been marked by a progressive minimalism. This has been evident in the development of an entire arsenal of modern neurosurgical enterprises, including microneurosurgery, neuroendoscopy, stereotactic neurosurgery, endovascular techniques, radiosurgical systems, intraoperative and navigational devices, and in the last decade, cellular and molecular adjuvants. AIMS In addition to reviewing the major developments and paradigm shifts in the cyclic reinvention of the field as it currently stands, this paper attempts to identify forces and developments that are likely to fuel the irresistible escalation of minimalism into the future. These forces include discoveries in computational science, imaging, molecular science, biomedical engineering, and information processing as they relate to the theme of minimalism. DISCUSSION These areas are explained in the light of future possibilities offered by the emerging field of nanotechnology with molecular engineering.
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Affiliation(s)
- Charles Y Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, KAM 415, Los Angeles, CA 90033, USA
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Abstract
Traditionally neural transplantation has had as its central tenet the replacement of missing neurons that have been lost because of neurodegenerative processes, as exemplified by diseases such as Parkinson disease (PD). However, the effectiveness and widespread application of this approach clinically has been limited, primarily because of the poor donor supply of human fetal neural tissue and the incomplete neurobiological understanding of the circuit reconstruction required to normalize function in these diseases. So, in PD the progress from promising neural transplantation in animal models to proof-of-principle, open-labeled clinical transplants, to randomized, placebo-controlled studies of neural transplantation has not been straightforward. The emergence of previously undescribed adverse effects and lack of significant functional advantage in recent clinical studies has been disappointing and has served to cast a new, and perhaps more realistic, perspective on this treatment approach. In fact, there have been calls by some involved in neural transplantation to return to the drawing board before pressing on with further clinical trials, and the return to basic experimentation. This therefore precipitates the question - is there a future for neural transplantation? It is important to remember that there are a number of possible explanations for the disappointing results from the recent clinical trials in PD, ranging from the mode of transplantation to patient selection. Nevertheless, almost irrespective of these reasons for the current trial results, there have always been significant practical and ethical problems with using human fetal tissue, and so a number of alternative cell sources have been investigated. These alternative sources include stem cells, which are attractive for cell-based therapies because of their potential ease of isolation, propagation and manipulation, and their ability in some cases to migrate to areas of pathology and differentiate into specific and appropriate cell types. Furthermore, the availability of stem cells derived from non-embryonic sources (e.g. adult stem cells derived from the sub-ventricular zone) has removed some of the ethical limitations associated with the use of embryonic human tissue. These potentially beneficial aspects of stem cells means that there is a future for neural transplantation as a means of treating patients with a range of neurological disorders, although whether this will ever translate into a truly effective, widely available therapy remains unknown.
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Abstract
This article focuses on molecular imaging of novel cell-based therapies, particularly stem cell therapies and the adoptive transfer of immunocytes. The animal models,potential clinical applications, and likely future prospects of these therapies are discussed in the context of imaging.
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Affiliation(s)
- Dawid Schellingerhout
- Department of Radiology, Center for Molecular Imaging Research, Massachusetts General Hospital, Room 5403, Building 149, 13th Street, Charlestown, MA 02129, USA.
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Neuwelt EA. Mechanisms of Disease: The Blood-Brain Barrier. Neurosurgery 2004; 54:131-40; discussion 141-2. [PMID: 14683550 DOI: 10.1227/01.neu.0000097715.11966.8e] [Citation(s) in RCA: 240] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2003] [Accepted: 09/03/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The blood-brain barrier (BBB) is often perceived as a passive membrane. However, evidence has demonstrated that the BBB plays an active role in normal homeostasis and in certain disease processes. METHODS Approximately 300 peer-reviewed publications that discussed normal or abnormal BBB function were reviewed. RESULTS The role of the BBB and how it contributes to disorders of the central nervous system vary, depending on the specific disease process. CONCLUSION In health and disease and extending to old age, endothelial cells, neurons, and glia constitute a neurovascular unit that regulates the BBB. Advances toward penetrating the BBB must account for both normal and abnormal functions of the neurovascular unit.
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Affiliation(s)
- Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon 97201, USA.
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22
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Abstract
The discovery of neural stem cells (NSCs) has changed our long-held view that the adult mammalian central nervous system (CNS) is postmitotic and lacks the capability for self-repair. The role of NSCs in physiological and pathological processes in the brain is slowly emerging. We are now able to isolate, expand, genetically engineer and transplant NSCs. An important characteristic of NSCs, not fully understood so far, is their migratory ability and their tropism to brain pathology. The migratory ability of NSCs and their capacity to differentiate into all neural phenotypes gives us a potentially powerful tool for the treatment of both diffuse and localised neurologic disorders. The delivery of gene products by NSCs to specific sites in the CNS can maximise the efficiency of delivery and minimise the unwanted exposure of surrounding intact tissue. Here, the recent preclinical advances in the use of NSCs for the delivery of therapeutic products are reviewed, in particular the employment of their migratory potential and the homing ability to pathology in the nervous system.
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Affiliation(s)
- Peter Kabos
- Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Ste. 800E, 8631 W 3rd St, Los Angeles, CA 90048, USA
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