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López-Ornelas A, Escobedo-Avila I, Ramírez-García G, Lara-Rodarte R, Meléndez-Ramírez C, Urrieta-Chávez B, Barrios-García T, Cáceres-Chávez VA, Flores-Ponce X, Carmona F, Reynoso CA, Aguilar C, Kerik NE, Rocha L, Verdugo-Díaz L, Treviño V, Bargas J, Ramos-Mejía V, Fernández-Ruiz J, Campos-Romo A, Velasco I. Human Embryonic Stem Cell-Derived Immature Midbrain Dopaminergic Neurons Transplanted in Parkinsonian Monkeys. Cells 2023; 12:2738. [PMID: 38067166 PMCID: PMC10706241 DOI: 10.3390/cells12232738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Human embryonic stem cells (hESCs) differentiate into specialized cells, including midbrain dopaminergic neurons (DANs), and Non-human primates (NHPs) injected with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine develop some alterations observed in Parkinson's disease (PD) patients. Here, we obtained well-characterized DANs from hESCs and transplanted them into two parkinsonian monkeys to assess their behavioral and imaging changes. DANs from hESCs expressed dopaminergic markers, generated action potentials, and released dopamine (DA) in vitro. These neurons were transplanted bilaterally into the putamen of parkinsonian NHPs, and using magnetic resonance imaging techniques, we calculated the fractional anisotropy (FA) and mean diffusivity (MD), both employed for the first time for these purposes, to detect in vivo axonal and cellular density changes in the brain. Likewise, positron-emission tomography scans were performed to evaluate grafted DANs. Histological analyses identified grafted DANs, which were quantified stereologically. After grafting, animals showed signs of partially improved motor behavior in some of the HALLWAY motor tasks. Improvement in motor evaluations was inversely correlated with increases in bilateral FA. MD did not correlate with behavior but presented a negative correlation with FA. We also found higher 11C-DTBZ binding in positron-emission tomography scans associated with grafts. Higher DA levels measured by microdialysis after stimulation with a high-potassium solution or amphetamine were present in grafted animals after ten months, which has not been previously reported. Postmortem analysis of NHP brains showed that transplanted DANs survived in the putamen long-term, without developing tumors, in immunosuppressed animals. Although these results need to be confirmed with larger groups of NHPs, our molecular, behavioral, biochemical, and imaging findings support the integration and survival of human DANs in this pre-clinical PD model.
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Affiliation(s)
- Adolfo López-Ornelas
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
- División de Investigación, Hospital Juárez de México, Mexico City 07760, Mexico
| | - Itzel Escobedo-Avila
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (L.V.-D.); (J.F.-R.)
- Unidad Periférica de Neurociencias, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico;
| | - Gabriel Ramírez-García
- Unidad Periférica de Neurociencias, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico;
| | - Rolando Lara-Rodarte
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
| | - César Meléndez-Ramírez
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
| | - Beetsi Urrieta-Chávez
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
| | - Tonatiuh Barrios-García
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey 64710, Mexico; (T.B.-G.); (V.T.)
| | - Verónica A. Cáceres-Chávez
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
| | - Xóchitl Flores-Ponce
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
| | - Francia Carmona
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del IPN (Cinvestav), Mexico City 07360, Mexico; (F.C.); (L.R.)
| | - Carlos Alberto Reynoso
- Molecular Imaging PET-CT Unit, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico; (C.A.R.); (C.A.); (N.E.K.)
| | - Carlos Aguilar
- Molecular Imaging PET-CT Unit, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico; (C.A.R.); (C.A.); (N.E.K.)
| | - Nora E. Kerik
- Molecular Imaging PET-CT Unit, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico; (C.A.R.); (C.A.); (N.E.K.)
| | - Luisa Rocha
- Departamento de Farmacobiología, Centro de Investigación y de Estudios Avanzados del IPN (Cinvestav), Mexico City 07360, Mexico; (F.C.); (L.R.)
| | - Leticia Verdugo-Díaz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (L.V.-D.); (J.F.-R.)
| | - Víctor Treviño
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey 64710, Mexico; (T.B.-G.); (V.T.)
| | - José Bargas
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
| | - Verónica Ramos-Mejía
- Gene Regulation, Stem Cells, and Development Group, GENYO-Centre for Genomics and Oncological Research Pfizer, University of Granada, Andalusian Regional Government, PTS, 18016 Granada, Spain;
| | - Juan Fernández-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (L.V.-D.); (J.F.-R.)
| | - Aurelio Campos-Romo
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (L.V.-D.); (J.F.-R.)
- Unidad Periférica de Neurociencias, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico;
| | - Iván Velasco
- Instituto de Fisiología Celular—Neurociencias, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico; (A.L.-O.); (I.E.-A.); (R.L.-R.); (C.M.-R.); (B.U.-C.); (V.A.C.-C.); (X.F.-P.); (J.B.)
- Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City 14269, Mexico
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Contreras Lopez WO, Navarro PA, Gouveia FV, Fonoff ET, Lebrun I, Auada AVV, Lopes Alho EJ, Martinez RCR. Directional Deep Brain Stimulation of the Posteromedial Hypothalamus for Refractory Intermittent Explosive Disorder: A Case Series Using a Novel Neurostimulation Device and Intraoperative Microdialysis. World Neurosurg 2021; 155:e19-e33. [PMID: 34325026 DOI: 10.1016/j.wneu.2021.07.086] [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: 05/17/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intermittent explosive disorder (IED) is a psychiatric disorder characterized by recurrent outbursts of aggressive behavior. Deep brain stimulation (DBS) in the posteromedial nucleus of the hypothalamus (pHyp) is an alternative therapy for extreme cases and shows promising results. Intraoperative microdialysis can help elucidate the neurobiological mechanism of pHyp-DBS. We sought to evaluate efficacy and safety of pHyp-DBS using 8-contact directional leads in patients with refractory IED (rIED) and the accompanying changes in neurotransmitters. METHODS This was a prospective study in which patients with a diagnosis of rIED were treated with pHyp-DBS for symptom alleviation. Bilateral pHyp-DBS was performed with 8-contact directional electrodes. Follow-up was performed at 3, 6, and 12 months after surgery. RESULTS Four patients (3 men, mean age 27 ± 2.8 years) were included. All patients were diagnosed with rIED and severe intellectual disability. Two patients had congenital rubella, one had a co-diagnosis of infantile autism, and the fourth presented with drug-resistant epilepsy. There was a marked increase in the levels of gamma-aminobutyric acid and glycine during intraoperative stimulation. The average improvement in aggressive behavior in the last follow-up was 6 points (Δ: 50%, P = 0.003) while also documenting an important improvement of the Short Form Health Survey in all domains except bodily pain. No adverse events associated with pHyp-DBS were observed. CONCLUSIONS This is the first study to show the safety and beneficial effect of directional lead pHyp-DBS in patients with rIED and to demonstrate the corresponding mechanism of action through increases in gamma-aminobutyric acid and glycine concentration in the pHyp.
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Affiliation(s)
- William Omar Contreras Lopez
- Nemod Research Group, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia; Division of Functional Neurosurgery, Department of Neurosurgery, FOSCAL Clinic, Bucaramanga, Colombia.
| | - Paula Alejandra Navarro
- Division of Functional Neurosurgery, Department of Neurosurgery, FOSCAL Clinic, Bucaramanga, Colombia; Department of Epidemiology, School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo School of Medicine and Integrated Clinic of Neuroscience, São Paulo, Brazil
| | - Ivo Lebrun
- Biochemistry and Biophysics Laboratory, Butantan Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Aline V V Auada
- Biochemistry and Biophysics Laboratory, Butantan Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Joaquim Lopes Alho
- Department of Neurology, University of São Paulo School of Medicine and Integrated Clinic of Neuroscience, São Paulo, Brazil
| | - Raquel C R Martinez
- LIM 23, Institute of Psychiatry, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil; Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil
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de Andrade EM, Martinez RCR, Pagano RL, Lopes PSS, Auada AVV, Gouveia FV, Antunes GF, Assis DV, Lebrun I, Fonoff ET. Neurochemical effects of motor cortex stimulation in the periaqueductal gray during neuropathic pain. J Neurosurg 2019; 132:239-251. [PMID: 30611141 DOI: 10.3171/2018.7.jns173239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/24/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Motor cortex stimulation (MCS) is a neurosurgical technique used to treat patients with refractory neuropathic pain syndromes. MCS activates the periaqueductal gray (PAG) matter, which is one of the major centers of the descending pain inhibitory system. However, the neurochemical mechanisms in the PAG that underlie the analgesic effect of MCS have not yet been described. The main goal of this study was to investigate the neurochemical mechanisms involved in the analgesic effect induced by MCS in neuropathic pain. Specifically, we investigated the release of γ-aminobutyric acid (GABA), glycine, and glutamate in the PAG and performed pharmacological antagonism experiments to validate of our findings. METHODS Male Wistar rats with surgically induced chronic constriction of the sciatic nerve, along with sham-operated rats and naive rats, were implanted with both unilateral transdural electrodes in the motor cortex and a microdialysis guide cannula in the PAG and subjected to MCS. The MCS was delivered in single 15-minute sessions. Neurotransmitter release was evaluated in the PAG before, during, and after MCS. Quantification of the neurotransmitters GABA, glycine, and glutamate was performed using a high-performance liquid chromatography system. The mechanical nociceptive threshold was evaluated initially, on the 14th day following the surgery, and during the MCS. In another group of neuropathic rats, once the analgesic effect after MCS was confirmed by the mechanical nociceptive test, rats were microinjected with saline or a glycine antagonist (strychnine), a GABA antagonist (bicuculline), or a combination of glycine and GABA antagonists (strychnine+bicuculline) and reevaluated for the mechanical nociceptive threshold during MCS. RESULTS MCS reversed the hyperalgesia induced by peripheral neuropathy in the rats with chronic sciatic nerve constriction and induced a significant increase in the glycine and GABA levels in the PAG in comparison with the naive and sham-treated rats. The glutamate levels remained stable under all conditions. The antagonism of glycine, GABA, and the combination of glycine and GABA reversed the MCS-induced analgesia. CONCLUSIONS These results suggest that the neurotransmitters glycine and GABA released in the PAG may be involved in the analgesia induced by cortical stimulation in animals with neuropathic pain. Further investigation of the mechanisms involved in MCS-induced analgesia may contribute to clinical improvements for the treatment of persistent neuropathic pain syndromes.
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Affiliation(s)
- Emerson Magno de Andrade
- 1Department of Neurology, School of Medicine, University of São Paulo
- 2Laboratory of Neuroscience, Hospital Sirio-Libanes; and
| | | | | | | | - Aline V V Auada
- 3Biochemistry and Biophysics Laboratory, Butantan Institute, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Ivo Lebrun
- 3Biochemistry and Biophysics Laboratory, Butantan Institute, University of São Paulo, São Paulo, Brazil
| | - Erich T Fonoff
- 1Department of Neurology, School of Medicine, University of São Paulo
- 2Laboratory of Neuroscience, Hospital Sirio-Libanes; and
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