硫化氢与脊髓损伤治疗

脊髓损伤(spinal cord injury,SCI)是一种由于脊髓外部损伤或内部病变引起的暂时性或永久性的功能损伤,其症状包括肌肉功能损伤、自主运动功能减退或丧失等。目前,流行病学调查发现,我国SCI患病率较高,具有较高的社会和医疗负担。因此,合理引导SCI病人进行治疗和康复尤为重要。硫化氢（hydrogen sulfide,H2S）是一种重要的神经信号分子,近年来H2S对SCI康复的作用机制逐渐成为研究热点,例如一些国内外研究团队对SCI后缺血-再灌注损伤（ischemia reperfusion injury,I/R injury）、降低SCI后氧化应激及抗炎作用等机制,以及SCI康复临床治疗研究均取得了一定的成果。本文通过H2S对SCI康复的机制研究和临床治疗发展进行综述,旨在为后续研究及临床应用提供参考。     

免疫细胞在脊髓损伤后炎性微环境中的作用

脊髓损伤(spinal cord injury, SCI)的治疗和康复一直是临床医学领域的重大难题。现代医学虽然显著提高了脊髓损伤患者的存活率,然而在改善患者损伤神经功能方面进展甚微,其原因主要在于脊髓损伤后复杂的病理生理变化。在脊髓损伤的病理过程中,原发性损伤对脊髓神经结构的伤害难以逆转,因此目前国内外研究治疗脊髓损伤的方法主要围绕减轻继发性损伤和促进再生来开展。SCI后炎症反应始终存在,这与免疫细胞在炎症反应的不同时间、不同损伤部位发挥不同作用密切相关。该文就免疫细胞在SCI后炎症微环境中的作用做一简要综述。     

生长因子修复脊髓损伤的疗效及其机制

脊髓损伤(spinal cord injury,SCI)是神经系统最严重的创伤之一,其所造成的高致残率和严重并发症,给个人、家庭和社会均造成巨大负担。脊髓损伤后,由于原发性损伤和继发性损伤等一系列病理变化,使轴突再生和受损神经元的重塑变得非常困难,其中微环境的紊乱是导致二次损伤恢复的主要障碍。脊髓损伤治疗的药物选择对于其预后有较大影响。其中,生长因子(growth factors,GFs)在中枢神经系统发育与损伤修复中具有重要的调控作用。目前,利用GFs干预治疗锯齿动物SCI后的结构和功能恢复方面,包括神经发生、轴突生长、神经保护和再生,促进血管生成、组织修复、保护内源性神经干细胞等方面已取得较为满意的效果,为SCI的临床治疗提供了良好的应用前景。随着对GFs的研究深入,单一的GFs难以满足脊髓损伤后复杂的生理病理变化。因此,探索多种GFs的联合应用以期达到协同的神经再生和功能恢复,是目前治疗SCI的重要策略之一。由于GFs是大分子蛋白质类药物,存在半衰期短,以及原位注射在损伤部位易流失等缺点限制了GFs的临床应用。因此,很多研究将GFs结合不同生物材料治疗SCI,以此克服GFs本身的缺陷,并进一步延长该类药物的修复效果。本综述归纳总结了几种典型的GFs对SCI修复的研究进展和可能的作用机制,并展望不同的生物材料结合GFs提高SCI修复效果的未来发展前景。     

白藜芦醇对脊髓损伤小鼠神经元凋亡及Fas/FasL等凋亡相关蛋白表达的影响

摘要 目的：研究白藜芦醇对脊髓损伤（Spinal cord injury, SCI）小鼠脊髓组织神经元凋亡和凋亡相关蛋白表达的影响。方法：21只雌性C57BL/6小鼠,6-8周龄,随机分为三组：Sham组（假手术对照组）,SCI组（脊髓损伤模型）和Resveratrol组（白藜芦醇治疗的脊髓损伤模型）,每组7只。通过Basso小鼠量表（BMS）评估小鼠后肢运动功能、HE染色评估小鼠脊髓病变面积、尼氏染色检测脊髓组织神经元数目、TUNEL染色检测凋亡细胞数目。通过酶联免疫试剂盒检测脊髓组织髓过氧化物酶（myeloperoxidase,MPO）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素（interleukin, IL）-6和IL-8蛋白表达水平。通过免疫印迹法检测脊髓组织凋亡相关蛋白Fas、FasL、caspase 3和caspase 8表达水平。结果：与Sham组小鼠相比,SCI模型小鼠脊髓组织病变面积和MPO活性均显著增加（P<0.05）,但经白芦藜醇治疗后的Resveratrol组SCI小鼠脊髓组织病变面积和MPO活性较SCI组小鼠显著降低（P<0.05）。与Sham组小鼠相比,SCI模型小鼠BMS评分显著降低（P<0.05）,但经白芦藜醇治疗后的Resveratrol组SCI小鼠BMS评分较SCI组小鼠显著升高（P<0.05）。与Sham组小鼠相比,SCI模型小鼠脊髓组织神经元丢失和凋亡均显著增加（P<0.05）,但经白芦藜醇治疗后的Resveratrol组SCI小鼠脊髓组织病神经元丢失和凋亡较SCI组小鼠显著降低（P<0.05）。与Sham组小鼠相比,SCI模型小鼠脊髓组织Fas、FasL、caspase 3、caspase 8、TNF-α、IL-6和IL-8蛋白表达水平均显著升高（P<0.05）,但经白芦藜醇治疗后均显著降低（P<0.05）。结论：白芦藜醇可显著降低脊髓损伤小鼠脊髓组织神经元凋亡,其机制可能与抑制脊髓损伤小鼠脊髓组织炎症和炎症引起的凋亡蛋白表达有关。     

急性脊髓损伤的药物治疗进展概况

脊髓损伤(spinal cord injury,SCI)是临床上常见的一种创伤性疾病。随着社会的发展呈现上升的趋势,其来源主要有交通事故,工伤,坠落伤,暴力伤,运动损伤,积累性损伤等。传统的手术治疗是围绕脊柱的骨性结构进行椎管减压、脊柱稳定性的重建,并不能解决瘫痪的主要原因-脊髓损伤问题,预后并不理想。近年来国内外学者都在对SCI进行深入研究,想要找到SCI的根本机制,从而能针对性的研究出能改变SCI患者预后的药物。本文就对脊髓损伤目前的常用治疗药物做一篇综述。     

铁死亡参与脊髓损伤调控的研究进展

铁死亡是一种铁依赖性的,以细胞内脂质活性氧堆积为特征的细胞程序性死亡方式。广泛存在于肿瘤、癌症、急性肾损伤等多种疾病当中。脊髓损伤(spinal cord injury, SCI) 是一种严重的创伤性神经系统疾病,具有高发病率、高死亡率、高致残率的特点。目前,脊髓损伤的具体发生机制及高效治疗方法仍在探索当中,这也是亟待解决的世界性难题。研究表明,脊髓损伤后调控神经细胞的程序性死亡是治疗SCI的重点。然而,对于铁死亡参与脊髓损伤的分子生物学机制尚缺乏系统和深入的认识。收集和整理了近几年国内外有关脊髓损伤后铁死亡方面的相关文献,针对铁死亡参与脊髓损伤的调控机制和研究进展进行了综述,以期为治疗脊髓损伤带来新的思路。     

肠道菌群在脊髓损伤后胃肠道炎症反应中的研究进展

脊髓损伤(spinal cord injury, SCI)目前尚无有效的治疗手段。脊髓损伤后,患者常伴有严重的胃肠功能障碍,严重影响患者的生活质量。研究发现,脊髓损伤后肠道菌群的紊乱和脊髓损伤后的胃肠道功能障碍密切相关。因此,本文围绕脊髓损伤后肠道菌群的变化,探讨肠道菌群在迷走神经、下丘脑-垂体-肾上腺和肠道菌群代谢物3个途径中发挥的作用,及与胃肠道炎症反应相关的研究进展。     

热休克蛋白在脊髓损伤中的研究进展

脊髓损伤(spinal cord injury, SCI)可造成损伤平面以下神经功能障碍,严重影响患者的生活质量。热休克蛋白(heat shock proteins, HSPs)是机体受到应激后保护细胞或组织,使其免受进一步伤害的重要分子之一,在脊髓损伤后表达升高,并通过促进血管生成、抑制炎症反应、抑制神经元凋亡、抗氧化应激等作用减缓脊髓损伤的进一步加重。本文主要就脊髓损伤后热休克蛋白的产生及其作用机制的研究进展进行综述,为后续相关研究提供参考。     

姜黄素对大鼠脊髓损伤后后肢功能恢复的作用机制

目的:观察姜黄素(CUR)对大鼠脊髓损伤后的运动功能的影响,并探讨其对大鼠脊髓损伤的神经保护作用机制,为临床治疗脊髓损伤提供理论和实验依据。方法:采用HI-0400脊髓打击器制备脊髓急性打击损伤动物模型。将105只SD健康清洁级大鼠随机分为3组:假手术组(Sham)、脊髓损伤组(SCI)、姜黄素组(SCI+CUR),在脊髓损伤模型建立后30 min灌胃,以后每天灌胃1次,直到处死为止。SCI+CUR组0.5%羧甲基纤维素钠制备姜黄素(100 mg/kg)灌胃,Sham组与SCI组同等剂量的0.5%羧甲基纤维素钠灌胃。应用BBB评分评估大鼠术后3d,7 d,14 d,21 d和28 d后肢运动功能恢复的情况;分别在术后12 h、1 d、3 d和7 d天取脊髓组织和血液,通过免疫荧光法检测NF-κB,免疫组化发检测Bcl-2、Bax及Caspase-3蛋白,Elisa法检测Bcl-2、Bax蛋白的表达。结果 :BBB评分中3 d时SCI+CUR组与SCI组时无明显差异,7 d、14 d、21 d和28 d SCI+CUR组得分高于SCI组,其差异具有统计学意义(P0.05);炎症因子NF-κB的表达于脊髓损伤后12 h出现,1 d达高峰,3 d下降。SCI+CUR组中NF-κB在各个时间点的表达与SCI组出现的时间点相对应,SCI+CUR组少于SCI组;Sham组无明显的Bax及Bcl-2蛋白染色。SCI+CUR组中Caspase-3及Bax染色明显较SCI组减弱,而Bcl-2较SCI组增强。结论:姜黄素可以促进大鼠脊髓损伤后后肢运动功能的恢复,其作用机制是通过抑制NF-κB而阻止炎症发生;并通过抑制Bax、Caspase-3的表达,促进Bcl-2的表达来抑制细胞凋亡,从而促进了大鼠脊髓损伤后的运动功能恢复。     

药物及靶向治疗在脊髓损伤中的治疗新进展

脊髓损伤(spinalcordinjury,SCI)是一种严重的损伤,它对患者的影响是相当持久的,SCI治疗的难点主要是由于损伤后脊髓中的微环境不利于神经细胞的再生、轴突的生长和新突触的形成,从而影响了脊髓组织的修复。现在SCI治疗的策略就是要改善损伤脊髓微环境,减少不利因素,从而促进脊髓结构修复和功能重建。本研究综述近年来逐渐发展起来的药物及靶向治疗方法,为SCI的新治疗提供参考依据,真正提高患者的生活质量。     

WJSC 6th Anniversary Special Issues（2）:Mesenchymal stem cells Mesenchymal stem cells in the treatment of spinal cord injuries:A review

With technological advances in basic research,the intricate mechanism of secondary delayed spinal cord injury(SCI)continues to unravel at a rapid pace.However,despite our deeper understanding of the molecular changes occurring after initial insult to the spinal cord,the cure for paralysis remains elusive.Current treatment of SCI is limited to early administration of high dose steroids to mitigate the harmful effect of cord edema that occurs after SCI and to reduce the cascade of secondary delayed SCI.R ecent evident-based clinical studies have cast doubt on the clinical benefit of steroids in SCI and intense focus on stem cell-based therapy has yielded some encouraging results.An array of mesenchymal stem cells(MSCs)from various sources with novel and promising strategies are being developed to improve function after SCI.In this review,we briefly discuss the pathophysiology of spinal cord injuries and characteristics and the potential sources of MSCs that can be used in the treatment of SCI.We will discuss the progress of MSCs application in research,focusing on the neuroprotective properties of MSCs.Finally,we will discuss the results from preclinical and clinical trials involving stem cell-based therapy in SCI.     

Extremely low-frequency electromagnetic fields: A possible non-invasive therapeutic tool for spinal cord injury rehabilitation

Traumatic insults to the spinal cord induce both immediate mechanical damage and subsequent tissue degeneration. The latter involves a range of events namely cellular disturbance, homeostatic imbalance, ionic and neurotransmitters derangement that ultimately result in loss of sensorimotor functions. The targets for improving function after spinal cord injury (SCI) are mainly directed toward limiting these secondary injury events. Extremely low-frequency electromagnetic field (ELF-EMF) is a possible non-invasive therapeutic intervention for SCI rehabilitation which has the potential to constrain the secondary injury-induced events. In the present review, we discuss the effects of ELF-EMF on experimental and clinical SCI as well as on biological system.     

HSP70 alleviates spinal cord injury by activating the NF-kB pathway

Objectives:Spinal cord injury (SCI) is an acute traumatic lesion of neurons in the spinal cord which has a high prevalence in the world, and has no effective surgical treatment. HSP70 is a molecular chaperone protein, serves a protective role in several different models of nervous system injury. The aim of the present study was to investigate the anti-inflammatory role of HSP70 in spinal cord injury and explore its mechanism.Methods:In vivo and in vitro models were constructed to mimic SCI. The Basso Mouse Scale (BMS) was applied to assess SCI degrees of the mouse model. Immunofluorescence (IF) was used for visualizing HSP70 and Iba1 in the spinal cord. Western blot assay was employed to quantify HSP70 and p65, and ELISA was for IL-1β and TNF-α.Results:The results showed that HSP70 expression decreased after SCI. HSP70 and Iba1 showed a decrease of co-localization in SCI mice. Further studies revealed that p65 was upregulated during the process of SCI. Overexpression of HSP70 inhibited the expression of p65 both in vitro and in vivo, and promoted the recovery of SCI mice.Conclusions:HSP70 was involved in the pathological process of spinal cord injury, HSP70 alleviated the spinal cord injury via inhibiting NF-κB signaling pathway.     

Rehabilitation management in two siblings with Von Hippel-Lindau syndrome: A case series

Von Hippel Lindau (VHL) is a hereditary multiple neoplasia syndrome. We report a case series of two siblings with Von Hippel Lindau (VHL) disease admitted to the rehabilitation department after surgical excision of Central Nervous System (CNS) haemangioblastomas. These clinical cases present rehabilitation challenges in VHL disease. We present a 39-year-old brother and his 45-year-old sister, with the diagnosis of incomplete spinal cord injury (SCI) associated with VHL syndrome lesions. The female patient was diagnosed with chronic motor incomplete cervical SCI and the male patient with acute motor incomplete thoracic SCI. Our target was to increase their functionality and improve their quality of life. Both underwent a comprehensive inpatient rehabilitation program. Programs were individualized as the female patient was admitted 15 years after her spinal cord surgical intervention, while the male patient’s admission was after 4 months of his surgery.     

Adult stem cell transplants for spinal cord injury repair: current state in preclinical research

Spinal cord injury (SCI) is a traumatic disorder resulting in a functional deficit that usually leads to severe and permanent paralysis. After the initial insult to the spinal cord, additional structure and function are lost through an active and complex secondary process. Since there is not effective treatment for SCI, several strategies including cellular, pharmacological and rehabilitation therapies have been approached in animal models. Some of them have been proved in clinical trials. In this review we focus on the current state of cell therapies, particularly on cells from adult origin, assayed in preclinical research. Cell types used in SCI therapy include Schwann cells, olfactory ensheathing cells and adult stem cells, such as neural stem cells, umbilical cord blood derived cells, mesenchymal stem cells or induced pluripotent stem cells. There are not yet conclusive evidences on which types of glial or adult stem cells are most effective in SCI treatment. Their ability to incorporate into the damaged spinal cord, to differentiate into neural lineages, to exert neuroprotective effects, to promote regeneration of damaged axons, and to improve functional deficits are still discussed, before translation towards clinical use, as a single therapy or in combination with other strategies.     

Omega-3 fatty acids and neurological injury

Studies with omega-3 polyunsaturated fatty acids (PUFA) have shown that these compounds have therapeutic potential in several indications in neurology and psychiatry. Acute spinal cord injury (SCI) is an event with devastating consequences, and no satisfactory treatment is available at present. The pathogenetic mechanisms associated with SCI include excitotoxicity, increased oxidation and inflammation. We review here our recent studies, which suggest that omega-3 PUFA have significant neuroprotective potential in spinal cord trauma. In a first study, we administered an intravenous bolus of alpha-linolenic acid (LNA) or docosahexaenoic acid (DHA) 30 min after spinal cord hemisection injury in adult rats. The omega-3 PUFA led to increased neuronal and glial survival, and a significantly improved neurological outcome. In subsequent studies, we tested DHA in a more severe compression model of SCI. We also explored a combined acute and chronic treatment regime using DHA. Saline or DHA was administered intravenously 30 min after compression of the spinal cord. After injury, the saline group received a standard control diet, whereas DHA-injected animals received either a control or a DHA-enriched diet for 6 weeks following injury. We assessed locomotor recovery and analysed markers for cell survival and axonal damage, and we also investigated the effects of the treatment on the inflammatory reaction and the oxidative stress that follow SCI. We showed that the acute DHA treatment is neuroprotective after compression SCI, even if the treatment is delayed up to an hour after injury. The DHA injection led to an increased neuronal and glial cell survival, and the effect of the DHA injection was amplified by addition of DHA to the diet. Rats treated with a DHA injection and a DHA-enriched diet performed significantly better at 6 weeks in terms of neurological outcome. The analysis of the tissue after DHA administration showed that the fatty acid significantly reduced lipid peroxidation, protein oxidation and RNA/DNA oxidation, and the induction of COX-2. Parallel studies in a facial nerve injury model in mice also showed pro-regenerative effects of chronic dietary administration of DHA after nerve lesion. These observations suggest that treatment with omega-3 PUFA could represent a promising therapeutic approach in the management of neurological injury.     

KU0063794, a Dual mTORC1 and mTORC2 Inhibitor,Reduces Neural Tissue Damage and Locomotor Impairment After Spinal Cord Injury in Mice

Autophagy is an intracellular catabolic mechanism for the degradation of cytoplasmic constituents in the autophagosomal–lysosomal pathway. This mechanism plays an important role in homeostasis and it is defective in certain diseases. Preceding studies have revealed that autophagy is developing as an important moderator of pathological responses associated to spinal cord injury (SCI) and plays a crucial role in secondary injury initiating a progressive degeneration of the spinal cord. Thus, based on this evidence in this study, we used two different selective inhibitors of mTOR activity to explore the functional role of autophagy in an in vivo model of SCI as well as to determine whether the autophagic process is involved in spinal cord tissue damage. We treated animals with a novel synthetic inhibitor temsirolimus and with a dual mTORC1 and mTORC2 inhibitor KU0063794 matched all with the well-known inhibitor of mTOR the rapamycin. Our results demonstrated that mTOR inhibitors could regulate the neuroinflammation associated to SCI and the results that we obtained evidently demonstrated that rapamycin and temsirolimus significantly diminished the expression of iNOS, COX2, GFAP, and re-established nNOS levels, but the administration of KU0063794 is able to blunt the neuroinflammation better than rapamycin and temsirolimus. In addition, neuronal loss and cell mortality in the spinal cord after injury were considerably reduced in the KU0063794-treated mice. Accordingly, taken together our results denote that the administration of KU0063794 produced a neuroprotective function at the lesion site following SCI, representing a novel therapeutic approach after SCI.     

Chondroitinase ABC treatment and the phenotype of neural progenitor cells isolated from injured rat spinal cord

The aim of the present study was to investigate whether enzyme chondroitinase ABC (ChABC) treatment influences the phenotype of neural progenitor cells (NPCs) derived from injured rat spinal cord. Adult as well as fetal spinal cords contain a pool of endogenous neural progenitors cells, which play a key role in the neuroregenerative processes following spinal cord injury (SCI) and hold particular promise for therapeutic approaches in CNS injury or neurodegenerative disorders. In our study we used in vitro model to demonstrate the differentiation potential of NPCs isolated from adult rat spinal cord after SCI, treated with ChABC. The intrathecal delivery of ChABC (10 U/ml) was performed at day 1 and 2 after SCI. The present findings indicate that the impact of SCI resulted in a decrease of all NPCs phenotypes and the ChABC treatment, on the contrary, caused an opposite effect.