Investigation on cerebrospinal fluid opioids and neurotransmitters related to spinal cord stimulation

The purpose of this study was to assess the biochemical mechanisms underlying spinal cord stimulation (SCS). Seventeen patients with chronic pain were investigated by measuring cerebrospinal fluid concentrations of endogenous opioids and biogenic amines before and during dorsal column stimulation. Basal cerebrospinal fluid beta-endorphin levels were below the normal range. No significant change of norepinephrine, epinephrine, dopamine, beta-endorphin, beta-lipotropin, or adrenocorticotropic hormone levels were found after SCS. A 50% increase of cerebrospinal beta-endorphin and beta-lipotropin levels occurred in 6 out of 16 patients, namely those where SCS gave the major pain relief. These data confirm the derangement of the endogenous opioid system in chronic pain conditions and suggest that the beta-endorphin response to SCS could have clinical value in predicting the success of treatment.     

Reduction of PrPC in human cerebrospinal fluid after spinal cord injury

It has been estimated that cerebrospinal fluid (CS F) contains approximately 80 proteins that significantly increase or decrease in response to various clinical conditions. Here we have evaluated the CS F protein PrP^C (cellular prion protein) for possible increases or decreases following spinal cord injury. The physiological function of PrP^C is not yet completely understood; however, recent findings suggest that PrP^C may have neuroprotective properties. Our results show that CS F PrP^C is decreased in spinal cord injured patients 12 h following injury and is absent at 7 days. Given that normal PrP^C has been proposed to be neuroprotective, we speculate that the decrease in CS F PrP^C levels may influence neuronal cell survival following spinal cord injury.Key words: CSF, PrP^C, Hsp25, crystallin domain, spinal cord injury     

Biomarkers for severity of spinal cord injury in the cerebrospinal fluid of rats

One of the major challenges in management of spinal cord injury (SCI) is that the assessment of injury severity is often imprecise. Identification of reliable, easily quantifiable biomarkers that delineate the severity of the initial injury and that have prognostic value for the degree of functional recovery would significantly aid the clinician in the choice of potential treatments. To find such biomarkers we performed quantitative liquid chromatography-mass spectrometry (LC-MS/MS) analyses of cerebrospinal fluid (CSF) collected from rats 24 h after either a moderate or severe SCI. We identified a panel of 42 putative biomarkers of SCI, 10 of which represent potential biomarkers of SCI severity. Three of the candidate biomarkers, Ywhaz, Itih4, and Gpx3 were also validated by Western blot in a biological replicate of the injury. The putative biomarkers identified in this study may potentially be a valuable tool in the assessment of the extent of spinal cord damage.     

Noradrenergic mediation of traumatic spinal cord autodestruction

Acute spinal injury initiates hemorrhagic necrosis (HN), a novel tissue destructive process, within traumatized cord tissues. HN assures permanent paralysis within 24 hours by locally destroying the injured cord. It results from microvascular failure and subsequent lethal tissue hypoxia. Norepinephrine (NE) a normal spinal cord transmitter material rapidly increases (four to tenfold) at the injury site. This vasoactive substance has been implicated in post wounding vascular stasis and permanent spinal paralysis because: 1. Direct spinal NE injections reproduce histological HN. 2. Phenoxybenzamine (alpha receptor blockade) pretreatment significantly diminishes traumatic lesion size. 3. NE synthesis inhibition by alpha methyl tyrosine (acts upon tyrosine hydroxylase), alpha methyl dopa (acts upon L dopa decarboxylase) and FLA-63 (acts upon dopamine beta hydroxylase) all variously protect the wounded cord against HN traumatic lesions. 4. Reserpine (NE depletion) provides significant tissue protection. This drug restores some useful spinal function after severe experimental injuries which consistently paralyze untreated animals.NE bulbospinal fibers are modulated, as determined by tissue lesion size, by two other neural systems. 1. Facilitation occurs from afferent dorsal rootposterior spinal column fibers (non-catecholamine) because prior surgical interruptions significantly diminish traumatic lesions. 2. Inhibition by dopaminergic (DA) fibers was detected by: a. Cord protection with apomorphine DA receptor stimulation. b. Aggravation of traumatic lesions by Pimozide DA receptor blockade. Although these studies are early and incomplete, there is convincing evidence for NE post wounding involvement. As this system is better understood we believe treatments will be developed for spinal injured man.     

The chaperone protein clusterin may serve as a cerebrospinal fluid biomarker for chronic spinal cord disorders in the dog

Chronic spinal cord dysfunction occurs in dogs as a consequence of diverse aetiologies, including long-standing spinal cord compression and insidious neurodegenerative conditions. One such neurodegenerative condition is canine degenerative myelopathy (DM), which clinically is a challenge to differentiate from other chronic spinal cord conditions. Although the clinical diagnosis of DM can be strengthened by the identification of the Sod1 mutations that are observed in affected dogs, genetic analysis alone is insufficient to provide a definitive diagnosis. There is a requirement to identify biomarkers that can differentiate conditions with a similar clinical presentation, thus facilitating patient diagnostic and management strategies. A comparison of the cerebrospinal fluid (CSF) protein gel electrophoresis profile between idiopathic epilepsy (IE) and DM identified a protein band that was more prominent in DM. This band was subsequently found to contain a multifunctional protein clusterin (apolipoprotein J) that is protective against endoplasmic reticulum (ER) stress-mediated apoptosis, oxidative stress, and also serves as an extracellular chaperone influencing protein aggregation. Western blot analysis of CSF clusterin confirmed elevated levels in DM compared to IE (p < 0.05). Analysis of spinal cord tissue from DM and control material found that clusterin expression was evident in neurons and that the clusterin mRNA levels from tissue extracts were elevated in DM compared to the control. The plasma clusterin levels was comparable between these groups. However, a comparison of clusterin CSF levels in a number of neurological conditions found that clusterin was elevated in both DM and chronic intervertebral disc disease (cIVDD) but not in meningoencephalitis and IE. These findings indicate that clusterin may potentially serve as a marker for chronic spinal cord disease in the dog; however, additional markers are required to differentiate DM from a concurrent condition such as cIVDD.

Electronic supplementary material

The online version of this article (doi:10.1007/s12192-013-0457-4) contains supplementary material, which is available to authorized users.     

The effect of rFVIIa on pro- and anti-inflammatory cytokines in serum and cerebrospinal fluid in a swine model of traumatic brain injury

Traumatic brain injury (TBI) is associated with significant infectious and inflammatory complications. Though increasing evidence suggests that rFVIIa administration may be efficacious for the pre-hospital treatment of TBI, the FVIIa-tissue factor complex has been shown to be immunologically active. To date the cytokine response to rFVIIa administration for the treatment of TBI has not been evaluated. Twenty anesthetized immature Yorkshire swine underwent fluid percussion TBI. At 15 min following injury, animals were randomized to receive either 90 μg/kg rFVIIa (rFVIIa) or nothing. Animals were observed for 6 h and then euthanized. Plasma and cerebrospinal (CSF) samples were collected at 0 min and 360 min, and ELISA analysis of TNF-α, IL-1β and IL-10 was performed. Survival in both groups was 100%. Baseline cytokine concentrations were not statistically different between rFVIIa and control animals in plasma or CSF. Animals in both groups did not have significant changes in plasma cytokine concentrations following TBI. Control animals did not demonstrate significant changes from baseline of CSF cytokine concentrations following TBI. The administration of rFVIIa however, resulted in significant increases in CSF TNF-α concentration (232.0 pg/ml ± 75.9 vs 36.4 pg/ml ± 10.4, p = 0.036) and IL-10 concentration (10.7 pg/ml ± 0.6 vs 8.8 pg/ml ± 0.1, p = 0.015). IL-1β concentrations were not significantly changed over the experimental time course. These results suggest that rFVIIa administration for the treatment of TBI is not immunologically inert, and is associated with increased CSF concentrations of TNF-α and IL-10.     

Cervical spinal cord deformation during simulated head-first impact injuries

The relationship between bony spinal column and spinal cord injury during an injury event is not well understood. While several studies have measured spinal canal occlusion during axial impact, there has been limited work done to quantify the spinal cord compression or deformation during simulated injury. Because the cord is a viscoelastic solid it may provide resistance to bone fragments, ligaments or other elements that move into the canal and impinge it during column injury. This would differentiate the measurement of cord compression from the measurement of occlusion of an empty canal. In the present study, a novel method of visualizing and quantifying spinal cord deformation during dynamic head-first impact of ex vivo human cervical spine specimens (N=6) was developed. A radiodense, biofidelic surrogate spinal cord was imaged in the spinal canal using high speed cineradiography at 1000 frames per second. The dorsal-ventral diameter of the cord was measured at 1.5mm increments along its length for each frame of the radiographic footage. The resulting cord deformations were used to determine the theoretical neurological outcome of the impact based on published in vivo ferret studies. The corresponding probability of recovery for the spinal cord deformations in these tests ranged between 8% for atlantoaxial dislocation injury and 95% for mid-cervical spine hyperextension injury (based on the ferret data). Clinically relevant spinal column fracture patterns were produced in this study.     

Hydrodynamic modeling of cerebrospinal fluid motion within the spinal cavity

The fluid that resides within cranial and spinal cavities, cerebrospinal fluid (CSF), moves in a pulsatile fashion to and from the cranial cavity. This motion can be measured hy magnetic resonance imaging (MRI) and may he of clinical importance in the diagnosis of several brain and spinal cord disorders such as hydrocephalus, Chiari malformation, and syringomyelia. In the present work, a geometric and hydrodynamic characterization of an anatomically relevant spinal canal model is presented. We found that inertial effects dominate the flow field under normal physiological flow rates. Along the length of the spinal canal, hydraulic diameter was found to vary significantly from 5 to 15 mm. The instantaneous Reynolds number at peak flow rate ranged from 150 to 450, and the Womersle number ranged from 5 to 17. Pulsatile flow calculations are presented for an idealized geometric representation of the spinal cavity. A linearized Navier-Stokes model of the pulsatile CSF flow was constructed based on MRI flow rate measurements taken on a healthy volunteer. The numerical model was employed to investigate effects of cross-sectional geometry and spinal cord motion on unsteady velocity, shear stress, and pressure gradientfields. The velocity field was shown to be blunt, due to the inertial character of the flow, with velocity peaks located near the boundaries of the spinal canal rather than at the midpoint between boundaries. The pressure gradient waveform was found to be almost exclusively dependent on the flow waveform and cross-sectional area. Characterization of the CSF dynamics in normal and diseased states may be important in understanding the pathophysiology of CSF related disorders. Flow models coupled with MRI flow measurements mnay become a noninvasive tool to explain the abnormal dynamics of CSF in related brain disorders as well as to determine concentration and local distribution of drugs delivered into the CSF space.     

Increased dynorphin immunoreactivity in spinal cord after traumatic injury

Opiate antagonists, at high doses, have been shown to improve physiological variables and outcome after experimental spinal injury. Dynorphin appears to be unique amongst opioids in producing hindlimb paralysis after intrathecal injection. Taken together, these findings suggest a possible pathophysiological role for endogenous opioids, particularly dynorphin, in spinal injury. In the present studies we examined the relationship between changes in dynorphin immunoreactivity (Dyn-ir) in rat spinal cord after traumatic injury and the subsequent motor dysfunction. Trauma was associated with significantly increased Dyn-ir at the injury site, but not distant from the lesion. Dyn-ir was found elevated as early as 2 h and as late as 2 weeks after trauma, and was significantly correlated with the degree of injury. These data are consistent with the hypothesis that dynorphin systems may be involved in the secondary injury that follows spinal trauma.     

福尔马林致痛对大鼠脊髓背角神经元神经肽CCK表达的影响

目的：本实验观察胆囊收缩素（CCK）在福尔马林致痛大鼠感觉信息传递中的作用。方法：用免疫组织化学技术,分别观察阴性对照、生理盐水、福尔马林致痛后1h和福尔马林致痛后3h大鼠脊髓背角的感觉神经元神经肽CCK表达的变化。结果：大鼠足底注射福尔马林1h后,脊髓背角Ⅰ、Ⅱ层神经元CCK表达阳性细胞数明显增加（P〈0．01）,且注射侧阳性细胞数明显高于非注射侧。注射福尔马林1h后,注射侧和非注射侧CCK表达阳性细胞的半定量光密度均值分别是0．397±0．014和0．295±0．007,差异有显著性（P〈0．01）;注射福尔马林3h后,注射侧和非注射侧脊髓背角CCK表达阳性细胞的半定量光密度均值分别是0．366±0．009和0．303±0．005,差异仍有显著性（P〈0．01）。结论：福尔马林致痛大鼠脊髓CCK表达阳性细胞的半定量光密度均值增加,进一步证实CCK在炎性痛信息传递通路的多个环节中参与了痛觉调制。     

The effect of craniotomy on the intracranial hemodynamics and cerebrospinal fluid dynamics in humans

The goal of the research was to study the effect of the trephination of the human cranial cavity on the intracranial hemodynamics and cerebrospinal fluid (CSF) dynamics. The sample comprised 15 patients of a neurosurgical clinic in whom a trephine opening in the cranial bones was made for medical indications. In these patients, at rest and during an appropriate functional load, we recorded pulse changes in blood circulation (by transcranial Doppler sonography) and in the ratio between the pulse fluctuations in the blood and CSF volumes (by rheoencephalography) before and after surgery. Simultaneous recording of these parameters followed by computer pattern and phase analyses allowed evaluation of the complex biomedical compliance of the cranium during successive phases of the cardiac rhythm: the inflow of arterial blood, the redistribution of blood/CSF volumes, and the outflow of venous blood. Analysis of the results showed a beneficial influence of craniotomy on the intracranial hemodynamics and CSF dynamics. This was reflected in an increase in the cranial compliance, which increased the pulse increment in the volume of the arterial blood in the skull almost twofold. After craniotomy, the cross-flow of CSF between the cranial and spinal cavities decreased significantly, giving way to volumetric compensatory translocations of blood and CSF within the cranial cavity per se during the cardiac cycle, which increased the intracranial utilization of the energy of the cardiac output and contributed to the outflow of venous blood from the cranium. The results suggest a beneficial effect of craniotomy on the physiological mechanisms of the circulatory and metabolic maintenance of the brain activity.