肌苷促进脑损伤后神经功能恢复的实验研究

目的:中枢损伤是目前致残率最高的疾病之一,肌苷对于神经损伤后功能恢复的促进作用已经成为研究热点,本研究拟建立一侧前肢瘫痪的大鼠脑外伤模型,证实肌苷治疗促进中枢损伤后上肢功能恢复的有效性,同时初步探索其机制。方法:建立一侧运动皮层冲击损毁的大鼠模型,通过肢体不对称实验、抓取实验等行为学观察证实其患侧上肢功能受损,后在实验组进行肌苷药物14天,观察28天内上肢功能的恢复情况,与对照组作对比,证实其行为学上的有效性,同时对损伤侧大脑进行顺行BDA染色,探索其内在机制。结果:通过28天的观察发现经过肌苷治疗的的实验组大鼠肢体不对称实验、抓取实验等行为学评分明显好于隐性对照组,顺行BDA染色证实其有促进损伤周围健存皮层突触再生和代偿的作用。结论:肌苷可以促进中枢损伤后大鼠残存神经元得突触再生,使其大脑能在最大程度上代偿其丧失的功能,该药物可能会成为一种新的中枢损伤治疗的前体药物。     

肌苷促进脑损伤后神经功能恢复的实验研究

目的：中枢损伤是目前致残率最高的疾病之一,肌苷对于神经损伤后功能恢复的促进作用已经成为研究热点,本研究拟建立一侧前肢瘫痪的大鼠脑外伤模型,证实肌苷治疗促进中枢损伤后上肢功能恢复的有效性,同时初步探索其机制。方法：建立一侧运动皮层冲击损毁的大鼠模型,通过肢体不对称实验、抓取实验等行为学观察证实其惠侧上肢功能受损,后在实验组进行肌苷药物14天,观察28天内上肢功能的恢复情况,与对照组作对比。证实其行为学上的有效性,同时对损伤侧大脑进行顺行BDA染色,探索其内在机制。结果：通过28天的观察发现经过肌苷治疗的的实验组大鼠肢体不对称实验、抓取实验等行为学评分明显好于隐性对照组,顺行BDA染色证实其有促进损伤周围健存皮层突触再生和代偿的作用。结论：肌苷可以促进中枢损伤后大鼠残存神经元得突触再生,使其大脑能在最大程度上代偿其丧失的功能,该药物可能会成为一种新的中枢损伤治疗的前体药物。     

用弥散张量成像检测猕猴大脑运动区占位病变对健侧皮质脊髓束的作用

因皮质脊髓束(corticospinal tract,CST)损伤而造成的运动功能丧失可得到一定恢复,但关于大脑运动区占位性病变对健侧CST结构功能影响的研究却相对较少。该研究采用两只健康猕猴行球囊置入术建立大脑运动区占位性病变模型,行4次磁共振弥散张量成像(diffusion tensor imaging,DTI)扫描,检测手术区对侧CST的FA值("各向异性"值),发现球囊置入术后当天,对侧CST的FA值无明显变化,但随时间的延长升高,球囊取出术后一周更为明显。实验表明该模型可行、可靠,从DTI观察到病变健侧CST出现代偿,即使占位解除短期内这一作用仍明显,提示健侧CST共同参与瘫痪肢体功能的恢复。     

康复训练对脑缺血大鼠运动功能恢复和脑组织cAMP-PKA信号通路的影响

目的观察康复训练对脑缺血再灌注大鼠运动功能及缺血灶周边脑组织cAMP、PKA表达的影响,探讨康复训练促进缺血性脑卒中运动功能恢复的分子机制。方法采用Longa改良线栓法制备大鼠大脑中动脉缺血再灌注模型（middle cerebral artery ischemia-reperfusion model,MCAO）,选择Bederson标准评分为1-3分的模型大鼠42只,随机分为自然恢复组（n=24）、康复训练组（n=18）,同时设立假手术组（n=12）。康复训练组大鼠于MACO术后48 h开始每天给予平衡木、转棒及滚筒训练。酶联免疫法（ELISA）检测缺血灶周围脑组织cAMP、PKA蛋白的表达,平衡木及网屏试验评定大鼠的运动功能。结果 （1）康复训练组缺血灶周围脑组织cAMP、PKA表达在术后7、14、21d均明显高于自然恢复组;（2）康复训练组大鼠的运动功能较自然恢复组明显改善。结论康复训练促进脑缺血再灌注大鼠的运动功能恢复,可能与cAMP-PKA信号通路活动有关。     

cAMP/PKA-pCREB信号通路介导康复训练促进脑缺血大鼠运动功能恢复的探讨

目的探讨cAMP/PKA-pCREB信号通路是否在康复训练促进的缺血性脑卒中大鼠运动功能的恢复方面发挥作用。方法采用Longa改良线栓法制备大鼠大脑中动脉缺血再灌注模型(middle cerebral artery ischemia-reperfusion model,MCAO),造模成功的大鼠随机分为自然恢复组(n=24)、自然恢复+Rp-cAMP组(n=24)、康复训练组(n=18)和康复训练+Rp-cAMP组(n=18)。同时设立假手术组(n=12)。于侧脑室注射RpcAMP后立即进行MCAO模型的制备。训练组大鼠于术后48 h开始每天给予平衡木、转棒及滚筒训练。采用平衡木试验评定大鼠的运动功能。酶联免疫法(ELISA)检测缺血灶周围的脑组织内PKA表达,蛋白免疫印迹法(Western blot)检测pCREB蛋白表达,同时采用免疫组化法对pCREB进行定位检测。结果 (1)运动功能评分结果揭示,自然恢复+Rp-cAMP组大鼠的运动功能低于自然恢复组,提示Rp-cAMP可抑制脑缺血大鼠运动神经功能的恢复;康复训练组大鼠的运动功能明显高于自然恢复组,也高于康复训练+Rp-cAMP组,提示Rp-cAMP明显减弱康复训练促进脑缺血大鼠运动神经功能的恢复;(2)于术后2 d、7 d、14 d、21 d检测缺血灶周围的脑组织PKA、pCREB的蛋白表达结果显示:康复训练组明显高于自然恢复组,同时高于康复训练+Rp-cAMP组,提示康复训练促进脑缺血大鼠的PKA、pCREB蛋白的表达,且Rp-cAMP明显抑制了康复训练促进脑缺血大鼠的PKA、pCREB蛋白的表达。结论 cAMP/PKA-pCREB信号通路可能介导康复训练促进的脑缺血大鼠运动功能的恢复。     

Stroke:干细胞疗法可有效治疗中风

正患有中风的患者在经过向大脑中注射干细胞治疗,能够明显地提高其讲话能力、身体强度以及行动力。其中一些患者甚至能够重新行走。这一临床试验的成功意味着我们低估了大脑自愈的能力,也许有一天这种疗法能够使大脑重新恢复功能。"一位71岁的老年女性在治疗开始前仅仅能够活动左手大拇指",该研究的首席研究员,来自斯坦福大学的神经科医生Gary Steinberg说道:"如今她能够行走以及将手举过头顶"。     

《BMC神经科学》：人类脐带血可“唤醒”动物衰老大脑

美国科学家的一项最新研究发现,将人类脐带血细胞（umbilical cord blood cells,UCBC）注射入老龄大鼠后,它们大脑海马区的微环境会得到改善,同时神经干细胞（或前体细胞）也得到相应的恢复。这一研究成果开启了利用细胞疗法应对大脑衰老的可能性。相关论文在线发表于《BMC神经科学》杂志上。     

慢性痛的皮层神经可塑性及其对治疗的启示

慢性痛疗效时常不够理想,使人们开始怀疑慢性痛患者大脑的功能或结构发生了病理性改变。脑成像研究表明,大脑功能和结构都存在明显的可塑性:从功能来看,慢性痛患者可能存在大脑网络功能状态失衡;从结构来看,患者大脑某些区域灰质密度明显减少。这些可塑性变化与慢性疼痛的存在及其治疗转归有可能存在密切联系。     

成年内源性神经发生在脑损伤修复中的应用研究进展

成年哺乳动物大脑中的脑室室下区(subventricular zone, SVZ)和海马齿状回颗粒层下区(subgranular zone, SGZ)存在持续的神经发生。成年内源性神经发生不仅在正常脑功能中发挥重要作用,同时也在脑损伤或脑疾病的修复治疗中具有重要意义。本文通过综述成年内源性神经发生过程及其在创伤性脑损伤(traumatic brain injury, TBI)和缺血性脑卒中修复中的应用,讨论激活成年内源性神经发生修复脑损伤的策略及其促进脑损伤后功能恢复的意义。     

减重手术改善肥胖症认知功能障碍及其机制

越来越多的证据表明，肥胖会对大脑功能和结构产生负面影响。肥胖个体在食物线索、味觉和嗅觉、静息状态活动和功能连接方面显示出异常的神经反应，同时在决策、抑制控制、学习、记忆和注意力等认知任务中表现出异常。减重手术作为一种专门的治疗方案，可以改变消化系统解剖和生理机制，从而限制食物摄入或改变营养吸收来实现短期和长期的减重效果，改善并发症，降低死亡率，并提高生活质量。最近的研究表明，减重手术对改善肥胖症相关的认知功能障碍具有积极的影响。本文概述了肥胖与认知功能之间的关联，并重点阐述了近年来减重手术改善肥胖相关认知损伤的研究进展。涉及的内容包括奖励处理、食物摄入控制、大脑区域对认知功能的调控、大脑结构异常的恢复、激素调节改变以及对肠道微生物组成的改变，这些变化可能会影响脑功能和认知过程，这些研究成果有望为改善肥胖症患者的认知功能提供新的治疗策略和临床指导。     

精氨酸酶Ⅰ参与环腺苷酸促进脑缺血再灌注大鼠的轴突再生

环腺苷酸（cAMP）作为细胞内的重要第二信使之一,主要通过激活下游cAMP依赖性蛋白激酶A（PKA）,进一步激活转录因子-cAMP效应元件结合蛋（CREB）,达到促进损伤轴突再生的作用.精氨酸酶Ⅰ主要是通过促进多胺的表达,从而克服髓鞘相关抑制因子对轴突再生的抑制作用,达到促进轴突再生的效果.在脑缺血中,cAMP促进轴突再生的过程是否有精氨酸酶Ⅰ的参与及其与RhoA信号通路的关系尚不清楚.本研究采用线栓法制备脑缺血再灌注模型（MACO）,采用Longa 5评分法对大鼠运动功能进行评分,利用逆转录聚合酶链反应（RT-PCR）和Western蛋白印迹方法分别检测缺血灶周边脑组织生长相关蛋白43（GAP-43）和RhoA的mRNA和蛋白表达,免疫组化法进行GAP-43的形态学检测,作为轴突再生的标志.通过尾静脉注射cAMP类似物db-cAMP增加脑缺血后大鼠脑组织内cAMP的浓度后发现：db-cAMP处理可明显降低MACO大鼠的运动功能评分,且可促进GAP-43 mRNA及蛋白的表达,抑制RhoA mRNA及蛋白的表达,由此可见db-cAMP处理可促进脑缺血后大鼠运动功能的恢复,且这一过程与抑制RhoA通路,进而促进轴突再生有关;通过在db-cAMP的基础上给予精氨酸酶Ⅰ拮抗剂NOHA来降低精氨酸酶Ⅰ的活性发现：给予NOHA的大鼠运动功能评分明显增加,这一变化趋势与RhoA mRNA及蛋白表达的变化趋势相一致,而与GAP-43 mRNA及蛋白表达的变化趋势相反. 因此可推断：精氨酸酶Ⅰ参与了db-cAMP促进轴突再生、改善脑缺血后大鼠运动功能的过程,且与钝化RhoA通路有关.     

Exercise Promotes Axon Regeneration of Newborn Striatonigral and Corticonigral Projection Neurons in Rats after Ischemic Stroke

Newborn striatal neurons induced by middle cerebral artery occlusion (MCAO) can form functional projections targeting into the substantia nigra, which should be very important for the recovery of motor function. Exercise training post-stroke improves motor recovery in clinic patients and increases striatal neurogenesis in experimental animals. This study aimed to investigate the effects of exercise on axon regeneration of newborn projection neurons in adult rat brains following ischemic stroke. Rats were subjected to a transient MCAO to induce focal cerebral ischemic injury, followed by 30 minutes of exercise training daily from 5 to 28 days after MCAO. Motor function was tested using the rotarod test. We used fluorogold (FG) nigral injection to trace striatonigral and corticonigral projection neurons, and green fluorescent protein (GFP)-targeting retroviral vectors combined with FG double labeling (GFP⁺ -FG⁺) to detect newborn projection neurons. The results showed that exercise improved the recovery of motor function of rats after MCAO. Meanwhile, exercise also increased the levels of BDNF and VEGF, and reduced Nogo-A in ischemic brain. On this condition, we further found that exercise significantly increased the number of GFP⁺ -FG⁺ neurons in the striatum and frontal and parietal cortex ipsilateral to MCAO, suggesting an increase of newborn striatonigral and corticonigral projection neurons by exercise post-stroke. In addition, we found that exercise also increased NeuN⁺ and FG⁺ cells in the striatum and frontal and parietal cortex, the ischemic territory, and tyrosine hydroxylase (TH) immunopositive staining cells in the substantia nigra, a region remote from the ischemic territory. Our results provide the first evidence that exercise can effectively enhance the capacity for regeneration of newborn projection neurons in ischemic injured mammalian brains while improving motor function. Our results provide a very important cellular mechanism to illustrate the effectiveness of rehabilitative treatment post-stroke in the clinic.     

Org.2766 improves functional and electrophysiological aspects of regenerating sciatic nerve in the rat

The beneficial effect of short-term (8 days) melanocortin therapy on regenerating peripheral nerves is demonstrated using functional and electrophysiological tests. Following a crush lesion of the rat sciatic nerve, recovery of sensory function is monitored by assessing the responsiveness of the rat to a small electric current applied to the footsole. Recovery of motor function is assessed by means of an analysis of walking patterns. Normalization of the walking pattern reflects reinnervation of different muscle groups. The motor and H-reflex related sensory nerve conduction velocity of the regenerated nerves are longitudinally investigated in the same rats in which the recovery of motor and sensory function had been assessed previously. Functional tests show an enhanced recovery under melanocortin therapy, but in the end both saline- and melanocortin-treated rats show 100% recovery. However, when compared to the contralateral sciatic nerve, in the peptide-treated animals motor nerve conduction in the regenerated nerves has fully recovered after about 90 days following the crush lesion and the sensory conduction after about 120 days, whereas in the saline-treated rats a deficit of 20-40% in both motor and sensory conduction remains. This difference is observed even 214 days following crush.     

Post-lesional cerebral reorganisation: Evidence from functional neuroimaging and transcranial magnetic stimulation

Reorganisation of cerebral representations has been hypothesised to underlie the recovery from ischaemic brain infarction. The mechanisms can be investigated non-invasively in the human brain using functional neuroimaging and transcranial magnetic stimulation (TMS). Functional neuroimaging showed that reorganisation is a dynamic process beginning after stroke manifestation. In the acute stage, the mismatch between a large perfusion deficit and a smaller area with impaired water diffusion signifies the brain tissue that potentially enables recovery subsequent to early reperfusion as in thrombolysis. Single-pulse TMS showed that the integrity of the cortico-spinal tract system was critical for motor recovery within the first four weeks, irrespective of a concomitant affection of the somatosensory system. Follow-up studies over several months revealed that ischaemia results in atrophy of brain tissue adjacent to and of brain areas remote from the infarct lesion. In patients with hemiparetic stroke activation of premotor cortical areas in both cerebral hemispheres was found to underlie recovery of finger movements with the affected hand. Paired-pulse TMS showed regression of perilesional inhibition as well as intracortical disinhibition of the motor cortex contralateral to the infarction as mechanisms related to recovery. Training strategies can employ post-lesional brain plasticity resulting in enhanced perilesional activations and modulation of large-scale bihemispheric circuits.     

Prediction of lower limb motor outcomes based on transcranial magnetic stimulation findings in patients with an infarct of the anterior cerebral artery

Abstract

The aim was to investigate the relationship between transcranial magnetic stimulation (TMS) at the early stage of stroke and 6-month motor outcome for patients with anterior cerebral artery territory infarct. Patients were classified into TMS(+) and TMS(?) groups. At the 6-month evaluation, lower limb motor function for the TMS(+) group was significantly better than those for the TMS(?) group. Thus, early TMS evaluation is useful for predicting recovery of lower limb motor function in patients experiencing this type of stroke.     

Knockdown of α-synuclein in cerebral cortex improves neural behavior associated with apoptotic inhibition and neurotrophin expression in spinal cord transected rats

Spinal cord injury (SCI) often causes severe functional impairment with poor recovery. The treatment, however, is far from satisfaction, and the mechanisms remain unclear. By using proteomics and western blot, we found spinal cord transection (SCT) resulted in a significant down-regulation of α-synuclein (SNCA) in the motor cortex of SCT rats at 3 days post-operation. In order to detect the role of SNCA, we used SNCA-ORF/shRNA lentivirus to upregulate or knockdown SNCA expression. In vivo, SNCA-shRNA lentivirus injection into the cerebral cortex motor area not only inhibited SNCA expression, but also significantly enhanced neurons’ survival, and attenuated neuronal apoptosis, as well as promoted motor and sensory function recovery in hind limbs. While, overexpression SNCA exhibited the opposite effects. In vitro, cortical neurons transfected with SNCA-shRNA lentivirus gave rise to an optimal neuronal survival and neurite outgrowth, while it was accompanied by reverse efficiency in SNCA-ORF group. In molecular level, SNCA silence induced the upregulation of Bcl-2 and the downregulation of Bax, and the expression of NGF, BDNF and NT3 was substantially upregulated in cortical neurons. Together, endogenous SNCA play a crucial role in motor and sensory function regulation, in which, the underlying mechanism may be linked to the regulation of apoptosis associated with apoptotic gene (Bax, Bcl2) and neurotrophic factors expression (NGF, BDNF and NT3). These finds provide novel insights to understand the role of SNCA in cerebral cortex after SCT, and it may be as a novel treatment target for SCI repair in future clinic trials.     

SALGOT - <Emphasis Type="Underline">S</Emphasis>troke <Emphasis Type="Underline">A</Emphasis>rm <Emphasis Type="Underline">L</Emphasis>ongitudinal study at the University of <Emphasis Type="Underline">Got</Emphasis>henburg,prospective cohort study protocol

Background  

Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area.     

The effects of voluntary, involuntary, and forced exercises on brain-derived neurotrophic factor and motor function recovery: a rat brain ischemia model

Background

Stroke rehabilitation with different exercise paradigms has been investigated, but which one is more effective in facilitating motor recovery and up-regulating brain neurotrophic factor (BDNF) after brain ischemia would be interesting to clinicians and patients. Voluntary exercise, forced exercise, and involuntary muscle movement caused by functional electrical stimulation (FES) have been individually demonstrated effective as stroke rehabilitation intervention. The aim of this study was to investigate the effects of these three common interventions on brain BDNF changes and motor recovery levels using a rat ischemic stroke model.

Methodology/Principal Findings

One hundred and seventeen Sprague-Dawley rats were randomly distributed into four groups: Control (Con), Voluntary exercise of wheel running (V-Ex), Forced exercise of treadmill running (F-Ex), and Involuntary exercise of FES (I-Ex) with implanted electrodes placed in two hind limb muscles on the affected side to mimic gait-like walking pattern during stimulation. Ischemic stroke was induced in all rats with the middle cerebral artery occlusion/reperfusion model and fifty-seven rats had motor deficits after stroke. Twenty-four hours after reperfusion, rats were arranged to their intervention programs. De Ryck''s behavioral test was conducted daily during the 7-day intervention as an evaluation tool of motor recovery. Serum corticosterone concentration and BDNF levels in the hippocampus, striatum, and cortex were measured after the rats were sacrificed. V-Ex had significantly better motor recovery in the behavioral test. V-Ex also had significantly higher hippocampal BDNF concentration than F-Ex and Con. F-Ex had significantly higher serum corticosterone level than other groups.

Conclusion/Significance

Voluntary exercise is the most effective intervention in upregulating the hippocampal BDNF level, and facilitating motor recovery. Rats that exercised voluntarily also showed less corticosterone stress response than other groups. The results also suggested that the forced exercise group was the least preferred intervention with high stress, low brain BDNF levels and less motor recovery.