中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (10): 1594-1595.doi: 10.4103/1673-5374.165267

• 观点:脊髓损伤修复保护与再生 • 上一篇    下一篇

神经假体重建脊髓损伤后丧失的功能

  

  • 收稿日期:2015-07-08 出版日期:2015-10-28 发布日期:2015-10-28

Neural prostheses for restoring functions lost after spinal cord injury

Marc Fakhoury*   

  1. Department of Neurosciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
  • Received:2015-07-08 Online:2015-10-28 Published:2015-10-28
  • Contact: Marc Fakhoury, B.Sc., M.Eng.,marc.fakhoury@umontreal.ca.

摘要:

脊髓损伤通常分为完全和不完全损伤。完全性脊髓损伤患者康复的希望不大,而不完全性损伤患者的运动功能恢复是可以发生的。脊髓损伤导致的不同结果取决于损伤的严重程度和位置。例如,高颈椎病变会导致四肢瘫痪,而低位病变则导致人体截瘫后生物下部瘫痪。多数脊髓损伤患者也会伴随有并发症,如呼吸道感染,泌尿道感染,心血管疾病,以及合并精神症状,如抑郁和焦虑。在分子水平上,脊髓损伤引起的生化改变会导致各种细胞,包括神经元和星形胶质细胞的死亡。脊髓损伤后通常也能观察到正在进行的脱髓鞘和少突胶质细胞凋亡现象。不完全脊髓损伤患者运动恢复的关键事件之一是神经再生,这基本发生在损伤后第一天,并且可能需要几个月到几年来充分发展。众所周知的是,灵长类动物和人类进行脊髓半切病变时,由于皮质轴突在损伤水平中的自发可塑性,通常表现出行动恢复,并引导运动功能的广泛能力。在过去的几年中,神经再生领域内的不断研究已经帮助研究人员确定可能会减轻脊髓损伤症状和促进长期功能恢复的具体目标。然而,尽管有大量的非手术治疗和手术治疗策略,但脊髓损伤后神经再生和功能恢复仍然非常有限。神经假体可用于促进轴突生长并能够调节神经元存活和分化的几个基因表达。通过使用脊髓电和化学刺激,植入神经假体都显示出了对轴突出芽及再生的显著增强能力。尽管神经假体已经在动物研究取得了治疗效率的关键信息,但仍然需要从临床研究中得到该治疗方式的完全效率。在脊髓损伤动物模型中观察到的变化是可以利于临床研究的,只要它们对最终恢复瘫痪病人自主运动控制方面足够重要。我们希望,今后的工作将给新一代神经假体恢复脊髓损伤后失去的功能方面制定并实施策略,进而显著提高瘫痪患者的生活质量。

Abstract:

This disorder is typically classified into complete and incomplete SCI. Individuals suffering from a complete SCI have little prospect of rehabilitation, whereas motor recovery can still take place in patients with incomplete SCI. Damage to the spinal cord can lead to a variety of different outcomes, depending on the severity and location of the injury. For instance, high cervical lesions lead to paralysis of the four limbs (tetraplegia), whereas lower lesions lead to paralysis of the lower part of the body (paraplegia).The majority of patients with SCI also experience complications such as respiratory infections, urinary tract infections, cardiovascular diseases, as well as comorbid psychiatric symptoms such as depression and anxiety. At the molecular level, SCI causes biochemical changes leading to the death of a variety of cells, including neurons and astrocytes. Ongoing demyelination and apoptosis of oligodendrocytes are also commonly observed following damage to the spinal cord. One of the key events mediating motor recovery in patients with incomplete SCI is neural regeneration, which occurs during the first days after injury and can take months to years to fully develop. It is well known that primates and humans subjected to spinal cord hemisection lesions typically exhibit an extensive ability to recover volitionally guided locomotion, due to spontaneous plasticity of corticospinal axons at the level of the injury. In the past few years, continued research in the field of neural regeneration has helped researchers identified specific targets that may mitigate the symptoms of SCI and promote long-term functional recovery. However, despite the tremendous growth in the number of nonoperative and operative treatment strategies, neural regeneration and functional recovery after damage to the spinal cord remains very limited. This field of research would clearly benefit from ongoing development of new therapeutic approaches that could facilitate functional rehabilitation.