中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (2): 222-226.doi: 10.4103/1673-5374.244779

• 综述:脊髓损伤修复保护与再生 • 上一篇    下一篇

研究实验性脊髓损伤中的神经源性肠道:从哪里开始?

  

  • 出版日期:2019-02-15 发布日期:2019-02-15

Investigating neurogenic bowel in experimental spinal cord injury: where to begin?

Amanda R. White , Gregory M. Holmes   

  1. Department of Neural & Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
  • Online:2019-02-15 Published:2019-02-15
  • Contact: Amanda R. White, MSc, awhite3@pennstatehealth.psu.edu; Gregory M. Holmes, PhD, gholmes@pennstatehealth.psu.edu.
  • Supported by:

    This work was supported by grants from the National Institutes of Health, No. NINDS 49177 (to GMN) and Craig H. Neilsen Foundation Senior Research award, No. 295319 (to GMN).

摘要:

orcid: 0000-0001-5176-8376(Gregory M. Holmes)

Abstract:

The devastating losses following traumatic spinal cord injury (SCI) encompass the motor, sensory and autonomic nervous systems. Neurogenic bowel is a slow transit colonic dysfunction marked by constipation, rectal evacuation difficulties, decreased anorectal sensation, fecal incontinence or some combination thereof. Furthermore, neurogenic bowel is one of the most prevalent comorbidities of SCI and is recognized by afflicted individuals and caregivers as a lifelong physical and psychological challenge that profoundly affects quality of life. The restoration of post-injury control of movement has received considerable scientific scrutiny yet the daily necessity of voiding the bowel and bladder remains critically under-investigated. Subsequently, physicians and caregivers are rarely presented with consistent, evidence-based strategies to successfully address the consequences of dysregulated voiding reflexes. Neurogenic bowel is commonly believed to result from the interruption of the supraspinal control of the spinal autonomic circuits regulating the colon. In this mini-review, we discuss the clinical challenges presented by neurogenic bowel and emerging pre-clinical evidence that is revealing that SCI also initiates functional remodeling of the colonic wall concurrent with a decrease in local enteric neurons. Since the enteric input to the colonic smooth muscle is the final common pathway for functional contractions of the colon, changes to the neuromuscular interface must first be understood in order to maximize the efficacy of therapeutic interventions targeting colonic dysfunction following SCI.

Key words: colon, enteric nervous system, parasympathetic, sympathetic, autonomic nervous system, defecation reflexes, gastrointestinal, inflammation, constipation, incontinence