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    15 February 2018, Volume 13 Issue 2 Previous Issue    Next Issue
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    DNA plasticity and damage in amyotrophic lateral sclerosis
    Diane Penndorf, Otto W. Witte, Alexandra Kretz
    2018, 13 (2):  173-180.  doi: 10.4103/1673-5374.226377
    Abstract ( 137 )   PDF (425KB) ( 303 )   Save

    The pathophysiology of amyotrophic lateral sclerosis (ALS) is particularly challenging due to the heterogeneity of its clinical presentation and the diversity of cellular, molecular and genetic peculiarities involved. Molecular insights unveiled several novel genetic factors to be inherent in both familial and sporadic disease entities, whose characterizations in terms of phenotype prediction, pathophysiological impact and putative prognostic value are a topic of current researches. However, apart from genetically well-defined high-confidence and other susceptibility loci, the role of DNA damage and repair strategies of the genome as a whole, either elicited as a direct consequence of the underlying genetic mutation or seen as an autonomous parameter, in the initiation and progression of ALS, and the different cues involved in either process are still incompletely understood. This mini review summarizes current knowledge on DNA alterations and counteracting DNA repair strategies in ALS pathology and discusses the putative role of unconventional DNA entities including transposable elements and extrachromosomal circular DNA in the disease process. Focus is set on SOD1-related pathophysiology, with extension to FUS, TDP-43 and C9ORF72 mutations. Advancing our knowledge in the field will contribute to an improved understanding of this relentless disease, for which therapeutic options others than symptomatic approaches are almost unavailable.

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    Glia and hemichannels: key mediators of perinatal encephalopathy
    Robert Galinsky, Joanne O. Davidson, Justin M. Dean, Colin R. Green, Laura Bennet, Alistair J. Gunn
    2018, 13 (2):  181-189.  doi: 10.4103/1673-5374.226378
    Abstract ( 130 )   PDF (488KB) ( 269 )   Save

    Perinatal encephalopathy remains a major cause of disability, such as cerebral palsy. Therapeutic hypothermia is now well established to partially reduce risk of disability in late preterm/term infants. However, new and complementary therapeutic targets are needed to further improve outcomes. There is increasing evidence that glia play a key role in neural damage after hypoxia-ischemia and infection/inflammation. In this review, we discuss the role of astrocytic gap junction (connexin) hemichannels in the spread of neural injury after hypoxia-ischemia and/or infection/inflammation. Potential mechanisms of hemichannel mediated injury likely involve impaired intracellular calcium handling, loss of blood-brain barrier integrity and release of adenosine triphosphate (ATP) resulting in over-activation of purinergic receptors. We propose the hypothesis that inflammation-induced opening of connexin hemichannels is a key regulating event that initiates a vicious cycle of excessive ATP release, which in turn propagates activation of purinergic receptors on microglia and astrocytes. This suggests that developing new neuroprotective strategies for preterm infants will benefit from a detailed understanding of glial and connexin hemichannel responses.

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    A new direction for Alzheimer’s research
    James D. Weinstein
    2018, 13 (2):  190-193.  doi: 10.4103/1673-5374.226381
    Abstract ( 107 )   PDF (182KB) ( 248 )   Save

    Despite decades of research, at present there is no curative therapy for Alzheimer’s disease (AD). Changes in the way new drugs are tested appear to be necessary. Three changes are presented here and will be discussed. The first change is that AD must be considered a disease of four major pathological processes, not one. The four processes are: 1) vascular hypoperfusion of the brain with associated mitochondrial dysfunction, 2) destructive protein inclusions, 3) uncontrolled oxidative stress, and 4) proinflammatory immune processes secondary to microglial and astrocytic dysfunction in the brain. The second change recommended is to alter the standard cognitive measurement tools used to quantify mental decline in test patients. Specifically the Dementia Severity Rating Scale (DSRS) should supersede Mini-Mental State Examination (MMSE) and other popular tests, and a measurement scale developed in research should be used to produce a linear and non-irregular baseline. Finally, accepting the concept that four etiologies cause AD leads to the last necessary change, that new therapies must be employed directed against all four causes, likely as a combination. There are drugs ready to be employed in such combinations which are available and used clinically for other purposes so can be used “off label” and one such combination is suggested.

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    Mitochondrial transplantation strategies as potential therapeutics for central nervous system trauma
    Jenna L. Gollihue, Samir P. Patel, Alexander G. Rabchevsky
    2018, 13 (2):  194-197.  doi: 10.4103/1673-5374.226382
    Abstract ( 128 )   PDF (280KB) ( 208 )   Save

    Mitochondria are essential cellular organelles critical for generating adenosine triphosphate (ATP) for cellular homeostasis, as well as various mechanisms that can lead to both necrosis and apoptosis. The field of “mitochondrial medicine” is emerging in which injury/disease states are targeted therapeutically at the level of the mitochondrion, including specific antioxidants, bioenergetic substrate additions, and membrane uncoupling agents. Consequently, novel mitochondrial transplantation strategies represent a potentially multifactorial therapy leading to increased ATP production, decreased oxidative stress, mitochondrial DNA replacement, improved bioenergetics and tissue sparing. Herein, we describe briefly the history of mitochondrial transplantation and the various techniques used for both in vitro and in vivo delivery, the benefits associated with successful transference into both peripheral and central nervous system (CNS) tissues, along with caveats and pitfalls that hinder the advancements of this novel therapeutic.

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    Neuroprotective effects of statins against amyloid β-induced neurotoxicity
    Hsin-Hua Li, Chih-Li Lin, Chien-Ning Huang
    2018, 13 (2):  198-206.  doi: 10.4103/1673-5374.226379
    Abstract ( 128 )   PDF (475KB) ( 285 )   Save

    A growing body of evidence suggests that disruption of the homeostasis of lipid metabolism affects the pathogenesis of Alzheimer’s disease (AD). In particular, dysregulation of cholesterol homeostasis in the brain has been reported to considerably increase the risk of developing AD. Thus, dysregulation of lipid homeostasis may increase the amyloid β (Aβ) levels by affecting amyloid precursor protein (APP) cleavage, which is the most important risk factor involved in the pathogenesis of AD. Previous research demonstrated that Aβ can trigger neuronal insulin resistance, which plays an important role in response to Aβ-induced neurotoxicity in AD. Epidemiological studies also suggested that statin use is associated with a decreased incidence of AD. Therefore, statins are believed to be a good candidate for conferring neuroprotective effects against AD. Statins may play a beneficial role in reducing Aβ-induced neurotoxicity. Their effect involves a putative mechanism beyond its cholesterol-lowering effects in preventing Aβ-induced neurotoxicity. However, the underlying molecular mechanisms of the protective effect of statins have not been clearly determined in Aβ-induced neurotoxicity. Given that statins may provide benefits beyond the inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, these drugs may also improve the brain. Thus, statins may have beneficial effects on impaired insulin signaling by activating AMP-activated protein kinase (AMPK) in neuronal cells. They play a potential therapeutic role in targeting Aβ-mediated neurotoxicity.

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    Dyslipidemia modulates Müller glial sensing and transduction of ambient information
    Monika Lakk, Felix Vazquez-Chona, Oleg Yarishkin, David Križaj
    2018, 13 (2):  207-210.  doi: 10.4103/1673-5374.226383
    Abstract ( 147 )   PDF (880KB) ( 214 )   Save

    Unesterified cholesterol controls the fluidity, permeability and electrical properties of eukaryotic cell membranes. Consequently, cholesterol levels in the retina and the brain are tightly regulated whereas depletion or oversupply caused by diet or heredity contribute to neurodegenerative diseases and vision loss. Astroglia, which play a central role in the biosynthesis, uptake and transport of cholesterol but also drive inflammatory signaling under hypercholesterolemic conditions associated with high-fat diet (diabetes) and neurodegenerative disease. A growing body of evidence shows that unesterified membrane cholesterol modulates the ability of glia to sense and transduce ambient information. Cholesterol-dependence of Muller glia - the retinal sentinels for metabolic, mechanical, osmotic and inflammatory signals - is mediated in part by transient receptor potential V4 (TRPV4) channels. Cholesterol supplementation facilitates whereas depletion suppresses TRPV4-mediated transduction of temperature and lipid agonists. However, it has less effect on the glial response to swelling. The acute effects of cholesterol supplementation/depletion on plasma membrane ion channels and calcium homeostasis differ from the effects of chronic dyslipidemia, possibly due to differential modulation of modality-dependent energy barriers associated with the functionality of polymodal channels embedded within lipid rafts. Understanding of cholesterol-dependence of TRP channels is thus providing insight into dyslipidemic pathologies associated with diabetic retinopathy, glaucoma and macular degeneration.

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    Contributions of neurotropic human herpesviruses herpes simplex virus 1 and human herpesvirus 6 to neurodegenerative disease pathology
    Jessica M. Hogestyn, David J. Mock, Margot Mayer-Proschel
    2018, 13 (2):  211-221.  doi: 10.4103/1673-5374.226380
    Abstract ( 141 )   PDF (612KB) ( 278 )   Save

    Human herpesviruses (HVs) have developed ingenious mechanisms that enable them to traverse the defenses of the central nervous system (CNS). The ability of HVs to enter a state of latency, a defining characteristic of this viral family, allows them to persist in the human host indefinitely. As such, HVs represent the most frequently detected pathogens in the brain. Under constant immune pressure, these infections are largely asymptomatic in healthy hosts. However, many neurotropic HVs have been directly connected with CNS pathology in the context of other stressors and genetic risk factors. In this review, we discuss the potential mechanisms by which neurotropic HVs contribute to neurodegenerative disease (NDD) pathology by highlighting two prominent members of the HV family, herpes simplex virus 1 (HSV-1) and human herpesvirus 6 (HHV-6). We (i) introduce the infectious pathways and replicative cycles of HSV-1 and HHV-6 and then (ii) review the clinical evidence supporting associations between these viruses and the NDDs Alzheimer’s disease (AD) and multiple sclerosis (MS), respectively. We then (iii) highlight and discuss potential mechanisms by which these viruses exert negative effects on neurons and glia. Finally, we (iv) discuss how these viruses could interact with other disease-modifying factors to contribute to the initiation and/or progression of NDDs.

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    Microglial dynamics during brain development
    Tomomi Okajima, Fuminori Tsuruta
    2018, 13 (2):  222-223.  doi: 10.4103/1673-5374.226386
    Abstract ( 127 )   PDF (166KB) ( 195 )   Save

    Microglia are the resident immune cells of the central nervous system (CNS). In the normal state, microglia have a ramified shape and continuously survey the conditions of the brain. In response to various stimuli, some microglia change to an amoeboid shape. This type of microglia is motile and produces several secretory proteins, including inflammatory cytokines and neurotrophic factors, which regulate brain homeostasis. Microglial morphology also changes a great deal in concert with environmental factors during brain development, and related to microglial migration and proliferation, which contribute to the establishment of precise synaptic connectivity and neural circuits.In this review, we focus on the fundamental concepts of microglial fate during brain development, and discuss whether the molecular mechanisms that control microglial morphology are linked to microglial functions.

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    Is it time to rethink the Alzheimer’s disease drug development strategy by targeting its silent phase?
    Benoit Souchet, Mickael Audrain, Baptiste Billoir, Laurent Lecanu, Satoru Tada, Jérôme Braudeau
    2018, 13 (2):  224-225.  doi: 10.4103/1673-5374.226389
    Abstract ( 102 )   PDF (118KB) ( 260 )   Save

    Alzheimer’s disease (AD) is the most frequent cause of dementia in the western world. In clinical terms, AD is characterized by progressive cognitive decline that usually begins with memory impairment. As the disease progresses, AD inevitably affects all intellectual functions including executive functions, leading to complete dependence for basic activities of daily life and premature death. Around 47 million people live with AD worldwide and the number of patients is estimated to surge to 130 million in 2050 if we don’t find a cure (Prince et al., 2015). By 2018 it will become a trillion-dollar disease and this economic cost inflicts a significant financial burden on individuals and families. In the US, out-of-pocket costs for families affected by Alzheimer’s account for more than $8,000 on average each year. It makes Alzheimer’s disease the most expensive illness for families during the last five years of life (Kelley et al., 2013). Unfortunately,there are no effective treatments against AD, although some drugs can alleviate the symptoms associated with it.

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    Efficacy of cognitive rehabilitation in Parkinson’s disease
    María Díez-Cirarda, Naroa Ibarretxe-Bilbao, Javier Peña, Natalia Ojeda
    2018, 13 (2):  226-227.  doi: 10.4103/1673-5374.226390
    Abstract ( 114 )   PDF (114KB) ( 223 )   Save

    Cognitive rehabilitation is a potential and promising treatment for cognitive impairment in Parkinson’s disease (PD) that has shown efficacy in diverse studies. In addition, some few studies have found brain changes after cognitive rehabilitation in PD, which supports the existence of brain plasticity associated to cognitive training in a degenerative disease. In this perspective article authors will discuss current knowledge regarding the efficacy of cognitive interventions in PD and highlight some of the following steps that should be carried out to obtain a complete picture of the efficacy of cognitive rehabilitation in PD.

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    Retinal ganglion cell neuroprotection by growth factors and exosomes: lessons from mesenchymal stem cells
    Ben Mead, Stanislav Tomarev
    2018, 13 (2):  228-229.  doi: 10.4103/1673-5374.226392
    Abstract ( 114 )   PDF (127KB) ( 234 )   Save

    Retinal ganglions cells (RGCs) are responsible for propagating electrochemical information from the eye to the brain along their axons which make up the optic nerve. The loss of RGCs is characteristic in several conditions such as glaucoma and traumatic optic neuropathy and leads to visual loss and blindness.While no therapy exists to directly treat RGCs, the use of bone marrow-derived mesenchymal stem cells (BMSCs) has shown promise in eliciting significant RGC neuroprotection. Their efficacy is proven in both in vitro (retinal co-culture (Mead et al.,2014) and organotypic retinal explants (Johnson et al., 2014))and in vivo (ocular hypertension (Johnson et al., 2010) and optic nerve crush (Mesentier-Louro et al., 2014)) models from multiple laboratories and are currently being investigated in clinical trials (reviewed in Mead et al., 2015). While other MSCs exist,such as those isolated from adipose tissue, umbilical cord blood and dental pulp, and have even been demonstrated to act differently in neuroprotective assays (Mead et al., 2014), BMSCs are the most widely studied and the predominant MSC undergoing clinical trials. Although BMSCs do not replace retinal cells and their mechanism of action is exclusively through the secretion of neuroprotective compounds, BMSCs represent an exciting candidate for cellular therapy of the retina. A large body of evidence exists for the efficacious use of BMSCs in several eye disease models and over ten stage 1 clinical trials are underway (Reviewed in Mead et al., 2015). While many of these trials have now reported good findings with successful transplantation into patients, the safety aspect of delivering living, dividing cells into the eye can still be questioned given the recent case study of three patients going blind after receiving intravitreal adipose-derived MSCs (Kuriyan et al., 2017). Issues such as hemorrhage and retinal detachment were observed and may reflect a possible side effect of intravitreal cell therapy. What is also not clear is the “shelf-life” of the BMSCs, particularly considering that they will need to be stored in liquid nitrogen, or grown and maintained at 37°C/5% CO2. These requirements add further costs and expertise needed for such a treatment while also introducing variability,particularly since the longer the cells are grown the lower the titers of secreted neuroprotective compounds (Mead et al., 2014).Another issue is that the BMSCs secretome contains a wide variety of compounds, some of which, such as vascular endothelial growth factor (VEGF), may be detrimental to the retina in high concentrations. While using BMSCs as a therapy is one avenue of research, understanding of their mechanism and the development of new treatments, independent of the cells themselves is equally important and would circumnavigate much of the issues detailed above. Our research has identified two very different modalities by which BMSCs protect RGCs, secretion of multiple neuroprotective peptides, of which platelet-derived growth factor (PDGF)-AA was the most neuroprotective, and secretion of extracellular vesicles including exosomes.

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    Territory maximization hypothesis during peripheral nerve regeneration
    Jiu-xu Deng, Jian Weng, Yu-hui Kou, Pei-xun Zhang, Yan-hua Wang, Na Han, Bao-guo Jiang, Xiao-feng Yin
    2018, 13 (2):  230-231.  doi: 10.4103/1673-5374.226393
    Abstract ( 125 )   PDF (130KB) ( 234 )   Save

    Territory awareness refers to the notion that an organism lives in a territory, considers this territory its own, and prevents entry of other organisms. Generally, an organism maximizes its territory for best survival advantages, which subsequently allows for species continuation. Axonal sprouting occurs when peripheral nerves regenerate. The distal regenerated nerve fibers significantly outnumber those at the proximal end of the donor nerve, which has long been termed the “multiple amplification”phenomenon (Yin et al., 2013). Previous studies have shown that sprouting and multiple amplification occur during peripheral nerve regeneration. The regenerated nerve fibers greatly outnumber the original fibers of the donor nerve, thereby filling the entire physiological space of the acceptor nerves and allowing for the peripheral neurons to maximize innervation to the target organs. However, the role of the fibers in the amplification processes remains to be shown, as well as the factors involved in amplification. Additionally, very little is understood about how the fibers serve as donor nerves to repair peripheral nerve injury, whether there is a biological motive for the regeneration process, and whether the peripheral neurons have their own behavioral pattern. Further investigation might offer different perspectives about peripheral nerve regeneration and the potential application in disease treatments.

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    Urokinase-type plasminogen activator promotes synaptic repair in the ischemic brain
    Ariel Diaz, Manuel Yepes
    2018, 13 (2):  232-233.  doi: 10.4103/1673-5374.226384
    Abstract ( 124 )   PDF (215KB) ( 230 )   Save

    The central nervous system has a very high energy requirement. Accordingly,despite representing only 2% of the body’s mass, the brain uses 20% of the total oxygen consumption. Importantly, because most of this energy is used to maintain synaptic activity, even a mild decrease in its supply to the brain has deleterious implications for synaptic function.For example, only one minute of interruption of the cerebral blood flow during an acute ischemic stroke (AIS) is enough to destroy approximately 14 billion synapses (Saver, 2006). Importantly, because synaptic dysfunction leads to functional impairment, cerebral ischemia is one of the leading cause of disability in the world. Unfortunately, to this date there is no effective therapeutic strategy to promote neurological recovery among AIS survivors. Here we will discuss recent data indicating that binding of the serine proteinase urokinase-type plasminogen activator (uPA) to its receptor (uPAR) promotes synaptic repair in the ischemic brain, and will argue that this discovery has significant translational implications for the treatment of the rapidly growing number of patients that survive an AIS.

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    Regulation of neuroinflammatory properties of glial cells by T cell effector molecules
    Chittappen K. Prajeeth, Jochen Huehn, Martin Stangel
    2018, 13 (2):  234-236.  doi: 10.4103/1673-5374.226385
    Abstract ( 117 )   PDF (433KB) ( 245 )   Save

    Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disorder that is thought to be mediated by autoreactive T lymphocytes that find their way into the central nervous system (CNS). The pathological mechanism of MS is still being elucidated but it involves complex interactions between infiltrating immune cells and resident glial cells within the CNS that culminate into strong neuroinflammation and axonal damage. Most of the current knowledge on the immunopathology of MS has been generated using the rodent model of experimental autoimmune encephalomyelitis (EAE). Among CD4+ T helper cell subsets, interferon gamma (IFN-γ)-producing Th1 cells as well as interleukin 17 (IL-17)-producing Th17 cells are crucial in driving the pathology of EAE. Th1 and Th17 cell differentiation is guided by distinct transcriptional programs induced by polarizing factors. Presumably, following a trigger, some local factors and effector molecules produced by Th1 and Th17 cells facilitate their entry into the CNS and induce a pathological neuroinflammatory response by activating resident glial cells, which further assist massive infiltration of a second wave of immune cells into the CNS. This scenario was evident from the fact that adoptive transfer of in vitro activated myelin oligodendrocyte glycoprotein (MOG)-specific Th1 and Th17 cells into naïve rodent hosts was sufficient to induce EAE (Codarri et al., 2011). Nevertheless, disease severity and clinical manifestation of EAE induced after adoptive transfer of Th1 and Th17 cells were highly variable. Transfer of Th1 cells induced classical paralytic EAE, whereas Th17 cell transfer drove atypical ataxic EAE, an indication that mechanisms used by effector Th1 and Th17 cells in driving neuroinflammation might be different. A number of parameters could account for these differences. First, Th1 and Th17 cells might have different capacities to directly target neurons (Siffrin et al., 2010). Second, by virtue of distinct sets of effector molecules they target and recruit different cells within and towards the CNS and altogether induce a different neuroinflammatory profile. Third, they might have different capacities to regulate repair mechanisms following initial neuroinflammatory damage. Here we focus on the current knowledge of T cell-glial interactions and discuss how effector molecules of Th1 and Th17 cells influence the phenotype and function of resident glial cells within the CNS. There is a great body of evidence describing IFN-γ and IL-17 as major effector molecules of Th1 and Th17 cells, respectively. However, induction of EAE by IFN-γ-/- and IL-17-/- T cells has demonstrated that these factors are dispensable for neuropathology (Codarri et al., 2011). Further studies have identified granulocyte macrophage colony stimulating factor (GM-CSF), largely associated with Th17 cells but also produced by Th1 cells,as an indispensable effector molecule whose overexpression in CD4+ T cells alone was sufficient for driving neuropathology similar to EAE (Codarri et al., 2011; Spath et al., 2017). Following infiltration into the CNS, autoreactive Th1 and Th17 cells are involved in constant crosstalk with microglia and astrocytes and their effector molecules profoundly influence the phenotype and function of these major glial cell types. Microglia are the sentinels of the CNS that rapidly respond to invading pathogens, CNS injury and inflammation. Depending on external cues they can attain pro- (M1-like) or anti-inflammatory (M2-like)phenotypes. Although this dichotomy vastly oversimplifies the plasticity of microglia, the original thought is that an M1-like phenotype is attained by sensing invading pathogens or inflammatory mediators and is considered to be neurotoxic, whereas M2-like microglia are involved in repair mechanisms and are considered to play a neuroprotective role by providing anti-inflammatory mediators and growth factors (Aguzzi et al., 2013). Microglial responses need to be tightly balanced between these phenotypes to maintain the integrity of neural tissue. A sustained pro-inflammatory milieu during MS favors M1-like microglia to populate the lesions triggering demyelination and axonal damage. Similarly, reactive astrogliosis is also a characteristic feature of neurodegenerative disorders like MS. Astrocytes are the most abundant cell type in the CNS with a multitude of functions including support of neural homeostasis. Anatomically astrocytes are active components of the blood-brain barrier (BBB) and are also found in close association with neurons. Therefore they were believed to be less reactive than microglia to avoid any imminent damage to the neural tissue. However, astrocytes do respond to injury by releasing diverse molecules. Primarily, they are a major source of neurotrophic growth factors (nerve growth factor, glial cell-derived neurotrophic factor,ciliary neurotrophic factor, etc.) which drive neurogenesis and assist tissue repair mechanisms. Additionally,astrocytes produce anti-inflammatory factors that dampen any minor inflammation in the CNS and avoid potential damage. Under pathological conditions they also respond to pathogens and infiltrating leukocytes and release a large array of pro-inflammatory cytokines and chemokines,thereby directly contributing to exacerbation of neuroinflammation.

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    Serotonin controls axon and neuronal regeneration in the nervous system: lessons from regenerating animalmodels
    Daniel Sobrido-Cameán, María Celina Rodicio, Antón Barreiro-Iglesias
    2018, 13 (2):  237-238.  doi: 10.4103/1673-5374.226387
    Abstract ( 145 )   PDF (118KB) ( 277 )   Save

    Traumatic brain injury (TBI) is a mechanical injury to brain tissue that leads to an impairment of function and a broad spectrum of symptoms and disabilities; often, it is followed by diffuse axonal injury, which causes denaturation of the white matter and axon retraction, leaving patients with severe brain damage or even in a persistent vegetative state. Spinal cord injury (SCI) is defined as a lesion within the spinal cord that results in the disruption of nerve fibre bundles that convey ascending sensory and descending motor information. In mammals, including humans, SCI can lead to permanent disability and an irreversible loss of function below the site of injury due to the disruption of motor, sensory and autonomic systems. The inability of axons to regrow within the injured central nervous system (CNS) of adult mammals is a fundamental feature that explains the poor regenerative capacity observed after TBI or SCI. In addition, TBI and SCI cause a loss of cells (neurons and glia)due to the primary physical injury. Also, after the primary injury, a cascade of secondary injury events expands the zona of neural tissue injury causing further cell death.

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    Ocular findings in Zucker Diabetic Fatty rats emphasize the key role of neuroglia degeneration in diabetic retinopathy pathophysiology
    Ivan Fernandez-Bueno, Yolanda Diebold
    2018, 13 (2):  239-240.  doi: 10.4103/1673-5374.226391
    Abstract ( 126 )   PDF (306KB) ( 195 )   Save

    Diabetes mellitus is a leading cause of acquired vision loss and one of the world’s fastest growing chronic diseases. Diabetic retinopathy (DR), a specific complication of chronic hyperglycemia, is the leading cause of acquired vision loss worldwide in middle-aged and therefore economically active people that also increases the medical and economic burden on the society (Klein, 2007). The natural history of DR has been divided into two clinical stages based on the proliferative status of the retinal vasculature: an early, non-proliferative stage and an advanced, proliferative or neovascular stage. Although DR has been regarded as a vascular disorder for many years, neuroglial abnormalities have also been recognized and are still being explored to determine their clinical significance. A lot of important information or clues on the development of DR can be obtained from human studies; however, the complete mechanisms of DR development have not yet been elucidated. In this sense, diabetic rat models are playing key roles in elucidating the pathogenesis of human diabetes and its complications, such as nephropathy, retinopathy, and neuropathy.Although spontaneous diabetic rat models are well characterized in terms of retina-choroid vascular modifications, changes in retinal cells (neurons and glia) associated with hyperglycemia have not been studied in detail on most available models (Lai and Lo, 2013; Olivares et al., 2017). Early structural gliotic reactions were initially described in pharmacologically induced rat models of diabetes (Rungger-Brändle et al., 2000). Recently, neuroglial morphologic degenerative changes have been described in spontaneous diabetic Zucker Diabetic Fatty (ZDF) rats prior to changes in vasculature appearance (Fernandez-Bueno et al., 2017). The ocular findings observed in animal models of diabetes, such as the ZDF rats, emphasize that DR is not, at least initially, a primary vascular disorder and that prolonged damage to the neural and glial components of the retina plays a key role in the development of the disease.

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    Adenosine A2A-dopamine D2 receptor heteromers operate striatal function: impact on Parkinson’s disease pharmacotherapeutics
    Víctor Fernández-Dueñas, Sergi Ferré, Francisco Ciruela
    2018, 13 (2):  241-243.  doi: 10.4103/1673-5374.226388
    Abstract ( 133 )   PDF (452KB) ( 246 )   Save

    The basal ganglia (BG) assemble a series of deep gray matter structures forming recurrent loops that include the cortex and thalamus, and that participate in the regulation of a plethora of brain functions, including elicitation and learning of reward-and aversive stimuli-associated behaviors,motor activity control and sensorimotor gating (Bromberg-Martin et al., 2010). The striatum is the main input BG structure, thus it receives cortical glutamatergic projections from widespread areas of cortex and projects into other BG nuclei, including globus pallidus pars externa and the BG outputsglobus pallidus pars interna and substantia nigra pars reticulata. On the other hand, the substantia nigra pars compacta-ventral tegmental area (SNpc-VTA) modulates cortical-BG-thalamic circuits by means of dopaminergic innervation of the striatum. Interestingly, the main population of striatal neurons, the medium spiny neurons (MSNs),provide the origin of two different striatal efferent pathways,the direct and indirect pathways (Schiffmann et al., 2007).Both project to the BG outputs, and the direct pathway also projects to brainstem, to the SNpc-VTA. The MSN originating these two pathways are characterized by the differential expression of several key genes. Thus, while MSNs from the direct pathway (direct MSNs) express dopamine D1 receptors (D1R) and contain the neuropeptides dynorphin and substance P, indirect MSNs express dopamine D2 receptors (D2R) and contain the neuropeptide enkephalin (Fuxe et al.,2007; Schiffmann et al., 2007). Striatal dopamine from SNpc-VTA projections potentiates direct and inhibits indirect pathway MSN, which leads to a net inhibition of thalamocortical areas.

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    Wake-promoting effects of vagus nerve stimulation after traumatic brain injury: upregulation of orexin-A and orexin receptor type 1 expression in the prefrontal cortex
    Xiao-yang Dong, Zhen Feng
    2018, 13 (2):  244-251.  doi: 10.4103/1673-5374.226395
    Abstract ( 158 )   PDF (652KB) ( 357 )   Save

    Orexins, produced in the lateral hypothalamus, are important neuropeptides that participate in the sleep/wake cycle, and their expression coincides with the projection area of the vagus nerve in the brain. Vagus nerve stimulation has been shown to decrease the amounts of daytime sleep and rapid eye movement in epilepsy patients with traumatic brain injury. In the present study, we investigated whether vagus nerve stimulation promotes wakefulness and affects orexin expression. A rat model of traumatic brain injury was established using the free fall drop method. In the stimulated group, rats with traumatic brain injury received vagus nerve stimulation (frequency, 30 Hz;current, 1.0 mA; pulse width, 0.5 ms; total stimulation time, 15 minutes). In the antagonist group, rats with traumatic brain injury were intracerebroventricularly injected with the orexin receptor type 1 (OX1R) antagonist SB334867 and received vagus nerve stimulation.Changes in consciousness were observed after stimulation in each group. Enzyme-linked immunosorbent assay, western blot assay and immunohistochemistry were used to assess the levels of orexin-A and OX1R expression in the prefrontal cortex. In the stimulated group,consciousness was substantially improved, orexin-A protein expression gradually increased within 24 hours after injury and OX1R expression reached a peak at 12 hours, compared with rats subjected to traumatic brain injury only. In the antagonist group, the wake-promoting effect of vagus nerve stimulation was diminished, and orexin-A and OX1R expression were decreased, compared with that of the stimulated group. Taken together, our findings suggest that vagus nerve stimulation promotes the recovery of consciousness in comatose rats after traumatic brain injury. The upregulation of orexin-A and OX1R expression in the prefrontal cortex might be involved in the wake-promoting effects of vagus nerve stimulation.

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    Dabrafenib, an inhibitor of RIP3 kinase-dependent necroptosis, reduces ischemic brain injury
    Shelly A. Cruz, Zhaohong Qin, Alexandre F. R. Stewart, Hsiao-Huei Chen
    2018, 13 (2):  252-256.  doi: 10.4103/1673-5374.226394
    Abstract ( 182 )   PDF (955KB) ( 362 )   Save

    Ischemic brain injury triggers neuronal cell death by apoptosis via caspase activation and by necroptosis through activation of the receptor-interacting protein kinases (RIPK) associated with the tumor necrosis factor-alpha (TNF-α)/death receptor. Recent evidence shows RIPK inhibitors are neuroprotective and alleviate ischemic brain injury in a number of animal models, however, most have not yet undergone clinical trials and safety in humans remains in question. Dabrafenib, originally identified as a B-raf inhibitor that is currently used to treat melanoma, was later revealed to be a potent RIPK3 inhibitor at micromolar concentrations.Here, we investigated whether Dabrafenib would show a similar neuroprotective effect in mice subjected to ischemic brain injury by photothrombosis. Dabrafenib administered intraperitoneally at 10 mg/kg one hour after photothrombosis-induced focal ischemic injury significantly reduced infarct lesion size in C57BL6 mice the following day, accompanied by a markedly attenuated upregulation of TNF-α. However,subsequent lower doses (5 mg/kg/day) failed to sustain this neuroprotective effect after 4 days. Dabrafenib blocked lipopolysaccharides-induced activation of TNF-α in bone marrow-derived macrophages, suggesting that Dabrafenib may attenuate TNF-α-induced necroptotic pathway after ischemic brain injury. Since Dabrafenib is already in clinical use for the treatment of melanoma, it might be repurposed for stroke therapy.

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    Comparison of the anti-apoptotic effects of 15- and 35-minute suspended moxibustion after focal cerebral ischemia/reperfusion injury
    Ai-jiao Xiao, Lin He, Xin Ouyang, Jie-min Liu, Ming-ren Chen
    2018, 13 (2):  257-264.  doi: 10.4103/1673-5374.226396
    Abstract ( 155 )   PDF (1171KB) ( 311 )   Save

    Heat-sensitive suspended moxibustion has a neuroprotective effect against focal cerebral ischemia/reperfusion injury, but the underlying mechanisms remain unclear. The duration of heat-sensitive suspended moxibustion (usually from 30 minutes to 1 hour) is longer than traditional suspended moxibustion (usually 15 minutes). However, the effects of 15- and 35-minute suspended moxibustion in rats with cerebral ischemia/reperfusion injury are poorly understood. In this study, we performed 15- or 35-minute suspended moxibustion at acupoint Dazhui (GV14) in an adult rat model of focal cerebral ischemia/reperfusion injury. Infarct volume was evaluated with the 2,3,5-triphenyltetrazolium chloride assay. Histopathological changes and neuronal apoptosis at the injury site were assessed by hematoxylin-eosin staining and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Caspase-9 and caspase-3 expression at the injury site was detected using immunofluorescent staining. Bax and Bcl-2 expression at the injury site was assessed using western blot assay.In the 35-minute moxibustion group, infarct volume was decreased, neuronal apoptosis was reduced, caspase-9, caspase-3 and Bax expression was lower, and Bcl-2 expression was increased, compared with the 15-minute moxibustion group. Our findings show that 35-minute moxibustion has a greater anti-apoptotic effect than 15-minute moxibustion after focal cerebral ischemia/reperfusion injury.

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    High-throughput sequencing analysis of differentially expressed miRNAs and target genes in ischemia/reperfusion injury and apelin-13 neuroprotection
    Chun-mei Wang, Xue-lu Yang, Ming-hui Liu, Bao-hua Cheng, Jing Chen, Bo Bai
    2018, 13 (2):  265-271.  doi: 10.4103/1673-5374.226397
    Abstract ( 142 )   PDF (1002KB) ( 264 )   Save

    miRNAs regulate a variety of biological processes through pairing-based regulation of gene expression at the 3′ end of the noncoding region of the target miRNA. miRNAs were found to be abnormally expressed in ischemia/reperfusion injury models. High-throughput sequencing is a recently developed method for sequencing miRNAs and has been widely used in the analysis of miRNAs. In this study,ischemia/reperfusion injury models were intracerebroventricularly injected with 50 μg/kg apelin-13. High-throughput sequencing showed that 357 known miRNAs were differentially expressed among rat models, among which 78 changed to > 2-fold or < 0.5-fold. Quantitative real-time polymerase chain reaction was selected to confirm the expression levels of four miRNAs that were differentially expressed,the results of which were consistent with the results of high-throughput sequencing. Gene Ontology analysis revealed that the predicted targets of the different miRNAs are particularly associated with cellular process, metabolic process, single-organism process, cell, and binding. Kyoto Encyclopedia of Gene and Genome analysis showed that the target genes are involved in metabolic pathways, mitogen-activated protein kinase signaling pathway, calcium signaling pathway, and nuclear factor-κB signaling pathway. Our findings suggest that differentially expressed miRNAs and their target genes play an important role in ischemia/reperfusion injury and neuroprotection by apelin-13.

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    Hyperhomocysteinemia induces injury in olfactory bulb neurons by downregulating Hes1 and Hes5 expression
    Jing-wen Zhang, Bo Pang, Qi Zhao, Yue Chang, Yi-li Wang, Yi-deng Jiang, Li Jing
    2018, 13 (2):  272-279.  doi: 10.4103/1673-5374.220779
    Abstract ( 136 )   PDF (5218KB) ( 343 )   Save

    Hyperhomocysteinemia has been shown to be associated with neurodegenerative diseases; however, lesions or histological changes and mechanisms underlying homocysteine-induced injury in olfactory bulb neurons remain unclear. In this study, hyperhomocysteinemia was induced in apolipoprotein E-deficient mice with 1.7% methionine. Pathological changes in the olfactory bulb were observed through hematoxylin-eosin and Pischingert staining. Cell apoptosis in the olfactory bulb was determined through terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. Transmission electron microscopy revealed an abnormal ultrastructure of neurons. Furthermore, immunoreactivity and expression of the hairy enhancer of the split 1 (Hes1) and Hes5 were measured using immunohistochemistry, immunofluorescence, and western blot assay. Our results revealed no significant structural abnormality in the olfactory bulb of hyperhomocysteinemic mice. However, the number of TUNEL-positive cells increased in the olfactory bulb, lipofuscin and vacuolization were visible in mitochondria, and the expression of Hes1 and Hes5 decreased. These findings confirm that hyperhomocysteinemia induces injury in olfactory bulb neurons by downregulating Hes1 and Hes5 expression.

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    Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization
    Chao-liang Tang, Juan Li, Zhe-tao Zhang, Bo Zhao, Shu-dong Wang, Hua-ming Zhang, Si Shi, Yang Zhang, Zhong-yuan Xia
    2018, 13 (2):  280-288.  doi: 10.4103/1673-5374.226399
    Abstract ( 149 )   PDF (502KB) ( 272 )   Save

    Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 μg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 μg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spontaneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100β and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) (registration number: ChiCTR-IPR-16008113).

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    Effect of chondroitin sulfate proteoglycans on neuronal cell adhesion, spreading and neurite growth in culture
    Jingyu Jin, Sharada Tilve, Zhonghai Huang, Libing Zhou, Herbert M. Geller, Panpan Yu
    2018, 13 (2):  289-297.  doi: 10.4103/1673-5374.226398
    Abstract ( 210 )   PDF (5554KB) ( 352 )   Save

    As one major component of extracellular matrix (ECM) in the central nervous system, chondroitin sulfate proteoglycans (CSPGs) have long been known as inhibitors enriched in the glial scar that prevent axon regeneration after injury. Although many studies have shown that CSPGs inhibited neurite outgrowth in vitro using different types of neurons, the mechanism by which CSPGs inhibit axonal growth remains poorly understood. Using cerebellar granule neuron (CGN) culture, in this study, we evaluated the effects of different concentrations of both immobilized and soluble CSPGs on neuronal growth, including cell adhesion, spreading and neurite growth. Neurite length decreased while CSPGs concentration arised, meanwhile, a decrease in cell density accompanied by an increase in cell aggregates formation was observed. Soluble CSPGs also showed an inhibition on neurite outgrowth, but it required a higher concentration to induce cell aggregates formation than coated CSPGs. We also found that growth cone size was significantly reduced on CSPGs and neuronal cell spreading was restrained by CSPGs, attributing to an inhibition on lamellipodial extension. The effect of CSPGs on neuron adhesion was further evidenced by interference reflection microscopy (IRM) which directly demonstrated that both CGNs and cerebral cortical neurons were more loosely adherent to a CSPG substrate. These data demonstrate that CSPGs have an effect on cell adhesion and spreading in addition to neurite outgrowth.

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    Modified insulin-like growth factor 1 containing collagen-binding domain for nerve regeneration
    Jian-an Li, Chang-fu Zhao, Shao-jun Li, Jun Zhang, Zhen-hua Li, Qiao Zhang, Xiao-yu Yang, Chun-fang Zan
    2018, 13 (2):  298-303.  doi: 10.4103/1673-5374.226400
    Abstract ( 148 )   PDF (806KB) ( 262 )   Save

    Insulin-like growth factor 1 (IGF-1) is a potential nutrient for nerve repair. However, it is impractical as a therapy because of its limited halflife,rapid clearance, and limited target specificity. To achieve targeted and long-lasting treatment, we investigated the addition of a binding structure by fusing a collagen-binding domain to IGF-1. After confirming its affinity for collagen, the biological activity of this construct was examined by measuring cell proliferation after transfection into PC12 and Schwann cells using a 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assay. Immunofluorescence staining was conducted to detect neurofilament and microtubule-associated protein 2 expression, while real time-polymerase chain reaction was utilized to determine IGF-1 receptor and nerve growth factor mRNA expression. Our results demonstrate a significant increase in collagen-binding activity of the recombinant protein compared with IGF-1.Moreover, the recombinant protein promoted proliferation of PC12 and Schwann cells, and increased the expression of neurofilament and microtubule-associated protein 2. Importantly, the recombinant protein also stimulated sustained expression of IGF-1 receptor and nerve growth factor mRNA for days. These results show that the recombinant protein achieved the goal of targeting and long-lasting treatment,and thus could become a clinically used factor for promoting nerve regeneration with a prolonged therapeutic effect.

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    Predictive power of abnormal electroencephalogram for post-cerebral infarction depression
    Yan-ping Zheng, Fu-xi Wang, De-qiang Zhao, Yan-qing Wang, Zi-wei Zhao, Zhan-wen Wang, Jun Liu, Jun Wang, Ping Luan
    2018, 13 (2):  304-308.  doi: 10.4103/1673-5374.213555
    Abstract ( 167 )   PDF (376KB) ( 232 )   Save

    Electroencephalography is a sensitive indicator for measuring brain condition, and can reflect early changes in brain function and severity of cerebral ischemia. However, it is not yet known whether electroencephalography can predict development of post-cerebral infarction depression. A total of 321 patients with ischemic stroke underwent electroencephalography and Hamilton Depression Rating Scale assessment to analyze the relationship between electroencephalography and post-cerebral infarction depression. Our results show that electroencephalograms of ischemic stroke patients with depression exhibit low-amplitude alpha activity and slow theta activity. In contrast,electroencephalograms of ischemic stroke patients without depression show fast beta activity and slow delta activity. These findings confirm that low-amplitude alpha activity and slow theta activity can be considered as independent predictors for post-cerebral infarction depression.

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    Anastomotic stoma coated with chitosan film as a betamethasone dipropionate carrier for peripheral nerve regeneration
    Ping Yao, Peng Li, Jun-jian Jiang, Hong-ye Li
    2018, 13 (2):  309-316.  doi: 10.4103/1673-5374.226401
    Abstract ( 142 )   PDF (568KB) ( 268 )   Save

    Scar hyperplasia at the suture site is an important reason for hindering the repair effect of peripheral nerve injury anastomosis. To address this issue, two repair methods are often used. Biological agents are used to block nerve sutures and the surrounding tissue to achieve physical anti-adhesion effects. Another agent is glucocorticosteroid, which can prevent scar growth by inhibiting inflammation. However, the overall effect of promoting regeneration of the injured nerve is not satisfactory. In this regard, we envision that these two methods can be combined and lead to shared understanding for achieving improved nerve repair. In this study, the right tibial nerve was transected 1 cm above the knee to establish a rat tibial nerve injury model. The incision was directly sutured after nerve transection. The anastomotic stoma was coated with 0.5 × 0.5 cm2 chitosan sheets with betamethasone dipropionate. At 12 weeks after injury, compared with the control and poly (D, L-lactic acid) groups, chitosan-betamethasone dipropionate film slowly degraded with the shape of the membrane still intact. Further, scar hyperplasia and the degree of adhesion at anastomotic stoma were obviously reduced, while the regenerated nerve fiber structure was complete and arranged in a good order in model rats. Electrophysiological study showed enhanced compound muscle action potential. Our results confirm that chitosan-betamethasone dipropionate film can effectively prevent local scar hyperplasia after tibial nerve repair and promote nerve regeneration.

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    Exploratory use of ultrasound to determine whether demyelination following carpal tunnel syndrome co-exists with axonal degeneration
    Xue Deng, Lai-Heung Phoebe Chau, Suk-Yee Chiu, Kwok-Pui Leung, Sheung-Wai Li, Wing-Yuk Ip
    2018, 13 (2):  317-323.  doi: 10.4103/1673-5374.226402
    Abstract ( 151 )   PDF (1136KB) ( 268 )   Save

    Carpal tunnel syndrome (CTS) accompanied by secondary axonal degeneration cannot be clearly discriminated using the current cross-validated ultrasound severity classification system. This study aimed at exploring cut-off values of ultrasound parameters, including wrist cross-sectional area (W-CSA), wrist perimeter (W-P), ratio of cross-sectional area (R-CSA) and perimeter (R-P), changes of CSA and P from wrist to one third distal forearm (ΔCSA&ΔP) for differentiation. Seventy-three patients (13 male and 60 female) were assigned into group A (demyelination only, n = 40) and group B (demyelination with secondary axonal degeneration, n = 33) based on the outcomes of nerve conduction studies (NCS). Receiver Operative Characteristics (ROC) curves were plotted to obtain sensitivity, specificity, and accuracy of cutoff values for all the ultrasound parameters. The overall identified cut-off values (W-CSA 12.0 mm2, W-P 16.27 mm, R-CSA 1.85, R-P 1.48, ΔCSA 6.98 mm2, ΔP 5.77 mm) had good sensitivity (77.1–88.6%), fair specificity (40–62.2%) and fair-to-good accuracy (0.676–0.758). There were also significant differences in demographics (age and severity gradation, P < 0.001), NCS findings (wrist motor latency and conduction velocity, P < 0.0001; wrist motor amplitude, P < 0.05; distal sensory latency, P < 0.05; sensory amplitude, P < 0.001) and ultrasound measurements (W-CSA, W-P, R-CSA, R-P, ΔCSA&ΔP, P < 0.05) between groups.These findings suggest that ultrasound can be potentially used to differentiate demyelinating CTS with secondary axonal degeneration and provide better treatment guidance.

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    GSK3β inhibitor promotes myelination and mitigates muscle atrophy after peripheral nerve injury
    Jian Weng, Yan-hua Wang, Ming Li, Dian-ying Zhang, Bao-guo Jiang
    2018, 13 (2):  324-330.  doi: 10.4103/1673-5374.226403
    Abstract ( 154 )   PDF (1654KB) ( 339 )   Save

    Delay of axon regeneration after peripheral nerve injury usually leads to progressive muscle atrophy and poor functional recovery. The Wnt/β-catenin signaling pathway is considered to be one of the main molecular mechanisms that lead to skeletal muscle atrophy in the elderly. We hold the hypothesis that the innervation of target muscle can be promoted by accelerating axon regeneration and decelerating muscle cell degeneration so as to improve functional recovery of skeletal muscle following peripheral nerve injury. This process may be associated with the Wnt/β-catenin signaling pathway. Our study designed in vitro cell models to simulate myelin regeneration and muscle atrophy. We investigated the effects of SB216763, a glycogen synthase kinase 3 beta inhibitor, on the two major murine cell lines RSC96 and C2C12 derived from Schwann cells and muscle satellite cells. The results showed that SB216763 stimulated the Schwann cell migration and myotube contraction. Quantitative polymerase chain reaction results demonstrated that myelin related genes, myelin associated glycoprotein and cyclin-D1, muscle related gene myogenin and endplate-associated gene nicotinic acetylcholine receptors levels were stimulated by SB216763. Immunocytochemical staining revealed that the expressions of β-catenin in the RSC96 and C2C12 cytosolic and nuclear compartments were increased in the SB216763-treated cells. These findings confirm that the glycogen synthase kinase 3 beta inhibitor,SB216763, promoted the myelination and myotube differentiation through the Wnt/β-catenin signaling pathway and contributed to nerve remyelination and reduced denervated muscle atrophy after peripheral nerve injury.

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     Proteomic analysis of trans-hemispheric motor cortex reorganization following contralateral C7 nerve transfer
    Yin Yuan, Xiu-yue Xu, Jie Lao, Xin Zhao
    2018, 13 (2):  331-339.  doi: 10.4103/1673-5374.226429
    Abstract ( 137 )   PDF (615KB) ( 254 )   Save

    Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Previous studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth associated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function (including neuron differentiation and development, axonogenesis,and guidance), microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light (NFL) and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteomic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C7 nerve transfer.

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    Effect of electrical stimulation on neural regeneration via the p38-RhoA and ERK1/2-Bcl-2 pathways in spinal cord-injured rats
    Min Cheol Joo, Chul Hwan Jang, Jong Tae Park, Seung Won Choi, Seungil Ro, Min Seob Kim, Moon Young Lee
    2018, 13 (2):  340-346.  doi: 10.4103/1673-5374.226404
    Abstract ( 174 )   PDF (658KB) ( 289 )   Save

    Although electrical stimulation is therapeutically applied for neural regeneration in patients, it remains unclear how electrical stimulation exerts its effects at the molecular level on spinal cord injury (SCI).To identify the signaling pathway involved in electrical stimulation improving the function of injured spinal cord, 21 female Sprague-Dawley rats were randomly assigned to three groups: control (no surgical intervention, n = 6), SCI (SCI only, n = 5), and electrical simulation (ES; SCI induction followed by ES treatment, n = 10). A complete spinal cord transection was performed at the 10th thoracic level. Electrical stimulation of the injured spinal cord region was applied for 4 hours per day for 7 days. On days 2 and 7 post SCI, the Touch-Test Sensory Evaluators and the Basso-Beattie-Bresnahan locomotor scale were used to evaluate rat sensory and motor function. Somatosensory-evoked potentials of the tibial nerve of a hind paw of the rat were measured to evaluate the electrophysiological function of injured spinal cord. Western blot analysis was performed to measure p38-RhoA and ERK1/2-Bcl-2 pathways related protein levels in the injured spinal cord. Rat sensory and motor functions were similar between SCI and ES groups. Compared with the SCI group, in the ES group, the latencies of the somatosensory-evoked potential of the tibial nerve of rats were significantly shortened, the amplitudes were significantly increased, RhoA protein level was significantly decreased, protein gene product 9.5 expression, ERK1/2, p38, and Bcl-2 protein levels in the spinal cord were significantly increased. These data suggest that ES can promote the recovery of electrophysiological function of the injured spinal cord through regulating p38-RhoA and ERK1/2-Bcl-2 pathway-related protein levels in the injured spinal cord.

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    Voltage adjustment improves rigidity and tremor in Parkinson’s disease patients receiving deep brain stimulation
    Shao-hua Xu, Chao Yang, Wen-biao Xian, Jing Gu, Jin-long Liu, Lu-lu Jiang, Jing Ye, Yan-mei Liu, Qi-yu Guo, Yi-fan Zheng, Lei Wu
    2018, 13 (2):  347-352.  doi: 10.4103/1673-5374.226406
    Abstract ( 224 )   PDF (553KB) ( 178 )   Save

    Deep brain stimulation of the subthalamic nucleus is recognized as the most effective treatment for moderate and advanced Parkinson’s disease. Programming of the stimulation parameters is important for maintaining the efficacy of deep brain stimulation. Voltage is considered to be the most effective programming parameter. The present study is a retrospective analysis of six patients with Parkinson’s disease (four men and two women, aged 37–65 years), who underwent bilateral deep brain stimulation of the subthalamic nucleus at the First Affiliated Hospital of Sun Yat-sen University, China, and who subsequently adjusted only the stimulation voltage. We evaluated motor symptom severity using the Unified Parkinson’s Disease Rating Scale Part III, symptom progression using the Hoehn and Yahr scale, and the levodopa equivalent daily dose, before surgery and 1 and 2 years after surgery. The 2-year follow-up results show that rigidity and tremor improved, and clinical symptoms were reduced, while pulse width was maintained at 60 μs and frequency at 130 Hz. Voltage adjustment alone is particularly suitable for patients who cannot tolerate multiparameter program adjustment. Levodopa equivalent daily dose was markedly reduced 1 and 2 years after surgery compared with baseline. Our results confirm that rigidity, tremor and bradykinesia can be best alleviated by voltage adjustment. The trial was registered at ClinicalTrials.gov (identifier: NCT01934881).

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    The effect of increased intra-abdominal pressure on orbital subarachnoid space width and intraocular pressure
    Su-meng Liu, Ning-li Wang, Zhen-tao Zuo, Wei-wei Chen, Di-ya Yang, Zhen Li, Yi-wen Cao
    2018, 13 (2):  353-359.  doi: 10.4103/1673-5374.226407
    Abstract ( 257 )   PDF (819KB) ( 189 )   Save

    In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can relieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe,effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22–30 years (12 females and 3 males), at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg (1 mmHg = 0.133 kPa), then the orbital subarachnoid space width was measured every 10 minutes for 2 hours.After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ± 0.1 mm (range: 0.77–1.05 mm), 0.77 ± 0.11 mm (range: 0.60–0.94 mm), 0.70 ±0.08 mm (range: 0.62–0.80 mm), and 0.68 ± 0.08 mm (range: 0.57–0.77 mm) at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the intra-abdominal pressure elevation. These results verified that the increased intra-abdominal pressure widens the orbital subarachnoid space in this acute trial, but does not alter the intraocular pressure, indicating that intraocular pressure is not affected by rapid increased intra-abdominal pressure. This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ONRC-14004947).

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    Relationship of distraction rate with inferior alveolar nerve degeneration-regeneration shift
    Ying-hua Zhao, Shi-jian Zhang, Zi-hui Yang, Xiao-chang Liu, De-lin Lei4, Jing Li, Lei Wang
    2018, 13 (2):  360-365.  doi: 10.4103/1673-5374.226426
    Abstract ( 123 )   PDF (1151KB) ( 218 )   Save

    Distraction osteogenesis is an important technique for the treatment of maxillofacial abnormities and defects. However, distraction osteogenesis may cause the injury of the inferior alveolar nerve. The relationship between distraction rate and nerve degeneration-regeneration shift remains poorly understood. In this study, 24 rabbits were randomly divided into four groups. To establish the rabbit mandibular distraction osteogenesis model, the mandibles of rabbits in distraction osteogenesis groups were subjected to continuous osteogenesis distraction at a rate of 1.0, 1.5 and 2.0 mm/d, respectively, by controlling rounds of screwing each day in the distractors. In the sham group,mandible osteotomy was performed without distraction. Pin-prick test with a 10 g blunt pin on the labium, histological and histomorphometric analyses with methylene blue staining, Bodian’s silver staining, transmission electron microscopy and myelinated fiber density of inferior alveolar nerve cross-sections were performed to assess inferior alveolar nerve conditions. At 28 days after model establishment, in the pin-prick test, the inferior alveolar nerve showed no response in the labium to a pin pricks in the 2 mm/d group, indicating a severe dysfunction. Histological and histomorphometric analyses indicated that the inferior alveolar nerve suffered more degeneration and injuries at a high distraction rate (2 mm/d). Importantly, the nerve regeneration, indicated by newborn Schwann cells and axons, was more abundant in 1.0 and 1.5 mm/d groups than in 2.0 mm/d group. We concluded that the distraction rate was strongly associated with the inferior alveolar nerve function, and the distraction rates of 1.0 and 1.5 mm/d had regenerative effects on the inferior alveolar nerve. This study provides an experimental basis for the relationship between distraction rate and nerve degeneration-regeneration shift during distraction osteogenesis, and may facilitate reducing nerve complications during distraction osteogenesis.

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    Detection of thinned corticospinal tract and corticoreticular pathway in a patient with a calf circumference discrepancy
    Han Do Lee, Min Cheol Chang
    2018, 13 (2):  366-368.  doi: 10.4103/1673-5374.226427
    Abstract ( 151 )   PDF (473KB) ( 209 )   Save

    In clinical practice, it is challenging to elucidate the location of the lesion in a patient’s nervous system that is causing the neurologic symptoms, because lesions are often microscopic and cannot be revealed by conventional evaluation methods.However, recently developed techniques may aid clinicians in detecting these microscopic lesions. In particular, diffusion tensor tractography (DTT), derived from diffusion tensor imaging (DTI), possesses the unique advantages of allowing three-dimensional visualization and estimation of neural tracts (Jang and Kwon, 2015; Kim et al., 2015; Chang et al., 2016). Several previous studies have demonstrated that DTT can detect hidden neural tract injuries in various disorders (Jang and Kwon,2015; Kim et al., 2015; Chang et al., 2016). Therefore, DTT is
    being widely employed to accurately diagnose patients with neurologic symptoms.

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