脑缺血后内源性激活神经干细胞的机制研究

1 脑缺血后内源性神经干细胞的自身激活 近年来研究表明,脑缺血后自身的神经干细胞有大量的增殖分化[1,2],说明神经干细胞可能参与脑缺血的病理生理过程.Zhang等通过建立沙鼠大脑中动脉缺血(MCAO)模型,观察缺血再灌注后不同时期的室管膜下层(SVZ)、海马颗粒细胞层(DG)、嗅球以及梗死灶周边皮质的神经干细胞增殖、分化情况,发现7 d后在梗死同侧脑SVZ出现神经干细胞增殖高峰,14 d达最高,而DG区则无增殖,且14 d后远离梗死区的嗅球有大量的神经干细胞增殖,但28 d后,标记Brdu阳性细胞大量减少,说明脑缺血只引起短暂的神经干细胞的增殖,Zhang认为是脑缺血损伤的应急保护反应[3].     

大鼠脑缺血再灌注诱导自体神经干细胞原位增殖的研究

目的研究缺血性脑损伤对内源性神经干细胞增殖、迁移的影响。方法参照Pulsinelli-Brierley法制作短暂性全脑缺血动物模型,全脑缺血10min后再灌注,采用SABC免疫组化染色显示5'-溴脱氧尿嘧啶(BrdU)阳性细胞和神经巢蛋白(Nestin)阳性细胞,光镜下观察并统计分析脑缺血损伤后内源性神经干细胞增殖、迁移的变化过程。结果脑缺血再灌流24h后,海马、齿状回和室管膜下区的BrdU阳性细胞和Nestin阳性细胞增多,7～10d达到高峰,术后20d仍有表达;在室管膜下区,BrdU阳性细胞和Nestin阳性细胞有向皮质、海马迁移的现象。结论①成年大鼠全脑缺血后7～10d,内源性神经干细胞的增殖达到高峰。②增殖的内源性神经干细胞存在由增殖区向靶区迁移的现象。     

TRPC1沉默对脑缺血大鼠神经干细胞迁移的影响

目的探讨瞬时受体电位通道1(TRPC1)沉默对脑缺血大鼠内源性神经干细胞增殖、迁移和分化的影响。方法 SD大鼠分为假手术组、脑缺血组、TRPC1沉默组(脑缺血+TRPC1沉默)和阴性对照组,以脑室内注射siRNA沉默TRPC1,以线栓法制作大鼠大脑中动脉脑缺血(MCAO)模型,脑缺血模型制作成功后,腹腔内注射Brdu标记内源性神经干细胞,分别于48 h、4 w后处死大鼠,行Brdu免疫组化染色、免疫荧光双标染色(Brdu/GFAP、Brdu/Neun)观察NSC的增殖、迁移和分化情况。结果脑缺血后48 h,脑缺血组和TRPC1沉默组SVZ区Brdu阳性表达均较假手术组明显增多(P0.01),但TRPC1沉默组Brdu阳性细胞数较缺血组低(P0.01)。脑缺血4 w后,缺血组与假手术组相比,皮质区具有更多的Brdu阳性细胞(P0.01),同样TRPC1沉默组Brdu阳性细胞数多于假手术组,但明显低于脑缺血组(P0.01);免疫荧光双标染色发现,脑缺血各组Brdu/GFAP、Brdu/Neun双阳性细胞的数量均比假手术组明显增高,但TRPC沉默组双阳性细胞显著少于脑缺血组和阴性对照组(P0.01)。结论 TRPC1沉默显著影响脑缺血大鼠SVZ区NSC的增殖、向脑缺血区迁移及向成熟细胞的分化。     

大鼠局灶性脑缺血后神经前体细胞增殖迁移的研究

目的研究成年大鼠内源性神经前体细胞在局灶性脑缺血后不同时间窗的增殖分化情况。方法用Longa线栓法制作大鼠脑缺血模型，用免疫组化的方法检测大鼠内源性神经前体细胞最佳增殖时间及最大增殖效果：j结果脑缺血半球室管膜下区、嗅球和头端迁徙渠道(rostral migratory stream，RMS)Brdu阳性细胞数在脑缺血后1d明显增多，3～7d达高峰，14d后开始下降；Brdu阳性细胞数在脑缺血半球室管膜下区和嗅球成止相关；脯缺血侧海马齿状回未见Brdu阳性细胞数明显增多；Brdu阳性细胞在脑缺血缸后第3周数量最大，从第4周开始下降。结论成年大鼠局灶性脑缺血后3～7d内源性神经前体细胞增殖达高峰，住该期进行外源性细胞移植治疗可能更有效。     

缺血性脑损伤诱导大鼠巢蛋白表达的实验研究

目的探讨缺血性脑损伤对内源性神经干细胞增殖、迁移的影响。方法选用健康雄性SD大鼠62只，随机分为正常组（6只）、脑缺血10min再灌流1、3、5、7、10、15、20d组（简称手术组，每时间点6只）、假手术对照组（14只，每时间点2只），参照Pulsinelli—Brierley方法制作短暂性全脑缺血动物模型：用SABC免疫组化法显示巢蛋白（nestin）阳性细胞；光镜下观察nestin阳性细胞的形态学变化并计数，半定量分析脑缺血损伤后内源性神经干细胞增殖、迁移的变化过程。结果手术组的nestin阳性细胞在缺血再灌流24h后表达增多，7～10d到高峰，15d时仍有显著表达；在室管膜下区的nestin阳性细胞有向皮质、海马迁移的迹象。结论缺血性脑损伤能诱导内源性神经干细胞增殖，这可能对脑损伤后的修复发挥作用。     

N-Methyl-D-Aspartate受体拮抗剂对脑缺血后成年大鼠神经干细胞内源性激活的实验研究

目的　研究N - Methyl- D- Aspartate(NMDA)受体拮抗剂MK- 80 1对脑缺血后神经干细胞(NSC)激活的作用。方法　将4 0只SD大鼠分成对照组和实验组,两组大鼠均采用传统线栓法作成大脑中动脉缺血再灌注模型,实验组大鼠腹腔注射MK- 80 1,对照组腹腔注射生理盐水,通过免疫组织化学技术标记鼠脑海马齿状回颗粒细胞层(SGZ)、室管膜下层(SVZ)及梗死皮质周边区注射后第3、7、11、18天的Brdu、Nestin阳性细胞数。结果　对照组大鼠Brdu、Nestin阳性细胞7d在SGZ出现一小高峰,然后迅速下降,11d阳性细胞甚少,梗死皮质周边区更少;而实验组Brdu、Nestin阳性细胞3d在SVZ明显表达,7～11d在SGZ区达高峰,并可持续至18d,同样梗死皮质区Brdu、Nestin阳性细胞7～18d表达明显,两组比较,有统计学意义(P<0 .0 1)。结论　NMDA受体拮抗剂MK- 80 1在脑缺血后,能促进NSC的增殖、分化。     

电刺激嗅球对脑缺血再灌注大鼠内源性神经干细胞增殖、迁移及分化的影响

目的：探讨嗅球电刺激对脑缺血再灌注大鼠脑内神经发生的影响。方法将健康雌性SD大鼠随机分为假手术组、脑缺血再灌注组、电刺激组、假刺激组,其中脑缺血再灌注组、电刺激组,以线栓法建立大鼠右侧大脑中动脉缺血（middle cerebral artery occlusion ,MCAO）/再灌注模型,假手术组仅分离出颈内动脉;电刺激组在右侧嗅球内埋置双极电极,于MCAO再灌注后对嗅球进行电刺激,假刺激组只埋置电极,不进行电刺激;以5－溴脱氧尿嘧啶（Brdu）标记内源性神经干细胞（NSC ）。假手术组于术后48 h、1周,脑缺血再灌注组于缺血再灌注后48 h、1周,电刺激组及假刺激组于刺激后48 h、1周分别行Brdu免疫组化染色,观察各组脑室下区（SVZ）区NSC增殖情况;假手术组、缺血再灌注组、电刺激组、假刺激组4组大鼠在电刺激组行电刺激后腹腔注射Brdu 50 mg/kg ,2次/d ,连续2 d ,4周后处死,分别取脑切片,进行免疫组化和免疫荧光双标染色,观察各组NSC迁移和分化情况。结果缺血再灌注组（37.67±1.97）、假刺激组（36.5±2.35）和电刺激组（43.67±1.63）大鼠48 h后SVZ区Brdu阳性NSC细胞数较假手术组（15.5±1.52）明显增多（F＝57.21,P＜0.05）,缺血再灌注组（41.17±2.94）、假刺激组（41.83±2.14）和电刺激组（47.67±2.34）1周后Brdu阳性细胞数较假手术组（15.5±1.52）增多（F＝73.62,P＜0.01）,电刺激组在各时间点均较其他组Brdu阳性 NSC细胞数增多（P＜0.01）。缺血并注射Brdu 4周后缺血侧皮质区电刺激组Brdu阳性NSC细胞数（57.17±2.4）较缺血再灌注组（46.83±2.48）和假刺激组（45.83±2.14）增多（F＝161.50,P＜0.01）;免疫荧光双标染色示电刺激组Brdu阳性NSC细胞中Brdu/神经元核抗原（Neun ）双阳性细胞比例约为（74.67±3.61）％,Brdu/胶质纤维酸性蛋白（GFAP）双阳性细胞比例约为（38.83±3.36）％,与缺血再灌注组和假刺激组比较差异均无统计学意义（均 P＞0.05）。结论电刺激嗅球可能促进脑缺血大鼠SVZ区NSC增殖,并可能促进新生NSC向缺血皮质区迁移,增加缺血皮质新生神经元数量,但SVZ区新生NSC的分化不受影响。     

白藜芦醇对缺血再灌注小鼠神经干细胞增殖作用的研究

目的研究白藜芦醇对小鼠缺血再灌注后海马区神经干细胞增殖的影响,探讨其促进缺血再灌注后神经功能恢复的机制。方法 15只雄性BALB/c小鼠随机分为缺血再灌注组、白藜芦醇组及假手术组,采用大脑中动脉线栓法制作局灶性脑缺血模型,Brdu标记增殖的干细胞,免疫组化法测定增殖细胞数。结果白藜芦醇组与缺血再灌注组相比Brdu阳性细胞数存在差异。结论白藜芦醇可以促进小鼠缺血再灌注后海马区神经干细胞的增殖,可能在其促进缺血后神经功能恢复中发挥作用。     

雌激素对大鼠脑缺血再灌注神经干细胞内源性激活的实验研究

目的探讨雌激素对脑缺血再灌注神经干细胞(neural stem cell,NSC)内源性激活的作用.方法将44只雄性大鼠随机分成假手术组、对照组和实验组.采用传统的线栓法制备大鼠大脑中动脉闭塞再灌注模型,实验组大鼠腹腔注射苯甲酸雌二醇,对照组腹腔注射生理盐水,通过免疫组织化学技术标记大鼠海马齿状回颗粒下层(subgranular zone,SGZ)、侧脑室室下层(subventricular zone,SVZ)以及梗死皮质周边区在缺血再灌注3、7、11、18 d的5-溴脱氧尿嘧啶核苷(bromodeoxyuridine,BrdU)阳性细胞,并采用HPIAS图像分析系统进行分析.结果正常成年大鼠脑组织SGZ和SVZ存在少量Brdu阳性细胞,对照组脑缺血再灌注3 d SGZ、SVZ和梗死皮质周边Brdu阳性细胞的数量开始增多,7 d达到高峰,11d后开始减少,18 d进一步下降.实验组与对照组相比,在各个时间点均能显著提高BrdU阳性细胞的数量(P＜0.01),而且增殖可以持续11d.结论脑缺血再灌注可激活脑内NSC的增殖,雌激素可以促进脑缺血再灌注多个区域NSC的增殖.     

动员自体骨髓干细胞对大鼠脑缺血／再灌注损伤及细胞凋亡的影响

目的 探讨应用G-CSF动员自体骨髓干细胞对大鼠脑缺血／再灌注损伤及细胞凋亡的影响。方法 应用线栓法制备大鼠局灶性大脑中动脉栓塞／再灌注(MCAO／R)模型，应用粒细胞集落刺激因子(G-GSF)刺激自体骨髓干细胞分裂增殖，并用5-溴脱氧尿核苷(Brdu)标记。观察大鼠神经病学评分，HE染色和免疫组化检测脑缺血区病理改变及CD34和Brdu阳性细胞，原位末端标记法(TUNEL法)观察细胞凋亡。结果 模型动员组大鼠脑缺血／再灌注后24h，大量炎症细胞浸润。再灌注后48h，缺血区可见CD34和Brdu阳性细胞；72h后CD34阳性细胞消失，而Brdu阳性细胞持续存在；模型未动员组缺血区无CD34和很少Brdu阳性细胞表达。48h缺血区新生毛细血管密度明显高于对照组。再灌注后24h细胞凋亡显著，1周时达高峰；与模型非动员组比较，模型动员组48h后细胞凋亡改善明显。结论 自体骨髓干细胞经G-CSF动员后可向大鼠脑缺血区趋化并可分化为神经元前体细胞，显著促进脑缺血区血管再生，降低脑神经功能评分，降低细胞凋亡率。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.