脊髓损伤后轴突再生的研究进展

轴突再生并与靶细胞形成功能性突触是脊髓损伤修复的目标．也是脊髓损伤患者功能恢复的基础。一般来说．脊髓损伤后。损伤神经再生或／和芽生并不少见，但是，因为脊髓损伤后环境中出现一系列不利因素（营养因子减少、抑制因子的释放、瘢痕形成等）使轴突再生或芽生的距离有限，难以穿越损伤部位与残存或未受损的神经形成功能性突触。促进轴突再生的原则是改善抑制再生的环境和提高轴突生长能力．措施主要有轴突生长抑制因子阻滞剂和神经营养因子应用以及免疫治疗等。     

基因治疗脊髓损伤的研究现状及应用前景

基因治疗是近年来生物医学发展较快的领域，其基础研究和临床试验都表现出巨大的前景，但在中枢神经系统损伤的研究还处于实验阶段。现以脊髓损伤为代表，介绍基因治疗技术在中枢神经系统损伤中的研究现状和前景。目前，基因治疗脊髓损伤的基本策略是将神经营养因子转至一定的受体细胞后移植到损伤区，让其在体内表达并发挥生物学效应而刺激轴索再生。转基因载体以病毒载体转染率高而常用。受体细胞包括成纤维细胞、肌母细胞等。介绍了当前国际上基因治疗脊髓损伤的研究情况，并对其存在的问题和前景作了分析和展望     

脊髓损伤基因治疗的研究进展

目的：探讨脊髓损伤基因治疗的最新研究进展。方法;综述了脊髓损伤基因治疗相关的神经营养素家庭的应用,移植细胞的选择,研究现状,存在的问题等。结果：ＮＧＦｓ在干预脊髓损伤后的病理反应和促进工矿企业 能恢复有潜在的治疗作用。雪旺细胞不仅可作为ＳＣＩ基因治疗的移植载体,其本身也可促进中枢神经的再生,髓鞘的重建和部分神经功能的恢复。     

脊髓损伤后轴突再生的研究进展

近20多年来，脊髓损伤的研究取得了长足的进步。本文针对损伤脊髓轴突再生情况，综述了细胞移植、神经桥接、细胞因子、脊髓瘢痕及慢性损伤等方面的研究成果。     

脊髓损伤修复的研究进展

脊髓损伤 (ＳｐｉｎａｌＣｏｒｄＩｎｊｕｒｙ ,ＳＣＩ)是骨科领域的常见创伤 ,其年发生率为 2 0～ 40 /10 0万。ＳＣＩ的修复主要面临两大难点 :一方面是如何预防ＳＣＩ引起的脊髓细胞的死亡 ,以及如何替代已死亡的脊髓细胞 ;另一方面是如何抑制损伤局部疤痕形成 ,创造适合神经再生的微环境 ,促进诱导神经生长[1] 。随着基因工程的问世[2 ] ,应用基因转移技术治疗ＳＣＩ的研究取得了许多进展 ,特别是近年对神经干细胞研究的不断深入[3 ,4] ,通过分离 ,定向诱导分化的神经干细胞移植替代损伤引起的死亡的脊髓细胞成为可能 ,以下就目前国内外…     

组织工程支架修复脊髓损伤的研究进展

脊髓损伤(spinal Cord Injury，SCI)是骨科领域致残率、死亡率最高的创伤之一，人们不断努力探索神经元轴突再生机制，试图找到有效的治疗方法。目前，治疗SCI的主要策略有：挽救受损神经元，减少其发生迟发性损伤和凋亡；应用刺激神经生长的因子和／或阻断抑制轴突生长和延伸物质的作用，促进受损轴突的再生；组织或细胞(外周神经、胚胎脊髓、神经干细胞、神经胶质细胞等)移植诱导轴突再生和细胞分化。他们对修复SCI起到了很大作用，但尚无根本突破。近年来，运用组织工程支架修复SCI的新思路已日益受到人们重视。     

神经营养因子治疗脊髓损伤的研究进展

神经营养因子治疗脊髓损伤的研究进展邓少丽１廖维宏１神经营养因子家族的居员包括神经生长因子（ＮＧＦ）、脑源性神经营养因子（ＢＤＮＦ）、神经营养素Ⅲ（ＮＴ－３）、神经营养素Ⅳ／Ⅴ（ＮＴ－４／５）及新近发现的神经营养素Ⅵ（ＮＴ－６）等。它们在体内和离体情况...     

脊髓损伤的基因治疗

许多年来 ,人们一直在苦苦探索脊髓损伤 (ｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ ,ＳＣＩ)后继发性损害所造成的神经功能永久性缺失的机理及使其功能恢复的良方 ,但收效甚微。自 1990年美国国立卫生研究院 (ＮＩＨ )首次成功地进行腺苷脱胺酶缺乏的基因治疗以来 ,基因治疗已成为当前生物医学中进展最快的领域之一 ,其基本原理是 :把外源基因通过基因转移技术插入病人适当的受体细胞中 ,使其得以表达 ,发挥生物学活性 ,从而纠正或补偿因基因缺陷和异常所引起的疾患。1　ＳＣＩ基因治疗的分子生物学基础基因转移 (ｇｅｎｅｔｒａｎｓｆｅｒ)是指将…     

脊髓损伤修复研究进展

脊髓损伤治疗至今仍是世界性医学难题。随着医学的发展和临床治疗的需求,学者们越来越关注脊髓损伤后修复的实验研究,以更好地为临床服务。该文就脊髓损伤修复研究中信号转导通路、神经营养因子、细胞移植、剔除神经生长抑制因子及基因治疗等方面作一综述。     

细胞移植治疗脊髓损伤的研究现状与展望

脊髓损伤（spinal cord injury，SCI）治疗的移植物包括组织移植和营养支持细胞移植。组织移植可作为支架桥接损伤间隙，使新生和损伤的轴突沿适当的方向生长，并可刺激有助于轴突生长的蛋白质释放。细胞移植可在脊髓损伤的多个方面起作用，如替代受损细胞如神经元和少突胶质细胞，分泌促进再生的神经营养因子，保护神经元，减轻继发损伤，在脊髓损伤空洞区形成桥接引导神经再生，酶解胶质瘢痕，去除细胞碎片，调节免疫反应，修复脊髓中的非神经组织如血管等。     

基因治疗脊髓损伤的研究进展

脊髓损伤(spinal cord injury,SCI)多由外伤引起,如挫伤、压伤和贯通伤.这些机械损伤破坏了脊髓结构和血供,致使脊髓细胞和轴突死亡、胶质瘢痕形成,最终导致感觉运动通路的阻断[1].成年人的中枢神经细胞轴突损伤后很难再生[2],研究发现,轴突不能再生是由于损伤细胞本身再生能力低和损伤细胞周围环境中存在抑制因素[3].因此,脊髓损伤的治疗研究大多致力于增加损伤神经细胞本身的再生能力和阻断其周围环境中潜在的生长抑制分子[2].虽然在动物模型中这些治疗显示了很好的促轴突生长作用,但是传统的治疗药物导入方法有很多缺点,如降解迅速、不能有效穿透组织和对非目的细胞有毒性等.基因治疗可以克服这些缺点.笔者就基因治疗脊髓损伤的研究进展综述如下.     

Kinetic therapy for spinal cord injury

Kinetic therapy, also referred to as kinetic nursing, is the process of mobilizing severely disabled individuals by placing them on a special rotating bed. This therapy has the unique capability of anatomically immobilizing acutely ill patients while simultaneously creating a state of relative physiological mobility. A series of 162 patients suffering acute spinal cord injuries were treated with kinetic therapy during a 60-month period. A retrospective review of this patient population was performed with regard to the effectiveness of kinetic therapy in reducing commonly occurring sequelae in major organ systems. Results of the study provide preliminary evidence for the efficacy of kinetic therapy, yet point to the need to assess benefits relative to those achieved with standard therapy within a prospective randomized trial.     

Gene therapy for spinal cord injury and disease

An incomplete understanding of the pathological processes involved in neurodegeneration and dysfunction of spinal cord injuries and diseases makes these disorders difficult to treat. Repair of damaged or genetically impaired spinal cord also has been limited by the complexity, cellular heterogeneity, and relative inaccessibility of the tissue. Thus, therapeutic options for the treatment of either chronic spinal cord diseases such as amyotrophic lateral sclerosis or acute spinal cord injuries have been rather limited. Potential new therapeutic targets are being identified as our understanding of the molecular pathology involved in neural injury and regeneration increases. Recent advances in gene transfer techniques have made gene therapy a more realistic and viable strategy for the treatment of a broad range of spinal cord disorders. This review summarizes the current state of knowledge regarding the limitations and recent advances in gene therapy and potential application of this technology toward spinal cord injury and disease.     

Stem cell-based cell therapy for spinal cord injury

Traumatic injuries to the spinal cord lead to severe and permanent neurological deficits. Although no effective therapeutic option is currently available, recent animal studies have shown that cellular transplantation strategies hold promise to enhance functional recovery after spinal cord injury (SCI). This review is to analyze the experiments where transplantation of stem/progenitor cells produced successful functional outcome in animal models of SCI. There is no consensus yet on what kind of stem/progenitor cells is an ideal source for cellular grafts. Three kinds of stem/progenitor cells have been utilized in cell therapy in animal models of SCI: embryonic stem cells, bone marrow mesenchymal stem cells, and neural stem cells. Neural stem cells or fate-restricted neuronal or glial progenitor cells were preferably used because they have clear capacity to become neurons or glial cells after transplantation into the injured spinal cord. At least a part of functional deficits after SCI is attributable to chronic progressive demyelination. Therefore, several studies transplanted glial-restricted progenitors or oligodendrocyte precursors to target the demyelination process. Directed differentiation of stem/progenitor cells to oligodendrocyte lineage prior to transplantation or modulation of microenvironment in the injured spinal cord to promote oligodendroglial differentiation seems to be an effective strategy to increase the extent of remyelination. Transplanted stem/progenitor cells can also contribute to promoting axonal regeneration by functioning as cellular scaffolds for growing axons. Combinatorial approaches using polymer scaffolds to fill the lesion cavity or introducing regeneration-promoting genes will greatly increase the efficacy of cellular transplantation strategies for SCI.     

锂剂治疗脊髓损伤机制的研究进展

脊髓损伤是由一系列内外因素所造成的骨科及神经科学领域严重的致残性疾病,是目前医学界的一大难题.锂剂作为治疗双相情感障碍的主要药物已有100多年的历史.研究证实锂剂对脑神经元有保护作用,其对脊髓损伤的治疗作用也渐渐被观察到.锂剂能够通过保护神经元完整、减少损伤后炎症反应、促进神经营养因子的生成和释放、刺激神经发生以及促进自噬、抑制凋亡等机制达到治疗脊髓损伤的目的.通过回顾有关锂剂对神经系统作用的研究,总结分析了锂剂治疗脊髓损伤作用机制的研究进展,以锂剂为基础的综合治疗具有良好的应用前景.     

Direct gene therapy for repair of the spinal cord

For regrowth of injured nerve fibers following spinal cord injury (SCI), the environment must be favorable for axonal growth. The delivery of a therapeutic gene, beneficial for axonal growth, into the central nervous system for repair can be accomplished in many ways. Perhaps the most simple and elegant strategy is the so-called direct gene therapy approach that uses a single injection for delivery of a gene therapy vehicle. Among the vectors that have been used to transduce neural tissue in vivo are non-viral, herpes simplex viral, adeno-associated viral, adenoviral, and lentiviral vectors, each with their own merits and limitations. Many studies have been undertaken using direct gene therapy, ranging from strategies for neuroprotection to axonal growth promotion at the injury site, dorsal root injury repair, and initiation of a growth-supporting genetic program. The limitations and successes of direct gene transfer for spinal cord repair are discussed in this review.     

Advances in the management of acute spinal cord injury

Numerous secondary neurologic and systemic complications can occur in the face of a spinal cord injury. The goal of immediate treatment is early spine immobilization and realignment, stabilization of hemodynamic and pulmonary status, prompt radiographic evaluation, and prevention of medical complications. These measures should optimize the chances for neurologic recovery.     

脊髓损伤药物治疗新进展

随着对脊髓损伤（spinal cord injury,SCI）基础、临床研究的不断进步,在20世纪90年代确定了甲基强的松龙早期应用于脊髓伤肯定的临床效果后,又对其治疗机制不断深入研究。在此基础上一系列新药被开发用于实验性或临床脊髓损伤治疗。     

Combined calcitriol-pamidronate therapy for bone hyperresorption in spinal cord injury

OBJECTIVE: To determine the biochemical effects of combined calcitriol-pamidronate therapy on bone hyperresorption in patients with spinal cord injury (SCI). METHODS: This was a retrospective study of 21 SCI inpatients (4 women and 17 men, mean age 34 years) treated for bone hyperresorption. Initial treatment was 0.5 microg oral calcitriol once daily and 1,250 mg CaCO3 twice a day (1000 mg elemental calcium/day). On days 4 through 6 following the initial treatment, patients received 30 mg pamidronate intravenously once daily (total of 3 doses). Urinary N-telopeptide (NTx) and calcium excretion rates, and serum parathyroid hormone (PTH), 25-hydroxyvitamin D (25-D), 1,25-dihydroxyvitamin D (1,25-D), calcium, and phosphorus levels were measured within 2 weeks prior to and 2 weeks following pamidronate therapy. RESULTS: Patients demonstrated increased urinary NTx and calcium excretion, indicative of bone hyperresorption, and suppressed PTH and 1,25-D levels as early as 9 days post-SCI. Combined calcitriol-pamidronate therapy decreased urinary NTx and calcium excretion by 71% (P < .001) and 73% (P < .001), respectively. This therapy also increased serum levels of PTH (P <.05) and 1,25-D (P < .005). Post-pamidronate hypocalcemia or hypophosphatemia was observed in 44% (P < .01) or 53% (P < .01), respectively. CONCLUSION: Combined calcitriol-pamidronate therapy significantly inhibited bone hyperresorption in SCI patients.     

嗅鞘细胞治疗脊髓损伤的研究进展

脊髓损伤是一种高致残性神经系统损伤性疾病,目前仍然缺乏有效的治疗方法.研究证实嗅鞘细胞是促进脊髓损伤后神经再生的理想种子细胞之一.嗅鞘细胞能通过分泌作用、与星形胶质细胞相互作用、调节炎症反应、迁移特性、髓鞘形成作用、抗氧化作用、脂质调节作用等方式或特性促进轴突的萌发及定向延长,从而发挥神经保护以及神经修复作用.近年来,...