双重荧光标记验证静脉移植碱性成纤维细胞生长因子基因修饰骨髓间充质干细胞在脑缺血模型大鼠脑内的存活及分化

背景：碱性成纤维细胞生长因子可以促进骨髓间充质干细胞的增殖和向神经细胞方向分化，并被认为是胶质细胞的分裂原。 目的：以双重荧光标记验证静脉移植碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞在脑缺血模型大鼠脑内的存活及分化情况，及其向神经元样细胞和神经胶质细胞分化的趋势。 设计、时间及地点：随机对照动物实验，于2005-07/2006-03在中南大学实验动物中心实验室完成。 材料：选用50只SD大鼠，按随机数字表法分为4组：假手术组（n=10），脑缺血/再灌注损伤模型组（n=10），骨髓间充质干细胞治疗组（n=15），碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞治疗组（n=15）。 方法：除假手术组外，其余3组制备局灶性脑缺血再灌注模型。分别将骨髓间充质干细胞或碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞通过静脉移植至实验性脑缺血大鼠体内，脑缺血再灌注损伤组大鼠注入相同体积的DMEM培养基。 主要观察指标：应用5-溴-2-脱氧尿苷-神经元特异核蛋白及5-溴-2-脱氧尿苷-胶质纤维酸性蛋白双重荧光标记法观察移植细胞在脑内的存活和分化情况，比较各组大鼠脑缺血后的神经功能评分及脑梗死体积变化。 结果：移植7 d后，碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞组大鼠脑内5-溴-2-脱氧尿苷阳性细胞数、5-溴-2-脱氧尿苷-神经元特异核蛋白双标阳性细胞数均高于骨髓间充质干细胞治疗组（P < 0.05），两组间5-溴-2-脱氧尿苷-胶质纤维酸性蛋白双标阳性细胞数差异无显著性意义（P > 0.05）。再灌注7 d后，静脉移植骨髓间充质干细胞和碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞均能改善脑缺血后大鼠的神经功能、减少脑梗死体积，碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞的作用明显优于骨髓间充质干细胞。 结论：碱性成纤维细胞生长因子诱导的骨髓间充质干细胞静脉移植后可在脑内缺血区存活，并分化为比例更合适的神经元和神经胶质细胞，发挥神经修复作用。     

Bcl-2基因修饰的骨髓间充质干细胞移植治疗脑缺血的实验研究

目的观察Bcl-2基因修饰的骨髓间充质干细胞（MSCs）移植对大鼠脑缺血性损伤的治疗作用及对移植的MSCs保护性作用。方法将114只SD大鼠随机分为假手术组、Model组、MSCs组和Bcl-2-MSCs组;线栓法制作大鼠一侧大脑中动脉缺血再灌注模型,MSCs组及Bcl-2-MSCs组在缺血24h后经尾静脉注射方式移植BrdU标记的MSCs及人Bcl-2基因修饰的MSCs;分别于术后1、7、14、28d对各组大鼠进行神经功能缺损评分（NSS）;在脑缺血14d应用TTC法观察梗死灶体积;BrdU和TUNEL免疫荧光双重标记检测移植的MSCs凋亡情况;Westernblot检测大鼠脑梗死周边区Bcl-2蛋白的表达;HE染色观察脑组织病理形态。结果MSCs-Bcl-2组和MSCs组NSS评分、脑梗死体积百分比、TUNEL阳性细胞数较Model组低（P〈0.05）,且MSCs-Bcl-2组比MSCs组更低,BrdU阳性细胞数较多（P〈0.05）;MSCs-Bcl-2组BrdU和TUNEL免疫荧光双标细胞数稍多,但差异不显著（P〉0.05）,而MSCs-Bcl-2组BrdU和TUNEL免疫荧光双标细胞占BrdU阳性细胞百分比明显较低（P〈0.05）。MSCs-Bcl-2组Bcl-2蛋白呈持续较高水平的表达,和MSCs组同时间点相比差异有统计学意义（P〈0.05）。HE染色示MSCs组和MSCs-Bcl-2组脑组织损伤及细胞丢失较轻,MSCs-Bcl-2组更明显,脑梗死周边区均未见到核大、浓染的异形细胞。结论Bcl-2基因修饰的MSCs移植较MSCs移植能进一步改善脑缺血大鼠的神经功能,减少脑梗死体积;其机制为Bcl-2基因修饰使MSCs持续、稳定表达一定量的Bcl-2蛋白,从而能保护移植的MSCs,减少其凋亡,增加其存活。     

尾静脉移植骨髓间充质干细胞治疗脑缺血损伤大鼠的研究

目的通过尾静脉途径移植大鼠骨髓间充质干细胞(MSCs)到大脑中动脉闭塞模型(MCAO)的大鼠体内,观察MSCs移植对大鼠缺血性脑损伤后神经功能恢复的作用并探讨其作用机制。方法分离和培养大鼠的MSCs,线栓法制作脑缺血再灌注模型。将48只SD大鼠随机分为对照组和尾静脉移植组2组,移植组在造模7d后尾静脉途径将MSCs植入MCAO大鼠体内,对照组仅造模。比较两组大鼠在不同时间的神经功能评分的差异,免疫组化染色和脑源性神经生长因子(BDNF)分泌的情况。结果移植后1d两组之间无统计学差异;在2w、1m、2m、3m时移植组NSS评分均低于对照组;免疫组化结果发现尾静脉组见到双侧半球均可见较多的Brdu阳性细胞。移植后1m即可见到MSCs分化为Brdu+NSE、Brdu+GFAP免疫组化双阳性细胞。不同时间点移植组的BDNF分泌较对照组明显增高。结论 MSCs可以在体外分离、培养和传代,尾静脉移植的MSCs可在宿主脑内存活和分化并改善神经功能。MSCs移植后可促进脑内BDNF的分泌。     

骨髓间充质干细胞联合bFGF治疗颅脑损伤的实验研究

目的探讨骨髓间充质干细胞(MSCs)及碱性成纤维生长因子(bFGF)移植治疗大鼠脑损伤的疗效及机制。方法①采取成年大鼠的MSCs进行体外培养并鉴定;②建立大鼠脑损伤模型;③将48只脑外伤大鼠分为4组,每组12只,分别为对照组、MSCs治疗组、bFGF治疗组及MSCs+bFGF治疗组;分别于脑室注入相应的试剂后不同时间采用行为学评分的方法比较其疗效。④每组大鼠分为伤后3、7和14d3个亚组,并分别用Brdu标记干细胞,免疫组化法测定Brdu标记阳性细胞,计算并比较各组的阳性细胞数。结果免疫组化结果证实MSCs培养成功。脑室注射后3～13d各实验组动物的神经功能明显好于对照组(P<0.05),MSCs+bFGF治疗组又明显好于MSCs治疗组和bFGF治疗组(P<0.05)。用药后3、7和14d,在各实验组损伤的脑区、伤侧海马及室管膜下区的Brdu标记的干细胞数明显多于对照组(P<0.05)。而MSCs+bFGF治疗组又明显好于MSCs治疗组和bFGF治疗组(P<0.05)。结论 bFGF联合MSCs脑内移植可以改善脑损伤大鼠模型的神经功能,且较单纯MSCs移植或单纯bFGF注射的效果更佳;bFGF可促进移植MSCs及内源性干细胞的增殖并控制它治疗的分化方向。     

骨髓间充质干细胞移植对永久性大脑中动脉阻塞大鼠生长相关蛋白43及脑梗死体积的影响

背景：大量实验表明骨髓间充质干细胞植入缺血大鼠脑内能够通过血脑屏障在脑中成活并迁移,可部分转变为神经元,并能促进多种神经营养因子分泌,明显改善神经功能缺损,较神经保护剂具有更长的治疗时间窗。 目的：观察骨髓间充质干细胞移植对大鼠永久性大脑中动脉阻塞后内源性轴突再生标志物生长相关蛋白43的表达及脑梗死体积的影响。 方法：将成年SD大鼠按随机数字表法分为模型对照组、假手术组、干细胞移植组。另取成年SD大鼠4只制备骨髓间充质干细胞,并以5-溴脱氧尿嘧啶核苷标记。假手术组分离结扎右侧颈总动脉;其余大鼠制备永久性右侧大脑中动脉缺血模型,造模后,干细胞移植组移植骨髓间充质干细胞,模型对照组推注等量磷酸盐缓冲液。于移植前、移植后7,14,21,28 d进行神经功能缺损评分,应用免疫组织化学法检测脑梗死灶周边区生长相关蛋白43表达。 结果与结论：干细胞移植组移植后7 d在梗死灶能检测到5-溴脱氧尿嘧啶核苷标记的阳性细胞, 移植后14 d增多达高峰,移植后28 d逐渐减少并消失;移植后7,14 d脑梗死灶周边区生长相关蛋白43免疫活性显著高于模型对照组(P < 0.05)。假手术组大鼠无神经损伤症状,神经功能评分均为0分;随时间推移,模型对照组和干细胞移植组神经功能评分逐渐降低,从移植后14 d开始,干细胞移植组神经功能评分明显低于模型对照组(P < 0.05)。与模型对照组相比,干细胞移植组脑梗死体积均显著减小(P < 0.05)。结果显示,骨髓间充质干细胞移植能上调局灶性脑缺血大鼠脑梗死灶周边区生长相关蛋白43的表达,并显著减小脑梗死体积。     

骨髓间充质干细胞立体定向移植治疗大鼠脊髓损伤*

摘要 背景：传统观念认为,神经组织损伤后几乎不能再生,以往对SCI的治疗缺乏有效手段,致使本病致残率高,疗效差。干细胞治疗关键在于移植具有再生能力的干细胞,通过多种作用机制,可以重建中枢神经系统的结构和功能,近年来引起了广泛的关注。 目的：探讨立体定向移植骨髓间充质干细胞（MSCs）对大鼠脊髓损伤修复的影响并探讨其机制 设计、时间及地点：随机对照动物实验,于2007-10/2008-6在天津市环湖医院完成。 材料：1月龄SD大鼠20只,用于制备骨髓间充质干细胞;健康成年Wistar大鼠45只,雌性、同系,体质量280±20 g。将动物随机分为对照组、假手术组与移植组,每组各15只。 方法：密度梯度离心法结合贴壁筛选法分离骨髓间充质干细胞,经流式细胞仪鉴定为MSCs。以动脉瘤夹夹闭法制备大鼠脊髓损伤（SCI）模型,在SCI大鼠致伤后第7天,通过立体定向途径移植MSCs到移植组大鼠脊髓损伤中心,移植等量生理盐水至假手术组大鼠脊髓损伤中心,对照组大鼠不做处理。 主要观察指标：SCI大鼠损伤前及损伤后第7天、14天、30天、60天、90天的BBB评分;损伤后第90天处死大鼠,观察其脊髓组织中有无BrdU阳性细胞、Brdu+NSE、Brdu+GFAP、Brdu+bFGF、Brdu+BDNF免疫组化双染阳性细胞并观察NSE、GFAP、bFGF、BDNF单染阳性细胞。 结果： ①BBB评分发现,MSCs移植组大鼠BBB后肢功能评分恢复优于对照组（p<0.05）;假手术组BBB评分在损伤后30天内恢复速度慢于对照组（p<0.05）,至第90天与对照组比较无显著差异（P>0.05）;②免疫组织化学染色发现,移植组大鼠脊髓内在损伤中心及头、尾端距离脊髓损伤中心1cm处均可见BrdU染色阳性细胞及Brdu+NSE、Brdu+GFAP、Brdu+bFGF、Brdu+BDNF免疫组化双染阳性细胞。移植组NSE、GFAP、bFGF、BDNF单染阳性细胞数明显高于对照组和假手术组（p<0.05）。 结论： MSCs移植可以促进SCI大鼠的神经功能的恢复,其机制可能与移植细胞分化为神经元样和神经胶质细胞样细胞,并分泌或促进宿主分泌神经营养因子有关。 关键词 脊髓损伤 骨髓间充质干细胞 立体定向 细胞移植     

骨髓间充质干细胞移植大鼠脑缺血区微血管密度和肝细胞生长因子的表达

背景：应用骨髓间充质干细胞移植治疗脑缺血可促进损伤神经功能的恢复,目前其作用机制尚未明确。 目的：分析骨髓间充质干细胞移植对大鼠脑缺血保护作用的机制。 方法：采用线栓法复制大鼠大脑中动脉栓塞模型,随机分为假手术组、大脑中动脉栓塞组、溶剂对照组和骨髓间充质干细胞组。骨髓间充质干细胞组于脑梗死1 d后经侧脑室注射入骨髓间充质干细胞,溶剂对照组则注射同等剂量的PBS。 结果与结论：大鼠脑缺血后缺血区皮质可见大量的微血管生成,2周达高峰。骨髓间充质干细胞组缺血区微血管密度显著高于大脑中动脉栓塞组和溶剂对照组(P < 0.01)。治疗后4,7,14 d骨髓间充质干细胞组脑组织中肝细胞生长因子的表达水平显著高于大脑中动脉栓塞组和溶剂对照组(P < 0.01)。提示骨髓间充质干细胞移植可促进大鼠缺血区微血管生成,改善缺血区血运,从而改善脑缺血大鼠的神经功能。     

人脐血间充质干细胞静脉移植治疗大鼠局灶性脑缺血的实验研究

目的 探讨来源于人脐血的间充质干细胞经静脉移植治疗大鼠局灶性脑缺血的可行性及其机制.方法 将人脐血间充质干细胞在体外纯化、扩增并经BrdU标记后,经尾静脉移植到局灶性脑缺血大鼠体内,通过神经缺损评分观察移植后大鼠神经行为学改善情况,通过组织学方法观察移植到脑内的人脐血间充质干细胞表达脑源性神经营养因子和缺血灶周围微血管密度变化的情况.结果 人脐血间充质干细胞移植组大鼠的神经缺损评分显著低于对照组(P＜0.05);移植到脑内的人脐血间充质干细胞主要选择性分布于缺血灶周围区域并表达脑源性神经营养因子,移植组大鼠梗死灶周围的微血管密度显著高于对照组(P＜0.01).结论 经静脉注射移植人脐血间充质干细胞能明显促进局灶性脑缺血大鼠的神经行为功能恢复,促进缺血灶周边区微血管增生可能是人脐血间充质干细胞移植治疗局灶性脑缺血的机制之一.     

骨髓间充质干细胞移植对脑缺血大鼠突触可塑性影响的实验研究

目的：探讨骨髓间充质干细胞（MSCs）移植对脑缺血大鼠神经功能恢复及突触可塑性的影响。方法：采用大鼠大脑中动脉缺血模型，分为假手术组、模型组、PBS组和MSCs组，研究脑缺血24h后移植MSCs的大鼠神经功能缺损评分（NSS）；分别测定梗死灶周围脑组织突触素（SYN）和脑源性神经营养因子（BDNF）mRNA的表达；电镜及免疫电镜下观察突触结构的变化。结果：与模型组及PBS组大鼠相比，MSCs组的NSS评分较低，SYN及BDNF mRNA的表达则明显较高；电镜检查示MSCs组大鼠突触界面曲率较大，突触后致密物质的厚度增加，突触间隙宽度变窄，突触活性带长度增加；免疫电镜示BrdU阳性细胞和宿主脑神经元形成非成熟的突触样结构。结论：MSCs移植可能通过神经营养效应调节脑缺血周围神经细胞的可塑性改善脑缺血大鼠的神经功能。     

对比研究经颈动脉和立体定位注射骨髓间充质干细胞治疗缺血性脑卒中

目的探讨安全高效移植骨髓间充质干细胞(mensenchymal stem cells,MSCs)治疗脑缺血的方法.方法采用连续传代培养的方法纯化MSCs,Brdu标记后分别经颈动脉(1×104/μl,200 μl)和立体定位(1×105/μl,10 μl)注射至大鼠脑缺血2 h再灌注1 d模型,各自设立对照组,观察术后神经功能评分以及脑部Brdu阳性细胞的分布.结果经颈动脉注射组较立体定位注射组爬杆实验评分低(P＜0.05),Brdu阳性细胞存活多,迁移范围更广.结论 MSCs具有卒中后脑保护作用,而经颈动脉的给药方式优于立体定位注射.     

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.