嗅鞘细胞与脊髓损伤的治疗

摘要：嗅鞘细胞是一种特殊类型的神经胶质细胞,起源于嗅基底膜,分布在嗅球、嗅神经,并可伴随嗅神经轴突迁徙入脑。尽管目前嗅鞘细胞移植技术治疗脊髓损伤的疗效已经被大量基础实验证实,并且已经开始了初步的临床试验,但其在移植后作用的主要机制仍然需要继续探讨。脊髓的再生与修复是一个非常复杂的过程, 目前还有许多问题有待解决, 如嗅鞘细胞移植治疗的主要机制、嗅鞘细胞移植时机的选择、嗅鞘细胞纯度对移植效果的影响、嗅鞘细胞植入的方法等。     

Olfactory ensheathing cells transplanted in lesioned spinal cord prevent loss of spinal cord parenchyma and promote functional recovery

We studied the effects of olfactory ensheathing cells (OECs) transplanted in a photochemical spinal cord injury in adult rats. After dorsal laminectomy at T8 vertebra, subjacent spinal cord was bathed with rose Bengal for 10 min and illuminated with visible light by means of an optic fiber connected to a halogen lamp for 2.5 min at maximal intensity of 8 kLux. Eight injured rats received a suspension of OECs in DMEM, and another eight rats received DMEM alone. Locomotor ability scored by the BBB scale, pain sensibility by the plantar algesimetry test, and motor- and somatosensory-evoked potentials by electrophysiological techniques were evaluated for 3 months postsurgery. Finally, all rats were perfused with paraformaldehyde and transverse sections from the spinal cord segment at the lesion site were immunostained against GFAP. Area of the preserved spinal cord parenchyma was measured from the GFAP-immunolabeled cord sections. The BBB score and the amplitude of motor- and somatosensory-evoked potentials were higher in OECs-transplanted rats than in DMEM-injected animals throughout follow-up, whereas the withdrawal response to heat noxious stimulus was lower in OEC- than in DMEM-injected rats. The area of preserved spinal cord was significantly larger in OECs-transplanted rats than in DMEM-injected animals. These results indicate that OECs promote functional and morphological preservation of the spinal cord after photochemical injury.     

Olfactory ensheathing cells from the nose: Clinical application in human spinal cord injuries

Olfactory mucosa, the sense organ of smell, is an adult tissue that is regenerated and repaired throughout life to maintain the integrity of the sense of smell. When the sensory neurons of the olfactory epithelium die they are replaced by proliferation of stem cells and their axons grow from the nose to brain assisted by olfactory ensheathing cells located in the lamina propria beneath the sensory epithelium. When transplanted into the site of traumatic spinal cord injury in rat, olfactory lamina propria or purified olfactory ensheathing cells promote behavioural recovery and assist regrowth of some nerves in the spinal cord. A Phase I clinical trial demonstrated that autologous olfactory ensheathing cell transplantation is safe, with no adverse outcomes recorded for three years following transplantation. Autologous olfactory mucosa transplantation is also being investigated in traumatic spinal cord injury although this whole tissue contains many cells in addition to olfactory ensheathing cells, including stem cells. If olfactory ensheathing cells are proven therapeutic for human spinal cord injury there are several important practical issues that will need to be solved before they reach general clinical application. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.     

Olfactory ensheathing cells promote collateral axonal branching in the injured adult rat spinal cord

In recent years, injection of olfactory ensheathing cells (ECs) into the spinal cord has been used as an experimental strategy to promote regeneration of injured axons. In this study, we have compared the effects of transplanting encapsulated ECs with those injected directly into the spinal cord. The dorsal columns of adult rats were cut at T(8-9) and rats in experimental groups received either EC-filled porous polymer capsules or culture medium (CM)-filled capsules with ECs injected at the injury site. Control rats were in three groups: (1) uninjured, (2) lesion with transplantation of CM-filled capsules and (3) lesion with transplantation of CM-filled capsules and injections of CM. Three weeks after injury, Fluororuby was injected into the hindlimb motor and somatosensory cortex to label corticospinal neurons. Observations indicated that there were a few regenerating fibres, up to 10, in the EC-treated groups. In rats that received encapsulated ECs, regenerating fibres were present in close association with the capsule. Rats that received EC injections demonstrated a significant increase in the number of collateral branches from the intact ventral corticospinal tract (vCST) compared with the corresponding control, CM-injected group (P=0.003), while a trend for increased collateral branches was observed in rats that received encapsulated ECs (P=0.07).     

嗅鞘细胞移植联合督脉电针治疗大鼠前脊髓综合征

背景：电针在脊髓损伤的康复过程中有其一定的临床作用,同时以嗅鞘细胞为代表的细胞治疗在部分患者的康复过程中亦起到了一定的作用,两者是否具有协同应用尚不清楚。 目的：观察督脉电针联合嗅鞘细胞移植对前脊髓综合征大鼠神经营养因子3水平及P75NTR表达的影响。 方法：将40只成年大鼠随机分为对照组、督脉电针组、嗅鞘细胞移植组、督脉电针+嗅鞘细胞移植组,经嗅鞘细胞移植和督脉电针治疗2周后 ELISA法检测脊髓组织神经营养因子3水平,免疫组化检测P75NTR的表达。 结果与结论：督脉电针+嗅鞘细胞移植组神经营养因子3水平较对照组及其他实验组高(P < 0.05);嗅鞘细胞移植组和督脉电针+嗅鞘细胞移植组的脊髓损伤部位以及相邻的组织内均有P75NTR表达,且督脉电针+嗅鞘细胞移植组阳性表达明显较嗅鞘细胞移植组多。实验证实督脉电针联合嗅鞘细胞移植能够明显增高大鼠前脊髓综合征邻近组织的神经营养因子3水平;督脉电针可以有效促进移植的嗅鞘细胞在宿主内存活。     

Olfactory ensheathing cells for spinal cord repair: crucial differences between subpopulations of the glia

<正>OECs for spinal cord repair:Is repairing the injured spinal cord by olfactory ensheathing cell(OEC)transplantation possible?A recent human trial in which a paralysed man regained some function after transplantation of partially purified OECs suggests that this therapy may be a successful approach(Tabakow et al.,2014).In another human trial in which olfactory mucosa lamina propria was transplanted,patients recovered     

Olfactory ensheathing cells exhibit unique migratory, phagocytic, and myelinating properties in the X-irradiated spinal cord not shared by Schwann cells

Although several studies have shown that Schwann cells (SCs) and olfactory ensheathing cells (OECs) interact differently with central nervous system (CNS) cells in vitro, all classes of adult myelin-forming cells show poor survival and migration after transplantation into normal CNS. X-irradiation of the spinal cord, however, selectively facilitates migration of oligodendrocyte progenitor cells (OPCs), but not SCs, revealing differences in in vivo migratory capabilities that are not apparent in intact tissue. To compare the in vivo migratory properties of OECs and SCs and evaluate the potential of migrating cells to participate in subsequent repair, we first transplanted freshly isolated GFP-expressing adult rat olfactory bulb-derived OECs and SCs into normal and X-irradiated spinal cords. Both OECs and SCs showed limited survival and migration in normal spinal cord at 3 weeks. However, OECs, unlike SCs, migrated extensively in both grey and white matter of the X-irradiated spinal cord, and exhibited a phagocytic phenotype with OX-42 staining on their processes. If a X-irradiated and OEC transplanted spinal cord was then subjected to a focal demyelinating lesion 3 weeks after transplantation, OECs moved into the delayed demyelinated lesion and remyelinated host axons with a peripheral-like pattern of myelin. These results revealed a clear difference between the migratory properties of OECs and SCs in the X-irradiated spinal cord and demonstrated that engrafted OECs can participate in repair of subsequent lesions.     

Traumatic spinal cord injury in rats causes increases in tissue thromboxane but not peptidoleukotrienes

Spinal cord samples from rats subjected to three different levels of impact trauma (25, 50, 100 g-cm) were examined for immunoreactive thromboxane B2 and 6-sulfidopeptide-containing leukotrienes, using specific radioimmunoassays. Trauma resulted in pronounced increases in thromboxane levels as early as 5 min after injury, with maximum values at 1 hr. Although thromboxane values then slowly declined, they remained significantly above control values for up to 7 days. Significantly smaller thromboxane values were found in rats subjected to mild injury (25 g-cm) than in those that received more severe, irreversible impact injury (50 and 100 g-cm). No statistically significant changes were observed in leukotriene levels in any of the experimental groups. These findings are consistent with the hypothesis that cyclooxygenase products of arachidonic acid metabolism may contribute to secondary injury after spinal cord trauma and provides the rationale for the use of cyclooxygenase inhibitors in the treatment of such injury.     

Glial cell loss, proliferation and replacement in the contused murine spinal cord

Studies in the rat have shown that contusive spinal cord injury (SCI) results in devastating pathology, including significant loss of mature oligodendrocytes and astrocytes even in spared white matter. Subsequently, there is increased proliferation of endogenous NG2(+) cells, postulated to contribute to replacement of mature glia chronically, which is important for functional recovery. Studies of mechanisms that stimulate endogenous progenitor cells would be facilitated by using mouse models with naturally occurring and genetically engineered mutations. To determine whether the murine response is similar to that in the rat, we performed contusive SCI on adult female C57Bl/6 mice at the T8-9 level. Animals received bromodeoxyuridine injections in the first week following injury and were killed at 1, 3, 4, 7 or 28 days postinjury (DPI). The overall loss of macroglia and the temporal-spatial response of NG2(+) cells after SCI in the (C57Bl/6) mouse was very similar to that in the (Sprague-Dawley) rat. By 24 h after SCI nearly half of the macroglia in spared ventral white matter had been lost. Cell proliferation was increased at 1-7 DPI, peaking at 3-4 DPI. Dividing cells included NG2(+) cells and Cd11b(+) macrophages and microglia. Furthermore, cells dividing in the first week expressed markers of mature glia at 28 DPI. The similarities in endogenous progenitor cell response to SCI in the mouse and rat suggest that this is a fundamental injury response, and that transgenic mouse models may be used to further probe how this cellular response to SCI might be enhanced to improve recovery after SCI.     

Olfactory ensheathing cell transplantation improves sympathetic skin responses in chronic spinal cord injury

Forty-three patients with chronic spinal cord injury for over 6 months were transplanted with bryonic olfactory ensheathing cells, 2-4 × 106, into multiple sites in the injured area under the sur-gical...     

Treadmill training enhances the recovery of normal stepping patterns in spinal cord contused rats

Treadmill training is known to improve stepping in complete spinal cord injured animals. Few studies have examined whether treadmill training also enhances locomotor recovery in animals following incomplete spinal cord injuries. In the present study, we compared locomotor recovery in trained and untrained rats that received a severe mid-thoracic contusion of the spinal cord. A robotic device was used to train and to test bipedal hindlimb stepping on a treadmill. Training was imposed for 8 weeks. The robotic device supported the weight of the rats and recorded ankle movements in the hindlimbs for movement analyses. Both the trained and untrained rats generated partial weight bearing hindlimb steps after the spinal cord contusion. Dragging during swing was more prevalent in the untrained rats than the trained rats. In addition, only the trained rats performed step cycle trajectories that were similar to normal step cycle trajectories in terms of the trajectory shape and movement velocity characteristics. In contrast, untrained rats executed step cycles that consisted of fast, kick-like movements during forward swing. These findings indicate that spinal cord contused rats can generate partial weight bearing stepping in the absence of treadmill training. The findings also suggest that the effect of treadmill training is to restore normal patterns of hindlimb movements following severe incomplete spinal cord injury in rats.     

Thermomineral water promotes axonal sprouting but does not reduce glial scar formation in a mouse model of spinal cord injury

Thermomineral water from the Atomic Spa Gornja Trepca has been used for a century in the treatment of neurologic disease. The thermomineral water contains microelements, including lithium and magnesium, which show neural regeneration-promoting effects after central nervous system injury. In this study, we investigated the effects of oral intake of thermomineral water from the Atomic Spa Gornja Trepca on nerve regeneration in a 3-month-old mouse model of spinal cord injury. The mice receiving oral intake of thermomineral water showed better locomotor recovery than those without administration of thermomineral water at 8 and 12 weeks after lower thoracic spinal cord compression. At 12 weeks after injury, sprouting of catecholaminergic axons was better in mice that drank thermomineral water than in those without administration of thermomineral water, but there was no difference in glial reaction to injury between mice with and without administration of thermomineral water. These findings suggest that thermomineral water can promote the nerve regeneration but cannot reduce glial scar formation in a mouse model of spinal cord injury.     

嗅鞘细胞移植脊髓损伤大鼠NG2的表达

背景：对于脊髓损伤,目前临床尚无有效的治疗对策,近年来嗅鞘细胞移植治疗脊髓损伤修复取得了一定的进展。NG2是主要的硫酸软骨素蛋白多糖分子,对轴突有抑制作用。 目的：观察嗅鞘细胞移植对脊髓损伤大鼠NG2表达的影响,进一步分析嗅鞘细胞移植在修复脊髓损伤中的作用途径。 方法：将112只大鼠随机分为4组,空白组、模型组、嗅鞘细胞移植组及DF12组各28只。空白组仅切开T10全椎板及T9,T11部分椎板,对脊髓未作其他处理;其他3组应用脊髓横切法制作脊髓损伤动物模型。嗅鞘细胞移植组进行嗅鞘细胞移植,每侧断端植入20 000 cells;DF12组于相同部位注射DF12培养液。在大鼠脊髓损伤后1,3,7,14,28,42和56 d时,取材按照SP试剂盒的操作步骤检测NG2的表达。 结果与结论：空白组NG2呈低表达,在模型组、DF12组脊髓损伤24 h后损伤部位的NG2的表达开始升高,7 d时达到顶点,4周时NG2表达明显降低,6,8周时仅在局部有所表达。嗅鞘细胞移植组脊髓损伤1 d时NG2表达开始增加,主要在损伤部位,在各时间点与模型组、DF12组相比NG2表达水平明显降低,但高于空白组NG2各时间点的表达。提示嗅鞘细胞移植后NG2的表达水平降低,嗅鞘细胞具有抑制NG2表达的作用,可消除或减轻细胞外基质中对轴突有抑制作用的化学屏障,这可能是其治疗脊髓损伤促进轴突再生的机制之一。     

嗅鞘细胞静脉移植治疗脊髓损伤

背景：嗅鞘细胞移植治疗脊髓损伤在众多疗法中效果较佳,成为最有前景的治疗方法之一。目前移植方法为局部移植,存在操作复杂、创伤大、重复移植治疗困难等缺点。寻找一种简单易行且疗效好的移植方法成为各国学者研究的热点。 目的：分析嗅鞘细胞静脉移植治疗脊髓损伤的可行性和疗效。 方法：制备Wistar大鼠脊髓半切模型,随机分4组：嗅鞘细胞髓内局部移植组、嗅鞘细胞静脉移植组、D/F12静脉移植组和空白对照组。定期行CBS功能评分及组织学检查,评价脊髓修复情况。 结果与结论：嗅鞘细胞髓内局部移植组、嗅鞘细胞静脉移植组的功能恢复和组织学改变优于D/F12静脉移植组和空白对照组,嗅鞘细胞髓内局部移植组、嗅鞘细胞静脉移植组间无显著差别。说明嗅鞘细胞静脉移植可向脊髓损伤部位迁移并修复脊髓损伤,其疗效与嗅鞘细胞髓内局部移植相当。     

低能激光照射嗅鞘细胞促进脊髓损伤大鼠神经功能的修复

BACKGROUND： Previous studies have demonstrated that low-power laser （LPL） irradiation can promote the regeneration of peripheral nerves and central nerves, as well as influence cellular proliferation. Therefore, it is thought to be a potential treatment for spinal cord injury. OBJECTIVE： Utilizing histological observations and behavioral evaluations, the aim of this study was to investigate the influence of transplanted olfactory ensheathing cells （OECs）, irradiated by LPL, on functional repair of rats following transversal spinal cord injury. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the animal experimental center in the First Affiliated Hospital of Xinjiang Medical University between January 2007 and February 2008. MATERIALS： A total of 52 Sprague Dawley rats were included in this experiment. Twelve rats were used to harvest OECs, some of which were irradiated by LPL on days 3, 5, and 7 in culture. The remaining 40 rats were used to establish T12 complete spinal cord transection injury. DMEM/F12 medium was purchased from Sigma, USA, Fluorogold was provided by Chemicon, USA, and the LY/JG650-D500-16 low-power laser was produced by Xi＇an Lingyue Electromechanical Science And Technology Co., Ltd., China. METHODS： The successful rat models were randomly divided into three groups： OEC transplantation, LPL-irradiated OEC transplantation, and control. These animals were microinjected with OEC suspension, LPL-irradiated OEC suspension, and DMEM/F12 medium （10μL） respectively 4 weeks after spinal cord was completely transected at the T12 level. MAIN OUTCOME MEASURES： Spinal cord injury was observed using hematoxylin-eosin staining Expression of nerve growth factor receptor p75 and glial fibrillary acidic protein were determined using immunohistochemical staining. Regeneration of spinal nerve fibers in rats was assayed by Fluorogold retrograde labeling method. Basso, Beattie and Bresnahan （BBB） scores were used to evaluate motor functions of rat lower limbs. RESULTS： Structural disturbances were observed following spinal cord injury in each group, and a large amount of scar tissue covered the broken ends, accompanied by porosis and inflammatory cell infiltration. Following OEC transplantation, the distal end connected to the proximal end. nerve growth factor receptor p75 and glial fibrillary acidic protein immunohistochemistry revealed positive OECs in the cephalad and caudal area of rats that received LPL-irradiated OEC transplantation. In the OECs group, only glial fibrillary acidic protein staining was observed. No staining was found in the control group. Neural fibers labeled with Fluorogold extended across the lesion area and into the cephalad and caudal area in the OECs and LPL-irradiated OECs groups, but were not present in the control group. BBB scores revealed statistically significant differences among the three groups （P 〈 0.05）： OECs irradiated by LPL group 〉 OECs group 〉 control group. CONCLUSION： Transplantation of OECs and LPL-irradiated OECs promoted functional repair in the injured spinal cord of rats, although LPL-irradiated OECs resulted in greater beneficial effects.     

The importance of olfactory ensheathing cells for spinal cord injury

<正>We have been conducting clinical trials on olfactory ensheathing cell(OEC)transplantation for incomplete chronic spinal cord injury(SCI)since 2005.Long-term follow-up results verified that sensory and motor functions improved in most patients to varying degrees.However,the main source of OECs     

不同来源嗅鞘细胞修复脊髓损伤的效果比较

背景：研究表明嗅鞘细胞所分泌的细胞黏附分子和神经营养因子具有保护脊髓神经元和促进脊髓轴突再生的效应。 目的：比较嗅球及嗅黏膜固有层来源的嗅鞘细胞异体移植修复脊髓损伤的能力。 设计、时间及地点：随机对照动物实验,于2007-06/2008-06在西电集团医院中心实验室完成。 材料：随机选取雄性3月龄及23月龄SD大鼠各6只,分为实验组(23月龄)和对照组(3月龄),用于嗅鞘细胞的体外培养和纯化;SD大鼠30只随机分为乳鼠嗅球嗅鞘细胞移植组、正常嗅黏膜嗅鞘细胞移植组、对照组,每组10只。 方法：30只SD大鼠制造脊髓损伤模型,分别将体外培养的乳鼠和SD大鼠嗅鞘细胞进行脊髓损伤模型的异体移植,对照组不做移植。 主要观察指标：术后4,8周,进行BBB神经功能评分,诱发电位,组织病理学观察。 结果：实验过程中大鼠死亡7只,各组死亡率大致相同。移植后第4,8周时,乳鼠嗅鞘细胞移植组、正常嗅黏膜嗅鞘细胞组评分差异无显著性意义(P > 0.05),均显著高于空白对照组(P < 0.001);嗅鞘细胞移植2组评分8周高于4周(P < 0.01)。术后4周,各组动物均未引出运动诱发电位,移植后8周时,2组嗅鞘细胞移植组动物均可引出运动诱发电位,2组差异无显著性意义(P > 0.05),空白对照组动物仍未引出运动诱发电位(P < 0.001)。移植后8周,2组嗅鞘细胞移植组脊髓损伤区有较多细胞浸润,对照组细胞数目较少。 结论：来源于嗅球与嗅黏膜的嗅鞘细胞对脊髓损伤修复均有促进作用,且两者作用无明显差异。