Kim Daniel H, Jahng Tae-Ahn
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
J Korean Med Sci. 2004 Feb;19(1):113-22. doi: 10.3346/jkms.2004.19.1.113.
Although methylprednisolone (MP) is the standard of care in acute spinal cord injury (SCI), its functional outcome varies in clinical situation. Recent report demonstrated that MP depresses the expression of growth-promoting neurotrophic factors after acute SCI. The present study was designed to investigate whether continuous infusion of brain-derived neurotrophic factor (BDNF) after MP treatment promotes functional recovery in severe SCI. Contusion injury was produced at the T10 vertebral level of the spinal cord in adult rats. The rats received MP intravenously immediately after the injury and BDNF was infused intrathecally using an osmotic mini-pump for six weeks. Immunohistochemical methods were used to detect ED-1, Growth associated protein-43 (GAP-43), neurofilament (NF), and choline acethyl transferase (ChAT) levels. BDNF did not alter the effect of MP on hematogenous inflammatory cellular infiltration. MP treatment with BDNF infusion resulted in greater axonal survival and regeneration compared to MP treatment alone, as indicated by increases in NF and GAP-43 gene expression. Adjunctive BDNF infusion resulted in better locomotor test scores using the Basso-Beattie-Bresnahan (BBB) test. This study demonstrated that continuous infusion of BDNF after initial MP treatment improved functional recovery after severe spinal cord injury without dampening the acute effect of MP.
尽管甲基强的松龙（MP）是急性脊髓损伤（SCI）的标准治疗药物，但其功能结果在临床情况下存在差异。最近的报告表明，MP会抑制急性脊髓损伤后促进生长的神经营养因子的表达。本研究旨在探讨MP治疗后持续输注脑源性神经营养因子（BDNF）是否能促进严重脊髓损伤后的功能恢复。在成年大鼠脊髓的T10椎体水平制造挫伤损伤。大鼠在受伤后立即静脉注射MP，并使用渗透微型泵鞘内输注BDNF六周。采用免疫组织化学方法检测ED-1、生长相关蛋白-43（GAP-43）、神经丝（NF）和胆碱乙酰转移酶（ChAT）水平。BDNF并未改变MP对血源性炎性细胞浸润的影响。与单独使用MP治疗相比，MP治疗联合BDNF输注导致轴突存活和再生增加，这通过NF和GAP-43基因表达的增加得以体现。使用Basso-Beattie-Bresnahan（BBB）试验，辅助输注BDNF导致更好的运动测试评分。本研究表明，在初始MP治疗后持续输注BDNF可改善严重脊髓损伤后的功能恢复，而不会减弱MP的急性作用。
