Kwiecien Jacek M, Jarosz Bozena, Oakden Wendy, Klapec Michal, Stanisz Greg J, Delaney Kathleen H, Kotlinska-Hasiec Edyta, Janik Rafal, Rola Radoslaw, Dabrowski Wojciech
Department of Pathology and Molecular Medicine, M. deGroote School of Medicine, McMaster University, Hamilton, Canada; Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland.
Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland.
Neurol Neurochir Pol. 2016;50(1):7-15. doi: 10.1016/j.pjnns.2015.10.006. Epub 2015 Nov 27.
Current therapies to limit the neural tissue destruction following the spinal cord injury are not effective. Our recent studies indicate that the injury to the white matter of the spinal cord results in a severe inflammatory response where macrophages phagocytize damaged myelin and the fluid-filled cavity of injury extends in size with concurrent and irreversible destruction of the surrounding neural tissue over several months. We previously established that a high dose of 4mg/rat of dexamethasone administered for 1 week via subdural infusion remarkably lowers the numbers of infiltrating macrophages leaving large amounts of un-phagocytized myelin debris and therefore inhibits the severity of inflammation and related tissue destruction. But this dose was potently toxic to the rats. In the present study the lower doses of dexamethasone, 0.125-2.0mg, were administered via the subdural infusion for 2 weeks after an epidural balloon crush of the mid-thoracic spinal cord. The spinal cord cross-sections were analyzed histologically. Levels of dexamethasone used in the current study had no systemic toxic effect and limited phagocytosis of myelin debris by macrophages in the lesion cavity. The subdural infusion with 0.125-2.0mg dexamethasone over 2 week period did not eliminate the inflammatory process indicating the need for a longer period of infusion to do so. However, this treatment has probably lead to inhibition of the tissue destruction by the severe, prolonged inflammatory process.
目前用于限制脊髓损伤后神经组织破坏的治疗方法并不有效。我们最近的研究表明,脊髓白质损伤会引发严重的炎症反应,巨噬细胞吞噬受损的髓磷脂,损伤的充满液体的腔隙会随着时间推移而扩大,同时周围神经组织会在数月内遭受不可逆的破坏。我们之前发现,通过硬膜下输注给予大鼠4mg/大鼠的高剂量地塞米松,持续1周,可显著降低浸润巨噬细胞的数量,留下大量未被吞噬的髓磷脂碎片,从而抑制炎症的严重程度和相关组织破坏。但该剂量对大鼠具有明显毒性。在本研究中,在胸段脊髓硬膜外气囊挤压损伤后,通过硬膜下输注给予较低剂量的地塞米松(0.125 - 2.0mg),持续2周。对脊髓横截面进行组织学分析。本研究中使用的地塞米松剂量没有全身毒性作用,并且限制了损伤腔内巨噬细胞对髓磷脂碎片的吞噬作用。在2周内通过硬膜下输注0.125 - 2.0mg地塞米松并不能消除炎症过程,这表明需要更长时间的输注才能做到这一点。然而,这种治疗可能抑制了严重、持续的炎症过程对组织的破坏。