Chiaretti Antonio, Conti Giorgio, Falsini Benedetto, Buonsenso Danilo, Crasti Matteo, Manni Luigi, Soligo Marzia, Fantacci Claudia, Genovese Orazio, Calcagni Maria Lucia, Di Giuda Daniela, Mattoli Maria Vittoria, Cocciolillo Fabrizio, Ferrara Pietro, Ruggiero Antonio, Staccioli Susanna, Colafati Giovanna Stefania, Riccardi Riccardo
a Institute of Pediatrics , Università Cattolica del Sacro Cuore , Rome , Italy.
b Pediatric Intensive Care Unit , Università Cattolica del Sacro Cuore , Rome , Italy.
Brain Inj. 2017;31(11):1538-1547. doi: 10.1080/02699052.2017.1376760. Epub 2017 Oct 3.
Nerve growth factor (NGF) promotes neural recovery after experimental traumatic brain injury (TBI) supporting neuronal growth, differentiation and survival of brain cells and up-regulating the neurogenesis-associated protein Doublecortin (DCX). Only a few studies reported NGF administration in paediatric patients with severe TBI.
A four-year-old boy in a persistent unresponsive wakefulness syndrome (UWS) was treated with intranasal murine NGF administration 6 months after severe TBI. The patient received four cycles of intranasal NGF (0.1 mg/kg, twice a day for 10 consecutive days).
NGF administration improved functional [Positron Emission Tomography/Computed Tomography (PET/CT); Single photon emission/Computed Tomography (SPECT/CT) and Magnetic Resonance Imaging (MRI)] assessment, electrophysiological [Electroencephalogram (EEG) and Visual Evoked Potential (VEP)] studies and clinical conditions. He showed improvements in voluntary movements, facial mimicry, phonation, attention and verbal comprehension, ability to cry, cough reflex, oral motility, feeding capacity, and bowel and urinary functions. After NGF administration, raised levels of both NGF and DCX were found in the cerebrospinal fluid of the patient. No side effects were reported.
Although further studies are needed for better understanding the neuroprotective role of this neurotrophin, intranasal NGF administration appears to be a promising and safe rescuing strategy treatment in children with neurological impairment after TBI.
神经生长因子（NGF）可促进实验性创伤性脑损伤（TBI）后的神经恢复，支持神经元生长、分化及脑细胞存活，并上调与神经发生相关的蛋白双皮质素（DCX）。仅有少数研究报道了在重度TBI儿科患者中应用NGF。
一名4岁处于持续性无反应觉醒综合征（UWS）的男孩在重度TBI 6个月后接受鼻内给予鼠源NGF治疗。该患者接受了四个周期的鼻内NGF治疗（0.1mg/kg，每天两次，连续10天）。
给予NGF改善了功能[正电子发射断层扫描/计算机断层扫描（PET/CT）；单光子发射/计算机断层扫描（SPECT/CT）和磁共振成像（MRI）]评估、电生理[脑电图（EEG）和视觉诱发电位（VEP）]研究及临床状况。他在自主运动、面部模仿、发声、注意力和言语理解、哭泣能力、咳嗽反射、口腔运动、进食能力以及肠道和泌尿功能方面均有改善。给予NGF后，患者脑脊液中NGF和DCX水平均升高。未报告有副作用。
尽管需要进一步研究以更好地了解这种神经营养因子的神经保护作用，但鼻内给予NGF似乎是TBI后神经功能受损儿童一种有前景且安全的抢救策略治疗方法。
