Internal decompression of the acutely contused spinal cord: Differential effects of irrigation only versus biodegradable scaffold implantation.

Autor: Guest JD; Department of Neurosurgery, University of Miami, Miami, FL, USA; The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA. Electronic address: jguest@miami.edu., Moore SW; InVivo Therapeutics Corporation, Cambridge, MA, USA. Electronic address: smoore@invivotherapeutics.com., Aimetti AA; InVivo Therapeutics Corporation, Cambridge, MA, USA. Electronic address: aaimetti@invivotherapeutics.com., Kutikov AB; InVivo Therapeutics Corporation, Cambridge, MA, USA. Electronic address: akutikov@invivotherapeutics.com., Santamaria AJ; The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA. Electronic address: asantamaria@miami.edu., Hofstetter CP; Department of Neurological Surgery, University of Washington, Seattle, WA, USA. Electronic address: chh9045@neurosurgery.washington.edu., Ropper AE; Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Alexander.Ropper@bcm.edu., Theodore N; Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Electronic address: Theodore@jhmi.edu., Ulich TR; InVivo Therapeutics Corporation, Cambridge, MA, USA. Electronic address: tulich@invivotherapeutics.com., Layer RT; InVivo Therapeutics Corporation, Cambridge, MA, USA. Electronic address: rlayer@invivotherapeutics.com.
Jazyk: angličtina
Zdroj: Biomaterials [Biomaterials] 2018 Dec; Vol. 185, pp. 284-300. Date of Electronic Publication: 2018 Sep 19.
DOI: 10.1016/j.biomaterials.2018.09.025
Abstrakt: Severe spinal cord injury leads to hemorrhage, edema and elevated tissue pressures that propagate ischemia. Liquefactive necrosis of damaged tissue eventually results in chronic cavities due to a wound healing process lacking adhesive contractile cells. Biomaterials can potently influence wound healing responses. Internal decompression (ID) refers to pial opening, allowing spontaneous extrusion and irrigation of fluid necrotic debris relieving pressure and resulting in a space for biomaterial scaffold insertion. After thoracic contusions, rats were randomized to: contusion only, contusion + ID and contusion + ID + PLGA-PLL scaffold implantation, to test for neuroprotection and endogenous repair over 3 months. ID alone reduced inflammatory activity, cavity volume, and increased tissue sparing. Scaffold biodegradation produced delayed ingrowth of inflammatory and other cells resulting in endogenously derived laminin-rich tissue, marked reduction in cavitation and presence of tissue remodeling macrophages. Extensive recruitment of Schwann cells into adjacent spared white matter occurred, greatest in scaffold-implanted animals. Despite tissue preservation with myelin repair, no groups differed significantly in open field locomotion. However, across all rats, spared epicenter tissue and locomotor outcomes were correlated. Scaffold-implanted animals showed no obvious toxicity. To study the clinical feasibility, timing and indications for scaffold implantation, Göttingen minipigs underwent ID and were implanted with scaffolds 4, 6, and 24 h after T10 contusion. High intra-spinal tissue pressures fell to pre-injury levels after ID and scaffold implantation. Extrusion of necrotic debris left sufficient space for a sized scaffold. These results provided the preclinical rationale for a current clinical study of biomaterial scaffold implantation into the human injured spinal cord.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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