Automated determination of peripheral nerve stimulation parameters to achieve desired effector response – a procedural routine, preliminary studies and proposal of improvements

BACKGROUND: The feasibility of selectively stimulating fascicles and fibers within peripheral nerves has been demonstrated by a number of groups. Although various multi-contact electrodes have been developed for this purpose, the lack of procedures for fast determination of stimulation parameters to produce the desired effector activity hampers the clinical application of these techniques. In this paper, we propose an automated search routine that may facilitate the determination of stimulation parameters. To verify the routine's performance, we also developed an another routine that performs systematic stimulus–response mapping (the mapping routine). METHOD: The mapping routine performs systematic mapping of all possible combinations of the allowed stimulation parameters (i.e. combinations of electrode contacts used to provide the stimulus and sets of stimulus parameters values) and the observed displacements. The proposed automated search routine, similarly to the mapping routine, maps stimulation parameters to muscle responses, but it first investigates stimuli of the low charge and during the mapping process it compares the recorded responses with the desired one. Depending on the result of that comparison, it decides whether the use of a particular combination of electrode contacts should be further investigated or skipped. Both approaches were implemented on a custom-made closed-loop FES platform and preliminary experiments were performed on a rat model. The rat's sciatic nerve was stimulated with a 12-contact cuff electrode and the resulting displacement of the rat's paw was determined using a MEMS accelerometer. RESULTS: The automated search routine was faster than the mapping routine; however, it failed to find correct stimulation parameters in one out of three searches. This could be due to unexpectedly high variability in the responses to a constant stimulus. CONCLUSION: Our initial tests have proven that the proposed method determines the desired stimulation parameters much more quickly than systematic stimulus–response mapping. However, the factors influencing the variability of responses to constant stimuli should be identified, and their influence diminished; the remaining essential variability can then be identified. Thereafter, the criteria influencing the search process should be investigated and refined. Further improvements to the search routine are also proposed

Application of peripheral nerve conduits in clinical practice: A literature review

Understanding the pathomechanisms behind peripheral nerve damage and learning the course of regeneration seem to be crucial for selecting the appropriate methods of treatment. Autografts are currently the gold standard procedure in nerve reconstruction. However, due to the frequency of complications resulting from autografting and a desire to create a better environment for the regeneration of the damaged nerve, artificial conduits have become an approved alternative treatment method. The aim of this mini-review is to present the nerve scaffolds that have been applied in clinical practice to date, and the potential directions of developments in nerve conduit bioengineering. Articles regarding construction and characterization of nerve conduits were used as the theoretical background. All papers, available in PubMed database since 2000, presenting results of application of artificial nerve conduits in clinical trials were included into this mini-review. Fourteen studies including ≤10 patients and 10 trials conducted on >10 patients were analyzed as well as 24 papers focused on artificial nerve conduits per se. Taking into consideration the experiences of the authors investigating nerve conduits in clinical trials, it is essential to point out the emergence of bioresorbable scaffolds, which in the future may significantly change the treatment of peripheral nerve injuries. Also worth mentioning among the advanced conduits are hybrid conduits, which combine several modifications of a synthetic material to provide the optimal regeneration of a damaged nerve

The Role of Endogenous Neuroprotective Mechanisms in the Prevention of Retinal Ganglion Cells Degeneration

Retinal neurons are not able to undergo spontaneous regeneration in response to damage. A variety of stressors, i.e., UV radiation, high temperature, ischemia, allergens, and others, induce reactive oxygen species production, resulting in consecutive alteration of stress-response gene expression and finally can lead to cell apoptosis. Neurons have developed their own endogenous cellular protective systems. Some of them are preventing cell death and others are allowing functional recovery after injury. The high efficiency of these mechanisms is crucial for cell survival. In this review we focus on the contribution of the most recently studied endogenous neuroprotective factors involved in retinal ganglion cell (RGC) survival, among which, neurotrophic factors and their signaling pathways, processes regulating the redox status, and different pathways regulating cell death are the most important. Additionally, we summarize currently ongoing clinical trials for therapies for RGC degeneration and optic neuropathies, including glaucoma. Knowledge of the endogenous cellular protective mechanisms may help in the development of effective therapies and potential novel therapeutic targets in order to achieve progress in the treatment of retinal and optic nerve diseases

FluoroGold-Labeled Organotypic Retinal Explant Culture for Neurotoxicity Screening Studies

Preclinical toxicity screening of the new retinal compounds is an absolute requirement in the pathway of further drug development. Since retinal neuron cultivation and in vivo studies are relatively expensive and time consuming, we aimed to create a fast and reproducible ex vivo system for retinal toxicity screening. For this purpose, we used rat retinal explant culture that was retrogradely labeled with the FluoroGold before the isolation. Explants were exposed to a toxic concentration of gentamicin and ciliary neurotrophic factor (CNTF), a known neuroprotective agent. The measured outcomes showed the cell density in retinal ganglion cell layer (GCL) and the activity of lactate dehydrogenase (LDH) in the culture medium. Gentamicin-induced oxidative stress resulted in retinal cell damage and rapid LDH release to the culture medium (p<0.05). Additional CNTF supplementation minimized the cell damage, and the increase of LDH release was insignificant when compared to LDH levels before gentamicin insult (p>0.05). As well as this, the LDH activity was directly correlated with the cell count in GCL (R=−0.84, p<0.00001), making a sensitive marker of retinal neuron damage. The FLOREC protocol could be considered as a fast, reproducible, and sensitive method to detect neurotoxicity in the screening studies of the retinal drugs

Predegenerated Schwann cells-a novel prospect for cell therapy for glaucoma : neuroprotection, neuroregeneration and neuroplasticity

Glaucoma is an optic neuropathy that leads to irreversible blindness. Because the current therapies are not sufficient to protect against glaucoma-induced visual impairment, new treatment approaches are necessary to prevent disease progression. Cell transplantation techniques are currently considered to be among the most promising opportunities for nervous system damage treatment. The beneficial effects of undifferentiated cells have been investigated in experimental models of glaucoma, however experiments were accompanied by various barriers, which would make putative treatment difficult or even impossible to apply in a clinical setting. The novel therapy proposed in our study creates conditions to eliminate some of the identified barriers described for precursor cells transplantation and allows us to observe direct neuroprotective and pro-regenerative effects in ongoing optic neuropathy without additional modifications to the transplanted cells. We demonstrated that the proposed novel Schwann cell therapy might be promising, effective and easy to apply, and is safer than the alternative cell therapies for the treatment of glaucoma.Peer reviewe

Electrical synapses interconnecting axons revealed in the optic nerve head – a novel model of gap junctions’ involvement in optic nerve function

Abstract Purpose To characterize newly discovered electrical synapses, formed by connexin (Cx) 36 and 45, between neighbouring axons within the optic nerve head. Methods Twenty-five Wistar rats were killed by CO2 inhalation. Proximal and distal optic nerve (ON) stumps were collected and processed for immunostainings, electron microscopy (EM) with immunogold labelling, PCR and Western blots (WB). Additional 15 animals were deeply anaesthetized, and flash visual evoked potentials (fVEP) after retrobulbar injection of saline (negative control) or 100 ?m meclofenamic acid solution (gap junctions? blocker) were recorded. Human paraffin cross-sections of eyeballs for immunostainings were obtained from the Human Eye Biobank for Research. Results Immunostainings of both rat and human ON revealed the presence of Cx45 and 36 colocalizing with ?3-tubulin, but not with glial fibrillary acidic protein (GFAP). In WB, Cx36 content in optic nerve was approximately halved when compared with retina (0.58 ± 0.005 in proximal stump and 0.44 ± 0.02 in distal stump), Cx45 showed higher levels (0.68 ± 0.01 in proximal stump and 0.9 ± 0.07 in distal stump). In immunogold-EM of optic nerve sections, we found electric synapses (formed mostly by Cx45) directly coupling neighbouring axons. In fVEP, blocking of gap junctions with meclofenamic acid resulted in significant prolongation of the latency of P1 wave up to 160% after 30 min (p Peer reviewe

Charakterystyka diety ketogennej i jej właściwości terapeutycznych w chorobach centralnego układu nerwowego

A fat-rich and low-carbohydrate ketogenic diet has been successfully used in epilepsy treatment in children and adults for many years. Lately, advances have been made in the use of ketogenics as therapy for other disorders such the tuberous sclerosis complex, brain tumors and neurodegenerative diseases: Alzheimer’s disease and Parkinson’s disease. Many studies have also shown its neuroprotective abilities. This neuroprotection is connected with the molecular mechanisms of a ketogenic diet and ketone metabolism. This review shows how a ketogenic diet induces ketosis, how it works and how the molecular mechanisms of a ketogenic diet may be used in the therapy of central nervous system disorders.Wysokotłuszczowa, niskowęglowodanowa dieta ketogenna jest terapią, która od wielu lat z sukcesem jest stosowana u dzieci i dorosłych w leczeniu epilepsji. Późniejsze badania pozwoliły na rozszerzenie poszukiwań jej terapeutycznego zastosowania o stwardnienie guzowate, guzy mózgu i schorzenia neurodegeneracyjne, jak choroba Alzheimera i choroba Parkinsona. Wiele badań wykazało również neuroprotekcyjne właściwości tej terapii. Indukowanie neuroprotekcji jest związane z molekularnymi mechanizmami działania diety ketogennej i metabolizmem ciał ketonowych. Niniejsza praca opisuje działanie diety ketogennej oraz jej mechanizmy molekularne, które mogą być wykorzystywane w terapii chorób centralnego układu nerwowego