Abstract
In individuals with severe spinal cord injury (SCI), the autonomic nervous system (ANS) is affected leading to cardiovascular deficits, which include significant blood pressure instability, with the prevalence of systemic hypotension and orthostatic intolerance resulting in an increased risk of stroke. Additionally, persons with SCI rostral to thoracic vertebral level 5 (T5), where sympathetic nervous system fibers exit the spinal cord and innervate the immune system, have clinically significant systemic inflammation and increased infection risk. Our recent studies show that lumbosacral spinal cord epidural stimulation (scES), applied at the lumbosacral level using targeted configurations that promote cardiovascular stability (CV-scES), can safely and effectively normalize blood pressure in persons with chronic SCI. Herein we present a case report in a female (age 27 years) with chronic clinically motor complete cervical SCI demonstrating that 97-sessions of CV-scES, which increased systemic blood pressure, improved orthostatic tolerance in association with increased cerebral blood flow velocity in the middle cerebral artery, also promoted positive immunological changes in whole-blood gene expression. Specifically, there was evidence of the down-regulation of inflammatory pathways and the up-regulation of adaptative immune pathways. The findings of this case report suggest that the autonomic effects of epidural stimulation, targeted to promote cardiovascular homeostasis, also improves immune system function, which has a significant benefit to long-term cardiovascular and immunologic health in individuals with long-standing SCI.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02307565.
Highlights
Severe cervical spinal cord injury (SCI) results in multi-organ system dysfunction that stems, in part, from impaired descending supraspinal control of the autonomic nervous system (ANS)
Most individuals with chronic cervical SCI do not report symptoms associated with cerebral hypoperfusion, mounting evidence suggests that asymptomatic daily fluctuations in blood pressure along with persistent hypotension are associated with reduced cerebral blood flow velocity in the middle cerebral artery (Phillips et al, 2014a,b, 2018; Wecht et al, 2017), and cognitive impairments (Jegede et al, 2010; Phillips et al, 2014b; Wecht et al, 2018)
The Gene Ontology (GO) platform (Ashburner et al, 2000; Carbon et al, 2019), which categorizes known functions of biological molecules by drawing on data from many species, was used to analyze the enrichment of differentially expressed genes using the Biological Process ontology, which describes how genes contribute to multiple biological processes. highlighted regulation of gene expression related to T cell receptor signaling (GO: 0050852), as enriched among downregulated transcripts
Summary
Severe cervical spinal cord injury (SCI) results in multi-organ system dysfunction that stems, in part, from impaired descending supraspinal control of the autonomic nervous system (ANS). As a result of ANS impairment, cardiovascular dysfunction is common and takes the form of blood pressure instability, which includes persistent hypotension, orthostatic hypotension, and autonomic dysreflexia. These blood pressure disorders have been implicated in an increased prevalence of cerebrovascular compromise (Saleem et al, 2018), cognitive deficits (Wecht et al, 2018), and stroke (Wu et al, 2012), which are independent of symptom reporting in the majority of individuals with SCI. Individuals with SCI-induced blood pressure instability report that this condition restricts their participation in daily activities, and diminishes their independence, vitality, and quality of life (Weaver et al, 2007; Carlozzi et al, 2013)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
