PMID- 33177997
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201113
IS  - 1662-5137 (Print)
IS  - 1662-5137 (Electronic)
IS  - 1662-5137 (Linking)
VI  - 14
DP  - 2020
TI  - Prolonged Targeted Cardiovascular Epidural Stimulation Improves Immunological 
      Molecular Profile: A Case Report in Chronic Severe Spinal Cord Injury.
PG  - 571011
LID - 10.3389/fnsys.2020.571011 [doi]
LID - 571011
AB  - 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.
CI  - Copyright (c) 2020 Bloom, Wecht, Ditterline, Wang, Ovechkin, Angeli, Arcese and 
      Harkema.
FAU - Bloom, Ona
AU  - Bloom O
AD  - VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James 
      J. Peters VA Medical Center, Bronx, NY, United States.
AD  - Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, 
      Manhasset, NY, United States.
AD  - Departments of Molecular Medicine; Physical Medicine and Rehabilitation, Donald 
      and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United 
      States.
FAU - Wecht, Jill M
AU  - Wecht JM
AD  - VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James 
      J. Peters VA Medical Center, Bronx, NY, United States.
AD  - Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, NY, 
      United States.
AD  - Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, NY, 
      United States.
FAU - Legg Ditterline, Bonnie E
AU  - Legg Ditterline BE
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, United States.
AD  - Department of Neurosurgery, School of Medicine, University of Louisville, 
      Louisville, KY, United States.
FAU - Wang, Siqi
AU  - Wang S
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, United States.
AD  - Department of Neurosurgery, School of Medicine, University of Louisville, 
      Louisville, KY, United States.
FAU - Ovechkin, Alexander V
AU  - Ovechkin AV
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, United States.
AD  - Department of Neurosurgery, School of Medicine, University of Louisville, 
      Louisville, KY, United States.
FAU - Angeli, Claudia A
AU  - Angeli CA
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, United States.
AD  - Department of Bioengineering, University of Louisville, Louisville, KY, United 
      States.
FAU - Arcese, Anthony A
AU  - Arcese AA
AD  - Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, 
      Manhasset, NY, United States.
FAU - Harkema, Susan J
AU  - Harkema SJ
AD  - Departments of Molecular Medicine; Physical Medicine and Rehabilitation, Donald 
      and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United 
      States.
AD  - Kentucky Spinal Cord Injury Research Center, University of Louisville, 
      Louisville, KY, United States.
AD  - Department of Neurosurgery, School of Medicine, University of Louisville, 
      Louisville, KY, United States.
AD  - Department of Bioengineering, University of Louisville, Louisville, KY, United 
      States.
LA  - eng
SI  - ClinicalTrials.gov/NCT02307565
PT  - Journal Article
DEP - 20201015
PL  - Switzerland
TA  - Front Syst Neurosci
JT  - Frontiers in systems neuroscience
JID - 101477946
PMC - PMC7593242
OTO - NOTNLM
OT  - blood pressure regulation
OT  - cardiovascular regulation
OT  - cerebral blood flow velocity
OT  - epidural stimulation
OT  - immune system
OT  - neuromodulation
OT  - orthostatic hypotension
OT  - spinal cord injury
EDAT- 2020/11/13 06:00
MHDA- 2020/11/13 06:01
PMCR- 2020/01/01
CRDT- 2020/11/12 05:41
PHST- 2020/06/09 00:00 [received]
PHST- 2020/09/09 00:00 [accepted]
PHST- 2020/11/12 05:41 [entrez]
PHST- 2020/11/13 06:00 [pubmed]
PHST- 2020/11/13 06:01 [medline]
PHST- 2020/01/01 00:00 [pmc-release]
AID - 10.3389/fnsys.2020.571011 [doi]
PST - epublish
SO  - Front Syst Neurosci. 2020 Oct 15;14:571011. doi: 10.3389/fnsys.2020.571011. 
      eCollection 2020.