Spinal cord injury (SCI) is a debilitating condition accompanied by motor and sensory deficits and a reduced quality of life. Current treatment options are limited and are associated with variable efficacy and a risk of adverse effects. The pathophysiology of SCI is initiated by a primary mechanical insult to the spinal cord, followed by a complex series of deleterious events known as secondary injury. Secondary injury processes include free radical formation, glutamate excitotoxicity, inflammation and cell death. Apoptotic cell death in particular plays a key role in the secondary injury processes and exacerbates tissue degradation and loss of function. The role of Fas-mediated apoptosis in SCI pathophysiology is poorly defined in the literature to date. Correlative evidence suggests that this form of cell death is delayed and occurs in white matter adjacent to sites of primary damage. The cellular and temporal mechanisms of Fas-mediated apoptosis following experimental SCI were evaluated using a clinically relevant clip compression SCI model in the rat. Furthermore, therapeutic manipulation of Fas activation using a soluble form of the Fas receptor (sFasR) was carried out to establish the efficacy and clinical relevance of targeting this aspect of secondary injury. This work shows that Fas-mediated apoptosis is an important contributor to secondary SCI pathology. Oligodendrocytes are targeted by this form of cell death in a delayed fashion post-injury, providing an opportunity for therapeutic intervention. Intrathecal administration of sFasR following SCI reduced post-traumatic apoptosis, improved cell survival, enhanced tissue preservation and resulted in an improved motor recovery. Administration of sFasR was effectively delayed by up to 24 hours post-injury, however a shorter delay of 8 hours post-injury was most efficacious. A surprising result emerged from this work. Delayed intrathecal administration of IgG following SCI showed significant efficacy in both cellular and tissue level outcomes, as well as at the functional level. Fas-mediated apoptosis is an important aspect of secondary SCI pathophysiology and is an attractive therapeutic target. The beneficial outcomes of manipulating Fas activation using sFasR provide further evidence for this. Future work will refine this treatment strategy, bringing it into the SCI patient population.

The blood system is organized as a developmental hierarchy in which rare hematopoietic stem cells (HSCs) generate large numbers of immature progenitors and differentiated mature blood cells. In this process, at least ten distict lineages are specified from multipotent stem cells, however the cellular and molecular organization of the hematopoietic hierarchy is a topic of intense investigation. While much has been learned from mouse models, there is also an appreciation for species-specific differences and the need for human studies. Blood lineages have been traditionally grouped into myeloid and lymphoid branches, and the long-standing dogma has been that the separation between these branches is the earliest event in fate specification. However, recent murine studies indicate that the progeny of initial specification retain the more ancestral myeloid potential. By contrast, much less is known about the progenitor hierarchy in human hematopoiesis. To dissect human hematopoiesis, we developed a novel sorting scheme to isolate human stem and progenitor cells from neonatal cord blood and adult bone marrow. As few as one in five single sorted HSCs efficiently repopulated immunodeficient mice enabling interrogation of homogeneous human stem cells. By analyzing the developmental potential of sorted progenitors at a single-cell level we showed that earliest human lymphoid progenitors (termed LMPs) possess myelo-monocytic potential. In addition to B-, T-, and natural killer cells, LMPs gave rise to dendritic cells and macrophages indicating that these closely related myeloid lineages also remain entangled in lymphoid development. These studies provide systematic insight into the organization of the human hematopoietic hierarchy, which provides the basis for detailed genetic analysis of molecular regulation in defined cell populations. In a pilot study, we investigated the role of a zinc finger transcription factor (ZNF145), PLZF, in myeloid development. We found that PLZF restrained proliferation and differentiation of myeloid progenitors and maintained the progenitor pool. Induction of ERK1/2 by myeloid cytokines, reflective of a stress response, leads to nuclear export and inactivation of PLZF, which augments mature cell production. Thus, negative regulators of differentiation can serve to maintain developmental systems in a primed state, so that their inactivation by extrinsic signals can induce proliferation and differentiation to rapidly satisfy increased demand for mature cells. Taken together, these studies advance our understanding of the cellular and molecular architecture of human hematopoiesis.

Spinal cord injury (SCI) is a devastating condition that causes its victims to experience functional deficits. Inflammation plays a complex role in the progression of SCI. While some inflammatory cells attenuate further damage to the spinal cord tissue, other inflammatory mediators exacerbate the damage. Attenuating the detrimental aspects of inflammation after SCI is an attractive neuroprotective strategy that could potentially lead to significant functional improvement. In this regard, intravenous immunoglobulin G (IgG), which has many proposed immuno-modulatory mechanisms, is a potential treatment candidate. In this study, we investigated the neuroprotective properties of IgG by examining its effects after SCI at the molecular, cellular, and neurobehavioral levels. We observed that IgG treatment after SCI is associated with significant reduction in pro-inflammatory mediators and significant improvement in neurobehavioral recovery compared to the control. The results of the study suggest that IgG could potentially be used as an immuno-modulatory therapy for SCI.

More than one million people are living with spinal cord injury (SCI) in North America alone. Restoring lost motor function can alleviate SCI-related health problems, as well as markedly increase the quality of life enjoyed by individuals with SCI. Functional electrical stimulation (FES) can replace motor function in individuals with SCI by using short electrical pulses to generate contractions in paralyzed muscles. A wide range of FES applications have been proposed, but few application are actually available for community use by SCI consumers. A major factor contributing to this shortage of real-world FES applications is the lack of a feasible closed-loop control algorithm. The purpose of this thesis is to develop a closed-loop control algorithm that is suitable for use in practical FES applications. This thesis consists of three separate studies. The first study examined existing closed-loop control algorithms for FES applications, and showed that a method of testing FES control algorithms under realistic conditions is needed to evaluate their likely real-world performance. The second study provided such a testing method by developing a non-idealities block that can be used to modify the nominal response of electrically stimulated muscle in simulations of FES applications. Fatigue, muscle spasm, and tremor non-idealities are included in the block, which allows the user to specify the severity level for each type of non-ideal behaviour. This nonidealities block was tested in a simulation of electrically induced knee extension against gravity, and showed that the nominal performance of the controllers was substantially better than their performance in the realistic case that included the non-idealities model. The third study concerned the development and testing of a novel observer-based sliding mode control (SMC) algorithm that is suitable for use in real-world FES applications. This algorithm incorporated a fatigue minimization objective as well as co-contraction of the antagonist muscle group to cause the joint stiffness to track a desired value. The SMC algorithm was tested in a simulation of FES-based quiet standing, and the non-idealities block was used to determine the probable performance of the controller in the real world. This novel controller performed very well in simulation, and would be suitable for use in selected practical FES applications. The work contained in this thesis can easily be extended to a wide range of FES applications. This work represents a significant step forward in closed-loop control for FES applications, and will facilitate the development of sophisticated new electrical stimulation systems for use by consumers in their homes and communities.

Neuropathic pain (NP) after spinal cord injury (SCI) can significantly and negatively affect a person’s quality of life and is often refractory to currently available treatments. In order to advance the field and find effective therapeutic avenues; signs, symptoms, and biomarkers in humans should be identified and related to specific pain-generating mechanisms. The present work utilizes quantitative sensory testing (QST) and magnetic resonance spectroscopy (MRS) to evaluate the relationship between the functional integrity of the dorsal column-medial lemniscus pathway (DCML), the spinothalamic tract (STT), and metabolic markers of neuronal loss and glial activation in the thalamus of persons with/without NP after SCI. This work was based on the hypothesis that the presence/severity of NP after SCI is dependent both on function of ascending somatosensory pathways and changes in neuronal and glial markers in the thalamus. The results indicate that NP is associated with a decreased afferent DCML input to the thalamus resulting in a loss of inhibitory neurons and that residual function from STT afferents may contribute to thalamic glial activation and NP. Based on this work, in combination with previous studies in animals and humans, it can be proposed that NP after SCI partly results from the combination of residual STT function and loss of neuronal inhibition leading to neuronal hyperexcitability in the spinal cord and the thalamus. Thus, the presence of NP in chronic SCI is dependent on several underlying mechanisms which may be measured in human subjects with methods such as QST and MRS. Clinical implications and recommendations for further research are enclosed.

Brainstem derived serotonin (5-HT) normally facilitates spinal motoneuron excitability and inhibits sensory afferent transmission and associated spinal reflexes. Because the 5-HT innervation of the spinal cord is almost exclusively derived from brainstem neurons, spinal cord injury leads to an immediate and dramatic loss of 5-HT and this in turn leads to the simultaneous loss of motoneuron excitability and increase (disinhibition) of sensory afferent transmission. This thesis examined how spinal cord 5-HT receptors adapt over the months after SCI (chronic injury) to compensate for the loss of 5-HT. We showed that after SCI 5-HT2B and 5-HT2C receptors become constitutively active (active in the absence of 5-HT) with chronic injury, and this leads to a recovery of motoneuron excitability and contributes to the recovery of locomotor function. Unfortunately, this also contributes to the development of muscle spasms when combined with the disinhibition of sensory afferent transmission. In contrast, 5-HT1 receptors that modulate sensory afferent transmission do not become constitutively active after chronic SCI, and this contributes to the continued disinhibition of sensory afferent transmission and associated hyperreflexia and muscle spasms after chronic SCI. However, exogenous application of 5-HT1B and 5-HT1F receptor agonists can restore inhibition over sensory afferent transmission and ultimately reduce muscle spasms. In summary, 5-HT2 receptors exhibit a remarkable adaptation to the loss of 5-HT with SCI, whereas 5-HT1 receptors do not. Understanding and promoting this natural plasticity may help in the development of better therapeutic interventions for treating SCI.

Cord blood IgE has previously been studied as a possible predictor of asthma and allergic diseases. Results from different studies have been contradictory, and most have focused on high-risk infants and early infancy. Few studies have followed their study population into adulthood. This study assessed whether cord blood IgE levels and a family history of asthma were associated with, and could predict, asthma medication and allergy-related respiratory symptoms in adults. A follow-up was carried out in a Swedish birth cohort comprising 1701 consecutively born children. In all, 1661 individuals could be linked to the Swedish Prescribed Drug Register and the Medical Birth Register, and 1227 responded to a postal questionnaire. Cord blood IgE and family history of asthma were correlated with reported respiratory symptoms and dispensed asthma medication at 32–34 years. Elevated cord blood IgE was associated with a two- to threefold increased risk of pollen-induced respiratory symptoms and dispensed anti-inflammatory asthma medication. Similarly, a family history of asthma was associated with an increased risk of pollen-induced respiratory symptoms and anti-inflammatory medication. However, only 8% of the individuals with elevated cord blood IgE or a family history of asthma in infancy could be linked to current dispensation of anti-inflammatory asthma medication at follow-up. Elevated cord blood IgE and a positive family history of asthma were associated with reported respiratory symptoms and dispensed asthma medication in adulthood, but their predictive power was poor in this long-time follow-up. / <p>The status of this article was on the day of the defence date <em>Manuscript</em>.</p>

Transplants of olfactory ensheathing cells (OECs) from olfactory bulbs have recently been shown to support regrowth and reinnervation of damaged spinal cord, which has led to improved functional recovery. Using complete transection in adult rat, the studies presented in this thesis examine the role of peripherally derived olfactory tissue in promoting axonal regeneration and functional recovery. Chapter One and Two provide the background to the area of spinal cord regeneration and the methods used in this thesis. Chapter Three shows that transplants of OECs from rat olfactory lamina propria (OLP) are able to support axon regrowth in the lesioned spinal cord. The BBB score was significantly higher in experimental rats (5.4???0.84) compared with control animals (1.9???0.33) (P&lt0.001). These dissociated OECs from OLP can promote axonal regrowth through the lesion. Histological assessment showed that: 1) axons labelled with Fluororuby grew into the injury site in OECs-transplanted rats, with occasional fibres extending into the rostral cord; 2) brainstem neurons in the raphe nucleus were retrogradely labeled with Fluororuby; and 3) serotonergic axons were detectable distal to the lesion in OECs-transplanted rats. No fibres grew into the injured region and no retrograde labeling or serotonergic fibres were seen in control animals. The role of regenerated serotonergic fibres in OECs-transplanted rats is discussed. Chapter Four demonstrates that solid pieces of OLP dissected from the nose can re-establish the continuity of the transected cord and supply the OECs that can migrate to the cord stumps to support the axon regeneration. Experimental rats which received OLP from olfactory mucosa showed significantly greater locomotive recovery (BBB scores: OLP, 5.0???1.9; control, 1.5???0.5, p&lt0.0001). In animals with OLP transplants, histological analysis indicated that nerve fibres, expressing neurofilament and serotonin were present at the transection site. Locomotive recovery of the hindlimbs occurred, similar to that seen after OECs transplantation. Retrograde labeling of medullary raphe neurons and gigantocellular reticular nucleus occurred following Fluororuby injection in the cord distal to the lesion, further supporting the supraspinal origin of the 5-HT innervation in the present studies. These results indicate that OLP is effective in promoting partial spinal cord repair. Chapter Five examines functional recovery of spinal reflex circuitry, ie., H-reflex excitability using paired stimuli, in OLP-transplanted rats compared with normal and respiratory lamina propria (RLP) transplanted animals. H-reflex amplitude of the conditioned response was significantly reduced in OLP transplanted rats compared to RLP transplanted animals (p&lt 0.05). Therefore, hindlimb reflex excitability can be modulated by OLP transplants after transection of the spinal cord in adult rats. Chapter Six examines whether functional recovery can occur if transplantation of OLP tissue is delayed by 1 month after the spinal cord transection. The BBB score was significantly higher in experimental rats (4.3???0.8 for OLP) compared with control animals (1.0???0.3, P&lt 0.001), but recovery was less than after acute transplantation. Asx before, histological assessment of OLP animals showed: a) serotonergic axons were present in the cord below the transection site; b) brainstem raphe nuclei was retrogradely labeled; c) bisbenzimide pre-labeled cells from OLP transplants migrated in host spinal cord. These changes were not seen in control animals. These results indicate that OLP has the ability to promote axonal regeneration in chronically injured cord of adult rats. Chapter Seven compares the results from these three types of intervention. In conclusion, these studies show that peripherally derived OECs or solid pieces of OLP can promote partial spinal cord repair in acute or chronic transection injuries. Such tissue might provide a potential source for autologous grafting in human paraplegia.

In the adult central nervous system (CNS) several factors are implicated in the failure of neurons to regenerate after spinal cord injury (SCI). However, this reduced ability of injured CNS neurons to regenerate can be improved by under certain conditions. For instance, in adult dorsal root ganglion (DRG) neurons, injury to its peripheral branch (unilateral conditioning lesion) prior to injury of its central DRG branch (dorsal column cut) enhances the intrinsic capability of some but not all CNS afferent neurons to regenerate. The exact mechanism mediating this type of response is not known. However, previous studies by other groups have proposed that the regeneration of these CNS afferent neurons might be associated with the inflammatory response following injury to the peripheral DRG branch. Our general aim, was to examine the involvement of the immune response in the regeneration of the CNS DRG branch, as part of the pre-conditioned lesion model. To test this, three questions/hypotheses were investigated. Firstly, we investigated the effects of vaccination in pre-conditioned lesion animals using a peripheral nerve homogenate (PNH, sciatic nerve) as the immunogen. Given the regenerative capabilities of peripheral nerves, we proposed that exposure to this homogenate could enhance the limited regeneration of CNS fibres, after pre-conditioning of DRG neurons. Our results showed that in adult and/or neonatal Sprague Dawley (SD) rats PNH-vaccinated, had greater number of regenerated fibres, as compared to injury matched saline-vaccinated controls. Conversely, passive exposure to PNH through parental vaccination resulted in the suppression of this regenerative trigger. This suppressed competence of CNS fibres to regenerate was indirectly correlated with a reduced number of macrophage cells throughout the SCI epicentre, as compared to greater macrophage numbers found in the adult and/or neonatal treated groups. Secondly, we explored the possibility that a systemic inflammatory effect originating from the peripheral conditioning lesion, might be able to contribute to the regeneration of other injured neurons within the matured CNS. Again, using adult SD rats, we pre-conditioned the peripheral DRG branch as previous and changed the location of the CNS injury from the spinal cord to the optic nerve. Where alike any other injured neuron within the CNS, fails to regenerate. Unfortunately, our results from anterograde or retrograde labelling did not find any regenerated optic nerve fibres, although, we did find macrophage numbers to be higher in pre-conditioned lesion animals as compared to sham-operated animals. Therefore, it is possible that the pre-conditioning peripheral lesion might be allowing for a greater macrophage infiltration into the CNS compartment. Finally, we determined whether an early macrophage infiltration into the CNS compartment could be correlated with the observed CNS regeneration, characteristic of the pre-conditioned lesion model. To test this, we temporarily depleted macrophages before, during and after peripheral nerve lesion, via liposomal clodronate delivery. Our results from anterograde and retrograde labelling of spinal cord fibres revealed no regenerated CNS fibres in macrophage depleted animals, only in injury matched controls. In conclusion, macrophage cells play a beneficial role in the regeneration of CNS afferent fibres of pre-conditioned lesion DRG neurons. This most likely occurs through activation of intrinsic somatic DRG responses, as well as, an increased macrophage activation. We believe this inflammatory response to be of favourable phenotypic characteristic to the regeneration of injured CNS neurons, especially those in proximity to the DRG cell body. In addition, we propose that the conditioning peripheral lesion permits an influx of macrophage cells into the CNS compartment before injury of the CNS DRG branch, which is also likely to be supporting regeneration of afferent fibres. Future studies should evaluate the possibility that activated inflammatory cells might be infiltrating into the CNS under minimal blood-brain barrier disruption. It is clear that a complex communication between the nervous and immune system is occurring after the initial peripheral injury.

Haemopoietic stem and progenitor cells from bone marrow and cord blood are well characterised with respect to their phenotype, growth in clonal assays, responsiveness to cytokine stimulation, receptor profile and their ability to sustain multilineage engraftment of receptive hosts in animal models of transplantation and of course, clinically in the treatment of some haemopoietic and immunological disorders. It is generally accepted that cells bearing the CD34+ phenotype are enriched for the most primitive of haemopoietic stem cells that possess the cardinal features of self-renewal and multipotency. However, the molecular mechanisms, the spectrum of expressed genes that give rise to the physical characteristics of haemopoietic progenitor cells are not well understood. Furthermore, although CD34+ cells from different sources (bone marrow, cord blood, mobilised peripheral blood) share many common features, there are also significant differences. (For complete abstract open document)