Delivery of neurotrophins to the injury site via cellular transplants or viral vectors administration has previously been shown to promote recovery of locomotor behavior in the absence of locomotor training in adult spinalized animals. Viral vectors still pose clinical concerns associated to recombinant genetics and the lack of understanding of how they react with the human immune system. Delivery via graft of autologous fibroblast engineered to produce brain derived neurotrophic factor (BDNF) and Neurotrophin-3 (NT-3) has been shown as a valuable method; however, the need for multiple invasive surgeries, along with the impossibility of delivering a controlled and constant dosage of protein are serious obstacles to obtaining approval by the FDA. The present study was aimed at evaluating the efficacy of BDNF delivered to the lumbar locomotor centers using a clinically translational delivery method at restoring stepping abilities in a large animal model of spinal cord injury. We wanted to evaluate if intrathecal delivery of BDNF to the lumbar spinal cord would promote a locomotor recovery as effective as delivery to the injury site, even at doses low enough not to trigger the side effects observed at high doses. A programmable and implantable mini-pump was used to intrathecally deliver a 50 ng/day dose of BDNF to the lumbar spinal cord for 35 days after spinal thoracic transection. Kinematic evaluation was conducted before, 3 and 5 weeks after injury/pump implant. Ground reaction forces (GRFs) analysis was performed 5 weeks after injury to evaluate the animals’ ability to weight support during locomotion and standing trials. Results showed that treated cats were capable of executing weight-bearing plantar stepping at all velocities tested (0.3-0.8 m/s). Control cats did not recover stepping ability, especially at higher velocities, and dragged their hind paws on the treadmill. We were also interested in measuring the extent of BDNF diffusion within the lumbar area of the spinal cord and the potential damage to the cord caused by catheter insertion. Immunohistological evaluation showed higher BDNF expression in the dorsal root ganglions, with BDNF Immuno-Histo Chemistry (IHC) extending from L3 to L7 in all treated cats. BDNF was also found within multiple cells of the grey matter, although the levels were not significantly higher than background density. Glial fibrillary acidic protein (GFAP) stain was used to measure the immunohistological reaction of the spinal cord to the implanted catheter, and to establish the safety of the delivery method. Gross examination of the spinal cord post-mortem revealed no damage to the cord or the roots with minimal encapsulation of the catheter/pump. Minimal tissue inflammation was revealed by the GFAP stain, underlying the safety of our method. We also wanted to investigate and characterize changes in the locomotor circuitry induced by BDNF delivery. Comparison of multiunit activity in the lumbar area between BDNF treated and non-treated cats allows a better understanding of the mechanism of action of BDNF on the spinal interneurons. This was accomplished by extracellularly recording lumbar interneuronal firing during air-stepping in a 5 weeks post-injury terminal experiment. The cord was exposed at the lumbar level between the L3 and L7 spinal segments. In-vivo recordings of spinal extracellular signals were conducted using two 64 channels microelectrode arrays inserted at the dorsal root entry zone to depths of ~3000µm and ~1500µm. The ability to record simultaneous activity of multiple single neurons made it possible to study the extent to which spiking activity in a given neuron is related to concurrent ensemble spiking activity. A point process generalized linear model (PP-GLM) approach was used to assess the strength of the connections between spike trains. Interneurons activity was assessed in terms of average firing rate, signal-to-noise ratio (SNR), and number of active units per trial. Although BDNF infusion in the lumbar segments did not show significant effect on strengthening synaptic connections, we did find greater multiunit activity in the treated animals, sign of a potential BDNF-induced increase in interneuronal activation, which could be likely involved in recovery of stepping ability after SCI. Together, findings from these aims demonstrated the therapeutic potential of intrathecal lumbar BDNF delivery in spinalized animals. Constant infusion of BDNF to the locomotor centers promotes locomotor recovery similar to training or delivery to the injury site via cellular transplants after complete SCI. Intrathecal delivery by an implantable/programmable pump is a safe and effective method for delivery of a controlled BDNF dosage; it poses minimal risks to the cord and is clinically usable. Lastly, this study confirmed the major involvement of BDNF in increasing the activity of the interneurons in the locomotor circuitry, opening the door to further investigating the mechanism through which neurotrophins induce recovery of locomotion. / Bioengineering

Résumé : Contrairement à ce que l'on pourrait croire, les douleurs chroniques ne constituent pas uniquement des symptômes, mais bien une pathologie à part entière. La pharmacopée actuelle ne permettant pas de les soulager efficacement, il y a maintenant un besoin de les considérer dans leur spécificité lors de la recherche de nouvelles thérapies. Dans cette optique, nous avons étudié le rôle des chimiokines et de leurs récepteurs dans le contrôle de la douleur. Connu pour leur rôle dans la réponse immunitaire, nous avons en particulier investigué le rôle du couple ligand-récepteur CCL2-CCR2 dans la régulation des douleurs d’origine arthritique. Nous avons d'abord évalué l'effet analgésique de notre molécule antagoniste du récepteur CCR2, l'INCB3344, dans un modèle de douleur inflammatoire où elle renverse d'environ 50% les douleurs provoquées et les douleurs spontanées lorsqu'administrée par voie spinale. Nous avons également pu observer que bloquer l'activation de CCR2 au niveau de la moelle épinière limite non seulement la neuroinflammation spinale, mais permet également de réduire la sévérité de l'atteinte inflammatoire périphérique en limitant le transport rétrograde de la substance P. Nous avons ensuite appliqué nos observations sur un modèle de douleur arthritique plus près de la réalité clinique des patients souffrant d'arthrite rhumatoïde. Nous y avons reproduit la majorité de nos effets analgésiques suite à une administration spinale. Le traitement est cependant demeuré sans effet sur l'œdème périphérique. Parallèlement à cela, l'administration périphérique du composé, sur une base de deux bolus par jour ou en libération continue par des mini-pompes osmotiques, n'a eu que de très faibles effets analgésiques, mais s'est révélé avoir un impact marquant sur l'œdème périphérique et le gain de poids des animaux. Finalement, c'est en combinant l'INCB3344 avec de l'ibuprofène qu'il a été possible d'avoir un impact positif sur le plus grand nombre de paramètres associés à la douleur chronique. Ces résultats suggèrent donc qu'un antagoniste du récepteur CCR2 possède un potentiel analgésique intéressant, d'autant plus lorsqu'il s'agit de douleur d'origine inflammatoire puisqu'il permet d'agir à la fois sur l'hypersensibilité nociceptive et sur la source même de la douleur inflammatoire. Ce potentiel devient d'autant plus intéressant que de le combiner à un anti-inflammatoire non-stéroïdien (l'ibuprofène) améliore l'efficacité des deux composés. // Abstract : Contrary to popular beliefs, chronic pain is not only a set of symptoms, but a bona fide pathology that the drugs currently available are not sufficient to efficiently relieve. There is thus a need to modify our approach to discover new analgesic agents, taking into consideration the specific physiopathology of chronic pain. With this in mind, we investigated the role of chemokines and their receptors in the modulation of pain. Also known for their participation in the immune response, we focused on the CCL2-CCR2 ability to regulate arthritic pain. We first evaluated the analgesic properties of INCB3344, a specific antagonist of the CCR2 receptor, in a model of inflammatory pain. It reverses both provoked and spontaneous pain by 50% when administered i.t. We also observed that spinally blocking CCR2 limited the expression of proinflammatory mediators. It also reduced peripheral inflammation by preventing peripheral transport of SP. We then translated our findings in a model of arthritic pain, closer to the clinical reality of patients with rheumatoid arthritis. Spinal administration of INCB3344 had similar analgesic actions, but did not altered peripheral inflammation. On the other hand, peripheral administration of INCB3344, either by subcutaneous injection or by continuous release assured by an osmotic pump, had almost no analgesic effects, but significantly reduced peripheral inflammation and reduced the weight loss. By combining INCB3344 with a daily administration of ibuprofen, we were however able to reduce both pain hypersensitivity and the severity of the peripheral inflammation. Taken together, these results suggest that CCR2 antagonism has promising analgesic properties; especially for inflammatory or arthritic pain as it can acts both on the sensibilized nociceptive network and on the peripheral source of the inflammatory pain. This become even more interesting as its mechanism is at least not completely redundant with those of classic non-steroidal anti-inflammatory drugs, which allow the combination of both class of molecule to yield even larger effect.