Platelet P2Y(12) receptor influences the vessel wall response to arterial injury and thrombosis.

BACKGROUND: Platelets are believed to play an important role in atherogenesis and the vessel response to vascular injury. The P2Y(12) receptor (P2Y(12)) plays a central role in amplifying platelet aggregation, dense granule and alpha-granule secretion, P-selectin expression, microparticle formation, and procoagulant membrane changes, regardless of the activating stimulus. We hypothesized that P2Y(12) deficiency might reduce the vessel wall response to vascular injury as well as thrombosis in murine vascular injury models. METHODS AND RESULTS: P2Y(12)-deficient (-/-) mice and littermate controls (+/+) were bred on a C57 BL/6 background. In vivo murine models of arterial injury were employed alone and in combination with bone marrow transplantation to investigate the role of P2Y(12) in the vessel wall response to arterial injury and thrombosis. At 21 days after ferric chloride injury, neointima formation in P2Y(12)(-/-) arteries was significantly less than that observed in control strain arteries (P<0.025). In agreement with this, the intima-media ratio was significantly greater in femoral wire-injured arteries from P2Y(12)(+/+) compared with P2Y(12)(-/-) animals (P<0.05). Bone marrow transplantation was used to examine the importance of vessel wall P2Y(12) versus platelet P2Y(12). Analysis of arterial sections from chimeric animals at 21 days after injury revealed a smaller intima-media ratio in -/- to +/+ animals than in the positive (+/+ to +/+) control group (P<0.01). CONCLUSIONS: These data demonstrate a role for platelet P2Y(12) in the vessel wall response to arterial injury and thrombosis. This illustrates the manner in which platelets may contribute to atherogenesis and restenosis.

Absence of trauma-induced leukocyte rolling in mice deficient in both P-selectin and intercellular adhesion molecule 1.

Leukocyte recruitment during inflammation is achieved through a multistep paradigm that includes margination, selectin-mediated rolling, beta 2 integrin-mediated firm adhesion, emigration, and migration into the site of inflammation. We have used the mouse cremaster muscle as a model of trauma- and cytokine-induced inflammation to study the possible role of intercellular adhesion molecule (ICAM) 1 in leukocyte rolling using gene-targeted mice deficient in ICAM-1, P-selectin, and a combination of P-selectin and ICAM-1. Rolling flux and average leukocyte rolling velocity in ICAM-1-deficient mice was not different from wild-type mice, but P-selectin/ICAM-1-deficient mice showed a total absence of rolling for at least 2 h after surgical trauma. Rolling in both wild-type and ICAM-1-deficient mice 60-120 min after trauma was significantly inhibited by a P-selectin monoclonal antibody (mAb) (RB40.34). In contrast, an mAb (KAT-1) blocking ICAM-1 binding to leukocyte function-associated antigen 1 did not block residual rolling in P-selectin-deficient mice. TNF-alpha induced leukocyte rolling in P-selectin/ICAM-1-deficient mice, but the rolling flux fraction was significantly lower than in TNF-alpha-treated ICAM-1-deficient mice. Leukocyte rolling in P-selectin/ICAM-1-deficient mice treated with TNF-alpha for 3 h was completely blocked by an E-selectin mAb (9A9E3), and partially by an L-selectin mAb (MEL-14). This clearly demonstrates E-selectin-dependent rolling in vivo. Leukocyte rolling velocities were significantly reduced after TNF-alpha treatment and were similar in wild-type and gene-targeted strains. We conclude that the residual trauma-induced leukocyte rolling seen in P-selectin-deficient mice is completely abolished by concomitant ICAM-1 deficiency. This severe defect in leukocyte rolling may explain the absence of leukocyte recruitment into the inflamed peritoneal cavity of P-selectin/ICAM-1-deficient mice at early time points (< or = 4 h).

Transit time of leukocytes rolling through venules controls cytokine-induced inflammatory cell recruitment in vivo.

Leukocyte recruitment requires leukocyte rolling, activation, firm adhesion, and transmigration. Injection of the proinflammatory cytokine TNF-alpha induces expression of E-selectin, interleukin-8, and other adhesion molecules and chemoattractants on the endothelial surface. TNF-alpha- treated CD18 null mouse cremaster muscle venules show increased leukocyte rolling velocity and reduced leukocyte recruitment efficiency. Leukocyte recruitment in CD18 null but not wild-type mice is significantly blocked by an mAb to E-selectin. To understand this overlap between adhesion events previously considered separate, we introduce a quantitative analysis of the efficiency of induction of rolling, conversion of rolling to adhesion, and of adhesion to transmigration. We find that CD18 and E-selectin cooperate to control the time a leukocyte needs to roll through an inflamed area and to convert rolling to firm adhesion. Leukocyte rolling time, defined as the time it takes for a rolling leukocyte to pass through a defined length of a vessel segment, emerges as a unifying parameter determining the efficiency of inducing firm adhesion, which is a rate-limiting step controlling leukocyte recruitment in inflammation. We conclude that leukocytes integrate chemoattractant signals while rolling along the endothelial surface until they reach a critical level of activation and become firmly adherent.

Effect of soluble P55 tumour-necrosis factor binding fusion protein on the local Shwartzman and Arthus reactions.

1. In this study, the effects of a protein synthesis inhibitor, cycloheximide, and a soluble tumour necrosis factor (TNF) binding/IgG fusion protein, p55-sf2, on the priming and challenge stages of the local Shwartzman reaction (LSR) were assessed and compared with their effects on the acute inflammatory response induced by recombinant human tumour necrosis factor-alpha (rhTNF), lipopolysaccharide (LPS) and a reversed passive Arthus (RPA) reaction in rabbit skin. 2. The LSR was induced in skin by giving an intradermal (i.d.) priming injection of LPS followed by two i.v. challenge injections 20 h and 22 h later. Accumulation of 51-Cr-labelled red blood cells and [125I]-albumin were measured at 24 h as markers of haemorrhage and oedema formation, respectively. 3. The RPA reaction was induced in the rabbit by giving i.d. injections of Arthus anti-serum (anti-bovine-gamma-globulin, BGG) followed 5 min later by an i.v. injection of the antigen (BGG). Oedema formation and the accumulation of 111In-labelled neutrophils produced in the RPA reaction and in response to i.d. injection of rhTNF and LPS were measured over the 4 h period after inducing the responses. 4. A single local injection of cycloheximide (10 micrograms/site) did not inhibit neutrophil accumulation or oedema formation produced by 100% Arthus anti-sera. Although LPS injected i.d. induced a marked dose-dependent neutrophil accumulation, there was little associated plasma leakage. Cycloheximide (10 micrograms/site) did not significantly inhibit the neutrophil accumulation induced by LPS (0.1 microgram/site). In the LSR, priming i.d. injections of LPS caused a dose-dependent increase in haemorrhage and plasma leakage at skin sites after challenge with LPS (two injections of 100 micrograms, i.v.). Co-injection of a single dose of cycloheximide (10 micrograms/site) with LPS (30 micrograms/site) caused a marked reduction in the amount of haemorrhage. Local cycloheximide (10 micrograms/site) administered immediately before LSR challenge did not affect the responses produced in the LSR. 5. Neutrophil accumulation induced by TNF (0.17 micrograms/site) was abolished by co-administration of p55-sf2 (3 micrograms/site) whereas neutrophil accumulation induced by i.d. LPS and produced in the RPA reaction was not affected. In the LSR, haemorrhage and oedema formation were inhibited by p55-sf2 (3 micrograms/site) when it was administered i.d. with the LPS priming injection, but not when given i.d. immediately before LSR challenge. 6. These data suggest that the acute neutrophil accumulation produced in the RPA reaction and in response to i.d. LPS may not be dependent on local protein synthesis or TNF production. On the other hand, haemorrhage appears to be dependent on local protein synthesis during the priming phase but not during the challenge stage of the LSR. Importantly, haemorrhage and plasma leakage appear to be dependent on local TNF generation during the priming phase but not during the challenge stage of the LSR. Thus TNF appears to play a key role in the LSR in rabbit skin.

Comparison of the reversed passive Arthus and local Shwartzman reactions of rabbit skin: effects of the long-acting PAF antagonist UK-74,505.

1. By using the selective, potent and long acting platelet-activating factor (PAF) antagonist, UK-74,505, we investigated the role of PAF in a local Shwartzman reaction (LSR) and a reversed passive Arthus (RPA) reaction in rabbit skin. For comparison, we also studied the effect of the PAF antagonist on neutrophil aggregation in vitro and on acute inflammatory responses induced by intradermally (i.d.) injected lipopolysaccharide (LPS), PAF, bradykinin and zymosan-activated plasma. 2. Neutrophil aggregation was assessed photometrically. Haemorrhage, oedema formation, platelet deposition and neutrophil accumulation were quantified in rabbit skin by measuring the accumulation of i.v. injected 51Cr-labelled red blood cells (RBC), 125I-labelled human serum albumin, 111In-labelled platelets and 111In-labelled neutrophils respectively. 3. UK-74,505 inhibited in vitro neutrophil aggregation induced by PAF but not by leukotriene B4. When injected i.v. into rabbits UK-74,505 suppressed oedema formation in response to i.d. PAF for up to 4 h but had no effect on oedema induced by bradykinin or zymosan-activated plasma. 4. Oedema formation, but not neutrophil accumulation, produced during the RPA reaction was significantly inhibited by i.v. UK-74,505. The PAF antagonist also suppressed 111In-platelet but not 111In-neutrophil accumulation in response to i.d. LPS. UK-74,505 did not affect haemorrhage or oedema formation produced during the LPS-mediated LSR. 5. The results demonstrate that PAF is an important mediator of oedema formation, but not neutrophil accumulation, in the immune-complex mediated RPA reaction in rabbit skin. PAF also appears to be required for platelet, but not neutrophil, accumulation in response to locally injected LPS. Our studies do not suggest a role for PAF in the LPS-mediated LSR.

Role of adhesion glycoproteins CD18 and intercellular adhesion molecule-1 in complement-mediated reactions of rabbit skin.

1. The role of the adhesion glycoproteins CD18 and intercellular adhesion molecule-1 (ICAM-1) in inflammatory responses produced during a reversed passive Arthus (RPA) reaction and induced by zymosan and zymosan-activated plasma (ZAP) were studied in rabbit skin. 2. Oedema formation and haemorrhage were quantified by measuring accumulation of 125I-albumin and 111In-labelled red blood cells (111In-RBC) respectively. 3. Monoclonal antibody (mAb) R15.7 (anti-CD18), administered intravenously, abolished accumulation of 125I-albumin and 111In-RBC in dermal RPA reactions and in response to locally injected zymosan and ZAP. 4. When administered intravenously, the mAb RR1/1 (anti-ICAM-1) suppressed 125I-albumin and 111In-RBC accumulation in dermal RPA reactions and at sites treated with zymosan and ZAP. 5. Oedema formation in response to platelet-activating factor (PAF) and bradykinin (BK) either in the presence or absence of prostaglandin E2 (PGE2) were not affected by mAb R15.7 or by mAb RR1/1.1.1. 6. We conclude that oedema formation and haemorrhage associated with RPA reactions and in responses to zymosan and ZAP are completely CD18-dependent, and are mediated, at least in part, via ICAM-1. Responses to the neutrophil-independent oedema forming mediators, PAF and BK are not dependent upon CD18 or ICAM-1.

Role of platelet-activating factor (PAF) in platelet accumulation in rabbit skin: effect of the novel long-acting PAF antagonist, UK-74,505.

1. The contribution of platelet-activating factor (PAF) to platelet deposition and oedema formation induced by exogenous soluble mediators, zymosan particles and associated with a reversed passive Arthus (RPA) reaction in rabbit skin was investigated by use of a novel long-acting PAF receptor antagonist, UK-74,505. 2. Oedema formation and platelet accumulation were simultaneously measured by i.v. injection of [125I]-albumin and 111In-labelled rabbit platelets. UK-74,505 was either administered i.v. or used to pretreat radiolabelled platelets in vitro before their injection into recipient animals. Platelets pretreated with UK-74,505 were also labelled with the fluorescent calcium indicator, Fura-2, to assess their ex vivo reactivity to PAF at the end of the in vivo experiment. 3. UK-74,505 (0.5 mg kg-1), administered i.v., inhibited PAF-induced oedema formation, but did not affect oedema induced by zymosan particles, bradykinin (BK), histamine, formyl-methionyl-leucylphenylalanine (FMLP), zymosan-activated plasma (ZAP, as a source of C5a des Arg), leukotriene B4 (LTB4) or interleukin-8 (IL-8). 4. UK-74,505, administered i.v. also suppressed the small platelet accumulation induced by exogenous PAF, but had no effect on accumulation induced by IL-8 or ZAP. Although oedema induced by zymosan was not affected by i.v. UK-74,505, zymosan-induced platelet accumulation was significantly attenuated by the antagonist. 5. The RPA reaction in rabbit skin was associated with marked oedema formation and platelet accumulation which were both inhibited by i.v. UK-74,505. 6. In vitro, UK-74,505 inhibited aggregation and the increase in intracellular calcium concentration induced by PAF in rabbit washed platelets in a concentration-dependent manner (IC50 = 1.6 x 10-8 M and 1.1 x 10-8 M, respectively). Platelets pretreated with 10-6 M UK-74,505, and maintained at 37 degrees C,were unresponsive to PAF, whilst responding normally to thrombin, for up to 4 h.7. In a second series of in vivo experiments, platelets were labelled with 111In and loaded with Fura-2.The platelets were then pretreated with 10-6 M UK-74,505, washed, and injected into recipient rabbits.These platelets, prepared from blood samples taken at the end of the in vivo experiments, exhibited an 80% reduction in their response to PAF as measured ex vivo with Fura-2. However, in contrast to the effects of i.v. UK-74,505, platelets pretreated with the antagonist did accumulate effectively in the RPA reaction, a significant reduction only being observed in responses at the lowest antibody dose. In addition, pretreatment of platelets had no effect on the small platelet accumulation induced by PAF.8. These results suggest that PAF is an important mediator of oedema formation and platelet accumulation in the RPA reaction in rabbit skin. However, they question the role of PAF receptors on platelets in this model. The results also indicate that PAF may be involved in platelet accumulation induced by zymosan in rabbit skin.

Studies on the mechanisms involved in the inflammatory response in a reversed passive Arthus reaction in guinea-pig skin: contribution of neutrophils and endogenous mediators.

1. Mediators of inflammation can increase vascular permeability in at least two different ways: by acting directly on endothelial cells or, indirectly, through an incompletely understood mechanism, dependent on circulating neutrophils. Neutrophil-dependent oedema formation has been described in the skin of rabbits, rats, hamsters, mice and man. In contrast, we presented evidence in a previous study that local oedema formation induced by i.d. injection of chemoattractants in guinea-pig skin was neutrophil-independent. In the present study, we sought evidence of neutrophil-dependent oedema formation in immune-complex-mediated vasculitis, the reversed passive Arthus (RPA) reaction, in guinea-pig skin. We also investigated whether haemorrhage in the RPA reaction was neutrophil-dependent (as it is in other species) and the role of endogenous mediators of inflammation (prostaglandins, nitric oxide, histamine, PAF and leukotrienes) in contributing to the local inflammatory response. 2. In the RPA reaction, most oedema formation occurred over the first 60 min whereas 111In-neutrophil accumulation was still increasing from 60 to 240 min. The different kinetics of these two events suggested that they may be dissociated. 3. Oedema formation was partially inhibited by a long-acting PAF antagonist (UK-74,505) and an H1 histamine receptor antagonist (mepyramine) but not by a 5-lipoxygenase inhibitor (ZM 230487). A nitric oxide synthesis inhibitor (NG-nitro-L-arginine methyl ester, L-NAME) suppressed oedema formation by 68% whereas a cyclo-oxygenase inhibitor suppressed oedema by 27%. 4. 111In-neutrophil accumulation in the RPA reaction was partially suppressed by UK-74,505. In contrast, ZM 230487 was without effect at doses which abrogated arachidonic acid-induced 111In-neutrophil accumulation. 5. The anti-CD18 monoclonal antibody, (mAb) 6.5E F(ab')2, effectively inhibited 111In-neutrophil accumulation induced by PAF, zymosan-activated plasma (ZAP) and in the RPA reaction. However, oedema formation measured in the same sites was not altered. In contrast, oedema formation in the RPA reaction was partially suppressed by 6.5E whole mAb which was 2.5 times more potent than 6.5EF(ab')2 at inhibiting guinea-pig neutrophil adhesion to protein-coated plastic. Haemorrhage induced by PAF and in the RPA reaction was significantly inhibited by 6.5E F(ab')2 pretreatment.6. We conclude that in the RPA reaction in guinea-pig skin, oedema formation is partially neutrophil dependent as assessed by using an anti-CD18 mAb, whereas ZAP-induced oedema formation is neutrophil-independent. Haemorrhage was also dependent on neutrophil accumulation. In addition, our studies support a role for PAF in mediating both oedema formation and "'In-neutrophil accumulation in the RPA reaction. Endogenous release of histamine also appears to be important in mediating oedema formation suggesting that mast cells play a critical role in increases of vascular permeability in inflammatory reactions in guinea-pig skin. Moreover, our results confirm previous findings which suggest a dominant role for nitric oxide in maintaining cutaneous blood flow in the guinea-pig.

The role of complement, platelet-activating factor and leukotriene B4 in a reversed passive Arthus reaction.

1. The mechanisms underlying oedema formation induced in a reversed passive Arthus (RPA) reaction and, for comparison, in response to zymosan in rabbit skin were investigated. 2. Oedema formation at skin sites was quantified by the accumulation of intravenously-injected 125I-labelled human serum albumin. 3. Recombinant soluble complement receptor type 1 (sCR1), administered locally in rabbit skin, suppressed oedema formation induced in the RPA reaction and by zymosan. 4. The platelet-activating factor (PAF) antagonists, WEB 2086 and PF10040 administered locally, inhibited oedema formation induced in the RPA reaction and by PAF but not by zymosan. 5. A locally administered leukotriene B4 (LTB4) antagonist, LY-255283, inhibited oedema formation induced by LTB4 but did not inhibit oedema responses to PAF, zymosan or the RPA reaction. 6. The results demonstrate a role for complement in oedema formation in both the RPA reaction and in response to zymosan. An important contribution by PAF is indicated in the RPA reaction but not in response to zymosan whereas no evidence was obtained to suggest a role for LTB4 in either inflammatory response.

The measurement of tremor using a velocity transducer: comparison to simultaneous recordings using transducers of displacement, acceleration and muscle activity.

Precise kinematic measurements of tremor have historically been obtained using accelerometers. However, current technology permits precise measurements in velocity and displacement. The primary advantage of velocity recording is that only one step of integration or differentiation is required for either displacement or acceleration. A method is presented of measuring finger tremor using a laser system that transduces velocity precisely. Measurements of postural finger tremor thus obtained were compared to those simultaneously obtained from a laser system that transduces displacement, from an accelerometer and from surface electromyography (EMG) of the extensor digitorum communis. A range of amplitude and frequency content was obtained by testing control subjects and subjects with Parkinson's disease. The velocity transducer showed excellent correspondence of amplitude and frequency measurement with the displacement transducer. Measures of absolute and relative amplitude correlated well (r > or = 0.96 in amplitude measures in displacement, velocity and acceleration), and high coherence was found throughout the frequency range of interest. Measurements by the accelerometer generally showed poorer correspondence with those of the other instruments. EMG measurements showed good correspondence in some trials but poorer correspondence in others, attributed to the low level of muscle activity required in the task. Precise kinematic measurements appear to be highly sensitive to neuromotor impairment.

Functional assessment of balance and gait.

Individuals must be able to maintain an upright posture under a variety of conditions and to move independently. These constructs of balance and gait are fundamental components of physical functioning and should be incorporated into clinical assessment of older adults. The primary objective, therefore, is to review existing measures of functional balance and gait, concentrating on those which are quantitative, practical for use in clinical settings, and have demonstrated acceptable measurement properties. In addition, we discuss the rationale for the functional assessment of balance and gait, review essential measurement criteria, and discuss the utility of valid standardized measurement in clinical practice.

The effect of inertial loading on wrist kinetic tremor and rhythmic muscle activity in individuals with essential tremor.

OBJECTIVES: Determine the effect of concentric and eccentric movement and contraction intensity on the strength of rhythmic muscle activity in individuals with essential tremor (ET). METHODS: 21 ET subjects and 22 healthy controls produced wrist flexion-extension movements while supporting sub-maximal loads (no-load, 5%, 15% and 25% 1-repetition maximum). Kinetic tremor and wrist extensor neuromuscular activity were recorded using an angular displacement sensor and electromyography (EMG). RESULTS: Rhythmic muscle activity was twice as big during movement compared to previous results involving postural or isometric tasks. ET subjects with greater rhythmic muscle activity had (1) larger overall kinetic tremor amplitude, (2) greater tremor spectral power during eccentric compared to concentric movement and (3) a reduction in overall kinetic tremor amplitude and the percentage of EMG spectral power accounted for by the tremor spectral peak in the presence of inertial loading. CONCLUSIONS: Greater than normal kinetic tremor amplitude appears to be limited to ET subjects with higher levels of rhythmic muscle activity. Furthermore, rhythmic muscle activity is much greater during movement compared to during postural or closed-kinetic tasks. SIGNIFICANCE: The strength of rhythmic muscle activity in ET is influenced by the type of contraction (i.e., static vs. dynamic) being performed. Clinicians and researchers should include measures of simple kinetic tremor as part of their assessments.

The effect of contraction intensity on force fluctuations and motor unit entrainment in individuals with essential tremor.

OBJECTIVES: Quantify the effect of increasing contraction intensity on the amplitude of force fluctuations and neuromuscular and force tremor spectral power. METHODS: Twenty-one subjects with essential tremor (ET) and 22 healthy controls applied isometric wrist extension contractions. Various sub-maximal contraction intensities were evaluated (5%-, 10%-, 20%- and 30%-MVC). Force fluctuations and wrist extensor neuromuscular activity were recorded using a load cell and electromyography (EMG). RESULTS: Higher contraction intensities were associated with larger amplitude force fluctuations and greater neuromuscular activation. However, spectral power associated with tremor peaks remained relatively constant (EMG) or decreased (force) with increasing contraction intensity. CONCLUSIONS: Motor unit entrainment associated with centrally generated oscillatory inputs does not increase with greater levels of muscle activation. SIGNIFICANCE: Rather than influencing a constant proportion of active motor units, abnormal oscillatory drive influences a relative constant number of total motor units. When combined with the findings from our previous study on postural tremor, the present results provide preliminary evidence that abnormal stretch reflex activity may contribute to this motor unit entrainment.

The effect of inertial loading on wrist postural tremor in essential tremor.

OBJECTIVES: Determine the effect of inertial loading on the strength of motor unit entrainment and the synergistic/competitive interaction between central and mechanical reflex tremor components in subjects with essential tremor (ET). METHODS: Twenty-three subjects with ET and 22 controls held their hand in an outstretched position while supporting sub-maximal loads (no-load, 5%, 15% and 25% 1-repetition maximum). Hand postural tremor and wrist extensor neuromuscular activity were recorded. RESULTS: Inertial loading resulted in a reduction in postural tremor in all ET subjects. The largest reduction in tremor amplitude occurred between 5% and 15% loads, which was associated with spectral separation of the mechanical reflex and central tremor components in a large number of ET subjects. Despite an increase in overall neuromuscular activity with inertial loading, EMG tremor spectral power did not increase with loading. CONCLUSIONS: The effect of inertial loading on postural tremor amplitude appears to be mediated in large part by its effect on the interaction between mechanical reflex and central tremor components. Also, ET is associated with a constant absolute level of motor unit entrainment. SIGNIFICANCE: The amplitude of postural tremor is dependent on both central and peripheral factors, with proportionally greater motor unit entrainment occurring at low contraction intensities.

An effective and economical solution for digitizing and analyzing video recordings of the microcirculation.

OBJECTIVE: To assemble an economical system for analysis of microcirculation movies. METHODS: Images of cremaster microvessels were recorded onto sVHS video cassettes. These recordings were digitized onto a Macintosh computer using a MiroMotion DC30 plus video compression card and Adobe Premiere software, which permits video rate (25-30 fps) capture of full-sized (768 x 576 PAL, 640 x 480 NTSC) frames. Once captured, images were analyzed using NIH Image software. RESULTS: Combination of the Macintosh computer, the MiroMotion card, and Adobe Premiere allowed capture of high-resolution images at video rate, with the only limitation to sequence length being available hard-drive space. Captured movies could be directly accessed using the freely available NIH Image software. Use of built-in analysis tools and custom-written macros greatly facilitated rapid, accurate, and reproducible analysis of parameters such as blood flow velocity, leukocyte rolling velocity, and firm adhesion. CONCLUSIONS: Low-priced hardware and software aimed at the home-video enthusiast can be combined with free image-analysis software to provide a powerful image-analysis solution for study of the microcirculation.

The effect of noradrenergic drugs on the recovery of walking after spinal cord injury.

UNLABELLED: Clonidine, a noradrenergic agonist has been associated with improved walking in both spinal cat and spinal cord injured (SCI) subjects. OBJECTIVES: The objective of this brief review is to compare the effects of clonidine on walking capabilities in SCI subjects with functionally complete and incomplete spinal cord injuries. STUDY DESIGN/METHODS: Both oral administration and intrathecal injection of clonidine were investigated. A motorized treadmill was used and harness support provided in most of the SCI subjects as no walking capabilities could be observed overground. A single subject design was used in these chronic SCI subjects. SETTING: Canada and France. RESULTS: In complete SCI subjects while receiving clonidine, none of the subjects was able to initiate independent stepping. In contrast, the greatest effects were found in SCI subjects with injuries that are incomplete but still severely disabling while minimal effects could be observed in the more functional SCI subjects. These effects on walking are observed in measures of walking speed, and electromyographic and kinematic patterns. Regardless of effects on walking, however, a consistent decrease of the flexor reflex amplitude could be observed in all SCI subjects independent of the severity of the lesion. CONCLUSION: This review demonstrated that clonidine could be a powerful anti-spasmodic drug in addition to improving locomotion in a limited number of SCI subjects. The mechanism, significance and implications of these results will be discussed.

A treadmill apparatus and harness support for evaluation and rehabilitation of gait.

This report describes a treadmill apparatus for the evaluation and rehabilitation of gait in disabled persons. The apparatus incorporates a body weight support system as well as mechanisms to change certain conditions: treadmill belt speed, upward-downward and lateral slopes, and provision of obstacles. The apparatus enables elements of a treadmill walking pattern to be visible in persons for whom gait evaluation or rehabilitation may not otherwise be possible. It also allows for exploration of factors that limit the adaptability of gait in person after disease or injury by changing the mechanical demand of the locomotor task.

Treadmill walking in incomplete spinal-cord-injured subjects: 1. Adaptation to changes in speed.

UNLABELLED: Walking in spinal-cord-injured (SCI) subjects is usually achieved at a lower speed than in normal subjects. STUDY DESIGN/METHODS: Time and distance parameters, angular displacements of lower limbs and electromyographic (EMG) activity were measured for seven normal and seven SCI subjects at several walking speeds. Analyses of variance were used for comparing groups and speeds. OBJECTIVES: First, to measure the adaptability of SCI subjects' walking pattern to different speeds (0.1-1.0 m/s), and to compare it to that of normal subjects. Second, to characterize SCI subjects' walking pattern as compared to that of normal subjects at a matched treadmill speed (0.3 m/s). SETTING: University-Based Human Gait Laboratory, Montreal, Canada. RESULTS: SCI subjects' pattern adapted to a limited range of speeds. Longer cycle duration, flexed knee at foot contact, increased hip joint flexion at foot contact and during swing, and altered coordination of hip and knee joints were found for the SCI group. At all speeds, duration of muscle activity was longer in the SCI group and the increase in amplitude of soleus EMG activity at higher speeds was not specific to push-off. The importance of matching the walking speed of SCI and normal subjects in order to differentiate the features that are a consequence of SCI subjects' reduced walking speed rather than a direct consequence of the injury is demonstrated. CONCLUSIONS: All SCI subjects could adapt to a narrow range of speeds and only three could reach the maximal tested speed. This limited maximal speed seems to be a consequence of SCI subjects having reached their limit in increasing stride length and not being able to increase stride frequency further. This limitation in increasing stride frequency is likely because of the altered neural drive. SPONSORSHIP: Neuroscience Network of the Canadian Centre of Excellence.

Effects of drugs on walking after spinal cord injury.

Clonidine, a noradrenergic agonist, and cyproheptadine, a serotonergic antagonist, have each been associated with improved walking in SCI subjects. Baclofen, a GABA agonist, is frequently prescribed for spasticity but its effects on walking have not been well quantified. The objective of this study was to compare the effects of clonidine, cyproheptadine and baclofen on walking in SCI subjects with incomplete injuries. A motorized treadmill was used and harness support provided when necessary. A repeated single-subject design was employed for the twelve subjects. The greatest effects were found in more severely disabled subjects. Cyproheptadine was associated with greatly reduced need for assistance, increases in maximum treadmill speed (MTS) and reduced clonus. Clonidine was associated with increases in MTS and a generally more upright posture. Baclofen was associated with minor changes in walking. In many cases of drug effects, MTS increases and other changes were retained following washout of drugs. The significance and implications of the drug effects and the retention of effects during washout periods are discussed. It is concluded that clonidine and cyproheptadine have different effects but both appear useful for severely disabled SCI subjects. The effects of baclofen on walking after spinal cord injury remains unclear.