RESUMEN
Spinal cord injury (SCI) results in long-term neurological and systemic consequences, including antibody-mediated autoimmunity, which has been related to impaired functional recovery. Here we show that autoantibodies that increase at the subacute phase of human SCI, 1 month after lesion, are already present in healthy subjects and directed against non-native proteins rarely present in the normal spinal cord. The increase of these autoantibodies is a fast phenomenon-their levels are already elevated before 5 days after lesion-characteristic of secondary immune responses, further supporting their origin as natural antibodies. By proteomics studies we have identified that the increased autoantibodies are directed against 16 different nervous system and systemic self-antigens related to changes known to occur after SCI, including alterations in neural cell cytoskeleton, metabolism and bone remodeling. Overall, in the context of previous studies, our results offer an explanation to why autoimmunity develops after SCI and identify novel targets involved in SCI pathology that warrant further investigation.
Asunto(s)
Autoanticuerpos/inmunología , Susceptibilidad a Enfermedades , Traumatismos de la Médula Espinal/etiología , Adulto , Animales , Astrocitos/metabolismo , Biomarcadores , Modelos Animales de Enfermedad , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Neuronas/metabolismo , Oligodendroglía/metabolismo , Ratas , Índice de Severidad de la Enfermedad , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/patologíaRESUMEN
Postoperative wound infection is a severe complication after spinal instrumentation, especially in a patient with spinal injury. We used vacuum-assisted wound closure (VAC) in two patients with spinal cord injury, who presented deep wound infection after spinal instrumentation and were treated with an aggressive irrigation and debridement procedure. Three and four weeks after VAC application, the hardware was completely covered by granulation tissue and a secondary closure was undertaken. No significant complications were observed. Six months after secondary closure, the wounds remained healed, no signs of instrumentation loosening, haloing or lysis around the instrumentation were observed, and patients had completed their rehabilitation program and were discharged from hospital. Vacuum assisted wound closure appears as an excellent option in the treatment of deep wound infections after spinal instrumentation in patients with spinal cord injury.
