Prolonged Targeted Cardiovascular Epidural Stimulation Improves Immunological Molecular Profile: A Case Report in Chronic Severe Spinal Cord Injury

Ona Bloom, Jill M. Wecht, Bonnie E. Legg Ditterline, Siqi Wang, Alexander V. Ovechkin, Claudia A. Angeli, Anthony A. Arcese, Susan J. Harkema

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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.

Original languageEnglish
Article number571011
JournalFrontiers in Systems Neuroscience
Volume14
DOIs
StatePublished - 15 Oct 2020

Keywords

  • blood pressure regulation
  • cardiovascular regulation
  • cerebral blood flow velocity
  • epidural stimulation
  • immune system
  • neuromodulation
  • orthostatic hypotension
  • spinal cord injury

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