补阳还五汤联合骨髓间充质干细胞移植对脊髓损伤气虚血瘀证的疗效

Therapeutic Effect of Buyang Huanwu Decoction Combined with BMSCs Transplantation on Spinal Cord Injury with Chinese Medicine Pattern of Qi Deficiency and Blood Stasis

目的:探讨补阳还五汤(BYHWD)联合骨髓间充质干细胞(BMSCs)移植对脊髓损伤(SCI)气虚血瘀证的疗效,并探讨其分子机制。方法:将120只雄性SD大鼠随机分为5组:对照组、气虚血瘀组、BYHWD组、BMSCs组、BYHWD+BMSCs组,每组24只。制作SCI气虚血瘀证复合动物模型,并分别予以BYHWD、BMSCs或BYHWD+BMSCs治疗28 d。治疗前、治疗后1 d、14 d、28 d通过自发性直立探究行为观察前肢运动功能恢复情况;治疗后28 d,ELISA法检测脊髓损伤局部cAMP浓度,HE染色观察损伤局部轴突形态,免疫组织化学法检测脊髓损伤局部RhoA、神经生长因子(NGF)、脑源性神经营养因子(BDNF)的表达。结果:治疗后,BYHWD组、BMSCs组和BYHWD+BMSCs组大鼠的前肢使用率均高于气虚血瘀组,脊髓cAMP含量均高于气虚血瘀组(均P<0.01),且BYHWD+BMSCs组高于BYHWD组和BMSCs组(均P<0.05或P<0.01)。HE染色显示气虚血瘀组、BMSCs组脊髓右后外侧索轴突水肿或缺失,髓鞘排列散乱;BYHWD组、BYHWD+BMSCs组脊髓损伤程度减轻。与气虚血瘀组相比,BYHWD组、BYHWD+BMSCs组NGF、BDNF阳性表达升高,BMSCs组BDNF阳性表达升高,RhoA表达下降(P<0.05或P<0.01);且BYHWD+BMSCs组BDNF表达水平高于BYHWD组和BMSCs组(P<0.05),RhoA表达水平低于BYHWD组和BMSCs组(P<0.05)。结论:BYHWD联合BMSCs移植对保护SCI气虚血瘀证脊髓局部轴突、改善前肢运动功能可产生协同增效作用,其作用机制可能与上调脊髓局部微环境cAMP浓度,抑制RhoA表达,上调NGF、BDNF有关。

Objectives: To examine the therapeutic effect of Buyang Huanwu Decoction(BYHWD) combined with bone marrow mesenchymal stem cells(BMSCs) transplantation on spinal cord injury(SCI) with Chinese medicine pattern of qi deficiency and blood stasis, and to explore its mechanism. Methods: A total of 120 male SD rats were randomly divided into the following five groups with 24 rats in each: the control, qi deficiency and blood stasis, BYHWD, BMSC, and BYHWD+BMSCs groups. SCI with qi deficiency and blood stasis rat models were established, and BYHWD, BMSC, or BYHWD+ BMSC treatment was administered for a duration of28 days. Recovery of forelimb motor function was assessed by observing spontaneous vertical exploration before treatment and at 1, 14, and 28 days of treatment. After 28 days of treatment, we performed the ELISA test to measure cAMP concentration in the spinal cord, HE staining to observe the local axon morphology in areas of damage, and immunohistochemistry to detect the local expression of RhoA, nerve growth factor(NGF), and brain-derived neurotrophic factor(BDNF). Results: After treatment, rats in the BYHWD, BMSC, and BYHWD+BMSC groups showed greater usage rate of forelimbs and higher spinal cord concentrations of c AMP compared to the qi deficiency and blood stasis group rats(all P<0.01);furthermore, the BYHWD+BMSC group displayed greater results than the BYHWD and BMSC groups(all P<0.05 or P<0.01). HE staining revealed that, in the qi deficiency and blood stasis group and BMSC group, rubrospinal tract(RST) axons suffered edema or disappeared, and myelin sheaths became disorderly arranged. In the BYHWD and BYHWD+BMSC groups, there was a reduction in the degree of spinal cord injury. Immunohistochemistry showed that, compared with that in the qi deficiency and blood stasis group, expression of NGF and BDNF in the BYHWD and BYHWD+BMSC groups increased;expression of BDNF in the BMSC group increased and that of RhoA decreased(P<0.05 or P<0.01). Additionally,expression of BDNF was higher and that of RhoA was lower in the BYHWD + BMSC group compared to the BYHWD and BMSC groups(P<0.05). Conclusion: BYHWD combined with BMSC transplantation can produce a synergistic effect on the protection of local axons in SCI with qi deficiency and blood stasis and on the improvement of forelimb motor function. The mechanism may be related to up-regulating cAMP concentration, inhibiting RhoA expression, and up-regulating NGF and BDNF expression in the spinal cord microenvironment.