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The Journal of Neuroscience, May 15, 2001, 21(10):3665-3673
Locomotor Recovery in Spinal Cord-Injured Rats Treated with an
Antibody Neutralizing the Myelin-Associated Neurite Growth Inhibitor
Nogo-A
Doron
Merkler1,
Gerlinde A. S.
Metz2,
Olivier
Raineteau1,
Volker
Dietz3,
Martin E.
Schwab1, and
Karim
Fouad1, 3
1 Department of Neuromorphology, Brain Research
Institute, University and Swiss Federal Institute of Technology
Zürich, 8057 Zürich, Switzerland, 2 Department
of Psychology, University of Lethbridge, Lethbridge, Alberta T1K
3M4, Canada, and 3 Swiss Paraplegic Centre, University
Hospital Balgrist, University of Zürich, 8008 Zürich,
Switzerland
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ABSTRACT |
The limited plastic and regenerative capabilities of axons in the
adult mammalian CNS can be enhanced by the application of a
monoclonal antibody (mAb), IN-1, raised against the myelin-associated neurite growth inhibitor Nogo-A. The aim of the present study was to
investigate the effects of this treatment on the functional recovery of
adult rats with a dorsal over-hemisection of the spinal cord. Directly
after injury, half of the animals were implanted with mAb
IN-1-secreting hybridoma cells, whereas the others received cells
secreting a control antibody (anti-HRP). A broad spectrum of locomotor
tests (open field locomotor) score, grid walk, misstep withdrawal response, narrow-beam crossing) was used to
characterize locomotor recovery during the 5 weeks after the injury. In
all behavioral tests, the recovery in the mAb IN-1-treated group was significantly augmented compared with the control
antibody-treated rats. EMG recordings of flexor and extensor muscles
during treadmill walking confirmed the improvement of the locomotor
pattern in the mAb IN-1-treated rats; step-cycle duration, rhythmicity,
and coupling of the hindlimbs were significantly improved. No
differences between the two groups with regard to nociception were
observed in the tail flick test 5 weeks after the operation. These
results indicating improved functional recovery suggest that the
increased plastic and regenerative capabilities of the CNS after Nogo-A neutralization result in a functionally meaningful rewiring of the
motor systems.
Key words:
spinal cord injury; functional recovery; locomotion; Nogo-A; regeneration; plasticity; rats
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INTRODUCTION |
Spontaneous regeneration of injured
axons or plastic rearrangements of spared fiber systems after spinal
cord injury in mammals are very limited. The major reasons for this
poor spontaneous repair capacity seem to be the insufficient growth
response of neurons to injury, the growth-inhibitory components of the
adult CNS tissue, and the formation of cysts and scar tissue at the injury site. Attempts to overcome local barriers by grafting peripheral nerve bridges (Cheng et al., 1996 ), Schwann cells (Li and Raisman, 1994 ; Xu et al., 1995 ), or olfactory ensheathing cells (Li et al.,
1997 ; Ramon-Cueto et al., 2000 ) have led to regenerative fiber growth
and in some instances to behavioral recovery in animal models of spinal
cord injury, although the mechanistic understanding of this
recovery remains incomplete because of the complexity of these
interventions; Schwann cells and olfactory ensheathing glia are also
important sources of trophic factors and extracellular matrix molecules
(Guénard et al., 1993 ; Franklin and Barnett, 2000 ). Attempts to
increase the neuronal growth response by local applications of
neurotrophic factors to spinal cord injury sites have led to
increased sprouting of CNS fibers and dorsal root axons (Schnell et
al., 1994 ; Grill et al., 1997 ; Kobayashi et al., 1997 ; Liu et al.,
1999 ; Ramer et al., 2000 ). In addition, neutralization of the
myelin-associated neurite growth inhibitor Nogo-A (Chen et al., 2000 )
with a monoclonal antibody (mAb), IN-1, resulted in growth of lesioned
and uninjured CNS fibers (Schnell and Schwab, 1990 , 1993 ; Bregman et
al., 1995 ; Thallmair et al., 1998 ; Brosamle et al., 2000 ).
A major question arising from all these studies is whether regenerating
or plastically growing neurons can be reconnected in a functionally
meaningful way in the adult mammalian spinal cord. Detailed assessments
of a variety of behavioral tasks after a spinal cord injury and
subsequent treatment can provide a first, "global" answer. In the
case of the treatment with mAb IN-1, beneficial effects on the recovery
of incomplete spinal cord-injured rats were reflected by an improved
contact-placing response and normalized stride length during walking
(Bregman et al., 1995 ). In the present study, numerous behavioral
evaluations were achieved by using the well established BBB open field
locomotor score (Basso et al., 1995 ), the grid walk test, and
the narrow-beam test. The analysis was refined by the recording of
muscle activity during treadmill walking, offering the possibility of
transparently analyzing the locomotor pattern.
Our results show that mAb IN-1 treatment, which is known to enhance
regeneration and plastic fiber growth, induces significant functional
improvements in locomotion in the absence of changes in a sensory test
(tail flick) in adult spinal cord-injured rats.
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MATERIALS AND METHODS |
Animals. Experiments were performed on 43 adult Lewis
rats of either sex (200-250 gm). All animals were analyzed
behaviorally. Initially, an mAb IN-1-treated and a control antibody
(Ab) (anti-HRP) group (n = 10 rats per group) were
tested without the implantation of EMG electrodes. Another experimental
set (n = 10 rats per group) was initiated, in which EMG
electrodes were implanted 40 d after the injury. The implantation
of EMG electrodes into uninjured rats was performed separately
(n = 3).
All rats were kept in a 12 hr light/dark cycle and received water and
food ad libitum. The study was approved by the veterinary authorities of the Kanton of Zürich.
Surgical procedure. The animals were anesthetized with
Dormicum [midazolam, 0.6 mg per 100 gm body weight (bw), i.p.; Roche, Basel, Switzerland] and Hypnorm (fentanyl, 0.02 mg per 100 gm bw, i.p.; Janssen-Cilag, Beerse, Belgium). To expose the spinal cord, a
laminectomy of half a vertebra was performed at the thoracic level
Th8. Using iridectomy scissors, a dorsal
over-hemisection, sparing just parts of the ventral funiculus, was
performed. Afterward, the dorsal musculature was sutured, and the skin
was closed with surgical clips.
For constant antibody supply, hybridoma cells
(~106) either producing mAb IN-1 (Caroni
and Schwab, 1988 ) or anti-HRP antibodies (as a control) (Schnell and
Schwab, 1990 ) were injected unilaterally into the hippocampal area. To
prevent rejection of the hybridoma xenograft, the animals were
immunosuppressed by daily injections of cyclosporin A (Sandimmun, 1.2 mg per 100 gm bw, i.p.; Novartis, Basel, Switzerland). The treatment
commenced 1 d before surgery and continued for a total of 7 d. For prophylactic reasons, doxycyclin (Vibravenoes, 0.85 mg per 100 gm bw, s.c.; Pfizer, Groton, CT) was injected once during the surgery.
For postoperative pain relief, the animals received two
applications (one every 24 hr) of rimadyl (Carprofen, 1 mg per
100 gm bw, s.c.; Pfizer). Until the rats displayed restored autonomic
bladder function, the bladder-voiding reflex was triggered by a tender
massage of the lower part of the abdomen three times a day. During the
testing period, bladder infections occurred in two animals, which were
then treated daily with antibiotics [cotrimoxazol (Bactrim), 2 mg per
100 gm bw, s.c.; Roche].
Behavioral testing. All tests were performed in a
double-blind manner. Before the surgery, the animals were trained for 2 weeks before baseline measurements were taken. At 7 d after
surgery, the testing sessions were performed in weekly intervals up to day 35 after surgery.
BBB locomotor score. Open-field locomotion was evaluated by
using the 21-point BBB locomotion scale (Basso et al., 1995 ). The rats
were placed in an open field (80 × 130 × 30 cm) with a
pasteboard-covered nonslippery floor. In each testing session, the
animals were observed individually for 4 min by two observers. The
hindlimb locomotion was then scored from 0 to 21 points (no observable
locomotor movements to normal locomotor movements).
Grid walk. The animals had to walk on a 1-m-long horizontal
runway of metal grid bars elevated 30 cm from the ground. A defined 10 bar sector was chosen for analysis. To prevent habituation to a fixed
bar distance, the bars in this sector were placed irregularly (1-4 cm
spacing) and were changed in every testing session. Analysis was
performed by counting the number of errors in foot placing; if the
animal could not walk with its hindlimbs, it would make two errors per
bar, resulting in a total of 20 errors.
Misplacement of a foot led to a withdrawal response, as described
previously in cats (Gorassini et al., 1994 ; Hiebert et al., 1994 ). To
calculate the retraction time after a stepping error, the rats were
monitored with a digital video camera while crossing the grid. In the
case of a stepping error of a hindlimb, the latency was measured from
the beginning of the misstep (paw crossing a fictive ground line)
(see Fig. 3B) until the animal started to retract the
limb. At the end of the testing period, a minimum of five withdrawal
movements per animal were recorded. In the baseline measurements,
stepping mistakes were observed only very rarely. The average of the
withdrawal latencies of those events was taken as a reference value.
Narrow-beam crossing. This paradigm assesses the ability of
the rats to balance on 30 cm elevated wooden beams with a length of
1 m. Different beam shapes were used to increase the level of
difficulty: two beams with rectangular cross-sections (2 × 2 cm;
1.2 × 1.2 cm) and a beam with a round cross-section (2.5 cm in
diameter) (Metz et al., 1998 ). Crossing one beam by properly placing
both hindlimbs was scored as 2 points; a total of 1.5 points was
assigned when an animal placed only one paw plantar on the beam. Only 1 point was given if the rat was able to cross the whole beam but was
unable to place the hindpaws, and 0.5 points was given if the rat could
only traverse half of the beam. The score was zero in cases in which
the rat was not able to cross at least half of the beam. The scores of
all three beams were added to a maximum score of 6 points.
Electromyographic recordings. EMG recordings were acquired
at postoperative day 40 in 10 lesioned and mAb IN-1-treated animals, 10 lesioned and control Ab-treated animals, and 3 unlesioned animals. Bipolar electrodes were implanted in each hindlimb into the vastus lateralis (VL) muscle (knee extensor) and the tibialis anterior (TA)
muscle (ankle flexor). Under pentobarbital anesthesia (Nembutal, 50 mg/kg bw, i.p.; Abbott, Irving, TX), the skull surface was exposed, and
one self-tapering screw (1.4 × 7 mm) was anchored on each side 2 mm lateral to the sagittal and 3 mm frontal to the lambdoidal suture of
the skull. A 9-pin connector was fixed to the screws with dental
acrylic cement (Paladur Cold-Curing). Teflon-insulated multistranded
stainless steel wires (AS 632; Cooner Wire, Chatsworth, CA) were led
from the connector subcutaneously via the back to the designated
muscles. The wires were sutured into the muscles, whereby a 1 mm
stripped region of each wire was placed within the muscle and served as
an electrode. One wire was placed as a ground electrode subcutaneously
on the back. Two days after electrode implantation, EMG recordings on
the treadmill (running at a speed of 10.5 m/min) were performed. The
headpiece on the rats was connected via a customized eight channel
amplifier to an analog-to-digital board (Axoscope DigiData
interface; Axon Instruments, Foster City, CA), and the signals were
recorded with a sampling rate of 1 kHz and filtered (high-pass, 30 Hz;
low-pass, 300 Hz).
EMGs of ~20 step cycles were analyzed per rat (Axoscope; Axon
Instruments). The step-cycle duration and burst duration of the TA and
the VL muscles were measured. The deviation between step cycles was
used as marker for rhythmicity. Uncoupling of the stepping pattern of
the hindlimbs (irregular alternation between the muscle activity) (see
Fig. 7B) was counted and set in relation to the number of
performed steps (n = 20).
Tail flick. The level of nociception after spinal cord
injury was evaluated by performing a standardized tail flick test
(D'Amour and Smith, 1941 ; Gentsch et al., 1988 ). Rats were placed in a 17 × 23 cm Plexiglas box and were first allowed to adjust to the new environment. When exploratory behavior ceased, an infrared source
producing a calibrated heating beam (diameter, 1 mm) was placed under
the tail base and triggered together with a timer (Plantar tester, Ugo
Basile Biological research apparatus; Ugo Basile, Comerio, Italy). The
time for the first movement of the tail was noted. Each measurement was
repeated three times, with at least a 4 min interval.
Lesion size (spared white matter). After the last testing
session, the animals were deeply anesthetized with pentobarbital (Nembutal, 450 mg/kg bw, i.p.) and perfused transcardially with a
Ringer's solution containing 50,000 IU/l heparin (Liquemin; Roche) and
0.25% NaNO2, followed by a fixative solution
(4% paraformaldehyde solution in 0.1 M phosphate buffer with 5%
sucrose). The spinal cords were dissected, post-fixed overnight in the
same fixative, and cryoprotected in a 30% sucrose solution for 3 d. The tissue was then embedded in Tissue Tek (Satura Finetek,
Torrance, CA) and frozen by immersion in 40°C isopentane. Sagittal
sections of 50 µm were made on a cryostat and counterstained with
cresyl violet.
The lesion size was measured with regard to its maximal
rostrocaudal and its dorsoventral extension. Every second section was
measured under a light microscope (Zeiss, Oberkochen, Germany) using
100× magnification.
The dorsoventral extension of ventral and dorsal white matter was
measured in an uninjured cranial part of the spinal cord and taken as
100% white matter. The remaining white matter bridge at
the epicenter of the lesion was then measured, and the ratio between
the two measures was defined as a percentage of spared white matter
(SWM). Using this method, every second section (16-20 per animal) was
analyzed; from the SWM value of these sections, a mean value was
calculated for each animal.
Statistics. Statistical comparisons were performed by using
the Mann-Whitney U test. p values of 0.05 were
considered significant; values of 0.01 were considered highly
significant. Values represent means ± SEM unless stated
differently above in Electromyographic recordings. Regression
lines were compared by using multiple regression analysis.
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RESULTS |
Lesion size
In all control Ab-treated and mAb IN-1 Ab-treated rats, the lesion
size was quantified. Thirty-four rats had a severe lesion with
complete destruction of the gray matter. Six animals with either a
complete or too small lesion deviating more than twice the SD from the
group mean were removed retrospectively from additional statistical
evaluation. Three animals were left unlesioned for EMG analysis. In the
remaining lesioned rats, the rostrocaudal extension of the lesion was
between 1 and 2.75 mm with no significant difference between the
control Ab-treated group and the mAb IN-1-treated group. A dense glial
scar around the lesion site and the formation of cavities was observed
in all of the animals (Fig. 1). Also the
evaluation of the mean spared white matter showed no difference between
both groups with 40.8 ± 2.2% (mean ± SEM) SWM in control Ab-treated rats and with 43.2 ± 2.9% SWM in mAb IN-1-treated
rats.

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Figure 1.
Evaluation of lesion size at the epicenter of the
injury at thoracic level Th8. SWM was
assessed from alternating sagittal sections of the spinal cord
(arrows) and set in relation to the amount of white
matter in the intact spinal cord rostral to the lesion (equaling
100%). Sections at the center of the spinal cord are shown from a
control animal and an IN-1 Ab-treated animal.
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All of the rats were analyzed for tumor remnants in the brain after
perfusion. Enlarged ventricles, scar tissue, casts, and tumor
debris were found in 80% of the animals (mAb IN-1 and control Ab groups).
Open field locomotion (BBB score)
The BBB locomotor score quantifies multiple aspects of spontaneous
open-field, over-ground locomotion (Basso et al., 1995 ). The score
reaches a maximum of 21 points, accomplished by all of the animals in
the preoperative baseline measurements. Scores were very low and highly
variable during the first 4-7 d after the injury, reflecting the
spinal shock phase. Reproducible measurements could be taken from
7 d after lesion onward. Even at this early time point, a small
difference between the two experimental groups could be observed: the
BBB score in the control Ab-treated group was 4.8 ± 0.64 (n = 17), versus 6.1 ± 0.83 in the mAb
IN-1-treated group (p > 0.05; n = 17) (Fig. 2A). Four
of the control Ab-treated rats but only two of the mAb IN-1-treated
animals were not able to move their hindlimbs at this time point. These
six animals exhibited a low amount of SWM (<30%). The remaining
animals were capable of moving one to three joints. Only three animals
showed plantar placement of the paw; all of these animals were treated with mAb IN-1. Over the following 4 weeks, both groups showed substantial recovery of hindlimb movements (Fig. 2A).
At day 35 after the injury, the mAb IN-1-treated group reached a BBB
score of 12.5 ± 0.7, which was significantly higher than that of
the control Ab-treated group (10.3 ± 0.54; Fig.
2A). When comparing the single animals at this time
point (Fig. 2B), the mAb IN-1-treated group could be
split into two subgroups. Five of 17 animals failed to improve beyond a
BBB level of 9, whereas 11 of 17 rats reached BBB scores of 12-17. In
contrast, the control Ab-treated group appeared more homogenous, with
minimum BBB scores of 8 and maximum scores of 14.

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Figure 2.
Recovery monitored with the BBB open-field
locomotor score. A, Time course of the recovery in
IN-1-treated and control Ab-treated rats (n = 17 rats per group). B, Comparison of single animals with
regard to BBB score 35 d after injury. Note the two
subgroups in the mAb IN-1-treated animals. C,
Correlation between SWM and the BBB locomotor score of single animals
and the regression lines of the two groups. Data are given as
means ± SEM; *p < 0.05.
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A strong correlation of the lesion size and the BBB score was observed
in both groups, but the slope of the regression line in the mAb
IN-1-treated rats was significantly steeper (p = 0.006), thereby indicating that the animals with a larger amount of
spared white matter (>40% SWM) could benefit especially from the
treatment (Fig. 2C).
Grid walk
The ability to precisely control and place the hindlimbs was
tested on a horizontal, irregular ladder-like grid, as described in
Materials and Methods. After a short preoperative training period, the
animals were able to cross the grid almost without any faults (on
average less than one mistake per crossing). Seven days after injury,
rats of both groups were able to cross the grid but only by performing
movements without accurate placing of the hindpaws, resulting in a high
number of mistakes (Fig. 3A).
After 14 d, the control Ab-treated rats slightly improved to
14.6 ± 1.1 of a maximum of 20 mistakes. At the same time point, the average score of the mAb IN-1-treated group was significantly better (10.7 ± 0.9). Up to 35 d after the injury, the mAb
IN-1-treated group further improved to 7.5 ± 0.72 mistakes,
whereas the control Ab-treated animals made 10.8 ± 1.1 mistakes
(p = 0.01) (Fig. 3A).

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Figure 3.
Grid walk performance. A, Time
course of the recovery in IN-1-treated and control Ab-treated rats
(n = 17 rats per group) shows significantly lower
error rates in the mAb IN-1 animals. B, Latency of the
onset of the withdrawal movement in the case of a stepping error on the
grid. The stick figure is illustrating the measurement (also
see Materials and Methods). C, Bar graph (means ± SEM) showing that mAb IN-1-treated rats have recovered their response
latency to preoperative values, in contrast to the control animals.
*p < 0.05; **p < 0.01.
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Withdrawal response
When an animal misses a grid bar, thus stepping into a hole, a
withdrawal movement occurs, which is known to be modulated by
supraspinal input (Hiebert et al., 1994 ). The delay from a step into a
hole between two bars until the onset of the withdrawal movement of the
hindlimb was determined as described in Materials and Methods (Fig.
3B). In the preoperative measurement, this latency was
170 ± 6 msec (n = 29). At 35 d after lesion,
14 control Ab-treated rats and 15 mAb IN-1-treated animals showed a
withdrawal response in the case of a misstep. In the control Ab group,
the withdrawal latency was prolonged to 213 ± 4 msec (Fig.
3C). In contrast, the withdrawal latency of the mAb IN-1
group was not significantly different from the value of the intact
animals, indicating a full recovery of this withdrawal response
(178 ± 7 msec).
Narrow-beam crossing
Before injury, all of the animals could cross the three
differently shaped beams without any balancing difficulties (6 points) (Fig. 4). Seven days after the injury,
the average narrow-beam score of the control Ab-treated rats was
severely reduced from 6 to 0.3 ± 0.09 points, indicating that
most rats lost balance as soon as they were placed on the beams. At
this time point, the mAb IN-1-treated rats showed an average score of
0.8 ± 0.12, reflecting their ability to cross the whole length of
the broadest beam. Over the next few weeks, the performance in this
test recovered modestly, so that at 35 d after the injury, the
average narrow-beam score of the control Ab group was 1.2 ± 0.17 and that of the mAb IN-1-treated group was 2.1 ± 0.25. One mAb
IN-1-treated rat was able to cross all three beams. Statistically, mAb
IN-1 treatment led to a significant improvement as soon as 7 d
after lesion (p < 0.05), which consistently
increased during the whole testing period when compared with the
control Ab-treated group. However, severe deficits were still obvious
when compared with uninjured animals, probably because of the loss of
proprioceptive information by the complete, bilateral dorsal column
lesion.

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Figure 4.
Time course of the recovery in IN-1-treated and
control Ab-treated rats in the narrow-beam test (n = 17 rats per group). The ability of the rats to walk on differently
shaped wooden beams is scored from 0 to 6 (see Materials and Methods).
Data are given as means ± SEM; *p < 0.05;
**p < 0.01.
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Electromyographic recordings during treadmill walking
At the end of the second set of experiments (as described in
Materials and Methods), EMG electrodes were implanted into the tibialis
anterior and the vastus lateralis muscle of both hindlimbs in 10 mAb
IN-1-treated and 10 control Ab-treated rats. EMGs were recorded during
stable treadmill walking of the rats. Evaluation of the EMGs revealed
major and characteristic changes of the gait pattern in the spinal
cord-injured animals (Fig. 5). In animals with a low BBB score (<8), hardly any rhythmic extensor activity (i.e., VL muscle) could be observed (Fig. 5A, control
Ab-treated animals). The flexor (i.e., TA muscle) was rhythmically
active, but the burst duration was prolonged in comparison with
uninjured animals (Fig. 5D, intact control animals), and the
rhythm was fairly slow and irregular. Cocontractions between the flexor
and the extensor muscles in one limb were detected frequently (see Fig.
7A). Because extensor activity was not patterned in some of
the animals, no evaluation of this parameter could be performed. All of
these parameters (i.e., rhythmic activity of flexor and extensor
muscles, step-cycle duration, and rhythmicity) were improved in animals
with higher locomotor scores, independent of their treatment (Fig.
5B,C, control Ab-treated and mAb IN-1-treated animals,
respectively). This finding was confirmed by the correlation between
the average step-cycle duration or step-cycle variation of the
individual animals (mAb IN-1-treated and control Ab-treated as well as
unlesioned rats) with their corresponding individual BBB score (Fig.
6A,B). A correlation
factor of r = 0.61 and 0.65 was found for the duration
and the variation (equaling the SD of step-cycle duration in single
animals), respectively, indicating that both measurements are valuable
indicators for the evaluation of the functional recovery. A comparison
of both parameters between the treatment groups showed a strong
recovery of stepping frequency and rhythmicity in mAb IN-1-treated
animals (Fig. 6C). Whereas the difference between the mAb
IN-1-treated group and the control Ab-treated group was highly
significant for step-cycle duration and the variation, the mAb
IN-1-treated group did not differ significantly from the preoperative
values (normal animals). Measurements of the burst duration of the
extensor muscle (possible in seven control Ab-treated rats and eight
mAb IN-1-treated rats) showed a significant increase in both the mAb
IN-1-treated group and the control Ab-treated group compared with
unlesioned animals. There was no statistical difference between the two
treatment groups (285.7 ± 20.4 in unlesioned rats, 461.9 ± 42 in mAb IN-1-treated rats, and 505.1 ± 55.5 in control
Ab-treated rats). The flexor burst duration was modestly increased only
in the control Ab-treated group, but this increase was not
statistically significant (139.1 ± 5.6 in unlesioned rats, 146.4 ± 9.8 in mAb IN-1-treated rats, and 236.4 ± 80.3 in
control Ab-treated rats).

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Figure 5.
EMG recordings of treadmill-walking rats 40 d
after lesion from two hindlimb muscles in rats with different locomotor
scores. A, Only the recorded flexor muscle TA was found
to be rhythmically active. In comparison with an uninjured rat
(D), the contractions were prolonged and
irregular, and the frequency was fairly low. The extensor muscle VL
rarely shows activity. B, The extensor muscle VL is more
active and bursts in a more rhythmic pattern. Cocontractions between
the muscles occurred frequently. C, The flexor
(TA) rhythm is increased, and the bursts are more
defined and shorter. In addition, the extensor (VL)
bursts are more regular and are well coordinated with the flexor
muscle. D, Recordings of an intact control animal.
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Figure 6.
Evaluation of EMG recordings 40 d after
injury: step-cycle duration and rhythmicity. A, The
correlation between the BBB locomotor score and the step-cycle duration
of all EMG implanted rats 40 d after lesion showed a decrease in
the duration with increasing performance in the open field.
B, A correlation between the deviation in the step-cycle
duration and the BBB locomotor score 40 d after lesion indicates a
strong relationship between an increase in open field performance and a
more regular stepping pattern. C, A comparison of the
average step-cycle duration (means ± SEM) as well as
its variation (shown as SD) between IN-1-treated and control Ab-treated
rats shows a highly significant improvement in the mAb IN-1 group.
**p < 0.01.
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Uncoupling of the two hindlimbs (Fig.
7B) was observed in the spinal
cord-injured rats of both treatment groups (mAb IN-1 and control Ab),
but never in the unlesioned animals. When such uncoupling events were
compared (during 20 steps) between the two treatment groups, the mAb
IN-1-treated rats performed significantly better (1.5 ± 0.7 uncoupling events per 20 steps) than the control Ab-treated rats
(3.3 ± 0.35 events) (p < 0.05).

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Figure 7.
A, Cocontractions between the VL
and the TA occurred frequently in all spinal cord-injured rats
especially at BBB scores of <12. Because some animals did not show
patterned extensor activity, no statistical comparison was performed.
The black bars and white bars represent
the activity pattern of the TA and the VL muscles, respectively.
B, Uncoupling of the rhythmically active hindlimbs
(arrows) occurred in animals of both treatment groups,
especially in rats with a BBB score of <10. An example for the right
and left TA is shown.
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Tail flick
Uncontrolled fiber growth in the spinal cord could lead to
malfunctions such as neurogenic pain. We used the tail flick test to
assess changes in this single spinal reflex pathway. The delay from the
beginning of heating the tail base to the first withdrawal movement of
the tail in preoperative baseline measurements was 5.0 ± 0.9 sec
for the future mAb IN-1-treated group and 4.5 ± 0.5 sec for the
future control Ab-treated group (n = 17 rats per group)
(Fig. 8). At 5 weeks after the lesion,
this withdrawal movement could still be consistently initiated in all
of the animals. Its latency was very similar to the baseline
measurements: the withdrawal time was 5.3 ± 1.7 sec in the mAb
IN-1-treated group and 5.0 ± 1.2 sec in the control Ab group,
with no significant difference between both groups (Fig. 8).

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Figure 8.
No significant changes were observed in the
withdrawal response to a nociceptive stimulus (infrared beam) at
35 d after injury in the tail flick test (means ± SEM;
n = 17 rats per group).
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DISCUSSION |
In this study, we examined whether the enhanced anatomical
reorganization of the adult CNS occurring after lesion and the treatment with the Nogo-A-neutralizing antibody mAb IN-1 (Schnell and
Schwab, 1990 , 1993 ; Bregman et al., 1995 ; Thallmair et al., 1998 ;
Raineteau et al., 1999 ; Brosamle et al., 2000 ; Buffo et al., 2000 ; Chen
et al., 2000 ) is beneficial for the locomotor recovery after a severe
spinal cord injury. We found that all animals recovered substantially
from their injury, but the mAb IN-1-treated rats performed in all
applied locomotor tests significantly better than the control
Ab-treated rats. Recordings of muscle EMG activity during treadmill
walking confirmed these results and showed clear differences between
the two treatment groups in step-cycle duration, rhythmicity, and limb
coordination. In these parameters, the mAb IN-1-treated group showed
values not significantly different from unlesioned animals. The tail
withdrawal reflex that occurred during thermal stimulation was
unchanged in both treatment groups, without a difference between the
control and mAb IN-1-treated group, indicating the absence of an
increased pain threshold.
Our results are consistent with earlier findings in that mAb IN-1
treatment after injuries of the adult CNS leads to functional benefits
(Bregman et al., 1995 ; Thallmair et al., 1998 ). The relatively high
number of animals used in our study allows a clear statistical interpretation of the data, despite considerable variation in lesion
size and outcome typical for spinal cord lesion experiments (Noble and
Wrathall, 1989 ; Basso et al., 1996 ). The preservation of a few
ventrolateral fibers can result in large differences in locomotor
performance (Rossignol, 1996 ; Brustein and Rossignol, 1998 ).
Histological evaluation showed that the ventrally located reticulospinal and vestibulospinal tracts were at least partly intact
in all injured rats (data not shown). These tracts are important for
the initiation and the control of the locomotor pattern (Brustein and
Rossignol, 1998 ; Jordan, 1998 ), which is generated by spinal
pattern-generating networks (Grillner, 1985 ; Pearson, 1993 ). This
probably explains our finding that the animals of both groups were able
to initiate a rhythmic movement pattern of the hindlimbs and to
locomote on a flat surface as demonstrated in the BBB locomotor score.
Because in the BBB score points are not assigned in a linear manner,
functional importance of single points for the recovery of stepping
should not be expressed by using absolute values only. In our study,
the control Ab-treated rats reached a mean of 10 points at 35 d
after injury, representing occasional (<50%) weight-supported plantar
steps with no forelimb-hindlimb coordination. In contrast, the mAb
IN-1-treated rats reached a mean of 12.5 points (good weight support
and nearly consistent forelimb-hindlimb coordination), indicating
major improvements in the recovery of walking.
In contrast to the ventral tracts, the dorsal and dorsolateral
corticospinal tract (CST) and rubrospinal tract were completely disconnected in all of the animals. These tracts are mainly involved in
fine control of movements (Armstrong, 1986 ; Kennedy, 1990 ; Whishaw et
al., 1992 ), and the corticospinal tract has been shown to be relatively
unimportant for plain locomotion (Metz et al., 1998 , Muir and Whishaw,
1999 ). This was reflected by severe deficits in those tests requiring
precise motor control (i.e., in the grid walk or in the narrow-beam
test). Although there were still severe deficits present, the mAb
IN-1-treated rats recovered significantly better in these tests,
possibly reflecting a partial reestablishment of descending control in
these animals. As another test for descending control, we evaluated the
latency of the withdrawal response in the case of a misstep on the
grid. Supraspinal input facilitates the activation of this spinal
reflex, as shown in spinalized (complete spinal-cord injured)
cats in which the withdrawal response elicited by loss of ground was
delayed compared with intact animals (Gorassini et al., 1994 ; Hiebert
et al., 1994 ). Similar to the results obtained with cats, our
results show that the initiation of the withdrawal response was delayed
after spinal cord injury also in rats. However, this has been found
only in control Ab-treated animals, whereas the mAb IN-1-treated group
had recovered to the preoperative level 35 d after injury.
The functional recovery observed here probably involves multiple
plastic and regenerative changes on different levels of the motor
system. On the cortical level, adaptive changes of the motor map have
been observed in spinal cord-injured humans and animals (Bruehlmeier et
al., 1998 ) as well after limb amputation (Kaas et al., 1999 ).
Plastic modification also seem to occur on the level of descending
spinal tracts, because spontaneous recovery of locomotion after
incomplete lesions was observed in cats and humans. Even very
small amounts of remaining ventrolateral white matter were sufficient
to initiate locomotion (Windle et al., 1958 ; Nathan, 1994 ). At the
level of the spinal central pattern-generating network, activity-dependent modifications were recently described (De
Leon et al., 1999 ; Pearson et al., 1999 ).
Because the mAb IN-1-treated rats improved significantly better than
the control Ab-treated animals, enhancement of spontaneous plasticity
and/or additional effects have to be taken into account. Regeneration
of injured CST fibers occurs in the lesion paradigm used here
after mAb IN-1 treatment (Schnell and Schwab, 1990 , 1993 ; Bregman et
al., 1995 ; Brosamle et al., 2000 ) and may contribute to the observed
recovery. Furthermore, it has been shown that the mAb IN-1 allows
sprouting and reorganization of lesioned as well as unlesioned fibers
in adult rats at a degree that is normally only observed after
perinatal lesions (Thallmair et al., 1998 ; Z'Graggen et al., 1998 ,
2000 ). Recent results have shown that after mAb IN-1 treatment even the
rubrospinal tract can sprout and functionally innervate CST targets
after CST removal (O. Raineteau, K. Fouad, P. Noth, and M. E. Schwab, unpublished observation). In the intact adult cerebellum,
antibodies neutralizing Nogo-A induce transient sprouting of Purkinje
cell axons (Buffo et al., 2000 ). This sprouting occurs as early as
2 d after antibody injection. Such plastic rearrangements could be
the basis of the fast recovery observed in the present study.
Using our histological analysis approach of spared white matter, we
found that only animals with higher amounts of SWM (>40%) (Fig.
2C) benefited in the BBB locomotor score from the mAb IN-1 treatment. This result indicates that for functionally meaningful plastic rearrangements to occur, a minimal amount of preserved descending input is necessary and/or regenerating fibers depend on a
minimum bridge size as a growth substrate. One has to keep in mind that
by using the method described, small but critical differences in the
lesion size could be missed, which might explain the deviation
in the results (Fig. 2C).
Another important feature of the mAb IN-1-enhanced recovery is the fast
onset, starting already at 7 d after lesion. Although little
information on antibody concentration and spatial distribution after
hybridoma cell implantation is available, we believe that the fast
recovery is mediated by the IN-1 antibodies. The application method via
antibody-producing hybridoma cells involves a certain variability;
however, we found a detectable amount of antibodies in the blood serum
of treated animals already at 4 d after implantation (our
unpublished data). The recovery described in this study parallels the
rapidly observed improvements in forelimb food pellet-grasping tests after lesions of the pyramidal tract and subsequent mAb IN-1
treatment (Thallmair et al., 1998 ; Z'Graggen et al., 1998 ). An earlier
testing session has not been considered because the results would be
misleading as a result of the spinal shock phase, which lasts for
several days and varies from animal to animal (Holaday and Faden, 1983 ;
Basso et al., 1996 ). Regenerating fibers can grow >1 mm/d in the rat
spinal cord (Schnell and Schwab, 1990 ; Li and Raisman, 1994 ), and
sprouting occurs rapidly (2-5 d) after mAb IN-1 treatment (Buffo et
al., 2000 ).
Because of the Ab delivery strategy (via hybridoma cells used), the
time of IN-1 antibody supply was limited to ~10 d; nevertheless, the
effects on the functional outcome are encouraging. The observed functional recovery indicates that the mAb IN-1 treatment leads to
a meaningful rewiring of circuitry in the lesioned CNS. Cues and
mechanisms for synapse formation, for integration of newly grown fibers
into existing circuits, and for stabilization of connections still
appear to be present or to be re-expressed as a consequence of the
lesion in the adult rat CNS.
Enhanced fiber growth because of a treatment may also include a certain
danger. A possible example could be neuropathic pain (e.g., after
incomplete spinal cord injury) (Eide, 1998 ). The mechanisms causing
neuropathic pain after spinal cord lesion are to a large extent
unclear, but inappropriate sprouting of afferent fibers has often been
considered (Woolf and Doubell, 1994 ; Christensen and Hulsebosch, 1997 ;
Kennedy et al., 1997 ). Although so far such growth of sensory fibers
has not been examined, it was of special interest to study
whether the mAb IN-1 treatment influences pain perception or leads to
hyper-reflexia. According to the classical tail flick test,
spinal cord injury did not cause a change in reaction time, and no
difference was observed between the IN-1-treated group and the control
Ab-treated group. This suggests either that sprouting did not occur or
that no inappropriate connections of afferent fibers have been formed.
In conclusion, the present study shows that the mAb IN-1 treatment
enhances functional recovery after spinal cord lesions, probably by
allowing the formation of functionally meaningful new connections of
uninjured and also severed axons in the adult rat CNS.
 |
FOOTNOTES |
Received Dec. 1, 2000; revised March 5, 2001; accepted March 6, 2001.
This study was supported by the Swiss National Science Foundation
(Grant 4038-043918.95), by the Spinal Cord Consortium of the
Christopher Reeve Paralysis Foundation (Springfield, NJ), and by the
International Institute for Research in Paraplegia (Grant
P49/99). We thank H. J. Kasper and J. Scholl for technical support, B. Niederöst for hybridoma cell supply, and Drs. A. McKinney and D. Pinschewer for critically reading this manuscript.
Correspondence should be addressed to Dr. Karim Fouad, Faculty of
Rehabilitation Medicine, The University of Alberta, Corbett Hall,
Edmonton, Alberta T6G 2G4, Canada. E-mail:
Karim.Fouad{at}ualberta.ca.
 |
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