Intranasal nerve growth factor administration improves neurological outcome after GBS meningitis
Intranasal nerve growth factor administration improves neurological outcome after GBS meningitis
复制标题
DOI：
10.1007/s00381-020-04590-x
复制
发表时间：
2020-04-10
影响因子：
1.4
通讯作者：
Conti, Giorgio
中科院分区：
文献类型：
--
作者：
Chiaretti, Antonio;Eftimiadi, Gemma;Conti, Giorgio
神经生长因子(NGF)是一种神经营养因子，可促进实验性脑损伤后神经的恢复和可塑性，支持神经细胞的生长、分化和存活。只有几项研究报道了在创伤、缺血或感染性疾病(如脑膜炎)后脑功能受损的儿童患者中使用NGF。我们描述了人类重组神经生长因子(hr-NGF)治疗婴儿持续性无反应觉醒综合征(UWS)的有益疗效，该综合征是由迟发性B组链球菌炎引起的。婴儿通过黏膜雾化装置(MAD)接受每月5个周期的鼻腔注射hR-NGF(0.1 mg/kg，每天3次，连续7天)。NGF治疗改善了功能[正电子发射断层扫描/计算机断层扫描(PET/CT)、单光子发射/计算机断层扫描(SPECT/CT)和磁共振成像(MRI)]评估、电生理[脑电(EEG)]研究，以及主要认知过程和临床和神经功能。在HR-NGF治疗后，观察到面部模仿、注意力、运动反应、口腔运动和进食能力有显著改善。她的下丘脑功能也恢复了一些，咳嗽反射也恢复了。治疗过程中和治疗后均未发现副作用。有史以来第一次，HR-NGF成功地应用于一名患有UWS并因细菌性脑膜炎而导致严重神经系统后果的婴儿。虽然还需要进一步的研究来更好地了解这种神经营养素的神经保护作用，但鼻腔内给予hr-NGF似乎是一种有希望的拯救策略，用于治疗脑损伤后严重神经功能障碍的婴儿。
Nerve growth factor (NGF) is a neurotrophin that promotes neural recovery and plasticity after experimental brain injury, supporting neuronal growth, differentiation, and survival of brain cells. Only a few studies reported NGF administration in pediatric patients with impaired brain functions after traumatic injuries, ischemic or infectious diseases, such as meningitis. We described the beneficial therapeutic effects of human-recombinant nerve growth factor (hr-NGF) treatment in an infant with persistent unresponsive wakefulness syndrome (UWS), due to late-onset group B Streptococcus meningitis. The infant received five monthly cycles of intranasal hr-NGF (0.1 mg/kg, 3 times daily for 7 consecutive days) through a mucosal atomizer device (MAD). NGF administration improved functional [positron emission tomography/computed tomography (PET/CT), single-photon emission/computed tomography (SPECT/CT), and magnetic resonance imaging (MRI)] assessments, electrophysiological [Electroencephalogram (EEG)] studies, as well as main cognitive processes and clinical and neurological functions. After hr-NGF treatment, significant improvements in facial mimicry, attention, motor reactions, oral motility, and feeding capacity were observed. She also recovered some hypothalamic functions and her cough reflex was restored. No side effects were reported during and after the treatment. For the first time ever, hr-NGF has been successfully utilized in an infant with UWS and severe neurologic outcome due to a bacterial meningitis. Although further studies are needed for better understanding the neuroprotective role of this neurotrophin, intranasal hr-NGF administration appears to be a promising and save rescuing strategy treatment in infants with severe neurological impairment after brain damage.