Effects of local hypothermia-rewarming on physiology, metabolism and inflammation of acutely injured human spinal cord

• Published in: Scientific reports Vol. 10; no. 1; p. 8125
• Main Authors: Gallagher, Mathew J, Hogg, Florence R A, Kearney, Siobhan, Kopp, Marcel A, Blex, Christian, Serdani, Leonarda, Sherwood, Oliver, Schwab, Jan M, Zoumprouli, Argyro, Papadopoulos, Marios C, Saadoun, Samira
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 15.05.2020; Nature Publishing Group UK
• Subjects: Adolescent; Adult; Aged; Cerebrospinal Fluid Pressure; Cytokines - metabolism; Female; Glucose metabolism; Glycerol; Humans; Hypothermia; Hypothermia, Induced - methods; Inflammation; Inflammation - etiology; Inflammation - pathology; Inflammation - therapy; Injuries; Interleukin 1; Interleukin 10; Interleukin 4; Interleukin 8; Ischemia; Lactic acid; Male; Metabolism; Microdialysis; Middle Aged; Monitoring, Physiologic; Perfusion; Physiology; Pressure; Prospective Studies; Pyruvic acid; Rewarming - methods; Spinal cord; Spinal cord injuries; Spinal Cord Injuries - complications; Thorax; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-64944-y

In five patients with acute, severe thoracic traumatic spinal cord injuries (TSCIs), American spinal injuries association Impairment Scale (AIS) grades A-C, we induced cord hypothermia (33 °C) then rewarming (37 °C). A pressure probe and a microdialysis catheter were placed intradurally at the injury site to monitor intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue metabolism and inflammation. Cord hypothermia-rewarming, applied to awake patients, did not cause discomfort or neurological deterioration. Cooling did not affect cord physiology (ISP, SCPP), but markedly altered cord metabolism (increased glucose, lactate, lactate/pyruvate ratio (LPR), glutamate; decreased glycerol) and markedly reduced cord inflammation (reduced IL1β, IL8, MCP, MIP1α, MIP1β). Compared with pre-cooling baseline, rewarming was associated with significantly worse cord physiology (increased ICP, decreased SCPP), cord metabolism (increased lactate, LPR; decreased glucose, glycerol) and cord inflammation (increased IL1β, IL8, IL4, IL10, MCP, MIP1α). The study was terminated because three patients developed delayed wound infections. At 18-months, two patients improved and three stayed the same. We conclude that, after TSCI, hypothermia is potentially beneficial by reducing cord inflammation, though after rewarming these benefits are lost due to increases in cord swelling, ischemia and inflammation. We thus urge caution when using hypothermia-rewarming therapeutically in TSCI.