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Granulocyte Colony-Stimulating Factor Potential Use in the Treatment of Children with Cerebral Palsy

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Granulocyte Colony-Stimulating Factor Potential Use in the Treatment of Children with Cerebral Palsy Prog Health Sci 2017, Vol 7, No 1 Granulocyte colony stimulating factor cerebral palsy Granulocyte colony-stimulating factor potential use in the treatment of children with cerebral palsy Paszko-Patej G.A,D,E,F , Sienkiewicz D. E,F, Okurowska-Zawada B. E,F, Kułak W. D,E,F* Department of Pediatric Rehabilitation and Center of Early Support for Handicapped Children “Give a Chance,” Medical University of Bialystok, Bialystok, Poland ___________________________________________________________________________ A- Conception and study design; B - Collection of data; C - Data analysis; D - Writing the paper; E- Review article; F - Approval of the final version of the article; G - Other (please specify) ______________________________________________________________________________________ ABSTRACT ___________________________________________________________________________ Granulocyte colony-stimulating factor (G-CSF) is a recovery. G-CSF exerts neuroprotective actions glycoprotein that stimulates the bone marrow to through the inhibition of apoptosis and produce granulocytes and stem cells and release inflammation, and the stimulation of neurogenesis. them into the blood. Recent studies demonstrated This review highlights recent studies on the the presence of CSF-receptor (G-CSFR) system in potential use of G-CSF in cerebral palsy. the brain and spinal cord, and their roles in Keywords: Granulocyte colony-stimulating factor, neuroprotection and neural tissue repair, as well as neuroprotection, studies, cerebral palsy improvement in functional ___________________________________________________________________________ DOI: 10.5604/01.3001.0010.1882 *Corresponding author: Wojciech Kułak Department of Pediatric Rehabilitation and Center of Early Support for Handicapped Children “Give a Chance” Medical University of Bialystok, 17 Waszyngtona street, 15-274 Bialystok, Poland e-mail: [email protected] Received: 20.04.2017 Accepted: 19.05.2017 Progress in Health Sciences Vol. 7(1) 2017 pp 187-192 © Medical University of Białystok, Poland 187 Prog Health Sci 2017, Vol 7, No 1 Granulocyte colony stimulating factor cerebral palsy INTRODUCTION the dentate gyrus [7]. Changes in the migration patterns of neural progenitor cells (NPCs) following Granulocyte colony-stimulating factor (G- brain injury have been observed. Endogenous CSF) is a glycoprotein that stimulates the bone neural stem cells and cultured stem cells are marrow to produce granulocytes and stem cells and capable of self-renewal and give rise to virtually all release them into the blood. Also, it induces the types of cells essential for the makeup of neuronal proliferation and differentiation of neutrophil structures. Meanwhile, stem cells and neural precursors and mature neutrophils. G-CSF is widely progenitor cells are well-known for their potential used for treating and preventing chemotherapy- for trophic support after transplantation into the induced neutropenia. G-CSF is a cytokine and ischemic brain [8,9]. hormone as well. G-CSF is produced by the Neurogenesis is stimulated by many endothelium of blood vessels, macrophages, and a factors such as: promoting pathways as potential number of other immune cells. Moreover, G-CSF methods to stimulate NPC proliferation, glial- stimulates endothelial cells to proliferation and derived neurotrophic factor, brain-derived migration related to angiogenesis [1]. G-CSF is a neurotrophic factor, vascular endothelial growth strong inducer of hematopoietic stem cell factor, G-CSF, basic fibroblast growth factor–2, mobilization from the bone marrow into the insulin-like growth factor–1, bone morphogenetic bloodstream [2]. protein–7, epidermal growth factor, and Recent studies have demonstrated the transforming growth factor–a [10,11]. presence of a CSF-receptor (G-CSFR) system in the brain and spinal cord, and their roles in Experimental and clinical studies neuroprotection and neural tissue repair as well as Recent clinical studies investigated the improvement in functional recovery. G-CSF dual role of G-CSF in the activation of bone receptors are expressed in pyramidal neurons in the marrow cells and neuroprotection. Ongoing clinical cortex (mainly layers II/III and V), the Purkinje cell trials are investigating the dual roles of G-CSF, the layer of the cerebellum, the hippocampus (hilus and activation of endogenous bone marrow cells, and CA3 field), the entorhinal cortex and the olfactory neuroprotection to determine efficacy in stroke bulb. G-CSF is also expressed in the neurogenic recovery. A recent review of 10 studies comprising regions in the adult brain: in the subgranular zone 711 patients reported that G-CSF is safe and well of the dentate gyrus and the subventricular zone [3]. tolerated. Moreover, G-CSF may foster functional Increased expression of G-CSF/G-CSFR in recovery, as measured by the National Institutes of neurons subjected to hypoxia supports evidence that Health Stroke Scale and modified Rankin Scale G-CSF has a protective signaling mechanism in scores [12]. response to neural damage. G-CSF exerts Nishio et al. [13] evaluated the potential neuroprotective actions through the inhibition of therapeutic effect of G-CSF for spinal cord injury in apoptosis and inflammation, and the stimulation of mice. They found that G-CSF is neuroprotective neurogenesis. Furthermore, G-CSF has been shown against glutamate-induced cell death of cerebellar to mobilize bone marrow stem cells into the injured granule neurons in vitro. Also, histologic brain, improving neural plasticity [4]. G-CSF also examination revealed that the number of surviving stimulates neurogenesis and synaptogenesis in the neurons in the spinal cord was increased. An brain and prevents apoptosis. It has regenerative immunohistochemistry study confirmed that G-CSF potential in various neurological disease models. suppressed neuronal apoptosis after SCI. Moreover, [5,6]. administration of G-CSF promoted hindlimb functional recovery. Stem cells G-CSF in a mouse spinal cord hemisection Stem cells are undifferentiated cells that recruits microglia to the injury site in the first 72h may specialize into multiple cell types and can self- after spinal cord injury [14]. Also, G-CSF reduces renew. Stroke pathophysiology may be particularly the expression of pro-inflammatory factors and amenable to stem cell therapy [7]. activates the expression of neurotrophic factors. After the initial injury and associated Furthermore, G-CSF induces the expression of changes, there is no enduring neurodegenerative markers of M2 macrophage and inhibits the process inhibiting recovery. The mechanism of expression of markers of M1 macrophage in BV2 stem cell therapy remains uncertain, and the three microglia in an in vitro model. The authors possible mechanisms include structural support for suggested that the administration of G-CSF within damaged or surrounding tissue re-myelination of the first 72h after spinal cord injury might reduce the damaged axon, induction of regeneration via early inflammation-induced detrimental effects and neurotrophic growth factor reduction TNF-a, IL-b, promote an anti-inflammatory response that favors and IL- 1a level, and increase IL-6 level repair via improving alternative activation of The canonical niches for neural stem cells microglia. (NSCs) in the brain are the subventricular zone and 188 Prog Health Sci 2017, Vol 7, No 1 Granulocyte colony stimulating factor cerebral palsy In an experimental study of neonatal as erythropoietin (EPO) and G-CSF, which hypoxia-ischemia, G-CSF+ stem cell factor (SCF) influence the proliferation of neural stem and coadministration showed significant improvement progenitor cells. EPO and G-CSF have specific in neurological function. The administration of G- receptors in the brain and both factors are produced CSF in combination with SCF not only prevented in the brain [Brines, 2005; Schneider, 2005]. brain atrophy but also improved neurological Therefore, EPO and G-CSF have been investigated function [15]. for their ability to stop neurodegenerative In a recent experimental study of a conditions [19,20]. neonatal animal model of excitotoxic brain injury, Hoh et al. [21] investigated the therapeutic [16] showed that G-CSF protects against N-methyl- mechanism of cell therapy in patients with cerebral D-aspartate receptor-mediated developmental palsy using G-CSF mobilized mPBMCs. They excitotoxic brain damage. The neuroprotective compared the expression of inflammatory cytokines effects in this model of excitotoxic brain injury and neurotrophic factors in PBMCs and mPBMCs depended on the timing of drug administration after from children with cerebral palsy to those from the insult. healthy adult donors and to cord blood Also, Lu et al. [17] investigated the mononuclear cells donated from healthy newborns. potential protective effects of G-CSF in a gerbil In cerebral palsy children, the expression of model of global cerebral ischemia. They examined interleukin-6 was significantly increased in neuronal death, inflammatory reaction, and mPBMCs compared with PBMCs. The expression neurogenesis in the hippocampus 72 h after of brain-derived neurotrophic factors in mPBMC transient forebrain ischemia and functional deficits. from children with cerebral palsy was significantly G-CSF at 25-50 μg/kg significantly reduced higher than that in cord blood or mPBMCs from neuronal loss in the hippocampus CA1 area, but not healthy adults. The authors suggested that at 10 μg/kg. G-CSF at 50 μg/kg reduced the level of mPBMCs have the potential to
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