In individuals with severe spinal cord injury (SCI), the autonomic nervous system (ANS) is affected leading to cardiovascular deficits, which include significant blood pressure instability, with the prevalence of systemic hypotension and orthostatic intolerance resulting in an increased risk of stroke. Additionally, persons with SCI rostral to thoracic vertebral level 5 (T5), where sympathetic nervous system fibers exit the spinal cord and innervate the immune system, have clinically significant systemic inflammation and increased infection risk. Our recent studies show that lumbosacral spinal cord epidural stimulation (scES), applied at the lumbosacral level using targeted configurations that promote cardiovascular stability (CV-scES), can safely and effectively normalize blood pressure in persons with chronic SCI. Herein we present a case report in a female (age 27 years) with chronic clinically motor complete cervical SCI demonstrating that 97-sessions of CV-scES, which increased systemic blood pressure, improved orthostatic tolerance in association with increased cerebral blood flow velocity in the middle cerebral artery, also promoted positive immunological changes in whole-blood gene expression. Specifically, there was evidence of the down-regulation of inflammatory pathways and the up-regulation of adaptative immune pathways. The findings of this case report suggest that the autonomic effects of epidural stimulation, targeted to promote cardiovascular homeostasis, also improves immune system function, which has a significant benefit to long-term cardiovascular and immunologic health in individuals with long-standing SCI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02307565.

中文翻译：

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长期靶向心血管硬膜外刺激可改善免疫分子特征：慢性严重脊髓损伤的病例报告

在患有严重脊髓损伤 (SCI) 的个体中，自主神经系统 (ANS) 受到影响导致心血管功能障碍，包括显着的血压不稳定，全身性低血压和直立性不耐受的流行导致中风风险增加。此外，在交感神经系统纤维离开脊髓并支配免疫系统的 5 级胸椎 (T5) 头端 SCI 患者，具有临床上显着的全身炎症和感染风险增加。我们最近的研究表明，使用促进心血管稳定性的靶向配置 (CV-scES) 在腰骶水平应用腰骶脊髓硬膜外刺激 (scES)，可以安全有效地使慢性 SCI 患者的血压正常化。在此，我们介绍了一名患有慢性临床运动完全性颈椎 SCI 的女性（27 岁）病例报告，证明 97 次 CV-scES 会增加全身血压，改善直立耐受性，同时增加脑血流速度。大脑中动脉也促进了全血基因表达的阳性免疫学变化。具体而言，有证据表明炎症途径下调和适应性免疫途径上调。本病例报告的结果表明，硬膜外刺激的自主神经作用，旨在促进心血管稳态，也改善免疫系统功能，这对长期 SCI 患者的长期心血管和免疫健康具有显着益处。临床试验注册：