New perspectives for the treatment options in spinal cord injury

Abstract

Spinal cord injury (SCI) is a serious clinical disorder that leads to lifetime disability for which no suitable therapeutic agents are available so far. Further research is needed to understand the basic mechanisms of spinal cord pathology that results in permanent disability and poses a heavy burden on our society. In the past, a lot of effort was placed on improving functional outcome with the help of various therapeutic agents, however less attention has been paid on the development and propagation of spinal cord pathology over time. Thus, it is still unclear whether improvement of functional outcome is related to spinal cord pathology or vice versa. Few drugs are able to influence functional outcome without having any improvement on cord pathology. Some drugs, however, can lessen cord pathology but fail to influence the functional outcome. The goal of future treatment options for SCI is therefore to find suitable new drugs or a combination of existing drugs and to use various cellular transplants, neurotrophic factors, myelin-inhibiting factors, tissue engineering and nano-drug delivery to improve both the functional and the pathological outcome in the inured patient. This review deals with the key aspects of the latest treatments for SCI and suggests some possible future therapeutic measures to enhance healthcare in clinical situations.

Keywords::

• blood–spinal cord barrier
• edema formation
• electrophysiology
• endothelial cells
• functional paralysis
• glial cells
• motor neuron
• spinal cord injury
• spinal cord pathology
• treatment

Acknowledgements

I am grateful to Professor Erik V Stålberg and Tomas Winkler, Department of Clinical Neurophysiology, Uppsala University Hospital; Jose V Lafuente, Institute of Neurosciences, University of Basque countries, Bilbao, Spain; Alexander Vlad Cieura, Neurosurgical Department, Clinic Hospital ‘Bagdasar-Arseni’, Bucharest, Romania; Dafin F Muresanu, Department of Neurology, Medical University of Cluj Napoca, Romania; RD Badgaiyan, Massachusetts General Hospital, Harvard University, Boston, MA, USA; Syed F Ali, Division of Neurotoxicology, National Centre for Toxicological Research, Food & Drug Administration, US/FDA, AR Jefferson, USA; Byron Kakulas, University of Western Perth, Queen Elizabeth Hospital, Perth, Western Australia and Russell Pendleton, London, UK for providing important advice and suggestions throughout this work and critically reading the manuscript. The secretarial assistance of Aruna Sharma and Angela Ludwig is highly appreciated.

Supply of human spinal cord tissues for research mentioned in this study was generously provided by Professor Byron Kakulas, Perth University.

Notes