Combination Therapies in the CNS: Engineering the Environment

After traumatic brain injury and spinal cord injury, the environment around the injury site becomes inhibitory to axon growth, hindering functional recovery. Combination therapies aim to engineer a more permissive environment in the central nervous system (CNS) to promote regeneration. The inhibitory nature of the CNS lesion means that using multiple therapies together might be more effective than single treatments. This review discusses recent attempts to engineer the CNS environment using combined strategies. These combination therapies involve things like delivering neurotrophins (growth factors), transplanting cells, and using biomaterial scaffolds to help rebuild damaged tissue and encourage axon regeneration.

• 1
  Combining neurotrophic factor delivery with cell transplantation or biomaterial scaffolds may provide synergistic effects to improve functional recovery after spinal cord injury.
• 2
  Chondroitinase ABC (chABC), an enzyme that degrades inhibitory molecules called CSPGs, can increase axon extension into scaffolds and improve migration and integration of transplanted cells.
• 3
  Targeting myelin-associated inhibitors (MAIs) with treatments like Nogo-A antibodies or NgR competitive agonist peptides can help regenerating host axons overcome inhibition in white matter and myelin debris.