Effectiveness of biomaterial-based combination strategies for spinal cord repair – a systematic review and meta-analysis of preclinical literature

Spinal Cord, 2022 · DOI: https://doi.org/10.1038/s41393-022-00811-z · Published: May 23, 2022

Spinal Cord Injury Regenerative Medicine Biomedical

Simple Explanation

Adult mammalian Central Nervous System (CNS) neurons cannot regrow in response to spinal cord injury (SCI) due to their limited intrinsic regrowth capacity and a hostile post-injury environment. Biomaterials for SCI repair have been used because of their ability to provide structural or active growth support to damaged axons and can act as a delivery platform for cells and therapeutic molecules. Combination therapies seem necessary and among these, many are biomaterial-based.

Study Duration

Not specified

Participants

134 publications, preclinical studies

Evidence Level

Systematic review and meta-analysis of preclinical literature

Key Findings

1
Treatment with BMO resulted in a signiﬁcant improvement in locomotor recovery and axonal regeneration.
2
Combination treatments improve locomotor recovery by 25.3% and in vivo axonal regeneration by 1.6 SD.
3
Overall, combinations based on PLGA resulted in robust improvements in outcomes.

Research Summary

This study provides a comprehensive summary of biomaterial-based combination strategies tested in preclinical SCI models and demonstrates the effectiveness of these strategies overall for improving locomotor recovery and axonal regeneration. A diverse range of combination strategies has been tested and, while some appear more promising than others, a lack of evidence for many biomaterials and combinations limits our ability to draw deﬁnitive conclusions about their relative efﬁcacy. The study highlights where gaps exist in current knowledge and identifies promising strategies to pursue in future preclinical research directed at SCI repair and notes the importance of assessing biomaterial-based combination strategies at clinically relevant time points.

Practical Implications

Combination Therapy Importance

The study supports the consensus that a combination therapeutic strategy is a necessity for SCI repair, providing quantitative data to back this claim.

PLGA-Based Combinations

The robust improvements in outcomes seen with PLGA-based combinations suggest this is a promising avenue for further research and potential clinical translation.

In Vitro Testing

The authors advocate for the assessment of biomaterial suitability for SCI repair using in vitro and/or ex vivo models before advancing to in vivo testing, to minimize animal welfare concerns.

Study Limitations

1
In vitro models can only ever mimic certain aspects of SCI
2
High variability between studies and a lack of data for many strategies.
3
The study's focus on a broad range of BMC strategies limited more speciﬁc conclusions.

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