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  4. Experimental Treatments for Oedema in Spinal Cord Injury: A Systematic Review and Meta-Analysis

Experimental Treatments for Oedema in Spinal Cord Injury: A Systematic Review and Meta-Analysis

Cells, 2021 · DOI: 10.3390/cells10102682 · Published: October 7, 2021

Spinal Cord InjuryCardiovascular ScienceGenetics

Simple Explanation

Spinal cord injury (SCI) often leads to neurological deficits, impacting a person's life quality, creating a need for treatments that prevent injury progression and improve recovery. The initial mechanical insult and subsequent secondary mechanisms exacerbate the lesion site, inhibiting neurological recovery. Oedema, the accumulation of fluid, rapidly follows SCI and worsens the detrimental pathophysiology, leading to poorer functional outcomes. Experimental treatments targeting oedema are currently being explored to mitigate these effects. This study identifies key modalities such as selective inhibition of aquaporin 4 (AQP4), modulation of inflammation, and surgical interventions that attenuate oedema, ultimately leading to its reduction and improved functional outcomes after SCI.

Study Duration
Not specified
Participants
Not specified
Evidence Level
Level 1: Systematic Review and Meta-Analysis

Key Findings

  • 1
    Selective inhibition of aquaporin 4 (AQP4), modulation of inflammation, and surgical interventions are key modalities that attenuate oedema following spinal cord injury.
  • 2
    Trifluoperazine (TFP), a calmodulin kinase inhibitor, significantly eliminates oedema within 7 days of administration by preventing the cell-surface localization of AQP4.
  • 3
    Downregulation of AQP4, achieved through various mechanisms, is crucial for reducing oedema and improving functional recovery in experimental spinal cord injury treatments.

Research Summary

This study systematically reviews experimental treatments for oedema following spinal cord injury (SCI). It identifies key modalities such as selective inhibition of aquaporin 4 (AQP4), modulation of inflammation, and surgical interventions. The meta-analysis reveals that trifluoperazine (TFP), a calmodulin kinase inhibitor, is the most efficacious treatment, significantly eliminating oedema within 7 days of administration. The review highlights that the downregulation of AQP4, regardless of the specific mechanism employed, is a crucial step in reducing oedema and improving functional outcomes in SCI.

Practical Implications

Targeted Therapies for SCI

The identification of AQP4 as a key regulator of oedema provides a specific target for future therapeutic interventions.

Drug Repurposing Potential

The efficacy of trifluoperazine (TFP), an already licensed drug, suggests potential for drug repurposing to treat oedema in SCI.

Optimizing Treatment Timing

The study emphasizes the importance of early intervention with anti-oedemic therapies to limit secondary damage and improve functional outcomes.

Study Limitations

  • 1
    Variation in time points of analysis of oedema
  • 2
    Variety of locomotor tests used to assess the recovery of function
  • 3
    Potential high risk of bias in some studies due to a lack of clear reporting

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