Recent Advances in the Pharmacologic Treatment of Spinal Cord Injury

Metab Brain Dis, 2015 · DOI: 10.1007/s11011-014-9547-y · Published: April 1, 2015

Spinal Cord Injury Pharmacology Neurology

Simple Explanation

Spinal cord injury (SCI) treatment has evolved from ancient beliefs of being untreatable to modern pharmacological interventions aimed at neuroprotection and regeneration. The review summarizes the mechanisms and pharmacological therapeutics studied over the past decade, with an emphasis on neuroprotection and regeneration of the spinal cord. Secondary injury after SCI involves hypoxia, ischemia, excitotoxicity, and inflammation, which can be targeted with pharmacological agents.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Oxycyte, an oxygen carrier, significantly increased oxygen saturation and reduced apoptotic cell death in a rat model of spinal cord injury.
2
Riluzole, a sodium channel blocker/glutamate receptor modulator, has shown neuroprotective effects through modulation of excitotoxicity and has been evaluated in a phase I safety trial.
3
Minocycline has been shown to decrease apoptosis and improve functional outcomes in animal models, leading to a phase II clinical trial showing safety and potential improved motor function.

Research Summary

The review provides a historical overview of SCI treatment, from ancient times to the present day, highlighting the shift from surgical interventions to pharmacological approaches. The complex pathophysiological mechanisms driving secondary injury and regenerative capacity of the spinal cord are beginning to be unraveled. SCI research has greatly expanded over the last 10 years, evaluating a number of potential treatments: hypothermia, Riluzole, Cethrin, Premarin, ATI-355, and Minocycline to name some.

Practical Implications

Early Intervention

Pharmacological agents should be administered as early as possible following SCI to mitigate the detrimental effects of secondary injury cascades.

Combination Therapies

Combination therapeutic strategies targeting multiple pathological processes occurring in acute, intermediate, and chronic stages of SCI may prove more effective.

Drug Repurposing

Fast-tracking drugs with prior FDA approval for alternate indications (e.g., estrogen) represents a promising strategy for rapid translation into SCI treatment.

Study Limitations

1
The review focuses primarily on pharmacological interventions and does not extensively cover non-pharmacological approaches.
2
The exact contribution of myelin inhibitors to successful axon regeneration in vivo is not yet clearly defined.
3
Difficulties with drug safety and solubility have precluded advancement of some calpain inhibitors into the clinic.

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