Repairing the injured spinal cord: sprouting versus regeneration. Is this a realistic match?

Neural Regen Res, 2014 · DOI: 10.4103/1673-5374.130059 · Published: March 1, 2014

Spinal Cord Injury Regenerative Medicine Neuroplasticity

Simple Explanation

The article discusses the shifting focus in spinal cord injury (SCI) research from targeting regeneration by neutralizing inhibitory factors to studying neuroplasticity, which involves adaptive changes in the nervous system following injury. Neuroplasticity is seen as the mechanism behind limited functional recovery in animal models and humans with nervous system damage. Adaptations occur at various levels, including sprouting of fibers and changes in cellular properties. The paper questions whether the shift from regeneration research indicates a loss of momentum due to underwhelming success or if plasticity is a more promising treatment target, considering factors like lesion severity and the complexity of neuronal networks.

Study Duration

Not specified

Participants

Animal models and humans with damage to the nervous system

Evidence Level

Not specified

Key Findings

1
Treatments aimed at promoting regeneration have been found to promote sprouting of spared and injured nerve cells, further supporting the shift towards studying neuroplasticity.
2
Long-distance regeneration may not be necessary for functional recovery, as neurons can form "detour" pathways by connecting onto spared neurons.
3
Plasticity-promoting treatments may facilitate the efficient use of remaining CNS tissue but cannot restore tissue damage or pre-injury motor function, and it can also contribute to detrimental effects like neuropathic pain.

Research Summary

The field of spinal cord injury research has evolved, with some trends losing momentum and new approaches emerging. A balanced treatment approach for spinal cord injury is needed, including neuroprotective efforts, regeneration, and plasticity-promoting treatments, along with rehabilitative training. Plasticity-promoting treatments can neither restore tissue damage nor restore motor function to pre-injury performance, but it may facilitate the efficient use of remaining CNS tissue.

Practical Implications

Comprehensive Treatment Strategies

Future SCI treatments should combine neuroprotection, regeneration, plasticity, and rehabilitation for optimal recovery.

Realistic Expectations for Plasticity

While plasticity-promoting treatments can improve function, they may not fully restore pre-injury capabilities and can have negative side effects.

Further Research on Intrinsic Mechanisms

Continued investigation into intrinsic mechanisms that inhibit regenerative growth, such as the PTEN pathway, could provide new therapeutic targets.

Study Limitations

1
The magnitude of plasticity-dependent functional recovery is affected by numerous factors, including lesion severity.
2
Understanding of neuronal networks, even in the uninjured CNS, is still limited, making it difficult to interpret complex adaptive changes.
3
Plasticity is limited by the amount of spared tissue, and rehabilitative training often results in compensation rather than restoration.

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