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  4. Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level

Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level

Brain, 2016 · DOI: 10.1093/brain/awv375 · Published: January 10, 2016

Spinal Cord InjuryImmunologyNeurology

Simple Explanation

Spinal cord injury (SCI) can lead to a weakened immune system, known as spinal cord injury-induced immune deficiency syndrome (SCI-IDS). This study investigates whether SCI-IDS increases the risk of pneumonia depending on the location of the spinal cord injury. The study found that high thoracic lesions, which disrupt the sympathetic innervation to major immune organs, significantly increased bacterial load in the lungs of mice. This suggests that the level of spinal cord injury affects the body's ability to fight off infection. The study also found that thoracic spinal cord injury level was confirmed as an independent increased risk factor of pneumonia in patients after motor complete spinal cord injury. This confirms the findings in mice, in humans.

Study Duration
Not specified
Participants
Mice and 1221 human SCI patients
Evidence Level
Level 1-2: Experimental study in mice and retrospective cohort study in humans

Key Findings

  • 1
    High thoracic spinal cord injuries in mice significantly increased bacterial load in the lungs, indicating increased susceptibility to pneumonia.
  • 2
    Injury to central pre-ganglionic sympathetic innervation to the spleen, but not peripheral postganglionic innervation, propagated immune susceptibility.
  • 3
    Thoracic spinal cord injury level was confirmed as an independent increased risk factor of pneumonia in patients after motor complete spinal cord injury.

Research Summary

This study investigates the link between spinal cord injury (SCI), a weakened immune system (SCI-IDS), and increased susceptibility to pneumonia, focusing on the impact of injury level on this relationship. Using a mouse model of induced pneumonia, the researchers found that high thoracic lesions, which interrupt sympathetic innervation to major immune organs, significantly increased bacterial load in the lungs. The study confirmed that thoracic spinal cord injury level is an independent risk factor for pneumonia in patients after motor complete SCI, reinforcing the experimental findings in a clinical setting.

Practical Implications

Clinical intervention

Targeting the sympathetic nervous system after SCI may help to improve immune function and reduce the risk of pneumonia.

Risk stratification

Identifying patients with high thoracic SCI as being at higher risk for pneumonia can help to guide preventative care and treatment strategies.

Further research

Further research is needed to fully understand the mechanisms underlying SCI-IDS and to develop effective interventions to prevent and treat it.

Study Limitations

  • 1
    The clinical observations are not population based.
  • 2
    The lower rate of pneumonia in low thoracic SCI might be related to better bacterial clearance of the respiratory tracts due to residual intercostal and abdominal motor function.
  • 3
    Concomitant effects of the hypothalamic-adrenal-pituitary gland (HPA)-axis are likely aggravating SCI-IDS

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