Review
Spinal Cord (2009) 47, 716–726; doi:10.1038/sc.2009.52; published online 14 July 2009
A review of published reports on neuroprotection in spinal cord injury
G Onose1, A Anghelescu1, D F Muresanu2, L Padure3, M A Haras1, C O Chendreanu1, L V Onose4, A Mirea1, A V Ciurea5, W S El Masri6 and K R H von Wild7
- 1The Clinic Division of Physical & Rehabilitation Medicine, Emergency Hospital 'Bagdasar-Arseni', Bucharest, Romania
- 2The Neurological Clinic of the 'Iuliu Hatieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 3The National Clinical Center for Pediatric Rehabilitation, Bucharest, Romania
- 4The Medical Service of Metrorex, Bucharest, Romania
- 5The Ist Clinic Division of Neurosurgery, Emergency Hospital 'Bagdasar-Arseni', Bucharest, Romania
- 6Midlands Center for Spinal Injuries, Oswestry, UK
- 7Medical Faculty of the Westfälische Wilhelms University, Münster, Germany
Correspondence: Professor G Onose, The Clinic Division of Physical & Rehabilitation Medicine of the Emergency Hospital 'Bagdasar-Arseni', Berceni Av. no.12, 041915 Bucharest, Romania. E-mail: geluonose@clicknet.ro
Received 29 August 2008; Revised 12 March 2009; Accepted 4 April 2009; Published online 14 July 2009.
Abstract
Study design:
Literature review.
Objectives:
To review the main published current neuroprotection research trends and results in spinal cord injury (SCI).
Setting:
This paper is the result of a collaboration between a group of European scientists.
Methods:
Recent studies, especially in genetic, immune, histochemical and bio (nano)-technological fields, have provided new insight into the cellular and molecular mechanisms occurring within the central nervous system (NS), including SCIs. As a consequence, a new spectrum of therapies aiming to antagonize the 'secondary injury' pathways (that is, to provide neuroprotection) and also to repair such classically irreparable structures is emerging. We reviewed the most significant published works related to such novel, but not yet entirely validated, clinical practice therapies.
Results:
There have been identified many molecules, primarily expressed by heterogenous glial and neural subpopulations of cells, which are directly or indirectly critical for tissue damaging/sparing/re-growth inhibiting, angiogenesis and neural plasticity, and also various substances/energy vectors with regenerative properties, such as MAG (myelin-associated glycoprotein), Omgp (oligodendrocyte myelin glycoprotein), KDI (synthetic: Lysine–Asparagine–Isoleucine '
-1 of Laminin Kainat Domain'), Nogo (Neurite outgrowth inhibitor), NgR (Nogo protein Receptor), the Rho signaling pathway (superfamily of 'Rho-dopsin gene—including neurotransmitter—receptors'), EphA4 (Ephrine), GFAP (Glial Fibrillary Acidic Protein), different subtypes of serotonergic and glutamatergic receptors, antigens, antibodies, immune modulators, adhesion molecules, scavengers, neurotrophic factors, enzymes, hormones, collagen scar inhibitors, remyelinating agents and neurogenetic/plasticity inducers, all aiming to preserve/re-establish the morphology and functional connections across the lesion site. Accordingly, modern research and experimental SCI therapies focus on several intricate, rather overlapping, therapeutic objectives and means, such as neuroprotective, neurotrophic, neurorestorative, neuroreparative, neuroregenerative, neuro(re)constructive and neurogenetic interventions.
Conclusion:
The first three of these therapeutical directions are generically assimilated as neuroprotective, and are synthetically presented and commented in this paper in an attempt to conceptually systematize them; thus, the aim of this article is, by emphasizing the state-of-the art in the domain, to optimize theoretical support in selecting the most effective pharmacological and physical interventions for preventing, as much as possible, paralysis, and for maximizing recovery chances after SCI.
Keywords:
SCI, neuroprotection, neuroregeneration, recovery
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