Clinical Trials Targeting Secondary Damage after Traumatic Spinal Cord Injury

Abstract

Spinal cord injury (SCI) often causes loss of sensory and motor function resulting in a significant reduction in quality of life for patients. Currently, no therapies are available that can repair spinal cord tissue. After the primary SCI, an acute inflammatory response induces further tissue damage in a process known as secondary injury. Targeting secondary injury to prevent additional tissue damage during the acute and subacute phases of SCI represents a promising strategy to improve patient outcomes. Here, we review clinical trials of neuroprotective therapeutics expected to mitigate secondary injury, focusing primarily on those in the last decade. The strategies discussed are broadly categorized as acute-phase procedural/surgical interventions, systemically delivered pharmacological agents, and cell-based therapies. In addition, we summarize the potential for combinatorial therapies and considerations.

Effect of umbilical cord mesenchymal stem cells on hypoxia-inducible factor-1 alpha (HIF-1α) production in arteriovenous fistula (AVF) animal model: A preliminary study

“…These newly formed blood vessels may support the delivery of oxygen and nutrients to the surrounding tissues, reducing hypoxia and preventing IH formation [ 20 ]. Another possible mechanism is that UC-MSCs have immunomodulatory properties [ 21 ] which are important factors in IH development by modulating the immune response and can suppress inflammation in the vessel wall [ 22 ]. This anti-inflammatory effect may prevent the activation of smooth muscle cells and the subsequent proliferation of these cells, which is a key process in IH development [ 23 ].…”

Spinal cord tethering and syringomyelia after trauma: impact of age and surgical outcome

“…This adheres with recent investigations focusing on trauma severity and inflammatory state 20 , 21 , which may result in excessive scarring of the subarachnoid web and accelerated development of symptomatic spinal cord tethering and syringomyelia. Notably, several clinical trials targeting mediators of inflammation aim to reduce or omit secondary damage to the spinal cord following SCI and are currently a high intensity research area since the primary damage to the spinal cord can currently not be reversed or repaired 22 , 23 . Here, B cell lymphocytes might represent a new and promising target in neuromodulation of the central nervous system 24 .…”

Hydrogel scaffolds in the treatment of spinal cord injury: a review

“…However, due to the complex pathological mechanism of SCI, hydrogel treatment alone does not restore neurological function completely, and combined biologic factor and cellular hydrogel treatment is more effective than single treatment. Current hydrogel-based tissue engineering strategies involving scaffolds, cells, small molecules, and growth factors hold promise for SCI treatment ( Li et al, 2022 ; Khaing et al, 2023 ) ( Figure 4 ).…”