Translational Regenerative Therapies for Chronic Spinal Cord Injury

Abstract

Spinal cord injury is a chronic and debilitating neurological condition that is currently being managed symptomatically with no real therapeutic strategies available. Even though there is no consensus on the best time to start interventions, the chronic phase is definitely the most stable target in order to determine whether a therapy can effectively restore neurological function. The advancements of nanoscience and stem cell technology, combined with the powerful, novel neuroimaging modalities that have arisen can now accelerate the path of promising novel therapeutic strategies from bench to bedside. Several types of stem cells have reached up to clinical trials phase II, including adult neural stem cells, human spinal cord stem cells, olfactory ensheathing cells, autologous Schwann cells, umbilical cord blood-derived mononuclear cells, adult mesenchymal cells, and autologous bone-marrow-derived stem cells. There also have been combinations of different molecular therapies; these have been either alone or combined with supportive scaffolds with nanostructures to facilitate favorable cell–material interactions. The results already show promise but it will take some coordinated actions in order to develop a proper step-by-step approach to solve impactful problems with neural repair.

Rehabilitation of patients in late period after spinal cord injury: a meta-analysis of literature data

“…Возможности и перспективы регенераторной медицины в хронической фазе травматической болезни спинного мозга показаны в статье Dalamagkas et al [22]. Для отдаленного периода травмы характерно завершение процессов воспаления, нейропластичности и спонтанной регенерации.…”

“…Регенераторные технологии, перспективные для внедрения в клинику: нейросферы -популяции нервных стволовых клеток человека, которые способны обновляться и дифференцироваться в основные типы клеток ЦНС после культивирования в течение нескольких поколений; леска из биоматериала и нейрональных стволовых клеток для создания перекидного моста на уровне повреждения; трансплантация шванновских клеток и мононуклеарных клеток пуповинной крови; бактериальный энзим, воздействующий на рубцовую ткань; генная терапия с использованием модифицированного гена хондроитиназы; наноструктурные матрицы на основе оксида графена, фибрина и гидрогеля; биоматериал на основе хитозана и ламинина. В настоящее время эти технологии являются экспериментальными с клиническими случаями наблюдения, показания и методы их применения не определены [22].…”

Acidic Fibroblast Growth Factor in Spinal Cord Injury

“…Thus, patients with chronic phase SCI are good targets to determinate whether a therapy is effective or not. 9…”

Transplantation or Transference of Cultured Cells as a Treatment for Spinal Cord Injury

“…In several studies, it was seen that after sciatic nerve crush, the axons were able to rapidly grow back to their targets, also redundant myelin was removed and replaced with new myelin surrounding the regenerated axons, resulting in a generally normal tissue at an impressive speed (3-4 weeks) [14,19]. On the other hand, crushing the SC results in the formation of a lesion filled with fluid or matrix leading to axonal retraction, permanency of myelin debris and absence of axonal regeneration [20]. In the PNS, the injury triggers a broad set of changes in the differentiation of both injured neurons and SC's, causing neurons to switch their function from cell to cell signaling to axonal growth and SC's change their function from axonal maintenance to support axonal regeneration [18,21,22].…”