Activity-Based Physical Rehabilitation with Adjuvant Testosterone to Promote Neuromuscular Recovery after Spinal Cord...

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Endocrinology

Background:

• Spinal cord injury (SCI) causes significant neuromuscular impairment and reduced musculoskeletal integrity, hindering locomotor recovery.
• Activity-based therapies (ABTs) promote neuromuscular plasticity but their efficacy decreases with SCI severity.
• Low testosterone levels in men with SCI can worsen neuromusculoskeletal deficits.

Purpose of the Study:

• To review the molecular deficits contributing to muscle loss post-SCI.
• To examine the individual effects of testosterone and locomotor training on neuromuscular function and musculoskeletal integrity after SCI.
• To explore the potential of a combined therapy of ABT and testosterone for enhanced SCI recovery.

Main Methods:

• Literature review of studies on SCI, neuromuscular function, and testosterone therapy.
• Analysis of molecular mechanisms underlying muscle atrophy and fiber-type changes post-SCI.
• Evaluation of preclinical data on testosterone and ABT efficacy, individually and in combination.

Main Results:

• Testosterone can attenuate muscle loss and slow-to-fast fiber-type transition post-SCI, independent of mechanical strain.
• Testosterone promotes motoneuron survival, contributing to potential neuroplasticity.
• While testosterone alone shows limited functional improvement in rodent models, it holds promise as an adjuvant therapy.

Conclusions:

• A multimodal approach combining activity-based therapies with adjuvant testosterone may offer superior neuromusculoskeletal recovery compared to either intervention alone.
• Understanding the hormonal and molecular mechanisms of testosterone and ABTs is crucial for optimizing SCI rehabilitation strategies.
• Further research is warranted to validate the efficacy of combined ABT and testosterone therapy in clinical settings.