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[Treatment of the future for spinal cord injuries]
1INSERM UNité 336 Développement, plasticité et viellissement du système nerveux (DPVSN), Montpellier.
Abstract:
Future therapy of spinal cord trauma is based on the careful analysis of pathophysiological phenomena secondary to the initial lesion. The toxicity of excitatory amino-acids, which is an early phenomenon, can be treated by specific antagonists. Axonal regrowth, which spontaneously occurs within days after the trauma must be supported by trophic factors on the one hand, and by blocking of the glial scar formation on the other hand. Finally, neuronal loss can be replaced by grafts either from embryonic neurons, or from genetically engineered cells, or direct gene therapy using viral vectors. Clinical applications are on their way for the early toxic phenomena, more remote for axonal regrowth and grafts. In any case, future treatment will have to use concurrently these three approaches, in specialized spinal units.
Insights
Future spinal cord trauma therapy involves targeting excitatory amino-acid toxicity, promoting axonal regrowth with trophic factors and blocking glial scars, and replacing neuronal loss via cell grafts or gene therapy.
Area of Science:
- Neuroscience
- Regenerative Medicine
- Cell Biology
Context:
- Spinal cord trauma triggers secondary pathophysiological events.
- Early toxicity from excitatory amino-acids is a key concern.
- Spontaneous axonal regrowth occurs but requires support.
Purpose:
- To outline a multi-pronged therapeutic strategy for spinal cord injury.
- To address early excitotoxicity, support axonal regeneration, and replace neuronal loss.
- To explore clinical applications of novel regenerative approaches.
Summary:
- Therapeutic strategies for spinal cord injury focus on mitigating secondary damage.
- Treatments include antagonists for excitatory amino-acid toxicity.
- Supporting axonal regrowth via trophic factors and inhibiting glial scarring is crucial.
- Neuronal replacement strategies involve embryonic cells, engineered cells, or gene therapy.
- Combined approaches are essential for future spinal cord repair.
Impact:
- Clinical applications for early toxic phenomena are emerging.
- Axonal regrowth and neuronal replacement therapies are in earlier stages of development.
- Integrated therapeutic strategies promise improved outcomes for spinal cord injury patients.
- Specialized spinal units will be vital for implementing these advanced treatments.