Abstract
Spinal Cord Injury (SCI) is a major challenge in Neurotrauma research. Complex pathophysiological processes take place immediately after the injury and later on as the chronic injury develops. Moreover, SCI is usually accompanied by traumatic injuries because the most common modality of injury is road traffic accidents and falls. Patients develop significant permanent neurological deficits that depend on the extent and the location of the injury itself and in time they develop further neurological and body changes that may risk their mere survival. In our review, we explored the recent updates with regards to SCI biomarkers. We observed two methods that may lead to the appearance of biomarkers for SCI. First, during the first few weeks following the injury the Blood Spinal Cord Barrier (BSCB) disruption that releases several neurologic structure components from the injured tissue. These components find their way to Cerebrospinal Fluid (CSF) and the systemic circulation. Also, as the injury develops several components of the pathological process are expressed or released such as in neuroinflammation, apoptosis, reactive oxygen species, and excitotoxicity sequences. Therefore, there is a growing interest in examining any correlations between these components and the degrees or the outcomes of the injury. Additionally, some of the candidate biomarkers are theorized to track the progressive changes of SCI which offers an insight on the patients' prognoses, potential-treatments-outcomes assessment, and monitoring the progression of the complications of chronic SCI such as Pressure Ulcers and urinary dysfunction. An extensive literature review was performed covering literature, published in English, until February 2018 using the Medline/PubMed database. Experimental and human studies were included and titles, PMID, publication year, authors, biomarkers studies, the method of validation, relationship to SCI pathophysiology, and concluded correlation were reported. Potential SCI biomarkers need further validation using clinical studies. The selection of the appropriate biomarker group should be made based on the stage of the injuries, the accompanying trauma and with regards to any surgical, or medical interference that might have been done. Additionally, we suggest testing multiple biomarkers related to the several pathological changes coinciding to offer a more precise prediction of the outcome.
Highlights
Spinal Cord Injury (SCI) remains one of the most devastating and difficult to manage medical pathologies despite the tremendous progress in neuroscience and neurosurgery
Biomarker discovery using proteomics is generally done using a “shotgun” approach, where protein quantities are assessed using mass spectrometry or microarray-based techniques often combined with gel electrophoresis of tissue or Cerebrospinal Fluid (CSF) samples taken from SCI patients and compared to control groups [80, 81]
Medical care decisions would become more personal and tailored to each case, which minimizes unnecessary interventions and makes patient followup easier. Such tools would be helpful in providing health care for SCI patients in developing countries that lack sophisticated medical resources
Summary
Spinal Cord Injury (SCI) remains one of the most devastating and difficult to manage medical pathologies despite the tremendous progress in neuroscience and neurosurgery. During the chronic phase of SCI, these substances form a physical and chemical barrier known as the glial scar, which inhibits axon regeneration Another significant process that develops after injury is oxidative stress. We prioritize discussing clinically significant and reliable biomarkers that have the potential to predict recovery after SCI, distinguish an array of severities, monitor complications, and estimate neurological and non-neurological prognoses. Animal experiments may show some significance regarding the correlation between the biomarkers and recovery status, the translation of utilizing these biomarkers for making sensitive and specific predictions might still be troublesome These challenges can be attributed to the differences in the nature of SCI between humans and experimental animal models, as human SCIs usually present in variable severities and often in the context of polytrauma. We discuss the current status of biomarkers of SCI-related complications and what needs to be addressed in chronic SCI patient populations
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