Abstract
Spinal cord injury (SCI) is a central nervous system- (CNS-) related disorder for which there is yet no successful treatment. Within the past several years, cell-based therapies have been explored for SCI repair, including the use of pluripotent human stem cells, and a number of adult-derived stem and mature cells such as mesenchymal stem cells, olfactory ensheathing cells, and Schwann cells. Although promising, cell transplantation is often overturned by the poor cell survival in the treatment of spinal cord injuries. Alternatively, the therapeutic role of different cells has been used in tissue engineering approaches by engrafting cells with biomaterials. The latter have the advantages of physically mimicking the CNS tissue, while promoting a more permissive environment for cell survival, growth, and differentiation. The roles of both cell- and biomaterial-based therapies as single therapeutic approaches for SCI repair will be discussed in this review. Moreover, as the multifactorial inhibitory environment of a SCI suggests that combinatorial approaches would be more effective, the importance of using biomaterials as cell carriers will be herein highlighted, as well as the recent advances and achievements of these promising tools for neural tissue regeneration.
Highlights
Spinal cord injury (SCI) is a devastating condition that often leads to permanent functional and neurological deficits in injured individuals
The inability of the adult CNS to regenerate is not completely understood regarding the mechanisms that are responsible for repressing axonal regeneration and spinal cord functional recovery
We focused on some the most promising therapies currently used for SCI repair: cell- and biomaterial-based therapies and their conjugation
Summary
SCI is a devastating condition that often leads to permanent functional and neurological deficits in injured individuals. The limited ability of the CNS to spontaneously regenerate, mainly due to the establishment of an inhibitory environment around the lesion site and to the formation of a dense scar tissue, impairs axonal regeneration and functional recovery of the spinal cord [1,2,3]. Upon evaluation of the severity of the damage, the lesion is broadly characterized as complete or incomplete [8, 9], with distinct clinical implications to the patients (e.g., paralysis, sensory loss, intractable pain, pressure sores, and urinary/other infections) [5, 8]. The combination of biomaterials with cell transplantation is being widely explored in the scope of SCI In this context, biomaterials are expected to stabilize the lesion site, while directly delivering the cells into it, and provide an adequate environment for the regeneration of the injured tissues. A discussion on the potential of these therapies for SCI regeneration will be the starting point, after which the contributions of biomaterials for the development of more efficient cell-based therapies will be discussed
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