Abstract
Every year, 0.93 million people worldwide suffer from spinal cord injury (SCI) with irretrievable sequelae. Rehabilitation, currently the only available treatment, does not restore damaged tissues; therefore, the functional recovery of patients remains limited. The pathophysiology of spinal cord injuries is heterogeneous, implying that potential therapeutic targets differ depending on the time of injury onset, the degree of injury, or the spinal level of injury. In recent years, despite a significant number of clinical trials based on various types of stem cells, these aspects of injury have not been effectively considered, resulting in difficult outcomes of trials. In a specialty such as cancerology, precision medicine based on a patient’s characteristics has brought indisputable therapeutic advances. The objective of the present review is to promote the development of precision medicine in the field of SCI. Here, we first describe the multifaceted pathophysiology of SCI, with the temporal changes after injury, the characteristics of the chronic phase, and the subtypes of complete injury. We then detail the appropriate targets and related mechanisms of the different types of stem cell therapy for each pathological condition. Finally, we highlight the great potential of stem cell therapy in cervical SCI.
Highlights
Spinal cord injury (SCI) affects 0.93 million (0.78–1.16 million) people worldwide each year [1], leaving irretrievable debilitating sequelae
Stem cells, which have pluripotency and renewal ability and are rich in trophic factors, have been attracting attention as a source of effective treatment for various diseases, and clinical trials with many different types of stem cells have already been conducted for SCI [3,4,5,6]
Neurotrophic factors secreted by MSCs have been shown to exert a therapeutic effect on the lesion [23,24]. This category of stem cell therapy with various types of MSCs, which we will refer to as supportive stem cell therapy in this review, constitutes the vast majority of clinical trials or studies in the field of SCI [18,19,20,25,26,27,28,29,30,31,32,33]
Summary
Spinal cord injury (SCI) affects 0.93 million (0.78–1.16 million) people worldwide each year [1], leaving irretrievable debilitating sequelae. We categorize stem cell therapies that have been proposed for SCI and carefully refer to the pathophysiology of various spinal cord injuries. This condition is considered the most difficult to treat, some recent studies have suggested that non-functional neural tissue remaining even in such so-called complete injury can provide some functional recovery once reactivated with appropriate treatment. One of the objectives of this review is to discuss the possibility of stem cell therapy in this specific subtype of complete chronic injury, which has not been discussed so far and remains unexplored. We will discuss what can be expected from stem cell therapy for cervical spinal cord injuries
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