Potential neuroprotective therapies in traumatic acute spinal injury: an integrative review

doi:10.37118/ijdr.23320.11.2021

Abstract

Introduction: Acute traumatic spinal cord injury is a complex injury affecting the nervous tissue of the spinal cord, vertebrae, joints, innervation and local vasculature, resulting in high mortality, physical dependence, stress, financial losses, lifelong risk of medical complications and reduced longevity. The complexity of the clinical repercussions of acute spinal cord trauma (SCI) makes early interventions necessary to ensure better prognosis. Emerging therapies with neuroprotective agents emerge 1,2,3 Methodology: For the integrative literature review, the PubMed databases were used, Scielo, Google Scholar, Cochrane and the descriptors “spinal injury”; “spinal cord trauma”; “neuroprotective” and “drug therapy”. Results: Therapies with corticosteroids, ion channel blockers, agonists and antagonists of neurotransmitters, cellular and genetic agents, vitamin D, progesterone, erythropoietin and caspase inhibitors demonstrated different neuroprotective effects involving reduction of secondary spinal cord injury and acceleration of neuronal recovery. in uneven research phases. Conclusion: It is concluded that preclinical studies with neuroprotectors as a potential treatment for TRM are promising, however, not all of them evolve into clinical trials, which limits the application of these therapies in humans. Therefore, it is necessary to improve research and clinical trials related to the use of neuroprotective agents in the management of traumatic acute spinal cord injury.

Highlights

Acute spinal cord injury of traumatic origin or spinal cord trauma (SCI) is a complex injury that affects the nervous tissue of the spinal cord, which can affect vertebrae, joints, innervation and local vasculature, resulting in high mortality rates or serious sequelae that generate physical dependence, psychological stress, financial losses, significantly increased risk of lifelong medical complications and reduced life expectancy. 1 More than 50% of patients who suffer a traumatic spinal cord injury may not recover their normal function and the population most commonly affected are healthy young people between 15 and 25 years
The experiment demonstrated the neuroprotective effects of isolated and combined therapies with dantrolene and mesenchymal stem cells through the early initiation of neurological and functional recovery in animals soon after acute spinal cord trauma compared to animals using placebo
It is concluded that research aimed at acute spinal cord injury of traumatic origin faces several obstacles that hinder the evolution of therapy with neuroprotective agents and its application in clinical practice

Summary

Introduction

Acute spinal cord injury of traumatic origin or spinal cord trauma (SCI) is a complex injury that affects the nervous tissue of the spinal cord, which can affect vertebrae, joints, innervation and local vasculature, resulting in high mortality rates or serious sequelae that generate physical dependence, psychological stress, financial losses, significantly increased risk of lifelong medical complications and reduced life expectancy. 1 More than 50% of patients who suffer a traumatic spinal cord injury may not recover their normal function and the population most commonly affected are healthy young people between 15 and 25 years. Data from Canada indicate that the total lifetime costs of a patient with a spinal cord injury exceeds $3 million. The extravasation of immune cells at the site of injury creates increased pressure on spinal tissues and produces vasospasms, leading to further interruption of local blood flow. Neuronal ischemia and inflammation caused by the penetration of immune cells and inflammatory cytokines into spinal tissues result in vasogenic edema that culminates in cell death and tissue necrosis. All of these processes lead to free radical formation and excitotoxicity through excessive release and impaired glutamate uptake, which

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