Setting the stage for functional repair of spinal cord injuries: a cast of thousands

• Published in: Spinal cord Vol. 43; no. 3; pp. 134 - 161
• Main Authors: RAMER, L. M, RAMER, M. S, STEEVES, J. D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01.03.2005; Nature Publishing Group
• Subjects: Animals; Biological and medical sciences; Cerebrospinal fluid. Meninges. Spinal cord; Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Medical sciences; Nerve Regeneration - physiology; Nervous system (semeiology, syndromes); Neurology; Neuronal Plasticity; Neuroprotective Agents - therapeutic use; Neurosurgery; Recovery of Function - physiology; Spinal Cord - drug effects; Spinal Cord - physiopathology; Spinal Cord - surgery; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - rehabilitation; Stem Cell Transplantation - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; spinal cord injury; Spinal cord; Nervous system diseases; Vertebral canal; Central nervous system; Transplantation; Regeneration; neuroprotection; Central nervous system disease; Plasticity; Rehabilitation; Repair; Spinal cord disease
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3101715

Here we review mechanisms and molecules that necessitate protection and oppose axonal growth in the injured spinal cord, representing not only a cast of villains but also a company of therapeutic targets, many of which have yet to be fully exploited. We next discuss recent progress in the fields of bridging, overcoming conduction block and rehabilitation after spinal cord injury (SCI), where several treatments in each category have entered the spotlight, and some are being tested clinically. Finally, studies that combine treatments targeting different aspects of SCI are reviewed. Although experiments applying some treatments in combination have been completed, auditions for each part in the much-sought combination therapy are ongoing, and performers must demonstrate robust anatomical regeneration and/or significant return of function in animal models before being considered for a lead role.