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sábado, 10 de abril de 2010

Treatment of spinal cord injury requires a multidisciplinary approach, surgeon says


Advances in the treatment of spinal cord injury are likely to involve a multidisciplinary approach that may include acute patient management optimization, pharmacologic interventions and cellular transplantation, according to a review article recently published in the Journal of the American Academy of Orthopaedic Surgeons.

Ranjan Gupta, MD, the lead author of the article, stated in an American Academy of Orthopaedic Surgeons (AAOS) press release that newer therapeutic approaches including stem cell therapy and novel drug formulations hold special promise for the management of patients with spinal cord injuries (SCI).
Secondary injuries

“Yet, spinal cord injuries are especially difficult to treat because they involve more than a direct injury to the spine,” Gupta, chair of the department of orthopedic surgery and professor of orthopedic surgery, anatomy and neurobiology, and biomedical engineering at the University of California, Irvine, stated in the release. “The primary mode of an SCI involves changes to the patient’s anatomy that occur as the result of the actual traumatic event. Secondary injuries may occur as a result of how the body responds to the primary injury, usually by producing scar tissue that can make treatment problematic.”

Gupta also noted that there are many promising areas of research related to these secondary injuries, and that there has been a renewed interest in stem cell transplantation under the current administration.

Stem cell trials

“Currently, the FDA has been more receptive to cellular transplantation trials, with one of the first trials being actively planned in the next 2 years,” he stated in the release. “While there have been several animal studies showing benefits from various pharmacological interventions, the human clinical trials are still pending.”
Gupta referred to ongoing clinical trials that continue to explore new multidisciplinary approaches to management of SCI.
“It is extremely unlikely that SCI will respond to one single intervention, or that there will be a ‘magic bullet,’” he stated in the release.
  • References:
Gupta R, Bathen ME, Smith JS, et al. Advances in the management of spinal cord injury. J Am Acad Orthop Surg. 2010;18(4):210-222.
Gupta or an immediate family member has received research or institutional support from Arthrex and National Institutes of Health (NIH)-NINDS.
The authors are to be commended for an excellent review of current treatment strategies, as well as active areas of ongoing research for the management of acute SCI. SCI is a devastating scenario, often the sequelae of traumatic injury to a relatively young patient population. Due to the coupling of a perceived lack of clinical advances in humans, yet multiple promising proposed therapeutic modalities in rodent models, this patient population is particularly vulnerable to an eagerness to enroll in highly experimental protocols, a fact appropriately noted by the authors. The vulnerability of this patient population highlights the need for close independent oversight of any clinical trial.
Recently, there have been a number of novel proposed cellular and pharmacologic therapies, coupled with an increased recognition and characterization of the complex chemical cascade of the secondary injury. In particular, the initiation of the clinical trial of cellular therapeutics based on the promising work of Keirstead and colleagues deserves special attention, as this trial represents a milestone. As noted by the authors, clinical enthusiasm must be matched with similar enthusiasm for carefully designed trials.

– Harvey E. Smith, MD
The Methodist Hospital, Houston, Texas


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