University Health Network, Toronto Western Hospital, Toronto, ON M5T2S8, Canada.
Neurotherapeutics. 2011 Oct;8(4):704-20. doi: 10.1007/s13311-011-0076-7.
More than 1 million people in the United States live with a spinal cord injury (SCI). Despite medical advances, many patients with SCIs still experience substantial neurological disability, with loss of motor, sensory, and autonomic function. Cell therapy is ideally suited to address the multifactorial nature of the secondary events following SCI. Remarkable advances in our understanding of the pathophysiology of SCI, structural and functional magnetic resonance imaging, image-guided micro-neurosurgical techniques, and transplantable cell biology have enabled the use of cell-based regenerative techniques in the clinic. It is important to note that there are more than a dozen recently completed, ongoing, or recruiting cell therapy clinical trials for SCI that reflect the views of many key stakeholders. The field of regenerative neuroscience has reached a stage in which the clinical trials are scientifically and ethically justified. Although experimental models and analysis methods and techniques continue to evolve, no model will completely replicate the human condition. It is recognized that more work with cervical models of contusive/compressive SCI are required in parallel with clinical trials. It is also important that the clinical translation of advances made through well-established and validated experimental approaches in animal models move forward to meet the compelling needs of individuals with SCI and to advance the field of regenerative neuroscience. However, it is imperative that such efforts at translation be done in the most rigorous and informed fashion to determine safety and possible efficacy, and to provide key information to clinicians and basic scientists, which will allow improvements in regenerative techniques and the validation and refinement of existing preclinical animal models and research approaches. The field of regenerative neuroscience should not be stalled at the animal model stage, but instead the clinical trials need to be focused, safe, and ethical, backed up by a robust, translationally relevant preclinical research strategy.
美国有超过 100 万人患有脊髓损伤 (SCI)。尽管医学取得了进步,但许多 SCI 患者仍然存在严重的神经功能障碍,丧失运动、感觉和自主功能。细胞疗法非常适合解决 SCI 后继发事件的多因素性质。我们对 SCI 病理生理学、结构和功能磁共振成像、图像引导微神经外科技术以及可移植细胞生物学的理解的显著进展,使基于细胞的再生技术能够在临床上应用。值得注意的是,有十几个最近完成、正在进行或正在招募的 SCI 细胞治疗临床试验反映了许多主要利益相关者的观点。再生神经科学领域已经达到了临床试验在科学和伦理上都是合理的阶段。尽管实验模型和分析方法和技术仍在不断发展,但没有一种模型能够完全复制人类的情况。人们认识到,需要在临床试验的同时,用颈椎撞击/压迫性 SCI 模型进行更多的工作。同样重要的是,通过在动物模型中建立的成熟和经过验证的实验方法,将在临床前研究方面取得的进展转化为满足 SCI 患者的迫切需求,并推进再生神经科学领域,这一点也很重要。然而,至关重要的是,以最严格和最明智的方式进行这种转化工作,以确定安全性和可能的疗效,并为临床医生和基础科学家提供关键信息,这将允许再生技术的改进以及现有临床前动物模型和研究方法的验证和改进。再生神经科学领域不应停留在动物模型阶段,而是临床试验需要集中、安全和符合伦理,并由强大的、具有转化相关性的临床前研究策略支持。