Oudega M, Bradbury E J, Ramer M S
Departments of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Handb Clin Neurol. 2012;109:617-36. doi: 10.1016/B978-0-444-52137-8.00038-3.
Spinal cord injury (SCI) has multiple consequences, ranging from molecular imbalances to glial scar formation to functional impairments. It is logical to think that a combination of single treatments implemented in the right order and at the right time will be required to repair the spinal cord. However, the single treatments that compose the combination therapy will need to be chosen with caution as many have multiple outcomes that may or may not be synergistic. Single treatments may also elicit unwanted side-effects and/or effects that would decrease the repair potential of other components and/or the entire combination therapy. In this chapter a number of single treatments are discussed with respect to their multiplicity of action. These include strategies to boost growth and survival (such as neurotrophins and cyclic AMP) and strategies to reduce inhibitory factors (such as antimyelin-associated growth inhibitors and digestion of glial scar-associated inhibitors). We also present an overview of combination therapies that have successfully or unsuccessfully been tested in the laboratory using animal models. To effectively design a combination therapy a number of considerations need to be made such as the nature and timing of the treatments and the method for delivery. This chapter discusses these issues as well as considerations related to chronic SCI and the logistics of bringing combination therapies to the clinic.
脊髓损伤（SCI）会产生多种后果，从分子失衡到胶质瘢痕形成，再到功能障碍。由此推断，要修复脊髓，需要按正确顺序并在恰当时间实施多种单一治疗方法的组合。然而，组成联合疗法的单一治疗方法需谨慎选择，因为许多单一治疗方法具有多种结果，这些结果可能具有协同作用，也可能没有。单一治疗方法还可能引发不良副作用和/或产生会降低其他成分和/或整个联合疗法修复潜力的效应。在本章中，将讨论一些单一治疗方法的多重作用。这些方法包括促进生长和存活的策略（如神经营养因子和环磷酸腺苷）以及减少抑制因子的策略（如抗髓磷脂相关生长抑制剂和消化胶质瘢痕相关抑制剂）。我们还概述了在实验室中使用动物模型成功或未成功测试的联合疗法。为了有效设计联合疗法，需要考虑诸多因素，如治疗方法的性质和时机以及给药方式。本章将讨论这些问题以及与慢性脊髓损伤相关的考虑因素，还有将联合疗法应用于临床的相关事宜。
