Hayta Emrullah, Elden Hasan
Cumhuriyet University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Sivas, Turkey.
Cumhuriyet University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Sivas, Turkey.
J Chem Neuroanat. 2018 Jan;87:25-31. doi: 10.1016/j.jchemneu.2017.08.001. Epub 2017 Aug 10.
Acute spinal cord injury (SCI) is one of the serious central nervous system injuries, which can lead to significant neurological impairments and a reduction in quality of life with loss in sensory and motor functions. Although recent advancements contribute to the understanding of the underlying pathophysiological processes developed after SCI, currently, there is limited innovative and effective treatment options besides conventional rehabilitation and management of SCI to alleviate the condition. Improvements in neurological functions of the individuals with SCI depend mainly on the mechanical damage occurring in the primary injury and on pathophysiological alterations associated with secondary damage. Since in the treatment of SCI, there are no therapeutic strategies for neurological alterations caused by primary injury, all innovative treatments utilize treatment strategies targeting to the secondary damage. Non-steroidal anti-inflammatory drugs (NSAIDs) have become the focus of various experimental SCI models as these may be expected to reduce inflammation in secondary damage due to their potent anti-inflammatory effects. Experimentally, they exhibit neuro-protective and apoptotic effects by suppressing axonal re-growth, thus inhibiting the RhoA pathway, which leads to apoptotic cell death, in addition to the recovery of motor functions along with histological improvement. However, histological improvement is not significantly associated with improvement of motor function. The main target of SCI research should not only focus on histological improvement of lesion, but also on its potential for contribution to effective clinical therapies targeting improvements in sensory and motor functions. In the present review, we have summarized the current knowledge about pathophysiologic mechanisms working after SCI and discussed the potential of NSAIDs as promising agents in the management of SCI.
急性脊髓损伤（SCI）是严重的中枢神经系统损伤之一，可导致显著的神经功能障碍，以及因感觉和运动功能丧失而导致的生活质量下降。尽管最近的进展有助于理解SCI后发生的潜在病理生理过程，但目前除了传统的SCI康复和管理外，创新且有效的治疗选择有限，难以缓解病情。SCI患者神经功能的改善主要取决于原发性损伤中的机械损伤以及与继发性损伤相关的病理生理改变。由于在SCI治疗中，对于原发性损伤引起的神经改变尚无治疗策略，所有创新治疗都采用针对继发性损伤的治疗策略。非甾体抗炎药（NSAIDs）已成为各种实验性SCI模型的研究重点，因为它们可能因其强大的抗炎作用而减少继发性损伤中的炎症。在实验中，它们通过抑制轴突再生表现出神经保护和凋亡作用，从而抑制RhoA途径，该途径除了能恢复运动功能并改善组织学外，还会导致凋亡性细胞死亡。然而，组织学改善与运动功能改善并无显著关联。SCI研究的主要目标不应仅关注损伤的组织学改善，还应关注其对以感觉和运动功能改善为目标的有效临床治疗的潜在贡献。在本综述中，我们总结了目前关于SCI后病理生理机制的知识，并讨论了NSAIDs作为SCI管理中有前景药物的潜力。
