Division of Plastic Surgery, Department of Surgery, Oulu University, Oulu, Finland.
Center for Minimally Invasive Therapeutics (C-MIT), Los Angeles, California.
Tissue Eng Part B Rev. 2019 Dec;25(6):471-491. doi: 10.1089/ten.TEB.2019.0182. Epub 2019 Oct 23.
Spinal cord injury (SCI) is a serious problem that primarily affects younger and middle-aged adults at its onset. To date, no effective regenerative treatment has been developed. Over the last decade, researchers have made significant advances in stem cell technology, biomaterials, nanotechnology, and immune engineering, which may be applied as regenerative therapies for the spinal cord. Although the results of clinical trials using specific cell-based therapies have proven safe, their efficacy has not yet been demonstrated. The pathophysiology of SCI is multifaceted, complex and yet to be fully understood. Thus, combinatorial therapies that simultaneously leverage multiple approaches will likely be required to achieve satisfactory outcomes. Although combinations of biomaterials with pharmacologic agents or cells have been explored, few studies have combined these modalities in a systematic way. For most strategies, clinical translation will be facilitated by the use of minimally invasive therapies, which are the focus of this review. In addition, this review discusses previously explored therapies designed to promote neuroregeneration and neuroprotection after SCI, while highlighting present challenges and future directions. Impact Statement To date there are no effective treatments that can regenerate the spinal cord after injury. Although there have been significant preclinical advances in bioengineering and regenerative medicine over the last decade, these have not translated into effective clinical therapies for spinal cord injury. This review focuses on minimally invasive therapies, providing extensive background as well as updates on recent technological developments and current clinical trials. This review is a comprehensive resource for researchers working towards regenerative therapies for spinal cord injury that will help guide future innovation.
脊髓损伤（SCI）是一个严重的问题，主要在发病时影响年轻和中年成年人。迄今为止，尚未开发出有效的再生治疗方法。在过去的十年中，研究人员在干细胞技术、生物材料、纳米技术和免疫工程方面取得了重大进展，这些技术可能被应用于脊髓的再生治疗。尽管使用特定细胞疗法的临床试验结果已被证明是安全的，但它们的疗效尚未得到证实。SCI 的病理生理学是多方面的、复杂的，尚未完全理解。因此，可能需要同时利用多种方法的组合疗法才能达到满意的效果。尽管已经探索了生物材料与药物制剂或细胞的组合，但很少有研究以系统的方式将这些方式结合起来。对于大多数策略，微创疗法的使用将促进其临床转化，这是本综述的重点。此外，本综述还讨论了以前探索的旨在促进 SCI 后神经再生和神经保护的治疗方法，同时强调了当前的挑战和未来的方向。
影响说明 迄今为止，尚无有效的治疗方法可以在损伤后再生脊髓。尽管在过去的十年中，生物工程和再生医学领域取得了重大的临床前进展，但这些进展并未转化为有效的脊髓损伤临床治疗方法。本综述重点关注微创疗法，提供了广泛的背景以及最近技术发展和当前临床试验的最新信息。对于致力于脊髓损伤再生治疗的研究人员来说，这是一个全面的资源，将有助于指导未来的创新。
