Spinal cord injuries

Spinal cord injury is associated with the loss of both neurons and glial cells thus, stem cell-based therapy for reconstituting the injured spinal cord could be used to replace multiple cell types. 

The extent of spinal cord injury depends on the severity of the initial trauma as well as the level of subsequent injury. The primary impact of contusion injury triggers a cascade of secondary events including hemorrhage, ischemia, excitotoxicity 

The potential application of neural stem cells for spinal cord injury has been investigated by numerous studies. It has been reported that neural stem cells induced to neuronal differentiation by neurogenin-2 provided significant functional benefit following transplantation after contusion injury (Hof-stetter et al., 2005). Further, undifferentiated cells can achieve the regional appropriate phenotype specification in response to local signals in exclusive niches (Gage, 2000). 

The use of neural stem cells in remyelinating therapy has been explored by many researchers. Pluchino et al. (2003) successfully used adult neural stem cells to promote functional recovery in a multiple sclerosis model. Transplanted neural stem cells showed the ability to selectively reach the demy-elinating areas, where they differentiated into axon-ensheathing oligodendrocytes and achieved extensive remyehnation (Pluchino et al., 2003). 

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Adrenocortical insufficiency Organ transplants Liver disease Adrenogenital syndrome Nephrotic syndrome Acute spinal cord injury Hyp ere alemia Hematologic disorders Myasthenia gravis Neoplastic disease... 

Etiology Trauma, viral infections, ischemia, inflammation, genetic defects Neuropathy, genetic defects Peripheral inflammation, peripheral neuropathy, trauma, genetic defects, spinal cord injury, inflammation in the central nervous system ... 

Association of Pain, neuropathic pain is defined as pain initiated or caused by a primary lesion, dysfunction in the nervous system". Neuropathy can be divided broadly into peripheral and central neuropathic pain, depending on whether the primary lesion or dysfunction is situated in the peripheral or central nervous system. In the periphery, neuropathic pain can result from disease or inflammatory states that affect peripheral nerves (e.g. diabetes mellitus, herpes zoster, HIV) or alternatively due to neuroma formation (amputation, nerve transection), nerve compression (e.g. tumours, entrapment) or other injuries (e.g. nerve crush, trauma). Central pain syndromes, on the other hand, result from alterations in different regions of the brain or the spinal cord. Examples include tumour or trauma affecting particular CNS structures (e.g. brainstem and thalamus) or spinal cord injury. Both the symptoms and origins of neuropathic pain are extremely diverse. Due to this variability, neuropathic pain syndromes are often difficult to treat. Some of the clinical symptoms associated with this condition include spontaneous pain, tactile allodynia (touch-evoked pain), hyperalgesia (enhanced responses to a painful stimulus) and sensory deficits. 

Tso and Lam suggested that astaxanthin could be useful for prevention and treatment of neuronal damage associated with age-related macular degeneration and may also be effective in treating ischemic reperfusion injury, Alzheimer s disease, Parkinson s disease, spinal cord injuries, and other types of central nervous system injuries. Astaxanthin was found to easily cross the blood-brain barrier and did not form crystals in the eye. 

Hall, E.D., Braughler, J.M. and McCall, J.M. (1991a). Antioxidant effects in brain and spinal cord injury. J. Neurotrauma 9, 165-172. 

There have been a number of studies to evaluate the therapeutic effect of carmabinoids against spastic disorders, including multiple sclerosis and spinal cord injury. For example, a randomised placebo-controlled trial in more than... 

Venous stasis Major medical illness (e.g., congestive heart failure) Major surgery (e.g., general anesthesia for greater than 30 minutes) Paralysis (e.g., due to stroke or spinal cord injury) Polycythemia vera Obesity Varicose veins... 

Neurogenic conditions (brain trauma, spinal cord injury, cerebrovascular accident, Parkinson s disease)... 

Neuropathic pain is defined as spontaneous pain and hypersensitivity to pain associated with damage to or pathologic changes in the peripheral nervous system as in painful diabetic peripheral neuropathy (DPN), acquired immunodeficiency syndrome (AIDS), polyneuropathy, post-herpetic neuralgia (PHN) or pain originating in the central nervous system (CNS), that which occurs with spinal cord injury, multiple sclerosis, and stroke. Functional pain, a relatively newer concept, is pain sensitivity due to an abnormal processing or function of the central nervous system in response to normal stimuli. Several conditions considered to have this abnormal sensitivity or hyperresponsiveness include fibromyalgia and irritable bowel syndrome. 

People with any condition that can compromise respiratory function or the handling of respiratory secretions (i.e., a condition that makes it hard to breathe or swallow, such as brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders)... 

Pressures sores, also known as decubitous ulcers or bedsores, affect 1.5 to 3 million Americans annually.35 The cost of healing pressure sores can be substantial, with current estimates ranging from 2000 to 70,000 per wound.35 Although the prevalence of pressure sores is highest in long-term care facilities, 57% to 60% of new pressure sores actually develop in the hospital, most commonly in intensive-care and orthopedic patients. Elderly patients and those with spinal cord injuries are most at risk36... 

Tens of thousands of Americans, including 1 of every 12 persons with spinal cord injury, die each year as a result of complications relating to pressure sores.41 Most complications are infectious. The most common is osteomyelitis, which is present in approximately 38% of infected pressure sores.37 Less frequently, NF, clostridial myonecrosis, and sepsis can occur. 

Spinal shock Shock that occurs as a result of malfunction of the sympathetic nervous system after a spinal cord injury. 

Ronaghi M, Erceg S, Moreno-Manzano V, Stojkovic M (2010) Challenges of stem cell therapy for spinal cord injury Human embryonic stem cells, endogenous neural stem cells, or induced pluripotent stem cells Stem Cells 28 93-99... 

Nogo-A neutralizing antibodies lead to axonal growth and functional recovery in vivo. After cell culture experiments, the next step was to show the ability to block myelin inhibitors and achieve axonal regrowth after spinal cord injury. The monoclonal antibody IN-1 was initially raised against myelin fractions enriched for... 

Nogo-A. Treatment with IN-1 promoted axonal regeneration and behavioral recovery in rats after thoracic spinal cord injury. These exciting results have since been confirmed using local intrathecal pump infusions of recombinant IN-1 Fab fragments or novel anti-Nogo-A antibodies [9]. 

Another important aspect of this study was that the time window for starting the treatment was extended to 1 week after stroke, demonstrating that anti-Nogo therapy is effective even beyond the time of acute brain damage. These findings open the possibility of treatment options for those suffering from chronic brain or spinal cord injuries. 

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