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Spinal Cord Injury: Progress, Promise, and Priorities
TABLE ES-1 Priorities for Spinal Cord Injury Research
Develop neuroprotection therapies: identify interventions that promote neuroprotective mechanisms that preserve the spinal cord.
Promote axonal sprouting and growth: enhance understanding of the molecular mechanisms that promote and inhibit axonal regeneration—including the roles of glia (astrocytes and oligodendrocytes), scar formation, and inflammation and inhibitory molecules—and develop therapeutic approaches to promote growth.
Steer axonal growth: determine the molecular mechanisms that direct axons to their appropriate targets and regulate the formation and maintenance of appropriate synaptic connections.
Reestablish essential neuronal and glial circuitry: advance the understanding of the molecular mechanisms that regulate the formation and maintenance of the intricate neuronal and glial circuitry, which controls the complex multimodal function of the spinal cord, including autonomic, sensory, and motor functions. Increase knowledge of the mechanisms that control locomotion, including the differences in the central pattern generator between bipeds and quadrupeds.
Prevent acute and chronic complications: develop interventions that prevent and reverse the evolution of events that lead to the wide range of outcomes that result from chronic injury and disability after a spinal cord injury.
Maintain maximal potential for recovery: expand the understanding of the requirements for proper postinjury care and rehabilitation that are needed to maintain the maximal potential for full recovery.
Recommendation 5.1:1Increase Efforts to Develop Therapeutic Interventions
The National Institutes of Health, other federal and state agencies, nonprofit organizations, and the pharmaceutical and medical device industries should increase research funding and efforts to develop therapeutic interventions that will prevent or reverse the physiological events that lead to chronic disability and interventions that are applicable to chronic spinal cord injuries. Specifically, research is needed to
improve understanding of the basic mechanisms and identify suitable targets to promote neuroprotection, foster axonal growth, enhance axonal guidance, regulate the maintenance of appropriate synaptic connections, and reestablish functional neuronal and glial circuitry; and
For ease of reference, the committee’s recommendations are numbered according to the chapter of the main text in which they appear followed by the order in which they appear in the chapter.