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Spinal Cord Injury: Progress, Promise, and Priorities
Progress in spinal cord injury research offers the potential to make significant improvements in the lives of individuals with spinal cord injuries. The challenges are to move research efforts forward in such a way as to accelerate the translation of the findings from research in the laboratory to clinical trials and then into clinical practice while ensuring patient safety and effectiveness. Although few therapeutic interventions are ready for clinical trials, the body of knowledge on the mechanisms underlying neuronal injury and repair is increasing rapidly, and many potential therapies show promise in in vitro studies and in studies with animals.
The committee believes that accelerating progress in spinal cord injury research involves the following three key efforts that, in addition to the recommendations for the New York State program, are the focus of the committee’s recommendations (Box ES-1) and highlight the need for a concerted national priority effort to find the best treatments for spinal cord injuries.
Focus on increasing knowledge of basic neurobiology and therapeutic approaches. Many research avenues remain to be examined in understanding the biochemical mechanisms responsible for spinal cord injuries and thus the targets of therapeutic interventions. Research is needed on the processes involved in maintaining cellular viability and the therapeutic targets for those processes, the mechanisms that promote and inhibit axon regeneration, and the processes by which axons are directed to their appropriate targets and that regulate the formation and maintenance of appropriate and functional synaptic connections and circuitry. As no one solution for spinal cord injuries likely exists, strategies need to be developed to provide an organized approach to testing and evaluating therapies in combination.
To conduct this research, new and refined technologies are needed. In addition, assessment measures need to be standardized to provide insights into potential therapeutic interventions. Efforts are needed to improve animal models and assessment techniques, increase training efforts on the use of standardized research tools and techniques, identify biomarkers that can be used to monitor the progression of injury and recovery, improve imaging technologies to provide a real-time means to assess spinal cord injuries, and standardize outcome measures for preclinical studies.
Emphasize and coordinate translational multidisciplinary research and clinical trials. Research on spinal cord injuries is now at the point at which the biological targets and pathways that can be the focus of interventions can be identified. The development of regional clinical trial networks, the bolstering of collaborative efforts between basic and clinical researchers through the development of research centers, as well as the development of