Conclusions
•Most
preclinical data providing the rationales for clinical trials in SCI are based on:
–Effects
on embryonic neurons and axon growth cones in cell culture, which may not be a relevant model for
regeneration of mature CNS axons
–Effects
on hemisection or contusion models of partial spinal cord injury, in which assessment of regeneration is
often ambiguous
–Experiments
in rodents, which may not provide the scale of required regeneration distances to assess efficacy
in humans
•Nevertheless,
after many years of basic research, clinical trials for spinal cord repair are now under way.
•Most
trials are for neuroprotection. Even
when there is a regeneration
rationale, as in activated macrophages and Rho inhibitors, the strongest evidence is still
for neuroprotection.
•Bioethics
of highly invasive procedures are being addressed vigorously in the scientific community.
