Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms

Multi-target neural circuit reconstruction and enhancement in spinal cord injury

After spinal cord injury, impairment of the sensorimotor circuit can lead to dysfunction in the motor, sensory, proprioceptive, and autonomic nervous systems. Functional recovery is often hindered by constraints on the timing of interventions, combined with the limitations of current methods. To address these challenges, various techniques have been developed to aid in the repair and reconstruction of neural circuits at different stages of injury. Notably, neuromodulation has garnered considerable attention for its potential to enhance nerve regeneration, provide neuroprotection, restore neurons, and regulate the neural reorganization of circuits within the cerebral cortex and corticospinal tract. To improve the effectiveness of these interventions, the implementation of multi-target early interventional neuromodulation strategies, such as electrical and magnetic stimulation, is recommended to enhance functional recovery across different phases of nerve injury. This review concisely outlines the challenges encountered following spinal cord injury, synthesizes existing neurostimulation techniques while emphasizing neuroprotection, repair, and regeneration of impaired connections, and advocates for multi-targeted, task-oriented, and timely interventions.

Recent advances in nanotechnology for repairing spinal cord injuries

Spinal cord injury (SCI) remains a formidable clinical challenge with limited therapeutic options. Recent advances in nanotechnology have introduced paradigm-shifting strategies that transcend the limitations of traditional treatments by offering precision, controllability, and multifunctionality in modulating the hostile post-injury microenvironment. This review systematically summarizes nanotechnology-based therapeutic approaches for SCI, including cell-based nanotherapeutics, nanogels/hydrogels, nano-engineered materials, and combinatorial strategies. We emphasize the synergistic design of multifunctional nanoplatforms that integrate neuroprotection, immune modulation, antioxidative capacity, and axonal regeneration within a single system. Special attention is given to microenvironment-responsive smart materials capable of dynamic therapeutic delivery in response to pathological cues. We critically analyze the challenges of clinical translation, such as the need for standardized safety evaluation and personalized therapeutic dosing, and explore emerging solutions including AI-driven nanocarrier design and organoid-based validation. By integrating interdisciplinary innovations, nanotherapies represent an irreplaceable therapeutic paradigm with the potential to achieve spatiotemporal precision and sustained regenerative support for SCI repair.

Nerve root magnetic stimulation regulates the synaptic plasticity of injured spinal cord by ascending sensory pathway

JOURNAL/nrgr/04.03/01300535-202512000-00026/figure1/v/2025-01-31T122243Z/r/image-tiff Promoting synaptic plasticity and inducing functional reorganization of residual nerve fibers hold clinical significance for restoring motor function following spinal cord injury. Neuromagnetic stimulation targeting the nerve roots has been shown to improve motor function by enhancing nerve conduction in the injured spinal cord and restoring the synaptic ultrastructure of both the sensory and motor cortex. However, our understanding of the neurophysiological mechanisms by which nerve root magnetic stimulation facilitates motor function recovery in the spinal cord is limited, and its role in neuroplasticity remains unclear. In this study, we established a model of spinal cord injury in adult male Sprague-Dawley rats by applying moderate compression at the T10 vertebra. We then performed magnetic stimulation on the L5 nerve root for 3 weeks, beginning on day 3 post-injury. At day 22 post-injury, we observed that nerve root magnetic stimulation downregulated the level of interleukin-6 in the injured spinal cord tissue of rats. Additionally, this treatment reduced neuronal damage and glial scar formation, and increased the number of neurons in the injured spinal cord. Furthermore, nerve root magnetic stimulation decreased the levels of acetylcholine, norepinephrine, and dopamine, and increased the expression of synaptic plasticity-related mRNA and proteins PSD95, GAP43, and Synapsin II. Taken together, these results showed that nerve root magnetic stimulation alleviated neuronal damage in the injured spinal cord, regulated synaptic plasticity, and suppressed inflammatory responses. These findings provide laboratory evidence for the clinical application of nerve root magnetic stimulation in the treatment of spinal cord injury.

Pharmacological targeting cGAS/STING/NF-κB axis by tryptanthrin induces microglia polarization toward M2 phenotype and promotes functional recovery in a mouse model of spinal cord injury

JOURNAL/nrgr/04.03/01300535-202511000-00031/figure1/v/2024-12-20T164640Z/r/image-tiff The M1/M2 phenotypic shift of microglia after spinal cord injury plays an important role in the regulation of neuroinflammation during the secondary injury phase of spinal cord injury. Regulation of shifting microglia polarization from M1 (neurotoxic and proinflammatory type) to M2 (neuroprotective and anti-inflammatory type) after spinal cord injury appears to be crucial. Tryptanthrin possesses an anti-inflammatory biological function. However, its roles and the underlying molecular mechanisms in spinal cord injury remain unknown. In this study, we found that tryptanthrin inhibited microglia-derived inflammation by promoting polarization to the M2 phenotype in vitro . Tryptanthrin promoted M2 polarization through inactivating the cGAS/STING/NF-κB pathway. Additionally, we found that targeting the cGAS/STING/NF-κB pathway with tryptanthrin shifted microglia from the M1 to M2 phenotype after spinal cord injury, inhibited neuronal loss, and promoted tissue repair and functional recovery in a mouse model of spinal cord injury. Finally, using a conditional co-culture system, we found that microglia treated with tryptanthrin suppressed endoplasmic reticulum stress-related neuronal apoptosis. Taken together, these results suggest that by targeting the cGAS/STING/NF-κB axis, tryptanthrin attenuates microglia-derived neuroinflammation and promotes functional recovery after spinal cord injury through shifting microglia polarization to the M2 phenotype.

Rab27a-mediated extracellular vesicle release drives astrocytic CSPG secretion and glial scarring in spinal cord injury

Traumatic spinal cord injury (SCI) prevents axonal regeneration by impairing neuronal function and causing glial scarring. Chondroitin sulfate proteoglycans (CSPGs) from astrocytes drive this process, yet the release mechanism, potentially involving extracellular vesicles (EVs), remains unclear. Rab27a releases EVs from multivesicular bodies (MVBs) by enabling their docking and fusion with the plasma membrane. We confirmed Rab27a expression, and its localization, subsequently, EV release was validated with CD9, Alix, and TSG101 markers. Rab27a-mediated EV release was confirmed in both Rab27a-induced and Rab27a-siRNA-treated cells. Rab27a-derived EVs inhibited neuronal cell growth, while Rab27a-siRNA EVs promoted neuronal growth. Our study also observed upregulated Rab27a expression in the rat contusion model of SCI. Further analysis showed increased CSPG expression in Rab27a-induced conditions via the Rho/ROCK pathway, with altered pAkt, and β-tubulin III, levels. Immunohistochemistry confirmed CSPG/Rab27a/GFAP and CSPG/CD9 co-localization in tissue sections, verifying that Rab27a mediates EV release containing CSPG from astrocytes. These findings suggest that Rab27a plays a crucial role in CSPG release via EVs and scar formation. Functional recovery was significantly improved with Rab27a-siRNA treatment, suggesting Rab27a as a potential target for astrocytic scar modulation in SCI. The study reveals the detailed mechanistic insight of Rab27a-dependent CSPG release via EVs for sub-acute scar formation in contusion SCI.

Tetramethylpyrazine exerts a neuroprotective effect in acute spinal cord injury by mitigating oxidative stress through PKD1: Multi-omics analysis and experimental validation

BACKGROUND

Spinal cord injury (SCI) leads to permanent paralysis, with no current treatments capable of enhancing neurological recovery. Tetramethylpyrazine (TMP) has recently emerged as a potential therapeutic agent for SCI, although further investigation is required to clarify its mechanisms of action.

METHODS

To evaluate the therapeutic effects of TMP on SCI, SCI models were established in rats, followed by assessment of therapeutic efficacy. Motor function recovery was quantified using the Beattie, Bresnahan and Basso (BBB) score, electrophysiological measurements, footprint analysis, and CatWalk gait analysis. Spinal cord tissues were examined through HE, Nissl, dihydroethidium (DHE), transmission electron microscopy, and immunofluorescence. Key molecular targets and functional pathways were analyzed via transcriptomic and proteomic sequencing. Additionally, PC12 cells were cultured to validate the molecular mechanisms of TMP, employing cell counting kit-8 (CCK-8) assays, live/dead staining, 2, 7-dichlorodihydrofluorescein diacetic acid fluorescent probe (DCFH-DA), western blotting (WB), and immunofluorescence staining.

RESULTS

TMP treatment significantly enhanced neuronal survival and improved motor function in rats. Sequencing analysis revealed a considerable number of differentially expressed genes following SCI and TMP administration, predominantly associated with stress response, external stimuli, and defense mechanisms. Venn analysis identified PKD1 as a key target, showing reduced expression after SCI and upregulation following TMP treatment. Further validation in spinal cord tissues and cells confirmed these findings. The reduction in PKD1 expression post-SCI was correlated with a marked oxidative stress response, which TMP effectively reversed.

CONCLUSIONS

TMP may promote functional recovery by upregulating PKD1 and alleviating oxidative stress-related damage.

The use of exoskeleton robotic training on lower extremity function in spinal cord injuries: A systematic review

Objective

To perform a systematic review of the utility of exoskeleton robotic therapy on lower extremity recovery in Spinal Cord Injury (SCI) patients.

Methods

We used the Embase, Cochrane, and PubMed databases and searched from January 2012 to December 2023 for studies on exoskeleton robotic assist devices used in working with SCI patients. Only articles published in English were evaluated, and the retrieved articles were screened via our inclusion/exclusion criteria. We conducted our meta-analysis with the Cochrane Review Manager 5.4 (RevMan) software. Robotic assisted gait training and conventional gait training methodology were compared using Walking Index for Spinal Cord Injury II (WISCII), Spinal Cord Independence Measure III (SCIM III), and 6 Minute Walk Test (6MWT) as reported outcome measures.

Results

Eleven randomized clinical trials (RCTs) involving 552 total participants were included in the meta-analysis. The results of the meta-analysis indicated statistically significant improvement in SCIM III [MD 5.14, 95 % CI = (4.47, 5.810), P < 0.00001], WISCII [MD 2.31, 95 % CI = (2.13, 2.49), P < 0.00001] and 6MWT [MD 37.04, 95 % CI = (32.35, 41.74), P < 0.00001] in patients with SCI as compared to conventional gait training (CGT) therapy. Conclusion: Robotic Therapy could improve ambulation/quality of life in patients with spinal cord injuries compared to the standard treatment only, but future studies should include additional measures addressing quality of life and patient satisfaction.

Bone marrow mesenchymal stem cells-derived exosomal miR-24-3p alleviates spinal cord injury by targeting MAPK9 to inhibit the JNK/c-Jun/c-Fos pathway

Spinal cord injury (SCI) is a very harmful neurological disease that can cause serious damage to sensation, movement, and autonomic nervous function below the affected area. Apoptosis and inflammatory response play important roles in the pathological process of spinal cord injury. The exosomes secreted by bone marrow mesenchymal stem cells (BMSCs) may play a protective role against spinal cord injury. However, the detailed mechanism behind this is not fully understood. The main objective of this study was to investigate the anti-inflammatory and anti-apoptotic effects of bone marrow mesenchymal stem cell exosomes (BMSCs-EXO) in SCI in vitro and in vivo and their mechanisms. The study demonstrated that bone marrow mesenchymal stem cells reduced apoptosis and inflammation and promoted axon growth in LPS-treated PC12 cells. The miRDB predicted that miR-24-3p targets MAPK9(JNK2). Transcriptome sequencing and Western blot confirmed that miR-24-3p inhibits the JNK/c-Jun/c-Fos pathway by targeting MAPK9. In vivo experiments, injection of BMSC exosomes overexpressing miR-24-3p from the tail vein attenuated the SCI exercise injury-related behavior in rats. In conclusion, this study indicates that bone marrow MSC-derived exosomes can mitigate SCI-related injury by suppressing apoptosis and inflammation, with miR-24-3p playing a crucial role, potentially offering a novel therapeutic approach for SCI treatment.

Incorporation of graphene oxide into collagenous biomaterials attenuates scar-forming phenotype transition of reactive astrocytes in vitro

The integrin-mediated interaction between collagen type I and reactive astrocytes was recently shown to induce a detrimental, scar-forming phenotype transformation following spinal cord injury (SCI), which severely limits the therapeutic potential of commonly used collagen-based biomaterials. Graphene oxide (GO) is a promising candidate to disrupt the collagen-integrin interaction, since it is capable of altering the surface topography of biomaterials applied as SCI treatment. Moreover, free GO contributes towards potassium and glutamate transport, which is often implicated following SCI. However, it remains unclear whether both the integrin-mediated binding and astrocytic transport of potassium and glutamate are affected by GO, when inserted into collagenous biomaterials. Therefore, in the current study GO was incorporated into collagen-based hydrogels in an attempt to prevent the scar-forming phenotype transition and promote the expression of astrocytic potassium channels and glutamate transporters. Primary astrocytes were cultured either on top of or embedded within GO-enriched collagen type I or adipose tissue-derived extracellular matrix (ECM) gels. The impact of GO incorporation on integrin β1-mediated binding, astrocyte phenotype and potassium and glutamate transport was assessed by gene expression analysis and immunofluorescence studies. Upon GO incorporation into ECM gels, expression of integrin β1 and N-cadherin was significantly decreased. Moreover, GO decreased proteoglycan-associated gene expression by four-fold. Finally, GO incorporation led to a decrease in expression of both potassium channels and glutamate transporters. In conclusion, the incorporation of GO into collagen-based materials attenuated the transition of reactive astrocytes into a scar-forming phenotype.

Pharmacological Activation of GPR68 Attenuates Ferroptosis in Spinal Cord Ischemia/Reperfusion Injury Through PI3K/Akt-Mediated Nrf2 Antioxidant Pathway

Spinal cord ischemia-reperfusion injury (SCIRI) is a devastating condition with limited therapeutic options. This study unveils a novel role of G protein-coupled receptor 68 (GPR68), a pH-sensing G protein-coupled receptor (GPCR), in mitigating ferroptosis-a lipid peroxidation-driven cell death-through the Phosphoinositide 3-Kinase/ Protein Kinase B/ Nuclear Factor Erythroid 2-Related Factor 2 (PI3K/Akt/Nrf2) antioxidant axis. Using in vitro (Oxygen-Glucose Deprivation/Reperfusion (OGD/R)-treated Pheochromocytoma Cell Line 12 (PC12) cells ) and in vivo (rat spinal cord ischemia-reperfusion (I/R) ) models, we demonstrate that GPR68 downregulation exacerbates ferroptosis, evidenced by elevated Acyl-CoA Synthetase Long-Chain Family Member 4 (ACSL4), Malondialdehyde (MDA), and Oxidized Glutathione/ Total Glutathione (GSSG/T-GSH) levels, alongside reduced Solute Carrier Family 7 Member 11 (SLC7A11) and Glutathione Peroxidase 4 (GPX4). Pharmacological activation of GPR68 with MS48107 or the clinically approved benzodiazepine Lorazepam robustly reversed ferroptosis by enhancing Akt phosphorylation and Nrf2 nuclear translocation. Mechanistically, GPR68 siRNA or PI3K/Akt inhibition abolished these protective effects. Crucially, Lorazepam rescued neuronal viability and suppressed ferroptosis in spinal I/R rats, effects fully negated by the GPR68 antagonist Ogremorphin (OGM). Our findings establish GPR68 as a key ferroptosis regulator and propose repurposing Lorazepam as a therapeutic strategy for SCIRI.

Advanced Therapeutic Approaches Based on Small Extracellular Vehicles (sEVs) For the Regeneration of Spinal Cord Injuries

Spinal cord injury (SCI) is severe damage to part of the central nervous system (CNS) that can result in impaired sensory and motor function, significantly impacting the quality of life for patients and creating a substantial economic burden on society. The process of SCI involves both primary and secondary injury, with the latter being a series of heightened responses triggered by the initial damage. The complex nature of SCI's pathological mechanisms has made it challenging to develop effective treatment strategies in clinical settings. Small extracellular vesicles (sEVs) are membrane-bound vesicles with a size range of ≤200 nm, released from cells into extracellular spaces. These vesicles are heterogeneous and can originate from various intracellular compartments, including endosomal and non-endosomal sources. A growing body of evidence points to the potential of sEVs in repairing SCI. This review explores the preparation, functions, routes of administration, advantages, challenges, and advanced therapies for sEVs. It also examines the mechanisms through which various types of sEVs can promote healing in SCI and assesses the effectiveness of combining sEVs with other treatment approaches. Furthermore, the review discusses the opportunities and obstacles associated with using sEVs to repair SCI.

Electroacupuncture promotes functional recovery after spinal cord injury in rats by regulating P2X4R/p38 MAPK signaling pathway and suppressing inflammatory responses

This study aimed to investigate whether electroacupuncture can modulate the purinergic P2X4 receptor (P2X4R)/p38 mitogen-activated protein kinase (MAPK) pathway, thereby reducing inflammatory responses and facilitating functional recovery in a rat model of spinal cord injury (SCI). The SCI model was developed in female rats. The electroacupuncture intervention began on the seventh day after modeling, mainly Jiaji, Dazhui, and Mingmen. Sensory function was evaluated via the mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL), while motor function was measured using the Basso, Beattie, and Bresnahan (BBB) scoring system and footprint analysis. To analyze the protein expression related to the P2X4R/p38 MAPK signaling pathways, methods such as immunohistochemistry, immunofluorescence analysis, quantitative real-time PCR, and western blotting were utilized. To evaluate the levels of inflammatory cytokines, ELISAs were utilized. Additionally, after hematoxylin and eosin staining, histological alterations in spinal cord tissue were investigated. The results showed that MWT, TWL, and BBB scores were decreased, while P2X4R, phosphorylated-p38 MAPK, and phosphorylated nuclear factor κB p65 expression levels were increased, tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 levels were elevated, and histopathological damage was more pronounced after SCI. However, electroacupuncture treatment effectively reversed these pathological changes. We demonstrate that electroacupuncture can alleviate SCI in rats by inhibiting the activation of the P2X4R/p38 MAPK pathway and reducing inflammatory response.

The key role of Piezo1 channels in ferroptosis after spinal cord injury and the therapeutic potential of Piezo1 inhibitors

BACKGROUND

Ferroptosis has been confirmed to be one of the key mechanisms of neuronal injury and dysfunction after spinal cord injury (SCI). Mechanical stresses such as deformation, compression, and stretching not only directly cause physical damage to spinal cord tissue at the moment of SCI, but also promote the development of ferroptosis through various pathways. However, the mechanism of ferroptosis after SCI remains unclear, which hinders the development of therapeutic methods.

OBJECTIVE

This article aims to review the key mechanisms by which mechanical stress affects ferroptosis after SCI, including its impact on the structure and function of the endoplasmic reticulum (ER) and mitochondria, its role in triggering inflammatory responses, and its activation of mechanosensitive channels. Special emphasis is placed on the role of Piezo1 channels, which are key factors in cell mechanosensation and ion homeostasis regulation. The review explores how Piezo1 channels are upregulated by mechanical stress after SCI and participate in the ferroptosis process by mediating ion flow and other mechanisms.

CONCLUSIONS

Inhibiting Piezo1 channels may be a potential therapeutic strategy for SCI. This review summarizes the therapeutic potential of Piezo1 inhibitors by sorting out existing studies, hoping to provide a theoretical basis for effective therapeutic strategies targeting ferroptosis after SCI.

Effect of granulocyte colony-stimulating factor (G-CSF) in functional outcome of acute spinal cord injury patients: A single-blinded randomized controlled trial

Background

Spinal Cord Injury (SCI) is a major public health issue causing significant disability and economic burden. Current treatments primarily focus on mitigating secondary injury, with limited effective therapies available. This study explores the efficacy of the Granulocyte Colony-Stimulating Factor (G-CSF) in improving functional outcomes in acute SCI patients.

Materials and methods

This single-blinded randomized control trial was conducted at JIPMER's orthopedic department. Patients with acute spinal cord injury (SCI) were enrolled based on specific inclusion and exclusion criteria. Participants were divided into two groups: Group A (n = 16) received a G-CSF injection whereas Group B (n = 18) received a placebo (normal saline) injection. The primary evaluation was based on the changes in the ASIA impairment scale at 1-, 3-, and 6-months post-injury.

Results

The study involved 34 participants, predominantly male. Initial assessments showed significant differences in ASIA scores between the groups. Group A demonstrated marked improvement in neurological status at 1, 3, and 6 months post-treatment compared to Group B. The frequency of adverse events was comparable between the two groups.

Conclusion

G-CSF showed significant improvement in ASIA scores at various time points post-administration compared to placebo. These findings suggest G-CSF as a potential therapeutic agent in acute SCI treatment. However, due to the small sample size, further research is necessary to confirm these results.

Investigation into recent advanced strategies of reactive oxygen species-mediated therapy based on Prussian blue: Conceptualization and prospect

Prussian blue (PB) has garnered considerable scholarly interest in the field of biomedical research owing to its notably high biocompatibility, formidable multi-enzyme mimetic capabilities, and established clinical safety profile. These properties in combination with its reactive oxygen species (ROS) scavenging activity have facilitated significant progress in disease diagnosis and therapy for various ROS-mediated pathologies, where overproduced ROS exacerbates disease symptoms. Additionally, the underlying ROS-associated mechanisms are disease-specific. Hence, we systematically examined the role of ROS and its basic underlying mechanisms in representative disease categories and comprehensively reviewed the effect of PB-based materials in effectively alleviating pathological states. Furthermore, we present a thorough synthesis of disease-specific design methodologies and prospective directions for PB as a potent ROS-scavenging biotherapeutic material with emphasis on its applications in neurological, cardiovascular, inflammatory, and other pathological states. Through this review, we aim to accelerate the progress of research on disease treatment using PB-based integrated therapeutic system.

Conditioned medium derived from mesenchymal stem cells and spinal cord injury: A review of the current therapeutic capacities

Spinal cord injury (SCI) is a debilitating condition of the nervous system that imposes considerable challenges for subjects, such as bladder and bowel incontinence and infections. The standard therapeutic strategy is methylprednisolone utilization accompanied by surgical decompression. However, achieving an effective therapy with the minimum side effects for SCI is still a puzzle. Nowadays, mesenchymal stem cell (MSC) therapy has received much consideration in scientific communities in light of its pharmacological and therapeutic properties, for instance, anti-inflammatory, regenerative, analgesic, and immunomodulatory influences. Despite the mentioned advantages for MSCs, their tumorigenic potential is a limiting agent for its wide therapeutic application. Recent documents show that the use of conditioned medium (CM) derived from MSCs can largely solve these problems. CM encompasses neuroprotective growth factors and cytokines, such as stem cell factor (SCF), vascular endothelial growth factor (VEGF), and glial cell line-derived neurotrophic factor (GDNF). The persuasive evidence from experimental studies revealed that CM originating from MSCs can have a considerable role in the amelioration of SCI. Hence, in the current papers, we will review and summarize evidence indicating the anti-SCI mechanisms of MSC-derived CM by relying the current experimental data.

UCP2 attenuates neural apoptosis and inflammation in spinal cord injury by inducing the acetylation of ANXA1 and activating the PI3K/AKT pathway

Spinal cord injury (SCI) represents a prevalent form of mechanical trauma, frequently resulting in significant disability and mortality. Uncoupling protein 2 (UCP2) has been recognized for its neuroprotective properties; however, its specific role in SCI remains to be elucidated. This study aims to investigate the neuroprotective effects of UCP2 in the context of SCI and to further explore its downstream mechanisms of action. Through in vitro experiments, we demonstrated that UCP2 overexpression significantly improved cell viability and inhibited apoptosis and inflammatory responses in the lipopolysaccharides (LPS)-induced SCI cell model. Results of animal experiments showed that adeno-associated virus-mediated overexpression of UCP2 contributed to the recovery of SCI-afflicted rats, evidenced by improved Basso, Beattie, and Bresnahan scores, decreased water content in spinal tissues, reduced number of apoptotic cells in spinal cord. Mechanistic investigations revealed that UCP2 directly interacts with annexin A1 (ANXA1), enhancing its protein stability through acetylation at the K58 site. Furthermore, UCP2 was found to activate the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway by upregulating ANXA1 expression. Rescue assays indicated that knockdown of ANXA1 or inactivation of the PI3K/AKT pathway by LY294002 treatment partially neutralized the protective effects of UCP2 overexpression against apoptosis and inflammatory responses in LPS-stimulated BV-2 cells. Taken together, this study concludes that UCP2 ameliorates apoptosis and inflammatory responses in the SCI model by modulating acetylation-mediated protein stabilization of ANXA1 and activating the PI3K/AKT pathway.

Total recovery spinal cord injury in cervical 5-6 dislocation: Case reports

INTRODUCTION AND IMPORTANCE

The challenges in spinal cord injury (SCI) cases are the regeneration mechanism, low recovery rate, and absence of neuroprotective agent. The recovery rate for SCI in cervical spine dislocation is still around 1 %.

CASE PRESENTATION

The patient is a 59-year-old woman, suffer from SCI in cervical dislocation C4-C5. The initial assessment was cervical trauma with airway, breathing, circulation, and disability problems. The cervical spine was controlled with a collar brace. ASIA impairment scale was grade A. Posterior approach surgery was performed, including open reduction, laminectomy, stabilization, and fusion. It was continued with mechanical ventilation and rehabilitation. Monitoring and follow up was done for three months of surgery.

CLINICAL DISCUSSION

Early diagnosis, prompt treatment of an interprofessional team, early surgery, mechanical ventilation, steroid administration, and rehabilitation will provide better results. The activity daily living (ADL) assessment was normal, either function of JOA score or disability of ODI score.

CONCLUSIONS

The patient has normal neurologic function, including motoric, sensory, urination, and defecation. There is still hope SCI recovery in cervical spine dislocation after early and multidisciplinary treatment.

Nitric oxide synthases: A delicate dance between bone regeneration and neuronal birth

Spinal cord injury (SCI) is a devastating condition resulting from traumatic or nontraumatic injury/chronic disorder. The pathogenesis of SCI necessitates a comprehensive approach, as it involves therapeutic strategies addressing both bone (spine) and neural (spinal cord) damage. This review centers on the pivotal role of nitric oxide (NO) and its synthesizing enzymes, nitric oxide synthases (NOS), in mediating the crosstalk between osteogenesis and neurogenesis. NO's effects are context-dependent, exhibiting a delicate balance between beneficial and detrimental actions. Reduced levels of nitric oxide (NO), primarily derived from endothelial NOS (eNOS), tipically stimulate osteoblast activity and promote neurogenesis by influencing neural stem cell (NSC) migration and differentiation. Conversely, elevated NO levels, predominantly from inducible NOS (iNOS), tipically triggered by inflammation, inhibit both processes through pro-apoptotic mechanisms. Nevertheless, these phenomena are not merely simplistic; they can be influenced by a variety of other factors. We explore the intricate interplay of NO/NOS with key signaling pathways crucial in neurogenesis and osteogenesis, including mechanical stimuli, Wnt, interleukins, BMPs, NF-κB, etc., revealing their influence on neuroinflammation, neurogenesis, and osteoblast differentiation. The temporal and spatial dynamics of NO/NOS activity and the implications for therapeutic intervention have been discussed. Precise modulation of NO levels and NOS isoforms, potentially through targeted therapies manipulating these interacting signaling pathways, emerges as a promising strategy for promoting bone and neural regeneration. This review highlights the critical need for a balanced approach in therapeutic strategies to harness the beneficial effects of NO/NOS while mitigating its detrimental consequences.

Using diffusion tensor imaging to assess children with spinal cord injury without fracture or dislocation

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

This study investigates changes in spinal DTI metrics above lesion in children with spinal cord injury without fracture or dislocation (SCIWOFD), aiming to assess DTI's potential as a diagnostic and evaluative tool for SCIWOFD in children.

SETTING

Xuanwu Hospital, Capital Medical University, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, China.

METHODS

This study included 18 children with SCIWOFD and 12 typically developing (TD) children. SCIWOFD children underwent International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessments and MRI with axial spinal cord DTI. DTI data were processed with Diffusion Toolkit and TrackVis, with four levels above the lesion (Level 1 to Level 4). Spinal DTI metrics were extracted, and statistical analysis was performed using multiple linear regression and Pearson correlation.

RESULTS

Compared to the TD group, the SCIWOFD group displayed significant changes in DTI metrics at four spinal cord levels. At level 1, FA decreased (p < 0.000), while MD (p < 0.000), AD (p = 0.007), and RD (p < 0.000) increased. Levels 2 and 3 showed decreased FA (level 2: p < 0.000; level 3: p = 0.001) and increased MD (level 2: p = 0.001; level 3: p = 0.029) and RD values (level 2: p < 0.000; level 3:p = 0.001). At level 4, FA decreased (p < 0.000), while RD increased (p = 0.009). At level 1 in the SCIWOFD group, MD (r = -0.534, p = 0.022) and RD (r = -0.569, p = 0.009) correlated with sensory scores.

CONCLUSIONS

Spinal DTI metrics above the lesion in children with SCIWOFD exhibit gradient changes, with a statistically correlation between the DTI metrics at the rostral edge of the lesion and ISNCSCI sensory scores. DTI metrics may serve as stable, objective indicators for assessing SCIWOFD in children.

TRIM55 suppresses inflammatory response after spinal cord injury by accelerating the ubiquitination and degradation of TLR4

BACKGROUND

Spinal cord injury (SCI) is a neurological disorder characterized by severe and often irreversible damage to the spinal cord, for which no effective treatments currently exist. Ubiquitination, a reversible post-translational modification, plays a critical role in regulating protein degradation and stabilization. Tripartite motif-containing 55 (TRIM55), an E3 ubiquitin ligase, belongs to the TRIM protein family. This study aimed to explore the potential mechanism of TRIM55 in SCI.

METHODS

An SCI rat model was established to investigate the effects of TRIM55 on SCI. LPS-stimulated PC12 cells were used to evaluate inflammation by measuring IL-1β, IL-6, and TNF-α levels using enzyme-linked immunosorbent assays. The proliferation and apoptosis of PC12 cells were assessed using the cell counting kit-8 assay and TUNEL staining. Quantitative real-time PCR, western blot analysis, co-immunoprecipitation, and cycloheximide chase experiments were performed to elucidate the underlying mechanism.

RESULTS

The findings revealed that TRIM55 was downregulated both in vitro and in vivo. Functionally, TRIM55 inhibited apoptosis and reduced the expression of pro-inflammatory cytokines in LPS-stimulated PC12 cells. Mechanistically, TRIM55 interacted with toll-like receptor 4 (TLR4) and promoted its degradation by modulating the ubiquitination process, thereby attenuating the inflammatory response. Furthermore, TRIM55 enhanced recovery from SCI and alleviated inflammation in vivo.

CONCLUSION

This study not only provides robust theoretical evidence supporting TRIM55 as an anti-inflammatory factor but also offers a novel therapeutic approach for SCI research.

Injectable thermosensitive hydrogel system based on hyaluronic acid and methylcellulose for the synergistic therapy of traumatic spinal cord injury

Spinal cord injury (SCI) is a neurological disease with a high rate of disability. Inflammation plays a key role in all stages of pathological of SCI and interacts with ferroptosis to induce deterioration. Methylprednisolone sodium succinate (MPSS) is currently the only drug in clinical to treat SCI through anti-inflammation, but due to the lack of efficacy and systemic adverse reactions, the drug therapy of SCI is still limited. Therefore, a locally administered injectable thermosensitive hydrogel MPSS/Fer-1@HA-MC was designed to treat SCI synergistically by anti-inflammation and anti-ferroptosis. Considering the insolubility of Fer-1 in water, Fer-1@β-CD inclusion complex was used to co-contained with MPSS in HA-MC hydrogel. Faster release of dissolved MPSS inhibits inflammation in acute and subacute stages of SCI. With a smaller solubility of Fer-1@β-CD, Fer-1 released slowly and persistently to anti-ferroptosis and anti-inflammation in whole stages. Therefore, motricity function of SCI mouse was repaired after treat with MPSS/Fer-1@HA-MC, better than single-drug hydrogels. Furthermore, MPSS/Fer-1@HA-MC inhibit inflammatory damage by decreased the expression of IL-1β, CD68, ROS and iNOS, and inhibit ferroptosis by reduced the overexpression of TfR1 and lipid peroxidation, and increased GPX4 level in whole stages. In summary, MPSS/Fer-1@HA-MC successfully achieved a more sustained and comprehensive therapeutic of SCI.

Autophagy modulation by hADSCs and green light therapy alleviates inflammation and promotes functional recovery after spinal cord injury

BACKGROUND

Spinal cord injury (SCI) results in chronic motor deficits and intractable neuropathic pain, driven by neuroinflammation and impaired tissue repair. Current therapies inadequately address these multifaceted challenges. This study investigated the therapeutic effects of human adipose-derived mesenchymal stem cells (hADSCs) transplantation combined with green light (GL) therapy to modulate inflammation, enhance autophagy, and facilitate functional restoration post-SCI.

METHODS

In a murine SCI model, hADSCs (1 × 106 cells) were intraspinally delivered with concurrent GL irradiation (100 lux, 8 h/d). Behavioral assessments included footprint analysis, von Frey test, and thermal hyperalgesia testing. Histological analyses included Luxol Fast Blue (LFB), Nissl, Masson, and hematoxylin and eosin (HE) staining for myelin integrity, neuronal survival and glial scar area. Immunofluorescence, ELISA and qPCR were used to assess inflammation, and autophagy-related proteins were analyzed using immunofluorescence and western blotting. The role of microglial autophagy was investigated by inhibiting autophagy using 3-methyladenine (3MA).

RESULTS

The combined treatment group (hADSCs + GL) showed significant motor function recovery, pain relief, and histological improvement, outperforming either treatment alone. Histological analyses revealed enhanced myelin preservation, reduced glial scar formation, and increased neuronal survival. Quantitative analysis revealed that TNF-α, IL-1β, and CD68 expression in the combined treatment group were markedly lower than those in single-treatment cohorts (P < 0.05). Furthermore, the combined treatment promoted microglia autophagy, evidenced by increased Beclin1 and LC3B expression and decreased P62 in microglia. Inhibition of autophagy with 3MA reversed the anti-inflammatory benefits of the combined therapy, exacerbating the inflammatory response.

CONCLUSIONS

The combined treatment of hADSCs transplantation and GL therapy significantly improves functional recovery and reduces inflammation following SCI. The therapeutic effects are mediated in part by the modulation of microglial autophagy.

Relaxin-2 Ameliorates Spinal Cord Injury by Inhibiting Microglia Activation

This study aims to assess the therapeutic effectiveness of Relaxin-2 (RLN-2) in promoting functional recovery and neuroprotection following spinal cord injury (SCI) in mice. Furthermore, continuous subcutaneous infusion of Serelaxin (0.5 mg/kg/day; human recombinant relaxin-2) improved neurological recovery, as evidenced by higher Basso-Beattie-Bresnahan (BBB) scores and reduced foot-stepping angles compared to the SCI group. Additionally, RLN-2 effectively reduced edema in the injured spinal cord, as shown by decreased water content and downregulated AQP4 expression at mRNA and protein levels. RLN-2 reduced oxidative stress markers such as malondialdehyde (MDA) and reactive oxygen species (ROS) and increased the activity of catalase (CAT). Further, RLN-2 mitigated neuroinflammation by reducing the levels of pro-inflammatory cytokines (TNF-α and IL-6) and by inhibiting the activation of M1 microglia while promoting the polarization of M2 microglia. It also inhibited the activation of the NF-κB signaling and strengthened the activation of the STAT6 signaling in the spinal cord of SCI mice. These findings suggest that RLN-2 may be a promising therapeutic agent for the treatment of spinal cord injury.

Neuroprotective Riluzole-Releasing Electrospun Implants for Spinal Cord Injury

Spinal cord injury (SCI) results in paralysis, driven partly by widespread glutamate-induced secondary excitotoxic neuronal cell death in and around the injury site. While there is no curative treatment, the standard of care often requires interventive decompression surgery and repair of the damaged dura mater close to the injury locus using dural substitutes. Such intervention provides an opportunity for early and local delivery of therapeutics directly to the injured cord via a drug-loaded synthetic dural substitute for localized pharmacological therapy. Riluzole, a glutamate-release inhibitor, has shown neuroprotective potential in patients with traumatic SCI, and therefore, this study aimed to develop an electrospun riluzole-loaded synthetic dural substitute patch suitable for the treatment of glutamate-induced injury in neurons. A glutamate-induced excitotoxicity was optimized in SH-SY5Y cells by exploring the effect of glutamate concentration and exposure duration. The most effective timing for administering riluzole was found to be at the onset of glutamate release as this helped to limit extended periods of glutamate-induced excitotoxic cell death. Riluzole-loaded patches were prepared by using blend electrospinning. Physicochemical characterization of the patches showed the successful encapsulation of riluzole within polycaprolactone fibers. A drug release study showed an initial burst release of riluzole within the first 24 h, followed by a sustained release of the drug over 52 days to up to approximately 400 μg released for the highest loading of riluzole within fiber patches. Finally, riluzole eluted from electrospun fibers remained pharmacologically active and was capable of counteracting glutamate-induced excitotoxicity in SH-SY5Y cells, suggesting the clinical potential of riluzole-loaded dural substitutes in counteracting the effects of secondary injury in the injured spinal cord.

Manganese Porphyrin Treatment Improves Redox Status Caused by Acute Compressive Spinal Cord Trauma

There is increasing interest in identifying drugs that can prevent or delay neurological complications following spinal cord injury, thus expanding the therapeutic window for other potential neuroprotective agents. In this context, manganese porphyrins (MnPs) have shown high antioxidant and anti-inflammatory potential in various experimental disease models, including stroke, cancer, diabetes, ischemia, and radiotherapy. However, they have been little evaluated in spinal cord injuries. This study aimed to assess the therapeutic potential of the manganese porphyrins [MnTE-2-PyP]5+ (MnPI) and [MnT(5-Br-3-E-Py)P]5+ (MnPII) in acute compressive spinal cord trauma in rats. Twenty-four animals were used (six animals/group). Following general inhalation anesthesia, acute compressive spinal cord trauma was induced in all groups except for the negative control (SHAM). Treatment commenced 60 min post-trauma, with animals receiving treatment for seven days at 24 h intervals. While no improvement in motor capacity was observed, MnPs effectively blocked the increase in oxidative stress and endoplasmic reticulum (ER) stress mediators caused by trauma, maintaining the protein expression levels of Hifα, 8-OHdG and MDA, as well as the expression of the genes Grp78, Chop, Ho1, and Perk, similar to those of the control group. Moreover, there was an increase in protein expression of SOD1, Cat, and GPX1, along with a restoration of SOD and CAT enzymatic activity. Additionally, MnPs improved the expression of IL-6, neurotrophic markers, and apoptotic factors. In conclusion, treatment with MnPs attenuated the oxidative stress and ER stress caused by acute compressive spinal cord trauma and restored spinal expression of neurotrophic mediators.

Roles for Exosomes from Various Cellular Sources in Spinal Cord Injury

Spinal cord injury (SCI) is a severe disorder characterized by regeneration challenges in the central nervous system (CNS), resulting in permanent paralysis, loss of sensation, and abnormal autonomic functions. The complex pathophysiology of SCI poses challenges to traditional treatments, highlighting the urgent need for novel treatment approaches. Exosomes have emerged as promising candidates for SCI therapy because of their ability to deliver a wide range of bioactive molecules, such as RNAs, proteins, and lipids, to target cells with minimal immunogenicity, which contribute to anti-inflammatory, anti-apoptotic, autophagic, angiogenic, neurogenic, and axon remodeling activities. In this study, we classified exosomes from different sources into four categories based on the characteristics of the donor cells (mesenchymal stem cells, neurogenic cells, immune cells, vascular-associated cells) and provided a detailed summary and discussion of the current research progress and future directions for each source. We also conducted an in-depth investigation into the applications of engineered exosomes in SCI therapy, focusing on their roles in drug delivery and combination with surface engineering technologies and tissue engineering strategies. Finally, the challenges and prospects of exosomal clinical applications in SCI repair are described.

Antioxidant nanozymes: current status and future perspectives in spinal cord injury treatments

Spinal cord injury (SCI) is a life - altering neurological condition that carries significant global morbidity and mortality. It results in the disruption of motor and sensory pathways below the site of injury, often leading to permanent functional impairments and severely diminished quality of life. Despite decades of clinical and research efforts, current treatment options remain largely supportive, with limited success in promoting meaningful functional recovery or neural regeneration. In recent years, nanozymes have emerged as a promising frontier in the therapeutic landscape for SCI. These nanomaterial - based artificial enzymes offer several compelling advantages over their natural counterparts, including superior stability under physiological conditions, adjustable catalytic activity, cost - effective production, and prolonged shelf life. Unlike traditional therapeutic agents, nanozymes can be engineered to closely mimic the activity of key endogenous antioxidant enzymes such as superoxide dismutase, catalase, and glutathione peroxidase. By scavenging reactive oxygen species and attenuating oxidative damage, nanozymes help preserve neuronal integrity and support the intrinsic repair processes of the central nervous system. This review provides a comprehensive overview of the pathophysiological mechanisms underlying SCI and examines the classification and catalytic principles governing nanozyme activity. We delve into the molecular pathways through which nanozymes exert their neuroprotective effects, particularly their roles in modulating oxidative stress and suppressing inflammatory responses following injury. Additionally, we explore the current challenges associated with nanozyme development, such as biocompatibility, targeted delivery, and long - term safety, and discuss future directions for optimizing their therapeutic potential in clinical applications. By synthesizing emerging insights into antioxidant nanozyme - based strategies, this review aims to contribute to the evolving landscape of SCI treatment and to highlight the transformative potential of nanozymes in advancing neuroregenerative medicine. These innovative agents represent a new horizon in SCI management, offering renewed hope for improving neurological outcomes and quality of life in affected individuals.

Risk factors for in-hospital mortality in cervical spinal cord injuries: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 3.847 cases

BACKGROUND CONTEXT

Cervical spinal cord injuries (CSCIs) present challenges with potential severe neurological complications. Despite advances in care, in-hospital mortality remains a concern.

PURPOSE

This study explores the impact of patient-related factors and therapeutic strategies on in-hospital mortality in individuals with CSCIs.

STUDY DESIGN/SETTING

Retrospective cross-sectional study.

PATIENT SAMPLE

Admissions with CSCIs recruited between January 2019 and December 2023.

OUTCOME MEASURES

Data from the German Diagnosis Related Groups (DRG) system were used to analyze main diagnoses, patient demographics, concomitant diagnoses (ICD-10), and procedures (OPS). Specific data were extracted from the database of the German Institute for the Hospital Remuneration System (InEK GmbH).

METHODS

Differences in comorbidities and injuries were analyzed using the Chi-square test. Odds ratios (OR) were calculated to analyze potential risk factors for in-hospital mortality.

RESULTS

In the analysis of 3.847 hospital admission cases, an in-hospital mortality rate of 11.7% (n=451) was observed. The patient cohort demonstrated a male predominance at 72.9%. The overall incidence of CSCI in Germany is 9.2 per million annually, with a significant increase in incidence rate observed with age, particularly after 60 years. The majority of admissions were aged over 65 years and this age group (>65 years) was identified as a significant risk factor for increased in-hospital mortality (n=2.064; OR 1.83; p<.001). Vertebral fractures at the levels C4 (n=364; 9.5%), C5 (n=582; 15.1%), and C6 (n=598; 15.5%) were the most common spinal injuries, while concomitant fractures at atlas (C1), axis (C2) and C7 fractures were associated with an elevated significant risk for in-hospital mortality (OR 2.40, OR=2.67, OR=2.21; p<.001). The need for blood transfusion was associated with a high in-hospital mortality rate of 31.3%. Amongst others, hypothermia, acute kidney failure, pleural effusion, and atrial fibrillation were significantly associated with in-hospital mortality (all p<.001). Additionally, aspiration pneumonia and hospital-acquired pneumonia were linked to increased in-hospital mortality risk (OR 2.21, OR 1.52; p<.001).

CONCLUSIONS

Concomitant injuries and comorbidities indicating frailty and medical complications increase in-hospital mortality risk. The study highlights the need for thorough health assessments in patients with CSCIs, encouraging personalized and optimized treatment strategies.

Alterations in Topological Structure and Modular Interactions in Pediatric Patients with Complete Spinal Cord Injury: A Functional Brain Network Study

Traumatic complete spinal cord injury (CSCI) leads to severe impairment of sensory-motor function, and patients often suffer from neuropsychological deficits such as anxiety, depression, and cognitive deficits, which involve different brain functional modules. However, the alterations in modular organization and the interactions between these modules in pediatric patients with CSCI remain unclear. In this study, a total of 70 participants, including 34 pediatric CSCI patients and 36 healthy controls (HCs) aged 6 to 12 years, underwent whole-brain resting-state functional MRI. The functional networks were analyzed via a graph theory approach based on the 90-region Automated Anatomical Labeling (AAL 90) atlas, generating a 90 × 90 correlation matrix. Metrics for nodal, global, and modular scales were calculated to evaluate alterations in the network's topology. Between-group comparisons and partial correlation analysis were performed. Compared to HCs, pediatric CSCI patients exhibited significant decreases in nodal metrics, particularly in subcortical networks (SN) like the bilateral thalamus. Besides, the distribution of core nodes changed, with five newly added core nodes primarily located in the regions of the default mode network (DMN). For modular interactions, patients group presented increased connectivity within the DMN and between the DMN and the attention network (AN) but reduced connectivity between DMN and SN, DMN and vision network (VN), and AN and SN. Notably, the participation coefficient (Pc) of the TPOmid.L (left temporal pole: middle temporal gyrus) was positively correlated with motor scores, suggesting its potential as an indicator for evaluating the motor function in pediatric CSCI patients. Additionally, the patients demonstrated a different modular structure with significantly lower modularity. These findings suggest that functional network and modular alterations chiefly occur in emotional cognition and vision-associated regions, emphasizing the importance to focus on their psychocognitive well-being and providing evidence for visual-feedback related rehabilitation strategies.

Research on complications and bladder management of the chronic phase spinal cord injury in China

This study aimed to investigate common complications during the chronic phase of spinal cord injury (SCI) and to assess bladder management methods and their associated complications in patients with neurogenic lower urinary tract dysfunction (NLUTD). A retrospective analysis was performed using clinical data from chronic-phase SCI patients across multiple centers in China. The study population included individuals diagnosed with SCI and admitted between January 1, 2017, and December 31, 2022. Chi-square tests were used to evaluate differences in the distribution of complications, disease duration, bladder management methods, and urinary complications. Univariate and multivariate analyses were conducted to identify risk factors for urinary complications. A total of 849 SCI patients from 28 provinces in China were included, showing significant demographic and clinical differences between traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Urinary tract infection (59.95%) and bowel-related complications, such as constipation (62.17%), were the most frequently reported complications. Additionally, the incidences of osteoporosis (38.50%), neuropathic pain (29.99%), bowel incontinence (12.06%), and hydronephrosis (11.91%) were also high. NLUTD was present in 90.58% of SCI patients. Among these, intermittent catheterization was associated with significantly lower rates of urological complications compared to indwelling catheterization (p = 0.025). Multivariate analysis identified bladder management method as a significant risk factor for urinary complications, with indwelling catheterization associated with a higher risk of urinary stones (p < 0.001) compared to intermittent catheterization. The high prevalence of bowel- and urological-related complications among Chinese SCI patients highlights the need for increased societal attention. In terms of bladder management, intermittent catheterization may provide greater benefits compared to indwelling catheterization. Further research and education are necessary to promote intermittent catheterization as a standardized bladder management approach for SCI patients.

Reactive astrocytes in spinal cord injury: An analysis of heterogeneity based on temporality and spatiality, potential therapies, and limitations

Spinal cord injury (SCI) constitutes a profound central nervous system disorder characterized by significant neurological dysfunction and sensory loss below the injury site. SCI elicits a multifaceted cellular response in which the proliferation of reactive astrocytes and the ensuing diversity in their functions and phenotypes play pivotal roles within the injury microenvironment, especially during the secondary phases of the condition. This review explores the activation and heterogeneity of astrocytes following SCI. It underscores the necessity of delineating the heterogeneity among reactive astrocyte subpopulations throughout the secondary injury phase of SCI. Developing therapeutic strategies that capitalize on the beneficial properties of certain reactive astrocyte subpopulations while mitigating the adverse effects of others could have profound implications for future clinical management of SCI.

Revisiting the Emerging Role of Light-Based Therapies in the Management of Spinal Cord Injuries

The surge in spinal cord injuries (SCI) attracted many neurobiologists to explore the underlying complex pathophysiology and to offer better therapeutic outcomes. The multimodal approaches to therapy in SCI have proven to be effective but to a limited extent. The clinical basics involve invasive procedures and limited therapeutic interventions, and most preclinical studies and formulations are yet to be translated due to numerous factors. In recent years, photobiomodulation therapy (PBMT) has found many applications in various medical fields. In most PBMT, studies on SCI have employed laser sources in experimental animal models as a non-invasive source. PBMT has been applied in numerous facets of SCI pathophysiology, especially attenuation of neuroinflammatory cascades, enhanced neuronal regeneration, reduced apoptosis and gliosis, and increased behavioral recovery within a short span. Although PBMT is specific in modulating mitochondrial bioenergetics, innumerous molecular pathways such as JAK-STAT, PI3K-AKT, NF-κB, MAPK, JNK/TLR/MYD88, ERK/CREB, TGF-β/SMAD, GSK3β-AKT-β-catenin, and AMPK/PGC-1α/TFAM signaling pathways have been or are yet to be exploited. PMBT has been effective not only in cell-specific actions in SCI such as astrocyte activation or microglial polarization or alterations in neuronal pathology but also modulated overall pathobiology in SCI animals such as rapid behavioral recovery. The goal of this review is to summarize research that has used PBMT for various models of SCI in different animals, including clarifying its mechanisms and prospective molecular pathways that may be utilized for better therapeutic outcomes.

Lupeol mitigates spinal cord injury by modulating microglial M1/M2 polarization via Na+/K+-ATPase-mediated mitophagy

Spinal cord injury (SCI) often results in severe disability or even death, with inflammation playing a critical role in hindering recovery. Although Lupeol is known for its potent anti-inflammatory properties, its specific role in SCI-induced inflammation remains underexplored. In this study, an in vitro inflammation model was established using LPS-stimulated BV2 microglia. Lupeol treatment effectively counteracted LPS-induced reductions in Na+/K+-ATPase (NKA) activity, suppression of mitophagy, M1 polarization of microglia, release of inflammatory factors, and increased pyroptosis. Mechanistically, Lupeol alleviated microglial inflammation by enhancing mitophagy through the activation of NKA activity. Furthermore, Lupeol upregulated NKA activity and mitophagy by activating the AMPKα2-mTOR-TFEB pathway. In vivo, a mouse model of SCI was established, and Lupeol was administered daily via intraperitoneal injection. Lupeol treatment significantly reduced neuronal loss, promoted microglial polarization from the M1 to the M2 phenotype, attenuated inflammation, and improved motor function recovery in SCI mice. In conclusion, Lupeol promotes mitophagy by enhancing NKA activity via the AMPK-mTOR-TFEB pathway, thereby suppressing the pro-inflammatory phenotype of microglia and mitigating SCI progression.

lncRNA SNHG6 Knockdown Promotes Microglial M2 Polarization and Alleviates Spinal Cord Injury via Regulating the miR-182-5p/NEUROD4 Axis

Spinal cord injury (SCI) is one of the devastating neurological disorders that leads to a loss of motor and sensory functions. Long non-coding RNA small nucleolar RNA host gene 6 (lncRNA SNHG6) plays a crucial role in inflammatory regulation across various diseases. This study investigates the role of SNHG6 in SCI development and its underlying regulatory mechanisms. Two experimental models were established: an in vitro model using LPS-challenged (100 ng/mL) mouse microglia BV2 cells and an in vivo model employing controlled spinal cord impact in mice. SNHG6, miR-182-5p, and NEUROD4 expression levels were quantified through RT-qPCR and Western blot. Functional and histological assessments were performed using the Basso mouse scale (BMS) and Nissl staining, respectively. Putative binding sites between SNHG6 and miR-182-5p, as well as between miR-182-5p and NEUROD4, were predicted using the ENCORI/starBase platform. These molecular interactions were validated through dual-luciferase reporter assays and RNA pull-down experiments, with further confirmation by qRT-PCR and Western blot analyses. Both LPS-stimulated BV2 cells and spinal cord tissues from SCI mice exhibited elevated SNHG6 expression. Downregulation of SNHG6 enhanced LPS-induced polarization of BV2 cells from M1-type to M2-type, significantly modulated the expression of pro-inflammatory factors (TNF-α, IL-1β, and IL-6) and anti-inflammatory factors (TGF-β, IL-10, and IL-13), and reduced injury severity in SCI mice. Our mechanistic studies revealed that SNHG6 functions as a molecular sponge for miR-182-5p to regulate NEUROD4 expression. This study demonstrates that SNHG6 knockdown promotes microglial M2-type polarization and alleviates inflammatory responses through modulation of the miR-182-5p/NEUROD4 axis, suggesting SNHG6 as a potential therapeutic target for SCI treatment.

Hydrogen Sulfide Modulates Microglial Polarization and Remodels the Injury Microenvironment to Promote Functional Recovery After Spinal Cord Injury

AIMS

Spinal cord injury (SCI) disrupts tissue homeostasis, leading to persistent neuroinflammation and scar formation that severely impedes functional recovery. Current therapeutic approaches are insufficient to address these challenges. In this study, we investigated whether exogenous hydrogen sulfide (H2S) can modulate neuroinflammatory responses and remodel the injury microenvironment to promote tissue repair and restore motor function following SCI.

METHODS

T10 crush SCI was induced in mice, followed by daily intraperitoneal administration of the H2S donor anethole trithione (ADT). Immunofluorescence staining, tissue clearing, western blotting, and behavioral assessments were performed to evaluate scar formation, vascular regeneration, neuronal survival, and motor function.

RESULTS

ADT-based H2S therapy significantly promoted wound healing, inhibited scar formation, enhanced vascular regeneration, and protected residual neurons and axons from secondary injury. Mechanistically, H2S suppressed microglial proliferation and activation, promoting their polarization toward an anti-inflammatory phenotype and alleviating neuroinflammation. Consequently, motor function recovery was markedly improved.

CONCLUSION

H2S modulates microglial activation and mitigates neuroinflammation, establishing a permissive microenvironment for SCI repair and significantly enhancing motor function recovery. Given ADT's established clinical safety and its effective gasotransmitter properties, our findings underscore its immediate translational potential for treating SCI.

Causal Association Between Inflammatory Proteins, Inflammatory Cells, and Cauda Equina Syndrome: A Two-Sample Mendelian Randomization

BACKGROUND

Recent studies have shown that inflammation plays a crucial role in the progression of cauda equina syndrome (CES). However, the exact cause-and-effect relationship between them is still unclear.

METHODS

We used CES data from the FinnGen genome-wide association study (GWAS), containing 329 cases and 408,351 control patients. Inflammatory proteins data were obtained from a large scale GWAS of 14,828 European ancestry participants, and inflammatory cells data were obtained from a GWAS summary of 3757 Sardinians. We chose inverse variance weighted as the main method and the Cochrane Q test to assess heterogeneity in the results. The MR-Egger intercept test and MR pleiotropy residual sum and outliers test were used to evaluate the horizontal pleiotropy, and sensitivity analysis was performed by leave-one-out analysis.

RESULTS

We examined robust associations between inflammatory proteins, inflammatory cells, and CES using Mendelian randomization. Two inflammatory proteins and 12 inflammatory cells were found as risk factors for CES: IL-8 and PD-L1; and basophil plasmacytoid dendritic cell, CD86+plasmacytoid dendritic cell, CD62L-plasmacytoid dendritic cell, CD39+secreting Treg, IgD+CD38-B cell, switched memory B cell, IgD+CD24+B cell, CD62L+dendritic cell, CD4+T cell, γδ T cell, and CD33dim HLA DR-myeloid cell. Two inflammatory proteins and 7 inflammatory cells were found as protective factors for CES: IL-10RA and CCL25; and transitional B cell, terminal differentiation double negative T cell, CD28-CD127-CD25++CD8br T cell, IgD+CD38br B cell, CD28+CD45RA-CD8br Treg, IgD+CD38-naive B cell, and granulocyte. Heterogeneity and pleiotropy analysis confirmed the reliability of the results. Our study reveals the causal relationship between inflammatory proteins, inflammatory cells, and CES, offering new insights for the development of future therapeutic drugs and early warning indicators.

CONCLUSIONS

Our findings extend genetic research to causal analysis between inflammatory proteins, cells, and CES. We found 2 proteins and 12 cells as risk factors and 2 proteins and 7 cells as protective factors. Further investigations are needed to verify whether these inflammation markers can be used to prevent or treat CES.

Trace amine-associated receptor 1 (TAAR1): an emerging therapeutic target for neurodegenerative, neurodevelopmental, and neurotraumatic disorders

Trace amines are physiologically active amines present in all organisms. They are structurally identical to traditional monoamines and are rapidly metabolized by monoamine oxidases. The mammalian neurological system generates these molecules at rates equivalent to traditional monoamines, but because of their short half-life, they are only observable in trace quantities. Their receptors are G protein-coupled receptors present in both the CNS and peripheral locations, with trace amine-associated receptor 1 (TAAR1) being the most researched. TAAR1's capacity to regulate glutamatergic and monoaminergic neurotransmission has made it a viable therapeutic target for neuropsychiatric illnesses. Although the TAAR1 role in schizophrenia and other neuropsychiatric disorders is well established, its role in the pathology of neurodegenerative and neurotraumatic disorders recently got attention. This review discusses the role of TAAR1 in neurodegenerative, neurodevelopment, and neurotraumatic disorders and explores its potential to be a novel therapeutic target in these disorders.

Combinatorial therapies for spinal cord injury repair

Spinal cord injuries have profound detrimental effects on individuals, regardless of whether they are caused by trauma or non-traumatic events. The compromised regeneration of the spinal cord is primarily attributed to damaged neurons, inhibitory molecules, dysfunctional immune response, and glial scarring. Unfortunately, currently, there are no effective treatments available that can fully repair the spinal cord and improve functional outcomes. Nevertheless, numerous pre-clinical approaches have been studied for spinal cord injury recovery, including using biomaterials, cells, drugs, or technological-based strategies. Combinatorial treatments, which target various aspects of spinal cord injury pathophysiology, have been extensively tested in the last decade. These approaches aim to synergistically enhance repair processes by addressing various obstacles faced during spinal cord regeneration. Thus, this review intends to provide scientists and clinicians with an overview of pre-clinical combinatorial approaches that have been developed toward the solution of spinal cord regeneration as well as update the current knowledge about spinal cord injury pathophysiology with an emphasis on the current clinical management.

Nanofibrous Guidance Conduits with Multiple Gradient Cues for Spinal Cord Repair

Spinal cord injury (SCI) is a debilitating condition that leads to severe disabilities and imposes significant economic and social burdens. Current therapeutic strategies primarily focus on symptom management, with limited success in promoting full neurological recovery. In response to this challenge, the design of novel guidance conduits incorporating multiple gradient cues, inspired is reported by biological processes, to enhance spinal cord repair. These conduits are fabricated using electrospinning and masked coaxial electrospraying, a simple yet effective method that integrates topological, haptotactic, and chemotactic cues into a single scaffold. The synergy of these cues significantly promoted cell migration, neural stem cell differentiation into neurons, and axonal extension, resulting in substantial improvements in spinal cord regeneration and functional recovery in a rat model. Single-nucleus RNA sequencing further demonstrated that the guidance conduit inhibited fibroblast proliferation, preserved microglial homeostasis, restored cellular proportions, and facilitated the regeneration of neuronal axons, dendrites, and synapses. This work presents an innovative, versatile platform for fabricating tissue scaffolds that integrate multiple gradient cues, offering a promising strategy for SCI treatment and broader tissue regeneration applications.

Exploring the neuroprotective potential of naringin following spinal cord injury in rats: improving sensory and motor function through combating inflammation and oxidative stress

Introduction

Spinal cord injury (SCI) leads to widespread cascades of inflammatory and oxidative factors. This pathological condition damages nerves and causes neurological disorders. To address these complex conditions, it is important to identify therapeutic candidates that affect multiple dysregulated signaling mediators and targets. Some phytochemicals such as naringin (NAI) with neuroprotective, antioxidant, and anti-inflammatory effects can be seen as a possible candidate for treating neurodegenerative diseases.

Purpose

Therefore, this study aims to evaluate the impact and mechanism of NAI on sensory and motor function in rats with SCI.

Materials and methods

In total, 35 rats were studied in five groups, including sham, SCI, and three groups treated with intrathecal administration of NAI (5, 10, and 15 mM). After the injury, sensorimotor behavioral tests and weight changes were performed for 4 weeks. On the 28th day, the serum of rats was checked to measure biochemical factors such as catalase, glutathione, and nitrite and the activity of metalloproteinases 2 (MMP-2) and MMP-9. Also, histological changes in spinal cord tissue were evaluated weekly for 4 weeks.

Results and discussion

NAI treatment demonstrated significant benefits in rats with SCI, including reducing pain, improvement in motor performance, and attenuated animal weight gain. Besides, NAI decreased the lesion area of spinal tissue and enhanced neuronal survival at both ventral and dorsal horns of spinal tissue. Furthermore, serum analysis revealed that NAI increased MMP-2 activity and catalase and glutathione levels while decreasing nitrite and MMP-9 activity.

Conclusion

The intrathecal administration of NAI can be proposed as a proper alternative in the treatment of sensory-motor disorders caused by SCI through neuroprotective, anti-inflammatory, and antioxidant mechanisms.

Identification of Differentially Expressed Genes in Spinal Cord Injury

BACKGROUND

Spinal cord injury (SCI) remains a profound medical challenge, with limited therapeutic options available. Studies focusing on individual molecular markers have limitations in addressing the complex disease process.

METHODS

This study utilizes RNA-sequencing (RNA-seq) to investigate the differentially expressed genes (DEGs) in spinal cord tissue from a rat SCI model at 1 and 21 days post-injury (dpi). After data processing and analysis, a series of biological pathway enrichment analyses were performed using online tools DAVID and GSEA. Interactions among the enriched genes were studied using Cytoscape software to visualize protein-protein interaction networks.

RESULTS

Our analysis identified 595 DEGs, with 399 genes significantly upregulated and 196 significantly downregulated at both time points. CD68 was the most upregulated gene at 21 dpi, with a significant fold change at 1 dpi. Conversely, MPZ was the most downregulated gene. Key immune response processes, including tumor necrosis factor (TNF) production, phagocytosis, and complement cascades, as well as systemic lupus erythematosus (SLE)-associated pathways, were enriched in the upregulated group. The enriched pathways in the downregulated group were related to the myelin sheath and neuronal synapse. Genes of interest from the most significantly downregulated DEGs were SCD, DHCR24, PRX, HHIP, and ZDHHC22. Upregulation of Fc-γ receptor genes, including FCGR2B and FCGR2A, points to potential autoimmune mechanisms.

CONCLUSIONS

Our findings highlight complex immune and autoimmune responses that contribute to ongoing inflammation and tissue damage post-SCI, underscoring new avenues for therapeutic interventions targeting these molecular processes.

Synergistic Antioxidant and Anti-Ferroptosis Therapy via BPNS-Encapsulated Thermoresponsive Chitosan Hydrogel for Spinal Cord Injury Regeneration

Background: Spinal cord injury (SCI) is a devastating neurological condition with limited therapeutic options. Current clinical interventions predominantly rely on prolonged or high-dose pharmacological regimens, often causing systemic toxicity and adverse events. Although black phosphorus nanosheets (BPNSs) exhibit remarkable reactive oxygen species (ROS)-scavenging capacity to mitigate oxidative damage, their rapid degradation severely compromises their therapeutic efficacy. Methods: This study presents a thermosensitive hydrogel with rapid gelation properties by incorporating different proportions and concentrations of sodium alginate (SA) into a chitosan/β-glycerophosphate (CS/β-GP) hydrogel and loading it with BPNS for the treatment of SCI in rats. In vitro, the physical properties of the composite were characterized and the cytotoxicity and ROS scavenging abilities were assessed using PC12 cells; in vivo, behavioral tests, histopathological analysis, transcriptomics, immunohistochemistry, and Western blotting were performed to explore the therapeutic effects and mechanisms. Results: The results demonstrate that this hydrogel effectively slows BPNS degradation, exhibits a high ROS scavenging capacity, reduces lipid peroxidation, and thereby inhibits ferroptosis and apoptosis, offering neuroprotective effects and promoting motor function recovery. Conclusions: Our findings establish the CS/β-GP/SA-BPNS hydrogel as a multifunctional therapeutic platform for SCI, synergizing sustained drug release with ROS-ferroptosis-apoptosis axis modulation to achieve neuroprotection and functional restoration. This strategy provides a translatable paradigm for combining nanotechnology and biomaterial engineering in neural repair.

Machine learning-driven prediction model for cuproptosis-related genes in spinal cord injury: construction and experimental validation

Introduction

Spinal cord injury (SCI) severely affects the central nervous system. Copper homeostasis is closely related to mitochondrial regulation, and cuproptosis is a novel form of cell death associated with mitochondrial metabolism. This study aimed to explore the relationship between SCI and cuproptosis and construct prediction models.

Methods

Gene expression data of SCI patient samples from the GSE151371 dataset were analyzed. The differential expression and correlation of 13 cuproptosis-related genes (CRGs) between SCI and non-SCI samples were identified, and the ssGSEA algorithm was used for immunological infiltration analysis. Unsupervised clustering was performed based on differentially expressed CRGs, followed by weighted gene co-expression network analysis (WGCNA) and enrichment analysis. Three machine learning models (RF, LASSO, and SVM) were constructed to screen candidate genes, and a Nomogram model was used for verification. Animal experiments were carried out on an SCI rat model, including behavioral scoring, histological staining, electron microscopic observation, and qRT-PCR.

Results

Seven CRGs showed differential expression between SCI and non-SCI samples, and there were significant differences in immune cell infiltration levels. Unsupervised clustering divided 38 SCI samples into two clusters (Cluster C1 and Cluster C2). WGCNA identified key modules related to the clusters, and enrichment analysis showed involvement in pathways such as the Ribosome and HIF-1 signaling pathway. Four candidate genes (SLC31A1, DBT, DLST, LIAS) were obtained from the machine learning models, with SLC31A1 performing best (AUC = 0.958). Animal experiments confirmed a significant decrease in the behavioral scores of rats in the SCI group, pathological changes in tissue sections, and differential expression of candidate genes in the SCI rat model.

Discussion

This study revealed a close association between SCI and cuproptosis. Abnormal expression of the four candidate genes affects mitochondrial function, energy metabolism, oxidative stress, and the immune response, which is detrimental to the recovery of neurological function in SCI. However, this study has some limitations, such as unidentified SRGs, a small sample size. Future research requires more in vitro and in vivo experiments to deeply explore regulatory mechanisms and develop intervention methods.

The Influence of Pathological Extracellular Matrix on the Biological Properties of Stem Cells: Possible Hints for Cell Transplantation Therapies in Spinal Cord Injury

Traumatic spinal cord injury (SCI) initiates a cascade of events, including persistent inflammation, which contributes to secondary injury. At a molecular level, the lesion is characterized by an altered microenvironment with changes in extracellular matrix (ECM) composition and organization, identified as a potential obstacle for effective stem cell-based cell therapies. We investigated the interactions between decellularized intact and injured rat spinal cords and rat embryonic (RESCs) and neural stem cells (NSCs) at 2 and 47 days post-lesion (dpl). Decellularized ECM was used to generate 2D coating and 3D gel in vitro platforms for cell seeding. Results showed that the 2dpl 2D coating exerted a significant negative effect on the viability of both cell types, while the 47dpl 2D coating maintained RESC pluripotency. NSCs cultured on the 2dpl 2D coating for seven days showed a severe impairment in cell growth, while maintaining a cluster formation potential and differentiation marker expression comparable to normal ECM for astrocytic and oligodendroglial lineages. Notably, when NSCs are grown in 47dpl 3D gel, the lineage turns dramatically toward an astroglial lineage. These results clearly show the detrimental effects of the SCI ECM microenvironment on stem cells, advancing the understanding of potential timings suitable for effective SCI cell-based therapies.

Neurotrophin-3/chitosan inhibits cuproptosis-related genes to enable functional recovery after spinal cord injury

OBJECTIVES

This study investigated the regulatory mechanisms of cuproptosis-related genes (CRGs) in spinal cord injury (SCI) and explored the therapeutic potential of neurotrophin-3 (NT3)-loaded chitosan in promoting functional recovery.

METHODS

We conducted integrated bulk RNA-seq and single-cell RNA-seq (scRNA-seq) analyses of mouse spinal cord tissue at various time points after SCI. The key CRGs were identified using differential expression analysis, weighted gene co-expression network analysis, and machine learning. The therapeutic effects of NT3-loaded chitosan were evaluated using animal models and molecular docking analysis.

RESULTS

We identified four key CRGs (Atp7a, Cp, Loxl2, and Pde3b) and three key transcription factors (C/EBPα, Stat6, and Runx1) that were upregulated post-SCI, promoting cuproptosis and neuroinflammation. NT3-loaded chitosan treatment significantly inhibited CRG expression and enhanced functional recovery in the animal models. Molecular docking analysis demonstrated binding interactions between chitosan and key CRGs, suggesting a potential mechanism for their therapeutic effects.

CONCLUSIONS

Our findings highlight the critical role of CRGs in SCI progression and the potential of NT3-loaded chitosan as a therapeutic strategy for inhibiting cuproptosis and promoting functional recovery. Future studies should focus on validating these findings in larger cohorts and exploring the detailed mechanisms by which NT3-loaded chitosan modulates CRG expression.

Differential changes in the microglial transcriptome between neonatal and adult mice after spinal cord injury

Spinal cord injury (SCI) remains a significant therapeutic challenge, lacking effective treatment options. Related studies have found that neonatal microglia are more effective than adult microglia in promoting the recovery of SCI, but the reason why neonatal, not adult, microglia are more conducive to SCI recovery is not clear, the differences of gene expression and pathways between them are still worth exploring. Therefore, we examined changes in the microglial transcriptome after SCI in neonatal and adult mice. We identified hub genes or pathways that exhibited significant differential expression between the two groups. Four Gene sets were established for further analysis, named Gene set 1, Gene set 2, Gene set 3, Gene set 4, respectively. GO analysis revealed enrichment in categories critical for injury repair, including DNA metabolism, replication, recombination, meiotic cell cycle progression, regulation of cell-cell adhesion, megakaryocyte and endothelial development, modulation of the neuroinflammatory response, endocytosis, and regulation of cytokine production and cell migration. KEGG analysis revealed enrichment in pathways critical for various cellular processes, including the p53, TNF, PI3K-AKT, PPAR and B cell receptor signaling pathway, axon guidance, cytokine-cytokine receptor interaction. PPI and TF-hub gene-microRNA networks were constructed to elucidate the underlying gene regulatory mechanisms. Additionally, drug prediction was performed to identify potential therapeutic candidates. Finally, 11 hub genes (Chek1, RRM2, Lyve1, Mboat1, Clec4a3, Ccnd1, Cdk6, Zeb1, Igf1, Pparg, and Cd163) were selected from four Gene sets for further validation using qRT-PCR. We identified candidate genes and pathways involved in microglial transcriptome heterogeneity after SCI in neonatal and adult mice. These findings provide valuable insights into potential therapeutic targets for neonatal microglia in the treatment of SCI.

APOE4 impairs macrophage lipophagy and promotes demyelination of spiral ganglion neurons in mouse cochleae

The ApoE-ε4 gene is a well-established genetic risk factor for neurodegenerative diseases, such as Alzheimer's disease and multiple sclerosis, which are characterized by axonal demyelination in the central nervous system. Recent studies have implicated ApoE-ε4 in age-related hearing loss (ARHL), suggesting a potential role of APOE4 isoform in peripheral nervous system degeneration. However, the role of APOE4 in ARHL are still unclear. In this study, we explored the potential role of APOE4 in axonal demyelination of spiral ganglion neurons (SGNs). ApoE-ε4/ε4 (APOE4) and ApoE-ε3/ε3 (APOE3) mice were used to characterize SGNs. The effect of APOE4 on phagocytosis and autophagy as well as intracellular cholesterol level was evaluated in resident cochlear macrophages (RCMs) and mouse bone marrow-derived macrophages (BMDMs). The results showed that significant axonal demyelination was observed in SGNs of 10-month-old APOE4 mice, accompanied by the presence of myelin debris engulfed by RCMs. Meanwhile, inhibited phagocytosis of myelin debris and impaired lipophagy were detected in APOE4 RCMs and APOE4 BMDMs with an aberrant accumulation of lipid droplets (LDs), which could be reversed by trehalose treatment. This study provided a deep insight into the pathogenesis of APOE4-induced axonal demyelination of SGNs associated with the impaired lipophagy in RCMs, which helped to elucidate the underlying mechanism of ApoE-ε4 in ARHL.

Regulation of Neuroimmune Microenvironment by PLA/GO/Anti-TNF-α Composite to Enhance Neurological Repair After Spinal Cord Injury

Introduction

Spinal cord injury (SCI) is a severe neurological condition with limited treatment options. Polylactic acid (PLA)+graphene oxide (GO)+anti-TNF-α (Ab) composites have shown potential in regulating immune responses and promoting neural repair.

Methods

Electrospinning PLA+GO+Ab materials were characterized using scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and X-ray diffraction (XRD). Their effects on neural stem cells (NSCs) and macrophage polarization were evaluated through in vitro assays, including proliferation, migration, differentiation, and flow cytometry. A rat SCI model was used to assess motor function recovery and histological changes.

Results

PLA+GO+Ab promoted NSC proliferation, migration, and differentiation while inducing macrophage polarization toward the M2 phenotype, reducing inflammation. In the SCI model, PLA+GO+Ab treatment enhanced motor function recovery, reduced spinal cord damage, and promoted axonal regeneration and oligodendrocyte maturation. RNA sequencing identified activation of the Rap1 signaling pathway, contributing to these effects.

Discussion

PLA+GO+Ab composites effectively modulate the neuroimmune microenvironment, supporting SCI recovery by promoting neural repair and immune regulation. These findings suggest its potential as a therapeutic biomaterial for SCI treatment.