Spinal Cord Injury Management Based on Microglia-Targeting Therapies

Abstract

Spinal cord injury is a complicated medical condition both from the clinician's point of view in terms of management and from the patient's perspective in terms of unsatisfactory recovery. Depending on the severity, this disorder can be devastating despite the rapid and appropriate use of modern imaging techniques and convenient surgical spinal cord decompression and stabilization. In this context, there is a mandatory need for novel adjunctive therapeutic approaches to classical treatments to improve rehabilitation chances and clinical outcomes. This review offers a new and original perspective on therapies targeting the microglia, one of the most relevant immune cells implicated in spinal cord disorders. The first part of the manuscript reviews the anatomical and pathophysiological importance of the blood-spinal cord barrier components, including the role of microglia in post-acute neuroinflammation. Subsequently, the authors present the emerging therapies based on microglia modulation, such as cytokines modulators, stem cell, microRNA, and nanoparticle-based treatments that could positively impact spinal cord injury management. Finally, future perspectives and challenges are also highlighted based on the ongoing clinical trials related to medications targeting microglia.

Keywords: blood-spinal cord barrier; cytokines; microRNA; microglia; neuroinflammation; spinal cord injury; stem cells.

Figure 1

The blood-spinal cord barrier in physiological conditions: (A) blood supply of the spinal cord; (B) schematic representation of the blood-spinal cord barrier; (C) schematic representation of a tight junction (designed by using Biorender.com, accessed on 23 March 2024).