Top 5 Challenges in SCI Repair

Here are the top five challenges in the race for a cure for SCI:

1. Post-injury survival – Keep nerve cells that survive the initial injury alive and healthy
2. Regeneration and growth – Promote the re-growth of injured nerve cells and their fibers
3. Axon pathfinding – Guide growing axons toward their normal targets (i.e., muscles or other neural tissues)
4. Electrical conduction – Nerve cells must conduct electrical impulses with reliability and fidelity to carry information needed to execute complex tasks
5. Synaptic connection –  Axons that reach their targets must connect and stabilize a line of communication

Progress: In my opinion, in more than 10 years in this field, I firmly believe that we’ve grown exponentially in terms of knowledge and application for milestones #1, 2,  3, and 4. And this is great news because this means that we are more than halfway toward fixing SCI. In fact, there are ongoing clinical trials in various parts of the globe investigating ways to increase the survival of nerve cells (a critical first step!), enhancing the growth of spared fibers, and guiding those axons toward their normal targets.

Next Steps: While less is known about how to promote re-connections between injured nerve cells and their targets (#5), we have a firm grasp on the molecular mechanisms involved in this challenge. We know that specific proteins interact in the growing nervous system (i.e., those that functioned when you were still in the womb, or just an infant) and that they turn-off, don’t work, or are non-existent in adulthood. So, in essence, we need to learn how to turn these switches back on, or replace them with functional ones. While no easy task, there are emerging tools to do this, including genetic therapies which has become a huge advancement and addition to our repair tool box.

What I expect: In the next few years, we will see some very big pushes on various research fronts in the SCI battle space. I think the biggest successes and those soonest to arrive will be in the form of new strategies designed to overcome many of the serious quality-of-life issues associated with SCI, including pain, reflex disorders, and poor autonomic function. Hang on; stay alert; stay hopeful!