Immune system and spinal cord injury

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Almost half of all the subjects that experience a spinal cord injury will develop infections, mostly in the short period of time following the injury. Based on the assumption that infections might spread neuronal death and therefore limit the functional neurological recovery, the group of Prof. Jan Schwab investigated the association of infections with the functional neurological outcome after acute traumatic spinal cord injury. The results of this work were recently published in Brain, one of the neurology journals with the highest citation rating.

Several risk factors contribute to increased susceptibility of SCI subjects for infections and it was recently shown that an immune depression syndrome is also induced after the trauma. This immune deficiency syndrome, which is translated into a paralysis of the immune system, occurs already 24 hours after the injury and deeply affects the capacity of the subjects to effectively fight infections.

The study was based on the American National Spinal Cord Injury Database, the world largest spinal cord injury database, which includes detailed record on more than 25.000 SCI subjects from the first day of their injury to at least one year later (sometimes up to 10 years follow-up). During this period of time, all subjects were assessed through numerous functional tests, including residual sensation and motricity (like arms or legs movements). Analysis then revealed that ASI A and B subjects (the individuals of choice for clinical trials) that developed an infection did not recover as well as they should have when compared to control (infection free) subjects.

The impact of this study will be double. On one side upcoming clinical trials might gain efficacy by separating subjects that develop an infection from the analysis. Additionally, infections constitute a clinically relevant target in order to protect the functional regeneration capacity. Current work of Dr. Schwab focuses on establishing early predictive parameters that would allow detecting subjects that are developing infections in the early phase, to have an opportunity to stop it in time to preserve the full recovery potential.

Brain. 2012 Oct 25. Functional neurological recovery after spinal cord injury is impaired in patients with infections. Failli V, Kopp MA, Gericke C, Martus P, Klingbeil S, Brommer B, Laginha I, Chen Y, Devivo MJ, Dirnagl U, Schwab JM.