Jan Schwab, Charité-Universitätsmedizin Berlin, Berlin, Germany

Spinal Cord Injury-induced Secondary Immune Depression Syndrome

Funded in: 2012, 2013, 2014, 2015, 2016

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Besides the loss of sensation and motility below the level of the injury, there are far less known and investigated defects which are nevertheless clinically highly relevant. Spinal cord injury induces a severe disturbance (“Immune Paralysis”) of the normally well-balanced interplay between the immune system and the central nervous system. A suppressed immune system leaves the body unable to actively fight external microorganism attacks (like bacteria). This defect syndrome, termed Spinal Cord Injury-induced Secondary Immune Depression Syndrome (SCI-IDS) causes detrimental consequences.
A large number of patients suffering SCI-IDS will consequently develop infections (like pneumonia or urinary tract infection), which are the leading cause of death in acute spinal cord injury patients. In addition, the development of infections is an independent risk factor for significantly poorer neurological outcome. SCI-patients developing pneumonia/wound infections have a 190% higher chance not being able to convert from being “complete” to “incomplete” paralysed, compared to patients without infections (pneumonia/wound infections).
Thus, the development of infections caused by an immune-suppressed state represents a feasible target to improve care for SCI-injured patients in order to reduce mortality, enhance the efficacy of neurorehabiliation and finally to improve neurological function (“Protection of endogenous regeneration capacity”).

The current study aims at developing predictive surrogate parameter (“immunological biomarker”) in order to foresee (predict) which patients are at risk to develop infections and therefore loose their functional recovery potential. This will enable a “timeframe of opportunity” for a selective, specific treatment for patients “at risk”, before they will develop infections (preventive therapy).
Based on a preceding pilot trial this prospective clinical trial will monitor pre-selected immunological parameters for their predictive value to foresee the development of infections across several international SCI-specialized centres (Berlin, Tübingen, Zürich, Toronto).