Neuroprotective role of Noggin in spinal cord injury

Spinal cord injury is one of the leading causes of morbidity and mortality among young adults in many countries including the United States.Difficulty in the regeneration of neurons is one of the main obstacles that leave spinal cord injury patients with permanent paralysis in most instances.Recent research has found that preventing acute and subacute secondary cellular damages to the neurons and supporting glial cells can help slow the progression of spinal cord injury pathogenesis,in part by reactivating endogenous regenerative proteins including Noggin that are normally present during spinal cord development.Noggin is a complex protein and natural inhibitor of the multifunctional bone morphogenetic proteins,and its expression is high during spinal cord development and after induction of spinal cord injury.In this review article,we first discuss the change in expression of Noggin during pathogenesis in spinal cord injury.Second,we discuss the current research knowledge about the neuroprotective role of Noggin in preclinical models of spinal cord injury.Lastly,we explain the gap in the knowledge for the use of Noggin in the treatment of spinal cord injury.The results from extensive in vitro and in vivo research have revealed that the therapeutic efficacy of Noggin treatment remains debatable due to its neuroprotective effects observed only in early phases of spinal cord injury but little to no effect on altering pathogenesis and functional recovery observed in the chronic phase of spinal cord injury.Furthermore,clinical information regarding the role of Noggin in the alleviation of progression of pathogenesis,its therapeutic efficacy,bioavailability,and safety in human spinal cord injury is still lacking and therefore needs further investigation.

Modulation of autophagy for neuroprotection and functional recovery in traumatic spinal cord injury

Spinal cord injury(SCI) is a serious central nervous system trauma that leads to loss of motor and sensory functions in the SCI patients. One of the cell death mechanisms is autophagy, which is ‘self-eating' of the damaged and misfolded proteins and nucleic acids, damaged mitochondria, and other impaired organelles for recycling of cellular building blocks. Autophagy is different from all other cell death mechanisms in one important aspect that it gives the cells an opportunity to survive or demise depending on the circumstances. Autophagy is a therapeutic target for alleviation of pathogenesis in traumatic SCI. However, functions of autophagy in traumatic SCI remain controversial. Spatial and temporal patterns of activation of autophagy after traumatic SCI have been reported to be contradictory. Formation of autophagosomes following therapeutic activation or inhibition of autophagy flux is ambiguous in traumatic SCI studies. Both beneficial and harmful outcomes due to enhancement autophagy have been reported in traumatic SCI studies in preclinical models. Only further studies will make it clear whether therapeutic activation or inhibition of autophagy is beneficial in overall outcomes in preclinical models of traumatic SCI. Therapeutic enhancement of autophagy flux may digest the damaged components of the central nervous system cells for recycling and thereby facilitating functional recovery. Many studies demonstrated activation of autophagy flux and inhibition of apoptosis for neuroprotective effects in traumatic SCI. Therapeutic induction of autophagy in traumatic SCI promotes axonal regeneration, supporting another beneficial role of autophagy in traumatic SCI. In contrast, some other studies demonstrated that disruption of autophagy flux in traumatic SCI strongly correlated with neuronal death at remote location and impaired functional recovery. This article describes our current understanding of roles of autophagy in acute and chronic traumatic SCI, crosstalk between autophagy and apoptosis, therapeutic activation or inhibition of autophagy for promoting functional recovery, and future of autophagy in traumatic SCI.

Histone deacetylase enzymes and selective histone deacetylase inhibitors for antitumor effects and enhancement of antitumor immunity in glioblastoma

Glioblastoma multiforme (GBM), which is the most common primary central nervous system malignancy in adults, has long presented a formidable challenge to researchers and clinicians alike. Dismal 5-year survival rates of the patients with these tumors and the ability of the recurrent tumors to evade primary treatment strategies have prompted a need for alternative therapies in the treatment of GBM. Histone deacetylase (HDAC) inhibitors are currently a potential epigenetic therapy modality under investigation for use in GBM with mixed results. While these agents show promise through a variety of proposed mechanisms in the pre-clinical realm, only several of these agents have shown this same promise when translated into the clinical arena, either as monotherapy or for use in combination regimens. This review will examine the current state of use of HDAC inhibitors in GBM, the mechanistic rationale for use of HDAC inhibitors in GBM, and then examine an exciting new mechanistic revelation of certain HDAC inhibitors that promote antitumor immunity in GBM. The details of this antitumor immunity will be discussed with an emphasis on application of this antitumor immunity towards developing alternative therapies for treatment of GBM. The final section of this article will provide an overview of the current state of immunotherapy targeted specifically to GBM.

Bone morphogenic protein signaling in spinal cord injury

Spinal cord injury(SCI)is a debilitating injury that results from traumatic or non-traumatic insults to the spinal cord,causing significant impairment of the patient's activity and quality of life.Bone morphogenic proteins(BMPs)are a group of polyfunctional cytokines belonging to the transforming growth factor beta superfamily that regulates a wide variety of cellular functions in healthy and disease states.Recent studies suggest that dysregulation of BMP signaling is involved in neuronal demyelination and death after traumatic SCI.The focus of this article is to describe our current understanding of the role of BMP signaling in the regulation of cell fate,proliferation,apoptosis,autophagy,and inflammation in traumatic SCI.First,we will describe the expression of BMPs and pattern of BMP signaling before and after traumatic SCI in rodent models and in vitro.Next,we will discuss the role of BMP in the regulation of neuronal and glial cell differentiation,survival,functional recovery from traumatic SCI,and the gap in knowledge in this area that requires further investigation to improve SCI prognosis.

Roles of miRNAs in spinal cord injury and potential therapeutic interventions

Spinal cord injury(SCI)affects approximately 200,000 individuals per year worldwide.There are more than 27 million people worldwide living with long-term disability due to SCI.Historically,it was thought that the central nervous system(CNS)had little ability for regeneration;however,more recent studies have demonstrated potential for repair within the CNS.Because of this,there exists a renewed interest in the discovery of novel approaches to promote regeneration in the CNS including the spinal cord.It is important to know the roles of the microRNAs(miRNAs)in modulation of pathogenesis in SCI and the potentials of the miRNA-based clinical interventions for controlling post-injury symptoms and improving functional recovery.The miRNAs,which are non-coding RNAs with an average of 22 nucleotides in length,are post-transcriptional gene regulators that cause degradation of the target mRNAs and thus negatively control their translation.This review article focuses on current research related to miRNAs and their roles in modulating SCI symptoms,asserting that miRNAs contribute to critical post-SCI molecular processes including neuroplasticity,functional recovery,astrogliosis,neuropathic pain,inflammation,and apoptosis.In particular,miR-96 provides a promising therapeutic opportunity to improve the outcomes of clinical interventions,including the way SCI injuries are evaluated and treated.

Economic impact of traumatic spinal cord injuries in the United States

Individuals having sustained traumatic spinal cord injury(TSCI)in the United States are living longer as compared to historical trends,thanks to an ever-evolving understanding of the nature of this injury.Despite this,multiple barriers to care for TSCI patients remain including variations in government-issued veteran insurance,privatized insurance,and among uninsured individuals.The United States alone experiences 12,000 new TSCI cases every year,many of these are found to occur in a growing proportion of elderly individuals.It is crucial to understand both the short-term direct costs as wells as the long-term rehabilitation costs required by these TSCI patients.The lifetime financial burden for those having sustained a TSCI can be immense for patients,insurance companies,and hospital systems alike.Among those with TSCI,re-hospitalization rates are high,leading to increased healthcare resource utilization within this specific patient population.Costs can quickly balloon into hundreds of thousands of dollars and cause a profound financial burden for these patients.This review article seeks to communicate an understanding of the current financial landscape surrounding TSCI patients.The authors will also examine the costs of acute emergency room surgical care such as American spinal injury association grade,hospital length of stay,as well as the timing delay between injury and surgical decompression.Long-term costs associated with TSCI such as rehabilitation,care of secondary comorbidities,and post-injury employment prospects will be examined as well.These costs will be framed from the patient's perspective as well as from both the hospital and insurance company's perspectives.It is hoped a complete understanding as to what makes TSCI such a medically and financially burdensome injury will allow for improved healthcare resource utilization in this population.