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Int. J. Mol. Sci. 2015, 16(8), 16848-16879; doi:10.3390/ijms160816848

Therapeutic Hypothermia in Spinal Cord Injury: The Status of Its Use and Open Questions

1,†,* and 1,2,3,4,†,*
1
The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA
2
The Department of Neurological Surgery, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA
3
The Neuroscience Program, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA
4
The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, the Lois Pope Life Center, Locator code (R-48), PO BOX 016960, Miami, FL 33136, USA
These authors contributed equally to the work.
*
Authors to whom correspondence should be addressed.
Academic Editor: Xiaofeng Jia
Received: 30 June 2015 / Revised: 10 July 2015 / Accepted: 14 July 2015 / Published: 24 July 2015
(This article belongs to the Special Issue Neurological Injuries’ Monitoring, Tracking and Treatment)
View Full-Text   |   Download PDF [1029 KB, uploaded 24 July 2015]   |  

Abstract

Spinal cord injury (SCI) is a major health problem and is associated with a diversity of neurological symptoms. Pathophysiologically, dysfunction after SCI results from the culmination of tissue damage produced both by the primary insult and a range of secondary injury mechanisms. The application of hypothermia has been demonstrated to be neuroprotective after SCI in both experimental and human studies. The myriad of protective mechanisms of hypothermia include the slowing down of metabolism, decreasing free radical generation, inhibiting excitotoxicity and apoptosis, ameliorating inflammation, preserving the blood spinal cord barrier, inhibiting astrogliosis, promoting angiogenesis, as well as decreasing axonal damage and encouraging neurogenesis. Hypothermia has also been combined with other interventions, such as antioxidants, anesthetics, alkalinization and cell transplantation for additional benefit. Although a large body of work has reported on the effectiveness of hypothermia as a neuroprotective approach after SCI and its application has been translated to the clinic, a number of questions still remain regarding its use, including the identification of hypothermia’s therapeutic window, optimal duration and the most appropriate rewarming rate. In addition, it is necessary to investigate the neuroprotective effect of combining therapeutic hypothermia with other treatment strategies for putative synergies, particularly those involving neurorepair. View Full-Text
Keywords: hypothermia; spinal cord injury; neuroprotectivion; cell death; inflammation; cooling; transplantation; angiogenesis; free radicals hypothermia; spinal cord injury; neuroprotectivion; cell death; inflammation; cooling; transplantation; angiogenesis; free radicals
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Wang, J.; Pearse, D.D. Therapeutic Hypothermia in Spinal Cord Injury: The Status of Its Use and Open Questions. Int. J. Mol. Sci. 2015, 16, 16848-16879.

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