title: Therapeutic Hypothermia in Spinal Cord Injury: The Status of Its Use and Open Questions.
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.
authors.affiliation: 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. jxw24@med.miami.edu.
authors.forename: Jiaqiong
authors.initials: J
authors.lastname: Wang
authors.affiliation: 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. dpearse@med.miami.edu.|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. dpearse@med.miami.edu.|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. dpearse@med.miami.edu.|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. dpearse@med.miami.edu.
authors.forename: Damien D
authors.initials: DD
authors.lastname: Pearse
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D007036:Hypothermia, Induced; D000066829:Neuroprotection; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D057170:Translational Research, Biomedical
keywords: angiogenesis; cell death; cooling; free radicals; hypothermia; inflammation; neuroprotectivion; spinal cord injury; transplantation