Spinal Cord Injury Progress, Promise, and Priorities (2005) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-12
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Many current avenues of research suggest that a concerted research effort on spinal cord injuries could result in important gains in restoring function and improving quality of life. Recognizing this wealth of new opportunity, the New York State Spinal Cord Injury Research Board asked the Institute of Medicine (IOM)
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By setting forth a set of goals for spinal cord injury research, the committee wishes to emphasize the different stages of the injury during which interventions are needed and the multiple health impairments that affect an individual's daily quality of life and that require the development of effective therapeutic interventions. IDENTIFYING RESEARCH DIRECTIONS Spinal cord injury results in a cascading biological response ranging from the changes in blood pressure and blood volume and hypoxia (reduc
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Research toward addressing the consequences of spinal cord injuries focuses on a natural progression of strategies: preventing further tissue loss, maintaining the health of living cells, replacing cells that have died through apoptosis or necrosis, growing axons and ensuring functional connections, and strengthening and reestablishing synapses that restore the neural circuits required for functional recovery. These strategies lead to a range of therapeutic targets and priorities for spinal cord injury research (Table ES-1)
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Recommendation 5.1:1 Increase Efforts to Develop Therapeutic Interventions The National Institutes of Health, other federal and state agencies, nonprofit organizations, and the pharmaceutical and medical device industries should increase research funding and efforts to develop thera peutic interventions that will prevent or reverse the physiological events that lead to chronic disability and interventions that are applicable to chronic spinal cord injuries. Specifically, research is needed to · improve understanding of the basic mechanisms and identify suit able targets to promote neuroprotection, foster axonal growth, en hance axonal guidance, regulate the maintenance of appropriate synap tic connections, and reestablish functional neuronal and glial circuitry; and 1 For ease of reference, the committee's recommendations are numbered according to the chapter of the main text in which they appear followed by the order in which they appear in the chapter.
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Key to accelerating progress in the treatment of spinal cord injuries is the development of a coordinated, focused, and centralized network that connects individual investigators, research programs, and research centers; facilitates collaborative and replicative research projects; incorporates relevant research from diverse fields; and builds on the unique strengths of each research effort to move toward effective therapies. A research network is of particular importance in spinal cord injury research because of the emphasis on interdisciplinary research and the need for an organized and systematic approach to examining potential combination therapies.
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Recommendation 7.2: Establish Spinal Cord Injury Research Centers of Excellence The National Institutes of Health should designate and support five to seven Spinal Cord Injury Research Centers of Excellence with adequate resources to sustain multidisciplinary basic, translational, and clinical research on spinal cord injuries. This would involve establishing two to three new Centers of Excellence and designating three to four current spinal cord injury research programs as Centers of Excellence.
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Opportunities to strengthen New York State's program, to reduce the administrative bureaucracy, and to bolster its impact also exist. The committee's recommendations focus on the following four areas: · building and strengthening New York State's research infrastructure, · developing a regional clinical trials center, · restructuring the research funding and oversight processes, and · ensuring independent evaluation of the progress that has been made toward the stated mission of the New York State Spinal Cord Injury Research Board.
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Although few therapeutic interventions are ready for clinical trials, the body of knowledge on the mechanisms underlying neuronal injury and repair is increasing rapidly, and many potential therapies show promise in in vitro studies and in studies with animals. The committee believes that accelerating progress in spinal cord injury research involves the following three key efforts that, in addition to the recommendations for the New York State program, are the focus of the committee's recommendations (Box ES-1)
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Treating spinal cord injury, particularly in the near term, will involve improving functional deficits and quality of life. The complexity of the nervous system, the varied nature of spinal cord injuries, and the severity of the loss of function present real and significant hurdles to be overcome to reach the ultimate goals of restoring total function.
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Spinal cord injury researchers should receive training in the use of standard ized animal models and evaluation techniques.
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Strengthen the Research Infrastructure and Enhance Training Establish Spinal Cord Injury Research Centers of Excellence (Recommendation 7.2) The National Institutes of Health should designate and support five to seven Spinal Cord Injury Research Centers of Excellence with adequate resources to sustain multidisciplinary basic, translational, and clinical research on spinal cord injuries.
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The New York State Spinal Cord Injury Research Board should establish an independent external review panel that meets periodically to rigorously assess the program's efforts toward its stated mission to cure spinal cord injuries.
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