Progress in spinal cord research - A refined strategy for the International Spinal Research Trust

Achieving regeneration in the central nervous system represents one of the greatest intellectual and practical challenges in neurobiology, and yet it is an absolute requirement if spinal cord injury patients are to have any h ope of recovery. The mission of the International Spinal Research Trust (IS RT), established in 1980, is to raise money specifically for spinal researc h, with a view to ending the permanence of paralysis caused by spinal cord injury. This review summarises some of the major steps forward made in rece nt years in understanding the mechanisms involved in spinal cord injury and where these discoveries fit in with the ISRT's overall objectives. We revi ew approaches aimed at (1) preventing immediate adverse reactions to injury such as neuronal death and scar formation; (2) minimising inhibitory prope rties of the CNS environment and maximising the growth potential of damaged neurons; (3) understanding axonal guidance systems that will be required f or directed outgrowth and functional reconnection; and (4) optimising the f unction of surviving systems. We also discuss 'infrastructural' prerequisit es for applying knowledge gained through spinal research to the clinical co ndition, including basic scientific issues such as developing representativ e animal models of spinal cord injury and sensitive quantitative methods fo r assessing growth and functional restoration. In addition, we point out th e importance of communication. The need to share knowledge between research groups is vital for advancing our understanding of injury and repair mecha nisms. Equally important is the need for communication between basic scient ists and clinicians which will be essential for what is the ultimate goal o f the ISRT, the development of relevant treatment strategies that will prov e beneficial to the spinal injured patient.