Borgens (2001): Cellular engineering: molecular repair of membranes to rescue cells of the damaged nervous system

[Wise Young]

• Borgens RB (2001). Cellular engineering: molecular repair of membranes to rescue cells of the damaged nervous system. Neurosurgery. 49 (2): 370-8; discussion 378-9. Summary: PURPOSE: The acute administration of hydrophilic polymers (polyethylene glycol) can immediately seal nerve membranes, preventing their continuing dissolution and secondary axotomy. Polymer application can even be used to reconnect, or fuse, the proximal and distal segments of severed axons in completely transected adult mammalian spinal cord. CONCEPT: The sealing or fusion of damaged nerve membranes leads to a very rapid (minutes or hours) recovery of excitability in severely damaged nerve fibers, observed as a rapid return of nerve impulse conduction in vitro, as well as an in vivo recovery of spinal cord conduction and behavioral loss in spinal cord-injured adult guinea pigs. RATIONALE: Surfactant application produces a rapid repair of membrane breaches through mechanisms of interaction between the polymers and the aqueous phase of damaged membranes, and their ability to insert into, or seal, the hydrophobic core of the axolemma exposed by mechanical damage. DISCUSSION: This new technology applied to severe neurotrauma offers a clinically safe and practical means to rescue significant populations of spinal cord nerve fibers within 8 hours after damage--preventing their continued dissolution and secondary axotomy by secondary injury mechanisms. Application of this novel technology to other injuries to the peripheral and central nervous system is discussed, as well as a general application to soft tissue trauma. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11504113> Department of Basic Medical Sciences, Institute for Applied Neurology, Center for Paralysis Research, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907-1244, USA. CPR@vet.purdue.edu

[This message was edited by Wise Young on September 23, 2001 at 10:36 PM.]

[flashfox]

Dr. Young i belive that the best procedure in acute trauma is a complete decompression of bone around the injury with other drugs (metil prendisolone) but italian neurosorgers don't do that; often they wait a week before surgery or they don't do any surgery . what do you think about? Thank you so much for all very interesting
articles.

[Wise Young]

flashfox, I agree with you that there should be rapid (immediate, if possible) decompression of the spinal cord. In any other part of the central nervous system, they would do so. However, such pessimism surrounds spinal cord injury that many neurosurgeons choose to wait. About half of the neurosurgeons in the U.S. today will operate as soon as possible. Another half wait. There is no consensus on the subject yet. There have been several attempts by neurosurgery groups to start a clinical trial to answer this question rigorously. However, such a trial never took place. Wise.