A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities

Military Medical Research, 2023 · DOI: https://doi.org/10.1186/s40779-023-00461-z · Published: June 1, 2023

Simple Explanation

Spinal cord injury (SCI) is a devastating condition resulting from trauma that leads to both local and systemic biological changes. These changes can either help to repair the damage or make it worse. Psychoneuroimmunoendocrinology (PNIE) explores how different systems in the body interact, considering the mind and body as a whole. SCI can cause immune, endocrine, and other system dysfunctions that affect a person’s psychological well-being. This review explores the local and systemic effects of SCI from a PNIE perspective, describing the changes in each system and how they are connected. It also suggests potential clinical approaches to develop comprehensive therapies for better patient management.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
SCI involves both primary injury, which is often irreversible, and secondary injury, which can be delayed and potentially treatable. Understanding the pathophysiology of secondary damage is crucial for timely specialist intervention.
2
SCI leads to neurological changes affecting both the central and peripheral nervous systems, causing loss of sensory and motor function, and dysregulation of the autonomic nervous system.
3
SCI results in systemic immune dysfunction, which can manifest as systemic inflammatory events, low-grade chronic inflammation, autoimmunity, or immunosuppression, influencing the body's ability to fight infections and recover.

Research Summary

This review comprehensively examines the psychoneuroimmunoendocrinology (PNIE) of spinal cord injury (SCI), emphasizing the interconnectedness of neurological, immunological, and endocrine systems in SCI progression and management. The article highlights that SCI leads to a complex interplay of local spinal cord damage and systemic alterations, impacting the central and peripheral nervous systems, immune responses, metabolic functions, and psychological well-being. The authors propose an integrative approach to SCI management, considering the mind-body connection through the PNIE framework, which may lead to the development of more effective and personalized therapeutic strategies.

Practical Implications

Early Intervention Strategies

Focus on early surgical decompression and the use of vasopressor medications to improve spinal cord perfusion and mitigate primary and secondary injuries.

Personalized Immunomodulation

Develop tailored immunomodulatory therapies based on individual immune profiles to balance the dual roles of inflammation and prevent immunosuppression.

Integrative Rehabilitation Programs

Implement comprehensive rehabilitation programs that address neurological, immunological, endocrine, and psychological aspects, including lifestyle interventions such as diet, physical activity, and sleep management.

Study Limitations

1
Limited data hinders understanding due to the small number of studies exploring metagenomics in post-SCI trauma/diagnosis
2
There is a lack of information related to the differences between sexes in preclinical models to apply them translationally.
3
Further knowledge of the immune response in the spinal cord is needed, and many translational efforts are required in this field.

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