Treatments to restore respiratory function after spinal cord injury and their implications for regeneration, plasticity and adaptation

Spinal cord injuries, especially in the neck area, can severely impact breathing because they disrupt the nerve signals that control the diaphragm. This review explores different methods to restore breathing after such injuries, focusing on how the nervous system's ability to adapt and change (plasticity) can be harnessed to improve respiratory function. One approach involves using drugs like theophylline to stimulate the respiratory system and activate dormant pathways that can compensate for the damaged ones. Another method involves intermittent hypoxia, which is exposing the body to short periods of low oxygen, which can trigger long-lasting improvements in respiratory motor output. Researchers are also investigating ways to promote the regrowth of damaged nerve fibers and modify the spinal cord's respiratory neurons to enhance their function. These strategies aim to tap into the spinal cord's inherent capacity to reorganize and adapt in response to injury, ultimately leading to improved breathing and quality of life for SCI patients.

• 1
  Pharmacological treatments, such as theophylline, can partially restore function to the paralyzed hemidiaphragm by increasing respiratory drive.
• 2
  Intermittent hypoxia (IH) protocols, both acute (AIH) and chronic (CIH), can elicit long-lasting increases in respiratory motor output, a phenomenon known as long-term facilitation (LTF).
• 3
  Chondroitinase ABC (ChABC) treatment, which degrades inhibitory molecules in the glial scar, can promote regeneration of axons back into the CNS from peripheral nerve grafts, leading to functional improvements.