The Importance of Basic Science: Filling the Pipeline

As a clinician-scientist in the field of spinal cord injury, I believe it is essential to maintain a comprehensive pipeline of research in order to make important gains. At one end is basic science research from the genomics and molecular level to the cellular and tissue level, with clinical research at the other end.  In fact, there is probably more than one pipeline, and one could identify the need to unravel the complex pathophysiology of spinal cord injury as one pipeline, and treatment as another. As well, there is the spectrum of acute injury at one end, and chronic injury at the other, each with its own needs for comprehensive studies in tissues and whole animal/human studies. It is essential to unravel the mysteries of the complex pathophysiology of spinal cord injury with its myriad of primary and secondary injury mechanisms in order to devise the most effective therapies.  The research must be multidisciplinary and collaborative across the breadth of these pipelines, and encompass the concept of combinatorial therapy to solve the complex structural and physiologic damage involved.  Research to date indicates that the enemy is formidable.

The basic research will require a variety of clinically relevant models, both in vitro and in vivo, and fortunately many are already available. These models should simulate clinical injuries to all regions of the cord and throughout the time spectrum from acute to chronic, and in both small and large animals. To date, most of the therapeutic interventions for spinal cord injury have been based on attempts to prevent or moderate one or more of the major secondary injury mechanisms that have been identified. Currently, there are approximately 20 important secondary injury mechanisms causing tissue destruction such as post traumatic ischemia, edema and inflammation, and more basic science studies are required to establish more effective ways to overcome these processes through the administration of neuroprotective agents. Similarly, there is a long list of inhibitory mechanisms in the injured spinal cord that impair or block regeneration, and these must be overcome to enhance regeneration. Furthermore, it will probably be most effective to administer both neuroprotective and neuroregenerative therapies, perhaps simultaneously, to maximize effect.