Lazaroids and Neuroprotection: What Benefit?

Acute spinal cord injuries (SCI) are among the most devastating traumatic situations and are responsible for high morbidity and mortality rates. The consequences include motor and sensory impairment as well as perturbations of intestinal, urinary and sexual functioning. Chronic neuropathic pain is a common consequence of SCI, develops over time and negatively impacts quality of life, often leading to substance abuse and depression. Many factors are involved in the pathogenesis of SCI. After the initial mechanical injury, the secondary lesions arise and involve a variety of processes leading to expansion of the primary lesion. These phenomena include inflammation, oedema, ischemia, electrolytic imbalance, glutamate-induced excitoxicity, apoptosis, lipid peroxidation (LP). Although many key players are involved in the secondary cascade of events, reactive oxygen-induced LP appears to play a critical role. Therefore, a neuroprotective pharmacologic strategy would aim at antagonizing oxygen radical-induced LP in a safe and effective manner. Indeed, the pharmacological therapy of SCI is actually unsatisfactory. Modest benefits from the treatment with a high dose regimen of methylprednisolone (MP), if applied early, could improve spinal cord tissue survival, thus preserving the necessary anatomic substrate for functional recovery to take place.