Suffering a spinal cord injury is something that should not be taken lightly, and proper treatment should be found immediately. The spinal cord serves as a gateway between the signals the brain transmits and the actions going to the rest of the body. A spinal cord injury can put this crucial function of our body in jeopardy, meaning that effective treatment is necessary to eliminate these long term effects that completely ruin someone’s life. To find a solution to such an intricate part of the body, we take a look at some of the smallest and versatile medical interventions that have been utilized over history. This is referring to nanoparticles, hydrogels, and stem cells. Because of their small size and desirable properties, these serve as a great starting point to find the treatment to this problem. After taking a deeper dive into the properties and characteristics of hydrogels, stem cells, and nanoparticles, it was found that it was a great fit to be utilized for this specific course of treatment. Our research found that the drug methylprednisolone, specifically, was a great medicine that would control inflammation around the injury site. To administer this drug in high doses, where it is most effective, the use of nanoparticles and hydrogels were utilized for the most precise delivery. This method has found that if this treatment is provided in the first 8 hours following the injury, the possibility of long term effects and neurological deficits decrease significantly. Overall, with a deep dive into the properties of nanoparticles, hydrogels, and stem cells, we were able to come up with an effective treatment for an injury affecting almost half a million people every year.
Mukesh Kandra, Grade 11, Middlesex County Academy for Allied Health, New Jersey
Use of Hydrogels, Nanoparticles, and Stem Cells in the Treatment of Spinal Cord Injuries
You have just gotten into a motor vehicle accident, and you are trapped in the car with no help and nowhere to go. You have suffered a spinal cord injury. This is the situation of 250,000 to 500,000 people every year. A spinal cord injury can be defined as damage to any part of the spinal cord or nerves at the end of the spinal canal. Depending on the injury site and severity of the injury, the effects can either be permanent or treatable. If treated appropriately and early enough, the damages of a SCI can be fixed. Since the spine and nerves are such an intricate part of the body, and crucial as it is a bridge between the brain’s signals and the rest of the body, the treatment must be precise with no room for error. One possible solution in a new treatment for SCIs include the use of nanoparticles, hydrogels, stem cells, and a medicine known as methylprednisolone. A combination of all of these interventions will allow for the most effective treatment for the patient due to their individual properties. Overall, due to the properties and characteristics of hydrogels, stem cells, and methylprednisolone, the treatment of SCI can become more effective, reviving the function of many individuals who have lost function due to improper treatment.
What is a Spinal Cord Injury?
The spinal cord’s function is to act as a gateway between the brain and the rest of the body when messages are required to be sent. It is protected by meninges, which are layers of tissue, and vertebrae. When the vertebrae experience a blunt trauma, a spinal cord injury can occur. If the bones cause irreversible damage to the nerves or the spinal cord itself, long term changes to sensation, strength, movement, and body functions. The most common causes that result in a spinal cord injury are motor vehicle accidents and catastrophic falls. Currently, the treatment options for SCIs are limited. If a patient is found at the scene, a neck collar is placed and the patient is transported via a backboard. Regarding hospital care, invasive surgeries are common to remove the broken bone fragments from the vertebrae. This procedure is long and requires an extensive recovery process. Depending on the location of the injury, the effects vary. For example, injuries higher up on the spinal cord is more likely to result in paralysis of all the limbs. On the contrary, injury to the lower part of the spinal cord causes paralysis of the legs and lower body. When it comes to the different spinal cord injuries, there are two main types: complete and incomplete spinal cord injuries.
Figure 1. The chart above depicts the main causes of SCI from 1990 to 2003, with vehicular accidents and falls being the two most common reasons
The first type of spinal cord injury is a complete spinal cord injury. This can be described as when the spinal cord is completely compressed. This completely takes away the ability of the brain to transfer any signals to the parts of the body below the injury. Symptoms of complete SCIs include inability to feel anything below the site of injury, difficulty with bladder and bowel control, and even difficulty breathing depending on the injury sight. When it comes to an incomplete SCI, it can be described as still having minimal function below the injury site. This can be in one or more areas below the site. The outcomes of an incomplete SCI can vary greatly. It can be almost as severe as a complete SCI, but also so unnoticeable that you would not be able to tell that they have endured any sort of trauma. Unlike a complete SCI, the brain still has the ability to send signals to areas of the body below the injury site to a certain extent. The causes for both, however, are similar. Something as simple as the position of an individual at the time of the trauma can determine if they will suffer a complete or incomplete SCI. Some signs that you may have an incomplete SCI is if you feel pain below the injury site, be able to move muscles below, or retain any sort of feeling in general below the injury. Those with incomplete SCIs have a more optimistic chance of recovery, but both can still be treated.
Figure 2. While a complete SCI completely cuts off any signals from being sent below the injury site, an incomplete SCI can still allow signals to be sent to certain parts below the injury.
What are hydrogels?
First reported by Wichterle and Lím in 1960, hydrogels are three dimensional networks of hydrophilic polymers. They are water-swollen and are able to maintain their shape due to their chemical or physical cross-linking of individual polymer chains. Water must be at least 10% of total weight or volume of material to be classified as a hydrogel leading to them having a degree of flexibility similar to natural tissue. Being one of the first biomaterials used in the human body, common uses of hydrogels include in contact lenses, hygiene products, wound dressings, drug delivery, and tissue engineering. Some of the characteristics of hydrogels that make them favorable not only in the medical field, but also in other uses, are its high water content, softness, flexibility, and wide biocompatibility. Because of these favorable traits, they are able to stimulate natural living tissue more than any other type of synthetic biomaterial. Hydrogels allow for the control over the release of various therapeutic agents. This is crucial because the administration of a certain drug must be completed in a precise way to get the desired results. With hydrogels, the precise control of the drug delivery makes it a great material to use. Another reason hydrogels are properly suited for drug delivery is their porous structure, which enables drugs to be loaded and released efficiently.
What are stem cells?
Stem cells generate all other cells in the human body with specialized functions. These generated cells can develop into new stem cells or specialized cells with specific functions (red blood cells, egg cells, nerve cells, muscle cells, etc). Since only stem cells are able to generate new cell types, they are extremely important and can be used to treat many different conditions. Stem cells therapy has been used to treat a wide range of medical conditions, such as Alzheimer’s disease, heart disease, stroke, Parkinson’s disease, and yes, spinal cord injuries. One of the recent advancements in the medical field has been using stem cells in transplant and regenerative medicine. However, as with most things, there were some issues at first. Human stem cell research in 2009 had strict guidelines put in place by the National Institutes of Health. This especially affected the study of embryonic cells- cells that form when eggs are fertilized with sperm at an in vitro fertilization clinic. The ethical concerns and issues arose because the stem cells were being taken from human embryos. However, the new guidelines stated that the stem cells can only be used when the embryo is no longer needed.
The original thought was that stem cells could only create similar types of cells. For example, stem cells originating in the heart would only be able to produce cells pertaining to the heart. However, this is far from the truth. According to new evidence, stem cells have the capability to create different cells. For example, stem cells found in the heart will have the ability to generate blood cells or nerve cells. With this breakthrough discovery, clinical trials were utilized to test the efficacy of the stem cells and how safe they are for medical use. Through the clinical trials, it was concluded that stem cells are more compliant than originally presumed. For example, the research and clinical trials done supported that adult bone marrow stem cells that generated heart cells were able to repair heart tissue in people and improve their condition.
Figure 3. Stem cells can generate specialized cells that can be utilized to treat certain organs or areas of the body.
One specific study published in the Journal of Clinical Neurology and Neurosurgery suggests that an intravenous injection- which contains stem cells originating in bone marrow- given to patients that have suffered from a SCI can result in tremendous advancements in motor functions. The study explains that the ability to walk or use their hands saw considerable improvements within weeks of being given the injection. No noticeable or note-worthy side effects were observed. The patients being studied suffered their injury from falls or blunt traumas weeks prior to the stem cell injection. As discussed previously, some of the key symptoms complained by the patients include sensory loss, bowel and bladder dysfunction, and loss of motor function. This study further provides an example of how stem cells are benefiting patients currently with injuries and different conditions.
What is methylprednisolone?
The use of methylprednisolone is one of the treatment options for SCI. Similar to the natural hormone produced by your adrenal glands, this corticosteroid, sometimes referred to by its brand name, medrol, is often used to relieve inflammation, blood or bone marrow problems, certain types of arthritis, severe allergies, asthma, and even specific cancers. Methylprednisolone is made in the form of a tablet taken orally. Your general physician will prescribe the appropriate course of treatment, which must be followed carefully. If you stop the course of treatment as you see improvement without consulting with your doctor, this can have serious implications, such as loss of appetite, confusion, fevers, muscle pain, and weight loss. Taking the correct dosage is crucial, so contact your doctor immediately if you are experiencing negative effects so the necessary changes can be made. Common with the administration of a course of methylprednisolone is a low-sodium, low-salt, potassium-rich, or high-protein diet. As this drug may lead to an upset stomach, take methylprednisolone with food or milk.
Methylprednisolone can be utilized as a treatment option for spinal cord injuries. Since it is a synthetic cortico-steroid, it can be used in high doses. The properties of this drug allows it to suppress the body’s immune system, controlling the inflammation around the injury site. Improved neurologic recovery and lower permanent damage can be seen in patients that receive this treatment less than 8 hours after the initial injury. To avoid any side effects from the high dosage, administration of this drug requires a targeted delivery to the injury site. Nanoparticles such as the poly lactic-co-glycolic acid based methylprednisolone allow for this specified delivery point. This locally delivery increases the responsiveness of anti-apoptotic protein. The use of nanoparticles combined with the powerful and useful properties of methylprednisolone allow for the least side effects while doing the most good for the patient.
Figure 4. The chemical formula for methylprednisolone is C22H30O5.
Figure 5. Medrol is the brand name for methylprednisolone
As explained in detail throughout the research paper, a spinal cord injury is a serious and fatal condition that so many people suffer every year. The inadequate access to proper medical treatment results in permanent damage and difficult long term effects that so many patients have to deal with for the rest of their lives. The discussion about a proper treatment involved a deep dive into what a spinal cord injury is, the different kinds, a description of hydrogels, stem cells, and also information about a medical intervention, known as methylprednisolone. The combination of all of these interventions result in a course of treatment that not only treats the blunt trauma of the spinal cord injury, but also regenerates it and eliminates the possibility for long term neurological deficits. Overall, the treatment of a SCI, such a common injury, can be changed forever with the implementation of this treatment, and can change the quality of life for so many individuals.
I would like to thank Dr. Rajagopal Appavu and Dr. Jothsna Kethar for their guidance on my journey while writing this research paper.
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