Table 1 Pharmacologic repair strategy of spinal cord injury

 Corticosteroids

• Upregulate the release of anti-inflammatory cytokines

• Reduce the extravasation of inflammatory cells

• Promote the survival of neurons

• NASCIS-1, NASCIS-2 and NASCIS-3 has been completed.

• The controversial research is still being further clarified.

 Minocycline

• Excellent lipid solubility²⁰⁶

• Reduce inflammatory response and prevent neuronal apoptosis²⁰⁷

• Phase II study proved that minocycline can significantly improve the ASIA motor score for patients with SCI.²⁰⁸

• Phase III is underway

 Riluzole

• Sodium channel blocker

• Inhibiting excitotoxicity by reducing the release of presynaptic glutamate to inhibit excitotoxicity²⁰⁹

• Phase I trial showed that Riluzole is effective in improving the ASIA score without serious adverse events

• Phase II/III multicenter, randomized trial is in progress^210,211

 Granulocyte-colony- stimulating factor (G-CSF)

• Promote differentiation and proliferation of granulocytes

• Induce migration of bone marrow mesenchymal cells to SCI sites and inhibit apoptosis²¹²

• Phase I/II trial have shown that CSF can significantly improve motor function in patients with cervical and thoracic spinal cord injuries for 5 days.²¹³

 Chondroitinase ABC (ChABC)

• Eliminate CSPG glycosaminoglycan (GAG) chains to achieve the inactivation of CSPGs⁹⁴

• Promoting axonal regeneration

• Preclinical researches have shown that the superiority of ChABC in regulating the inhibitory environment^214,215,216

 Ganglioside (GM-1)

• Downregulate caspase-3 and upregulate the expression of NGF

• Maintain neuronal cell survival

• Phase I clinical trial conducted a preliminary assessment of the safety and effectiveness of GM-1

• Phase III trial shown that GM-1 did not show a significant difference in the improvement of the primary outcome measures.

• More experiments are demonstrating the role of GM-1 in spinal cord injury.

 Magnesium

• Block NMDA receptors to prevent glutamatergic excitotoxicity

• Preclinical studies have demonstrated that Magnesium has a neuroprotective effect on the rat model of SCI and optimizes motor functional outcome²¹⁷

 Cethrin

• A recombinant of VX-210

• Involve the down-regulation of the RHOA pathway to promote axonal regeneration²¹⁸

• The phase I/IIa study has demonstrated the effectiveness of this medicine in improving motor function²¹⁹

• Phase IIb/III trial is being carried out²²⁰

 Nogo-A antibodies

• The antibody of a myelin-derived axon growth inhibitor

• Inhibit Nogo-A to facilitate nerve repair and reconstruction after SCI

• Nogo-A antibodies have proved an attraction in facilitating nerve regeneration in preclinical SCI trials, and a phase I research has been completed^221,222

• Phase II placebo-controlled trial is underway

 Basic fibroblast growth factor (bFGF)

• A ligand of tyrosine kinase receptor

• Inhibit inflammatory response, glial scar and astrogliosis and stimulate axon regeneration

• Neuroprotective function

• A preliminary Phase I clinical study has shown that FGF may have a positive effect in improving ASIA motor score

• Phase I/II trial has evaluated with the unpublished conclusion^223,224