Neuroscience: Treating hypotension induced by spinal cord injuries

A spinal stimulation treatment that restores blood pressure maintenance after spinal cord injury in rodents and non-human primates is demonstrated in Nature this week. Preliminary investigations in a human patient indicate that the human spinal cord also responds effectively to this treatment.

Paralysis and loss of sensation are often the main focus when it comes to treating spinal cord injuries. However, haemodynamic instability — an inability to maintain blood pressure when moving from lying to sitting or standing is a major issue for some individuals with spinal cord injuries.

Grégoire Courtine, Aaron Phillips and colleagues previously developed a neuroprosthetic device for delivering electrical stimulation that helped to restore walking function in patients who were paralysed from a spinal injury. The authors modify their system to produce a stimulation protocol that modulates the neural circuits involved in the regulation of blood pressure, which become unresponsive as a result of spinal cord injury. This neuroprosthetic was able to adjust the dynamics of blood flow quickly and for extended periods of time in rodent and non-human primate models of spinal cord injury. The device was also tested in a human patient who has a spinal cord injury with haemodynamic instability, in whom the neuroprosthetic was shown to restore normal haemodynamics.

Clinical trials are needed to evaluate the safety and therapeutic efficacy of this treatment in different stages of spinal cord injury, the authors note. In an accompanying News & Views article, Patrice Guyenet writes: “The approach could conceivably replace currently available treatments — although it is much too early to say this for sure.”