The widely prescribed pain-relief drug gabapentin can prevent harmful structural changes in the injured spinal cords of mice, and also block cardiovascular changes and immune suppression caused by spinal cord injury, research led by the Ohio State University Wexner Medical Center and College of Medicine has found.
Phillip Popovich, senior author of the study – which was published in the journal Cell Reports – and chair of Ohio State’s Department of Neuroscience (Ohio, USA), said: “Gabapentin is often prescribed as a treatment for pain, but if it is given early after injury – before symptoms develop – it can also limit structural changes in nerve cells.
“We show that these benefits remain even one month after stopping gabapentin treatment in spinal injured mice. We believe that gabapentin could be repurposed as a prophylactic therapy that can prevent autonomic dysfunction in people affected by spinal cord injuries.”
Faith Brennan, research scientist in Ohio State’s department of neuroscience, added: “This is the first time a treatment has been shown to prevent the development of autonomic dysfunction, rather than manage the symptoms caused by autonomic dysfunction.
“In response to stress or danger, autonomic nerve cells in the spinal cord trigger a ‘fight or flight’ response. This is a normal and helpful response that increases blood pressure and releases hormones like adrenaline and cortisol.”
However, after traumatic spinal cord injury, massive structural changes occur within spinal autonomic nerve centres that control the fight or flight response, and these changes cause uncontrolled autonomic reflexes.
For example, normally harmless stimuli, such as the bladder filling, will trigger the fight or flight response. But because of the spinal cord injury, the response is uncontrolled and can cause several health problems, including severe high blood pressure, heart rate slowing and long-term immune suppression.
“Autonomic dysfunction is a major problem for people living with a spinal cord injury. The cardiovascular complications can lead to severe morbidities like heart attack and stroke while long-term immune suppression can lead to serious recurrent infections like pneumonia,” says Popovich.
Currently, such symptoms can only be managed through regular bowel/bladder voiding regimens for example.
“The possibility of repurposing gabapentin as a prophylactic therapy to prevent the development of autonomic dysfunction could significantly improve the quality of life for individuals living with spinal cord injuries, including greater independence in society, reduced caregiver reliance, reduced infection susceptibility and increased life expectancy”, concludes Brennan.