Severity depends on location of injury

Patients with acute spinal cord injury (SCI) lose weight and muscle mass, despite eating a high-calorie diet during their stay in the intensive care unit. Their muscle wasting is significant and extends beyond what can be explained by inactivity or denervation (loss of nerve supply) alone.

Research conducted by Wexner Medical Center and The Ohio State University College of Medicine, published in the journal Scientific translational medicine sheds new light and decodes early muscle loss after spinal cord injury to provide an unprecedented first understanding that muscle wasting is:

• fast and severe
• a systemic phenomenon
• glucocorticoid dependent

Researchers have found that the severity of this SCI-induced systemic muscle atrophy depends on the location of the spinal cord injury (level of injury). Specifically, it depends on whether the adrenal gland becomes denervated after a high chest injury (above T5) or not (after a low chest injury).

These results have direct clinical ramifications.

“Patients with a low body mass index (BMI) are at much higher risk (of dying) shortly after sustaining a spinal cord injury. With a better understanding of this muscle wasting and weight loss “We hope to explore new ways to reduce deaths in this fragile patient population,” said Jan Schwab, MD, PHD, William E. Hunt and Charlotte M. Curtis Professor of Neurology and Neuroscience. at the Ohio State College of Medicine.

Researchers have found that systemic muscle loss is worsened when the adrenal glands are deprived of central nervous system control, resulting in asymmetric hormonal (endocrine) tone. When this happens, hypercortisolism (excessive release of cortisol) often develops after the spinal cord injury.

“This hypercortisolism then acts on specific receptors in muscles throughout the body to cause muscle loss. Interfering with this pathway could rescue muscle tissue and improve response to rehabilitation,” said first author Markus Harrigan, a lab member. of Schwab and Ohio Research. The MD-Ph.D dual degree of State. Medical Scientist Training Program as well as Ruth L. Kirschstein Individual NIH-Research Fellow.

This research also provides new information on how to maintain muscle integrity while reducing the risk of developing higher-grade pressure ulcers that often affect these patients, Harrigan said. The study builds on previous Ohio State research on the effects of SCI on the immune system that impair immune system function, improve susceptibility to infections and contribute to infectious complications.

“We are now beginning to understand how spinal cord injury leads to spinal cord disease affecting the entire body,” said Schwab, who is also medical director of the Belford Center for Spinal Cord Injury and a Chronic Brain Injury investigator. Initiative at Ohio State. “Our future research will look for ways to block these complications and protect the adrenal gland from receiving ‘false’ autonomic nervous system information from the spinal cord below the injury site.”

The Ohio State scientists collaborated with researchers in Berlin, Germany, as well as Nationwide Children’s Hospital in Columbus, Ohio, and the University of Missouri.