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The therapeutic effects of etanercept-methotrexate combination on experimental spinal cord injury

Ali Riza Gezici, Semih Akar, Tulin Firat, Yasar Dagistan, Seckin Emre Cancan, Aysel Kukner, Nezih Ozkan

Background: Experimental studies have demonstrated that neurons keep dying in an unrecoverable and non-regenerative pattern in following hours after primary mechanical injury to spinal cord. The cascade of events which is called secondary injury is composed of vascular impairment, oedema, ischemia, inflammation, exotoxicity, electrolyte imbalance, lipid peroxidation, free radicals, necrosis and apoptotic cell death.

Aims: With clinical and histopathological tests, this study investigated the therapeutic effects of etanercept-methotrexate combination which is an option in mono-therapy resistant rheumatological diseases; but this combination has not been used on recovery processes in clip compression Spinal Cord Injury (SCI) model yet.

Study Design: Forty Spraque-Dawley rats were divided into five groups: group 1 (Sham-control), group 2 (SCI+2 ml saline intramuscular), group 3 (SCI+1.25 mg/kg etanercept), group 4 (SCI+0.5 mg/kg methotrexate) and group 5 (SCI+1.25 mg/kg etanercept+0.5 mg/kg methotrexate).

Methods: Rats were evaluated 1^st, 3^rd, 5^th and 10^th days after SCI, clinically by Drummond and Moore scale, under light microscopy and by Tunel test; after sacrification on 10th day.

Results: Clinical and histopathological results of all treatment groups were found significantly better than the results of the trauma group; also no superiority in the monotherapy groups, over each other, was noted.

Conclusion: Combined-treatment group had a statistically significant better outcome in preventing apoptosis, but there was no difference according to the clinical results.