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ABSTRACT
Background
To comprehensively assess the neurologic recovery potential of chondroitinase ABC (ChABC) in rats after spinal cord injury (SCI).
Methods
The PubMed, Embase, ScienceDirect, Web of Science, and China National Knowledge Infrastructure databases were searched for animal experiments that evaluated the use of ChABC in the treatment of SCI up to November 2022. Studies reporting neurological function using the Basso, Beattie, and Bresnahan (BBB) scale, as well as assessments of cavity area, lesion area, and glial fibrillary acidic protein (GFAP) levels, were included in the analysis.
Results
A total of 46 studies were ultimately selected for inclusion. The results of the study showed that rats with SCI that received ChABC therapy exhibited a significant improvement in locomotor function after 7 days compared with controls (32 studies, weighted mean difference (WMD) = 0.58, [0.33, 0.83], p < 0.00001). Furthermore, the benefits of ChABC therapy were maintained for up to 28 days according to BBB scale. The lesion area was reduced by ChABC (5 studies, WMD = −20.94, [−28.42, −13.46], p < 0.00001). Meanwhile, GFAP levels were reduced in the ChABC treatment group (8 studies, WMD = −29.15, [−41.57, −16.72], p < 0.00001). Cavity area is not statistically significant. The subgroup analysis recommended that a single injection of 10 μL (8 studies, WMD = 2.82, [1.99, 3.65], p < 0.00001) or 20 U/mL (4 studies, WMD = 2.21, [0.73, 3.70], p = 0.003) had a better effect on improving the function. The funnel plot of the BBB scale was found to be essentially symmetrical, indicating a low risk of publication bias.
Conclusions
This systematic review and meta-analysis has indicated that ChABC could improve functional recovery in rats after SCI.
LEVEL OF EVIDENCE:
Acknowledgements
Ya-yun Zhang, Rui-rui Xue, and Min Yao designed the study. Yu-xiang Dai, Yi-de Fang, Xing Ding, Zhuo-yao Li and Rui-rui Xue collected the data. Ya-yun Zhang, Cai-wei Hu, and Min Yao did the data analysis. Ya-yun Zhang, Min Yao, and Jin-hai Xu wrote the manuscript. Min Yao and Wen Mo revised the manuscript. Min Yao and Wen Mo decided to submit the manuscript for publication.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The data used to support the findings of this study are available from the corresponding author upon request.
Additional information
Funding
Notes on contributors
Ya-yun Zhang
Ya-yun Zhang received a Bachelor of Medicine degree in 2014 and a Clinical Medicine degree from Nanjing University of Chinese Medicine, Nanjing City, China in 2017. He received an M.D. degree in Traditional Chinese medicine orthopedics specialty from Shanghai University of Traditional Chinese Medicine, Shanghai City, China in 2023. His research interests include SCI, TCM, and Neurorehabilitation.
Rui-rui Xue
Rui-rui Xue graduated from Shanghai University of Traditional Chinese Medicine in Shanghai, China with a master's degree in traditional Chinese medicine. His research fields include TCM treatment of cervical spondylotic myelopathy, TCM treatment of spinal cord injury and rehabilitation after spinal cord injury.
Min Yao
Min Yao, traditional Chinese medicine orthopedics and traumatology, Doctoral Degree, Master's Supervisor, from Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China. Her areas of research include Chinese medicine for cervical spondylotic myelopathy, Chinese medicine for spinal cord injury.
Zhuo-yao Li
Zhuo-yao Li received a bachelor's degree, specializing in traditional Chinese medicine, from Shanghai University of Traditional Chinese Medicine, Shanghai, China. His areas of research include Chinese medicine for cervical spondylotic myelopathy, Chinese medicine for spinal cord injury, and acupuncture rehabilitation after spinal cord injury.
Cai-wei Hu
Cai-wei Hu received a bachelor's degree, specializing in traditional Chinese medicine, from Shanghai University of Traditional Chinese Medicine, Shanghai, China. Her areas of research include Acupuncture and Manipulation rehabilitation for treating degenerative cervical diseases, Chinese medicine for cervical spondylotic myelopathy.
Yu-xiang Dai
Yu-xiang Dai obtained a master's degree in Traditional Chinese Medicine Orthopedics from Nanjing University of Chinese Medicine in 2018. He is currently pursuing a doctoral degree in Traditional Chinese Medicine Orthopedics at Shanghai University of Traditional Chinese Medicine. His main research focus is the basic and clinical research of degenerative changes in the spine.
Yi-de Fang
Yi-de Fang is currently pursuing a doctorate in Traditional Chinese Orthopedics at Shanghai University of Traditional Chinese Medicine, Shanghai, China. His research focuses on the integrated treatment of neck and shoulder disorders, such as cervical spondylosis and periarthritis, as well as osteoporosis in the elderly, using traditional Chinese medical practices.
Xing Ding
Xing Ding received a doctorate's degree, specializing in traditional Chinese medicine, from Shanghai University of Traditional Chinese Medicine, Shanghai, China. His areas of research include Chinese medicine for cervical spondylotic myelopathy, Chinese medicine for spinal cord injury, and Chinese medicine rehabilitation after spinal surgery.
Jin-hai Xu
Jin-hai Xu, the secretary of the Department of Orthopedics and Traumatology at Longhua Hospital, affiliated with Shanghai University of Traditional Chinese Medicine, also serves as the secretary of the clinical cooperation project for cervical spondylotic myelopathy, a significant and challenging national disease. He is a young member of both the Orthopedic Branch of the Chinese Medical Association and the Cervical Spondylosis Professional Committee of the Chinese Rehabilitation Medical Association. Dr. Xu has been involved in formulating clinical diagnosis and treatment guidelines. He has been invited to attend international and domestic conferences such as the World Orthopedic Congress, ICMRS, CGCM, CSRS-AP, COA, and the Annual Meeting of the Cervical Spondylosis Professional Committee of the Chinese Rehabilitation Medical Association and has presented at these conferences 35 times. Dr. Xu specializes in assessing patients with cervical spondylosis, lumbar disc herniation, and lumbar spinal stenosis, and is skilled in conservative treatment methods, particularly traditional Chinese medicine treatments and sports rehabilitation.
Xue-jun Cui
Xue-jun Cui, traditional Chinese medicine orthopedics and traumatology, Doctoral Degree, Master's and doctoral supervisor, from Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China. His areas of research include Chinese medicine for cervical spondylotic myelopathy, Chinese medicine for spinal cord injury.
Wen Mo
Wen Mo, chief physician, professor, and doctoral supervisor, serves as the director of the Department of Orthopedics and Traumatology at Longhua Hospital, affiliated with Shanghai University of Traditional Chinese Medicine. He is also the deputy director of the Institute of Spinal Diseases at the Shanghai Institute of Traditional Chinese Medicine. With his expertise in treating degenerative spinal and joint diseases through the integration of traditional Chinese medicine's internal and external therapies, including decoctions, acupuncture, manipulation, and surgery, Dr. Wen has led his team to conduct evidence-based and mechanism research on traditional Chinese medicine. He has registered 18 clinical studies on Clinicaltrials.org and China clinical trial registration centers and has led six multi-center clinical studies.