Cellular and Molecular Approaches to Spinal Cord Repair: A Hypothetical Therapeutic Framework

Traumatic spinal cord injury (SCI) remains a serious condition with limited treatment options and poor regenerative outcomes. This review proposes a multi-step, hypothesis-driven regenerative protocol based on key cellular and molecular targets involved in SCI repair. The protocol integrates two main therapeutic strategies: (1) preservation of damaged tissue through anti-inflammatory and anti-edema interventions, and (2) stimulation of endogenous regeneration via astrocyte reprogramming, neuronal conversion, and activation of Reelin+ cells to support axonal guidance. The proposed protocol also incorporates pharmacological agents such as Rolipram, S-ketamine, BDNF, perfluorocarbons, and methylprednisolone to modulate neuroimmune and regenerative responses. By targeting multiple pathways including cAMP signaling, Reelin and BDNF expression, and glial-to-neuronal reprogramming, this framework aims to provide a foundation for future translational studies and potentially more effective clinical interventions. The review highlights the need for integrated, cell-specific therapies to overcome barriers in SCI treatment and recovery.