Immune modulatory therapies for spinal cord injury – Past, present and future

• We discuss the past, present and potential future of immunomodulation after SCI.
• Historically, attempts to prevent inflammation after SCI yielded mixed success.
• Recently, new immune cell subtypes have been identified.
• Some immune cell subtypes can be beneficial after SCI.
• Improved understanding of immune cell subtypes may produce new therapies.

Historically, the immune response after spinal cord injury was considered largely detrimental owing to the release of neurotoxic factors. While there is validity to this view, there is much greater heterogeneity of immune cells than was previously realized. Associated with this heterogeneity of immune cell subtypes, there is diversity of functions of immune cells that is still poorly understood after spinal cord injury. Modulating the immune system requires improved understanding of the major players: those immune cell subtypes that are more detrimental than beneficial and those that are important in repair. In this review we will discuss the early findings that supported the use of various anti-inflammatory medications as well as the evolving concept that not all immune subtypes are detrimental and some might even be beneficial. In the last section we will highlight the need to characterize better the role of immune cell subsets in the hopes of developing potential therapeutic targets for the future.