Dr. Shekar Kurpad
Spinal cord injury (SCI) is a relatively frequent event; estimates suggest that 12,500 new cases of SCI occur every year in the US alone. In the US, approximately 276,000 persons live with SCI, which has a huge impact on their lives and families, and has tremendous socioeconomic and medical costs. The main causes for SCI are motor vehicle accidents (38%), falls (30%), acts of violence (14%), and sports injuries (9%) (National SCI Database).
The type and degree of disability that is caused by SCI is determined by the location and extent of the injury. Spinal cord tissue is damaged in the injury process and this damage occurs in two steps. The initial damage, the primary injury, is caused by the mechanical trauma to the spinal cord during the accident. This is followed by the secondary injury, which is caused by a number of events, including hemorrhage and inflammation. While acute inflammation is observed in all tissues as a response to injury and is an important prerequisite for the healing process, prolonged and unresolved inflammation, as it is present after SCI, strongly contributes to the tissue damage. Immune cells in the tissue produce factors that maintain and stimulate the inflammatory response and produce factors that contribute to tissue damage.
Red blood cells (RBCs), which are present in the spinal cord tissue due to the hemorrhage, are taken up by phagocytic cells like macrophages. This can result in increased production of pro-inflammatory cytokines and chemokines, factors that activate immune cells. Previous experiments have shown the relevance of some of these factors after SCI. For example, the absence of one of these cytokines, TNF, leads to a better recovery in mice after SCI and reduces inflammatory activation of cells at the injury site. However, these extent of these results suggests that other factors also contribute to the tissue damage.
We are now attempting to investigate further mechanisms contributing to the secondary tissue damage, including other cytokines and chemokines which may play a role after SCI. We aim to modulate these and investigate the effect on recovery after SCI.
Ultimately, our goal is a translational treatment approach to reduce secondary damage after injury and to improve the outcome and quality of life after SCI. In summary, the broad goal of my research is to investigate and modulate the inflammatory tissue response after spinal cord injury (SCI) with the aim to reduce the secondary damage and thereby to improve the functional outcome after SCI.
Trends in the Use of Corticosteroids in the Management of Acute Spinal Cord Injury in North American Clinical Trials Networks (NACTN) Sites.
(Hejrati N, Aarabi B, Neal CJ, Ugiliweneza B, Kurpad SN, Shaffrey C, Guest J, Toups EG, Harrop JS, Fehlings MG.) J Neurotrauma. 2023 Jan 03 PMID: 36597351 01/05/2023
IL-12p40 promotes secondary damage and functional impairment after spinal cord contusional injury.
(Rosas Almanza J, Stehlik KE, Page JJ, Xiong SH, Tabor EG, Aperi B, Patel K, Kodali R, Kurpad S, Budde MD, Tarima S, Swartz K, Kroner A.) J Neurosci Res. 2022 Dec;100(12):2213-2231 PMID: 36089917 SCOPUS ID: 2-s2.0-85137752150 09/13/2022
Acute Magnetic Resonance Imaging Predictors of Chronic Motor Function and Tissue Sparing in Rat Cervical Spinal Cord Injury.
(Lee SY, Schmit BD, Kurpad SN, Budde MD.) J Neurotrauma. 2022 Dec;39(23-24):1727-1740 PMID: 35708112 PMCID: PMC9734017 SCOPUS ID: 2-s2.0-85144094095 06/17/2022
The Evolving Profile of Acute Spinal Cord Injury Demographics, Outcomes and Surgical Treatment in North America: Analysis of a Prospective Multicenter Dataset of 989 Patients.
(Vedantam A, Ugiliweneza B, Williamson T, Guest J, Harrop JS, Tator C, Aarabi B, Fehlings MG, Kurpad SN, Neal CJ.) J Neurotrauma. 2022 Nov 30 PMID: 36448585 12/01/2022
Differential Trajectory of Diffusion and Perfusion Magnetic Resonance Imaging of Rat Spinal Cord Injury.
(Meyer BP, Lee SY, Kurpad SN, Budde MD.) J Neurotrauma. 2022 Nov 07 PMID: 36226406 10/14/2022
We Choose to Call it 'Degenerative Cervical Myelopathy': Findings of AO Spine RECODE-DCM, an International and Multi-Stakeholder Partnership to Agree a Standard Unifying Term and Definition for a Disease.
(Davies BM, Khan DZ, Barzangi K, Ali A, Mowforth OD, Nouri A, Harrop JS, Aarabi B, Rahimi-Movaghar V, Kurpad SN, Guest JD, Tetreault L, Kwon BK, Boerger TF, Rodrigues-Pinto R, Furlan JC, Chen R, Zipser CM, Curt A, Milligan J, Kalsi-Rayn S, Sarewitz E, Sadler I, Widdop S, Fehlings MG, Kotter MRN.) Global Spine J. 2022 Jun 29:21925682221111780 PMID: 35769029 07/01/2022
Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?
(Boerger TF, Hyngstrom AS, Furlan JC, Kalsi-Ryan S, Curt A, Kwon BK, Kurpad SN, Fehlings MG, Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Wilson JR, Davies BM, Kotter MRN, Koljonen PA.) Global Spine J. 2022 Feb;12(1_suppl):97S-108S PMID: 35174735 PMCID: PMC8859699 02/18/2022
Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1].
(Davies BM, Mowforth O, Wood H, Karimi Z, Sadler I, Tetreault L, Milligan J, Wilson JRF, Kalsi-Ryan S, Furlan JC, Kawaguchi Y, Ito M, Zipser CM, Boerger TF, Vaccaro AR, Murphy RKJ, Hutton M, Rodrigues-Pinto R, Koljonen PA, Harrop JS, Aarabi B, Rahimi-Movaghar V, Kurpad SN, Guest JD, Wilson JR, Kwon BK, Kotter MRN, Fehlings MG.) Global Spine J. 2022 Feb;12(1_suppl):28S-38S PMID: 35174734 PMCID: PMC8859708 02/18/2022
Optimizing the Application of Surgery for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 10].
(Rodrigues-Pinto R, Montenegro TS, Davies BM, Kato S, Kawaguchi Y, Ito M, Zileli M, Kwon BK, Fehlings MG, Koljonen PA, Kurpad SN, Guest JD, Aarabi B, Rahimi-Movaghar V, Wilson JR, Kotter MRN, Harrop JS.) Global Spine J. 2022 Feb;12(1_suppl):147S-158S PMID: 35174733 PMCID: PMC8859702 02/18/2022
James Lind Alliance Priority Setting Partnership for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM]: An Overview of the Methodology Used to Process and Short-List Research Uncertainties.
(Tetreault L, Mowforth O, Khan DZ, Gronlund T, Garwood P, Hazenbiller O, Harrop JS, Aarabi B, Rahimi-Movaghar V, Kurpad SN, Guest JD, Wilson JR, Kwon BK, Fehlings MG, Davies BM, Kotter MRN, AO Spine RECODE-DCM Steering Committee and AO Spine RECODE-DCM Consortium.) Global Spine J. 2022 Feb;12(1_suppl):19S-27S PMID: 35174731 PMCID: PMC8859709 02/18/2022
Establishing the Socio-Economic Impact of Degenerative Cervical Myelopathy Is Fundamental to Improving Outcomes [AO Spine RECODE-DCM Research Priority Number 8].
(Davies BM, Phillips R, Clarke D, Furlan JC, Demetriades AK, Milligan J, Witiw CD, Harrop JS, Aarabi B, Kurpad SN, Guest JD, Wilson JR, Kwon BK, Vaccaro AR, Fehlings MG, Rahimi-Movaghar V, Kotter MRN.) Global Spine J. 2022 Feb;12(1_suppl):122S-129S PMID: 35174730 PMCID: PMC8859704 02/18/2022
A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time.
(Davies BM, Mowforth O, Gharooni AA, Tetreault L, Nouri A, Dhillon RS, Bednarik J, Martin AR, Young A, Takahashi H, Boerger TF, Newcombe VF, Zipser CM, Freund P, Koljonen PA, Rodrigues-Pinto R, Rahimi-Movaghar V, Wilson JR, Kurpad SN, Fehlings MG, Kwon BK, Harrop JS, Guest JD, Curt A, Kotter MRN.) Global Spine J. 2022 Feb;12(1_suppl):78S-96S PMID: 35174728 PMCID: PMC8859710 02/18/2022