Evaluating the Anti-inflammatory Efficacy of Steroids, COX-2 Selective, and Nonselective NSAIDs in Contusion Spinal Cord Injury: An Experimental Analysis.

CONTEXT: The inclusion of an anti-inflammatory agent shall be inevitable in a combinatorial approach toward treating spinal cord injury (SCI). However, the best among the commonly used anti-inflammatory agents, namely, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenases-2 (COX-2) selective NSAIDs is not known due to the lack of comparative studies.

AIM: It was intended to compare the efficacy of three classes of anti-inflammatory drugs in SCI by estimating the relevant cytokines.

MATERIALS AND

METHODS

Sprague Dawley rats subjected to contusion SCI were treated with methylprednisolone (steroid), or diclofenac (general COX-inhibitor), or meloxicam (selective COX-2 inhibitor). After three days of postlesion, the efficacy of the drugs was assessed by quantifying the levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1) β, IL-6, IL-10, transforming growth factor-beta (TGF-β), and COX-2 through Western blotting.

STATISTICAL ANALYSIS USED: The data were analyzed using one-way analysis of variance to determine statistical significance, and post-hoc analysis was performed using Tukey's test.

RESULTS

Pro-inflammatory cytokines (TNF-α, IL-6, and IL-1) upregulated by SCI were reduced only by meloxicam treatment. Upregulation of anti-inflammatory cytokines (IL-10, TGF-β) observed in injury was unaffected by methylprednisolone and diclofenac but was downregulated in the meloxicam group although statistically not significant.

CONCLUSION

By reducing the levels of pro-inflammatory cytokines and a mild increase in the levels of TGF-β, meloxicam outperforms the other two drugs tested. Reduced anti-inflammatory IL-10 levels in the meloxicam treatment were the only concern. Spinal inflammation may be more resilient and further studies are required to formulate a consistent anti-inflammatory therapy to treat contusion SCI.