Roles and regulatory mechanisms of autophagy in the pathology of spinal cord injury.

Spinal cord injury (SCI) remains a major clinical challenge due to its limited therapeutic options and the resulting severe functional impairments. Autophagy is an essential intracellular degradation process that plays a critical role in maintaining cellular homeostasis by degrading and recycling abnormal proteins and toxic substances. Recent studies have shown that autophagy significantly regulates several key pathological processes in the acute phase of SCI, including oxidative stress and neuroinflammation, and may also influence axonal regeneration during subsequent repair stages. Pharmacological modulation of autophagic flux has shown therapeutic promise and may exert neuroprotective effects. However, the precise relationship between autophagy activation or inhibition and functional recovery remains controversial and has not been fully elucidated. This review systematically summarizes recent advances in understanding the role and regulatory mechanisms of autophagy in the pathological processes of SCI, with particular emphasis on current controversies and unresolved issues. It also outlines potential pharmacological strategies targeting autophagy and proposes future research directions to support the clinical translation of these therapeutic approaches.