Platelet-rich plasma in the treatment of spinal cord injury: Mechanisms, efficacy, and clinical translation

Spinal cord injury (SCI) is a devastating condition of the central nervous system characterized by complex pathophysiological processes, including primary mechanical damage and secondary injury cascades, ultimately leading to permanent neurological deficits. Current standard treatments—including surgical decompression and high-dose methylprednisolone—offer limited therapeutic benefits and fail to effectively promote neuroregeneration. Platelet-rich plasma (PRP), an autologous biological derivative enriched with multiple growth factors, has demonstrated remarkable potential in tissue repair and has recently emerged as a promising therapeutic strategy for SCI. This comprehensive review systematically examines the pathophysiological characteristics of SCI and the limitations of existing treatments, with particular emphasis on the multifaceted mechanisms of PRP in SCI repair. These mechanisms include anti-inflammatory and antioxidant effects through activation of the Nrf2 signaling pathway, regulation of apoptosis, promotion of angiogenesis, and stimulation of axonal regeneration. Preclinical studies and preliminary clinical observations have consistently demonstrated that PRP administration significantly improves neurological functional recovery following SCI. However, substantial challenges impede clinical translation, including a lack of standardization in PRP preparation, an incomplete understanding of underlying mechanisms, limited efficacy of monotherapy, and a scarcity of high-quality clinical evidence. Future directions emphasize the development of combination strategies integrating PRP with biomaterials such as hydrogels or stem cells, which may represent the key to successful clinical implementation.