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The effect of low-level laser therapy on pathophysiology and locomotor recovery after traumatic spinal cord injuries: a systematic review and meta-analysis

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Abstract

This study was designed to determine the effective therapeutic parameters and evaluate the regenerative potential of low-level laser therapy (LLLT) after traumatic spinal cord injuries (TSCIs) in animal studies. The EMBASE and MEDLINE databases were searched on October 5, 2019, and followed with an update on January 2, 2021. All animal studies discussing the effect of LLLT on main pathophysiological events after TSCI, including inflammation, axon growth, remyelination, glial scar formation, cavity size, and locomotor recovery, were included. For statistical analysis, we used mean difference with 95% confidence intervals for locomotor recovery. In total, 19 articles were included based on our criteria. The results showed that regardless of laser type, laser beams with a wavelength between 600 and 850 nm significantly suppress inflammation and led inflammatory cells to M2 polarization and wound healing. Also, laser therapy using these wavelengths for more than 2 weeks significantly improved axon regeneration and remyelination. Improvement of locomotor recovery was more efficient using wavelengths less than 700 nm (SMD = 1.21; 95%CI: 0.09, 2.33; p = 0.03), lasers with energy densities less than 100 J/cm2 (SMD = 1.72; 95%CI: 0.84, 2.59; p = 0.0001) and treatment duration between 1 and 2 weeks (SMD = 2.21; 95%CI: 1.24, 3.19; p < 0.00001). The LLLT showed promising potential to modulate pathophysiological events and recovery after TSCI, although there was heterogeneity in study design and reporting methods, which should be considered in future studies.

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Abbreviations

Arg1:

Arginase 1

ATP:

Adenosine triphosphate

BBB:

Basso, Beattie, and Bresnahan locomotor scale method

BDNF:

Brain-derived neurotrophic factor

COX:

Cytochrome oxidase

CST:

Corticospinal tract

GaAlAs:

Gallium aluminum-arsenide

GM1:

Monosialotetrahexosylganglioside

IL-6:

Interleukin 6

iNOS:

Inducible nitric oxide synthase

LLLT:

Low-level laser therapy

MCP-1:

Monocyte chemoattractant protein

MIP-1α:

Macrophage inflammatory protein

MPS:

Methylprednisolone

NF200:

200-kDa Neurofilament protein

NG2:

Neuron-glial antigen 2

OEC:

Olfactory ensheathing cells

PCR:

Polymerase chain reaction

RT-PCR:

Reverse transcription-polymerase chain reaction

SD:

Sprague-Dawley

STAT3:

Signal transducer and activator of transcription 3

TNF-α:

Tumor necrosis factor-alpha

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Acknowledgements

The authors would like to thank Dr. Mahmoud Yousefifard for his contribution on publication bias assessment.

Funding

This work was funded by the Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (No. 97-03-38-40875).

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Authors and Affiliations

  1. Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran

    Zahra Ayar

  2. Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, Tehran, 11365-3876, Iran

    Bahareh Gholami, Seyed Mohammad Piri, Meysam Kaveh, Vali Baigi, Zahra Ghodsi & Vafa Rahimi-Movaghar

  3. Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib’s Street, Keshavarz Boulevard, Tehran, 1419733151, Iran

    Zahra Hassannejad

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  1. Zahra Ayar
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Ayar, Z., Gholami, B., Piri, S.M. et al. The effect of low-level laser therapy on pathophysiology and locomotor recovery after traumatic spinal cord injuries: a systematic review and meta-analysis. Lasers Med Sci 37, 61–75 (2022). https://doi.org/10.1007/s10103-021-03301-5

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