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Active and passive immunization with myelin basic protein as a window for treatment of spinal cord injury; A systematic review and meta-analysis.

OBJECTIVE
Spinal cord injury (SCI), as a dangerous central nervous system damage, continues to threaten communities by imposing various disabilities and costs. These damages may be prevented by adjusting the immune system response using Myelin Basic Protein (MBP) immunization. As a result, the current study is designed to review and analyze the evidence on this subject.


METHODS
Medline, Embase, Scopus, and Web of Science databases were systematically searched by the end of 2020. Criteria for inclusion in the current study included pre-clinical studies which performed passive or active immunization for MBP after SCI. Exclusion criteria was defined as lack of a control group, lack of evaluation of motor function, review studies, and combination therapy. Finally, analyses were conducted using STATA software, and a standardized mean difference (SMD) with a 95% confidence interval (CI) were reported.


RESULTS
Data from 17 papers were included in the present study. Finally, analysis on these data showed that passive immunization (SMD=0.87; 95%CI: 0.19-1.55; p=0.012) and active immunization (SMD=2.08, 95%CI: 1.42-2.73; p<0.001) for MBP both have favourable efficacy in improving motor function following SCI. However, significant heterogeneity was observed in both of them. The most important sources of heterogeneity in active immunization were differences in SCI models, route of administration, time interval between SCI and transplantation and type of used vaccine. In passive immunization however, these sources were the model of SCI and the time interval between SCI and transplantation.


CONCLUSION
The results of the present study demonstrated that immunization with MBP, especially in its active form, could significantly improve motor function following SCI. However, the safety of this method is still in debate. Therefore, it is recommended for future research to focus on the investigation of its safety in animal studies, before conducting human clinical trials.