Adenosine A2A analogue improves neurologic outcome after spinal cord trauma in the rabbit

Background. ATL-146e, an adenosine A(2A) agonist, reduces paralysis after spinal cord ischemia-reperfusion. We hypothesized that systemic ATL-146e could improve neurologic outcome after blunt spinal cord trauma. Methods: Twenty rabbits survived a thoracic spinal cord impact of 30 g-cm. One group received 0.06 mug/kg/min ATL-146e for the first 3 hours after impact (A2A group), whereas a second group received saline carrier (T/C group). Neurologic outcome was measured using the Tarlov scale (0-5). Histologic sections from the A2A and T/C groups were compared for neuronal viability. Results: There was significant improvement in Tarlov scores of A2A animals compared with T/C animals at 12 hours (p=0.007), with a trend toward improvement at 36 (p=0.08) and 48 (p=0.09) hours after injury. There was decreased neuronal attrition in A2A animals (p=0.06). Conclusion. Systemic ATL-146e given after spinal cord trauma results in improved neurologic outcome. Adenosine A(2A) agonists may hold promise as a rapidly acting alternative to steroids in the early treatment of the spinal cord injured patient.