Anti-Nogo-A antibodies as a potential causal therapy for lower urinary tract dysfunction after spinal cord injury

Loss of bladder control is common after spinal cord injury (SCI) and no causal therapies are available. Here we investigated if function blocking antibodies against the nerve fiber growth inhibitory protein Nogo-A applied to rats with severe SCI could prevent development of neurogenic lower urinary tract dysfunction. Bladder function of rats with SCI was repeatedly assessed by urodynamic examination in fully awake animals. Four weeks after SCI, detrusor sphincter dyssynergia had developed in all untreated or control antibody infused animals. In contrast, 2 weeks of intrathecal anti-Nogo-A-antibody treatment led to a significantly reduced aberrant maximum detrusor pressure during voiding and a reduction of the abnormal EMG high frequency activity in the external urethral sphincter. Anatomically, we found higher densities of fibers originating from the pontine micturition center in the lumbo-sacral grey matter in the anti-Nogo-A antibody treated animals, as well as a reduced number of inhibitory interneurons in Lamina X . These results suggest that anti-Nogo-A therapy could have positive effects on bladder function also clinically. Significance Statement: Bladder function is after spinal cord injury completely out of control. Detrusor sphincter dyssynergia, a potentially live threatening consequence, is greatly feared. Currently there are only symptomatic treatment options available and first causal treatment options are urgently needed in humans. In this work we show that function blocking antibodies against the nerve fiber growth inhibitory protein Nogo-A applied to rats with severe spinal cord injury could prevent development of neurogenic lower urinary tract dysfunction, in particular detrusor sphincter dyssynergia. Anti-Nogo-A therapy enters currently phase II clinical trial in humans and might therefore be soon the first causal treatment option for neurogenic lower urinary tract dysfunction.