From sedation to regeneration: the emerging role of Dexmedetomidine in biomaterial-assisted spinal cord repair

Abstract

Spinal cord injury (SCI) remains a major clinical challenge with limited regenerative capacity. Dexmedetomidine (DEX), a selective alpha2-adrenergic agonist widely used in anesthesia, has demonstrated neuroprotective effects that extend beyond sedation and analgesia. In parallel, biomaterials offer structural scaffolds and controlled-release platforms capable of modulating the hostile post-injury microenvironment. This narrative review summarizes studies published over the past two decades that were retrieved from PubMed, Web of Science, and other databases using combinations of keywords related to “dexmedetomidine,” “biomaterials,” and “spinal cord injury.” Preclinical and clinical evidence relevant to DEX pharmacology, biomaterial-based delivery, and their potential integration in SCI repair was critically analyzed. Current findings indicate that DEX exerts multifaceted neuroprotection by regulating inflammation, apoptosis, oxidative stress, and endoplasmic reticulum stress, while biomaterials such as hydrogels, nanocarriers, and scaffolds can enhance its local and sustained delivery, thereby improving bioavailability and therapeutic efficacy. Preliminary preclinical evidence suggests that combining DEX with biomaterials augments scaffold bioactivity and mitigates the limitations of systemic administration, although direct clinical validation remains scarce. These emerging strategies highlight a multidisciplinary direction for integrating pharmacology, biomaterials, and clinical translation. Overall, the synergy between DEX and biomaterial-assisted delivery represents a promising conceptual framework for advancing SCI management from symptomatic care toward functional neuroregeneration.