Carbon Nanotube–Based Strategies for Spinal Cord Injury: A Prisma-Guided Systematic Review of Functionalization, Mechanisms, and Therapeutic Outcomes Publisher



Mashayekhi S ; Fazel B ; Moradkhani S ; Vazirzadeh M ; Hossein Javadi S A ; Pestehei S K ; Sharif S B ; Khodaparast S ; Karimi A
Source: Journal of Nanotechnology Published:2026

Abstract

Background: Spinal cord injury (SCI) remains a debilitating neurological condition with limited regenerative treatment options. Carbon nanotubes (CNTs), owing to their electrical conductivity, nanoscale architecture, and tunable surface properties, have emerged as promising candidates for neural repair. However, existing evidence remains fragmented, and a systematic synthesis linking CNT design features to therapeutic outcomes in SCI is lacking. Objective: To the best of our knowledge, this study provides the first Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–guided systematic review of preclinical CNT-based interventions in SCI, integrating material design parameters (e.g., CNT type and functionalization) with biological and functional outcomes. Methods: A systematic literature search was conducted in PubMed, Scopus, and Embase in accordance with PRISMA guidelines and a registered PROSPERO protocol (CRD420251059692). SCI-related terms were applied as mandatory inclusion criteria. Eighteen preclinical studies were included. Data were extracted on CNT characteristics, experimental models, therapeutic outcomes, and underlying mechanisms. Risk of bias was assessed using adapted tools for in vitro, in vivo, and computational studies. Results: CNT-based interventions demonstrated therapeutic effects, including enhanced axonal regeneration (8/18), improved motor function (6/18), and reduced neuroinflammation (5/18). Functionalized CNTs showed improved biocompatibility and efficacy compared with pristine forms. Mechanistically, CNTs exert their effects through three primary pathways: restoration of electrical conductivity, provision of structural scaffolds for axonal guidance, and targeted delivery of bioactive molecules. Key limitations include the absence of clinical studies, lack of standardized synthesis and characterization protocols, and a predominance of positive findings, which raises the possibility of publication bias. Conclusion: CNTs represent a promising platform for SCI repair by integrating structural, electrical, and biochemical functionalities. This review provides a focused and methodologically rigorous synthesis of preclinical evidence while highlighting key translational challenges. Future research should prioritize standardization, long-term safety evaluation, and validation in clinically relevant models. Copyright © 2026 Samine Mashayekhi et al. Journal of Nanotechnology published by John Wiley & Sons Ltd.