Cancer Drug May Prevent Contractures in Children with Cerebral Palsy and Neonatal Brachial Plexus Injury

Cerebral palsy (CP) and brachial plexus injuries both typically manifest in early childhood, as they are often caused by birth injuries (harm to a baby during or near the time of birth).

These conditions differ in many ways, including that cerebral palsy is the result of brain damage/abnormalities which can be caused by traumatic birth injuries or hypoxic-ischemic encephalopathy (a birth injury in which the baby’s brain is damaged due to a lack of oxygenated blood flow) (1). In contrast, brachial plexus injuries are caused by trauma to nerves near the baby’s neck (2). 

Despite having different underlying issues, both cerebral palsy and brachial plexus injuries result in impaired motor control in the affected regions of the body. One of the major factors behind this is muscle contractures (i.e. stiffness or constriction). Although there are various treatments, therapies, and surgeries that can mitigate the effects of contractures, they typically cannot be cured.  

However, recent research suggests that the cancer drug bortezomib, a proteasome inhibitor, may be able to prevent muscle contractures before they develop.

The role of proteasome inhibition

Previous research by Sia Nikolaou and colleagues showed that muscle contractures in mice are caused by impaired longitudinal muscle growth. In a more recent paper (3), also using mice as a study subject, they found that the mechanism behind muscle contractures is increased proteasome activity, which leads to impaired longitudinal muscle growth.

Moreover, Nikolaoue et al. showed that muscle contractures could be prevented in mice with neonatal brachial plexus injuries (NBPI) who were given the proteasome inhibitor bortezomib during the neonatal period.

In humans, bortezomib is currently used as a cancer treatment in adults, and is in clinical trials for use in children. Bortezomib does have associated toxicity, but Nikolaoue et al. were able to minimize this by co-administering [Gly14]-Humanin G ([Gly14]-HN) and adjusting the dose and timing of treatment. 

Moreover, they note that, “even if bortezomib is not the ultimate therapy used in humans, our findings here provide the proof of concept that proteasome inhibition is sufficient to prevent contractures following NBPI, representing the first biological solution to the mechanical problem of neuromuscular contractures.”

Although this study was on mice with NBPI, the authors emphasize that their findings may be applicable to humans with a variety of conditions. In particular, contractures associated with cerebral palsy are also characterized by impaired longitudinal muscle growth; therefore, children with CP may also benefit from proteasome inhibition. Much more research into this area is needed, but these findings are a promising start. 

About ABC Law Centers

ABC Law Centers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as oxygen deprivation, infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.

If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources. 

If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win. 

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  1. ABC Law Centers. (n.d.). Retrieved November 13, 2019, from
  2. ABC Law Centers. (n.d.). Retrieved November 13, 2019, from
  3. Nikolaou, S., Cramer, A. A., Hu, L., Goh, Q., Millay, D. P., & Cornwall, R. (2019). Proteasome inhibition preserves longitudinal growth of denervated muscle and prevents neonatal neuromuscular contractures. JCI insight.


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