Mechanical properties of acellular peripheral nerve

Graphene-based hybrid materials as promising scaffolds for peripheral nerve regeneration

Peripheral nerve injury (PNI) is a serious clinical health problem caused by the damage of peripheral nerves which results in neurological deficits and permanent disability. There are several factors that may cause PNI such as localized damage (car accident, trauma, electrical injury) and outbreak of the systemic diseases (autoimmune or diabetes). While various diagnostic procedures including X-ray, magnetic resonance imaging (MRI), as well as other type of examinations such as electromyography or nerve conduction studies have been efficiently developed, a full recovery in patients with PNI is in many cases deficient or incomplete. This is the reason why additional therapeutic strategies should be explored to favor a complete rehabilitation in order to get appropriate nerve injury regeneration. The use of biomaterials acting as scaffolds opens an interesting approach in regenerative medicine and tissue engineering applications due to their ability to guide the growth of new tissues, adhesion and proliferation of cells including the expression of bioactive signals. This review discusses the preparation and therapeutic strategies describing in vitro and in vivo experiments using graphene-based materials in the context of PNI and their ability to promote nerve tissue regeneration.

Fabrication and in vitro evaluation of 3D composite scaffold based on collagen/hyaluronic acid sponge and electrospun polycaprolactone nanofibers for peripheral nerve regeneration

Replacement of peripheral nerve autografts with tissue engineered nerve grafts will potentially resolve the lack of nerve tissue especially in patients with severe concomitant soft tissue injuries. This study attempted to fabricate a tissue engineered nerve graft composed of electrospun PCL conduit filled with collagen-hyaluronic acid (COL-HA) sponge with different COL-HA weight ratios including 100:0, 98:2, 95:5 and 90:10. The effect of HA addition on the sponge porosity, mechanical properties, water absorption and degradation rate was assessed. A good cohesion between the electrospun PCL nanofibers and COL-HA sponges were seen in all sponges with different HA contents. Mechanical properties of PCL nanofibrous layer were similar to the rat sciatic nerve; the ultimate tensile strength was 2.23 ± 0.35 MPa at the elongation of 35%. Additionally, Schwann cell proliferation and morphology on three dimensional (3D) composite scaffold were evaluated by using MTT and SEM assays, respectively. Rising the HA content resulted in higher water absorption as well as greater pore size and porosity, while a decrease in Schwann cell proliferation compared to pure collagen sponge, although reduction in cell proliferation was not statistically significant. The lower Schwann cell proliferation on the COL-HA was attributed to the greater degradation rate and pore size of the COL-HA sponges. Also, dorsal root ganglion assay showed that the engineered 3D construct significantly increases axon growth. Taken together, these results suggest that the fabricated 3D composite scaffold provide a permissive environment for Schwann cells proliferation and maturation and can encourage axon growth.

A Tuneable, Photocurable, Poly(Caprolactone)-Based Resin for Tissue Engineering-Synthesis, Characterisation and Use in Stereolithography

Stereolithography is a useful additive manufacturing technique for the production of scaffolds for tissue engineering. Here we present a tuneable, easy-to-manufacture, photocurable resin for use in stereolithography, based on the widely used biomaterial, poly(caprolactone) (PCL). PCL triol was methacrylated to varying degrees and mixed with photoinitiator to produce a photocurable prepolymer resin, which cured under UV light to produce a cytocompatible material. This study demonstrates that poly(caprolactone) methacrylate (PCLMA) can be produced with a range of mechanical properties and degradation rates. By increasing the degree of methacrylation (DM) of the prepolymer, the Young's modulus of the crosslinked PCLMA could be varied from 0.12-3.51 MPa. The accelerated degradation rate was also reduced from complete degradation in 17 days to non-significant degradation in 21 days. The additive manufacturing capabilities of the resin were demonstrated by the production of a variety of different 3D structures using micro-stereolithography. Here, β-carotene was used as a novel, cytocompatible photoabsorber and enabled the production of complex geometries by giving control over cure depth. The PCLMA presented here offers an attractive, tuneable biomaterial for the production of tissue engineering scaffolds for a wide range of applications.

Soft, Wireless and subdermally implantable recording and neuromodulation tools

Progress in understanding neuronal interaction and circuit behavior of the central and peripheral nervous system strongly relies on the advancement of tools that record and stimulate with high fidelity and specificity. Currently, devices used in exploratory research predominantly utilize cables or tethers to provide pathways for power supply, data communication, stimulus delivery and recording, which constrains the scope and use of such devices. In particular, the tethered connection, mechanical mismatch to surrounding soft tissues and bones frustrate the interface leading to irritation and limitation of motion of the subject, which in the case of fundamental and preclinical studies, impacts naturalistic behaviors of animals and precludes the use in experiments involving social interaction and ethologically relevant three-dimensional environments, limiting the use of current tools to mostly rodents and exclude species such as birds and fish. This review explores the current state-of-the-art in wireless, subdermally implantable tools that quantitively expand capabilities in analysis and perturbation of the central and peripheral nervous system by removing tethers and externalized features of implantable neuromodulation and recording tools. Specifically, the review explores power harvesting strategies, wireless communication schemes, and soft materials and mechanics that enable the creation of such devices and discuss their capabilities in the context of freely-behaving subjects. Highlights of this class of devices includes wireless battery-free and fully implantable operation with capabilities in cell specific recording, multimodal neural stimulation and electrical, optogenetic and pharmacological neuromodulation capabilities. We conclude with discussion on translation of such technologies which promises routes towards broad dissemination.

Soft Electronics Based on Stretchable and Conductive Nanocomposites for Biomedical Applications

Research on the field of implantable electronic devices that can be directly applied in the body with various functionalities is increasingly intensifying due to its great potential for various therapeutic applications. While conventional implantable electronics generally include rigid and hard conductive materials, their surrounding biological objects are soft and dynamic. The mechanical mismatch between implanted devices and biological environments induces damages in the body especially for long-term applications. Stretchable electronics with outstanding mechanical compliance with biological objects effectively improve such limitations of existing rigid implantable electronics. In this article, the recent progress of implantable soft electronics based on various conductive nanocomposites is systematically described. In particular, representative fabrication approaches of conductive and stretchable nanocomposites for implantable soft electronics and various in vivo applications of implantable soft electronics are focused on. To conclude, challenges and perspectives of current implantable soft electronics that should be considered for further advances are discussed.

Optimizing the electrical conductivity of polyacrylonitrile/polyaniline with nickel nanoparticles for the enhanced electrostimulation of Schwann cells proliferation

Tissue engineering scaffolds made of biocompatible polymers are promising alternatives for nerve reparation. For this application, cell proliferation will be speeded up by electrostimulation, which required electrically-conductive materials. Here, a biomimicking scaffold with optimized conductivity was developed from electrospun polyacrylonitrile/electrically-conductive polyaniline (PAN/PANI) nanofibers doped with Ni nanoparticles. PAN/PANI/Ni was biocompatible for Schwann cells and exhibited a suitable tensile strength and wettability for cell proliferation. When compared with unmodified PAN/PANI, the electrical conductivity of PAN/PANI/Ni was 6.4 fold higher. Without electrostimulation, PAN/PANI and PAN/PANI/Ni exhibited similar Schwann cells' proliferation rates. Upon electrostimulation at 100 mV cm^-1 for one hour per day over five days, PAN/PANI/Ni accelerated Schwann cells' proliferation 2.1 times compared to PAN/PANI. These results demonstrate the importance of expanding the electrical conductivity of the tissue engineering scaffold to ensure optimal electrostimulation of nerve cell growth. Additionally, this study describes a straightforward approach to modulate the electrical conductivity of polymeric materials via the addition of Ni nanoparticles that can be applied to different biomimicking scaffolds for nerve healing.

Adjustable conduits for guided peripheral nerve regeneration prepared from bi-zonal unidirectional and multidirectional laminar scaffold of type I collagen

Shortness of donor nerves has led to the development of nerve conduits that connect sectioned peripheral nerve stumps and help to prevent the formation of neuromas. Often, the standard diameters of these devices cannot be adapted at the time of surgery to the diameter of the nerve injured. In this work, scaffolds were developed to form filled nerve conduits with an inner matrix with unidirectional channels covered by a multidirectional pore zone. Collagen type I dispersions (5 mg/g and 8 mg/g) were sequentially frozen using different methods to obtain six laminar scaffolds (P1 to P5) formed by a unidirectional (U) pore/channel zone adjacent to a multidirectional (M) pore zone. The physicochemical and microstructural properties of the scaffolds were determined and compared, as well as their biodegradability, residual glutaraldehyde and cytocompatibility. Also, the Young's modulus of the conduits made by rolling up the bizonal scaffolds from the unidirectional to the multidirectional zone was determined. Based on these comparisons, the proliferation and differentiation of hASC were assessed only in the P3 scaffolds. The cells adhered, aligned in the same direction as the unidirectional porous fibers, proliferated, and differentiated into Schwann-like cells. Adjustable conduits made with the P3 scaffold were implanted in rats 10 mm sciatic nerve lesions to compare their performance with that of autologous sciatic nerve grafted lesions. The in vivo results demonstrated that the tested conduit can be adapted to the diameter of the nerve stumps to guide their growth and promote their regeneration.

High-resolution combinatorial 3D printing of gelatin-based biomimetic triple-layered conduits for nerve tissue engineering

Peripheral nerve injury is a common clinical problem often requiring surgical nerve reconstruction. To this end, tissue-engineered conduit has been proved to be crucial for nerve reconstruction. Despite its progress in recent years, the design and fabrication of translational biomimetic nerve conduits is highly challenging. Therefore, this study aims to design and fabricate mechanically-tunable nerve conduits with biomimetic structural features of the human nerve suitable for nerve tissue engineering. Herein, we employed combinatorial approach comprising of electrohydrodynamic (EHD) jet printing, dip-coating, and electrospinning techniques for fabricating triple-layered conduits. The intricate structural details were achieved via high-resolution EHD jet printed PCL filaments with tunable directionality, as the innermost layer; followed by dip coating of gelatin hydrogels to form the middle layer, and lastly, wrapped with electrospun PCL nanofibers as an outer layer of the conduits. The mechanical properties, porosity, and biocompatibility of the fabricated conduits were studied and compared with control. The results of this study confirmed that the combinatorial approach has greater potential to fabricate mechanically-tunable triple-layered conduits with favorable neuronal precursor and vascular cell compatibility.

Natural-Based Biomaterials for Peripheral Nerve Injury Repair

Peripheral nerve injury treatment is a relevant problem because of nerve lesion high incidence and because of unsatisfactory regeneration after severe injuries, thus resulting in a reduced patient's life quality. To repair severe nerve injuries characterized by substance loss and to improve the regeneration outcome at both motor and sensory level, different strategies have been investigated. Although autograft remains the gold standard technique, a growing number of research articles concerning nerve conduit use has been reported in the last years. Nerve conduits aim to overcome autograft disadvantages, but they must satisfy some requirements to be suitable for nerve repair. A universal ideal conduit does not exist, since conduit properties have to be evaluated case by case; nevertheless, because of their high biocompatibility and biodegradability, natural-based biomaterials have great potentiality to be used to produce nerve guides. Although they share many characteristics with synthetic biomaterials, natural-based biomaterials should also be preferable because of their extraction sources; indeed, these biomaterials are obtained from different renewable sources or food waste, thus reducing environmental impact and enhancing sustainability in comparison to synthetic ones. This review reports the strengths and weaknesses of natural-based biomaterials used for manufacturing peripheral nerve conduits, analyzing the interactions between natural-based biomaterials and biological environment. Particular attention was paid to the description of the preclinical outcome of nerve regeneration in injury repaired with the different natural-based conduits.

Carbon nanotubes and their polymeric composites: the applications in tissue engineering

Carbon nanotubes (CNTs), with unique graphitic structure, superior mechanical, electrical, optical and biological properties, has attracted more and more interests in biomedical applications, including gene/drug delivery, bioimaging, biosensor and tissue engineering. In this review, we focus on the role of CNTs and their polymeric composites in tissue engineering applications, with emphasis on their usages in the nerve, cardiac and bone tissue regenerations. The intrinsic natures of CNTs including their physical and chemical properties are first introduced, explaining the structure effects on CNTs electrical conductivity and various functionalization of CNTs to improve their hydrophobic characteristics. Biosafety issues of CNTs are also discussed in detail including the potential reasons to induce the toxicity and their potential strategies to minimise the toxicity effects. Several processing strategies including solution-based processing, polymerization, melt-based processing and grafting methods are presented to show the 2D/3D construct formations using the polymeric composite containing CNTs. For the sake of improving mechanical, electrical and biological properties and minimising the potential toxicity effects, recent advances using polymer/CNT composite the tissue engineering applications are displayed and they are mainly used in the neural tissue (to improve electrical conductivity and biological properties), cardiac tissue (to improve electrical, elastic properties and biological properties) and bone tissue (to improve mechanical properties and biological properties). Current limitations of CNTs in the tissue engineering are discussed and the corresponded future prospective are also provided. Overall, this review indicates that CNTs are promising “next-generation” materials for future biomedical applications.

Machine intelligence for nerve conduit design and production

Nerve guidance conduits (NGCs) have emerged from recent advances within tissue engineering as a promising alternative to autografts for peripheral nerve repair. NGCs are tubular structures with engineered biomaterials, which guide axonal regeneration from the injured proximal nerve to the distal stump. NGC design can synergistically combine multiple properties to enhance proliferation of stem and neuronal cells, improve nerve migration, attenuate inflammation and reduce scar tissue formation. The aim of most laboratories fabricating NGCs is the development of an automated process that incorporates patient-specific features and complex tissue blueprints (e.g. neurovascular conduit) that serve as the basis for more complicated muscular and skin grafts. One of the major limitations for tissue engineering is lack of guidance for generating tissue blueprints and the absence of streamlined manufacturing processes. With the rapid expansion of machine intelligence, high dimensional image analysis, and computational scaffold design, optimized tissue templates for 3D bioprinting (3DBP) are feasible. In this review, we examine the translational challenges to peripheral nerve regeneration and where machine intelligence can innovate bottlenecks in neural tissue engineering.

3D Printing and Bioprinting Nerve Conduits for Neural Tissue Engineering

Fabrication of nerve conduits for perfectly repairing or replacing damaged peripheral nerve is an urgent demand worldwide, but it is also a formidable clinical challenge. In the last decade, with the rapid development of manufacture technologies, 3D printing and bioprinting have been becoming remarkable stars in the field of neural engineering. In this review, we explore that the biomaterial inks (hydrogels, thermoplastic, and thermoset polyesters and composite) and bioinks have been selected for 3D printing and bioprinting of peripheral nerve conduits. This review covers 3D manufacturing technologies, including extrusion printing, inkjet printing, stereolithography, and bioprinting with inclusion of cells, bioactive molecules, and drugs. Finally, an outlook on the future directions of 3D printing and 4D printing in customizable nerve therapies is presented.

Materials for flexible bioelectronic systems as chronic neural interfaces

Engineered systems that can serve as chronically stable, high-performance electronic recording and stimulation interfaces to the brain and other parts of the nervous system, with cellular-level resolution across macroscopic areas, are of broad interest to the neuroscience and biomedical communities. Challenges remain in the development of biocompatible materials and the design of flexible implants for these purposes, where ulimate goals are for performance attributes approaching those of conventional wafer-based technologies and for operational timescales reaching the human lifespan. This Review summarizes recent advances in this field, with emphasis on active and passive constituent materials, design architectures and integration methods that support necessary levels of biocompatibility, electronic functionality, long-term stable operation in biofluids and reliability for use in vivo. Bioelectronic systems that enable multiplexed electrophysiological mapping across large areas at high spatiotemporal resolution are surveyed, with a particular focus on those with proven chronic stability in live animal models and scalability to thousands of channels over human-brain-scale dimensions. Research in materials science will continue to underpin progress in this field of study.

UV-Casting on Methacrylated PCL for the Production of a Peripheral Nerve Implant Containing an Array of Porous Aligned Microchannels

Peripheral nerves are basic communication structures guiding motor and sensory information from the central nervous system to receptor units. Severed peripheral nerve injuries represent a large clinical problem with relevant challenges to successful synthetic nerve repair scaffolds as substitutes to autologous nerve grafting. Numerous studies reported the use of hollow tubes made of synthetic polymers sutured between severed nerve stumps to promote nerve regeneration while providing protection for external factors, such as scar tissue formation and inflammation. Few approaches have described the potential use of a lumen structure comprised of microchannels or microfibers to provide axon growth avoiding misdirection and fostering proper healing. Here, we report the use of a 3D porous microchannel-based structure made of a photocurable methacrylated polycaprolactone, whose mechanical properties are comparable to native nerves. The neuro-regenerative properties of the polymer were assessed in vitro, prior to the implantation of the 3D porous structure, in a 6-mm rat sciatic nerve gap injury. The manufactured implants were biocompatible and able to be resorbed by the host's body at a suitable rate, allowing the complete healing of the nerve. The innovative design of the highly porous structure with the axon guiding microchannels, along with the observation of myelinated axons and Schwann cells in the in vivo tests, led to a significant progress towards the standardized use of synthetic 3D multichannel-based structures in peripheral nerve surgery.

Magnesium-based biodegradable microelectrodes for neural recording

This article reports fabrication, characterization, degradation and electrical properties of biodegradable magnesium (Mg) microwires coated with two functional polymers, and the first in vivo evidence on the feasibility of Mg-based biodegradable microelectrodes for neural recording. Conductive poly(3,4‑ethylenedioxythiophene) (PEDOT) coating was first electrochemically deposited onto Mg microwire surface, and insulating biodegradable poly(glycerol sebacate) (PGS) was then spray-coated onto PEDOT surface to improve the overall properties of microelectrode. The assembled PGS/PEDOT-coated Mg microelectrodes showed high homogeneity in coating thickness, surface morphology and composition before and after in vivo recording. The charge storage capacity (CSC) of PGS/PEDOT-coated Mg microwire (1.72 mC/cm²) was nearly 5 times higher than the standard platinum (Pt) microwire widely used in implantable electrodes. The Mg-based microelectrode demonstrated excellent neural-recording capability and stability during in vivo multi-unit neural recordings in the auditory cortex of a mouse. Specifically, the Mg-based electrode showed clear and stable onset response, and excellent signal-to-noise ratio during spontaneous-activity recordings and three repeats of stimulus-evoked recordings at two different anatomical locations in the auditory cortex. During 10 days of immersion in artificial cerebrospinal fluid (aCSF) in vitro, PGS/PEDOT-coated Mg microelectrodes showed slower degradation and less change in impedance than PEDOT-coated Mg electrodes. The biodegradable PGS coating protected the PEDOT coating from delamination, and prolonged the mechanical integrity and electrical properties of Mg-based microelectrode. Mg-based novel microelectrodes should be further studied toward clinical translation because they can potentially eliminate the risks and costs associated with secondary surgeries for removal of failed or no longer needed electrodes.

Design framework for mechanically tunable soft biomaterial composites enhanced by modified horseshoe lattice structures

Soft biomaterials have a wide range of applications in many areas. However, one material can only cover a specific range of mechanical performance such as the elastic modulus and stretchability. In order to improve the mechanical performance of soft biomaterials, lattice structures are embedded to reinforce the biomaterials. In this paper, rectangular and triangular lattice structures formed by modified horseshoe microstructures are used because their mechanical properties are tunable and can be tailored precisely to match the desired properties by adjusting four geometrical parameters, the length L, radius R, width w and arc angle θ0. A theoretical design framework for the modified horseshoe lattice structures is developed to predict the dependence of the mechanical behaviors on geometrical parameters. Both experiments and finite element simulations on lattice structures are conducted to validate the theoretical models. Results show that a wide range of design space for the elastic modulus (a few kPa to hundreds of MPa), stretchability (strain up to 180%) and Poisson ratio (ranging from -0.5 to 1.2) can be achieved. Experiments on lattice-hydrogel composites are also conducted to verify the reinforcement effect of lattice structures on the hydrogel. This work provides a theoretical method to predict the mechanical behaviors of the lattice structures and aid the rational design of reinforced biomaterials, which has applications in tissue engineering, drug delivery and intraocular lenses.

Conducting Polymer-Based Composite Materials for Therapeutic Implantations: From Advanced Drug Delivery System to Minimally Invasive Electronics

Conducting polymer-based composites have recently becoming popular in both academic research and industrial practices due to their high conductivity, ease of process, and tunable electrical properties. The multifunctional conducting polymer-based composites demonstrated great application potential for in vivo therapeutics and implantable electronics, including drug delivery, neural interfacing, and minimally invasive electronics. In this review article, the state-of-the-art conducting polymer-based composites in the mentioned biological fields are discussed and summarized. The recent progress on the synthesis, structure, properties, and application of the conducting polymer-based composites is presented, aimed at revealing the structure-property relationship and the corresponding functional applications of the conducting polymer-based composites. Furthermore, key issues and challenges regarding the implantation performance of these composites are highlighted in this paper.

3D Printed Neural Regeneration Devices

Neural regeneration devices interface with the nervous system and can provide flexibility in material choice, implantation without the need for additional surgeries, and the ability to serve as guides augmented with physical, biological (e.g., cellular), and biochemical functionalities. Given the complexity and challenges associated with neural regeneration, a 3D printing approach to the design and manufacturing of neural devices could provide next-generation opportunities for advanced neural regeneration via the production of anatomically accurate geometries, spatial distributions of cellular components, and incorporation of therapeutic biomolecules. A 3D printing-based approach offers compatibility with 3D scanning, computer modeling, choice of input material, and increasing control over hierarchical integration. Therefore, a 3D printed implantable platform could ultimately be used to prepare novel biomimetic scaffolds and model complex tissue architectures for clinical implants in order to treat neurological diseases and injuries. Further, the flexibility and specificity offered by 3D printed in vitro platforms have the potential to be a significant foundational breakthrough with broad research implications in cell signaling and drug screening for personalized healthcare. This progress report examines recent advances in 3D printing strategies for neural regeneration as well as insight into how these approaches can be improved in future studies.

Effect of nanocomposite coating and biomolecule functionalization on silk fibroin based conducting 3D braided scaffolds for peripheral nerve tissue engineering

In this work, the effects of carbon nanofiber (CNF) dispersed poly-ε-caprolactone (PCL) nanocomposite coatings and biomolecules functionalization on silk fibroin based conducting braided nerve conduits were studied for enhancing Neuro 2a cellular activities. A unique combination of biomolecules (UCM) and varying concentrations of CNF (5, 7.5, 10% w/w) were dispersed in 10% (w/v) PCL solution for coating on degummed silk threads. The coated silk threads were braided to develop the scaffold structure. As the concentration of CNF increased in the coating, the electrical impedance decreased up to 400 Ω indicating better conductivity. The tensile and dynamic mechanical property analysis showed better mechanical properties in CNF coated samples. In vitro cytocompatibility analysis proved the non-toxicity of the developed braided conduits. Cell attachment, growth and proliferation were significantly enhanced on the biomolecule functionalized nanocomposite coated silk braided structure, exhibiting their potential for peripheral nerve regeneration and recovery.

Repairing Transected Peripheral Nerve Using a Biomimetic Nerve Guidance Conduit Containing Intraluminal Sponge Fillers

Nerve guide conduits (NGCs) with geometric design have shown significant advantages in guidance of nerve reinnervation across the defect of injured peripheral nerves. It is realized that intraluminal fillers with distinctive structure can effectively provide an inner guidance for sprouting of axons and improve the permeability of NGC. In this work, a poly(lactic-co-glycolic acid) (PLGA) NGC is prepared containing intraluminal sponge fillers (labeled as ISF-NGC) and used for reconstruction of a rat sciatic nerve with a 10 mm gap. For comparison, the same procedure is applied to a single hollow PLGA NGC (labeled as H-NGC) and an autologous nerve. As evidenced by significantly improved nerve morphology and function, the ISF-NGC achieves a superior nerve repair effect over H-NGC, which is comparable to autologous nerve grafting. It is likely that the H-NGC only provides a protected tunnel for nerve fiber regrowth and axonal extension, while ISF-NGC offers an extracellular matrix-mimetic architecture as autograft to provide contact guidance for nerve reinnervation. This newly developed ISF-NGC is a promising candidate to aid nerve reinnervation across longer gaps commonly encountered in clinical cases.

Chitosan films for regenerative medicine: fabrication methods and mechanical characterization of nanostructured chitosan films

Regenerative medicine is continuously facing new challenges and it is searching for new biocompatible, green/natural polymer materials, possibly biodegradable and non-immunogenic. Moreover, the critical importance of the nano/microstructuring of surfaces is overall accepted for their full biocompatibility and in vitro/in vivo performances. Chitosan is emerging as a promising biopolymer for tissue engineering and its application can be further improved by exploiting its nano/microstructuration. Here, we report the state of the art of chitosan films and scaffolds nano/micro-structuration. We show that it is possible to obtain, by solvent casting, chitosan thin films with good mechanical properties and to structure them at the microscale and even nanoscale level, with resolutions down to 100 nm.

Evaluation methods as quality control in the generation of decellularized peripheral nerve allografts

Nowadays, the high incidence of peripheral nerve injuries and the low success ratio of surgical treatments are driving research to the generation of novel alternatives to repair critical nerve defects. In this sense, tissue engineering has emerged as a possible alternative with special attention to decellularization techniques. Tissue decellularization offers the possibility to obtain a cell-free, natural extracellular matrix (ECM), characterized by an adequate 3D organization and proper molecular composition to repair different tissues or organs, including peripheral nerves. One major problem, however, is that there are no standard quality control methods to evaluate decellularized tissues. Therefore, in this review, a brief description of current strategies for peripheral nerve repair is given, followed by an overview of different decellularization methods used for peripheral nerves. Furthermore, we extensively discuss the available and currently used methods to demonstrate the success of tissue decellularization in terms of the cell removal, preservation of essential ECM molecules and maintenance or modification of biomechanical properties. Finally, orientative guidelines for the evaluation of decellularized peripheral nerve allografts are proposed.

Fabrication and characterization of 3D microtubular collagen scaffolds for peripheral nerve repair

Understanding the structure-function relationship in biomaterial constructs is critical in optimizing biological outcomes. For ensheathed structures such as peripheral nerve, engineering implantable tissue substitutes has been challenging. This is due to a unique geometry of thin-walled microtube arrays composed mostly of basement membrane. In this work, we propose a sacrificial templating method to create Matrigel scaffolds that resemble endogenous peripheral nerve. These paralleled microtube constructs possess high void space and membrane-like walls. Additionally, we investigated the effect of chemical crosslinking in altering the physical, mechanical, and biologic properties of Matrigel. Results show that both glutaraldehyde and genipin increased the modulus and failure stress of Matrigel while also improving degradation resistance. However, glutaraldehyde crosslinking induced some cytotoxicity whereas genipin showed good biocompatibility. PC-12 cells, Schwann cells, and primary chick dorsal root ganglia cultured onto microtube scaffolds demonstrated viability up to 10 days. Strong cellular alignment along the channels was observed in Schwann cells whereas neurite outgrowth in primary chick dorsal root ganglia was also biased along the major axis of the microtubes. This suggests that the microtubes may mediate cell orientation and axon pathfinding. This proof of concept study provides a tunable workflow that may be adapted to other collagen types.

One-Pot Synthesis of Unsaturated Polyester Bioelastomer with Controllable Material Curing for Microscale Designs

Synthetic polyester elastomeric constructs have become increasingly important for a range of healthcare applications, due to tunable soft elastic properties that mimic those of human tissues. A number of these constructs require intricate mechanical design to achieve a tunable material with controllable curing. Here, the synthesis and characterization of poly(itaconate-co-citrate-co-octanediol) (PICO) is presented, which exhibits tunable formation of elastomeric networks through radical crosslinking of itaconate in the polymer backbone of viscous polyester gels. Through variation of reaction times and monomer molar composition, materials with modulation of a wide range of elasticity (36-1476 kPa) are generated, indicating the tunability of materials to specific elastomeric constructs. This correlated with measured rapid and controllable gelation times. As a proof of principle, scaffold support for cardiac tissue patches is developed, which presents visible tissue organization and viability with appropriate elastomeric support from PICO materials. These formulations present potential application in a range of healthcare applications with requirement for elastomeric support with controllable, rapid gelation under mild conditions.

Soft Conducting Elastomer for Peripheral Nerve Interface

State-of-the-art intraneural electrodes made from silicon or polyimide substrates have shown promise in selectively modulating efferent and afferent activity in the peripheral nervous system. However, when chronically implanted, these devices trigger a multiphase foreign body response ending in device encapsulation. The presence of encapsulation increases the distance between the electrode and the excitable tissue, which not only reduces the recordable signal amplitude but also requires increased current to activate nearby axons. Herein, this study reports a novel conducting polymer based intraneural electrode which has Young's moduli similar to that of nerve tissue. The study first describes material optimization of the soft wire conductive matrix and evaluates their mechanical and electrochemical properties. Second, the study demonstrates 3T3 cell survival when cultured with media eluted from the soft wires. Third, the study presents acute in vivo functionality for stimulation of peripheral nerves to evoke force and compound muscle action potential in a rat model. Furthermore, comprehensive histological analyses show that soft wires elicit significantly less scar tissue encapsulation, less changes to axon size, density and morphology, and reduced macrophage activation compared to polyimide implants in the sciatic nerves at 1 month postimplantation.

Biomechanical evaluation of peripheral nerves after crush injuries

Background

Crush injury of nerves is a common condition but the biomechanical integrity of the human peripheral nerve after crushing is unknown. This study aims to investigate the impact of crush injury on human digital nerves based on different compressive forces.

Materials and methods

Twenty digital nerves were harvested from three fresh-frozen cadaver hands. The original diameters of proximal, middle and distal end of nerve segment were measured. The midst of each digital nerve was compressed by a customized mechanical system, at 1N, 3N and 5N for 30sec. The diameters were measured again within 1 minute after the nerve crush test was performed. The digital nerve was then subjected to biomechanical test to measure its ultimate tensile strength, stiffness, maximum stress and strain. Deformity of digital nerve was computed based on the diameter of middle nerve segment before and after crush test.

Results

No significant difference was found in between groups for ultimate tensile strength (p=0.598), stiffness (p=0.593), maximum stress (p=0.7) and strain (p=0.666). The deformity of nerves under the compression of 1N, 3N and 5N was computed at 72.1%, 54.2% and 45.9%. The effect of compression on the deformity of nerves was statistically significant (p<0.001).

Conclusions

It was found that the compressive forces have no impact on the biomechanical integrity of peripheral nerves but the deformity of nerves could be severely caused by low compressive force. It is suggested that the management of nerve crush injury shall be taken immediately and focus on neurophysiological function and degeneration of nerves for a crush with low compressive force and short duration.

Climbing-inspired twining electrodes using shape memory for peripheral nerve stimulation and recording

Peripheral neuromodulation has been widely used throughout clinical practices and basic neuroscience research. However, the mechanical and geometrical mismatches at current electrode-nerve interfaces and complicated surgical implantation often induce irreversible neural damage, such as axonal degradation. Here, compatible with traditional 2D planar processing, we propose a 3D twining electrode by integrating stretchable mesh serpentine wires onto a flexible shape memory substrate, which has permanent shape reconfigurability (from 2D to 3D), distinct elastic modulus controllability (from ~100 MPa to ~300 kPa), and shape memory recoverability at body temperature. Similar to the climbing process of twining plants, the temporarily flattened 2D stiff twining electrode can naturally self-climb onto nerves driven by 37°C normal saline and form 3D flexible neural interfaces with minimal constraint on the deforming nerves. In vivo animal experiments, including right vagus nerve stimulation for reducing the heart rate and action potential recording of the sciatic nerve, demonstrate the potential clinical utility.

Synthetic bioresorbable poly-α-hydroxyesters as peripheral nerve guidance conduits; a review of material properties, design strategies and their efficacy to date

Implantable tubular devices known as nerve guidance conduits (NGCs) have drawn considerable interest as an alternative to autografting in the repair of peripheral nerve injuries.

Silicone-based simulation models for peripheral nerve microsurgery

BACKGROUND

There is a need for a peripheral nerve model on which surgeons-in-training can simulate the repair of nerve injuries at their own pace. Although practicing on animal models/cadavers is considered the "gold standard" of microsurgical training, the proposed model aims to provide a platform for improving the technical skills of surgical trainees prior to their practice on cadaver/animal models. In addition, this model has the potential to serve as a standardized test medium for assessing the skill sets of surgeons.

METHODS

Several formulations of silicone were utilized for the design and fabrication of a model which realizes the hierarchical structure of peripheral nerves. The mechanical properties were characterized via the Universal Testing Machine; the damage caused by the needle on the entry sites was assessed through scanning electron microscopy (SEM).

RESULTS

Mechanical properties of the formulations of silicone were tested to mimic human peripheral nerves. A formulation with 83.3 wt% silicone oil and 0.1 wt% cotton fiber was chosen to be used as nerve fascicles. Both 83.3 wt% silicone oil with cotton fiber and 66.6 wt% silicone oil without fiber provided a microsuturing response similar to that of epineurium at a wall thickness of 1 mm. SEM also confirmed that the entry of the needle did not introduce significant holes at the microsuturing sites.

CONCLUSIONS

The proposed peripheral nerve model mimicked human tissues mechanically and cosmetically, and a simulation of the repair of a fifth-degree nerve injury was achieved.

Bands of Fontana are caused exclusively by the sinusoidal path of axons in peripheral nerves and predict axon path; evidence from rodent nerves and physical models

The precise cause of the bands of Fontana, striations on peripheral nerves visible to the naked eye, has been the subject of debate for hundreds of years. Some researchers have described them as reflecting the sinuous course of nerve fibres passing through nerves, and others have proposed that endoneurial collagen and sheaths surrounding nerves play a role in their appearance. We hypothesised that the bands are caused exclusively by reflection of light from the surfaces of nerve fibres travelling in phase in sinusoidal waveforms through peripheral nerves. We aligned images of obliquely illuminated nerves with confocal images of axons in those nerves, and the numbers and positions of the bands precisely matched the axonal waves. We also developed three-dimensional models of nerves with representations of the sinusoidal path of axons at their surface. We observed patterns resembling the bands of Fontana when these models were obliquely illuminated. This provides evidence that the bands of Fontana can be caused by light reflected sinusoidal path of axons alone. We subsequently describe a mechanism of band production based on our observations of both nerves and models. We report that smaller diameter nerves such as phrenic nerves and distal branches of sciatic nerves have shorter band intervals than larger nerves, such as proximal trunks of sciatic nerves, and that shorter band intervals correlate with longer axons per unit length of nerve, which suggests a greater tolerance to stretch. Inspection of banding patterns on peripheral nerves may permit prediction of axon length within nerves, and assist in the interpretation of nerve conduction data, especially in diseases where axon path has become altered.

Rapid continuous 3D printing of customizable peripheral nerve guidance conduits

Engineered nerve guidance conduits (NGCs) have been demonstrated for repairing peripheral nerve injuries. However, there remains a need for an advanced biofabrication system to build NGCs with complex architectures, tunable material properties, and customizable geometrical control. Here, a rapid continuous 3D-printing platform was developed to print customizable NGCs with unprecedented resolution, speed, flexibility, and scalability. A variety of NGC designs varying in complexity and size were created including a life-size biomimetic branched human facial NGC. In vivo implantation of NGCs with microchannels into complete sciatic nerve transections of mouse models demonstrated the effective directional guidance of regenerating sciatic nerves via branching into the microchannels and extending toward the distal end of the injury site. Histological staining and immunostaining further confirmed the progressive directional nerve regeneration and branching behavior across the entire NGC length. Observational and functional tests, including the von Frey threshold test and thermal test, showed promising recovery of motor function and sensation in the ipsilateral limbs grafted with the 3D-printed NGCs.

Bacterial Cellulose as a Supersoft Neural Interfacing Substrate

Biocompatible neural interfaces hold great promise for treating neurological disorders and enhancing the mental and physical ability of human beings. Most of the currently available neural interfaces are made from rigid, dense inorganic materials that cause tissue damage. We present supersoft multichannel electrodes by depositing gold layers on thin bacterial cellulose (BC) (Au-BC electrodes). The Young's modulus of BC ( E_BC = 120 kPa) is between those of the brain tissue ( E_brain = 2.7-3.1 kPa) and the peripheral neural tissues ( E_{peripheral nerve} = 580-840 kPa). The bending stiffness of the Au-BC electrodes corresponds to 1/5200 of Au-polyimide electrodes with the same layout. Furthermore, the Au-BC electrodes are highly durable (conductivity >95% after 100 cycles of 180° bending). In vivo recording of brain electric activity demonstrates the great potential of the Au-BC electrodes for neural interfacing applications.

Photocrosslinkable Gelatin/Tropoelastin Hydrogel Adhesives for Peripheral Nerve Repair

Suturing peripheral nerve transections is the predominant therapeutic strategy for nerve repair. However, the use of sutures leads to scar tissue formation, hinders nerve regeneration, and prevents functional recovery. Fibrin-based adhesives have been widely used for nerve reconstruction, but their limited adhesive and mechanical strength and inability to promote nerve regeneration hamper their utility as a stand-alone intervention. To overcome these challenges, we engineered composite hydrogels that are neurosupportive and possess strong tissue adhesion. These composites were synthesized by photocrosslinking two naturally derived polymers, gelatin-methacryloyl (GelMA) and methacryloyl-substituted tropoelastin (MeTro). The engineered materials exhibited tunable mechanical properties by varying the GelMA/MeTro ratio. In addition, GelMA/MeTro hydrogels exhibited 15-fold higher adhesive strength to nerve tissue ex vivo compared to fibrin control. Furthermore, the composites were shown to support Schwann cell (SC) viability and proliferation, as well as neurite extension and glial cell participation in vitro, which are essential cellular components for nerve regeneration. Finally, subcutaneously implanted GelMA/MeTro hydrogels exhibited slower degradation in vivo compared with pure GelMA, indicating its potential to support the growth of slowly regenerating nerves. Thus, GelMA/MeTro composites may be used as clinically relevant biomaterials to regenerate nerves and reduce the need for microsurgical suturing during nerve reconstruction.

Deformation of dorsal root ganglion due to pressure transients of venous blood and cerebrospinal fluid in the cervical vertebral canal

The dorsal root ganglion (DRG) that is embedded in the foramen of the cervical vertebra can be injured during a whiplash motion. A potential cause is that whilst the neck bends in the whiplash motion, the changes of spinal canal volume induce impulsive pressure transients in the venous blood outside the dura mater (DM) and in the cerebrospinal fluid (CSF) inside the DM. The fluids can dynamically interact with the DRG and DM, which are deformable. In this work, the interaction is investigated numerically using a strong-coupling partitioned method that synchronize the computations of the fluid and structure. It is found that the interaction includes two basic processes, i.e., the pulling and pressing processes. In the pulling process, the DRG is stretched towards the spinal canal, and the venous blood is driven into the canal via the foramen. This process results from negative pressure in the fluids. In contrast, the pressing process is caused by positive pressure that leads to compression of the DRG and the outflow of the venous blood from the canal. The largest pressure gradient is observed at the foramen, where the DRG is located at. The DRG is subject to prominent von Mises stress near its end, which is fixed without motions. The negative internal pressure is more efficient to deform the DRG than the positive internal pressure. This indicates that the most hazardous condition for the DRG is the pulling process.

Lycium barbarum polysaccharide encapsulated Poly lactic-co-glycolic acid Nanofibers: cost effective herbal medicine for potential application in peripheral nerve tissue engineering

Nerve regeneration is a serious clinical challenge following peripheral nerve injury. Lycium barbarum polysaccharide (LBP) is the major component of wolfberry extract, which has been shown to be neuroprotective and promising in nerve recovery in many studies. Electrospun nanofibers, especially core-shell structured nanofibers being capable of serving as both drug delivery system and tissue engineering scaffolds, are well known to be suitable scaffolds for regeneration of peripheral nerve applications. In this study, LBP was incorporated into core-shell structured nanofibrous scaffolds via coaxial electrospinning. Alamar blue assays were performed to investigate the proliferation of both PC12 and Schwann cells cultured on the scaffolds. The neuronal differentiation of PC12 cells was evaluated by NF200 expression with immunostaining and morphology changes observed by SEM. The results indicated that the released LBP dramatically enhanced both proliferation and neuronal differentiation of PC12 cells induced by NGF. Additionally, the promotion of Schwann cells myelination and neurite outgrowth of DRG neurons were also observed on LBP loaded scaffolds by LSCM with immunostaining. In summary, LBP, as a drug with neuroprotection, encapsulated into electrospun nanofibers could be a potential candidate as tissue engineered scaffold for peripheral nerve regeneration.

A ternary nanofibrous scaffold potential for central nerve system tissue engineering

In the present research, a ternary polycaprolactone (PCL)/gelatin/fibrinogen nanofibrous scaffold for tissue engineering application was developed. Through this combination, PCL improved the scaffold mechanical properties; meanwhile, gelatin and fibrinogen provided more hydrophilicity and cell proliferation. Three types of nanofibrous scaffolds containing different fibrinogen contents were prepared and characterized. Morphological study of the nanofibers showed that the prepared nanofibers were smooth, uniform without any formation of beads with a significant reduction in nanofiber diameter after incorporation of fibrinogen. The chemical characterization of the scaffolds confirmed that no chemical reaction occurred between the scaffold components. The tensile test results of the scaffolds showed that increasing in fibrinogen content led to a decrease in mechanical properties. Furthermore, adipose-derived stem cells were employed to evaluate cell-scaffold interaction. Cell culture results indicated that higher cell proliferation occurred for the higher amount of fibrinogen. Statistical analysis was also carried out to evaluate the significant difference for the obtained results of water droplet contact angle and cell culture. Therefore, the results confirmed that PCL/gel/fibrinogen scaffold has a good potential for tissue engineering applications including central nerve system tissue engineering. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2394-2401, 2018.

Aligned laminin core-polydioxanone/collagen shell fiber matrices effective for neuritogenesis

Neural tissue regeneration is a significant challenge, because severe nerve injury is quite difficult to regenerate spontaneously. Although, many studies have been devoted to promote nerve regeneration, there are still many technical challenges to achieve satisfactory results. In this study, we designed biomimetic matrices composed of aligned laminin core-polydioxanone/collagen shell (Lam-PDO/Col) fibers, which can provide both topographical and biochemical cues for promoting neuritogenesis. The aligned Lam-PDO/Col core-shell fiber matrices were fabricated by magnetic field-assisted electrospinning with the coaxial system, and their potential as biofunctional scaffolds for promoting neuritogenesis was explored. It was demonstrated that the aligned Lam-PDO/Col core-shell fibers were successfully fabricated, and the laminin in the core of fibers was steadily and continuously released from fibers. In addition, the cellular behaviors of hippocampal neuronal cells on the matrices were significantly enhanced. Moreover, the aligned Lam-PDO/Col fiber matrices effectively improved and guided neurite outgrowth as well as the neurogenic differentiation by providing both topographical and biochemical cues through aligned fiber structure and sustained release of laminin. Collectively, it is suggested that the aligned Lam-PDO/Col core-shell fiber matrices are one of the most promising approaches for promoting neuritogenesis and neural tissue regeneration.

Electrochemical deposition of conductive polymers onto magnesium microwires for neural electrode applications

Metals are widely used in electrode design for recording neural activities because of their excellent electrical conductivity and mechanical strength. However, there are still serious problems related to these currently used metallic electrodes, including tissue damage due to the mechanical mismatch between metals and neural tissues, fibrosis, and electrode fouling and encapsulation that lead to the loss of signal and eventual failure. In this study, a biocompatible, biodegradable, and conductive electrode was created. Specifically, pure magnesium (Mg) microwire with a diameter of 127 µm was used as the electrode substrate and the conductive polymer, that is, poly(3,4-ethylenedioxythiophene) (PEDOT), was electrochemically deposited onto Mg microwires to decrease corrosion rate and improve biocompatibility of the electrodes for potential neural electrode applications. Both chronopotentiometry and cyclic voltammetry (CV) methods and the associated parameters for electrochemical deposition of PEDOT onto Mg microwires were investigated, such as deposition current, deposition temperature, voltage, sweep rate, cycle number, and duration. The CV method from -2.0 to 1.25 V for 1 cycle at a cycle duration of 600 s with a sweep rate of 5 mV/s at 65°C led to a consistent, uniform, and complete PEDOT coating on Mg microwires. The surface conditions of Mg microwires also affected the quality of PEDOT coating. The corrosion rate of PEDOT-coated Mg microwire was 0.75 mm/year, much slower than the noncoated Mg microwire that showed a corrosion rate of 1.78 mm/year. The optimal Mg microwires with PEDOT coating could potentially serve as biodegradable electrodes for neural recording and stimulation applications. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1887-1895, 2018.