Development and evaluation of silk fibroin-based nerve grafts used for peripheral nerve regeneration

Spatiotemporal expression profiling of proteins in rat sciatic nerve regeneration using reverse phase protein arrays

Background

Protein expression profiles throughout 28 days of peripheral nerve regeneration were characterized using an established rat sciatic nerve transection injury model. Reverse phase protein microarrays were used to identify the spatial and temporal expression profile of multiple proteins implicated in peripheral nerve regeneration including growth factors, extracellular matrix proteins, and proteins involved in adhesion and migration. This high-throughput approach enabled the simultaneous analysis of 3,360 samples on a nitrocellulose-coated slide.

Results

The extracellular matrix proteins collagen I and III, laminin gamma-1, fibronectin, nidogen and versican displayed an early increase in protein levels in the guide and proximal sections of the regenerating nerve with levels at or above the baseline expression of intact nerve by the end of the 28 day experimental course. The 28 day protein levels were also at or above baseline in the distal segment however an early increase was only noted for laminin, nidogen, and fibronectin. While the level of epidermal growth factor, ciliary neurotrophic factor and fibroblast growth factor-1 and -2 increased throughout the experimental course in the proximal and distal segments, nerve growth factor only increased in the distal segment and fibroblast growth factor-1 and -2 and nerve growth factor were the only proteins in that group to show an early increase in the guide contents. As expected, several proteins involved in cell adhesion and motility; namely focal adhesion kinase, N-cadherin and β-catenin increased earlier in the proximal and distal segments than in the guide contents reflecting the relatively acellular matrix of the early regenerate.

Conclusions

In this study we identified changes in expression of multiple proteins over time linked to regeneration of the rat sciatic nerve both demonstrating the utility of reverse phase protein arrays in nerve regeneration research and revealing a detailed, composite spatiotemporal expression profile of peripheral nerve regeneration.

Next generation nerve guides: materials, fabrication, growth factors, and cell delivery

Nerve guides are increasingly being used surgically to repair acute peripheral nerve injuries. This is not only due to an increase in the number of commercially available devices, but also clinical acceptance. However, regeneration distance is typically limited to 20-25 mm, in part due to the basic tubular design. A number of experimental studies have shown improvements in nerve regeneration distance when conduits incorporate coatings, internal scaffolds, topographical cues, or the delivery of support cells. Current studies on designing nerve guides for maximizing nerve regeneration focus both on cell-containing and cell-free devices, the latter being clinically attractive as "off the shelf" products. Arguably better results are obtained when conduits are used in conjunction with support cells (e.g., Schwann cells or stem cells) that can improve regeneration distance and speed of repair, and provide informative experimental data on how Schwann and neuronal cells respond in regenerating injured nerves. In this review we discuss the range of current nerve guides commercially available and appraise experimental studies in the context of the future design of nerve guides for clinical use.

Biomaterials for the development of peripheral nerve guidance conduits

Currently, surgical treatments for peripheral nerve injury are less than satisfactory. The gold standard of treatment for peripheral nerve gaps >5 mm is the autologous nerve graft; however, this treatment is associated with a variety of clinical complications, such as donor site morbidity, limited availability, nerve site mismatch, and the formation of neuromas. Despite many recent advances in the field, clinical studies implementing the use of artificial nerve guides have yielded results that are yet to surpass those of autografts. Thus, the development of a nerve guidance conduit, which could match the effectiveness of the autologous nerve graft, would be beneficial to the field of peripheral nerve surgery. Design strategies to improve surgical outcomes have included the development of biopolymers and synthetic polymers as primary scaffolds with tailored mechanical and physical properties, luminal "fillers" such as laminin and fibronectin as secondary internal scaffolds, surface micropatterning, stem cell inclusion, and controlled release of neurotrophic factors. The current article highlights approaches to peripheral nerve repair through a channel or conduit, implementing chemical and physical growth and guidance cues to direct that repair process.

Joint use of a chitosan/PLGA scaffold and MSCs to bridge an extra large gap in dog sciatic nerve

BACKGROUND

Tissue-engineered nerve grafts (TENGs) constitute a promising alternative to nerve autografts that are recognized as the gold standard for surgical repair of peripheral nerve gaps.

OBJECTIVE

To investigate the feasibility of using TENGs for bridging extra large peripheral nerve gaps in large animals.

METHODS

TENGs were constructed by incorporating autologous bone marrow mesenchymal stem cells (MSCs) into a neural scaffold that consisted of a chitosan conduit inserted with poly(lactic-co-glycolic acid) (PLGA) fibers. A 60-mm-long sciatic nerve gap in dogs was bridged by TENGs, chitosan/PLGA scaffolds, or nerve autografts. At 12 months postsurgery, behavioral analysis, electrophysiology, retrograde fluorogold tracing, and histological examination were performed.

RESULTS

The outcomes of TENGs were similar to those of autografts and better than those of scaffolds alone.

CONCLUSION

Introduction of autologous MSCs to a chitosan/PLGA scaffold improved the repair and rehabilitation of a large gap after peripheral nerve injury in dogs. Autologous MSCs may be a source of support cells for neural tissue engineering.

Structure and Antibacterial Activity of Silk Fibroin/chitosan Nanofibrous Mats Using an Electrospinning Technique

More and more attention has been paid to natural materials. This paper was carried out with an intention to investigate the effect of electrospun silk fibroin (SF) nanofibrous mats by mixing different weight raito of chitosan (CS) in the same solvent-formic acid. Based on good electrospining feasibility, it was found that the average diameter of spun fibers became fine from 337nm to 103nm, with the concentration of CS in the blend compositions increasing to 4%.At the same time, the conformational transition of SF nanofibers adding CS occured to the tendence towards β-sheet structure by means of the analysis of the Fourier transform infrared spectroscopy (FTIR), Wide angle X-ray diffraction (WAXD) and Differential thermal analysis (TGA).What was more, excellent antibacterial activity(a degree growth inhibition of more than 95%) of the promising nanofibrous mats was revealed, through utilizing the colony counting method against Gram-positive bacteria S. aureus and Gram-negative bacteria E.coli ,which would open up wide applications on would dressing, filtration and environmental purification.

Repair of rat sciatic nerve gap by a silk fibroin-based scaffold added with bone marrow mesenchymal stem cells

Tissue-engineered nerve grafts (TENGs), typically consisting of a neural scaffold included with support cells and/or growth factors, represent a promising alternative to autologous nerve grafts for surgical repair of large peripheral nerve gaps. Here, we developed a new design of TENGs by introducing bone marrow mesenchymal stem cells (MSCs) of rats, as support cells, into a silk fibroin (SF)-based scaffold, which was composed of an SF nerve guidance conduit and oriented SF filaments as the conduit lumen filler. The biomaterial SF had been tested to possess good biocompatibility and noncytoxicity with MSCs before the TENG was implanted to bridge a 10-mm-long gap in rat sciatic nerve. Functional and histological assessments showed that at 12 weeks after nerve grafting, TENGs yielded an improved outcome of nerve regeneration and functional recovery, which was better than that achieved by SF scaffolds and close to that by autologous nerve grafts. During 1-4 weeks after nerve grafting, MSCs contained in the TENG significantly accelerated axonal growth, displaying a positive reaction to S-100 (a Schwann cell marker). During 1-3 weeks after nerve grafting, MSCs contained in the TENG led to gene expression upregulation of S100 and several growth factors (brain-derived neurotrophic factor, ciliary neurotrophic factor, and basic fibroblast growth factor). These results suggest that the cell behaviors and neurotrophic functions of MSCs might be responsible for their promoting effects on peripheral nerve regeneration.

Silk fibroin conduits: a cellular and functional assessment of peripheral nerve repair

Silk fibroin conduits were designed with appropriate porosity for peripheral nerve repair. The aim of this work was to use these conduits to examine cell inflammatory responses and functional recovery in a sciatic nerve defect model. A total of 45 randomized Lewis rats were used to create an 8-mm defect bridged by a silk guide, commercial collagen guide, or an autograft. After 1, 4, and 8 weeks, macrophage recruitment, percentage of newly formed collagen, number of myelinated axons, and gastrocnemius muscle mass were evaluated. Following 8 weeks, ED1+ cells in autograft and silk conduits decreased to <1% and 17% of week 1 values, respectively. Collagen formation revealed no difference for all measured time points, suggesting a similar foreign body response. Myelinated axon counts within the silk guide revealed a greater number of proximal spouts and distal connections than collagen guides. Gastrocnemius weights demonstrated a 27% decrease between silk and autografts after 8 weeks. This study demonstrates that, in addition to tailorable degradation rates, our silk conduits possess a favorable immunogenicity and remyelination capacity for nerve repair.

Synthesis and characterization of photocrosslinkable gelatin and silk fibroin interpenetrating polymer network hydrogels

To effectively repair or replace damaged tissues, it is necessary to design scaffolds with tunable structural and biomechanical properties that closely mimic the host tissue. In this paper, we describe a newly synthesized photocrosslinkable interpenetrating polymer network (IPN) hydrogel based on gelatin methacrylate (GelMA) and silk fibroin (SF) formed by sequential polymerization, which possesses tunable structural and biological properties. Experimental results revealed that IPNs, where both the GelMA and SF were independently crosslinked in interpenetrating networks, demonstrated a lower swelling ratio, higher compressive modulus and lower degradation rate as compared to the GelMA and semi-IPN hydrogels, where only GelMA was crosslinked. These differences were likely caused by a higher degree of overall crosslinking due to the presence of crystallized SF in the IPN hydrogels. NIH-3T3 fibroblasts readily attached to, spread and proliferated on the surface of IPN hydrogels, as demonstrated by F-actin staining and analysis of mitochondrial activity (MTT). In addition, photolithography combined with lyophilization techniques was used to fabricate three-dimensional micropatterned and porous microscaffolds from GelMA-SF IPN hydrogels, furthering their versatility for use in various microscale tissue engineering applications. Overall, this study introduces a class of photocrosslinkable, mechanically robust and tunable IPN hydrogels that could be useful for various tissue engineering and regenerative medicine applications.

PDLLA/chondroitin sulfate/chitosan/NGF conduits for peripheral nerve regeneration

Biodegradable PDLLA/Chondroitin sulfate/Chitosan(PDLLA/CS/CHS) nerve conduits with potentially good biocompatibility and good mechanical property feasible for surgical manipulation have been developed in our previous work. The purpose of this study was to investigate their possible application in repairing damaged nerves and the effect of nerve growth factor (NGF). The PDLLA/CS/CHS/NGF nerve conduits were prepared by immobilizing NGF onto the PDLLA/CS/CHS nerve conduits with carbodiimide. Adult Sprague-Dawley (SD) rats weighing 200-250 g were used as the animal model. The conduits were employed to bridge the 10 mm defects in the sciatic nerve of the SD rats. Nerve conduction velocities (NCVs) were clearly detected in both nerve conduits after 3 months of implantation, indicating a rapid functional recovery for the disrupted nerves. The results of histological sections showed that the internal sides of the conduits were compact enough to prevent the connective tissues from ingrowth. Combined with the strong mechanical properties, good nerve regeneration ability and non-toxicity of its degradation products, PDLLA/CS/CHS nerve conduits would be expected to be useful materials to repair nerve damage and NGF can effectively promote the regeneration of peripheral nerve defect.

Regeneration and repair of peripheral nerves with different biomaterials: review

Peripheral nerve injury may cause gaps between the nerve stumps. Axonal proliferation in nerve conduits is limited to 10-15 mm. Most of the supportive research has been done on rat or mouse models which are different from humans. Herein we review autografts and biomaterials which are commonly used for nerve gap repair and their respective outcomes. Nerve autografting has been the first choice for repairing peripheral nerve gaps. However, it has been demonstrated experimentally that tissue engineered tubes can also permit lead to effective nerve repair over gaps longer than 4 cm repair that was previously thought to be restorable by means of nerve graft only. All of the discoveries in the nerve armamentarium are making their way into the clinic, where they are, showing great potential for improving both the extent and rate of functional recovery compared with alternative nerve guides.

Spider silk constructs enhance axonal regeneration and remyelination in long nerve defects in sheep

BACKGROUND

Surgical reapposition of peripheral nerve results in some axonal regeneration and functional recovery, but the clinical outcome in long distance nerve defects is disappointing and research continues to utilize further interventional approaches to optimize functional recovery. We describe the use of nerve constructs consisting of decellularized vein grafts filled with spider silk fibers as a guiding material to bridge a 6.0 cm tibial nerve defect in adult sheep.

METHODOLOGY/PRINCIPAL FINDINGS

The nerve constructs were compared to autologous nerve grafts. Regeneration was evaluated for clinical, electrophysiological and histological outcome. Electrophysiological recordings were obtained at 6 months and 10 months post surgery in each group. Ten months later, the nerves were removed and prepared for immunostaining, electrophysiological and electron microscopy. Immunostaining for sodium channel (NaV 1.6) was used to define nodes of Ranvier on regenerated axons in combination with anti-S100 and neurofilament. Anti-S100 was used to identify Schwann cells. Axons regenerated through the constructs and were myelinated indicating migration of Schwann cells into the constructs. Nodes of Ranvier between myelin segments were observed and identified by intense sodium channel (NaV 1.6) staining on the regenerated axons. There was no significant difference in electrophysiological results between control autologous experimental and construct implantation indicating that our construct are an effective alternative to autologous nerve transplantation.

CONCLUSIONS/SIGNIFICANCE

This study demonstrates that spider silk enhances Schwann cell migration, axonal regrowth and remyelination including electrophysiological recovery in a long-distance peripheral nerve gap model resulting in functional recovery. This improvement in nerve regeneration could have significant clinical implications for reconstructive nerve surgery.

Aligned natural-synthetic polyblend nanofibers for peripheral nerve regeneration

Peripheral nerve regeneration remains a significant clinical challenge to researchers. Progress in the design of tissue engineering scaffolds provides an alternative approach for neural regeneration. In this study aligned silk fibroin (SF) blended poly(L-lactic acid-co-ε-caprolactone) (P(LLA-CL)) nanofibrous scaffolds were fabricated by electrospinning methods and then reeled into aligned nerve guidance conduits (NGC) to promote nerve regeneration. The aligned SF/P(LLA-CL) NGC was used as a bridge implanted across a 10mm defect in the sciatic nerve of rats and the outcome in terms of of regenerated nerve at 4 and 8 weeks was evaluated by a combination of electrophysiological assessment and histological and immunohistological analysis, as well as electron microscopy. The electrophysiological examination showed that functional recovery of the regenerated nerve in the SF/P(LLA-CL) NGC group was superior to that in the P(LLA-CL) NGC group. The morphological analysis also indicated that the regenerated nerve in the SF/P(LLA-CL) NGC was more mature. All the results demonstrated that the aligned SF/P(LLA-CL) NGC promoted peripheral nerve regeneration significantly better in comparison with the aligned P(LLA-CL) NGC, thus suggesting a potential application in nerve regeneration.

Preparation of 3D fibroin/chitosan blend porous scaffold for tissue engineering via a simplified method

In this work, we developed a simple and flexible method to manufacture a 3D porous scaffold based on the blend of regenerated silk fibroin (RSF) and chitosan (CS). No crosslinker or other toxic reagents were used in this method. The pores of resulted 3D scaffolds were connected with each other, and their sizes could be easily controlled by the concentration of the mixed solution. Compared with pure RSF scaffolds, the water absorptivities of these RSF/CS blend scaffolds with significantly enhanced mechanical properties were greatly increased. The results of MTT and RT-PCR tests indicated that the chondrocytes grew very well in these blend RSF/CS porous scaffolds. This suggested that the RSF/CS blend scaffold prepared by this new method could be a promising candidate for applications in tissue engineering.

Preparation and Characterization of Electrospun Silk Fibroin-Based Tubular Scaffolds

Artificial nerve conduits (NC) can be used as an alternative to autologous nerve grafts to enhance the repair of small nerve gaps. Many natural and synthetic biomaterials have been processed to be tubular scaffolds. However, current NC lack adequate molecular and structural functionalities. Thus, we prepared silk fibroin (SF)-based nanofibrous tubular scaffolds (inner diameter=1.5 mm) for nerve repair. The Bombyx mori silk fibroin was firstly dissolved in hexafluoroisopropanol (HFIP), and then was electrospun to be nanofibrous silk fibroin tube which topographically functionalized with aligned and non-aligned SF nanofibers. Effects of electrospinning parameters (including collection distance, rotational speed and translational speed) on the micro-morphology of SF tube were investigated. The nanofibers orientation in SF tube affects the mechanical property of SF tube. The results suggest that this tubular scaffold shows promising application in nerve tissue engineering.

Construction of tissue engineered nerve grafts and their application in peripheral nerve regeneration

Surgical repair of severe peripheral nerve injuries represents not only a pressing medical need, but also a great clinical challenge. Autologous nerve grafting remains a golden standard for bridging an extended gap in transected nerves. The formidable limitations related to this approach, however, have evoked the development of tissue engineered nerve grafts as a promising alternative to autologous nerve grafts. A tissue engineered nerve graft is typically constructed through a combination of a neural scaffold and a variety of cellular and molecular components. The initial and basic structure of the neural scaffold that serves to provide mechanical guidance and optimal environment for nerve regeneration was a single hollow nerve guidance conduit. Later there have been several improvements to the basic structure, especially introduction of physical fillers into the lumen of a hollow nerve guidance conduit. Up to now, a diverse array of biomaterials, either of natural or of synthetic origin, together with well-defined fabrication techniques, has been employed to prepare neural scaffolds with different structures and properties. Meanwhile different types of support cells and/or growth factors have been incorporated into the neural scaffold, producing unique biochemical effects on nerve regeneration and function restoration. This review attempts to summarize different nerve grafts used for peripheral nerve repair, to highlight various basic components of tissue engineered nerve grafts in terms of their structures, features, and nerve regeneration-promoting actions, and finally to discuss current clinical applications and future perspectives of tissue engineered nerve grafts.

Types of neural guides and using nanotechnology for peripheral nerve reconstruction

Peripheral nerve injuries can lead to lifetime loss of function and permanent disfigurement. Different methods, such as conventional allograft procedures and use of biologic tubes present problems when used for damaged peripheral nerve reconstruction. Designed scaffolds comprised of natural and synthetic materials are now widely used in the reconstruction of damaged tissues. Utilization of absorbable and nonabsorbable synthetic and natural polymers with unique characteristics can be an appropriate solution to repair damaged nerve tissues. Polymeric nanofibrous scaffolds with properties similar to neural structures can be more effective in the reconstruction process. Better cell adhesion and migration, more guiding of axons, and structural features, such as porosity, provide a clearer role for nanofibers in the restoration of neural tissues. In this paper, basic concepts of peripheral nerve injury, types of artificial and natural guides, and methods to improve the performance of tubes, such as orientation, nanotechnology applications for nerve reconstruction, fibers and nanofibers, electrospinning methods, and their application in peripheral nerve reconstruction are reviewed.

Stabilization and release of enzymes from silk films

A significant challenge remains to protect protein drugs from inactivation during production, storage, and use. In the present study, the stabilization and release of horseradish peroxidase (HRP) in silk films was investigated. Water-insoluble silk films were prepared under mild aqueous conditions, maintaining the activity of the entrapped enzyme. Depending on film processing and post-processing conditions, HRP retained more than 90% of the initial activity at 4 degrees C, room temperature and 37 degrees C over two months. The stability of protein drugs in silk films is attributed to intermolecular interactions between the silk and the enzymes, based on Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The unique structural feature of silk molecules, periodic hydrophobic-hydrophilic domains, enabled strong interactions with proteins. The entrapped protein was present in two states, untrapped active and trapped inactive forms. The ratio between the two forms varied according to processing conditions. Proteolytic degradation and dissolution of the silk films resulted in the release of the bound enzyme which was otherwise not released by diffusion; enzyme recovered full activity upon release. There was a linear relationship between silk degradation/dissolution and the release of entrapped enzyme. Modifying the secondary structure of the silk matrix and the interactions with the non-crystalline domains resulted in control of the film degradation or dissolution rate, and therefore the release rate of the entrapped enzyme. Based on the above results, silk materials are an intriguing carrier for proteins in terms of both retention of activity and controllable release kinetics from the films.

Controlling dispersion of axonal regeneration using a multichannel collagen nerve conduit

Single channel conduits are used clinically in nerve repair as an alternative to the autologous nerve graft. Axons regenerating across single channel tubes, however, may disperse resulting in inappropriate target reinnervation. This dispersion may be limited by multichannel nerve conduits as they resemble the structure of nerve multiple basal lamina tubes. In this study, we investigated the influence of channel number on the axonal regeneration using a series of 1-, 2-, 4-, and 7-channel collagen conduits and commercial (NeuraGen) single channel conduits. Nerve conduits were implanted in rats with a 1 cm gap of sciatic nerve. After four months, quantitative results of regeneration were evaluated with nerve morphometry and the accuracy of regeneration was assessed using retrograde tracing: two tracers being applied simultaneously to tibial and peroneal nerves to determine the percentage of motor neurons with double projections. Recovery of function was investigated with compound muscle action potential recordings and ankle motion analysis. We showed that the fabricated 1-channel and 4-channel conduits are superior to other types of conduits in axonal regeneration. Simultaneous tracing showed a significantly lower percentage of motor neurons with double projections after 2- and 4-channel compared with 1-channel conduit repair. This study shows the potential influence of multichannel guidance on limiting dispersion without decreasing quantitative results of regeneration.

Modulation of cell growth on exposure to silkworm and spider silk fibers

Recent years have seen an increased interest in the use of natural and modified silks for tissue engineering. Despite longstanding concerns regarding the biocompatibility of silk sutures, only a few studies have been carried out to investigate the biocompatibility of natural silk fibers. Here, we report an in vitro assessment of the effect of nonmodified, degummed silks on cells. We describe the effects of degummed silk fibers as well as extracted sericin on cell metabolism and proliferation. Endothelial cells directly exposed to native degummed Bombyx mori and Antheraea pernyi silks showed lower rates of proliferation and metabolism than nonexposed cells. A similar but milder effect was observed for cells in direct contact with Nephila edulis egg sack fibers. Sericin and silk-conditioned medium had no negative effect on cell proliferation except in medium supplemented with 5% bovine serum prior to conditioning with A. pernyi silk. The toxicity of A. pernyi was negligible after thorough enzymatic treatment of the fibers with trypsin. It is, therefore, proposed that A. pernyi silk contain one or more cytotoxic components, which need to be removed prior to medical use.

A novel scaffold with longitudinally oriented microchannels promotes peripheral nerve regeneration

Longitudinally oriented microstructures are essential for a nerve scaffold to promote significant regeneration of injured peripheral axons across nerve gaps. Extensive attention has been devoted to develop scaffolds with inner structures mimicking the nerve-guiding basal lamina microchannels in autografts. However, to date, little information has been obtained about scaffolds with similar inner microstructures, and the efficacy of such scaffolds in bridging peripheral nerve gaps in vivo has never been examined. In the present study, we describe a novel nerve-guiding collagen-chitosan (CCH) scaffold with inner dimensions resembling the basal lamina microchannels of normal nerves. The scaffold has a number of structural advantages, including longitudinally orientated microchannels and extensive interconnected pores between the parallel microchannels. We evaluated the efficacy of the CCH scaffold to bridge a 15-mm-long sciatic nerve defect in rats using a combination of morphological and functional techniques. The in vivo animal study showed that the CCH scaffold achieved nerve regeneration and functional recovery equivalent to that of an autograft, without the exogenous delivery of regenerative agents or cell transplantation. These findings demonstrate that CCH scaffolds may be used as alternatives to nerve autografts for peripheral nerve regeneration.

Polymers for Fabricating Nerve Conduits

Peripheral nerve regeneration is a complicated and long-term medical challenge that requires suitable guides for bridging nerve injury gaps and restoring nerve functions. Many natural and synthetic polymers have been used to fabricate nerve conduits as well as luminal fillers for achieving desired nerve regenerative functions. It is important to understand the intrinsic properties of these polymers and techniques that have been used for fabricating nerve conduits. Previously extensive reviews have been focused on the biological functions and in vivo performance of polymeric nerve conduits. In this paper, we emphasize on the structures, thermal and mechanical properties of these naturally derived synthetic polymers, and their fabrication methods. These aspects are critical for the performance of fabricated nerve conduits. By learning from the existing candidates, we can advance the strategies for designing novel polymeric systems with better properties for nerve regeneration.

Silk Fibroin Based Porous Materials

Silk from the Bombyx mori silkworm is a protein-based fiber. Bombyx mori silk fibroin (SF) is one of the most important candidates for biomedical porous material based on its superior machinability, biocompatibility, biodegradation, bioresorbability, and so on. In this paper, we have reviewed the key features of SF. Moreover we have focused on the morphous, technical processing, and biocompatibility of SF porous materials, followed by the application research. Finally, we provide a perspective the potential and problems of SF porous materials.

Current applications and future perspectives of artificial nerve conduits

Artificial nerve guide conduits have the advantage over autografts in terms of their availability and ease of fabrication. However, clinical outcomes associated with the use of artificial nerve conduits are often inferior to that of autografts, particularly over long lesion gaps. There have been significant advances in the designs of artificial nerve conduits over the years. In terms of materials selection and design, a wide variety of new synthetic polymers and biopolymers have been evaluated. The inclusion of nerve conduit lumen fillers has also been demonstrated as essential to enable nerve regeneration across large defect gaps. These lumen filler designs have involved the integration of physical cues for contact guidance and biochemical signals to control cellular function and differentiation. Novel conduit architectural designs using porous and fibrous substrates have also been developed. This review highlights the recent advances in synthetic nerve guide designs for peripheral nerve regeneration, and the in vivo applicability and future prospects of these nerve guide conduits.

Enhanced cell affinity of the silk fibroin- modified PHBHHx material

Cell affinity is one of the important issues required for developing tissue engineering materials. Although the poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) has been attractive for its controllable mechanical properties recent years, its cell affinity is still necessary to be improved for the requirements. For this purpose, the regenerated silk fibroin (SF) was coated on the PHBHHx films and its porous scaffolds. The mechanical test showed that SF-modified PHBHHx (SF/PHBHHx) film has a maximum tensile strength of 11.5 +/- 0.5 MPa and elongation at break of 175 +/- 5%. ATR-FTIR spectroscopy demonstrated that SF firmly attached on the scaffold by the hydrogen bonding interaction between SF and PHBHHx even flushed for 21 days in the phosphate-buffer saline (PBS) solution (pH = 7.4). In order to characterize the cell affinity of the SF-modified material, endothelial-like cell line ECV304 cells were seeded on the SF/PHBHHx films and its porous scaffolds. The histochemical analyses of cells stained by the hematoxylin and eosin (HE) as well as cell nuclei stained by the 4',6-diamindine-2'-phenylindole (DAPI) demonstrated that cell attached and reached nearly 100% confluence on the SF/PHBHHx films when cultured for 4 days, which was much faster than that on the pure PHBHHx film. Moreover, the assay of cell activity by the 3-(4, 5-dimethyl thiazol -2-yl)-2, 5-diphenyl terazolium bromide (MTT) showed quantitatively that the number of cells on the SF/PHBHHx porous scaffolds was significant more than that on the unmodified ones after 4, 8, and 14 days culture, respectively. Scanning electron microscopy (SEM) revealed the similar results. Therefore, the SF-modified PHBHHx material is maybe a potential material applicable in the cardiovascular tissue engineering.

Chitosan/polyglycolic acid nerve grafts for axon regeneration from prolonged axotomized neurons to chronically denervated segments

Peripheral nerve regeneration for long-term delayed injuries is usually unsatisfied. Here we attempted to use a chitosan/polyglycolic acid (PGA) artificial nerve graft to bridge a long-term delayed 10-mm defect in SD rats based on the previous studies on the graft used for immediate repair of 30-mm-long dog sciatic nerve defects and for clinical treatment of a 35-mm-long median nerve defect at elbow of a human patient. In this study, for experimental groups, the rat sciatic nerve had been transected leaving a 10-mm defect, which was maintained for 3 or 6 months before implantation with the chitosan/PGA artificial nerve graft. The animals non-grafted or grafted with autograft served as negative or positive control group. In experiment groups, nerve regeneration with functional recovery was achieved as measured by electrophysiological and histological techniques, although differences in the quantity and the quality of the regenerated nerve were observed between the 3- and 6-month delayed subgroups. The results showed that: (1) a few denervated Schwann cells survived and sustained their ability to myelinate axons at least 6 months, and (2) the atrophic denervated muscle could be reinnervated by regenerated axons through new muscle-nerve connections. These observations provide the possibility of guiding regenerated axons from survived axotomized neurons to distal nerve stump by the chitosan/PGA artificial nerve graft.

Peripheral sensory axon growth: from receptor binding to cellular signaling

Regeneration following axonal injury of the adult peripheral sensory nervous system is heavily influenced by factors located in a neuron's extracellular environment. These factors include neurotrophins, such as Nerve Growth Factor (NGF) and the extracellular matrix, such as laminin. The presence of these molecules in the peripheral nervous system (PNS) is a major contributing factor for the dichotomy between regenerative capacities of central vs. peripheral neurons. Although PNS neurons are capable of spontaneous regeneration, this response is critically dependent on many different factors including the type, location and severity of the injury. In this article, we will focus on the plasticity of adult dorsal root ganglion (DRG) sensory neurons and how trophic factors and the extracellular environment stimulate the activation of intracellular signaling cascades that promote axonal growth in adult dorsal root ganglion neurons.

The promotion of peripheral nerve regeneration by chitooligosaccharides in the rat nerve crush injury model

Chitooligosaccharides (COSs), the biodegradation product of chitosan, have shown many biological functions. In this study, we examined the possible benefits of treatment with COSs (M.W. 800) on regeneration of rat crushed sciatic nerves. The rats with sciatic nerve crush injury were administered intraperitoneally daily with 3 or 6mg/kg body weight of COSs over a 3-week period. During and at the end of COSs treatment, a series of functional and histological examinations, including the measurement of withdrawal reflex latency (WRL) values, walking track analysis, electrophysiological assessments, morphometric analysis of gastrocnemius muscle, as well as immunohistochemistry and electromicroscopy to regenerated sciatic nerves, were performed to evaluate the therapeutic outcomes of COSs. The experimental data demonstrated that COSs promoted peripheral nerve regeneration with the desired functional recovery in the rat sciatic nerve crush injury model. This study raises a possibility of developing COSs as a potential neuroprotective agent for peripheral nerve repair applications.

Preparation and characterization of fibroin/hyaluronic acid composite scaffold

Hyaluronic acid (HA) was added into fibroin solution to prepare fibroin-based porous composite scaffolds. HA exhibited important effects on pore formation and hydrophilicity of fibroin-based scaffold. The aqueous-fibroin/HA scaffolds had highly homogeneous and interconnected pores with porosity of above 90% and controllable pore size ranging from 123 to 253 microm. The water take-up of fibroin/HA scaffolds increased significantly with the increase of HA content. Containing HA at a defined content range, such as 3-6%, fibroin-based scaffolds' affinity to primary neural cells was improved. In 6%HA/fibroin scaffolds, neurosphere-forming cell migrated from their original aggregate and adhered tightly to the surface of scaffolds.

Evaluation of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) conduits for peripheral nerve regeneration

Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) was investigated for possible application in repairing damaged nerves. Porous nerve conduits with both uniform wall porosity and non-uniform wall porosity were prepared using a particle leaching method. Adult Sprague-Dawley (SD) rats weighing 200-250 g were used as the animal model. The conduits were employed to bridge the 10mm defects in the sciatic nerve of the Sprague-Dawley (SD) rats. Mechanical tests showed that the PHBHHx nerve conduits had proper mechanical properties including maximal loads of 3.1N and 1.3N for the conduits with non-uniform wall porosity and with uniform wall porosity, respectively, and maximal stresses of 2.3 MPa and 0.94 MPa for the conduits with non-uniform wall porosity and with uniform wall porosity, respectively. At the same time, both types of conduits were permeable to three compounds tested including glucose, lysozyme and bovine serum albumin, indicating the suitability of the conduits for free exchanges of nutrients. Compound Muscle Action Potentials (CMAPs) were clearly observed in both types of the PHBHHx nerve conduits after 1 month of implantation, indicating a rapid functional recovery for the disrupted nerves. The results of histological sections demonstrated that the internal sides of the conduits with non-uniform wall porosity were compact enough to prevent the connective tissues from ingrowth penetration. After implantation for 3 months in the rats, the conduits with uniform wall porosity and those with non-uniform wall porosity lost 24% and 20% of their original weight average molecular weights, respectively. Combined with the strong mechanical properties, good nerve regeneration ability and non-toxicity of its degradation products, PHBHHx nerve conduits can be developed into a useful material to repair nerve damage.