151
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Zargar Kharazi A, Dini G, Naser R. Fabrication and evaluation of a nerve guidance conduit capable of Ca 2+ ion release to accelerate axon extension in peripheral nerve regeneration. J Biomed Mater Res A 2018; 106:2181-2189. [PMID: 29637737 DOI: 10.1002/jbm.a.36425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 11/11/2022]
Abstract
In this study, biodegradable nanocomposites consisting of poly (glycerol sebacate) (PGS) elastomeric matrix and the reinforcing phase of calcium titanate (CaTiO3 ) nanoparticles were fabricated as a nerve guidance conduit (NGC) for peripheral nerve regeneration. CaTiO3 nanoparticles were synthesized via the sol-gel method and calcined at 800°C for 60 min. PGS elastomer was synthesized via the polycondensation reaction of glycerol and sebacate (1:1) and 2.5 and 5 wt. percentages of the synthesized CaTiO3 nanoparticles were added to the PGS prepolymer solution. The composites obtained were heated in order to make crosslinks in the pre-polymer. CaTiO3 nanoparticles, PGS elastomer, and the composites fabricated were characterized in terms of their structural, chemical, physical, mechanical, and cell response properties to evaluate the feasibility of using the nanocomposite for NGC applications. The results indicated that CaTiO3 nanoparticles were 50 nm in size. When the nanoparticles were added to the PGS, the elastic modulus and tensile strength of the nanocomposite reached values of about 1 and 0.5 MPa, respectively that are near those of natural nerves. The degradation behavior and swelling of the nanocomposites, as compared with those of the PGS elastomer, were controlled by introducing CaTiO3 into the PGS, which swelling limitation could prevent nerve compression. It was observed that Ca2+ ions established chemical bonds with PGS, which led to high crosslink densities that, in turn, contribute to improved mechanical properties of the composite. The Ca2+ ions released from the nanocomposite samples were in the nontoxic range. The PC12 cell line on the surface of the nanocomposite specimens showed good cell adhesion and proliferation with improved axon outgrowth and extension. Based on the results obtained the fabricated PGS/CaTiO3 nanocomposite may be recommended as a suitable NGC with desirable effects on peripheral nerve regeneration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2181-2189, 2018.
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Affiliation(s)
- Anousheh Zargar Kharazi
- Biomaterials Nanotechnology and Tissue Engineering faculty, School of Advanced Medical Technology, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran
| | - Ghasem Dini
- Department of Nanotechnology Engineering, Faculty of Advanced Sciences and Technologies, University of Isfahan, Isfahan, 81746-73441, Iran
| | - Reza Naser
- Biomaterials Nanotechnology and Tissue Engineering faculty, School of Advanced Medical Technology, Isfahan University of Medical Sciences, Isfahan, 8174673461, Iran
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152
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Wieringa PA, Gonçalves de Pinho AR, Micera S, Wezel RJA, Moroni L. Biomimetic Architectures for Peripheral Nerve Repair: A Review of Biofabrication Strategies. Adv Healthc Mater 2018; 7:e1701164. [PMID: 29349931 DOI: 10.1002/adhm.201701164] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/13/2017] [Indexed: 12/19/2022]
Abstract
Biofabrication techniques have endeavored to improve the regeneration of the peripheral nervous system (PNS), but nothing has surpassed the performance of current clinical practices. However, these current approaches have intrinsic limitations that compromise patient care. The "gold standard" autograft provides the best outcomes but requires suitable donor material, while implantable hollow nerve guide conduits (NGCs) can only repair small nerve defects. This review places emphasis on approaches that create structural cues within a hollow NGC lumen in order to match or exceed the regenerative performance of the autograft. An overview of the PNS and nerve regeneration is provided. This is followed by an assessment of reported devices, divided into three major categories: isotropic hydrogel fillers, acting as unstructured interluminal support for regenerating nerves; fibrous interluminal fillers, presenting neurites with topographical guidance within the lumen; and patterned interluminal scaffolds, providing 3D support for nerve growth via structures that mimic native PNS tissue. Also presented is a critical framework to evaluate the impact of reported outcomes. While a universal and versatile nerve repair strategy remains elusive, outlined here is a roadmap of past, present, and emerging fabrication techniques to inform and motivate new developments in the field of peripheral nerve regeneration.
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Affiliation(s)
- Paul A. Wieringa
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht University Universiteitssingel 40 Maastricht 6229 ER The Netherlands
| | - Ana Rita Gonçalves de Pinho
- Tissue Regeneration DepartmentMIRA InstituteUniversity of Twente Drienerlolaan 5 Enschede 7522 NB The Netherlands
| | - Silvestro Micera
- BioRobotics InstituteScuola Superiore Sant'Anna Viale Rinaldo Piaggio 34 Pontedera 56025 Italy
- Translational Neural Engineering LaboratoryEcole Polytechnique Federale de Lausanne Ch. des Mines 9 Geneva CH‐1202 Switzerland
| | - Richard J. A. Wezel
- BiophysicsDonders Institute for BrainCognition and BehaviourRadboud University Kapittelweg 29 Nijmegen 6525 EN The Netherlands
- Biomedical Signals and SystemsMIRA InstituteUniversity of Twente Drienerlolaan 5 Enschede 7522 NB The Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht University Universiteitssingel 40 Maastricht 6229 ER The Netherlands
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153
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Jones PE, Meyer RM, Faillace WJ, Landau ME, Smith JK, McKay PL, Nesti LJ. Combat Injury of the Sciatic Nerve – An Institutional Experience. Mil Med 2018; 183:e434-e441. [DOI: 10.1093/milmed/usy030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 01/19/2023] Open
Affiliation(s)
- Patrick E Jones
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
- Department of Surgery, United States Naval Hospital, Kuwae, Chatan, Nakagami District, Okinawa Prefecture, Japan
| | - R Michael Meyer
- Department of Surgery, Uniformed Services University of the Health Sciences, 8901 Rockville Pike, Bethesda, MD
- Department of Neurological Surgery, University of Washington, 325 9th Ave, Seattle, WA
| | - Walter J Faillace
- Department of Neurosurgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, 8901 Rockville Pike, Bethesda, MD
| | - Mark E Landau
- Department of Neurology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Jonathan K Smith
- Department of Neurology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
| | - Patricia L McKay
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, 8901 Rockville Pike, Bethesda, MD
| | - Leon J Nesti
- Department of Surgery, Uniformed Services University of the Health Sciences, 8901 Rockville Pike, Bethesda, MD
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154
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Rebowe R, Rogers A, Yang X, Kundu SC, Smith TL, Li Z. Nerve Repair with Nerve Conduits: Problems, Solutions, and Future Directions. J Hand Microsurg 2018; 10:61-65. [PMID: 30154617 DOI: 10.1055/s-0038-1626687] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/02/2018] [Indexed: 01/09/2023] Open
Abstract
Nerve conduits are becoming increasingly popular for the repair of peripheral nerve injuries. Their ease of application and lack of donor site morbidity make them an attractive option for nerve repair in many situations. Today, there are many different conduits to choose in different sizes and materials, giving the reconstructive surgeon many options for any given clinical problem. However, to properly utilize these unique reconstructive tools, the peripheral nerve surgeon must be familiar not only with their standard indications but also with their functional limitations. In this review, the authors identify the common applications of nerve conduits, expected results, and shortcomings of current techniques. Furthermore, future directions for nerve conduit use are identified.
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Affiliation(s)
- Ryan Rebowe
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Ashley Rogers
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Xuebin Yang
- Department of Oral Biology, University of Leeds, Leeds, United Kingdom
| | - S C Kundu
- Department of Biotechnology, Indian Institute of Technology, Kharagpur, West Bengal, India
| | - Thomas L Smith
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
| | - Zhongyu Li
- Department of Orthopaedics, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
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155
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Thompson R, Sakiyama-Elbert S. Using biomaterials to promote pro-regenerative glial phenotypes after nervous system injuries. ACTA ACUST UNITED AC 2018; 13:024104. [PMID: 29186011 DOI: 10.1088/1748-605x/aa9e23] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Trauma to either the central or peripheral nervous system (PNS) often leads to significant loss of function and disability in patients. This high rate of long-term disability is due to the overall limited regenerative potential of nervous tissue, even though the PNS has more regenerative potential than the central nervous system (CNS). The supporting glial cells in the periphery, Schwann cells, are part of the reason for the improved recovery observed in the PNS. In the CNS, the glial populations, astrocytes and oligodendrocytes (OLs), do not have as much potential to promote regeneration and are at times inhibitory to neuronal growth. In particular, the inhibitory roles astrocytes play following trauma has led to a historical focus on neurons and OLs instead of astrocytes. Recently, this focus has shifted as new, regenerative astrocyte phenotypes have been described. From these observations, glial cells clearly play critical roles in native recovery pathways in both the CNS and PNS. This makes the ability to manipulate both transplanted and native glial cell phenotypes a potentially successful strategy to improve nerve injury outcomes. This review focuses on factors that cause glial cells to adopt repair phenotypes and biomaterials that manipulate and/or harness these glial phenotypes.
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Affiliation(s)
- Russell Thompson
- Department of Biomedical Engineering, University of Texas at Austin 107 W Dean Keeton, Austin, TX 78712, United States of America. Department of Biomedical Engineering, Washington University in St. Louis, 1 Brooking Drive, St. Louis, MO 63130, United States of America
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156
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Zhang M, Zhang Y, Bian Y, Fu H, Xu Y, Guo Y. Effect of long-term electroacupuncture stimulation on recovery of sensorimotor function after peripheral nerve anastomosis. Acupunct Med 2018; 36:170-175. [PMID: 29436383 PMCID: PMC6029640 DOI: 10.1136/acupmed-2017-011367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/17/2022]
Abstract
Background Recently, application of electroacupuncture (EA) to stimulate nerve regeneration has become a mainstream treatment in clinical rehabilitation and related basic research, but the efficacy of long-term stimulation has not been confirmed. Objective To evaluate the influence of long term EA on peripheral nerve injury (PNI) from multiple angles. Method Twenty-four rats were divided into three groups: control, PNI and PNI+EA. In the latter two groups, PNI was modelled by transection followed by re-anastomosis of thesciatic nerve. In the PNI+EA group only, EA was delivered using a discontinuous wave with frequency 5 Hz, pulse width 2 ms, and intensity approximately 2 mA, until the affected limb was observed to twitch slightly. The treatment was given for 15 min each time, six times a week (continuously for 6 days followed by a 1-day break) for a total of 8 weeks. The effects of EA on anastomotic sciatic nerve regeneration were evaluated using the sciatic function index (SFI), mechanical withdrawal thresholds, thermo-nociceptive thresholds, conduction velocity of the sciatic nerve and bilateral gastrocnemius wet weight. Results From weeks 2 to 4 after modelling, the SFI recovery rate in the PNI+EA group was faster than that in the PNI group. In week 4, the SFI of the PNI+EA group was significantly higher than that of the PNI group (p<0.05). However, a significant effect of EA was no longer evident from weeks 5 to 8. There was no effect of acupuncture on anti-amyotrophy and conduction velocity of the sciatic nerve at 8 weeks after modelling. EA did not shorten the paw withdrawal threshold time, but appeared to alleviate thermo-nociceptive sensitivity. Conclusion Long term repeated stimulation of the same site with EA does not appear to be conducive to the functional recovery of an injured sciatic nerve in rats.
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Affiliation(s)
- Mingxing Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ye Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuhong Bian
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hui Fu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ying Xu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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157
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De la Rosa MB, Kozik EM, Sakaguchi DS. Adult Stem Cell-Based Strategies for Peripheral Nerve Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1119:41-71. [PMID: 30151648 DOI: 10.1007/5584_2018_254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peripheral nerve injuries (PNI) occur as the result of sudden trauma and can lead to life-long disability, reduced quality of life, and heavy economic and social burdens. Although the peripheral nervous system (PNS) has the intrinsic capacity to regenerate and regrow axons to a certain extent, current treatments frequently show incomplete recovery with poor functional outcomes, particularly for large PNI. Many surgical procedures are available to halt the propagation of nerve damage, and the choice of a procedure depends on the extent of the injury. In particular, recovery from large PNI gaps is difficult to achieve without any therapeutic intervention or some form of tissue/cell-based therapy. Autologous nerve grafting, considered the "gold standard" is often implemented for treatment of gap formation type PNI. Although these surgical procedures provide many benefits, there are still considerable limitations associated with such procedures as donor site morbidity, neuroma formation, fascicle mismatch, and scarring. To overcome such restrictions, researchers have explored various avenues to improve post-surgical outcomes. The most commonly studied methods include: cell transplantation, growth factor delivery to stimulate regenerating axons and implanting nerve guidance conduits containing replacement cells at the site of injury. Replacement cells which offer maximum benefits for the treatment of PNI, are Schwann cells (SCs), which are the peripheral glial cells and in part responsible for clearing out debris from the site of injury. Additionally, they release growth factors to stimulate myelination and axonal regeneration. Both primary SCs and genetically modified SCs enhance nerve regeneration in animal models; however, there is no good source for extracting SCs and the only method to obtain SCs is by sacrificing a healthy nerve. To overcome such challenges, various cell types have been investigated and reported to enhance nerve regeneration.In this review, we have focused on cell-based strategies aimed to enhance peripheral nerve regeneration, in particular the use of mesenchymal stem cells (MSCs). Mesenchymal stem cells are preferred due to benefits such as autologous transplantation, routine isolation procedures, and paracrine and immunomodulatory properties. Mesenchymal stem cells have been transplanted at the site of injury either directly in their native form (undifferentiated) or in a SC-like form (transdifferentiated) and have been shown to significantly enhance nerve regeneration. In addition to transdifferentiated MSCs, some studies have also transplanted ex-vivo genetically modified MSCs that hypersecrete growth factors to improve neuroregeneration.
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Affiliation(s)
- Metzere Bierlein De la Rosa
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA.,Veterinary Specialty Center, Buffalo Grove, IL, USA
| | - Emily M Kozik
- Biology Program, Department of Genetics, Development and Cell Biology, Iowa State University, Ames, IA, USA.,Department of Genetics, Development and Cell Biology, Iowa State University, Ames, IA, USA
| | - Donald S Sakaguchi
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, USA. .,Biology Program, Department of Genetics, Development and Cell Biology, Iowa State University, Ames, IA, USA. .,Department of Genetics, Development and Cell Biology, Iowa State University, Ames, IA, USA. .,Neuroscience Program, Iowa State University, Ames, IA, USA.
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158
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Huang J, Patel N, Lyon K. An update–tissue engineered nerve grafts for the repair of peripheral nerve injuries. Neural Regen Res 2018. [DOI: 10.4103/1673-5374.232458
expr 973353844 + 912195704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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159
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Patel NP, Lyon KA, Huang JH. An update-tissue engineered nerve grafts for the repair of peripheral nerve injuries. Neural Regen Res 2018; 13:764-774. [PMID: 29862995 PMCID: PMC5998615 DOI: 10.4103/1673-5374.232458] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Peripheral nerve injuries (PNI) are caused by a range of etiologies and result in a broad spectrum of disability. While nerve autografts are the current gold standard for the reconstruction of extensive nerve damage, the limited supply of autologous nerve and complications associated with harvesting nerve from a second surgical site has driven groups from multiple disciplines, including biomedical engineering, neurosurgery, plastic surgery, and orthopedic surgery, to develop a suitable or superior alternative to autografting. Over the last couple of decades, various types of scaffolds, such as acellular nerve grafts (ANGs), nerve guidance conduits, and non-nervous tissues, have been filled with Schwann cells, stem cells, and/or neurotrophic factors to develop tissue engineered nerve grafts (TENGs). Although these have shown promising effects on peripheral nerve regeneration in experimental models, the autograft has remained the gold standard for large nerve gaps. This review provides a discussion of recent advances in the development of TENGs and their efficacy in experimental models. Specifically, TENGs have been enhanced via incorporation of genetically engineered cells, methods to improve stem cell survival and differentiation, optimized delivery of neurotrophic factors via drug delivery systems (DDS), co-administration of platelet-rich plasma (PRP), and pretreatment with chondroitinase ABC (Ch-ABC). Other notable advancements include conduits that have been bioengineered to mimic native nerve structure via cell-derived extracellular matrix (ECM) deposition, and the development of transplantable living nervous tissue constructs from rat and human dorsal root ganglia (DRG) neurons. Grafts composed of non-nervous tissues, such as vein, artery, and muscle, will be briefly discussed.
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Affiliation(s)
| | - Kristopher A Lyon
- Texas A&M College of Medicine; Department of Neurosurgery, Baylor Scott & White Healthcare, Temple, TX, USA
| | - Jason H Huang
- Texas A&M College of Medicine; Department of Neurosurgery, Baylor Scott & White Healthcare, Temple, TX, USA
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160
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Martins DF, Martins TC, Batisti AP, dos Santos Leonel L, Bobinski F, Belmonte LAO, Mazzardo-Martins L, Cargnin-Ferreira E, Santos ARS. Long-Term Regular Eccentric Exercise Decreases Neuropathic Pain-like Behavior and Improves Motor Functional Recovery in an Axonotmesis Mouse Model: the Role of Insulin-like Growth Factor-1. Mol Neurobiol 2017; 55:6155-6168. [DOI: 10.1007/s12035-017-0829-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
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161
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Quantification of Collagen Organization after Nerve Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1586. [PMID: 29632766 PMCID: PMC5889458 DOI: 10.1097/gox.0000000000001586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/13/2017] [Indexed: 01/09/2023]
Abstract
Background: Clinical outcomes after nerve injury and repair remain suboptimal. Patients may be plagued by poor functional recovery and painful neuroma at the repair site, characterized by disorganized collagen and sprouting axons. Collagen deposition during wound healing can be intrinsically imaged using second harmonic generation (SHG) microscopy. The purpose of this study was to develop a protocol for SHG imaging of nerves and to assess whether collagen alignment can be quantified after nerve repair. Methods: Sciatic nerve transection and epineural repair was performed in male rats. The contralateral nerves were used as intra-animal controls. Ten-millimeter nerve segments were harvested and fixed onto slides. SHG images were collected using a 20× objective on a multiphoton microscope. Collagen fiber alignment was calculated using CurveAlign software. Alignment was calculated on a scale from 0 to 1, where 1 represents perfect alignment. Statistical analysis was performed using a linear mixed-effects model. Results: Eight male rats underwent right sciatic nerve repair using 9-0 Nylon suture. There were gross variations in collagen fiber organization in the repaired nerves compared with the controls. Quantitatively, collagen fibers were more aligned in the control nerves (mean alignment 0.754, SE 0.055) than in the repairs (mean alignment 0.413, SE 0.047; P < 0.001). Conclusions: SHG microscopy can be used to quantitate collagen after nerve repair via fiber alignment. Given that the development of neuroma likely reflects aberrant wound healing, ex vivo and/or in vivo SHG imaging may be useful for further investigation of the variables predisposing to neuroma.
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162
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Hader M, Sporer ME, Roche AD, Unger E, Bergmeister KD, Wakolbinger R, Aszmann OC. Fascicular shifting: a novel technique to overcome large nerve defects. J Neurosurg Spine 2017; 27:723-731. [PMID: 28984513 DOI: 10.3171/2017.3.spine16276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Over the last decade, a number of authors have investigated the utility of different biological and synthetic matrices as alternatives to conventional nerve grafts. However, the autologous nerve graft remains the gold standard, even though it often involves using a pure sensory nerve to reconstruct a mixed or even a pure motor nerve. Furthermore, limited donor sites often necessitate a significant mismatch of needed nerve tissue, especially for large proximal nerve defects such as brachial plexus lesions. Here, the authors present a new technique that overcomes these problems: the fascicular shift procedure (FSP). A fascicular group of the nerve distal to the injury is harvested in a sufficient length to bridge the nerve defect. METHODS The method of fascicular shifting was tested at the sciatic nerve in 45 Lewis rats. In the experimental group, a 15-mm nerve defect was created and reconstructed with a fascicular group that was harvested directly distal to the gap. This group was compared with 1 negative control group (defect without reconstruction) and 3 positive control groups (sensory, motor, and mixed graft). After 12 weeks of nerve regeneration, outcome was evaluated using retrograde labeling, histomorphometric analysis, and muscle force analysis. RESULTS All reconstructed groups showed successful regeneration with various levels of function. The negative control group showed minimal force measurements that were of no functional value. The fascicular shift provided sufficient guidance to overcome nerve defects, had higher (p < 0.1) motor neuron counts (1958.75 ± 657.21) than the sensory graft (1263.50 ± 538.90), and was equal to motor grafts (1490.43 ± 794.80) and mixed grafts (1720.00 ± 866.421). This tendency of improved motor regeneration was confirmed in all analyses. The mixed graft group was compared with the experimental group to investigate the influence of the potential damage induced by the fascicular shift distal to the repair site. However, none of the analyses revealed an impairment of nerve regeneration for both the tibial and common peroneal index muscles. CONCLUSIONS This study demonstrates that harvesting a transplant from the nerve segment distal to the injury site offers a mixed graft without causing additional donor-site morbidity. These grafts perform statistically better than a standard sensory graft in terms of motor recovery. The fascicular shift presents a novel method to reconstruct large proximal nerve defects, making it immensely attractive in brachial plexus reconstruction.
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Affiliation(s)
- Maria Hader
- 1Christian Doppler Laboratory for Restoration of Extremity Function
| | | | - Aidan D Roche
- 1Christian Doppler Laboratory for Restoration of Extremity Function
| | - Ewald Unger
- 3Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | | | | | - Oskar C Aszmann
- 1Christian Doppler Laboratory for Restoration of Extremity Function.,2Division of Plastic and Reconstructive Surgery, Department of Surgery; and
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163
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Rasulic L. Current Concept in Adult Peripheral Nerve and Brachial Plexus Surgery. J Brachial Plex Peripher Nerve Inj 2017; 12:e7-e14. [PMID: 28974982 PMCID: PMC5624798 DOI: 10.1055/s-0037-1606841] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/24/2017] [Indexed: 01/09/2023] Open
Abstract
Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years—endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.
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Affiliation(s)
- Lukas Rasulic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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164
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Ronchi G, Cillino M, Gambarotta G, Fornasari BE, Raimondo S, Pugliese P, Tos P, Cordova A, Moschella F, Geuna S. Irreversible changes occurring in long-term denervated Schwann cells affect delayed nerve repair. J Neurosurg 2017; 127:843-856. [DOI: 10.3171/2016.9.jns16140] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVEMultiple factors may affect functional recovery after peripheral nerve injury, among them the lesion site and the interval between the injury and the surgical repair. When the nerve segment distal to the lesion site undergoes chronic degeneration, the ensuing regeneration (when allowed) is often poor. The aims of the current study were as follows: 1) to examine the expression changes of the neuregulin 1/ErbB system during long-term nerve degeneration; and 2) to investigate whether a chronically denervated distal nerve stump can sustain nerve regeneration of freshly axotomized axons.METHODSThis study used a rat surgical model of delayed nerve repair consisting of a cross suture between the chronically degenerated median nerve distal stump and the freshly axotomized ulnar proximal stump. Before the suture, a segment of long-term degenerated median nerve stump was harvested for analysis. Functional, morphological, morphometric, and biomolecular analyses were performed.RESULTSThe results showed that neuregulin 1 is highly downregulated after chronic degeneration, as well as some Schwann cell markers, demonstrating that these cells undergo atrophy, which was also confirmed by ultrastructural analysis. After delayed nerve repair, it was observed that chronic degeneration of the distal nerve stump compromises nerve regeneration in terms of functional recovery, as well as the number and size of regenerated myelinated fibers. Moreover, neuregulin 1 is still downregulated after delayed regeneration.CONCLUSIONSThe poor outcome after delayed nerve regeneration might be explained by Schwann cell impairment and the consequent ineffective support for nerve regeneration. Understanding the molecular and biological changes occurring both in the chronically degenerating nerve and in the delayed nerve repair may be useful to the development of new strategies to promote nerve regeneration. The results suggest that neuregulin 1 has an important role in Schwann cell activity after denervation, indicating that its manipulation might be a good strategy for improving outcome after delayed nerve repair.
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Affiliation(s)
- Giulia Ronchi
- 1Department of Clinical and Biological Sciences,
- 2Neuroscience Institute Cavalieri Ottolenghi, and
| | - Michele Cillino
- 3Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | | | | | - Stefania Raimondo
- 1Department of Clinical and Biological Sciences,
- 2Neuroscience Institute Cavalieri Ottolenghi, and
| | - Pierfrancesco Pugliese
- 4Reconstructive Microsurgery, Centro Traumatologico Ortopedico Hospital, University of Torino; and
| | - Pierluigi Tos
- 4Reconstructive Microsurgery, Centro Traumatologico Ortopedico Hospital, University of Torino; and
| | - Adriana Cordova
- 3Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Francesco Moschella
- 3Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Stefano Geuna
- 1Department of Clinical and Biological Sciences,
- 2Neuroscience Institute Cavalieri Ottolenghi, and
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165
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Fan L, Xiong Y, Fu Z, Xu D, Wang L, Chen Y, Xia H, Peng N, Ye S, Wang Y, Zhang L, Ye Q. Polyaniline promotes peripheral nerve regeneration by enhancement of the brain‑derived neurotrophic factor and ciliary neurotrophic factor expression and activation of the ERK1/2/MAPK signaling pathway. Mol Med Rep 2017; 16:7534-7540. [PMID: 28944860 PMCID: PMC5865887 DOI: 10.3892/mmr.2017.7534] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/02/2017] [Indexed: 12/12/2022] Open
Abstract
A previous study has demonstrated a progression in the nerve regeneration by polyaniline/cellulose (PANI/RC), although the underlying mechanism was not elucidated. In the present study, regenerated nerves were investigated, using histological techniques, functional assays and western blot analysis. The triceps surae muscle weight ratio percentages of the sham, regenerated cellulose (RC) and the PANI/RC groups were 38.88±4.76 and 76.32±7.11%, respectively. The thickness of the myelin sheath for the aforementioned groups were as follows: 1.2±0.27; 0.49±0.21 and 0.93±0.28 µl. Western blot analysis demonstrated that the ciliary neurotrophic factor (CNTF) and brain-derived neurotrophic factor (BDNF) were highly expressed in the regenerated nerve in the presence of polyaniline. Phosphorylated extracellular kinase (p-ERK)1/2 expression in the PANI/RC group was significantly elevated compared with the RC group (1.83-fold) and the sham group (4.92-fold). The expression of the axon sprout-associated proteins, such as Tau, α-tubulin and growth associated protein-43, were increased (1.64, 1.59 and 1.24-fold, respectively) compared with the RC group. The results demonstrated that PANI enhances the expression and secretion of BDNF and CNTF, activates the ERK1/2 signaling pathway and increases the expression levels of the GAP-43, Tau and α-tubulin, suggesting an insight into nerve regeneration and possible clinical interventions in nerve injury.
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Affiliation(s)
- Lin Fan
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Yan Xiong
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Zhen Fu
- Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, The 3rd Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Dingfeng Xu
- College of Chemistry & Molecule Sciences, Wuhan University, Wuhan, Hubei 430081, P.R. China
| | - Lei Wang
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Yong Chen
- Department of Abdominal Laparoscopic Surgery, Qinghai University Affiliated Hospital, Xining, Qinghai 810001, P.R. China
| | - Haoyang Xia
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Na Peng
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Shaojun Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Yanfeng Wang
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
| | - Lina Zhang
- College of Chemistry & Molecule Sciences, Wuhan University, Wuhan, Hubei 430081, P.R. China
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, Hubei 430071, P.R. China
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166
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Brill NA, Tyler DJ. Quantification of human upper extremity nerves and fascicular anatomy. Muscle Nerve 2017; 56:463-471. [PMID: 28006854 PMCID: PMC5712902 DOI: 10.1002/mus.25534] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/04/2016] [Accepted: 12/20/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In this study we provide detailed quantification of upper extremity nerve and fascicular anatomy. The purpose is to provide values and trends in neural features useful for clinical applications and neural interface device design. METHODS Nerve cross-sections were taken from 4 ulnar, 4 median, and 3 radial nerves from 5 arms of 3 human cadavers. Quantified nerve features included cross-sectional area, minor diameter, and major diameter. Fascicular features analyzed included count, perimeter, area, and position. RESULTS Mean fascicular diameters were 0.57 ± 0.39, 0.6 ± 0.3, 0.5 ± 0.26 mm in the upper arm and 0.38 ± 0.18, 0.47 ± 0.18, 0.4 ± 0.27 mm in the forearm of ulnar, median, and radial nerves, respectively. Mean fascicular diameters were inversely proportional to fascicle count. CONCLUSION Detailed quantitative anatomy of upper extremity nerves is a resource for design of neural electrodes, guidance in extraneural procedures, and improved neurosurgical planning. Muscle Nerve 56: 463-471, 2017.
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Affiliation(s)
- Natalie A Brill
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44104, USA
| | - Dustin J Tyler
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44104, USA
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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167
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Turner NJ, Johnson SA, Foster LJR, Badylak SF. Sutureless nerve repair with ECM bioscaffolds and laser-activated chitosan adhesive. J Biomed Mater Res B Appl Biomater 2017; 106:1698-1711. [DOI: 10.1002/jbm.b.33975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/21/2017] [Accepted: 07/29/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Neill J. Turner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Scott A. Johnson
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Leslie J. R. Foster
- Biopolymer Research Group; School of Biotechnology and Bimolecular Sciences, The University of New South Wales; Sydney Australia
- Save Sight Institute, Faculty of Medicine, University of Sydney; Sydney Australia
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania 15260
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168
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Chen MM, Qin J, Chen SJ, Yao LM, Zhang LY, Yin ZQ, Liao H. Quercetin promotes motor and sensory function recovery following sciatic nerve-crush injury in C57BL/6J mice. J Nutr Biochem 2017; 46:57-67. [DOI: 10.1016/j.jnutbio.2017.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/29/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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169
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Mu L, Sobotka S, Chen J, Nyirenda T. Nerve growth factor and basic fibroblast growth factor promote reinnervation by nerve-muscle-endplate grafting. Muscle Nerve 2017. [PMID: 28632904 DOI: 10.1002/mus.25726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION This study was designed to test whether exogenous application of nerve growth factor (NGF) and basic fibroblast growth factor (FGF-2) to muscles reinnervated with nerve-muscle-endplate band grafting (NMEG) could promote specific outcomes. METHODS The right sternomastoid muscle in adult rats was experimentally denervated and immediately reinnervated by implanting an NMEG pedicle from the ipsilateral sternohyoid muscle. A fibrin sealant containing NGF and FGF-2 was focally applied to the implantation site. Maximal tetanic force, muscle weight, regenerated axons, and motor endplates were analyzed 3 months after treatment. RESULTS Mean tetanic force, wet muscle weight, and number of regenerated axons in the treated muscles were 91%, 92%, and 84% of the contralateral controls, respectively. The majority of endplates (86%) in the treated muscles were reinnervated by regenerated axons. DISCUSSION Focal administration of NGF and FGF-2 promotes efficacy of the NMEG technique. Muscle Nerve 57: 449-459, 2018.
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Affiliation(s)
- Liancai Mu
- Department of Biomedical Research, Hackensack University Medical Center, 40 Prospect Avenue, Hackensack, New Jersey, 07601, USA
| | - Stanislaw Sobotka
- Department of Biomedical Research, Hackensack University Medical Center, 40 Prospect Avenue, Hackensack, New Jersey, 07601, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, New York, USA
| | - Jingming Chen
- Department of Biomedical Research, Hackensack University Medical Center, 40 Prospect Avenue, Hackensack, New Jersey, 07601, USA
| | - Themba Nyirenda
- Department of Biomedical Research, Hackensack University Medical Center, 40 Prospect Avenue, Hackensack, New Jersey, 07601, USA
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170
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Yapici AK, Bayram Y, Akgun H, Gumus R, Zor F. The effect of in vivo created vascularized neurotube on peripheric nerve regeneration. Injury 2017; 48:1486-1491. [PMID: 28529011 DOI: 10.1016/j.injury.2017.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Creating vascularized nerve conduits for treatment of nerve gaps have been researched, however, these methods need microsurgical anastomosis thereby complicating the nerve repair process. Thus, the concept of vascularized nerve conduits has not popularized up till now. The aim of this study is to evaluate the effects of vascularized and non-vascularized biological conduits on peripheral nerve regeneration. MATERIAL AND METHODS Following ethical board approval, 15 Sprague-Dawley rats were used in the study. The rats were equally divided into three groups. In group I, a silicon rod was inserted next to the sciatic nerve of the rat and connective tissue generated around this rod was used as a vascularized biological conduit. In group II, a silicon rod was inserted into the dorsum of the rat and connective tissue generated around this rod was used as a non-vascularized biological conduit. In group III, autogenic nerve graft was used to repair the nerve gap. The contralateral sciatic nerve is used as a control in all rats. Macroscopic, electrophysiological and histomorphometric evaluations were performed to determine the nerve regeneration. RESULTS There was no statistically significant difference between groups, in terms of latency. However, the mean amplitude of group I was found to be higher than other groups. The difference between group I and II was statistically significant. Myelinated axonal counts in group I was significantly higher than groups II and III. CONCLUSION Our results showed that vascularized biological conduits provided better nerve regeneration when compared to autografts and non-vascularized biological conduits. Creation and application of vascularized conduits by using the technique described here is easy. Although this method is not an alternative to autogenic nerve grafts, our results are promising and encouraging for further studies.
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Affiliation(s)
- Abdul Kerim Yapici
- Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey.
| | - Yalcin Bayram
- Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey
| | - Hakan Akgun
- Gulhane Military Medical Academy, Dept. of Neurology, Ankara, Turkey
| | - Recep Gumus
- Gulhane Military Medical Academy, Dept. of Histology, Ankara, Turkey
| | - Fatih Zor
- Gulhane Military Medical Academy, Dept. of Plastic Surgery, Ankara, Turkey
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171
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Gnavi S, Fornasari BE, Tonda-Turo C, Laurano R, Zanetti M, Ciardelli G, Geuna S. In vitro evaluation of gelatin and chitosan electrospun fibres as an artificial guide in peripheral nerve repair: a comparative study. J Tissue Eng Regen Med 2017; 12:e679-e694. [PMID: 27860458 DOI: 10.1002/term.2351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 11/07/2022]
Abstract
Random and aligned gelatin (GL) and chitosan (CS) nano-fibres have been prepared by electrospinning tuning the collector rotation speed. The effect of fibre alignment on cell adhesion and proliferation was assessed in vitro by using different Schwann cell (SC) and neuronal models. Moreover, actin cytoskeleton organization, lamellipodia and filipodia formation, and axon outgrowth were evaluated. GL and CS fibres induced similar adhesion and proliferation rates. GL and CS random fibres promoted higher adhesion and proliferation rates induction in comparison to the aligned ones, although GL and CS fibres alignment resulted in SC and axon-oriented growth. Filipodia formation was higher on aligned fibres, suggesting that these substrates can promote higher cell migration in comparison to random ones. 50B11 (neuronal cell line) differentiation was higher on GL fibres, whereas no differences were observed in dorsal root ganglia explants model. These data suggest that both GL and CS fibres can be promising substrates to be used in peripheral nerve reconstruction. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- S Gnavi
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, 10043, Italy.,Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, University of Torino, Orbassano, 10043, Italy
| | - B E Fornasari
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, 10043, Italy.,Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, University of Torino, Orbassano, 10043, Italy
| | - C Tonda-Turo
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Politecnico of Torino, Torino, 10100, Italy
| | - R Laurano
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Politecnico of Torino, Torino, 10100, Italy
| | - M Zanetti
- Nanostructured Interfaces and Surfaces, Department of Chemistry, University of Torino, Torino, 10100, Italy
| | - G Ciardelli
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Politecnico of Torino, Torino, 10100, Italy.,CNR-IPCF UOS, Pisa, 56124, Italy
| | - S Geuna
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, 10043, Italy.,Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, University of Torino, Orbassano, 10043, Italy
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172
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Mu L, Sobotka S, Chen J, Nyirenda T. Reinnervation of denervated muscle by implantation of nerve-muscle-endplate band graft to the native motor zone of the target muscle. Brain Behav 2017; 7:e00668. [PMID: 28638701 PMCID: PMC5474699 DOI: 10.1002/brb3.668] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Motor endplate reinnervation is critical for restoring motor function of the denervated muscle. We developed a novel surgical technique called nerve-muscle-endplate band grafting (NMEG) for muscle reinnervation. METHODS Experimentally denervated sternomastoid muscle in the rat was reinnervated by transferring a NMEG from the ipsilateral sternohyoid muscle to the native motor zone (NMZ) of the target muscle. A NMEG pedicle contained a block of muscle (~ 6 × 6 × 3 mm), a nerve branch with axon terminals, and a motor endplate band with numerous neuromuscular junctions. At 3 months after surgery, maximal tetanic muscle force measurement, muscle mass and myofiber morphology, motoneurons, regenerated axons, and axon-endplate connections of the muscles were analyzed. RESULTS The mean force of the reinnervated muscles was 82% of the contralateral controls. The average weight of the treated muscles was 89% of the controls. The reinnervated muscles exhibited extensive axonal regeneration. Specifically, the mean count of the regenerated axons in the reinnervated muscles reached up to 76.8% of the controls. The majority (80%) of the denervated endplates in the target muscle regained motor innervation. CONCLUSIONS The NMZ of the denervated muscle is an ideal site for NMEG implantation and for the development of new microsurgical and therapeutic strategies to achieve sufficient axonal regeneration, rapid endplate reinnervation, and optimal functional recovery. NMEG-NMZ technique may become a useful tool in the treatment of muscle paralysis caused by peripheral nerve injuries in certain clinical situations.
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Affiliation(s)
- Liancai Mu
- Department of Research Hackensack University Medical Center Hackensack NJ USA
| | - Stanislaw Sobotka
- Department of Research Hackensack University Medical Center Hackensack NJ USA.,Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York NY USA
| | - Jingming Chen
- Department of Research Hackensack University Medical Center Hackensack NJ USA
| | - Themba Nyirenda
- Department of Research Hackensack University Medical Center Hackensack NJ USA
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173
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Du J, Liu J, Yao S, Mao H, Peng J, Sun X, Cao Z, Yang Y, Xiao B, Wang Y, Tang P, Wang X. Prompt peripheral nerve regeneration induced by a hierarchically aligned fibrin nanofiber hydrogel. Acta Biomater 2017; 55:296-309. [PMID: 28412554 DOI: 10.1016/j.actbio.2017.04.010] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/01/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
Abstract
Fibrin plays a crucial role in peripheral nerve regeneration, which could occur spontaneously in the format of longitudinally oriented fibrin cables during the initial stage of nerve regeneration. This fibrin cable can direct migration and proliferation of Schwann cells and axonal regrowth, which is very important to nerve regeneration. In the present study, we prepared a three-dimensional hierarchically aligned fibrin nanofiber hydrogel (AFG) through electrospinning and molecular self-assembly to resemble the architecture and biological function of the native fibrin cable. The AFG displayed a hierarchically aligned topography as well as low elasticity (∼1.5kPa) that were similar to nerve extracellular matrix (ECM) and the native fibrin cable. Rapid, directional cell adhesion and migration of Schwann cells (SCs) and dorsal root ganglions were observed in vitro. The AFG was then used as a potential intraluminal substrate in a bioengineered chitosan tube to bridge a 10-mm-long sciatic nerve gap in rats. We found that the AFG served as a beneficial microenvironment to support SCs cable formation and axonal regrowth within 2weeks. Further histological and morphological analyses as well as electrophysiological and functional examinations were performed after AFG implantation for up to 12weeks. The results from morphological analysis and electrophysiological examination indicated that regenerative outcomes achieved by our developed graft were close to those by an autologous nerve graft, but superior to those by hollow chitosan tubes (hCST) and random fibrin nanofiber hydrogel (RFG). Our results demonstrate that the AFG creates an instructive microenvironment by mimicking the native fibrin cable as well as the oriented and soft features of nerve ECM to accelerate axonal regrowth, thus showing great promising potential for applications in neural regeneration. STATEMENT OF SIGNIFICANCE In peripheral nervous system defect repair, a wide variety of strategies have been proposed for preparing functionalized nerve guidance conduits (NGC) with more complex configurations to obtain optimal repair effects. Longitudinally oriented fibrin cables were reported to form spontaneously during the initial stages of peripheral nerve regeneration in an empty NGC, which can direct the migration and proliferation of Schwann cells and promote axonal regrowth. Therefore, based on the biomimetic idea, we prepared a three-dimensional hierarchically aligned fibrin nanofiber hydrogel (AFG) through electrospinning and molecular self-assembly, resembling the architecture and biological function of the native fibrin cable and serving as an intraluminal filling to accelerate axon regeneration. We found that the AFG was a beneficial microenvironment to support SCs cable formation and accelerate axonal regrowth with improved motor functional recovery.
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174
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Zheng CS, Zhang X, Chen YY, Zhang F, Duan XH, Chen MW, Lu LJ, Shen J. Assessment of the synergic effect of immunomodulation on nerve repair using multiparametric magnetic resonance imaging. Muscle Nerve 2017; 57:E38-E45. [PMID: 28445921 DOI: 10.1002/mus.25674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/05/2017] [Accepted: 04/23/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The immune system plays a pivotal role in nerve injury. The aim of this study was to determine the role of multiparametric magnetic resonance imaging (MRI) in evaluation of the synergic effect of immunomodulation on nerve regeneration in neurotmesis. METHODS Rats with sciatic nerve neurotmesis and surgical repair underwent serial multiparametric MR examinations over an 8-week period after subepineurial microinjection of lipopolysaccharide (LPS) and subsequent subcutaneous injection of FK506 or subepineurial microinjection of LPS or phosphate-buffered saline (PBS) alone. RESULTS Nerves treated with immunomodulation showed more prominent regeneration than those treated with LPS or PBS alone and more rapid restoration toward normal T2, fractional anisotropy (FA), and radial diffusivity (RD) values than nerves injected with LPS or PBS. DISCUSSION Nerves treated with immunomodulation exert synergic beneficial effects on nerve regeneration that can be predicted by T2 measurements and FA and RD values. Muscle Nerve 57: E38-E45, 2018.
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Affiliation(s)
- Chu-Shan Zheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Xiang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Yue-Yao Chen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Fang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Xiao-Hui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Mei-Wei Chen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Lie-Jing Lu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, Guangdong, China
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175
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Rbia N, Shin AY. The Role of Nerve Graft Substitutes in Motor and Mixed Motor/Sensory Peripheral Nerve Injuries. J Hand Surg Am 2017; 42:367-377. [PMID: 28473159 DOI: 10.1016/j.jhsa.2017.02.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
Alternatives to nerve autograft have been invented and approved for clinical use. The reported outcomes of these alternatives in mixed motor nerve repair in humans are scarce and marked by wide variabilities. The purpose of our Current Concepts review is to provide an evidence-based overview of the effectiveness of nerve conduits and allografts in motor and mixed sensory/motor nerve reconstruction. Nerve graft substitutes have good outcomes in mixed/motor nerves in gaps less than 6 mm and internal diameters between 3 and 7 mm. There is insufficient evidence for their use in larger-gap and -diameter nerves; the evidence remains that major segmental motor or mixed nerve injury is optimally treated with a cabled nerve autograft.
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Affiliation(s)
- Nadia Rbia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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176
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Tonazzini I, Moffa M, Pisignano D, Cecchini M. Neuregulin 1 functionalization of organic fibers for Schwann cell guidance. NANOTECHNOLOGY 2017; 28:155303. [PMID: 28303795 DOI: 10.1088/1361-6528/aa6316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The repair of peripheral nerve lesions is a clinical problem where the functional recovery is often far from being satisfactory, although peripheral nerves generally retain good potential for regeneration. Here, we develop a novel scaffold approach based on bioactive fibers of poly(ε-caprolactone) where nanotopographical guidance and neuregulin 1 (NRG1) cues are combined. We interface them with rat primary Schwann cells (SCs), the peripheral glial cells that drive initial regeneration of injured nerves, and found that the combination of NRG1 with parallel nano-fibrous topographies is effective in improving SC growth up to 72 h, alignment to fiber topography, and bipolar differentiation, opening original perspectives for nerve repair applications.
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Affiliation(s)
- Ilaria Tonazzini
- NEST, Istituto Nanoscienze-CNR and Scuola Normale Superiore, Piazza San Silvestro 12, Pisa I-56127, Italy. Fondazione Umberto Veronesi, Piazza Velasca 5, Milan I-20122, Italy
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177
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Gesslbauer B, Furtmüller GJ, Schuhfried O, Roche AD, Sporer M, Aszmann OC. Nerve grafts bridging the thenar branch of the median nerve to the ulnar nerve to enhance nerve recovery: a report of three cases. J Hand Surg Eur Vol 2017; 42:281-285. [PMID: 27803377 DOI: 10.1177/1753193416675069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We report a nerve graft procedure bridging the thenar branch of the median nerve to the ulnar nerve in three patients with ulnar nerve transection and defect at the mid-forearm. Ulnar nerve function was evaluated with electroneurography and quantitative sensory-motor testing before and after surgery, and at a 6-year follow-up. After surgery all patients showed electroneurographic evidence of median nerve innervation of the intrinsic muscles normally innervated by the ulnar nerve. The average strength was Grade 4 in the intrinsic muscles originally supplied by the ulnar nerve at the final follow-up. Our results indicate that the thenar branch of the median nerve may support ulnar nerve regeneration and so help prevent intrinsic muscles from irreversible atrophy, but our report is preliminary. This procedure should be validated by future clinical data, especially those with complete ulnar nerve transection at or above the elbow. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B Gesslbauer
- 1 Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - G J Furtmüller
- 3 Vascularized Composite Allotransplantation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Schuhfried
- 4 Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
| | - A D Roche
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - M Sporer
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - O C Aszmann
- 1 Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
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178
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Teymur H, Tiftikcioglu YO, Cavusoglu T, Tiftikcioglu BI, Erbas O, Yigitturk G, Uyanikgil Y. Effect of platelet-rich plasma on reconstruction with nerve autografts. Kaohsiung J Med Sci 2017; 33:69-77. [DOI: 10.1016/j.kjms.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/04/2016] [Accepted: 11/14/2016] [Indexed: 01/09/2023] Open
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179
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Sanen K, Martens W, Georgiou M, Ameloot M, Lambrichts I, Phillips J. Engineered neural tissue with Schwann cell differentiated human dental pulp stem cells: potential for peripheral nerve repair? J Tissue Eng Regen Med 2017; 11:3362-3372. [PMID: 28052540 DOI: 10.1002/term.2249] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 06/14/2016] [Accepted: 07/03/2016] [Indexed: 12/18/2022]
Abstract
Despite the spontaneous regenerative capacity of the peripheral nervous system, large gap peripheral nerve injuries (PNIs) require bridging strategies. The limitations and suboptimal results obtained with autografts or hollow nerve conduits in the clinic urge the need for alternative treatments. Recently, we have described promising neuroregenerative capacities of Schwann cells derived from differentiated human dental pulp stem cells (d-hDPSCs) in vitro. Here, we extended the in vitro assays to show the pro-angiogenic effects of d-hDPSCs, such as enhanced endothelial cell proliferation, migration and differentiation. In addition, for the first time we evaluated the performance of d-hDPSCs in an in vivo rat model of PNI. Eight weeks after transplantation of NeuraWrap™ conduits filled with engineered neural tissue (EngNT) containing aligned d-hDPSCs in 15-mm rat sciatic nerve defects, immunohistochemistry and ultrastructural analysis revealed ingrowing neurites, myelinated nerve fibres and blood vessels along the construct. Although further research is required to optimize the delivery of this EngNT, our findings suggest that d-hDPSCs are able to exert a positive effect in the regeneration of nerve tissue in vivo. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kathleen Sanen
- Biophysics Group, Biomedical Research Institute, Hasselt University, Agoralaan Building C, 3590, Diepenbeek, Belgium
| | - Wendy Martens
- Morphology Group, Biomedical Research Institute, Hasselt University, Agoralaan Building C, 3590, Diepenbeek, Belgium
| | - Melanie Georgiou
- Advanced Centre for Biochemical Engineering, University College London, Bernard Katz Building, Gordon Street, London, WC1H 0AH, UK
| | - Marcel Ameloot
- Biophysics Group, Biomedical Research Institute, Hasselt University, Agoralaan Building C, 3590, Diepenbeek, Belgium
| | - Ivo Lambrichts
- Morphology Group, Biomedical Research Institute, Hasselt University, Agoralaan Building C, 3590, Diepenbeek, Belgium
| | - James Phillips
- Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London, WC1X 8LD, UK
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180
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Panagopoulos GN, Megaloikonomos PD, Mavrogenis AF. The Present and Future for Peripheral Nerve Regeneration. Orthopedics 2017; 40:e141-e156. [PMID: 27783836 DOI: 10.3928/01477447-20161019-01] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023]
Abstract
Peripheral nerve injury can have a potentially devastating impact on a patient's quality of life, resulting in severe disability with substantial social and personal cost. Refined microsurgical techniques, advances in peripheral nerve topography, and a better understanding of the pathophysiology and molecular basis of nerve injury have all led to a decisive leap forward in the field of translational neurophysiology. Nerve repair, nerve grafting, and nerve transfers have improved significantly with consistently better functional outcomes. Direct nerve repair with epineural microsutures is still the surgical treatment of choice when a tension-free coaptation in a well-vascularized bed can be achieved. In the presence of a significant gap (>2-3 cm) between the proximal and distal nerve stumps, primary end-to-end nerve repair often is not possible; in these cases, nerve grafting is the treatment of choice. Indications for nerve transfer include brachial plexus injuries, especially avulsion type, with long distance from target motor end plates, delayed presentation, segmental loss of nerve function, and broad zone of injury with dense scarring. Current experimental research in peripheral nerve regeneration aims to accelerate the process of regeneration using pharmacologic agents, bioengineering of sophisticated nerve conduits, pluripotent stem cells, and gene therapy. Several small molecules, peptides, hormones, neurotoxins, and growth factors have been studied to improve and accelerate nerve repair and regeneration by reducing neuronal death and promoting axonal outgrowth. Targeting specific steps in molecular pathways also allows for purposeful pharmacologic intervention, potentially leading to a better functional recovery after nerve injury. This article summarizes the principles of nerve repair and the current concepts of peripheral nerve regeneration research, as well as future perspectives. [Orthopedics. 2017; 40(1):e141-e156.].
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181
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Huang G, Sun Z, Wu J, Shui S, Han X, Guo D, Li T. Calreticulin Promotes Proliferation and Migration But Inhibits Apoptosis in Schwann Cells. Med Sci Monit 2016; 22:4516-4522. [PMID: 27876711 PMCID: PMC5132423 DOI: 10.12659/msm.900956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Previous studies indicated that calreticulin (CRT) regulated various biological processes. This study was aimed to investigate the function of CRT in Schwann cells (SCs). Material/Methods SCs were separated from sciatic nerves of mice and were transfected with pcDNA3.1-CRT (pc-CRT), small interfering RNA targets CRT (siCRT), or their corresponding negative controls. The expression of CRT was determined by quantitative reverse transcription PCR (qRT-PCR) and Western blot analysis. Then, cell proliferation, migration, and apoptosis were measured by 3-(4, 5-dimethylhiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay, modified 2-chamber migration assay, and flow cytometry, respectively. Finally, the phosphorylation levels of key kinases in the phosphatidylinositol-3-kinase (PI3K)/AKT and the extracellular signal-regulated kinase/ribosomal S6 kinase 2 (ERK/S6) pathways were detected by Western blot analysis. Results Overexpression of CRT remarkably increased viability (P<0.05, P<0.01 or P<0.001) and migration (P<0.001), but inhibited apoptosis (P<0.05). The CRT-knockdown showed the inverse impacts on viability (P<0.05 or P<0.001), migration (P<0.001), and apoptosis (P<0.001). Additionally, the phosphorylation levels of AKT (Thr308 and Ser473), ERK, and S6 were all up-regulated in CRT-overexpressed cells (P<0.001), and were down-regulated in CRT-knockdown cells (P<0.05, P<0.01 or P<0.001). Conclusions Overexpression of CRT in SCs promoted cell proliferation and migration but suppressed cell apoptosis. The PI3K/AKT and ERK/S6 pathways might be involved in the functional effects of CRT on SCs.
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Affiliation(s)
- Gui Huang
- Department of Pathology, Huaihe Hospital, Henan University, Kaifeng, Henan, China (mainland)
| | - Zhulei Sun
- Department of Pathology, Huaihe Hospital, Henan University, Kaifeng, Henan, China (mainland)
| | - Jiang Wu
- Department of Pathology, Huaihe Hospital, Henan University, Kaifeng, Henan, China (mainland)
| | - Shaofeng Shui
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Dong Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Tengfei Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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182
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Ultrasonographic and Surgical Findings of Acute Radial Neuropathy Following Blunt Trauma. Am J Phys Med Rehabil 2016; 95:e177-e182. [PMID: 27763908 DOI: 10.1097/phm.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ultrasonographic study is useful for decision making of treatment for focal neuropathy with unusual electrodiagnostic findings. We present a patient with severe acute radial neuropathy with sensory sparing around the distal arm secondary to twisting of the radial nerve following blunt trauma. A 24-year-old man with a 2-week history of left wrist drop and severe pain around the left elbow presented after hitting the left distal arm on the doorknob. The left wrist and finger extensions were grade 0, but elbow extension could not be tested because of severe pain during this action. The left superficial radial sensory territory was intact. Electrodiagnostic findings suggested severe left radial neuropathy around the distal arm with sensory sparing. Ultrasonographic study demonstrated 2 stenotic lesions around the distal arm and absence of the left superficial radial sensory nerve. Surgical exploration revealed 2 stenotic lesions with twisting of the nerve, concordant with ultrasonographic study. End-to-end anastomosis was performed in the proximal lesion. Sixteen months later, wrist and finger extension was grade 3, and reinnervation signs in the radial-innervated muscles except extensor indicis muscle were observed. The complementary relationship between electrophysiologic and ultrasonographic examinations is very important for precise lesion location and decision making for treatment of peripheral nerve injury.
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183
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Natural Occurring Silks and Their Analogues as Materials for Nerve Conduits. Int J Mol Sci 2016; 17:ijms17101754. [PMID: 27775616 PMCID: PMC5085779 DOI: 10.3390/ijms17101754] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/17/2016] [Accepted: 09/28/2016] [Indexed: 01/07/2023] Open
Abstract
Spider silk and its synthetic derivatives have a light weight in combination with good strength and elasticity. Their high cytocompatibility and low immunogenicity make them well suited for biomaterial products such as nerve conduits. Silk proteins slowly degrade enzymatically in vivo, thus allowing for an initial therapeutic effect such as in nerve scaffolding to facilitate endogenous repair processes, and then are removed. Silks are biopolymers naturally produced by many species of arthropods including spiders, caterpillars and mites. The silk fibers are secreted by the labial gland of the larvae of some orders of Holometabola (insects with pupa) or the spinnerets of spiders. The majority of studies using silks for biomedical applications use materials from silkworms or spiders, mostly of the genus Nephila clavipes. Silk is one of the most promising biomaterials with effects not only in nerve regeneration, but in a number of regenerative applications. The development of silks for human biomedical applications is of high scientific and clinical interest. Biomaterials in use for biomedical applications have to meet a number of requirements such as biocompatibility and elicitation of no more than a minor inflammatory response, biodegradability in a reasonable time and specific structural properties. Here we present the current status in the field of silk-based conduit development for nerve repair and discuss current advances with regard to potential clinical transfer of an implantable nerve conduit for enhancement of nerve regeneration.
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184
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Schuh CM, Hausner T, Redl HR. A therapeutic shock propels Schwann cells to proliferate in peripheral nerve injury. Brain Circ 2016; 2:138-140. [PMID: 30276290 PMCID: PMC6126275 DOI: 10.4103/2394-8108.192520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 01/09/2023] Open
Abstract
Damage to the peripheral nervous system (PNS) is a prevalent issue and represents a great burden to patients. Although the PNS has a good capacity for regeneration, regeneration over long distances poses several difficulties. Several recent studies have addressed Schwann cells’ limited proliferative capacity; however, a solution has yet to be found. Here, we examine the effects of extracorporeal shock wave therapy (ESWT) on Schwann cell isolation, culture, and proliferation rate. The study conducted demonstrated that Schwann cells treated with ESWT had significantly improved isolation, culture, and proliferative capacities. These findings represent a solution to a significant problem that hospitals and health-care providers face every year: how to treat long distance damage to the PNS with the limited proliferative capabilities of Schwann cells. Although these findings are promising, further studies must be conducted to address the molecular mechanisms by which ESWT alters Schwann cells and the potential implications for peripheral nerve damage and other prevalent illnesses. This study is a review article. Referred literature in this paper has been listed in the references part. The datasets supporting the conclusions of this article are available online by searching the PubMed. Some original points in this article come from the laboratory practice in our research centers and the authors’ experiences.
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Affiliation(s)
- Christina Map Schuh
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, A-1200 Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200 Vienna, Austria
| | - Thomas Hausner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, A-1200 Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200 Vienna, Austria
| | - Heinz R Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, A-1200 Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200 Vienna, Austria
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185
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Rosén A, Tardast A, Shi TJ. How Far Have We Come in the Field of Nerve Regeneration After Trigeminal Nerve Injury? ACTA ACUST UNITED AC 2016; 3:309-313. [PMID: 27891301 PMCID: PMC5104765 DOI: 10.1007/s40496-016-0115-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients suffering from nerve injury with sensory disturbances or orofacial pain have greatly reduced quality of life, and it is a big cost for the society. Abnormal sensations caused by trigeminal nerve injury often become chronic, severely debilitating, and extremely difficult to treat. In general, non-invasive treatment such as drug treatment has been insufficient, and there are currently few available effective treatments. Surgical interventions such as end-to-end connection or nerve grafting have disadvantages such as donor site morbidity or formation of neuroma. There is need for optimizing the technique for nerve repair, especially for the trigeminal nerve system, which has so far not yet been well explored. Recently, tissue engineering using biodegradable synthetic material and cell-based therapies represents a promising approach to nerve repair and it has been reported that mesenchymal stem cell (MSC) has an anti-inflammatory effect and seems to play an important role in nerve healing and regeneration.
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Affiliation(s)
- Annika Rosén
- Division of Oral and Maxillofacial Surgery, University of Bergen, Årstadveien 19, 5020 Bergen, Norway ; Department of Clinical Dentistry, University of Bergen, Årstadveien 19, 5020 Bergen, Norway
| | - Arezo Tardast
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, 501 82 Borås, Sweden
| | - Tie-Jun Shi
- Department of Clinical Dentistry, University of Bergen, Årstadveien 19, 5020 Bergen, Norway ; Department of Biomedicine, University of Bergen, Bergen, Norway
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186
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Advances in peripheral nervous system regenerative therapeutic strategies: A biomaterials approach. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 65:425-32. [DOI: 10.1016/j.msec.2016.04.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/20/2016] [Accepted: 04/14/2016] [Indexed: 01/02/2023]
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187
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Lee DJ, Fontaine A, Meng X, Park D. Biomimetic Nerve Guidance Conduit Containing Intraluminal Microchannels with Aligned Nanofibers Markedly Facilitates in Nerve Regeneration. ACS Biomater Sci Eng 2016; 2:1403-1410. [DOI: 10.1021/acsbiomaterials.6b00344] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David J. Lee
- Department
of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 East 19th Avenue, Aurora, Colorado 80045, United States
| | - Arjun Fontaine
- Department
of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 East 19th Avenue, Aurora, Colorado 80045, United States
| | - Xianzhong Meng
- Department
of Surgery, University of Colorado Denver Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, Colorado 80045, United States
| | - Daewon Park
- Department
of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 East 19th Avenue, Aurora, Colorado 80045, United States
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188
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Technical Assessment of Connector-Assisted Nerve Repair. J Hand Surg Am 2016; 41:760-6. [PMID: 27189149 DOI: 10.1016/j.jhsa.2016.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/23/2016] [Accepted: 04/22/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Clinical outcomes of nerve repair have not substantially improved over the last several decades. Although clearly a multifactorial problem, basic principles including proper fascicular alignment are not always realized. The use of short conduits as connectors may enhance nerve alignment by entubulating and directing the approximation of nerve ends. METHODS Ten hand surgeons (5 experienced and 5 inexperienced) performed a series of in vitro human cadaver nerve repairs. Three small-diameter (2 mm), 3 medium-diameter (3-4 mm), and 3 large-diameter (5-6 mm) nerves were repaired (under 10× magnification) utilizing each of 3 techniques: suture-only, connector-only (sutures placed through the ends of the connector), and connector-assisted (alignment sutures at the nerve interface plus connector). Three judges (blinded to who performed the repairs) assessed each repair for fascicular alignment based on predetermined qualitative scales. RESULTS Across all surgeons, 23 of 30 connector-assisted repairs were judged good or excellent versus 18 of 30 of the suture-only and 13 of 30 of the connector-only repairs. Experienced surgeons in general did better repairs and in particular were more likely to obtain superior alignment for conduit-only repairs (73.3% vs 13.3% good or excellent) and suture-only repairs (73.3% vs 46.7% good or excellent) and were not statistically different for connector-assisted repairs (86.7% vs 66.7% good or excellent) compared with inexperienced surgeons. CONCLUSIONS In a cadaver nerve model, there was no significant difference in the technical alignment of conduit-assisted repairs between experienced and inexperienced surgeons whereas inexperienced surgeons were more likely to achieve inadequate alignment with suture-only or conduit-only repairs. CLINICAL RELEVANCE Connector-assisted repairs combining suture-approximation and entubulation may improve the technical alignment of nerve repairs performed, especially by less-experienced surgeons.
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189
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Schuh CM, Hercher D, Stainer M, Hopf R, Teuschl AH, Schmidhammer R, Redl H. Extracorporeal shockwave treatment: A novel tool to improve Schwann cell isolation and culture. Cytotherapy 2016; 18:760-70. [DOI: 10.1016/j.jcyt.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/05/2016] [Indexed: 02/07/2023]
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190
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Effects of hyaluronic acid and tacrolimus on the prevention of perineural scar formation and on nerve regeneration after sciatic nerve repair in a rabbit model. Eur J Trauma Emerg Surg 2016; 43:497-504. [PMID: 27194249 DOI: 10.1007/s00068-016-0683-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/02/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Scar formation after injured peripheral nerve repair is a significant clinical problem because it prevents nerve regeneration. The aim of this study was to investigate and compare the effects of hyaluronic acid (HA) and tacrolimus (FK506) on peripheral nerve regeneration in rabbits after the drugs were topically applied at the site of nerve repair. METHODS Thirty adult male European rabbits (Oryctolagus cuniculus), ranging in weight from 2.5 to 3 kg, were randomly assigned to three groups: the HA and FK506 groups comprised the experimental groups, while the saline group served as the control. At week 12, macroscopic and microscopic evaluations were performed and analyzed. RESULTS In general, the macroscopic evaluations (skin and muscle fascia closure and nerve adherence), microscopic evaluations (cellular components, scar tissue formation index, and histomorphological organization), and measurements of nerve diameter and gastrocnemius muscle wet weight demonstrated the positive effects of topical application of these pharmacological agents (HA and FK506); HA and FK506 prevented scar formation and enhanced nerve regeneration. No significant differences in the parameters described above were observed between the HA and FK506 groups (P > 0.05). However, significant differences were observed between both the HA and FK506 groups and the saline group (P < 0.05). CONCLUSION Based on our findings, topical application of HA and FK506 exhibits equally positive effects, preventing perineural scar formation and enhancing nerve regeneration after peripheral nerve repair.
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191
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Antman-Passig M, Shefi O. Remote Magnetic Orientation of 3D Collagen Hydrogels for Directed Neuronal Regeneration. NANO LETTERS 2016; 16:2567-2573. [PMID: 26943183 DOI: 10.1021/acs.nanolett.6b00131] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hydrogel matrices are valuable platforms for neuronal tissue engineering. Orienting gel fibers to achieve a directed scaffold is important for effective functional neuronal regeneration. However, current methods are limited and require treatment of gels prior to implantation, ex-vivo, without taking into consideration the pathology in the injured site. We have developed a method to control gel orientation dynamically and remotely in situ. We have mixed into collagen hydrogels magnetic nanoparticles then applied an external magnetic field. During the gelation period the magnetic particles aggregated into magnetic particle strings, leading to the alignment of the collagen fibers. We have shown that neurons within the 3D magnetically induced gels exhibited normal electrical activity and viability. Importantly, neurons formed elongated cooriented morphology, relying on the particle strings and fibers as supportive cues for growth. The ability to inject the mixed gel directly into the injured site as a solution then to control scaffold orientation remotely opens future possibilities for therapeutic engineered scaffolds.
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Affiliation(s)
- Merav Antman-Passig
- Faculty of Engineering and Bar Ilan Institute of Nanotechnologies and Advanced Materials, Bar Ilan University , Ramat Gan 5290002, Israel
| | - Orit Shefi
- Faculty of Engineering and Bar Ilan Institute of Nanotechnologies and Advanced Materials, Bar Ilan University , Ramat Gan 5290002, Israel
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192
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Manoli T, Schiefer JL, Schulz L, Fuchsberger T, Schaller HE. Influence of immobilization and sensory re-education on the sensory recovery after reconstruction of digital nerves with direct suture or muscle-in-vein conduits. Neural Regen Res 2016; 11:338-44. [PMID: 27073390 PMCID: PMC4811001 DOI: 10.4103/1673-5374.169638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The influence of duration of immobilization and postoperative sensory re-education on the final outcome after reconstruction of digital nerves with direct suture or muscle-in-vein conduits was investigated. The final sensory outcome of 35 patients with 41 digital nerve injuries, who either underwent a direct suture (DS) or a nerve reconstruction with muscle-in-vein conduits (MVC), was assessed the earliest 12 months postoperatively using static and moving two-point discrimination as well as Semmes-Weinstein monofilaments. There was no significant difference in sensory recovery in cases with an immobilization of 3-7 days versus 10 days in the DS or MVC group. Moreover, no statistically significant difference in sensory recovery was found in cases receiving postoperative sensory re-education versus those not receiving in the DS or MVC group. An early mobilization does not seem to have a negative impact on the final outcome after digital nerve reconstruction. The effect of sensory re-education after digital nerve reconstruction should be reconsidered.
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Affiliation(s)
- Theodora Manoli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Unit, BG Trauma Center, University of Tuebingen, Tuebingen, Germany
| | - Jennifer Lynn Schiefer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Unit, BG Trauma Center, University of Tuebingen, Tuebingen, Germany
| | - Lukas Schulz
- Department of Hand, Plastic and Reconstructive Surgery, Burn Unit, BG Trauma Center, University of Tuebingen, Tuebingen, Germany
| | - Thomas Fuchsberger
- Department of Hand, Plastic and Reconstructive Surgery, Burn Unit, BG Trauma Center, University of Tuebingen, Tuebingen, Germany
| | - Hans-Eberhard Schaller
- Department of Hand, Plastic and Reconstructive Surgery, Burn Unit, BG Trauma Center, University of Tuebingen, Tuebingen, Germany
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193
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Study of synergistic role of allogenic skin-derived precursor differentiated Schwann cells and heregulin-1β in nerve regeneration with an acellular nerve allograft. Neurochem Int 2016; 97:146-53. [PMID: 27063890 DOI: 10.1016/j.neuint.2016.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 12/25/2022]
Abstract
Development of tissue structure and three-dimensional microenvironment is crucial for regeneration of axons in the peripheral nerve repair. In this study we aimed to evaluate the efficacy of nerve regeneration by using an acellular nerve allograft (ANA) injected with allogenic skin-derived precursor differentiated Schwann cells (SKP-SCs) and heregulin-1β. Skin-derived precursor cells (SKPs) were generated from dermis of newborn (postnatal day 2) Wistar rats. In a rat model, nerve regeneration was determined across a 15 mm lesion in the sciatic nerve by using an ANA injected with allogenic SKP-SCs and heregulin-1β. The electrophysiological analysis, histological examination and electron microscopy were involved in this study. Cultured SKPs expressed nestin and fibronectin, and differentiated into cells with phenotype of SCs that presented characteristic markers of p75NGFR and S100-β. Implantation of SKP-SCs into the rat models by using ANA and allogenic skin-derived precursor differentiated Schwann cells (SKP-SCs) increases sciatic nerve functional index (SFI), peak amplitudes, nerve conduction velocities, number of myelinated fibers within the graft, while reduces incubation period, sciatic nerve injury-induced weight and contractions loss. Using ANA injected with SKP-SCs combined with heregulin-1β greatly promote peripheral nerve repair in a rat model. Our results suggest that SKP-SCs transplantation with heregulin-1β represents a powerful therapeutic approach, and facilitates the efficacy of acellular nerve allograft in peripheral nerve injury, though the detailed mechanism remains to be elucidated.
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194
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Sánchez-Burgos R, Otero TG, Lassaletta L, Arias Gallo J, Cuellar IN, García MB. Facial nerve reconstruction following radical parotidectomy and subtotal petrosectomy for advanced malignant parotid neoplasms. Ann Maxillofac Surg 2016; 5:203-7. [PMID: 26981471 PMCID: PMC4772561 DOI: 10.4103/2231-0746.175747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: To describe the oncological management and functional outcome of patients with advanced parotid malignant tumors undergoing facial nerve reconstruction after radical parotidectomy and subtotal petrosectomy. Materials and Methods: A combined approach was used to treat advanced stage parotid malignancies with intrapetrous involvement of the facial nerve main trunk or abutment on the stylomastoid foramen. Patients underwent facial nerve rehabilitation with cable graft reconstruction or with static techniques. Results: Six patients were included. All patients had Stage IV disease and underwent surgical treatment using a combined approach. Three patients underwent facial-nerve cable graft technique and three patients underwent static techniques to rehabilitate facial nerve function. Five patients received adjuvant treatment with radiotherapy and/or chemotherapy. The mean follow-up was 27.5 months, with a minimum of 7 months and a maximum of 8 years. Four patients remain disease-free, with an overall survival rate of 66%. Among the patients undergoing dynamic reconstruction, first signs of recovery were established at 6 months of follow-up. All patients achieved a House-Brackmann score of III-IV within the first two postoperative years. Conclusions: When possible, facial nerve grafting is the preferred method of facial nerve rehabilitation in an advanced stage parotid tumors. A multidisciplinary approach allows better functional and oncological outcomes.
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Affiliation(s)
- Rocío Sánchez-Burgos
- Department of Oral and Maxillofacial Surgery, University Hospital of the Canary Islands, Tenerife, Spain
| | - Teresa Gonzalez Otero
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - Javier Arias Gallo
- Department of Oral and Maxillofacial Surgery, La Moraleja Hospital, Madrid, Spain
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195
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Krisa L, Murray M. The implications of injury in the developing nervous system on upper extremity function. J Hand Ther 2016; 28:101-4; quiz 105. [PMID: 25835256 DOI: 10.1016/j.jht.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Literature review. PURPOSE The corticospinal system (CS) and peripheral nervous system (PNS) are common sites of damage during the early stages of life. The prenatal or immediately prenatal period is the most common time for damage to occur. Here we briefly review the basic features of the development of the CS and the PNS and the clinical consequences of injury to or improper development of these systems on upper extremity (UE) function. RESULTS The proper development of both the CS and PNS is necessary to achieve adequate function of the (UE). Injury or improper development of these systems can lead to upper extremity dysfunction and limit participation in activities of daily living. CONCLUSIONS Both the PNS and CS play major roles in the proper functioning of the UE. A better understanding of their roles and common developmental disorders is needed to move rehabilitation of motor impairments forward.
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Affiliation(s)
- Laura Krisa
- Jefferson University School of Health Professions, Department of Occupational Therapy, Philadelphia, PA, USA; Jefferson University School of Health Professions, Department of Physical Therapy, Philadelphia, PA, USA; Drexel University College of Medicine, Department of Neurobiology and Anatomy, Philadelphia, PA, USA.
| | - Marion Murray
- Jefferson University School of Health Professions, Department of Occupational Therapy, Philadelphia, PA, USA; Jefferson University School of Health Professions, Department of Physical Therapy, Philadelphia, PA, USA; Drexel University College of Medicine, Department of Neurobiology and Anatomy, Philadelphia, PA, USA
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196
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197
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Li HF, Wang YR, Huo HP, Wang YX, Tang J. Neuroprotective effects of ultrasound-guided nerve growth factor injections after sciatic nerve injury. Neural Regen Res 2016; 10:1846-55. [PMID: 26807123 PMCID: PMC4705800 DOI: 10.4103/1673-5374.170315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Nerve growth factor (NGF) plays an important role in promoting neuroregeneration after peripheral nerve injury. However, its effects are limited by its short half-life; it is therefore important to identify an effective mode of administration. High-frequency ultrasound (HFU) is increasingly used in the clinic for high-resolution visualization of tissues, and has been proposed as a method for identifying and evaluating peripheral nerve damage after injury. In addition, HFU is widely used for guiding needle placement when administering drugs to a specific site. We hypothesized that HFU guiding would optimize the neuroprotective effects of NGF on sciatic nerve injury in the rabbit. We performed behavioral, ultrasound, electrophysiological, histological, and immunohistochemical evaluation of HFU-guided NGF injections administered immediately after injury, or 14 days later, and compared this mode of administration with intramuscular NGF injections. Across all assessments, HFU-guided NGF injections gave consistently better outcomes than intramuscular NGF injections administered immediately or 14 days after injury, with immediate treatment also yielding better structural and functional results than when the treatment was delayed by 14 days. Our findings indicate that NGF should be administered as early as possible after peripheral nerve injury, and highlight the striking neuroprotective effects of HFU-guided NGF injections on peripheral nerve injury compared with intramuscular administration.
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Affiliation(s)
- Hong-Fei Li
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yi-Ru Wang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hui-Ping Huo
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yue-Xiang Wang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
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198
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Reichenberger MA, Mueller W, Hartmann J, Diehm Y, Lass U, Koellensperger E, Leimer U, Germann G, Fischer S. ADSCs in a fibrin matrix enhance nerve regeneration after epineural suturing in a rat model. Microsurgery 2015; 36:491-500. [DOI: 10.1002/micr.30018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/14/2015] [Accepted: 12/08/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Matthias A. Reichenberger
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Wolf Mueller
- University Hospital Leipzig, Department of Neuropathology; University of Leipzig; Leipzig Germany
| | - Jennifer Hartmann
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Yannick Diehm
- BG Trauma Centre Ludwigshafen; Clinic for Hand, Plastic and Reconstructive Surgery, Burn Centre, Hand and Plastic Surgery of the University of Heidelberg; Heidelberg Germany
| | - Ulrike Lass
- Clinical Cooperation Unit Neuropathology; German Cancer Research Center; Heidelberg Germany
| | - Eva Koellensperger
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Uwe Leimer
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Günter Germann
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Sebastian Fischer
- BG Trauma Centre Ludwigshafen; Clinic for Hand, Plastic and Reconstructive Surgery, Burn Centre, Hand and Plastic Surgery of the University of Heidelberg; Heidelberg Germany
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199
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Zhao Q, Li ZY, Zhang ZP, Mo ZY, Chen SJ, Xiang SY, Zhang QS, Xue M. Polylactic-co-glycolic acid microspheres containing three neurotrophic factors promote sciatic nerve repair after injury. Neural Regen Res 2015; 10:1491-7. [PMID: 26604912 PMCID: PMC4625517 DOI: 10.4103/1673-5374.165522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A variety of neurotrophic factors have been shown to repair the damaged peripheral nerve. However, in clinical practice, nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor are all peptides or proteins that may be rapidly deactivated at the focal injury site; their local effective concentration time following a single medication cannot meet the required time for spinal axons to regenerate and cross the glial scar. In this study, we produced polymer sustained-release microspheres based on the polylactic-co-glycolic acid copolymer; the microspheres at 300-μm diameter contained nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor. Six microspheres were longitudinally implanted into the sciatic nerve at the anastomosis site, serving as the experimental group; while the sciatic nerve in the control group was subjected to the end-to-end anastomosis using 10/0 suture thread. At 6 weeks after implantation, the lower limb activity, weight of triceps surae muscle, sciatic nerve conduction velocity and the maximum amplitude were obviously better in the experimental group than in the control group. Compared with the control group, more regenerating nerve fibers were observed and distributed in a dense and ordered manner with thicker myelin sheaths in the experimental group. More angiogenesis was also visible. Experimental findings indicate that polylactic-co-glycolic acid composite microspheres containing nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor can promote the restoration of sciatic nerve in rats after injury.
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Affiliation(s)
- Qun Zhao
- Health Management Center, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhi-Yue Li
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ze-Peng Zhang
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhou-Yun Mo
- Department of Orthopedics, Yiyang Municipal Central Hospital, Yiyang, Hunan Province, China
| | - Shi-Jie Chen
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Si-Yu Xiang
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Qing-Shan Zhang
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Min Xue
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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200
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Gessmann J, Seybold D, Peter E, Schildhauer TA, Köller M. Alignment of the Fibrin Network Within an Autologous Plasma Clot. Tissue Eng Part C Methods 2015; 22:30-7. [PMID: 26544864 DOI: 10.1089/ten.tec.2015.0207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Autologous plasma clots with longitudinally aligned fibrin fibers could serve as a scaffold for longitudinal axonal regrowth in cases of traumatic peripheral nerve injuries. Three different techniques for assembling longitudinally oriented fibrin fibers during the fibrin polymerization process were investigated as follows: fiber alignment was induced by the application of either a magnetic field or-as a novel approach-electric field or by the induction of orientated flow. Fiber alignment was characterized by scanning electron microscopy analysis followed by image processing using fast Fourier transformation (FFT). Besides FFT output images, area xmin to xmax, as well as full width at half maximum (FWHM) of the FFT graph plot peaks, was calculated to determine the relative degree of fiber alignment. In addition, fluorescently labeled human fibrinogen and mesenchymal stem cells (MSCs) were used to visualize fibrin and cell orientation in aligned and nonaligned plasma clots. Varying degrees of fiber alignment were achieved by the three different methods, with the electric field application producing the highest degree of fiber alignment. The embedded MSCs showed a longitudinal orientation in the electric field-aligned plasma clots. The key feature of this study is the ability to produce autologous plasma clots with aligned fibrin fibers using physical techniques. This orientated internal structure of an autologous biomaterial is promising for distinct therapeutic applications, such as a guiding structure for cell migration and growth dynamics.
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Affiliation(s)
- Jan Gessmann
- 1 Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany .,2 Department of Surgical Research, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany
| | - Dominik Seybold
- 1 Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany .,2 Department of Surgical Research, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany
| | - Elvira Peter
- 2 Department of Surgical Research, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany
| | - Thomas Armin Schildhauer
- 1 Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany
| | - Manfred Köller
- 2 Department of Surgical Research, BG University Hospital Bergmannsheil, Ruhr University Bochum , Bochum, Germany
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