Conductive multichannel PCL/gelatin conduit with tunable mechanical and structural properties for peripheral nerve regeneration

Multichannel Conduits with Fascicular Complementation: Significance in Long Segmental Peripheral Nerve Injury

Despite the advances in tissue engineering approaches, reconstruction of long segmental peripheral nerve defects remains unsatisfactory. Although autologous grafts with proper fascicular complementation have shown meaningful functional recovery according to the Medical Research Council Classification (MRCC), the lack of donor nerve for such larger defect sizes (>30 mm) has been a serious clinical issue. Further clinical use of hollow nerve conduits is limited to bridging smaller segmental defects of denuded nerve ends (<30 mm). Recently, bioinspired multichannel nerve guidance conduits (NGCs) gained attention as autograft substitutes as they mimic the fascicular connective tissue microarchitecture in promoting aligned axonal outgrowth with desirable innervation for complete sensory and motor function restoration. This review outlines the hierarchical organization of nerve bundles and their significance in the sensory and motor functions of peripheral nerves. This review also emphasizes the major challenges in addressing the longer nerve defects with the role of fascicular arrangement in the multichannel nerve guidance conduits and the need for fascicular matching to accomplish complete functional restoration, especially in treating long segmental nerve defects. Further, currently available fabrication strategies in developing multichannel nerve conduits and their inconsistency in existing preclinical outcomes captured in this review would seed a new process in designing an ideal larger nerve conduit for peripheral nerve repair.

State of the Art and Current Challenges on Electroactive Biomaterials and Strategies for Neural Tissue Regeneration

The loss or failure of an organ/tissue stands as one of the healthcare system's most prevalent, devastating, and costly challenges. Strategies for neural tissue repair and regeneration have received significant attention due to their particularly strong impact on patients' well-being. Many research efforts are dedicated not only to control the disease symptoms but also to find solutions to repair the damaged tissues. Neural tissue engineering (TE) plays a key role in addressing this problem and significant efforts are being carried out to develop strategies for neural repair treatment. In the last years, active materials allowing to tune cell-materials interaction are being increasingly used, representing a recent paradigm in TE applications. Among the most important stimuli influencing cell behavior are the electrical and mechanical ones. In this way, materials with the ability to provide this kind of stimuli to the neural cells seem to be appropriate to support neural TE. In this scope, this review summarizes the different biomaterials types used for neural TE, highlighting the relevance of using active biomaterials and electrical stimulation. Furthermore, this review provides not only a compilation of the most relevant studies and results but also strategies for novel and more biomimetic approaches for neural TE.

Conductive nerve conduit with piezoelectric properties for enhanced PC12 differentiation

Restoration of nerve tissue remains highly challenging, mainly due to the limited regeneration capacity of the nervous system and the development of fibrosis. This limitation necessitates designing new nerve guidance channel to promote nerve repairing. In this study, we developed a novel core/shell conduit to induce PC12 differentiation. Co-electrospinning method was utilized to produce a fibrous shell containing polycaprolactone/polyvinylidene fluoride PCL/PVDF, gelatin and polyaniline/graphene (PAG) nanocomposite. The core section of the conduit was filled with chitosan-gelatin hydrogel containing PAG and ZnO nanoparticles. Such conduit shows antibacterial activity, electrical conductivity and piezoelectric property. The effect of such engineered conduit on PC12 differentiation was investigated by analyzing differentiation markers Nestin and microtubule-associated protein 2 (MAP2) through immunocytochemistry and PCR-RT techniques. The result revealed that such conduit could significantly induce Nestin and MAP2 gene expression in the PC12 cells and, thus, it is a viable option for effective cell differentiation and nerve regeneration.

Design of Novel Mechanically Resistant and Biodegradable Multichannel Platforms for the Treatment of Peripheral Nerve Injuries

Peripheral nerve injury is one of the most debilitating pathologies that severely impair patients' life. Although many efforts have been made to advance in the treatment of such a complex disorder, successful strategies to ensure full recovery are still scarce. The aim of the present work was to develop flexible and mechanically resistant platforms intended to act as a support and guide for neural cells during the regeneration process of peripheral nerve injury. For this purpose, poly(lactic-co-glycolic acid) (PLGA)/poly(d,l-lactic acid) (PDLLA)/poly(ethylene glycol) 400 (PEG)-multichannel-based scaffolds (MCs) were prepared through a multistep process involving electrospun microfibers coated with a polymer blend solution and used as a sacrificial mold. In particular, scaffolds characterized by random (MCR) and aligned (MCA) multichannel were obtained. A design of experiments approach (DoE) was employed to identify a scaffold-optimized composition. MCs were characterized for morphological and mechanical properties, suturability, degradability, cell colonization, and in vivo safety. A new biodegradable, biocompatible, and safe microscale multichannel scaffold was developed as the result of an easy multistep procedure.

Development of 3D-Printed, Biodegradable, Conductive PGSA Composites for Nerve Tissue Regeneration

Nerve conduits are used to reconnect broken nerve bundles and provide protection to facilitate nerve regeneration. However, the low degradation rate and regeneration rate, as well as the requirement for secondary surgery are some of the most criticized drawbacks of existing nerve conduits. With high processing flexibility from the photo-curability, poly (glycerol sebacate) acrylate (PGSA) is a promising material with tunable mechanical properties and biocompatibility for the development of medical devices. Here, polyvinylpyrrolidone (PVP), silver nanoparticles (AgNPs), and graphene are embedded in biodegradable PGSA matrix. The polymer composites are then assessed for their electrical conductivity, biodegradability, three-dimensional-printability (3D-printability), and promotion of cell proliferation. Through the four-probe technique, it is shown that the PGSA composites are identified as highly conductive in swollen state. Furthermore, biodegradability is evaluated through enzymatic degradation and facilitated hydrolysis. Cell proliferation and guidance are significantly promoted by three-dimensional-printed microstructures and electrical stimulation on PGSA composites, especially on PGSA-PVP. Hence, microstructured nerve conduits are 3D-printed with PGSA-PVP. Guided cell growth and promoted proliferation are subsequently demonstrated by Schwann cell culture combined with electrical stimulation. Consequently, 3D-printed nerve conduits fabricated with PGSA composites hold great potential in nerve tissue regeneration through electrical stimulation.

Schwann cell-matrix coated PCL-MWCNT multifunctional nanofibrous scaffolds for neural regeneration

Nerve tissue engineering aims to create scaffolds that promote nerve regeneration in the damaged peripheral nervous system. However, there remain some challenges in the construction of scaffolds in terms of mechanical properties and cellular behaviour. The present work aims to develop multifunctional implantable nanofibrous scaffolds for nerve regeneration. Using electrospinning, nanofibrous neat polycaprolactone (PCL) and PCL/multiwalled carbon nanotubes (PCL-MWCNT) composite scaffolds were prepared in random and aligned morphology. Schwann cells and their secreted biochemical factors are responsible for neuronal survival in the peripheral nervous system. Therefore, the acellular matrix of Schwann cells was spin-coated on the PCL-MWCNT scaffolds to aid nerve regeneration. Physicochemical and mechanical properties, and the in vitro cellular response of the developed nanofibrous were investigated. We observed no significant change in fibre diameter between neat PCL and PCL-MWCNT scaffolds regardless of the morphology. However, the inclusion of MWCNT reduced the mechanical strength of nanocomposite scaffolds compared to neat PCL. In vitro study revealed biocompatibility of the developed scaffolds both with and without an acellular matrix. Gene expression study revealed a significant increase in peripheral myelin protein (PMP22) expression on acellular matrix-coated PCL-MWCNT scaffolds compared to neat PCL counterparts. Overall, the results suggested Schwann cell matrix-coated PCL-MWCNT nanofibers as a promising conduit for peripheral nerve regeneration.

Piezoelectric conductive electrospun nanocomposite PCL/Polyaniline/Barium Titanate scaffold for tissue engineering applications

Recent trends in tissue engineering technology have switched to electrical potentials generated through bioactive scaffolds regarding their appropriate effects on cell behaviors. Preparing a piezo-electrical stimuli scaffold with high electrical conductivity for bone and cartilage tissue regeneration is the ultimate goal of the present study. Here, Barium Titanate nanoparticles (BaTiO₃ NPs) were used as piezoelectric material and highly conductive binary doped Polyaniline nanoparticles (PANI NPs) were synthesized by oxidative polymerization. Polycaprolactone (PCL) was applied as carrier substrate polymer and conductive spun nanofibrous scaffolds of PCL/PANI composites were prepared in two different amounts of PANI (3 and 5 wt.%). The conductivity of PCL/PANI nanofibers has been analyzed by standard four probes test. Based on the obtained results, the PCL/PANI5 (with 5 wt.% PANI) was selected due to the superior electrical conductivity of 8.06 × 10^-4 s cm ^- 1. Moreover, the piezoelectric nanofibrous scaffolds of PCL/BT composite were electrospun in three different amounts of BT (20, 30, and 40 wt.%). To investigate the synergic effect of conductive PANI and piezoelectric BT, ternary nanocomposite scaffolds of PCL/PANI/BT were prepared using the dual jet electrospinning technique. The piezoelectric properties have been analyzed by determining the produced voltage. The morphological assessment, contact angle, mechanical test, and MTT assay have been conducted to evaluate other properties including biocompatibility of nanofibrous scaffolds. The PCL/PANI5/BT40 composite resulted in an unprecedented voltage of 1.9 Volt. SEM results confirm that BT NPs have been distributed and embedded inside PCL fibers quite appropriately. Also, the chosen scaffolds were homogeneously intertwined and possessed an average fiber diameter of 288 ± 180 nm, and a contact angle of 92 ± 7°, making it a desirable surface for cell attachment and protein interactions. Moreover, Young's modulus, ultimate tensile stress, and elongation were obtained as 11 ± 1 MPa, 5 ± 0.6 MPa, and 109 ± 15% respectively. Obtained results assert the novel potential of piezo-electrical stimuli conductive nanocomposite scaffold for tissue engineering applications.

Biofeedback electrostimulation for bionic and long-lasting neural modulation

Invasive electrical stimulation (iES) is prone to cause neural stimulus-inertia owing to its excessive accumulation of exogenous charges, thereby resulting in many side effects and even failure of nerve regeneration and functional recovery. Here, a wearable neural iES system is well designed and built for bionic and long-lasting neural modulation. It can automatically yield biomimetic pulsed electrical signals under the driven of respiratory motion. These electrical signals are full of unique physiological synchronization can give biofeedback to respiratory behaviors, self-adjusting with different physiological states of the living body, and thus realizing a dynamic and biological self-matched modulation of voltage-gated calcium channels on the cell membrane. Abundant cellular and animal experimental evidence confirm an effective elimination of neural stimulus-inertia by these bioelectrical signals. An unprecedented nerve regeneration and motor functional reconstruction are achieved in long-segmental peripheral nerve defects, which is equal to the gold standard of nerve repair -- autograft. The wearable neural iES system provides an advanced platform to overcome the common neural stimulus-inertia and gives a broad avenue for personalized iES therapy of nerve injury and neurodegenerative diseases.

Designing wereable neural invasive electrical stimulation system remains a challenge. Here, researchers provide an effective technology platform for the elimination of tricky neural stimulus-inertia using bionic electronic modulation, which is a significant step forward for long-lasting treatment of nervous system diseases.

Electroceuticals for peripheral nerve regeneration

Electroceuticals provide promising opportunities for peripheral nerve regeneration, in terms of modulating the extensive endogenous tissue repair mechanisms between neural cell body, axons and target muscles. However, great challenges remain to deliver effective and controllable electroceuticals via bioelectronic implantable device. In this review, the modern fabrication methods of bioelectronic conduit for bridging critical nerve gaps after nerve injury are summarized, with regard to conductive materials and core manufacturing process. In addition, to deliver versatile electrical stimulation, the integration of implantable bioelectronic device is discussed, including wireless energy harvesters, actuators and sensors. Moreover, a comprehensive insight of beneficial mechanisms is presented, including up-to-date in vitro, in vivo and clinical evidence. By integrating conductive biomaterials, 3D engineering manufacturing process and bioelectronic platform to deliver versatile electroceuticals, the modern biofabrication enables comprehensive biomimetic therapies for neural tissue engineering and regeneration in the new era.

Preparation and mechanical optimization of a two-layer silk/magnesium wires braided porous artificial nerve guidance conduit

Peripheral nerve injures have long been a tricky problem in surgery and a feasible treatment is the transplantation of nerve guidance conduits (NGCs). This study presents a two-layer composite NGC with fair mechanical properties and good biocompatibility. The inner layer was made of degummed silk yarns/magnesium wires using braiding technology, and the outer layer was made from mixed solution of silk fibroin/chitosan (SF/CS) using freeze-drying treatment. Orthogonal experimental design was applied to rationally design the braided structural layer and obtain the optimal combination of technical process parameters. Meanwhile, the SF/CS porous outer layer was optimized from three concentrations of SF/CS solution. In vitro and in vivo study suggested that the textile-forming scaffold exhibited good biocompatibility and no toxicity. During 4 weeks' degradation, the skeleton of conduits retained its shape, and magnesium ions released from degraded magnesium wires contributed to sustainable release and uniform dispersion, proliferation and adhesion of Schwann cells, indicating potential approach in the development of NGCs.

Graphene-Based Materials Prove to Be a Promising Candidate for Nerve Regeneration Following Peripheral Nerve Injury

Peripheral nerve injury is a common medical condition that has a great impact on patient quality of life. Currently, surgical management is considered to be a gold standard first-line treatment; however, is often not successful and requires further surgical procedures. Commercially available FDA- and CE-approved decellularized nerve conduits offer considerable benefits to patients suffering from a completely transected nerve but they fail to support neural regeneration in gaps > 30 mm. To address this unmet clinical need, current research is focused on biomaterial-based therapies to regenerate dysfunctional neural tissues, specifically damaged peripheral nerve, and spinal cord. Recently, attention has been paid to the capability of graphene-based materials (GBMs) to develop bifunctional scaffolds for promoting nerve regeneration, often via supporting enhanced neural differentiation. The unique features of GBMs have been applied to fabricate an electroactive conductive surface in order to direct stem cells and improve neural proliferation and differentiation. The use of GBMs for nerve tissue engineering (NTE) is considered an emerging technology bringing hope to peripheral nerve injury repair, with some products already in preclinical stages. This review assesses the last six years of research in the field of GBMs application in NTE, focusing on the fabrication and effects of GBMs for neurogenesis in various scaffold forms, including electrospun fibres, films, hydrogels, foams, 3D printing, and bioprinting.

Materials for peripheral nerve repair constructs: Natural proteins or synthetic polymers?

The efficacious repair of severe peripheral nerve injuries is currently an unmet clinical need, and biomaterial constructs offer a promising approach to help promote nerve regeneration. Current research focuses on the development of more sophisticated constructs with complex architecture and the addition of regenerative agents to encourage timely reinnervation and promote functional recovery. This review surveyed the present landscape of nerve repair construct literature with a focus on six selected materials that are frequently encountered in this application: the natural proteins collagen, chitosan, and silk, and the synthetic polymers poly-ε-caprolactone (PCL), poly-lactic-co-glycolic acid (PLGA) and poly-glycolic acid (PGA). This review also investigated the use of cell therapy in nerve repair constructs, and in all instances concentrated on publications reporting constructs developed and tested in vivo in the last five years (2015-2020). Across the selected literature, the popularity of natural proteins and synthetic polymers appears to be broadly equivalent, with a similar number of studies reporting successful outcomes in vivo. Both material types are also utilised as vehicles for cell therapy, which has much potential to improve the results of nerve bridging for treating longer gaps.

Preparation and characterization of self-electrical stimuli conductive gellan based nano scaffold for nerve regeneration containing chopped short spun nanofibers of PVDF/MCM41 and polyaniline/graphene nanoparticles: Physical, mechanical and morphological studies

Conductive self -electrical stimuli bioactive scaffolds could be used the potential for peripheral nerve regeneration with the maximum efficiency. To produce such conductive self-electrical stimuli bioactive scaffolds, chopped spun piezoelectric nanofibers of polyvinylidene fluoride/mesoporous silica nanoparticle (PVDF/MCM41) are prepared and incorporated in gellan/polyaniline/graphene (gellan/PAG) nanocomposites which have been previously prepared by incorporation of polyaniline/graphene (PAG) nanoparticles in gellan gel at 80 °C. Highly conductive binary doped polyaniline/graphene nanoparticles are prepared by chemical oxidative polymerization of aniline monomer using in-suite precipitation polymerization method in presence of graphene nanoparticles and sodium dodecyl sulfate. All intermediate and final products including spun PVDF/MCM41 nanofibers, PAG nanoparticles, and gellan-gelatin gel scaffolds containing PVDF/MCM41 nano spun fibers and PAG nanoparticles are characterized using different analysis methods. Chemical and structural analyses of PAG nanoparticles and PVDF/MCM41 nanofibers have been done using FTIR and XRD methods. The morphological structure of different samples is investigated using SEM. Morphological investigation and DLS results confirm fabrication of MCM41 nanoparticle with a completely spherical shape and the average size of 50 nm of which have been dispersed in electrospun PVDF nanofibers very well. Also, the preparation of PAG nanoparticle with high conductivity is verified with morphological and conductivity tests. MTT easy and biocompatibility test results indicate potential applicability of the prepared conductive self -stimuli nano-scaffold for nerve regeneration applications.