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Soltani Khaboushan A, Azimzadeh A, Behboodi Tanourlouee S, Mamdoohi M, Kajbafzadeh AM, Slavin KV, Rahimi-Movaghar V, Hassannejad Z. Electrical stimulation enhances sciatic nerve regeneration using a silk-based conductive scaffold beyond traditional nerve guide conduits. Sci Rep 2024; 14:15196. [PMID: 38956215 PMCID: PMC11219763 DOI: 10.1038/s41598-024-65286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
Despite recent advancements in peripheral nerve regeneration, the creation of nerve conduits with chemical and physical cues to enhance glial cell function and support axonal growth remains challenging. This study aimed to assess the impact of electrical stimulation (ES) using a conductive nerve conduit on sciatic nerve regeneration in a rat model with transection injury. The study involved the fabrication of conductive nerve conduits using silk fibroin and Au nanoparticles (AuNPs). Collagen hydrogel loaded with green fluorescent protein (GFP)-positive adipose-derived mesenchymal stem cells (ADSCs) served as the filling for the conduit. Both conductive and non-conductive conduits were applied with and without ES in rat models. Locomotor recovery was assessed using walking track analysis. Histological evaluations were performed using H&E, luxol fast blue staining and immunohistochemistry. Moreover, TEM analysis was conducted to distinguish various ultrastructural aspects of sciatic tissue. In the ES + conductive conduit group, higher S100 (p < 0.0001) and neurofilament (p < 0.001) expression was seen after 6 weeks. Ultrastructural evaluations showed that conductive scaffolds with ES minimized Wallerian degeneration. Furthermore, the conductive conduit with ES group demonstrated significantly increased myelin sheet thickness and decreased G. ratio compared to the autograft. Immunofluorescent images confirmed the presence of GFP-positive ADSCs by the 6th week. Locomotor recovery assessments revealed improved function in the conductive conduit with ES group compared to the control group and groups without ES. These results show that a Silk/AuNPs conduit filled with ADSC-seeded collagen hydrogel can function as a nerve conduit, aiding in the restoration of substantial gaps in the sciatic nerve with ES. Histological and locomotor evaluations indicated that ES had a greater impact on functional recovery compared to using a conductive conduit alone, although the use of conductive conduits did enhance the effects of ES.
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Affiliation(s)
- Alireza Soltani Khaboushan
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan Azimzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Saman Behboodi Tanourlouee
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Melina Mamdoohi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave., Tehran, 11365-3876, Iran.
| | - Zahra Hassannejad
- Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419733151, Iran.
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Perrelle JM, Boreland AJ, Gamboa JM, Gowda P, Murthy NS. Biomimetic Strategies for Peripheral Nerve Injury Repair: An Exploration of Microarchitecture and Cellularization. BIOMEDICAL MATERIALS & DEVICES (NEW YORK, N.Y.) 2023; 1:21-37. [PMID: 38343513 PMCID: PMC10857769 DOI: 10.1007/s44174-022-00039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/14/2022] [Indexed: 02/15/2024]
Abstract
Injuries to the nervous system present formidable challenges to scientists, clinicians, and patients. While regeneration within the central nervous system is minimal, peripheral nerves can regenerate, albeit with limitations. The regenerative mechanisms of the peripheral nervous system thus provide fertile ground for clinical and scientific advancement, and opportunities to learn fundamental lessons regarding nerve behavior in the context of regeneration, particularly the relationship of axons to their support cells and the extracellular matrix environment. However, few current interventions adequately address peripheral nerve injuries. This article aims to elucidate areas in which progress might be made toward developing better interventions, particularly using synthetic nerve grafts. The article first provides a thorough review of peripheral nerve anatomy, physiology, and the regenerative mechanisms that occur in response to injury. This is followed by a discussion of currently available interventions for peripheral nerve injuries. Promising biomaterial fabrication techniques which aim to recapitulate nerve architecture, along with approaches to enhancing these biomaterial scaffolds with growth factors and cellular components, are then described. The final section elucidates specific considerations when developing nerve grafts, including utilizing induced pluripotent stem cells, Schwann cells, nerve growth factors, and multilayered structures that mimic the architectures of the natural nerve.
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Affiliation(s)
- Jeremy M. Perrelle
- Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Andrew J. Boreland
- Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Graduate Program in Molecular Biosciences, Rutgers University, Piscataway, NJ, USA
| | - Jasmine M. Gamboa
- Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Prarthana Gowda
- Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - N. Sanjeeva Murthy
- Laboratory for Biomaterials Research, Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, NJ 08854, USA
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Optimal Morphometric Characteristics of a Tubular Polymeric Scaffold to Promote Peripheral Nerve Regeneration: A Scoping Review. Polymers (Basel) 2022; 14:polym14030397. [PMID: 35160387 PMCID: PMC8838152 DOI: 10.3390/polym14030397] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 12/27/2022] Open
Abstract
Cellular behavior in nerve regeneration is affected by the architecture of the polymeric nerve guide conduits (NGCs); therefore, design features of polymeric NGCs are critical for neural tissue engineering. Hence, the purpose of this scoping review is to summarize the adequate quantitative/morphometric parameters of the characteristics of NGC that provide a supportive environment for nerve regeneration, enhancing the understanding of a previous study. 394 studies were found, of which 29 studies were selected. The selected studies revealed four morphometric characteristics for promoting nerve regeneration: wall thickness, fiber size, pore size, and porosity. An NGC with a wall thickness between 250–400 μm and porosity of 60–80%, with a small pore on the inner surface and a large pore on the outer surface, significantly favored nerve regeneration; resulting in an increase in nutrient permeability, retention of neurotrophic factors, and optimal mechanical properties. On the other hand, the superiority of electrospun fibers is described; however, the size of the fiber is controversial in the literature, obtaining optimal results in the range of 300 nm to 30 µm. The incorporation of these optimal morphometric characteristics will encourage nerve regeneration and help reduce the number of experimental studies as it will provide the initial morphometric parameters for the preparation of an NGC.
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Apablaza JA, Lezcano MF, Lopez Marquez A, Godoy Sánchez K, Oporto GH, Dias FJ. Main Morphological Characteristics of Tubular Polymeric Scaffolds to Promote Peripheral Nerve Regeneration-A Scoping Review. Polymers (Basel) 2021; 13:polym13152563. [PMID: 34372166 PMCID: PMC8347244 DOI: 10.3390/polym13152563] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
The "nerve guide conduits" (NGC) used in nerve regeneration must mimic the natural environment for proper cell behavior. OBJECTIVE To describe the main morphological characteristics of polymeric NGC to promote nerve regeneration. METHODS A scoping review was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) criteria in the PubMed, Web of Science, Science Direct, and Scientific Electronic Library Online (SciELO) databases. Primary studies that considered/evaluated morphological characteristics of NGC to promote nerve regeneration were included. RESULT A total of 704 studies were found, of which 52 were selected. The NGC main morphological characteristics found in the literature were: (I) NGC diameter affects the mechanical properties of the scaffold. (II) Wall thickness of NGC determines the exchange of nutrients, molecules, and neurotrophins between the internal and external environment; and influences the mechanical properties and biodegradation, similarly to NGC (III) porosity, (IV) pore size, and (V) pore distribution. The (VI) alignment of the NGC fibers influences the phenotype of cells involved in nerve regeneration. In addition, the (VII) thickness of the polymeric fiber influences neurite extension and orientation. CONCLUSIONS An NGC should have its diameter adjusted to the nerve with wall thickness, porosity, pore size, and distribution of pores, to favor vascularization, permeability, and exchange of nutrients, and retention of neurotrophic factors, also favoring its mechanical properties and biodegradability.
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Affiliation(s)
- Josefa Alarcón Apablaza
- Research Centre in Dental Sciences (CICO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile; (J.A.A.); (M.F.L.); (G.H.O.)
- Program of Master in Dental Science, Dental School, Universidad de La Frontera, Temuco 4780000, Chile
| | - María Florencia Lezcano
- Research Centre in Dental Sciences (CICO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile; (J.A.A.); (M.F.L.); (G.H.O.)
- Department of Integral Adults Dentistry, Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
- Laboratorio de Cibernética, Departamento de Bioingeniería, Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Oro Verde 3100, Argentina
| | - Alex Lopez Marquez
- HAWK—Hochschule für Angewandte Wissenschaften und Kunst, 37085 Göttingen, Germany;
| | - Karina Godoy Sánchez
- Scientific and Technological Bioresource Nucleus (BIOREN-UFRO), Universidad de La Frontera, Temuco 4780000, Chile;
- Center of Molecular Biology and Phamacogenetics, Universidad de La Frontera, Temuco 4780000, Chile
| | - Gonzalo H. Oporto
- Research Centre in Dental Sciences (CICO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile; (J.A.A.); (M.F.L.); (G.H.O.)
- Department of Integral Adults Dentistry, Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
| | - Fernando José Dias
- Research Centre in Dental Sciences (CICO-UFRO), Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile; (J.A.A.); (M.F.L.); (G.H.O.)
- Department of Integral Adults Dentistry, Dental School—Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
- Correspondence: ; Tel.: +56-9-8474-6702
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Bahremandi Tolou N, Salimijazi H, Kharaziha M, Faggio G, Chierchia R, Lisi N. A three-dimensional nerve guide conduit based on graphene foam/polycaprolactone. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 126:112110. [PMID: 34082932 DOI: 10.1016/j.msec.2021.112110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 01/17/2023]
Abstract
In this study, a novel nerve guide conduit was developed, based on a three-dimensional (3D) graphene conductive core grown, by chemical vapor deposition (CVD) coupled with a polycaprolactone (PCL) polymer coating. Firstly, the monolithic 3D-graphene foam (3D-GF) was synthesized on Ni foam templates via inductive heating CVD, subsequently, Ni/Graphene samples were dipped successively in PCL and cyclododecane (CDD) solutions prior to the removal of Ni from the 3D-GF/PCL scaffold in FeCl3. Our results showed that the electrical conductivity of the polymer composites reached to 25 S.m-1 after incorporation of 3D-GF. Moreover, the mechanical properties of 3D-GF/PCL composite scaffold were enhanced with respect to the same geometry of PCL scaffolds. The wettability, surface porosity, and morphology did not show any significant changes, while the PC12 cell proliferation and extension were increased for the developed 3D-GF/PCL nanocomposite. It can be concluded that 3D-GF/PCL nanocomposites could be good candidates to utilize as a versatile system for the engineering of peripheral nerve tissue.
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Affiliation(s)
- Neda Bahremandi Tolou
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran; ENEA Casaccia, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy.
| | - Hamidreza Salimijazi
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Mahshid Kharaziha
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Giuliana Faggio
- Department of Information Engineering, Infrastructure and Sustainable Energy (DIIES), Mediterranea University of Reggio Calabria, Reggio Calabria, Italy.
| | - Rosa Chierchia
- ENEA Casaccia, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy.
| | - Nicola Lisi
- ENEA Casaccia, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy.
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Passipieri JA, Dienes J, Frank J, Glazier J, Portell A, Venkatesh KP, Bliley JM, Grybowski D, Schilling BK, Marra KG, Christ GJ. Adipose Stem Cells Enhance Nerve Regeneration and Muscle Function in a Peroneal Nerve Ablation Model. Tissue Eng Part A 2019; 27:297-310. [PMID: 30760135 DOI: 10.1089/ten.tea.2018.0244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Severe peripheral nerve injuries have devastating consequences on the quality of life in affected patients, and they represent a significant unmet medical need. Destruction of nerve fibers results in denervation of targeted muscles, which, subsequently, undergo progressive atrophy and loss of function. Timely restoration of neural innervation to muscle fibers is crucial to the preservation of muscle homeostasis and function. The goal of this study was to evaluate the impact of addition of adipose stem cells (ASCs) to polycaprolactone (PCL) nerve conduit guides on peripheral nerve repair and functional muscle recovery in the setting of a critical size nerve defect. To this end, peripheral nerve injury was created by surgically ablating 6 mm of the common peroneal nerve in a rat model. A PCL nerve guide, filled with ASCs and/or poloxamer hydrogel, was sutured to the nerve ends. Negative and positive controls included nerve ablation only (no repair), and reversed polarity autograft nerve implant, respectively. Tibialis anterior (TA) muscle function was assessed at 4, 8, and 12 weeks postinjury, and nerve and muscle tissue was retrieved at the 12-week terminal time point. Inclusion of ASCs in the PCL nerve guide elicited statistically significant time-dependent increases in functional recovery (contraction) after denervation; ∼25% higher than observed in acellular (poloxamer-filled) implants and indistinguishable from autograft implants, respectively, at 12 weeks postinjury (p < 0.05, n = 7-8 in each group). Analysis of single muscle fiber cross-sectional area (CSA) revealed that ASC-based treatment of nerve injury provided a better recapitulation of the overall distribution of muscle fiber CSAs observed in the contralateral TA muscle of uninjured limbs. In addition, the presence of ASCs was associated with improved features of re-innervation distal to the defect, with respect to neurofilament and S100 (Schwann cell marker) expression. In conclusion, these initial studies indicate significant benefits of inclusion of ASCs to the rate and magnitude of both peripheral nerve regeneration and functional recovery of muscle contraction, to levels equivalent to autograft implantation. These findings have important implications to improved nerve repair, and they provide input for future work directed to restoration of nerve and muscle function after polytraumatic injury. Impact Statement This works explores the application of adipose stem cells (ASCs) for peripheral nerve regeneration in a rat model. Herein, we demonstrate that the addition of ASCs in poloxamer-filled PCL nerve guide conduits impacts nerve regeneration and recovery of muscle function, to levels equivalent to autograft implantation, which is considered to be the current gold standard treatment. This study builds on the importance of a timely restoration of innervation to muscle fibers for preservation of muscle homeostasis, and it will provide input for future work aiming at restoring nerve and muscle function after polytraumatic injury.
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Affiliation(s)
- Juliana A Passipieri
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Jack Dienes
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Joseph Frank
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Joshua Glazier
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Andrew Portell
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Kaushik P Venkatesh
- Department of Bioengineering and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacqueline M Bliley
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Damian Grybowski
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin K Schilling
- Department of Bioengineering and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kacey G Marra
- Department of Bioengineering and University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George J Christ
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia.,Orthopaedics Department, University of Virginia, Charlottesville, Virginia
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Zhang Y, Wang Z, Wang Y, Li L, Wu Z, Ito Y, Yang X, Zhang P. A Novel Approach via Surface Modification of Degradable Polymers With Adhesive DOPA-IGF-1 for Neural Tissue Engineering. J Pharm Sci 2018; 108:551-562. [PMID: 30321547 DOI: 10.1016/j.xphs.2018.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 01/06/2023]
Abstract
The highly damaging state of spinal cord injuries has provided much inspiration for the design of surface modification of the implants that can promote nerve regeneration and functional reconstruction. DOPA-IGF-1, a new recombinant protein designed in our previous study, exhibited strong binding affinity to titanium and significantly enhanced the growth of NIH3T3 cells on the surface of titanium with the same biological activity as IGF-1. In this article, surface modification of poly(lactide-co-glycolide) (PLGA) films with recombinant DOPA-IGF-1 was performed to promote the paracrine activity of human umbilical cord mesenchymal stem cells (hUCMSCs) by secreting neurotrophic factors. DOPA-IGF-1 exhibited the strongest binding ability to PLGA films than commercial IGF-1 and nonhydroxylated YKYKY-IGF-1. In vitro cultures of hUCMSCs on the modified PLGA films showed that DOPA-IGF-1@PLGA substrates significantly improved the proliferation, adhesion, and neurotrophic factors secretion of hUCMSCs, especially for nerve growth factor, as confirmed by qRT-PCR and western blot analysis. Subsequently, the acquired neurotrophic factors secreted by the hUCMSCs cultured on the DOPA-IGF-1@PLGA films obviously enhanced neurite outgrowth of PC12 cells. Taken together, PLGA substrates with DOPA-IGF-1 immobilization is a promising platform for neural tissue engineering via neurotrophic factors secretion from MSCs and should be further tested in vivo.
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Affiliation(s)
- Yi Zhang
- Department of Orthopaedics, The Second Hospital, Jilin University, Changchun 130041, PR China; Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Zongliang Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Yu Wang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Linlong Li
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China
| | - Zhenxu Wu
- School of Pharmaceutical Sciences, Jilin University, Changchun 130021, PR China
| | - Yoshihiro Ito
- Emergent Bioengineering Materials Research Team, RIKEN Center for Emergent Matter Science 2-1 Hirosawa, Wako-shi, Saitama 351-0198 Japan
| | - Xiaoyu Yang
- Department of Orthopaedics, The Second Hospital, Jilin University, Changchun 130041, PR China.
| | - Peibiao Zhang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, PR China; Institute of Applied Chemistry and Engineering, University of Science and Technology of China, Hefei 230026, PR China.
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8
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Pinho AC, Fonseca AC, Serra AC, Santos JD, Coelho JFJ. Peripheral Nerve Regeneration: Current Status and New Strategies Using Polymeric Materials. Adv Healthc Mater 2016; 5:2732-2744. [PMID: 27600578 DOI: 10.1002/adhm.201600236] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 12/16/2022]
Abstract
Experiments concerning peripheral nerve regeneration have been reported since the end of the 19th century. The need to implement an effective surgical procedure in terms of functional recovery has resulted in the appearance of several approaches to solve this problem. Nerve autograft was the first approach studied and is still considered the gold standard. Since autografts require donor harvesting, other strategies involving the use of natural materials have also been studied. Nevertheless, the results were not very encouraging and attention has moved towards the use of nerve conduits made from polymers, whose properties can be easily tailored and which allow the nerve conduit to be easily processed into a variety of shapes and forms. Some of these materials are already approved by the US Food and Drug Administration (FDA), as is presented here. Furthermore, polymers with conductive properties have very recently been subject to intensive study in this field, since it is believed that such properties have a positive influence in the regeneration of the new axons. This manuscript intends to give a global view of the mechanisms involved in peripheral nerve regeneration and the main strategies used to recover motor and sensorial function of injured nerves.
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Affiliation(s)
- Ana C. Pinho
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
| | - Ana C. Fonseca
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
| | - Arménio C. Serra
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
| | - José D. Santos
- CEMUC Department of Metallurgical and Materials Engineering; University of Porto; Rua Dr Roberto Frias 4200-465 Porto Portugal
| | - Jorge F. J. Coelho
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
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9
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Cui WL, Qiu LH, Lian JY, Li JC, Hu J, Liu XL. Cartilage oligomeric matrix protein enhances the vascularization of acellular nerves. Neural Regen Res 2016; 11:512-8. [PMID: 27127495 PMCID: PMC4829021 DOI: 10.4103/1673-5374.179078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vascularization of acellular nerves has been shown to contribute to nerve bridging. In this study, we used a 10-mm sciatic nerve defect model in rats to determine whether cartilage oligomeric matrix protein enhances the vascularization of injured acellular nerves. The rat nerve defects were treated with acellular nerve grafting (control group) alone or acellular nerve grafting combined with intraperitoneal injection of cartilage oligomeric matrix protein (experimental group). As shown through two-dimensional imaging, the vessels began to invade into the acellular nerve graft from both anastomotic ends at day 7 post-operation, and gradually covered the entire graft at day 21. The vascular density, vascular area, and the velocity of revascularization in the experimental group were all higher than those in the control group. These results indicate that cartilage oligomeric matrix protein enhances the vascularization of acellular nerves.
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Affiliation(s)
- Wei-Ling Cui
- Department of Endocrinology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Long-Hai Qiu
- Department of Orthopaedics and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jia-Yan Lian
- Department of Endocrinology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jia-Chun Li
- Department of Orthopaedics and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jun Hu
- Department of Orthopaedics and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiao-Lin Liu
- Department of Orthopaedics and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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10
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Jenkins PM, Laughter MR, Lee DJ, Lee YM, Freed CR, Park D. A nerve guidance conduit with topographical and biochemical cues: potential application using human neural stem cells. NANOSCALE RESEARCH LETTERS 2015; 10:972. [PMID: 26071111 PMCID: PMC4469602 DOI: 10.1186/s11671-015-0972-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/03/2015] [Indexed: 05/26/2023]
Abstract
Despite major advances in the pathophysiological understanding of peripheral nerve damage, the treatment of nerve injuries still remains an unmet medical need. Nerve guidance conduits present a promising treatment option by providing a growth-permissive environment that 1) promotes neuronal cell survival and axon growth and 2) directs axonal extension. To this end, we designed an electrospun nerve guidance conduit using a blend of polyurea and poly-caprolactone with both biochemical and topographical cues. Biochemical cues were integrated into the conduit by functionalizing the polyurea with RGD to improve cell attachment. Topographical cues that resemble natural nerve tissue were incorporated by introducing intraluminal microchannels aligned with nanofibers. We determined that electrospinning the polymer solution across a two electrode system with dissolvable sucrose fibers produced a polymer conduit with the appropriate biomimetic properties. Human neural stem cells were cultured on the conduit to evaluate its ability to promote neuronal growth and axonal extension. The nerve guidance conduit was shown to enhance cell survival, migration, and guide neurite extension.
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Affiliation(s)
- Phillip M Jenkins
- />Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 E. 19th Avenue, Aurora, CO 80045 USA
| | - Melissa R Laughter
- />Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 E. 19th Avenue, Aurora, CO 80045 USA
| | - David J Lee
- />Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 E. 19th Avenue, Aurora, CO 80045 USA
| | - Young M Lee
- />Division of Clinical Pharmacology and Toxicology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Aurora, CO 80045 USA
| | - Curt R Freed
- />Division of Clinical Pharmacology and Toxicology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Aurora, CO 80045 USA
| | - Daewon Park
- />Department of Bioengineering, University of Colorado Denver Anschutz Medical Campus, 12800 E. 19th Avenue, Aurora, CO 80045 USA
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11
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Nagamine K, Hirata T, Okamoto K, Abe Y, Kaji H, Nishizawa M. Portable Micropatterns of Neuronal Cells Supported by Thin Hydrogel Films. ACS Biomater Sci Eng 2015; 1:329-334. [PMID: 33429573 DOI: 10.1021/acsbiomaterials.5b00020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A grid micropattern of neuronal cells was formed on a free-standing collagen film (35 μm thickness) by directing migration and extension of neurons along a Matrigel pattern previously prepared on the film by the microcontact printing method. The neurons migrated to reach the nodes on the grid pattern and extended neurites to bridge cell bodies at the nodes. The resulting neuronal micropattern on the collagen film containing culture medium can be handled and deformed with tweezers with maintenance of physiological activity of the neurons, as examined by response of cytosolic Ca2+ concentration to a dose of bradykinin. This portability is the unique advantage of the present system that will open novel possibility of cellular engineering including the on-demand combination with analytical devices. The repetitive lamination of the film on a microelectrode chip was demonstrated for local electrical stimulation of a specific part of the grid micropattern of neurons, showing Ca2+ wave propagation along the neurites. The molecular permeability is the further advantage of the free-standing hydrogel substrate, which allows external supply of nutrients and dosing with chemical stimulants through the film even under rolled and laminated conditions.
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Affiliation(s)
- Kuniaki Nagamine
- Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Takuya Hirata
- Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Kohei Okamoto
- Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Yuina Abe
- Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Hirokazu Kaji
- Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
| | - Matsuhiko Nishizawa
- Department of Bioengineering and Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki, Aoba-ku, Sendai 980-8579, Japan
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12
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Sridharan R, Reilly RB, Buckley CT. Decellularized grafts with axially aligned channels for peripheral nerve regeneration. J Mech Behav Biomed Mater 2015; 41:124-35. [DOI: 10.1016/j.jmbbm.2014.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/30/2014] [Accepted: 10/02/2014] [Indexed: 01/05/2023]
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13
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Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BIOMED RESEARCH INTERNATIONAL 2014. [PMID: 25276813 DOI: 10.1155/2014/698256.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.
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Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:698256. [PMID: 25276813 PMCID: PMC4167952 DOI: 10.1155/2014/698256] [Citation(s) in RCA: 566] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/16/2014] [Indexed: 01/09/2023]
Abstract
Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.
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Affiliation(s)
- D. Grinsell
- Plastic and Reconstructive Surgery Unit, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia
| | - C. P. Keating
- Plastic and Reconstructive Surgery Unit, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia
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15
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Abstract
Nerve injury secondary to trauma, neurological disease or tumor excision presents a challenge for surgical reconstruction. Current practice for nerve repair involves autologous nerve transplantation, which is associated with significant donor-site morbidity and other complications. Previously artificial nerve conduits made from polycaprolactone, polyglycolic acid and collagen were approved by the FDA (USA) for nerve repair. More recently, there have been significant advances in nerve conduit design that better address the requirements of nerve regrowth. Innovations in materials science, nanotechnology, and biology open the way for the synthesis of new generation nerve repair conduits that address issues currently faced in nerve repair and regeneration. This review discusses recent innovations in this area, including the use of nanotechnology to improve the design of nerve conduits and to enhance nerve regeneration.
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16
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Mauro N, Manfredi A, Ranucci E, Procacci P, Laus M, Antonioli D, Mantovani C, Magnaghi V, Ferruti P. Degradable Poly(amidoamine) Hydrogels as Scaffolds for In Vitro Culturing of Peripheral Nervous System Cells. Macromol Biosci 2012; 13:332-47. [DOI: 10.1002/mabi.201200354] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/08/2012] [Indexed: 02/02/2023]
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17
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Kehoe S, Zhang XF, Lewis L, O'Shea H, Boyd D. Characterization of PLGA based composite nerve guidance conduits: effect of F127 content on modulus over time in simulated physiological conditions. J Mech Behav Biomed Mater 2012; 14:180-5. [PMID: 23026696 DOI: 10.1016/j.jmbbm.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/31/2012] [Accepted: 06/07/2012] [Indexed: 11/15/2022]
Abstract
PLGA/pluronic F127 based nerve guidance conduits (NGCs) for peripheral nerve regeneration offer excellent potential for clinical use. To date, little emphasis has been directed towards the effect of pluronic F127 on their subsequent mechanical properties as a function of degradation time or the physiological environment. This report was designed to redress the balance. This study synthesised 5 groups of 20wt% PLGA NGCs with varied additions of pluronic F127 (range 0-5wt%) to obtain Young's Moduli (E) in the range of 7-107MPa, depending on degradation conditions and pluronic F127 content.
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Affiliation(s)
- S Kehoe
- Department of Applied Oral Science, Dalhousie University, P.O. Box 15000, Halifax, NS, Canada B3H 4R2.
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Jiang X, Mi R, Hoke A, Chew SY. Nanofibrous nerve conduit-enhanced peripheral nerve regeneration. J Tissue Eng Regen Med 2012; 8:377-85. [PMID: 22700359 DOI: 10.1002/term.1531] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/28/2012] [Accepted: 04/04/2012] [Indexed: 11/09/2022]
Abstract
Fibre structures represent a potential class of materials for the formation of synthetic nerve conduits due to their biomimicking architecture. Although the advantages of fibres in enhancing nerve regeneration have been demonstrated, in vivo evaluation of fibre size effect on nerve regeneration remains limited. In this study, we analyzed the effects of fibre diameter of electrospun conduits on peripheral nerve regeneration across a 15-mm critical defect gap in a rat sciatic nerve injury model. By using an electrospinning technique, fibrous conduits comprised of aligned electrospun poly (ε-caprolactone) (PCL) microfibers (981 ± 83 nm, Microfiber) or nanofibers (251 ± 32 nm, Nanofiber) were obtained. At three months post implantation, axons regenerated across the defect gap in all animals that received fibrous conduits. In contrast, complete nerve regeneration was not observed in the control group that received empty, non-porous PCL film conduits (Film). Nanofiber conduits resulted in significantly higher total number of myelinated axons and thicker myelin sheaths compared to Microfiber and Film conduits. Retrograde labeling revealed a significant increase in number of regenerated dorsal root ganglion sensory neurons in the presence of Nanofiber conduits (1.93 ± 0.71 × 10(3) vs. 0.98 ± 0.30 × 10(3) in Microfiber, p < 0.01). In addition, the compound muscle action potential (CMAP) amplitudes were higher and distal motor latency values were lower in the Nanofiber conduit group compared to the Microfiber group. This study demonstrated the impact of fibre size on peripheral nerve regeneration. These results could provide useful insights for future nerve guide designs.
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Affiliation(s)
- Xu Jiang
- Nanyang Technological University, School of Chemical & Biomedical Engineering, Singapore, 637459, Singapore
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19
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Time-dependent evaluation of mechanical properties and in vitro cytocompatibility of experimental composite-based nerve guidance conduits. J Mech Behav Biomed Mater 2011; 4:1266-74. [DOI: 10.1016/j.jmbbm.2011.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/11/2011] [Accepted: 04/15/2011] [Indexed: 11/19/2022]
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Siemionow M, Bozkurt M, Zor F. Regeneration and repair of peripheral nerves with different biomaterials: review. Microsurgery 2011; 30:574-88. [PMID: 20878689 DOI: 10.1002/micr.20799] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peripheral nerve injury may cause gaps between the nerve stumps. Axonal proliferation in nerve conduits is limited to 10-15 mm. Most of the supportive research has been done on rat or mouse models which are different from humans. Herein we review autografts and biomaterials which are commonly used for nerve gap repair and their respective outcomes. Nerve autografting has been the first choice for repairing peripheral nerve gaps. However, it has been demonstrated experimentally that tissue engineered tubes can also permit lead to effective nerve repair over gaps longer than 4 cm repair that was previously thought to be restorable by means of nerve graft only. All of the discoveries in the nerve armamentarium are making their way into the clinic, where they are, showing great potential for improving both the extent and rate of functional recovery compared with alternative nerve guides.
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Affiliation(s)
- Maria Siemionow
- Department of Plastic Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA.
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21
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Fan J, Zhang H, He J, Xiao Z, Chen B, Xiaodan J, Dai J, Xu R. Neural regrowth induced by PLGA nerve conduits and neurotrophin-3 in rats with complete spinal cord transection. J Biomed Mater Res B Appl Biomater 2011; 97:271-7. [DOI: 10.1002/jbm.b.31810] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 11/16/2010] [Accepted: 11/25/2010] [Indexed: 11/09/2022]
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22
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Merolli A, Marceddu S, Rocchi L, Catalano F. In vivo study of ethyl-2-cyanoacrylate applied in direct contact with nerves regenerating in a novel nerve-guide. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:1979-1987. [PMID: 20300954 DOI: 10.1007/s10856-010-4036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
Stitch suture is still the most recommended method to hold a nerve-guide in place but stitch suture is a well known cause of local inflammatory response. Glues of several kinds have been proposed as an alternative but they are not easy to apply in a real surgical setting. In 2006 authors developed a new concept of nerve-guide termed "NeuroBox" which is double-halved, not-degradable and rigid, and allows the use of cyanoacrylic glues. In this study, Authors analyzed histologically the nerve-glue interface. Wistar rats were used as animal model. In group 1, animals were implanted a NeuroBox to promote the regeneration of an experimentally produced 4 mm gap in the sciatic nerve. In group 2, the gap was left without repair ("sham-operated" group). Group 3 was assembled by harvesting 10 contralateral intact nerves to document the normal anatomy. Semi-thin sections for visible light microscopy and ultra-thin sections for Transmission Electron Microscopy were analyzed. Results showed that application of ethyl-2-cyanoacrylate directly to the epineurium produced no significative insult to the underlining nerve fibers nor impaired nerve regeneration. No regeneration occurred in the "sham-operated" group.
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Affiliation(s)
- A Merolli
- Orthopaedics and Hand Surgery Unit, The Catholic University School of Medicine in Rome, Complesso "Columbus", via Moscati 31, 00168 Rome, Italy.
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Abstract
Peripheral nerve regeneration is a complicated and long-term medical challenge that requires suitable guides for bridging nerve injury gaps and restoring nerve functions. Many natural and synthetic polymers have been used to fabricate nerve conduits as well as luminal fillers for achieving desired nerve regenerative functions. It is important to understand the intrinsic properties of these polymers and techniques that have been used for fabricating nerve conduits. Previously extensive reviews have been focused on the biological functions and in vivo performance of polymeric nerve conduits. In this paper, we emphasize on the structures, thermal and mechanical properties of these naturally derived synthetic polymers, and their fabrication methods. These aspects are critical for the performance of fabricated nerve conduits. By learning from the existing candidates, we can advance the strategies for designing novel polymeric systems with better properties for nerve regeneration.
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Meek MF, Den Dunnen WFA. Porosity of the wall of a Neurolac nerve conduit hampers nerve regeneration. Microsurgery 2009; 29:473-8. [PMID: 19308952 DOI: 10.1002/micr.20642] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One way to improve nerve regeneration and bridge longer nerve gaps may be the use of semipermeable/porous conduits. With porosity less biomaterial is used for the nerve conduit. We evaluated the short-term effects of porous Neurolac nerve conduits for in vivo peripheral nerve regeneration. In 10 male Black Hooded rats, a gap of 10 mm was bridged by a porous Neurolac nerve conduit. Evaluation point ranged from 3 to 12 weeks. The sciatic nerve function was not measurable due to automutilation and flexion contractures. The gait-stance duration showed no improvement with time, indicating a disturbed walking pattern. The nerve guides showed very fast degradation with swelling, fragmentation, and collapse. Furthermore, a severe foreign body reaction occurred. Nerve regeneration was severely hampered. This study showed no beneficial effects of porous Neurolac nerve conduits when compared with previous findings with nonporous copolymeric nerve guides of a slightly different composition.
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Affiliation(s)
- Marcel F Meek
- Department of Plastic and Hand Surgery, Scheper Hospital, Boermarkeweg 60, Emmen, The Netherlands. marcelfmeek@hotmail. com
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Jiang X, Lim SH, Mao HQ, Chew SY. Current applications and future perspectives of artificial nerve conduits. Exp Neurol 2009; 223:86-101. [PMID: 19769967 DOI: 10.1016/j.expneurol.2009.09.009] [Citation(s) in RCA: 268] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/09/2009] [Accepted: 09/11/2009] [Indexed: 12/27/2022]
Abstract
Artificial nerve guide conduits have the advantage over autografts in terms of their availability and ease of fabrication. However, clinical outcomes associated with the use of artificial nerve conduits are often inferior to that of autografts, particularly over long lesion gaps. There have been significant advances in the designs of artificial nerve conduits over the years. In terms of materials selection and design, a wide variety of new synthetic polymers and biopolymers have been evaluated. The inclusion of nerve conduit lumen fillers has also been demonstrated as essential to enable nerve regeneration across large defect gaps. These lumen filler designs have involved the integration of physical cues for contact guidance and biochemical signals to control cellular function and differentiation. Novel conduit architectural designs using porous and fibrous substrates have also been developed. This review highlights the recent advances in synthetic nerve guide designs for peripheral nerve regeneration, and the in vivo applicability and future prospects of these nerve guide conduits.
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Affiliation(s)
- Xu Jiang
- School of Chemical & Biomedical Engineering, Nanyang Technological University, 62 Nanyang Drive, Block N1.2-B2-20, Singapore 637459, Singapore
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Chang CJ. The Effect of Pulse-Released Nerve Growth Factor from Genipin-Crosslinked Gelatin in Schwann Cell–Seeded Polycaprolactone Conduits on Large-Gap Peripheral Nerve Regeneration. Tissue Eng Part A 2009; 15:547-57. [DOI: 10.1089/ten.tea.2007.0342] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chiono V, Tonda-Turo C, Ciardelli G. Chapter 9: Artificial scaffolds for peripheral nerve reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:173-98. [PMID: 19682638 DOI: 10.1016/s0074-7742(09)87009-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Posttraumatic peripheral nerve repair is one of the major challenges in restorative medicine and microsurgery. Despite the recent progresses in the field of tissue engineering, functional recovery after severe nerve lesions is generally partial and unsatisfactory. Autograft is still the best method to treat peripheral nerve lesions, although it has several drawbacks and does not allow complete functional recovery. Full recovery of nerve functionality could ideally be achieved by proper guiding axon regeneration toward the original target tissues, through the use of purposely engineered artificial nerve guidance channels (NGCs). In the last decade, artificial NGCs have been produced using a variety of both natural and synthetic, biodegradable and nonbiodegradable polymers. Several techniques have been developed to obtain porous and nonporous NGCs and to realize and incorporate bioactive fillers for NGCs. Some of the developed products have been approved for clinical applications. Many other NGC typologies have been object of interest and are currently under investigation. The current trend of nerve tissue engineering is the realization of biomimetic NGCs, providing chemotactic, topological, and haptotactic signalling to cells, respectively by surface functionalization with cell binding domains, the use of internal-oriented matrices/fibres and the sustained release of neurotrophic factors. The present contribution provides a balanced integration of the most recent achievements of tissue engineering in the field of peripheral nerve repair. By an accurate evaluation of the status of research, the review delineates the most promising directions to which research should address for consistent progress in the field of peripheral nerve repair.
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Affiliation(s)
- Valeria Chiono
- Department of Mechanics, Politecnico di Torino, Torino, Italy
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Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:141-72. [PMID: 19682637 DOI: 10.1016/s0074-7742(09)87008-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite the progress in understanding the pathophysiology of peripheral nervous system injury and regeneration, as well as advancements in microsurgical techniques, peripheral nerve injuries are still a major challenge for reconstructive surgeons. Thorough knowledge of anatomy, pathophysiology, and surgical reconstruction is a prerequisite of proper peripheral nerve injury management. This chapter reviews the currently available surgical treatment options for different types of nerve injuries in clinical conditions. In overview of direct nerve repair, various end-to-end coaptation techniques and the role of end-to-side repair for proximal nerve injuries is described. When primary repair cannot be performed without undue tension, nerve grafting or tubulization techniques are required. Current gold standard for bridging nerve gaps is nerve autografting. However, disadvantages of this approach, such as donor site morbidity and limited length of available graft material encouraged the search for alternative means of nerve gap reconstruction. Nerve allografting was introduced for repair of extensive nerve injuries. Tubulization techniques with natural or artificial conduits are applicable as an alternative for bridging short nerve defects without the morbidities associated with harvesting of autologous nerve grafts. Achieving better outcomes depends both on the advancements in microsurgical techniques and introduction of molecular biology discoveries into clinical practice. The field of peripheral nerve research is dynamically developing and concentrates on more sophisticated approaches tested at the basic science level. Future directions in peripheral nerve reconstruction including, tolerance induction and minimal immunosuppression for nerve allografting, cell based supportive therapies and bioengineering of nerve conduits are also reviewed in this chapter.
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Affiliation(s)
- Maria Siemionow
- Cleveland Clinic, Department of Plastic Surgery, Cleveland, Ohio 44195, USA
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Ichihara S, Inada Y, Nakamura T. Artificial nerve tubes and their application for repair of peripheral nerve injury: an update of current concepts. Injury 2008; 39 Suppl 4:29-39. [PMID: 18804584 DOI: 10.1016/j.injury.2008.08.029] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the last 20 years, an increasing number of research articles have reported on the use of artificial nerve tubes to repair nerve defects. The development of an artificial nerve tube as an alternative to autogenous nerve grafting is currently a focus of interest for peripheral nerve repair. The clinical employment of tubes as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. Numerous studies indicate that short-distance defects in humans can be successfully treated by implantation of artificial nerve guides. This review provides a brief overview of various preclinical and clinical trials conducted to evaluate the utility of artificial nerve tubes for the regeneration of peripheral nerves. This review is also intended to help update hand surgeons on the rapid advances in tubulization techniques, and to provide them with indications of the various directions toward which future research can proceed. Future studies need to provide us with as much comparative information as possible on the effectiveness of different tubulization techniques, in order to guide the surgeon in choosing the best indications for their optimal clinical employment. Future progress in implant development can be expected from interdisciplinary approaches involving both materials and life sciences, leading to advances in neuro-tissue engineering that will be needed to effectively treat larger nerve defects.
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Affiliation(s)
- Satoshi Ichihara
- Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
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