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Leckenby J, Sweitzer K, Olsen T, Mayorga-Young D, Milek D, Grobbelaar A. Current Treatments and Future Directions for Facial Paralysis. Facial Plast Surg 2024. [PMID: 38955219 DOI: 10.1055/a-2358-9401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Facial palsy is a condition that affects the facial nerve, the seventh of the 12 cranial nerves. Its main function is to control the muscles of facial expression. This involves the ability to express emotion through controlling the position of the mouth, the eyebrow, nostrils, and eye closure. The facial nerve also plays a key role in maintaining the posture of the mouth and as such, people with facial paralysis often have problems with drooling, speech, and dental hygiene.Due to the devastating effects on the quality of life of individuals with facial palsy, there are a multitude of various treatment options for the paralyzed face. This article reviews current management strategies and points towards promising future directions for research in the field of facial reanimation.
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Affiliation(s)
- Jonathan Leckenby
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, New York
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Sick Children, London, United Kingdom
| | - Keith Sweitzer
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, New York
| | - Timothy Olsen
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, New York
| | - Danielle Mayorga-Young
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, New York
| | - David Milek
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, New York
| | - Adriaan Grobbelaar
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Sick Children, London, United Kingdom
- Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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Bertelli JA, Rosa ICN, Ghizoni MF. Retrograde peripheral nerve regeneration from sensory to motor pathways in rats: a new experimental concept in nerve repair. Neurol Res 2024; 46:125-131. [PMID: 37729085 DOI: 10.1080/01616412.2023.2258039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The polarity of nerve grafts does not interfere with axon growth. Our goal was to investigate whether axons can regenerate in a retrograde fashion within sensory pathways and then extend into motor pathways, leading to muscle reinnervation. METHODS Fifty-four rats were randomized into four groups. In Group 1, the ulnar nerve was connected end-to-end to the superficial radial nerve after neurectomy of the radial nerve in the axilla. In Group 2, the ulnar nerve was connected end-to-end to the radial nerve distal to the humerus; the radial nerve then was divided in the axilla. In Group 3, the radial nerve was divided in the axilla, but no nerve reconstruction was performed. In Group 4, the radial nerve was crushed in the axilla. Over 6 months, we behaviorally assessed the recovery of toe spread in the right operated-upon forepaw by lifting the rat by its tail and lowering it onto a flat surface. Six months after surgery, rats underwent reoperation, nerve transfers were tested electrophysiologically, and the posterior interosseous nerve (PIN) was removed for histological evaluation. RESULTS Rats in the crush group recovered toe spread between 5 and 8 days after surgery. Rats with nerve transfers demonstrated electrophysiological and histological findings of nerve regeneration but no behavioral recovery. CONCLUSIONS Ulnar nerve axons regrew into the superficial radial nerve and then into the PIN to reinnervate the extensor digitorum communis. We were unable to demonstrate behavioral recovery because rats cannot readapt to cross-nerve transfer.
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Affiliation(s)
- Jayme A Bertelli
- Department of Surgery in lieu of Department of Surgical Techniques, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Isadora Carvalho Nunes Rosa
- Center of Biological and Health Sciences, University of the South of Santa Catarina (UNISUL), Tubarão, Santa Catarina, Brazil
| | - Marcos F Ghizoni
- Department of Neurosurgery, Center of Biological and Health Sciences, University of the South of Santa Catarina (UNISUL), Tubarão, Santa Catarina, Brazil
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Chen S, Gil CJ, Ning L, Jin L, Perez L, Kabboul G, Tomov ML, Serpooshan V. Adhesive Tissue Engineered Scaffolds: Mechanisms and Applications. Front Bioeng Biotechnol 2021; 9:683079. [PMID: 34354985 PMCID: PMC8329531 DOI: 10.3389/fbioe.2021.683079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
A variety of suture and bioglue techniques are conventionally used to secure engineered scaffold systems onto the target tissues. These techniques, however, confront several obstacles including secondary damages, cytotoxicity, insufficient adhesion strength, improper degradation rate, and possible allergic reactions. Adhesive tissue engineering scaffolds (ATESs) can circumvent these limitations by introducing their intrinsic tissue adhesion ability. This article highlights the significance of ATESs, reviews their key characteristics and requirements, and explores various mechanisms of action to secure the scaffold onto the tissue. We discuss the current applications of advanced ATES products in various fields of tissue engineering, together with some of the key challenges for each specific field. Strategies for qualitative and quantitative assessment of adhesive properties of scaffolds are presented. Furthermore, we highlight the future prospective in the development of advanced ATES systems for regenerative medicine therapies.
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Affiliation(s)
- Shuai Chen
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Carmen J. Gil
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Liqun Ning
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Linqi Jin
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Lilanni Perez
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Gabriella Kabboul
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Martin L. Tomov
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Vahid Serpooshan
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Children’s Healthcare of Atlanta, Atlanta, GA, United States
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4
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Van Nest DS, Kahan DM, Ilyas AM. Polyethylene Glycol Fusion of Nerve Injuries: Review of the Technique and Clinical Applicability. J Hand Microsurg 2020; 13:49-54. [PMID: 33867761 PMCID: PMC8041495 DOI: 10.1055/s-0040-1718651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Traumatic peripheral nerve injuries present a particular challenge to hand surgeons as mechanisms of nerve-healing pose serious limitations to achieving complete functional recovery. The loss of distal axonal segments through Wallerian degeneration results in the loss of neuromuscular junctions and irreversible muscle atrophy. Current methods of repair depend on the outgrowth of proximal nerve fibers following direct end-to-end repair or gap repair techniques. Investigational techniques in nerve repair using polyethylene glycol (PEG) nerve fusion have been shown to bypass Wallerian degeneration by immediately restoring nerve axonal continuity, thus resulting in a rapid and more complete functional recovery. The purpose of this article is to review the current literature surrounding this novel technique for traumatic nerve repair, paying particular attention to the underlying physiology of nerve healing and the current applications of PEG fusion in the laboratory and clinical setting. This article also serves to identify areas of future investigation to further establish validity and feasibility and encourage the translation of PEG fusion into clinical use.
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Affiliation(s)
- Duncan S Van Nest
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - David M Kahan
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M Ilyas
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Smith TA, Ghergherehchi CL, Mikesh M, Shores JT, Tucker HO, Bittner GD. Polyethylene glycol-fusion repair of sciatic allografts in female rats achieves immunotolerance via attenuated innate and adaptive responses. J Neurosci Res 2020; 98:2468-2495. [PMID: 32931034 DOI: 10.1002/jnr.24720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Ablation/segmental loss peripheral nerve injuries (PNIs) exhibit poor functional recovery due to slow and inaccurate outgrowth of regenerating axons. Viable peripheral nerve allografts (PNAs) as growth-guide conduits are immunologically rejected and all anucleated donor/host axonal segments undergo Wallerian degeneration. In contrast, we report that ablation-type sciatic PNIs repaired by neurorrhaphy of viable sciatic PNAs and a polyethylene glycol (PEG)-fusion protocol using PEG immediately restored axonal continuity for many axons, reinnervated/maintained their neuromuscular junctions, and prevented much Wallerian degeneration. PEG-fused PNAs permanently restored many sciatic-mediated behaviors within 2-6 weeks. PEG-fused PNAs were not rejected even though host/donors were neither immunosuppressed nor tissue-matched in outbred female Sprague Dawley rats. Innate and adaptive immune responses to PEG-fused sciatic PNAs were analyzed using electron microscopy, immunohistochemistry, and quantitative reverse transcription polymerase chain reaction for morphological features, T cell and macrophage infiltration, major histocompatibility complex (MHC) expression, apoptosis, expression of cytokines, chemokines, and cytotoxic effectors. PEG-fused PNAs exhibited attenuated innate and adaptive immune responses by 14-21 days postoperatively, as evidenced by (a) many axons and cells remaining viable, (b) significantly reduced infiltration of cytotoxic and total T cells and macrophages, (c) significantly reduced expression of inflammatory cytokines, chemokines, and MHC proteins, (d) consistently low apoptotic response. Morphologically and/or biochemically, PEG-fused sciatic PNAs often resembled sciatic autografts or intact sciatic nerves. In brief, PEG-fused PNAs are an unstudied, perhaps unique, example of immune tolerance of viable allograft tissue in a nonimmune-privileged environment and could greatly improve the clinical outcomes for PNIs relative to current protocols.
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Affiliation(s)
- Tyler A Smith
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | | | - Michelle Mikesh
- Department of Neuroscience, University of Texas at Austin, Austin, TX, USA
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haley O Tucker
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - George D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, TX, USA
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6
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Brown BL, Sandelski MM, Drejet SM, Runge EM, Shipchandler TZ, Jones KJ, Walker CL. Facial nerve repair utilizing intraoperative repair strategies. Laryngoscope Investig Otolaryngol 2020; 5:552-559. [PMID: 32596500 PMCID: PMC7314485 DOI: 10.1002/lio2.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To determine whether functional and anatomical outcomes following suture neurorrhaphy are improved by the addition of electrical stimulation with or without the addition of polyethylene glycol (PEG). METHODS In a rat model of facial nerve injury, complete facial nerve transection and repair was performed via (a) suture neurorrhaphy alone, (b) neurorrhaphy with the addition of brief (30 minutes) intraoperative electrical stimulation, or (c) neurorrhaphy with the addition electrical stimulation and PEG. Functional recovery was assessed weekly for 16 weeks. At 16 weeks postoperatively, motoneuron survival, amount of regrowth, and specificity of regrowth were assessed by branch labeling and tissue analysis. RESULTS The addition of brief intraoperative electrical stimulation improved all functional outcomes compared to suturing alone. The addition of PEG to electrical stimulation impaired this benefit. Motoneuron survival, amount of regrowth, and specificity of regrowth were unaltered at 16 weeks postoperative in all treatment groups. CONCLUSION The addition of brief intraoperative electrical stimulation to neurorrhaphy in this rodent model shows promising neurological benefit in the surgical repair of facial nerve injury. LEVEL OF EVIDENCE Animal study.
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Affiliation(s)
- Brandon L. Brown
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Anatomical Sciences and NeurobiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Morgan M. Sandelski
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sarah M. Drejet
- Department of OtolaryngologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Elizabeth M. Runge
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Taha Z. Shipchandler
- Department of OtolaryngologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kathryn J. Jones
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Research and Development ServiceRichard L Roudebush Veterans Affairs Medical CenterIndianapolisIndianaUSA
| | - Chandler L. Walker
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Research and Development ServiceRichard L Roudebush Veterans Affairs Medical CenterIndianapolisIndianaUSA
- Department of Biomedical Sciences and Comprehensive CareIndiana University School of DentistryIndianapolisIndianaUSA
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Brown BL, Asante T, Welch HR, Sandelski MM, Drejet SM, Shah K, Runge EM, Shipchandler TZ, Jones KJ, Walker CL. Functional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat Model. JAMA FACIAL PLAST SU 2020; 21:61-68. [PMID: 29800078 DOI: 10.1001/jamafacial.2018.0308] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Functional and anatomical outcomes after surgical repair of facial nerve injury may be improved with the addition of polyethylene glycol (PEG) to direct suture neurorrhaphy. The application of PEG has shown promise in treating spinal nerve injuries, but its efficacy has not been evaluated in treatment of cranial nerve injuries. Objective To determine whether PEG in addition to neurorrhaphy can improve functional outcomes and synkinesis after facial nerve injury. Design, Setting, and Subjects In this animal experiment, 36 rats underwent right facial nerve transection and neurorrhaphy with addition of PEG. Weekly behavioral scoring was done for 10 rats for 6 weeks and 14 rats for 16 weeks after the operations. In the 16-week study, the buccal branches were labeled and tissue analysis was performed. In the 6-week study, the mandibular and buccal branches were labeled and tissue analysis was performed. Histologic analysis was performed for 10 rats in a 1-week study to assess the association of PEG with axonal continuity and Wallerian degeneration. Six rats served as the uninjured control group. Data were collected from February 8, 2016, through July 10, 2017. Intervention Polyethylene glycol applied to the facial nerve after neurorrhaphy. Main Outcomes and Measures Functional recovery was assessed weekly for the 16- and 6-week studies, as well as motoneuron survival, amount of regrowth, specificity of regrowth, and aberrant branching. Short-term effects of PEG were assessed in the 1-week study. Results Among the 40 male rats included in the study, PEG addition to neurorrhaphy showed no functional benefit in eye blink reflex (mean [SEM], 3.57 [0.88] weeks; 95% CI, -2.8 to 1.9 weeks; P = .70) or whisking function (mean [SEM], 4.00 [0.72] weeks; 95% CI, -3.6 to 2.4 weeks; P = .69) compared with suturing alone at 16 weeks. Motoneuron survival was not changed by PEG in the 16-week (mean, 132.1 motoneurons per tissue section; 95% CI, -21.0 to 8.4; P = .13) or 6-week (mean, 131.1 motoneurons per tissue section; 95% CI, -11.0 to 10.0; P = .06) studies. Compared with controls, neither surgical group showed differences in buccal branch regrowth at 16 (36.9 motoneurons per tissue section; 95% CI, -14.5 to 22.0; P = .28) or 6 (36.7 motoneurons per tissue section; 95% CI, -7.8 to 18.5; P = .48) weeks or in the mandibular branch at 6 weeks (25.2 motoneurons per tissue section; 95% CI, -14.5 to 15.5; P = .99). Addition of PEG had no advantage in regrowth specificity compared with suturing alone at 16 weeks (15.3% buccal branch motoneurons with misguided projections; 95% CI, -7.2% to 11.0%; P = .84). After 6 weeks, the number of motoneurons with misguided projections to the mandibular branch showed no advantage of PEG treatment compared with suturing alone (12.1% buccal branch motoneurons with misguided projections; 95% CI, -8.2% to 9.2%; P = .98). In the 1-week study, improved axonal continuity and muscular innervation were not observed in PEG-treated rats. Conclusions and Relevance Although PEG has shown efficacy in treating other nervous system injuries, PEG in addition to neurorraphy was not beneficial in a rat model of facial nerve injury. The addition of PEG to suturing may not be warranted in the surgical repair of facial nerve injury. Level of Evidence NA.
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Affiliation(s)
- Brandon L Brown
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky
| | - Tony Asante
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Haley R Welch
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Morgan M Sandelski
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Sarah M Drejet
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - Kishan Shah
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Elizabeth M Runge
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Taha Z Shipchandler
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - Kathryn J Jones
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.,Research and Development Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Chandler L Walker
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.,Research and Development Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Department of Biomedical and Applied Sciences, Indiana University School of Dentistry, Indianapolis
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Amani H, Kazerooni H, Hassanpoor H, Akbarzadeh A, Pazoki-Toroudi H. Tailoring synthetic polymeric biomaterials towards nerve tissue engineering: a review. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2020; 47:3524-3539. [PMID: 31437011 DOI: 10.1080/21691401.2019.1639723] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The nervous system is known as a crucial part of the body and derangement in this system can cause potentially lethal consequences or serious side effects. Unfortunately, the nervous system is unable to rehabilitate damaged regions following seriously debilitating disorders such as stroke, spinal cord injury and brain trauma which, in turn, lead to the reduction of quality of life for the patient. Major challenges in restoring the damaged nervous system are low regenerative capacity and the complexity of physiology system. Synthetic polymeric biomaterials with outstanding properties such as excellent biocompatibility and non-immunogenicity find a wide range of applications in biomedical fields especially neural implants and nerve tissue engineering scaffolds. Despite these advancements, tailoring polymeric biomaterials for design of a desired scaffold is fundamental issue that needs tremendous attention to promote the therapeutic benefits and minimize adverse effects. This review aims to (i) describe the nervous system and related injuries. Then, (ii) nerve tissue engineering strategies are discussed and (iii) physiochemical properties of synthetic polymeric biomaterials systematically highlighted. Moreover, tailoring synthetic polymeric biomaterials for nerve tissue engineering is reviewed.
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Affiliation(s)
- Hamed Amani
- Department of Medical Nanotechnology, Faculty of Advanced Technologies in Medicine, Iran University of Medical Science , Tehran , Iran
| | - Hanif Kazerooni
- Biotechnology Group, Department of Chemical Engineering, Amirkabir University of Technology (Tehran Polytechnic) , Tehran , Iran
| | - Hossein Hassanpoor
- Department of Cognitive Science, Dade Pardazi, Shenakht Mehvar, Atynegar (DSA) Institute , Tehran , Iran
| | - Abolfazl Akbarzadeh
- Department of Medical Nanotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hamidreza Pazoki-Toroudi
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences , Tehran , Iran
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9
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Paskal AM, Paskal W, Pietruski P, Kusmierczyk Z, Jankowska-Steifer E, Andrychowski J, Wlodarski PK. Neuroregenerative effects of polyethylene glycol and FK-506 in a rat model of sciatic nerve injury. J Plast Reconstr Aesthet Surg 2019; 73:222-230. [PMID: 31759923 DOI: 10.1016/j.bjps.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 09/29/2019] [Accepted: 10/05/2019] [Indexed: 01/25/2023]
Abstract
The recently introduced polyethylene glycol (PEG) treatment restores axonal continuity after nerve injury, leading to rapid recovery of nerve function. The impact of PEG therapy on neuroregeneration has not yet been compared with any intervention with an established proneuroregenerative potential. FK-506 is an immunosuppressive agent with documented proneuroregenerative potential in nerve injury models. The aim of this study was to compare the effects of PEG therapy and preinjury FK-506 administration in rats with sciatic nerve transection injury. Four groups of male Sprague Dawley rats (seven per group) underwent sciatic nerve transection with primary repair. Group A received placebo injections, group B placebo injections and PEG treatment, group C FK-506 injections, and group D both FK-506 injections and PEG treatment. Clinical outcomes were assessed by the skin prick test and Sciatic Functional Index (SFI). Regenerated nerves underwent histomorphometric analysis. The histomorphometric analysis demonstrated that compared with the controls, nerve specimens from all treated groups showed signs of enhanced neuroregeneration (higher mean axonal area) (p < 0.001). The histomorphometric parameters for group D (PEG + FK-506), mean axonal area (p < 0.001) and axonal count (p > 0.05), were significantly better than those in the other study groups. The Form factor was closest to its optimal values in group B (p < 0.0001). At the end of the study, mean skin prick test scores in all treated groups were significantly higher than those in controls (p > 0.05). During the first postoperative week, PEG-treated rats (groups B and D) presented with higher values of the SFI than animals from groups A and C, but the difference was not statistically significant. Combined therapy with PEG and FK-506 seems to produce better neuroregeneration outcomes than a simple suture-based repair complemented with either PEG or FK-506 treatment.
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Affiliation(s)
- Adriana M Paskal
- Department of Methodology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Wiktor Paskal
- Department of Methodology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland.
| | - Piotr Pietruski
- Timeless Plastic Surgery Clinic, gen. Romana Abrahama 18/322, 03-982 Warsaw, Poland
| | - Zofia Kusmierczyk
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Ewa Jankowska-Steifer
- Department of Histology and Embryology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland.
| | - Jaroslaw Andrychowski
- Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland.
| | - Pawel K Wlodarski
- Department of Methodology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland.
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10
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Zhao X, Li B, Guan X, Sun G, Zhang M, Zhang W, Xu J, Ren X. Peg-Enhanced Behavioral Recovery After Sciatic Nerve Transection and Either Suturing Or Sleeve Conduit Deployment in Rats. J INVEST SURG 2019; 34:524-533. [PMID: 31438740 DOI: 10.1080/08941939.2019.1654047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Polyethylene glycol (PEG) has previously been reported to improve outcomes of peripheral nerve microsuturing. However, recent studies have challenged this finding. Given its clinical importance, we investigated the potential of PEG as a facilitator of peripheral nerve restoration. The sciatic nerve of 144 rats was transected and submitted either to simple suturing (Group A), PEG-enhanced suturing (Group B), and insertion in an arterial sleeve conduit without PEG (Group C), or with PEG (Group D) in equal numbers. Behavioral recovery was assessed with the sciatic function index (SFI). Nerve impulse conduction was assessed with compound muscle action potentials (CMAPs). Histology comprised standard hematoxylin/eosin staining, electron microscopy and glial cell line-derived neurotrophic factor (GDNF) immunohistochemistry. Expression of GDNF was also assessed with western blotting. Results were evaluated at weeks 1, 4, and 8. PEG treatment significantly improved behavioral recovery and morphology of nerve restoration, particularly in the sleeve conduit group, relative to that of controls. In conclusion, PEG may improve outcomes of peripheral nerve reconstruction.
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Affiliation(s)
- Xin Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiangchen Guan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyin Sun
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mingzhe Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weihua Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junfeng Xu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoping Ren
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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11
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Ren X, Kim CY, Canavero S. Bridging the gap: Spinal cord fusion as a treatment of chronic spinal cord injury. Surg Neurol Int 2019; 10:51. [PMID: 31528389 PMCID: PMC6743693 DOI: 10.25259/sni-19-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 12/15/2022] Open
Abstract
Despite decades of animal experimentation, human translation with cell grafts, conduits, and other strategies has failed to cure patients with chronic spinal cord injury (SCI). Recent data show that motor deficits due to spinal cord transection in animal models can be reversed by local application of fusogens, such as Polyethylene glycol (PEG). Results proved superior at short term over all other treatments deployed in animal studies, opening the way to human trials. In particular, removal of the injured spinal cord segment followed by PEG fusion of the two ends along with vertebral osteotomy to shorten the spine holds the promise for a cure in many cases.
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Affiliation(s)
- Xiaoping Ren
- Hand and Microsurgery Center, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, China
- State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Nangang, Harbin, China
- Heilongjiang Medical Science Institute, Harbin Medical University, Nangang, Harbin, China
| | - C-Yoon Kim
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, Korea
| | - Sergio Canavero
- HEAVEN-GEMINI International Collaborative Group, Turin, Italy
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Paskal AM, Paskal W, Pietruski P, Wlodarski PK. Polyethylene Glycol: The Future of Posttraumatic Nerve Repair? Systemic Review. Int J Mol Sci 2019; 20:E1478. [PMID: 30909624 PMCID: PMC6471459 DOI: 10.3390/ijms20061478] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
Peripheral nerve injury is a common posttraumatic complication. The precise surgical repair of nerve lesion does not always guarantee satisfactory motor and sensory function recovery. Therefore, enhancement of the regeneration process is a subject of many research strategies. It is believed that polyethylene glycol (PEG) mediates axolemmal fusion, thus enabling the direct restoration of axon continuity. It also inhibits Wallerian degeneration and recovers nerve conduction. This systemic review, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, describes and summarizes published studies on PEG treatment efficiency in various nerve injury types and repair techniques. Sixteen original experimental studies in animal models and one in humans were analyzed. PEG treatment superiority was reported in almost all experiments (based on favorable electrophysiological, histological, or behavioral results). To date, only one study attempted to transfer the procedure into the clinical phase. However, some technical aspects, e.g., the maximal delay between trauma and successful treatment, await determination. PEG therapy is a promising prospect that may improve the surgical treatment of peripheral nerve injuries in the clinical practice.
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Affiliation(s)
- Adriana M Paskal
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, Banacha 1B, 02-091 Warsaw, Poland.
| | - Wiktor Paskal
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, Banacha 1B, 02-091 Warsaw, Poland.
| | - Piotr Pietruski
- Timeless Plastic Surgery Clinic, gen. Romana Abrahama 18/322, 03-982 Warsaw, Poland.
| | - Pawel K Wlodarski
- Laboratory of Centre for Preclinical Research, Department of Research Methodology, Medical University of Warsaw, Banacha 1B, 02-091 Warsaw, Poland.
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Ghergherehchi CL, Mikesh M, Sengelaub DR, Jackson DM, Smith T, Nguyen J, Shores JT, Bittner GD. Polyethylene glycol (PEG) and other bioactive solutions with neurorrhaphy for rapid and dramatic repair of peripheral nerve lesions by PEG-fusion. J Neurosci Methods 2018; 314:1-12. [PMID: 30586569 DOI: 10.1016/j.jneumeth.2018.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Nervous system injuries in mammals often involve transection or segmental loss of peripheral nerves. Such injuries result in functional (behavioral) deficits poorly restored by naturally occurring 1-2 mm/d axonal outgrowths aided by primary repair or reconstruction. "Neurorrhaphy" or nerve repair joins severed connective tissues, but not severed cytoplasmic/plasmalemmal extensions (axons) within the tissue. NEW METHOD PEG-fusion consists of neurorrhaphy combined with a well-defined sequence of four pharmaceutical agents in solution, one containing polyethylene glycol (PEG), applied directly to closely apposed viable ends of severed axons. RESULTS PEG-fusion of rat sciatic nerves: (1) restores axonal continuity across coaptation site(s) within minutes, (2) prevents Wallerian degeneration of many distal severed axons, (3) preserves neuromuscular junctions, (4) prevents target muscle atrophy, (5) produces rapid and improved recovery of voluntary behaviors compared with neurorrhaphy alone, and (6) PEG-fused allografts are not rejected, despite no tissue-matching nor immunosuppression. COMPARISON WITH EXISTING METHODS If PEG-fusion protocols are not correctly executed, the results are similar to that of neurorrhaphy alone: (1) axonal continuity across coaptation site(s) is not re-established, (2) Wallerian degeneration of all distal severed axons rapidly occurs, (3) neuromuscular junctions are non-functional, (4) target muscle atrophy begins within weeks, (5) recovery of voluntary behavior occurs, if ever, after months to levels well-below that observed in unoperated animals, and (6) allografts are either rejected or not well-accepted. CONCLUSION PEG-fusion produces rapid and dramatic recovery of function following rat peripheral nerve injuries.
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Affiliation(s)
| | - Michelle Mikesh
- Department of Neuroscience, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Dale R Sengelaub
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, 47405, USA.
| | | | - Tyler Smith
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Jacklyn Nguyen
- Department of Neuroscience, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, Ross Research Building 749D, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
| | - George D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, TX, 78712, USA.
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Abstract
The principal focus of this paper is to consider the implications of head and neck transplantation surgery on the issue of personal identity. To this end, it is noted that the immune system has not only been established to impose a level of self-identity on bodily cells, it has also been implicated in mental development and the regulation of mental state. In this it serves as a paradigm for the mind as the product of cephalic and extracephalic systems. The importance of bodily systems in identity is then discussed in relation to phantom tissue syndrome. The data strongly indicate that, even if surgically successful, head and neck transplantation will result in the loss of the continuity of personal identity.
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Yi S, Xu L, Gu X. Scaffolds for peripheral nerve repair and reconstruction. Exp Neurol 2018; 319:112761. [PMID: 29772248 DOI: 10.1016/j.expneurol.2018.05.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/05/2018] [Accepted: 05/13/2018] [Indexed: 12/22/2022]
Abstract
Trauma-associated peripheral nerve defect is a widespread clinical problem. Autologous nerve grafting, the current gold standard technique for the treatment of peripheral nerve injury, has many internal disadvantages. Emerging studies showed that tissue engineered nerve graft is an effective substitute to autologous nerves. Tissue engineered nerve graft is generally composed of neural scaffolds and incorporating cells and molecules. A variety of biomaterials have been used to construct neural scaffolds, the main component of tissue engineered nerve graft. Synthetic polymers (e.g. silicone, polyglycolic acid, and poly(lactic-co-glycolic acid)) and natural materials (e.g. chitosan, silk fibroin, and extracellular matrix components) are commonly used along or together to build neural scaffolds. Many other materials, including the extracellular matrix, glass fabrics, ceramics, and metallic materials, have also been used to construct neural scaffolds. These biomaterials are fabricated to create specific structures and surface features. Seeding supporting cells and/or incorporating neurotrophic factors to neural scaffolds further improve restoration effects. Preliminary studies demonstrate that clinical applications of these neural scaffolds achieve satisfactory functional recovery. Therefore, tissue engineered nerve graft provides a good alternative to autologous nerve graft and represents a promising frontier in neural tissue engineering.
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Affiliation(s)
- Sheng Yi
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Lai Xu
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Xiaosong Gu
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
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Mikesh M, Ghergherehchi CL, Hastings RL, Ali A, Rahesh S, Jagannath K, Sengelaub DR, Trevino RC, Jackson DM, Bittner GD. Polyethylene glycol solutions rapidly restore and maintain axonal continuity, neuromuscular structures, and behaviors lost after sciatic nerve transections in female rats. J Neurosci Res 2018; 96:1223-1242. [PMID: 29659058 DOI: 10.1002/jnr.24225] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
Complete severance of major peripheral mixed sensory-motor nerve proximally in a mammalian limb produces immediate loss of action potential conduction and voluntary behaviors mediated by the severed distal axonal segments. These severed distal segments undergo Wallerian degeneration within days. Denervated muscles atrophy within weeks. Slowly regenerating (∼1 mm/day) outgrowths from surviving proximal stumps that often nonspecifically reinnervate denervated targets produce poor, if any, restoration of lost voluntary behaviors. In contrast, in this study using completely transected female rat sciatic axons as a model system, we provide extensive morphometric, immunohistochemical, electrophysiological, and behavioral data to show that these adverse outcomes are avoided by microsuturing closely apposed axonal cut ends (neurorrhaphy) and applying a sequence of well-specified solutions, one of which contains polyethylene glycol (PEG). This "PEG-fusion" procedure within minutes reestablishes axoplasmic and axolemmal continuity and signaling by nonspecifically fusing (connecting) closely apposed open ends of severed motor and/or sensory axons at the lesion site. These PEG-fused axons continue to conduct action potentials and generate muscle action potentials and muscle twitches for months and do not undergo Wallerian degeneration. Continuously innervated muscle fibers undergo much less atrophy compared with denervated muscle fibers. Dramatic behavioral recovery to near-unoperated levels occurs within days to weeks, almost certainly by activating many central nervous system and peripheral nervous system synaptic and other plasticities, some perhaps to a greater extent than most neuroscientists would expect. Negative control transections in which neurorrhaphy and all solutions except the PEG-containing solution are applied produce none of these remarkably fortuitous outcomes observed for PEG-fusion.
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Affiliation(s)
- Michelle Mikesh
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | | | | | - Amir Ali
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - Sina Rahesh
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - Karthik Jagannath
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - Dale R Sengelaub
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Richard C Trevino
- Department of Orthopedic Surgery, Wellspan Teaching Hospitals, York, Pennsylvania
| | | | - George D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
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Mikesh M, Ghergherehchi CL, Rahesh S, Jagannath K, Ali A, Sengelaub DR, Trevino RC, Jackson DM, Tucker HO, Bittner GD. Polyethylene glycol treated allografts not tissue matched nor immunosuppressed rapidly repair sciatic nerve gaps, maintain neuromuscular functions, and restore voluntary behaviors in female rats. J Neurosci Res 2018; 96:1243-1264. [PMID: 29659046 DOI: 10.1002/jnr.24227] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 02/05/2023]
Abstract
Many publications report that ablations of segments of peripheral nerves produce the following unfortunate results: (1) Immediate loss of sensory signaling and motor control; (2) rapid Wallerian degeneration of severed distal axons within days; (3) muscle atrophy within weeks; (4) poor behavioral (functional) recovery after many months, if ever, by slowly-regenerating (∼1mm/d) axon outgrowths from surviving proximal nerve stumps; and (5) Nerve allografts to repair gap injuries are rejected, often even if tissue matched and immunosuppressed. In contrast, using a female rat sciatic nerve model system, we report that neurorrhaphy of allografts plus a well-specified-sequence of solutions (one containing polyethylene glycol: PEG) successfully addresses each of these problems by: (a) Reestablishing axonal continuity/signaling within minutes by nonspecific ally PEG-fusing (connecting) severed motor and sensory axons across each anastomosis; (b) preventing Wallerian degeneration by maintaining many distal segments of inappropriately-reconnected, PEG-fused axons that continuously activate nerve-muscle junctions; (c) maintaining innervation of muscle fibers that undergo much less atrophy than otherwise-denervated muscle fibers; (d) inducing remarkable behavioral recovery to near-unoperated levels within days to weeks, almost certainly by CNS and PNS plasticities well-beyond what most neuroscientists currently imagine; and (e) preventing rejection of PEG-fused donor nerve allografts with no tissue matching or immunosuppression. Similar behavioral results are produced by PEG-fused autografts. All results for Negative Control allografts agree with current neuroscience data 1-5 given above. Hence, PEG-fusion of allografts for repair of ablated peripheral nerve segments expand on previous observations in single-cut injuries, provoke reconsideration of some current neuroscience dogma, and further extend the potential of PEG-fusion in clinical practice.
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Affiliation(s)
- Michelle Mikesh
- Department of Neuroscience, University of Texas at Austin, Austin, Texas, 78712, USA
| | - Cameron L Ghergherehchi
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, 78712, USA
| | - Sina Rahesh
- Department of Neuroscience, University of Texas at Austin, Austin, Texas, 78712, USA
| | - Karthik Jagannath
- Department of Neuroscience, University of Texas at Austin, Austin, Texas, 78712, USA
| | - Amir Ali
- Department of Neuroscience, University of Texas at Austin, Austin, Texas, 78712, USA
| | - Dale R Sengelaub
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, 47405, USA
| | - Richard C Trevino
- Department of Orthopedic Surgery, Wellspan Teaching Hospitals, York, PA, USA
| | | | - Haley O Tucker
- Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, 78712, USA
| | - George D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, Texas, 78712, USA
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Bamba R, Riley DC, Kim JS, Cardwell NL, Pollins AC, Shack RB, Thayer WP. Evaluation of a Nerve Fusion Technique With Polyethylene Glycol in a Delayed Setting After Nerve Injury. J Hand Surg Am 2018; 43:82.e1-82.e7. [PMID: 28823535 DOI: 10.1016/j.jhsa.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Polyethylene glycol (PEG) has been hypothesized to restore axonal continuity using an in vivo rat sciatic nerve injury model when nerve repair occurs within minutes after nerve injury. We hypothesized that PEG could restore axonal continuity when nerve repair was delayed. METHODS The left sciatic nerves of female Sprague-Dawley rats were transected and repaired in an end-to-end fashion using standard microsurgical techniques at 3 time points (1, 8, and 24 hours) after injury. Polyethylene glycol was delivered to the neurorrhaphy in the experimental group. Post-repair compound action potentials were immediately recorded after repair. Animals underwent behavioral assessments at 3 days and 1 week after surgery using the sciatic functional index test. The animals were sacrificed at 1 week to obtain axon counts. RESULTS The PEG-treated nerves had improved compound action potential conduction and animals treated with PEG had improved sciatic function index. Compound action potential conduction was restored in PEG-fused rats when nerves were repaired at 1, 8, and 24 hours. In the control groups, no compound action potential conduction was restored when nerves were repaired. Sciatic functional index was superior in PEG-fused rats at 3 and 7 days after surgery compared with control groups at all 3 time points of nerve repair. Distal motor and sensory axon counts were higher in the PEG-treated rats. CONCLUSIONS Polyethylene glycol fusion is a new adjunct for nerve repair that allows rapid restoration of axonal continuity. It effective when delayed nerve repair is performed. CLINICAL RELEVANCE Nerve repair with application of PEG is a potential therapy that may have efficacy in a clinical setting. It is an experimental therapy that needs more investigation as well as clinical trials.
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Affiliation(s)
- Ravinder Bamba
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Surgery, Georgetown University, Washington, DC.
| | - David Colton Riley
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN; Georgetown University School of Medicine, Washington, DC
| | - Justine S Kim
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Nancy L Cardwell
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Alonda C Pollins
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - R Bruce Shack
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Bittner GD, Sengelaub DR, Ghergherehchi CL. Conundrums and confusions regarding how polyethylene glycol-fusion produces excellent behavioral recovery after peripheral nerve injuries. Neural Regen Res 2018; 13:53-57. [PMID: 29451204 PMCID: PMC5840989 DOI: 10.4103/1673-5374.224363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Current Neuroscience dogma holds that transections or ablations of a segment of peripheral nerves produce: (1) Immediate loss of axonal continuity, sensory signaling, and motor control; (2) Wallerian rapid (1–3 days) degeneration of severed distal axons, muscle atrophy, and poor behavioral recovery after many months (if ever, after ablations) by slowly-regenerating (1 mm/d), proximal-stump outgrowths that must specifically reinnervate denervated targets; (3) Poor acceptance of microsutured nerve allografts, even if tissue-matched and immune-suppressed. Repair of transections/ablations by neurorrhaphy and well-specified-sequences of PEG-fusion solutions (one containing polyethylene glycol, PEG) successfully address these problems. However, conundrums and confusions regarding unorthodox and dramatic results of PEG-fusion repair in animal model systems often lead to misunderstandings. For example, (1) Axonal continuity and signaling is re-established within minutes by non-specifically PEG-fusing (connecting) severed motor and sensory axons across each lesion site, but remarkable behavioral recovery to near-unoperated levels takes several weeks; (2) Many distal stumps of inappropriately-reconnected, PEG-fused axons do not ever (Wallerian) degenerate and continuously innervate muscle fibers that undergo much less atrophy than otherwise-denervated muscle fibers; (3) Host rats do not reject PEG-fused donor nerve allografts in a non-immuno-privileged environment with no tissue matching or immunosuppression; (4) PEG fuses apposed open axonal ends or seals each shut (thereby preventing PEG-fusion), depending on the experimental protocol; (5) PEG-fusion protocols produce similar results in animal model systems and early human case studies. Hence, iconoclastic PEG-fusion data appropriately understood might provoke a re-thinking of some Neuroscience dogma and a paradigm shift in clinical treatment of peripheral nerve injuries.
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Affiliation(s)
- George D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, TX, USA
| | - Dale R Sengelaub
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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Bittner GD, Sengelaub DR, Trevino RC, Ghergherehchi CL, Mikesh M. Robinson and madison have published no data on whether polyethylene glycol fusion repair prevents reinnervation accuracy in rat peripheral nerve. J Neurosci Res 2016; 95:863-866. [PMID: 27514994 DOI: 10.1002/jnr.23849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/20/2016] [Accepted: 07/05/2016] [Indexed: 12/26/2022]
Affiliation(s)
- G D Bittner
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - D R Sengelaub
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - R C Trevino
- Department of Orthopedic Surgery, Wellspan Health, York, Pennsylvania
| | - C L Ghergherehchi
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
| | - M Mikesh
- Department of Neuroscience, University of Texas at Austin, Austin, Texas
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Robinson GA, Madison RD. The title and data of Robinson and Madison (2016) are valid. J Neurosci Res 2016; 95:867-868. [PMID: 27510502 DOI: 10.1002/jnr.23867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Grant A Robinson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Roger D Madison
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,Biological Laboratory Research and Development Service, Veterans Affairs Medical Center, Durham, North Carolina
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