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Ronchi G, Morano M, Fregnan F, Pugliese P, Crosio A, Tos P, Geuna S, Haastert-Talini K, Gambarotta G. The Median Nerve Injury Model in Pre-clinical Research - A Critical Review on Benefits and Limitations. Front Cell Neurosci 2019; 13:288. [PMID: 31316355 PMCID: PMC6609919 DOI: 10.3389/fncel.2019.00288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/13/2019] [Indexed: 12/21/2022] Open
Abstract
The successful introduction of innovative treatment strategies into clinical practise strongly depends on the availability of effective experimental models and their reliable pre-clinical assessment. Considering pre-clinical research for peripheral nerve repair and reconstruction, the far most used nerve regeneration model in the last decades is the sciatic nerve injury and repair model. More recently, the use of the median nerve injury and repair model has gained increasing attention due to some significant advantages it provides compared to sciatic nerve injury. Outstanding advantages are the availability of reliable behavioural tests for assessing posttraumatic voluntary motor recovery and a much lower impact on the animal wellbeing. In this article, the potential application of the median nerve injury and repair model in pre-clinical research is reviewed. In addition, we provide a synthetic overview of a variety of methods that can be applied in this model for nerve regeneration assessment. This article is aimed at helping researchers in adequately adopting this in vivo model for pre-clinical evaluation of peripheral nerve reconstruction as well as for interpreting the results in a translational perspective.
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Affiliation(s)
- Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Michela Morano
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Pierfrancesco Pugliese
- Dipartimento di Chirurgia Generale e Specialistica, Azienda Ospedaliera Universitaria, Ancona, Italy
| | - Alessandro Crosio
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milan, Italy
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milan, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin, Italy
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hanover, Germany
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Li Y, Lao J, Zhao X, Tian D, Zhu Y, Wei X. The optimal distance between two electrode tips during recording of compound nerve action potentials in the rat median nerve. Neural Regen Res 2014; 9:171-8. [PMID: 25206798 PMCID: PMC4146167 DOI: 10.4103/1673-5374.125346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 11/25/2022] Open
Abstract
The distance between the two electrode tips can greatly influence the parameters used for recording compound nerve action potentials. To investigate the optimal parameters for these recordings in the rat median nerve, we dissociated the nerve using different methods and compound nerve action potentials were orthodromically or antidromically recorded with different electrode spacings. Compound nerve action potentials could be consistently recorded using a method in which the middle part of the median nerve was intact, with both ends dissociated from the surrounding fascia and a ground wire inserted into the muscle close to the intact part. When the distance between two stimulating electrode tips was increased, the threshold and supramaximal stimulating intensity of compound nerve action potentials were gradually decreased, but the amplitude was not changed significantly. When the distance between two recording electrode tips was increased, the amplitude was gradually increased, but the threshold and supramaximal stimulating intensity exhibited no significant change. Different distances between recording and stimulating sites did not produce significant effects on the aforementioned parameters. A distance of 5 mm between recording and stimulating electrodes and a distance of 10 mm between recording and stimulating sites were found to be optimal for compound nerve action potential recording in the rat median nerve. In addition, the orthodromic compound action potential, with a biphasic waveform that was more stable and displayed less interference (however also required a higher threshold and higher supramaximal stimulus), was found to be superior to the antidromic compound action potential.
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Affiliation(s)
- Yongping Li
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China ; Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jie Lao
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Dong Tian
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yi Zhu
- Department of Hand Surgery of HuaShan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Healthy; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xiaochun Wei
- Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
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Geuna S, Tos P, Titolo P, Ciclamini D, Beningo T, Battiston B. Update on nerve repair by biological tubulization. J Brachial Plex Peripher Nerve Inj 2014; 9:3. [PMID: 24606921 PMCID: PMC3953745 DOI: 10.1186/1749-7221-9-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 03/02/2014] [Indexed: 12/18/2022] Open
Abstract
Many surgical techniques are available for bridging peripheral nerve defects. Autologous nerve grafts are the current gold standard for most clinical conditions. In selected cases, alternative types of conduits can be used. Although most efforts are today directed towards the development of artificial synthetic nerve guides, the use of non-nervous autologous tissue-based conduits (biological tubulization) can still be considered a valuable alternative to nerve autografts. In this paper we will overview the advancements in biological tubulization of nerve defects, with either mono-component or multiple-component autotransplants, with a special focus on the use of a vein segment filled with skeletal muscle fibers, a technique that has been widely investigated in our laboratory and that has already been successfully introduced in the clinical practice.
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Affiliation(s)
- Stefano Geuna
- Neuroscience Institute of the Cavalieri Ottolenghi Foundation (NICO), University of Turin, Turin 10043, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin 10043, Italy
| | - Pierluigi Tos
- Department of Traumatology, Microsurgery Unit, CTO Hospital, Turin, Italy
| | - Paolo Titolo
- UOC Traumatology–Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy
| | - Davide Ciclamini
- Department of Traumatology, Microsurgery Unit, CTO Hospital, Turin, Italy
| | - Teresa Beningo
- Department of Traumatology, Microsurgery Unit, CTO Hospital, Turin, Italy
| | - Bruno Battiston
- Department of Traumatology, Microsurgery Unit, CTO Hospital, Turin, Italy
- UOC Traumatology–Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy
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4
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Functional and morphometric differences between the early and delayed use of phototherapy in crushed median nerves of rats. Lasers Med Sci 2011; 27:479-86. [DOI: 10.1007/s10103-011-0972-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
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Functional, morphological and biomolecular assessment of posttraumatic neuro-muscular recovery in the rat forelimb model. HOW TO IMPROVE THE RESULTS OF PERIPHERAL NERVE SURGERY 2011; 100:173-7. [DOI: 10.1007/978-3-211-72958-8_36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Flores LP. The use of autogenous veins for microsurgical repair of the sural nerve after nerve biopsy. Neurosurgery 2010; 66:238-43; discussion 243-4. [PMID: 20489512 DOI: 10.1227/01.neu.0000369657.42680.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study evaluates the results of an alternative technique developed to minimize the risk of complications associated with sural nerve biopsy for histopathological analysis. METHODS Twelve subjects underwent sural nerve biopsy and the defect created in the nerve was bridged by a 50-mm-length segment of the saphenous vein; the control group enrolled 23 patients in whom the entire length of the nerve was harvested to be used as autograft for reconstruction of nerves in the upper limb. Sensory reinnervation was quantified by use of the monofilament test and the static 2-point discrimination test, after a follow-up period of 18 months. RESULTS The mean time for recovery of protective sensation was 8.7 months in patients submitted to nerve repair, and 10.3 months in the control group (P > .05). The monofilament test and static 2-point discrimination testing demonstrated a mean value of 3.22 and 8 mm (S3), respectively, in the group who underwent sural nerve repair; and 4.17 and 13 mm (S2), respectively, for the control group (P <.05). CONCLUSION The use of vein as conduits for the repair of the sural nerve did not shorten the time for sensory recovery at the autonomous zone of the nerve; however, the quality of the reinnervation was considered better than the control group. This study suggests that empty veins could be used as conduits to bridge gaps with a length up to 50 mm in cases of injuries of the sural nerve and, possibly, for injuries of other pure sensory nerves as well.
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Affiliation(s)
- Leandro Pretto Flores
- Unit of Neurosurgery, Hospital de Base do Distrito Federal Brasília, Distrito Federal, Brazil.
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Low-Dose FK506 After Contralateral C7 Transfer to the Musculocutaneous Nerve Using Two Different Tubes. Ann Plast Surg 2010; 64:622-31. [DOI: 10.1097/sap.0b013e3181b6aae1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Werdin F, Grüssinger H, Jaminet P, Kraus A, Manoli T, Danker T, Guenther E, Haerlec M, Schaller HE, Sinis N. An improved electrophysiological method to study peripheral nerve regeneration in rats. J Neurosci Methods 2009; 182:71-7. [DOI: 10.1016/j.jneumeth.2009.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 04/22/2009] [Accepted: 05/27/2009] [Indexed: 12/18/2022]
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9
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Battiston B, Raimondo S, Tos P, Gaidano V, Audisio C, Scevola A, Perroteau I, Geuna S. Chapter 11 Tissue Engineering of Peripheral Nerves. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:227-49. [DOI: 10.1016/s0074-7742(09)87011-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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10
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Wang H, Sorenson EJ, Spinner RJ, Windebank AJ. Electrophysiologic findings and grip strength after nerve injuries in the rat forelimb. Muscle Nerve 2008; 38:1254-65. [PMID: 18671290 DOI: 10.1002/mus.20971] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We developed electrophysiologic methods for testing the three major forelimb nerves as a tool to evaluate motor and sensory recovery in rats. Median, ulnar, or radial nerves were transected and repaired in Sprague-Dawley rats. Compound muscle action potentials (CMAPs) and somatosensory evoked potentials (SSEPs) were recorded preoperatively and at various postoperative intervals. Correlation between grip strength and CMAPs was investigated. Reliable CMAPs were recorded for all three nerves. Median- or ulnar-nerve-derived SSEPs were reliably recorded; radial SSEPs could not be recorded. CMAPs followed typical regeneration patterns after nerve repair. SSEPs showed a consistent peak latency but fluctuating amplitude. Grip strength and median CMAP amplitude correlated positively. We conclude that it is possible to conduct minimally invasive electrophysiologic testing in rat forelimbs. The CMAP is a valid parameter that shows the typical time course of nerve regeneration and reinnervation.
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Affiliation(s)
- Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Piskin A, Kaplan S, Aktaş A, Ayyildiz M, Raimondo S, Aliç T, Bozkurt HH, Geuna S. Platelet gel does not improve peripheral nerve regeneration: An electrophysiological, stereological, and electron microscopic study. Microsurgery 2008; 29:144-53. [DOI: 10.1002/micr.20599] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Schonauer F, Taglialatela Scafati S, La Rusca I, Molea G. Digital nerve reconstruction by multiple Y-shaped nerve grafts at the metacarpophalangeal joint level. J Plast Reconstr Aesthet Surg 2008; 61:e13-6. [PMID: 18703388 DOI: 10.1016/j.bjps.2008.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Accepted: 04/03/2008] [Indexed: 11/28/2022]
Abstract
Digital nerve injuries are common; injuries of the common digital nerves are less frequent than those involving the proper digital nerves. Traditional techniques used to reconstruct peripheral nerves are: direct suture, autologous nerve grafts, autologous vein grafts, vascularised nerve graft and alloplastic nerve grafts. Autologous nerve grafts remain the most common conduits for segmental defects. Difficulties can arise when attempting to repair complex nerve gaps, particularly when joining the proximal stump of the common digital nerve with two distal stumps of proper digital nerves as in lesions involving the web space. We present below a case of such a lesion. We describe the use of the lateral antebrachial cutaneous nerve (LABCN) as donor nerve, by exploiting its natural branchings.
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Affiliation(s)
- Fabrizio Schonauer
- Department of Plastic and Reconstructive Surgery, University of Naples Federico II, Naples, Italy.
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14
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Luis AL, Rodrigues JM, Amado S, Veloso AP, Armada-Da-Silva PAS, Raimondo S, Fregnan F, Ferreira AJ, Lopes MA, Santos JD, Geuna S, Varejão ASP, Maurício AC. PLGA 90/10 and caprolactone biodegradable nerve guides for the reconstruction of the rat sciatic nerve. Microsurgery 2007; 27:125-37. [PMID: 17290381 DOI: 10.1002/micr.20317] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to test in vivo two different nerve guides for promoting nerve regeneration across a 10-mm gap of the rat sciatic nerve: 1) one made of PLGA in a novel proportion (90:10) of the two polymers poly(L-lactide):poly(glycolide); 2) another made of (DL-lactide-epsilon-caprolactone) copolyester (Neurolac) tube, by comparing its healing efficacy with that of the more traditional methods of end-to-end nerve suture and autologous graft. Motor and sensory functional recovery were assessed throughout the healing period of 20 weeks, and the repaired nerves were processed for morphological and histomorphometrical analysis. Both motor and sensory functions improved significantly in all experimental nerve repaired groups. At the end of the 20-week follow-up, the end-to-end group showed better recovery of motor function when compared with the groups treated with guiding tubes. However, at this time point, the level of motor function in the Neurolac(R) and PLGA groups was similar to the one of the graft group. Nociception function also recovered faster in the end-to-end group compared with the Neurolac(R) and PLGA groups, and in this case, recovery was also delayed in the graft group. At the end of follow-up, nociception was similar in all experimental groups. Morphological and histomorphometrical analysis showed that axon regeneration occurred in both PLGA and Neurolac(R) experimental groups, with no significant differences in the total number of regenerated fibers, but disclosed a different pattern of degradation of the two types of tubes with larger biodegradation of PLGA material by the end of 20 weeks. These results suggest that both types of biomaterials are a good substrate for preparing tubular nerve guides, and their different pattern of degradation does not seem to influence the degree of nerve regeneration.
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Affiliation(s)
- Ana L Luis
- Animal Science and Study Centre, Food and Agrarian Sciences and Technologies Institute, Porto University, Porto, Portugal
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Sinis N, Haerle M, Becker ST, Schulte-Eversum C, Vonthein R, Rösner H, Schaller HE. Neuroma formation in a rat median nerve model: influence of distal stump and muscular coating. Plast Reconstr Surg 2007; 119:960-6. [PMID: 17312502 DOI: 10.1097/01.prs.0000242486.70919.82] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to investigate neuroma formation in a rat median nerve model. METHODS In three groups, the median nerve was exposed and a gap was created. In the first group, a short gap of 1 cm (n = 12) was created; in the second, a long gap of 2 cm (n = 12) was created in the nerve. Another group was used to analyze the development of neuroma formation when the proximal stump was buried in adjacent muscle with an additional gap of 2 cm (n = 12). The use of different lengths should allow one to gain information about dilution effects of distal stump factors that may contribute to neuroma formation. Nine months later, specimens were gathered and histologically analyzed. The cross-sectional areas of neuromas were measured and the neural/connective tissue ratios were estimated. RESULTS The cross-sectional areas demonstrated that neuroma formation was significantly higher in the short-gap group than in the long-gap group, and smallest in the muscle-covered group. The percentage of neural tissue was highest in the muscle-covered and long-gap groups and lowest in the short-gap group. CONCLUSIONS These results demonstrate an association between neuroma formation and distal stump distance. This observation may be explained by the factors originating from the distal stump that were blocked when the proximal nerve stump was completely buried in the muscle. For clinical application, the authors recommend not only burying the proximal stump in a muscle but also surgically augmenting the gap between the proximal and distal stumps.
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Affiliation(s)
- Nektarios Sinis
- Klinik für Plastische, Hand, Rekonstruktive, und Verbrennungschirurgie, Universität Tübingen, BG-Unfallklinik, Tübingen, Germany.
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Galtrey CM, Fawcett JW. Characterization of tests of functional recovery after median and ulnar nerve injury and repair in the rat forelimb. J Peripher Nerv Syst 2007; 12:11-27. [PMID: 17374098 DOI: 10.1111/j.1529-8027.2007.00113.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The majority of human peripheral nerve injuries occur in the upper limb but the majority of studies in the rat are performed in the hindlimb. The upper and lower limbs differ in dexterity and control by supraspinal systems, so an upper limb model is a better representation of the common form of human injury. The purpose of this study was to further develop a rat model involving lesions of the median and ulnar nerves. To produce different degrees of misdirection of axons following nerve repair, we studied nerve crush, cut and repair of the two nerves, and cut and repair with crossover. Assessment of functional recovery was performed using a battery of motor and sensory tests: the staircase test, which assesses skilled forepaw reaching; grip strength meter, which assesses grip strength; pawprint analysis, which assesses toe spread and print length; horizontal ladder, which assesses forepaw placement during skilled locomotion; modified Randall-Selitto device and electronic von Frey probes, which assess fine touch; and cold probes, which assess temperature sensation. All tests revealed deficits in forepaw function after nerve injury except the print length and modified Randall-Selitto device. The time course of functional recovery was observed over 15 weeks. The final degree of functional recovery achieved was related to the misdirection of axon regeneration. The tests that most clearly revealed the effects of axon misdirection on function were the skilled paw reaching and grip strength tests. The lesion model and functional tests that we have developed will be useful in testing therapeutic strategies for treating the consequences of inaccurate axon regeneration following peripheral nerve injury in humans.
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Affiliation(s)
- Clare M Galtrey
- Centre for Brain Repair, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
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Lee JM, Tos P, Raimondo S, Fornaro M, Papalia I, Geuna S, Giacobini-Robecchi MG. Lack of topographic specificity in nerve fiber regeneration of rat forelimb mixed nerves. Neuroscience 2007; 144:985-90. [PMID: 17157991 DOI: 10.1016/j.neuroscience.2006.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 10/31/2006] [Accepted: 11/01/2006] [Indexed: 01/25/2023]
Abstract
Multiple nerve repair by means of a Y-shaped nerve guide represents a good model for studying the specificity of peripheral nerve fiber regeneration. Here we have used it for investigating the specificity of axonal regeneration in mixed nerves of the rat forelimb model. The left median and ulnar nerves, in adult female rats, were transected and repaired with a 14-mm Y-shaped conduit. The proximal end of the Y-shaped conduit was sutured to the proximal stump of either the median nerve or the ulnar nerve. Ten months after surgery, rats were tested for functional recovery of each median and ulnar nerve. Quantitative morphology of regenerated myelinated nerve fibers was then carried out by the two-dimensional disector technique. Results showed that partial recovery of both median and ulnar nerve motor function was regained in all experimental groups. Performance in the grasping test was significantly lower when the ulnar nerve was used as the proximal stump. Ulnar test assessment showed no significant difference between the two Y-shaped repair groups. The number of regenerated nerve fibers was significantly higher in the median nerve irrespectively of the donor nerve, maintaining the same proportion of myelinated fibers between the two nerves (about 60% median and 40% ulnar). On the other hand, nerve fiber size and myelin thickness were significantly larger in both distal nerves when the median nerve was used as the proximal donor nerve stump. G-ratio and myelin thickness/axon diameter ratio returned to normal values in all experimental groups. These results demonstrate that combined Y-shaped-tubulization repair of median and ulnar nerves permits the functional recovery of both nerves, independently from the proximal donor nerve employed, and that tissue, and not topographic, specificity guides nerve fiber regeneration in major forelimb mixed nerves of rats.
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Affiliation(s)
- J M Lee
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi, Regione Gonzole 10, Orbassano (TO), 10043 Italy
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Tos P, Battiston B, Nicolino S, Raimondo S, Fornaro M, Lee JM, Chirila L, Geuna S, Perroteau I. Comparison of fresh and predegenerated muscle-vein-combined guides for the repair of rat median nerve. Microsurgery 2007; 27:48-55. [PMID: 17211839 DOI: 10.1002/micr.20306] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the last 10 years, we have investigated a particular type of bioengineered nerve guide, the muscle-vein-combined tube, which is made by filling a vein with skeletal muscle. In our previous studies we have always used fresh skeletal muscle to fill vein conduits. In the present study we compared the use of fresh and predegenerated (freeze-thawed) skeletal muscle for muscle-vein-combined nerve guides. In this study, a 10-mm-long rat median nerve defect was repaired using either type of nerve guide. The samples were analyzed 5 and 30 days after surgery by light and electron microscopy. In addition, reverse transcription polymerase chain reaction (RT-PCR) was carried out to investigate the expression of mRNAs coding for glial markers, as well as glial growth factor (NRG1) and its receptors (erbB2 and erbB3). Results showed differences between the two types of nerve guides at postoperative day 5; however, no difference was detected at day 30 suggesting that both types of tissue-engineered conduit are effective for repairing peripheral nerve defects in this experimental model.
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Affiliation(s)
- P Tos
- UOD Reconstructive Microsurgery, Orthopaedic Department, C.T.O. Hospital, Via Zuretti 29, 10100 Turin, Italy
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Santos AP, Suaid CA, Fazan VPS, Barreira AA. Microscopic anatomy of brachial plexus branches in Wistar rats. Anat Rec (Hoboken) 2007; 290:477-85. [PMID: 17436315 DOI: 10.1002/ar.20519] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the present study, we analyze the morphology and morphometry of the lateral proper digital nerve of the third finger, and of the proximal and distal segments of the ulnar, median, and radial nerves, in Wistar rats 4 or 7 weeks old. The fascicular area and diameter were generally significantly greater in the proximal compared to distal segments and tended to be larger in 7-week-old compared to 4-week-old rats (e.g., median nerve area of 0.13 mm(2) for the proximal and 0.07 mm(2) for distal segments in 4-week-old rats, and 0.17 and 0.10 mm(2), respectively, for the proximal and distal segments of 7-week-old rats). The number of fascicles was significantly greater while the number of myelinated fibers was significantly less in the distal segments (e.g., 1,359 and 509 myelinated fibers, respectively, in the proximal and distal segments of the radial nerve 4-week-old rats). There was no significant difference in these parameters between the two age groups. The diameter of the myelinated fibers and their respective axons increased from 4 to 7 weeks of age (e.g., myelinated fiber diameter of 4.10 microm in 4-week-old animals and 4.7 microm in the ulnar nerve proximal segment of 7-week-old rats). The g-ratio regression line (axon diameter vs. fiber diameter quotient) was outlined for all the nerves studied here. Differences in myelinated fiber density were detected between the segments of the radial nerve, accompanying the number of myelinated fibers. Detailed knowledge of the microscopic anatomy of rat forelimb nerves provides control data for comparison with studies of experimentally induced neuropathies, which can shed more light on human neuropathies.
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Affiliation(s)
- Ana Paula Santos
- Department of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Sinis N, Schaller HE, Becker ST, Lanaras T, Schulte-Eversum C, Müller HW, Vonthein R, Rösner H, Haerle M. Cross-chest median nerve transfer: A new model for the evaluation of nerve regeneration across a 40mm gap in the rat. J Neurosci Methods 2006; 156:166-72. [PMID: 16621004 DOI: 10.1016/j.jneumeth.2006.02.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Revised: 02/15/2006] [Accepted: 02/23/2006] [Indexed: 11/17/2022]
Abstract
A new animal model for the study of nerve regeneration in rats across a 40 mm gap between both median nerves is described. For autologous grafting, the ulnar nerves were dissected and sutured together. From the left median nerve, they were transplanted across the chest to the right median nerve. Animals having undergone this operation were observed for 12 months and periodically assessed using the grasping test and measurements of body-weight. For histological analysis rats were sacrificed after this period and axon counts were determined at the suture points of operated animals and in the median nerve of non-operated animals. Functional recovery could be seen, although partially, beginning as early as the fifth postoperative month, as demonstrated by the grasping test. Quantification of the number of axons demonstrated axonal regeneration across all three coaptation points. This model provides a new approach for analysis of long distance peripheral nerve regeneration without impairment of behaviour.
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Affiliation(s)
- Nektarios Sinis
- Klinik für Hand-, Plastische-, Rekonstruktive- und Verbrennungschirurgie, Universität Tübingen, BG-Unfallklinik, Tübingen, Germany.
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Papalia I, Tos P, Scevola A, Raimondo S, Geuna S. The ulnar test: A method for the quantitative functional assessment of posttraumatic ulnar nerve recovery in the rat. J Neurosci Methods 2006; 154:198-203. [PMID: 16466801 DOI: 10.1016/j.jneumeth.2005.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 12/17/2005] [Accepted: 12/19/2005] [Indexed: 11/25/2022]
Abstract
The assessment of recovery of the neuromuscular function following nerve lesion and repair is one of the main goals of peripheral nerve researchers. The forelimb model has recently seen an increase in its employment for experimental nerve repair studies especially because of the availability of the grasping test for assessing the functional recovery of one of its major nerves, the median nerve. Nerve repair studies sometimes require the use of more than one nerve to simulate severe clinical situations and, in this case, the ulnar nerve is often used together with the median nerve. However, a test for assessing ulnar nerve functional recovery is yet not available. To fill this gap, we have developed and experimentally tested a method for the functional assessment of posttraumatic ulnar nerve recovery in the rat. Animal testing using this method is simple, quick and provides the animal with minimal distress. The method proved to be effective in detecting the date on which recovery starts after ulnar nerve impairment and in following its improvement, over time. The availability of this new test is expected to further increase the employment of forelimb experimental nerve models instead of the more disabling hindlimb models.
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Affiliation(s)
- Igor Papalia
- Dipartimento delle Specialità Chirurgiche, Sezione di Chirurgia Plastica, Università di Messina, Policlinico Universitario, Italy.
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Abstract
Posttraumatic nerve repair continues to be a major challenge in restorative medicine and microsurgery. Although progress has been made in surgical techniques over the last 30 years, functional recovery after a severe lesion of a major nerve trunk is often incomplete and often unsatisfactory. Functional recovery after surgical repair of mixed nerves is even more disappointing. Functional recovery after peripheral nerve lesion is dependent upon accurate regeneration of axons to their original target tissues. Thus, in order to enhance regeneration, a better understanding of the cellular and molecular biology of selective nerve regeneration is required. Schwann cells and their endoneurial extracellular matrix play pivotal roles in the selective promotion of motor and sensory axon regeneration. Knowledge of these mechanisms allows for the better development of biocompatible nerve grafting material.
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Affiliation(s)
- Elizabeth O Johnson
- Department of Anatomy, Histology and Embryology, University of Ioannina, School of Medicine, 45110 Ioannina, Greece.
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Battiston B, Geuna S, Ferrero M, Tos P. Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery 2005; 25:258-67. [PMID: 15934044 DOI: 10.1002/micr.20127] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nerve repair is usually accomplished by direct suture when the two stumps can be approximated without tension. In the presence of a nerve defect, the placement of an autologous nerve graft is the current gold standard for nerve restoration. However, over the last 20 years, an increasing number of research articles reported on the use of non-nervous tubes (tubulization) for repairing nerve defects. The clinical employment of tubes (both biological and synthetic) as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. In addition, tubulization was proposed as an alternative to direct nerve sutures in order to create optimal conditions for nerve regeneration over the short empty space intentionally left between two nerve stumps. This paper outlines recent important advances in this field. Different tubulization techniques proposed so far are described, focusing in particular on studies that reported on the employment of tubes with patients. Our personal clinical experience on tubulization repair of sensory nerve lesions (digital nerves), using both biological and synthetic tubes, is presented, and the clinical results are compared. In our case series, both types of tubes led to good clinical results. Finally, we speculate about the prospects in the clinical application of tubulization for peripheral nerve repair.
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Affiliation(s)
- Bruno Battiston
- UOD Reconstructive Microsurgery, Department of Orthopedics, C.T.O. Hospital, Turin, Italy.
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Raimondo S, Nicolino S, Tos P, Battiston B, Giacobini-Robecchi MG, Perroteau I, Geuna S. Schwann cell behavior after nerve repair by means of tissue-engineered muscle-vein combined guides. J Comp Neurol 2005; 489:249-59. [PMID: 15984006 DOI: 10.1002/cne.20625] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Schwann cells play a critical role in peripheral nerve regeneration. When a non-nervous conduit is used to bridge a nerve defect, the conduit is soon colonized by a number of Schwann cells that make a pathway for regrowing axons. By using electron microscopy, immunohistochemistry, and reverse transcriptase-polymerase chain reaction analysis, we have investigated the behavior of migratory glial cells along a particular type of autologous tissue-engineered conduit made of a vein filled with fresh skeletal muscle, using the rat sciatic nerve model. With this particular type of autograft, our data show that many Schwann cells soon take up a close relationship with grafted muscle fibers, and especially with their basal lamina, which appears to serve as a migration pathway for them. The early and massive colonization of the conduit is sustained by both Schwann cell migration and proliferation, as demonstrated by PCNA immunostaining. Later, as they meet regenerating axons, Schwann cells become closely associated with them and eventually lose their connections with grafted muscle fibers because of the formation of perineurial envelopes. Because previous studies showed that alpha(2a-2b) NRG1 is overexpressed at early stages along the muscle-vein combined tubes, we have also investigated mRNA expression of its two receptors, erbB2 and erbB3. Both messengers are overexpressed, although with different time courses. Overall, our results provide some morphological and biochemical bases for explaining the effectiveness of fresh muscle-vein combined nerve guides and throw an interesting light on the possible role of alpha(2a-2b) NRG1 through the erbB2/erbB3 heterodimer receptor for nerve regeneration inside non-nervous conduits.
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Affiliation(s)
- Stefania Raimondo
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi Gonzaga, 10043 Orbassano (TO), Italy
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