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Behun MN, Kulkarni M, Nolfi AL, France CT, Skillen CD, Mahan MA, Soletti L, Brown BN. Porcine Acellular Nerve-Derived Hydrogel Improves Outcomes of Direct Muscle Neurotization in Rats. Tissue Eng Part A 2024; 30:84-93. [PMID: 37917102 DOI: 10.1089/ten.tea.2023.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Background: The ability to reinnervate a muscle in the absence of a viable nerve stump is a challenging clinical scenario. Direct muscle neurotization (DMN) is an approach to overcome this obstacle; however, success depends on the formation of new muscle endplates, a process, which is often limited due to lack of appropriate axonal pathfinding cues. Objective: This study explored the use of a porcine nerve extracellular matrix hydrogel as a neuroinductive interface between nerve and muscle in a rat DMN model. The goal of the study was to establish whether such hydrogel can be used to improve neuromuscular function in this model. Materials and Methods: A common peroneal nerve-to-gastrocnemius model of DMN was developed. Animals were survived for 2 or 8 weeks following DMN with or without the addition of the hydrogel at the site of neurotization. Longitudinal postural thrust, terminal electrophysiology, and muscle weight assessments were performed to qualify and quantify neuromuscular function. Histological assessments were made to qualify the host response at the DMN site, and to quantify neuromuscular junctions (NMJs) and muscle fiber diameter. Results: The hydrogel-treated group showed a 132% increase in postural thrust at 8 weeks compared with that of the DMN alone group. This was accompanied by an 80% increase in the number of NMJs at 2 weeks, and 26% increase in mean muscle fiber diameter at 8 weeks. Conclusions: These results suggest that a nerve-derived hydrogel may improve the neuromuscular outcome following DNM.
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Affiliation(s)
- Marissa N Behun
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mangesh Kulkarni
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexis L Nolfi
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cambell T France
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clint D Skillen
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | | | - Bryan N Brown
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Renerva, LLC, Pittsburgh, Pennsylvania, USA
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Li M, Chen S, Wang W, Chen D, Zhu M, Liu F, Zhang C, Li Y, Zheng H. Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation. Laryngoscope 2014; 124:1900-5. [PMID: 24473920 DOI: 10.1002/lary.24623] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/03/2014] [Accepted: 01/27/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Meng Li
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Shicai Chen
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Wei Wang
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Donghui Chen
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Minhui Zhu
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Fei Liu
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Caiyun Zhang
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Yan Li
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Hongliang Zheng
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
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Kang SB, Ju YM, Lee SJ, Atala A, Yoo JJ. Functional recovery of denervated muscle by neurotization using nerve guidance channels. J Tissue Eng Regen Med 2013; 9:838-46. [DOI: 10.1002/term.1696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/29/2012] [Accepted: 12/20/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Sung-Bum Kang
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
- Department of Surgery, Seoul National University College of Medicine; Seoul National University Bundang Hospital; Seongnam South Korea
| | - Young Min Ju
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Sang Jin Lee
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - James J. Yoo
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
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Dy CJ, Kitay A, Garg R, Kang L, Feinberg JH, Wolfe SW. Neurotization to innervate the deltoid and biceps: 3 cases. J Hand Surg Am 2013; 38:237-40. [PMID: 23267757 DOI: 10.1016/j.jhsa.2012.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/17/2012] [Accepted: 10/20/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe our experience using direct muscle neurotization as a treatment adjunct during delayed surgical reconstruction for traumatic denervation injuries. METHODS Three patients who had direct muscle neurotization were chosen from a consecutive series of patients undergoing reconstruction for brachial plexus injuries. The cases are presented in detail, including long-term clinical follow-up at 2, 5, and 10 years with accompanying postoperative electrodiagnostic studies. Postoperative motor strength using British Medical Research Council grading and active range of motion were retrospectively extracted from the clinical charts. RESULTS Direct muscle neurotization was performed into the deltoid in 2 cases and into the biceps in 1 case after delays of up to 10 months from injury. Two patients had recovery of M4 strength, and the other patient had recovery of M3 strength. All 3 patients had evidence on electrodiagnostic studies of at least partial muscle reinnervation after neurotization. CONCLUSIONS Direct muscle neurotization has shown promising results in numerous basic science investigations and a limited number of clinical cases. The current series provides additional clinical and electrodiagnostic evidence that direct muscle neurotization can successfully provide reinnervation, even after lengthy delays from injury to surgical treatment. CLINICAL RELEVANCE Microsurgeons should consider direct muscle neurotization as a viable adjunct treatment and part of a comprehensive reconstructive plan, especially for injuries associated with avulsion of the distal nerve stump from its insertion into the muscle.
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Affiliation(s)
- Christopher J Dy
- Division of Hand and Upper Extremity Surgery and Department of Physical Medicine and Rehabilitation, Hospital for Special Surgery, New York, NY 10021, USA.
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Kang SB, Olson JL, Atala A, Yoo JJ. Functional recovery of completely denervated muscle: implications for innervation of tissue-engineered muscle. Tissue Eng Part A 2012; 18:1912-20. [PMID: 22559300 DOI: 10.1089/ten.tea.2011.0225] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tissue-engineered muscle has been proposed as a solution to repair volumetric muscle defects and to restore muscle function. To achieve functional recovery, engineered muscle tissue requires integration of the host nerve. In this study, we investigated whether denervated muscle, which is analogous to tissue-engineered muscle tissue, can be reinnervated and can recover muscle function using an in vivo model of denervation followed by neurotization. The outcomes of this investigation may provide insights on the ability of tissue-engineered muscle to integrate with the host nerve and acquire normal muscle function. Eighty Lewis rats were classified into three groups: a normal control group (n=16); a denervated group in which sciatic innervations to the gastrocnemius muscle were disrupted (n=32); and a transplantation group in which the denervated gastrocnemius was repaired with a common peroneal nerve graft into the muscle (n=32). Neurofunctional behavior, including extensor postural thrust (EPT), withdrawal reflex latency (WRL), and compound muscle action potential (CMAP), as well as histological evaluations using alpha-bungarotoxin and anti-NF-200 were performed at 2, 4, 8, and 12 weeks (n=8) after surgery. We found that EPT was improved by transplantation of the nerve grafts, but the EPT values in the transplanted animals at 12 weeks postsurgery were still significantly lower than those measured for the normal control group at 4 weeks (EPT, 155.0±38.9 vs. 26.3±13.8 g, p<0.001; WRL, 2.7±2.30 vs. 8.3±5.5 s, p=0.027). In addition, CMAP latency and amplitude significantly improved with time after surgery in the transplantation group (p<0.001, one-way analysis of variance), and at 12 weeks postsurgery, CMAP latency and amplitude were not statistically different from normal control values (latency, 0.9±0.0 vs. 1.3±0.7 ms, p=0.164; amplitude, 30.2±7.0 vs. 46.4±26.9 mV, p=0.184). Histologically, regeneration of neuromuscular junctions was seen in the transplantation group. This study indicates that transplanted nerve tissue is able to regenerate neuromuscular junctions within denervated muscle, and thus the muscle can recover partial function. However, the function of the denervated muscle remains in the subnormal range even at 12 weeks after direct nerve transplantation. These results suggest that tissue-engineered muscle, which is similarly denervated, could be innervated and become functional in vivo if it is properly integrated with the host nerve.
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Affiliation(s)
- Sung-Bum Kang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Miyamaru S, Kumai Y, Minoda R, Yumoto E. Nerve-muscle pedicle implantation in the denervated thyroarytenoid muscle of aged rats. Acta Otolaryngol 2012; 132:210-7. [PMID: 22103397 DOI: 10.3109/00016489.2011.630018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Nerve-muscle pedicle (NMP) implantation was effective in the recovery of atrophic changes in the denervated thyroarytenoid (TA) muscle in aged rats. OBJECTIVES To evaluate the effects of NMP implantation on the denervated TA muscle in aged rats. METHODS Wistar rats aged 20 months and 8 weeks were respectively divided into two groups in which the left recurrent laryngeal nerve (RLN) was transected without (aged/young DNV group) or with (aged/young NMP group) NMP implantation. The aged DNV and NMP groups were further divided into two subgroups, based on the period after RLN transection (10 or 20 weeks). In the DNV groups, we assessed the area of muscle and the number of neuromuscular junctions (NMJs) histologically. In the NMP groups, we performed electromyography and histological assessments. For electromyography, we stimulated the transferred nerve and evaluated the muscle action potentials (MAPs) of the TA muscle. RESULTS The muscle areas in the aged NMP groups were significantly larger than those in the aged DNV groups. More NMJs were found in aged NMP groups compared with aged DNV groups. MAPs were seen in all NMP animals. No significant differences were observed between the aged and young NMP groups in histological and physiological assessments.
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Affiliation(s)
- Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan.
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Delétang F, Dautel G. [Free re-innervated gracilis muscle transfer to restore flexion or extension of the fingers: about three cases]. CHIRURGIE DE LA MAIN 2010; 29:195-8. [PMID: 20227319 DOI: 10.1016/j.main.2010.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 01/18/2010] [Accepted: 02/01/2010] [Indexed: 11/24/2022]
Abstract
Free re-innervated gracilis muscle transfer is used to restore fingers or wrist flexion or extension after severe forearm injuries and when none muscle transfer is possible. The long-term function after this procedure is evaluated for three patients treated in our unit. This microsurgical transfer is technically demanding but allows good fingers mobility and good autonomy for daily activities and working.
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Affiliation(s)
- F Delétang
- Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, SOS Mains, hôpital, Jeanne-d'Arc, BP 303, 54201 Dommartin-lès-Toul, France.
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Miyamaru S, Kumai Y, Ito T, Sanuki T, Yumoto E. Nerve-muscle pedicle implantation facilitates re-innervation of long-term denervated thyroarytenoid muscle in rats. Acta Otolaryngol 2009; 129:1486-92. [PMID: 19922102 DOI: 10.3109/00016480902814280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONCLUSIONS Nerve-muscle pedicle (NMP) implantation was effective in the recovery from atrophic changes in long-term denervated thyroarytenoid (TA) muscle. Re-innervation occurred via the transferred nerve. However, the effectiveness of the NMP method may decline with increasing duration of denervation. OBJECTIVES To evaluate the effects of NMP implantation on long-term denervated rat TA muscle. MATERIALS AND METHODS Wistar rats (n=105) were divided into two groups in which the left recurrent laryngeal nerve (RLN) was transected without (DNV group) or with (NMP group) subsequent NMP implantation, and subgroups of each group were formed depending on the period after RLN transection (immediate to 48 weeks). In the DNV subgroups, we histologically assessed the area of muscle and the number of neuromuscular junctions. In the NMP subgroups, we performed electromyographic, videolaryngoscopic, and histologic assessments. The muscle area and muscle action potentials were evaluated by comparing the treated and untreated sides. The ratio of the number of nerve terminals to that of acetylcholine receptors was also assessed. RESULTS The TA muscle area was significantly larger in most of the NMP subgroups compared with the DNV subgroups. Muscle action potentials were present in all NMP animals. All histologic and physiologic assessments revealed degradation as the denervation period in the five NMP subgroups.
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Affiliation(s)
- Satoru Miyamaru
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
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Outcomes of Mini-Hypoglossal Nerve Transfer and Direct Muscle Neurotization for Restoration of Lower Lip Function in Facial Palsy. Plast Reconstr Surg 2009; 124:1891-1904. [PMID: 19952645 DOI: 10.1097/prs.0b013e3181bf81f6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Intrinsic Laryngeal Muscle Reinnervation Using the Muscle-Nerve-Muscle Technique. Ann Otol Rhinol Laryngol 2008; 117:382-8. [DOI: 10.1177/000348940811700509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study was performed to investigate the muscle-nerve-muscle reinnervation technique in the larynx, in which a nerve conduit implanted into an innervated muscle conducts axonal sprouting into a denervated muscle while maintaining function of the donor muscle. Methods: In this study, the muscle-nerve-muscle technique was used to direct superior laryngeal nerve axons to reinnervate intrinsic laryngeal muscles by implanting the recurrent laryngeal nerve stump into the cricothyroid muscle in 8 dogs. In 4 of the dogs, the recurrent laryngeal nerve trunk to the adductor muscles was divided so that all axonal sprouting was directed to the posterior cricoarytenoid muscle. Six-month electromyography data were obtained from 6 of the 8 dogs. Results: All 6 dogs showed evidence of successful reinnervation of the thyroarytenoid or posterior cricoarytenoid muscles with action potentials that corresponded to spontaneous respiratory efforts, while the donor cricothyroid muscles retained their phasic contraction. These responses were obliterated when the recurrent laryngeal nerve conduit was divided. Histologic examination of the intrinsic laryngeal muscles demonstrated successful reinnervation. Conclusions: The results confirm that intrinsic laryngeal muscles may be successfully reinnervated by the superior laryngeal nerve with the muscle-nerve-muscle technique, without sacrifice of function of the cricothyroid muscle. This method offers an alternative source of appropriately firing axons for laryngeal reinnervation procedures.
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Noordin S, Ahmed M, Rehman R, Ahmad T, Hashmi P. Neuronal regeneration in denervated muscle following sensory and muscular neurotization. Acta Orthop 2008; 79:126-33. [PMID: 18283584 DOI: 10.1080/17453670710014879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Neurotization of denervated muscles has been shown to improve muscle bulk, but the neuronal regeneration response has not been compared previously in different surgical techniques of neurotization. Thus, using a rat model of experimental skeletal muscle denervation, we studied neuronal regeneration following sensory neurotization by two methods: sensory nerve to motor branch of muscle and direct sensory nerve implantation to muscle. MATERIAL AND METHODS The lateral head of the gastrocnemius muscle was denervated in 36 rats, of which the first 12 served as denervated controls. In the second group of 12, the sural nerve was anastomosed to the motor branch of the gastrocnemius muscle (sensory-to-motor nerve neurotization) and in the remaining 12 rats the sural nerve was split into 4 fascicles and embedded into 4 quadrants of the muscle (direct sensory nerve-to-muscle neurotization). Immunohistochemistry was used to examine nerve fibers in muscle containing the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP), and general neuronal marker protein gene product 9.5 (PGP 9.5). RESULTS Semiquantitative analysis showed that, compared to the control side, the number of nerve fibers on the experimental side was highest (p < 0.01) for group III (direct sensory nerve-to-muscle neurotization) for all 3 markers. The difference was 71%, 298%, and 254% for PGP 9.5, CGRP, and SP, respectively. INTERPRETATION This method may be a good option for inducing neuronal regeneration in denervated muscles, and has therapeutic implications for prevention of atrophy of denervated muscles and as an adjunct for reconstruction of soft tissue defects.
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Affiliation(s)
- Shahryar Noordin
- Section of Orthopaedics, Department of Surgery, Aga Khan University, Karachi, Pakistan
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Mourkioti F, Kratsios P, Luedde T, Song YH, Delafontaine P, Adami R, Parente V, Bottinelli R, Pasparakis M, Rosenthal N. Targeted ablation of IKK2 improves skeletal muscle strength, maintains mass, and promotes regeneration. J Clin Invest 2006; 116:2945-54. [PMID: 17080195 PMCID: PMC1626136 DOI: 10.1172/jci28721] [Citation(s) in RCA: 244] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 07/25/2006] [Indexed: 12/16/2022] Open
Abstract
NF-kappaB is a major pleiotropic transcription factor modulating immune, inflammatory, cell survival, and proliferative responses, yet the relevance of NF-kappaB signaling in muscle physiology and disease is less well documented. Here we show that muscle-restricted NF-kappaB inhibition in mice, through targeted deletion of the activating kinase inhibitor of NF-kappaB kinase 2 (IKK2), shifted muscle fiber distribution and improved muscle force. In response to denervation, IKK2 depletion protected against atrophy, maintaining fiber type, size, and strength, increasing protein synthesis, and decreasing protein degradation. IKK2-depleted mice with a muscle-specific transgene expressing a local Igf-1 isoform (mIgf-1) showed enhanced protection against muscle atrophy. In response to muscle damage, IKK2 depletion facilitated skeletal muscle regeneration through enhanced satellite cell activation and reduced fibrosis. Our results establish IKK2/NF-kappaB signaling as an important modulator of muscle homeostasis and suggest a combined role for IKK inhibitors and growth factors in the therapy of muscle diseases.
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Affiliation(s)
- Foteini Mourkioti
- European Molecular Biology Laboratory (EMBL) Mouse Biology Unit, Campus "A. Buzzati-Traverso," Monterotondo-Scalo, Italy.
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