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Walzik D, Wences Chirino TY, Zimmer P, Joisten N. Molecular insights of exercise therapy in disease prevention and treatment. Signal Transduct Target Ther 2024; 9:138. [PMID: 38806473 PMCID: PMC11133400 DOI: 10.1038/s41392-024-01841-0] [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: 01/20/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/30/2024] Open
Abstract
Despite substantial evidence emphasizing the pleiotropic benefits of exercise for the prevention and treatment of various diseases, the underlying biological mechanisms have not been fully elucidated. Several exercise benefits have been attributed to signaling molecules that are released in response to exercise by different tissues such as skeletal muscle, cardiac muscle, adipose, and liver tissue. These signaling molecules, which are collectively termed exerkines, form a heterogenous group of bioactive substances, mediating inter-organ crosstalk as well as structural and functional tissue adaption. Numerous scientific endeavors have focused on identifying and characterizing new biological mediators with such properties. Additionally, some investigations have focused on the molecular targets of exerkines and the cellular signaling cascades that trigger adaption processes. A detailed understanding of the tissue-specific downstream effects of exerkines is crucial to harness the health-related benefits mediated by exercise and improve targeted exercise programs in health and disease. Herein, we review the current in vivo evidence on exerkine-induced signal transduction across multiple target tissues and highlight the preventive and therapeutic value of exerkine signaling in various diseases. By emphasizing different aspects of exerkine research, we provide a comprehensive overview of (i) the molecular underpinnings of exerkine secretion, (ii) the receptor-dependent and receptor-independent signaling cascades mediating tissue adaption, and (iii) the clinical implications of these mechanisms in disease prevention and treatment.
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Affiliation(s)
- David Walzik
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, 44227, Dortmund, North Rhine-Westphalia, Germany
| | - Tiffany Y Wences Chirino
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, 44227, Dortmund, North Rhine-Westphalia, Germany
| | - Philipp Zimmer
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, 44227, Dortmund, North Rhine-Westphalia, Germany.
| | - Niklas Joisten
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, 44227, Dortmund, North Rhine-Westphalia, Germany.
- Division of Exercise and Movement Science, Institute for Sport Science, University of Göttingen, 37075, Göttingen, Lower Saxony, Germany.
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Lin W, Yao B, He J, Lin S, Wang Y, Chen F, Zhang W, Yang J, Ye Z, Qiu J, Wang Y. The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report. J Med Case Rep 2024; 18:207. [PMID: 38610054 PMCID: PMC11015665 DOI: 10.1186/s13256-024-04516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear. CASE PRESENTATION A 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis. CONCLUSION Standardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.
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Affiliation(s)
- Wujian Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Yao
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiahui He
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Therapy Technology, Lvkang Bomei Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Shuangyan Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Yafei Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fangting Chen
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weichao Zhang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiashu Yang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital, Jinan University, Heyuan, Guangdong, China
| | - Zhihong Ye
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen University, No.26 Yuancun Erheng Road, Guangzhou, Guangdong, China.
- Guangdong Provincial Clinical Research Center for Rehabilitation Medicine, Guangzhou, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Farsani MS, Fathi M, Farsani ZH, Gourgin Karaji Z. Swimming alters some proteins of skeletal muscle tissue in rats with Alzheimer-like phenotype. Arch Gerontol Geriatr 2024; 117:105260. [PMID: 37979338 DOI: 10.1016/j.archger.2023.105260] [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: 09/03/2023] [Revised: 10/04/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Exercise training plays a significant role in preventing the destruction of central nerve neurons and muscle atrophy. The purpose of the present study was to investigate the effect of a period of swimming training on the expression of Neural cell adhesion molecule (NCAM), Semaphorin 3A (SEMA3A), and Profilin-1 (PFN1) proteins in the gastrocnemius muscle of Alzheimer-like phenotype rats. METHODS & MATERIALS 32 Wistar males were (6 weeks of age) divided into four groups: Healthy Control (HC), Alzheimer-like phenotype's Control (AC), Healthy Training (HT), and Alzheimer-like phenotype's Training (AT). Alzheimer-like phenotypes were induced by beta-amyloid injection in the hippocampus. The training program consisted of 20 swimming sessions. Gastrocnemius muscle was removed after the intervention, and NCAM, SEMA3A, and PFN1 proteins were measured by the immunohistoflorescent method. RESULTS The results showed that SEMA3A was increased (p = 0.001), and NCAM (p = 0.001), and PFN1 (p = 0.001) were decreased in AC compared to the HC group. Also, the results showed that NCAM (p = 0.001) and Pfn1 (p = 0.002) increased in the HT group compared to HC, and the NCAM (p = 0.001) and Pfn1 (p = 0.002) in AT group compared to AC (p = 0.001) increased significantly, while SEMA3A was reduced in the HT group compared to HC (p = 0.001) and AT group compared to AC (p = 0.001) CONCLUSION: Swimming effectively improves axon regeneration and neuronal formation in motor neurons and, therefore, can be an effective intervention to prevent and control the complications of Alzheimer-like phenotype.
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Affiliation(s)
| | - Mohammad Fathi
- Dept. of Sport Sciences, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran.
| | | | - Zinab Gourgin Karaji
- Dept. of Physical education, Farhanguian University of Kermanshah Province, Kermanshah, Iran
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Gordon T. Brief Electrical Stimulation Promotes Recovery after Surgical Repair of Injured Peripheral Nerves. Int J Mol Sci 2024; 25:665. [PMID: 38203836 PMCID: PMC10779324 DOI: 10.3390/ijms25010665] [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: 10/13/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Injured peripheral nerves regenerate their axons in contrast to those in the central nervous system. Yet, functional recovery after surgical repair is often disappointing. The basis for poor recovery is progressive deterioration with time and distance of the growth capacity of the neurons that lose their contact with targets (chronic axotomy) and the growth support of the chronically denervated Schwann cells (SC) in the distal nerve stumps. Nonetheless, chronically denervated atrophic muscle retains the capacity for reinnervation. Declining electrical activity of motoneurons accompanies the progressive fall in axotomized neuronal and denervated SC expression of regeneration-associated-genes and declining regenerative success. Reduced motoneuronal activity is due to the withdrawal of synaptic contacts from the soma. Exogenous neurotrophic factors that promote nerve regeneration can replace the endogenous factors whose expression declines with time. But the profuse axonal outgrowth they provoke and the difficulties in their delivery hinder their efficacy. Brief (1 h) low-frequency (20 Hz) electrical stimulation (ES) proximal to the injury site promotes the expression of endogenous growth factors and, in turn, dramatically accelerates axon outgrowth and target reinnervation. The latter ES effect has been demonstrated in both rats and humans. A conditioning ES of intact nerve days prior to nerve injury increases axonal outgrowth and regeneration rate. Thereby, this form of ES is amenable for nerve transfer surgeries and end-to-side neurorrhaphies. However, additional surgery for applying the required electrodes may be a hurdle. ES is applicable in all surgeries with excellent outcomes.
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Affiliation(s)
- Tessa Gordon
- Division of Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON M4G 1X8, Canada
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Khan S, Carrasco DI, Isaacson R, English AW. Proportions of four distinct classes of sensory neurons are retained even when axon regeneration is enhanced following peripheral nerve injury. Front Neuroanat 2023; 17:1303888. [PMID: 38020215 PMCID: PMC10657864 DOI: 10.3389/fnana.2023.1303888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Recovery from peripheral nerve injuries is poor because axon regeneration is slow and inefficient. Experimental therapies that increase signaling of neuronal brain-derived neurotrophic factor (BDNF) through its TrkB receptor or through its downstream effectors enhance axon regeneration, increasing the number of motor and sensory neurons whose axons successfully regenerate and reinnervate muscle targets. The goal of this study was to compare the proportions of four different classes of sensory (dorsal root ganglion, DRG) neurons that successfully reinnervate two different muscle targets in control mice and mice treated pharmacologically to enhance axon regeneration. Methods Following sciatic nerve transection and repair, C57BL/6 J mice were treated for 2 weeks, either with R13, a prodrug that releases the small molecule TrkB ligand, 7,8-dihydroxyflavone, with compound 11 (CP11), an inhibitor of asparaginyl endopeptidase (δ-secretase), or with a control vehicle. Four weeks after injury, different fluorescent retrograde tracers were injected into the gastrocnemius and tibialis anterior muscles to mark DRG neurons that had successfully reinnervated these muscles. Using immunofluorescence, retrogradely labeled DRG neurons also expressing markers of four different sensory neuronal classes were counted. Results and discussion Treatments with R13 or CP11 resulted in muscle reinnervation by many more DRG neurons than vehicletreated controls, but neurons expressing proteins associated with the different classes of DRG neurons studied were largely in the same proportions found in intact mice.
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Affiliation(s)
| | | | | | - Arthur W. English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
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Isaacson RH, Carrasco DI, Holliday H, Kang SS, Khan S, Kim D, Liu X, Ye K, English AW. Treatments with the specific δ-secretase inhibitor, compound 11, promote the regeneration of motor and sensory axons after peripheral nerve injury. Eur J Neurosci 2023; 58:3555-3568. [PMID: 37608574 DOI: 10.1111/ejn.16126] [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: 05/31/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
Limited axon regeneration following peripheral nerve injury may be related to activation of the lysosomal protease, asparaginyl endopeptidase (AEP, δ-secretase) and its degradation of the microtubule associated protein, Tau. Activity of AEP was increased at the site of sciatic nerve transection and repair but blocked in mice treated systemically with a specific AEP inhibitor, compound 11 (CP11). Treatments with CP11 enhanced axon regeneration in vivo. Amplitudes of compound muscle action potentials recorded 4 weeks after nerve transection and repair and 2 weeks after daily treatments with CP11 were double those of vehicle-treated mice. At that time after injury, axons of significantly more motor and sensory neurons had regenerated successfully and reinnervated the tibialis anterior and gastrocnemius muscles in CP11-treated mice than vehicle-treated controls. In cultured adult dorsal root ganglion neurons derived from wild type mice that were treated in vitro for 24 h with CP11, neurites were nearly 50% longer than in vehicle-treated controls and similar to neurite lengths in cultures treated with the TrkB agonist, 7,8-dihydroxyflavone (7,8-DHF). Combined treatment with CP11 and 7,8-DHF did not enhance outgrowth more than treatments with either one alone. Enhanced neurite outgrowth produced by CP11 was found also in the presence of the TrkB inhibitor, ANA-12, indicating that the enhancement was independent of TrkB signalling. Longer neurites were found after CP11 treatment in both TrkB+ and TrkB- neurons. Delta secretase inhibition by CP11 is a treatment for peripheral nerve injury with great potential.
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Affiliation(s)
- Robin H Isaacson
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dario I Carrasco
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hannah Holliday
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Seong Su Kang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samia Khan
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Kim
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Xia Liu
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Keqiang Ye
- Faculty of Life and Health Sciences, and Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology (SIAT), Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Arthur W English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA
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Barham M, Andermahr J, Majczyński H, Sławińska U, Vogt J, Neiss WF. Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation. Front Neurol 2023; 13:1050822. [PMID: 36742044 PMCID: PMC9893025 DOI: 10.3389/fneur.2022.1050822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023] Open
Abstract
Background and purpose After peripheral nerve lesions, surgical reconstruction facilitates axonal regeneration and motor reinnervation. However, functional recovery is impaired by aberrant reinnervation. Materials and methods We tested whether training therapy by treadmill exercise (9 × 250 m/week) before (run-idle), after (idle-run), or both before and after (run-run) sciatic nerve graft improves the accuracy of reinnervation in rats. Female Lewis rats (LEW/SsNHsd) were either trained for 12 weeks (run) or not trained (kept under control conditions, idle). The right sciatic nerves were then excised and reconstructed with 5 mm of a congenic allograft. One week later, training started in the run-run and idle-run groups for another 12 weeks. No further training was conducted in the run-idle and idle-idle groups. Reinnervation was measured using the following parameters: counting of retrogradely labeled motoneurons, walking track analysis, and compound muscle action potential (CMAP) recordings. Results In intact rats, the common fibular (peroneal) and the soleus nerve received axons from 549 ± 83 motoneurons. In the run-idle group, 94% of these motoneurons had regenerated 13 weeks after the nerve graft. In the idle-run group, 81% of the normal number of motoneurons had regenerated into the denervated musculature and 87% in both run-run and idle-idle groups. Despite reinnervation, functional outcome was poor: walking tracks indicated no functional improvement of motion in any group. However, in the operated hindlimb of run-idle rats, the CMAP of the soleus muscle reached 11.9 mV (normal 16.3 mV), yet only 6.3-8.1 mV in the other groups. Conclusion Treadmill training neither altered the accuracy of reinnervation nor the functional recovery, and pre-operative training (run-idle) led to a higher motor unit activation after regeneration.
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Affiliation(s)
- Mohammed Barham
- Department II of Anatomy, University of Cologne and University Hospital of Cologne, Cologne, Germany,*Correspondence: Mohammed Barham ✉
| | | | - Henryk Majczyński
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warszawa, Poland
| | - Urszula Sławińska
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warszawa, Poland
| | - Johannes Vogt
- Department II of Anatomy, University of Cologne and University Hospital of Cologne, Cologne, Germany,Cluster of Excellence for Aging Research (CECAD) and Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Wolfram F. Neiss
- Department I of Anatomy, University of Cologne and University Hospital of Cologne, Cologne, Germany
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The Role of Physical Exercise and Rehabilitative Implications in the Process of Nerve Repair in Peripheral Neuropathies: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13030364. [PMID: 36766469 PMCID: PMC9914426 DOI: 10.3390/diagnostics13030364] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The various mechanisms involved in peripheral nerve regeneration, induced by exercise and electrical nerve stimulation, are still unclear. OBJECTIVE The aim of this review was to summarize the influence of physical exercise and/or electrical stimulation on peripheral nerve repair and regeneration and the variation of impact of intervention depending on timing, as well as kind and dosage of the intervention. A literature survey was conducted on PubMed, Scopus, and Web of Science, between February 2021 to July 2021, with an update in September 2022. METHODOLOGY The literature search identified 101,386 articles with the keywords: "peripheral nerve" OR "neuropathy" AND "sprouting" OR "neuroapraxia" OR "axonotmesis" OR "neurotmesis" OR "muscle denervation" OR "denervated muscle" AND "rehabilitation" OR "physical activity" OR "physical exercise" OR "activity" OR "electrical stimulation". A total of 60 publications were included. Eligible studies were focused on evaluating the process of nerve repair (biopsy, electromyographic parameters or biomarker outcomes) after electrical stimulation or physical exercise interventions on humans or animals with peripheral sensory or motor nerve injury. SYNTHESIS This study shows that the literature, especially regarding preclinical research, is mainly in agreement that an early physical program with active exercise and/or electrical stimulation promotes axonal regenerative responses and prevents maladaptive response. This was evaluated by means of changes in electrophysiological recordings of CMAPs for latency amplitude, and the sciatic functional index (SFI). Furthermore, this type of activity can cause an increase in weight and in muscle fiber diameter. Nevertheless, some detrimental effects of exercising and electrical stimulation too early after nerve repair were recorded. CONCLUSION In most preclinical studies, peripheral neuropathy function was associated with improvements after physical exercise and electrical stimulation. For humans, too little research has been conducted on this topic to reach a complete conclusion. This research supports the need for future studies to test the validity of a possible rehabilitation treatment in humans in cases of peripheral neuropathy to help nerve sprouting.
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Enhancing Motor and Sensory Axon Regeneration after Peripheral Nerve Injury Using Bioluminescent Optogenetics. Int J Mol Sci 2022; 23:ijms232416084. [PMID: 36555724 PMCID: PMC9783325 DOI: 10.3390/ijms232416084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction-Recovery from peripheral nerve injuries is poor even though injured peripheral axons can regenerate. Novel therapeutic approaches are needed. The most successful preclinical experimental treatments have relied on increasing the activity of the regenerating axons, but the approaches taken are not applicable to many nerve-injured patients. Bioluminescent optogenetics (BL-OG) is a novel method of increasing the excitation of neurons that might be similar to that found with activity-dependent experimental therapies. We investigated the use of BL-OG as an approach to promoting axon regeneration following peripheral nerve injury. Methods-BL-OG uses luminopsins, light-sensing ion channels (opsins) fused with a light-emitting luciferase. When exposed to a luciferase substrate, such as coelenterazine (CTZ), luminopsins expressed in neurons generate bioluminescence and produce excitation through their opsin component. Adeno-associated viral vectors encoding either an excitatory luminopsin (eLMO3) or a mutated form (R115A) that can generate bioluminescence but not excite neurons were injected into mouse sciatic nerves. After retrograde transport and viral transduction, nerves were cut and repaired by simple end-to-end anastomosis, and mice were treated with a single dose of CTZ. Results-Four weeks after nerve injury, compound muscle action potentials (M waves) recorded in response to sciatic nerve stimulation were more than fourfold larger in mice expressing the excitatory luminopsin than in controls expressing the mutant luminopsin. The number of motor and sensory neurons retrogradely labeled from reinnervated muscles in mice expressing eLMO3 was significantly greater than the number in mice expressing the R115A luminopsin and not significantly different from those in intact mice. When viral injection was delayed so that luminopsin expression was induced after nerve injury, a clinically relevant scenario, evoked M waves recorded from reinnervated muscles were significantly larger after injury in eLMO3-expressing mice. Conclusions-Treatment of peripheral nerve injuries using BL-OG has significant potential to enhance axon regeneration and promote functional recovery.
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Adidharma W, Khouri AN, Lee JC, Vanderboll K, Kung TA, Cederna PS, Kemp SWP. Sensory nerve regeneration and reinnervation in muscle following peripheral nerve injury. Muscle Nerve 2022; 66:384-396. [PMID: 35779064 DOI: 10.1002/mus.27661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/11/2022]
Abstract
Sensory afferent fibers are an important component of motor nerves and compose the majority of axons in many nerves traditionally thought of as "pure" motor nerves. These sensory afferent fibers innervate special sensory end organs in muscle, including muscle spindles that respond to changes in muscle length and Golgi tendons that detect muscle tension. Both play a major role in proprioception, sensorimotor extremity control feedback, and force regulation. After peripheral nerve injury, there is histological and electrophysiological evidence that sensory afferents can reinnervate muscle, including muscle that was not the nerve's original target. Reinnervation can occur after different nerve injury and muscle models, including muscle graft, crush, and transection injuries, and occurs in a nonspecific manner, allowing for cross-innervation to occur. Evidence of cross-innervation includes the following: muscle spindle and Golgi tendon afferent-receptor mismatch, vagal sensory fiber reinnervation of muscle, and cutaneous afferent reinnervation of muscle spindle or Golgi tendons. There are several notable clinical applications of sensory reinnervation and cross-reinnervation of muscle, including restoration of optimal motor control after peripheral nerve repair, flap sensation, sensory protection of denervated muscle, neuroma treatment and prevention, and facilitation of prosthetic sensorimotor control. This review focuses on sensory nerve regeneration and reinnervation in muscle, and the clinical applications of this phenomena. Understanding the physiology and limitations of sensory nerve regeneration and reinnervation in muscle may ultimately facilitate improvement of its clinical applications.
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Affiliation(s)
- Widya Adidharma
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Alexander N Khouri
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Jennifer C Lee
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Kathryn Vanderboll
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Theodore A Kung
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Paul S Cederna
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan.,Department of Biomedical Engineering, Ann Arbor, Michigan
| | - Stephen W P Kemp
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan.,Department of Biomedical Engineering, Ann Arbor, Michigan
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de Moura JA, de Morais J, Barbosa SMN, Ferreira MC, de Sousa Neto IV, Leite HR, Oliveira MX, Gaiad TP, Santos AP. Negative neuromuscular and functional repercussion of forced swimming after axonotmesis. J Exerc Rehabil 2022; 18:179-186. [PMID: 35846236 PMCID: PMC9271644 DOI: 10.12965/jer.2244150.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Peripheral nerve injuries are cause of sensory disturbances and in functional abilities, and are associated personal and social costs. Strategies that maximize nerve regeneration and functional recovery are necessary, the exercise is an option. This study evaluated the effects of forced swimming exercise on neuromuscular histomorphometry and on functional recovery in a median nerve crush model. Sixteen Wistar rats underwent median nerve crush and were divided into control group (CG) and swimming group (SG). The forced swimming protocol started one week after the injury and was performed for 1 hr a day, 5 days per week, for 2 weeks. The rats swam with an overload of 5% and 10% of body weight in the first and second week, respectively. The functional recovery was assessed in three moments using the grasping test. On day 21, fragments of the median nerve and of the forearm flexors muscles were removed for histomorphometric analysis. The SG had functional recovery impaired (P<0.001) and presented lower myelinated fibers number, fiber and axon minimal diameter, myelin thickness and g-ratio in the proximal e distal segments of the median nerve (P<0.005) and area muscle fiber (P<0.005) than CG. Also, the SG presented a number of capillaries in the proximal segments of the median nerve greater than CG (P<0.005). The exercise protocol used in this study impaired the regeneration of the median nerve and negatively influenced the functional recovery.
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Affiliation(s)
- Júlia Araújo de Moura
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Jaqueline de Morais
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Samara Maria Neves Barbosa
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Marcílio Coelho Ferreira
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | | | - Hércules Ribeiro Leite
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Murilo Xavier Oliveira
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Thaís Peixoto Gaiad
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ana Paula Santos
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
- Corresponding author: Ana Paula Santos, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, CEP 39100-000, Brazil,
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12
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Donor activation focused rehabilitation approach to hand closing nerve transfer surgery in individuals with cervical level spinal cord injury. Spinal Cord Ser Cases 2022; 8:47. [PMID: 35487892 PMCID: PMC9055048 DOI: 10.1038/s41394-022-00512-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Case Series. OBJECTIVES To describe the donor activation focused rehabilitation approach (DAFRA) in the setting of the hand closing nerve transfers in cervical spinal cord injury (SCI) so that therapists may apply it to treatment of individuals undergoing this procedure. SETTING United States of America-Academic Level 1 Trauma Center. METHODS We reviewed the records of individuals with cervical SCI who underwent nerve transfer to restore hand closing and post-surgery DAFRA therapy at our institution. The three post-surgery phases of DAFRA included (1) early phase (0-12 months) education, limb preparation, and donor activation exercises, (2) middle phase (12-24 months) volitional recipient muscle activation and (3) late phase (18 + months) strengthening and incorporation of motion in activities of daily living. RESULTS Subtle gains in hand closing were first observed at a mean of 8.4 months after hand closing nerve transfer surgery. Remarkable improvements including discontinuation of assistive devices, independence with feeding and urinary function, and measurable grip were observed. Function continued to improve slowly for one to two more years. CONCLUSIONS A deliberate, slow-paced (monthly for >2 years post-surgery) and incremental therapy program-DAFRA-can be used to improve outcomes after nerve transfer to restore hand closing in cervical SCI. SPONSORSHIP This work was made possible by funding from the Craig H. Neilsen Foundation Spinal Cord Injury Research on the Translation Spectrum (SCIRTS) Grant: Nerve Transfers to Restore Hand Function in Cervical Spinal Cord Injury (PI: Ida Fox).
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13
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Minegishi Y, Nishimoto J, Uto M, Ozone K, Oka Y, Kokubun T, Murata K, Takemoto H, Kanemura N. Effects of exercise on muscle reinnervation and plasticity of spinal circuits in rat sciatic nerve crush injury models with different numbers of crushes. Muscle Nerve 2022; 65:612-620. [PMID: 35119696 DOI: 10.1002/mus.27512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS Motor function recovery is frequently poor after peripheral nerve injury. The effect of different numbers of nerve crushes and exercise on motor function recovery is unknown. We aimed to examine how different numbers of crushes of the rat sciatic nerve affects muscle reinnervation and plasticity of spinal circuits and the effect of exercise intervention. METHODS Single and multiple sciatic nerve crush models with different numbers of crushes were created in rats. Treadmill exercise was performed at 10 m/min for 60 min, five times a week. Muscle reinnervation and synaptic changes in L4-5 motor neurons were examined by immunofluorescence staining. Behavioral tests were the sciatic functional index (SFI) and the pinprick tests. RESULTS The percentage of soleus muscle reinnervation was not significantly increased by the presence of exercise in single or multiple crushes. Exercise after a single crush increased the contact of motor neurons with VGLUT1-containing structures (Exercised vs. Unexercised, 12.9% vs. 8.7%; P < 0.01), but after multiple crushes, it decreased with or without exercise (8.1% vs. 8.6%). Exercise after a single crush significantly improved SFI values from 14 to 24 days, and exercise after multiple crushes from 21 to 35 days (all P < 0.05). The pinprick test showed no difference in recovery depending on the number of crushes or whether or not exercised. DISCUSSION Different numbers of sciatic nerve crushes affect muscle reinnervation and motor neuron synaptic changes differently, but motor function recovery may improve with exercise regardless of the number of crushes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuki Minegishi
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.,Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Junji Nishimoto
- Department of Rehabilitation, Saitama Medical University Saitama Medical Center, Saitama, Japan
| | - Minori Uto
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan
| | - Kaichi Ozone
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.,Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yuichiro Oka
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.,Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takanori Kokubun
- Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - Hidenori Takemoto
- Department of Rehabilitation, Hiroshima International Medical and Welfare College, Hiroshima, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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14
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Hsieh YL, Yang NP, Chen SF, Lu YL, Yang CC. Early Intervention of Cold-Water Swimming on Functional Recovery and Spinal Pain Modulation Following Brachial Plexus Avulsion in Rats. Int J Mol Sci 2022; 23:ijms23031178. [PMID: 35163098 PMCID: PMC8835039 DOI: 10.3390/ijms23031178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Brachial plexus avulsion (BPA) causes peripheral nerve injury complications with motor and sensory dysfunction of the upper limb. Growing evidence has shown an active role played by cold-water swimming (CWS) in alleviating peripheral neuropathic pain and functional recovery. This study examined whether CWS could promote functional recovery and pain modulation through the reduction of neuroinflammation and microglial overactivation in dorsal horn neurons at the early-stage of BPA. After BPA surgery was performed on rats, they were assigned to CWS or sham training for 5 min twice a day for two weeks. Functional behavioral responses were tested before and after BPA surgery, and each week during training. Results after the two-week training program showed significant improvements in BPA-induced motor and sensory loss (p < 0.05), lower inflammatory cell infiltration, and vacuole formation in injured nerves among the BPA-CWS group. Moreover, BPA significantly increased the expression of SP and IBA1 in dorsal horn neurons (p < 0.05), whereas CWS prevented their overexpression in the BPA-CWS group. The present findings evidenced beneficial rehabilitative effects of CWS on functional recovery and pain modulation at early-stage BPA. The beneficial effects are partially related to inflammatory suppression and spinal modulation. The synergistic role of CWS combined with other management approaches merits further investigation.
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Affiliation(s)
- Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan;
- Correspondence: ; Tel.: +886-4-22053366 (ext. 7312)
| | - Nian-Pu Yang
- Kao-An Physical Medicine and Rehabilitation Clinic, Taichung 40763, Taiwan; (N.-P.Y.); (S.-F.C.); (C.-C.Y.)
| | - Shih-Fong Chen
- Kao-An Physical Medicine and Rehabilitation Clinic, Taichung 40763, Taiwan; (N.-P.Y.); (S.-F.C.); (C.-C.Y.)
| | - Yu-Lin Lu
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan;
| | - Chen-Chia Yang
- Kao-An Physical Medicine and Rehabilitation Clinic, Taichung 40763, Taiwan; (N.-P.Y.); (S.-F.C.); (C.-C.Y.)
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15
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Maugeri G, D'Agata V, Trovato B, Roggio F, Castorina A, Vecchio M, Di Rosa M, Musumeci G. The role of exercise on peripheral nerve regeneration: from animal model to clinical application. Heliyon 2021; 7:e08281. [PMID: 34765794 PMCID: PMC8571504 DOI: 10.1016/j.heliyon.2021.e08281] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/26/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Peripheral nerve injury is a complex condition with a variety of signs and symptoms depending on the severity and nerves involved. Peripheral nerve damage may lead to sensory and motor functions deficits and even lifelong disability, causing important socioeconomic costs worldwide. Despite the increase in knowledge of the mechanisms of injury and regeneration, a full functional recovery is still unsatisfying in the majority of patients. It is well known that exercise promotes physical and psychological well-being, by ameliorating general health. In the last years, there has been a growing interest in evaluating the effects of exercise on the peripheral nervous system. Experimental works with rodent models showed the potential utility of exercise following peripheral nerve injuries, as evinced by increasing axon regeneration, muscle reinnervation, better recovery of strength, muscle mass and higher expression of neurotrophic factors. Moreover, clinical evidence showed positive trends in favour of physical therapy following peripheral nerve damage based on the improvement of range of motion (ROM), muscle power grade and pain. After a brief overview of peripheral nerve anatomy and the different types of nerve injury, the present review aims to summarize the impact of exercise on peripheral nerve regeneration. Some clinical evidence regarding the effect of exercise after peripheral nerve injury will also be discussed.
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Affiliation(s)
- Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy
| | - Velia D'Agata
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy
| | - Bruno Trovato
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Federico Roggio
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Alessandro Castorina
- Laboratory of Cellular and Molecular Neuroscience (LCMN), School of Life Sciences, Faculty of Science, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.,Laboratory of Neural Structure and Function (LNSF), School of Medical Sciences, (Anatomy & Histology), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Michele Vecchio
- Unit of Rehabilitation, Vittorio Emanuele University Hospital, Catania, Italy
| | - Michelino Di Rosa
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy.,Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy.,Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA
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16
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Kampanis V, Tolou-Dabbaghian B, Zhou L, Roth W, Puttagunta R. Cyclic Stretch of Either PNS or CNS Located Nerves Can Stimulate Neurite Outgrowth. Cells 2020; 10:cells10010032. [PMID: 33379276 PMCID: PMC7824691 DOI: 10.3390/cells10010032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
The central nervous system (CNS) does not recover from traumatic axonal injury, but the peripheral nervous system (PNS) does. We hypothesize that this fundamental difference in regenerative capacity may be based upon the absence of stimulatory mechanical forces in the CNS due to the protective rigidity of the vertebral column and skull. We developed a bioreactor to apply low-strain cyclic axonal stretch to adult rat dorsal root ganglia (DRG) connected to either the peripheral or central nerves in an explant model for inducing axonal growth. In response, larger diameter DRG neurons, mechanoreceptors and proprioceptors showed enhanced neurite outgrowth as well as increased Activating Transcription Factor 3 (ATF3).
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Affiliation(s)
- Vasileios Kampanis
- Laboratory for Experimental Neuroregeneration, Spinal Cord Injury Center, Heidelberg University Hospital, 69118 Heidelberg, Germany; (V.K.); (B.T.-D.)
| | - Bahardokht Tolou-Dabbaghian
- Laboratory for Experimental Neuroregeneration, Spinal Cord Injury Center, Heidelberg University Hospital, 69118 Heidelberg, Germany; (V.K.); (B.T.-D.)
| | - Luming Zhou
- Laboratory of NeuroRegeneration and Repair, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany;
| | - Wolfgang Roth
- Laboratory for Experimental Neurorehabilitation, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Radhika Puttagunta
- Laboratory for Experimental Neuroregeneration, Spinal Cord Injury Center, Heidelberg University Hospital, 69118 Heidelberg, Germany; (V.K.); (B.T.-D.)
- Correspondence:
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17
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Whitehead TJ, Mays EA, Prasad M, Mora A, Chen C, Mazhari A, Peduzzi J, Sundararaghavan HG. Mechanical, topographical and chemical cues combined with physical therapy for peripheral nerve injuries. Regen Med 2020; 15:2193-2207. [PMID: 33284662 DOI: 10.2217/rme-2020-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this paper is to evaluate biomaterial cues combined with physical therapy (PT) on functional recovery in a rat sciatic nerve injury model. Materials & methods: Nerve growth conduits were filled with longitudinally aligned hyaluronic acid fibers and microspheres containing neurotrophic factor (growth factor [GF]). All animals received behavior and functional testing throughout the study, which concluded with measurement of compound muscle action potentials and contractile force of the gastrocnemius muscle. Results & conclusion: Including GF improved recovery of gross motor function and increased sensory pain sensation. During the 4 weeks that animals participated in PT, these groups showed higher static sciatic index scores. Including GF and PT has the potential to improve clinical outcomes following peripheral nerve injury.
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Affiliation(s)
- Tonya J Whitehead
- Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI 48201, USA
| | - Elizabeth A Mays
- Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI 48201, USA
| | - Monica Prasad
- Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI 48201, USA
| | - Anthony Mora
- Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI 48201, USA
| | - Chaoyang Chen
- Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI 48201, USA
| | - Assadollah Mazhari
- Department of Neurosurgery, Wayne State University School of Medicine, 4160 John R St, Detroit, MI 48201, USA
| | - Jean Peduzzi
- Department of Neurosurgery, Wayne State University School of Medicine, 4160 John R St, Detroit, MI 48201, USA.,Department of Ophthalmology, Visual & Anatomical Sciences, 540 E Canfield Ave, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Harini G Sundararaghavan
- Department of Biomedical Engineering, Wayne State University, 818 W Hancock St, Detroit, MI 48201, USA
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18
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Kim JE, Cho YH, Seo TB. Treadmill exercise activates ATF3 and ERK1/2 downstream molecules to facilitate axonal regrowth after sciatic nerve injury. J Exerc Rehabil 2020; 16:141-147. [PMID: 32509698 PMCID: PMC7248442 DOI: 10.12965/jer.2040188.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to investigate the effect of treadmill exer-cise on activating transcription factors such as activating transcription factor 3 (ATF3) and extracellular signal-regulated kinase (ERK1/2) sig-naling pathway to facilitate axonal regrowth after sciatic nerve injury (SNI). The experimental rats divided into the normal control (n=10), sedentary groups for 7 (n=10) and 14 days (n=10) post crush, exercise group for 7 (n=10) and 14 days (n=10) post crush (dpc). The rats in ex-ercise groups run on treadmill device at a speed of 8 m/min for 20 min once a day according to exercise duration. In order to evaluate specific regeneration markers and axonal elongation in injured sciatic nerve, we applied immunofluorescence staining and western blot techniques. Treadmill exercise further increased growth-associated protein (GAP-43) expression and axonal regrowth at 7 and 14 dpc than those in sed-entary group. Among mitogen-activated protein kinase downstream molecules, phospho-ERK1/2 (p-ERK1/2) was enhanced by treadmill ex-ercise at only 7 dpc and decreased to basal level 14 days later. But c-Jun N-terminal kinase, c-Jun, and phospho-cyclic adenosine mono-phosphate response element-binding protein showed a tendency to in-crease continuously until 14 dpc by exercise. ATF3 expression in exer-cise group was upregulated at both 7 and 14 dpc compared to the sed-entary group. These results indicate that treadmill exercise had benefi-cial effect on expression of regeneration-related proteins after SNI, suggesting that exercise might be one of various therapeutic strategies for sciatic nerve regeneration.
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Affiliation(s)
- Ji-Eun Kim
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
| | - Yeong-Hyun Cho
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
| | - Tae-Beom Seo
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju, Korea
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19
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Akhter ET, Griffith RW, English AW, Alvarez FJ. Removal of the Potassium Chloride Co-Transporter from the Somatodendritic Membrane of Axotomized Motoneurons Is Independent of BDNF/TrkB Signaling But Is Controlled by Neuromuscular Innervation. eNeuro 2019; 6:ENEURO.0172-19.2019. [PMID: 31541001 PMCID: PMC6795555 DOI: 10.1523/eneuro.0172-19.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/21/2019] [Accepted: 09/15/2019] [Indexed: 01/09/2023] Open
Abstract
The potassium-chloride cotransporter (KCC2) maintains the low intracellular chloride found in mature central neurons and controls the strength and direction of GABA/glycine synapses. We found that following axotomy as a consequence of peripheral nerve injuries (PNIs), KCC2 protein is lost throughout the somatodendritic membrane of axotomized spinal cord motoneurons after downregulation of kcc2 mRNA expression. This large loss likely depolarizes the reversal potential of GABA/glycine synapses, resulting in GABAergic-driven spontaneous activity in spinal motoneurons similar to previous reports in brainstem motoneurons. We hypothesized that the mechanism inducing KCC2 downregulation in spinal motoneurons following peripheral axotomy might be mediated by microglia or motoneuron release of BDNF and TrkB activation as has been reported on spinal cord dorsal horn neurons after nerve injury, motoneurons after spinal cord injury (SCI), and in many other central neurons throughout development or a variety of pathologies. To test this hypothesis, we used genetic approaches to interfere with microglia activation or delete bdnf from specifically microglia or motoneurons, as well as pharmacology (ANA-12) and pharmacogenetics (F616A mice) to block TrkB activation. We show that KCC2 dysregulation in axotomized motoneurons is independent of microglia, BDNF, and TrkB. KCC2 is instead dependent on neuromuscular innervation; KCC2 levels are restored only when motoneurons reinnervate muscle. Thus, downregulation of KCC2 occurs specifically while injured motoneurons are regenerating and might be controlled by target-derived signals. GABAergic and glycinergic synapses might therefore depolarize motoneurons disconnected from their targets and contribute to augment motoneuron activity known to promote motor axon regeneration.
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Affiliation(s)
- Erica Tracey Akhter
- Departments of Physiology, Emory University, Atlanta, GA 30322
- Cell Biology, Emory University, Atlanta, GA 30322
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20
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Qian Y, Cheng Y, Cai J, Zhao X, Ouyang Y, Yuan WE, Fan C. Advances in electrical and magnetic stimulation on nerve regeneration. Regen Med 2019; 14:969-979. [PMID: 31583954 DOI: 10.2217/rme-2018-0079] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central and peripheral nerve injuries pose a great threat to people. Complications such as inflammation, muscle atrophy, traumatic neuromas and delayed reinnervation can bring huge challenges to clinical practices and barriers to complete nerve regrowth. Physical interventions such as electrical and magnetic stimulation show satisfactory results with varying parameters for acute and chronic nerve damages. The biological basis of electrical and magnetic stimulation mainly relies on protein synthesis, ion channel regulation and growth factor secretion. This review focuses on the various paradigms used in different models of electrical and magnetic stimulation and their regenerative potentials and underlying mechanisms in nerve injuries. The combination of physical stimulation and conductive biomaterial scaffolds displays an infinite potentiality in translational application in nerve regeneration.
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Affiliation(s)
- Yun Qian
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Yuan Cheng
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, & School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Jiangyu Cai
- Department of Sports Medicine & Arthroscopic Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, PR China
| | - Xiaotian Zhao
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, & School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Yuanming Ouyang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Wei-En Yuan
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, & School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
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21
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Gabira MM, Rosa Junior GM, Alcalde GE, Ferraresi C, Simionato LH, Bortoluci CHF. Eficácia da estimulação elétrica com corrente russa após neurorrafia término-lateral do nervo fibular comum: análise eletroneuromiográfica e de força muscular. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17022626032019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Lesões de nervos periféricos levam a perda funcional elevada no tecido muscular. Assim, muitas pesquisas têm investigado técnicas cirúrgicas, como neurorrafias, e recursos terapêuticos, como eletroestimulação, para melhorar a funcionalidade de um músculo reinervado após lesão periférica. Este estudo tem como objetivo investigar os efeitos da eletroestimulação com corrente russa (2.500Hz, 4ms, 10 seg. de contração por 20 seg. de relaxamento, modulação de 10Hz e 100 Hz) na recuperação funcional após secção e neurorrafia término-lateral do coto distal do nervo fibular comum à face lateral do nervo tibial em ratos. Foram utilizados 25 ratos Wistar, machos, com 80 dias de vida, fornecidos pelo Biotério Central da Universidade Sagrado Coração (Bauru, SP, Brasil). Os animais foram divididos aleatoriamente em cinco grupos: grupo-controle Inicial (GCI), grupo-controle final (GCF), grupo experimental não tratado (GENT), grupo neurorrafia término-lateral com estimulação russa (GNTLER) e grupo-controle desnervado (GCD). A corrente russa foi iniciada cinco dias após neurorrafia e aplicada no músculo tibial cranial do GNTLER, 3 vezes por semana, totalizando 36 sessões. A estimulação elétrica foi eficaz para aumentar a amplitude e diminuir a latência do músculo reinervado, além de aumentar a força muscular em comparação ao GCD. Diante disso, conclui-se que a eletroestimulação de média frequência (corrente russa) foi eficiente na recuperação funcional do músculo tibial cranial após neurorrafia término-lateral do nervo fibular comum.
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Ferreira MC, Oliveira MX, Souza JI, Souza RA, Machado TPG, Santos AP. Effects of two intensities of treadmill exercise on neuromuscular recovery after median nerve crush injury in Wistar rats. J Exerc Rehabil 2019; 15:392-400. [PMID: 31316931 PMCID: PMC6614769 DOI: 10.12965/jer.19.328126.063] [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: 03/15/2019] [Accepted: 04/17/2019] [Indexed: 01/02/2023] Open
Abstract
Considering the potential action of exercise on neuroplasticity and the need to adapt protocols to enhance functional recovery after nerve injury, this study evaluated the effects of two intensities of treadmill exercise on nervous and muscular tissues and functional recovery after nerve crush injury. Wistar rats were distributed into sedentary group (SED), and 10 m/min (EG10) and 17 m/min (EG17) exercise groups. The exercise started one week after the injury. Ten daily sessions were performed with a 2-day interval after the fifth day. The flexor digitorum muscle and two segments of the median nerve were analysed histomorphometrically by light microscopy and computer analysis. Function was evaluated by grasping test, in 3 moments. Approval number: 016/2013. In the proximal segments of the median nerve, the diameter of myelinated fibres and axon, the myelin sheath thickness and the ratio of axon diameter to fibre diameter (g ratio) were significantly larger (P<0.05) in the EG10. The number of myelinated fibres was lesser in the EG17 than the other groups (P<0.05). No difference in the number of myelinated fibres among groups was observed in the distal segments, but the SED presented significantly larger axon and fibre diameters than those that performed exercise. The EG10 presented greater area and diameter of muscle fibres (P<0.05) and functional improvement observed on the 21st day after injury (P<0.05) compared with the EG17 and SED. Continuous exercise at 10 m/min accentuates nerve regeneration, accelerating functional recovery and preventing muscle atrophy.
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Affiliation(s)
- Marcílio Coelho Ferreira
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Murilo X Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Josiane I Souza
- Animal Experimentation Center, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Renato A Souza
- Federal Institute of South of Minas Gerais, Campus Muzambinho, Muzambinho, Minas Gerais, Brazil
| | - Thaís P G Machado
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Ana Paula Santos
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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Arbat-Plana A, Puigdomenech M, Navarro X, Udina E. Role of Noradrenergic Inputs From Locus Coeruleus on Changes Induced on Axotomized Motoneurons by Physical Exercise. Front Cell Neurosci 2019; 13:65. [PMID: 30863285 PMCID: PMC6399159 DOI: 10.3389/fncel.2019.00065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Abstract
Physical rehabilitation is one of the cornerstones for the treatment of lesions of the nervous system. After peripheral nerve injuries, activity dependent therapies promote trophic support for the paralyzed muscles, enhance axonal growth and also modulate the maladaptive plastic changes induced by the injury at the spinal level. We have previously demonstrated that an intensive protocol of treadmill running (TR) in rats reduces synaptic stripping on axotomized motoneurons, preserves their perineuronal nets (PNN) and attenuates microglia reactivity. However, it is not clear through which mechanisms exercise is exerting these effects. Here we aimed to evaluate if activation of the locus coeruleus (LC), the noradrenergic center in the brain stem, plays a role in these effects. Since LC is strongly activated during stressful situations, as during intensive exercise, we selectively destroyed the LC by administering the neurotoxin DPS-4 before injuring the sciatic nerve of adult rats. Animals without LC had increased microglia reactivity around injured motoneurons. In these animals, an increasing intensity protocol of TR was not able to prevent synaptic stripping on axotomized motoneurons and the reduction in the thickness of their PNN. In contrast, TR was still able to attenuate microglia reactivity in DSP-4 treated animals, thus indicating that the noradrenergic projections are important for some but not all the effects that exercise induces on the spinal cord after peripheral nerve injury. Moreover, animals subjected to treadmill training showed delayed muscle reinnervation, more evident if treated with DSP-4. However, we did not find differences in treated animals regarding the H/M amplitude ratio, which increased during the first stages of regeneration in all injured groups.
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Affiliation(s)
- Ariadna Arbat-Plana
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Puigdomenech
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Esther Udina
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
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McGregor CE, English AW. The Role of BDNF in Peripheral Nerve Regeneration: Activity-Dependent Treatments and Val66Met. Front Cell Neurosci 2019; 12:522. [PMID: 30687012 PMCID: PMC6336700 DOI: 10.3389/fncel.2018.00522] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022] Open
Abstract
Despite the ability of peripheral nerves to spontaneously regenerate after injury, recovery is generally very poor. The neurotrophins have emerged as an important modulator of axon regeneration, particularly brain derived neurotrophic factor (BDNF). BDNF regulation and signaling, as well as its role in activity-dependent treatments including electrical stimulation, exercise, and optogenetic stimulation are discussed here. The importance of a single nucleotide polymorphism in the BDNF gene, Val66Met, which is present in 30% of the human population and may hinder the efficacy of these treatments in enhancing regeneration after injury is considered. Preliminary data are presented on the effectiveness of one such activity-dependent treatment, electrical stimulation, in enhancing axon regeneration in mice expressing the met allele of the Val66Met polymorphism.
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Affiliation(s)
- Claire Emma McGregor
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - Arthur W English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
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Duret C, Mazzoleni S. Upper limb robotics applied to neurorehabilitation: An overview of clinical practice. NeuroRehabilitation 2018; 41:5-15. [PMID: 28505985 DOI: 10.3233/nre-171452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND During the last two decades, extensive interaction between clinicians and engineers has led to the development of systems that stimulate neural plasticity to optimize motor recovery after neurological lesions. This has resulted in the expansion of the field of robotics for rehabilitation. Studies in patients with stroke-related upper-limb paresis have shown that robotic rehabilitation can improve motor capacity. However, few other applications have been evaluated (e.g. tremor, peripheral nerve injuries or other neurological diseases). PURPOSE This paper presents an overview of the current use of upper limb robotic systems for neurorehabilitation, and highlights the rationale behind their use for the assessment and treatment of common neurological disorders. CONCLUSIONS Rehabilitation robots are little integrated in clinical practice, except after stroke. Although few studies have been carried out to evaluate their effectiveness, evidence from the neurosciences and indications from pilot studies suggests that upper limb robotic rehabilitation can be applied safely in various other neurological conditions. Rehabilitation robots provide an intensity, quality and dose of treatment that exceeds therapist-mediated rehabilitation. Moreover, the use of force fields, multi-sensory environments, feedback etc. renders such rehabilitation engaging and motivating. Future studies should evaluate the effectiveness of rehabilitation robots in neurological pathologies other than stroke.
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Affiliation(s)
- Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Rehabilitation Bioengineering Laboratory, Volterra, Italy
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Chaparro-Cárdenas SL, Lozano-Guzmán AA, Ramirez-Bautista JA, Hernández-Zavala A. A review in gait rehabilitation devices and applied control techniques. Disabil Rehabil Assist Technol 2018; 13:819-834. [PMID: 29577779 DOI: 10.1080/17483107.2018.1447611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this review is to analyse the different existing technologies for gait rehabilitation, focusing mainly in robotic devices. Those robots help the patient to recover a lost function due to neurological gait disorders, accidents or after injury. Besides, they facilitate the identification of normal and abnormal features by registering muscle activity providing the doctor important data where he can observe the evolution of the patient. METHOD A deep literature review was realized using selected keywords considering not only the most common medical and engineering databases, but also other available sources that provide information on commercial and scientific gait rehabilitation devices. The founded literature for this review corresponds to control techniques for gait rehabilitation robots, since the early seventies to the present year. RESULTS Different control strategies for gait analysis in rehabilitation devices have been developed and implemented such as position control, force and impedance control, haptic simulation, and control of EMG signals. These control techniques are used to analyze the force of the patient during therapy, compensating it with the force generated by the mechanism in the rehabilitation device. It is observed that the largest number of studies reported, focuses on the impedance control technique. Leading to include new control techniques and validate them using the necessary protocols with ill patients, obtaining reliable results that allows a progressive and active rehabilitation. CONCLUSIONS With this exhaustive review, we can conclude that the degree of complexity of the rehabilitation device influences in short and long-term therapeutic results since the movements become more controlled. However, there is still a lot of work in the sense of motion control in order to perform trajectories that are more alike the natural movements of humans. There are many control techniques in other areas, which seek to improve the performance of the process. These techniques may possibly be applicable in gait rehabilitation devices, obtaining controllers that are more efficient and that adapts to different people and the necessities that entail every disease. Implications for Rehabilitation Rehabilitation helps people to improve the activities of their daily life, allowing them to observe their progress in the functional abilities as the months pass by with intensive and repetitive therapies. There is a mobility issue when the patient needs to move to the hospital or to the laboratory, which is not always feasible. For overcoming it, patients use the equipment at home to perform their daily therapy. However, they need the sufficient knowledge about its operation, also about the therapeutic movements, the therapy duration and the movement speed. Besides, is necessary to place the equipment in a proper and lively environment that helps to forget or reduce pain while the patient moves his joints progressively. The purpose of robotic rehabilitation devices is to generate repetitive and progressive movements, according to the motor disability. There are training trajectories to follow, which motivate patients to generate active movements. The benefits of robotic rehabilitation depend on the ability of each patient to adapt to the speed and load variations generated by the device, improving and reinforcing motor functions in therapy, especially in patients with advanced disabilities in early rehabilitation. Multi-joint rehabilitation devices are more effective than single-joint rehabilitation devices because they involve a higher number of muscles in the therapy. The greater the number of degrees of freedom (DoF) of the device, it cushions its effect in the patient because the inertia is reduced and higher torques are generated. The assistive technological devices allows to explore different rehabilitation techniques that motivate the patient in therapy, increasing appropriately the energy and pressure in the blood which is reflected in gradually recovering his ability to walk.
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Affiliation(s)
- Silvia L Chaparro-Cárdenas
- a Department of Mechatronics , Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada - Instituto Politécnico Nacional , Querétaro , Querétaro , México
| | - Alejandro A Lozano-Guzmán
- a Department of Mechatronics , Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada - Instituto Politécnico Nacional , Querétaro , Querétaro , México
| | - Julian Andres Ramirez-Bautista
- a Department of Mechatronics , Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada - Instituto Politécnico Nacional , Querétaro , Querétaro , México
| | - Antonio Hernández-Zavala
- a Department of Mechatronics , Centro de Investigación en Ciencia Aplicada y Tecnología Avanzada - Instituto Politécnico Nacional , Querétaro , Querétaro , México
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Feter N, Freitas M, Gonzales N, Umpierre D, Cardoso R, Rombaldi A. Effects of physical exercise on myelin sheath regeneration: A systematic review and meta-analysis. Sci Sports 2018. [DOI: 10.1016/j.scispo.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Arbat‐Plana A, Navarro X, Udina E. Effects of forced, passive, and voluntary exercise on spinal motoneurons changes after peripheral nerve injury. Eur J Neurosci 2017; 46:2885-2892. [DOI: 10.1111/ejn.13739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/26/2017] [Accepted: 10/12/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Ariadna Arbat‐Plana
- Unitat de Fisiologia Mèdica Institute of Neurosciences Department of Cell Biology, Physiology and Immunology Universitat Autònoma de Barcelona Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Av Can Domènech, Edifici M E‐08193 Bellaterra Spain
| | - Xavier Navarro
- Unitat de Fisiologia Mèdica Institute of Neurosciences Department of Cell Biology, Physiology and Immunology Universitat Autònoma de Barcelona Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Av Can Domènech, Edifici M E‐08193 Bellaterra Spain
| | - Esther Udina
- Unitat de Fisiologia Mèdica Institute of Neurosciences Department of Cell Biology, Physiology and Immunology Universitat Autònoma de Barcelona Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Av Can Domènech, Edifici M E‐08193 Bellaterra Spain
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Burns J, Sman AD, Cornett KMD, Wojciechowski E, Walker T, Menezes MP, Mandarakas MR, Rose KJ, Bray P, Sampaio H, Farrar M, Refshauge KM, Raymond J, Burns J, Sman AD, Cornett KMD, Wojciechowski E, Menezes MP, Mandarakas MR, Rose KJ, Bray P, Baldwin J, McKay MJ, Refshauge KM, Raymond J, Walker T, Sampaio H, Mudge A, Purcell L, Miller C, Gray K, Harman M, Gabrael N, Ouvrier RA, Farrar M. Safety and efficacy of progressive resistance exercise for Charcot-Marie-Tooth disease in children: a randomised, double-blind, sham-controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:106-113. [DOI: 10.1016/s2352-4642(17)30013-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 01/22/2023]
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Jaiswal PB, Tung JK, Gross RE, English AW. Motoneuron activity is required for enhancements in functional recovery after peripheral nerve injury in exercised female mice. J Neurosci Res 2017; 98:448-457. [PMID: 28771790 DOI: 10.1002/jnr.24109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/05/2017] [Accepted: 06/13/2017] [Indexed: 01/11/2023]
Abstract
Inhibitory luminopsins (iLMO2) integrate opto- and chemo-genetic approaches and allow for cell-type specific inhibition of neuronal activity. When exposed to a Renilla luciferase substrate, Coelenterazine (CTZ), iLMO2 generates bioluminescence-mediated activation of its amino-terminal halorhodopsin, resulting in neuronal inhibition. Moderate daily exercise in the form of interval treadmill-training (IT) applied following a peripheral nerve injury results in enhanced motor axon regeneration and muscle fiber reinnervation in female mice. We hypothesized that iLMO2 mediated inhibition of motoneuron activity during IT would block this enhancement. Unilateral intramuscular injections of Cre-dependent AAV2/9-EF1a-DIO-iLMO2 (∼8.5 x 1013 vg/ml) were made into the gastrocnemius and tibialis anterior muscles of young female ChAT-IRES-Cre mice, thereby limiting iLMO2 expression specifically to their motoneurons. Four to six weeks were allowed for retrograde viral transduction after which a unilateral sciatic nerve transection (Tx) and repair was performed. Animals were randomized into four groups: IT only, IT + CTZ, CTZ only, and untreated (UT). Three weeks post Tx-repair, the maximal amplitude direct muscle responses (M-max) in both muscles in the IT only group were significantly greater than in UT mice, consistent with the enhancing effects of this exercise regimen. Inhibiting motoneuron activity during exercise by a single injection of CTZ, administered 30 minutes prior to exercise, completely blocked the enhancing effect of exercise. Similar treatments with CTZ in mice without iLMO2 had no effect on regeneration. Neuronal activity is required for successful enhancement of motor axon regeneration by exercise.
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Affiliation(s)
- Poonam B Jaiswal
- Department of Cell Biology and Emory University, Atlanta, GA, USA
| | - Jack K Tung
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Arthur W English
- Department of Cell Biology and Emory University, Atlanta, GA, USA
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Bonetti LV, Malysz T, Ilha J, Barbosa S, Achaval M, Faccioni-Heuser MC. The Effects of Two Different Exercise Programs on the Ultrastructural Features of the Sciatic Nerve and Soleus Muscle After Sciatic Crush. Anat Rec (Hoboken) 2017; 300:1654-1661. [PMID: 28463452 DOI: 10.1002/ar.23611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/16/2016] [Accepted: 01/25/2017] [Indexed: 01/09/2023]
Abstract
Peripheral nerve injuries constitute a significant medical problem and the recovery is critically dependent on post-injury treatment. In this study, following sciatic nerve crush, we investigated the effects of a 4-week endurance training program (ET) and balance and coordination training program (BCT) on the ultrastructural features of the sciatic nerve and soleus muscle. The animals were randomly divided into Sham, non-trained (NT), ET, and BCT groups each of which included three animals. Ultra-thin cross and longitudinal sections (70-85 nm) were digitized and analyzed comparatively. The electron micrographic analysis of the sciatic nerve showed similar organelles features in the injury groups (myelin debris and swelling mitochondria). Nonetheless, the ET group presented better ultrastructural features as demonstrated by the greater predominance of rounded fibers and more defined organization in the myelinated axon bundles. In the soleus muscle's analyses, the injured groups demonstrated similar organelles' features (nucleus contained highly heterochromatic nuclei and smaller mitochondria). However, ET and BCT groups showed apparently enlarged myofibril cross-sectional areas and less collagen around muscle fibers, although, the ET group displayed reduced intermyofibrillar spaces and more closely aligned myofilaments when compared with the BCT group. Based on electron micrographic analysis, our findings suggest the presence of ultrastructural differences between the Sham, NT, and the trained groups. Therefore, exercise type seems to be responsible for producing some different positive features in the trained groups, while ET seems to have a more pronounced influence on the ultrastructural features of the sciatic nerve and the soleus muscle after a crush injury. Anat Rec, 300:1654-1661, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Leandro Viçosa Bonetti
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Taís Malysz
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Jocemar Ilha
- Laboratório de Pesquisa Experimental (LAPEx), Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, SC, Brazil
| | - Silvia Barbosa
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Matilde Achaval
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Maria Cristina Faccioni-Heuser
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, RS, Brazil
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Jaiswal PB, English AW. Chemogenetic enhancement of functional recovery after a sciatic nerve injury. Eur J Neurosci 2017; 45:1252-1257. [PMID: 28244163 DOI: 10.1111/ejn.13550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/15/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
Designer receptors exclusively activated by designer drugs (DREADDs) are chemogenetic tools used to modulate neuronal excitability. We hypothesized that activation of excitatory (Gq) DREADD by its designer ligand, clozapine-N-oxide (CNO), would increase the excitability of neurons whose axons have been transected following peripheral nerve injury, and that this increase will lead to an enhanced functional recovery. The lateral gastrocnemius (LG) muscle of adult female Lewis rats was injected unilaterally with AAV9- hsyn- hM3Dq-mCherry (7.6 × 109 viral genomes/μL) to transduce Gq-DREADD expression in LG neurons. The contralateral LG muscle served as an uninjected control. No significant changes in either spontaneous EMG activity or electrically evoked direct muscle (M) responses were found in either muscle after injection of CNO (1 mg/kg, i.p.). The amplitude of monosynaptic H-reflexes in LG was increased after CNO treatment exclusively in muscles previously injected with virus, suggesting that Gq-DREADD activation increased neuronal excitability. After bilateral sciatic nerve transection and repair, additional rats were treated similarly with CNO for up to three days after injury. Electrophysiological data were collected at 2, 4 and 6 weeks after injury. Evoked EMG responses were observed as early as 2 weeks after injury only in Gq-DREADD expressing virus injected LG muscle. By 4 weeks after injury, both M-response and H-reflex amplitudes were significantly greater in muscles previously injected with viral vector than contralateral, uninjected muscles. Increases in the excitability of injured neurons produced by this novel use of Gq-DREADD were sufficient to promote an enhancement in functional recovery after a sciatic nerve injury.
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Affiliation(s)
- Poonam B Jaiswal
- Department of Cell Biology, Emory University, 615 Michael St, Atlanta, GA, 30322, USA
| | - Arthur W English
- Department of Cell Biology, Emory University, 615 Michael St, Atlanta, GA, 30322, USA
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Meyers EC, Granja R, Solorzano BR, Romero-Ortega M, Kilgard MP, Rennaker RL, Hays S. Median and ulnar nerve injuries reduce volitional forelimb strength in rats. Muscle Nerve 2017; 56:1149-1154. [PMID: 28120500 DOI: 10.1002/mus.25590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Peripheral nerve injuries (PNI) are among the leading causes of physical disability in the United States. The majority of injuries occur in the upper extremities, and functional recovery is often limited. Robust animal models are critical first steps for developing effective therapies to restore function after PNI. METHODS We developed an automated behavioral assay that provides quantitative measurements of volitional forelimb strength in rats. Multiple forelimb PNI models involving the median and ulnar nerves were used to assess forelimb function for up to 13 weeks postinjury. RESULTS Despite multiple weeks of task-oriented training following injury, rats exhibit significant reductions in multiple quantitative parameters of forelimb function, including maximal pull force and speed of force generation. DISCUSSION This study demonstrates that the isometric pull task is an effective method of evaluating forelimb function following PNI and may aid in development of therapeutic interventions to restore function. Muscle Nerve 56: 1149-1154, 2017.
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Affiliation(s)
- Eric C Meyers
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
| | - Rafael Granja
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
| | - Bleyda R Solorzano
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA
| | - Mario Romero-Ortega
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, Texas, USA
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA.,The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, Texas, USA
| | - Seth Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, Texas, 75080-3021, USA.,The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, Texas, USA
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Arbat-Plana A, Cobianchi S, Herrando-Grabulosa M, Navarro X, Udina E. Endogenous modulation of TrkB signaling by treadmill exercise after peripheral nerve injury. Neuroscience 2017; 340:188-200. [DOI: 10.1016/j.neuroscience.2016.10.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/18/2016] [Accepted: 10/22/2016] [Indexed: 12/20/2022]
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Optically-Induced Neuronal Activity Is Sufficient to Promote Functional Motor Axon Regeneration In Vivo. PLoS One 2016; 11:e0154243. [PMID: 27152611 PMCID: PMC4859548 DOI: 10.1371/journal.pone.0154243] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/11/2016] [Indexed: 12/16/2022] Open
Abstract
Peripheral nerve injuries are common, and functional recovery is very poor. Beyond surgical repair of the nerve, there are currently no treatment options for these patients. In experimental models of nerve injury, interventions (such as exercise and electrical stimulation) that increase neuronal activity of the injured neurons effectively enhance axon regeneration. Here, we utilized optogenetics to determine whether increased activity alone is sufficient to promote motor axon regeneration. In thy-1-ChR2/YFP transgenic mice in which a subset of motoneurons express the light-sensitive cation channel, channelrhodopsin (ChR2), we activated axons in the sciatic nerve using blue light immediately prior to transection and surgical repair of the sciatic nerve. At four weeks post-injury, direct muscle EMG responses evoked with both optical and electrical stimuli as well as the ratio of these optical/electrical evoked EMG responses were significantly greater in mice that received optical treatment. Thus, significantly more ChR2+ axons successfully re-innervated the gastrocnemius muscle in mice that received optical treatment. Sections of the gastrocnemius muscles were reacted with antibodies to Synaptic Vesicle Protein 2 (SV2) to quantify the number of re-occupied motor endplates. The number of SV2+ endplates was greater in mice that received optical treatment. The number of retrogradely-labeled motoneurons following intramuscular injection of cholera toxin subunit B (conjugated to Alexa Fluor 555) was greater in mice that received optical treatment. Thus, the acute (1 hour), one-time optical treatment resulted in robust, long-lasting effects compared to untreated animals as well as untreated axons (ChR2-). We conclude that neuronal activation is sufficient to promote motor axon regeneration, and this regenerative effect is specific to the activated neurons.
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Abstract
As nerve transfers become the mainstay in treatment of brachial plexus and isolated nerve injuries, the preoperative and postoperative therapy performed to restore motor function requires continued dedication and appreciation. Through the understanding of the general principles of muscle activation and patient education, the therapist has a unique impact on the return of function in patients with nerve injuries. As surgeons continue to develop novel nerve transfers, the perioperative training, education, and implementation of the donor activation focused rehabilitation approach model is critical to ensure successful outcomes.
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Affiliation(s)
- Lorna Canavan Kahn
- Milliken Hand Rehabilitation Center, The Rehabilitation Institute of St. Louis, 4921 Parkview Place, Suite 6F, St Louis, MO 63110, USA
| | - Amy M Moore
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, CB 8238, St Louis, MO 63110, USA.
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Rosa Junior GM, Magalhães RMG, Rosa VC, Bueno CRDS, Simionato LH, Bortoluci CHF. Efeito da associação da laserterapia com a natação no reparo morfológico do nervo isquiático e na recuperação funcional de ratos submetidos à axonotmese. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/13929623012016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO As lesões de nervos periféricos ocorrem frequentemente e, de modo geral, causam perda funcional impactando de forma negativa na vida do paciente. O objetivo do estudo foi verificar a eficiência da associação da laserterapia e natação em ratos acometidos por axonotmeses. A amostra foi composta por 50 ratos da linhagem Wistar. Foram divididos em 5 grupos, sendo: grupo controle (GC); grupo controle cirúrgico (GCC); grupo experimental laser (GEL); grupo experimental natação (GEN) e grupo experimental laser associado à natação (GELAN). O nervo foi esmagado em um segmento de 5 mm de comprimento próximo a trifurcação do nervo isquiático, feito com uma pinça durante 60 segundos. Foi utilizado o laser infravermelho AsGa (904 nm) com energia irradiada de 0,4 J na primeira semana, 0,8 J na segunda semana e 1,2 J na terceira e quarta semana. Para avaliação funcional (IFC), os animais foram imobilizados, e a região plantar das patas foram pintadas com tinta de carimbo. Esse procedimento foi repetido duas vezes com cada animal. Foi realizada a morfometria (áreas, diâmetros e espessuras das fibras, axônios e bainha de mielina) dos nervos com mensuração de 220 fibras por animal de cada grupo. Pudemos observar que os grupos GEL e GEN, em todas as variáveis morfométricas estudadas, obtiveram os melhores resultados, quando comparados com os outros grupos (GC, GCC e GELAN), mas não apresentou diferença estatisticamente significante entre eles. Na análise funcional observou-se que o grupo GELAN obteve o melhor resultado quando comparado com os outros grupos (GCC, GEL e GEN) e quando comparados os grupos GEL e GEN entre eles não houve diferença estatisticamente significante. A conclusão foi que os grupos GEL e GEN obtiveram os melhores resultados morfométricos, enquanto o GELAN apresentou o melhor resultado funcional. Portanto, pode-se concluir que a associação destes recursos favoreceu a recuperação funcional desses animais.
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Simon NG, Spinner RJ, Kline DG, Kliot M. Advances in the neurological and neurosurgical management of peripheral nerve trauma. J Neurol Neurosurg Psychiatry 2016; 87:198-208. [PMID: 25922080 DOI: 10.1136/jnnp-2014-310175] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 04/03/2015] [Indexed: 12/31/2022]
Abstract
Peripheral nerve trauma frequently affects younger people and may result in significant and long-lasting functional disability. Currently, diagnosis and monitoring of peripheral nerve injury relies on clinical and electrodiagnostic information, supplemented by intraoperative electrophysiological studies. However, in a significant proportion of nerve injuries, the likelihood of spontaneous regeneration resulting in good functional outcome remains uncertain and unnecessary delays to treatment may be faced while monitoring for recovery. Advances in non-invasive imaging techniques to diagnose and monitor nerve injury and regeneration are being developed, and have the potential to streamline the decision-making process. In addition, advances in operative and non-operative treatment strategies may provide more effective ways to maximise functional outcomes following severe peripheral nerve trauma. This review discusses these advances in light of the current state of the art of management of peripheral nerve trauma.
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Affiliation(s)
- Neil G Simon
- Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia Brain and Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Kline
- Department of Neurosurgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Michel Kliot
- Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Simon NG, Franz CK, Gupta N, Alden T, Kliot M. Central Adaptation following Brachial Plexus Injury. World Neurosurg 2016; 85:325-32. [DOI: 10.1016/j.wneu.2015.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022]
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Gözen AS, Aktoz T, Akin Y, Klein J, Rieker P, Rassweiler J. Is It Possible to Draw a Risk Map for Obturator Nerve Injury During Pelvic Lymph Node Dissection? The Heilbronn Experience and a Review of the Literature. J Laparoendosc Adv Surg Tech A 2015; 25:826-32. [DOI: 10.1089/lap.2015.0190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Tevfik Aktoz
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
| | - Yigit Akin
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jan Klein
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Philip Rieker
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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41
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Bonetti LV, Ilha J, Schneider APK, Barbosa S, Faccioni-Heuser MC. Balance and coordination training, but not endurance training, enhances synaptophysin and neurotrophin-3 immunoreactivity in the lumbar spinal cord after sciatic nerve crush. Muscle Nerve 2015; 53:617-25. [PMID: 26316168 DOI: 10.1002/mus.24889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Numerous rehabilitation treatments have been shown to be useful for peripheral and central restoration after (PNI). METHODS After sciatic nerve crush, we investigated 4 weeks of endurance training (ET) and balance and coordination training (BCT) with sciatic function index, hind-paw stride length, and spinal cord dorsal horn synaptophysin and neurotrophin-3 immunoreactivity. RESULTS Our results demonstrated no significant differences between the non-trained (NT), ET, and BCT groups in sciatic functional index, and in stride-length analysis, but the ET showed higher values compared with the NT group. Synaptophysin immunoreactivity was higher in the BCT group compared with the NT group, and neurotrophin-3 immunoreactivity in the BCT group was greater compared with the other groups. CONCLUSION BCT can positively affect spinal cord plasticity after a (PNI), and these modifications are important in the rehabilitation process.
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Affiliation(s)
- Leandro Viçosa Bonetti
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jocemar Ilha
- Laboratório de Pesquisa Experimental, Departamento de Fisioterapia, Universidade do Estado de Santa Catarina, Santa Catarina, Brazil
| | - Ana Paula Krauthein Schneider
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | - Silvia Barbosa
- Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Cristina Faccioni-Heuser
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
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42
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English AW, Wilhelm JC, Ward PJ. Exercise, neurotrophins, and axon regeneration in the PNS. Physiology (Bethesda) 2015; 29:437-45. [PMID: 25362637 DOI: 10.1152/physiol.00028.2014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Electrical stimulation and exercise are treatments to enhance recovery from peripheral nerve injuries. Brain-derived neurotrophic factor and androgen receptor signaling are requirements for the effectiveness of these treatments. Increased neuronal activity is adequate to promote regeneration in injured nerves, but the dosing of activity and its relationship to neurotrophins and sex steroid hormones is less clear. Translation of these therapies will require principles associated with their cellular mechanisms.
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Affiliation(s)
- Arthur W English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia; and
| | - Jennifer C Wilhelm
- Department of Psychology, College of Charleston, Charleston, South Carolina
| | - Patricia J Ward
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia; and
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43
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Gordon T, English AW. Strategies to promote peripheral nerve regeneration: electrical stimulation and/or exercise. Eur J Neurosci 2015; 43:336-50. [PMID: 26121368 DOI: 10.1111/ejn.13005] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 12/14/2022]
Abstract
Enhancing the regeneration of axons is often considered to be a therapeutic target for improving functional recovery after peripheral nerve injury. In this review, the evidence for the efficacy of electrical stimulation (ES), daily exercise and their combination in promoting nerve regeneration after peripheral nerve injuries in both animal models and in human patients is explored. The rationale, effectiveness and molecular basis of ES and exercise in accelerating axon outgrowth are reviewed. In comparing the effects of ES and exercise in enhancing axon regeneration, increased neural activity, neurotrophins and androgens are considered to be common requirements. Similarly, there are sex-specific requirements for exercise to enhance axon regeneration in the periphery and for sustaining synaptic inputs onto injured motoneurons. ES promotes nerve regeneration after delayed nerve repair in humans and rats. The effectiveness of exercise is less clear. Although ES, but not exercise, results in a significant misdirection of regenerating motor axons to reinnervate different muscle targets, the loss of neuromuscular specificity encountered has only a very small impact on resulting functional recovery. Both ES and exercise are promising experimental treatments for peripheral nerve injury that seem to be ready to be translated to clinical use.
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Affiliation(s)
- Tessa Gordon
- Division of Plastic Reconstructive Surgery, Department of Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, M4G 1X8, Canada
| | - Arthur W English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, USA
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44
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Goulart CO, Martinez AMB. Tubular conduits, cell-based therapy and exercise to improve peripheral nerve regeneration. Neural Regen Res 2015; 10:565-7. [PMID: 26170815 PMCID: PMC4424747 DOI: 10.4103/1673-5374.155424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 02/03/2023] Open
Affiliation(s)
- Camila Oliveira Goulart
- Laboratório de Neurodegeneração e Reparo, Departamento de Patologia, Faculdade de Medicina, HUCFF -UFRJ - Rio de Janeiro - RJ, Brazil
| | - Ana Maria Blanco Martinez
- Laboratório de Neurodegeneração e Reparo, Departamento de Patologia, Faculdade de Medicina, HUCFF -UFRJ - Rio de Janeiro - RJ, Brazil
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45
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Kim KH, Hwangbo G, Kim SG. The effect of weight-bearing exercise and non-weight-bearing exercise on gait in rats with sciatic nerve crush injury. J Phys Ther Sci 2015; 27:1177-9. [PMID: 25995583 PMCID: PMC4434004 DOI: 10.1589/jpts.27.1177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/11/2014] [Indexed: 11/29/2022] Open
Abstract
[Purpose] The purpose of this study was to access the effect of weight bearing exercise
(treadmill exercise) and non-weight-bearing exercise (swimming exercise) on gait in the
recovery process after a sciatic nerve crush injury. [Subjects and Methods] Rats were
randomly divided into a swimming group (n=3) with non-weight-bearing exercise after a
sciatic nerve crush and a treadmill group (n=3) with weight bearing exercise after a
sciatic nerve crush. Dartfish is a program that can analyze and interpret motion through
video images. The knee lateral epicondyle, lateral malleolus, and metatarsophalangeal
joint of the fifth toe were marked by black dots before recording. [Results] There were
significant differences in TOK (knee angle toe off) and ICK (knee angle at initial
contact) in the swimming group and in TOK, ICA (ankle angle at initial contact), and ICK
in the treadmill group. In comparison between groups, there were significant differences
in TOA (ankle angle in toe off) and ICA at the 7th day. [Conclusion] There was no
difference between weight bearing and non-weight-bearing exercise in sciatic nerve damage,
and both exercises accelerated the recovery process in this study.
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Affiliation(s)
- Ki-Hyun Kim
- Department of Hippotheray Welfare, Sungduk College, Republic of Korea
| | - Gak Hwangbo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Seong-Gil Kim
- Department of Physical Therapy, Uiduk University: 261 Donghaedaero, Gangdong, Gyeongju, Gyeongbuk 780-713, Republic of Korea
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Elzinga K, Tyreman N, Ladak A, Savaryn B, Olson J, Gordon T. Brief electrical stimulation improves nerve regeneration after delayed repair in Sprague Dawley rats. Exp Neurol 2015; 269:142-53. [PMID: 25842267 DOI: 10.1016/j.expneurol.2015.03.022] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 01/09/2023]
Abstract
Functional recovery after peripheral nerve injury and surgical repair declines with time and distance because the injured neurons without target contacts (chronic axotomy) progressively lose their regenerative capacity and chronically denervated Schwann cells (SCs) atrophy and fail to support axon regeneration. Findings that brief low frequency electrical stimulation (ES) accelerates axon outgrowth and muscle reinnervation after immediate nerve surgery in rats and human patients suggest that ES might improve regeneration after delayed nerve repair. To test this hypothesis, common peroneal (CP) neurons were chronically axotomized and/or tibial (TIB) SCs and ankle extensor muscles were chronically denervated by transection and ligation in rats. The CP and TIB nerves were cross-sutured after three months and subjected to either sham or one hour 20Hz ES. Using retrograde tracing, we found that ES significantly increased the numbers of both motor and sensory neurons that regenerated their axons after a three month period of chronic CP axotomy and/or chronic TIB SC denervation. Muscle and motor unit forces recorded to determine the numbers of neurons that reinnervated gastrocnemius muscle demonstrated that ES significantly increased the numbers of motoneurons that reinnervated chronically denervated muscles. We conclude that electrical stimulation of chronically axotomized motor and sensory neurons is effective in accelerating axon outgrowth into chronically denervated nerve stumps and improving target reinnervation after delayed nerve repair. Possible mechanisms for the efficacy of ES in promoting axon regeneration and target reinnervation after delayed nerve repair include the upregulation of neurotrophic factors.
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Affiliation(s)
- Kate Elzinga
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Neil Tyreman
- Center for Neuroscience, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Adil Ladak
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Bohdan Savaryn
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jaret Olson
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Tessa Gordon
- Center for Neuroscience, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Kleiss IJ, Knox CJ, Malo JS, Marres HAM, Hadlock TA, Heaton JT. Whisking recovery after automated mechanical stimulation during facial nerve regeneration. JAMA FACIAL PLAST SU 2014; 16:133-9. [PMID: 24407357 DOI: 10.1001/jamafacial.2013.2217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Recovery from facial nerve transection is typically poor, but daily mechanical stimulation of the face in rats has been reported to remarkably enhance functional recovery after facial nerve transection and suture repair. This phenomenon needs additional investigation because of its important clinical implications. OBJECTIVE To determine whether automated mechanical stimulation of the whisker pad improves whisking recovery after facial nerve transection and repair in a rat model. DESIGN AND SETTING Sixty-one rats underwent unilateral facial nerve transection and suture repair and were randomized into 8 groups. Six groups received daily automated whisker or whisker pad mechanical stimulation including 0.5-, 1.5-, and 8.0-Hz patterns. Two control groups received restraint without stimulation. Treatment started on postoperative day 8, occurred 5 days per week, and lasted throughout 15 weeks of recovery. Whisking amplitude, velocity, and acceleration were quantified weekly for 15 weeks. INTERVENTIONS Unilateral facial nerve transection, suture repair, and, for 6 groups, daily automated whisker or whisker pad mechanical stimulation. MAIN OUTCOMES AND MEASURES Quantification of whisking amplitude, velocity, and acceleration. RESULTS Rats receiving the low frequencies of stimulation of the whiskers or whisker pad did not demonstrate enhanced whisking recovery, and rats receiving stimulation at 8.0 Hz showed significantly worse whisking recovery compared with controls and previously published groups receiving lower dose manual stimulation. CONCLUSIONS AND RELEVANCE Although daily manual whisker pad stimulation has been shown to enhance whisking recovery, rats in this study did not demonstrate improved whisking recovery after automated mechanical stimulation across a wide range of driving frequencies. Moreover, faster stimulation (8.0 Hz) was actually detrimental to recovery. Further work is needed to understand the relationship between stimulation patterns and the physiologic mechanisms underlying improved or worsened functional outcomes after facial nerve transection and repair.
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Affiliation(s)
- Ingrid J Kleiss
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston3Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Christopher J Knox
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Juan S Malo
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Henri A M Marres
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Tessa A Hadlock
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - James T Heaton
- Department of Surgery, Massachusetts General Hospital, Boston
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Bonetti LV, Schneider APK, Barbosa S, Ilha J, Faccioni-Heuser MC. Balance and coordination training and endurance training after nerve injury. Muscle Nerve 2014; 51:83-91. [PMID: 24752648 DOI: 10.1002/mus.24268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Different rehabilitation treatments have proven useful in accelerating regeneration. METHODS After sciatic nerve crush in rats, we tested balance and coordination training (BCT) and endurance training (ET) through sensorimotor tests and analyzed nerve and muscle morphology. RESULTS After BCT and ET, rats performed better in sensorimotor tests than did non-trained animals. However, only BCT maintained sensorimotor function during training. Furthermore, BCT and ET produced significantly larger muscle area than in non-trained animals. CONCLUSIONS These findings indicate that BCT and ET, when initiated in the early phase after sciatic nerve injury, improve morphological properties of the soleus muscle and sciatic nerve, but only the task-oriented BCT maintained sensorimotor function. The success of rehabilitative strategies appears to be highly task-specific, and strategies that stimulate sensory pathways are the most effective in improving balance and/or coordination parameters.
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Affiliation(s)
- Leandro Viçosa Bonetti
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP: 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
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49
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Kruspe M, Thieme H, Guntinas-Lichius O, Irintchev A. Motoneuron regeneration accuracy and recovery of gait after femoral nerve injuries in rats. Neuroscience 2014; 280:73-87. [DOI: 10.1016/j.neuroscience.2014.08.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/28/2014] [Accepted: 08/28/2014] [Indexed: 11/27/2022]
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Arbat-Plana A, Torres-Espín A, Navarro X, Udina E. Activity dependent therapies modulate the spinal changes that motoneurons suffer after a peripheral nerve injury. Exp Neurol 2014; 263:293-305. [PMID: 25448160 DOI: 10.1016/j.expneurol.2014.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 12/11/2022]
Abstract
Injury of a peripheral nerve not only leads to target denervation, but also induces massive stripping of spinal synapses on axotomized motoneurons, with disruption of spinal circuits. Even when regeneration is successful, unspecific reinnervation and the limited reconnection of the spinal circuits impair functional recovery. The aim of this study was to describe the changes that axotomized motoneurons suffer after peripheral nerve injury and how activity-dependent therapies and neurotrophic factors can modulate these events. We observed a marked decrease in glutamatergic synapses, with a maximum peak at two weeks post-axotomy, which was only partially reversed with time. This decrease was accompanied by an increase in gephyrin immunoreactivity and a disintegration of perineuronal nets (PNNs) surrounding the motoneurons. Direct application of neurotrophins at the proximal stump was not able to reverse these effects. In contrast, activity-dependent treatment, in the form of treadmill running, reduced the observed destructuring of perineuronal nets and the loss of glutamatergic synapses two weeks after injury. These changes were proportional to the intensity of the exercise protocol. Blockade of sensory inputs from the homolateral hindlimb also reduced PNN immunoreactivity around intact motoneurons, and in that case treadmill running did not reverse that loss, suggesting that the effects of exercise on motoneuron PNN depend on increased sensory activity. Preservation of motoneuron PNN and reduction of synaptic stripping by exercise could facilitate the maintenance of the spinal circuitry and benefit functional recovery after peripheral nerve injury.
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Affiliation(s)
- Ariadna Arbat-Plana
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Abel Torres-Espín
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Xavier Navarro
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Esther Udina
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain.
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