Role of ornithine decarboxylase in proliferation of Schwann cells during Wallerian degeneration and its enhancement by nerve expansion

Differential Effects of Coating Materials on Viability and Migration of Schwann Cells

Synthetic nerve conduits have emerged as an alternative to guide axonal regeneration in peripheral nerve gap injuries. Migration of Schwann cells (SC) from nerve stumps has been demonstrated as one essential factor for nerve regeneration in nerve defects. In this experiment, SC viability and migration were investigated for various materials to determine the optimal conditions for nerve regeneration. Cell viability and SC migration assays were conducted for collagen I, laminin, fibronectin, lysine and ornithine. The highest values for cell viability were detected for collagen I, whereas fibronectin was most stimulatory for SC migration. At this time, clinically approved conduits are based on single-material structures. In contrast, the results of this experiment suggest that material compounds such as collagen I in conjunction with fibronectin should be considered for optimal nerve healing.

Acute Putrescine Supplementation with Schwann Cell Implantation Improves Sensory and Serotonergic Axon Growth and Functional Recovery in Spinal Cord Injured Rats

Schwann cell (SC) transplantation exhibits significant potential for spinal cord injury (SCI) repair and its use as a therapeutic modality has now progressed to clinical trials for subacute and chronic human SCI. Although SC implants provide a receptive environment for axonal regrowth and support functional recovery in a number of experimental SCI models, axonal regeneration is largely limited to local systems and the behavioral improvements are modest without additional combinatory approaches. In the current study we investigated whether the concurrent delivery of the polyamine putrescine, started either 30 min or 1 week after SCI, could enhance the efficacy of SCs when implanted subacutely (1 week after injury) into the contused rat spinal cord. Polyamines are ubiquitous organic cations that play an important role in the regulation of the cell cycle, cell division, cytoskeletal organization, and cell differentiation. We show that the combination of putrescine with SCs provides a significant increase in implant size, an enhancement in axonal (sensory and serotonergic) sparing and/or growth, and improved open field locomotion after SCI, as compared to SC implantation alone. These findings demonstrate that polyamine supplementation can augment the effectiveness of SCs when used as a therapeutic approach for subacute SCI repair.

End-to-Side Nerve Repair in Peripheral Nerve Injury

In peripheral nerve injury, end-to-side neurorrhaphy has been reported as an alternative in cases that the proximal nerve stump is not accessible. Several hypotheses have been proposed to explain peripheral nerve regeneration after end-to-side neurorrhaphy. Recent evidence suggests that nerve regeneration occurs by collateral sprouting. Although a great number of humoral factors have been identified, molecular mechanism of nerve regeneration after end-to-side neurorrhaphy has not been completely clarified yet. The goal of this technique is to provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. End-to-side technique has been investigated in detail in both experimental and clinical studies. Only a limited number of reported cases in clinical practice, until today, can reveal that end-to-side technique may become a viable means of repairing peripheral nerves in certain clinical situations.

Enhanced reinnervation after neurotization with Schwann cell transplantation

We investigated the feasibility of using Schwann cell transplantation to enhance reinnervation after direct nerve-to-muscle neurotization (NMN). The denervated anterior tibial muscle was neurotized by tibial nerve implantation, and Schwann cell suspension (transplantation group) or an equivalent volume of culture medium (control group) was injected at the implantation site. In the control group, few axons invaded the muscle, demonstrating that skeletal muscle was poorly permissive to the advancement of axons. In the transplantation group, a large number of regenerating axons grew for a longer distance throughout the muscle, and reinnervated motor endplates were significantly more abundant. Enhanced reinnervation and functional recovery of the muscle in the transplantation group was confirmed by a significant increase in the compound muscle action potential and in muscle weight. These results suggest that intramuscular Schwann cell transplantation has potential as a cell therapy to improve functional recovery after NMN.

Distal nerve elongation vs. nerve grafting in repairing segmental nerve defects in rabbits

Segmental nerve defects have been repaired with nerve grafts. However, regenerating fibers must go through two coaptation sites, and donor site morbidities are inevitable. We elongated the distal nerve segment using a tissue expander and reconnected the nerve. We compared these results with those of nerve grafting. Nerve injury models were created in the median nerves of both forelimbs in 27 rabbits. The right nerve was repaired by elongation, and the left by tibial nerve grafting. The length of the elongation was the same as that of the graft in each animal. Eight rabbits had a 10-mm segment repaired, 9 had a 15-mm segment repaired, and 10 had a 20-mm segment repaired. Evaluated outcomes were nerve conduction velocity, contractile force of the flexor muscle, axons number, and fiber diameter. The elongated and grafted groups did not differ substantially on any outcome. Distal nerve elongation could be an alternative to nerve grafting for repairing large nerve defects.

End-to-side neurorrhaphy

End-to-side neurorrhaphy, a possible strategy for treating nerve lesions without useable proximal nerve stumps, has been experimentally and clinically investigated. In end-to-side neurorrhaphy, three main elements should be considered: 1) the induction of axonal collateral sprouting in the donor nerve; 2) the ability of the collateral axons to pierce the different conjunctival layers, including the ability the donor nerve basal laminae, to reinnervate the recipient nerve; and 3) the functional plasticity and behavioral readjustment of single motoneurons that have eventually adopted new motor units. This article reviews the following areas of research and clinical investigation: animal models, axonal collateral sprouting from end-to-side neurorrhaphy, effect of epineurotomy and perineurotomy on axon regeneration, motor reinnervation, and clinical trials.

Repair of nerve gap with the elongation of Wallerian degenerated nerve by tissue expansion

We have found previously that expansion of the Wallerian degenerated nerve was accompanied by accelerated Schwann cell proliferation. In this study, we investigated the usefulness of the elongation of Wallerian degenerated nerve for the repair of short nerve gap. Male Wistar rats were used. After the left sciatic nerve was transected the rats were divided into 4 groups. In the control group, nerve coaptation was not performed. In group 1, tensionless coaptation was performed immediately. In group 2, delayed tensionless coaptation was performed with the elongation of Wallerian degenerated nerve. In group 3, coaptation was performed immediately with autologous interposition nerve graft. The ideal tensionless nerve repair of group 1 was considered to produce the best result. Rats in group 2 showed functional recovery as good as rats in group 1. On histologic assessment, in group 2, a fibrous capsule that was very rich in vascularity was formed around the tissue expander. After 14 weeks, the capsule was diminished markedly in size, but the vascularity was rich around the sciatic nerve. We think that the excellent functional recovery seen in group 2 can be attributed to the increased activity of Schwann cell proliferation and increased vascularity.

Nerve expansion in nerve regeneration: effect of time on induction of ornithine decarboxylase and Schwann cell proliferation

We studied the effect of initiation time of nerve expansion after nerve transection on the induction of ODC activity and Schwann cell proliferation in nerve tissue under Wallerian degeneration. The levels of ODC activity and Schwann cell proliferation decreased as the initiation time of nerve expansion was delayed after nerve transection, and peak levels of ODC activity following nerve expansion preceded peak levels of Schwann cell proliferation.