1
|
Senger JL, Power H, Moore AM. Electrical Stimulation: How It Works and How to Apply It. Hand Clin 2024; 40:409-420. [PMID: 38972685 DOI: 10.1016/j.hcl.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Electrical stimulation is emerging as a perioperative strategy to improve peripheral nerve regeneration and enhance functional recovery. Despite decades of research, new insights into the complex multifaceted mechanisms of electrical stimulation continue to emerge, providing greater understanding of the neurophysiology of nerve regeneration. In this study, we summarize what is known about how electrical stimulation modulates the molecular cascades and cellular responses innate to nerve injury and repair, and the consequential effects on axonal growth and plasticity. Further, we discuss how electrical stimulation is delivered in preclinical and clinical studies and identify knowledge gaps that may provide opportunities for optimization.
Collapse
Affiliation(s)
- Jenna-Lynn Senger
- Division of Plastic Surgery, University of British Columbia, Suite 1788, 1111 W Georgia Street, Vancouver, British Columbia, V6E 4M3, Canada
| | - Hollie Power
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Suite 401, 316 Windermere Road NorthWest, Edmonton, Alberta T6W 2Z8, Canada
| | - Amy M Moore
- Department of Plastic and Reconstructive Surgery, The Ohio State University, 915 Olentangy River Road Suite 2100, Columbus, OH 43212, USA.
| |
Collapse
|
2
|
Gordon T. Physiology of Nerve Regeneration: Key Factors Affecting Clinical Outcomes. Hand Clin 2024; 40:337-345. [PMID: 38972678 DOI: 10.1016/j.hcl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Functional recovery after peripheral nerve injuries is disappointing despite surgical advances in nerve repair. This review summarizes the relatively short window of opportunity for successful nerve regeneration due to the decline in the expression of growth-associated genes and in turn, the decline in regenerative capacity of the injured neurons and the support provided by the denervated Schwann cells, and the atrophy of denervated muscles. Brief, low-frequency electrical stimulation and post-injury exercise regimes ameliorate these deficits in animal models and patients, but the misdirection of regenerating nerve fibers compromises functional recovery and remains an important area of future research.
Collapse
Affiliation(s)
- Tessa Gordon
- Department of Surgery, University of Toronto, Toronto, Ontario M5G 1X8, Canada.
| |
Collapse
|
3
|
Izhiman Y, Esfandiari L. Emerging role of extracellular vesicles and exogenous stimuli in molecular mechanisms of peripheral nerve regeneration. Front Cell Neurosci 2024; 18:1368630. [PMID: 38572074 PMCID: PMC10989355 DOI: 10.3389/fncel.2024.1368630] [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: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
Peripheral nerve injuries lead to significant morbidity and adversely affect quality of life. The peripheral nervous system harbors the unique trait of autonomous regeneration; however, achieving successful regeneration remains uncertain. Research continues to augment and expedite successful peripheral nerve recovery, offering promising strategies for promoting peripheral nerve regeneration (PNR). These include leveraging extracellular vesicle (EV) communication and harnessing cellular activation through electrical and mechanical stimulation. Small extracellular vesicles (sEVs), 30-150 nm in diameter, play a pivotal role in regulating intercellular communication within the regenerative cascade, specifically among nerve cells, Schwann cells, macrophages, and fibroblasts. Furthermore, the utilization of exogenous stimuli, including electrical stimulation (ES), ultrasound stimulation (US), and extracorporeal shock wave therapy (ESWT), offers remarkable advantages in accelerating and augmenting PNR. Moreover, the application of mechanical and electrical stimuli can potentially affect the biogenesis and secretion of sEVs, consequently leading to potential improvements in PNR. In this review article, we comprehensively delve into the intricacies of cell-to-cell communication facilitated by sEVs and the key regulatory signaling pathways governing PNR. Additionally, we investigated the broad-ranging impacts of ES, US, and ESWT on PNR.
Collapse
Affiliation(s)
- Yara Izhiman
- Esfandiari Laboratory, Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Leyla Esfandiari
- Esfandiari Laboratory, Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, United States
- Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
- Department of Electrical and Computer Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
4
|
Pion AM, Roy AA, Ma X, Beaumont E, Lin JC. Transcutaneous and Direct Electrical Stimulation of Mouse Sciatic Nerve Accelerates Functional Recovery After Nerve Transection and Immediate Repair. Ann Plast Surg 2023; 90:237-241. [PMID: 36796045 DOI: 10.1097/sap.0000000000003463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Electrical stimulation can accelerate peripheral nerve regeneration after injury and repair. Clinically, direct electrical stimulation (DES) may involve longer operating times, increasing risks of perioperative complications. Transcutaneous electrical stimulation (TCES) is a noninvasive alternative. In this study, we investigate how transcutaneous and DES compare for accelerating functional nerve recovery in a mouse sciatic nerve model. METHODS Twenty-eight mice were divided into sham (n = 4), axotomy (n = 8), DES (n = 8), and TCES (n = 8) groups. After sciatic nerve transection and repair, the proximal nerve was subjected to DES or TCES at 20 Hz for 1 hour. Sciatic functional index was measured before the injury, and at weeks 1, 2, 4, 6, 8, 10, and 12 by walking-track analysis. Electrophysiological measures were taken at week 12. RESULTS Kinematic studies showed significant improvement from the 8th week to the 12th week for both electrical stimulation groups compared with the axotomy group (P < 0.05), with no difference between the electrical stimulation groups. At the 12th week, both DES and TCES groups had significantly faster average conduction velocity than the axotomy group. CONCLUSIONS Functional recovery was significantly better from 8 weeks onward in mice receiving either DES or TCES stimulation when compared with axotomy and repair alone. Transcutaneous electrical stimulation is a minimally invasive alternative treatment for accelerating functional recovery after peripheral nerve injury.
Collapse
Affiliation(s)
- Anne-Marie Pion
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Andrée-Anne Roy
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Xiya Ma
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Eric Beaumont
- Faculty of Medicine, East Tennessee State University, Johnson City, TN
| | - Jenny C Lin
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Sobotka S, Mu L, Chen J, Li J, Nyirenda T. Reinnervation of Paralyzed Limb Muscle by Nerve-Muscle-Endplate Grafting Technique. Neurosurgery 2023; 92:1091-1098. [PMID: 36700699 DOI: 10.1227/neu.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We have developed a novel reinnervation technique called nerve-muscle-endplate grafting in the native motor zone (NMEG-NMZ). However, it remains unknown whether the NMEG-NMZ is effective for limb reinnervation. OBJECTIVE To evaluate the efficacy of the NMEG-NMZ in limb muscle reinnervation. METHODS Forty-five adult rats were divided into 3 groups: NMEG, end-to-end anastomosis (EEA, technique control), and denervation control (DC). The left tibialis anterior muscle was denervated by resecting its nerve. For NMEG-NMZ, the denervated tibialis anterior was reinnervated by transferring a NMEG pedicle from the lateral gastrocnemius muscle. Three months after surgery, static toe spread analysis was performed for all rats and muscle force was measured for the rats treated with NMEG and EEA. Muscle weight, myofiber morphology, regenerated axons, and reinnervated motor endplates in the treated muscles were also quantified and compared with those in the DC group. RESULTS NMEG-NMZ technique resulted in better muscle force recovery (79% of the control) compared with EEA (51% of the control, P = .048). Toe spread analysis in NMEG-NMZ reinnervated muscles showed static sciatic index = -16.8, whereas -41.4 in EEA, P < .0001). The average weight of the NMEG-NMZ reinnervated muscles (86%) was greater than those of the EEA treated (71%) and DC (26%) muscles (all P < .0001). The mean count of the regenerated axons in the muscles with NMEG-NMZ was 76% of the control, which was larger than that in the muscles with EEA (46%), P < .0001. CONCLUSION NMEG-NMZ technique has unique advantages and is superior to EEA for muscle reinnervation and functional recovery.
Collapse
Affiliation(s)
- Stanislaw Sobotka
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Liancai Mu
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Jingming Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Jing Li
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Themba Nyirenda
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| |
Collapse
|
6
|
Li Q, Kang B, Wang L, Chen T, Zhao Y, Feng S, Li R, Zhang H. Microfluidics embedded with microelectrodes for electrostimulation of neural stem cells proliferation. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Oleck NC, Malhotra R, Ayyala HS, Datiashvili RO. Pediatric Replantation after Traumatic Amputation at the Distal Forearm: Rehabilitation Protocol and Outcomes. J Hand Microsurg 2021; 13:169-172. [PMID: 34511833 DOI: 10.1055/s-0040-1703096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Major limb replantation is a formidable task, especially in the pediatric setting. While meticulous microsurgical technique is required in the operating room, the authors aim to highlight the importance of postoperative rehabilitation therapy for optimal function. We highlight the case of a 12-year-old boy who suffered complete traumatic amputation through the distal left forearm. The limb was successfully replanted with successful restoration of sensation and function with the aid of intensive postoperative occupational therapy. A multidisciplinary team is of paramount importance to maximize function of a replanted upper extremity.
Collapse
Affiliation(s)
- Nicholas C Oleck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, New Jersey, United States
| | - Radhika Malhotra
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, New Jersey, United States
| | - Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, New Jersey, United States
| | - Ramazi O Datiashvili
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, New Jersey, United States
| |
Collapse
|
8
|
Manto KM, Govindappa PK, Parisi D, Karuman Z, Martinazzi B, Hegarty JP, Talukder MAH, Elfar JC. (4-Aminopyridine)-PLGA-PEG as a Novel Thermosensitive and Locally Injectable Treatment for Acute Peripheral Nerve Injury. ACS APPLIED BIO MATERIALS 2021; 4:4140-4151. [PMID: 34142019 PMCID: PMC8206837 DOI: 10.1021/acsabm.0c01566] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Traumatic peripheral nerve injury (TPNI) represents a major medical problem that results in loss of motor and sensory function, and in severe cases, limb paralysis and amputation. To date, there are no effective treatments beyond surgery in selective cases. In repurposing studies, we found that daily systemic administration of the FDA-approved drug 4-aminopyridine (4-AP) enhanced functional recovery after acute peripheral nerve injury. This study was aimed at constructing a novel local delivery system of 4-AP using thermogelling polymers. We optimized a thermosensitive (4-AP)-poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA) block copolymer formulation. (4-AP)-PLGA-PEG exhibited controlled release of 4-AP both in vitro and in vivo for approximately 3 weeks, with clinically relevant safe serum levels in animals. Rheological investigation showed that (4-AP)-PLGA-PEG underwent a solution to gel transition at 32 °C, a physiologically relevant temperature, allowing us to administer it to an injured limb while subsequently forming an in situ gel. A single local administration of (4-AP)-PLGA-PEG remarkably enhanced motor and sensory functional recovery on post-sciatic nerve crush injury days 1, 3, 7, 14, and 21. Moreover, immunohistochemical studies of injured nerves treated with (4-AP)-PLGA-PEG demonstrated an increased expression of neurofilament heavy chain (NF-H) and myelin protein zero (MPZ) proteins, two major markers of nerve regeneration. These findings demonstrate that (4-AP)-PLGA-PEG may be a promising long-acting local therapeutic agent in TPNI, for which no pharmacologic treatment exists.
Collapse
Affiliation(s)
- Kristen M Manto
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - Prem Kumar Govindappa
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - Daniele Parisi
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Zara Karuman
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - Brandon Martinazzi
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - John P Hegarty
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - M A Hassan Talukder
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - John C Elfar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| |
Collapse
|
9
|
Gordon T. Peripheral Nerve Regeneration and Muscle Reinnervation. Int J Mol Sci 2020; 21:ijms21228652. [PMID: 33212795 PMCID: PMC7697710 DOI: 10.3390/ijms21228652] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022] Open
Abstract
Injured peripheral nerves but not central nerves have the capacity to regenerate and reinnervate their target organs. After the two most severe peripheral nerve injuries of six types, crush and transection injuries, nerve fibers distal to the injury site undergo Wallerian degeneration. The denervated Schwann cells (SCs) proliferate, elongate and line the endoneurial tubes to guide and support regenerating axons. The axons emerge from the stump of the viable nerve attached to the neuronal soma. The SCs downregulate myelin-associated genes and concurrently, upregulate growth-associated genes that include neurotrophic factors as do the injured neurons. However, the gene expression is transient and progressively fails to support axon regeneration within the SC-containing endoneurial tubes. Moreover, despite some preference of regenerating motor and sensory axons to “find” their appropriate pathways, the axons fail to enter their original endoneurial tubes and to reinnervate original target organs, obstacles to functional recovery that confront nerve surgeons. Several surgical manipulations in clinical use, including nerve and tendon transfers, the potential for brief low-frequency electrical stimulation proximal to nerve repair, and local FK506 application to accelerate axon outgrowth, are encouraging as is the continuing research to elucidate the molecular basis of nerve regeneration.
Collapse
Affiliation(s)
- Tessa Gordon
- Department of Surgery, University of Toronto, Division of Plastic Reconstructive Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| |
Collapse
|
10
|
Ransom SC, Shahrestani S, Lien BV, Tafreshi AR, Brown NJ, Hanst B, Lehrich BM, Ransom RC, Sahyouni R. Translational Approaches to Electrical Stimulation for Peripheral Nerve Regeneration. Neurorehabil Neural Repair 2020; 34:979-985. [PMID: 33043791 DOI: 10.1177/1545968320962508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Achieving functional repair after peripheral nerve injury (PNI) remains problematic despite considerable advances in surgical technique. Therein, questions lie regarding the variable capacity of peripheral nerves to regenerate based on environmental influence. In-depth analyses of multiple therapeutic strategies have ensued to overcome these natural obstacles. Of these candidate therapies, electrical stimulation has emerged a frontrunner. Extensive animal studies have reported the ability of brief intraoperative electrical stimulation (BES) to enhance functional regeneration after PNI. Despite these reports, the exact mechanisms by which BES enhances regeneration and its effects on long nerve lesions are largely unknown. Indeed, clinical translation of this seemingly simple therapeutic has not been so simple, but a few studies performed in humans have yielded highly encouraging results. OBJECTIVE We aimed to help bridge this translational gap by presenting the latest clinical trials on electrical stimulation for PNIs in combination with relevant etiologies, treatments and nonclinical findings. METHODS To do so, a systematic search was performed on PubMed, IEEE, and Web of Science databases up to February 2020 using keywords significant to our study. References of each manuscript were screened for additional manuscripts of relevance to our study. RESULTS We found multiple BES clinical studies reporting enhanced functional recovery or increased nerve regeneration. Although improved outcomes were reported, high variability after BES is seen between and within species likely due to injury severity, location and timeline along with other factors. CONCLUSION Further clinical studies and introduction of novel delivery platforms are vital to uncover the true regenerative potential of electrical stimulationtherapy.
Collapse
Affiliation(s)
- Seth C Ransom
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Shane Shahrestani
- California Institute of Technology, Pasadena, CA, USA.,Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Brian V Lien
- University of California, Irvine, Irvine, CA, USA
| | | | | | - Brian Hanst
- University of California, Irvine, Irvine, CA, USA
| | | | | | | |
Collapse
|
11
|
Lien BV, Brown NJ, Ransom SC, Lehrich BM, Shahrestani S, Tafreshi AR, Ransom RC, Sahyouni R. Enhancing peripheral nerve regeneration with neurotrophic factors and bioengineered scaffolds: A basic science and clinical perspective. J Peripher Nerv Syst 2020; 25:320-334. [DOI: 10.1111/jns.12414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Brian V. Lien
- School of Medicine University of California Irvine California USA
| | - Nolan J. Brown
- School of Medicine University of California Irvine California USA
| | - Seth C. Ransom
- College of Medicine University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Brandon M. Lehrich
- Department of Biomedical Engineering University of California Irvine California USA
| | - Shane Shahrestani
- Keck School of Medicine University of Southern California Los Angeles California USA
- Department of Medical Engineering California Institute of Technology Pasadena California USA
| | - Ali R. Tafreshi
- Department of Neurological Surgery Geisinger Health System Danville Pennsylvania USA
| | - Ryan C. Ransom
- Department of Neurological Surgery Mayo Clinic Rochester Minnesota USA
| | - Ronald Sahyouni
- Department of Neurological Surgery University of California San Diego California USA
| |
Collapse
|
12
|
Fujii K, Matsumine H, Osaki H, Ueta Y, Kamei W, Niimi Y, Hashimoto K, Miyata M, Sakurai H. Accelerated outgrowth in cross-facial nerve grafts wrapped with adipose-derived stem cell sheets. J Tissue Eng Regen Med 2020; 14:1087-1099. [PMID: 32592279 DOI: 10.1002/term.3083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/11/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
In this study, we devised a novel cross-facial nerve grafting (CFNG) procedure using an autologous nerve graft wrapped in an adipose-derived stem cell (ADSC) sheet that was formed on a temperature-responsive dish and examined its therapeutic effect in a rat model of facial palsy. The rat model of facial paralysis was prepared by ligating and transecting the main trunk of the left facial nerve. The sciatic nerve was used for CFNG, connecting the marginal mandibular branch of the left facial nerve and the marginal mandibular branch of the right facial nerve. CFNG alone, CFNG coated with an ADSC suspension, and CFNG wrapped in an ADSC sheet were transplanted in eight rats each, designated the CFNG, suspension, and sheet group, respectively. Nerve regeneration was compared histologically and physiologically. The time to reinnervation, assessed by a facial palsy scoring system, was significantly shorter in the sheet group than in the other two groups. Evoked compound electromyography showed a significantly higher amplitude in the sheet group (4.2 ± 1.3 mV) than in the suspension (1.7 ± 1.2 mV) or CFNG group (1.6 ± 0.8 mV; p < .01). Toluidine blue staining showed that the number of myelinated fibers was significantly higher in the sheet group (2,450 ± 687) than in the suspension (1,645 ± 659) or CFNG group (1,049 ± 307; p < .05). CFNG in combination with ADSC sheets, prepared using temperature-responsive dishes, promoted axonal outgrowth in autologous nerve grafts and reduced the time to reinnervation.
Collapse
Affiliation(s)
- Kaori Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironobu Osaki
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshifumi Ueta
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Kamei
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mariko Miyata
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
13
|
Restoration of Neurological Function Following Peripheral Nerve Trauma. Int J Mol Sci 2020; 21:ijms21051808. [PMID: 32155716 PMCID: PMC7084579 DOI: 10.3390/ijms21051808] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.
Collapse
|
14
|
Li J, Liu Y, Liu HQ, Chen L, Li RJ. Ketogenic Diet Potentiates Electrical Stimulation-Induced Peripheral Nerve Regeneration after Sciatic Nerve Crush Injury in Rats. Mol Nutr Food Res 2020; 64:e1900535. [PMID: 31914235 DOI: 10.1002/mnfr.201900535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/23/2019] [Indexed: 12/14/2022]
Abstract
SCOPE Recent findings indicate that the ketogenic diet (KD) is neuroprotective and electrical stimulation (ES) can improve functional recovery from peripheral nerve injury. However, it is not clear whether KD and ES play a synergistical role in the peripheral nerve recovery following injury. METHODS AND RESULTS A KD consisting of a 3:1 ratio of fat to carbohydrate + protein is used and is coupled with ES treatment in a rat model of peripheral nerve crush injury. Neuromuscular recovery is evaluated by electromyography, and axonal regeneration and myelination by histological methods. The effects on insulin-like growth factor 1 (IGF-1) and IGF-1 receptor expression in peripheral nerve tissue, pre- and post-nerve injury, are also investigated. The combination of KD and ES synergistically increases muscle force in biceps femoris and gluteus maximus and prevents development of hypersensitivity in biceps femoris. It promotes peripheral nerve regeneration by increasing total axons, axon density, and axonal diameter, as well as myelin thickness and axon/fiber ratio. These effects are due to modulation of the IGF system as the treatment expression of IGF-1 and IGF-1 receptor in regenerated nerve tissue. CONCLUSION The results establish that KD and ES promote peripheral nerve regeneration. Patients recovering from peripheral nerve injury may benefit from this combinational approach.
Collapse
Affiliation(s)
- Ji Li
- Department of Anesthesia, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Yang Liu
- Department of Hand Surgery, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Huan-Qiu Liu
- Department of Anesthesia, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Lei Chen
- Department of Hand Surgery, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Rui-Jun Li
- Department of Hand Surgery, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| |
Collapse
|
15
|
Noble M, Tseng KCC, Li H, Elfar JC. 4-Aminopyridine as a Single Agent Diagnostic and Treatment for Severe Nerve Crush Injury. Mil Med 2019; 184:379-385. [PMID: 30901424 DOI: 10.1093/milmed/usy399] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 05/11/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Traumatic peripheral nerve injury (TPI) is a major medical problem without effective treatment options. There is no way to diagnose or treat an incomplete injury and delays contribute to morbidity. We examined 4-aminopyridine (4-AP), a potassium-channel blocker as a possible treatment for TPI. METHODS We used standard mouse models of TPI with functional outcomes including sciatic-functional-index, sensory indices, and electrodiagnostics; in addition to standard immunohistochemical, and electron microscopic correlates of axon and myelin morphology. RESULTS Sustained early 4-AP administration increased the speed and extent of behavioral recovery too rapidly to be explained by axonal regeneration. 4-AP also enhanced recovery of nerve conduction velocity, promoted remyelination, and increased axonal area post-injury. 4-AP treatment also enabled the rapid distinction between incomplete and complete nerve lesions. CONCLUSION 4-AP singularly provides both a new potential therapy to promote durable recovery and remyelination in acute peripheral nerve injury and a means of identifying lesions in which this therapy would be most likely to be of value. The ability to distinguish injuries that may respond to extended therapy without intervention can offer benefit to wounded soldiers.
Collapse
Affiliation(s)
- Mark Noble
- University of Rochester, Stem Cell Regenerative Medicine Institute, Department of Molecular Genetics, 601 Elmwood Ave, Rochester, NY
| | | | - Haiyan Li
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave, Rochester, NY
| | - John C Elfar
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave, Rochester, NY.,The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA
| |
Collapse
|
16
|
McGregor CE, Irwin AM, English AW. The Val66Met BDNF Polymorphism and Peripheral Nerve Injury: Enhanced Regeneration in Mouse Met-Carriers Is Not Further Improved With Activity-Dependent Treatment. Neurorehabil Neural Repair 2019; 33:407-418. [PMID: 31068076 DOI: 10.1177/1545968319846131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Activity-dependent treatments to enhance peripheral nerve regeneration after injury have shown great promise, and clinical trials implementing them have begun. Success of these treatments requires activity-dependent release of brain-derived neurotrophic factor (BDNF). A single nucleotide polymorphism (SNP) in the bdnf gene known as Val66Met, which is found in nearly one third of the human population, results in defective activity-dependent BDNF secretion and could impact the effectiveness of these therapies. Here, we used a mouse model of this SNP to test the efficacy of treadmill exercise in enhancing axon regeneration in animals both heterozygous (V/M) and homozygous (M/M) for the SNP. Axon regeneration was studied 4 weeks after complete transection and repair of the sciatic nerve in both male and female animals, using both electrophysiological and histological outcome measures. Regeneration was enhanced significantly without treatment in V/M mice, compared with wild type (V/V) controls. Unlike V/V mice, treatment of both V/M and M/M mice with treadmill exercise did not result in enhanced regeneration. These results were recapitulated in vitro using dissociated neurons containing the light-sensitive cation channel, channelrhodopsin. Three days after plating, neurites of neurons from V/M and M/M mice were longer than those of V/V neurons. In neurons from V/V mice, but not those from V/M or M/M animals, longer neurites were found after optogenetic stimulation. Taken together, Met-carriers possess an intrinsically greater capacity to regenerate axons in peripheral nerves, but this cannot be enhanced further by activity-dependent treatments.
Collapse
|
17
|
Bone Marrow Mesenchymal Stem Cell Transplantation Enhances Nerve Regeneration in a Rat Model of Hindlimb Replantation. Plast Reconstr Surg 2019; 143:758e-768e. [PMID: 30921125 DOI: 10.1097/prs.0000000000005412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Successful limb replantation must be based not only on the viability of the amputated part but also on satisfactory long-term functional recovery. Once the vascular, skeletal, and soft-tissue problems have been taken care of, nerve recovery becomes the ultimate limiting factor. Unfortunately, nerve regeneration after limb replantation is impaired by several consequences. The authors tested the hypothesis that bone marrow mesenchymal stem cells could improve nerve regeneration outcomes in an experimental model of limb replantation. METHODS Twenty rats underwent replantation after total hindlimb amputation. Animals were subdivided into two groups: a replanted but nontreated control group and a replanted and bone marrow mesenchymal stem cell-transplanted group. Three months after surgery, nerve regeneration was assessed using functional, electrophysiologic, histomorphologic, and immunohistochemical analyses. RESULTS Bone marrow mesenchymal stem cell-treated animals showed significantly better sciatic functional index levels and higher compound muscle action potential amplitudes in comparison with the controls. Histomorphometric analysis revealed that the number of regenerating axons was approximately two-fold greater in the treated nerves. In addition, the mean g-ratio of these axons was within the optimal range. Immunohistochemical assessment revealed that expression of S-100 and myelin basic protein in the treated nerves was significantly higher than in controls. Correspondingly, the expression levels of anti-protein gene product 9.5 and vesicular acetylcholine transporter in motor endplates were also significantly higher. Finally, muscles in the bone marrow mesenchymal stem cell-transplanted group showed significantly larger average fiber areas. CONCLUSION The authors' findings demonstrate that it is possible to improve the degree of nerve regeneration after limb replantation by bone marrow mesenchymal stem cell transplantation.
Collapse
|
18
|
Rink S, Bendella H, Akkin SM, Manthou M, Grosheva M, Angelov DN. Experimental Studies on Facial Nerve Regeneration. Anat Rec (Hoboken) 2019; 302:1287-1303. [DOI: 10.1002/ar.24123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral MedicineUniversity of Cologne Cologne Germany
| | - Habib Bendella
- Department of NeurosurgeryUniversity of Witten/Herdecke, Cologne Merheim Medical Center (CMMC) Cologne Germany
| | - Salih Murat Akkin
- Department of Anatomy, School of MedicineSANKO University Gaziantep Turkey
| | - Marilena Manthou
- Department of Histology and EmbryologyAristotle University Thessaloniki Thessaloniki Greece
| | - Maria Grosheva
- Department of Oto‐Rhino‐LaryngologyUniversity of Cologne Cologne Germany
| | | |
Collapse
|
19
|
Duraikannu A, Krishnan A, Chandrasekhar A, Zochodne DW. Beyond Trophic Factors: Exploiting the Intrinsic Regenerative Properties of Adult Neurons. Front Cell Neurosci 2019; 13:128. [PMID: 31024258 PMCID: PMC6460947 DOI: 10.3389/fncel.2019.00128] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/14/2019] [Indexed: 01/19/2023] Open
Abstract
Injuries and diseases of the peripheral nervous system (PNS) are common but frequently irreversible. It is often but mistakenly assumed that peripheral neuron regeneration is robust without a need to be improved or supported. However, axonal lesions, especially those involving proximal nerves rarely recover fully and injuries generally are complicated by slow and incomplete regeneration. Strategies to enhance the intrinsic growth properties of reluctant adult neurons offer an alternative approach to consider during regeneration. Since axons rarely regrow without an intimately partnered Schwann cell (SC), approaches to enhance SC plasticity carry along benefits to their axon partners. Direct targeting of molecules that inhibit growth cone plasticity can inform important regenerative strategies. A newer approach, a focus of our laboratory, exploits tumor suppressor molecules that normally dampen unconstrained growth. However several are also prominently expressed in stable adult neurons. During regeneration their ongoing expression “brakes” growth, whereas their inhibition and knockdown may enhance regrowth. Examples have included phosphatase and tensin homolog deleted on chromosome ten (PTEN), a tumor suppressor that inhibits PI3K/pAkt signaling, Rb1, the protein involved in retinoblastoma development, and adenomatous polyposis coli (APC), a tumor suppressor that inhibits β-Catenin transcriptional signaling and its translocation to the nucleus. The identification of several new targets to manipulate the plasticity of regenerating adult peripheral neurons is exciting. How they fit with canonical regeneration strategies and their feasibility require additional work. Newer forms of nonviral siRNA delivery may be approaches for molecular manipulation to improve regeneration.
Collapse
Affiliation(s)
- Arul Duraikannu
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Anand Krishnan
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Ambika Chandrasekhar
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Douglas W Zochodne
- Division of Neurology, Department of Medicine, and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
20
|
Hu M, Hong L, Liu C, Hong S, He S, Zhou M, Huang G, Chen Q. Electrical stimulation enhances neuronal cell activity mediated by Schwann cell derived exosomes. Sci Rep 2019; 9:4206. [PMID: 30862846 PMCID: PMC6414536 DOI: 10.1038/s41598-019-41007-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 02/27/2019] [Indexed: 12/13/2022] Open
Abstract
Electrical stimulation (ES) therapy has good effects in patients with nervous system injury-related diseases. ES promotes nerve cell regeneration and stimulates Schwann cells to express neurotrophic factors. The incidence of stress urinary incontinence (SUI) among elderly people is increasing. Some studies suggest that damage to the pudendal nerve is closely related to the pathogenesis of SUI. It has also been found that pelvic ES can reduce SUI symptoms in a rat model of SUI caused by pudendal nerve injury. Clinically, pelvic floor electrical stimulation is effective in patients with mild to moderate SUI. These studies indicate that ES may ameliorate damage to the pudendal nerve and thus achieve the goal of SUI treatment, although the mechanism of action of this treatment remains unclear. Therefore, the purpose of the present study was to clarify the relationships among ES, neural cells and Schwann cells at the cellular level. We applied ES to nerve cells at 100 mV/mm or 200 mV/mm for 0, 0.5, 1, or 2 h to investigate changes in nerve cell activity. We then co-cultured the nerve cells with Schwann cells to explore the influence of single-culture and co-culture conditions on the nerve cells. Compared to non-ES, ES of the nerve cells increased their activity. Compared to those in single culture, co-cultured nerve cells exhibited an additional increase in activity. We also found that Schwann cell derived exosomes could promote the activity of nerve cells, with glutamate and calcium ions playing a potential role in this process. These results suggest that the mutual regulation of neural cells and Schwann cells plays an important role in the process by which ES ameliorates neurological function, which may provide a basis for subsequent studies.
Collapse
Affiliation(s)
- Ming Hu
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Li Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China.
| | - Cheng Liu
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Shasha Hong
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Songming He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Min Zhou
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Qian Chen
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| |
Collapse
|
21
|
Shang L, Huang Z, Pu X, Yin G, Chen X. Preparation of Graphene Oxide-Doped Polypyrrole Composite Films with Stable Conductivity and Their Effect on the Elongation and Alignment of Neurite. ACS Biomater Sci Eng 2019; 5:1268-1278. [DOI: 10.1021/acsbiomaterials.8b01326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lei Shang
- College of Materials Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Zhongbing Huang
- College of Materials Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Ximing Pu
- College of Materials Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Guangfu Yin
- College of Materials Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Xianchun Chen
- College of Materials Science and Engineering, Sichuan University, Chengdu 610065, China
| |
Collapse
|
22
|
Barber B, Seikaly H, Ming Chan K, Beaudry R, Rychlik S, Olson J, Curran M, Dziegielewski P, Biron V, Harris J, McNeely M, O'Connell D. Intraoperative Brief Electrical Stimulation of the Spinal Accessory Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: a double-blinded, randomized controlled trial. J Otolaryngol Head Neck Surg 2018; 47:7. [PMID: 29361981 PMCID: PMC5781293 DOI: 10.1186/s40463-017-0244-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/30/2017] [Indexed: 12/02/2022] Open
Abstract
Background Shoulder dysfunction is common after neck dissection for head and neck cancer (HNC). Brief electrical stimulation (BES) is a novel technique that has been shown to enhance neuronal regeneration after nerve injury by modulating the brain-derived neurotrophic growth factor (BDNF) pathways. The objective of this study was to evaluate the effect of BES on postoperative shoulder function following oncologic neck dissection. Methods Adult participants with a new diagnosis of HNC undergoing Level IIb +/− V neck dissection were recruited. Those in the treatment group received intraoperative BES applied to the spinal accessory nerve (SAN) after completion of neck dissection for 60 min of continuous 20 Hz stimulation at 3-5 V of 0.1 msec balanced biphasic pulses, while those in the control group received no stimulation (NS). The primary outcome measured was the Constant-Murley Shoulder (CMS) Score, comparing changes from baseline to 12 months post-neck dissection. Secondary outcomes included the change in the Neck Dissection Impairment Index (ΔNDII) score and the change in compound muscle action potential amplitude (ΔCMAP) over the same period. Results Fifty-four patients were randomized to the treatment or control group with a 1:1 allocation scheme. No differences in demographics, tumor characteristics, or neck dissection types were found between groups. Significantly lower ΔCMS scores were observed in the BES group at 12 months, indicating better preservation of shoulder function (p = 0.007). Only four in the BES group compared to 17 patients in the NS groups saw decreases greater than the minimally important clinical difference (MICD) of the CMS (p = 0.023). However, NDII scores (p = 0.089) and CMAP amplitudes (p = 0.067) between the groups did not reach statistical significance at 12 months. BES participants with Level IIb + V neck dissections had significantly better ΔCMS and ΔCMAP scores at 12 months (p = 0.048 and p = 0.025, respectively). Conclusions Application of BES to the SAN may help reduce impaired shoulder function in patients undergoing oncologic neck dissection, and may be considered a viable adjunct to functional rehabilitation therapies. Trial registration Clinicaltrials.gov (NCT02268344, October 17, 2014).
Collapse
Affiliation(s)
- Brittany Barber
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - K Ming Chan
- Department of Physical Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Rhys Beaudry
- Department of Physical Therapy, University of Texas, Arlington, Texas, USA
| | - Shannon Rychlik
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Jaret Olson
- Division of Plastic Surgery, University of Alberta, Edmonton, Canada
| | - Matthew Curran
- Division of Plastic Surgery, University of Alberta, Edmonton, Canada
| | | | - Vincent Biron
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Jeffrey Harris
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Margaret McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Daniel O'Connell
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada.
| |
Collapse
|
23
|
Adipose-Derived Stem Cells Enhance Axonal Regeneration through Cross-Facial Nerve Grafting in a Rat Model of Facial Paralysis. Plast Reconstr Surg 2017; 138:387-396. [PMID: 27465163 DOI: 10.1097/prs.0000000000002351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cross-face nerve grafting combined with functional muscle transplantation has become the standard in reconstructing an emotionally controlled smile in complete irreversible facial palsy. However, the efficacy of this procedure depends on the ability of regenerating axons to breach two nerve coaptations and reinnervate endplates in denervated muscle. The current study tested the hypothesis that adipose-derived stem cells would enhance axonal regeneration through a cross-facial nerve graft and thereby enhance recovery of the facial nerve function. METHODS Twelve rats underwent transection of the right facial nerve, and cross-facial nerve grafting using the sciatic nerve as an interpositional graft, with coaptations to the ipsilateral and contralateral buccal branches, was carried out. Rats were divided equally into two groups: a grafted but nontreated control group and a grafted and adipose-derived stem cell-treated group. Three months after surgery, biometric and electrophysiologic assessments of vibrissae movements were performed. Histologically, the spectra of fiber density, myelin sheath thickness, fiber diameter, and g ratio of the nerve were analyzed. Immunohistochemical staining was performed for the evaluation of acetylcholine in the neuromuscular junctions. RESULTS The data from the biometric and electrophysiologic analysis of vibrissae movements, immunohistochemical analysis, and histologic assessment of the nerve showed that adipose-derived stem cells significantly enhanced axonal regeneration through the graft. CONCLUSION These observations suggest that adipose-derived stem cells could be a clinically translatable route toward new methods to enhance recovery after cross-facial nerve grafting.
Collapse
|
24
|
Jiao H, Xiao B, Wang X, Li D, Song Y, Zheng H, Liu X. [Effect of short-term low-frequency electrical stimulation on nerve regeneration of delayed nerve defect during operation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:335-344. [PMID: 29806265 DOI: 10.7507/1002-1892.201609024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effect of short-term low-frequency electrical stimulation (SLES) during operation on nerve regeneration in delayed peripheral nerve injury with long gap. Methods Thirty female adult Sprague Dawley rats, weighing 160-180 g, were used to prepare 13-mm defect model by trimming the nerve stumps. Then all rats were randomly divided into 2 groups, 15 rats in each group. After nerve defect was bridged by the contralateral normal sciatic nerve, SLES was applied in the experimental group, but was not in the control group. The spinal cords and dorsal root ganglions (DRGs) were harvested to carry out immunofluorescence histochemistry double staining for growth-associated proteins 43 (GAP-43) and brain-derived neurotrophic factor (BDNF) at 1, 2, and 7 days after repair. Fluorogold (FG) retrograde tracing was performed at 3 months after repair. The mid-portion regenerated segments were harvested to perform Meyer's trichrome staining, immunofluorescence double staining for neurofilament (NF) and soluble protein 100 (S-100) on the transversely or longitudinal sections at 3 months after repair. The segment of the distal sciatic nerve trunk was harvested for electron microscopy and morphometric analyses to measure the diameter of the myelinated axons, thickness of myelin sheaths, the G ratio, and the density of the myelinated nerve fibers. The gastrocnemius muscles of the operated sides were harvested to measure the relative wet weight ratios. Karnovsky-Root cholinesterase staining of the motor endplate was carried out. Results In the experimental group, the expressions of GAP-43 and BDNF were higher than those in the control group at 1 and 2 days after repair. The number of labeled neurons in the anterior horn of gray matter in the spinal cord and DRGs at the operated side from the experimental group was more than that from the control group. Meyer's trichrome staining, immunofluorescence double staining, and the electron microscopy observation showed that the regenerated nerves were observed to develop better in the experimental group than the control group. The relative wet weight ratio of experimental group was significantly higher than that of the control group ( t=4.633, P=0.000). The size and the shape of the motor endplates in the experimental group were better than those in the control group. Conclusion SLES can promote the regeneration ability of the short-term (1 month) delayed nerve injury with long gap to a certain extent.
Collapse
Affiliation(s)
- Haishan Jiao
- Department of Basic Medicine, Suzhou Vocational Health College, Suzhou Jiangsu, 215009,
| | - Bo Xiao
- Department of Basic Medicine, Suzhou Vocational Health College, Suzhou Jiangsu, 215009, P.R.China
| | - Xiaodong Wang
- Department of Histology and Embryology, Medical College, Nantong University, Nantong Jiangsu, 226001, P.R.China
| | - Dongyin Li
- Department of Basic Medicine, Suzhou Vocational Health College, Suzhou Jiangsu, 215009, P.R.China
| | - Yuening Song
- Department of Basic Medicine, Suzhou Vocational Health College, Suzhou Jiangsu, 215009, P.R.China
| | - Hui Zheng
- Department of Basic Medicine, Suzhou Vocational Health College, Suzhou Jiangsu, 215009, P.R.China
| | - Xiaomei Liu
- Department of Basic Medicine, Suzhou Vocational Health College, Suzhou Jiangsu, 215009, P.R.China
| |
Collapse
|
25
|
Altered Satellite Cell Responsiveness and Denervation Implicated in Progression of Rotator-Cuff Injury. PLoS One 2016; 11:e0162494. [PMID: 27668864 PMCID: PMC5036792 DOI: 10.1371/journal.pone.0162494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background Rotator-cuff injury (RCI) is common and painful; even after surgery, joint stability and function may not recover. Relative contributions to atrophy from disuse, fibrosis, denervation, and satellite-cell responsiveness to activating stimuli are not known. Methods and Findings Potential contributions of denervation and disrupted satellite cell responses to growth signals were examined in supraspinatus (SS) and control (ipsilateral deltoid) muscles biopsied from participants with RCI (N = 27). Biopsies were prepared for explant culture (to study satellite cell activity), immunostained to localize Pax7, BrdU, and Semaphorin 3A in satellite cells, sectioning to study blood vessel density, and western blotting to measure the fetal (γ) subunit of acetylcholine receptor (γ-AchR). Principal component analysis (PCA) for 35 parameters extracted components identified variables that contributed most to variability in the dataset. γ-AchR was higher in SS than control, indicating denervation. Satellite cells in SS had a low baseline level of activity (Pax7+ cells labelled in S-phase) versus control; only satellite cells in SS showed increased proliferative activity after nitric oxide-donor treatment. Interestingly, satellite cell localization of Semaphorin 3A, a neuro-chemorepellent, was greater in SS (consistent with fiber denervation) than control muscle at baseline. PCAs extracted components including fiber atrophy, satellite cell activity, fibrosis, atrogin-1, smoking status, vascular density, γAchR, and the time between symptoms and surgery. Use of deltoid as a control for SS was supported by PCA findings since “muscle” was not extracted as a variable in the first two principal components. SS muscle in RCI is therefore atrophic, denervated, and fibrotic, and has satellite cells that respond to activating stimuli. Conclusions Since SS satellite cells can be activated in culture, a NO-donor drug combined with stretching could promote muscle growth and improve functional outcome after RCI. PCAs suggest indices including satellite cell responsiveness, atrogin-1, atrophy, and innervation may predict surgical outcome.
Collapse
|
26
|
Kumar PJ, Adams RD, Harkins AB, Engeberg ED, Willits RK. Stimulation Frequency Alters the Dorsal Root Ganglion Neurite Growth and Directionality In Vitro . IEEE Trans Biomed Eng 2016; 63:1257-68. [DOI: 10.1109/tbme.2015.2492998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
27
|
Abstract
BACKGROUND Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. This is the first update of a review first published in 2013. OBJECTIVES To review the effectiveness and safety of rehabilitation interventions following CTS surgery compared with no treatment, placebo, or another intervention. SEARCH METHODS On 29 September 2015, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, AMED, LILACS, and PsycINFO. We also searched PEDro (3 December 2015) and clinical trials registers (3 December 2015). SELECTION CRITERIA Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo, or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and assessed the quality of the body of evidence for primary outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach according to standard Cochrane methodology. MAIN RESULTS In this review we included 22 trials with a total of 1521 participants. Two of the trials were newly identified at this update. We studied different rehabilitation treatments including immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multi-modal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo, four compared rehabilitation to a no treatment control, three compared rehabilitation to standard care, and 15 compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Thirteen trials explicitly reported random sequence generation; of these, five adequately concealed the allocation sequence. Four trials achieved blinding of both participants and outcome assessors. Five were at high risk of bias from incompleteness of outcome data at one or more time intervals, and eight had high risk of selective reporting bias.These trials were heterogeneous in terms of treatments provided, duration of interventions, the nature and timing of outcomes measured, and setting. Therefore, we were not able to pool results across trials.Four trials reported our primary outcome, change in self reported functional ability at three months or more. Of these, three trials provided sufficient outcome data for inclusion in this review. One small high-quality trial studied a desensitisation programme compared with standard treatment and revealed no statistically significant functional benefit based on the Boston Carpal Tunnel Questionnaire (BCTQ) (mean difference (MD) -0.03, 95% confidence interval (CI) -0.39 to 0.33). One low-quality trial assessed participants six months post surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and found no significant difference between a no formal therapy group and a group given a two-week course of multi-modal therapy commenced at five to seven days post surgery (MD 1.00, 95% CI -4.44 to 6.44). One very low-quality quasi-randomised trial found no statistically significant difference in function on the BCTQ at three months post surgery with early immobilisation (plaster wrist orthosis worn until suture removal) compared with a splint and late mobilisation (MD 0.39, 95% CI -0.45 to 1.23).Differences between treatments for secondary outcome measures (change in self reported functional ability measured at less than three months; change in CTS symptoms; change in CTS-related impairment measures; presence of iatrogenic symptoms from surgery; return to work or occupation; and change in neurophysiological parameters) were generally small and not statistically significant. Few studies reported adverse events. AUTHORS' CONCLUSIONS There is limited and, in general, low quality evidence for the benefit of the reviewed interventions. People who have undergone CTS surgery should be informed about the limited evidence of effectiveness of postoperative rehabilitation interventions. Until researchers provide results of more high-quality trials that assess the effectiveness and safety of various rehabilitation treatments, the decision to provide rehabilitation following CTS surgery should be based on the clinician's expertise, the patient's preferences and the context of the rehabilitation environment. It is important for researchers to identify patients who respond to a particular treatment and those who do not, and to undertake high-quality studies that evaluate the severity of iatrogenic symptoms from surgery, measure function and return-to-work rates, and control for confounding variables.
Collapse
Affiliation(s)
- Susan Peters
- The University of QueenslandDivision of Occupational Therapy, School of Health and Rehabilitation SciencesBrisbaneAustralia
- Brisbane Hand and Upper Limb Research InstituteLevel 9, 259 Wickham TerraceBrisbaneQueenslandAustraliaQLD 4000
| | - Matthew J Page
- Monash UniversitySchool of Public Health & Preventive MedicineLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
- University of BristolSchool of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Michel W Coppieters
- Vrije Universiteit AmsterdamMOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement SciencesVan der Boechorststraat 9AmsterdamNetherlands1081BT
- The University of QueenslandDivision of Physiotherapy, School of Health and Rehabilitation SciencesBrisbaneAustralia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research InstituteLevel 9, 259 Wickham TerraceBrisbaneQueenslandAustraliaQLD 4000
- The University of QueenslandDivision of Orthopaedic Surgery, School of MedicineBrisbaneQueenslandAustralia
- Princess Alexandra HospitalOrthopaedic DepartmentWoolloongabbaBrisbaneAustralia
| | - Venerina Johnston
- The University of QueenslandDivision of Physiotherapy, School of Health and Rehabilitation SciencesBrisbaneAustralia
| | | |
Collapse
|
28
|
Berggren J, Baker LL. Therapeutic application of electrical stimulation and constraint induced movement therapy in perinatal brachial plexus injury: A case report. J Hand Ther 2016; 28:217-20; quiz 221. [PMID: 25841560 DOI: 10.1016/j.jht.2014.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 02/03/2023]
Abstract
Infants and children with perinatal brachial plexus injury (PBPI) have motion limitations in the shoulder, elbow, forearm and hand that are dependent on the level of injury and degree of recovery. The injury and subsequent recovery period occur during critical periods of central and spinal neural development placing infants and children at-risk for developmental disregard and disuse of the affected arm and hand. A case report outlines the therapy and surgical interventions provided in the first 2 years of life for a child with global PBPI and a positive Horner's sign. Electrical stimulation and constraint induced movement therapy provided sequentially were effective therapy interventions. Neurosurgery to repair the brachial plexus was performed at an optimal time period.(2) The Assisting Hand Assessment,(12) Modified Mallet(13) and Active Movement Scale(14) are effective outcome measures in PBPI and served as valuable guides for therapy intervention. Oxford Level of Evidence: 3b; Individual Case Control Study.
Collapse
Affiliation(s)
- Jamie Berggren
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., #56, Los Angeles, CA 90027, USA.
| | - Lucinda L Baker
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
29
|
Du Z, Bondarenko O, Wang D, Rouabhia M, Zhang Z. Ex Vivo Assay of Electrical Stimulation to Rat Sciatic Nerves: Cell Behaviors and Growth Factor Expression. J Cell Physiol 2015; 231:1301-12. [PMID: 26516696 DOI: 10.1002/jcp.25230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/28/2015] [Indexed: 01/27/2023]
Abstract
Neurite outgrowth and axon regeneration are known to benefit from electrical stimulation. However, how neuritis and their surroundings react to electrical field is difficult to replicate by monolayer cell culture. In this work freshly harvested rat sciatic nerves were cultured and exposed to two types of electrical field, after which time the nerve tissues were immunohistologically stained and the expression of neurotrophic factors and cytokines were evaluated. ELISA assay was used to confirm the production of specific proteins. All cell populations survived the 48 h culture with little necrosis. Electrical stimulation was found to accelerate Wallerian degeneration and help Schwann cells to switch into migratory phenotype. Inductive electrical stimulation was shown to upregulate the secretion of multiple neurotrophic factors. Cellular distribution in nerve tissue was altered upon the application of an electrical field. This work thus presents an ex vivo model to study denervated axon in well controlled electrical field, bridging monolayer cell culture and animal experiment. It also demonstrated the critical role of electrical field distribution in regulating cellular activities.
Collapse
Affiliation(s)
- Zhiyong Du
- Qiandongnan National Polytechnic, Kaili, China.,Département de chirurgie, Faculté de médecine, Centre de recherche du CHU de Québec, Université Laval, Québec (QC), Canada
| | - Olexandr Bondarenko
- Département de chirurgie, Faculté de médecine, Centre de recherche du CHU de Québec, Université Laval, Québec (QC), Canada
| | - Dingkun Wang
- Département de chirurgie, Faculté de médecine, Centre de recherche du CHU de Québec, Université Laval, Québec (QC), Canada
| | - Mahmoud Rouabhia
- Groupe de recherche en écologie buccale, Faculté de médecine dentaire, Université Laval, Québec (QC), Canada
| | - Ze Zhang
- Département de chirurgie, Faculté de médecine, Centre de recherche du CHU de Québec, Université Laval, Québec (QC), Canada
| |
Collapse
|
30
|
Abstract
Peripheral nerve injury afflicts individuals from all walks of life. Despite the peripheral nervous system’s intrinsic ability to regenerate, many patients experience incomplete functional recovery. Surgical repair aims to expedite this recovery process in the most thorough manner possible. However, full recovery is still rarely seen especially when nerve injury is compounded with polytrauma where surgical repair is delayed. Pharmaceutical strategies supplementary to nerve microsurgery have been investigated but surgery remains the only viable option. Brief low-frequency electrical stimulation of the proximal nerve stump after primary repair has been widely investigated. This article aims to review the currently known biological basis for the regenerative effects of acute brief low-frequency electrical stimulation on axonal regeneration and outline the recent clinical applications of the electrical stimulation protocol to demonstrate the significant translational potential of this modality for repairing peripheral nerve injuries. The review concludes with a discussion of emerging new advancements in this exciting area of research. The current literature indicates the imminent clinical applicability of acute brief low-frequency electrical stimulation after surgical repair to effectively promote axonal regeneration as the stimulation has yielded promising evidence to maximize functional recovery in diverse types of peripheral nerve injuries.
Collapse
|
31
|
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: 172] [Impact Index Per Article: 19.1] [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.
Collapse
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
| |
Collapse
|
32
|
Quintard H, Heurteaux C, Ichai C. Adult neurogenesis and brain remodelling after brain injury: From bench to bedside? Anaesth Crit Care Pain Med 2015; 34:239-45. [PMID: 26233283 DOI: 10.1016/j.accpm.2015.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 02/19/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Brain trauma and stroke cause important disabilities. The mechanisms involved are now well described, but all therapeutics developed thus far for neuro-protection are currently unsuccessful at improving neurologic prognosis. The recently studied neuro-restorative time following brain injury may point towards a promising therapeutic approach. The purpose of this paper is to explain the mechanisms of this revolutionary concept, give an overview of related knowledge and discuss its transfer into clinical practice. DATA SOURCES AND SYNTHESIS An overview of the neurogenesis concept using MEDLINE, EMBASE and CENTRAL databases was carried out in May 2014. The clinicaltrials.gov registry was used to search for ongoing clinical trials in this domain. CONCLUSION The concept of brain remodelling upset fundamental ideas concerning the neurologic system and opened new fields of research. Therapies currently under evaluation hold promising results and could have a real prognostic impact in future years, but the translation of these therapies from the laboratory to the clinic is still far from completion.
Collapse
Affiliation(s)
- Hervé Quintard
- Intensive Care Unit, CHU Nice, 4, rue Pierre-Dévoluy, 06000 Nice, France.
| | - Catherine Heurteaux
- Institut de Pharmacologie Moléculaire et Cellulaire (CNRS), Université de Sophia-Antipolis, 660, route des Lucioles, 06560 Valbonne, France.
| | - Carole Ichai
- Intensive Care Unit, CHU Nice, 4, rue Pierre-Dévoluy, 06000 Nice, France.
| |
Collapse
|
33
|
Intraoperative brief electrical stimulation (BES) for prevention of shoulder dysfunction after oncologic neck dissection: study protocol for a randomized controlled trial. Trials 2015; 16:240. [PMID: 26021563 PMCID: PMC4453046 DOI: 10.1186/s13063-015-0745-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 05/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Shoulder pain and dysfunction are common after oncologic neck dissection for head and neck cancer (HNC), due to traction, compression, and devascularization injuries to the spinal accessory nerve (SAN). Shoulder pain and dysfunction can hinder postoperative rehabilitation and hygiene, activities of daily living (ADLs), and return to work after treatment for HNC. Due to the rising incidence of human papillomavirus (HPV)-associated oropharyngeal cancer, patients are often diagnosed in the third or fourth decade of life, leaving many potential working years lost if shoulder dysfunction occurs. Brief electrical stimulation (BES) is a novel technique that has been shown to enhance and accelerate neuronal regeneration after injury through a brain-derived neurotrophic growth factor (BDNF)-driven molecular pathway in multiple peripheral nerves in both humans and animals. Methods/Design This is a randomized controlled trial testing the effect of intraoperative BES on postoperative shoulder pain and dysfunction. All adult participants with a new diagnosis of HNC undergoing surgery with neck dissection, including Level IIb and postoperative radiotherapy, will be enrolled. Participants will undergo intraoperative BES after completion of neck dissection for 60 min continuously at 20 Hz, 3 to 5 V, in 100-msec pulses. Postoperatively, participants will be evaluated using the Constant-Murley Shoulder Score, a scale that assesses shoulder pain, ADLs, strength, and range of motion. Secondary outcomes measured will include nerve conduction studies (NCS) and electromyographic (EMG) studies, as well as scores on the Oxford Shoulder Score (OSS), the Neck Dissection Impairment Index (NDII), and the University of Washington Quality of Life (UW-QOL) score. Primary and secondary outcomes will be assessed at 6 weeks, 3 months, 6 months, and 12 months. Discussion The objective of this study is to evaluate the effect of BES on postoperative clinical and objective shoulder functional outcomes and pain after oncologic neck dissection. BES has been shown to be successful in accelerating peripheral nerve regeneration in both animal and human participants in multiple different peripheral nerves. If successful, this technique may provide an adjunctive prevention option for shoulder pain and dysfunction in HNC patients. Trial registration NCT02268344: 17 October 2014.
Collapse
|
34
|
Calvey C, Zhou W, Stakleff KS, Sendelbach-Sloan P, Harkins AB, Lanzinger W, Willits RK. Short-term electrical stimulation to promote nerve repair and functional recovery in a rat model. J Hand Surg Am 2015; 40:314-22. [PMID: 25459379 DOI: 10.1016/j.jhsa.2014.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of duration of electrical stimulation on peripheral nerve regeneration and functional recovery. Based on previous work, we hypothesized that applying 10 minutes of electrical stimulation to a 10-mm rat sciatic nerve defect would significantly improve nerve regeneration and functional recovery compared with the non-electrical stimulation group. METHODS A silicone tube filled with a collagen gel was used to bridge a 10-mm nerve defect in rats, and either 10 minutes or 60 minutes of electrical stimulation was applied to the nerve during surgery. Controls consisted of a silicone tube with collagen gel and no electrical stimulation or an isograft. We analyzed recovery over a 12-week period, measuring sciatic functional index and extensor postural thrust scores and concluding with histological examination of the nerve. RESULTS Functional assessment scores at week 12 increased 24% in the 10-minute group as compared to the no stimulation control group. Electrical stimulation of either 10 or 60 minutes improved the number of nerve fibers over no stimulation. Additionally, the electrical stimulation group's histomorphometric analysis was not different from the isograft group. CONCLUSIONS Several previous studies have demonstrated the effectiveness of 60-minute stimulations on peripheral nerve regeneration. This study demonstrated that an electrical stimulation of 10 minutes enhanced several functional and histomorphometric outcomes of nerve regeneration and was overall similar to a 60-minute stimulation over 12 weeks. CLINICAL RELEVANCE Decreasing the electrical stimulation time from 60 minutes to 10 minutes provided a potential clinically feasible and safe method to enhance nerve regeneration and functional recovery.
Collapse
Affiliation(s)
- Colleen Calvey
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO
| | - Wenda Zhou
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO
| | - Kimberly Sloan Stakleff
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO
| | - Patricia Sendelbach-Sloan
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO
| | - Amy B Harkins
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO
| | - William Lanzinger
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO
| | - Rebecca Kuntz Willits
- Department of Orthopaedic Surgery and the Kenneth Calhoun Research Laboratory, Akron General Medical Center, Akron, OH; Department of Biomedical Engineering, The University of Akron, Akron, OH; Department of Pharmacological and Physiological Science, Saint Louis University, St. Louis, MO.
| |
Collapse
|
35
|
Novak CB, von der Heyde RL. Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how. Semin Plast Surg 2015; 29:73-80. [PMID: 25685106 PMCID: PMC4317280 DOI: 10.1055/s-0035-1544172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Following upper extremity nerve and tendon reconstruction, rehabilitation is necessary to achieve optimal function and outcome. In this review, the authors present current evidence and literature regarding the strategies and techniques of rehabilitation following peripheral nerve and tendon reconstruction.
Collapse
Affiliation(s)
- Christine B. Novak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehab and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | |
Collapse
|
36
|
Jiao H, Yao J, Song Y, Chen Y, Li D, Liu X, Chen X, Lin W, Li Y, Wang X. Morphological Proof of nerve regeneration after long-term defects of rat sciatic nerves. Int J Neurosci 2014; 125:861-74. [PMID: 25375266 DOI: 10.3109/00207454.2014.984296] [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] [Indexed: 11/13/2022]
Abstract
Unsatisfactory efficacy of clinical cure for long-term delayed injuries and other disadvantages such as the low regeneration rate and speed of axotomized neurons and the questionable reinnervation ability of atrophic target organ lead to inaction to the long-term delayed injuries. Here we attempted to use autologous nerve to bridge a long-term delayed 10-mm defect in SD rats based on some previous positive messages of basic and clinical research. In this study, for experimental groups, the rat sciatic nerve had been transected leaving a 10-mm defect, which was maintained for 3 or 6 months before implantation with the autologous graft. The non-grafted animals served as negative control. Measuring with electrophysiological and histological techniques, we find: (1) A number of long-term axotomized neurons survived and sustained certain degree of axonal regenerative capacity; (2) A few denervated Schwann cells survived and retained their ability to provide trophic support and myelinate axons in at least 6 months; (3) the chronically denervated muscle can partially be reinnervated by regenerated axons. But the quantity and the quality of the regenerated nerve fibers and the reinnervated muscle fibers were all poor. Thus these observations provide new positive morphological proof of nerve regeneration after long-term defects and further studies will be needed to increase the survival rate and the regenerative speed of long-term chronic axotomized neurons, enhance the support provided by denervated distal stumps and protect the target muscle.
Collapse
Affiliation(s)
- Haishan Jiao
- a Basic Medicine Staff Room, Nursing Department, Suzhou Health College , Suzhou , Jiangsu , China
| | - Jian Yao
- b Department of Histology and Embryology, Medical College, Nantong University , Nantong , Jiangsu , China
| | - Yuening Song
- a Basic Medicine Staff Room, Nursing Department, Suzhou Health College , Suzhou , Jiangsu , China
| | - Ying Chen
- b Department of Histology and Embryology, Medical College, Nantong University , Nantong , Jiangsu , China
| | - Dongyin Li
- a Basic Medicine Staff Room, Nursing Department, Suzhou Health College , Suzhou , Jiangsu , China
| | - Xiaomei Liu
- a Basic Medicine Staff Room, Nursing Department, Suzhou Health College , Suzhou , Jiangsu , China
| | - Xue Chen
- b Department of Histology and Embryology, Medical College, Nantong University , Nantong , Jiangsu , China
| | - Weiwei Lin
- b Department of Histology and Embryology, Medical College, Nantong University , Nantong , Jiangsu , China
| | - Yi Li
- b Department of Histology and Embryology, Medical College, Nantong University , Nantong , Jiangsu , China
| | - Xiaodong Wang
- b Department of Histology and Embryology, Medical College, Nantong University , Nantong , Jiangsu , China
| |
Collapse
|
37
|
Shakhbazau A, Archibald SJ, Shcharbin D, Bryszewska M, Midha R. Aligned collagen-GAG matrix as a 3D substrate for Schwann cell migration and dendrimer-based gene delivery. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1979-1989. [PMID: 24801062 DOI: 10.1007/s10856-014-5224-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/21/2014] [Indexed: 06/03/2023]
Abstract
The development of artificial off-the-shelf conduits that facilitate effective nerve regeneration and recovery after repair of traumatic nerve injury gaps is of fundamental importance. Collagen-glycosaminoglycan (GAG) matrix mimicking Schwann cell (SC) basal lamina has been proposed as a suitable and biologically rational substrate for nerve regeneration. In the present study, we have focused on the permissiveness of this matrix type for SC migration and repopulation, as these events play an essential role in nerve remodeling. We have also demonstrated that SCs cultured within collagen-GAG matrix are compatible with non-viral dendrimer-based gene delivery, that may allow conditioning of matrix-embedded cells for future gene therapy applications.
Collapse
Affiliation(s)
- Antos Shakhbazau
- Department of Clinical Neuroscience, Faculty of Medicine, University of Calgary, HMRB 109-3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada,
| | | | | | | | | |
Collapse
|
38
|
Koppes AN, Zaccor NW, Rivet CJ, Williams LA, Piselli JM, Gilbert RJ, Thompson DM. Neurite outgrowth on electrospun PLLA fibers is enhanced by exogenous electrical stimulation. J Neural Eng 2014; 11:046002. [PMID: 24891494 DOI: 10.1088/1741-2560/11/4/046002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Both electrical stimuli (endogenous and exogenous) and topographical cues are instructive to axonal extension. This report, for the first time, investigated the relative dominance of directional topographical guidance cues and directional electrical cues to enhance and/or direct primary neurite extension. We hypothesized the combination of electrical stimulation with electrospun fiber topography would induce longer neurite extension from dorsal root ganglia neurons than the presence of electrical stimulation or aligned topography alone. APPROACH To test the hypothesis, neurite outgrowth was examined on laminin-coated poly-L-lactide films or electrospun fibers (2 µm in diameter) in the presence or absence of electrical stimulation. Immunostained neurons were semi-automatically traced using Neurolucida software and morphology was evaluated. MAIN RESULTS Neurite extension increased 74% on the aligned fibers compared to film controls. Stimulation alone increased outgrowth by 32% on films or fibers relative to unstimulated film controls. The co-presentation of topographical (fibers) with biophysical (electrical stimulation) cues resulted in a synergistic 126% increase in outgrowth relative to unstimulated film controls. Field polarity had no influence on the directionality of neurites, indicating topographical cues are responsible for guiding neurite extension. SIGNIFICANCE Both cues (electrical stimulation and fiber geometry) are modular in nature and can be synergistically applied in conjunction with other common methods in regenerative medicine such as controlled release of growth factors to further influence axonal growth in vivo. The combined application of electrical and aligned fiber topographical guidance cues described herein, if translated in vivo, could provide a more supportive environment for directed and robust axonal regeneration following peripheral nerve injury.
Collapse
Affiliation(s)
- A N Koppes
- Department of Biomedical Engineering and the Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY, USA
| | | | | | | | | | | | | |
Collapse
|
39
|
Koppes AN, Nordberg AL, Paolillo GM, Goodsell NM, Darwish HA, Zhang L, Thompson DM. Electrical stimulation of schwann cells promotes sustained increases in neurite outgrowth. Tissue Eng Part A 2014; 20:494-506. [PMID: 24063574 PMCID: PMC3926181 DOI: 10.1089/ten.tea.2013.0012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 09/03/2013] [Indexed: 12/20/2022] Open
Abstract
Endogenous electric fields are instructive during embryogenesis by acting to direct cell migration, and postnatally, they can promote axonal growth after injury (McCaig 1991, Al-Majed 2000). However, the mechanisms for these changes are not well understood. Application of an appropriate electrical stimulus may increase the rate and success of nerve repair by directly promoting axonal growth. Previously, DC electrical stimulation at 50 mV/mm (1 mA, 8 h duration) was shown to promote neurite outgrowth and a more pronounced effect was observed if both peripheral glia (Schwann cells) and neurons were co-stimulated. If electrical stimulation is delivered to an injury site, both the neurons and all resident non-neuronal cells [e.g., Schwann cells, endothelial cells, fibroblasts] will be treated and this biophysical stimuli can influence axonal growth directly or indirectly via changes to the resident, non-neuronal cells. In this work, non-neuronal cells were electrically stimulated, and changes in morphology and neuro-supportive cells were evaluated. Schwann cell response (morphology and orientation) was examined after an 8 h stimulation over a range of DC fields (0-200 mV/mm, DC 1 mA), and changes in orientation were observed. Electrically prestimulating Schwann cells (50 mV/mm) promoted 30% more neurite outgrowth relative to co-stimulating both Schwann cells with neurons, suggesting that electrical stimulation modifies Schwann cell phenotype. Conditioned medium from the electrically prestimulated Schwann cells promoted a 20% increase in total neurite outgrowth and was sustained for 72 h poststimulation. An 11-fold increase in nerve growth factor but not brain-derived neurotrophic factor or glial-derived growth factor was found in the electrically prestimulated Schwann cell-conditioned medium. No significant changes in fibroblast or endothelial morphology and neuro-supportive behavior were observed poststimulation. Electrical stimulation is widely used in clinical settings; however, the rational application of this cue may directly impact and enhance neuro-supportive behavior, improving nerve repair.
Collapse
Affiliation(s)
- Abigail N Koppes
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Renssalaer Polytechnic Institute , Troy, New York
| | | | | | | | | | | | | |
Collapse
|
40
|
Khuong HT, Kumar R, Senjaya F, Grochmal J, Ivanovic A, Shakhbazau A, Forden J, Webb A, Biernaskie J, Midha R. Skin derived precursor Schwann cells improve behavioral recovery for acute and delayed nerve repair. Exp Neurol 2014; 254:168-79. [PMID: 24440805 DOI: 10.1016/j.expneurol.2014.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/31/2013] [Accepted: 01/02/2014] [Indexed: 12/23/2022]
Abstract
Previous work has shown that infusion of skin-derived precursors pre-differentiated into Schwann cells (SKP-SCs) can remyelinate injured and regenerating axons, and improve indices of axonal regeneration and electrophysiological parameters in rodents. We hypothesized that SKP-SC therapy would improve behavioral outcomes following nerve injury repair and tested this in a pre-clinical trial in 90 rats. A model of sciatic nerve injury and acellular graft repair was used to compare injected SKP-SCs to nerve-derived Schwann cells or media, and each was compared to the gold standard nerve isograft repair. In a second experiment, rats underwent right tibial nerve transection and received either acute or delayed direct nerve repair, with injections of either 1) SKP-SCs distal to the repair site, 2) carrier medium alone, or 3) dead SKP-SCs, and were followed for 4, 8 or 17weeks. For delayed repairs, both transected nerve ends were capped and repaired 11weeks later, along with injections of cells or media as above, and followed for 9 additional weeks (total of 20weeks). Rats were serially tested for skilled locomotion and a slip ratio was calculated for the horizontal ladder-rung and tapered beam tasks. Immediately after nerve injury and with chronic denervation, slip ratios were dramatically elevated. In the GRAFT repair study, the SKP-SC treated rats showed statistically significant improvement in ladder rung as compared to all other groups, and exhibited the greatest similarity to the sham controls on the tapered beam by study termination. In the ACUTE repair arm, the SKP-SC group showed marked improvement in ladder rung slip ratio as early as 5weeks after surgery, which was sustained for the duration of the experiment. Groups that received media and dead SKP-SCs improved with significantly slower progression. In the DELAYED repair arm, the SKP-SC group became significantly better than other groups 7weeks after the repair, while the media and the dead SKP-SCs showed no significant improvement in slip ratios. On histomorphometrical analysis, SKP-SC group showed significantly increased mean axon counts while the percent myelin debris was significantly lower at both 4 and 8weeks, suggesting that a less inhibitory micro-environment may have contributed to accelerated axonal regeneration. For delayed repair, mean axon counts were significantly higher in the SKP-SC group. Compound action potential amplitudes and muscle weights were also improved by cell therapy. In conclusion, SKP-SC therapy improves behavioral recovery after acute, chronic and nerve graft repair beyond the current standard of microsurgical nerve repair.
Collapse
Affiliation(s)
- Helene T Khuong
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada; Service de Neurochirurgie, Département des Sciences Neurologiques, CHU-de Québec (Hôpital de l'Enfant-Jésus), Centre de Recherché du CHU-de Québec, Canada; Division de Neurochirurgie, Département de Chirurgie, Université Laval, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Ranjan Kumar
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Ferry Senjaya
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Joey Grochmal
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Aleksandra Ivanovic
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Antos Shakhbazau
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Joanne Forden
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Aubrey Webb
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Jeffrey Biernaskie
- Alberta Children's Hospital Research Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada; Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada
| | - Rajiv Midha
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada.
| |
Collapse
|
41
|
Coulibaly AP, Gannon SM, Hawk K, Walsh BF, Isaacson LG. Transection of preganglionic axons leads to CNS neuronal plasticity followed by survival and target reinnervation. Auton Neurosci 2013; 179:49-59. [PMID: 23891533 DOI: 10.1016/j.autneu.2013.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/17/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
The goals of the present study were to investigate the changes in sympathetic preganglionic neurons following transection of distal axons in the cervical sympathetic trunk (CST) that innervate the superior cervical ganglion (SCG) and to assess changes in the protein expression of brain derived neurotrophic factor (BDNF) and its receptor TrkB in the thoracic spinal cord. At 1 week, a significant decrease in soma volume and reduced soma expression of choline acetyltransferase (ChAT) in the intermediolateral cell column (IML) of T1 spinal cord were observed, with both ChAT-ir and non-immunoreactive neurons expressing the injury marker activating transcription factor 3. These changes were transient, and at later time points, ChAT expression and soma volume returned to control values and the number of ATF3 neurons declined. No evidence for cell loss or neuronal apoptosis was detected at any time point. Protein levels of BDNF and/or full length TrkB in the spinal cord were increased throughout the survival period. In the SCG, both ChAT-ir axons and ChAT protein remained decreased at 16 weeks, but were increased compared to the 10 week time point. These results suggest that though IML neurons show reduced ChAT expression and cell volume at 1 week following CST transection, at later time points, the neurons recovered and exhibited no significant signs of neurodegeneration. The alterations in BDNF and/or TrkB may have contributed to the survival of the IML neurons and the recovery of ChAT expression, as well as to the reinnervation of the SCG.
Collapse
Affiliation(s)
- Aminata P Coulibaly
- Center for Neuroscience and Behavior, Miami University, Oxford, OH 45056, United States; Graduate Program in Cell, Molecular, and Structural Biology, Miami University, Oxford, OH 45056, United States
| | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. OBJECTIVES To review the effectiveness of rehabilitation following CTS surgery compared with no treatment, placebo, or another intervention. SEARCH METHODS On 3 April 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register (3 April 2012), CENTRAL (2012, Issue 3), MEDLINE (January 1966 to March 2012), EMBASE (January 1980 to March 2012), CINAHL Plus (January 1937 to March 2012), AMED (January 1985 to April 2012), LILACS (January 1982 to March 2012), PsycINFO (January 1806 to March 2012), PEDRO (29 January 2013) and clinical trials registers (29 January 2013). SELECTION CRITERIA Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials for inclusion, extracted data and assessed the risk of bias according to standard Cochrane methodology. MAIN RESULTS In this review we included 20 trials with a total of 1445 participants. We studied different rehabilitation treatments including: immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multimodal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo comparison; three trials compared rehabilitation to a no treatment control; three trials compared rehabilitation to standard care; and 14 trials compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Eleven trials explicitly reported random sequence generation and, of these, three adequately concealed the allocation sequence. Four trials achieved blinding of both participants and outcome assessors. Five studies were at high risk of bias from incompleteness of outcome data at one or more time intervals. Eight trials had a high risk of selective reporting bias.The trials were heterogenous in terms of the treatments provided, the duration of interventions, the nature and timing of outcomes measured and setting. Therefore, we were not able to pool results across trials.Four trials reported our primary outcome, change in self reported functional ability at three months or longer. Of these, three trials provided sufficient outcome data for inclusion in this review. One small high quality trial studied a desensitisation program compared to standard treatment and revealed no statistically significant functional benefit based on the Boston Carpal Tunnel Questionnaire (BCTQ) (MD -0.03; 95% CI -0.39 to 0.33). One moderate quality trial assessed participants six months post surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and found no significant difference between a no formal therapy group and a two-week course of multimodal therapy commenced at five to seven days post surgery (MD 1.00; 95% CI -4.44 to 6.44). One very low quality quasi-randomised trial found no statistically significant difference in function on the BCTQ at three months post surgery with early immobilisation (plaster wrist orthosis worn until suture removal) compared with a splint and late mobilisation (MD 0.39; 95% CI -0.45 to 1.23).The differences between the treatments for the secondary outcome measures (change in self reported functional ability measured at less than three months; change in CTS symptoms; change in CTS-related impairment measures; presence of iatrogenic symptoms from surgery; return to work or occupation; and change in neurophysiological parameters) were generally small and not statistically significant. Few studies reported adverse events. AUTHORS' CONCLUSIONS There is limited and, in general, low quality evidence for the benefit of the reviewed interventions. People who have had CTS surgery should be informed about the limited evidence of the effectiveness of postoperative rehabilitation interventions. Until the results of more high quality trials that assess the effectiveness and safety of various rehabilitation treatments have been reported, the decision to provide rehabilitation following CTS surgery should be based on the clinician's expertise, the patient's preferences and the context of the rehabilitation environment. It is important for researchers to identify patients who respond to a certain treatment and those who do not, and to undertake high quality studies that evaluate the severity of iatrogenic symptoms from the surgery, measure function and return-to-work rates, and control for confounding variables.
Collapse
Affiliation(s)
- Susan Peters
- Division of Physiotherapy, School ofHealth and Rehabilitation Sciences, TheUniversity ofQueensland, Brisbane,
| | | | | | | | | |
Collapse
|
43
|
Willand MP, Holmes M, Bain JR, Fahnestock M, De Bruin H. Electrical muscle stimulation after immediate nerve repair reduces muscle atrophy without affecting reinnervation. Muscle Nerve 2013; 48:219-25. [PMID: 23637030 DOI: 10.1002/mus.23726] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Electrical stimulation of denervated muscle has been shown to minimize atrophy and fibrosis and increase force in animal and human models. However, electrical stimulation after nerve repair is controversial due to questions of efficacy. METHODS Using a rat model, we investigated the efficacy of short-term electrical muscle stimulation for increasing reinnervation and preventing muscle atrophy. After tibial nerve transection and immediate repair with the fibular nerve, 1 month of electrical stimulation was applied 5 days/week for 1 hour to the gastrocnemius muscle via implanted electrodes. RESULTS After 2 months of further recovery without stimulation, muscle weights, twitch forces, and type I fiber areas were significantly greater in stimulated animals than in repaired controls without stimulation. Motor unit size and numbers were not different between the 2 groups. CONCLUSIONS Short-term electrical muscle stimulation after nerve repair significantly reduces muscle atrophy and does not affect motor reinnervation.
Collapse
Affiliation(s)
- Michael P Willand
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | | | | | | | | |
Collapse
|
44
|
Mowery TM, Walls SM, Garraghty PE. AMPA and GABA(A/B) receptor subunit expression in the cortex of adult squirrel monkeys during peripheral nerve regeneration. Brain Res 2013; 1520:80-94. [PMID: 23643858 DOI: 10.1016/j.brainres.2013.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
The primate somatosensory neuroaxis provides a highly translational model system with which to investigate adult neural plasticity. Here, we report immunohistochemical staining data for AMPA and GABAA/B receptor subunits in the area 3b cortex of adult squirrel monkeys one and five months after median nerve compression. This method of nerve injury was selected because it allows unique insight into how receptor expression changes during the regeneration of the peripheral nerve. One month after nerve compression, the pattern of subunit staining provides evidence that the cortex enters a state of reorganization. GABA α1 receptor subunits are significantly down-regulated in layer IV, V, and VI. Glur2/3 AMPA receptor subunits and postsynaptic GABABR1b receptor subunits are up and down regulated respectively across all layers of cortex. After five months of recovery from nerve compression, the pattern of AMPA and GABAA/B receptor subunits remain significantly altered in a layer specific manner. In layer II/III, GluR1, GluR2/3, and GABA α1 subunit expression is significantly up-regulated while post synaptic GABABR1b receptor subunits are significantly down regulated. In layer VI, V, and VI the GluR2/3 and presynaptic GABABR1a receptor subunits are significantly up-regulated, while the postsynaptic GABABR1b receptor subunits remain significantly down-regulated. Taken together, these results suggest that following nerve injury the cortex enters a state of reorganization that has persistent effects on cortical plasticity even after partial or total reinnervation of the peripheral nerve.
Collapse
Affiliation(s)
- Todd M Mowery
- Department of Psychological and Brain Sciences, 4 Washington Place, NY 10003, USA.
| | | | | |
Collapse
|
45
|
Haastert-Talini K, Grothe C. Electrical Stimulation for Promoting Peripheral Nerve Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 109:111-24. [DOI: 10.1016/b978-0-12-420045-6.00005-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
46
|
Results. STIMULATION OF TRIGEMINAL AFFERENTS IMPROVES MOTOR RECOVERY AFTER FACIAL NERVE INJURY 2013. [DOI: 10.1007/978-3-642-33311-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
47
|
Walsh MT. Interventions in the disturbances in the motor and sensory environment. J Hand Ther 2012; 25:202-18; quiz 219. [PMID: 22507214 DOI: 10.1016/j.jht.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 02/03/2023]
Abstract
Treatment of peripheral nervous system (PNS) pathology presents intervention challenges to every therapist. Many of the current and future interventions will be directed at restoring the normal anatomy, function, and biomechanical properties of the PNS, restoring normal neural physiology and ultimately patient function and quality of life. Present interventions use mechanical (movement) or electrical procedures to affect various properties of the peripheral nerve. The purpose of this article was to apply basic science to clinical practice. The pathology and accompanying structural and biomechanical changes in the PNS will be presented in three specific areas commonly encountered in the clinic: nerve injury and laceration; compression neuropathies; and neuropathic pain and neural tension dysfunction. The intent is to address possible interventions exploring the clinical reasoning process that combines basic science and evidence-based best practice. The current lack of literature to support any one intervention requires a strong foundation and understanding of the PNSs' structure and function to refine current and develop new intervention strategies. Current evidence will be presented and linked with future considerations for intervention and research. During this interlude of development and refinement, best practice will rely on sound clinical reasoning skills that incorporate basic science to achieve a successful outcome when treating these challenging patients.
Collapse
Affiliation(s)
- Mark T Walsh
- Hand & Orthopedic Physical Therapy Associates, P.C., Levittown, Pennsylvania 19056, USA.
| |
Collapse
|
48
|
Hesp ZC, Zhu Z, Morris TA, Walker RG, Isaacson LG. Sympathetic reinnervation of peripheral targets following bilateral axotomy of the adult superior cervical ganglion. Brain Res 2012; 1473:44-54. [PMID: 22842079 PMCID: PMC3440180 DOI: 10.1016/j.brainres.2012.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 11/16/2022]
Abstract
The ability of adult injured postganglionic axons to reinnervate cerebrovascular targets is unknown, yet these axons can influence cerebral blood flow, particularly during REM sleep. The objective of the present study was to assess quantitatively the sympathetic reinnervation of vascular as well as non-vascular targets following bilateral axotomy of the superior cervical ganglion (SCG) at short term (1 day, 7 day) and long term (8 weeks, 12 weeks) survival time points. The sympathetic innervation of representative extracerebral blood vessels [internal carotid artery (ICA), basilar artery (BA), middle cerebral artery (MCA)], the submandibular gland (SMG), and pineal gland was quantified following injury using an antibody to tyrosine hydroxylase (TH). Changes in TH innervation were related to TH protein content in the SCG. At 7 day following bilateral SCG axotomy, all targets were significantly depleted of TH innervation, and the exact site on the BA where SCG input was lost could be discerned. Complete sympathetic reinnervation of the ICA was observed at long term survival times, yet TH innervation of other vascular targets showed significant decreases even at 12 weeks following axotomy. The SMG was fully reinnervated by 12 weeks, yet TH innervation of the pineal gland remained significantly decreased. TH protein in the SCG was significantly decreased at both short term and long term time points and showed little evidence of recovery. Our data demonstrate a slow reinnervation of most vascular targets following axotomy of the SCG with only minimal recovery of TH protein in the SCG at 12 weeks following injury.
Collapse
Affiliation(s)
- Zoe C Hesp
- Center for Neuroscience and Behavior, Department of Zoology, Miami University, Oxford, OH 45056, USA
| | | | | | | | | |
Collapse
|
49
|
Abstract
INTRODUCTION Boron lies on the borderline between metals and non-metals in the periodic table. As such, it possesses peculiarities which render it suitable for a variety of applications in chemistry, technology and medicine. However, boron's peculiarities have been exploited only partially so far. AREAS COVERED In this review, the authors highlight selected areas of research which have witnessed new uses of boron compounds in recent times. The examples reported illustrate how difficulties in the synthesis and physicochemical characterization of boronated molecules, encountered in past years, can be overcome with positive effects in different fields. EXPERT OPINION Many potentialities of boron-based systems reside in the peculiar properties of both boron atoms (the ability to replace carbon atoms, electron deficiency) and of boronated compounds (hydrophobicity, lipophilicity, versatile stereochemistry). Taken in conjunction, these properties can provide innovative drugs. The authors highlight the need to further investigate the assembly of boronated compounds, in terms of drug design, since the mechanisms required to obtain supramolecular structures may be unconventional compared with the more standard molecules used. Furthermore, the authors propose that computational methods are a valuable tool for assessing the role of multicenter, quasi-aromatic bonds and its peculiar geometries.
Collapse
Affiliation(s)
- Laura Ciani
- University of Florence, Department of Chemistry & CSGI, Sesto Fiorentino, Italy.
| | | |
Collapse
|
50
|
|