1
|
von Guionneau N, Sarhane KA, Brandacher G, Hettiaratchy S, Belzberg AJ, Tuffaha S. Mechanisms and outcomes of the supercharged end-to-side nerve transfer: a review of preclinical and clinical studies. J Neurosurg 2021; 134:1590-1598. [PMID: 32470926 DOI: 10.3171/2020.3.jns191429] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
Proximal peripheral nerve injuries often result in poor functional outcomes, chiefly because of the long time period between injury and the reinnervation of distal targets, which leads to muscle and Schwann cell atrophy. The supercharged end-to-side (SETS) nerve transfer is a recent technical innovation that introduces donor axons distally into the side of an injured nerve to rapidly innervate and support end organs while allowing for additional reinnervation after a proximal repair at the injury site. However, the mechanisms by which donor axons grow within the recipient nerve, contribute to muscle function, and impact the regeneration of native recipient axons are poorly understood. This uncertainty has slowed the transfer's clinical adoption. The primary objective of this article is to comprehensively review the mechanisms underpinning axonal regeneration and functional recovery after a SETS nerve transfer. A secondary objective is to report current clinical applications in the upper limb and their functional outcomes. The authors also propose directions for future research with the aim of maximizing the clinical utility of the SETS transfer for peripheral nerve surgeons and their patients.
Collapse
Affiliation(s)
- Nicholas von Guionneau
- Departments of1Plastic and Reconstructive Surgery and
- 3Department of Brain Sciences, Imperial College London; and
| | | | | | - Shehan Hettiaratchy
- 4Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Allan J Belzberg
- 2Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sami Tuffaha
- Departments of1Plastic and Reconstructive Surgery and
| |
Collapse
|
2
|
Tajdaran K, Chan K, Gordon T, Borschel GH. Matrices, scaffolds, and carriers for protein and molecule delivery in peripheral nerve regeneration. Exp Neurol 2019; 319:112817. [DOI: 10.1016/j.expneurol.2018.08.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/12/2018] [Accepted: 08/29/2018] [Indexed: 01/04/2023]
|
3
|
Adult skin-derived precursor Schwann cells exhibit superior myelination and regeneration supportive properties compared to chronically denervated nerve-derived Schwann cells. Exp Neurol 2016; 278:127-42. [DOI: 10.1016/j.expneurol.2016.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/01/2016] [Accepted: 02/04/2016] [Indexed: 01/09/2023]
|
4
|
Viddeleer AR, Sijens PE, van Ooijen PMA, Kuypers PDL, Hovius SER, De Deyn PP, Oudkerk M. Quantitative STIR of muscle for monitoring nerve regeneration. J Magn Reson Imaging 2016; 44:401-10. [PMID: 26889629 DOI: 10.1002/jmri.25181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/22/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To assess whether short tau inversion recovery (STIR) MRI sequences can provide a tool for monitoring peripheral nerve regeneration, by comparing signal intensity changes in reinnervated muscle over time, and to determine potential clinical time points for monitoring. MATERIALS AND METHODS For this prospective study, 29 patients with complete traumatic transection of the ulnar or median nerves in the forearm were followed up to 45 months postsurgery. Standardized 1.5 Tesla STIR-MRI scans of hand muscles were obtained at fixed time intervals. Muscle signal intensities were measured semi-quantitatively and correlated to functional outcome. RESULTS For the patients with good function recovery, mean signal intensity ratios of 1.179 ± 0.039, 1.304 ± 0.180, 1.154 ± 0.121, 1.105 ± 0.046 and 1.038 ± 0.047 were found at 1-, 3-, 6-, 9-, and 12-month follow-up, respectively. In the group with poor function recovery, ratios of 1.240 ± 0.069, 1.374 ± 0.144, 1.407 ± 0.127, 1.386 ± 0.128 and 1.316 ± 0.116 were found. Comparing the groups showed significant differences from 6 months onward (P < 0.001), with normalizing signal intensities in the group with good function recovery and sustained elevated signal intensity in the group with poor function recovery. CONCLUSION MRI of muscle can be used as a tool for monitoring motor nerve regeneration, by comparing STIR muscle signal intensities over time. A decrease in signal intensity ratio of 50% (as compared to the initial increase) seems to predict good function recovery. Long-term follow-up shows that STIR MRI can be used for at least 15 months after nerve transection to differentiate between denervated and (re)innervated muscles. J. Magn. Reson. Imaging 2016;44:401-410.
Collapse
Affiliation(s)
- Alain R Viddeleer
- Department of Radiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Paul E Sijens
- Department of Radiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- Department of Radiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Paul D L Kuypers
- Department of Plastic and Reconstructive Surgery, Westfries Gasthuis, Hoorn, The Netherlands
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter P De Deyn
- Department of Neurology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Department of Radiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| |
Collapse
|
5
|
Jonsson S, Wiberg R, McGrath AM, Novikov LN, Wiberg M, Novikova LN, Kingham PJ. Effect of delayed peripheral nerve repair on nerve regeneration, Schwann cell function and target muscle recovery. PLoS One 2013; 8:e56484. [PMID: 23409189 PMCID: PMC3567071 DOI: 10.1371/journal.pone.0056484] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 01/10/2013] [Indexed: 12/14/2022] Open
Abstract
Despite advances in surgical techniques for peripheral nerve repair, functional restitution remains incomplete. The timing of surgery is one factor influencing the extent of recovery but it is not yet clearly defined how long a delay may be tolerated before repair becomes futile. In this study, rats underwent sciatic nerve transection before immediate (0) or 1, 3, or 6 months delayed repair with a nerve graft. Regeneration of spinal motoneurons, 13 weeks after nerve repair, was assessed using retrograde labeling. Nerve tissue was also collected from the proximal and distal stumps and from the nerve graft, together with the medial gastrocnemius (MG) muscles. A dramatic decline in the number of regenerating motoneurons and myelinated axons in the distal nerve stump was observed in the 3- and 6-months delayed groups. After 3 months delay, the axonal number in the proximal stump increased 2–3 folds, accompanied by a smaller axonal area. RT-PCR of distal nerve segments revealed a decline in Schwann cells (SC) markers, most notably in the 3 and 6 month delayed repair samples. There was also a progressive increase in fibrosis and proteoglycan scar markers in the distal nerve with increased delayed repair time. The yield of SC isolated from the distal nerve segments progressively fell with increased delay in repair time but cultured SC from all groups proliferated at similar rates. MG muscle at 3- and 6-months delay repair showed a significant decline in weight (61% and 27% compared with contra-lateral side). Muscle fiber atrophy and changes to neuromuscular junctions were observed with increased delayed repair time suggestive of progressively impaired reinnervation. This study demonstrates that one of the main limiting factors for nerve regeneration after delayed repair is the distal stump. The critical time point after which the outcome of regeneration becomes too poor appears to be 3-months.
Collapse
Affiliation(s)
- Samuel Jonsson
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
| | - Rebecca Wiberg
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
| | - Aleksandra M. McGrath
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
- Department of Surgical & Perioperative Science, Section of Hand and Plastic Surgery, Umeå University, Umeå, Sweden
| | - Lev N. Novikov
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
| | - Mikael Wiberg
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
- Department of Surgical & Perioperative Science, Section of Hand and Plastic Surgery, Umeå University, Umeå, Sweden
| | - Liudmila N. Novikova
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
- * E-mail: (PJK); (LNN)
| | - Paul J. Kingham
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, Umeå, Sweden
- * E-mail: (PJK); (LNN)
| |
Collapse
|
6
|
Bryan DJ, Litchfield CR, Manchio JV, Logvinenko T, Holway AH, Austin J, Summerhayes IC, Rieger-Christ KM. Spatiotemporal expression profiling of proteins in rat sciatic nerve regeneration using reverse phase protein arrays. Proteome Sci 2012; 10:9. [PMID: 22325251 PMCID: PMC3295716 DOI: 10.1186/1477-5956-10-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 02/10/2012] [Indexed: 01/19/2023] Open
Abstract
Background Protein expression profiles throughout 28 days of peripheral nerve regeneration were characterized using an established rat sciatic nerve transection injury model. Reverse phase protein microarrays were used to identify the spatial and temporal expression profile of multiple proteins implicated in peripheral nerve regeneration including growth factors, extracellular matrix proteins, and proteins involved in adhesion and migration. This high-throughput approach enabled the simultaneous analysis of 3,360 samples on a nitrocellulose-coated slide. Results The extracellular matrix proteins collagen I and III, laminin gamma-1, fibronectin, nidogen and versican displayed an early increase in protein levels in the guide and proximal sections of the regenerating nerve with levels at or above the baseline expression of intact nerve by the end of the 28 day experimental course. The 28 day protein levels were also at or above baseline in the distal segment however an early increase was only noted for laminin, nidogen, and fibronectin. While the level of epidermal growth factor, ciliary neurotrophic factor and fibroblast growth factor-1 and -2 increased throughout the experimental course in the proximal and distal segments, nerve growth factor only increased in the distal segment and fibroblast growth factor-1 and -2 and nerve growth factor were the only proteins in that group to show an early increase in the guide contents. As expected, several proteins involved in cell adhesion and motility; namely focal adhesion kinase, N-cadherin and β-catenin increased earlier in the proximal and distal segments than in the guide contents reflecting the relatively acellular matrix of the early regenerate. Conclusions In this study we identified changes in expression of multiple proteins over time linked to regeneration of the rat sciatic nerve both demonstrating the utility of reverse phase protein arrays in nerve regeneration research and revealing a detailed, composite spatiotemporal expression profile of peripheral nerve regeneration.
Collapse
Affiliation(s)
- David J Bryan
- Tissue Engineering Laboratory, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.,Department of Plastic and Reconstructive Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - C Robert Litchfield
- Tissue Engineering Laboratory, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - Jeffrey V Manchio
- Tissue Engineering Laboratory, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.,Department Surgery, Section of General Surgery, Saint Joseph Mercy Hospital, Ann Arbor, Michigan, USA
| | - Tanya Logvinenko
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Antonia H Holway
- Ian C. Summerhayes Cell and Molecular Biology Laboratory, Lahey Clinic Medical Center, Burlington, Massachusetts, USA.,Aushon BioSystems Inc., Billerica, Massachusetts, USA
| | - John Austin
- Aushon BioSystems Inc., Billerica, Massachusetts, USA
| | - Ian C Summerhayes
- Ian C. Summerhayes Cell and Molecular Biology Laboratory, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - Kimberly M Rieger-Christ
- Ian C. Summerhayes Cell and Molecular Biology Laboratory, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
7
|
Martins RS, Teodoro WR, Simplício H, Capellozi VL, Siqueira MG, Yoshinari NH, Pereira Plese JP, Teixeira MJ. Influence of Suture on Peripheral Nerve Regeneration and Collagen Production at the Site of Neurorrhaphy: An Experimental Study. Neurosurgery 2011; 68:765-72; discussion 772. [DOI: 10.1227/neu.0b013e3182077332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Roberto Sergio Martins
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, São Paulo University School of Medicine and Hospital do Servidor Público do Estado
| | - Walcy Rosolio Teodoro
- Division of Rheumatology, São Paulo University School of Medicine, São Paulo, Brazil
| | - Hougelle Simplício
- Department of Neurosurgery, São Paulo University School of Medicine, São Paulo, Brazil
| | - Vera Luiza Capellozi
- Departament of Pathology, São Paulo University School of Medicine, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
8
|
Chapter 19 The Role of Collagen in Peripheral Nerve Repair. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:363-79. [DOI: 10.1016/s0074-7742(09)87019-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
9
|
Saijilafu, Nishiura Y, Hara Y, Yoshii Y, Ochiai N. Simultaneous gradual lengthening of both proximal and distal nerve stumps for repair of peripheral nerve defect in rats. Muscle Nerve 2008; 38:1474-1480. [DOI: 10.1002/mus.21147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
10
|
Rueger MA, Aras S, Guntinas-Lichius O, Neiss WF. Re-activation of atrophic motor Schwann cells after hypoglossal-facial nerve anastomosis. Neurosci Lett 2008; 434:253-9. [PMID: 18337003 DOI: 10.1016/j.neulet.2008.01.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/13/2008] [Accepted: 01/16/2008] [Indexed: 11/24/2022]
Abstract
Facial nerve lesions are common in humans and often require surgical intervention. If repair is delayed, reinnervation can be facilitated by transposing the freshly cut hypoglossal nerve end-to-end directly to the distal facial nerve, allowing for uncompromised hypoglossal axons to reinnervate the denervated facial musculature (hypoglossal-facial anastomosis, HFA). Schwann cells (SCs) in the distal nerve stump have an important function in promoting axonal regeneration by expressing multiple regeneration-associated proteins. Chronically denervated SCs cease to express those factors, but it is unknown whether they can be reactivated by fresh axonal sprouts and regain part of their function. We evaluated SC function and viability in distal facial nerve stump of rats at various time points after chronic denervation as well as following immediate or delayed HFA by assessing their expression of growth-associated protein 43 kDa (GAP-43) and the neuregulin receptors erbB2 and erbB4. Our results show that maximal upregulation of those factors in denervated SCs occurred a few weeks after nerve transection, indicating that a short period of denervation might even be beneficial before nerve repair. Motor SCs denervated for 32 weeks had downregulated their activity and ceased to express the regeneration-associated factors. SCs immediately re-expressed GAP-43, erbB2, and erbB4 following contact with fresh hypoglossal motor axons, demonstrating they are competent to promote regeneration even after long-term denervation.
Collapse
|
11
|
Turgut M, Uyanikgil Y, Baka M, Tunç AT, Yavaşoğlu A, Yurtseven ME, Kaplan S. Pinealectomy exaggerates and melatonin treatment suppresses neuroma formation of transected sciatic nerve in rats: gross morphological, histological and stereological analysis. J Pineal Res 2005; 38:284-91. [PMID: 15813906 DOI: 10.1111/j.1600-079x.2004.00205.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At present, an intensive effort for prevention of neuroma formation following peripheral nerve section continues. It has been recently suggested that surgical pinealectomy (Px) induces elevation of the collagen content in the granulation tissue of a wound, while melatonin application after Px suppresses elevation of the collagen accumulation in the tissue. The aim of the present study was to assess whether melatonin had the ability to suppress collagen production and neuroma formation following peripheral nerve transection. A total of 40 male rats (four groups of 10) were left intact (intact controls) or sham operated (sham group), were Px, or were Px and given melatonin (Px + melatonin group). All animals underwent a surgical intervention consisting of right sciatic nerve neurectomy. After 4 wk, the animals were killed following intracardiac perfusion. Gross morphology of neuroma formation in the proximal nerve segment was examined and proximal neuroma evaluated. Macroscopic and microscopic findings revealed that Px caused a proliferation of connective tissue and large neuroma formation at the proximal ends of transected nerves. Stereological analysis showed that there was a statistically significant reduction in connective tissue content of the same region in Px animals treated with melatonin (P < 0.005). The results achieved in a rodent model of sciatic nerve neuroma formation showed that there was a positive correlation between macroscopic and microscopic observations, and that melatonin enhanced axonal regeneration presumably due to its inhibitory effect on neuroma formation.
Collapse
Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin, Turkey.
| | | | | | | | | | | | | |
Collapse
|
12
|
Gilmer-Hill HS, Beuerman R, Ma Q, Jiang J, Tiel RL, Kline DG. Response of GAP-43 and p75 in human neuromas over time after traumatic injury. Neurosurgery 2002; 51:1229-37; discussion 1237. [PMID: 12383368 DOI: 10.1097/00006123-200211000-00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2001] [Accepted: 06/25/2002] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE GAP-43 and p75 are proteins that promote growth cone and neurite formation, elongation, and arborization in regenerating nerve axons. The objectives of this study were to determine whether GAP-43 and the low-affinity nerve growth factor receptor p75 are elevated in traumatic neuromas and whether there is a correlation between the relative amount of GAP-43 or p75 and demographic characteristics such as time elapsed between injury and repair. METHODS Traumatic neuromas from 21 randomly selected patients were studied, and the charts were reviewed. Specimens were collected at the time of nerve resection and grafting. Immunohistochemical analysis was performed on each sample and normal human nerve with antibodies to GAP-43 and p75. Western blot and computerized gel analyses were performed. RESULTS All neuroma specimens harvested within 13 months of injury exhibited markedly elevated GAP-43 levels compared with normal nerve. Specimens harvested at 14 months or more after injury showed precipitously lower GAP-43 levels, similar to or less than those of normal nerve. The correlation between the amount of intra-axonal GAP-43 and postinjury time interval was statistically significant, P = 0.0038. High GAP-43 levels were also correlated with transection injury, high postoperative sensory grade, and pain. p75 levels were elevated, without consistent variation in our population. CONCLUSION These preliminary data suggest that the expression of intra-axonal GAP-43 may vary over time after injury, remaining elevated for approximately the first year, then decreasing abruptly to normal or subnormal levels. These results correlate with clinical experience, indicating that peripheral nerves should be repaired relatively early if repair is indicated.
Collapse
Affiliation(s)
- Holly S Gilmer-Hill
- Department of Neurological Surgery, University of California-Davis Medical Center, Davis, California, USA.
| | | | | | | | | | | |
Collapse
|
13
|
Abstract
Local events in the milieu of injured peripheral nerve trunks may have an important influence on the likelihood of regenerative success or the development of neuropathic pain. Injury-related changes in the microcirculation of this milieu have provided some evidence that axonal endbulbs, structures that form at the proximal end of transected axons, dump peptides and other molecules into the injury milieu where they may exert local actions, including those on microvessels. During a later phase of nerve repair, macrophage influx and pancellular proliferative events appear to develop in a coordinated fashion. Nitric oxide is probably an important and prominent player in the injured nerve trunk, both at early and later stages of the repair process. A better understanding of the injured peripheral nerve microenvironment may allow therapeutic approaches that can enhance regeneration and diminish pain.
Collapse
Affiliation(s)
- D W Zochodne
- Department of Clinical Neurosciences, University of Calgary, Room 182A, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
| |
Collapse
|
14
|
Labrador RO, Butí M, Navarro X. Influence of collagen and laminin gels concentration on nerve regeneration after resection and tube repair. Exp Neurol 1998; 149:243-52. [PMID: 9454634 DOI: 10.1006/exnr.1997.6650] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In order to assess the usefulness of collagen and laminin gels prefilling nerve chambers to enhance nerve regeneration, we compared reinnervation of target organs after sciatic nerve resection leaving gaps of 4 or 6 mm followed by repair with silicone tubes in different groups of mice. Tubes were prefilled with saline solution, collagen gels, or laminin-containing gels at different concentrations. Functional reinnervation was assessed by noninvasive methods to quantitate recovery of sweating, nociceptive, sensory, and motor functions in the hindpaw repeatedly during 4-5 months postoperation. The increase in gap length between nerve stumps delayed the beginning and reduced the degree of functional recovery achieved. Reinnervation started earlier and achieved slightly higher levels with collagen gel diluted at 1.28 mg/ml than with more concentrated (1.92 and 2.56 mg/ml) collagen gels and with saline-prefilled tubes bridging a 4-mm gap. Recovery was also better with diluted (4 mg/ml) than with concentrated (12 mg/ml) laminin-containing gel, although lower than with collagen gels and saline. By prefilling silicone tubes bridging a 6-mm gap, a length considered limiting for regeneration in the mouse sciatic nerve, with diluted collagen or laminin gels, both matrices allowed for higher levels of recovery and for successful regeneration in a higher proportion of mice than saline solution. The laminin gel performed slightly better than the collagen gel.
Collapse
Affiliation(s)
- R O Labrador
- Department of Cell Biology and Physiology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | | |
Collapse
|
15
|
Nath RK, Mackinnon SE, Jensen JN, Parks WC. Spatial pattern of type I collagen expression in injured peripheral nerve. J Neurosurg 1997; 86:866-70. [PMID: 9126904 DOI: 10.3171/jns.1997.86.5.0866] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors studied the spatial expression and regulation of messenger RNA for the alpha subunit of collagen type I in crushed rat sciatic nerve to provide a basis for future therapeutic manipulation. Sciatic nerves in 20 male or female adult Lewis rats were crushed for 60 seconds; the unharmed contralateral sciatic nerves served as controls. Twenty-one days after injury the experimental animals were killed and their tissue was harvested. The spatial expression of collagen type I was determined by using in situ hybridization techniques. Quantification of fibroblast number and total signal was performed through computerized morphometry. Collagen upregulation was evident in epineurial and perineurial layers, with the epineurium displaying higher activity. The cells responsible for procollagen type I production were fibroblasts. No activity was seen in the endoneurium. Morphometric findings indicated that collagen upregulation in the epineurium and perineurium occurred at both pretranscriptional and posttranslational levels when compared to controls; a paired t-test analysis confirmed statistical significance for all comparisons between injured and control tissues. Epineurial fibroblasts are responsible for the collagen production associated with crushed peripheral nerve injury in the rat. Regulation occurs pretranscriptionally as well as posttranslationally. It is interesting to speculate that the delivery of agents directed against collagen production (such as neutralizing antibodies to growth factors) into epineurial tissues proximate to the time and location of clinical nerve injury might mitigate later deleterious effects of excess collagen production in axonal regeneration.
Collapse
Affiliation(s)
- R K Nath
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | | | | |
Collapse
|
16
|
Abstract
Functional recovery from peripheral nerve injury and repair depends on a multitude of factors, both intrinsic and extrinsic to neurons. Neuronal survival after axotomy is a prerequisite for regeneration and is facilitated by an array of trophic factors from multiple sources, including neurotrophins, neuropoietic cytokines, insulin-like growth factors (IGFs), and glial-cell-line-derived neurotrophic factors (GDNFs). Axotomized neurons must switch from a transmitting mode to a growth mode and express growth-associated proteins, such as GAP-43, tubulin, and actin, as well as an array of novel neuropeptides and cytokines, all of which have the potential to promote axonal regeneration. Axonal sprouts must reach the distal nerve stump at a time when its growth support is optimal. Schwann cells in the distal stump undergo proliferation and phenotypical changes to prepare the local environment to be favorable for axonal regeneration. Schwann cells play an indispensable role in promoting regeneration by increasing their synthesis of surface cell adhesion molecules (CAMs), such as N-CAM, Ng-CAM/L1, N-cadherin, and L2/HNK-1, by elaborating basement membrane that contains many extracellular matrix proteins, such as laminin, fibronectin, and tenascin, and by producing many neurotrophic factors and their receptors. However, the growth support provided by the distal nerve stump and the capacity of the axotomized neurons to regenerate axons may not be sustained indefinitely. Axonal regenerations may be facilitated by new strategies that enhance the growth potential of neurons and optimize the growth support of the distal nerve stump in combination with prompt nerve repair.
Collapse
Affiliation(s)
- S Y Fu
- Department of Biochemistry, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
17
|
Vuorinen V, Siironen J, Röyttä M. Axonal regeneration into chronically denervated distal stump. 1. Electron microscope studies. Acta Neuropathol 1995; 89:209-18. [PMID: 7754742 DOI: 10.1007/bf00309336] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In this study, we have analyzed the ability of axons to regenerate into chronically denervated peripheral nerve. As an experimental rat model, the proximal end of a newly transected rat tibial nerve was sutured into chronically denervated (3 months up to 16 months) common peroneal nerve. Samples for morphological studies were collected 3 and 6 weeks after anastomosis of the tibial and common peroneal nerves. Our results showing a distinct organization of the endoneurial matrix in the chronically denervated distal stumps conformed with those from previous studies. Long cytoplasmic processes of endoneurial fibroblasts in close contact with collagen fibrils (with a diameter of 50-60 nm) surrounded areas of thin collagen fibrils (with a diameter of 25-30 nm). Remnants of Schwann cell columns (i.e., bands of Büngner) were situated in areas of thin collagen fibrils. After 12 months of denervation the majority of the Schwann cells columns were replaced by thin collagen fibrils. Successful axonal regeneration was noted in distal stumps that had been denervated for 14 and even 16 months. However, axonal regeneration diminished with prolonged denervation. The regenerating axons grew through the areas of thin collagen fibrils. The maturation and thickening of the regenerated axonal sprouts resulted in a decrease in areas of thin collagen fibrils. These results suggest that a chronically denervated nerve stump has the capacity to meet regenerating axons even after 16 months of denervation, although the progressive atrophy of Schwann cell columns impairs the likelihood of good axonal regeneration. The areas of thin collagen fibrils may act as a 'plastic' bed for successful axonal regeneration, and a study of these fibrils may provide further insight into the role of the extracellular matrix during peripheral nerve regeneration.
Collapse
Affiliation(s)
- V Vuorinen
- Department of Neurosurgery, University Hospital of Helsinki, Finland
| | | | | |
Collapse
|