A role for nerve growth factor in collateral reinnervation from sensory nerves in the guinea pig

Current concepts in end-to-side neurorrhaphy

In peripheral nerve injury, end-to-side neurorrhaphy involves coaptation of the distal stump of a transected nerve to the trunk of an adjacent donor nerve. It has been proposed as an alternative technique when the proximal stump of an injured nerve is unavailable or the nerve gap is too long to be bridged by a nerve graft. Experimental and clinical data suggests that end-to-side neurorrhaphy can provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. The most accepted mechanism of nerve regeneration following end-to-side neurorrhaphy is collateral sprouting. The source of the regenerating axons traveling in the epineurium of the donor nerve is thought to be the proximal Ranvier’s nodes at the site of end-to-side neurorrhaphy, however, histologic evidence is still lacking. Partial neurotomy of the donor nerve may enhance regeneration of motor neurons through end-to-side neurorrhaphy and reinnervation of motor targets.

Revisiting the Koebner phenomenon: role of NGF and its receptor system in the pathogenesis of psoriasis

Nerve growth factor (NGF) influences the key pathological events of psoriasis: keratinocyte proliferation, angiogenesis, and T-cell activation. We have systematically examined the kinetics of NGF expression, keratinocyte proliferation, and migration of T lymphocytes in the epidermis in Koebner-induced developing psoriatic plaques. In skin traumatized by the tape-stripping method (n = 12), a marked up-regulation of NGF in Koebner-positive lesions (n = 7) was observed 24 hours after trauma. Synthesis of NGF reached its maximum level in the 2nd week. Furthermore, cultured keratinocytes from nonlesional skin of psoriasis patients produced 10 times higher levels of NGF compared with keratinocytes from healthy individuals. To substantiate the in vivo effect of NGF secreted by keratinocytes in psoriatic plaques, we studied psoriatic plaques and normal human skin in a SCID-human skin xenograft model. The transplanted psoriatic plaques demonstrated marked proliferation of NGF-R (p75)-positive nerve fibers compared with only a few nerves in the transplanted normal human skin. Our results demonstrate that 1) in a developing psoriatic lesion, up-regulation of NGF together with keratinocyte proliferation are early events and precede epidermotropism of T lymphocytes; 2) keratinocytes in patients with psoriasis are primed to produce elevated levels of NGF; and 3) NGF synthesized by these keratinocytes is functionally active.

The reinnervation pattern of wounds and scars may explain their sensory symptoms

Anaesthesia, pruritus and pain are common in cutaneous scars. The reinnervation pattern of healing wounds and scars might help to explain these symptoms, as sensory neurotransmitters are known to be mediators of inflammation and healing. We quantified the regeneration patterns of blood vessels and nerves in excisional skin wounds as they matured into scars. Mice underwent 1cm(2) full thickness skin excisions. Wounds were harvested between five and 84 days. Sections underwent immunohistochemical staining for protein gene product 9.5 (PGP9.5) a pan-neuronal marker, and the sensory neuropeptides calcitonin gene related peptide (CGRP) and substance P (SP). The endothelial marker von Willebrand factor (VWF) was used to allow co-localisation and quantification of blood vessels. Nerve fibre density was quantified at multiple sites within wounds. There was no difference in the reinnervation/revascularisation pattern between peripheral and central sites. The density of PGP9.5, CGRP, SP and VWF peaked between 14 and 42 days, and levels of PGP9.5, CGRP and VWF all decreased to approximately those found in unwounded skin by 84 days (mature scar). SP levels, however, remained elevated at approximately twice the density found in unwounded skin. Increased densities of SP and CGRP in healing wounds could explain the unpleasant sensory symptoms of healing wounds.

K252a, a high-affinity nerve growth factor receptor blocker, improves psoriasis: an in vivo study using the severe combined immunodeficient mouse-human skin model

The peripheral nervous system, in addition to its sensory and motor functions, can induce a local inflammatory response known as neurogenic inflammation. This phenomenon plays a critical role in several inflammatory diseases, e.g., asthma, atopy, rheumatoid arthritis, psoriasis, and ulcerative colitis. Neurogenic inflammation and the role of nerve growth factor (NGF) have been extensively studied in psoriasis. There are increased levels of NGF in the keratinocytes and upregulation of NGF receptor (NGF-R) in the cutaneous nerves of psoriatic plaques. NGF can influence all the salient pathologic events noticed in psoriasis such as proliferation of keratinocytes, angiogenesis, T cell activation, expression of adhesion molecules, proliferation of cutaneous nerves, and upregulation of neuropeptides. In this double-blinded, placebo-controlled study, we addressed the role of NGF/NGF-R in psoriasis in an in vivo system using the severe combined immunodeficient (SCID) mouse-human skin model of psoriasis. The transplanted psoriatic plaques on the SCID mice (n=12) were treated with K252a, a high-affinity NGF receptor blocker. Psoriasis significantly improved following 2 wk of therapy. The length of the rete pegs changed from 308.57+/-98.72 to 164.64+/-46.78 microm (p<0.01, Student's t test). A similar improvement of psoriasis was observed by directly inhibiting NGF with NGF-neutralizing antibody. NGF-neutralizing antibody in normal saline at 10 ng (n=4) and 20 ng (n=4) per kilogram of body weight doses were used. Both doses of NGF-neutralizing antibody reduced rete peg lengths significantly, e.g., from 298.5+/-42.69 to 150.52+/-32.93 microm (p<0.05, Student's t test). This study provides evidence for the role of NGF and its high-affinity receptor in the pathogenesis of psoriasis and insights to develop novel therapeutic modalities.

Sex-related difference in collateral sprouting of nociceptive axons after peripheral nerve injury in the rat

Possible sex-related differences in the extent of collateral sprouting of noninjured nociceptive axons after peripheral nerve injury were examined. In the first experiment, peroneal, tibial, and saphenous nerves were transected and ligated in female and male rats. Eight weeks after nerve injury, skin pinch tests revealed that the nociceptive area of the noninjured sural nerve in the instep skin expanded faster in females; the final result was a 30% larger increase in females than in males. In the second experiment, the end-to-side nerve anastomosis was used as a model for axon sprouting. In addition to the previous procedure, the end of an excised peroneal nerve segment was sutured to the side of the intact sural nerve. Eight weeks later, collateral sprouting of nociceptive axons into the anastomosed peroneal nerve segment was assessed by the nerve pinch test and axon counting. There was no significant difference with respect to the percentages of male and female rats with a positive nerve pinch test. The number of myelinated axons in the anastomosed nerve segment was significantly larger in female (456 +/- 217) than in male (202 +/- 150) rats, but the numbers of unmyelinated axons were not significantly different. In normal sural nerves, the numbers of either all myelinated axons or thin myelinated axons did not significantly differ between the two sexes. Therefore, the more extensive collateral axon sprouting observed in female than in male rats is probably due to the higher sprouting capacity of thin myelinated sensory axons in females.

SHP-2 mediates target-regulated axonal termination and NGF-dependent neurite growth in sympathetic neurons

The tyrosine phosphatase SHP-2 has been implicated in a variety of signaling pathways, including those mediated by neurotrophins in neurons. To examine the role of SHP-2 in the development of sympathetic neurons, we inhibited the function of SHP-2 in transgenic mice by overexpressing a catalytically inactive SHP-2 mutant under the control of the human dopamine beta-hydroxylase promoter. Expression of mutant SHP-2 did not influence the survival, axon initiation, or pathfinding abilities of the sympathetic neurons. However, mutant SHP-2 expression resulted in an overproduction of sympathetic fibers in sympathetic target organs. This was due to interference with SHP-2 function, as overexpression of wild type SHP-2 had no such effect. In vitro, NGF-dependent neurite growth was inhibited in neurons expressing mutant SHP-2 but not in those expressing wild type SHP-2. Mutant (but not wt) SHP-2 expression also inhibited NGF-stimulated ERK activation. The NGF-dependent survival pathway was less affected than the neurite growth pathway. Our results suggest that NGF-regulated axon growth signals, and to a lesser degree survival signals, are mediated through a SHP-2-dependent pathway in sympathetic neurons. The increased sympathetic innervation in target tissues of neurons expressing mutant SHP-2 may result from interference with normal "stop" signals dependent on signaling by gradients of NGF.

Interneuronal signalling is involved in induction of collateral sprouting of nociceptive axons

Collateral sprouting of cutaneous nociceptive axons into the adjacent denervated skin critically depends on the nerve growth factor, presumably originating from the degenerated neural pathways and denervated skin. We hypothesised that the degenerated neural pathways are necessary, but not sufficient, to induce collateral sprouting of nociceptive axons, and, in addition, that the interaction between the injured and non-injured neurones within a dorsal root ganglion can trigger sprouting of nociceptive axons also in the absence of the denervated skin. End-to-side nerve anastomosis, made in female Wistar rats by suturing the end of an excised peroneal nerve segment to the side of the intact sural nerve, was used as a model for sprouting which allowed us to study the putative induction mechanisms separately. If the nerves adjacent to the sural nerve were transected concomitantly with the coaptation of the end-to-side anastomosis, robust nociceptive axon sprouting into the anastomosed nerve segment was observed by the nerve pinch test and counting of myelinated axons. Collateral sprouting did not occur, however, either if the cells in the anastomosed nerve segment were killed by freezing and thawing, or if the adjacent nerves had not been injured. However, if the ipsilateral dorsal cutaneous nerves, having their neurones in the same dorsal root ganglia as the sural nerve, were transected, but no other nerves were injured, then the sural nerve axons sprouted in abundance through the anastomosis even in the absence of denervated skin around the sural nerve terminals. From these results we suggest that cells (probably proliferating Schwann cells) in the degenerated neural pathways are necessary but not sufficient to induce collateral sprouting of nociceptive axons, and that interactions between the injured and non-injured neurones within the dorsal root ganglion (i.e. direct or indirect interneuronal signalling) are important in this regard.

Calcitonin gene-related peptide-immunoreactive nerves and neuroendocrine cells after lung transplantation in the rat

Bronchial innervation is interrupted at lung transplantation. Nerve fibers with cell bodies above the section, such as sensory C fibers, should degenerate. Using histofluorescence, we evaluated calcitonin gene-related peptide (CGRP) immunoreactivity in syngeneic Lewis rats 1 and 5 mo after unilateral lung transplantation and in controls. CGRP-immunoreactive (IR) neuroendocrine cells were located within the epithelium of large and small bronchi. At 1 mo after transplantation, their number had significantly increased in large bronchi and had normalized 5 mo after transplantation. The density of CGRP-IR fibers in control lungs gradually decreased from large (0. 35 +/- 0.02 micron/micron basal lamina) to small (0.23 +/- 0.02) and peripheral bronchi (0.12 +/- 0.01). At 1 mo after lung transplantation, few CGRP-IR fibers were observed in large bronchi (0.17 +/- 0.02), fewer in small bronchi (0.04 +/- 0.01) (P < 0.01), and none in peripheral bronchi. At 5 mo after lung transplantation, transplanted lungs still had fewer CGRP-IR fibers in large (0.22 +/- 0.02) and small (0.11 +/- 0.02) bronchi (P < 0.02) than did controls, but there were, nonetheless, more in the small bronchi than at 1 mo after transplantation (P < 0.01). Additionally, few CGRP fibers were present in the peripheral bronchi (0.03 +/- 0.01) (P < 0.01). These results clearly demonstrate the occurrence of denervation followed by partial reinnervation with CGRP-IR fibers after transplantation in rat lung.

Denervation of the skin following section of the inferior alveolar nerve leads to increased NGF accumulation without change in NGF mRNA expression

Following inferior alveolar nerve section and capping of the nerve to prevent regeneration, amounts of nerve growth factor (NGF) and NGF mRNA have been quantified in the chin skin, a discrete target of the nerve. NGF protein in the target region increases rapidly following nerve section and to levels known to induce sprouting. NGF on the ipsilateral side increased many-fold above unoperated control and the contralateral side also increased above control. Measurement of NGF mRNA levels using quantitative Northern analysis revealed, however, that there was no change in the expression levels of NGF mRNA, indicating that the large increase in protein occurs due to a cessation of transport back to the cell bodies of the innervating neurons.

Neuroinflammatory Implications of Schistosoma mansoni Infection: New Information from the Mouse Model

Schistosoma mansoni infection is known to induce granulomas, not only in the liver and intestine, but also in the brain, resulting in neuropathological and psychiatric disorders. In the past, the interaction between Schistosoma mansoni infection and the nervous system has received little attention. Here, Luigi Aloe and Marco Fiore discuss recent findings from experimental Schistosoma mansoni infection in the mouse nervous system showing that brain granulomas are associated with a significant alteration in the constitutive expression of nerve growth factor, a neurotrophic factor that plays an essential role in growth and differentiation and in preventing neuronal damage. These findings suggest that the neuropathological dysfunctions in neuroschistosomiasis may be linked to changes in the basal levels and/or activity of neurotrophic factors caused by local formation of granulomas.

Localized sources of neurotrophins initiate axon collateral sprouting

The sprouting of axon collateral branches is important in the establishment and refinement of neuronal connections during both development and regeneration. Collateral branches are initiated by the appearance of localized filopodial activity along quiescent axonal shafts. We report here that sensory neuron axonal shafts rapidly sprout filopodia at sites of contact with nerve growth factor-coated polystyrene beads. Some sprouts can extend up to at least 60 micro(m) through multiple bead contacts. Axonal filopodial sprouts often contained microtubules and exhibited a debundling of axonal microtubules at the site of bead-axon contact. Cytochalasin treatment abolished the filopodial sprouting, but not the accumulation of actin filaments at sites of bead-axon contact. The axonal sprouting response is mediated by the trkA receptor and likely acts through a phosphoinositide-3 kinase-dependent pathway, in a manner independent of intracellular Ca2+ fluctuations. These findings implicate neurotrophins as local cues that directly stimulate the formation of collateral axon branches.

Neurotrophin mRNA expression in the developing tooth suggests multiple roles in innervation and organogenesis

To analyze the roles of neurotrophins during early development of rat teeth, we studied the expression of neurotrophin mRNAs from the initiation of first molar formation to the completion of crown morphogenesis. With RNAase protection assay all neurotrophin mRNAs were detected in embryonic teeth. In situ hybridization analysis revealed developmentally changing, distinct expression patterns for nerve growth factor (NGF) and neurotrophin-3 (NT-3), which were shown not to be regulated by or dependent on peripheral innervation. NGF mRNAs appeared in the mesenchymal target field of the tooth at the time of the trigeminal axon ingrowth (embryonic days 14-15: E14-E15), and they were also present along the pathway taken by growing trigeminal axons. NT-4/5 mRNAs were uniformly expressed in all epithelial cells, but brain-derived neurotrophic factor (BDNF) transcripts were not detected. All neurotrophins induced neurite outgrowth from E13-E16 trigeminal ganglion explants. These results suggest that NGF is involved in the guidance of trigeminal axons to embryonic teeth. In postnatal teeth, expression of NGF mRNAs, but not other neurotrophins, correlated with trigeminal axon ingrowth, proposing that NGF is involved in local sprouting and establishment of the final innervation pattern of the dental papilla and dentin. These results suggest that NGF is required for tooth innervation and that other neurotrophins may also have regulatory roles. In addition, the expression patterns of NGF, NT-3, and NT-4/5 as well as of neurotrophin receptors suggest that the neurotrophin system may also serve non-neuronal functions during tooth development.

Degeneration and regeneration of cutaneous sensory nerve formations

Auxiliary structures of the cutaneous sensory nerve formations (SNF) are dependent on sensory innervation during their critical period of development. Denervation of mature cutaneous corpuscles results in survival of the terminal Schwann cells and the capsular structures which are probably responsible for successful reinnervation of the cutaneous SNF. In addition, the basal lamina tubes of Schwann cells are connected with the terminal Schwann cells and play an important role in the guidance of regrowing axons to their original targets. Long-lasting denervation causes atrophic changes of the terminal Schwann cells and alterations of their molecular equipment. These atrophic changes in the terminal Schwann cells may be responsible for erroneous reinnervation of cutaneous SNF. A population of the cutaneous Merkel cells surviving denervation may also serve as targets for regrowing sensory axons. The basal laminae of terminal Schwann cells are produced under control of the sensory terminals during maturation of cutaneous SNF. In adult animals, the basal laminae are capable of stimulating differentiation of migrated Schwann cells to the terminal Schwann cells without the presence of the sensory terminals. Nonspecific cholinesterase (nChE) is secreted by the terminal Schwann cells and is attached to their extracellular matrix. The synthesis of these molecules in adult animals is not influenced by the sensory terminals. However, the presence of nChE molecules is associated with living terminal Schwann cells. Fetal orthotopically grafted dorsal root ganglion (DRG) neurons have the ability to reinnervate cutaneous SNF of adult hosts. When cutaneous areas are denervated, axons from adjacent sensory nerves may extend collateral branches into this area. The capacity for such extension is dependent on: (1) type of sensory nerve ending, C and A delta fibers having significantly greater capacity than sensory axons of larger caliber; (2) age of the animal, immature animals generally showing a greater capacity for collateral sprouting; (3) the state of the adjacent axons, those already in a growth mode being more capable than "resting" ones; and (4) the regional and mechanical conditions at the site of denervation, hindpaw skin being much less extensively reinnervated by collateral fibers than that of the trunk.

Nerve growth factor depletion reduces collateral sprouting of cutaneous mechanoreceptive and tooth-pulp axons in ferrets

1. Electrophysiological experiments were carried out to determine whether or not collateral sprouting of cutaneous low-threshold mechanoreceptive fibres could be detected and to investigate the effect of nerve growth factor (NGF) deprivation on the sprouting of these fibres and the fibres innervating tooth pulps. 2. In twenty-one ferrets (eleven of which had been autoimmunized against NGF) the right inferior alveolar nerve (IAN) was sectioned and prevented from regenerating. After 12 weeks, transmedian innervation from the left IAN was determined by stimulating the nerve whilst recording from electrodes implanted in the contralateral anterior teeth and also by single unit recordings from the nerve whilst mechanically and electrically stimulating the skin. The results were compared with those from ten control animals. 3. Transmedian innervation of contralateral teeth was found in none of the control animals; in all ten of the animals which had undergone denervation without immunization (4/10 canines, 17/20 incisors); but in only six of the eleven immunized and denervated animals (0/11 canines, 7/22 incisors). 4. Of 270 cutaneous mechanoreceptive units sampled in the controls, only four units had transmedian receptive fields, extending a maximum of 1 mm across the mid-line. After denervation, significantly more units (42 of 274) crossed the mid-line and extended up to 4 mm. After immunization and denervation only eleven of 305 units crossed the midline by a maximum of 1 mm. 5. These data show that cutaneous low-threshold mechanoreceptive A beta and A delta fibres, as well as A delta tooth pulp fibres, are able to undergo collateral sprouting. This sprouting is partially blocked by NGF depletion, suggesting that NGF plays an essential role in the process.

Expression of NGF in sympathetic neurons leads to excessive axon outgrowth from ganglia but decreased terminal innervation within tissues

The effects of nerve growth factor (NGF) on sympathetic axon growth were investigated by generating transgenic mice in which the beta subunit of NGF was expressed in sympathetic neurons using the human dopamine beta-hydroxylase (DBH) promoter. In DBH-NGF mice, the sympathetic trunk and nerves growing to peripheral tissues were enlarged and contained an increased number of sympathetic fibers. Although sympathetic axons reached peripheral tissues, terminal sympathetic innervation within tissues was decreased in DBH-NGF mice. This effect could be reversed in the pancreas by overexpression of NGF in pancreatic islets. The observations are consistent with a model in which NGF gradients are not required to guide sympathetic axons to their targets, but are required for the establishment of the normal density and pattern of sympathetic innervation within target tissues.

The quest for better recovery from peripheral nerve injury: current status of nerve regeneration research

The author reviews relevant nerve regeneration research in the past half-century to give the reader familiarity with the background of current research efforts. Recent research has been aided by newer knowledge of the biology of nerve regeneration. Early efforts to improve nerve regeneration centered on improvements in technical or surgical repairs, with only modest gains. Although current technical improvements with lasers or fibrin glue to repair nerves may show promise, the approach of deMedinaceli et al. combines several new ideas with some improvement experimentally. With the discovery of nerve growth factors and a host of newer nerve growth promoting factors, the biochemical arena has explored. Special tubes to repair nerves enable easy manipulation of the environment to study the effects of various factors on nerve regeneration. Silastic and bioresorbable tubes show the most promise to enhance nerve regeneration by tubulization. Because of the explosion of knowledge and high levels of activity of research, it is apparent that further improvements of nerve regeneration are on the horizon.

The role of nerve growth factor in collateral reinnervation by cutaneous C-fibres in the rat

We have investigated whether chronic nerve growth factor (NGF) depletion affects the development of transmedian collateral reinnervation by C-fibres. Using a dye-labelled plasma extravasation technique in rats, the extent of transmedian innervation of the skin by C-fibres in the inferior alveolar nerve (IAN) was determined 8-10 weeks after sectioning and preventing regeneration of the contralateral IAN. Another group of animals were immunised against NGF prior to the nerve section and a third group acted as unoperated controls. A small but significant transmedian collateral reinnervation by C-fibres developed after contralateral denervation alone, but was not found in the animals also immunised against NGF. These results suggest that NGF is essential for the development of collateral reinnervation from cutaneous C-fibres.

Target attraction: are developing axons guided by chemotropism?

A century has elapsed since Ramón y Cajal proposed his chemotropic theory of axon guidance, i.e. the attraction of developing axons by diffusible molecules emanating from their targets. Although the precise contribution of axonal chemoattractants to guidance in vivo remains to be established, two lines of investigation have provided evidence for their existence and importance. First, concentration gradients of nerve growth factor (NGF) have been shown to orient the growth of regenerating sensory axons in vitro. Although NGF does not appear to guide axons during development, these studies show that growth cones can orient in gradients of diffusible molecules. Second, the cellular targets of several different classes of developing neurons have been shown to secrete as yet unidentified diffusible factors that can orient axons. We review these studies and discuss the potential contribution of chemotropism to the establishment of axonal projection patterns in vertebrates.

Restoration of paralyzed orbicularis oculi muscle function by controlled electrical current

A canine model of facial nerve paralysis was studied to apply controlled electrical current to the peripherally denervated orbicularis oculi muscle, in the attempt to effectively restore the absent function of this denervated muscle. After unilateral facial nerve neurotmesis was performed in eight dogs, the denervated orbicularis oculi muscles of four dogs were electrically stimulated for 75 postoperative days (40 min/day). Denervated and normal orbicularis oculi muscles were electrophysiologically studied and compared with the Student t test. During the study period, minimum closure of denervated treated orbicularis oculi muscles was evoked with average stimulus strength (80-ms duration) of 1.61 +/- 0.22 log mA x ms, not significantly different from that of denervated nontreated or normal orbicularis oculi muscles. From days 10 through 30 only, maximum closure of denervated treated orbicularis oculi muscles was achieved with mean pulse strength (80-ms duration) of 2.37 +/- 0.09 log mA x ms, significantly lower (P less than .01) than that evoking the same type of contraction from denervated nontreated muscles (80-ms duration, mean 2.83 +/- 0.10 log mA x ms). In addition, denervated treated muscle pulse strength eliciting maximum contraction was not significantly different from that of normal orbicularis oculi muscles during the same period. This finding was not observed, however, from day 40 through the end of the study. This investigation demonstrates (1) the transient reversal of denervation changes of paralyzed orbicularis oculi muscle by daily electrical stimulation, and (2) the feasibility of restoring orbicularis oculi muscle function by controlled electrical current.