Recovery of denervated muscle receptors following treatments to accelerate nerve regeneration

Influence of surface peripheral electrical stimulation on nerve regeneration after digital nerve neurorrhaphy: study protocol for a randomized clinical trial

We will study the influence of low intensity and frequency surface peripheral electrical stimulation (PES) on nerve regeneration of digital nerve injuries of the hand after its surgical repair in humans. Participants will be patients with acute traumatic peripheral nerve injury referred to the Hand Surgery Service of the General Hospital of the State of Bahia, a reference service in the state. These patients will undergo surgery followed by PES in the immediate postoperative period. After hospital discharge, they will be followed up on an outpatient basis by researchers, who will remotely supervise a physiotherapy program. Our hypothesis is that PES will positively influence the recovery of sensory function in patients undergoing neurorrhaphy of digital nerves of the hand.

ReBEC registration:  U1111-1259-1998 (12/18/2020)

Effect of muscle electrostimulation on afferent activities from tibialis anterior muscle after nerve repair by self-anastomosis

Numerous previous studies were devoted to the regeneration of motoneurons toward a denervated muscle after nerve repair by self-anastomosis but, to date, few investigations have evaluated the regeneration of sensory muscle endings. In a previous electrophysiological study (Decherchi et al., 2001) we showed that the functional characteristics of tibialis anterior muscle afferents are affected after self-anastomosis of the peroneal nerve even when the neuromuscular preparation was not chronically stimulated. The present study examines the regeneration of groups I-II (mechanosensitive) and groups III-IV (metabosensitive) muscle afferents by evaluating the recovery of their response to different test agents after self-anastomosis combined or not with chronic muscle stimulation for a 10-weeks period. We compared five groups of rats: C, control; L, nerve lesion without suture; LS, nerve lesion with suture; LSE(m): nerve lesion plus chronic muscle stimulation with a monophasic rectangular current; and LSE(b): nerve lesion plus chronic stimulation with a biphasic current with modulations of pulse duration and frequency, eliciting a pattern of activity resembling that delivered by the nerve to the muscle. Compared to the control group, (1) muscle kept only its original weight in the LSE(b) group, (2) in the LS group the response curve to tendon vibration was shifted toward the highest mechanical frequencies and the response of groups III-IV afferents after fatiguing muscle stimulation lowered, (3) in the LSE(m) group, the pattern of activation of mechanoreceptors by tendon vibrations was altered as in the LS group, and the response of metabosensitive afferents to KCl injections was markedly reduced, (4) in the LSE(b) group, the response to tendon vibration was not modified and the activation of metabosensitive units by increased extracellular potassium chloride concentration was conserved. Both LSE(b) and LSE(m) conditions were ineffective to maintain the post muscle stimulation activation of metabosensitive units as well as their activation by injected lactic acid solutions. Our data indicate that chronic muscle electrostimulation partially favors the recovery of mechano- and metabosensitivity in a denervated muscle and that biphasic modulated currents seem to provide better results.

Changes in afferent activities from tibialis anterior muscle after nerve repair by self-anastomosis

In order to study sensory nerve plasticity after nerve injury and repair, recordings were made from afferent axons innervating the tibialis anterior muscle in rats under several different experimental conditions. In two groups of rats, reinnervation of the denervated tibialis anterior was examined 2.5 months (group A) and 7 months (group B) after section, along with self-anastomosis of the common peroneal nerve. The other rats (group C) were examined 2.5 months after the nerve was cut and ligatured to its stumps to avoid axonal regeneration. No evoked potentials and no activation in response to any test agent were found in group C rats. We found a significant increase in the proportion of group I-II fibers and a significant decrease in group IV fibers in the group B rats when compared with group A (P < 0.05 and P < 0.01) and control animals (P < 0.01 and P < 0.01). A higher conduction velocity was measured in group IV fibers in group B rats when compared with group A (P < 0.01) and the controls (P < 0.01). The proportion of afferent units showing an optimal discharge in response to tendon vibration at 70 Hz (range 0-100 Hz) was higher in groups A and B (72.2 and 80%, respectively) than in the controls (36.8%). The response of muscle afferents to KCl (1-20 mM) and lactic acid (0.5-3 mM) concentrations was markedly depressed in group A rats (P < 0.05), whereas it was restored and even accentuated in group B animals when compared with the controls (P < 0.05). Electrically induced fatigue (3 min, 10 Hz) significantly activated (P < 0.05) muscle afferents only in controls. The present study indicates that after self-anastomosis of a cut hindlimb muscle nerve, sensory innervation was markedly modified in the direction of enhanced mechanosensitivity to high-frequency tendon vibration and depressed metabosensitivity.

The static sensitivity of tendon organs during recovery from nerve injury

An investigation has been carried out into the physiological properties of tendon organs and their interactions with motor units following two types of nerve injury: nerve crush and nerve transection followed by suture repair. Recovery from nerve crush was very successful: 6 weeks after the injury 60% of the tendon organ-motor unit interactions (n = 62) evoked normal or near-normal patterns of afferent discharge but with reduced firing rates. After 10 weeks of recovery 81% of the interactions (n = 43) were normal. The main abnormality observed was a phasic-only pattern of discharge. The overall reductions in firing rate during early recovery may be attributable to the lower contractile forces generated by the reinnervated muscle units, while the phasic-only responses may also represent immaturity of the transduction mechanism of the regenerated afferent axons. Following nerve transection the quality of recovery was much lower and a range of abnormal, as well as normal patterns of response were observed. For all the afferents studied, both types of response were recorded, suggesting that although there may be changes in the sensitivity of the afferents to muscle contraction, the abnormal responses more probably reflect changes in the form of the mechanical input rather than abnormalities of the transduction process.

Molecular cloning, functional expression and pharmacological characterization of a mouse melanocortin receptor gene

We describe the cloning of the mouse HGMP01A gene that encodes a melanocortin receptor functionally distinct from the adrenal cortex corticotropin (adrenocorticotrophic hormone; ACTH) receptor and the melanocyte-stimulating hormone (MSH) receptor expressed in melanoma. The gene encodes a protein of 323 amino acids with a calculated molecular mass of 35,800 Da, displaying potential sites for N-linked glycosylation and phosphorylation by protein kinase C. An RNAase protection assay detected weak expression in the brain, but not in adrenal gland, skin, or any of the other tissues tested. Stable CHO cell lines expressing over 100,000 receptors per cell were generated. The recombinant receptor binds iodinated [Nle4,D-Phe7]alpha-MSH (NDP-MSH) with an apparent Kd of 700 pM. Displacement of the ligand by a variety of pro-opiomelanocortin-derived peptides revealed a pharmacological profile distinct from that of the classical ACTH and MSH receptors. NDP-MSH was the most powerful competitor (IC50 1.4 nM), followed by gamma-MSH (IC50 7 nM). alpha-MSH, beta-MSH and ACTH-(1-39) were significantly less potent, with IC50 values of 30, 19 and 21 nM respectively. ACTH-(4-10) was poorly active (IC50 2.4 microM), while corticotropin-like intermediate lobe peptide (CLIP) and beta-endorphin were totally ineffective. The recombinant receptor was found to stimulate adenylate cyclase. The potency order of the agonists in this assay was consistent with that of the binding displacement assays. This receptor represents the orthologue of the human melanocortin 3 receptor reported recently. The growing family of melanocortin receptors constitute the molecular basis for the variety of actions of melanocortins that have been described over the years. The availability of functionally expressed receptors from the melanocortin family will allow the development of a specific pharmacology, and a better understanding of the function of the pro-opiomelanocortin-derived peptides.

Location and completeness of reinnervation by two types of neurons at a single target: the feline muscle spindle

Muscle spindles from the tenuissimus muscle of the cat were examined microscopically to assess the precision and completeness of reinnervation of intrafusal muscle fibers by efferent and afferent neurons. Positions of motor and sensory nerve terminals were charted relative to the cross-sectional area enclosed by the outer capsule of the spindle. Profiles of nerve endings were measured for normally innervated and reinnervated spindles. The tenuissimus was deprived of innervation by freezing its nerve, sometimes in conjunction with either spinal ganglion removal or ventral rhizotomy. Sensory and motor terminals occupied separate locales along the length of normal muscle spindles. Nerve terminals of efferent and afferent neurons were located in appropriate positions along the length of spindles when axons of both types of neurons regrew together and when either category of axon regenerated alone. Precise reinnervation of muscle spindles occurred in spite of a diminished diameter of intrafusal fibers. Repopulation of the spindle with motor endings was less complete than that by sensory endings, based on the proportion and size of the regenerated terminals. We conclude that under optimal conditions for axonal regrowth, efferent and afferent neurons reinnervate their respective regions along intrafusal muscle fibers but motor lags sensory reinnervation within the spindle. The mechanism by which positional specificity happens during reinnervation of intrafusal fibers requires neither an interaction between terminals of the two types of neurons nor target cells of normal bulk.

ACTH/MSH(4-10) analog BIM 22015 aids regeneration via neurotrophic and myotrophic attributes

Structural differences between noncorticotropic ACTH peptides result in marked differences in their effects on regenerating nerve and muscle in rats. The ACTH/MSH(4-10) analog BIM 22015 was administered IP in dosages from 0.1 to 40 micrograms/kg/48 h for 5, 7, or 11 days after peroneal nerve crush, and characteristics of extensor digitorum longus (EDL) muscle were studied and compared with ACTH/MSH(4-10). Eleven days postcrush 40 micrograms/kg BIM 22015 increases rate of development of tetanic tension and amplitude of contraction of indirectly stimulated EDL. In a 21-day study, reinnervated BIM 22015-treated muscles retain tetanic strength, whereas ACTH/MSH(4-10)-treated muscles are significantly weakened. Both peptides show neurotrophic characteristics in their stimulation of endplate nerve terminal branching. However, in contrast to ACTH/MSH(4-10), BIM 22015 also prevents denervation atrophy of the EDL. This dual neurotrophic and myotrophic role for BIM 22015 accords it a clinical potential for degenerative myopathies of either pure or mixed origin, such as muscular dystrophy, infantile spinal atrophy, and hypotonia.