Peripheral nerve lesions: the neuropharmacological outlook

Improvements in biomaterial matrices for neural precursor cell transplantation

Progress is being made in developing neuroprotective strategies for traumatic brain injuries; however, there will never be a therapy that will fully preserve neurons that are injured from moderate to severe head injuries. Therefore, to restore neurological function, regenerative strategies will be required. Given the limited regenerative capacity of the resident neural precursors of the CNS, many investigators have evaluated the regenerative potential of transplanted precursors. Unfortunately, these precursors do not thrive when engrafted without a biomaterial scaffold. In this article we review the types of natural and synthetic materials that are being used in brain tissue engineering applications for traumatic brain injury and stroke. We also analyze modifications of the scaffolds including immobilizing drugs, growth factors and extracellular matrix molecules to improve CNS regeneration and functional recovery. We conclude with a discussion of some of the challenges that remain to be solved towards repairing and regenerating the brain.

The role of a barrier between two nerve fascicles in adjacency after transection and repair of a peripheral nerve trunk

Aberrant reinnervation of target organs caused by misdirected axonal growth at the repair site is a major reason for the poor functional outcome usually seen after peripheral nerve transection and repair. The following two studies investigate whether criss-crossing of regenerating rat sciatic nerve axons between tibial and peroneal nerve fascicles can be reduced by using a barrier at the coaption site. The left sciatic nerve was transected and repaired at mid-thigh as follows: epineural sutures (group A, A-II), fascicular repair of tibial and peroneal nerve fascicles (group B, B-II), fascicular repair of tibial and peroneal nerve fascicles separating the two fascicles with a pedicled fat flap (group C), Integra (group D) or non-vascularized autologous fascia (group C-II). In the control groups E and D-II, only the left tibial fascicle was transected and repaired. Four and 5 months postoperatively, the outcome of regeneration was evaluated by histology, by retrograde tracing, and by assessment of the muscle force of the gastrocnemius and tibial anterior muscles. The tracing experiments showed that specificity of muscle reinnervation significantly improved when a barrier was employed, which significantly or clearly improved muscle twitch tension in groups C and D. However, muscle contraction force was not better when fascia was used as barrier. The histological picture indicated that this inferior result in group C-II was due to nerve compression caused by fibrotic scar tissue at the site of the fascia graft. Results of this study show that a pedicle fat flap and Integra used as barrier significantly prevent aberrant reinnervation between two sutured nerve fascicles in adjacency resulting in improved motor recovery in rats. Non-vascularized autologous fascia however, reduces also criss-crossing of regenerating axons between the fascicles, but causes significant nerve compression.

Controlled release of nerve growth factor from fibrin gel

Nerve growth factor (NGF) is known to promote the axonal regeneration in injured nerve system. Delivery of NGF for a long period in a controlled manner may enhance the regeneration efficacy. In this study, we investigated whether NGF can be released from fibrin gel for a long period in a controlled manner. We also investigated whether sustained delivery of NGF using fibrin gel can enhance the efficacy of NGF in vitro. The addition of heparin to fibrin gel decreased the rate of NGF release from the fibrin gel. As the concentrations of thrombin and fibrinogen in fibrin gel increased, the NGF release rate decreased significantly, and the initial release burst decreased. NGF was released for up to 14 days in vitro. The bioactivity of NGF released from fibrin gel was assessed by morphological changes of pheochromocytoma (PC12) cells cultured in the presence of NGF-containing fibrin gel. NGF released from fibrin gel exhibited significantly higher degrees of PC12 cell viability and differentiation than NGF added in a free form daily into the culture medium. This study demonstrates that fibrin gel can release NGF in a sustained, controlled manner and in a bioactive form.

Acceleration effect of basic fibroblast growth factor on the regeneration of peripheral nerve through a 15-mm gap

In this study, nerve guides composed of poly(D,L-lactide) (PDLLA) were fabricated and used in the repair of transected sciatic nerves (15-mm gaps) of rats. Nerve guides with a two-ply structure (inner layer dense, outer layer microporous) were prepared by controlling the solvent evaporation rate. Then basic fibroblast growth factor (bFGF) was embedded in the inner layer of the nerve guides. Thus the inner dense layer not only could prevent the ingrowth of fibroblast and avoid the outgrowing nerve cable, but it also could retain the released bFGF in the guide lumen. The outer porous layer allowed vascular ingrowth and the diffusion of essential nutrients into the guide lumen. The data show that by using this nerve guide, the transected 15-mm sciatic nerve was regenerated successfully within 4 months. The recovery of function of the regenerated nerves was significantly accelerated by bFGF, as indicated by an electrostimulation test and histologic assays. In addition, the bFGF retained its bioactivity during embedding and continuously was released from the matrix, as confirmed by the results of both the dorsal root ganglia (DRG) and the Schwann cell culture in the presence of PDLLA matrix containing bFGF. The released bFGF enhanced the ability of the nerve fibers to sprout from dorsal root ganglia, and it accelerated the proliferation of Schwann cells.

Tissue-engineered scaffolds are effective alternatives to autografts for bridging peripheral nerve gaps

The use of autografts for "bridging" peripheral nerve gaps is limited by lack of suitable donor nerve grafts. Using a tissue-engineering approach, we have designed a three-dimensional scaffold that presents laminin 1 (LN-1) and nerve growth factor (NGF) in vivo. Semipermeable polysulfone tubes were used as carriers to introduce the tissue-engineered scaffolds to a 10-mm sciatic nerve gap in adult rats. Two months after implantation, the gross morphology of the regenerated nerve, the success rate of regeneration, and the total number and density of myelinated axons in the tissue-engineered scaffolds matched that observed in autografts. LN-1- and NGF-containing scaffolds performed comparably to autografts when functional measures that include the relative gastrocnemius muscle weight and the sciatic functional index were quantified. Our results demonstrate that tissue-engineered scaffolds match the performance of autografts in an in vivo model of peripheral nerve regeneration, raising the possibility of the scaffolds being used clinically instead of scarce autografts.

Regeneration of sudomotor and sensory nerve fibres after digital replantation and microneurovascular toe-to-hand transfer

The end-stage sudomotor and sensory recovery in patients with replanted fingers and patients after microneurovascular toe-to-hand transfer was studied using quantitative electrophysiological investigations (recovery of sensory nerve action potentials and the sympathetic skin response), the ninhydrin test and clinical testing of sensory regeneration (light touch, pain, static and dynamic two-point discrimination). 13 adult patients with 22 replanted digits (11 males, 2 females) aged 21-58 years (mean 42.2 years) and 12 adults and adolescents (8 males, 4 females) aged 13-45 years, (mean 26.8 years) following 14 microneurovascular great and/or second toe-to-hand transfers were studied. The replanted fingers were examined 2-7 years after injury and replantation. The toe-to-hand transfers were examined 2-12 years after injury and transfer. The results show better end-stage recovery of sudomotor and sensory function following finger replantation when compared to microneurovascular toe-to-hand transfer.

Comparative effect of alpha-MSH and b-FGF on neurite extension of fetal rat spinal cord neurons in culture

Basic fibroblast growth factor (b-FGF) and alpha melanocyte stimulating hormone (alpha-MSH) were tested for their ability to promote axonal elongation on E14 fetal rat spinal cord cell culture, and to support cell survival. A similar development of neurite was observed in alpha-MSH treated cultures or in control cultures, with an axonal length ranging from 87.50 microns to 195.60 microns on day 3. Complete cell death occurred after 6 days of incubation. Whatever the concentration of b-FGF used (0.312-2.5 ng/ml), a significant increase (1.2- to 1.4-fold) in neurite length was observed, with neuronal survival up to 9 days.

Effect of basic fibroblast growth factor and alpha-melanocytic stimulating hormone on nerve regeneration through a collagen channel

An experimental study on the rat sciatic nerve was performed to evaluate nerve regeneration through a collagen guide and to study the effects of alpha-melanocytic stimulating hormone (alpha-MSH) and basic fibroblast growth factor (b-FGF) in accelerating axonal elongation. After transection, nerves were repaired over a 7 mm gap using a placental collagen type IV guide. The channel was filled with either a b-FGF solution or an alpha-MSH solution or was produced with b-FGF incorporated into the guide. Four weeks later, only groups in which b-FGF had been injected or incorporated displayed a significant somatosensory evoked potential response. Histological and quantitative analysis of nerve fibres confirmed the existence of nerve continuity in groups receiving an alpha-MSH solution or a channel containing b-FGF. These results demonstrate that alpha-MSH in solution and b-FGF incorporated into a collagen type IV channel enhance peripheral nerve regeneration. However, at 4 weeks, only b-FGF (3 ng) restores functional activity.