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De Marchi F, Venkatesan S, Saraceno M, Mazzini L, Grossini E. Acetyl-L-carnitine and Amyotrophic Lateral Sclerosis: Current Evidence and Potential use. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:588-601. [PMID: 36998125 DOI: 10.2174/1871527322666230330083757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND The management of neurodegenerative diseases can be frustrating for clinicians, given the limited progress of conventional medicine in this context. AIM For this reason, a more comprehensive, integrative approach is urgently needed. Among various emerging focuses for intervention, the modulation of central nervous system energetics, oxidative stress, and inflammation is becoming more and more promising. METHODS In particular, electrons leakage involved in the mitochondrial energetics can generate reactive oxygen-free radical-related mitochondrial dysfunction that would contribute to the etiopathology of many disorders, such as Alzheimer's and other dementias, Parkinson's disease, multiple sclerosis, stroke, and amyotrophic lateral sclerosis (ALS). RESULTS In this context, using agents, like acetyl L-carnitine (ALCAR), provides mitochondrial support, reduces oxidative stress, and improves synaptic transmission. CONCLUSION This narrative review aims to update the existing literature on ALCAR molecular profile, tolerability, and translational clinical potential use in neurodegeneration, focusing on ALS.
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Affiliation(s)
- Fabiola De Marchi
- ALS Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale 28100 Novara, Italy
| | - Sakthipriyan Venkatesan
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale 28100, Novara, Italy
| | - Massimo Saraceno
- ALS Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale 28100 Novara, Italy
| | - Letizia Mazzini
- ALS Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale 28100 Novara, Italy
| | - Elena Grossini
- Laboratory of Physiology, Department of Translational Medicine, University of Piemonte Orientale 28100, Novara, Italy
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Sun KH, Choi CH, Cho GW, Jang CH. Effect of Metformin on the Functional and Electrophysiological Recovery of Crush Injury-Induced Facial Nerve Paralysis in Diabetic Rats. J Pers Med 2023; 13:1317. [PMID: 37763084 PMCID: PMC10532940 DOI: 10.3390/jpm13091317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The impact of metformin on the rat facial nerve following crush injury has only occasionally been documented to date. The purpose of the current investigation was to use functional and electrophysiological evaluations to investigate the effects of metformin administration on recovery following crush injury to the rat facial nerve. The rats were randomly divided into four groups: the nonDM/PBS group (n = 4), the nonDM/metformin group (n = 4), the DM/PBS group (n = 4), and the DM/metformin group (n = 4). Diabetes was generated by an intraperitoneal injection of streptozotocin. Facial nerve paralysis was induced by a crush injury 7 days after diabetes induction. The blood glucose levels of the DM/PBS and DM/metformin groups were maintained at over 300 mg/dL, whereas the blood glucose levels of the nonDM/PBS and nonDM/metformin groups were maintained at less than 150 mg/dL. There was no significant difference between the two nonDM groups. In comparison to the PBS group, the metformin group's recurrence of vibrissa fibrillation occurred noticeably sooner over time. The nonDM/metformin group showed the highest recovery rate in the second, third, and fourth weeks post-crush, respectively. The threshold of action potential 4 weeks after crush injury showed that the nonDM/metformin group had a significantly lower mean threshold of MAP compared to other groups. The short-term effect of metformin on the recovery of facial nerve blood flow (FNBF) was significantly increased compared to the DM/PBS group. However, there was no significant difference in FNBF between the nonDM/metformin and nonDM/PBS groups. A diabetic condition promoted a delay in FN regeneration. Metformin is able to accelerate functional recovery in diabetic or nondiabetic FN-injured rats. Further studies using a morphometric or molecular approach are planned to understand the pharmacologic mechanism of metformin.
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Affiliation(s)
- Kyung Hoon Sun
- Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea;
| | - Cheol Hee Choi
- Department of Pharmacology, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea;
| | - Gwang-Won Cho
- Department of Biology, College of Natural Science, Chosun University, Gwangju 61452, Republic of Korea;
- BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Republic of Korea
| | - Chul Ho Jang
- Department of Otolaryngology, Chonnam University Medical School, Gwangju 61469, Republic of Korea
- Department of Otolaryngology, Gwangju Veterans Hospital, Gwangju 62284, Republic of Korea
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Pourshahidi S, Shamshiri AR, Derakhshan S, Mohammadi S, Ghorbani M. The Effect of Acetyl-L-Carnitine (ALCAR) on Peripheral Nerve Regeneration in Animal Models: A Systematic Review. Neurochem Res 2023:10.1007/s11064-023-03911-1. [PMID: 37037995 DOI: 10.1007/s11064-023-03911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/12/2023]
Abstract
Peripheral neuropathies caused by the peripheral nervous system (PNS) damage can occur due to trauma and other disorders. They present as altered sensation, weakness, autonomic symptoms, and debilitating pain syndrome with a wide range of clinical signs. Acetyl-L-Carnitine (ALCAR) is a biological compound with essential roles in mitochondrial oxidative metabolism and anti-oxidant effects that protects mitochondria from oxidative damage and inhibits apoptosis caused by mitochondrial damage. This study is a systematic review and meta-analysis of the effects of ALCAR on peripheral nerve injuries. This review examines studies on treating traumatic peripheral neuropathies in which ALCAR is administered to rats with sciatic nerve injury with an appropriate control group. The articles were divided based on the mode of ALCAR administration. If one method was used in more than one article, their results were entered in the "Revman5.4" software and were meta-analyzed. Studies were selected from 1994 to 2018 on rats with varying physical injuries to their sciatic nerves. In one study, ALCAR was provided to rats in their drinking water, while in other studies, ALCAR was injected intra-peritoneally. Different mechanisms of ALCAR actions have been suggested in this study, but the underpinnings of the neuroprotective effects of ALCAR are still unclear. Further studies are mandatory to clarify the actual mechanisms of the neuroprotective activity of ALCAR. Based on the results of existing studies, ALCAR effectively increases the tolerance threshold of thermal and mechanical stimuli, reduces latency, and reduces apoptosis; finally, adjusting the dose and duration of administration may increase the dose and duration axon diameter.
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Affiliation(s)
- Sara Pourshahidi
- Oral and Maxillofacial Diseases Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Research Center for Caries Prevention, Dentistry Research Institute, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Derakhshan
- Oral and Maxillofacial Pathology Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Preclinical Imaging Group, Preclinical Core Facility, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Mohammadi
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Ghorbani
- Faculty of Veterinary Medicine, Islamic Azad University, Urmia Branch, Urmia, Iran.
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Lepić S, Lepić M, Banjanin N, Mandić-Rajčević S, Rasulić L. A review of the diet, nutrients, and supplementation potential for the outcome augmentation in surgical treatment of peripheral nerve injuries. Front Surg 2022; 9:942739. [PMID: 36439529 PMCID: PMC9683533 DOI: 10.3389/fsurg.2022.942739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/13/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE Although the studies have shown the beneficial effects of diet, nutrition, and supplementation as an independent treatment modality, their roles are underestimated in the treatment of peripheral nerve injuries. This is in great part due to the development of efficient nerve repair techniques, combined with physical treatment and stimulation. To achieve the best possible functional recovery diet, nutrition, and supplementation should be implemented within a multidisciplinary approach. The aim of the study is to provide insight into the potentially beneficial effects of diet, nutrients, and supplementation, in the limitation of nerve damage and augmentation of the functional recovery after surgery in a review of human and animal studies. METHODS The data relating to the diet, nutrients, and supplementation effects on peripheral nerve injuries and their treatment was extracted from the previously published literature. RESULTS General balanced diet as well as obesity influence the initial nerve features prior to the injury. In the period following the injury, neuroprotective agents demonstrated beneficial effects prior to surgery, and immediately after the injury, while those potentiating nerve regeneration may be used after the surgical repair to complement the physical treatment and stimulation for improved functional recovery. CONCLUSIONS Standardized diet, nutrition, and supplementation recommendations and protocols may be of great importance for better nerve regeneration and functional recovery as a part of the multidisciplinary approach to achieve the best possible results in surgically treated patients with peripheral nerve injuries in the future.
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Affiliation(s)
- Sanja Lepić
- Institute of Hygiene, Military Medical Academy, Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Milan Lepić
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Nikolina Banjanin
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
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de Oliveira Otto MC, Li XS, Wang Z, Siscovick DS, Newman AB, Lai HTM, Nemet I, Lee Y, Wang M, Fretts A, Lemaitre RN, Tang WW, Lopez O, Hazen SL, Mozaffarian D. Longitudinal Associations of Plasma TMAO and Related Metabolites with Cognitive Impairment and Dementia in Older Adults: The Cardiovascular Health Study. J Alzheimers Dis 2022; 89:1439-1452. [PMID: 36057823 PMCID: PMC9720755 DOI: 10.3233/jad-220477] [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: 11/15/2022]
Abstract
BACKGROUND Animal studies suggest that gut microbiome metabolites such as trimethylamine N-oxide (TMAO) may influence cognitive function and dementia risk. However potential health effects of TMAO and related metabolites remain unclear. OBJECTIVE We examined prospective associations of TMAO, γ-butyrobetaine, crotonobetaine, carnitine, choline, and betaine with risk of cognitive impairment and dementia among older adults aged 65 years and older in the Cardiovascular Health Study (CHS). METHODS TMAO and metabolites were measured in stored plasma specimens collected at baseline. Incident cognitive impairment was assessed using the 100-point Modified Mini-Mental State Examination administered serially up to 7 times. Clinical dementia was identified using neuropsychological tests adjudicated by CHS Cognition Study investigators, and by ICD-9 codes from linked Medicare data. Associations of each metabolite with cognitive outcomes were assessed using Cox proportional hazards models. RESULTS Over a median of 13 years of follow-up, 529 cases of cognitive impairment, and 522 of dementia were identified. After multivariable adjustment for relevant risk factors, no associations were seen with TMAO, carnitine, choline, or betaine. In contrast, higher crotonobetaine was associated with 20-32% higher risk of cognitive impairment and dementia per interquintile range (IQR), while γ-butyrobetaine was associated with ∼25% lower risk of the same cognitive outcomes per IQR.∥Conclusion:These findings suggest that γ-butyrobetaine, crotonobetaine, two gut microbe and host metabolites, are associated with risk of cognitive impairment and dementia. Our results indicate a need for mechanistic studies evaluating potential effects of these metabolites, and their interconversion on brain health, especially later in life.
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Affiliation(s)
- Marcia C de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Xinmin S. Li
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA
| | - Zeneng Wang
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA
| | | | - Anne B Newman
- Department of Epidemiology, University of Pittsburg, Pittsburg, Pennsylvania
| | - Heidi Tsz Mung Lai
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ina Nemet
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA
| | - Yujin Lee
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA,Department of Food and Nutrition, Myongji University, Korea
| | - Meng Wang
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - W.H. Wilson. Tang
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Oscar Lopez
- Department of Neurology, University of Pittsburg School of Medicine Pittsburg, PA
| | - Stanley L. Hazen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA
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Widasmara D, Panjarwanto DA, Sananta P. The Correlation of Semmes-Weinstein Monofilament Test with the Level of P-75 Neurotrophin as Marker of Nerve Damage in Leprosy. Clin Cosmet Investig Dermatol 2020; 13:399-404. [PMID: 32606877 PMCID: PMC7304681 DOI: 10.2147/ccid.s251356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
Introduction Leprosy is a chronic infectious disease caused by Mycobacterium leprae that causes damage to the peripheral nerve, particularly Schwann cells. Treatment is useful only to kill bacteria but not to recover peripheral nerve damage. However, early detection of peripheral nerve damage is necessary. We examine P-75 neurotrophin (P75NTR) as an indicator of peripheral nerve damage in leprosy with the Semmes–Weinstein monofilament (SWM) test as the comparison. Methods This study uses a quantitative analytic observational study approach with cross-sectional design, conducted at Kediri Leprosy Hospital, Malang, East Java, Indonesia. All leprosy patients had a clinical examination and bacterial index to classify leprosy and then the SWM test to examine the presence of neuropathy in the palms and feet. P75NTR examination uses venous blood samples. An independent t-test was used to compare the SWM and P75NTR scores based on the type of leprosy, and then the Spearman correlation test was used to determine the correlation between SWM scores and P75NTR levels. Results In this study, SWM scores on the soles of the foot and palms and the P75NTR levels were higher in the PB group compared with MB (p<0.05). Also, a significant positive correlation was found between P75NTR and the SWM scores on the palms of the hand (r=0.864; p=0.000) and the soles of the foot (r=0.864; p=0.000). Conclusion There is a strong positive correlation between P75NTR levels and SWM scores, so P75NTR levels are very likely to be a marker of neuropathy in leprosy, but further studies are still needed to examine the specific role of these biomarkers.
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Affiliation(s)
- Dhelya Widasmara
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Regional General Hospital, Malang, Indonesia
| | | | - Panji Sananta
- Orthopaedic and Traumatology Department, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Regional General Hospital, Malang, Indonesia
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Atam C, Orhan Z, Toplu G, Serin M, Karaduman ZO, Öztürk A. Comparison of peripheral nerve repair using ethyl-cyanoacrylate and conventional suture technique in a rat sciatic nerve injury model. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:330-336. [PMID: 32544069 DOI: 10.5152/j.aott.2020.03.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcomes of primary nerve repair using either ethyl-cyanoacrylate or conventional microsuture technique in a rat peripheral nerve injury model. METHODS In this study, a total of 30 Wistar Albino rats weighing between 220 and 275 g were used. The rats were randomly divided into three groups (10 in each), including one control (group 1) and two experimental groups (group 2, conventional microsuture repair; group 3, cyanoacrylate repair). In each group, the sciatic nerve was identified and transected. No further intervention was performed in group 1. The nerve was repaired using the epineural technique with a 10/0 atraumatic nylon in group 2 and synthetic cyanoacrylate adhesive in group 3. At the fifth postoperative week, needle electromyography (EMG) was performed to measure distal latency, combined muscle action potential (CMAP), and motor nerve conduction velocity (MNCV). Following the EMG recordings, animals were euthanized. Nerve samples were collected to evaluate vacuolar degeneration, fibrosis, and foreign body reaction histopathologically. RESULTS In the EMG analysis, mean distal latency was significantly shorter in group 1 (0.85±0.09 ms) than in groups 2 (1.17±0.25 ms) (p=0.0052) and 3 (1.14±0.14 ms) (p=0.0026) while no significant differences existed between groups 2 and 3 (p>0.9999). The mean CMAP was greater in group 1 (10.5±0.35 mV) than in groups 2 (2.86±1.28 mV) (p=0.011) and 3 (2.16±1.34 mV) (p=0.0002), but there was no significant difference between groups 2 and 3 (p>0.9999). The mean MNCV was 53.5±5.95, 39.62±7.31, and 39.84±4.73 mm/sec in groups 1, 2, and 3, respectively. There was a significant difference between groups 1 and 2 (p=0.0052) and between 1 and 3 (p=0.0026), but not between 2 and 3 (p>0.9999). In the histopathological evaluation, the mean vacuolar degeneration score was 0, 2.12, and 1.88 in groups 1, 2, and 3, respectively. No obvious difference was observed between groups 2 and 3 (p=0.743). The mean fibrosis score was 0, 1.62, and 1.77 in groups 1, 2, and 3, respectively. There was no significant difference between groups 2 and 3 (p=0.888). The mean foreign body reaction score was 0, 2.5, and 2.44 in groups 1, 2, and 3, respectively. No difference was present between groups 2 and 3 (p=0.743). CONCLUSION Primary nerve repair using the cyanoacrylate adhesive may provide similar electrophysiological and histopathological results as compared to the conventional microsuture repair.
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Affiliation(s)
- Camettin Atam
- Clinic of Orthopedics and Traumatology, Kırklareli State Hospital, Kırklareli, Turkey
| | - Zafer Orhan
- Department of Orthopedics and Traumatology, Düzce University, School of Medicine, Düzce, Turkey
| | - Gaye Toplu
- Deparment of Plastic Surgery, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Merdan Serin
- Deparment of Plastic Surgery, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Z Okan Karaduman
- Department of Orthopedics and Traumatology, Düzce University, School of Medicine, Düzce, Turkey
| | - Ayhan Öztürk
- Deparment of Neurology, Düzce University, School of Medicine, Düzce, Turkey
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Korkmaz MF, Parlakpinar H, Erdem MN, Ceylan MF, Ediz L, Samdanci E, Kekilli E. The therapeutic efficacy of dexpanthenol on sciatic nerve injury in a rat model. Br J Neurosurg 2020; 34:397-401. [PMID: 32297525 DOI: 10.1080/02688697.2020.1749984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The aim of this study was to evaluate histopathological, functional and bone densitometry examinations of the beneficial effects of dexpanthenol (DEX) on nerve regeneration in a rat model of peripheral nerve crush injury.Methods: Thirty adult Sprague-Dawley rats were divided equally into three groups. A crush injury was simulated in all rats by clamping the right sciatic nerve for one minute. In group 1, one day before the surgical procedure, 500 mg/kg DEX administered via intraperitoneally (ip) was initiated and continued three times in a week during the experiment period as 28 days. In group 2, rats received a dose of 10 mg/kg DEX to investigate possible effects of DEX alone. Group 3 served as the control (sciatic nerve injury) and was not given any drugs.Results: Performance was significantly lower in group 3 compared to the drug treatment groups during the rotarod test (30 rpm and 40 rpm) (p < 0.05). After a while, the rats which were able to remain on the rod was significantly lower in group 3 during the acceleration test (p < 0.05). Hot plate latency test results in group 3 were significantly lower when compared to the other groups (p < 0.05).Conclusion: DEX appears to be useful as a supportive clinical agent for the treatment of pain and nerve damage.
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Affiliation(s)
- Mehmet Fatih Korkmaz
- Department of Orthopaedics and Traumatology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Hakan Parlakpinar
- Department of Pharmacology, Inonu University School of Medicine, Malatya, Turkey
| | - Mehmet Nuri Erdem
- Department of Orthopaedics and Traumatology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Mehmet Fethi Ceylan
- Department of Orthopaedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey
| | - Levent Ediz
- Department of Physical Therapy and Rehabilitation, Van YY University School of Medicine, Van, Turkey
| | - Emine Samdanci
- Department of Pathology, Inonu University School of Medicine, Malatya, Turkey
| | - Ersoy Kekilli
- Department of Nuclear Medicine, Inonu University School of Medicine, Malatya, Turkey
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Liu Y, Wang H. Peripheral nerve injury induced changes in the spinal cord and strategies to counteract/enhance the changes to promote nerve regeneration. Neural Regen Res 2020; 15:189-198. [PMID: 31552884 PMCID: PMC6905333 DOI: 10.4103/1673-5374.265540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Peripheral nerve injury leads to morphological, molecular and gene expression changes in the spinal cord and dorsal root ganglia, some of which have positive impact on the survival of neurons and nerve regeneration, while the effect of others is the opposite. It is crucial to take prompt measures to capitalize on the positive effects of these reactions and counteract the negative impact after peripheral nerve injury at the level of spinal cord, especially for peripheral nerve injuries that are severe, located close to the cell body, involve long distance for axons to regrow and happen in immature individuals. Early nerve repair, exogenous supply of neurotrophic factors and Schwann cells can sustain the regeneration inductive environment and enhance the positive changes in neurons. Administration of neurotrophic factors, acetyl-L-carnitine, N-acetyl-cysteine, and N-methyl-D-aspartate receptor antagonist MK-801 can help counteract axotomy-induced neuronal loss and promote regeneration, which are all time-dependent. Sustaining and reactivation of Schwann cells after denervation provides another effective strategy. FK506 can be used to accelerate axonal regeneration of neurons, especially after chronic axotomy. Exploring the axotomy-induced changes after peripheral nerve injury and applying protective and promotional measures in the spinal cord which help to retain a positive functional status for neuron cell bodies will inevitably benefit regeneration of the peripheral nerve and improve functional outcomes.
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Affiliation(s)
- Yan Liu
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Vela FJ, Martínez-Chacón G, Ballestín A, Campos JL, Sánchez-Margallo FM, Abellán E. Animal models used to study direct peripheral nerve repair: a systematic review. Neural Regen Res 2020; 15:491-502. [PMID: 31571661 PMCID: PMC6921335 DOI: 10.4103/1673-5374.266068] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective: Peripheral nerve repair is required after traumatic injury. This common condition represents a major public health problem worldwide. Recovery after nerve repair depends on several factors, including the severity of the injury, the nerve involved, and the surgeon’s technical skills. Despite the precise microsurgical repair of nerve lesions, adequate functional recovery is not always achieved and, therefore, the regeneration process and surgical techniques are still being studied. Pre-clinical animal models are essential for this research and, for this reason, the focus of the present systematic review (according to the PRISMA statement) was to analyze the different animal models used in pre-clinical peripheral nerve repair studies. Data sources: Original articles, published in English from 2000 to 2018, were collected using the Web of Science, Scopus, and PubMed databases. Data selection: Only preclinical trials on direct nerve repair were included in this review. The articles were evaluated by the first two authors, in accordance with predefined data fields. Outcome measures: The primary outcomes included functional motor abilities, daily activity and regeneration rate. Secondary outcomes included coaptation technique and animal model. Results: This review yielded 267 articles, of which, after completion of the screening, 49 studies were analyzed. There were 1425 animals in those 49 studies, being rats, mice, guinea pigs, rabbits, cats and dogs the different pre-clinical models. The nerves used were classified into three groups: head and neck (11), forelimb (8) and hindlimb (30). The techniques used to perform the coaptation were: microsuture (46), glue (12), laser (8) and mechanical (2). The follow-up examinations were histology (43), electrophysiological analysis (24) and behavioral observation (22). Conclusion: The most widely used animal model in the study of peripheral nerve repair is the rat. Other animal models are also used but the cost-benefit of the rat model provides several strengths over the others. Suture techniques are currently the first option for nerve repair, but the use of glues, lasers and bioengineering materials is increasing. Hence, further research in this field is required to improve clinical practice.
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Affiliation(s)
- Francisco Javier Vela
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | | | - Alberto Ballestín
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - José Luis Campos
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | | | - Elena Abellán
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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L-Carnitine and Acetyl-L-carnitine Roles and Neuroprotection in Developing Brain. Neurochem Res 2017; 42:1661-1675. [PMID: 28508995 DOI: 10.1007/s11064-017-2288-7] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 12/30/2022]
Abstract
L-Carnitine functions to transport long chain fatty acyl-CoAs into the mitochondria for degradation by β-oxidation. Treatment with L-carnitine can ameliorate metabolic imbalances in many inborn errors of metabolism. In recent years there has been considerable interest in the therapeutic potential of L-carnitine and its acetylated derivative acetyl-L-carnitine (ALCAR) for neuroprotection in a number of disorders including hypoxia-ischemia, traumatic brain injury, Alzheimer's disease and in conditions leading to central or peripheral nervous system injury. There is compelling evidence from preclinical studies that L-carnitine and ALCAR can improve energy status, decrease oxidative stress and prevent subsequent cell death in models of adult, neonatal and pediatric brain injury. ALCAR can provide an acetyl moiety that can be oxidized for energy, used as a precursor for acetylcholine, or incorporated into glutamate, glutamine and GABA, or into lipids for myelination and cell growth. Administration of ALCAR after brain injury in rat pups improved long-term functional outcomes, including memory. Additional studies are needed to better explore the potential of L-carnitine and ALCAR for protection of developing brain as there is an urgent need for therapies that can improve outcome after neonatal and pediatric brain injury.
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N-Acetylcysteine Prevents Retrograde Motor Neuron Death after Neonatal Peripheral Nerve Injury. Plast Reconstr Surg 2017; 139:1105e-1115e. [DOI: 10.1097/prs.0000000000003257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ozbay I, Ital I, Kucur C, Akcılar R, Deger A, Aktas S, Oghan F. Effects of ozone therapy on facial nerve regeneration. Braz J Otorhinolaryngol 2017; 83:168-175. [PMID: 27174776 PMCID: PMC9442687 DOI: 10.1016/j.bjorl.2016.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/05/2022] Open
Abstract
Introduction Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration. Objective We aimed to evaluate the effect of ozone therapy on facial nerve regeneration. Methods Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy. Results Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups. Conclusion We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats.
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Affiliation(s)
- Isa Ozbay
- Dumlupinar University, Department of Otolaryngology, Kutahya, Turkey.
| | - Ilker Ital
- Dumlupinar University, Department of Anesthesiology and Reanimation, Kutahya, Turkey
| | - Cuneyt Kucur
- Dumlupinar University, Department of Otolaryngology, Kutahya, Turkey
| | - Raziye Akcılar
- Dumlupinar University, Department of Physiology, Kutahya, Turkey
| | - Aysenur Deger
- Dumlupinar University, Department of Pathology, Kutahya, Turkey
| | - Savas Aktas
- Mersin University, Department of Histology and Embryology, Mersin, Turkey
| | - Fatih Oghan
- Dumlupinar University, Department of Otolaryngology, Kutahya, Turkey
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Possible promoting effects of melatonin, leptin and alcar on regeneration of the sciatic nerve. J Chem Neuroanat 2017; 81:34-41. [PMID: 28163216 DOI: 10.1016/j.jchemneu.2017.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/18/2017] [Accepted: 02/01/2017] [Indexed: 11/20/2022]
Abstract
Peripheral nerve injury is a widespread and disabling condition that can impair the individual's daily life. Studies involving medications that may positively affect peripheral nerve regeneration are rare. The aim of this study was to investigate new treatments after peripheral nerve injury using various neuroprotectants, melatonin, alcar and leptin, in the regenerative process in an experimental rat model. Wistar albino rats were randomly divided into eight groups containing equal number of animals. Intraperitoneal injection of melatonin (50mg/kg, for 21days), leptin (1mg/kg, for 21days) and acetyl-l-carnitine (50mg/kg, for six weeks) was performed postoperatively. Histological and electromyographical assessments of the regenerated nerves were performed 12 weeks after surgery. Stereological analysis was performed to estimate myelinated and unmyelinated axon numbers, surface area, myelin thickness and the myelin thickness/axon diameter ratio for each group. The results showed that only alcar has a beneficial effect on the regeneration of unmyelinated axons. Neither melatonin and leptin nor alcar were observed to have any therapeutic effect on the regeneration of myelinated axons. Alcar therapy has a positive effect on the regeneration of unmyelinated fiber in the sciatic nerve. However, the same effect was not observed in myelinated nerve fibers after intraperitoneal application of melatonin and leptin.
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Korkmaz MF, Parlakpınar H, Ceylan MF, Ediz L, Şamdancı E, Kekilli E, Sağır M. The Effect of Sildenafil on Recuperation from Sciatic Nerve Injury in Rats. Balkan Med J 2016; 33:204-11. [PMID: 27403391 DOI: 10.5152/balkanmedj.2016.14701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Severe functional and anatomical defects can be detected after the peripheral nerve injury. Pharmacological approaches are preferred rather than surgical treatment in the treatment of nerve injuries. AIMS The aim of this study is to perform histopathological, functional and bone densitometry examinations of the effects of sildenafil on nerve regeneration in a rat model of peripheral nerve crush injury. STUDY DESIGN Animal experiment. METHODS The study included a total of thirty adult Sprague-Dawley rats that were divided into three groups of ten rats each. In all rats, a crush injury was created by clamping the right sciatic nerve for one minute. One day before the procedure, rats in group 1 were started on a 28-day treatment consisting of a daily dose of 20 mg/kg body weight sildenafil citrate given orally via a nasogastric tube, while the rats in group 2 were started on an every-other-day dose of 10 mg/kg body weight sildenafil citrate. Rats from group 3 were not administered any drugs. Forty-two days after the nerve damage was created, functional and histopathological examination of both sciatic nerves and bone densitometric evaluation of the extremities were conducted. RESULTS During the rotarod test, rats from group 3 spent the least amount of time on the rod compared to the drug treatment groups at speeds of 20 rpm, 30 rpm and 40 rpm. In addition, the duration for which each animal could stay on the rod throughout the accelerod test significantly reduced in rats from group 3 compared to rats from groups 1 and 2 in the 4-min test. For the hot-plate latency time, there were no differences among the groups in either the basal level or after sciatic nerve injury. Moreover, there was no significant difference between the groups in terms of the static sciatic index (SSI) on the 42(nd) day (p=0.147). The amplitude was better evaluated in group 1 compared to the other two groups (p<0.05). Under microscopic evaluation, we observed the greatest amount of nerve regeneration in group 1 and the lowest in group 3. However, this difference was not statistically significant. Moreover, there was no significant difference in the bone mineral density (BMD) levels among the groups. CONCLUSION We believe that a daily single dose of sildenafil plays an important role in the treatment of sciatic nerve damage and bone healing and thus can be used as supportive clinical treatment.
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Affiliation(s)
- Mehmet Fatih Korkmaz
- Department of Orthopaedics and Traumatology, İnönü University School of Medicine, Malatya, Turkey
| | - Hakan Parlakpınar
- Department of Pharmacology, İnönü University School of Medicine, Malatya, Turkey
| | - Mehmet Fethi Ceylan
- Department of Orthopaedics and Traumatology, İnönü University School of Medicine, Malatya, Turkey
| | - Levent Ediz
- Department of Physical Therapy and Rehabilitation, Van Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Emine Şamdancı
- Department of Pathology, İnönü University School of Medicine, Malatya, Turkey
| | - Ersoy Kekilli
- Department of Nuclear Medicine, İnönü University School of Medicine, Malatya, Turkey
| | - Mustafa Sağır
- Department of Pharmacology, İnönü University School of Medicine, Malatya, Turkey
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Guo J, Li Y, Chen Z, He Z, Zhang B, Li Y, Hu J, Han M, Xu Y, Li Y. N-acetylcysteine treatment following spinal cord trauma reduces neural tissue damage and improves locomotor function in mice. Mol Med Rep 2015; 12:37-44. [PMID: 25738883 PMCID: PMC4438879 DOI: 10.3892/mmr.2015.3390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 11/12/2014] [Indexed: 01/11/2023] Open
Abstract
Following spinal cord trauma, mitochondrial dysfunction associated with increased oxidative stress is a critical event leading to leukocyte inflammatory responses, neuronal cell death and demyelination, contributing to permanent locomotor and neurological disability. The present study demonstrated that the mitochondrial enhancer N-acetylcysteine (NAC) may restore redox balance via enhancement of mitochondrial respiratory activity following traumatic spinal cord injury (SCI). In addition, NAC ameliorates oxidative stress-induced neuronal loss, demyelination, leukocyte infiltration and inflammatory mediator expression and improves long-term locomotor function. Furthermore, neuronal survival and neurological recovery are significantly correlated with increased mitochondrial bioenergetics in SCI following treatment with NAC. Therefore, NAC may represent a potential therapeutic agent for preserving mitochondrial dynamics and integrity following traumatic SCI.
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Affiliation(s)
- Jian Guo
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Yiqiao Li
- Central Laboratory, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Zhong Chen
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Zhennian He
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Bin Zhang
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Yonghuan Li
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Jianghua Hu
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Mingyuan Han
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Yuanlin Xu
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
| | - Yongfu Li
- Department of Orthopaedic Surgery, Ningbo Beilun People Hospital, Ningbo, Zhejiang 315800, P.R. China
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Chan KM, Gordon T, Zochodne DW, Power HA. Improving peripheral nerve regeneration: from molecular mechanisms to potential therapeutic targets. Exp Neurol 2014; 261:826-35. [PMID: 25220611 DOI: 10.1016/j.expneurol.2014.09.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022]
Abstract
Peripheral nerve injury is common especially among young individuals. Although injured neurons have the ability to regenerate, the rate is slow and functional outcomes are often poor. Several potential therapeutic agents have shown considerable promise for improving the survival and regenerative capacity of injured neurons. These agents are reviewed within the context of their molecular mechanisms. The PI3K/Akt and Ras/ERK signaling cascades play a key role in neuronal survival. A number of agents that target these pathways, including erythropoietin, tacrolimus, acetyl-l-carnitine, n-acetylcysteine and geldanamycin have been shown to be effective. Trk receptor signaling events that up-regulate cAMP play an important role in enhancing the rate of axonal outgrowth. Agents that target this pathway including rolipram, testosterone, fasudil, ibuprofen and chondroitinase ABC hold considerable promise for human application. A tantalizing prospect is to combine different molecular targeting strategies in complementary pathways to optimize their therapeutic effects. Although further study is needed prior to human trials, these modalities could open a new horizon in the clinical arena that has so far been elusive.
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Affiliation(s)
- K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada; Centre for Neuroscience, University of Alberta, Canada.
| | - Tessa Gordon
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada; Centre for Neuroscience, University of Alberta, Canada; Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Douglas W Zochodne
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Hollie A Power
- Division of Plastic Surgery, University of Alberta, Canada
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Gu X, Ding F, Williams DF. Neural tissue engineering options for peripheral nerve regeneration. Biomaterials 2014; 35:6143-56. [PMID: 24818883 DOI: 10.1016/j.biomaterials.2014.04.064] [Citation(s) in RCA: 411] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/16/2014] [Indexed: 12/19/2022]
Abstract
Tissue engineered nerve grafts (TENGs) have emerged as a potential alternative to autologous nerve grafts, the gold standard for peripheral nerve repair. Typically, TENGs are composed of a biomaterial-based template that incorporates biochemical cues. A number of TENGs have been used experimentally to bridge long peripheral nerve gaps in various animal models, where the desired outcome is nerve tissue regeneration and functional recovery. So far, the translation of TENGs to the clinic for use in humans has met with a certain degree of success. In order to optimize the TENG design and further approach the matching of TENGs with autologous nerve grafts, many new cues, beyond the traditional ones, will have to be integrated into TENGs. Furthermore, there is a strong requirement for monitoring the real-time dynamic information related to the construction of TENGs. The aim of this opinion paper is to specifically and critically describe the latest advances in the field of neural tissue engineering for peripheral nerve regeneration. Here we delineate new attempts in the design of template (or scaffold) materials, especially in the context of biocompatibility, the choice and handling of support cells, and growth factor release systems. We further discuss the significance of RNAi for peripheral nerve regeneration, anticipate the potential application of RNAi reagents for TENGs, and speculate on the possible contributions of additional elements, including angiogenesis, electrical stimulation, molecular inflammatory mediators, bioactive peptides, antioxidant reagents, and cultured biological constructs, to TENGs. Finally, we consider that a diverse array of physicochemical and biological cues must be orchestrated within a TENG to create a self-consistent coordinated system with a close proximity to the regenerative microenvironment of the peripheral nervous system.
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Affiliation(s)
- Xiaosong Gu
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China.
| | - Fei Ding
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China
| | - David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, NC, USA.
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Karalija A, Novikova LN, Kingham PJ, Wiberg M, Novikov LN. The effects of N-acetyl-cysteine and acetyl-L-carnitine on neural survival, neuroinflammation and regeneration following spinal cord injury. Neuroscience 2014; 269:143-51. [PMID: 24680856 DOI: 10.1016/j.neuroscience.2014.03.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
Abstract
Traumatic spinal cord injury induces a long-standing inflammatory response in the spinal cord tissue, leading to a progressive apoptotic death of spinal cord neurons and glial cells. We have recently demonstrated that immediate treatment with the antioxidants N-acetyl-cysteine (NAC) and acetyl-l-carnitine (ALC) attenuates neuroinflammation, induces axonal sprouting, and reduces the death of motoneurons in the vicinity of the trauma zone 4weeks after initial trauma. The objective of the current study was to investigate the effects of long-term antioxidant treatment on the survival of descending rubrospinal neurons after spinal cord injury in rats. It also examines the short- and long-term effects of treatment on apoptosis, inflammation, and regeneration in the spinal cord trauma zone. Spinal cord hemisection performed at the level C3 induced a significant loss of rubrospinal neurons 8 weeks after injury. At 2 weeks, an increase in the expression of the apoptosis-associated markers BCL-2-associated X protein (BAX) and caspase 3, as well as the microglial cell markers OX42 and ectodermal dysplasia 1 (ED1), was seen in the trauma zone. After 8 weeks, an increase in immunostaining for OX42 and the serotonin marker 5HT was detected in the same area. Antioxidant therapy reduced the loss of rubrospinal neurons by approximately 50%. Treatment also decreased the expression of BAX, caspase 3, OX42 and ED1 after 2 weeks. After 8 weeks, treatment decreased immunoreactivity for OX42, whereas it was increased for 5HT. In conclusion, this study provides further insight in the effects of treatment with NAC and ALC on descending pathways, as well as short- and long-term effects on the spinal cord trauma zone.
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Affiliation(s)
- A Karalija
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, SE-901 87 Umeå, Sweden; Department of Surgical and Perioperative Science, Section of Hand and Plastic Surgery, Umeå University, SE-901 87 Umeå, Sweden.
| | - L N Novikova
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, SE-901 87 Umeå, Sweden
| | - P J Kingham
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, SE-901 87 Umeå, Sweden
| | - M Wiberg
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, SE-901 87 Umeå, Sweden; Department of Surgical and Perioperative Science, Section of Hand and Plastic Surgery, Umeå University, SE-901 87 Umeå, Sweden
| | - L N Novikov
- Department of Integrative Medical Biology, Section of Anatomy, Umeå University, SE-901 87 Umeå, Sweden
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Onofrj M, Ciccocioppo F, Varanese S, di Muzio A, Calvani M, Chiechio S, Osio M, Thomas A. Acetyl-L-carnitine: from a biological curiosity to a drug for the peripheral nervous system and beyond. Expert Rev Neurother 2014; 13:925-36. [DOI: 10.1586/14737175.2013.814930] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hart AM, Terenghi G, Wiberg M. Neuronal death after peripheral nerve injury and experimental strategies for neuroprotection. Neurol Res 2013; 30:999-1011. [DOI: 10.1179/174313208x362479] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rajaram A, Chen XB, Schreyer DJ. Strategic Design and Recent Fabrication Techniques for Bioengineered Tissue Scaffolds to Improve Peripheral Nerve Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2012; 18:454-67. [DOI: 10.1089/ten.teb.2012.0006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ajay Rajaram
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Xiong-Biao Chen
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | - David J. Schreyer
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Jang CH, Cho YB, Choi CH. Effect of ginkgo biloba extract on recovery after facial nerve crush injury in the rat. Int J Pediatr Otorhinolaryngol 2012; 76:1823-6. [PMID: 23021527 DOI: 10.1016/j.ijporl.2012.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 08/28/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Many pharmacological agents have shown successful results in experimental crush injury of the peripheral nerve. To date, therapeutic effect of ginkgo biloba extract (GBE) on the peripheral nerve crush injury of rats has been rarely reported, moreover, neuroprotective effect on the facial nerve crush injury has not been reported. MATERIALS AND METHODS Prospective functional recovery, using a vibrissae movement and electrophysiological analysis of recovery 4 weeks after the facial nerve crush in adult rats, and comparison with randomized intraperitoneal injection of either GBE or control phosphate buffered saline. RESULTS Relative to the control group (26 days post operation), administration of GBE significantly accelerated the recovery of vibrissae orientation to 11.7 days post the operation. A significant functional recovery was observed by postoperative 2nd week in the experimental group. The recovery of threshold and conduction velocity, postoperative 4th week in the experimental group, showed statistically significant difference compared to that of the control group. CONCLUSION From this result, intraperitoneal injection of GBE has been found effective in promoting the regeneration of the nerve in an experimental facial nerve crush rat model. Further studies, including morphological and molecular analyses, are necessary to clarify the mechanisms of GBE on the facial nerve crush.
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Affiliation(s)
- Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea.
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Neuroprotective effects of N-acetyl-cysteine and acetyl-L-carnitine after spinal cord injury in adult rats. PLoS One 2012; 7:e41086. [PMID: 22815926 PMCID: PMC3398872 DOI: 10.1371/journal.pone.0041086] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/18/2012] [Indexed: 11/19/2022] Open
Abstract
Following the initial acute stage of spinal cord injury, a cascade of cellular and inflammatory responses will lead to progressive secondary damage of the nerve tissue surrounding the primary injury site. The degeneration is manifested by loss of neurons and glial cells, demyelination and cyst formation. Injury to the mammalian spinal cord results in nearly complete failure of the severed axons to regenerate. We have previously demonstrated that the antioxidants N-acetyl-cysteine (NAC) and acetyl-L-carnitine (ALC) can attenuate retrograde neuronal degeneration after peripheral nerve and ventral root injury. The present study evaluates the effects of NAC and ALC on neuronal survival, axonal sprouting and glial cell reactions after spinal cord injury in adult rats. Tibial motoneurons in the spinal cord were pre-labeled with fluorescent tracer Fast Blue one week before lumbar L5 hemisection. Continuous intrathecal infusion of NAC (2.4 mg/day) or ALC (0.9 mg/day) was initiated immediately after spinal injury using Alzet 2002 osmotic minipumps. Neuroprotective effects of treatment were assessed by counting surviving motoneurons and by using quantitative immunohistochemistry and Western blotting for neuronal and glial cell markers 4 weeks after hemisection. Spinal cord injury induced significant loss of tibial motoneurons in L4–L6 segments. Neuronal degeneration was associated with decreased immunostaining for microtubular-associated protein-2 (MAP2) in dendritic branches, synaptophysin in presynaptic boutons and neurofilaments in nerve fibers. Immunostaining for the astroglial marker GFAP and microglial marker OX42 was increased. Treatment with NAC and ALC rescued approximately half of the motoneurons destined to die. In addition, antioxidants restored MAP2 and synaptophysin immunoreactivity. However, the perineuronal synaptophysin labeling was not recovered. Although both treatments promoted axonal sprouting, there was no effect on reactive astrocytes. In contrast, the microglial reaction was significantly attenuated. The results indicate a therapeutic potential for NAC and ALC in the early treatment of traumatic spinal cord injury.
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Karsidag S, Akcal A, Sahin S, Karsidag S, Kabukcuoglu F, Ugurlu K. Neurophysiological and morphological responses to treatment with acetyl-L-carnitine in a sciatic nerve injury model: preliminary data. J Hand Surg Eur Vol 2012; 37:529-36. [PMID: 22080531 DOI: 10.1177/1753193411426969] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the effects of acetyl-L-carnitine (ALCAR) on the recovery of sciatic nerve injuries in rats. Sprague Dawley rats were randomized to two groups: ALCAR treated (for 14 days) and control. Each group was divided into three subgroups: distal transection, proximal transection, and grafted. Distal latencies, amplitudes, and motor nerve conduction velocities were measured. In the third month, biopsies were taken and examined under light microscopy. Electrophysiological measurements demonstrated that regeneration occurred earlier and was better in the ALCAR group, particularly in the distal transection subgroup. Better results were obtained in the distal transection subgroup in terms of axonal regeneration compared with the proximal transection and grafted subgroups because the regenerating segment was shorter. ALCAR enhanced the quality of neural recovery at the different levels and in different types of repair, and led to a decline in nerve death.
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Affiliation(s)
- S Karsidag
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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Abstract
Following distal nerve injury significant sensory neuronal cell death occurs in the dorsal root ganglia, while after a more proximal injury, such as brachial plexus injury, a sizeable proportion of spinal motoneurons also undergo cell death. This phenomenon has been undervalued for a long time, but it has a significant role in the lack of functional recuperation, as neuronal cells cannot divide and be replaced, hence the resulting nerve regeneration is usually suboptimal. It is now accepted that this cell death is due to apoptosis, as indicated by analysis of specific genes involved in the apoptotic signalling cascade. Immediate nerve repair, either by direct suturing or nerve grafting, gives a degree of neuroprotection, but this approach does not fully prevent neuronal cell death and importantly it is not always possible. Our work has shown that pharmacological intervention using either acetyl-L-carnitine (ALCAR) or N-acetyl-cysteine (NAC) give complete neuroprotection in different types of peripheral nerve injury. Both compounds are clinically safe and experimental work has defined the best dose, timing after injury and duration of administration. The efficacy of neuroprotection of ALCAR and NAC can be monitored non-invasively using MRI, as demonstrated experimentally and more recently by clinical studies of the volume of dorsal root ganglia. Translation to patients of this pharmacological intervention requires further work, but the available results indicate that this approach will help to secure a better functional outcome following peripheral nerve injury and repair.
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Affiliation(s)
- Giorgio Terenghi
- Blond McIndoe Laboratories, Biomedicine, University of Manchester, Manchester Academic Health Science Centre, UK.
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Martínez de Albornoz P, Delgado PJ, Forriol F, Maffulli N. Non-surgical therapies for peripheral nerve injury. Br Med Bull 2011; 100:73-100. [PMID: 21429947 DOI: 10.1093/bmb/ldr005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Non-surgical approaches have been developed to enhance nerve recovery, which are complementary to surgery and are an adjunct to the reinnervation process. SOURCES OF DATA A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the keywords 'peripheral nerve injury' and 'treatment'. AREAS OF CONTROVERSY Most of the conservative therapies are focused to control neuropathic pain after nerve tissue damage. Only physical therapy modalities have been studied in humans and their effectiveness is not proved. GROWING POINTS Many modalities have been experimented with to promote nerve healing and restore function in animal models and in vitro studies. Despite this, none have been actually translated into clinical practice. AREAS TIMELY FOR DEVELOPING RESEARCH The hypotheses proved in animals and in vitro should be translated to human clinical practice.
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Affiliation(s)
- Pilar Martínez de Albornoz
- Department of Trauma and Orthopaedic Surgery, FREMAP Hospital, Ctra de Pozuelo 61, 28220 Majadahonda, Madrid, Spain
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Wilson ADH, Hart A, Wiberg M, Terenghi G. Acetyl-l-carnitine increases nerve regeneration and target organ reinnervation - a morphological study. J Plast Reconstr Aesthet Surg 2009; 63:1186-95. [PMID: 19664977 DOI: 10.1016/j.bjps.2009.05.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/04/2009] [Accepted: 05/21/2009] [Indexed: 11/19/2022]
Abstract
Peripheral nerve injury frequently results in functional morbidity since standard management fails to adequately address many of the neurobiological hurdles to optimal regeneration. Neuronal survival and regeneration are neurotrophin dependent and require increased aerobic capacity. Acetyl-l-carnitine (ALCAR) facilitates this need and prevents neuronal loss. ALCAR is clinically safe and is shown here to significantly improve nerve regeneration and target organ reinnervation. Two groups of five rats underwent sciatic nerve division followed by immediate repair. One group received parenteral ALCAR (50mg/kg/day) from time of operation until termination at 12 weeks. A 'sham treatment' group received normal saline. A third group was left unoperated and did not receive any treatment. A segment of nerve was harvested between 5mm proximal and 10mm distal to the repair in operated groups, and at the corresponding level in the unoperated group. Mean axonal count in normal, non-axotomised nerve was 14,720 (SD 2378). That of the saline group (17,217 SD 1808) was not significantly different from normal nerve (P=0.0985). Mean number of myelinated axons in the ALCAR group (24,460 SD 3750) was significantly greater than both sham group (P<0.01) and normal nerve (P=0.0012). Mean myelin thickness in the saline treated group (0.408 microm SD 0.067 microm) was less than normal nerve (0.770 microm SD 0.143 microm) (P<0.001). Mean myelin thickness in the ALCAR group (0.627 microm SD 0.052 microm) was greater than the sham (saline) group (P<0.01) and not statistically different from normal nerve (P=0.07). ALCAR increased dermal PGP9.5 staining by 210% compared to sham treatment (P<0.0001) and significantly reduced the mean percentage weight loss in gastrocnemius muscle (ALCAR group 0.203% vs. 0.312% in sham group P=0.015). ALCAR not only increases the number of regenerating nerve fibres but also morphologically improves the quality of regeneration and target organ reinnervation. Adjuvant ALCAR treatment may improve both sensory and motor outcomes and merits further investigation.
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Affiliation(s)
- Andrew D H Wilson
- Blond McIndoe Research Laboratories, Tissue Injury and Repair Group, University of Manchester, Room 3.106 Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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[Retrospective monocentric comparative evaluation by sifting of vein grafts versus nerve grafts in palmar digital nerves defects. Report of 32 cases]. ANN CHIR PLAST ESTH 2009; 55:19-34. [PMID: 19556049 DOI: 10.1016/j.anplas.2009.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/13/2009] [Indexed: 02/04/2023]
Abstract
AIM Palmar digital nerves defects can be treated by conventional nerve grafts or by means of a conduit, such as a vein. We compared a vein graft technique to a nerve graft technique in a retrospective monocentric study. MATERIAL AND METHOD A surgeon who was not involved in the treatment reviewed blind 15 nerve grafts and 17 vein grafts. The evaluation concerned sensitivity, pain, donor site morbidity, social integration and autoassessment of the benefits by the patient. Data were compacted by a sifting method eliminating bad results. The classical functional scores (British Medical Research Council, Möberg, Chanson, Alnot, Dumontier) were also used. RESULTS The evaluation was carried out at least 11 months after treatment. Defect was never greater than 30 mm. After sifting, vein grafts appeared less efficient than nerve grafts (41% good results against 73%), except in emergencies (86% good results). CONCLUSION For defect loss of no more than 30 mm in emergencies, the authors propose to use vein grafting. In other situations, the surgeon must take into account the patient's profile and the hemi-pulp concerned, dominant or non-dominant, before opting for a nerve or a vein graft.
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Kalender AM, Dogan A, Bakan V, Yildiz H, Gokalp MA, Kalender M. Effect of Zofenopril on regeneration of sciatic nerve crush injury in a rat model. J Brachial Plex Peripher Nerve Inj 2009; 4:6. [PMID: 19508704 PMCID: PMC2700796 DOI: 10.1186/1749-7221-4-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/09/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zofenopril is an antioxidant agent which has been shown to have beneficial effects in hypertension and heart failure. The aim of this study was to test the effects of Zofenopril on nerve regeneration and scarring in a rat model of peripheral nerve crush injury. METHODS Twenty-one adult Sprague-Dawley rats underwent a surgical procedure involving right sciatic nerve crush injury. 15 mg/kg Zofenopril was administered orally to seven rats in group Z for seven days. Seven rats in group S received saline orally for seven days. Seven rats in the control group C received no drug after crush injury. Fourteenth and 42nd days after injury, functional and electromyography assessments of nerves were performed. Functional recovery was analyzed using a walking track assessment, and quantified using the sciatic functional index (SFI). After these evaluations, all rats were sacrificed and microscopic evaluations were performed. RESULTS The Sciatic functional Index (SFI) in group Z on 14th day is different significantly from group S and group C (p = 0.037). But on 42nd day there was no difference between groups (p = 0.278). The statistical analyses of electromyelographic (EMG) studies showed that the latency in group Z is significantly different from group S (p = 0.006) and group C (p = 0.045). But on 42nd day there was no difference between groups like SFI (p = 0.147). The amplitude was evaluated better in group Z than others (p < 0.05). In microscopic evaluation, we observed the highest number of nerve regeneration in the group Z and the lowest in the group C. But it was not significant statistically. CONCLUSION Our results demonstrate that Zofenopril promotes the regeneration of peripheral nerve injuries in rat models.
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Affiliation(s)
- Ali Murat Kalender
- Department of Orthopedics and Traumatology, Kahramanmaras Sutcu Imam University, Medical Faculty, K. Maras, Turkey.
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Abstract
Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.
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Affiliation(s)
- L B Dahlin
- Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden.
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Kostopoulos VK, Davis CL, Terzis JK. Effects of acetylo-L-carnitine in end-to-side neurorrhaphy: A pilot study. Microsurgery 2009; 29:456-63. [DOI: 10.1002/micr.20639] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lanni C, Lenzken SC, Pascale A, Del Vecchio I, Racchi M, Pistoia F, Govoni S. Cognition enhancers between treating and doping the mind. Pharmacol Res 2008; 57:196-213. [DOI: 10.1016/j.phrs.2008.02.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 02/07/2008] [Accepted: 02/08/2008] [Indexed: 11/25/2022]
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Prevention of paclitaxel-evoked painful peripheral neuropathy by acetyl-L-carnitine: effects on axonal mitochondria, sensory nerve fiber terminal arbors, and cutaneous Langerhans cells. Exp Neurol 2007; 210:229-37. [PMID: 18078936 DOI: 10.1016/j.expneurol.2007.11.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 10/28/2007] [Accepted: 11/02/2007] [Indexed: 11/21/2022]
Abstract
Prophylactic treatment with acetyl-L-carnitine (ALCAR) prevents the neuropathic pain syndrome that is evoked by the chemotherapeutic agent, paclitaxel. The paclitaxel-evoked pain syndrome is associated with degeneration of the intraepidermal terminal arbors of primary afferent neurons, with the activation of cutaneous Langerhans cells, and with an increased incidence of swollen and vacuolated axonal mitochondria in A-fibers and C-fibers. Previous work suggests that ALCAR is neuroprotective in other nerve injury models and that it improves mitochondrial dysfunction. Thus, we examined whether the prophylactic efficacy of ALCAR was associated with the prevention of intraepidermal terminal arbor degeneration, the inhibition of Langerhans cell activation, or the inhibition of swelling and vacuolation of axonal mitochondria. In animals with a confirmed ALCAR effect, we found no evidence of a neuroprotective effect on the paclitaxel-evoked degeneration of sensory terminal arbors or an inhibition of the paclitaxel-evoked activation of Langerhans cells. However, ALCAR treatment completely prevented the paclitaxel-evoked increase in the incidence of swollen and vacuolated C-fiber mitochondria, while having no effect on the paclitaxel-evoked changes in A-fiber mitochondria. Our results suggest that the efficacy of prophylactic ALCAR treatment against the paclitaxel-evoked pain may be related to a protective effect on C-fiber mitochondria.
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West CA, Hart AM, Terenghi G, Wiberg M. Analysis of the dose-response of N-acetylcysteine in the prevention of sensory neuronal loss after peripheral nerve injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 100:29-31. [PMID: 17985540 DOI: 10.1007/978-3-211-72958-8_6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND N-Acetylcysteine (NAC) is a safe pharmaceutical agent known to protect cells from oxidative damage. Following peripheral nerve transection, NAC has been found to eliminate sensory neuronal loss. This study examines the dose-response relationship of NAC in preventing neuronal death. METHODS AND FINDINGS The rat sciatic nerve transection model was used, and stereological quantification of sensory neuron survival carried out at two weeks post-axotomy. NAC was administered systemically as an intraperitoneal injection to five groups of rats at a range of doses (1-300 mg/kg/day). Significant neuronal loss was observed in the 1 mg/kg/day dosage group (18.5% loss, p = 0.067 vs. sham treatment). A degree of neuroprotection occurred with 10 mg/kg/day (9.1% loss, p < 0.005 vs. control), whilst there was no significant loss with either 150 or 300 mg/kg/day. CONCLUSIONS The prevention of sensory neuronal loss with NAC is dose dependent and effective over a wide therapeutic range. This analysis confirms the efficacy of systemic administration and provides a dose framework with which NAC has clinical potential to improve outcome after peripheral nerve trauma.
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Affiliation(s)
- C A West
- Blond McIndoe Research Laboratories, University of Manchester, Manchester, UK
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