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Isaacs JE, Drinane JJ. Nerve Allografts: Current Utility and Future Directions. Hand Clin 2024; 40:357-367. [PMID: 38972680 DOI: 10.1016/j.hcl.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Processed nerve allograft is a widely accepted tool for reconstructing peripheral nerve defects. Repair parameters that need to be considered include gap length, nerve diameter, nerve type (motor, sensory, or mixed), and the soft tissue envelope. Although the use of processed nerve allograft must be considered based on each unique clinical scenario, a rough algorithm can be formed based on the available animal and clinical literature. This article critically reviews the current surgical algorithm, defines the role of processed nerve allograft compared with nerve autograft, and discusses how this role may change in the future.
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Affiliation(s)
- Jonathan E Isaacs
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, Richmond, VA, USA.
| | - James J Drinane
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, Richmond, VA, USA
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Redolfi Riva E, Özkan M, Contreras E, Pawar S, Zinno C, Escarda-Castro E, Kim J, Wieringa P, Stellacci F, Micera S, Navarro X. Beyond the limiting gap length: peripheral nerve regeneration through implantable nerve guidance conduits. Biomater Sci 2024; 12:1371-1404. [PMID: 38363090 DOI: 10.1039/d3bm01163a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Peripheral nerve damage results in the loss of sensorimotor and autonomic functions, which is a significant burden to patients. Furthermore, nerve injuries greater than the limiting gap length require surgical repair. Although autografts are the preferred clinical choice, their usage is impeded by their limited availability, dimensional mismatch, and the sacrifice of another functional donor nerve. Accordingly, nerve guidance conduits, which are tubular scaffolds engineered to provide a biomimetic environment for nerve regeneration, have emerged as alternatives to autografts. Consequently, a few nerve guidance conduits have received clinical approval for the repair of short-mid nerve gaps but failed to regenerate limiting gap damage, which represents the bottleneck of this technology. Thus, it is still necessary to optimize the morphology and constituent materials of conduits. This review summarizes the recent advances in nerve conduit technology. Several manufacturing techniques and conduit designs are discussed, with emphasis on the structural improvement of simple hollow tubes, additive manufacturing techniques, and decellularized grafts. The main objective of this review is to provide a critical overview of nerve guidance conduit technology to support regeneration in long nerve defects, promote future developments, and speed up its clinical translation as a reliable alternative to autografts.
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Affiliation(s)
- Eugenio Redolfi Riva
- The Biorobotic Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
| | - Melis Özkan
- Institute of Materials, école Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- Bertarelli Foundation Chair in Translational Neural Engineering, Center for Neuroprosthetics and Institute of Bioengineering, école Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Estefania Contreras
- Integral Service for Laboratory Animals (SIAL), Faculty of Veterinary, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain.
| | - Sujeet Pawar
- Institute of Materials, école Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
| | - Ciro Zinno
- The Biorobotic Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
| | - Enrique Escarda-Castro
- Complex Tissue Regeneration Department, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jaehyeon Kim
- Complex Tissue Regeneration Department, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Paul Wieringa
- Complex Tissue Regeneration Department, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Francesco Stellacci
- Institute of Materials, école Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
- Institute of Materials, Department of Bioengineering and Global Health Institute, École Polytechnique Fédérale de Lausanne (EPFL), Station 12, CH-1015 Lausanne, Switzerland
| | - Silvestro Micera
- The Biorobotic Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Bertarelli Foundation Chair in Translational Neural Engineering, Center for Neuroprosthetics and Institute of Bioengineering, école Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain.
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Institute Guttmann Foundation, Hospital of Neurorehabilitation, Badalona, Spain
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Broeren BO, Hundepool CA, Kumas AH, Duraku LS, Walbeehm ET, Hooijmans CR, Power DM, Zuidam JM, De Jong T. The effectiveness of acellular nerve allografts compared to autografts in animal models: A systematic review and meta-analysis. PLoS One 2024; 19:e0279324. [PMID: 38295088 PMCID: PMC10829984 DOI: 10.1371/journal.pone.0279324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/07/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft. OBJECTIVE To systematically review the efficacy of the acellular nerve allograft, its difference from the gold standard (the nerve autograft) and to discuss its possible indications. MATERIAL AND METHODS PubMed, Embase and Web of Science were systematically searched until the 4th of January 2022. Original peer reviewed paper that presented 1) distinctive data; 2) a clear comparison between not immunologically processed acellular allografts and autologous nerve transfers; 3) was performed in laboratory animals of all species and sex. Meta analyses and subgroup analyses (for graft length and species) were conducted for muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count diameter, tetanic contraction and amplitude using a Random effects model. Subgroup analyses were conducted on graft length and species. RESULTS Fifty articles were included in this review and all were included in the meta-analyses. An acellular allograft resulted in a significantly lower muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count and smaller diameter, tetanic contraction compared to an autologous nerve graft. No difference was found in amplitude between acellular allografts and autologous nerve transfers. Post hoc subgroup analyses of graft length showed a significant reduced muscle weight in long grafts versus small and medium length grafts. All included studies showed a large variance in methodological design. CONCLUSION Our review shows that the included studies, investigating the use of acellular allografts, showed a large variance in methodological design and are as a consequence difficult to compare. Nevertheless, our results indicate that treating a nerve gap with an allograft results in an inferior nerve recovery compared to an autograft in seven out of eight outcomes assessed in experimental animals. In addition, based on our preliminary post hoc subgroup analyses we suggest that when an allograft is being used an allograft in short and medium (0-1cm, > 1-2cm) nerve gaps is preferred over an allograft in long (> 2cm) nerve gaps.
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Affiliation(s)
- Berend O. Broeren
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic & Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Ali H. Kumas
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Liron S. Duraku
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Erik T. Walbeehm
- Department of Plastic, Reconstructive & Hand Surgery, Haga Hospital and Xpert Clinic, Den Haag, The Netherlands
| | - Carlijn R. Hooijmans
- Department for Health Evidence Unit SYRCLE, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Anesthesiology, Pain and Palliative Care (Meta Research Team), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dominic M. Power
- Department of Hand & Peripheral Nerve Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Michiel Zuidam
- Department of Plastic & Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Tim De Jong
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Isaacs J, Nydick JA, Means KR, Merrell GA, Ilyas A, Levin LS. A Multicenter Prospective Randomized Comparison of Conduits Versus Decellularized Nerve Allograft for Digital Nerve Repairs. J Hand Surg Am 2023; 48:904-913. [PMID: 37530686 DOI: 10.1016/j.jhsa.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/06/2023] [Accepted: 05/24/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE While there are advantages and disadvantages to both processed nerve allografts (PNA) and conduits, a large, well-controlled prospective study is needed to compare the efficacy and to delineate how each of these repair tools can be best applied to digital nerve injuries. We hypothesized that PNA digital nerve repairs would achieve superior functional recovery for longer length gaps compared with conduit-based repairs. METHODS Patients (aged 18-69 years) presenting with suspected acute or subacute (less than 24 weeks old) digital nerve injuries were recruited to prticipate at 20 medical centers across the United States. After stratification to short (5-14 mm) and long (15-25 mm) gap subgroups, the patients were randomized (1:1) to repair with either a commercially available PNA or collagen conduit. Baseline and outcomes assessments were obtained either before or immediately after surgery and planned at 3-, 6-, 9-, and 12-months after surgery. All assessors and patients were blinded to the treatment arm. RESULTS In total, 220 patients were enrolled, and 183 patients completed an acceptable last evaluable visit (at least 6 months and not more than 15 months postrepair). At last follow-up, for the short gap repair groups, average static two-point discrimination was 7.3 ± 2.8 mm for PNA and 7.5 ± 3.1 mm for conduit repairs. For the long gap group, average static two-point discrimination was significantly lower at 6.1 ± 3.3 mm for PNA compared with 7.5 ± 2.4 mm for conduit repairs. Normal sensation (American Society for Surgery of the Hand scale) was achieved in 40% of PNA long gap repairs, which was significantly more than the 18% observed in long conduit patients. Long gap conduits had more clinical failures (lack of protective sensation) than short gap conduits. CONCLUSIONS Although supporting similar levels of nerve regeneration for short gap length digital nerve repairs, PNA was clinically superior to conduits for long gap reconstructions. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Jonathan Isaacs
- Virginia Commonwealth University Medical Center, Richmond, VA.
| | | | | | | | | | - L Scott Levin
- University of Pennsylvania, Penn Medicine, Philadelphia, PA
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Leversedge FJ, Safa B, Lin WC, Iorio ML, Merced-O’Neill O, Tajdaran K. Histologic Comparison of the Fascicular Area of Processed Nerve Allograft Versus Cabled Sural Nerve Autograft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5201. [PMID: 37600836 PMCID: PMC10435049 DOI: 10.1097/gox.0000000000005201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/29/2023] [Indexed: 08/22/2023]
Abstract
Background The use of multiple cables of sural nerve autograft is common for peripheral nerve reconstruction when injured nerve caliber exceeds the nerve graft caliber. Although the optimal matching of neural to nonneural elements and its association with functional outcomes are unknown, it is reasonable to consider maximizing the neural tissue structure available for nerve regeneration. No prior studies have compared directly the cross-sectional fascicular area between cabled nerve autografts and size-selected nerve allografts. This study evaluated the cross-sectional fascicular area between native nerve stumps and two reconstructive nerve grafting methods: cabled sural nerve autograft (CSNA) and processed nerve allograft (PNA). Methods CSNA from matched cadaveric specimens and PNA were used to reconstruct nerve defects in the median and ulnar nerves of six pairs of cadaveric specimens. Nerve reconstructions were done by fellowship-trained hand surgeons. The total nerve area, fascicular area, and nonfascicular area were measured histologically. Results The CSNA grafts had significantly less fascicular area than PNA and caliber-matched native nerve. The PNA grafts had a significantly higher percent fascicular area compared with the intercalary CNSA graft. Conclusions Fascicular area was significantly greater in PNA versus CSNA. The PNA consistently demonstrated a match in fascicular area closer to the native nerve stumps than CSNA, where CSNA had significantly smaller fascicular area compared with native nerve stumps.
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Affiliation(s)
- Fraser J. Leversedge
- From the Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Bauback Safa
- Department of Plastic and Reconstructive Surgery, The Buncke Clinic, San Francisco, Calif
| | - Walter C. Lin
- Department of Plastic and Reconstructive Surgery, The Buncke Clinic, San Francisco, Calif
| | - Matthew L. Iorio
- Division of Plastic Surgery, University of Colorado School of Medicine, Aurora, Colo
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Frostadottir D, Chemnitz A, Johansson OT LJ, Holst J, Dahlin LB. Evaluation of Processed Nerve Allograft in Peripheral Nerve Surgery: A Systematic Review and Critical Appraisal. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5088. [PMID: 37383478 PMCID: PMC10299771 DOI: 10.1097/gox.0000000000005088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/05/2023] [Indexed: 06/30/2023]
Abstract
Peripheral nerve injuries cause substantial problems when not treated properly. A specific problem is reconstruction of nerve defects, which can be treated in different ways. This study aimed to systematically review whether processed nerve allograft (PNA) is justified in reconstruction of a nerve defect in patients after posttraumatic or iatrogenic peripheral nerve injury and to compare PNA with other established methods. Methods A systematic review with a focused question, PICO (patient, intervention, comparison, outcome) and constraints, was performed. A structured literature search, including several databases, was done to evaluate the existing evidence for outcomes and postoperative complications related to PNA. The certainty of evidence was classified according to Grading of Recommendations, Assessment, Development and Evaluations. Results No conclusions, concerning differences in outcome of nerve reconstruction using PNA compared with the use of nerve autograft or conduits, could be drawn. The level of certainty for all evaluated outcomes was very low (⊕◯◯◯). Most published studies lack a control group to patients treated with PNA; being only descriptive, making it difficult to compare PNA with established methods without substantial risk of bias. For studies including a control group, the scientific evidence was of very low certainty, due to a low number of included patients, and large, undefined loss of patients during follow-up, rendering a high risk of bias. Finally, the authors often had financial disclosures. Conclusion Properly conducted randomized controlled trial studies on the use of PNA in reconstruction of peripheral nerve injuries are needed to establish recommendations in clinical practice.
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Affiliation(s)
- Drifa Frostadottir
- From the Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
| | - Anette Chemnitz
- From the Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - Jan Holst
- Department of Vascular Disease, Skåne University Hospital, Malmö, Sweden
- Department of Research and Education, HTA syd, Skåne University Hospital, Lund, Sweden
| | - Lars B. Dahlin
- From the Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Weber MB, Isaacs JE. Digital Nerve Injury: Assessment and Treatment. J Am Acad Orthop Surg 2023; Publish Ahead of Print:00124635-990000000-00703. [PMID: 37205873 DOI: 10.5435/jaaos-d-23-00255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Undertreated digital nerve injuries may result in sensory deficits and pain. Early recognition and treatment will optimize outcomes, and providers should maintain a high index of suspicion when assessing patients with open wounds. Acute, sharp lacerations may be amenable to direct repair while avulsion injuries or delayed repairs require adequate resection and bridging with nerve autograft, processed nerve allograft, or conduits. Conduits are most appropriate for gaps less than 15 mm, and processed nerve allografts have demonstrated reliable outcomes across longer gaps.
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Affiliation(s)
- Matthew B Weber
- From the Virginia Commonwealth University Medical Center, Richmond, VA
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Repair of Long Nerve Defects with a New Decellularized Nerve Graft in Rats and in Sheep. Cells 2022; 11:cells11244074. [PMID: 36552838 PMCID: PMC9777287 DOI: 10.3390/cells11244074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Decellularized nerve allografts (DC) are an alternative to autografts (AG) for repairing severe peripheral nerve injuries. We have assessed a new DC provided by VERIGRAFT. The decellularization procedure completely removed cellularity while preserving the extracellular matrix. We first assessed the DC in a 15 mm gap in the sciatic nerve of rats, showing slightly delayed but effective regeneration. Then, we assayed the DC in a 70 mm gap in the peroneal nerve of sheep compared with AG. Evaluation of nerve regeneration and functional recovery was performed by clinical, electrophysiology and ultrasound tests. No significant differences were found in functional recovery between groups of sheep. Histology showed a preserved fascicular structure in the AG while in the DC grafts regenerated axons were grouped in small units. In conclusion, the DC was permissive for axonal regeneration and allowed to repair a 70 mm long gap in the sheep nerve.
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Yu T, Ao Q, Ao T, Ahmad MA, Wang A, Xu Y, Zhang Z, Zhou Q. Preparation and assessment of an optimized multichannel acellular nerve allograft for peripheral nerve regeneration. Bioeng Transl Med 2022. [DOI: 10.1002/btm2.10435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Tianhao Yu
- The VIP Department, School and Hospital of Stomatology China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases Shenyang China
| | - Qiang Ao
- Department of Developmental Cell Biology, Key Laboratory of Medical Cell Biology, Ministry of Education China Medical University Shenyang China
- NMPA Key Laboratory for Quality Research and Control of Tissue Regenerative Biomaterial, Institute of Regulatory Science for Medical Device, National Engineering Research Center for Biomaterials Sichuan University Chengdu Sichuan China
| | - Tianrang Ao
- Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | | | - Aijun Wang
- Department of Neurological Surgery University of California Davis Sacramento California USA
| | - Yingxi Xu
- Department of Clinical Nutrition Shengjing Hospital of China Medical University Shenyang China
| | - Zhongti Zhang
- The VIP Department, School and Hospital of Stomatology China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases Shenyang China
| | - Qing Zhou
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases Shenyang China
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Grimm PD, Wheatley BM, Tomasino A, Leonhardt C, Hunter DA, Wood MD, Moore AM, Davis TA, Tintle SM. Controlling axonal regeneration with acellular nerve allograft limits neuroma formation in peripheral nerve transection: An experimental study in a swine model. Microsurgery 2022; 42:603-610. [PMID: 35925036 DOI: 10.1002/micr.30943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/06/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Symptomatic neuromata are a common indication for revision surgery following amputation. Previously described treatments, including traction neurectomy, nerve transposition, targeted muscle re-innervation, and nerve capping, have provided inconsistent results or are technically challenging. Prior research using acellular nerve allografts (ANA) has shown controlled termination of axonal regrowth in long grafts. The purpose of this study was to determine the ability of a long ANA to prevent neuroma formation following transection of a peripheral nerve in a swine model. MATERIALS AND METHODS Twenty-two adult female Yucatan miniature swine (Sus scrofa; 4-6 months, 15-25 kg) were assigned to control (ulnar nerve transection only, n = 10), treatment (ulnar transection and coaptation of 50 mm ANA, n = 10), or donor (n = 2) groups. Nerves harvested from donor group animals were treated to create the ANA. After 20 weeks, the transected nerves including any neuroma or graft were harvested. Both qualitative (nerve architecture, axonal sprouting) and quantitative histologic analyses (myelinated axon number, cross sectional area of nerve tissue) were performed. RESULTS Qualitative histologic analysis of control specimens revealed robust axon growth into dense scar tissue. In contrast, the treatment group revealed dwindling axons in the terminal tissue, consistent with attenuated neuroma formation. Quantitative analysis revealed a significantly decreased number of myelinated axons in the treatment group (1232 ± 540) compared to the control group (44,380 ± 7204) (p < .0001). Cross sectional area of nerve tissue was significantly smaller in treatment group (2.83 ± 1.53 mm2 ) compared to the control group (9.14 ± 1.19 mm2 ) (p = .0012). CONCLUSIONS Aberrant axonal growth is controlled to termination with coaptation of a 50 mm ANA in a swine model of nerve injury. These early results suggest further investigation of this technique to prevent and/or treat neuroma formation.
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Affiliation(s)
- Patrick D Grimm
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA.,Orthopaedics, Uniformed Services University of the Health Sciences-Walter Reed Department of Surgery, Bethesda, Maryland, USA
| | - Benjamin M Wheatley
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA.,Orthopaedics, Uniformed Services University of the Health Sciences-Walter Reed Department of Surgery, Bethesda, Maryland, USA
| | - Allison Tomasino
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Crystal Leonhardt
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Daniel A Hunter
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Matthew D Wood
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Amy M Moore
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Thomas A Davis
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Scott M Tintle
- Orthopaedics, Uniformed Services University of the Health Sciences-Walter Reed Department of Surgery, Bethesda, Maryland, USA
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White-Dzuro CG, Burns B, Pollins A, Rector JA, Assi PE, Thomas HC, Jackson K, Perdikis G, Al Kassis S, Bellan LM, Thayer WP. Successful prevention of secondary burn progression using infliximab hydrogel: A murine model. Burns 2022; 48:896-901. [PMID: 34952735 DOI: 10.1016/j.burns.2021.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Burn injury remains a serious cause of morbidity and mortality worldwide. Severity of burns is determined by the percentage of burned area compared to the body surface area, age of patient, and by the depth of skin and soft tissue involvement; these factors determine management as well as prospective outcomes. The pathophysiology of partial- to full-thickness burn conversion remains poorly understood and is associated with a worse overall prognosis. Recent studies have demonstrated that an altered inflammatory response may play a significant role in this conversion and therefore a reduction in early inflammation is crucial to ultimately decreasing burn severity and morbidity. We hypothesize that the application of a microcapillary gelatin-alginate hydrogel loaded with anti-TNF-α (infliximab) monoclonal antibodies to a partial-thickness burn will reduce inflammation within partially burned skin and prevent further progression to a full-thickness burn. METHODS Assembly of the microfluidic hydrogels is achieved by embedding microfibers within a hydrogel scaffold composed of a gelatin-alginate blend, which is then soaked in a solution containing anti-TNF-α antibodies for drug loading. 12 young (2-4 months) and 12 old (>16 months) mice were given partial thickness burns. The treatment cohort received the anti-TNF-α infused hydrogel with an occlusive dressing and the control cohort only received an occlusive dressing. Mice were euthanized at post-burn day 3 and skin samples were taken. Burn depth was evaluated using Vimentin immunostaining. RESULTS All mice in the treatment cohort demonstrated decreased conversion of burn from partial to full thickness injury (old = p < 0.01, young = p < 0.001) as compared to the control group. Old mice had greater depth of burn than young mice (p < 0.001). There were greater eosinophils in the treatment cohort for both young and old mice, but it did not reach statistical significance. CONCLUSION The application of a novel microcapillary gelatin-alginate hydrogel infused with anti-TNF-α antibody to partial thickness burns in mice showed reduction in partial to full thickness burn secondary progression as compared to controls using this murine model; this promising finding might help decrease the high morbidity and mortality associated with burn injuries.
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Affiliation(s)
| | - Brady Burns
- Meharry Medical College, Nashville, TN, USA; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alonda Pollins
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John A Rector
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Patrick E Assi
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kianna Jackson
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Salam Al Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leon M Bellan
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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12
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Moffat D, Ye K, Jin S. Decellularization for the retention of tissue niches. J Tissue Eng 2022; 13:20417314221101151. [PMID: 35620656 PMCID: PMC9128068 DOI: 10.1177/20417314221101151] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/01/2022] [Indexed: 12/25/2022] Open
Abstract
Decellularization of natural tissues to produce extracellular matrix is a promising method for three-dimensional scaffolding and for understanding microenvironment of the tissue of interest. Due to the lack of a universal standard protocol for tissue decellularization, recent investigations seek to develop novel methods for whole or partial organ decellularization capable of supporting cell differentiation and implantation towards appropriate tissue regeneration. This review provides a comprehensive and updated perspective on the most recent advances in decellularization strategies for a variety of organs and tissues, highlighting techniques of chemical, physical, biological, enzymatic, or combinative-based methods to remove cellular contents from tissues. In addition, the review presents modernized approaches for improving standard decellularization protocols for numerous organ types.
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Affiliation(s)
- Deana Moffat
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
| | - Kaiming Ye
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
- Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
| | - Sha Jin
- Department of Biomedical Engineering, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
- Center of Biomanufacturing for Regenerative Medicine, Binghamton University, State University of New York (SUNY), Binghamton, NY, USA
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13
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Tamez-Mata Y, Pedroza-Montoya FE, Martínez-Rodríguez HG, García-Pérez MM, Ríos-Cantú AA, González-Flores JR, Soto-Domínguez A, Montes-de-Oca-Luna R, Simental-Mendía M, Peña-Martínez VM, Vílchez-Cavazos F. Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial. J Plast Reconstr Aesthet Surg 2022; 75:296-306. [PMID: 34257032 DOI: 10.1016/j.bjps.2021.05.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Acellular nerve allografts (ANA) recellularized with mesenchymal stem cells (MSC) or Schwann cells (SC) are, at present, a therapeutic option for peripheral nerve injuries (PNI). This study aimed to evaluate the regenerative and functional capacity of a recellularized allograft (RA) compared with autograft nerve reconstruction in PNI. METHODS Fourteen ovines were randomly included in two groups (n=7). A peroneal nerve gap 30 mm in length was excised, and nerve repair was performed by the transplantation of either an autograft or a recellularized allograft with SC-like cells. Evaluations included a histomorphological analysis of the ANA, MSC pre differentiated into SC-like cells, at one year follow-up functional limb recovery (support and gait), and nerve regeneration using neurophysiological tests and histomorphometric analysis. All evaluations were compared with the contralateral hindlimb as the control. RESULTS The nerve allograft was successfully decellularized and more than 70% of MSC were pre differentiated into SC-like cells. Functional assessment in both treated groups improved similarly over time (p <0.05). Neurophysiological results (latency, amplitude, and conduction velocity) also improved in both treated groups at twelve months. Histological results demonstrated a less organized arrangement of nerve fibers (p <0.05) with an active remyelination process (p <0.05) in both treated groups compared with controls at twelve months. CONCLUSIONS ANA recellularized with SC-like cells proved to be a successful treatment for nerve gaps. Motor recovery and nerve regeneration were satisfactorily achieved in both graft groups compared with their contralateral nontreated nerves. This approach could be useful for the clinical therapy of PNI.
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Affiliation(s)
- Y Tamez-Mata
- Traumatology and Orthopedics, Bone and Tissue Bank Division, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - F E Pedroza-Montoya
- Biochemistry and Molecular Medicine Department, Cell Therapy Division, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - H G Martínez-Rodríguez
- Biochemistry and Molecular Medicine Department, Cell Therapy Division, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - M M García-Pérez
- Plastic Surgery Service, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - A A Ríos-Cantú
- Plastic Surgery Service, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - J R González-Flores
- Plastic Surgery Service, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - A Soto-Domínguez
- Histology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - R Montes-de-Oca-Luna
- Histology Department, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - M Simental-Mendía
- Traumatology and Orthopedics, Bone and Tissue Bank Division, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - V M Peña-Martínez
- Traumatology and Orthopedics, Bone and Tissue Bank Division, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González"
| | - F Vílchez-Cavazos
- Traumatology and Orthopedics, Bone and Tissue Bank Division, Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González".
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Clinical Outcomes of Symptomatic Neuroma Resection and Reconstruction with Processed Nerve Allograft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3832. [PMID: 34616638 PMCID: PMC8489892 DOI: 10.1097/gox.0000000000003832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/22/2021] [Indexed: 01/10/2023]
Abstract
Background: Neuromas causing sensory disturbance can substantially affect nerve function and quality of life. Historically, passive termination of the nerve end and proximal relocation to muscle or bone has been performed after neuroma resection, but this method does not allow for neurologic recovery or prevent recurrent neuromas. The use of processed nerve allografts (PNAs) for intercalary reconstruction of nerve defects following neuroma resection is reasonable for neuroma management, although reported outcomes are limited. The purpose of this study was to assess the outcomes of pain reduction and functional recovery following neuroma resection and intercalary nerve reconstruction using PNA. Methods: Data on outcomes of PNA use for peripheral nerve reconstruction were collected from a multicenter registry study. The registry database was queried for upper extremity nerve reconstruction with PNA after resection of symptomatic neuroma. Patients completing both pain and quantitative sensory assessments were included in the analysis. Improvement in pain-related symptoms was determined via patient self-reported outcomes and/or the visual analog scale. Meaningful sensory recovery was defined as a score of at least S3 on the Medical Research Council Classification scale. Results: Twenty-five repairs involving 21 patients were included in this study. The median interval from injury to reconstruction was 386 days, and the average nerve defect length was 31 mm. Pain improved in 80% of repairs. Meaningful sensory recovery was achieved in 88% of repairs. Conclusion: Neuroma resection and nerve reconstruction using PNA can reduce or eliminate chronic peripheral nerve pain and provide meaningful sensory recovery.
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15
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Kang HV, Im JH, Chung YG, Shin EY, Lee MK, Lee JY. Comparison of two different decellularization methods for processed nerve allograft. Cell Tissue Bank 2021; 22:575-585. [PMID: 34581914 DOI: 10.1007/s10561-021-09965-1] [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: 05/04/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
The use of processed nerve allografts as an alternative to autologous nerve grafts, the gold standard treatment for peripheral nerve defects, is increasing. However, it is not widely used in Korea due to cost and insurance issues. Moreover, the main detergent used in the conventional Hudson method is unavailable. Therefore, a new nerve allograft decellularization process is needed. We aimed to compare the traditional Hudson method with a novel decellularization process that may remove cellular content more efficiently while preserving the extracellular matrix (ECM) structure using low concentration sodium dodecyl sulfate (SDS) and nuclease. After each decellularization process, DNA content was measured in nerve tissue. Masson's trichrome staining and scanning electron microscopy were performed to determine the state of preservation of the ECM. A significantly greater amount of DNA content was removed in the novel method, and the ECM structure was preserved in both methods. For the in vivo study, a 15-mm long sciatic nerve defect was created in two groups of Sprague-Dawley rats, and processed nerve allografts decellularized using the Hudson or novel method were transplanted. Functional and histological recovery results were measured 12 weeks post-transplantation. Ankle contracture angle, maximal isometric tetanic force of the tibialis anterior (TA), and the TA mass were compared between the groups, as well as the percent neural tissue (100 × neural area/intrafascicular area). There was no significant difference in functional and histological nerve recovery between the methods. The novel method is appropriate for developing a processed nerve allograft.
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Affiliation(s)
- Han-Vit Kang
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hyung Im
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Young Shin
- College of Medicine, Research Institute of Medical Science, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Joo-Yup Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Le Donne M, Jouan R, Bourlet J, Louvrier A, Ducret M, Sigaux N. Inferior alveolar nerve allogenic repair following mandibulectomy: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:233-238. [PMID: 33933668 DOI: 10.1016/j.jormas.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Processed nerve allografts (PNA) are an alternative to nerve autografts to reconstruct the inferior alveolar nerve (IAN) when it is damaged. The purpose of this study was to report the results of IAN reconstruction using PNA in the context of aggressive benign mandibular pathology. MATERIAL AND METHOD A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement through the MEDLINE (Pubmed) and SCOPUS (Elsevier) databases. Studies concerning reconstructive surgeries of IAN by PNA, performed at the same time as the surgical resection of the benign pathologies of the mandible were included. The following data were analyzed: gender and patient age, cause of mandibular resection, graft dimensions, sensory recovery at least 6 months after surgery according to the MRC scale, and adverse events related to the intervention. RESULTS The initial search yielded 290 studies and 5 were included in the final review. A total of 33 patients underwent 36 IAN reconstructions; 14 patients were female (42.4%) and mean age was 30 years old. The mean length of graft used was 64.0 ± 9.1 mm. The most common pathology that led to nerve resection was ameloblastoma (52%). Among the reconstructions for which follow-up data were available, functional sensory recovery occurred in 92.9% of cases. CONCLUSION PNA are a reliable, safe, and effective alternative to nerve autografts for the rehabilitation of the IAN with 92.9% of functional recovery according to the reported literature, avoiding any comorbidity associated with the use of a donor site.
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Affiliation(s)
- Mélanie Le Donne
- Private Practitioner, 3 Rue du Dr François Broussais 17100 Saintes, France, Faculté d'Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 11 rue Guillaume Paradin, 69008 Lyon, France.
| | - Robin Jouan
- Clinical Doctor, Chirurgie Maxillo-faciale, Hôpital Nord-Ouest, Plateau d'Ouilly 69400 Gleizé Villefranche sur Saône, France
| | - Jérôme Bourlet
- Clinical Doctor, Hospices Civils de Lyon, Chirurgie Maxillo-faciale et Stomatologie, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Aurélien Louvrier
- Clinical Doctor, Service de chirurgie Maxillo-faciale et Stomatologie, Centre Hospitalier Régional Universitaire Jean Minjoz, 3 boulevard Alexandre Fleming, 25000 Besançon, France
| | - Maxime Ducret
- Associate Professor, Hospices Civils de Lyon, PAM Odontologie, Lyon, France, Faculté d'Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 11 rue Guillaume Paradin 69008 Lyon, France; Faculty of Dentistry, McGill University, 2001 Avenue McGill College #500 Montreal QC H3A 1G1, Canada
| | - Nicolas Sigaux
- Clinical Doctor, Hospices Civils de Lyon, Chirurgie Maxillo-faciale et Plastique de la face, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France,; UFR de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Université de Lyon, 165 Chemin du petit Revoyet, 69221 Oullins, France
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Reconstruction of Critical Nerve Defects Using Allogenic Nerve Tissue: A Review of Current Approaches. Int J Mol Sci 2021; 22:ijms22073515. [PMID: 33805321 PMCID: PMC8036990 DOI: 10.3390/ijms22073515] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Regardless of the nerve defect length, nerve injury is a debilitating condition for the affected patient that results in loss of sensory and motor function. These functional impairments can have a profound impact on the patient’s quality of life. Surgical approaches for the treatment of short segment nerve defects are well-established. Autologous nerve transplantation, considered the gold standard, and the use of artificial nerve grafts are safe and successful procedures for short segment nerve defect reconstruction. Long segment nerve defects which extend 3.0 cm or more are more problematic for repair. Methods for reconstruction of long defects are limited. Artificial nerve grafts often fail to regenerate and autologous nerve grafts are limited in length and number. Cadaveric processed/unprocessed nerve allografts are a promising alternative in nerve surgery. This review gives a systematic overview on pre-clinical and clinical approaches in nerve allograft transplantation.
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18
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Ikegami Y, Ijima H. Decellularization of Nervous Tissues and Clinical Application. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1345:241-252. [PMID: 34582027 DOI: 10.1007/978-3-030-82735-9_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The nervous system is an ensemble of organs that transmit and process external information and are responsible for the adaption to the external environment and homeostasis control of the internal environment. The nervous system of vertebrates is divided into the central nervous system (CNS) and peripheral nervous system (PNS) due to its structural features. The CNS, which includes the brain and the spinal cord, processes information from external stimuli and assembles orders suitable for these stimuli. The CNS then sends signals to control other organs/tissues. On the other hand, the PNS connects the CNS to other organs/tissues and functions as a signal pathway. Therefore, the decline and loss of various functions due to injuries of the nervous system cause an impaired quality of life (QOL) and eventually the termination of life activities. Here, we report mainly on decellularized neural tissue and its application as a substrate for the regeneration of the nervous system.
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Affiliation(s)
- Yasuhiro Ikegami
- Department of Chemical Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan
| | - Hiroyuki Ijima
- Department of Chemical Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan.
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19
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Zhang Y, Nam K, Kimura T, Wu P, Nakamura N, Hashimoto Y, Funamoto S, Kishida A. Preparation of gradient-type biological tissue-polymer complex for interlinking device. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 114:111017. [PMID: 32993989 DOI: 10.1016/j.msec.2020.111017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2019] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the monomer absorption behavior of decellularized dermis and prepare a gradient-type decellularized dermis-polymer complex. Decellularized dermis was prepared using sodium dodecyl sulfate, and its monomer absorption behavior was investigated using three types of hydrophobic monomer with different surface free energies. The results show that monomer absorption depends strongly on the tissue structure, regardless of the surface free energy, and the amount of absorbed monomer can be increased by sonication. Based on these results, we prepared a gradient-type decellularized dermis-poly(methyl methacrylate) complex by controlling the permeation time of the methyl methacrylate monomer and polymerization initiator into the decellularized dermis. The mechanical strength of this complex gradually increased from the dermis side to the polymer side, and combined the physical characteristics of the dermis and the polymer.
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Affiliation(s)
- Yongwei Zhang
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Kwangwoo Nam
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Tsuyoshi Kimura
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Pingli Wu
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Naoko Nakamura
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Yoshihide Hashimoto
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Seiichi Funamoto
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
| | - Akio Kishida
- Department of Material-based Medical Engineering, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan.
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Kasper M, Deister C, Beck F, Schmidt CE. Bench-to-Bedside Lessons Learned: Commercialization of an Acellular Nerve Graft. Adv Healthc Mater 2020; 9:e2000174. [PMID: 32583574 DOI: 10.1002/adhm.202000174] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Peripheral nerve injury can result in debilitating outcomes including loss of function and neuropathic pain. Although nerve repair research and therapeutic development are widely studied, translation of these ideas into clinical interventions has not occurred at the same rate. At the turn of this century, approaches to peripheral nerve repair have included microsurgical techniques, hollow conduits, and autologous nerve grafts. These methods provide satisfactory results; however, they possess numerous limitations that can prevent effective surgical treatment. Commercialization of Avance, a processed nerve allograft, sought to address limitations of earlier approaches by providing an off-the-shelf alternative to hollow conduits while maintaining many proregenerative properties of autologous grafts. Since its launch in 2007, Avance has changed the landscape of the nerve repair market and is used to treat tens of thousands of patients. Although Avance has become an important addition to surgeon and patient clinical options, the product's journey from bench to bedside took over 20 years with many research and commercialization challenges. This article reviews the events that have brought a processed nerve allograft from the laboratory bench to the patient bedside. Additionally, this review provides a perspective on lessons and considerations that can assist in translation of future medical products.
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Affiliation(s)
- Mary Kasper
- J. Crayton Pruitt Family Department of Biomedical EngineeringUniversity of Florida Gainesville FL 32611 USA
| | | | | | - Christine E. Schmidt
- J. Crayton Pruitt Family Department of Biomedical EngineeringUniversity of Florida Gainesville FL 32611 USA
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21
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Im JH, Lee JY, Yeon WH, Lee MK, Chung YG. The anatomy of the saphenous and sural nerves as a source of processed nerve allografts. Cell Tissue Bank 2020; 21:547-555. [PMID: 32507993 DOI: 10.1007/s10561-020-09841-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 06/01/2020] [Indexed: 12/14/2022]
Abstract
As an alternative to autologous nerve donors, acellular nerve allografts (ANAs) have been studied in many experiments. There have been numerous studies on processing ANAs and various studies on the clinical applications of ANA, but there have not been many studies on sources of ANAs. The purposes of the present study were to evaluate the course of the saphenous and sural nerves in human cadavers and help harvest auto- or allografts for clinical implications. Eighteen lower extremities of 16 fresh cadavers were dissected. For the saphenous nerve and sural nerve, the distances between each branch and the diameters at the midpoint between each branch were measured. In the saphenous nerve, the mean length between each branch ranged from 7.2 to 28.6 cm, and the midpoint diameter ranged from 1.4 to 3.2 mm. In the sural nerve, the mean length between each branch ranged from 17.4 to 21 cm, and the midpoint diameter ranged from 2.3 to 2.8 mm. The present study demonstrates the length of the saphenous and sural nerve without branches with diameters larger than 1 mm. With regard for the clinical implications of allografts, the harvest of a selective nerve length with a large enough diameter could be possible based on the data presented in the present study.
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Affiliation(s)
- Jin-Hyung Im
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joo-Yup Lee
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
| | | | | | - Yang-Guk Chung
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.,Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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22
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Qiu S, Rao Z, He F, Wang T, Xu Y, Du Z, Yao Z, Lin T, Yan L, Quan D, Zhu Q, Liu X. Decellularized nerve matrix hydrogel and glial-derived neurotrophic factor modifications assisted nerve repair with decellularized nerve matrix scaffolds. J Tissue Eng Regen Med 2020; 14:931-943. [PMID: 32336045 DOI: 10.1002/term.3050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022]
Abstract
Nerve defects are challenging to address clinically without satisfactory treatments. As a reliable alternative to autografts, decellularized nerve matrix scaffolds (DNM-S) have been widely used in clinics for surgical nerve repair. However, DNM-S remain inferior to autografts in their ability to support nerve regeneration for long nerve defects. In this study, we systematically and clearly presented the nano-architecture of nerve-specific structures, including the endoneurium, basement membrane and perineurium/epineurium in DNM-S. Furthermore, we modified the DNM-S by supplementing decellularized nerve matrix hydrogel (DNMG) and glial-derived neurotrophic factor (GDNF) and then bridged a 50-mm sciatic nerve defect in a beagle model. Fifteen beagles were randomly divided into three groups (five per group): an autograft group, DNM-S group and GDNF-DNMG-modified DNM-S (DNM-S/GDNF@DNMG) group. DNM-S/GDNF@DNMG, as optimized nerve grafts, were used to bridge nerve defects in the same manner as in the DNM-S group. The repair outcome was evaluated by behavioural observations, electrophysiological assessments, regenerated nerve tissue histology and reinnervated target muscle examinations. Compared with the DNM-S group, limb function, electrophysiological responses and histological findings were improved in the DNM-S/GDNF@DNMG group 6 months after grafting, reflecting a narrower gap between the effects of DNM-S and autografts. In conclusion, modification of DNM-S with DNMG and GDNF enhanced nerve regeneration and functional recovery, indicating that noncellular modification of DNM-S is a promising method for treating long nerve defects.
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Affiliation(s)
- Shuai Qiu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zilong Rao
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China
| | - Fulin He
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Wang
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiwei Xu
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China
| | - Zhaoyi Du
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China
| | - Zhi Yao
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Lin
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liwei Yan
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Daping Quan
- Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Peripheral Nerve Tissue-Engineering and Technology Research Center, Guangzhou, China.,GD Functional Biomaterials Engineering Technology Research Center, School of Materials Science and Engineering, Sun Yat-sen University, Guangzhou, China.,PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China
| | - Qingtang Zhu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Peripheral Nerve Tissue-Engineering and Technology Research Center, Guangzhou, China
| | - Xiaolin Liu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Peripheral Nerve Tissue-Engineering and Technology Research Center, Guangzhou, China
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Pan D, Mackinnon SE, Wood MD. Advances in the repair of segmental nerve injuries and trends in reconstruction. Muscle Nerve 2020; 61:726-739. [PMID: 31883129 DOI: 10.1002/mus.26797] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system.
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Affiliation(s)
- Deng Pan
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Wood
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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24
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Recent advances in the therapeutic uses of chondroitinase ABC. Exp Neurol 2019; 321:113032. [PMID: 31398353 DOI: 10.1016/j.expneurol.2019.113032] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/19/2019] [Accepted: 08/03/2019] [Indexed: 12/18/2022]
Abstract
Many studies, using pre-clinical models of SCI, have demonstrated the efficacy of chondroitinase ABC as a treatment for spinal cord injury and this has been confirmed in laboratories worldwide and in several animal models. The aim of this review is report the current state of research in the field and to compare the relative efficacies of these new interventions to improve outcomes in both acute and chronic models of SCI. We also report new methods of chondroitinase delivery and the outcomes of two clinical trials using the enzyme to treat spinal cord injury in dogs and disc herniation in human patients. Recent studies have assessed the outcomes of combining chondroitinase with other strategies known to promote recovery following spinal cord injury and new approaches. Evidence is emerging that one of the most powerful combinations is that of chondroitinase with cell transplants. The particular benefits of each of the different cell types used for these transplant experiments are discussed. Combining chondroitinase with rehabilitation also improves outcomes. Gene therapy is an efficient method of enzyme delivery to the injured spinal cord and circumvents the issue of the enzyme's thermo-instability. Other methods of delivery, such as via nanoparticles or synthetic scaffolds, have shown promise; however, the outcomes from these experiments suggest that these methods of delivery require further optimization to achieve similar levels of efficacy to that obtained by a gene therapy approach. Pre-clinical models have also shown chondroitinase is efficacious in the treatment of other conditions, such as peripheral nerve injury, stroke, coronary reperfusion, Parkinson's disease and certain types of cancer. The wide range of conditions where the benefits of chondroitinase treatment have been demonstrated reflects the complex roles that chondroitin sulphate proteoglycans (its substrate) play in health and disease and warrants the enzyme's further development as a therapy.
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Sarhane KA, Tuffaha SH, Ibrahim Z, Cashman CR, Krick K, Martin R, Broyles JM, Cooney DS, Lee WPA, Mi R, Mao HQ, Höke A, Brandacher G. Glial Cell Line-Derived Neurotrophic Factor and Chondroitinase Promote Axonal Regeneration in a Chronic Denervation Animal Model. Neurotherapeutics 2019; 16:1283-1295. [PMID: 31148054 PMCID: PMC6985423 DOI: 10.1007/s13311-019-00745-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Functional recovery following nerve injury declines when target re-innervation is delayed. Currently, no intervention exists to improve outcomes after prolonged denervation. We explored the neuroregenerative effects of glial cell line-derived neurotrophic factor (GDNF) and chondroitinase (CDN) in a chronic denervation animal model. A fibrin-based sustained delivery method for growth factors was optimized in vitro and in vivo, and then tested in our animal model. GDNF, CDN, and GDNF+CDN were injected into the denervated stump at the time of nerve repair. Histomorphometry and retrograde labeling were used to assess axonal regeneration. The mechanisms promoting such regeneration were explored with immunofluorescence. Five weeks after repair, the GDNF+CDN group had the highest number and maturity of axons. GDNF was noted to preferentially promote axonal maturity, whereas CDN predominantly increased the number of axons. GDNF favored motor neuron regeneration, and upregulated Ki67 in Schwann cells. CDN did not favor motor versus sensory regeneration and was noted to cleave inhibitory endoneurial proteoglycans. Early measures of nerve regeneration after delayed repair are improved by activating Schwann cells and breaking down the inhibitory proteoglycans in the distal nerve segment, suggesting a role for GDNF+CDN to be translated for human nerve repairs.
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Affiliation(s)
- Karim A Sarhane
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, Maryland, 21205, USA
- Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, Maryland, 21205, USA
| | - Zuhaib Ibrahim
- Institute for Advanced Reconstruction, Shrewsbury, New Jersey, USA
| | - Christopher R Cashman
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kellin Krick
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell Martin
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Justin M Broyles
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, Maryland, 21205, USA
| | - Damon S Cooney
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, Maryland, 21205, USA
| | - W P Andrew Lee
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, Maryland, 21205, USA
| | - Ruifa Mi
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hai-Quan Mao
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmet Höke
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University, Ross Research Building/Suite 749D, 720 Rutland Avenue, Baltimore, Maryland, 21205, USA.
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Philips C, Cornelissen M, Carriel V. Evaluation methods as quality control in the generation of decellularized peripheral nerve allografts. J Neural Eng 2019; 15:021003. [PMID: 29244032 DOI: 10.1088/1741-2552/aaa21a] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nowadays, the high incidence of peripheral nerve injuries and the low success ratio of surgical treatments are driving research to the generation of novel alternatives to repair critical nerve defects. In this sense, tissue engineering has emerged as a possible alternative with special attention to decellularization techniques. Tissue decellularization offers the possibility to obtain a cell-free, natural extracellular matrix (ECM), characterized by an adequate 3D organization and proper molecular composition to repair different tissues or organs, including peripheral nerves. One major problem, however, is that there are no standard quality control methods to evaluate decellularized tissues. Therefore, in this review, a brief description of current strategies for peripheral nerve repair is given, followed by an overview of different decellularization methods used for peripheral nerves. Furthermore, we extensively discuss the available and currently used methods to demonstrate the success of tissue decellularization in terms of the cell removal, preservation of essential ECM molecules and maintenance or modification of biomechanical properties. Finally, orientative guidelines for the evaluation of decellularized peripheral nerve allografts are proposed.
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Affiliation(s)
- Charlot Philips
- Tissue Engineering and Biomaterials Group, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium
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Buckenmeyer MJ, Meder TJ, Prest TA, Brown BN. Decellularization techniques and their applications for the repair and regeneration of the nervous system. Methods 2019; 171:41-61. [PMID: 31398392 DOI: 10.1016/j.ymeth.2019.07.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/11/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023] Open
Abstract
A variety of surgical and non-surgical approaches have been used to address the impacts of nervous system injuries, which can lead to either impairment or a complete loss of function for affected patients. The inherent ability of nervous tissues to repair and/or regenerate is dampened due to irreversible changes that occur within the tissue remodeling microenvironment following injury. Specifically, dysregulation of the extracellular matrix (i.e., scarring) has been suggested as one of the major factors that can directly impair normal cell function and could significantly alter the regenerative potential of these tissues. A number of tissue engineering and regenerative medicine-based approaches have been suggested to intervene in the process of remodeling which occurs following injury. Decellularization has become an increasingly popular technique used to obtain acellular scaffolds, and their derivatives (hydrogels, etc.), which retain tissue-specific components, including critical structural and functional proteins. These advantageous characteristics make this approach an intriguing option for creating materials capable of stimulating the sensitive repair mechanisms associated with nervous system injuries. Over the past decade, several diverse decellularization methods have been implemented specifically for nervous system applications in an attempt to carefully remove cellular content while preserving tissue morphology and composition. Each application-based decellularized ECM product requires carefully designed treatments that preserve the unique biochemical signatures associated within each tissue type to stimulate the repair of brain, spinal cord, and peripheral nerve tissues. Herein, we review the decellularization techniques that have been applied to create biomaterials with the potential to promote the repair and regeneration of tissues within the central and peripheral nervous system.
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Affiliation(s)
- Michael J Buckenmeyer
- Department of Bioengineering, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, United States.
| | - Tyler J Meder
- Department of Bioengineering, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, United States.
| | - Travis A Prest
- Department of Bioengineering, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, United States.
| | - Bryan N Brown
- Department of Bioengineering, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, United States; Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, United States.
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28
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Tang P, Whiteman DR, Voigt C, Miller MC, Kim H. No Difference in Outcomes Detected Between Decellular Nerve Allograft and Cable Autograft in Rat Sciatic Nerve Defects. J Bone Joint Surg Am 2019; 101:e42. [PMID: 31094986 DOI: 10.2106/jbjs.18.00417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nerve injuries with a gap/defect represent a clinical challenge without a clear solution. Reconstruction with cable autografts is a common treatment technique, and repair with decellular nerve allograft is a newer option. The purpose of this study was to compare the functional outcomes of reconstruction with cable autografts with those of matched-diameter decellular nerve allografts to evaluate the relative importance of diameter as well as the autograft-versus-allograft nature of the reconstruction. METHODS A unilateral 10-mm sciatic nerve defect was created in 81 genetically identical male Lewis rats and then repaired with a reverse autograft, 4 or 5 sural nerve cable autografts, or a matched-diameter decellular nerve allograft. In each group, at each time point (12, 16, and 20 weeks), all 9 animals underwent functional testing and 5 of the 9 underwent histologic analysis. Functional testing included bilateral measurements of the isometric tetanic force of the tibialis anterior (primary outcome), the weight of the tibialis anterior, and the gastrocnemius compound muscle action potential (CMAP) latency. Histologic evaluation included an axon count as well as measurement of the axon density, fiber diameter, myelin thickness, and G-ratio. RESULTS The repair groups did not differ significantly in terms of isometric tetanic force, muscle weight, or CMAP latency, but these measurements did differ significantly according to the time after surgery (p < 0.05). The isometric tetanic force percent recovery (width of the 95% confidence interval) for the reverse autograft, cable autograft, and decellular nerve allograft was 57.7% (15.6%), 57.0% (23.4%), and 56.0% (19.7%), respectively, at 12 weeks; 69.1% (14.7%), 65.6% (18.5%), and 65.9% (29.1%) at 16 weeks; and 72.5% (18.2%), 73.7% (25.6%), and 71.8% (22.4%) at 20 weeks. Isometric tetanic force and muscle weight recovery were greater and CMAP latency was shorter at 20 and 16 weeks after surgery than they were at 12 weeks. The treatment type did not affect any of the histologic outcomes. CONCLUSIONS In this animal study, we found that matched-diameter decellular nerve allograft was not significantly different from reverse autograft or cable graft reconstruction in terms of function and histologic outcomes. These findings support decellular nerve allograft as a viable treatment option for nerve reconstruction. CLINICAL RELEVANCE This study showed that decellular nerve allograft was no different from cable or reverse autograft in terms of outcome measures in a rat sciatic nerve defect model. If these results are applicable clinically, it would obviate the need for autograft nerve harvest and its ensuing donor site morbidity.
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Affiliation(s)
- Peter Tang
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Daniel R Whiteman
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
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29
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Im JH, Lee JY, Lee S, Lee MG, Chung YG, Kim KW. Comparison of the regeneration induced by acellular nerve allografts processed with or without chondroitinase in a rat model. Cell Tissue Bank 2019; 20:307-319. [PMID: 31030290 DOI: 10.1007/s10561-019-09770-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/19/2019] [Indexed: 12/14/2022]
Abstract
There have been various studies about the acellular nerve allograft (ANA) as the alternative of autologous nerve graft in the treatment of peripheral nerve defects. As well as the decellularization process methods of ANA, the various enhancement methods of regeneration of the grafted ANA were investigated. The chondroitin sulfate proteoglycans (CSPGs) inhibit the action of laminin which is important for nerve regeneration in the extracellular matrix of nerve. Chondroitinase ABC (ChABC) has been reported that it enhances the nerve regeneration by degradation of CSPGs. The present study compared the regeneration of ANA between the processed without ChABC group and the processed with ChABC group in a rat sciatic nerve 15 mm gap model. At 12 weeks postoperatively, there was not a significant difference in the histomorphometric analysis. In the functional analysis, there were no significant differences in maximum isometric tetanic force, wet muscle weight of tibialis anterior. The processed without ChABC group had better result in ankle contracture angle significantly. In conclusion, there were no significant differences in the regeneration of ANA between the processed without ChABC group and the processed with ChABC group.
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Affiliation(s)
- Jin-Hyung Im
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joo-Yup Lee
- Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
| | | | | | - Yang-Guk Chung
- Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki-Won Kim
- Department of Orthopedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
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30
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Recovery of Motor Function after Mixed and Motor Nerve Repair with Processed Nerve Allograft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2163. [PMID: 31044125 PMCID: PMC6467606 DOI: 10.1097/gox.0000000000002163] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Severe trauma often results in the transection of major peripheral nerves. The RANGER Registry is an ongoing observational study on the use and outcomes of processed nerve allografts (PNAs; Avance Nerve Graft, AxoGen, Inc., Alachua, Fla.). Here, we report on motor recovery outcomes for nerve injuries repaired acutely or in a delayed fashion with PNA and comparisons to historical controls in the literature. Methods: The RANGER database was queried for mixed and motor nerve injuries in the upper extremities, head, and neck area having completed greater than 1 year of follow-up. All subjects with sufficient assessments to evaluate functional outcomes were included. Meaningful recovery was defined as ≥M3 on the Medical Research Council scale. Demographics, outcomes, and covariate analysis were performed to further characterize this subgroup. Results: The subgroup included 20 subjects with 22 nerve repairs. The mean ± SD (minimum–maximum) age was 38 ± 19 (16–77) years. The median repair time was 9 (0–133) days. The mean graft length was 33 ± 17 (10–70) mm with a mean follow-up of 779 ± 480 (371–2,423) days. Meaningful motor recovery was observed in 73%. Subgroup analysis showed no differences between gap lengths or mechanism of injury. There were no related adverse events. Conclusions: PNAs were safe and provided functional motor recovery in mixed and motor nerve repairs. Outcomes compare favorably to historical controls for nerve autograft and exceed those for hollow tube conduit. PNA may be considered as an option when reconstructing major peripheral nerve injuries.
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31
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Weller WJ. Emerging Technologies in Upper Extremity Surgery: Polyvinyl Alcohol Hydrogel Implant for Thumb Carpometacarpal Arthroplasty and Processed Nerve Allograft and Nerve Conduit for Digital Nerve Repairs. Orthop Clin North Am 2019; 50:87-93. [PMID: 30477709 DOI: 10.1016/j.ocl.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the field of upper extremity surgery there are myriad new and developing technologies. The purpose of this article is to highlight a few of the most compelling new technologies and review their background, indications for use, and most recently reported outcomes in clinical practice.
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Affiliation(s)
- William J Weller
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
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32
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Nerve grafting for peripheral nerve injuries with extended defect sizes. Wien Med Wochenschr 2018; 169:240-251. [PMID: 30547373 PMCID: PMC6538587 DOI: 10.1007/s10354-018-0675-6] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022]
Abstract
Artificial and non-artificial nerve grafts are the gold standard in peripheral nerve reconstruction in cases with extensive loss of nerve tissue, particularly where a direct end-to-end suture or an autologous nerve graft is inauspicious. Different materials are marketed and approved by the US Food and Drug Administration (FDA) for peripheral nerve graft reconstruction. The most frequently used materials are collagen and poly(DL-lactide-ε-caprolactone). Only one human nerve allograft is listed for peripheral nerve reconstruction by the FDA. All marketed nerve grafts are able to demonstrate sufficient nerve regeneration over small distances not exceeding 3.0 cm. A key question in the field is whether nerve reconstruction on large defect lengths extending 4.0 cm or more is possible. This review gives a summary of current clinical and experimental approaches in peripheral nerve surgery using artificial and non-artificial nerve grafts in short and long distance nerve defects. Strategies to extend nerve graft lengths for long nerve defects, such as enhancing axonal regeneration, include the additional application of Schwann cells, mesenchymal stem cells or supporting co-factors like growth factors on defect sizes between 4.0 and 8.0 cm.
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Tajdaran K, Chan K, Zhang J, Gordon T, Borschel GH. Local FK506 dose‐dependent study using a novel three‐dimensional organotypic assay. Biotechnol Bioeng 2018; 116:405-414. [DOI: 10.1002/bit.26853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Kasra Tajdaran
- Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto Ontario Canada
- Institute of Biomaterials and Biomedical Engineering, University of TorontoToronto Ontario Canada
| | - Katelyn Chan
- Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto Ontario Canada
- Institute of Biomaterials and Biomedical Engineering, University of TorontoToronto Ontario Canada
| | - Jennifer Zhang
- Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto Ontario Canada
- Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Program in Neuroscience, The Hospital for Sick Children Research InstituteToronto Ontario Canada
| | - Tessa Gordon
- Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto Ontario Canada
- Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Program in Neuroscience, The Hospital for Sick Children Research InstituteToronto Ontario Canada
| | - Gregory H. Borschel
- Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto Ontario Canada
- Institute of Biomaterials and Biomedical Engineering, University of TorontoToronto Ontario Canada
- Division of Plastic and Reconstructive Surgery, Department of SurgeryUniversity of TorontoToronto Ontario Canada
- Program in Neuroscience, The Hospital for Sick Children Research InstituteToronto Ontario Canada
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Boriani F, Fazio N, Bolognesi F, Pedrini FA, Marchetti C, Baldini N. Noncellular Modification of Acellular Nerve Allografts for Peripheral Nerve Reconstruction: A Systematic Critical Review of the Animal Literature. World Neurosurg 2018; 122:692-703.e2. [PMID: 30414518 DOI: 10.1016/j.wneu.2018.10.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acellular nerve allografts (ANAs) have been established as promising alternatives to autologous nerve grafts, which represent the reference standard. Our research group recently performed a systematic review of reported cell-based-enriching methods for recellularization of ANAs. Recellularization results in consistent improvement of peripheral neuroregeneration compared with plain ANAs. We systematically reviewed the effects on nerve regeneration when ANA enrichment was obtained through biological, chemical, and physical modification instead of cells. METHODS The PubMed, ScienceDirect, Medline, and Scopus databases were searched for reports of noncellular modification of ANAs, reported from January 2007 to December 2017. The inclusion criteria were English language, noncellular enrichment of ANAs in peripheral nerve regeneration, an in vivo study design, and postgrafting neuroregenerative outcomes assessment. The exclusion criteria were the central nervous system as the site of ANA application, nerve conduits, xenografts, case series, case reports, and reviews. RESULTS Only animal studies were found to be eligible. We included 16 studies, which were analyzed regarding the animal model, decellularization method, graft-enriching mode, and neuroregenerative tests performed. CONCLUSIONS Noncellular-based stimulation of ANAs demonstrated positive effects on recovery of nerve function compared with nerve grafting compared with plain ANAs. The neuroregenerative effect of autografting still appeared superior to ANAs, even with noncellular enrichment of ANAs. However, we found that in a few studies, modified ANAs closely approached or even outperformed autografts. Future research should include more preclinical investigations of this promising tool and clinical translation to increase the level of evidence available in the challenging field of peripheral nerve reconstruction.
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Affiliation(s)
- Filippo Boriani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Nicola Fazio
- Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, IRCCS, Bologna, Italy
| | - Federico Bolognesi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Alice Pedrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, IRCCS, Bologna, Italy
| | - Claudio Marchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Baldini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, IRCCS, Bologna, Italy
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Sun X, Wang Y, Guo Z, Xiao B, Sun Z, Yin H, Meng H, Sui X, Zhao Q, Guo Q, Wang A, Xu W, Liu S, Li Y, Lu S, Peng J. Acellular Cauda Equina Allograft as Main Material Combined with Biodegradable Chitin Conduit for Regeneration of Long-Distance Sciatic Nerve Defect in Rats. Adv Healthc Mater 2018; 7:e1800276. [PMID: 30044554 DOI: 10.1002/adhm.201800276] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/18/2018] [Indexed: 11/10/2022]
Abstract
Autologous nerve grafting (ANG), the gold standard treatment for peripheral nerve defects, still has many restrictions. In this study, the acellular cauda equina allograft (ACEA), which consists of biodegradable chitin conduit and acellular cauda equina, is developed. The cauda equina is able to complete decellularization more quickly and efficiently than sciatic nerves under the same conditions, and it is able to reserve more basal lamina tube. In vitro, ACEA shows superior guidance capacity for the regeneration of axons and migration of Schwann cells compared to acellular sciatic nerve allograft (ASNA) in dorsal root ganglion culture. In vivo, ACEA is used to bridge 15 mm long-distance defects in rat sciatic nerves. On day 21 after transplantation, the regenerative distance of neurofilaments in the grafting segment is not significantly different between the ACEA and ANG groups. At week 12, ACEA group shows better sciatic nerve repair than chitin conduit only and ASNA groups, and the effect is similar to that in the ANG group as determined by gait analysis, neural electrophysiological, and histological analyses. The above results suggest that the ACEA has the potential to become a new biological material as a replacement for autografting in the treatment of long-distance nerve defects.
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Affiliation(s)
- Xun Sun
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- School of Medicine; Nankai University; No. 94 Weijin Road Tianjin 300071 P. R. China
| | - Yu Wang
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| | - Zhiyuan Guo
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Bo Xiao
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Zhen Sun
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Heyong Yin
- Department of Surgery; Ludwig-Maximilians-University (LMU); Nussbaumstr. 20 Munich 80336 Germany
| | - Haoye Meng
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Xiang Sui
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Qing Zhao
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| | - Quanyi Guo
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Aiyuan Wang
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Wenjing Xu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Shuyun Liu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Yaojun Li
- Department of Otolaryngology; First Teaching Hospital of Tianjin University of Traditional Chinese Medicine; No. 314 An Shan Xi Road Tianjin 300192 P. R. China
| | - Shibi Lu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Jiang Peng
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
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Liu H, Huang H, Bi W, Tan X, Li R, Wen W, Song W, Zhang Y, Zhang F, Hu M. Effect of chitosan combined with hyaluronate on promoting the recovery of postoperative facial nerve regeneration and function in rabbits. Exp Ther Med 2018; 16:739-745. [PMID: 30116328 PMCID: PMC6090212 DOI: 10.3892/etm.2018.6238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/29/2018] [Indexed: 12/19/2022] Open
Abstract
To determine better solutions for postoperative nerve functional recovery, the effects of chitosan and hyaluronate on perineural scar formation and neural function recovery were investigated in 40 rabbits. Rabbits were randomized into 4 groups: A (chitosan), B (chitosan + hyaluronate), C (hyaluronate) and D (control). The rabbits underwent the same parotidectomy surgery, but different materials were used to cover the operated nerves. By evaluating specific indicators, including vibrissae motion tests, neural electrophysiological examinations and extraneural examinations, it was revealed that the amplitude of vibrissae motion of all groups had increased 6 weeks after surgery. The recovery of Group B was superior compared with all other groups at 4 and 12 weeks post-surgery; however no significant differences were detected. Group B exhibited a great number of nerve fibers, thicker myelin sheath and greater nerve conduction velocity. In summary, the use of a chitosan conduit combined with sodium hyaluronate gel may prevent perineural scar formation in facial nerves and promote nerve functional recovery.
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Affiliation(s)
- Huawei Liu
- Department of Stomatology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Haitao Huang
- Department of Stomatology, The 1st Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Wenting Bi
- Department of Stomatology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100026, P.R. China
| | - Xinying Tan
- Department of Stomatology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Runxin Li
- Department of Stomatology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Weisheng Wen
- Department of Stomatology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Wenling Song
- Department of Quality Control, Beijing Yierkang Bioengineering Development Center, Beijing 102600, P.R. China
| | - Yanhua Zhang
- Department of Quality Control, Beijing Yierkang Bioengineering Development Center, Beijing 102600, P.R. China
| | - Feng Zhang
- Department of Quality Control, Beijing Yierkang Bioengineering Development Center, Beijing 102600, P.R. China
| | - Min Hu
- Department of Stomatology, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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Wieringa PA, Gonçalves de Pinho AR, Micera S, Wezel RJA, Moroni L. Biomimetic Architectures for Peripheral Nerve Repair: A Review of Biofabrication Strategies. Adv Healthc Mater 2018; 7:e1701164. [PMID: 29349931 DOI: 10.1002/adhm.201701164] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/13/2017] [Indexed: 12/19/2022]
Abstract
Biofabrication techniques have endeavored to improve the regeneration of the peripheral nervous system (PNS), but nothing has surpassed the performance of current clinical practices. However, these current approaches have intrinsic limitations that compromise patient care. The "gold standard" autograft provides the best outcomes but requires suitable donor material, while implantable hollow nerve guide conduits (NGCs) can only repair small nerve defects. This review places emphasis on approaches that create structural cues within a hollow NGC lumen in order to match or exceed the regenerative performance of the autograft. An overview of the PNS and nerve regeneration is provided. This is followed by an assessment of reported devices, divided into three major categories: isotropic hydrogel fillers, acting as unstructured interluminal support for regenerating nerves; fibrous interluminal fillers, presenting neurites with topographical guidance within the lumen; and patterned interluminal scaffolds, providing 3D support for nerve growth via structures that mimic native PNS tissue. Also presented is a critical framework to evaluate the impact of reported outcomes. While a universal and versatile nerve repair strategy remains elusive, outlined here is a roadmap of past, present, and emerging fabrication techniques to inform and motivate new developments in the field of peripheral nerve regeneration.
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Affiliation(s)
- Paul A. Wieringa
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht University Universiteitssingel 40 Maastricht 6229 ER The Netherlands
| | - Ana Rita Gonçalves de Pinho
- Tissue Regeneration DepartmentMIRA InstituteUniversity of Twente Drienerlolaan 5 Enschede 7522 NB The Netherlands
| | - Silvestro Micera
- BioRobotics InstituteScuola Superiore Sant'Anna Viale Rinaldo Piaggio 34 Pontedera 56025 Italy
- Translational Neural Engineering LaboratoryEcole Polytechnique Federale de Lausanne Ch. des Mines 9 Geneva CH‐1202 Switzerland
| | - Richard J. A. Wezel
- BiophysicsDonders Institute for BrainCognition and BehaviourRadboud University Kapittelweg 29 Nijmegen 6525 EN The Netherlands
- Biomedical Signals and SystemsMIRA InstituteUniversity of Twente Drienerlolaan 5 Enschede 7522 NB The Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht University Universiteitssingel 40 Maastricht 6229 ER The Netherlands
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Cornelison RC, Gonzalez-Rothi EJ, Porvasnik SL, Wellman SM, Park JH, Fuller DD, Schmidt CE. Injectable hydrogels of optimized acellular nerve for injection in the injured spinal cord. Biomed Mater 2018; 13:034110. [PMID: 29380749 PMCID: PMC5911159 DOI: 10.1088/1748-605x/aaab82] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Spinal cord injury (SCI) affects a quarter million individuals in the United States, and there is currently no clinical treatment. Both fresh and acellular peripheral nerve grafts can induce spinal axon regeneration and support functional recovery in experimental injury models. Nonetheless, a scaffold that can be injected into a spinal contusion would be far less invasive to apply. We aimed to develop the first injectable acellular nerve graft for promoting repair after contusion SCI. APPROACH We report a method to enzymatically solubilize optimized acellular (OA) nerve-a decellularized peripheral nerve graft developed in our laboratory and currently used clinically-to obtain an injectable solution that undergoes thermal gelation under physiological conditions. We quantified multiple physical and compositional properties of this novel material as well as tested its efficacy at acute and chronic time points following cervical contusion SCI. MAIN RESULTS This injectable optimized acellular (iOA) nerve graft retains native chemical cues such as collagens and glycosaminoglycans. By varying hydrogel concentration, the rheological properties and compressive modulus of iOA were similar to that previous reported for rat central nervous tissue. iOA solution was compatible with rat Schwann cells in culture, and hydrogel injection into a rat cervical contusion model significantly reduced the ratio of M1:M2 macrophages after one week, favoring regenerative phenotypes (p < 0.05). Furthermore, while iOA treatment did not affect locomotor or respiratory recovery over an eight week period, the percentage of axonal coverage increased at the distal tissue interface (p < 0.05), suggesting enhanced axonal extension within this region. SIGNIFICANCE Our data indicate that this novel injectable form of acellular nerve grafts is amenable for use after contusion SCI and may bolster a simultaneous therapy by acutely modulating the inflammatory milieu and supporting axonal growth.
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Affiliation(s)
- R. Chase Cornelison
- McKetta Department of Chemical Engineering, University of Texas at Austin, Austin, TX 78712
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611
| | | | - Stacy L. Porvasnik
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611
| | - Steven M. Wellman
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611
| | - James H. Park
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611
| | - David D. Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611
| | - Christine E. Schmidt
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611
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Suchyta MA, Sabbagh MD, Morsy M, Mardini S, Moran SL. Advances in peripheral nerve regeneration as it relates to VCA. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23723505.2017.1344347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - M. Diya Sabbagh
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamed Morsy
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Samir Mardini
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L. Moran
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
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Hepatocytic differentiation of iPS cells on decellularized liver tissue. J Artif Organs 2017; 20:318-325. [PMID: 28776092 DOI: 10.1007/s10047-017-0977-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/24/2017] [Indexed: 01/12/2023]
Abstract
Decellularized tissues (DETs) have been attracting great attention as scaffolds for tissue-engineering approaches. Recently, some studies have reported that decellularized liver tissues (DLT) can provide an excellent environment for the hepatocytic differentiation of hepatic stem/progenitor cells that were already committed to the hepatocyte lineage. However, the effects of DLT on the hepatocytic differentiation of induced pluripotent stem cells (iPSs) have not yet been established. Here we studied the hepatocytic differentiation of iPSs on DLT and decellularized heart tissues (DHT) in order to determine the tissue-specific effects of DETs on iPSs differentiation. Our results showed that DLTs led to higher gene expression levels of forkhead box A2 (a marker of endoderm) and CCAAT/enhancer binding protein-α (master transcription factor to hepatocyte differentiation), alpha-fetoprotein (a marker of fetal hepatocyte,), and albumin (a marker of fetal and mature hepatocyte) of iPSs than on DHTs. Furthermore, gene expression levels of tyrosine aminotransferase (a marker of mature hepatocyte) were higher on DLT than that on DHT, and immunocytochemical analysis and ELISA assay showed that albumin secretion level of iPSs on DLT was higher than that on DHT. Our study demonstrated that the use of DLTs led to mature hepatocytic differentiation levels of iPSs compared to DHTs, which provides a better niche for iPSs cell engineering and enables the preparation of useful mature cells for regenerative therapy.
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Hundepool CA, Nijhuis THJ, Kotsougiani D, Friedrich PF, Bishop AT, Shin AY. Optimizing decellularization techniques to create a new nerve allograft: an in vitro study using rodent nerve segments. Neurosurg Focus 2017; 42:E4. [DOI: 10.3171/2017.1.focus16462] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE
Commercially available processed nerve allografts have been shown to be inferior to autografts in previous animal studies. The authors hypothesized that combining different processing and storage techniques will result in improved nerve ultrastructure preservation, lower immunogenicity, and minimized cellular debris. Different processing protocols were evaluated using chemical detergents, enzymes, and irradiation, with the addition the of enzyme elastase, were used. Additionally, the difference between cold and frozen storage was investigated. The goal of this study was to create an optimized nerve allograft.
METHODS
Fifty rat nerves were decellularized with modifications of previous protocols and the addition of elastase. Subsequently, the nerve segments were stored at either 4°C or −80°C. Both processed and fresh control nerves were analyzed with confocal microscopy using immunohistochemical staining on the basal lamina (laminin γ-1), Schwann cells (S100 protein), and immunogenicity using major histocompatibility complex–I (MHCI) staining. Morphology of the ultrastructure and amount of cellular debris were analyzed on cross-sections of the nerves stained with toluidine blue and H & E, and by using electron microscopy.
RESULTS
Nerve ultrastructure was preserved with all decellularization protocols. Storage at −80°C severely altered nerve ultrastructure after any decellularization method. Elastase was found to significantly reduce the immunogenicity and amount of Schwann cells, while maintaining good structural properties.
CONCLUSIONS
Reduced immunogenicity, diminished cellular debris, and the elimination of Schwann cells was observed when elastase was added to the nerve processing while maintaining ultrastructure. Storage at −80°C after the decellularization process heavily damaged the nerve ultrastructure as compared with cold storage. Further in vivo studies are needed to prove the nerve regenerative capacity of these optimized allografts.
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Affiliation(s)
- Caroline A. Hundepool
- 1Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota; and
- 2Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tim H. J. Nijhuis
- 2Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dimitra Kotsougiani
- 1Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota; and
| | - Patricia F. Friedrich
- 1Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota; and
| | - Allen T. Bishop
- 1Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota; and
| | - Alexander Y. Shin
- 1Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota; and
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Pollins AC, Kim JS, Boyer RB, Thayer WP. Mass spectrometry comparison of nerve allograft decellularization processes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:20. [PMID: 28012154 DOI: 10.1007/s10856-016-5834-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
Peripheral nerve repair using nerve grafts has been investigated for several decades using traditional techniques such as histology, immunohistochemistry, and electron microscopy. Recent advances in mass spectrometry techniques have made it possible to study the proteomes of complex tissues, including extracellular matrix rich tissues similar to peripheral nerves. The present study comparatively assessed three previously described processing methods for generating acellular nerve grafts by mass spectrometry. Acellular nerve grafts were additionally examined by F-actin staining and nuclear staining for debris clearance. Application of newer techniques allowed us to detect and highlight differences among the 3 treatments. Isolated proteins were separated by mass on polyacrylamide gels serving 2 purposes. This further illustrated that these treatments differ from one another and it allowed for selective protein extractions within specific bands/molecular weights. This approach resulted in small pools of proteins that could then be analyzed by mass spectrometry for content. In total, 543 proteins were identified, many of which corroborate previous findings for these processing methods. The remaining proteins are novel discoveries that expand the field. With this pilot study, we have proven that mass spectrometry techniques complement and add value to peripheral nerve repair studies.
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Affiliation(s)
- Alonda C Pollins
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Justine S Kim
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Richard B Boyer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Graham JB, Muir D. Chondroitinase C Selectively Degrades Chondroitin Sulfate Glycosaminoglycans that Inhibit Axonal Growth within the Endoneurium of Peripheral Nerve. PLoS One 2016; 11:e0167682. [PMID: 27973564 PMCID: PMC5156433 DOI: 10.1371/journal.pone.0167682] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/19/2016] [Indexed: 11/19/2022] Open
Abstract
The success of peripheral nerve regeneration is highly dependent on the regrowth of axons within the endoneurial basal lamina tubes that promote target-oriented pathfinding and appropriate reinnervation. Restoration of nerve continuity at this structural level after nerve transection injury by direct repair and nerve grafting remains a major surgical challenge. Recently, biological approaches that alter the balance of growth inhibitors and promoters in nerve have shown promise to improve appropriate axonal regeneration and recovery of peripheral nerve function. Chondroitin sulfate proteoglycans (CSPGs) are known inhibitors of axonal growth. This growth inhibition is mainly associated with a CSPG's glycosaminoglycan chains. Enzymatic degradation of these chains with chondroitinase eliminates this inhibitory activity and, when applied in vivo, can improve the outcome of nerve repair. To date, these encouraging findings were obtained with chondroitinase ABC (a pan-specific chondroitinase). The aim of this study was to examine the distribution of CSPG subtypes in rodent, rabbit, and human peripheral nerve and to test more selective biological enzymatic approaches to improve appropriate axonal growth within the endoneurium and minimize aberrant growth. Here we provide evidence that the endoneurium, but not the surrounding epineurium, is rich in CSPGs that have glycosaminoglycan chains readily degraded by chondroitinase C. Biochemical studies indicate that chondroitinase C has degradation specificity for 6-sulfated glycosaminoglycans found in peripheral nerve. We found that chondroitinase C degrades and inactivates inhibitory CSPGs within the endoneurium but not so much in the surrounding nerve compartments. Cryoculture bioassays (neurons grown on tissue sections) show that chondroitinase C selectively and significantly enhanced neuritic growth associated with the endoneurial basal laminae without changing growth-inhibiting properties of the surrounding epineurium. Interestingly, chondroitinase ABC treatment increased greatly the growth-promoting properties of the epineurial tissue whereas chondroitinase C had little effect. Our evidence indicates that chondroitinase C effectively degrades and inactivates inhibitory CSPGs present in the endoneurial Schwann cell basal lamina and does so more specifically than chondroitinase ABC. These findings are discussed in the context of improving nerve repair and regeneration and the growth-promoting properties of processed nerve allografts.
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Affiliation(s)
- James B. Graham
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - David Muir
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida, United States of America
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Abstract
Manufactured conduits and allografts are viable alternatives to direct suture repair and nerve autograft. Manufactured tubes should have gaps less than 10 mm, and ideally should be considered as an aid to the coaptation. Processed nerve allograft has utility as a substitute for either conduit or autograft in sensory nerve repairs. There is also a growing body of evidence supporting their utility in major peripheral nerve repairs, gap repairs up to 70 mm in length, as an alternative source of tissue to bolster the diameter of a cable graft, and for the management of neuromas in non-reconstructable injuries.
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Affiliation(s)
- Bauback Safa
- The Buncke Clinic, 45 Castro Street #121, San Francisco, CA 94114, USA.
| | - Gregory Buncke
- The Buncke Clinic, 45 Castro Street #121, San Francisco, CA 94114, USA
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Kundu J, Michaelson A, Talbot K, Baranov P, Young MJ, Carrier RL. Decellularized retinal matrix: Natural platforms for human retinal progenitor cell culture. Acta Biomater 2016; 31:61-70. [PMID: 26621699 DOI: 10.1016/j.actbio.2015.11.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/02/2015] [Accepted: 11/16/2015] [Indexed: 12/28/2022]
Abstract
Tissue decellularization strategies have enabled engineering of scaffolds that preserve native extracellular matrix (ECM) structure and composition. In this study, we developed decellularized retina (decell-retina) thin films. We hypothesized that these films, mimicking the retina niche, would promote human retinal progenitor cell (hRPC) attachment, proliferation and differentiation. Retinas isolated from bovine eyes were decellularized using 1% w/v sodium dodecyl sulfate (SDS) and pepsin digested. The resulting decell-retina was biochemically assayed for composition and cast dried to develop thin films. Attachment, viability, morphology, proliferation and gene expression of hRPC cultured on the films were studied in vitro. Biochemical analyses of decell-retina compared to native retina indicated the bulk of DNA (94%) was removed, while the majority of sulfated GAGs (55%), collagen (83%), hyaluronic acid (87%), and key growth factors were retained. The decell-retina films supported hRPC attachment and growth, with cell number increasing 1.5-fold over a week. RT-PCR analysis revealed hRPC expression of rhodopsin, rod outer membrane, neural retina-specific leucine zipper neural and cone-rod homeobox gene on decell-retina films, indicating photoreceptor development. In conclusion, novel decell-retina films show promise as potential substrates for culture and/or transplantation of retinal progenitor cells to treat retinal degenerative disorders. STATEMENT OF SIGNIFICANCE In this study, we report the development of a novel biomaterial, based on decellularized retina (decell-retina) that mimics the retina niche and promotes human retinal progenitor cell (hRPC) attachment, proliferation and differentiation. We estimated, for the first time, the amounts of collagen I, GAGs and HA present in native retina, as well as the decell-retina. We demonstrated that retinas can be decellularized using ionic detergents and can be processed into mechanically stable thin films, which can act as substrates for culturing hRPCs. Rhodopsin, ROM1, NRL and CRX gene expression on the decell-retina films indicated photoreceptor development from RPCs. These results support the potential of decell-retina as a cell delivery platform to treat and manage retinal degenerative disease like AMD.
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Tajdaran K, Gordon T, Wood MD, Shoichet MS, Borschel GH. A glial cell line-derived neurotrophic factor delivery system enhances nerve regeneration across acellular nerve allografts. Acta Biomater 2016; 29:62-70. [PMID: 26441127 DOI: 10.1016/j.actbio.2015.10.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Acellular nerve allografts (ANAs) are used clinically to bridge nerve gaps but these grafts, lacking Schwann cells and therapeutic levels of neurotrophic factors, do not support regeneration to the same extent as autografts. Here we investigated a local drug delivery system (DDS) for glial cell line-derived neurotrophic factor (GDNF) controlled release to implanted ANAs in rats using drug-loaded polymeric microspheres (MSs) embedded in a fibrin gel. In a rat hindlimb nerve gap model, a 10mm ANA was used to bridge a 5mm common peroneal (CP) nerve gap. Experimental groups received DDS treatment at both suture sites of the allografts releasing GDNF for either 2 weeks or 4 weeks. In negative control groups, rats received no DDS treatment or empty DDS. Rats receiving nerve isografts served as the positive control group. The numbers of motor and sensory neurons that regenerated their axons in all the groups with GDNF MS and isograft treatment were indistinguishable and significantly higher as compared to the negative control groups. Nerve histology distal to the nerve graft demonstrated increased axon counts and a shift to larger fiber diameters due to GDNF MS treatment. The sustained delivery of GDNF to the implanted ANA achieved in this study demonstrates the promise of this DDS for the management of severe nerve injuries in which allografts are placed. STATEMENT OF SIGNIFICANCE This work addresses the common clinical situation in which a nerve gap is bridged using acellular nerve allografts. However, these allografts are not as effective in supporting nerve regeneration as the gold standard method of autografting. The novel local drug delivery system used in this study provides sustained and controlled release of glial cell line-derived neurotrophic factor (GDNF), one of the most potent neurotrophic factors, which significantly improves nerve regeneration following severe nerve injuries. Results from this research will provide a mean of improving nerve allografts with locally delivered GDNF. This strategy may lead to a novel "off the shelf" alternative to the current management of severe nerve injuries.
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Kajbafzadeh AM, Khorramirouz R, Akbarzadeh A, Sabetkish S, Sabetkish N, Saadat P, Tehrani M. A novel technique for simultaneous whole-body and multi-organ decellularization: umbilical artery catheterization as a perfusion-based method in a sheep foetus model. Int J Exp Pathol 2015; 96:116-32. [PMID: 26031202 DOI: 10.1111/iep.12124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/09/2015] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to develop a method to generate multi-organ acellular matrices. Using a foetal sheep model have developed a method of systemic pulsatile perfusion via the umbilical artery which allows for simultaneous multi-organ decellularization. Twenty sheep foetuses were systemically perfused with Triton X-100 and sodium dodecyl sulphate. Following completion of the whole-body decellularization, multiple biopsy samples were taken from different parts of 21 organs to ascertain complete cell component removal in the preserved extracellular matrices. Both the natural and decellularized organs were subjected to several examinations. The samples were obtained from the skin, eye, ear, nose, throat, cardiovascular, respiratory, gastrointestinal, urinary, musculoskeletal, central nervous and peripheral nervous systems. The histological results depicted well-preserved extracellular matrix (ECM) integrity and intact vascular structures, without any evidence of residual cellular materials, in all decellularized bioscaffolds. Scanning electron microscope (SEM) and biochemical properties remained intact, similar to their age-matched native counterparts. Preservation of the collagen structure was evaluated by a hydroxyproline assay. Dense organs such as bone and muscle were also completely decellularized, with a preserved ECM structure. Thus, as shown in this study, several organs and different tissues were decellularized using a perfusion-based method, which has not been previously accomplished. Given the technical challenges that exist for the efficient generation of biological scaffolds, the current results may pave the way for obtaining a variety of decellularized scaffolds from a single donor. In this study, there have been unique responses to the single acellularization protocol in foetuses, which may reflect the homogeneity of tissues and organs in the developing foetal body.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Reza Khorramirouz
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Aram Akbarzadeh
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Shabnam Sabetkish
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Nastaran Sabetkish
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Paria Saadat
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Mona Tehrani
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
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Yu H, Xiang L, Xu W, Zhao B, Wang Y, Peng J, Lu S. Chondroitinase ABC improves recovery of long sciatic nerve defects. Neural Regen Res 2015; 7:61-5. [PMID: 25806060 PMCID: PMC4354120 DOI: 10.3969/j.issn.1673-5374.2012.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 12/24/2011] [Indexed: 01/30/2023] Open
Abstract
Sciatic nerves from allogeneic Sprague-Dawley rats were pretreated with chondroitinase ABC and were used to bridge damaged sciatic nerves in Wistar rats. Chondroitin sulfate proteoglycans were removed from the chemically extracted acellular nerves. At 3 months after grafting, the footplate pinch test result was positive in the Wistar rats. Autotomy scores decreased, and increased muscular contraction tension appeared when triceps surae muscles were stimulated. In addition, the recovery rate of wet triceps surae muscle weight increased, and the distal segment of the chondroitinase ABC-treated graft exhibited Schwann cells next to the nerve fibers. These results suggested that chondroitinase ABC pretreatment enhanced repair of long nerve defects via acellular nerve grafting.
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Affiliation(s)
- Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang 110016, Liaoning Province, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang 110016, Liaoning Province, China
| | - Wenjing Xu
- Institute of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
| | - Bin Zhao
- Institute of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
| | - Yu Wang
- Institute of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
| | - Jiang Peng
- Institute of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
| | - Shibi Lu
- Institute of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
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49
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Gause Ii TM, Sivak WN, Marra KG. The role of chondroitinase as an adjuvant to peripheral nerve repair. Cells Tissues Organs 2015; 200:59-68. [PMID: 25766067 DOI: 10.1159/000369449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 11/19/2022] Open
Abstract
Chondroitin sulfate proteoglycans (CSPGs) are potent inhibitors of neural regeneration in the peripheral nervous system. Following nerve injury, inhibitory CSPGs accumulate within the endoneurium and Schwann cell basal lamina of the distal nerve stump. The utilization of chondroitinase ABC (chABC) has led to a marked increase in the ability of injured axons to regenerate across gaps through the CSPG-laden extracellular matrix. Experimental models have repeatedly shown chABC to be capable of degrading the CSPGs that hinder neurite outgrowth. In this article, the characterization of CSPGs, their upregulation following peripheral nerve injury, and potential mechanisms behind their growth and inhibition are described. To date, the literature supports that the adjunct use of chABC may be beneficial to peripheral nerve repair in digesting inhibitory CSPGs. chABC has also shown some indication of synergism with other therapies, such as stem cell transplantation. Evidence supporting the use of chondroitinase as a treatment modality in nerve repair, either alone or in combination with other agents, is reviewed within. Finally, several shortcomings of chABC are addressed, notably its thermal stability and physiologic longevity - both hindering its widespread clinical adoption. Future studies are warranted in order to optimize the therapeutic benefits of the chondroitinase enzyme.
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50
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Moore AM, Wagner IJ, Fox IK. Principles of nerve repair in complex wounds of the upper extremity. Semin Plast Surg 2015; 29:40-7. [PMID: 25685102 DOI: 10.1055/s-0035-1544169] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Peripheral nerve injuries are common in the setting of complex upper extremity trauma. Early identification of nerve injuries and intervention is critical for maximizing return of function. In this review, the principles of nerve injury, patient evaluation, and surgical management are discussed. An evidence-based approach to nerve reconstruction is reviewed, including the benefits and limitations of direct repair and nerve gap reconstruction with the use of autografts, processed nerve allografts, and conduits. Further, the principles and indications of commonly used nerve transfers in proximal nerve injuries are also addressed.
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Affiliation(s)
- Amy M Moore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - I Janelle Wagner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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