1
|
Horowitz RS, Randall ZD, Dy CJ. Electrical Stimulation: Enhancing Axonal Growth following Peripheral Nerve Injury. J Hand Surg Asian Pac Vol 2024; 29:373-379. [PMID: 39205525 DOI: 10.1142/s2424835524400034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Electrical stimulation has been integrated in recent decades into rehabilitation protocols following neuromuscular injuries. Existing literature supports the utilisation of prolonged or continuous stimulation generated by implantable or transcutaneous devices for chronic pain subsidence and muscle trophism maintenance, which improve outcomes following microsurgical interventions. Newer uses include brief electrical stimulation for peripheral nerve injury. Brief electrical stimulation has shown promise in expediting regeneration of both torn and crushed nerve axons in the murine model and has been incorporated into a limited number of clinical studies. Augmentation of the natural response of an injured peripheral nerve by electrical stimulation has the potential to accelerate regeneration, presumably leading to improved function and clinical outcomes. We review the existing literature on intraoperative utilisation of electrical stimulation to enhance regeneration, such as neural mechanisms of action and their microscopic effect in animal models, as well as results from initial human studies. Level of Evidence: Level V (Therapeutic).
Collapse
|
2
|
Hardy PB, Wang BY, Chan KM, Webber CA, Senger JLB. The use of electrical stimulation to enhance recovery following peripheral nerve injury. Muscle Nerve 2024. [PMID: 39347555 DOI: 10.1002/mus.28262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 09/04/2024] [Accepted: 09/07/2024] [Indexed: 10/01/2024]
Abstract
Peripheral nerve injury is common and can have devastating consequences. In severe cases, functional recovery is often poor despite surgery. This is primarily due to the exceedingly slow rate of nerve regeneration at only 1-3 mm/day. The local environment in the distal nerve stump supportive of nerve regrowth deteriorates over time and the target end organs become atrophic. To overcome these challenges, investigations into treatments capable of accelerating nerve regrowth are of great clinical relevance and are an active area of research. One intervention that has shown great promise is perioperative electrical stimulation. Postoperative stimulation helps to expedite the Wallerian degeneration process and reduces delays caused by staggered regeneration at the site of nerve injury. By contrast, preoperative "conditioning" stimulation increases the rate of nerve regrowth along the nerve trunk. Over the past two decades, a rich body of literature has emerged that provides molecular insights into the mechanism by which electrical stimulation impacts nerve regeneration. The end result is upregulation of regeneration-associated genes in the neuronal body and accelerated transport to the axon front for regrowth. The efficacy of brief electrical stimulation on patients with peripheral nerve injuries was demonstrated in a number of randomized controlled trials on compressive, transection and traction injuries. As approved equipment to deliver this treatment is becoming available, it may be feasible to deploy this novel treatment in a wide range of clinical settings.
Collapse
Affiliation(s)
- Paige B Hardy
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Y Wang
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jenna-Lynn B Senger
- Division of Plastic & Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Senger JL, Power H, Moore AM. Electrical Stimulation: How It Works and How to Apply It. Hand Clin 2024; 40:409-420. [PMID: 38972685 DOI: 10.1016/j.hcl.2024.03.007] [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
Electrical stimulation is emerging as a perioperative strategy to improve peripheral nerve regeneration and enhance functional recovery. Despite decades of research, new insights into the complex multifaceted mechanisms of electrical stimulation continue to emerge, providing greater understanding of the neurophysiology of nerve regeneration. In this study, we summarize what is known about how electrical stimulation modulates the molecular cascades and cellular responses innate to nerve injury and repair, and the consequential effects on axonal growth and plasticity. Further, we discuss how electrical stimulation is delivered in preclinical and clinical studies and identify knowledge gaps that may provide opportunities for optimization.
Collapse
Affiliation(s)
- Jenna-Lynn Senger
- Division of Plastic Surgery, University of British Columbia, Suite 1788, 1111 W Georgia Street, Vancouver, British Columbia, V6E 4M3, Canada
| | - Hollie Power
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Suite 401, 316 Windermere Road NorthWest, Edmonton, Alberta T6W 2Z8, Canada
| | - Amy M Moore
- Department of Plastic and Reconstructive Surgery, The Ohio State University, 915 Olentangy River Road Suite 2100, Columbus, OH 43212, USA.
| |
Collapse
|
4
|
Gordon T. Brief Electrical Stimulation Promotes Recovery after Surgical Repair of Injured Peripheral Nerves. Int J Mol Sci 2024; 25:665. [PMID: 38203836 PMCID: PMC10779324 DOI: 10.3390/ijms25010665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Injured peripheral nerves regenerate their axons in contrast to those in the central nervous system. Yet, functional recovery after surgical repair is often disappointing. The basis for poor recovery is progressive deterioration with time and distance of the growth capacity of the neurons that lose their contact with targets (chronic axotomy) and the growth support of the chronically denervated Schwann cells (SC) in the distal nerve stumps. Nonetheless, chronically denervated atrophic muscle retains the capacity for reinnervation. Declining electrical activity of motoneurons accompanies the progressive fall in axotomized neuronal and denervated SC expression of regeneration-associated-genes and declining regenerative success. Reduced motoneuronal activity is due to the withdrawal of synaptic contacts from the soma. Exogenous neurotrophic factors that promote nerve regeneration can replace the endogenous factors whose expression declines with time. But the profuse axonal outgrowth they provoke and the difficulties in their delivery hinder their efficacy. Brief (1 h) low-frequency (20 Hz) electrical stimulation (ES) proximal to the injury site promotes the expression of endogenous growth factors and, in turn, dramatically accelerates axon outgrowth and target reinnervation. The latter ES effect has been demonstrated in both rats and humans. A conditioning ES of intact nerve days prior to nerve injury increases axonal outgrowth and regeneration rate. Thereby, this form of ES is amenable for nerve transfer surgeries and end-to-side neurorrhaphies. However, additional surgery for applying the required electrodes may be a hurdle. ES is applicable in all surgeries with excellent outcomes.
Collapse
Affiliation(s)
- Tessa Gordon
- Division of Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON M4G 1X8, Canada
| |
Collapse
|
5
|
Umansky D, Elzinga K, Midha R. Surgery for mononeuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:227-249. [PMID: 38697743 DOI: 10.1016/b978-0-323-90108-6.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Advancement in microsurgical techniques and innovative approaches including greater use of nerve and tendon transfers have resulted in better peripheral nerve injury (PNI) surgical outcomes. Clinical evaluation of the patient and their injury factors along with a shift toward earlier time frame for intervention remain key. A better understanding of the pathophysiology and biology involved in PNI and specifically mononeuropathies along with advances in ultrasound and magnetic resonance imaging allow us, nowadays, to provide our patients with a logical and sophisticated approach. While functional outcomes are constantly being refined through different surgical techniques, basic scientific concepts are being advanced and translated to clinical practice on a continuous basis. Finally, a combination of nerve transfers and technological advances in nerve/brain and machine interfaces are expanding the scope of nerve surgery to help patients with amputations, spinal cord, and brain lesions.
Collapse
Affiliation(s)
- Daniel Umansky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Kate Elzinga
- Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
6
|
Xu Q, Li Z, Su J, Hu M, Yin Q, Chen S, Song J, Chen H. Body Weight Support Treadmill Training Combined With Sciatic Nerve Electrical Stimulation Ameliorating Motor Function by Enhancing PI3K/Akt Proteins Expression via BDNF/TrkB Signaling Pathway in Rats with Spinal Cord Injury. World Neurosurg 2023; 178:e239-e253. [PMID: 37467957 DOI: 10.1016/j.wneu.2023.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To investigate the effects of body weight support treadmill training (BWSTT) and sciatic nerve electrical stimulation (SNES) on motor function recovery in spinal cord injury (SCI) rats and its possible mechanism. METHODS Modified Allen's method was utilized for T10 incomplete SCI. The Basso-Beattie-Bresnahan (BBB) score and modified Tarlov score were applied to assess motor function. Pathologic alterations of the spinal cord and muscles were observed by hematoxylin and eosin (HE) staining. The positive staining region of collagen fibers was assessed with Masson staining. Immunofluorescence was applied to count the positive cells of brain-derived neurotrophic factor (BDNF) and tropomyosin-related kinase B (TrkB). BDNF, TrkB, phosphatidylinositol-3-kinase (PI3K), and protein kinase B (Akt) relative mRNA and protein expressions were evaluated by reverse transcription polymerase chain reaction (RT-PCR) and Western blotting. RESULTS On the 21st day of the intervention, the motor scores in SNES and BWSTT + SNES groups were higher than that in SCI group (P < 0.05). Compared with SCI group, mRNA and protein expressions of BDNF/TrkB and PI3K/Akt were more significant on the 21st day of the intervention in SNES and BWSTT + SNES groups (P < 0.05), but there was no difference in BWSTT group (P > 0.05). CONCLUSIONS This experiment demonstrated that BWSTT combined with SNES contributed to alleviating spinal cord tissue injury, delaying muscle atrophy and improving locomotion. One of the possible mechanisms may be related to the regulation of the BDNF/TrkB signaling pathway, which changes the expression of PI3K/Akt protein. Furthermore, it was discovered that the ultra-early BWSTT may not be conducive to recovery.
Collapse
Affiliation(s)
- Qingqin Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Zhen Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Junhong Su
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Mengxuan Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Qiyong Yin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Shi Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Juan Song
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Hemu Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
7
|
Costello MC, Errante EL, Smartz T, Ray WZ, Levi AD, Burks SS. Clinical applications of electrical stimulation for peripheral nerve injury: a systematic review. Front Neurosci 2023; 17:1162851. [PMID: 37600003 PMCID: PMC10435250 DOI: 10.3389/fnins.2023.1162851] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/26/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Peripheral nerve injuries are common neurologic injuries that are challenging to treat with current therapies. Electrical stimulation has been shown to accelerate reinnervation and enhance functional recovery. This study aims to review the literature on clinical application of electrical stimulation for peripheral nerve injury. Methods PubMed and Embase were sourced from 1995 to August 2022. Selection was based on predetermined inclusion/exclusion criteria. Eight hundred and thirty-five articles were screened with seven being included in this review. Results Two hundred and twenty-nine patients with peripheral nerve injuries were represented. Six of the studies were randomized controlled trials. A variety of nerve injuries were represented with all being in the upper extremity and supraclavicular region. Electrical stimulation protocols and evaluation varied. Electrodes were implanted in four studies with one also implanting the stimulator. Length of stimulation per session was either 20 mins or 1 h. Median stimulation frequency was 20 Hz. Stimulation intensity varied from 3 to 30V; pulse width ranged from 0.1 to 1.007 ms. Three protocols were conducted immediately after surgery. Patients were followed for an average of 13.5 months and were evaluated using electrophysiology and combinations of motor, sensory, and functional criteria. Discussion Patients who received electrical stimulation consistently demonstrated better recovery compared to their respective controls. Electrical stimulation for peripheral nerve injury is a novel treatment that has not been well-studied in humans. Our review illustrates the potential benefit in implementing this approach into everyday practice. Future research should aim to optimize protocol for clinical use.
Collapse
Affiliation(s)
- Meredith C. Costello
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emily L. Errante
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- The Miami Project to Cure Paralysis, Miami, FL, United States
| | - Taylor Smartz
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Allan D. Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- The Miami Project to Cure Paralysis, Miami, FL, United States
| | - Stephen Shelby Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- The Miami Project to Cure Paralysis, Miami, FL, United States
| |
Collapse
|
8
|
Pion AM, Roy AA, Ma X, Beaumont E, Lin JC. Transcutaneous and Direct Electrical Stimulation of Mouse Sciatic Nerve Accelerates Functional Recovery After Nerve Transection and Immediate Repair. Ann Plast Surg 2023; 90:237-241. [PMID: 36796045 DOI: 10.1097/sap.0000000000003463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Electrical stimulation can accelerate peripheral nerve regeneration after injury and repair. Clinically, direct electrical stimulation (DES) may involve longer operating times, increasing risks of perioperative complications. Transcutaneous electrical stimulation (TCES) is a noninvasive alternative. In this study, we investigate how transcutaneous and DES compare for accelerating functional nerve recovery in a mouse sciatic nerve model. METHODS Twenty-eight mice were divided into sham (n = 4), axotomy (n = 8), DES (n = 8), and TCES (n = 8) groups. After sciatic nerve transection and repair, the proximal nerve was subjected to DES or TCES at 20 Hz for 1 hour. Sciatic functional index was measured before the injury, and at weeks 1, 2, 4, 6, 8, 10, and 12 by walking-track analysis. Electrophysiological measures were taken at week 12. RESULTS Kinematic studies showed significant improvement from the 8th week to the 12th week for both electrical stimulation groups compared with the axotomy group (P < 0.05), with no difference between the electrical stimulation groups. At the 12th week, both DES and TCES groups had significantly faster average conduction velocity than the axotomy group. CONCLUSIONS Functional recovery was significantly better from 8 weeks onward in mice receiving either DES or TCES stimulation when compared with axotomy and repair alone. Transcutaneous electrical stimulation is a minimally invasive alternative treatment for accelerating functional recovery after peripheral nerve injury.
Collapse
Affiliation(s)
- Anne-Marie Pion
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Andrée-Anne Roy
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Xiya Ma
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| | - Eric Beaumont
- Faculty of Medicine, East Tennessee State University, Johnson City, TN
| | - Jenny C Lin
- From the Plastic Surgery, Faculty of Medicine, University of Montréal, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Ip VHY, Kotteeswaran Y, Prete S, Sondekoppam RV, Tsui BCH. Neuromodulation using a hybrid technique of combined perineural local anesthetic and nerve stimulation in six challenging clinical scenarios. Can J Anaesth 2023; 70:273-279. [PMID: 36509952 DOI: 10.1007/s12630-022-02373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Postamputation pain is challenging because of complex mechanisms involving a multitude of pain pathways and psychological factors. This patient population also tends to have extensive comorbidities with or without a background of chronic pain. Electrical neuromodulation such as peripheral nerve stimulation has gained traction in the realm of chronic pain. Recently, the off-label use of hybrid perineural nerve stimulation in combination with locoregional block via the stimulating nerve block catheter has been described in single-center case reports. CLINICAL FEATURES Herein, we present a case series of six patients from two different Canadian hospitals using such a hybrid technique in three different clinical scenarios. These scenarios were (1) local anesthetic dose minimization in the presence of multiple nerve block catheters, (2) analgesia augmentation when local anesthetic alone is insufficient, and (3) provision of an analgesic adjunct as part of a multimodal regimen. A stimulating sciatic nerve block catheter was inserted under ultrasound and nerve stimulation guidance for these cases. Patients tended to experience pain on the subsequent postoperative days whereby the off-label use of nerve stimulation successfully reduced their pain score and stabilized or decreased their opioid consumption or minimized the need to increase the local anesthetic dose when doing so could have precipitated local anesthetic toxicity. CONCLUSION Our case series supports the feasibility of using a combination of low-frequency perineural stimulation and local anesthetic infusion via a single perineural nerve block catheter to manage challenging postamputation pain.
Collapse
Affiliation(s)
- Vivian H Y Ip
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
| | - Yuvaraj Kotteeswaran
- Department of Anesthesiology, Thunder Bay Regional Health Sciences Centre, Thunder, ON, Canada
| | - Savannah Prete
- Acute Pain Service, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative Medicine and Pain Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
10
|
Types of Vascular Response to Direct Intraoperative Electrical Stimulation of the Sciatic Nerve after Autoneuroplasty and Their Effect on Limb Function Recovery. Bull Exp Biol Med 2022; 174:269-272. [PMID: 36598671 DOI: 10.1007/s10517-023-05687-4] [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: 06/16/2022] [Indexed: 01/05/2023]
Abstract
We studied different types of the vascular response to direct intraoperative low-frequency electrical stimulation of the sciatic nerve after autoneuroplasty of its tibial portion and analyzed their effects on the limb function recovery. Rats (n=20) underwent 40-min intraoperative electrical stimulation, and hemodynamics in the leg was recorded by photoplethysmography. Functional recovery of the tibial nerve was assessed using a walking path analysis within 12 weeks after surgery. Three types of the vascular response to electrical stimulation were identified: the absence of pronounced hemodynamic changes during the electrostimulation session, hyperkinetic type of hemodynamics, and venous outflow disturbances. In rats demonstrating vascular responses of types I and II during the postoperative period, the functional index of the tibial nerve partially recovered within 12 weeks; in type III, no recovery was observed. It was concluded that the type of hemodynamics during intraoperative electrical stimulation of the damaged nerve subjected to autoneuroplasty affects further restoration of the motor function of the limb.
Collapse
|
11
|
Sarhane KA, Qiu C, Harris TG, Hanwright PJ, Mao HQ, Tuffaha SH. Translational bioengineering strategies for peripheral nerve regeneration: opportunities, challenges, and novel concepts. Neural Regen Res 2022; 18:1229-1234. [PMID: 36453398 PMCID: PMC9838159 DOI: 10.4103/1673-5374.358616] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Peripheral nerve injuries remain a challenging problem in need of better treatment strategies. Despite best efforts at surgical reconstruction and postoperative rehabilitation, patients are often left with persistent, debilitating motor and sensory deficits. There are currently no therapeutic strategies proven to enhance the regenerative process in humans. A clinical need exists for the development of technologies to promote nerve regeneration and improve functional outcomes. Recent advances in the fields of tissue engineering and nanotechnology have enabled biomaterial scaffolds to modulate the host response to tissue repair through tailored mechanical, chemical, and conductive cues. New bioengineered approaches have enabled targeted, sustained delivery of protein therapeutics with the capacity to unlock the clinical potential of a myriad of neurotrophic growth factors that have demonstrated promise in enhancing regenerative outcomes. As such, further exploration of combinatory strategies leveraging these technological advances may offer a pathway towards clinically translatable solutions to advance the care of patients with peripheral nerve injuries. This review first presents the various emerging bioengineering strategies that can be applied for the management of nerve gap injuries. We cover the rationale and limitations for their use as an alternative to autografts, focusing on the approaches to increase the number of regenerating axons crossing the repair site, and facilitating their growth towards the distal stump. We also discuss the emerging growth factor-based therapeutic strategies designed to improve functional outcomes in a multimodal fashion, by accelerating axonal growth, improving the distal regenerative environment, and preventing end-organs atrophy.
Collapse
Affiliation(s)
- Karim A. Sarhane
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chenhu Qiu
- Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas G.W. Harris
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip J. Hanwright
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hai-Quan Mao
- Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sami H. Tuffaha
- Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Correspondence to: Sami H. Tuffaha, .
| |
Collapse
|
12
|
Mutepfa AR, Hardy JG, Adams CF. Electroactive Scaffolds to Improve Neural Stem Cell Therapy for Spinal Cord Injury. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:693438. [PMID: 35274106 PMCID: PMC8902299 DOI: 10.3389/fmedt.2022.693438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) is a serious condition caused by damage to the spinal cord through trauma or disease, often with permanent debilitating effects. Globally, the prevalence of SCI is estimated between 40 to 80 cases per million people per year. Patients with SCI can experience devastating health and socioeconomic consequences from paralysis, which is a loss of motor, sensory and autonomic nerve function below the level of the injury that often accompanies SCI. SCI carries a high mortality and increased risk of premature death due to secondary complications. The health, social and economic consequences of SCI are significant, and therefore elucidation of the complex molecular processes that occur in SCI and development of novel effective treatments is critical. Despite advances in medicine for the SCI patient such as surgery and anaesthesiology, imaging, rehabilitation and drug discovery, there have been no definitive findings toward complete functional neurologic recovery. However, the advent of neural stem cell therapy and the engineering of functionalized biomaterials to facilitate cell transplantation and promote regeneration of damaged spinal cord tissue presents a potential avenue to advance SCI research. This review will explore this emerging field and identify new lines of research.
Collapse
Affiliation(s)
- Anthea R. Mutepfa
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
| | - John G. Hardy
- Department of Chemistry, Lancaster University, Lancaster, United Kingdom
- Materials Science Institute, Lancaster University, Lancaster, United Kingdom
| | - Christopher F. Adams
- Neural Tissue Engineering Keele, School of Life Sciences, Keele University, Keele, United Kingdom
| |
Collapse
|
13
|
Manousiouthakis E, Park J, Hardy JG, Lee JY, Schmidt CE. Towards the translation of electroconductive organic materials for regeneration of neural tissues. Acta Biomater 2022; 139:22-42. [PMID: 34339871 DOI: 10.1016/j.actbio.2021.07.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
Carbon-based conductive and electroactive materials (e.g., derivatives of graphene, fullerenes, polypyrrole, polythiophene, polyaniline) have been studied since the 1970s for use in a broad range of applications. These materials have electrical properties comparable to those of commonly used metals, while providing other benefits such as flexibility in processing and modification with biologics (e.g., cells, biomolecules), to yield electroactive materials with biomimetic mechanical and chemical properties. In this review, we focus on the uses of these electroconductive materials in the context of the central and peripheral nervous system, specifically recent studies in the peripheral nerve, spinal cord, brain, eye, and ear. We also highlight in vivo studies and clinical trials, as well as a snapshot of emerging classes of electroconductive materials (e.g., biodegradable materials). We believe such specialized electrically conductive biomaterials will clinically impact the field of tissue regeneration in the foreseeable future. STATEMENT OF SIGNIFICANCE: This review addresses the use of conductive and electroactive materials for neural tissue regeneration, which is of significant interest to a broad readership, and of particular relevance to the growing community of scientists, engineers and clinicians in academia and industry who develop novel medical devices for tissue engineering and regenerative medicine. The review covers the materials that may be employed (primarily focusing on derivatives of fullerenes, graphene and conjugated polymers) and techniques used to analyze materials composed thereof, followed by sections on the application of these materials to nervous tissues (i.e., peripheral nerve, spinal cord, brain, optical, and auditory tissues) throughout the body.
Collapse
Affiliation(s)
- Eleana Manousiouthakis
- Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville 32611, FL, United States
| | - Junggeon Park
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, Republic of Korea
| | - John G Hardy
- Department of Chemistry, Lancaster University, Lancaster LA1 4YB, United Kingdom; Materials Science Institute, Lancaster University, Lancaster LA1 4YB, United Kingdom.
| | - Jae Young Lee
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 61005, Republic of Korea.
| | - Christine E Schmidt
- Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville 32611, FL, United States.
| |
Collapse
|
14
|
Halim A, Qu KY, Zhang XF, Huang NP. Recent Advances in the Application of Two-Dimensional Nanomaterials for Neural Tissue Engineering and Regeneration. ACS Biomater Sci Eng 2021; 7:3503-3529. [PMID: 34291638 DOI: 10.1021/acsbiomaterials.1c00490] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The complexity of the nervous system structure and function, and its slow regeneration rate, makes it more difficult to treat compared to other tissues in the human body when an injury occurs. Moreover, the current therapeutic approaches including the use of autografts, allografts, and pharmacological agents have several drawbacks and can not fully restore nervous system injuries. Recently, nanotechnology and tissue engineering approaches have attracted many researchers to guide tissue regeneration in an effective manner. Owing to their remarkable physicochemical and biological properties, two-dimensional (2D) nanomaterials have been extensively studied in the tissue engineering and regenerative medicine field. The great conductivity of these materials makes them a promising candidate for the development of novel scaffolds for neural tissue engineering application. Moreover, the high loading capacity of 2D nanomaterials also has attracted many researchers to utilize them as a drug/gene delivery method to treat various devastating nervous system disorders. This review will first introduce the fundamental physicochemical properties of 2D nanomaterials used in biomedicine and the supporting biological properties of 2D nanomaterials for inducing neuroregeneration, including their biocompatibility on neural cells, the ability to promote the neural differentiation of stem cells, and their immunomodulatory properties which are beneficial for alleviating chronic inflammation at the site of the nervous system injury. It also discusses various types of 2D nanomaterials-based scaffolds for neural tissue engineering applications. Then, the latest progress on the use of 2D nanomaterials for nervous system disorder treatment is summarized. Finally, a discussion of the challenges and prospects of 2D nanomaterials-based applications in neural tissue engineering is provided.
Collapse
Affiliation(s)
- Alexander Halim
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Kai-Yun Qu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| | - Xiao-Feng Zhang
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, P.R. China
| | - Ning-Ping Huang
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, P.R. China
| |
Collapse
|
15
|
Application of electrical stimulation for peripheral nerve regeneration: Stimulation parameters and future horizons. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
16
|
Manto KM, Govindappa PK, Parisi D, Karuman Z, Martinazzi B, Hegarty JP, Talukder MAH, Elfar JC. (4-Aminopyridine)-PLGA-PEG as a Novel Thermosensitive and Locally Injectable Treatment for Acute Peripheral Nerve Injury. ACS APPLIED BIO MATERIALS 2021; 4:4140-4151. [PMID: 34142019 PMCID: PMC8206837 DOI: 10.1021/acsabm.0c01566] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Traumatic peripheral nerve injury (TPNI) represents a major medical problem that results in loss of motor and sensory function, and in severe cases, limb paralysis and amputation. To date, there are no effective treatments beyond surgery in selective cases. In repurposing studies, we found that daily systemic administration of the FDA-approved drug 4-aminopyridine (4-AP) enhanced functional recovery after acute peripheral nerve injury. This study was aimed at constructing a novel local delivery system of 4-AP using thermogelling polymers. We optimized a thermosensitive (4-AP)-poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA) block copolymer formulation. (4-AP)-PLGA-PEG exhibited controlled release of 4-AP both in vitro and in vivo for approximately 3 weeks, with clinically relevant safe serum levels in animals. Rheological investigation showed that (4-AP)-PLGA-PEG underwent a solution to gel transition at 32 °C, a physiologically relevant temperature, allowing us to administer it to an injured limb while subsequently forming an in situ gel. A single local administration of (4-AP)-PLGA-PEG remarkably enhanced motor and sensory functional recovery on post-sciatic nerve crush injury days 1, 3, 7, 14, and 21. Moreover, immunohistochemical studies of injured nerves treated with (4-AP)-PLGA-PEG demonstrated an increased expression of neurofilament heavy chain (NF-H) and myelin protein zero (MPZ) proteins, two major markers of nerve regeneration. These findings demonstrate that (4-AP)-PLGA-PEG may be a promising long-acting local therapeutic agent in TPNI, for which no pharmacologic treatment exists.
Collapse
Affiliation(s)
- Kristen M Manto
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - Prem Kumar Govindappa
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - Daniele Parisi
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - Zara Karuman
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - Brandon Martinazzi
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - John P Hegarty
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - M A Hassan Talukder
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| | - John C Elfar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States
| |
Collapse
|
17
|
Optimizing the electrical conductivity of polyacrylonitrile/polyaniline with nickel nanoparticles for the enhanced electrostimulation of Schwann cells proliferation. Bioelectrochemistry 2021; 140:107750. [PMID: 33578301 DOI: 10.1016/j.bioelechem.2021.107750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/09/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
Tissue engineering scaffolds made of biocompatible polymers are promising alternatives for nerve reparation. For this application, cell proliferation will be speeded up by electrostimulation, which required electrically-conductive materials. Here, a biomimicking scaffold with optimized conductivity was developed from electrospun polyacrylonitrile/electrically-conductive polyaniline (PAN/PANI) nanofibers doped with Ni nanoparticles. PAN/PANI/Ni was biocompatible for Schwann cells and exhibited a suitable tensile strength and wettability for cell proliferation. When compared with unmodified PAN/PANI, the electrical conductivity of PAN/PANI/Ni was 6.4 fold higher. Without electrostimulation, PAN/PANI and PAN/PANI/Ni exhibited similar Schwann cells' proliferation rates. Upon electrostimulation at 100 mV cm-1 for one hour per day over five days, PAN/PANI/Ni accelerated Schwann cells' proliferation 2.1 times compared to PAN/PANI. These results demonstrate the importance of expanding the electrical conductivity of the tissue engineering scaffold to ensure optimal electrostimulation of nerve cell growth. Additionally, this study describes a straightforward approach to modulate the electrical conductivity of polymeric materials via the addition of Ni nanoparticles that can be applied to different biomimicking scaffolds for nerve healing.
Collapse
|
18
|
Electrically conducting polymers for bio-interfacing electronics: From neural and cardiac interfaces to bone and artificial tissue biomaterials. Biosens Bioelectron 2020; 170:112620. [DOI: 10.1016/j.bios.2020.112620] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023]
|
19
|
Molecular and neural adaptations to neuromuscular electrical stimulation; Implications for ageing muscle. Mech Ageing Dev 2020; 193:111402. [PMID: 33189759 PMCID: PMC7816160 DOI: 10.1016/j.mad.2020.111402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
Muscle atrophy and functional declines observed with advancing age can be minimized via various NMES protocols. Animal models have shown that NMES induces motor axon regeneration and promotes axonal outgrowth and fibre reinnervation. The activation of BDNF-trkB contributes to promotion of nerve growth and survival and mediates neuroplasticity. NMES is able to regulate muscle protein homeostasis and elevate oxidative enzyme activity.
One of the most notable effects of ageing is an accelerated decline of skeletal muscle mass and function, resulting in various undesirable outcomes such as falls, frailty, and all-cause mortality. The loss of muscle mass directly leads to functional deficits and can be explained by the combined effects of individual fibre atrophy and fibre loss. The gradual degradation of fibre atrophy is attributed to impaired muscle protein homeostasis, while muscle fibre loss is a result of denervation and motor unit (MU) remodelling. Neuromuscular electrical stimulation (NMES), a substitute for voluntary contractions, has been applied to reduce muscle mass and functional declines. However, the measurement of the effectiveness of NMES in terms of its mechanism of action on the peripheral motor nervous system and neuromuscular junction, and multiple molecular adaptations at the single fibre level is not well described. NMES mediates neuroplasticity and upregulates a number of neurotropic factors, manifested by increased axonal sprouting and newly formed neuromuscular junctions. Repeated involuntary contractions increase the activity levels of oxidative enzymes, increase fibre capillarisation and can influence fibre type conversion. Additionally, following NMES muscle protein synthesis is increased as well as functional capacity. This review will detail the neural, molecular, metabolic and functional adaptations to NMES in human and animal studies.
Collapse
|
20
|
Li X, Yang W, Xie H, Wang J, Zhang L, Wang Z, Wang L. CNT/Sericin Conductive Nerve Guidance Conduit Promotes Functional Recovery of Transected Peripheral Nerve Injury in a Rat Model. ACS APPLIED MATERIALS & INTERFACES 2020; 12:36860-36872. [PMID: 32649170 DOI: 10.1021/acsami.0c08457] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Peripheral nerve injury usually leads to poor outcomes such as painful neuropathies and disabilities. Autogenous nerve grafting is the current gold standard; however, the limited source of a donor nerve remains a problem. Numerous tissue engineering nerve guidance conduits have been developed as substitutes for autografts. However, a few conduits can achieve the reparative effect equivalent to autografts. Here, we report for the development and application of a carbon nanotube (CNT)/sericin nerve conduit with electrical conductivity and suitable mechanical properties for nerve repair. This CNT/sericin conduit possesses favorable properties including biocompatibility, biodegradability, porous microarchitecture, and suitable swelling property. We thus applied this conduit for bridging a 10 mm gap defect of a transected sciatic nerve combined with electrical stimulation (ES) in a rat injury model. By the end of 12 weeks, we observed that the CNT/sericin conduit combined with electrical stimulation could effectively promote both structural repair and functional recovery comparable to those of the autografts, evidenced by the morphological and histological analyses, electrophysiological responses, functional studies, and target muscle reinnervation evaluations. These findings suggest that this electric conductive CNT/sericin conduit combined with electrical stimulation may have the potential to serve as a new alternative for the repair of transected peripheral nerves.
Collapse
Affiliation(s)
- Xiaolin Li
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wen Yang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hongjian Xie
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jian Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Zhang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zheng Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lin Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
21
|
Zuo KJ, Gordon T, Chan KM, Borschel GH. Electrical stimulation to enhance peripheral nerve regeneration: Update in molecular investigations and clinical translation. Exp Neurol 2020; 332:113397. [PMID: 32628968 DOI: 10.1016/j.expneurol.2020.113397] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/16/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
Peripheral nerve injuries are common and frequently result in incomplete functional recovery even with optimal surgical treatment. Permanent motor and sensory deficits are associated with significant patient morbidity and socioeconomic burden. Despite substantial research efforts to enhance peripheral nerve regeneration, few effective and clinically feasible treatment options have been found. One promising strategy is the use of low frequency electrical stimulation delivered perioperatively to an injured nerve at the time of surgical repair. Possibly through its effect of increasing intraneuronal cyclic AMP, perioperative electrical stimulation accelerates axon outgrowth, remyelination of regenerating axons, and reinnervation of end organs, even with delayed surgical intervention. Building on decades of experimental evidence in animal models, several recent, prospective, randomized clinical trials have affirmed electrical stimulation as a clinically translatable technique to enhance functional recovery in patients with peripheral nerve injuries requiring surgical treatment. This paper provides an updated review of the cellular physiology of electrical stimulation and its effects on axon regeneration, Level I evidence from recent prospective randomized clinical trials of electrical stimulation, and ongoing and future directions of research into electrical stimulation as a clinically feasible adjunct to surgical intervention in the treatment of patients with peripheral nerve injuries.
Collapse
Affiliation(s)
- Kevin J Zuo
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Tessa Gordon
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Gregory H Borschel
- Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
22
|
Ju C, Park E, Kim T, Kim T, Kang M, Lee KS, Park SM. Effectiveness of electrical stimulation on nerve regeneration after crush injury: Comparison between invasive and non-invasive stimulation. PLoS One 2020; 15:e0233531. [PMID: 32453807 PMCID: PMC7250463 DOI: 10.1371/journal.pone.0233531] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023] Open
Abstract
Several studies have investigated the use of invasive and non-invasive stimulation methods to enhance nerve regeneration, and varying degrees of effectiveness have been reported. However, due to the use of different parameters in these studies, a fair comparison between the effectiveness of invasive and non-invasive stimulation methods is not possible. The present study compared the effectiveness of invasive and non-invasive stimulation using similar parameters. Eighteen Sprague Dawley rats were classified into three groups: the iES group stimulated with fully implantable device, the tES group stimulated with transcutaneous electrical nerve stimulation (TENS), and the injury group (no stimulation). The iES and tES groups received stimulation for 6 weeks starting immediately after the injury. Motor function was evaluated using the sciatic functional index (SFI) every week. The SFI values increased over time in all groups; faster and superior functional recovery was observed in the iES group than in the tES group. Histological evaluation of the nerve sections and gastrocnemius muscle sections were performed every other week. The axon diameter and muscle fiber area in the iES group were larger, and the g-ratio in the iES group was closer to 0.6 than those in the tES group. To assess the cause of the difference in efficiency, a 3D rat anatomical model was used to simulate the induced electric fields in each group. A significantly higher concentration and intensity around the sciatic nerve was observed in the iES group than in the tES group. Vector field distribution showed that the field was orthogonal to the sciatic nerve spread in the tES group, whereas it was parallel in the iES group; this suggested that the tES group was less effective in nerve stimulation. The results indicated that even though rats in the TENS group showed better recovery than those in the injury group, it cannot replace direct stimulation yet because rats stimulated with the invasive method showed faster recovery and superior outcomes. This was likely attributable to the greater concentration and parallel distribution of electric field with respect to target nerve.
Collapse
Affiliation(s)
- Chanyang Ju
- Department of Creative IT Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Eunkyoung Park
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Taewoo Kim
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taekyung Kim
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Minhee Kang
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (KSL); (SMP)
| | - Sung-Min Park
- Department of Creative IT Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
- * E-mail: (KSL); (SMP)
| |
Collapse
|
23
|
Li J, Liu Y, Liu HQ, Chen L, Li RJ. Ketogenic Diet Potentiates Electrical Stimulation-Induced Peripheral Nerve Regeneration after Sciatic Nerve Crush Injury in Rats. Mol Nutr Food Res 2020; 64:e1900535. [PMID: 31914235 DOI: 10.1002/mnfr.201900535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/23/2019] [Indexed: 12/14/2022]
Abstract
SCOPE Recent findings indicate that the ketogenic diet (KD) is neuroprotective and electrical stimulation (ES) can improve functional recovery from peripheral nerve injury. However, it is not clear whether KD and ES play a synergistical role in the peripheral nerve recovery following injury. METHODS AND RESULTS A KD consisting of a 3:1 ratio of fat to carbohydrate + protein is used and is coupled with ES treatment in a rat model of peripheral nerve crush injury. Neuromuscular recovery is evaluated by electromyography, and axonal regeneration and myelination by histological methods. The effects on insulin-like growth factor 1 (IGF-1) and IGF-1 receptor expression in peripheral nerve tissue, pre- and post-nerve injury, are also investigated. The combination of KD and ES synergistically increases muscle force in biceps femoris and gluteus maximus and prevents development of hypersensitivity in biceps femoris. It promotes peripheral nerve regeneration by increasing total axons, axon density, and axonal diameter, as well as myelin thickness and axon/fiber ratio. These effects are due to modulation of the IGF system as the treatment expression of IGF-1 and IGF-1 receptor in regenerated nerve tissue. CONCLUSION The results establish that KD and ES promote peripheral nerve regeneration. Patients recovering from peripheral nerve injury may benefit from this combinational approach.
Collapse
Affiliation(s)
- Ji Li
- Department of Anesthesia, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Yang Liu
- Department of Hand Surgery, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Huan-Qiu Liu
- Department of Anesthesia, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Lei Chen
- Department of Hand Surgery, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| | - Rui-Jun Li
- Department of Hand Surgery, The First Hospital of Jilin University, 71 XinMin Street, Changchun, 130021, P. R. China
| |
Collapse
|
24
|
Chandrasekaran S, Davis J, Bersch I, Goldberg G, Gorgey AS. Electrical stimulation and denervated muscles after spinal cord injury. Neural Regen Res 2020; 15:1397-1407. [PMID: 31997798 PMCID: PMC7059583 DOI: 10.4103/1673-5374.274326] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Spinal cord injury (SCI) population with injury below T10 or injury to the cauda equina region is characterized by denervated muscles, extensive muscle atrophy, infiltration of intramuscular fat and formation of fibrous tissue. These morphological changes may put individuals with SCI at higher risk for developing other diseases such as various cardiovascular diseases, diabetes, obesity and osteoporosis. Currently, there is no available rehabilitation intervention to rescue the muscles or restore muscle size in SCI individuals with lower motor neuron denervation. We, hereby, performed a review of the available evidence that supports the use of electrical stimulation in restoration of denervated muscle following SCI. Long pulse width stimulation (LPWS) technique is an upcoming method of stimulating denervated muscles. Our primary objective is to explore the best stimulation paradigms (stimulation parameters, stimulation technique and stimulation wave) to achieve restoration of the denervated muscle. Stimulation parameters, such as the pulse duration, need to be 100–1000 times longer than in innervated muscles to achieve desirable excitability and contraction. The use of electrical stimulation in animal and human models induces muscle hypertrophy. Findings in animal models indicate that electrical stimulation, with a combination of exercise and pharmacological interventions, have proven to be effective in improving various aspects like relative muscle weight, muscle cross sectional area, number of myelinated regenerated fibers, and restoring some level of muscle function. Human studies have shown similar outcomes, identifying the use of LPWS as an effective strategy in increasing muscle cross sectional area, the size of muscle fibers, and improving muscle function. Therefore, displaying promise is an effective future stimulation intervention. In summary, LPWS is a novel stimulation technique for denervated muscles in humans with SCI. Successful studies on LPWS of denervated muscles will help in translating this stimulation technique to the clinical level as a rehabilitation intervention after SCI.
Collapse
Affiliation(s)
| | - John Davis
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ines Bersch
- Swiss Paraplegic Centre, Nottwil, Switzerland; Institute of Clinical Sciences, Department of Orthopedics at the University of Gothenburg, Gothenburg, Sweden
| | - Gary Goldberg
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University; Electrodiagnostic Center, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
25
|
Clark AR, Hsu CG, Talukder MAH, Noble M, Elfar JC. Transdermal delivery of 4-aminopyridine accelerates motor functional recovery and improves nerve morphology following sciatic nerve crush injury in mice. Neural Regen Res 2020; 15:136-144. [PMID: 31535662 PMCID: PMC6862422 DOI: 10.4103/1673-5374.264471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Oral 4-aminopyridine (4-AP) is clinically used for symptomatic relief in multiple sclerosis and we recently demonstrated that systemic 4-AP had previously unknown clinically-relevant effects after traumatic peripheral nerve injury including the promotion of re-myelination, improvement of nerve conductivity, and acceleration of functional recovery. We hypothesized that, instead of oral or injection administration, transdermal 4-AP (TD-4-AP) could also improve functional recovery after traumatic peripheral nerve injury. Mice with surgical traumatic peripheral nerve injury received TD-4AP or vehicle alone and were examined for skin permeability, pharmacokinetics, functional, electrophysiological, and nerve morphological properties. 4-AP showed linear pharmacokinetics and the maximum plasma 4-AP concentrations were proportional to TD-4-AP dose. While a single dose of TD-4-AP administration demonstrated rapid transient improvement in motor function, chronic TD-4-AP treatment significantly improved motor function and nerve conduction and these effects were associated with fewer degenerating axons and thicker myelin sheaths than those from vehicle controls. These findings provide direct evidence for the potential transdermal applicability of 4-AP and demonstrate that 4-AP delivered through the skin can enhance in-vivo functional recovery and nerve conduction while decreasing axonal degeneration. The animal experiments were approved by the University Committee on Animal Research (UCAR) at the University of Rochester (UCAR-2009-019) on March 31, 2017.
Collapse
Affiliation(s)
- Andrew R Clark
- Department of Orthopaedics, The University of Rochester Medical Center, Rochester, NY, USA
| | - Chia George Hsu
- Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - M A Hassan Talukder
- Center for Orthopaedic Research and Translational Science, Penn State Hershey College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mark Noble
- Department of Biomedical Genetics, The University of Rochester Medical Center, Rochester, NY, USA
| | - John C Elfar
- Center for Orthopaedic Research and Translational Science, Penn State Hershey College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
26
|
Homaeigohar S, Tsai TY, Young TH, Yang HJ, Ji YR. An electroactive alginate hydrogel nanocomposite reinforced by functionalized graphite nanofilaments for neural tissue engineering. Carbohydr Polym 2019; 224:115112. [DOI: 10.1016/j.carbpol.2019.115112] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022]
|
27
|
Qian Y, Cheng Y, Cai J, Zhao X, Ouyang Y, Yuan WE, Fan C. Advances in electrical and magnetic stimulation on nerve regeneration. Regen Med 2019; 14:969-979. [PMID: 31583954 DOI: 10.2217/rme-2018-0079] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central and peripheral nerve injuries pose a great threat to people. Complications such as inflammation, muscle atrophy, traumatic neuromas and delayed reinnervation can bring huge challenges to clinical practices and barriers to complete nerve regrowth. Physical interventions such as electrical and magnetic stimulation show satisfactory results with varying parameters for acute and chronic nerve damages. The biological basis of electrical and magnetic stimulation mainly relies on protein synthesis, ion channel regulation and growth factor secretion. This review focuses on the various paradigms used in different models of electrical and magnetic stimulation and their regenerative potentials and underlying mechanisms in nerve injuries. The combination of physical stimulation and conductive biomaterial scaffolds displays an infinite potentiality in translational application in nerve regeneration.
Collapse
Affiliation(s)
- Yun Qian
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Yuan Cheng
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, & School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Jiangyu Cai
- Department of Sports Medicine & Arthroscopic Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, PR China
| | - Xiaotian Zhao
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, & School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Yuanming Ouyang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| | - Wei-En Yuan
- Engineering Research Center of Cell & Therapeutic Antibody, Ministry of Education, & School of Pharmacy, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
- Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, PR China
| |
Collapse
|
28
|
Preparation of carboxylic graphene oxide‐composited polypyrrole conduits and their effect on sciatic nerve repair under electrical stimulation. J Biomed Mater Res A 2019; 107:2784-2795. [DOI: 10.1002/jbm.a.36781] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
|
29
|
Noble M, Tseng KCC, Li H, Elfar JC. 4-Aminopyridine as a Single Agent Diagnostic and Treatment for Severe Nerve Crush Injury. Mil Med 2019; 184:379-385. [PMID: 30901424 DOI: 10.1093/milmed/usy399] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 05/11/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Traumatic peripheral nerve injury (TPI) is a major medical problem without effective treatment options. There is no way to diagnose or treat an incomplete injury and delays contribute to morbidity. We examined 4-aminopyridine (4-AP), a potassium-channel blocker as a possible treatment for TPI. METHODS We used standard mouse models of TPI with functional outcomes including sciatic-functional-index, sensory indices, and electrodiagnostics; in addition to standard immunohistochemical, and electron microscopic correlates of axon and myelin morphology. RESULTS Sustained early 4-AP administration increased the speed and extent of behavioral recovery too rapidly to be explained by axonal regeneration. 4-AP also enhanced recovery of nerve conduction velocity, promoted remyelination, and increased axonal area post-injury. 4-AP treatment also enabled the rapid distinction between incomplete and complete nerve lesions. CONCLUSION 4-AP singularly provides both a new potential therapy to promote durable recovery and remyelination in acute peripheral nerve injury and a means of identifying lesions in which this therapy would be most likely to be of value. The ability to distinguish injuries that may respond to extended therapy without intervention can offer benefit to wounded soldiers.
Collapse
Affiliation(s)
- Mark Noble
- University of Rochester, Stem Cell Regenerative Medicine Institute, Department of Molecular Genetics, 601 Elmwood Ave, Rochester, NY
| | | | - Haiyan Li
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave, Rochester, NY
| | - John C Elfar
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave, Rochester, NY.,The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA
| |
Collapse
|
30
|
Raslan A, Salem MAM, Al‐Hussaini A, Guntinas‐Lichius O, Irintchev A. Brief Electrical Stimulation Improves Functional Recovery After Femoral But Not After Facial Nerve Injury in Rats. Anat Rec (Hoboken) 2019; 302:1304-1313. [DOI: 10.1002/ar.24127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/08/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Ashraf Raslan
- Department of OtorhinolaryngologyJena University Hospital Jena Germany
- Department of OtorhinolaryngologyAssiut University Assiut Egypt
| | | | | | | | - Andrey Irintchev
- Department of OtorhinolaryngologyJena University Hospital Jena Germany
| |
Collapse
|
31
|
Rink S, Bendella H, Akkin SM, Manthou M, Grosheva M, Angelov DN. Experimental Studies on Facial Nerve Regeneration. Anat Rec (Hoboken) 2019; 302:1287-1303. [DOI: 10.1002/ar.24123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral MedicineUniversity of Cologne Cologne Germany
| | - Habib Bendella
- Department of NeurosurgeryUniversity of Witten/Herdecke, Cologne Merheim Medical Center (CMMC) Cologne Germany
| | - Salih Murat Akkin
- Department of Anatomy, School of MedicineSANKO University Gaziantep Turkey
| | - Marilena Manthou
- Department of Histology and EmbryologyAristotle University Thessaloniki Thessaloniki Greece
| | - Maria Grosheva
- Department of Oto‐Rhino‐LaryngologyUniversity of Cologne Cologne Germany
| | | |
Collapse
|
32
|
Modrak M, Sundem L, Gupta R, Zuscik MJ, Elfar J. Pharmacological Attenuation of Electrical Effects in a Model of Compression Neuropathy. J Bone Joint Surg Am 2019; 101:523-530. [PMID: 30893233 PMCID: PMC6738556 DOI: 10.2106/jbjs.18.00162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peripheral nerve compression and entrapment can be debilitating. Using a validated animal model of peripheral nerve compression, we examined the utility of 2 drugs approved for other uses in humans, 4-aminopyridine (4-AP) and erythropoietin (EPO), as treatments for surgically induced ischemia and as adjuvants to surgical decompression. METHODS Peripheral nerve compression was induced in wild-type mice by placing an inert silicone sleeve around the sciatic nerve. Decompression surgery was performed at 6 weeks with mice receiving 4-AP, EPO, or saline solution either during and after compression or only after decompression. A nerve conduction study and morphometric analyses were performed to compare the extent of the injury and the efficacy of the therapies, and the findings were subjected to statistical analysis. RESULTS During peripheral nerve compression, there was a progressive decline in nerve conduction velocity compared with that in sham-treatment animals, in which nerve conduction velocity remained normal (∼55 m/s). Mice treated with 4-AP or EPO during the compression phase had significantly smaller declines in nerve conduction velocity and increased plateau nerve conduction velocities compared with untreated controls (animals that received saline solution). Histomorphometric analyses of newly decompressed nerves (i.e., nerves that underwent decompression on the day that the mouse was sacrificed) revealed that both treated groups had significantly greater proportions of large (>5-µm) axons than the untreated controls. Following surgical decompression, all animals recovered to a normal baseline nerve conduction velocity by day 15; however, treatment significantly accelerated improvement (in both the 4-AP and the EPO group), even when it was only started after decompression. Histomorphometric analyses at 7 and 15 days following surgical decompression revealed significantly increased myelin thickness and significantly greater proportions of large axons among the treated animals. CONCLUSIONS Both the 4-AP and the EPO-treated group demonstrated improvements in tissue architectural and electrodiagnostic measurements, both during and after peripheral nerve compression, compared with untreated mice. CLINICAL RELEVANCE Peripheral nerve decompression is one of the most commonly performed procedures in orthopaedic surgery. We believe that there is reason for some optimism about the translation of our findings to the clinical setting. Our findings in this murine model suggest that 4-AP and EPO may lessen the effects of nerve entrapment and that the use of these agents after decompression may speed and perhaps otherwise optimize recovery after surgery.
Collapse
Affiliation(s)
- Maxwell Modrak
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Leigh Sundem
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Ranjan Gupta
- Department of Orthopaedic Surgery, University of California at Irvine, Irvine, California
| | - Michael J. Zuscik
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York
| | - John Elfar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
33
|
Arbat-Plana A, Puigdomenech M, Navarro X, Udina E. Role of Noradrenergic Inputs From Locus Coeruleus on Changes Induced on Axotomized Motoneurons by Physical Exercise. Front Cell Neurosci 2019; 13:65. [PMID: 30863285 PMCID: PMC6399159 DOI: 10.3389/fncel.2019.00065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Abstract
Physical rehabilitation is one of the cornerstones for the treatment of lesions of the nervous system. After peripheral nerve injuries, activity dependent therapies promote trophic support for the paralyzed muscles, enhance axonal growth and also modulate the maladaptive plastic changes induced by the injury at the spinal level. We have previously demonstrated that an intensive protocol of treadmill running (TR) in rats reduces synaptic stripping on axotomized motoneurons, preserves their perineuronal nets (PNN) and attenuates microglia reactivity. However, it is not clear through which mechanisms exercise is exerting these effects. Here we aimed to evaluate if activation of the locus coeruleus (LC), the noradrenergic center in the brain stem, plays a role in these effects. Since LC is strongly activated during stressful situations, as during intensive exercise, we selectively destroyed the LC by administering the neurotoxin DPS-4 before injuring the sciatic nerve of adult rats. Animals without LC had increased microglia reactivity around injured motoneurons. In these animals, an increasing intensity protocol of TR was not able to prevent synaptic stripping on axotomized motoneurons and the reduction in the thickness of their PNN. In contrast, TR was still able to attenuate microglia reactivity in DSP-4 treated animals, thus indicating that the noradrenergic projections are important for some but not all the effects that exercise induces on the spinal cord after peripheral nerve injury. Moreover, animals subjected to treadmill training showed delayed muscle reinnervation, more evident if treated with DSP-4. However, we did not find differences in treated animals regarding the H/M amplitude ratio, which increased during the first stages of regeneration in all injured groups.
Collapse
Affiliation(s)
- Ariadna Arbat-Plana
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Puigdomenech
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Esther Udina
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Bellaterra, Spain
| |
Collapse
|
34
|
Schilling BK, Schusterman MA, Kim DY, Repko AJ, Klett KC, Christ GJ, Marra KG. Adipose-derived stem cells delay muscle atrophy after peripheral nerve injury in the rodent model. Muscle Nerve 2019; 59:603-610. [PMID: 30681163 DOI: 10.1002/mus.26432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 01/12/2019] [Accepted: 01/20/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Injuries to peripheral nerves cause distal muscle atrophy. The effects of adipose-derived stem cell (ASC) injections into a muscle after injury were examined. METHODS A 1.5 cm defect in the rat sciatic nerve was created, resulting in gastrocnemius muscle atrophy. The nerve defect was repaired with autograft; DiR-labeled ASCs were injected into the gastrocnemius immediately postoperatively. Quantitation of gross musculature and muscle fiber area, cell survival, fibrosis, lipid deposition, inflammation, and reconstructive responses were investigated. RESULTS ASCs were identified in the muscle at 6 weeks, where injections showed increased muscle mass percentage retained, larger average fiber area, and less overall lipid content accumulated throughout the musculature. Muscles having received ASCs showed increased presence of interlukin-10 and Ki67, and decreased inducible nitric oxide synthase (iNOS). DISCUSSION This investigation is suggestive that an ASC injection into denervated muscle post-operatively is able to delay the onset of atrophy. Muscle Nerve 59:603-603, 2019.
Collapse
Affiliation(s)
- Benjamin K Schilling
- Department of Bioengineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Asher Schusterman
- Department of Plastic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Deok-Yeol Kim
- Department of Plastic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexander J Repko
- Department of Biology, School of Arts & Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katarina C Klett
- Department of Chemical Engineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - George J Christ
- Department of Biomedical Engineering and Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Kacey G Marra
- Department of Bioengineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Plastic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
35
|
McGregor CE, English AW. The Role of BDNF in Peripheral Nerve Regeneration: Activity-Dependent Treatments and Val66Met. Front Cell Neurosci 2019; 12:522. [PMID: 30687012 PMCID: PMC6336700 DOI: 10.3389/fncel.2018.00522] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022] Open
Abstract
Despite the ability of peripheral nerves to spontaneously regenerate after injury, recovery is generally very poor. The neurotrophins have emerged as an important modulator of axon regeneration, particularly brain derived neurotrophic factor (BDNF). BDNF regulation and signaling, as well as its role in activity-dependent treatments including electrical stimulation, exercise, and optogenetic stimulation are discussed here. The importance of a single nucleotide polymorphism in the BDNF gene, Val66Met, which is present in 30% of the human population and may hinder the efficacy of these treatments in enhancing regeneration after injury is considered. Preliminary data are presented on the effectiveness of one such activity-dependent treatment, electrical stimulation, in enhancing axon regeneration in mice expressing the met allele of the Val66Met polymorphism.
Collapse
Affiliation(s)
- Claire Emma McGregor
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| | - Arthur W English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
| |
Collapse
|
36
|
Sardaru DP, Matei D, Zaharia-Kezdi D, Pendefunda L. Effects of biofeedback versus switch-triggered functional electrical stimulation on sciatica-related foot drop. J Back Musculoskelet Rehabil 2018; 31:239-245. [PMID: 28946515 DOI: 10.3233/bmr-169578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sciatica-related Foot Drop is a peripheral nervous condition that produces a loss of power in the ankle dorsiflexion muscles. Functional electrical stimulation is a modality of electrical stimulation that produces muscle contraction in a functional movement of the limb. This technique was utilized with positive effects in central nervous afflictions but it is not known whether or not it has any influence in motor recovery following peripheral nervous system problems. This study aims to clarify the effects of functional electrical stimulation on foot drop caused by peripheral nerve compression resulting from lumbar disc herniation. METHODS Fifty patients were enrolled in our study; of whom 25 were treated with EMG triggered electrical stimulation (EMG-FES) and 25 with heel-floor sensor triggered electrical stimulation (SWITCH-FES) during normal gait cycle. Patients received functional electrical stimulation (with a pulse of 60 Hz and phase duration of 200 ms) once a day, for 30 minutes during 5 consecutive days, over a period of 4 weeks. Electrical diagnostic tests (nerve conduction velocity/NCV and the amplitude of compound muscle action potential/CMAP), dynamometry and Osvestry Disability Index scores were measured at baseline and after treatment. RESULTS We found that axonal loss was lower in the EMG-FES group than in the SWITCH-FES group (p< 0.004). The motor functional recovery was higher in terms of muscle force and overall functional status for the EMG-FES group compared to the SWITCH-FES group. This was underlined by Dynamometry test with a p value of < 0.0001 and ODI score with a statistical significant p value of < 0.0001. CONCLUSIONS The overall results showed that there was a significant increase in all the parameters studied for both types of FES applications. However we found that the EMG triggered electrical stimulation technique had a higher influence on the quality of the muscle action control. For patients who cannot yet produce minimal muscle active contraction we recommend switch triggered stimulation first and then, immediately after the recovery of the motor control, to change to EMG triggered functional electrical stimulation.
Collapse
Affiliation(s)
- Dragos Petrica Sardaru
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Daniela Matei
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Dan Zaharia-Kezdi
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Liviu Pendefunda
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| |
Collapse
|
37
|
Nezakati T, Seifalian A, Tan A, Seifalian AM. Conductive Polymers: Opportunities and Challenges in Biomedical Applications. Chem Rev 2018; 118:6766-6843. [DOI: 10.1021/acs.chemrev.6b00275] [Citation(s) in RCA: 354] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Toktam Nezakati
- Google Inc.., Mountain View, California 94043, United States
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London NW3 2QG, United Kingdom
| | - Amelia Seifalian
- UCL Medical School, University College London, London WC1E 6BT, United Kingdom
| | - Aaron Tan
- UCL Medical School, University College London, London WC1E 6BT, United Kingdom
| | - Alexander M. Seifalian
- NanoRegMed Ltd. (Nanotechnology and Regenerative Medicine Commercialization Centre), The London Innovation BioScience Centre, London NW1 0NH, United Kingdom
| |
Collapse
|
38
|
Kappos EA, Baenziger‐Sieber P, Tremp M, Engels PE, Thommen S, Sprenger L, Benz RM, Schaefer DJ, Schaeren S, Kalbermatten DF. Epineural adipose-derived stem cell injection in a sciatic rodent model. Brain Behav 2018; 8:e01027. [PMID: 29920989 PMCID: PMC6043702 DOI: 10.1002/brb3.1027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/03/2018] [Accepted: 05/13/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim was to evaluate the regenerative effect of epineural injection of rat ASCs (rASCs) in three different settings of acute and chronic compression in a rat sciatic nerve model. METHODS Acute compression (60 s) with a vessel clamp over a distance of 1 mm (group 1) or 10 mm (group 2), as well as chronic compression with a permanent remaining, nonabsorbable polymeric clip over a distance of 1 mm (group 3) was performed. Depending on the group, either 5 × 106 rASCs or the same volume (25 μl) of culture medium (CM) was injected with a 30G needle in the epineurium at the time of compression. Outcome measures were functional gait evaluations, imaging analysis, histomorphometric analyses, and muscle weight. RESULTS The rats in group 2 had a better function than those with group 1 at one and especially at 2 weeks. After 4 weeks however, almost all rats were close to a normal function. There was a similar Muscle Weight Ratio (MWR) after 2 weeks in all groups, whereas after 4 weeks, the MWR in group 3 was lower compared with group 1 and 2. Histomorphometric analysis showed a better myelination in group 1 & 2 compared to group 3 after 4 weeks. ASCs have a beneficial effect on myelin thickness (G-Ratio). CONCLUSIONS We successfully evaluated the regenerative effect of epineural injection of rASCs in three different settings of acute and chronic compression. However, there were no significant differences in outcomes between the ASC-treated groups and control groups.
Collapse
Affiliation(s)
- Elisabeth A. Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
- Department of NeuropathologyInstitute of PathologyUniversity Hospital BaselBaselSwitzerland
| | - Patricia Baenziger‐Sieber
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
- Department of NeuropathologyInstitute of PathologyUniversity Hospital BaselBaselSwitzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
- Department of NeuropathologyInstitute of PathologyUniversity Hospital BaselBaselSwitzerland
| | - Patricia E. Engels
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
- Department of NeuropathologyInstitute of PathologyUniversity Hospital BaselBaselSwitzerland
| | - Sarah Thommen
- Basel Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital BaselBaselSwitzerland
| | - Lima Sprenger
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Robyn M. Benz
- Department of RadiologyUniversity Hospital BaselBaselSwitzerland
| | - Dirk J. Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Stefan Schaeren
- Department of Spinal SurgeryUniversity Hospital of BaselBaselSwitzerland
| | - Daniel Felix Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic and Hand SurgeryUniversity Hospital BaselBaselSwitzerland
- Department of NeuropathologyInstitute of PathologyUniversity Hospital BaselBaselSwitzerland
| |
Collapse
|
39
|
Nicolas N, Kobaiter-Maarrawi S, Georges S, Abadjian G, Maarrawi J. Motor Cortex Stimulation Regenerative Effects in Peripheral Nerve Injury: An Experimental Rat Model. World Neurosurg 2018; 114:e800-e808. [PMID: 29572175 DOI: 10.1016/j.wneu.2018.03.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immediate microsurgical nerve suture remains the gold standard after peripheral nerve injuries. However, functional recovery is delayed, and it is satisfactory in only 2/3 of cases. Peripheral electrical nerve stimulation proximal to the lesion enhances nerve regeneration and muscle reinnervation. This study aims to evaluate the effects of the motor cortex electrical stimulation on peripheral nerve regeneration after injury. METHODS Eighty rats underwent right sciatic nerve section, followed by immediate microsurgical epineural sutures. Rats were divided into 4 groups: Group 1 (control, n = 20): no electrical stimulation; group 2 (n = 20): immediate stimulation of the sciatic nerve just proximal to the lesion; Group 3 (n = 20): motor cortex stimulation (MCS) for 15 minutes after nerve section and suture (MCSa); group 4 (n = 20): MCS performed over the course of two weeks after nerve suture (MCSc). Assessment included electrophysiology and motor functional score at day 0 (baseline value before nerve section), and at weeks 4, 8, and 12. Rats were euthanized for histological study at week 12. RESULTS Our results showed that MCS enhances functional recovery, nerve regeneration, and muscle reinnervation starting week 4 compared with the control group (P < 0.05). The MCS induces higher reinnervation rates even compared with peripheral stimulation, with better results in the MCSa group (P < 0.05), especially in terms of functional recovery. CONCLUSIONS MCS seems to have a beneficial effect after peripheral nerve injury and repair in terms of nerve regeneration and muscle reinnervation, especially when acute mode is used.
Collapse
Affiliation(s)
- Nicolas Nicolas
- Laboratory of Research in Neurosciences (Mechanisms and Application of Neuromodulation), Faculty of Medicine, St. Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Sandra Kobaiter-Maarrawi
- Laboratory of Research in Neurosciences (Mechanisms and Application of Neuromodulation), Faculty of Medicine, St. Joseph University, Beirut, Lebanon
| | - Samuel Georges
- Laboratory of Research in Neurosciences (Mechanisms and Application of Neuromodulation), Faculty of Medicine, St. Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Gerard Abadjian
- Department of Pathology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Joseph Maarrawi
- Laboratory of Research in Neurosciences (Mechanisms and Application of Neuromodulation), Faculty of Medicine, St. Joseph University, Beirut, Lebanon; Department of Neurosurgery, Hôtel-Dieu de France Hospital, Beirut, Lebanon.
| |
Collapse
|
40
|
Liu X, Kim JC, Miller AL, Waletzki BE, Lu L. Electrically conductive nanocomposite hydrogels embedded with functionalized carbon nanotubes for spinal cord injury. NEW J CHEM 2018. [DOI: 10.1039/c8nj03038c] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Electrically conductive hydrogels incorporated with CNTs support PC12 cell growth and differentiation and hold promise for nerve regeneration.
Collapse
Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering
- Mayo Clinic
- Rochester
- USA
- Department of Orthopedic Surgery
| | - Joseph C. Kim
- Department of Physiology and Biomedical Engineering
- Mayo Clinic
- Rochester
- USA
| | - A. Lee Miller
- Department of Orthopedic Surgery
- Mayo Clinic
- Rochester
- USA
| | | | - Lichun Lu
- Department of Physiology and Biomedical Engineering
- Mayo Clinic
- Rochester
- USA
- Department of Orthopedic Surgery
| |
Collapse
|
41
|
Zhao Y, Gong J, Niu C, Wei Z, Shi J, Li G, Yang Y, Wang H. A new electrospun graphene-silk fibroin composite scaffolds for guiding Schwann cells. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2017; 28:2171-2185. [DOI: 10.1080/09205063.2017.1386835] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Yahong Zhao
- Key Laboratory of Science and Technology of Eco-textiles, Ministry of Education, Jiangnan University, Wuxi, PR China
- Key Laboratory of Neuroregeneration, Nantong University, Nantong, PR China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, PR China
| | - Jiahuan Gong
- Key Laboratory of Neuroregeneration, Nantong University, Nantong, PR China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, PR China
| | - Changmei Niu
- Medical School, Nantong University, Nantong, PR China
| | - Ziwei Wei
- Medical School, Nantong University, Nantong, PR China
| | - Jiaqi Shi
- Medical School, Nantong University, Nantong, PR China
| | - Guohui Li
- Key Laboratory of Science and Technology of Eco-textiles, Ministry of Education, Jiangnan University, Wuxi, PR China
| | - Yumin Yang
- Key Laboratory of Science and Technology of Eco-textiles, Ministry of Education, Jiangnan University, Wuxi, PR China
- Key Laboratory of Neuroregeneration, Nantong University, Nantong, PR China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, PR China
| | - Hongbo Wang
- Key Laboratory of Science and Technology of Eco-textiles, Ministry of Education, Jiangnan University, Wuxi, PR China
| |
Collapse
|
42
|
Liu X, Miller AL, Park S, Waletzki BE, Zhou Z, Terzic A, Lu L. Functionalized Carbon Nanotube and Graphene Oxide Embedded Electrically Conductive Hydrogel Synergistically Stimulates Nerve Cell Differentiation. ACS APPLIED MATERIALS & INTERFACES 2017; 9:14677-14690. [PMID: 28406608 DOI: 10.1021/acsami.7b02072] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nerve regeneration after injury is a critical medical issue. In previous work, we have developed an oligo(poly(ethylene glycol) fumarate) (OPF) hydrogel incorporated with positive charges as a promising nerve conduit. In this study, we introduced cross-linkable bonds to graphene oxide and carbon nanotube to obtain the functionalized graphene oxide acrylate (GOa) and carbon nanotube poly(ethylene glycol) acrylate (CNTpega). An electrically conductive hydrogel was then fabricated by covalently embedding GOa and CNTpega within OPF hydrogel through chemical cross-linking followed by in situ reduction of GOa in l-ascorbic acid solution. Positive charges were incorporated by 2-(methacryloyloxy)ethyltrimethylammonium chloride (MTAC) to obtain rGOaCNTpega-OPF-MTAC composite hydrogel with both surface charge and electrical conductivity. The distribution of CNTpega and GOa in the hydrogels was substantiated by transmission electron microscopy (TEM), and strengthened electrical conductivities were determined. Excellent biocompatibility was demonstrated for the carbon embedded composite hydrogels. Biological evaluation showed enhanced proliferation and spreading of PC12 cells on the conductive hydrogels. After induced differentiation using nerve growth factor (NGF), cells on the conductive hydrogels were effectively stimulated to have robust neurite development as observed by confocal microscope. A synergistic effect of electrical conductivity and positive charges on nerve cells was also observed in this study. Using a glass mold method, the composite hydrogel was successfully fabricated into conductive nerve conduits with surficial positive charges. These results suggest that rGOa-CNTpega-OPF-MTAC composite hydrogel holds great potential as conduits for neural tissue engineering.
Collapse
Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| | - A Lee Miller
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| | - Sungjo Park
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| | - Brian E Waletzki
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| | - Zifei Zhou
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| | - Andre Terzic
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, ‡Department of Orthopedic Surgery, and §Department of Cardiovascular Diseases and Center for Regenerative Medicine, Mayo Clinic , Rochester, Minnesota 55905, United States
| |
Collapse
|
43
|
Gordon T, Borschel GH. The use of the rat as a model for studying peripheral nerve regeneration and sprouting after complete and partial nerve injuries. Exp Neurol 2017; 287:331-347. [DOI: 10.1016/j.expneurol.2016.01.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 02/06/2023]
|
44
|
Arbat-Plana A, Cobianchi S, Herrando-Grabulosa M, Navarro X, Udina E. Endogenous modulation of TrkB signaling by treadmill exercise after peripheral nerve injury. Neuroscience 2017; 340:188-200. [DOI: 10.1016/j.neuroscience.2016.10.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/18/2016] [Accepted: 10/22/2016] [Indexed: 12/20/2022]
|
45
|
Badri O, Shahabi P, Abdolalizadeh J, Alipour MR, Veladi H, Farhoudi M, Zak MS. Combination therapy using evening primrose oil and electrical stimulation to improve nerve function following a crush injury of sciatic nerve in male rats. Neural Regen Res 2017; 12:458-463. [PMID: 28469662 PMCID: PMC5399725 DOI: 10.4103/1673-5374.202927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Peripheral nerve injuries with a poor prognosis are common. Evening primrose oil (EPO) has beneficial biological effects and immunomodulatory properties. Since electrical activity plays a major role in neural regeneration, the present study investigated the effects of electrical stimulation (ES), combined with evening primrose oil (EPO), on sciatic nerve function after a crush injury in rats. In anesthetized rats, the sciatic nerve was crushed using small haemostatic forceps followed by ES and/or EPO treatment for 4 weeks. Functional recovery of the sciatic nerve was assessed using the sciatic functional index. Histopathological changes of gastrocnemius muscle atrophy were investigated by light microscopy. Electrophysiological changes were assessed by the nerve conduction velocity of sciatic nerves. Immunohistochemistry was used to determine the remyelination of the sciatic nerve following the interventions. EPO + ES, EPO, and ES obviously improved sciatic nerve function assessed by the sciatic functional index and nerve conduction velocity of the sciatic nerve at 28 days after operation. Expression of the peripheral nerve remyelination marker, protein zero (P0), was increased in the treatment groups at 28 days after operation. Muscle atrophy severity was decreased significantly while the nerve conduction velocity was increased significantly in rats with sciatic nerve injury in the injury + EPO + ES group than in the EPO or ES group. Totally speaking, the combined use of EPO and ES may produce an improving effect on the function of sciatic nerves injured by a crush. The increased expression of P0 may have contributed to improving the functional effects of combination therapy with EPO and ES as well as the electrophysiological and histopathological features of the injured peripheral nerve.
Collapse
Affiliation(s)
- Omid Badri
- Tabriz University of Medical Sciences, International Branch Aras, Tabriz, Iran
| | - Parviz Shahabi
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalal Abdolalizadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hadi Veladi
- Microsystem Fabrication Laboratory, Tabriz University, Tabriz, Iran
| | - Mehdi Farhoudi
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Sharif Zak
- Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
46
|
Tseng KC, Li H, Clark A, Sundem L, Zuscik M, Noble M, Elfar J. 4-Aminopyridine promotes functional recovery and remyelination in acute peripheral nerve injury. EMBO Mol Med 2016; 8:1409-1420. [PMID: 27861125 PMCID: PMC5167128 DOI: 10.15252/emmm.201506035] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/25/2016] [Accepted: 09/29/2016] [Indexed: 01/12/2023] Open
Abstract
Traumatic peripheral nerve damage is a major medical problem without effective treatment options. In repurposing studies on 4-aminopyridine (4-AP), a potassium channel blocker that provides symptomatic relief in some chronic neurological afflictions, we discovered this agent offers significant promise as a small molecule regenerative agent for acute traumatic nerve injury. We found, in a mouse model of sciatic crush injury, that sustained early 4-AP administration increased the speed and extent of behavioral recovery too rapidly to be explained by axonal regeneration. Further studies demonstrated that 4-AP also enhanced recovery of nerve conduction velocity, promoted remyelination, and increased axonal area post-injury. We additionally found that 4-AP treatment enables distinction between incomplete and complete lesions more rapidly than existing approaches, thereby potentially addressing the critical challenge of more effectively distinguishing injured individuals who may require mutually exclusive treatment approaches. Thus, 4-AP singularly provides both a new potential therapy to promote durable recovery and remyelination in acute peripheral nerve injury and a means of identifying lesions in which this therapy would be most likely to be of value.
Collapse
Affiliation(s)
- Kuang-Ching Tseng
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Chemical Engineering, University of Rochester, Rochester, NY, USA
| | - Haiyan Li
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew Clark
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Leigh Sundem
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Zuscik
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Mark Noble
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA
| | - John Elfar
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
47
|
Liu X, Miller Ii AL, Park S, Waletzki BE, Terzic A, Yaszemski MJ, Lu L. Covalent crosslinking of graphene oxide and carbon nanotube into hydrogels enhances nerve cell responses. J Mater Chem B 2016; 4:6930-6941. [PMID: 32263560 PMCID: PMC8844883 DOI: 10.1039/c6tb01722c] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Healing of nerve injuries is a critical medical issue. Biodegradable polymeric conduits are a promising therapeutic solution to provide guidance for axon growth in a given space, thus helping nerve heal. Extensive studies in the past decade reported that conductive materials could effectively increase neurite and axon extension in vitro and nerve regeneration in vivo. In this study, graphene oxide and carbon nanotubes were covalently functionalized with double bonds to obtain crosslinkable graphene oxide acrylate (GOa) sheets and carbon nanotube poly(ethylene glycol) acrylate (CNTpega). An electrically conductive reduced GOa-CNTpega-oligo(polyethylene glycol fumarate) (OPF) hydrogel (rGOa-CNTpega-OPF) was successfully fabricated by chemically crosslinking GOa sheets and CNTpega with OPF chains followed by in situ chemical reduction in l-ascorbic acid solution. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) imaging showed homogenous distribution of GOa/CNTpega carbon content in the rGOa-CNTpega-OPF composite hydrogel, resulting in a significant increase of electrical conductivity compared with neutral OPF without carbon content. Cell studies showed excellent biocompatibility and distinguished PC12 cell proliferation and spreading on the rGOa-CNTpega-OPF composite hydrogel. Fluorescent microscopy imaging demonstrated robustly stimulated neurite development in these cells on a conductive rGOa-CNTpega-OPF composite hydrogel compared with that on neutral OPF hydrogels. These results illustrated a promising potential for the rGOa-CNTpega-OPF composite hydrogel to serve as conduits for neural tissue engineering.
Collapse
Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Simon NG, Franz CK, Gupta N, Alden T, Kliot M. Central Adaptation following Brachial Plexus Injury. World Neurosurg 2016; 85:325-32. [DOI: 10.1016/j.wneu.2015.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022]
|
49
|
DeFrancesco-Lisowitz A, Lindborg JA, Niemi JP, Zigmond RE. The neuroimmunology of degeneration and regeneration in the peripheral nervous system. Neuroscience 2015; 302:174-203. [PMID: 25242643 PMCID: PMC4366367 DOI: 10.1016/j.neuroscience.2014.09.027] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 12/25/2022]
Abstract
Peripheral nerves regenerate following injury due to the effective activation of the intrinsic growth capacity of the neurons and the formation of a permissive pathway for outgrowth due to Wallerian degeneration (WD). WD and subsequent regeneration are significantly influenced by various immune cells and the cytokines they secrete. Although macrophages have long been known to play a vital role in the degenerative process, recent work has pointed to their importance in influencing the regenerative capacity of peripheral neurons. In this review, we focus on the various immune cells, cytokines, and chemokines that make regeneration possible in the peripheral nervous system, with specific attention placed on the role macrophages play in this process.
Collapse
Affiliation(s)
| | - J A Lindborg
- Department of Neurosciences, Case Western Reserve University, Cleveland OH 44106-4975
| | - J P Niemi
- Department of Neurosciences, Case Western Reserve University, Cleveland OH 44106-4975
| | - R E Zigmond
- Department of Neurosciences, Case Western Reserve University, Cleveland OH 44106-4975
| |
Collapse
|
50
|
Navarro X. Functional evaluation of peripheral nerve regeneration and target reinnervation in animal models: a critical overview. Eur J Neurosci 2015; 43:271-86. [PMID: 26228942 DOI: 10.1111/ejn.13033] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/15/2015] [Accepted: 07/23/2015] [Indexed: 01/08/2023]
Abstract
Peripheral nerve injuries usually lead to severe loss of motor, sensory and autonomic functions in the patients. Due to the complex requirements for adequate axonal regeneration, functional recovery is often poorly achieved. Experimental models are useful to investigate the mechanisms related to axonal regeneration and tissue reinnervation, and to test new therapeutic strategies to improve functional recovery. Therefore, objective and reliable evaluation methods should be applied for the assessment of regeneration and function restitution after nerve injury in animal models. This review gives an overview of the most useful methods to assess nerve regeneration, target reinnervation and recovery of complex sensory and motor functions, their values and limitations. The selection of methods has to be adequate to the main objective of the research study, either enhancement of axonal regeneration, improving regeneration and reinnervation of target organs by different types of nerve fibres, or increasing recovery of complex sensory and motor functions. It is generally recommended to use more than one functional method for each purpose, and also to perform morphological studies of the injured nerve and the reinnervated targets.
Collapse
Affiliation(s)
- Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, E-08193, Bellaterra, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| |
Collapse
|