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Acevedo Cintrón JA, Hunter DA, Schellhardt L, Pan D, Mackinnon SE, Wood MD. Limited Nerve Regeneration across Acellular Nerve Allografts (ANAs) Coincides with Changes in Blood Vessel Morphology and the Development of a Pro-Inflammatory Microenvironment. Int J Mol Sci 2024; 25:6413. [PMID: 38928119 PMCID: PMC11204013 DOI: 10.3390/ijms25126413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The use of acellular nerve allografts (ANAs) to reconstruct long nerve gaps (>3 cm) is associated with limited axon regeneration. To understand why ANA length might limit regeneration, we focused on identifying differences in the regenerative and vascular microenvironment that develop within ANAs based on their length. A rat sciatic nerve gap model was repaired with either short (2 cm) or long (4 cm) ANAs, and histomorphometry was used to measure myelinated axon regeneration and blood vessel morphology at various timepoints (2-, 4- and 8-weeks). Both groups demonstrated robust axonal regeneration within the proximal graft region, which continued across the mid-distal graft of short ANAs as time progressed. By 8 weeks, long ANAs had limited regeneration across the ANA and into the distal nerve (98 vs. 7583 axons in short ANAs). Interestingly, blood vessels within the mid-distal graft of long ANAs underwent morphological changes characteristic of an inflammatory pathology by 8 weeks post surgery. Gene expression analysis revealed an increased expression of pro-inflammatory cytokines within the mid-distal graft region of long vs. short ANAs, which coincided with pathological changes in blood vessels. Our data show evidence of limited axonal regeneration and the development of a pro-inflammatory environment within long ANAs.
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Affiliation(s)
| | | | | | | | | | - Matthew D. Wood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (J.A.A.C.); (D.A.H.); (L.S.); (D.P.); (S.E.M.)
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Shin AY, Bishop AT, Loosbroch MF, Spinner RJ. A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years. J Hand Surg Eur Vol 2022; 47:1103-1113. [PMID: 35833214 DOI: 10.1177/17531934221110733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A multidisciplinary brachial plexus clinic has been a relatively new concept, offering different surgical speciality perspectives on the treatment of brachial plexus injuries. The resulting collaborative effort has proven to be greater than the sum of its parts. In this review, the history, philosophy of care, development/implementation and impact of a creation of a multidisciplinary brachial plexus team at the Mayo Clinic are detailed.
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Affiliation(s)
- Alexander Y Shin
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle F Loosbroch
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Orthopedic Surgery, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Heinzel JC, Oberhauser V, Keibl C, Schädl B, Swiadek NV, Längle G, Frick H, Slezak C, Prahm C, Grillari J, Kolbenschlag J, Hercher D. ESWT Diminishes Axonal Regeneration following Repair of the Rat Median Nerve with Muscle-In-Vein Conduits but Not after Autologous Nerve Grafting. Biomedicines 2022; 10:biomedicines10081777. [PMID: 35892677 PMCID: PMC9394363 DOI: 10.3390/biomedicines10081777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 12/02/2022] Open
Abstract
Investigations reporting positive effects of extracorporeal shockwave therapy (ESWT) on nerve regeneration are limited to the rat sciatic nerve model. The effects of ESWT on muscle-in-vein conduits (MVCs) have also not been investigated yet. This study aimed to evaluate the effects of ESWT after repair of the rat median nerve with either autografts (ANGs) or MVCs. In male Lewis rats, a 7 mm segment of the right median nerve was reconstructed either with an ANG or an MVC. For each reconstructive technique, one group of animals received one application of ESWT while the other rats served as controls. The animals were observed for 12 weeks, and nerve regeneration was assessed using computerized gait analysis, the grasping test, electrophysiological evaluations and histological quantification of axons, blood vessels and lymphatic vasculature. Here, we provide for the first time a comprehensive analysis of ESWT effects on nerve regeneration in a rat model of median nerve injury. Furthermore, this study is among the first reporting the quantification of lymphatic vessels following peripheral nerve injury and reconstruction in vivo. While we found no significant direct positive effects of ESWT on peripheral nerve regeneration, results following nerve repair with MVCs were significantly inferior to those after ANG repair.
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Affiliation(s)
- Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (J.C.H.); (C.P.); (J.K.)
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Viola Oberhauser
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Claudia Keibl
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Barbara Schädl
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Core Facility Morphology, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Nicole V. Swiadek
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Gregor Längle
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Helen Frick
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Cyrill Slezak
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Department of Physics, Utah Valley University, Orem, UT 84058, USA
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (J.C.H.); (C.P.); (J.K.)
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Institute of Molecular Biotechnology, Department of Biotechnology, BOKU—University of Natural Resources and Life Sciences, Muthgasse 18, 1190 Vienna, Austria
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (J.C.H.); (C.P.); (J.K.)
| | - David Hercher
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Donaueschingenstraße 13, 1200 Vienna, Austria; (V.O.); (C.K.); (B.S.); (N.V.S.); (G.L.); (H.F.); (C.S.); (J.G.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Correspondence:
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Wang C, Zhang Y, Xue H, Yang M, Leng F, Wang Y. Extraction kinetic model of polysaccharide from Codonopsis pilosula and the application of polysaccharide in wound healing. Biomed Mater 2022; 17. [PMID: 35090145 DOI: 10.1088/1748-605x/ac5008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/28/2022] [Indexed: 11/11/2022]
Abstract
The crude polysaccharide (CPNP) of Codonopsis pilosula was obtained by hot-water extraction technology. The extraction kinetic model established according to Fick's first law of diffusion and related parameters of polysaccharide was studied. CPNP microcapsules were prepared by blending with sodium alginate, Ca2+ ions and crude CPNP. The quality control (Drug loading rate, embedding rate and release rate, etc) of CPNP microcapsules were analyzed by pharmacopeas standards. The structure feature of CPNP microcapsules also were determined with various methods. The wound healing ability of CPNP microcapsules loading with different concentration of CPNP was evaluated using the rat wound model. The activity of various enzymes and the expression levels of pro-inflammatory factors in the model skin tissue also were determined by enzyme linked immunosorbent assay (ELISA). Hematoxylin-eosin staining (HE), Masson, immunohistochemistry were used to investigate the external application effect of CPNP microcapsules on skin wound repair. The extraction kinetics of CPNP was established with the linear correlation coefficient (R2) of 0.83-0.93, implied that the extraction process was fitted well with the Fick's first law of diffusion. The CPNP has good compatibility with sodium alginate and Ca2+ ions by SEM and TEM observation, and the particle size of CPNP microcapsules was 21.25±2.84 μm with the good degradation rate, loading rate (61.59%) and encapsulation rate (55.99%), maximum swelling rate (397.380 ±25.321%). Compared with control group, the redness, and swelling, bleeding, infection, and exudate of the damaged skin decreased significantly after CPNP microcapsules treatment, and the CPNP microcapsules groups exhibited good wound healing function with less inflammatory cell infiltration. The pathological structure showed that in the CPNP microcapsules group, more newborn capillaries, complete skin structure, and relatively tight and orderly arrangement of collagen fibers were observed in the skin of rats. CPNP microcapsules could effectively inhibit the high expression of pro-inflammatory factors in damaged skin, and significantly increase the contents of related enzymes (GSH-Px, T-AOC, LPO) and collagen fibers. The relative expression levels of genes (VEGF and miRNA21) in the CPNP microcapsules group were higher than those in the model group and the negative group. The above results suggested that the CPNP microcapsules could controlled-release the CPNP to the wound surface, and then played a better role in antibacterial, anti-inflammatory and skin wound repair.
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Affiliation(s)
- Chenliang Wang
- Lanzhou University of Technology, , Lanzhou, Gansu, 730050, CHINA
| | - Yuchun Zhang
- Lanzhou University of Technology, Langongping Road 287, Qilihe District, Lanzhou City, Lanzhou, 730050, CHINA
| | - Hongyan Xue
- Lanzhou University of Technology, School of Life Science and Engineering, Lanzhou University of Technology, Langongping Road 287, Qilihe District, Lanzhou City, Gansu Province, P. R. China, Lanzhou, Gansu, 730050, CHINA
| | - Mingjun Yang
- Lanzhou University of Technology, , Lanzhou, 730050, CHINA
| | - Feifan Leng
- Lanzhou University of Technology, , Lanzhou, Gansu, 730050, CHINA
| | - Yonggang Wang
- Lanzhou University of Technology, , Lanzhou, 730050, CHINA
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Saffari TM, Chan K, Saffari S, Zuo KJ, McGovern RM, Reid JM, Borschel GH, Shin AY. Combined local delivery of tacrolimus and stem cells in hydrogel for enhancing peripheral nerve regeneration. Biotechnol Bioeng 2021; 118:2804-2814. [PMID: 33913523 DOI: 10.1002/bit.27799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022]
Abstract
The application of scaffold-based stem cell transplantation to enhance peripheral nerve regeneration has great potential. Recently, the neuroregenerative potential of tacrolimus (a U.S. Food and Drug Administration-approved immunosuppressant) has been explored. In this study, a fibrin gel-based drug delivery system for sustained and localized tacrolimus release was combined with rat adipose-derived mesenchymal stem cells (MSC) to investigate cell viability in vitro. Tacrolimus was encapsulated in poly(lactic-co-glycolic) acid (PLGA) microspheres and suspended in fibrin hydrogel, using concentrations of 0.01 and 100 ng/ml. Drug release over time was measured. MSCs were cultured in drug-released media collected at various days to mimic systemic exposure. MSCs were combined with (i) hydrogel only, (ii) empty PLGA microspheres in the hydrogel, (iii) 0.01, and (iv) 100 ng/ml of tacrolimus PLGA microspheres in the hydrogel. Stem cell presence and viability were evaluated. A sustained release of 100 ng/ml tacrolimus microspheres was observed for up to 35 days. Stem cell presence was confirmed and cell viability was observed up to 7 days, with no significant differences between groups. This study suggests that combined delivery of 100 ng/ml tacrolimus and MSCs in fibrin hydrogel does not result in cytotoxic effects and could be used to enhance peripheral nerve regeneration.
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Affiliation(s)
- Tiam M Saffari
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Katelyn Chan
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Engineering, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Sara Saffari
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Kevin J Zuo
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Renee M McGovern
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel M Reid
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Plastic Surgery, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Saffari TM, Mathot F, Thaler R, van Wijnen AJ, Bishop AT, Shin AY. Microcomputed analysis of nerve angioarchitecture after combined stem cell delivery and surgical angiogenesis to nerve allograft. J Plast Reconstr Aesthet Surg 2020; 74:1919-1930. [PMID: 33436338 DOI: 10.1016/j.bjps.2020.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION A detailed three-dimensional (3D) evaluation of microvasculature is evolving to be a powerful tool, providing mechanistic understanding of angiomodulating strategies. The aim of this study was to evaluate the microvascular architecture of nerve allografts after combined stem cell delivery and surgical angiogenesis in a rat sciatic nerve defect model. MATERIALS AND METHODS In 25 Lewis rats, sciatic nerve gaps were repaired with (i) autografts, (ii) allografts, (iii) allografts wrapped in a pedicled superficial inferior epigastric artery fascia (SIEF) flap to provide surgical angiogenesis, combined with (iv) undifferentiated mesenchymal stem cells (MSC) and (v) MSCs differentiated into Schwann cell-like cells. At two weeks, vascular volume was measured using microcomputed tomography, and percentage and volume of vessels at different diameters were evaluated and compared with controls. RESULTS The vascular volume was significantly greatest in allografts treated with undifferentiated MSCs and surgical angiogenesis combined as compared to all experimental groups (P<0.01 as compared to autografts, P<0.0001 to allografts, and P<0.05 to SIEF and SIEF combined with differentiated MSCs, respectively). Volume and diameters of vessel segments in nerve allografts were enhanced by surgical angiogenesis. These distributions were further improved when surgical angiogenesis was combined with stem cells, with greatest increase found when combined with undifferentiated MSCs. CONCLUSIONS The interaction between vascularity and stem cells remains complex, however, this study provides some insight into its synergistic mechanisms. The combination of surgical angiogenesis with undifferentiated MSCs specifically, results in the greatest increase in revascularization, size of vessels, and stimulation of vessels to reach the middle longitudinal third of the nerve allograft.
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Affiliation(s)
- T M Saffari
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Plastic-, Reconstructive- and Hand Surgery, Radboud University, Nijmegen, the Netherlands
| | - F Mathot
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Plastic-, Reconstructive- and Hand Surgery, Radboud University, Nijmegen, the Netherlands
| | - R Thaler
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - A J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States
| | - A T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - A Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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