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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.
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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.
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Ashna M, Senthilkumar N, Sanpui P. Human Hair Keratin-Based Hydrogels in Regenerative Medicine: Current Status and Future Directions. ACS Biomater Sci Eng 2023; 9:5527-5547. [PMID: 37734053 DOI: 10.1021/acsbiomaterials.3c00883] [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] [Indexed: 09/23/2023]
Abstract
Regenerative medicine (RM) is a multidisciplinary field that utilizes the inherent regenerative potential of human cells to generate functionally and physiologically acceptable human cells, tissues, and organs in vivo or ex vivo. An appropriate biomaterial scaffold with desired physicochemical properties constitutes an important component of a successful RM approach. Among various forms of biomaterials explored until the present day, hydrogels have emerged as a versatile candidate for tissue engineering and regenerative medicine (TERM) applications such as scaffolds for spatial patterning and delivering therapeutic agents, or substrates to enhance cell growth, differentiation, and migration. Although hydrogels can be prepared from a variety of synthetic polymers as well as biopolymers, the latter are preferred for their inherent biocompatibility. Specifically, keratins are fibrous proteins that have been recently explored for constructing hydrogels useful for RM purposes. The present review discusses the suitability of keratin-based biomaterials in RM, with a particular focus on human hair keratin hydrogels and their use in various RM applications.
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Affiliation(s)
- Mymuna Ashna
- Department of Biotechnology, BITS Pilani Dubai Campus, Dubai International Academic City, Dubai, United Arab Emirates
| | - Neeharika Senthilkumar
- Department of Biotechnology, BITS Pilani Dubai Campus, Dubai International Academic City, Dubai, United Arab Emirates
| | - Pallab Sanpui
- Department of Biotechnology, BITS Pilani Dubai Campus, Dubai International Academic City, Dubai, United Arab Emirates
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Dahlin E, Gudinge H, Dahlin LB, Nyman E. Neuromas cause severe residual problems at long-term despite surgery. Sci Rep 2023; 13:15693. [PMID: 37735475 PMCID: PMC10514298 DOI: 10.1038/s41598-023-42245-4] [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: 04/09/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Pain, and disabilities after neuroma surgery, using patient reported outcome measurements (PROMs), were evaluated by QuickDASH and a specific Hand Questionnaire (HQ-8). The 69 responding individuals (response rate 61%; 59% women; 41% men; median follow up 51 months) reported high QuickDASH score, pain on load, cold sensitivity, ability to perform daily activities and sleeping difficulties. Individuals reporting impaired ability to perform daily activities and sleeping problems had higher scores for pain, stiffness, weakness, numbness/tingling, cold sensitivity and QuickDASH. Only 17% of individuals reported no limitations at all. No differences were observed between sexes. Surgical methods did not influence outcome. Symptoms and disabilities correlated moderately-strongly to each other and to ability to perform regular daily activities as well as to sleeping difficulties. Pain, cold sensitivity, sleeping difficulties and limitation to perform daily activities were associated to higher QuickDASH. A weak association was found between follow up time and QuickDASH score as well as pain on load, but not cold sensitivity. A major nerve injury was frequent among those with limitations during work/performing other regular daily activities. Despite surgical treatment, neuromas cause residual problems, which affect the capacity to perform daily activities and ability to sleep with limited improvement in long-term.
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Affiliation(s)
- Emma Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Translational Medicine-Hand Surgery, Lund University, Jan Waldenströms gata 5, 20502, Malmö, Sweden.
- Varberg Hospital, Region Halland, Varberg, Sweden.
| | - Hanna Gudinge
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Translational Medicine-Hand Surgery, Lund University, Jan Waldenströms gata 5, 20502, Malmö, Sweden
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Translational Medicine-Hand Surgery, Lund University, Jan Waldenströms gata 5, 20502, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, Sweden
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Zhang Y, Hou N, Zhang J, Xie B, Liang J, Chang X, Wang K, Tang X. Treatment options for digital nerve injury: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:675. [PMID: 37700356 PMCID: PMC10496177 DOI: 10.1186/s13018-023-04076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Surgical treatment of finger nerve injury is common for hand trauma. However, there are various surgical options with different functional outcomes. The aims of this study are to compare the outcomes of various finger nerve surgeries and to identify factors associated with the postsurgical outcomes via a systematic review and meta-analysis. METHODS The literature related to digital nerve repairs were retrieved comprehensively by searching the online databases of PubMed from January 1, 1965, to August 31, 2021. Data extraction, assessment of bias risk and the quality evaluation were then performed. Meta-analysis was performed using the postoperative static 2-point discrimination (S2PD) value, moving 2-point discrimination (M2PD) value, and Semmes-Weinstein monofilament testing (SWMF) good rate, modified Highet classification of nerve recovery good rate. Statistical analysis was performed using the R (V.3.6.3) software. The random effects model was used for the analysis. A systematic review was also performed on the other influencing factors especially the type of injury and postoperative complications of digital nerve repair. RESULTS Sixty-six studies with 2446 cases were included in this study. The polyglycolic acid conduit group has the best S2PD value (6.71 mm), while the neurorrhaphy group has the best M2PD value (4.91 mm). End-to-side coaptation has the highest modified Highet's scoring (98%), and autologous nerve graft has the highest SWMF (91%). Age, the size of the gap, and the type of injury were factors that may affect recovery. The type of injury has an impact on the postoperative outcome of neurorrhaphy. Complications reported in the studies were mainly neuroma, cold sensitivity, paresthesia, postoperative infection, and pain. CONCLUSION Our study demonstrated that the results of surgical treatment of digital nerve injury are generally satisfactory; however, no nerve repair method has absolute advantages. When choosing a surgical approach to repair finger nerve injury, we must comprehensively consider various factors, especially the gap size of the nerve defect, and postoperative complications. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Yi Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Nianzong Hou
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Bing Xie
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Jiahui Liang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Xiaohu Chang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Kai Wang
- Department of Critical Care Medicine, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
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Watanabe A, Kimura Y, Tsukamoto S, Taniguchi M, Ito S. Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery. Laryngoscope 2023. [PMID: 36939009 DOI: 10.1002/lary.30669] [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: 12/01/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Oncological reconstruction of the recurrent laryngeal nerve (RLN) is sometimes necessary for RLN invaded by thyroid cancer. There have been no case reports of RLN reconstruction using artificial nerve conduits, which are often used for peripheral nerves. In this study, we retrospectively evaluate the feasibility, safety, and efficacy of a collagen conduit with collagen filaments for RLN reconstruction cases at our hospital. METHODS Artificial nerve conduits were used in seven cases of RLN reconstruction. Two patients had preoperative unilateral vocal cord paralysis with severe vocal cord atrophy, and two had vocal cord paresis without atrophy. The remaining three patients had functional vocal cords before surgery that had to be resected via surgery due to thyroid cancer infiltration of the RLN. Reconstruction was performed using RENERVE®, which is a collagen conduit. Voice examination and laryngeal endoscopy were performed 1, 3, and 12 months after surgery. RESULTS There was no improvement in the phonetics of the two patients with vocal cord atrophy before surgery. In the remaining five cases, three with functional vocal cords improved to preoperative values, and two with vocal cord paresis improved to greater than preoperative values. CONCLUSION We report the first case series using an artificial nerve conduit for human RLN reconstruction. In cases of RLN resection when the patient has good voice quality pre-operatively, reconstruction of the RLN using an artificial nerve may be a favorable option in cases where direct anastomosis or ansa cervicalis to RLN anastomosis cannot be performed. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2023.
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Affiliation(s)
- Akihito Watanabe
- Department of Otolaryngology, Keiyukai Sapporo Hospital, Hondori 9 cho-me Minami 1-1, Shiroishi-ku, Sapporo, Hokkaido, 003-0026, Japan
| | - Yuki Kimura
- Department of Otolaryngology, Keiyukai Sapporo Hospital, Hondori 9 cho-me Minami 1-1, Shiroishi-ku, Sapporo, Hokkaido, 003-0026, Japan
| | - Shinji Tsukamoto
- Department of Otolaryngology, Keiyukai Sapporo Hospital, Hondori 9 cho-me Minami 1-1, Shiroishi-ku, Sapporo, Hokkaido, 003-0026, Japan
| | - Masanobu Taniguchi
- Department of Otolaryngology, Keiyukai Sapporo Hospital, Hondori 9 cho-me Minami 1-1, Shiroishi-ku, Sapporo, Hokkaido, 003-0026, Japan
| | - Suguru Ito
- Department of Otolaryngology, Keiyukai Sapporo Hospital, Hondori 9 cho-me Minami 1-1, Shiroishi-ku, Sapporo, Hokkaido, 003-0026, Japan
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Reshamwala R, Shah M. Regenerative Approaches in the Nervous System. Regen Med 2023. [DOI: 10.1007/978-981-19-6008-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Lu X, Han L, Kassab GS. Pulmonary Visceral Pleura Biomaterial: Elastin- and Collagen-Based Extracellular Matrix. Front Bioeng Biotechnol 2022; 10:796076. [PMID: 35433658 PMCID: PMC9006517 DOI: 10.3389/fbioe.2022.796076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 12/17/2022] Open
Abstract
Objective: The goal of the study is to determine the structural characteristics, mechanical properties, cytotoxicity, and biocompatibility of the pulmonary visceral pleura (PVP).Background: Collagen and elastin are the major components of the extracellular matrix. The PVP has an abundance of elastin and collagen that can serve as a potential biomaterial for clinical repair and reconstructions.Methods: The PVP was processed from swine and bovine lungs. Chemical analyses were used to determine collagen and elastin contents in the PVPs. Immunofluorescence microscopy was used to analyze the structure of the PVP. The stress–strain relationships and stress relaxation were determined by using the planar uniaxial test. The cytotoxicity of the PVP was tested in cultured cells. In in vivo evaluations, the PVP was implanted in the sciatic nerve and skin of rats.Results: Collagen and elastin contents are abundant in the PVP with larger proportions of elastin than in the bovine pericardium and porcine small intestinal submucosa. A microstructural analysis revealed that the elastin fibers were distributed throughout the PVP and the collagen was distributed mainly in the mesothelial basal lamina. The incremental moduli in stress–strain curves and relaxation moduli in the Maxwell–Wiechert model of PVP were approximately one-tenth of the bovine pericardium and small intestinal submucosa. The minimal cytotoxicity of the PVP was demonstrated. The axons proliferated in the PVP conduit guidance from proximal to distal sciatic nerves of rats. The neo-skin regenerated under the PVP skin substitute within 4 weeks.Conclusions: The PVP is composed of abundant collagen and elastin. The structural characteristics and mechanical compliance of the PVP render a suitable biological material for repair/reconstruction.
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Wolfe EM, Mathis SA, Ovadia SA, Panthaki ZJ. Comparison of Collagen and Human Amniotic Membrane Nerve Wraps and Conduits for Peripheral Nerve Repair in Preclinical Models: A Systematic Review of the Literature. J Reconstr Microsurg 2022; 39:245-253. [PMID: 35008116 DOI: 10.1055/s-0041-1732432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Collagen and human amniotic membrane (hAM) are Food and Drug Administration (FDA)-approved biomaterials that can be used as nerve wraps or conduits for repair of peripheral nerve injuries. Both biomaterials have been shown to reduce scarring and fibrosis of injured peripheral nerves. However, comparative advantages and disadvantages have not been definitively shown in the literature. The purpose of this systematic review is to comprehensively evaluate the literature regarding the roles of hAM and collagen nerve wraps and conduits on peripheral nerve regeneration in preclinical models. METHODS The MEDLINE database was queried using the PubMed search engine on July 7, 2019, with the following search strategy: ("amniotic membrane" OR "amnion") OR ("collagen conduit" OR "nerve wrap")] AND "nerve." All resulting articles were screened by two independent reviewers. Nerve type, lesion type/injury model, repair type, treatment, and outcomes were assessed. RESULTS Two hundred and fifty-eight articles were identified, and 44 studies remained after application of inclusion and exclusion criteria. Seventeen studies utilized hAM, whereas 27 studies utilized collagen wraps or conduits. Twenty-three (85%) of the collagen studies utilized conduits, and four (15%) utilized wraps. Six (35%) of the hAM studies utilized conduits and 11 (65%) utilized wraps. Two (9%) collagen studies involving a conduit and one (25%) involving a wrap demonstrated at least one significant improvement in outcomes compared with a control. While none of the hAM conduit studies showed significant improvements, eight (73%) of the studies investigating hAM wraps showed at least one significant improvement in outcomes. CONCLUSION The majority of studies reported positive outcomes, indicating that collagen and hAM nerve wraps and conduits both have the potential to enhance peripheral nerve regeneration. However, relatively few studies reported significant findings, except for studies evaluating hAM wraps. Preclinical models may help guide clinical practice regarding applications of these biomaterials in peripheral nerve repair.
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Affiliation(s)
- Erin M Wolfe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sydney A Mathis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Steven A Ovadia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Zubin J Panthaki
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Effect of Collagen Nerve Wrapping in a Rabbit Peripheral Neuropathy Model. Plast Reconstr Surg Glob Open 2021; 9:e3919. [PMID: 35028256 PMCID: PMC8751765 DOI: 10.1097/gox.0000000000003919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
Background: Collagen nerve wraps (CNWs) theoretically allow for improved nerve gliding and decreased perineural scarring, and create a secluded environment to allow for nerve myelination and axonal healing. The goal of this study was to investigate the effect of CNWs on nerve gliding as assessed by pull-out strength and nerve changes in a rabbit model of peripheral neuropathy. Methods: Ten New Zealand rabbits were included. Sham surgery (control) was performed on left hindlimbs. To simulate compressive neuropathy, right sciatic nerves were freed of the mesoneurium, and the epineurium was sutured to the wound bed. Five rabbits were euthanized at 6 weeks [scarred nerve (SN); n = 5]. Neurolysis with CNW was performed in the remaining rabbits at 6 weeks (CNW; n = 5), which were euthanized at 22 weeks. Outcomes included peak pull-out force and histopathological markers of nerve recovery (axonal and Schwann cell counts). Results: The CNW group demonstrated significantly higher pull-out forces compared with the CNW sham control group (median: 4.40N versus 0.37N, P = 0.043) and a trend toward greater peak pull-out forces compared with the SN group (median: 4.40N versus 2.01N, P = 0.076). The CNW group had a significantly higher median Schwann cell density compared with the CNW control group (CNW: 1.30 × 10−3 cells/μm2 versus CNW control: 7.781 × 10−4 cells/μm2, P = 0.0431) and SN group (CNW: 1.30 × 10−3 cells/μm2 versus SN: 7.31 × 10−4 cells/μm2, P = 0.009). No significant difference in axonal density was observed between groups. Conclusion: Our findings suggest using a CNW does not improve nerve gliding, but may instead play a role in recruiting and/or supporting Schwann cells and their proliferation.
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Hayakawa N, Matsumine H, Fujii K, Osaki H, Ueta Y, Kamei W, Niimi Y, Miyata M, Sakurai H. Facial nerve regeneration with bioabsorbable collagen conduits filled with collagen filaments: An experimental study. Regen Ther 2021; 18:302-308. [PMID: 34522722 PMCID: PMC8413834 DOI: 10.1016/j.reth.2021.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction A bioabsorbable collagen conduit (Renerve™) filled with collagen filaments is currently approved as an artificial nerve conduit in Japan and is mainly used for connecting and repairing peripheral nerves after traumatic nerve injury. However, there are few reports on its applications for reconstructing and repairing the facial nerve. The present study evaluated the efficacy of the conduit on promoting nerve regeneration in a murine model with a nerve defect at the buccal branch of the facial nerve. Methods Under inhalational anesthesia and microscopic guidance, the buccal branch of the left facial nerve in an 8-week-old Lewis rat was exposed, and a 7 mm gap was created in the nerve. The gap was then connected with either the nerve conduits (NC group) or an autologous nerve graft (the autograft group). At 13 weeks after the procedure, we compared the histological and physiological regenerations in the both groups. Results We found compound muscle action potential amplitude is significantly larger in the autograft group (2.8 ± 1.4 mV) than in NC group (1.3 ± 0.5 mV) (p < 0.05). The number of myelinated fibers of the autograft group was higher (3634 ± 1645) than that of NC group (1112 ± 490) (p < 0.01). The fiber diameter of the autograft group (4.8 ± 1.9 μm) was larger than that of NC group (3.8 ± 1.4 μm) (p < 0.05). The myelin thickness of the autograft group was thicker than that of NC group (0.6 ± 0.3 μm vs. 0.4 ± 0.1 μm) (p < 0.05). G-ratio of the autograft group (0.74 ± 0.19) was lower than that of NC group (0.79 ± 0.10) (p < 0.05). Conclusion This study demonstrated the efficacy of collagen nerve conduit for facial nerve reconstruction following nerve injury. However, the effectiveness of the conduit on the promotion of nerve regeneration was inferior to that of the autograft.
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Affiliation(s)
- Nami Hayakawa
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kaori Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hironobu Osaki
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoshifumi Ueta
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Wataru Kamei
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Mariko Miyata
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Kim DH, Shin SH, Lee MK, Lee JJ, Kim JK, Chung YG. Effectiveness and Biocompatibility of Decellularized Nerve Graft Using an In Vivo Rat Sciatic Nerve Model. Tissue Eng Regen Med 2021; 18:797-805. [PMID: 34386942 DOI: 10.1007/s13770-021-00353-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decellularized nerve allografting is one of promising treatment options for nerve defect. As an effort to develop more efficient nerve graft, recently we have developed a new decellularization method for nerve allograft. The aim of this study was to evaluate the effectiveness and biocompatibility of nerve graft decellularized by our newly developed method. METHODS Forty-eight inbred male Lewis rats were divided into two groups, Group I (autograft group, n = 25), Group II (decellularized isograft group, n = 23). Decellularized nerve grafts were prepared with our newly developed methods using amphoteric detergent and nuclease treatment. Serum cytokine level measurements at 0, 2, and 4 weeks and histologic evaluation for inflammatory cell infiltration at 6 and 16 weeks after nerve graft. RESULTS There was no significant difference in mean maximum isometric tetanic force and weight of tibialis anterior muscle or ankle angle at toe-off phase between two groups at 6 and 16 weeks survival time points (p > 0.05). There was no inflammatory cell infiltration in either group and histomorphometric assessments of 6- and 16-week specimens of the isograft group did not differ from those in the autograft group with regard to number of fascicle, cross sectional area, fascicle area ratio, and number of regenerated nerve cells. CONCLUSION Based on inflammatory reaction, axonal regeneration, and functional outcomes, our newly developed decellularized nerve grafts were fairly biocompatible and had comparable effectiveness to autografts for nerve regeneration, which suggested it would be suitable for nerve reconstruction as an alternative to autograft.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea
| | - Myeong-Kyu Lee
- Department of Research and Development, Korea Public Tissue Bank, 37 Sagimakgol-ro 62beon-gil, Jungwon-gu, Seongnam-si, Gyeonggi-do, 13211, Korea
| | - Jae-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591, Korea.
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Singh S, Srivastava AK, Baranwal AK, Bhatnagar A, Das KK, Jaiswal S, Behari S. Efficacy of Silicone Conduit in the Rat Sciatic Nerve Repair Model: Journey of a Thousand Miles. Neurol India 2021; 69:318-325. [PMID: 33904443 DOI: 10.4103/0028-3886.314576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A lot of options have been tried for bridging the two ends of the injured nerves. Researchers have used decellularized nerve grafts, artificial materials and even nerve growth factors to augment functional recovery. These materials are either costly or inaccessible in developing world. Objective The study aimed to evaluate the efficacy of the silicone conduit in a rat sciatic nerve injury model. Materials and Methods 24 healthy Sprague-Dawley (SD) rats (250-300 grams; 8-10 weeks) were used and right sciatic nerve was exposed; transected and re-anastomosed by two different methods in 16 rats. In control group, n = 8 (Group I) the sciatic nerve was untouched; Group II (reverse nerve anastomosis, n = 8): 1-centimeter of nerve was cut and re-anastomosed by using 10-0 monofilament suture; Group III (silicone conduit, n = 8) 1-centimeter nerve segment was cut, replaced by silicone conduit and supplemented by fibrin glue]. Evaluation of nerve recovery was done functionally (pain threshold and sciatic functional index) over 3 months and histologically and electron microscopically. Results Functional results showed a trend of clinical improvement in Group III and II but recovery was poor and never reached up to normal. Histopathological and electron microscopic results showed an incomplete axonal regeneration in Groups II and III. Psychological analyses showed that no outwards signs of stress were present and none of the rats showed paw biting and teeth chattering. Conclusion The silicone conduit graft may be an economical and effective alternative to presently available interposition grafts, however for short segments only.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Atul K Baranwal
- Veterinary Scientist, Animal House, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Bhatnagar
- Department of Plastic and Reconstruction Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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13
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Rodríguez-Sánchez DN, Pinto GBA, Cartarozzi LP, de Oliveira ALR, Bovolato ALC, de Carvalho M, da Silva JVL, Dernowsek JDA, Golim M, Barraviera B, Ferreira RS, Deffune E, Bertanha M, Amorim RM. 3D-printed nerve guidance conduits multi-functionalized with canine multipotent mesenchymal stromal cells promote neuroregeneration after sciatic nerve injury in rats. Stem Cell Res Ther 2021; 12:303. [PMID: 34051869 PMCID: PMC8164252 DOI: 10.1186/s13287-021-02315-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/29/2021] [Indexed: 01/09/2023] Open
Abstract
Background Nerve injuries are debilitating, leading to long-term motor deficits. Remyelination and axonal growth are supported and enhanced by growth factor and cytokines. Combination of nerve guidance conduits (NGCs) with adipose-tissue-derived multipotent mesenchymal stromal cells (AdMSCs) has been performing promising strategy for nerve regeneration. Methods 3D-printed polycaprolactone (PCL)-NGCs were fabricated. Wistar rats subjected to critical sciatic nerve damage (12-mm gap) were divided into sham, autograft, PCL (empty NGC), and PCL + MSCs (NGC multi-functionalized with 106 canine AdMSCs embedded in heterologous fibrin biopolymer) groups. In vitro, the cells were characterized and directly stimulated with interferon-gamma to evaluate their neuroregeneration potential. In vivo, the sciatic and tibial functional indices were evaluated for 12 weeks. Gait analysis and nerve conduction velocity were analyzed after 8 and 12 weeks. Morphometric analysis was performed after 8 and 12 weeks following lesion development. Real-time PCR was performed to evaluate the neurotrophic factors BDNF, GDNF, and HGF, and the cytokine and IL-10. Immunohistochemical analysis for the p75NTR neurotrophic receptor, S100, and neurofilament was performed with the sciatic nerve. Results The inflammatory environment in vitro have increased the expression of neurotrophins BDNF, GDNF, HGF, and IL-10 in canine AdMSCs. Nerve guidance conduits multi-functionalized with canine AdMSCs embedded in HFB improved functional motor and electrophysiological recovery compared with PCL group after 12 weeks. However, the results were not significantly different than those obtained using autografts. These findings were associated with a shift in the regeneration process towards the formation of myelinated fibers. Increased immunostaining of BDNF, GDNF, and growth factor receptor p75NTR was associated with the upregulation of BDNF, GDNF, and HGF in the spinal cord of the PCL + MSCs group. A trend demonstrating higher reactivity of Schwann cells and axonal branching in the sciatic nerve was observed, and canine AdMSCs were engrafted at 30 days following repair. Conclusions 3D-printed NGCs multi-functionalized with canine AdMSCs embedded in heterologous fibrin biopolymer as cell scaffold exerted neuroregenerative effects. Our multimodal approach supports the trophic microenvironment, resulting in a pro-regenerative state after critical sciatic nerve injury in rats.
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Affiliation(s)
- Diego Noé Rodríguez-Sánchez
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Giovana Boff Araujo Pinto
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Luciana Politti Cartarozzi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil
| | | | - Ana Livia Carvalho Bovolato
- Blood Transfusion Center, Cell Engineering Laboratory, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Marcio de Carvalho
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Jorge Vicente Lopes da Silva
- Renato Archer Information Technology Center (CTI), Three-dimensional Technologies Research Group, Campinas, SP, Brazil
| | - Janaina de Andréa Dernowsek
- Renato Archer Information Technology Center (CTI), Three-dimensional Technologies Research Group, Campinas, SP, Brazil
| | - Marjorie Golim
- Hemocenter division of Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Rui Seabra Ferreira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Elenice Deffune
- Blood Transfusion Center, Cell Engineering Laboratory, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Mathues Bertanha
- Blood Transfusion Center, Cell Engineering Laboratory, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Rogério Martins Amorim
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil.
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14
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Huang L, Yang X, Deng L, Ying D, Lu A, Zhang L, Yu A, Duan B. Biocompatible Chitin Hydrogel Incorporated with PEDOT Nanoparticles for Peripheral Nerve Repair. ACS APPLIED MATERIALS & INTERFACES 2021; 13:16106-16117. [PMID: 33787211 DOI: 10.1021/acsami.1c01904] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The nerve guidance conduit (NGC) is a promising clinical strategy for regenerating the critical-sized peripheral nerve injury. In this study, the polysaccharide chitin is used to fabricate the hydrogel film for inducing the impaired sciatic nerve regeneration through incorporating the conductive poly(3,4-ethylenedioxythiophene) nanoparticles (PEDOT NPs) and modifying with cell adhesive tetrapeptide Cys-Arg-Gly-Asp (CRGD) (ChT-PEDOT-p). The partial deacetylation process of chitin for exposing the amino groups is performed to (i) improve the electrostatic interaction between chitin and the negatively charged PEDOT for enhancing the composite hydrogel strength and (ii) offer the active sites for peptide modification. The as-prepared hydrogel remarkably promotes the in vitro RSC-96 cell adhesion and proliferation, as well as the Schwann cell activity-related gene S100, NF-200, and myelin basic protein (MBP) expression. Function of gastrocnemius muscle and thickness of myelinated axon in chitin/PEDOT groups are analogous to the autograft in 10 mm rat sciatic nerve defect. Immunofluorescence, immunohistochemistry, western blotting, and toluidine blue staining analyses on the regenerated sciatic nerve explain that the attachment and proliferation enhancement of Schwann cells and angiogenesis are the vital factors for the chitin/PEDOT composite to facilitate the nerve regeneration. This work provides an applicable chitin-based NGC material for accelerating the peripheral nerve restoration.
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Affiliation(s)
- Lin Huang
- College of Chemistry and Molecular Sciences, Hubei Engineering Center of Natural Polymer-based Medical Materials, and Key Laboratory of Biomedical Polymers of Ministry of Education, Wuhan University, Wuhan 430072, China
| | - Xiaqing Yang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Linglong Deng
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Daofa Ying
- College of Chemistry and Molecular Sciences, Hubei Engineering Center of Natural Polymer-based Medical Materials, and Key Laboratory of Biomedical Polymers of Ministry of Education, Wuhan University, Wuhan 430072, China
| | - Ang Lu
- College of Chemistry and Molecular Sciences, Hubei Engineering Center of Natural Polymer-based Medical Materials, and Key Laboratory of Biomedical Polymers of Ministry of Education, Wuhan University, Wuhan 430072, China
| | - Lina Zhang
- College of Chemistry and Molecular Sciences, Hubei Engineering Center of Natural Polymer-based Medical Materials, and Key Laboratory of Biomedical Polymers of Ministry of Education, Wuhan University, Wuhan 430072, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Bo Duan
- College of Chemistry and Molecular Sciences, Hubei Engineering Center of Natural Polymer-based Medical Materials, and Key Laboratory of Biomedical Polymers of Ministry of Education, Wuhan University, Wuhan 430072, China
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15
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Meena P, Kakkar A, Kumar M, Khatri N, Nagar RK, Singh A, Malhotra P, Shukla M, Saraswat SK, Srivastava S, Datt R, Pandey S. Advances and clinical challenges for translating nerve conduit technology from bench to bed side for peripheral nerve repair. Cell Tissue Res 2020; 383:617-644. [PMID: 33201351 DOI: 10.1007/s00441-020-03301-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
Injuries to the peripheral nervous system remain a large-scale clinical problem. These injuries often lead to loss of motor and/or sensory function that significantly affects patients' quality of life. The current neurosurgical approach for peripheral nerve repair involves autologous nerve transplantation, which often leads to clinical complications. The most pressing need is to increase the regenerative capacity of existing tubular constructs in the repair of large nerve gaps through development of tissue-engineered approaches that can surpass the performance of autografts. To fully realize the clinical potential of nerve conduit technology, there is a need to reconsider design strategies, biomaterial selection, fabrication techniques and the various potential modifications to optimize a conduit microenvironment that can best mimic the natural process of regeneration. In recent years, a significant progress has been made in the designing and functionality of bioengineered nerve conduits to bridge long peripheral nerve gaps in various animal models. However, translation of this work from lab to commercial scale has not been achieve. The current review summarizes recent advances in the development of tissue engineered nerve guidance conduits (NGCs) with regard to choice of material, novel fabrication methods, surface modifications and regenerative cues such as stem cells and growth factors to improve regeneration performance. Also, the current clinical potential and future perspectives to achieve therapeutic benefits of NGCs will be discussed in context of peripheral nerve regeneration.
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Affiliation(s)
- Poonam Meena
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Anupama Kakkar
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Mukesh Kumar
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Nitin Khatri
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Rakesh Kumar Nagar
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Aarti Singh
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Poonam Malhotra
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Manish Shukla
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Sumit Kumar Saraswat
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Supriya Srivastava
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Rajan Datt
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India
| | - Siddharth Pandey
- Department of Life Sciences, Datt Mediproducts Pvt. Ltd., Roz Ka Meo Industrial Area, District Mewat, Nuh, 122103, District Haryana, India.
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16
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Manoukian OS, Baker JT, Rudraiah S, Arul MR, Vella AT, Domb AJ, Kumbar SG. Functional polymeric nerve guidance conduits and drug delivery strategies for peripheral nerve repair and regeneration. J Control Release 2019; 317:78-95. [PMID: 31756394 DOI: 10.1016/j.jconrel.2019.11.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/16/2019] [Accepted: 11/18/2019] [Indexed: 12/25/2022]
Abstract
Peripheral nerve injuries can be extremely debilitating, resulting in sensory and motor loss-of-function. Endogenous repair is limited to non-severe injuries in which transection of nerves necessitates surgical intervention. Traditional treatment approaches include the use of biological grafts and alternative engineering approaches have made progress. The current article serves as a comprehensive, in-depth perspective on peripheral nerve regeneration, particularly nerve guidance conduits and drug delivery strategies. A detailed background of peripheral nerve injury and repair pathology, and an in-depth look into augmented nerve regeneration, nerve guidance conduits, and drug delivery strategies provide a state-of-the-art perspective on the field.
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Affiliation(s)
- Ohan S Manoukian
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA; Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Jiana T Baker
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Swetha Rudraiah
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA; Department of Pharmaceutical Sciences, University of Saint Joseph, Hartford, CT, USA
| | - Michael R Arul
- Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Anthony T Vella
- Department of Department of Immunology, University of Connecticut Health, Farmington, CT, USA
| | - Abraham J Domb
- Institute of Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Sangamesh G Kumbar
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA; Department of Orthopedic Surgery, University of Connecticut Health, Farmington, CT, USA.
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17
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Liao CF, Chen CC, Lu YW, Yao CH, Lin JH, Way TD, Yang TY, Chen YS. Effects of endogenous inflammation signals elicited by nerve growth factor, interferon-γ, and interleukin-4 on peripheral nerve regeneration. J Biol Eng 2019; 13:86. [PMID: 31754373 PMCID: PMC6854735 DOI: 10.1186/s13036-019-0216-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Background Large gap healing is a difficult issue in the recovery of peripheral nerve injury. The present study provides in vivo trials of silicone rubber chambers filled with collagen containing IFN-γ or IL-4 to bridge a 15 mm sciatic nerve defect in rats. Fillings of NGF and normal saline were used as the positive and negative controls. Neuronal electrophysiology, neuronal connectivity, macrophage infiltration, location and expression levels of calcitonin gene-related peptide and histology of the regenerated nerves were evaluated. Results At the end of 6 weeks, animals from the groups of NGF and IL-4 had dramatic higher rates of successful regeneration (100 and 80%) across the wide gap as compared to the groups of IFN-γ and saline controls (30 and 40%). In addition, the NGF group had significantly higher NCV and shorter latency compared to IFN-γ group (P < 0.05). The IL-4 group recruited significantly more macrophages in the nerves as compared to the saline controls and the NGF-treated animals (P < 0.05). Conclusions The current study demonstrated that NGF and IL-4 show potential growth-promoting capability for peripheral nerve regeneration. These fillings in the bridging conduits may modulate local inflammatory conditions affecting recovery of the nerves.
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Affiliation(s)
- Chien-Fu Liao
- 1Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Chung-Chia Chen
- Linsen Chinese Medicine and Kunming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Wen Lu
- 3Department of Chinese Medicine, Show Chwan Memorial Hospital, Chunaghua, Taiwan.,4Department of Chinese Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chun-Hsu Yao
- 5Lab of Biomaterials, School of Chinese Medicine, China Medical University , Taichung, Taiwan.,6Biomaterials Translational Research Center, China Medical University Hospital, Taichung, Taiwan.,7Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Jia-Horng Lin
- 8Department of Fiber and Composite Materials, Feng Chia University, Taichung, Taiwan
| | - Tzong-Der Way
- 1Department of Biological Science and Technology, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- 9Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,10Center for General Education & Master Program of Digital Health Innovation, China Medical University, Taichung, Taiwan
| | - Yueh-Sheng Chen
- 5Lab of Biomaterials, School of Chinese Medicine, China Medical University , Taichung, Taiwan.,6Biomaterials Translational Research Center, China Medical University Hospital, Taichung, Taiwan.,7Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,10Center for General Education & Master Program of Digital Health Innovation, China Medical University, Taichung, Taiwan.,11College of Humanities and Sciences, China Medical University, Taichung, Taiwan
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18
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Saltzman EB, Villa JC, Doty SB, Feinberg JH, Lee SK, Wolfe SW. A Comparison Between Two Collagen Nerve Conduits and Nerve Autograft: A Rat Model of Motor Nerve Regeneration. J Hand Surg Am 2019; 44:700.e1-700.e9. [PMID: 30502013 DOI: 10.1016/j.jhsa.2018.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 08/27/2018] [Accepted: 10/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare recovery in a rat model of sciatic nerve injury using a novel polyglycolic acid (PGA) conduit, which contains collagen fibers within the tube, as compared with both a hollow collagen conduit and nerve autograft. We hypothesize that a conduit with a scaffold will provide improved nerve regeneration over hollow conduits and demonstrate no significant differences when compared with autograft. METHODS A total of 72 Sprague-Dawley rats were randomized into 3 experimental groups, in which a unilateral 10-mm sciatic defect was repaired using either nerve autograft, a hollow collagen conduit, or a PGA collagen-filled conduit. Outcomes were measured at 12 and 16 weeks after surgery, and included bilateral tibialis anterior muscle weight, voltage and force maximal contractility, assessment of ankle contracture, and nerve histology. RESULTS In all groups, outcomes improved between 12 and 16 weeks. On average, the autograft group outperformed both conduit groups, and the hollow conduit demonstrated improved outcomes when compared with the PGA collagen-filled conduit. Differences in contractile force, however, were significant only at 12 weeks (autograft > hollow collagen conduit > PGA collagen-filled conduit). At 16 weeks, contractile force demonstrated no significant difference but corroborated the same absolute results (autograft > hollow collagen conduit > PGA collagen-filled conduit). CONCLUSIONS Nerve repair using autograft provided superior motor nerve recovery over the 2 conduits for a 10-mm nerve gap in a murine acute transection injury model. The hollow collagen conduit demonstrated superior results when compared with the PGA collagen-filled conduit. CLINICAL RELEVANCE The use of a hollow collagen conduit provides superior motor nerve recovery as compared with a PGA collagen-filled conduit.
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Affiliation(s)
- Eliana B Saltzman
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY
| | - Jordan C Villa
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY
| | - Stephen B Doty
- Hospital for Special Surgery, Mineralized Tissue Laboratory, New York, NY
| | - Joseph H Feinberg
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY
| | - Steve K Lee
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY
| | - Scott W Wolfe
- Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Weill Medical College of Cornell University, New York, NY.
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19
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Zhang L, Li B, Liu B, Dong Z. Co-transplantation of Epidermal Neural Crest Stem Cells and Olfactory Ensheathing Cells Repairs Sciatic Nerve Defects in Rats. Front Cell Neurosci 2019; 13:253. [PMID: 31244611 PMCID: PMC6582070 DOI: 10.3389/fncel.2019.00253] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/21/2019] [Indexed: 12/20/2022] Open
Abstract
Cell-based therapy is an alternative strategy to improve outcomes of peripheral nerve injury (PNI). Epidermal neural crest stem cell (EPI-NCSC) is obtained from autologous tissue without immunological rejection, which could expand quickly in vitro and is suitable candidate for cell-based therapy. Olfactory ensheathing cell (OEC) could secrete multiple neurotrophic factors (NTFs), which is often used to repair PNI individually. However, whether the combination of EPI-NCSC and OEC have better effects on PNI repair remains unclear. Here we use EPI-NCSC and OEC co-transplantation in a rat sciatic nerve defect model to ascertain the effects and potential mechanisms of cells co-transplantation on PNI. The effect of EPI-NCSC and OEC co-transplantation on PNI is assessed by using a combination of immunohistochemistry (IHC), electrophysiological recording and neural function test. Co-transplantation of EPI-NCSC and OEC exerts a beneficial effect upon PNI such as better organized structure, nerve function recovery, and lower motoneuron apoptosis. IHC and enzyme-linked immuno sorbent assay (ELISA) further demonstrate that cells co-transplantation may improve PNI via the expression of brain derived growth factor (BDNF) and nerve growth factor (NGF) up-regulated by EPI-NCSC and OEC synergistically. Eventually, the results from this study reveal that EPI-NCSC and OEC co-transplantation effectively repairs PNI through enhancing the level of BDNF and NGF, indicating that cells co-transplantation may serve as a fruitful avenue for PNI in clinic treatment.
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Affiliation(s)
- Lu Zhang
- Department of Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - Bingcang Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Bin Liu
- Key Laboratory of Freshwater Fish Reproduction and Development, Ministry of Education, School of Life Sciences, Southwest University, Chongqing, China
| | - Zhifang Dong
- Department of Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
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20
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Rbia N, Bulstra LF, Saffari TM, Hovius SER, Shin AY. Collagen Nerve Conduits and Processed Nerve Allografts for the Reconstruction of Digital Nerve Gaps: A Single-Institution Case Series and Review of the Literature. World Neurosurg 2019; 127:e1176-e1184. [PMID: 31003028 DOI: 10.1016/j.wneu.2019.04.087] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A single-institution case series is reported and a review of the literature on the outcomes of digital nerve gap reconstruction with the NeuraGen type 1 collagen nerve conduit (Integra Life Sciences, Plainsboro New Jersey, USA) and the Avance Nerve Graft (Axogen Inc., Alachua, Florida, USA) is presented. METHODS Thirty-seven patients were included with a minimal follow-up of 12 months. Primary outcome was postoperative sensory recovery measured by static 2-point discrimination test or the Semmes-Weinstein monofilament test. Secondary outcome measurements were perioperative or postoperative complications. Final outcome data were stratified to grade results as excellent, good, or poor. RESULTS The mean nerve gap length was 14 ± 4.9 mm for the collagen conduits versus 18.4 ± 9.3 for nerve allografts. After 12 months, outcomes were graded as excellent sensory recovery in 48% of the collagen conduit repairs and 39% of the nerve allografts (P = 0.608), good in 26% of the conduits and 55% of the allografts (P = 0.074), and poor in 26% of the conduits versus 6% of the allografts (P = 0.091). One neuroma and 1 infection were reported. Graft rejection or extrusion was not observed. CONCLUSIONS Nerve conduits and processed nerve allografts offer convenient off-the-shelf options for digital nerve gap repair. Both techniques offer effective means of reconstructing a digital nerve gap <2.5 cm at a minimum of 12 months of follow-up. Future prospective randomized large sample size studies comparing nerve conduits with allografts are needed to perform subgroup analyses and to define their exact role in digital nerve injuries.
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Affiliation(s)
- Nadia Rbia
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Liselotte F Bulstra
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Tiam M Saffari
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Steven E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Minnesota, USA.
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21
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Duffy P, McMahon S, Wang X, Keaveney S, O'Cearbhaill ED, Quintana I, Rodríguez FJ, Wang W. Synthetic bioresorbable poly-α-hydroxyesters as peripheral nerve guidance conduits; a review of material properties, design strategies and their efficacy to date. Biomater Sci 2019; 7:4912-4943. [DOI: 10.1039/c9bm00246d] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Implantable tubular devices known as nerve guidance conduits (NGCs) have drawn considerable interest as an alternative to autografting in the repair of peripheral nerve injuries.
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Affiliation(s)
- Patrick Duffy
- The Charles Institute of Dermatology
- School of Medicine
- University College Dublin
- Dublin
- Ireland
| | - Seán McMahon
- Ashland Specialties Ireland Ltd
- Synergy Centre
- Dublin
- Ireland
| | - Xi Wang
- The Charles Institute of Dermatology
- School of Medicine
- University College Dublin
- Dublin
- Ireland
| | - Shane Keaveney
- School of Mechanical & Materials Engineering
- UCD Centre for Biomedical Engineering
- UCD Conway Institute of Biomolecular and Biomedical Research
- University College Dublin
- Dublin
| | - Eoin D. O'Cearbhaill
- School of Mechanical & Materials Engineering
- UCD Centre for Biomedical Engineering
- UCD Conway Institute of Biomolecular and Biomedical Research
- University College Dublin
- Dublin
| | - Iban Quintana
- IK4-Tekniker
- Surface Engineering and Materials Science Unit
- Eibar
- Spain
| | | | - Wenxin Wang
- The Charles Institute of Dermatology
- School of Medicine
- University College Dublin
- Dublin
- Ireland
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Sahar MSU, Barton M, Tansley GD. Bridging larger gaps in peripheral nerves using neural prosthetics and physical therapeutic agents. Neural Regen Res 2019; 14:1109-1115. [PMID: 30804232 PMCID: PMC6425823 DOI: 10.4103/1673-5374.251186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Peripheral nerve injuries are relatively common and can be caused by a variety of traumatic events such as motor vehicle accidents. They can lead to long-term disability, pain, and financial burden, and contribute to poor quality of life. In this review, we systematically analyze the contemporary literature on peripheral nerve gap management using nerve prostheses in conjunction with physical therapeutic agents. The use of nerve prostheses to assist nerve regeneration across large gaps (> 30 mm) has revolutionized neural surgery. The materials used for nerve prostheses have been greatly refined, making them suitable for repairing large nerve gaps. However, research on peripheral nerve gap management using nerve prostheses reports inconsistent functional outcomes, especially when prostheses are integrated with physical therapeutic agents, and thus warrants careful investigation. This review explores the effectiveness of nerve prostheses for bridging large nerve gaps and then addresses their use in combination with physical therapeutic agents.
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Affiliation(s)
| | - Matthew Barton
- Clem Jones Centre for Neurobiology and Stem Cell Therapies, Griffith University, Gold Coast, Queensland, Australia
| | - Geoffrey Douglas Tansley
- School of Engineering and Built Environment, Griffith University, Gold Coast, Queensland, Australia
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Lovati AB, D’Arrigo D, Odella S, Tos P, Geuna S, Raimondo S. Nerve Repair Using Decellularized Nerve Grafts in Rat Models. A Review of the Literature. Front Cell Neurosci 2018; 12:427. [PMID: 30510503 PMCID: PMC6254089 DOI: 10.3389/fncel.2018.00427] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022] Open
Abstract
Peripheral nerve regeneration after severe traumatic nerve injury is a relevant clinical problem. Several different strategies have been investigated to solve the problem of bridging the nerve gap. Among these, the use of decellularized nerve grafts has been proposed as an alternative to auto/isografts, which represent the current gold standard in the treatment of severe nerve injury. This study reports the results of a systematic review of the literature published between January 2007 and October 2017. The aim was to quantitatively analyze the effectiveness of decellularized nerve grafts in rat experimental models. The review included 33 studies in which eight different decellularization protocols were described. The decellularized nerve grafts were reported to be immunologically safe and able to support both functional and morphological regeneration after nerve injury. Chemical protocols were found to be superior to physical protocols. However, further research is needed to optimize preparation protocols, including recellularization, improve their effectiveness, and substitute the current gold standard, especially in the repair of long nerve defects.
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Affiliation(s)
- Arianna B. Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Daniele D’Arrigo
- Cell and Tissue Engineering Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Simonetta Odella
- UOC Hand Surgery and Reconstructive Microsurgery Unit, ASST G. Pini-CTO, Milan, Italy
| | - Pierluigi Tos
- UOC Hand Surgery and Reconstructive Microsurgery Unit, ASST G. Pini-CTO, Milan, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Evaluation of two collagen conduits and autograft in rabbit sciatic nerve regeneration with quantitative magnetic resonance DTI, electrophysiology, and histology. Eur Radiol Exp 2018; 2:19. [PMID: 30148252 PMCID: PMC6091702 DOI: 10.1186/s41747-018-0049-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Background We compared different surgical techniques for nerve regeneration in a rabbit sciatic nerve gap model using magnetic resonance diffusion tensor imaging (DTI), electrophysiology, limb function, and histology. Methods A total of 24 male New Zealand white rabbits were randomized into three groups: autograft (n = 8), hollow conduit (n = 8), and collagen-filled conduit (n = 8). A 10-mm segment of the rabbit proximal sciatic nerve was cut, and autograft or collagen conduit was used to bridge the gap. DTI on a 3-T system was performed preoperatively and 13 weeks after surgery using the contralateral, nonoperated nerve as a control. Results Overall, autograft performed better compared with both conduit groups. Differences in axonal diameter were significant (autograft > hollow conduit > collagen-filled conduit) at 13 weeks (autograft vs. hollow conduit, p = 0.001, and hollow conduit vs. collagen-filled conduit, p < 0.001). Significant group differences were found for axial diffusivity but not for any of the other DTI metrics (autograft > hollow conduit > collagen-filled conduit) (autograft vs. hollow conduit, p = 0.001 and hollow conduit vs. collagen-filled conduit, p = 0.021). As compared with hollow conduit (autograft > collagen-filled conduit > hollow conduit), collagen-filled conduit animals demonstrated a nonsignificant increased maximum tetanic force. Conclusions Autograft-treated rabbits demonstrated improved sciatic nerve regeneration compared with collagen-filled and hollow conduits as assessed by histologic, functional, and DTI parameters at 13 weeks.
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Yi S, Xu L, Gu X. Scaffolds for peripheral nerve repair and reconstruction. Exp Neurol 2018; 319:112761. [PMID: 29772248 DOI: 10.1016/j.expneurol.2018.05.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/05/2018] [Accepted: 05/13/2018] [Indexed: 12/22/2022]
Abstract
Trauma-associated peripheral nerve defect is a widespread clinical problem. Autologous nerve grafting, the current gold standard technique for the treatment of peripheral nerve injury, has many internal disadvantages. Emerging studies showed that tissue engineered nerve graft is an effective substitute to autologous nerves. Tissue engineered nerve graft is generally composed of neural scaffolds and incorporating cells and molecules. A variety of biomaterials have been used to construct neural scaffolds, the main component of tissue engineered nerve graft. Synthetic polymers (e.g. silicone, polyglycolic acid, and poly(lactic-co-glycolic acid)) and natural materials (e.g. chitosan, silk fibroin, and extracellular matrix components) are commonly used along or together to build neural scaffolds. Many other materials, including the extracellular matrix, glass fabrics, ceramics, and metallic materials, have also been used to construct neural scaffolds. These biomaterials are fabricated to create specific structures and surface features. Seeding supporting cells and/or incorporating neurotrophic factors to neural scaffolds further improve restoration effects. Preliminary studies demonstrate that clinical applications of these neural scaffolds achieve satisfactory functional recovery. Therefore, tissue engineered nerve graft provides a good alternative to autologous nerve graft and represents a promising frontier in neural tissue engineering.
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Affiliation(s)
- Sheng Yi
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Lai Xu
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Xiaosong Gu
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
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Du J, Chen H, Qing L, Yang X, Jia X. Biomimetic neural scaffolds: a crucial step towards optimal peripheral nerve regeneration. Biomater Sci 2018; 6:1299-1311. [PMID: 29725688 PMCID: PMC5978680 DOI: 10.1039/c8bm00260f] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Peripheral nerve injury is a common disease that affects more than 20 million people in the United States alone and remains a major burden to society. The current gold standard treatment for critical-sized nerve defects is autologous nerve graft transplantation; however, this method is limited in many ways and does not always lead to satisfactory outcomes. The limitations of autografts have prompted investigations into artificial neural scaffolds as replacements, and some neural scaffold devices have progressed to widespread clinical use; scaffold technology overall has yet to be shown to be consistently on a par with or superior to autografts. Recent advances in biomimetic scaffold technologies have opened up many new and exciting opportunities, and novel improvements in material, fabrication technique, scaffold architecture, and lumen surface modifications that better reflect biological anatomy and physiology have independently been shown to benefit overall nerve regeneration. Furthermore, biomimetic features of neural scaffolds have also been shown to work synergistically with other nerve regeneration therapy strategies such as growth factor supplementation, stem cell transplantation, and cell surface glycoengineering. This review summarizes the current state of neural scaffolds, highlights major advances in biomimetic technologies, and discusses future opportunities in the field of peripheral nerve regeneration.
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Affiliation(s)
- Jian Du
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ; Tel: +1 410-706-5025
| | - Huanwen Chen
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ; Tel: +1 410-706-5025
| | - Liming Qing
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ; Tel: +1 410-706-5025
| | - Xiuli Yang
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ; Tel: +1 410-706-5025
| | - Xiaofeng Jia
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ; Tel: +1 410-706-5025
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Bridging the Gap: Engineered Porcine-derived Urinary Bladder Matrix Conduits as a Novel Scaffold for Peripheral Nerve Regeneration. Ann Plast Surg 2018; 78:S328-S334. [PMID: 28328634 DOI: 10.1097/sap.0000000000001042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE This study aims to compare engineered nerve conduits constructed from porcine-derived urinary bladder matrix (UBM) with the criterion-standard nerve autografts, for segmental loss peripheral nerve repairs. METHODS Forty-eight Sprague-Dawley rats were divided into 2 groups. All underwent a 10-mm sciatic nerve gap injury. This was repaired using either (1) reverse autograft-the 10-mm cut segment was oriented 180 degrees and used to coapt the proximal and distal stumps or (2) UBM conduit-the 10-mm nerve gap was bridged with UBM conduit. Behavior assessments such as sciatic function index and foot fault asymmetry scores were performed weekly. At 3- or 6-week time endpoints, the repaired nerves and bilateral gastrocnemius/soleus muscles were harvested from each animal. Nerves were evaluated using immunohistochemistry for motor and sensory axon staining and with diffusion tensor imaging. The net wet muscle weights were calculated to assess the degree of muscle atrophy. RESULTS The UBM group demonstrated significantly improved foot fault asymmetry scores at 2 and 4 weeks, whereas there was no difference in sciatic function index. The net muscle weights were similar between both groups. Motor axon counts proximal/inside/distal to the conduit/graft were similar between UBM conduits and reverse autografts, whereas sensory axon counts within and distal to the conduit were significantly higher than those of the autograft at 6 weeks. Sensory axonal regeneration seemed to be adherent to the inner surface of the UBM conduit, whereas it had a scattered appearance in autografts. Diffusion tensor imaging parameters between groups were similar. CONCLUSIONS Urinary bladder matrix conduits prove to be at least similar to nerve autografts for the repair of peripheral nerve injuries with a short gap. The matrix perhaps serves as a scaffold to augment sensory nerve growth. CLINICAL RELEVANCE In a clinical setting, UBM may eliminate the donor site morbidity and increased operative time associated with nerve autografting.
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Rosso MPDO, Rosa Júnior GM, Buchaim DV, German IJS, Pomini KT, de Souza RG, Pereira M, Favaretto Júnior IA, Bueno CRDS, Gonçalves JBDO, Ferreira Júnior RS, Barraviera B, Andreo JC, Buchaim RL. Stimulation of morphofunctional repair of the facial nerve with photobiomodulation, using the end-to-side technique or a new heterologous fibrin sealant. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 175:20-28. [PMID: 28846931 DOI: 10.1016/j.jphotobiol.2017.08.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/13/2017] [Accepted: 08/17/2017] [Indexed: 12/01/2022]
Abstract
This research evaluated the influence of Photobiomodulation Therapy (PBMT) on lesions of the facial nerve repaired with the end-to-side technique or coaptation with a new heterologous fibrin sealant. Thirty-two Wistar rats were separated into 5 groups: Control group (CG), where the buccal branch of the facial nerve was collected; Experimental Suture Group (ESG) and Experimental Fibrin Group (EFG), in which the buccal branch was end-to-side sutured to the zygomatic branch on the right side of the face or coaptated with fibrin sealant on the left side; Experimental Suture Laser Group (ESLG) and Experimental Fibrin Laser Group (EFLG), in which the same procedures were performed as the ESG and EFG, associated with PBMT (wavelength of 830nm, energy density 6.2J/cm2, power output 30mW, beam area of 0.116cm2, power density 0.26W/cm2, total energy per session 2.16J, cumulative dose of 34.56J). The laser was applied for 24s/site at 3 points on the skin's surface, for a total application time of 72s, performed immediately after surgery and 3 times a week for 5weeks. A statistically significant difference was observed in the fiber nerve area between the EFG and EFLG (57.49±3.13 and 62.52±3.56μm2, respectively). For the area of the axon, fiber diameter, axon diameter, myelin sheath area and myelin sheath thickness no statistically significant differences were found (p<0.05). The functional recovery of whisker movement occurred faster in the ESLG and EFLG, which were associated with PBMT, with results closer to the CG. Therefore, PBMT accelerated morphological and functional nerve repair in both techniques.
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Affiliation(s)
| | | | | | - Iris Jasmin Santos German
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | - Karina Torres Pomini
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | - Rafael Gomes de Souza
- Human Morphophysiology (Anatomy), University of Marilia (UNIMAR), Marilia, SP, Brazil
| | - Mizael Pereira
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | | | | | | | - Rui Seabra Ferreira Júnior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ. Estadual Paulista, UNESP), Botucatu, SP, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ. Estadual Paulista, UNESP), Botucatu, SP, Brazil
| | - Jesus Carlos Andreo
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | - Rogério Leone Buchaim
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil; Human Morphophysiology (Anatomy), University of Marilia (UNIMAR), Marilia, SP, Brazil
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Pinho AC, Fonseca AC, Serra AC, Santos JD, Coelho JFJ. Peripheral Nerve Regeneration: Current Status and New Strategies Using Polymeric Materials. Adv Healthc Mater 2016; 5:2732-2744. [PMID: 27600578 DOI: 10.1002/adhm.201600236] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 12/16/2022]
Abstract
Experiments concerning peripheral nerve regeneration have been reported since the end of the 19th century. The need to implement an effective surgical procedure in terms of functional recovery has resulted in the appearance of several approaches to solve this problem. Nerve autograft was the first approach studied and is still considered the gold standard. Since autografts require donor harvesting, other strategies involving the use of natural materials have also been studied. Nevertheless, the results were not very encouraging and attention has moved towards the use of nerve conduits made from polymers, whose properties can be easily tailored and which allow the nerve conduit to be easily processed into a variety of shapes and forms. Some of these materials are already approved by the US Food and Drug Administration (FDA), as is presented here. Furthermore, polymers with conductive properties have very recently been subject to intensive study in this field, since it is believed that such properties have a positive influence in the regeneration of the new axons. This manuscript intends to give a global view of the mechanisms involved in peripheral nerve regeneration and the main strategies used to recover motor and sensorial function of injured nerves.
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Affiliation(s)
- Ana C. Pinho
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
| | - Ana C. Fonseca
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
| | - Arménio C. Serra
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
| | - José D. Santos
- CEMUC Department of Metallurgical and Materials Engineering; University of Porto; Rua Dr Roberto Frias 4200-465 Porto Portugal
| | - Jorge F. J. Coelho
- CEMUC Department of Chemical Engineering; University of Coimbra; Rua Sílvio Lima-Pólo II 3030-790 Coimbra Portugal
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Luokkala T, Ryhänen J, Näpänkangas J, Karjalainen TV. Distal Inside-Out Epineural Sliding Technique to Repair Segmental Nerve Defects. Hand (N Y) 2016; 11:322-329. [PMID: 27698635 PMCID: PMC5030860 DOI: 10.1177/1558944715627304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The repair of a segmental peripheral nerve injury is a clinical challenge. Several studies have been performed to determine superior methods for overcoming nerve gaps. The purpose of this study was to investigate if the inside-out slided epineurium of the distal segment of an injured nerve can serve as a conduit to bridge a short nerve defect (10 mm). Methods: Nineteen sciatic nerves in Sprague-Dawley rats were transected, and a 10-mm gap was left between the ends. A section of distal epineurium was pulled inside out to bridge the gap. Walking track analysis was performed, and the sciatic function index (SFI) was calculated. Wet muscle mass and withdrawal reflex were measured. The density of axon fibers at different levels of repaired nerves was determined, and histological analysis was performed at 16 weeks. Results: The mean SFI improved from -81.0 at 4 weeks to 36.3 at 16 weeks. The axon densities showed regeneration through the epineural tube, and 5 of the rats demonstrated a withdrawal reflex. The weight of the tibialis anterior muscle of the injured limb at 16 weeks was 59% that of the uninjured side. Conclusions: The distal epineural sheath tube provided a size-matched conduit between the nerve stumps, with no histological donor-site morbidity. Histologically, regeneration occurred through the epineural tube without neuroma formation, and functional recovery was comparable to that of previous studies of nerve repair techniques. Technique may be an addition to the armamentarium of tools used to treat segmental nerve defects.
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Affiliation(s)
- Toni Luokkala
- Oulu University Hospital, Oulu, Finland,Central Finland Central Hospital, Jyväskylä, Finland,Toni Luokkala, Keski-Suomen Keskussairaala, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - Jorma Ryhänen
- Oulu University Hospital, Oulu, Finland,Terveystalo Oulu, Finland
| | | | - Teemu V Karjalainen
- Oulu University Hospital, Oulu, Finland,Central Finland Central Hospital, Jyväskylä, Finland
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Advances in peripheral nervous system regenerative therapeutic strategies: A biomaterials approach. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 65:425-32. [DOI: 10.1016/j.msec.2016.04.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/20/2016] [Accepted: 04/14/2016] [Indexed: 01/02/2023]
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Alberti KA, Neufeld CI, Wang J, Xu Q. In Vivo Peripheral Nerve Repair Using Tendon-Derived Nerve Guidance Conduits. ACS Biomater Sci Eng 2016; 2:937-945. [DOI: 10.1021/acsbiomaterials.6b00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Kyle A. Alberti
- Department of Biomedical
Engineering, Tufts University, 4 Colby Street, Medford, Massachusetts 02155, United States
| | - Caleb I. Neufeld
- Department of Biomedical
Engineering, Tufts University, 4 Colby Street, Medford, Massachusetts 02155, United States
| | - Jun Wang
- Department of Biomedical
Engineering, Tufts University, 4 Colby Street, Medford, Massachusetts 02155, United States
| | - Qiaobing Xu
- Department of Biomedical
Engineering, Tufts University, 4 Colby Street, Medford, Massachusetts 02155, United States
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Buchaim DV, Rodrigues ADC, Buchaim RL, Barraviera B, Junior RSF, Junior GMR, Bueno CRDS, Roque DD, Dias DV, Dare LR, Andreo JC. The new heterologous fibrin sealant in combination with low-level laser therapy (LLLT) in the repair of the buccal branch of the facial nerve. Lasers Med Sci 2016; 31:965-72. [PMID: 27112578 DOI: 10.1007/s10103-016-1939-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/11/2016] [Indexed: 01/09/2023]
Abstract
This study aimed to evaluate the effects of low-level laser therapy (LLLT) in the repair of the buccal branch of the facial nerve with two surgical techniques: end-to-end epineural suture and coaptation with heterologous fibrin sealant. Forty-two male Wistar rats were randomly divided into five groups: control group (CG) in which the buccal branch of the facial nerve was collected without injury; (2) experimental group with suture (EGS) and experimental group with fibrin (EGF): The buccal branch of the facial nerve was transected on both sides of the face. End-to-end suture was performed on the right side and fibrin sealant on the left side; (3) Experimental group with suture and laser (EGSL) and experimental group with fibrin and laser (EGFL). All animals underwent the same surgical procedures in the EGS and EGF groups, in combination with the application of LLLT (wavelength of 830 nm, 30 mW optical power output of potency, and energy density of 6 J/cm(2)). The animals of the five groups were euthanized at 5 weeks post-surgery and 10 weeks post-surgery. Axonal sprouting was observed in the distal stump of the facial nerve in all experimental groups. The observed morphology was similar to the fibers of the control group, with a predominance of myelinated fibers. In the final period of the experiment, the EGSL presented the closest results to the CG, in all variables measured, except in the axon area. Both surgical techniques analyzed were effective in the treatment of peripheral nerve injuries, where the use of fibrin sealant allowed the manipulation of the nerve stumps without trauma. LLLT exhibited satisfactory results on facial nerve regeneration, being therefore a useful technique to stimulate axonal regeneration process.
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Affiliation(s)
- Daniela Vieira Buchaim
- Human Morphophysiology (Anatomy), Faculty of Medicine, University of Marilia (UNIMAR), Marilia, SP, Brazil.
| | - Antonio de Castro Rodrigues
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Rogerio Leone Buchaim
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, São Paulo State, Brazil
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, São Paulo State, Brazil
| | | | | | - Domingos Donizeti Roque
- Human Morphophysiology (Anatomy), Faculty of Medicine, University of Marilia (UNIMAR), Marilia, SP, Brazil
| | | | | | - Jesus Carlos Andreo
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Sexton KW, Rodriguez-Feo CL, Boyer RB, Del Corral GA, Riley DC, Pollins AC, Cardwell NL, Shack RB, Nanney LB, Thayer WP. Axonal fusion via conduit-based delivery of hydrophilic polymers. Hand (N Y) 2015; 10:688-94. [PMID: 26568724 PMCID: PMC4641097 DOI: 10.1007/s11552-015-9780-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hydrophilic polymers have been shown to improve physiologic recovery following repair of transected nerves with microsutures. Our study was designed to combine hydrophilic polymer therapy with nerve tubes (NT) to enhance polymer delivery to the site of nerve injury. METHODS Using a rat sciatic nerve injury model, a single transection injury was repaired in an end-to-end fashion with NT + polyethylene glycol (PEG) to NT alone. Compound action potentials (CAPs) were recorded before nerve transection and after repair. Behavioral testing was performed for 5 weeks. RESULTS PEG therapy restored CAPS in all, but one, animals, while no CAPS were recorded in animals not receiving PEG. Behavioral nerve function was measured using the standardized functional assessment technique and foot fault asymmetry scores (FF). FF scores were improved for the PEG therapy groups on postoperative days 7, 14, and 21. However, after expected eventual axonal outgrowth, the benefit was less noticeable at days 28 and 35. Immunohistochemistry of the distal axon segments showed an increase number of sensory and motor axons in the NT + PEG group as compared to NT alone. CONCLUSION These data suggest that PEG delivery via a conduit may provide a simple, effective way to fuse severed axons and regain early nerve function. For proximal nerve injuries in large animals, recovery of axonal continuity could dramatically improve outcomes, even if fusion only occurs in a small percentage of axons.
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Affiliation(s)
- Kevin W. Sexton
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
- Department of General Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232 USA
| | | | - Richard B. Boyer
- Vanderbilt University School of Medicine, 215 Light Hall, Nashville, TN 37232 USA
| | - Gabriel A. Del Corral
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
| | - David C. Riley
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
| | - Alonda C. Pollins
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
| | - Nancy L. Cardwell
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
| | - R. Bruce Shack
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
| | - Lillian B. Nanney
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
| | - Wesley P. Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Avenue South S2221, Medical Center North, Nashville, TN 37232 USA
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Chang W, DeVince J, Green G, Shah MB, Johns MS, Meng Y, Yu X. The development of a normalization method for comparing nerve regeneration effectiveness among different graft types. J Peripher Nerv Syst 2014; 18:297-305. [PMID: 24118184 DOI: 10.1111/jns5.12043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/05/2013] [Accepted: 09/30/2013] [Indexed: 01/02/2023]
Abstract
The inability to compare directly different nerve grafts has been a significant factor hindering the advance of nerve graft development. Due to the abundance of variables that exist in nerve graft construction and multiple assessment types, there has been limited success in comparing nerve graft effectiveness among experiments. Using mathematical techniques on nerve conduction velocity (NCV) autograft data, a normalization function was empirically derived that normalizes differences in gap lengths. Further analysis allowed for the development of the relative regeneration ratio (RRR). The RRR function allows researchers to directly compare nerve graft results based on the NCV data from their respective studies as long as the data was collected at the same post-operation time. This function also allows for comparisons between grafts tested at different gap lengths. Initial testing of this RRR function provided confidence that the function is accurate for a continuum of gap lengths and different nerve graft types.
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Affiliation(s)
- Wei Chang
- Department of Chemistry, Chemical Biology and Biomedical Engineering
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Hazer DB, Bal E, Nurlu G, Benli K, Balci S, Öztürk F, Hazer B. In vivo application of poly-3-hydroxyoctanoate as peripheral nerve graft. J Zhejiang Univ Sci B 2014; 14:993-1003. [PMID: 24190445 DOI: 10.1631/jzus.b1300016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to investigate the degree of biocompatibility and neuroregeneration of a polymer tube, poly-3-hydroxyoctanoate (PHO) in nerve gap repair. METHODS Forty Wistar Albino male rats were randomized into two groups: autologous nerve gap repair group and PHO tube repair group. In each group, a 10-mm right sciatic nerve defect was created and reconstructed accordingly. Neuroregeneration was studied by sciatic function index (SFI), electromyography, and immunohistochemical studies on Days 7, 21, 45 and 60 of implantation. Biocompatibility was analyzed by the capsule formation around the conduit. Biodegradation was analyzed by the molecular weight loss in vivo. RESULTS Electrophysiological and histomorphometric assessments demonstrated neuroregeneration in both groups over time. In the experimental group, a straight alignment of the Schwann cells parallel to the axons was detected. However, autologous nerve graft seems to have a superior neuroregeneration compared to PHO grafts. Minor biodegradation was observed in PHO conduit at the end of 60 d. CONCLUSIONS Although neuroregeneration is detected in PHO grafts with minor degradation in 60 d, autologous nerve graft is found to be superior in axonal regeneration compared to PHO nerve tube grafts. PHO conduits were found to create minor inflammatory reaction in vivo, resulting in good soft tissue response.
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Affiliation(s)
- D Burcu Hazer
- Department of Neurosurgery, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla 48000, Turkey; Atatürk Research and Medical Center, Neurosurgery Clinic, Ministry of Health of the Republic of Turkey, Ankara 06110, Turkey; Department of Neurology, Faculty of Medicine, School of Medicine, Hacettepe University, Ankara 06100, Turkey; Department of Neurosurgery, Faculty of Medicine, School of Medicine, Hacettepe University, Ankara 06100, Turkey; Atatürk Research and Medical Center, Department of Pathology, Yıldırım Beyazıt University, Ankara 06110, Turkey; Department of Histology and Embryology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla 48000, Turkey; Department of Chemistry, Bülent Ecevit University, Zonguldak 67100, Turkey
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Giusti G, Shin RH, Lee JY, Mattar TG, Bishop AT, Shin AY. The influence of nerve conduits diameter in motor nerve recovery after segmental nerve repair. Microsurgery 2014; 34:646-52. [DOI: 10.1002/micr.22312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 02/06/2023]
Affiliation(s)
| | - Richard H. Shin
- Microvascular Research Laboratory; Mayo Clinic; Rochester MN
| | - Joo-Yup Lee
- Microvascular Research Laboratory; Mayo Clinic; Rochester MN
| | - Tiago G. Mattar
- Microvascular Research Laboratory; Mayo Clinic; Rochester MN
| | - Allen T. Bishop
- Microvascular Research Laboratory; Mayo Clinic; Rochester MN
- Department of Orthopedic Surgery; Mayo Clinic; Rochester MN
| | - Alexander Y. Shin
- Microvascular Research Laboratory; Mayo Clinic; Rochester MN
- Department of Orthopedic Surgery; Mayo Clinic; Rochester MN
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Abstract
Autologous nerve grafts are the current criterion standard for repair of peripheral nerve injuries when the transected nerve ends are not amenable to primary end-to-end tensionless neurorrhaphy. However, donor-site morbidities such as neuroma formation and permanent loss of function have led to tremendous interest in developing an alternative to this technique. Artificial nerve conduits have therefore emerged as an alternative to autologous nerve grafting for the repair of short peripheral nerve defects of less than 30 mm; however, they do not yet surpass autologous nerve grafts clinically. A thorough understanding of the complex biological reactions that take place during peripheral nerve regeneration will allow researchers to develop a nerve conduit with physical and biological properties similar to those of an autologous nerve graft that supports regeneration over long nerve gaps and in large-diameter nerves. In this article, the authors assess the currently available nerve conduits, summarize research in the field of developing these conduits, and establish areas within this field in which further research would prove most beneficial.
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Cirillo V, Clements BA, Guarino V, Bushman J, Kohn J, Ambrosio L. A comparison of the performance of mono- and bi-component electrospun conduits in a rat sciatic model. Biomaterials 2014; 35:8970-82. [PMID: 25085857 DOI: 10.1016/j.biomaterials.2014.07.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/10/2014] [Indexed: 12/16/2022]
Abstract
Synthetic nerve conduits represent a promising strategy to enhance functional recovery in peripheral nerve injury repair. However, the efficiency of synthetic nerve conduits is often compromised by the lack of molecular factors to create an enriched microenvironment for nerve regeneration. Here, we investigate the in vivo response of mono (MC) and bi-component (BC) fibrous conduits obtained by processing via electrospinning poly(ε-caprolactone) (PCL) and gelatin solutions. In vitro studies demonstrate that the inclusion of gelatin leads to uniform electrospun fiber size and positively influences the response of Dorsal Root Ganglia (DRGs) neurons as confirmed by the preferential extensions of neurites from DRG bodies. This behavior can be attributed to gelatin as a bioactive cue for the cultured DRG and to the reduced fibers size. However, in vivo studies in rat sciatic nerve defect model show an opposite response: MC conduits stimulate superior nerve regeneration than gelatin containing PCL conduits as confirmed by electrophysiology, muscle weight and histology. The G-ratio, 0.71 ± 0.07 for MC and 0.66 ± 0.05 for autograft, is close to 0.6, the value measured in healthy nerves. In contrast, BC implants elicited a strong host response and infiltrating tissue occluded the conduits preventing the formation of myelinated axons. Therefore, although gelatin promotes in vitro nerve regeneration, we conclude that bi-component electrospun conduits are not satisfactory in vivo due to intrinsic limits to their mechanical performance and degradation kinetics, which are essential to peripheral nerve regeneration in vivo.
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Affiliation(s)
- Valentina Cirillo
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy (IPCB-CNR), Viale Kennedy 54, Naples 80125, Italy; Department of Chemical, Materials and Industrial Production Engineering (DICMAPI), University of Naples Federico II, P.leTecchio 80, Naples 80125, Italy
| | - Basak A Clements
- New Jersey Center for Biomaterials, Rutgers - The State University of NJ, 145 Bevier Road, Piscataway, NJ 08854, USA
| | - Vincenzo Guarino
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy (IPCB-CNR), Viale Kennedy 54, Naples 80125, Italy.
| | - Jared Bushman
- New Jersey Center for Biomaterials, Rutgers - The State University of NJ, 145 Bevier Road, Piscataway, NJ 08854, USA
| | - Joachim Kohn
- New Jersey Center for Biomaterials, Rutgers - The State University of NJ, 145 Bevier Road, Piscataway, NJ 08854, USA
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy (IPCB-CNR), Viale Kennedy 54, Naples 80125, Italy
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Carriel V, Alaminos M, Garzón I, Campos A, Cornelissen M. Tissue engineering of the peripheral nervous system. Expert Rev Neurother 2014; 14:301-18. [DOI: 10.1586/14737175.2014.887444] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
When possible, direct repair remains the current standard of care for the repair of peripheral nerve lacerations. In large nerve gaps, in which direct repair is not possible, grafting remains the most viable option. Nerve scaffolds include autologous conduits, artificial nonbioabsorbable conduits, and bioabsorbable conduits and are options for repair of digital nerve gaps that are <3 cm in length. Experimental studies suggest that the use of allografts may be an option for repairing larger sensory nerve gaps without associated donor-site morbidity.
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Affiliation(s)
- Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia Health System, 400 Ray C. Hunt Drive, Suite 330, P.O. Box 800159, Charlottesville, VA 22908-0159
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Pace LA, Plate JF, Mannava S, Barnwell JC, Koman LA, Li Z, Smith TL, Van Dyke M. A human hair keratin hydrogel scaffold enhances median nerve regeneration in nonhuman primates: an electrophysiological and histological study. Tissue Eng Part A 2013; 20:507-17. [PMID: 24083825 DOI: 10.1089/ten.tea.2013.0084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A human hair keratin biomaterial hydrogel scaffold was evaluated as a nerve conduit luminal filler following median nerve transection injury in 10 Macaca fascicularis nonhuman primates (NHP). A 1 cm nerve gap was grafted with a NeuraGen® collagen conduit filled with either saline or keratin hydrogel and nerve regeneration was evaluated by electrophysiology for a period of 12 months. The keratin hydrogel-grafted nerves showed significant improvement in return of compound motor action potential (CMAP) latency and recovery of baseline nerve conduction velocity (NCV) compared with the saline-treated nerves. Histological evaluation was performed on retrieved median nerves and abductor pollicis brevis (APB) muscles at 12 months. Nerve histomorphometry showed a significantly larger nerve area in the keratin group compared with the saline group and the keratin APB muscles had a significantly higher myofiber density than the saline group. This is the first published study to show that an acellular biomaterial hydrogel conduit filler can be used to enhance peripheral nerve regeneration and motor recovery in an NHP model.
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Affiliation(s)
- Lauren A Pace
- 1 Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine , Winston-Salem, North Carolina
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Sahakyants T, Lee JY, Friedrich PF, Bishop AT, Shin AY. Return of motor function after repair of a 3-cm gap in a rabbit peroneal nerve: a comparison of autograft, collagen conduit, and conduit filled with collagen-GAG matrix. J Bone Joint Surg Am 2013; 95:1952-8. [PMID: 24196465 DOI: 10.2106/jbjs.m.00215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the motor nerve recovery in a rabbit model after repair of a 3-cm gap in the peroneal nerve with a conduit filled with a collagen-GAG (glycosaminoglycan) matrix and compare the results with those after reconstruction with an autograft or an empty collagen conduit. METHODS Forty-two male New Zealand rabbits were divided into three experimental groups. In each group, a unilateral 3-cm peroneal nerve defect was repaired with a nerve autograft, an empty collagen conduit, or a conduit filled with a collagen-GAG matrix. At six months, nerve regeneration was evaluated on the basis of the compound muscle action potentials, maximum isometric tetanic force, and wet muscle weight of the tibialis anterior muscle as well as nerve histomorphometry. RESULTS The autograft group had significantly better motor recovery than the conduit groups. The empty collagen conduits and conduits filled with the collagen-GAG matrix led to results that were similar to each other. CONCLUSIONS On the basis of this rabbit model, autologous nerve grafting remains the gold standard in the reconstruction of 3-cm segmental motor nerve defects. CLINICAL RELEVANCE Segmental motor nerve defects should be reconstructed with autograft nerves. The use of a collagen conduit filled with a collagen-GAG matrix for motor nerve reconstruction should be limited until additional animal studies are performed.
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Affiliation(s)
- Tatevik Sahakyants
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for A.Y. Shin:
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Pace LA, Plate JF, Smith TL, Van Dyke ME. The effect of human hair keratin hydrogel on early cellular response to sciatic nerve injury in a rat model. Biomaterials 2013; 34:5907-14. [DOI: 10.1016/j.biomaterials.2013.04.024] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 04/10/2013] [Indexed: 01/09/2023]
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Thomsen L, Schlur C. [Incidence of painful neuroma after end-to-end nerve suture wrapped into a collagen conduit. A prospective study of 185 cases]. ACTA ACUST UNITED AC 2013; 32:335-40. [PMID: 24075502 DOI: 10.1016/j.main.2013.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 06/11/2013] [Accepted: 07/05/2013] [Indexed: 01/10/2023]
Abstract
Three to 5% of the nerves directly and correctly sutured evolve towards significant neuropathy pain. The psychological, social and economic impact of such a consequence is very important. The purpose of this retrospective study was to evaluate the incidence of the occurrence of a trigger zone or a neuroma, at 6months of maximum follow-up after direct nervous suture bushed in a type 1 collagen tube. Every patient taken care for a traumatic nervous injury from November 2008 to March 2012 was included in the study. The exclusion criteria were any replantation, nervous tissue defect and any distal nervous stump which could not technically be wrapped around. The only conduct used was made of collagen type 1 (Revolnerv(®), Orthomed™). All patients were examined after one, three and sixmonths for a clinical evaluation made by the same surgeon. The apparition of a trigger zone or a real neuroma was clinically assessed. One hundred and seventy-four patients for a total of 197 sutured nerves were included in the study. At the 6 months follow-up, 163 patients were evaluated for a total of 185 nerves. No patient suffered from a neuroma at this time. As the treatment of neuroma is very difficult, considering the cost and the results, wrapping direct end-to-end sutures by a collagen type 1 tube seems helping to prevent the appearance of a neuroma.
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Affiliation(s)
- L Thomsen
- Clinique la Montagne, 10, rue la Montagne, 92400 Courbevoie, France.
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Gould JS, Naranje SM, McGwin G, Florence M, Cheppalli S. Use of collagen conduits in management of painful neuromas of the foot and ankle. Foot Ankle Int 2013; 34:932-40. [PMID: 23447512 DOI: 10.1177/1071100713478927] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Painful neuromas of the foot and ankle frequently pose a treatment dilemma due to persistent pain or recurrence after resection. The purpose of this survey was to evaluate the clinical and functional outcomes in patients in which collagen nerve conduits were used as an adjunct to the resection of a painful neuroma. Our prior experience with vein conduits for this purpose suggested that we might have similar success with the use of these devices. MATERIALS AND METHODS Chart reviews and telephone surveys were performed on patients operated by the senior surgeon (JSG) at our medical center from June 2006 to June 2011. A total of 50 patients underwent excision of painful single or multiple neuromas with the end of the resected nerve sutured into the collagen conduit. Each patient preoperatively was asked to describe the amount of pain he or she was experiencing on a scale from 1 to 10, with 10 indicating the most severe pain. In the telephone interview conducted during this study, the same question was asked of each patient following revision. Patient ages ranged from 16 to 77 years, with a mean of 54 years. In all, 30 right and 20 left sides were operated, and 1 patient had bilateral involvement. Mean follow-up was 36 months (6-55 months). There were a total of 69 nerves that underwent conduit procedures. RESULTS Of 69 nerve conduit constructs, 30 (43%) were painless at final outcome, 23 (33%) had pain scores of 1 to 4, 6 (9%) had pain scores of 5 to 7, and 10 (15%) had severe symptoms with pain scores of 8 to 10. Satisfactory outcomes in which patients stated that they were significantly improved with the procedure and now functional occurred in 59/69 (85%). In all, 24 (48%) patients were completely symptom free, 13 (26%) had a pain score of 1 to 4, 6 (12%) had scores of 5 to 7, and 10 (15%) had severe pain with scores of 8 to 10. Three patients had superficial infections (stitch abscesses): 2 resolved with oral antibiotics and 1 resolved spontaneously. Three patients developed complex regional pain syndrome. One patient responded to a dorsal column stimulator and 2 responded to sympathetic blocks. No other complications were reported. CONCLUSION Collagen conduits were safe and generally successful adjuncts to simple excision in the management of painful neuromas of the foot and ankle. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- John S Gould
- University of Alabama at Birmingham, Birmingham, AL 35205, USA.
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Nakada A, Shigeno K, Sato T, Kobayashi T, Wakatsuki M, Uji M, Nakamura T. Manufacture of a weakly denatured collagen fiber scaffold with excellent biocompatibility and space maintenance ability. Biomed Mater 2013; 8:045010. [DOI: 10.1088/1748-6041/8/4/045010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Long term peripheral nerve regeneration using a novel PCL nerve conduit. Neurosci Lett 2013; 544:125-30. [DOI: 10.1016/j.neulet.2013.04.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 01/09/2023]
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Quigley AF, Bulluss KJ, Kyratzis ILB, Gilmore K, Mysore T, Schirmer KSU, Kennedy EL, O'Shea M, Truong YB, Edwards SL, Peeters G, Herwig P, Razal JM, Campbell TE, Lowes KN, Higgins MJ, Moulton SE, Murphy MA, Cook MJ, Clark GM, Wallace GG, Kapsa RMI. Engineering a multimodal nerve conduit for repair of injured peripheral nerve. J Neural Eng 2013; 10:016008. [DOI: 10.1088/1741-2560/10/1/016008] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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