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Elhelali A, Tuffaha S. A Systematic Review of Registered Clinical Trials for Peripheral Nerve Injuries. Ann Plast Surg 2024; 92:e32-e54. [PMID: 38527351 DOI: 10.1097/sap.0000000000003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
ABSTRACT Upper extremity peripheral nerve injuries (PNIs) significantly impact daily functionality and necessitate effective treatment strategies. Clinical trials play a crucial role in developing these strategies. However, challenges like retrospective data collection, reporting biases, inconsistent outcome measures, and inadequate data sharing practices hinder effective research and treatment advancements. This review aims to analyze the landscape of reporting, methodological design, outcome measures, and data sharing practices in registered clinical trials concerning upper extremity PNIs. It seeks to guide future research in this vital area by identifying current trends and gaps.A systematic search was conducted on ClinicalTrials.gov and WHO International Clinical Trials Registry Platform up to November 10, 2023, using a combination of MeSH terms and keywords related to upper extremity nerve injury. The PRISMA 2020 guidelines were followed, and the studies were selected based on predefined inclusion and exclusion criteria. A narrative synthesis of findings was performed, with statistical analysis for associations and completion rates.Of 3051 identified studies, 96 met the inclusion criteria. These included 47 randomized controlled trials, 27 nonrandomized trials, and others. Sensory objective measures were the most common primary outcomes. Only 13 studies had a data sharing plan. The analysis revealed varied intervention methods and inconsistencies in outcome measures. There was a significant association between study funding, design, and completion status, but no association between enrollment numbers and completion.This review highlights the need for standardized outcome measures, patient-centered assessments, and improved data sharing in upper extremity PNI trials. The varied nature of interventions and inconsistency in outcome measures indicate the necessity for more rigorous and transparent research practices to strengthen the evidence base for managing these injuries.
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Affiliation(s)
- Ala Elhelali
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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2
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Xiao B, Feturi F, Su AJA, Van der Merwe Y, Barnett JM, Jabbari K, Khatter NJ, Li B, Katzel EB, Venkataramanan R, Solari MG, Wagner WR, Steketee MB, Simons DJ, Washington KM. Nerve Wrap for Local Delivery of FK506/Tacrolimus Accelerates Nerve Regeneration. Int J Mol Sci 2024; 25:847. [PMID: 38255920 PMCID: PMC10815243 DOI: 10.3390/ijms25020847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Peripheral nerve injuries (PNIs) occur frequently and can lead to devastating and permanent sensory and motor function disabilities. Systemic tacrolimus (FK506) administration has been shown to hasten recovery and improve functional outcomes after PNI repair. Unfortunately, high systemic levels of FK506 can result in adverse side effects. The localized administration of FK506 could provide the neuroregenerative benefits of FK506 while avoiding systemic, off-target side effects. This study investigates the utility of a novel FK506-impregnated polyester urethane urea (PEUU) nerve wrap to treat PNI in a previously validated rat infraorbital nerve (ION) transection and repair model. ION function was assessed by microelectrode recordings of trigeminal ganglion cells responding to controlled vibrissae deflections in ION-transected and -repaired animals, with and without the nerve wrap. Peristimulus time histograms (PSTHs) having 1 ms bins were constructed from spike times of individual single units. Responses to stimulus onsets (ON responses) were calculated during a 20 ms period beginning 1 ms after deflection onset; this epoch captures the initial, transient phase of the whisker-evoked response. Compared to no-wrap controls, rats with PEUU-FK506 wraps functionally recovered earlier, displaying larger response magnitudes. With nerve wrap treatment, FK506 blood levels up to six weeks were measured nearly at the limit of quantification (LOQ ≥ 2.0 ng/mL); whereas the drug concentrations within the ION and muscle were much higher, demonstrating the local delivery of FK506 to treat PNI. An immunohistological assessment of ION showed increased myelin expression for animals assigned to neurorrhaphy with PEUU-FK506 treatment compared to untreated or systemic-FK506-treated animals, suggesting that improved PNI outcomes using PEUU-FK506 is mediated by the modulation of Schwann cell activity.
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Affiliation(s)
- Bo Xiao
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
| | - Firuz Feturi
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
| | - An-Jey A. Su
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
- Department of Surgery, Division of Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | | | - Joshua M. Barnett
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
| | - Kayvon Jabbari
- Department of Surgery, Division of Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Neil J. Khatter
- Department of Surgery, Division of Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bing Li
- Department of Surgery, Division of Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Evan B. Katzel
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
| | | | - Mario G. Solari
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA; (W.R.W.); (D.J.S.)
| | - Michael B. Steketee
- Department of Ophthalmology, University of California, San Diego, CA 90095, USA
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA; (W.R.W.); (D.J.S.)
| | - Daniel J. Simons
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA; (W.R.W.); (D.J.S.)
| | - Kia M. Washington
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Veterans Administration Healthcare System, Pittsburgh, PA 15213, USA; (B.X.); (F.F.)
- Department of Surgery, Division of Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA; (W.R.W.); (D.J.S.)
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Seixas SF, Forte GC, Magnus GA, Stanham V, Mattiello R, Silva JB. Effect of Tacrolimus and Cyclosporine Immunosuppressants on Peripheral Nerve Regeneration: Systematic Review and Meta-analysis. Rev Bras Ortop 2022; 57:207-213. [PMID: 35652029 PMCID: PMC9142254 DOI: 10.1055/s-0041-1736467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93–2.39;
p
< 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38–1.18;
p
= 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI= 2.00–5.71;
p
< 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.
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Affiliation(s)
- Stéphanie Farias Seixas
- Serviço de Cirurgia da Mão e Microcirurgia Reconstrutiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Gabriele Carra Forte
- Departamento de Radiologia, Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil
| | - Gabriela Agne Magnus
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS Brasil
| | - Valentina Stanham
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS Brasil
| | - Rita Mattiello
- Programa de Pós-graduação em Pediatria e Saúde da Criança; Programa de Pós-graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Jefferson Braga Silva
- Serviço de Cirurgia da Mão e Microcirurgia Reconstrutiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
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4
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Barham M, Streppel M, Guntinas-Lichius O, Fulgham-Scott N, Vogt J, Neiss WF. Treatment With Nimodipine or FK506 After Facial Nerve Repair Neither Improves Accuracy of Reinnervation Nor Recovery of Mimetic Function in Rats. Front Neurosci 2022; 16:895076. [PMID: 35645727 PMCID: PMC9136327 DOI: 10.3389/fnins.2022.895076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Nimodipine and FK506 (Tacrolimus) are drugs that have been reported to accelerate peripheral nerve regeneration. We therefore tested these substances aiming to improve the final functional outcome of motoric reinnervation after facial nerve injury. Methods In 18 female rats, the transected facial nerve was repaired by an artificial nerve conduit. The rats were then treated with either placebo, nimodipine, or FK506, for 56 days. Facial motoneurons were pre-operatively double-labeled by Fluoro-Gold and again 56 days post-operation by Fast-Blue to measure the cytological accuracy of reinnervation. The whisking motion of the vibrissae was analyzed to assess the quality of functional recovery. Results On the non-operated side, 93–97% of those facial nerve motoneurons innervating the vibrissae were double-labeled. On the operated side, double-labeling only amounted to 38% (placebo), 40% (nimodipine), and 39% (FK506), indicating severe misdirection of reinnervation. Regardless of post-operative drug or placebo therapy, the whisking frequency reached 83–100% of the normal value (6.0 Hz), but whisking amplitude was reduced to 33–48% while whisking velocity reached 39–66% of the normal values. Compared to placebo, statistically neither nimodipine nor FK506 improved accuracy of reinnervation and function recovery. Conclusion Despite previous, positive data on the speed and quantity of axonal regeneration, nimodipine and FK506 do not improve the final functional outcome of motoric reinnervation in rats.
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Affiliation(s)
- Mohammed Barham
- Department II of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
- *Correspondence: Mohammed Barham,
| | - Michael Streppel
- Department of Ear, Nose and Throat-Department (ENT), PAN-Clinic at Neumarkt, Cologne, Germany
| | | | - Nicole Fulgham-Scott
- Department I of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Johannes Vogt
- Department II of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Wolfram F. Neiss
- Department I of Anatomy, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
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5
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Mourad SI, Al-Dubai SA, Elsayed SA, El-Zehary RR. Efficacy of platelet-rich fibrin and tacrolimus on facial nerve regeneration: an animal study. Int J Oral Maxillofac Surg 2022; 51:279-287. [PMID: 34090756 DOI: 10.1016/j.ijom.2021.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 01/16/2023]
Abstract
This study was performed to investigate the effect of platelet-rich fibrin membrane (PRFM), alone and with topical tacrolimus application, on regeneration of the crushed facial nerve (FN). Thirty healthy 7-week-old albino rats were used. The left FN was damaged by crushing in all rats. Three random groups of rats were formed: group 1, untreated; group 2, treated with PRFM; group 3, treated with PRFM plus topical tacrolimus. Functional recovery and histological and immunohistochemical evaluations were performed 4 and 8 weeks later. Anti-S100 was used to detect myelin sheath. At 4 weeks, blinking reflex recovery was more rapid in group 3 than in groups 2 and 1 (4.30 ± 0.48, 3.40 ± 0.52, and 2.20 ± 0.42, respectively); the difference was statistically significant (P = 0.001). Histologically, group 3 showed more apparent normal FN structures than the other groups. Immunohistochemical caspase-3 evaluation of the axon area revealed a significant difference between group 2 (PRFM alone; 8.67 ± 0.029) and group 3 (PRFM plus topical tacrolimus; 4.42 ± 0.028) (P = 0.001). Group 3 showed the greatest positive staining in the myelin sheath. Based on the results of this animal study, clinical studies should be performed to determine whether the combination of PRF and tacrolimus also improves the outcome of nerve regeneration in humans.
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Affiliation(s)
- S I Mourad
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - S A Al-Dubai
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - S A Elsayed
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo, Egypt.
| | - R R El-Zehary
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Crosio A, Ronchi G, Fornasari BE, Odella S, Raimondo S, Tos P. Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring. J Clin Med 2021; 10:jcm10081613. [PMID: 33920209 PMCID: PMC8070420 DOI: 10.3390/jcm10081613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 01/09/2023] Open
Abstract
As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices.
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Affiliation(s)
- Alessandro Crosio
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Piazza Andrea Ferrari 1, 20122 Milano, Italy; (A.C.); (S.O.); (P.T.)
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (G.R.); (B.E.F.)
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (G.R.); (B.E.F.)
| | - Simonetta Odella
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Piazza Andrea Ferrari 1, 20122 Milano, Italy; (A.C.); (S.O.); (P.T.)
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (G.R.); (B.E.F.)
- Correspondence: ; Tel.: +39-011-670-5433
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Piazza Andrea Ferrari 1, 20122 Milano, Italy; (A.C.); (S.O.); (P.T.)
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7
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Functionalized nerve conduits for peripheral nerve regeneration: A literature review. HAND SURGERY & REHABILITATION 2020; 39:343-351. [PMID: 32485240 DOI: 10.1016/j.hansur.2020.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
Functionalized neurotube are a third-generation of conduits with chemical or architectural bioactivity developed for axonal proliferation. The goal of this review is to provide a synopsis of the functionalized nerve conduits described in the literature according to their chemical and architectural properties and answer two questions: what are their mechanisms of action? Has their efficacy been proven compared to the autologous nerve graft? Our literature review relates all kind of conduits corresponding to functionalized neurotubes in peripheral nerve regeneration found in Medline and PubMed Central. Studies developing nerve gaps, chemotactic or structural features promoting each conduit, results, efficiency were selected. Fifty-five studies were selected and classified in: (a) intraluminal neurotrophic factors; (b) cell-based therapy (combined-in-vein muscles, amniotic membrane, Schwann cells, stem cells); (c) extracellular matrix proteins; (d) tissue engineering; (e) bioimplants. Functionalized neurotubes showed significantly better functional results than after end-to-end nerve suture. No studies can be able to show that neurotube results were better than autologous nerve graft results. We included all studies regardless of effectives to evaluate quality of reinnervation with modern tubulization. Functionalized neurotubes promote basic conduits for peripheral nerve regeneration. Thanks to bioengineering and microsurgery improvement, further neurotubes could promote best level of regeneration and functional recovery to successfully bridge a critical nerve gap.
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8
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Yang Z, Zheng C, Zhang F, Lin B, Cao M, Tian X, Zhang J, Zhang X, Shen J. Magnetic resonance imaging of enhanced nerve repair with mesenchymal stem cells combined with microenvironment immunomodulation in neurotmesis. Muscle Nerve 2020; 61:815-825. [PMID: 32170960 DOI: 10.1002/mus.26862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/04/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The immuno-microenvironment of injured nerves adversely affects mesenchymal stem cell (MSC) therapy for neurotmesis. Magnetic resonance imaging (MRI) can be used noninvasively to monitor nerve degeneration and regeneration. The aim of this study was to investigate nerve repair after MSC transplantation combined with microenvironment immunomodulation in neurotmesis by using multiparametric MRI. METHODS Rats with sciatic nerve transection and surgical coaptation were treated with MSCs combined with immunomodulation or MSCs alone. Serial multiparametric MRI examinations were performed over an 8-week period after surgery. RESULTS Nerves treated with MSCs combined with immunomodulation showed better functional recovery, rapid recovery of nerve T2, fractional anisotropy and radial diffusivity values, and more rapid restoration of the fiber tracks than nerves treated with MSCs alone. DISCUSSION Transplantation of MSCs in combination with immunomodulation can exert a synergistic repair effect on neurotmesis, which can be monitored by multiparametric MRI.
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Affiliation(s)
- Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fang Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Binglin Lin
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minghui Cao
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xuwei Tian
- Department of Radiology, The First People's Hospital of Kashgar, Kashgar, China
| | - Jingzhong Zhang
- The Key Laboratory of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Xiao Zhang
- CAS Key Laboratory of Regenerative Biology, Joint School of Life Sciences, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Saffari TM, Bedar M, Zuidam JM, Shin AY, Baan CC, Hesselink DA, Hundepool CA. Exploring the neuroregenerative potential of tacrolimus. Expert Rev Clin Pharmacol 2019; 12:1047-1057. [DOI: 10.1080/17512433.2019.1675507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- T. M. Saffari
- Department of Plastic-, Reconstructive- and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - M. Bedar
- Department of Plastic-, Reconstructive- and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - J. M. Zuidam
- Department of Plastic-, Reconstructive- and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A. Y. Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - C. C. Baan
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D. A. Hesselink
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C. A. Hundepool
- Department of Plastic-, Reconstructive- and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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10
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González Porto SA, Domenech N, Blanco FJ, Centeno Cortés A, Rivadulla Fernández C, Álvarez Jorge Á, Sánchez Ibáñez J, Rendal Vázquez E. Intraneural IFG-1 in Cryopreserved Nerve Isografts Increase Neural Regeneration and Functional Recovery in the Rat Sciatic Nerve. Neurosurgery 2019; 85:423-431. [PMID: 30060164 DOI: 10.1093/neuros/nyy339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/25/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insulin-like growth factor 1 (IGF-1) was found to stimulate Schwann cell mitosis. Exogenous IGF-1 may improve nerve regeneration after cryopreservation. OBJECTIVE To evaulate the effect of intraneural administration of IGF-1 in cryopreserved nerve isografts. METHODS Eighteen millimeter grafts were used for bridging an 18-mm defect in the rat sciatic nerve. A total of 57 rats were randomly divided into three groups: (1) autograft (Group 1); (2) cryopreserved isograft (Group 2); (3) cryopreserved isograft with intraneural IGF-1 administration (Group 3). 12 weeks after surgery, functional recovery (Sciatic functional index [SFI], Swing speed [SS], nerve conduction velocity [NCV], amplitude of compound motor action potentials [CMAP], and gastrocnemius muscle index [GMI]) and nerve regeneration (myelin sheath area, total fiber counts, fiber density, and fiber width) were all evaluated. RESULTS The intraneural injection of IGF-1 significantly improved SFI and SS at weeks 10 and 12. There were no statistical differences between Groups 1 and 3 in any of the SFI or SS evaluations. CMAP and NCV in Group 1 were significantly higher than in Groups 2 and 3, and Group 3 had significantly higher CMAP and NCV compared to Group 2. No significant differences were found in fiber width. The number of nerve fibers, percentage of myelinated fibers, fiber density, and GMI was significantly higher in Group 1 compared to Group 2, but no significant differences were found between Groups 1 and 3. CONCLUSION The results show that intraneural injection of IGF-1 in an 18 mm cryopreserved isograft improve axonal regeneration and functional recovery.
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Affiliation(s)
| | - Nieves Domenech
- Biobanco A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco J Blanco
- Grupo de Investigación de Proteómica-PBR2-ProteoRed/ISCIII-Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Universidade da Coruña (UDC), A Coruña, Spain
| | - Alberto Centeno Cortés
- Centro Tecnológico de Formación XXIAC, Instituto de Investigacións Biomédicas de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
| | - Casto Rivadulla Fernández
- Grupo de Neurociencia e Control Motor, NEUROcom, Facultade de Ciencias da Saúde, Departamento de Ciencias Biomédicas, Fisioterapia e Medicina, Instituto de Investigacións Biomédicas de A Coruña (INIBIC), A Coruña, Spain
| | - Ángel Álvarez Jorge
- Servicio de Cirugía Plástica, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
| | - Jacinto Sánchez Ibáñez
- Unidad de Criobiología, Banco de Tejidos, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
| | - Esther Rendal Vázquez
- Unidad de Criobiología, Banco de Tejidos, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
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11
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Abstract
Currently, there are no established adjuvant drugs for the acceleration of peripheral nerve regeneration. In this paper, we reviewed the literature from the last 10 years and described the drugs proved to accelerate the functional and histological regeneration of the peripheral nerves, either after trauma or in neuropathy experimental models. The vast majority of the studies were experimental with very few small clinical studies, which indicates the need for prospective randomized studies to identify the best drugs to use as adjuvants for nerve regeneration.
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Affiliation(s)
- Olimpiu Bota
- Department of Plastic and Hand Surgery, University Center of Orthopedics and Trauma Surgery, University Hospital Carl Gustav Carus , Dresden , Germany
| | - Lucian Fodor
- Department of Plastic Surgery, First Surgical Clinic, Emergency District Hospital , Cluj-Napoca , Romania
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Kikuta S, Iwanaga J, Watanabe K, Kusukawa J, Tubbs RS. The Feasibility of Using the Posterior Auricular Branch of the Facial Nerve as a Donor for Facial Nerve Reanimation Procedures: A Cadaveric Study. J Oral Maxillofac Surg 2019; 77:1470.e1-1470.e8. [PMID: 30959011 DOI: 10.1016/j.joms.2019.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Facial nerve paralysis can result in critical complications, including those to the visual, respiratory, and digestive systems. The facial nerve has been reanimated using various nerves, but the posterior auricular nerve (PAN) branching off the facial nerve has not been explored for this purpose. MATERIALS AND METHODS Ten sides from 6 fresh-frozen adult cadavers were used for dissection of the PAN to explore its potential as a donor for facial nerve reanimation. The facial nerve trunk (FNT) and PAN were consistently and readily identified by deep dissection using the tragal cartilage and tragal pointer as landmarks. The PAN was transected at the point of insertion of its innervated muscles. Its length and diameter were measured, and it was transposed anteriorly to the FNT and its 2 major extracranial divisions. RESULTS The PAN was observed on all sides. Its available length was 27.11 ± 5.02 mm and its mean diameter was 0.85 ± 0.20 mm. In all specimens, the PAN readily reached the FNT and its 2 major divisions without tension. CONCLUSION No previous study has explored the use of the PAN as a donor for facial nerve reanimation. Based on the present cadaveric study, surgeons might consider it for this purpose.
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Affiliation(s)
- Shogo Kikuta
- Assistant Professor, Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Clinical Anatomy Research Fellow, Seattle Science Foundation, Seattle, WA
| | - Joe Iwanaga
- Assistant Professor, Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Anatomical Researcher and Educator, Seattle Science Foundation, Seattle, WA.
| | - Koichi Watanabe
- Associate Professor, Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Jingo Kusukawa
- Professor, Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Chief Scientific Officer, Seattle Science Foundation, Seattle, WA; Professor, Department of Anatomical Sciences, St George's University, St. George's, Grenada, West Indies
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Yin Y, Xiao G, Zhang K, Ying G, Xu H, De Melo BAG, Li S, Liu F, Yetisen AK, Jiang N. Tacrolimus- and Nerve Growth Factor-Treated Allografts for Neural Tissue Regeneration. ACS Chem Neurosci 2019; 10:1411-1419. [PMID: 30525428 DOI: 10.1021/acschemneuro.8b00452] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Treatment of injured peripheral nerves, especially long-distance nerve defects, remains a significant challenge in regenerative medicine due to complex biological conditions and a lack of biomaterials for effective nerve reconstruction. Without proper treatment, nerve injury leads to motor and sensory dysfunction. Here, we have developed an efficacious nerve allograft treated with a dual drug containing acrolimus and nerve growth factor to bridge the nerve gap and achieve rapid neural tissue recovery without immunological rejection. The recovery of the structure, activity, and function of rats treated with the dual drug-treated allograft was investigated by walking track analysis and electrophysiological measurement. The sciatic functional index was measured to be -3.0 after a 12-week treatment. The nerve conduction velocity, peak latency, and peak amplitude of the nerve action potentials demonstrate the functional recovery of the nerve. To study the synergistic effect of the dual drug on the growth of neurites, a neural cell hypoxia model was created. The dual drug exhibited a high efficiency in promoting the growth of nerve cells under the nerve injury-induced hypoxic condition. The dual drug could protect the cells against antioxidative damage from hypoxia by the expression of heat shock protein, hypoxia-inducible factor, β-tubulin, and vimentin.
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Affiliation(s)
- Yixia Yin
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070, China
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Gao Xiao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, United States
- College of Environment and Resources, Fuzhou University, Fuzhou 350108, China
| | - Kaiming Zhang
- Department of Orthopedics, Second Hospital of Yueyang, Yueyang 414000, China
| | - Guoliang Ying
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan 430205, China
| | - Haixing Xu
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070, China
| | - Bruna A. G. De Melo
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Shipu Li
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070, China
| | - Fang Liu
- Department of Orthopedics, Second Hospital of Yueyang, Yueyang 414000, China
| | - Ali K. Yetisen
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, U.K
| | - Nan Jiang
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, United States
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Nerve grafting for peripheral nerve injuries with extended defect sizes. Wien Med Wochenschr 2018; 169:240-251. [PMID: 30547373 PMCID: PMC6538587 DOI: 10.1007/s10354-018-0675-6] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022]
Abstract
Artificial and non-artificial nerve grafts are the gold standard in peripheral nerve reconstruction in cases with extensive loss of nerve tissue, particularly where a direct end-to-end suture or an autologous nerve graft is inauspicious. Different materials are marketed and approved by the US Food and Drug Administration (FDA) for peripheral nerve graft reconstruction. The most frequently used materials are collagen and poly(DL-lactide-ε-caprolactone). Only one human nerve allograft is listed for peripheral nerve reconstruction by the FDA. All marketed nerve grafts are able to demonstrate sufficient nerve regeneration over small distances not exceeding 3.0 cm. A key question in the field is whether nerve reconstruction on large defect lengths extending 4.0 cm or more is possible. This review gives a summary of current clinical and experimental approaches in peripheral nerve surgery using artificial and non-artificial nerve grafts in short and long distance nerve defects. Strategies to extend nerve graft lengths for long nerve defects, such as enhancing axonal regeneration, include the additional application of Schwann cells, mesenchymal stem cells or supporting co-factors like growth factors on defect sizes between 4.0 and 8.0 cm.
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15
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Are We Ready for a Human Head Transplant? The Obstacles That Must Be Overcome. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Pediatric Vascular Composite Allograft Transplantation: Medical Considerations. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Characterization and Schwann Cell Seeding of up to 15.0 cm Long Spider Silk Nerve Conduits for Reconstruction of Peripheral Nerve Defects. J Funct Biomater 2016; 7:jfb7040030. [PMID: 27916868 PMCID: PMC5197989 DOI: 10.3390/jfb7040030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/22/2016] [Accepted: 11/11/2016] [Indexed: 01/31/2023] Open
Abstract
Nerve reconstruction of extended nerve defect injuries still remains challenging with respect to therapeutic options. The gold standard in nerve surgery is the autologous nerve graft. Due to the limitation of adequate donor nerves, surgical alternatives are needed. Nerve grafts made out of either natural or artificial materials represent this alternative. Several biomaterials are being explored and preclinical and clinical applications are ongoing. Unfortunately, nerve conduits with successful enhancement of axonal regeneration for nerve defects measuring over 4.0 cm are sparse and no conduits are available for nerve defects extending to 10.0 cm. In this study, spider silk nerve conduits seeded with Schwann cells were investigated for in vitro regeneration on defects measuring 4.0 cm, 10.0 cm and 15.0 cm in length. Schwann cells (SCs) were isolated, cultured and purified. Cell purity was determined by immunofluorescence. Nerve grafts were constructed out of spider silk from Nephila edulis and decellularized ovine vessels. Finally, spider silk implants were seeded with purified Schwann cells. Cell attachment was observed within the first hour. After 7 and 21 days of culture, immunofluorescence for viability and determination of Schwann cell proliferation and migration throughout the conduits was performed. Analyses revealed that SCs maintained viable (>95%) throughout the conduits independent of construct length. SC proliferation on the spider silk was determined from day 7 to day 21 with a proliferation index of 49.42% arithmetically averaged over all conduits. This indicates that spider silk nerve conduits represent a favorable environment for SC attachment, proliferation and distribution over a distance of least 15.0 cm in vitro. Thus spider silk nerve implants are a highly adequate biomaterial for nerve reconstruction.
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Advances and Future Applications of Augmented Peripheral Nerve Regeneration. Int J Mol Sci 2016; 17:ijms17091494. [PMID: 27618010 PMCID: PMC5037771 DOI: 10.3390/ijms17091494] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 02/06/2023] Open
Abstract
Peripheral nerve injuries remain a significant source of long lasting morbidity, disability, and economic costs. Much research continues to be performed in areas related to improving the surgical outcomes of peripheral nerve repair. In this review, the physiology of peripheral nerve regeneration and the multitude of efforts to improve surgical outcomes are discussed. Improvements in tissue engineering that have allowed for the use of synthetic conduits seeded with neurotrophic factors are highlighted. Selected pre-clinical and available clinical data using cell based methods such as Schwann cell, undifferentiated, and differentiated stem cell transplantation to guide and enhance peripheral nerve regeneration are presented. The limitations that still exist in the utility of neurotrophic factors and cell-based therapies are outlined. Strategies that are most promising for translation into the clinical arena are suggested.
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Effects of hyaluronic acid and tacrolimus on the prevention of perineural scar formation and on nerve regeneration after sciatic nerve repair in a rabbit model. Eur J Trauma Emerg Surg 2016; 43:497-504. [PMID: 27194249 DOI: 10.1007/s00068-016-0683-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/02/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Scar formation after injured peripheral nerve repair is a significant clinical problem because it prevents nerve regeneration. The aim of this study was to investigate and compare the effects of hyaluronic acid (HA) and tacrolimus (FK506) on peripheral nerve regeneration in rabbits after the drugs were topically applied at the site of nerve repair. METHODS Thirty adult male European rabbits (Oryctolagus cuniculus), ranging in weight from 2.5 to 3 kg, were randomly assigned to three groups: the HA and FK506 groups comprised the experimental groups, while the saline group served as the control. At week 12, macroscopic and microscopic evaluations were performed and analyzed. RESULTS In general, the macroscopic evaluations (skin and muscle fascia closure and nerve adherence), microscopic evaluations (cellular components, scar tissue formation index, and histomorphological organization), and measurements of nerve diameter and gastrocnemius muscle wet weight demonstrated the positive effects of topical application of these pharmacological agents (HA and FK506); HA and FK506 prevented scar formation and enhanced nerve regeneration. No significant differences in the parameters described above were observed between the HA and FK506 groups (P > 0.05). However, significant differences were observed between both the HA and FK506 groups and the saline group (P < 0.05). CONCLUSION Based on our findings, topical application of HA and FK506 exhibits equally positive effects, preventing perineural scar formation and enhancing nerve regeneration after peripheral nerve repair.
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Li BH, Yang K, Wang X. Biodegradable magnesium wire promotes regeneration of compressed sciatic nerves. Neural Regen Res 2016; 11:2012-2017. [PMID: 28197200 PMCID: PMC5270442 DOI: 10.4103/1673-5374.197146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Magnesium (Mg) wire has been shown to be biodegradable and have anti-inflammatory properties. It can induce Schwann cells to secrete nerve growth factor and promote the regeneration of nerve axons after central nervous system injury. We hypothesized that biodegradable Mg wire may enhance compressed peripheral nerve regeneration. A rat acute sciatic nerve compression model was made, and AZ31 Mg wire (3 mm diameter; 8 mm length) bridged at both ends of the nerve. Our results demonstrate that sciatic functional index, nerve growth factor, p75 neurotrophin receptor, and tyrosine receptor kinase A mRNA expression are increased by Mg wire in Mg model. The numbers of cross section nerve fibers and regenerating axons were also increased. Sciatic nerve function was improved and the myelinated axon number was increased in injured sciatic nerve following Mg treatment. Immunofluorescence histopathology showed that there were increased vigorous axonal regeneration and myelin sheath coverage in injured sciatic nerve after Mg treatment. Our findings confirm that biodegradable Mg wire can promote the regeneration of acute compressed sciatic nerves.
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Affiliation(s)
- Bo-Han Li
- Department of Oral & Maxillofacial Surgery, The General Hospital of the People's Liberation Army, Beijing, China; Department of Oral & Maxillofacial Surgery, Binzhou Medical University, Yantai, Shandong Province, China
| | - Ke Yang
- Metal Research Institute of Chinese Academy of Sciences, Shenyang, Liaoning Province, China
| | - Xiao Wang
- Department of Oral & Maxillofacial Surgery, Peking University Third Hospital, Beijing, China
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