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Marsh EB, Snyder-Warwick AK, Mackinnon SE, Wood MD. Interpretation of Data from Translational Rodent Nerve Injury and Repair Models. Hand Clin 2024; 40:429-440. [PMID: 38972687 PMCID: PMC11228394 DOI: 10.1016/j.hcl.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
This article highlights the use of rodents as preclinical models to evaluate the management of nerve injuries, describing the pitfalls and value from rodent nerve injury and regeneration outcomes, as well as treatments derived from these rodent models. The anatomic structure, size, and cellular and molecular differences and similarities between rodent and human nerves are summarized. Specific examples of success and failure when assessing outcome metrics are presented for context. Evidence for translation to clinical practice includes the topics of electrical stimulation, Tacrolimus (FK506), and acellular nerve allografts.
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Affiliation(s)
- Evan B Marsh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Matthew D Wood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA.
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2
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Gordon T. Physiology of Nerve Regeneration: Key Factors Affecting Clinical Outcomes. Hand Clin 2024; 40:337-345. [PMID: 38972678 DOI: 10.1016/j.hcl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Functional recovery after peripheral nerve injuries is disappointing despite surgical advances in nerve repair. This review summarizes the relatively short window of opportunity for successful nerve regeneration due to the decline in the expression of growth-associated genes and in turn, the decline in regenerative capacity of the injured neurons and the support provided by the denervated Schwann cells, and the atrophy of denervated muscles. Brief, low-frequency electrical stimulation and post-injury exercise regimes ameliorate these deficits in animal models and patients, but the misdirection of regenerating nerve fibers compromises functional recovery and remains an important area of future research.
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Affiliation(s)
- Tessa Gordon
- Department of Surgery, University of Toronto, Toronto, Ontario M5G 1X8, Canada.
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3
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Morrell NT, Dahlberg RK, Scott KL. Electrical Stimulation Use in Upper Extremity Peripheral Nerve Injuries. J Am Acad Orthop Surg 2024; 32:156-161. [PMID: 38109725 DOI: 10.5435/jaaos-d-23-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/08/2023] [Indexed: 12/20/2023] Open
Abstract
Peripheral nerve injuries can be debilitating and often have a variable course of recovery. Electrical stimulation (ES) has been used as an intervention to attempt to overcome the limits of peripheral nerve surgery and improve patient outcomes after peripheral nerve injury. Little has been written in the orthopaedic literature regarding the use of this technology. The purpose of this review was to provide a focused analysis of past and current literature surrounding the utilization of ES in the treatment of various upper extremity peripheral nerve pathologies including compression neuropathies and nerve transection. We aimed to provide clarity on the clinical benefits, appropriate timing for its employment, risks and limitations, and the need for future studies of ES.
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Affiliation(s)
- Nathan T Morrell
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM (Morrell and Dahlberg), Banner University Medical Center, Glendale, AZ (Scott)
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4
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Marques-Almeida T, Lanceros-Mendez S, Ribeiro C. State of the Art and Current Challenges on Electroactive Biomaterials and Strategies for Neural Tissue Regeneration. Adv Healthc Mater 2024; 13:e2301494. [PMID: 37843074 DOI: 10.1002/adhm.202301494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/22/2023] [Indexed: 10/17/2023]
Abstract
The loss or failure of an organ/tissue stands as one of the healthcare system's most prevalent, devastating, and costly challenges. Strategies for neural tissue repair and regeneration have received significant attention due to their particularly strong impact on patients' well-being. Many research efforts are dedicated not only to control the disease symptoms but also to find solutions to repair the damaged tissues. Neural tissue engineering (TE) plays a key role in addressing this problem and significant efforts are being carried out to develop strategies for neural repair treatment. In the last years, active materials allowing to tune cell-materials interaction are being increasingly used, representing a recent paradigm in TE applications. Among the most important stimuli influencing cell behavior are the electrical and mechanical ones. In this way, materials with the ability to provide this kind of stimuli to the neural cells seem to be appropriate to support neural TE. In this scope, this review summarizes the different biomaterials types used for neural TE, highlighting the relevance of using active biomaterials and electrical stimulation. Furthermore, this review provides not only a compilation of the most relevant studies and results but also strategies for novel and more biomimetic approaches for neural TE.
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Affiliation(s)
- Teresa Marques-Almeida
- Physics Centre of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, 4710-057, Portugal
- LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, Braga, 4710-057, Portugal
| | - Senentxu Lanceros-Mendez
- Physics Centre of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, 4710-057, Portugal
- LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, Braga, 4710-057, Portugal
- BCMaterials, Basque Center for Materials, Applications and Nanostructures, UPV/EHU Science Park, Leioa, 48940, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, 48009, Spain
| | - Clarisse Ribeiro
- Physics Centre of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, 4710-057, Portugal
- LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, Braga, 4710-057, Portugal
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Golshadi M, Claffey EF, Grenier JK, Miller A, Willand M, Edwards MG, Moore TP, Sledziona M, Gordon T, Borschel GH, Cheetham J. Delay modulates the immune response to nerve repair. NPJ Regen Med 2023; 8:12. [PMID: 36849720 PMCID: PMC9970988 DOI: 10.1038/s41536-023-00285-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
Effective regeneration after peripheral nerve injury requires macrophage recruitment. We investigated the activation of remodeling pathways within the macrophage population when repair is delayed and identified alteration of key upstream regulators of the inflammatory response. We then targeted one of these regulators, using exogenous IL10 to manipulate the response to injury at the repair site. We demonstrate that this approach alters macrophage polarization, promotes macrophage recruitment, axon extension, neuromuscular junction formation, and increases the number of regenerating motor units reaching their target. We also demonstrate that this approach can rescue the effects of delayed nerve graft.
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Affiliation(s)
- Masoud Golshadi
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA
| | - Elaine F Claffey
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA
| | - Jennifer K Grenier
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA
| | - Andrew Miller
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA
| | - Michael Willand
- Epineuron Technologies Inc, 5100 Orbitor Dr., Mississauga, ON, L4W 5R8, Canada
| | | | - Tim P Moore
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA
| | - Michael Sledziona
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA
| | - Tessa Gordon
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1×8, Canada
| | | | - Jonathan Cheetham
- Cornell University College of Veterinary Medicine, 930 Campus Road, Ithaca, NY, 14853, USA.
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Maeng WY, Tseng WL, Li S, Koo J, Hsueh YY. Electroceuticals for peripheral nerve regeneration. Biofabrication 2022; 14. [PMID: 35995036 PMCID: PMC10109522 DOI: 10.1088/1758-5090/ac8baa] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022]
Abstract
Electroceuticals provide promising opportunities for peripheral nerve regeneration, in terms of modulating the extensive endogenous tissue repair mechanisms between neural cell body, axons and target muscles. However, great challenges remain to deliver effective and controllable electroceuticals via bioelectronic implantable device. In this review, the modern fabrication methods of bioelectronic conduit for bridging critical nerve gaps after nerve injury are summarized, with regard to conductive materials and core manufacturing process. In addition, to deliver versatile electrical stimulation, the integration of implantable bioelectronic device is discussed, including wireless energy harvesters, actuators and sensors. Moreover, a comprehensive insight of beneficial mechanisms is presented, including up-to-date in vitro, in vivo and clinical evidence. By integrating conductive biomaterials, 3D engineering manufacturing process and bioelectronic platform to deliver versatile electroceuticals, the modern biofabrication enables comprehensive biomimetic therapies for neural tissue engineering and regeneration in the new era.
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Affiliation(s)
- Woo-Youl Maeng
- Bio-Medical Engineering, Korea University, B156, B, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, Seongbuk-gu, Seoul, 02841, Korea (the Republic of)
| | - Wan Ling Tseng
- Department of Surgery, National Cheng Kung University College of Medicine, No.138, Sheng-Li road, Tainan, 701, TAIWAN
| | - Song Li
- Department of Bioengineering, University of California Los Angeles, 5121 Eng V, Los Angeles, California, 90095, UNITED STATES
| | - Jahyun Koo
- Biomedical Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, 02841, Korea (the Republic of)
| | - Yuan-Yu Hsueh
- Department of Surgery, National Cheng Kung University College of Medicine, No.138, Sheng-Li road, Tainan, 701, TAIWAN
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Liu AY, Zhang QB, Zhu HL, Xiong YW, Wang F, Huang PP, Xu QY, Zhong HZ, Wang H, Zhou Y. Low-frequency electrical stimulation alleviates immobilization-evoked disuse muscle atrophy by repressing autophagy in skeletal muscle of rabbits. BMC Musculoskelet Disord 2022; 23:398. [PMID: 35484550 PMCID: PMC9047266 DOI: 10.1186/s12891-022-05350-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aimed to investigate the effect of low-frequency electrical stimulation (LFES) on disuse muscle atrophy and its mechanism in a rabbit model of knee extension contracture. METHODS This study involved two experiments. In the time-point experiment, 24 rabbits were randomly divided into 4 groups: Control 1 (Ctrl1 group), immobilization for 2 weeks (I-2 group), immobilization for 4 weeks (I-4 group), and immobilization for 6 weeks (I-6 group). In the intervention experiment, 24 rabbits were randomly divided into 4 groups: Control 2 (Ctrl2 group), electrical stimulation (ESG group), natural recovery (NRG group), and electrical stimulation treatment (ESTG group). All intervention effects were assessed by evaluating the knee joint range of motion (ROM), cross-sectional area (CSA) of the rectus femoris muscle, and expression of autophagy-related proteins. RESULTS The time-point experiment showed that immobilization reduced the knee ROM, reduced the rectus femoris muscle CSA, and activated autophagy in skeletal muscle. The levels of five autophagy-related proteins [mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), autophagy-related protein 7 (Atg7), p62, and microtubule-associated protein light chain 3B-II (LC3B-II)] were significantly elevated in the skeletal muscle of the I-4 group. The intervention experiment further showed that LFES significantly improved the immobilization-induced reductions in ROM and CSA. Additionally, LFES resulted in a significant decrease in the protein expression of mTOR, p-mTOR, Atg7, p62, and LC3B-II in the rectus femoris muscle. CONCLUSIONS LFES alleviates immobilization-evoked disuse muscle atrophy possibly by inhibiting autophagy in the skeletal muscle of rabbits.
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Affiliation(s)
- A-Ying Liu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Quan-Bing Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Hua-Long Zhu
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China.,Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Yong-Wei Xiong
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China.,Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Feng Wang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Peng-Peng Huang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Qi-Yu Xu
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Hua-Zhang Zhong
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Hua Wang
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China. .,Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, 230032, China.
| | - Yun Zhou
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, No.678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China.
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Hamid ARRH, Maliawan S, Samatra DPGP, Astawa NM, Bakta IM, Jawi IM, Manuaba IBP, Sukrama IMD, Perdanakusuma DS. Effect of immediate electrical stimulation in the distal segment of the nerve with Wallerian degeneration in rats with sciatic nerve injury. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.oa.225870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Electrical stimulation in the proximal segment is one of the modalities for peripheral nerve injury, although it is prone to cause excessive axonal sprouting growth in the proximal segment of the nerve. This study aimed to show that immediate electrical stimulation in the distal segment of the sciatic nerve in Wistar rats accelerated Wallerian degeneration by increasing the expression of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10, and galectin-3/MAC-2 macrophages to avoid sprouting axons excessively in the proximal segment.
METHODS This was an experimental study using male Wistar rats (Rattus norvegicus) with a randomized post-test only control group design. The treatment group received immediate electrical stimulation (20 Hz, 2 mA, for 5 sec) to the distal nerve after sciatic nerve injury, while the control group received no treatment. After 3 days, tissue samples were extracted from the distal segment of the sciatic nerve to examine the level of TNF-α, IL-10, and galectin 3/Mac-2 macrophages using ELISA and from proximal nerves to histologically examine the sprouting axons.
RESULTS Rats in the treatment group had higher TNF-α (52.1 [10.32] versus 40.4 [17.71] pg/100 mg, p = 0.031) and higher IL-10 (918 [167.6] versus 759 [158.9] pg/ml, p = 0.010). Expression of galectin 3/Mac-2 macrophages was similar in both groups (465 [49.5] versus 444 [54.4] pg/100 mg, p = 0.247). The number of sprouting axons was lower in the treatment group (2 [IQR 1–2] versus 2.5 [IQR 2–3], p = 0.003).
CONCLUSIONS Immediate electrical stimulation in the distal segment of the sciatic nerve can accelerate nerve regeneration.
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Hlavac N, Bousalis D, Ahmad RN, Pallack E, Vela A, Li Y, Mobini S, Patrick E, Schmidt CE. Effects of Varied Stimulation Parameters on Adipose-Derived Stem Cell Response to Low-Level Electrical Fields. Ann Biomed Eng 2021; 49:3401-3411. [PMID: 34704163 PMCID: PMC10947800 DOI: 10.1007/s10439-021-02875-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Exogenous electrical fields have been explored in regenerative medicine to increase cellular expression of pro-regenerative growth factors. Adipose-derived stem cells (ASCs) are attractive for regenerative applications, specifically for neural repair. Little is known about the relationship between low-level electrical stimulation (ES) and ASC regenerative potentiation. In this work, patterns of ASC expression and secretion of growth factors (i.e., secretome) were explored across a range of ES parameters. ASCs were stimulated with low-level stimulation (20 mV/mm) at varied pulse frequencies, durations, and with alternating versus direct current. Frequency and duration had the most significant effects on growth factor expression. While a range of stimulation frequencies (1, 20, 1000 Hz) applied intermittently (1 h × 3 days) induced upregulation of general wound healing factors, neural-specific factors were only increased at 1 Hz. Moreover, the most optimal expression of neural growth factors was achieved when ASCs were exposed to 1 Hz pulses continuously for 24 h. In evaluation of secretome, apparent inconsistencies were observed across biological replications. Nonetheless, ASC secretome (from 1 Hz, 24 h ES) caused significant increase in neurite extension compared to non-stimulated control. Overall, ASCs are sensitive to ES parameters at low field strengths, notably pulse frequency and stimulation duration.
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Affiliation(s)
- Nora Hlavac
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Deanna Bousalis
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Raffae N Ahmad
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Emily Pallack
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Angelique Vela
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, USA
| | - Yuan Li
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Sahba Mobini
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- Instituto de Micro y Nanotecnología, IMN- CNM, CSIC (CEI UAM+CSIC), Tres Cantos, Madrid, Spain
| | - Erin Patrick
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, USA
| | - Christine E Schmidt
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA.
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Magaz A, Li X, Gough JE, Blaker JJ. Graphene oxide and electroactive reduced graphene oxide-based composite fibrous scaffolds for engineering excitable nerve tissue. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 119:111632. [PMID: 33321671 DOI: 10.1016/j.msec.2020.111632] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
This study systematically investigates the role of graphene oxide (GO) and reduced GO (rGO)/silk-based composite micro/nano-fibrous scaffolds in regulating neuronal cell behavior in vitro, given the limited comparative studies on the effects of graphene family materials on nerve regeneration. Fibrous scaffolds can mimic the architecture of the native extracellular matrix and are potential candidates for tissue engineering peripheral nerves. Silk/GO micro/nano-fibrous scaffolds were electrospun with GO loadings 1 to 10 wt.%, and optionally post-reduced in situ to explore a family of electrically conductive non-woven silk/rGO scaffolds. Conductivities up to 4 × 10-5 S cm-1 were recorded in the dry state, which increased up to 3 × 10-4 S cm-1 after hydration. Neuronoma NG108-15 cells adhered and were viable on all substrates. Enhanced metabolic activity and proliferation were observed on the GO-containing scaffolds, and these cell responses were further promoted for electroactive silk/rGO. Neurite extensions up to 100 μm were achieved by day 5, with maximum outgrowth up to ~250 μm on some of the conductive substrates. These electroactive composite fibrous scaffolds exhibit potential to enhance the neuronal cell response and could be versatile supportive substrates for neural tissue engineering applications.
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Affiliation(s)
- Adrián Magaz
- Department of Materials and Henry Royce Institute, The University of Manchester, Manchester M13 9PL, United Kingdom; Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 138634, Singapore
| | - Xu Li
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 138634, Singapore; Department of Chemistry, National University of Singapore, 117543 Singapore, Singapore.
| | - Julie E Gough
- Department of Materials and Henry Royce Institute, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Jonny J Blaker
- Department of Materials and Henry Royce Institute, The University of Manchester, Manchester M13 9PL, United Kingdom; Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo 0317, Norway.
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11
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Stewart CE, Kan CFK, Stewart BR, Sanicola HW, Jung JP, Sulaiman OAR, Wang D. Machine intelligence for nerve conduit design and production. J Biol Eng 2020; 14:25. [PMID: 32944070 PMCID: PMC7487837 DOI: 10.1186/s13036-020-00245-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023] Open
Abstract
Nerve guidance conduits (NGCs) have emerged from recent advances within tissue engineering as a promising alternative to autografts for peripheral nerve repair. NGCs are tubular structures with engineered biomaterials, which guide axonal regeneration from the injured proximal nerve to the distal stump. NGC design can synergistically combine multiple properties to enhance proliferation of stem and neuronal cells, improve nerve migration, attenuate inflammation and reduce scar tissue formation. The aim of most laboratories fabricating NGCs is the development of an automated process that incorporates patient-specific features and complex tissue blueprints (e.g. neurovascular conduit) that serve as the basis for more complicated muscular and skin grafts. One of the major limitations for tissue engineering is lack of guidance for generating tissue blueprints and the absence of streamlined manufacturing processes. With the rapid expansion of machine intelligence, high dimensional image analysis, and computational scaffold design, optimized tissue templates for 3D bioprinting (3DBP) are feasible. In this review, we examine the translational challenges to peripheral nerve regeneration and where machine intelligence can innovate bottlenecks in neural tissue engineering.
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Affiliation(s)
- Caleb E. Stewart
- Current Affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport Louisiana, USA
| | - Chin Fung Kelvin Kan
- Current Affiliation: Department of General Surgery, Brigham and Women’s Hospital, Boston, MA 02115 USA
| | - Brody R. Stewart
- Current Affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905 USA
| | - Henry W. Sanicola
- Current Affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport Louisiana, USA
| | - Jangwook P. Jung
- Department of Biological Engineering, Louisiana State University, Baton Rouge, LA 70803 USA
| | - Olawale A. R. Sulaiman
- Ochsner Neural Injury & Regeneration Laboratory, Ochsner Clinic Foundation, New Orleans, LA 70121 USA
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, 70121 USA
| | - Dadong Wang
- Quantitative Imaging Research Team, Data 61, Commonwealth Scientific and Industrial Research Organization, Marsfield, NSW 2122 Australia
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12
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Kwon JH, Kim MD, Kim SH, Lee EW, Kahlid SA. Effects of irreversible electroporation on femoral nerves in a rabbit model. MINIM INVASIV THER 2020; 31:306-312. [PMID: 32744129 DOI: 10.1080/13645706.2020.1799820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Irreversible electroporation (IRE) is a novel technique that uses a non-thermal ablation to avoid adjacent major structure injury. The aim of this study was to sequentially evaluate the effects of IRE on the femoral nerve during acute-to-delayed periods in a rabbit model. MATERIAL AND METHODS Ultrasound-guided IRE of femoral neurovascular bundles was performed in seven rabbits. Functional and histopathologic evaluation was performed sequentially after IRE. The extent of nerve fiber affected, and the proportion of perineurial inflammation and surrounding tissue injury were recorded. RESULTS After IRE, femoral nerve function was damaged before four weeks, but then gradually returned to normal. Perineural inflammatory cell infiltration was most severe three days after IRE (80-85%), and was normalized after eight weeks. Surrounding tissue injury was prominent at three days and one week after IRE (80-90%), and then gradually recovered. However, peripheral nerve fibers were markedly damaged at one and two weeks (80-100%). Nerve fibers then recovered and were normalized at eight weeks. CONCLUSION Nerve tissue injury with transient functional impairment can occur after IRE. However, endoneurial and epineurial extracellular matrix were preserved with Schwann cell regeneration, which could lead to regeneration of nerve tissues within eight weeks.
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Affiliation(s)
- Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Edward W Lee
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA Medical Center, Los Angeles, CA, USA
| | - Suliman Aljoqiman Kahlid
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Radiology, King Faisal University College of Medicine, Al-Ahsa, Saudi Arabia
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13
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Zhao S, Mehta AS, Zhao M. Biomedical applications of electrical stimulation. Cell Mol Life Sci 2020; 77:2681-2699. [PMID: 31974658 PMCID: PMC7954539 DOI: 10.1007/s00018-019-03446-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/12/2019] [Accepted: 12/27/2019] [Indexed: 12/14/2022]
Abstract
This review provides a comprehensive overview on the biomedical applications of electrical stimulation (EStim). EStim has a wide range of direct effects on both biomolecules and cells. These effects have been exploited to facilitate proliferation and functional development of engineered tissue constructs for regenerative medicine applications. They have also been tested or used in clinics for pain mitigation, muscle rehabilitation, the treatment of motor/consciousness disorders, wound healing, and drug delivery. However, the research on fundamental mechanism of cellular response to EStim has fell behind its applications, which has hindered the full exploitation of the clinical potential of EStim. Moreover, despite the positive outcome from the in vitro and animal studies testing the efficacy of EStim, existing clinical trials failed to establish strong, conclusive supports for the therapeutic efficacy of EStim for most of the clinical applications mentioned above. Two potential directions of future research to improve the clinical utility of EStim are presented, including the optimization and standardization of the stimulation protocol and the development of more tissue-matching devices.
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Affiliation(s)
- Siwei Zhao
- Mary and Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, 985965 Nebraska Medical Center, Omaha, NE, 68198, USA.
- Department of Surgery, University of Nebraska Medical Center, Nebraska Medical Center 985965, Omaha, NE, 68198, USA.
| | - Abijeet Singh Mehta
- Department of Dermatology, University of California, Davis, CA, USA
- Department of Ophthalmology & Vision Science, Institute for Regenerative Cures, Center for Neuroscience, University of California at Davis, School of Medicine, Suite 1630, Room 1617, 2921 Stockton Blvd., Sacramento, CA, 95817, USA
| | - Min Zhao
- Department of Dermatology, University of California, Davis, CA, USA
- Department of Ophthalmology & Vision Science, Institute for Regenerative Cures, Center for Neuroscience, University of California at Davis, School of Medicine, Suite 1630, Room 1617, 2921 Stockton Blvd., Sacramento, CA, 95817, USA
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Ju C, Park E, Kim T, Kim T, Kang M, Lee KS, Park SM. Effectiveness of electrical stimulation on nerve regeneration after crush injury: Comparison between invasive and non-invasive stimulation. PLoS One 2020; 15:e0233531. [PMID: 32453807 PMCID: PMC7250463 DOI: 10.1371/journal.pone.0233531] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023] Open
Abstract
Several studies have investigated the use of invasive and non-invasive stimulation methods to enhance nerve regeneration, and varying degrees of effectiveness have been reported. However, due to the use of different parameters in these studies, a fair comparison between the effectiveness of invasive and non-invasive stimulation methods is not possible. The present study compared the effectiveness of invasive and non-invasive stimulation using similar parameters. Eighteen Sprague Dawley rats were classified into three groups: the iES group stimulated with fully implantable device, the tES group stimulated with transcutaneous electrical nerve stimulation (TENS), and the injury group (no stimulation). The iES and tES groups received stimulation for 6 weeks starting immediately after the injury. Motor function was evaluated using the sciatic functional index (SFI) every week. The SFI values increased over time in all groups; faster and superior functional recovery was observed in the iES group than in the tES group. Histological evaluation of the nerve sections and gastrocnemius muscle sections were performed every other week. The axon diameter and muscle fiber area in the iES group were larger, and the g-ratio in the iES group was closer to 0.6 than those in the tES group. To assess the cause of the difference in efficiency, a 3D rat anatomical model was used to simulate the induced electric fields in each group. A significantly higher concentration and intensity around the sciatic nerve was observed in the iES group than in the tES group. Vector field distribution showed that the field was orthogonal to the sciatic nerve spread in the tES group, whereas it was parallel in the iES group; this suggested that the tES group was less effective in nerve stimulation. The results indicated that even though rats in the TENS group showed better recovery than those in the injury group, it cannot replace direct stimulation yet because rats stimulated with the invasive method showed faster recovery and superior outcomes. This was likely attributable to the greater concentration and parallel distribution of electric field with respect to target nerve.
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Affiliation(s)
- Chanyang Ju
- Department of Creative IT Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Eunkyoung Park
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Taewoo Kim
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taekyung Kim
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Minhee Kang
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (KSL); (SMP)
| | - Sung-Min Park
- Department of Creative IT Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
- * E-mail: (KSL); (SMP)
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Modrak M, Talukder MAH, Gurgenashvili K, Noble M, Elfar JC. Peripheral nerve injury and myelination: Potential therapeutic strategies. J Neurosci Res 2019; 98:780-795. [PMID: 31608497 DOI: 10.1002/jnr.24538] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022]
Abstract
Traumatic peripheral nerve injury represents a major clinical and public health problem that often leads to significant functional impairment and permanent disability. Despite modern diagnostic procedures and advanced microsurgical techniques, functional recovery after peripheral nerve repair is often unsatisfactory. Therefore, there is an unmet need for new therapeutic or adjunctive strategies to promote the functional recovery in nerve injury patients. In contrast to the central nervous system, Schwann cells in the peripheral nervous system play a pivotal role in several aspects of nerve repair such as degeneration, remyelination, and axonal growth. Several non-surgical approaches, including pharmacological, electrical, cell-based, and laser therapies, have been employed to promote myelination and enhance functional recovery after peripheral nerve injury. This review will succinctly discuss the potential therapeutic strategies in the context of myelination following peripheral neurotrauma.
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Affiliation(s)
- Max Modrak
- School of Medicine & Dentistry, The University of Rochester Medical Center, Rochester, New York, USA
| | - M A Hassan Talukder
- Department of Orthopaedics & Rehabilitation, Penn State Hershey College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Khatuna Gurgenashvili
- Department of Neurology, Penn State Hershey College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mark Noble
- Department of Biomedical Genetics, The University of Rochester Medical Center, Rochester, New York, USA
| | - John C Elfar
- Department of Orthopaedics & Rehabilitation, Penn State Hershey College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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16
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Deng K, Balog BM, Lin DL, Hanzlicek B, Song QX, Zhu H, Damaser MS. Daily bilateral pudendal nerve electrical stimulation improves recovery from stress urinary incontinence. Interface Focus 2019; 9:20190020. [PMID: 31263536 DOI: 10.1098/rsfs.2019.0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 01/04/2023] Open
Abstract
Stress urinary incontinence (SUI) in women is strongly associated with childbirth which injures the pudendal nerve (PN) and the external urethral sphincter (EUS) during delivery. Electrical stimulation (ES) can increase brain-derived neurotrophic factor (BDNF) expression in injured neurons, activate Schwann cells and promote neuroregeneration after nerve injury. The aim of this study was to determine if more frequent ES would increase recovery from SUI in a rat model. Forty female Sprague-Dawley rats underwent either sham injury or pudendal nerve crush (PNC) and vaginal distention (VD) to establish SUI. Immediately after injury, electrodes were implanted at the pudendal nerve bilaterally. Each injured animal underwent sham ES, twice per week ES (2/week), or daily ES of 1 h duration for two weeks. Urethral and nerve function were assessed with leak point pressure (LPP), EUS electromyography and pudendal nerve sensory branch potential (PNSBP) recordings two weeks after injury. LPP was significantly increased after daily ES compared to 2/week ES. EUS neuromuscular junction innervation was decreased after injury with sham ES, but improved after 2/week or daily ES. This study demonstrates that daily bilateral ES to the pudendal nerve can accelerate recovery from SUI. Daily ES improved urethral function more than 2/week ES.
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Affiliation(s)
- Kangli Deng
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Urology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, People's Republic of China.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Brian M Balog
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA.,Department of Biology, University of Akron, Akron, OH, USA
| | - Dan Li Lin
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Brett Hanzlicek
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA
| | - Qi-Xiang Song
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA.,Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Hui Zhu
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave. Q100, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH 44195, USA.,Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave. Q100, Cleveland, OH 44195, USA
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17
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Zhang Z, Klausen LH, Chen M, Dong M. Electroactive Scaffolds for Neurogenesis and Myogenesis: Graphene-Based Nanomaterials. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2018; 14:e1801983. [PMID: 30264534 DOI: 10.1002/smll.201801983] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/28/2018] [Indexed: 05/24/2023]
Abstract
One of the major issues in tissue engineering is constructing a functional scaffold to support cell growth and also provide proper synergistic guidance cues. Graphene-based nanomaterials have emerged as biocompatible and electroactive scaffolds for neurogenesis and myogenesis, due to their excellent tunable chemical, physical, and mechanical properties. This review first assesses the recent investigations focusing on the fabrication and applications of graphene-based nanomaterials for neurogenesis and myogenesis, in the form of either 2D films, 3D scaffolds, or composite architectures. Besides, because of their outstanding electrical properties, graphene family materials are particularly suitable for designing electroactive scaffolds that could provide proper electrical stimulation (i.e., electrical or photo stimuli) to promote the regeneration of excitable neurons and muscle cells. Therefore, the effects and mechanism of electrical and/or photo stimulations on neurogenesis and myogenesis are followed. Furthermore, studies on their biocompatibilities and toxicities especially to neural and muscle cells are evaluated. Finally, the future challenges and perspectives in facilitating the development of clinical translation of graphene-family nanomaterials in treating neurodegenerative and muscle diseases are discussed.
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Affiliation(s)
- Zhongyang Zhang
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, DK-8000, Aarhus C, Denmark
| | | | - Menglin Chen
- Department of Engineering, Aarhus University, DK-8000, Aarhus C, Denmark
| | - Mingdong Dong
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, DK-8000, Aarhus C, Denmark
- Department of Chemistry, Stanford University, Stanford, CA, 94305, USA
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18
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Abstract
BACKGROUND Peripheral nerve injuries remain a major clinical concern, as they often lead to chronic disability and significant health care expenditures. Despite advancements in microsurgical techniques to enhance nerve repair, biological approaches are needed to augment nerve regeneration and improve functional outcomes after injury. METHODS Presented herein is a review of the current literature on state-of-the-art techniques to enhance functional recovery for patients with nerve injury. Four categories are considered: (1) electroceuticals, (2) nerve guidance conduits, (3) fat grafting, and (4) optogenetics. Significant study results are highlighted, focusing on histologic and functional outcome measures. RESULTS This review documents the current state of the literature. Advancements in neuronal stimulation, tissue engineering, and cell-based therapies demonstrate promise with regard to augmenting nerve regeneration and appropriate rehabilitation. CONCLUSIONS The future of treating peripheral nerve injury will include multimodality use of electroconductive conduits, fat grafting, neuronal stimulation, and optogenetics. Further clinical investigation is needed to confirm the efficacy of these technologies on peripheral nerve recovery in humans, and how best to implement this treatment for a diverse population of nerve-injured patients.
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19
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Russell RA, Foster LJR, Holden PJ. Carbon nanotube mediated miscibility of polyhydroxyalkanoate blends and chemical imaging using deuterium-labelled poly(3-hydroxyoctanoate). Eur Polym J 2018. [DOI: 10.1016/j.eurpolymj.2018.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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20
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Shapira Y, Sammons V, Forden J, Guo GF, Kipp A, Girgulis J, Mishra T, de Villers Alant JD, Midha R. Brief Electrical Stimulation Promotes Nerve Regeneration Following Experimental In-Continuity Nerve Injury. Neurosurgery 2018; 85:156-163. [DOI: 10.1093/neuros/nyy221] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/02/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Yuval Shapira
- Department of Neurosurgery, Tel Aviv University, Tel Aviv, Israel
| | - Vanessa Sammons
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Joanne Forden
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Gui Fang Guo
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Alexander Kipp
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jill Girgulis
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tanmay Mishra
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Rajiv Midha
- Department of Clinical Neuroscience, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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21
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Romeo-Guitart D, Forés J, Navarro X, Casas C. Boosted Regeneration and Reduced Denervated Muscle Atrophy by NeuroHeal in a Pre-clinical Model of Lumbar Root Avulsion with Delayed Reimplantation. Sci Rep 2017; 7:12028. [PMID: 28931824 PMCID: PMC5607317 DOI: 10.1038/s41598-017-11086-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
The “gold standard” treatment of patients with spinal root injuries consists of delayed surgical reconnection of nerves. The sooner, the better, but problems such as injury-induced motor neuronal death and muscle atrophy due to long-term denervation mean that normal movement is not restored. Herein we describe a preclinical model of root avulsion with delayed reimplantation of lumbar roots that was used to establish a new adjuvant pharmacological treatment. Chronic treatment (up to 6 months) with NeuroHeal, a new combination drug therapy identified using a systems biology approach, exerted long-lasting neuroprotection, reduced gliosis and matrix proteoglycan content, accelerated nerve regeneration by activating the AKT pathway, promoted the formation of functional neuromuscular junctions, and reduced denervation-induced muscular atrophy. Thus, NeuroHeal is a promising treatment for spinal nerve root injuries and axonal regeneration after trauma.
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Affiliation(s)
- David Romeo-Guitart
- Institut de Neurociències (INc) and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Joaquim Forés
- Hand and Peripheral Nerve Unit, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Navarro
- Institut de Neurociències (INc) and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Caty Casas
- Institut de Neurociències (INc) and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.
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22
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Lopes CDF, Gonçalves NP, Gomes CP, Saraiva MJ, Pêgo AP. BDNF gene delivery mediated by neuron-targeted nanoparticles is neuroprotective in peripheral nerve injury. Biomaterials 2016; 121:83-96. [PMID: 28081461 DOI: 10.1016/j.biomaterials.2016.12.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/05/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022]
Abstract
Neuron-targeted gene delivery is a promising strategy to treat peripheral neuropathies. Here we propose the use of polymeric nanoparticles based on thiolated trimethyl chitosan (TMCSH) to mediate targeted gene delivery to peripheral neurons upon a peripheral and minimally invasive intramuscular administration. Nanoparticles were grafted with the non-toxic carboxylic fragment of the tetanus neurotoxin (HC) to allow neuron targeting and were explored to deliver a plasmid DNA encoding for the brain-derived neurotrophic factor (BDNF) in a peripheral nerve injury model. The TMCSH-HC/BDNF nanoparticle treatment promoted the release and significant expression of BDNF in neural tissues, which resulted in an enhanced functional recovery after injury as compared to control treatments (vehicle and non-targeted nanoparticles), associated with an improvement in key pro-regenerative events, namely, the increased expression of neurofilament and growth-associated protein GAP-43 in the injured nerves. Moreover, the targeted nanoparticle treatment was correlated with a significantly higher density of myelinated axons in the distal stump of injured nerves, as well as with preservation of unmyelinated axon density as compared with controls and a protective role in injury-denervated muscles, preventing them from denervation. These results highlight the potential of TMCSH-HC nanoparticles as non-viral gene carriers to deliver therapeutic genes into the peripheral neurons and thus, pave the way for their use as an effective therapeutic intervention for peripheral neuropathies.
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Affiliation(s)
- Cátia D F Lopes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; FMUP - Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Nádia P Gonçalves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
| | - Carla P Gomes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; FEUP - Faculdade de Engenharia, Universidade do Porto, Porto, R. Dr. Roberto Frias s/n, 4200-465 Porto, Portugal
| | - Maria J Saraiva
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; IBMC - Instituto de Biologia Molecular e Celular, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
| | - Ana P Pêgo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; FEUP - Faculdade de Engenharia, Universidade do Porto, Porto, R. Dr. Roberto Frias s/n, 4200-465 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, Porto, Portugal.
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23
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Kumar PJ, Adams RD, Harkins AB, Engeberg ED, Willits RK. Stimulation Frequency Alters the Dorsal Root Ganglion Neurite Growth and Directionality In Vitro . IEEE Trans Biomed Eng 2016; 63:1257-68. [DOI: 10.1109/tbme.2015.2492998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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25
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Schirmer KSU, Gorkin R, Beirne S, Stewart E, Thompson BC, Quigley AF, Kapsa RMI, Wallace GG. Cell compatible encapsulation of filaments into 3D hydrogels. Biofabrication 2016; 8:025013. [DOI: 10.1088/1758-5090/8/2/025013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Gordon T. Nerve Regeneration: Understanding Biology and Its Influence on Return of Function After Nerve Transfers. Hand Clin 2016; 32:103-17. [PMID: 27094884 DOI: 10.1016/j.hcl.2015.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Poor functional outcomes are frequent after peripheral nerve injuries despite the regenerative support of Schwann cells. Motoneurons and, to a lesser extent, sensory neurons survive the injuries but outgrowth of axons across the injury site is slow. The neuronal regenerative capacity and the support of regenerating axons by the chronically denervated Schwann cells progressively declines with time and distance of the injury from the denervated targets. Strategies, including brief low-frequency electrical stimulation that accelerates target reinnervation and functional recovery, and the insertion of cross-bridges between a donor nerve and a recipient denervated nerve stump, are effective in promoting functional outcomes after complete and incomplete injuries.
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Affiliation(s)
- Tessa Gordon
- Division of Plastic Reconstructive Surgery, Department of Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada.
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Abstract
Peripheral nerve injury afflicts individuals from all walks of life. Despite the peripheral nervous system’s intrinsic ability to regenerate, many patients experience incomplete functional recovery. Surgical repair aims to expedite this recovery process in the most thorough manner possible. However, full recovery is still rarely seen especially when nerve injury is compounded with polytrauma where surgical repair is delayed. Pharmaceutical strategies supplementary to nerve microsurgery have been investigated but surgery remains the only viable option. Brief low-frequency electrical stimulation of the proximal nerve stump after primary repair has been widely investigated. This article aims to review the currently known biological basis for the regenerative effects of acute brief low-frequency electrical stimulation on axonal regeneration and outline the recent clinical applications of the electrical stimulation protocol to demonstrate the significant translational potential of this modality for repairing peripheral nerve injuries. The review concludes with a discussion of emerging new advancements in this exciting area of research. The current literature indicates the imminent clinical applicability of acute brief low-frequency electrical stimulation after surgical repair to effectively promote axonal regeneration as the stimulation has yielded promising evidence to maximize functional recovery in diverse types of peripheral nerve injuries.
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Abstract
This commentary provides perspective on a recent paper published in Experimental Neurology by Elzinga et al. where the authors investigated the effect of brief electrical stimulation (ES) on nerve regeneration after delayed nerve repair in a rodent model. Their results from a well controlled series of experiments indicated that brief ES promoted axonal outgrowth after chronic axotomy as well after chronic Schwann cell and muscle denervation. ES also increased chronically axotomized neurons regenerating into chronically denervated stumps, which represent a true delayed repair. The authors conclude that brief ES promotion of nerve regeneration after delayed nerve repair is as effective as after immediate repair. Given the prior experimental evidence, and the prior clinical data from patients with carpal tunnel syndrome and digital nerve repair, the implication of this new work is to consider a well designed clinical trial for use of brief ES in nerve graft and nerve transfer repairs.
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Affiliation(s)
- Yuval Shapira
- Peripheral Nerve Fellow, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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29
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Robinson LR. How electrodiagnosis predicts clinical outcome of focal peripheral nerve lesions. Muscle Nerve 2015; 52:321-33. [DOI: 10.1002/mus.24709] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Lawrence R. Robinson
- Division of Physical Medicine and Rehabilitation; University of Toronto, Sunnybrook Health Sciences Centre; H391, 2075 Bayview Avenue Toronto Ontario M4N 3M5
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30
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Xiao Y, Hafeez A, Zhang Y, Liu S, Kong Q, Duan Y, Luo Y, Ding Y, Shi H, Ji X. Neuroprotection by peripheral nerve electrical stimulation and remote postconditioning against acute experimental ischaemic stroke. Neurol Res 2015; 37:447-53. [PMID: 25819636 DOI: 10.1179/1743132815y.0000000032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Local electrical stimulation (ES) was reported to protect the brain during ischaemic injury, while the protective effect of limb remote ischaemic postconditioning (RIPostC) was confirmed. The aim of this study was to explore whether remote peripheral nerve ES exerted neuroprotection and whether this procedure shared the same neuroprotective mechanism underlying RIPostC. METHODS Stroke in Sprague-Dawley rats was induced by distal middle cerebral artery occlusion (dMCAO). Rats were divided into five groups: dMCAO, RIPostC, ES, nerve resection (NR) + ES and RIPostC+ES. Twenty-four hours after reperfusion, rats were examined for neurobehavioural function, including forelimb fault placing test, Ludmila Belayev 12 score test, and infarct volume. The expression of Bcl-2 and cleaved-caspase-3 in ischaemic cortex was assessed by Western blot. RESULTS In forelimb fault placing test, as compared to the highest score in the stroke-only group, RIPostC, ES and RIPostC+ES groups showed a significantly (P < 0.01) lower score. The results were similar for the Ludmila Belayev 12 score test. The infarct volume of the treatment groups also exhibited significant (P < 0.01) reduction as compared to the stroke-only group. The volume of infarct tissue in the combination of RIPostC+ES was significantly less than RIPostC and ES alone (P < 0.05). Furthermore, NR blocked the ES's protection (P < 0.05) as compared to the ES group by using above-mentioned methods. Bcl-2 was upregulated, while cleaved-caspase-3 was downregulated in the experimental groups as compared to the control group. No difference was found among the experimental groups. DISCUSSION Peripheral nerve ES appears to have a neuroprotective effect in a rat dMCAO model. This effect may indicate a neural protective mechanism underlying beneficial effect of RIPostC.
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Han N, Xu CG, Wang TB, Kou YH, Yin XF, Zhang PX, Xue F. Electrical stimulation does not enhance nerve regeneration if delayed after sciatic nerve injury: the role of fibrosis. Neural Regen Res 2015; 10:90-4. [PMID: 25788926 PMCID: PMC4357124 DOI: 10.4103/1673-5374.150714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/16/2022] Open
Abstract
Electrical stimulation has been shown to accelerate and enhance nerve regeneration in sensory and motor neurons after injury, but there is little evidence that focuses on the varying degrees of fibrosis in the delayed repair of peripheral nerve tissue. In this study, a rat model of sciatic nerve transection injury was repaired with a biodegradable conduit at 1 day, 1 week, 1 month and 2 months after injury, when the rats were divided into two subgroups. In the experimental group, rats were treated with electrical stimuli of frequency of 20 Hz, pulse width 100 ms and direct current voltage of 3 V; while rats in the control group received no electrical stimulation after the conduit operation. Histological results showed that stained collagen fibers comprised less than 20% of the total operated area in the two groups after delayed repair at both 1 day and 1 week but after longer delays, the collagen fiber area increased with the time after injury. Immunohistochemical staining revealed that the expression level of transforming growth factor β (an indicator of tissue fibrosis) decreased at both 1 day and 1 week after delayed repair but increased at both 1 and 2 months after delayed repair. These findings indicate that if the biodegradable conduit repair combined with electrical stimulation is delayed, it results in a poor outcome following sciatic nerve injury. One month after injury, tissue degeneration and distal fibrosis are apparent and are probably the main reason why electrical stimulation fails to promote nerve regeneration after delayed repair.
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Affiliation(s)
- Na Han
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Chun-Gui Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Tian-Bing Wang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Xiao-Feng Yin
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Feng Xue
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
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Novak CB, von der Heyde RL. Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how. Semin Plast Surg 2015; 29:73-80. [PMID: 25685106 PMCID: PMC4317280 DOI: 10.1055/s-0035-1544172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Following upper extremity nerve and tendon reconstruction, rehabilitation is necessary to achieve optimal function and outcome. In this review, the authors present current evidence and literature regarding the strategies and techniques of rehabilitation following peripheral nerve and tendon reconstruction.
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Affiliation(s)
- Christine B. Novak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehab and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Vennemeyer JJ, Hopkins T, Hershcovitch M, Little KD, Hagen MC, Minteer D, Hom DB, Marra K, Pixley SK. Initial observations on using magnesium metal in peripheral nerve repair. J Biomater Appl 2014; 29:1145-54. [PMID: 25281648 DOI: 10.1177/0885328214553135] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Biodegradable magnesium metal filaments placed inside biodegradable nerve conduits might provide the physical guidance support needed to improve the rate and extent of regeneration of peripheral nerves across injury gaps. In this study, we examined basic issues of magnesium metal resorption and biocompatibility by repairing sub-critical size gap injuries (6 mm) in one sciatic nerve of 24 adult male Lewis rats. Separated nerve stumps were connected with poly(caprolactone) nerve conduits, with and without magnesium filaments (0.25 mm diameter, 10 mm length), with two different conduit filler substances (saline and keratin hydrogel). At 6 weeks after implantation, magnesium degradation was examined by micro-computed tomography and histological analyses. Magnesium degradation was significantly greater when the conduits were filled with an acidic keratin hydrogel than with saline (p < 0.05). But magnesium filaments in some animals remained intact for 6 weeks. Using histological and immunocytochemical analyses, good biocompatibility of the magnesium implants was observed at 6 weeks, as shown by good development of regenerating nerve mini-fascicles and only mild inflammation in tissues even after complete degradation of the magnesium. Nerve regeneration was not interrupted by complete magnesium degradation. An initial functional evaluation, determination of size recovery of the gastrocnemius muscle, showed a slight improvement due to magnesium with the saline but not the keratin filler, compared with respective control conduits without magnesium. These results suggest that magnesium filament implants have the potential to improve repair of injured peripheral nerve defects in this rodent model.
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Affiliation(s)
- J J Vennemeyer
- Department of Biomedical Engineering, University of Cincinnati, OH, USA
| | - T Hopkins
- Department of Molecular and Cellular Physiology, University of Cincinnati, OH, USA
| | - M Hershcovitch
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, OH, USA
| | - K D Little
- Department of Orthopaedic Surgery, University of Cincinnati, OH, USA
| | - M C Hagen
- Department of Pathology and Laboratory Medicine, University of Cincinnati, OH, USA
| | - D Minteer
- Department of Bioengineering, University of Pittsburgh, PA, USA
| | - D B Hom
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery and Dermatology, University of Cincinnati, OH, USA
| | - K Marra
- Department of Bioengineering and Department of Plastic Surgery, University of Pittsburgh, PA, USA
| | - S K Pixley
- Department of Molecular and Cellular Physiology, University of Cincinnati, OH, USA
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Xu C, Kou Y, Zhang P, Han N, Yin X, Deng J, Chen B, Jiang B. Electrical stimulation promotes regeneration of defective peripheral nerves after delayed repair intervals lasting under one month. PLoS One 2014; 9:e105045. [PMID: 25181499 PMCID: PMC4152131 DOI: 10.1371/journal.pone.0105045] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 07/20/2014] [Indexed: 01/10/2023] Open
Abstract
Background Electrical stimulation (ES) has been proven to be an effective means of enhancing the speed and accuracy of nerve regeneration. However, these results were recorded when the procedure was performed almost immediately after nerve injury. In clinical settings, most patients cannot be treated immediately. Some patients with serious trauma or contaminated wounds need to wait for nerve repair surgery. Delays in nerve repair have been shown to be associated with poorer results than immediate surgery. It is not clear whether electrical stimulation still has any effect on nerve regeneration after enough time has elapsed. Methods A delayed nerve repair model in which the rats received delayed nerve repair after 1 day, 1 week, 1 month, and 2 months was designed. At each point in time, the nerve stumps of half the rats were bridged with an absorbable conduit and the rats were given 1 h of weak electrical stimulation. The other half was not treated. In order to analyze the morphological and molecular differences among these groups, 6 ES rats and 6 sham ES rats per point in time were killed 5 days after surgery. The other rats in each group were allowed to recover for 6 weeks before the final functional test and tissue observation. Results The amounts of myelinated fibers in the distal nerve stumps decreased as the delay in repair increased for both ES rats and sham ES rats. In the 1-day-delay and 1-week-delay groups, there were more fibers in ES rats than in sham ES rats. And the compound muscle action potential (CMAP) and motor nerve conduction velocity (MNCV) results were better for ES rats in these two groups. In order to analyze the mechanisms underlying these differences, Masson staining was performed on the distal nerves and quantitative PCR on the spinal cords. Results showed that, after delays in repair of 1 month and 2 months, there was more collagen tissue hyperplasia in the distal nerve in all rats. The brain-derived neurotrophic factor (BDNF) and trkB expression levels in the spinal cords of ES rats were higher than in sham ES rats. However, these differences decreased as the delay in repair increased. Conclusions Electrical stimulation does not continue to promote nerve regeneration after long delays in nerve repair. The effective interval for nerve regeneration after delayed repair was found to be less than 1 month. The mechanism seemed to be related to the expression of nerve growth factors and regeneration environment in the distal nerves.
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Affiliation(s)
- Chungui Xu
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Yuhui Kou
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Peixun Zhang
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Na Han
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Xiaofeng Yin
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Jiuxu Deng
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Bo Chen
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
| | - Baoguo Jiang
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing, P.R. China
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Promoting nerve regeneration in a neurotmesis rat model using poly(DL-lactide-ε-caprolactone) membranes and mesenchymal stem cells from the Wharton's jelly: in vitro and in vivo analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:302659. [PMID: 25121094 PMCID: PMC4119891 DOI: 10.1155/2014/302659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/17/2022]
Abstract
In peripheral nerves MSCs can modulate Wallerian degeneration and the overall regenerative response by acting through paracrine mechanisms directly on regenerating axons or upon the nerve-supporting Schwann cells. In the present study, the effect of human MSCs from Wharton's jelly (HMSCs), differentiated into neuroglial-like cells associated to poly (DL-lactide-ε-caprolactone) membrane, on nerve regeneration, was evaluated in the neurotmesis injury rat sciatic nerve model. Results in vitro showed successful differentiation of HMSCs into neuroglial-like cells, characterized by expression of specific neuroglial markers confirmed by immunocytochemistry and by RT-PCR and qPCR targeting specific genes expressed. In vivo testing evaluated during the healing period of 20 weeks, showed no evident positive effect of HMSCs or neuroglial-like cell enrichment at the sciatic nerve repair site on most of the functional and nerve morphometric predictors of nerve regeneration although the nociception function was almost normal. EPT on the other hand, recovered significantly better after HMSCs enriched membrane employment, to values of residual functional impairment compared to other treated groups. When the neurotmesis injury can be surgically reconstructed with an end-to-end suture or by grafting, the addition of a PLC membrane associated with HMSCs seems to bring significant advantage, especially concerning the motor function recovery.
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Rochkind S, Shapira Y, Nevo Z. The potential clinical utility of novel methods for peripheral nerve regeneration: where are we now? FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Shimon Rochkind
- Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Shapira
- Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Nevo
- Human Molecular Genetics & Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Miller S, Kühn D, Jungheim M, Schwemmle C, Ptok M. [Neuromuscular electric stimulation therapy in otorhinolaryngology]. HNO 2014; 62:131-8; quiz 139-40. [PMID: 24549514 DOI: 10.1007/s00106-013-2810-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. METHODS This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. RESULTS The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. DISCUSSION In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.
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Affiliation(s)
- S Miller
- Klinik für Phoniatrie und Pädaudiologie, MHH. OE 6510, 30623, Hannover, Deutschland
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Electrical Stimulation Induces Calcium-Dependent Neurite Outgrowth and Immediate Early Genes Expressions of Dorsal Root Ganglion Neurons. Neurochem Res 2013; 39:129-41. [DOI: 10.1007/s11064-013-1197-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/03/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
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Abstract
Rodent models of nerve injury have increased our understanding of peripheral nerve regeneration, but clinical applications have been scarce, partly because such models do not adequately recapitulate the situation in humans. In human injuries, axons are often required to extend over much longer distances than in mice, and injury leaves distal nerve fibres and target tissues without axonal contact for extended amounts of time. Distal Schwann cells undergo atrophy owing to the lack of contact with proximal neurons, which results in reduced expression of neurotrophic growth factors, changes in the extracellular matrix and loss of Schwann cell basal lamina, all of which hamper axonal extension. Furthermore, atrophy and denervation-related changes in target tissues make good functional recovery difficult to achieve even when axons regenerate all the way to the target tissue. To improve functional outcomes in humans, strategies to increase the speed of axonal growth, maintain Schwann cells in a healthy, repair-capable state and keep target tissues receptive to reinnervation are needed. Use of rodent models of chronic denervation will facilitate our understanding of the molecular mechanisms of peripheral nerve regeneration and create the potential to test therapeutic advances.
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Canavero S. HEAVEN: The head anastomosis venture Project outline for the first human head transplantation with spinal linkage (GEMINI). Surg Neurol Int 2013; 4:S335-42. [PMID: 24244881 PMCID: PMC3821155 DOI: 10.4103/2152-7806.113444] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Indexed: 01/20/2023] Open
Abstract
In 1970, the first cephalosomatic linkage was achieved in the monkey. However, the technology did not exist for reconnecting the spinal cord, and this line of research was no longer pursued. In this paper, an outline for the first total cephalic exchange in man is provided and spinal reconnection is described. The use of fusogens, special membrane-fusion substances, is discussed in view of the first human cord linkage. Several human diseases without cure might benefit from the procedure.
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Sato D, Shinzawa G, Kusunoki M, Matsui T, Sasaki H, Feng Z, Nishina A, Nakamura T. Effects of electrical microstimulation of peripheral sympathetic nervous fascicle on glucose uptake in rats. J Artif Organs 2013; 16:352-8. [PMID: 23468373 DOI: 10.1007/s10047-013-0700-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 02/24/2013] [Indexed: 11/25/2022]
Abstract
Artificial pancreas systems control insulin-mediated glucose uptake. Although these systems are widely used in the clinical setting, they are still fraught with structural and biological problems. The non-insulin mediated glucose uptake (NIMGU) mechanism could be an alternative candidate as a target system for the artificial control of peripheral glucose uptake. Although the sympathetic nervous system is known to be one of the regulators of NIMGU, the effects of peripheral sympathetic activation on glucose uptake have not been well documented. We electrically stimulated a sympathetic nerve fascicle to clarify the possibility of controlling peripheral glucose uptake. A sympathetic signal was microneurographically obtained in the unilateral sciatic nerve in normal (NRML), insulin-resistant high-fat-fed (HFF), and streptozotocin-induced insulin-depleted (STZ) rats, and electrical stimulation was applied via the microelectrode (microstimulation). The microstimulation was also applied to sites other than the sympathetic fascicles in an additional group of normal rats (NSYMP group). The stimulation applied to the sympathetic fibers resulted in an immediate and transient decrease of blood glucose (BG) in the NRML, HFF, and STZ groups, with little change in the plasma insulin. The change in BG level seemed to depend on the basal BG level (NRML < HFF < STZ). In contrast, no reduction in BG was observed in the NSYMP group. These results suggest that microstimulation in the peripheral sympathetic fascicle could enhance glucose uptake in peripheral tissues-independently of insulin function-and show an alternative possibility for controlling glucose uptake.
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Affiliation(s)
- Daisuke Sato
- Department of Biomedical Information Engineering, Graduate School of Medical Science, Yamagata University, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan,
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Hronik-Tupaj M, Raja WK, Tang-Schomer M, Omenetto FG, Kaplan DL. Neural responses to electrical stimulation on patterned silk films. J Biomed Mater Res A 2013; 101:2559-72. [PMID: 23401351 DOI: 10.1002/jbm.a.34565] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/15/2012] [Accepted: 12/18/2012] [Indexed: 12/21/2022]
Abstract
Peripheral nerve injury is a critical issue for patients with trauma. Following injury, incomplete axon regeneration or misguided axon innervation into tissue will result in loss of sensory and motor functions. The objective of this study was to examine axon outgrowth and axon alignment in response to surface patterning and electrical stimulation. To accomplish our objective, metal electrodes with dimensions of 1.5 mm × 4 cm, were sputter coated onto micropatterned silk protein films, with surface grooves 3.5 μm wide × 500 nm deep. P19 neurons were seeded on the patterned electronic silk films and stimulated at 120 mV, 1 kHz, for 45 min each day for 7 days. Responses were compared with neurons on flat electronic silk films, patterned silk films without stimulation, and flat silk films without stimulation. Significant alignment was found on the patterned film groups compared with the flat film groups. Axon outgrowth was greater (p < 0.05) on electronic films on days 5 and 7 compared with the unstimulated groups. In conclusion, electrical stimulation, at 120 mV, 1 kHz, for 45 min daily, in addition to surface patterning, of 3.5 μm wide × 500 nm deep grooves, offered control of nerve axon outgrowth and alignment.
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Affiliation(s)
- Marie Hronik-Tupaj
- Department of Biomedical Engineering, Science & Technology Center, Tufts University, Medford, Massachusetts 02155, USA
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Haastert-Talini K, Grothe C. Electrical Stimulation for Promoting Peripheral Nerve Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 109:111-24. [DOI: 10.1016/b978-0-12-420045-6.00005-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Geuna S, Gnavi S, Perroteau I, Tos P, Battiston B. Tissue Engineering and Peripheral Nerve Reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 108:35-57. [DOI: 10.1016/b978-0-12-410499-0.00002-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Robinson GA, Madison RD. Polysialic acid expression is not necessary for motor neuron target selectivity. Muscle Nerve 2012; 47:364-71. [PMID: 23169481 DOI: 10.1002/mus.23526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Recovery after peripheral nerve lesions depends on guiding axons back to their targets. Polysialic acid upregulation by regrowing axons has been proposed recently as necessary for this target selectivity. METHODS We reexamined this proposition using a cross-reinnervation model whereby axons from obturator motor neurons that do not upregulate polysialic acid regenerated into the distal femoral nerve. Our aim was to assess their target selectivity between pathways to muscle and skin. RESULTS After simple cross-repair, obturator motor neurons showed no pathway preference, but the same repair with a shortened skin pathway resulted in selective targeting of these motor neurons to muscle by a polysialic acid-independent mechanism. CONCLUSION The intrinsic molecular differences between motor neuron pools can be overcome by manipulation of their access to different peripheral nerve pathways such that obturator motor neurons preferentially project to a terminal nerve branch to muscle despite not upregulating the expression of polysialic acid.
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Affiliation(s)
- Grant A Robinson
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Kuffler DP, Reyes O, Sosa IJ, Santiago-Figueroa J. Neurological recovery across a 12-cm-long ulnar nerve gap repaired 3.25 years post trauma: case report. Neurosurgery 2012; 69:E1321-6. [PMID: 21712738 DOI: 10.1227/neu.0b013e31822a9fd2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE The standard clinical technique for repairing peripheral nerve gaps is the use of autologous sensory nerve grafts. The present study tested whether a collagen tube filled with autologous platelet-rich fibrin could induce sensory and motor recovery across a 12-cm nerve gap repaired 3.25 years post trauma, and reduce or eliminate neuropathic pain. CLINICAL PRESENTATION Two years postrepair, good ring and small finger motor function had developed that could generate 1 kg of force, and topographically correct 2-point discrimination and sensitivity to vibration in the small and ring finger and proximal but not distal wrist had developed. The patient's excruciating neuropathic pain was reduced to tolerable, and he avoided the indicated extremity amputation. The 12-cm-long nerve gap was bridged with a collagen tube filled with autologous platelet-rich fibrin. CONCLUSION We demonstrate that a conduit filled with platelet-rich fibrin can induce limited, but appropriate, sensory and motor recovery across a 12-cm nerve gap repaired 3.25 years post trauma, without sacrificing a sensory nerve, can reduce existing excruciating neuropathic pain to tolerable, and allow avoidance of an indicated upper-extremity amputation. We believe the technique can be improved to induce more extensive and reliable neurological recovery.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, University of Puerto Rico, San Juan, Puerto Rico 00901, USA.
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Hoyng SA, Tannemaat MR, De Winter F, Verhaagen J, Malessy MJA. Nerve surgery and gene therapy: a neurobiological and clinical perspective. J Hand Surg Eur Vol 2011; 36:735-46. [PMID: 21914696 DOI: 10.1177/1753193411420348] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite major microsurgical improvements the clinical outcome of peripheral nerve surgery is still regarded as suboptimal. Over the past decade several innovative techniques have been developed to extend the armamentarium of the nerve surgeon. This review evaluates the potential of gene therapy in the context of peripheral nerve repair. First the main challenges impeding peripheral nerve regeneration are presented. This is followed by a short introduction to gene therapy and an overview of its most important advantages over the classical delivery of therapeutic proteins. Next, this review focuses on the most promising viral vectors capable of targeting the peripheral nervous system and their first application in animal models. In addition, the challenges of translating these experimental results to the clinic, the limitations of current vectors and the further developments needed, are discussed. Finally, four strategies are presented on how gene therapy could help patients that have to undergo reconstructive nerve surgery in the future.
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Affiliation(s)
- S A Hoyng
- Laboratory for Neuroregeneration, Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Rev Neurother 2011; 11:735-53. [PMID: 21539490 DOI: 10.1586/ern.11.48] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. Clinical experience suggests that TENS is beneficial providing it is administered at a sufficiently strong intensity, close to the site of pain. At present, there are too few randomized controlled trials on TENS for neuropathic pain to judge effectiveness. The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future.
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Affiliation(s)
- Mark I Johnson
- Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, LS1 3HE, UK.
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Kim IS, Song YM, Cho TH, Pan H, Lee TH, Kim SJ, Hwang SJ. Biphasic Electrical Targeting Plays a Significant Role in Schwann Cell Activation. Tissue Eng Part A 2011; 17:1327-40. [DOI: 10.1089/ten.tea.2010.0519] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- In Sook Kim
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Yun Mi Song
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Tae Hyung Cho
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hui Pan
- Department of Maxillofacial Cell and Developmental Biology, Seoul National University, Seoul, Republic of Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Brain Korea 21 2nd Program for Craniomaxillofacial Life Science, Seoul National University, Seoul, Republic of Korea
| | - Tae Hyung Lee
- School of Electrical Engineering and Computer Science, Seoul National University, Seoul, Republic of Korea
| | - Sung June Kim
- School of Electrical Engineering and Computer Science, Seoul National University, Seoul, Republic of Korea
| | - Soon Jung Hwang
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
- Department of Maxillofacial Cell and Developmental Biology, Seoul National University, Seoul, Republic of Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Brain Korea 21 2nd Program for Craniomaxillofacial Life Science, Seoul National University, Seoul, Republic of Korea
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