Facial nerve repair with expanded polytetrafluoroethylene and collagen conduits: an experimental study in the rabbit

Porous Organic Materials in Tissue Engineering: Recent Advances and Applications for Severed Facial Nerve Injury Repair

The prevalence of facial nerve injury is substantial, and the restoration of its structure and function remains a significant challenge. Autologous nerve transplantation is a common treatment for severed facial nerve injury; however, it has great limitations. Therefore, there is an urgent need for clinical repair methods that can rival it. Tissue engineering nerve conduits are usually composed of scaffolds, cells and neurofactors. Tissue engineering is regarded as a promising method for facial nerve regeneration. Among different factors, the porous nerve conduit made of organic materials, which has high porosity and biocompatibility, plays an indispensable role. This review introduces facial nerve injury and the existing treatment methods and discusses the necessity of the application of porous nerve conduit. We focus on the application of porous organic polymer materials from production technology and material classification and summarize the necessity and research progress of these in repairing severed facial nerve injury, which is relatively rare in the existing articles. This review provides a theoretical basis for further research into and clinical interventions on facial nerve injury and has certain guiding significance for the development of new materials.

Chitosan Tubes Inoculated with Dental Pulp Stem Cells and Stem Cell Factor Enhance Facial Nerve-Vascularized Regeneration in Rabbits

Facial nerve injury is a common clinical condition that leads to disfigurement and emotional distress in the affected individuals, and the recovery presents clinical challenges. Tissue engineering is the standard method to repair nerve defects. However, nerve regeneration is still not satisfactory because of poor neovascularization after implantation, especially for the long-segment nerve defects. In the current study, we aimed to investigate the potential of chitosan tubes inoculated with stem cell factor (SCF) and dental pulp stem cells (DPSCs) in facial nerve-vascularized regeneration. In the in vitro experiment, DPSCs were isolated, cultured, and then identified. The optimal concentration of SCF was screened by CCK8. Cytoskeleton and living-cell staining, migration, CCK8 test, and neural differentiation assays were performed, revealing that SCF promoted the biological activity of DPSCs. Surprisingly, SCF increased the neural differentiation of DPSCs. The migration and angiogenesis experiments were carried out to show that SCF promoted the angiogenesis and migration of human umbilical vein endothelial cells (HUVECs). In the facial nerve, 7 mm defects of New Zealand white rabbits, hematoxylin-eosin (HE), immunohistochemistry, toluidine blue staining, and transmission electron microscopy observation were performed at 12 weeks postsurgery to show more nerve fibers and better myelin sheath in the SCF + DPSC group. In addition, the whisker movements, Masson's staining, and western blot assays were performed, demonstrating functional repair and that the expression level of CD31 protein in the group SCF + DPSCs was relatively close to that in the group Autograft. In summary, chitosan tubes inoculated with SCF and DPSCs increased neurovascularization and provided an effective method for repairing facial nerve defects, indicating great promise for clinical application.

Chitosan Tubes Prefilled with Aligned Fibrin Nanofiber Hydrogel Enhance Facial Nerve Regeneration in Rabbits

Facial nerves are fragile and easily injured, for example, by traffic accidents or operations. Facial nerve injury drastically reduces the quality of life in affected patients, and its treatment presents clinical challenges. A promising therapeutic strategy includes nerve conduits with appropriate fillers capable of guiding nerve regeneration. In this study, a three-dimensional hierarchically aligned fibrin nanofiber hydrogel (AFG) assembled via electrospinning and molecular self-assembly was first used to mimic the architecture of the native fibrin cable, which is similar to the nerve extracellular matrix (ECM). AFG as a substrate in chitosan tubes (CST) was used to bridge a 7 mm-long gap in a rabbit buccal branch facial nerve defect model. The results showed that AFG and CST showed good compatibility to support the adhesion, activity, and proliferation of Schwann cells (SCs). Further morphological, histological, and functional analyses demonstrated that the regenerative outcome of AFG-prefilled CST was close to that of autologous nerve grafts and superior to that of CST alone or CSTs prefilled with random fibrin nanofiber hydrogel (RFG), which indicated that AFG-prefilled CST markedly improved axonal regeneration with enhanced remyelination and functional recovery, thus showing great potential for clinical application for facial nerve regeneration treatments.

Facial Nerve Repair: Bioengineering Approaches in Preclinical Models

Injury to the facial nerve can occur after different etiologies and range from simple transection of the branches to varying degrees of segmental loss. Management depends on the extent of injury and options include primary repair for simple transections and using autografts, allografts, or conduits for larger gaps. Tissue engineering plays an important role to create artificial materials that are able to mimic the nerve itself without extra morbidity in the patients. The use of neurotrophic factors or stem cells inside the conduits or around the repair site is being increasingly studied to enhance neural recovery to a greater extent. Preclinical studies remain the hallmark for development of these novel approaches and translation into clinical practice. This review will focus on preclinical models of repair after facial nerve injury to help researchers establish an appropriate model to quantify recovery and analyze functional outcomes. Different bioengineered materials, including conduits and nerve grafts, will be discussed based on the experimental animals that were used and the defects introduced. Future directions to extend the applications of processed nerve allografts, bioengineered conduits, and cues inside the conduits to induce neural recovery after facial nerve injury will be highlighted.

Morphofunctional Effect of Stem Cells on the Regeneration of the Facial Nerve in a Rat Model

PURPOSE

The aim of the present study was to determine the clinical, histologic, and histomorphometric influence of stem cells on the regeneration of facial nerves in rats submitted to neurotmesis with 5-mm defects.

MATERIALS AND METHODS

Thirty-six male Wistar rats were submitted to neurotmesis. In group 1 (n = 18), the 2 extremities of the nerve trunk were sutured in a polyethylene tube containing a protein matrix (Matrigel; Invitrogen, BD Biosciences, Franklin Lakes, NJ). Group 2 (n = 18) underwent the same procedures with the incorporation of stem cells in the tube. The groups were subdivided by the day of euthanasia (30, 60, and 90 days). Evaluations of the central portion and distal extremity of the tubes were performed in both groups.

RESULTS

During the functional evaluation, group 2 exhibited better closing of the eyelids at 30 and 60 days. The histomorphometric analyses revealed a significant reduction in the area of the nerve fibers in group 1 compared with group 2 at all 3 evaluation (P = .031). In group 2, the area of the nerve fibers was significantly greater (P = .031), and the thickness of the myelin sheath was significantly greater in the center (P = .002) and distal (P = .019) extremity of the tube at 30 days compared with the findings in group 1.

CONCLUSIONS

The present findings suggest that the use of stem cells in nerve injuries will result in faster, more effective regeneration within the intervals analyzed.

Sustained delivery of glial cell-derived neurotrophic factors in collagen conduits for facial nerve regeneration

Facial nerve injury caused by traffic accidents or operations may reduce the quality of life in patients, and recovery following the injury presents unique clinical challenges. Glial cell-derived neurotrophic factor (GDNF) is important in nerve regeneration; however, soluble GDNF rapidly diffuses into body fluids, making it difficult to achieve therapeutic efficacy. In this work, we developed a rat tail derived collagen conduit to connect nerve defects in a simple and safe manner. GDNF was immobilized in the collagen conduits via chemical conjugation to enable controlled release of GDNF. The GDNF delivery system prevented rapid diffusion from the site without impacting bioactivity of GDNF; degradation of the collagen conduit was inhibited owing to the chemical conjugation. The artificial nerve conduit was then used to examine facial nerve regeneration across a facial nerve defect. Following transplantation, the artificial nerve conduits degraded gradually without causing dislocations and serious inflammation, with good integration into the host tissue. Functional and histological tests indicated that the artificial nerve conduits were able to guide the axons to grow through the defect, reaching the distal stumps. The degree of nerve regeneration in the group that was treated with the artificial nerve conduit approached that of the autograft group, and exceeded that of the other conduit grafted groups.

STATEMENT OF SIGNIFICANCE

In this study, we developed artificial nerve conduits consisting of GDNF immobilized on collagen, with the aim of providing an environment for nerve regeneration. Our results show that the artificial nerve conduits guided the regeneration of axons to the distal nerve segment. GDNF was immobilized stably in the artificial nerve conduits, and therefore retained a sufficient concentration at the target site to effectively promote the regeneration process. The artificial nerve conduits exhibited good biocompatibility and facilitated nerve regeneration and functional recovery with an efficacy that was close to that of an autograft, and better than that of the other conduit grafted groups. Our approach provides an effective delivery system that overcomes the rapid diffusion of GDNF in body fluids, promoting peripheral nerve regeneration. The artificial nerve conduit therefore qualifies as a putative candidate material for the fabrication of peripheral nerve reconstruction devices.

Low-frequency pulsed electromagnetic field pretreated bone marrow-derived mesenchymal stem cells promote the regeneration of crush-injured rat mental nerve

Bone marrow-derived mesenchymal stem cells (BMSCs) have been shown to promote the regeneration of injured peripheral nerves. Pulsed electromagnetic field (PEMF) reportedly promotes the proliferation and neuronal differentiation of BMSCs. Low-frequency PEMF can induce the neuronal differentiation of BMSCs in the absence of nerve growth factors. This study was designed to investigate the effects of low-frequency PEMF pretreatment on the proliferation and function of BMSCs and the effects of low-frequency PEMF pre-treated BMSCs on the regeneration of injured peripheral nerve using in vitro and in vivo experiments. In in vitro experiments, quantitative DNA analysis was performed to determine the proliferation of BMSCs, and reverse transcription-polymerase chain reaction was performed to detect S100 (Schwann cell marker), glial fibrillary acidic protein (astrocyte marker), and brain-derived neurotrophic factor and nerve growth factor (neurotrophic factors) mRNA expression. In the in vivo experiments, rat models of crush-injured mental nerve established using clamp method were randomly injected with low-frequency PEMF pretreated BMSCs, unpretreated BMSCs or PBS at the injury site (1 × 10⁶ cells). DiI-labeled BMSCs injected at the injury site were counted under the fluorescence microscope to determine cell survival. One or two weeks after cell injection, functional recovery of the injured nerve was assessed using the sensory test with von Frey filaments. Two weeks after cell injection, axonal regeneration was evaluated using histomorphometric analysis and retrograde labeling of trigeminal ganglion neurons. In vitro experiment results revealed that low-frequency PEMF pretreated BMSCs proliferated faster and had greater mRNA expression of growth factors than unpretreated BMSCs. In vivo experiment results revealed that compared with injection of unpretreated BMSCs, injection of low-frequency PEMF pretreated BMSCs led to higher myelinated axon count and axon density and more DiI-labeled neurons in the trigeminal ganglia, contributing to rapider functional recovery of injured mental nerve. These findings suggest that low-frequency PEMF pretreatment is a promising approach to enhance the efficacy of cell therapy for peripheral nerve injury repair.

Hydrogels as scaffolds and delivery systems to enhance axonal regeneration after injuries

Damage caused to neural tissue by disease or injury frequently produces a discontinuity in the nervous system (NS). Such damage generates diverse alterations that are commonly permanent, due to the limited regeneration capacity of the adult NS, particularly the Central Nervous System (CNS). The cellular reaction to noxious stimulus leads to several events such as the formation of glial and fibrous scars, which inhibit axonal regeneration in both the CNS and the Peripheral Nervous System (PNS). Although in the PNS there is some degree of nerve regeneration, it is common that the growing axons reinnervate incorrect areas, causing mismatches. Providing a permissive substrate for axonal regeneration in combination with delivery systems for the release of molecules, which enhances axonal growth, could increase regeneration and the recovery of functions in the CNS or the PNS. Currently, there are no effective vehicles to supply growth factors or cells to the damaged/diseased NS. Hydrogels are polymers that are biodegradable, biocompatible and have the capacity to deliver a large range of molecules in situ. The inclusion of cultured neural cells into hydrogels forming three-dimensional structures allows the formation of synapses and neuronal survival. There is also evidence showing that hydrogels constitute an amenable substrate for axonal growth of endogenous or grafted cells, overcoming the presence of axonal regeneration inhibitory molecules, in both the CNS and PNS. Recent experiments suggest that hydrogels can carry and deliver several proteins relevant for improving neuronal survival and axonal growth. Although the use of hydrogels is appealing, its effectiveness is still a matter of discussion, and more results are needed to achieve consistent recovery using different parameters. This review also discusses areas of opportunity where hydrogels can be applied, in order to promote axonal regeneration of the NS.

Mandibular branch of the facial nerve in wistar rats: new experimental model to assess facial nerve regeneration

Introduction The ideal animal model for nerve regeneration studies is the object of controversy, because all models described by the literature have advantages and disadvantages.

Objective To describe the histologic and functional patterns of the mandibular branch of the facial nerve of Wistar rats to create a new experimental model of facial nerve regeneration.

Methods Forty-two male rats were submitted to a nerve conduction test of the mandibular branch to obtain the compound muscle action potential. Twelve of these rats had the mandibular branch surgically removed and submitted to histologic analysis (number, partial density, and axonal diameter) of the proximal and distal segments.

Results There was no statistically significant difference in the functional and histologic variables studied.

Conclusion These new histologic and functional standards of the mandibular branch of the facial nerve of rats establish an objective, easy, and greatly reproducible model for future facial nerve regeneration studies.

Role of extracellular matrix components in facial nerve regeneration: an experimental study

OBJECTIVE

The aim of this study is to evaluate the role of extracellular matrix components in nerve regeneration. Matrigel, a complex of extracellular matrix components such as laminin (the most abundant) heparan sulphate proteoglycans (HSPG), type IV collagen and fibronectin, was used.

METHODS

Forty male rabbits, which had undergone section of the right facial nerve, were later treated by reinnervation through an artificial graft of expanded polytetrafluoroethylene (ePTFE). In 20 animals the tubes of ePTFE were filled with Matrigel; in 20 control animals the tubes were filled with saline solution.

RESULTS

The Matrigel group showed a better axonal organization and a significantly higher number of regenerated axons in the early phases (at days 15 and 30 respectively) than the control group, whereas the difference of the axons number at day 60 was less significant; besides, the axon diameter and the myelin thickness were not significantly improved by Matrigel.

DISCUSSION

Our data suggest that Matrigel is an important factor in promoting and enhancing the early phases of the regeneration after nerve injuries. Tree neurite promoting agents, such as laminin, fibronectin and collagen, allow a more systematic and agonized regeneration. Extracellular matrix components may represent a direction guidance for axonal pathway.

Bone marrow stem cells in facial nerve regeneration from isolated stumps

INTRODUCTION

Severe lesions in the facial nerve may have extensive axonal loss and leave isolated stumps that impose technical difficulties for nerve grafting.

METHODS

We evaluated bone marrow stem cells (BMSC) in a silicone conduit for rat facial nerve regeneration from isolated stumps. Group A utilized empty silicone tubes; in groups B-D, the tube was filled with acellular gel; and, in groups C and D, undifferentiated BMSC (uBMSC) or Schwann-like cells differentiated from BMSC (dBMSC) were added, respectively. Compound muscle action potentials (CMAPs) were measured, and histology was evaluated.

RESULTS

Groups C and D had the highest CMAP amplitudes. Group C had shorter CMAP durations than groups A, B, and D. Distal axonal number and density were increased in group C compared with groups A and B.

CONCLUSIONS

Regeneration of the facial nerve was improved by both uBMSC and dBMSC in rats, yet uBMSC was associated with superior functional results.

The effect of a small gap sleeve suture at the distal anastomosis of a nerve graft on promoting nerve regeneration and functional recovery

The effect of a small gap sleeve suture at the distal anastomosis of a nerve graft on promoting nerve regeneration and functional recovery was investigated by experimental observation. The model of common peroneal nerve defect in Sprague-Dawley (SD) rats was established, and an autologous sural nerve graft repair was performed. The small gap sleeve suture was applied at the distal anastomosis in the first stage for the experimental group. The results showed that the number of regenerated nerve fibers and the recovery of nerve function for the rats in the experimental group were superior to those in the control group.

The use of chitosan-based scaffolds to enhance regeneration in the nervous system

Various biomaterials have been proposed to build up scaffolds for promoting neural repair. Among them, chitosan, a derivative of chitin, has been raising more and more interest among basic and clinical scientists. A number of studies with neuronal and glial cell cultures have shown that this biomaterial has biomimetic properties, which make it a good candidate for developing innovative devices for neural repair. Yet, in vivo experimental studies have shown that chitosan can be successfully used to create scaffolds that promote regeneration both in the central and in the peripheral nervous system. In this review, the relevant literature on the use of chitosan in the nervous tissue, either alone or in combination with other components, is overviewed. Altogether, the promising in vitro and in vivo experimental results make it possible to foresee that time for clinical trials with chitosan-based nerve regeneration-promoting devices is approaching quickly.

Numerical study of axonal outgrowth in grooved nerve conduits

Nerve conduits with grooved inner texture, working as a topographical guidance cue, have been experimentally proved to play a significant role in axonal alignment. How grooved conduits guide axonal outgrowth is of particular interest for studying nerve regeneration. A viscoelastic model of axonal outgrowth in a conduit with a defined grooved geometry characterized by its width in the circumferential direction and its height in the radial direction is developed in this work. In this model, the axon is considered as an elastic beam and the axonal deformation and motion, including stretching, bending and torsion, are described using a Cosserat rod theory. The friction between axon and substrate is also considered in this model as well as the tip outgrowth. It is found that the directional outgrowth of the axon can be significantly improved by the grooved texture: when the groove width decreases or the groove height increases, the axonal elongation in the longitudinal direction of the conduit can be increased, which is in good agreement with experimental observations. This work is the first numerical model to study the effect of the substrate geometry on axonal outgrowth.

Return of motor function after segmental nerve loss in a rat model: comparison of autogenous nerve graft, collagen conduit, and processed allograft (AxoGen)

BACKGROUND

An effective alternative to nerve autograft is needed to minimize morbidity and solve limited-availability issues. We hypothesized that the use of processed allografts and collagen conduits would allow recovery of motor function that is equivalent to that seen after the use of autografts.

METHODS

Sixty-five Lewis rats were divided into three experimental groups. In each group, a unilateral 10-mm sciatic nerve defect was repaired with nerve autograft, allograft treated by AxoGen Laboratories, or a 2.0-mm-inner-diameter collagen conduit. The animals were studied at twelve and sixteen weeks postoperatively. Evaluation included bilateral measurement of the tibialis anterior muscle force and muscle weight, electrophysiology, assessment of ankle contracture, and peroneal nerve histomorphometry. Muscle force was measured with use of our previously described and validated method. Results were expressed as a percentage of the values on the contralateral side. Two-way analysis of variance (ANOVA) corrected by the Ryan-Einot-Gabriel-Welsch multiple range test was used for statistical investigation (α = 0.05).

RESULTS

At twelve weeks, the mean muscle force (and standard deviation), as compared with that on the contralateral (control) side, was 45.2% ± 15.0% in the autograft group, 43.4% ± 18.0% in the allograft group, and 7.0% ± 9.2% in the collagen group. After sixteen weeks, the recovered muscle force was 65.5% ± 14.1% in the autograft group, 36.3% ± 15.7% in the allograft group, and 12.1% ± 16.0% in the collagen group. Autograft was statistically superior to allograft and the collagen conduit at sixteen weeks with regard to all parameters except histomorphometric characteristics (p < 0.05). The collagen-group results were inferior. All autograft-group outcomes improved from twelve to sixteen weeks, with the increase in muscle force being significant.

CONCLUSIONS

The use of autograft resulted in better motor recovery than did the use of allograft or a collagen conduit for a short nerve gap in rats. A longer evaluation time of sixteen weeks after segmental nerve injuries in rats would be beneficial as more substantial muscle recovery was seen at that time.

Stimulation of neurite outgrowth using positively charged hydrogels

Autologous nerve grafts are currently the best option for the treatment of segmental peripheral nerve defects. However, autografts have several drawbacks including size mismatch and loss of sensation in the donor nerve's sensory distribution. In this work, we have investigated the development of a synthetic hydrogel that contains positive charge for use as a substrate for nerve cell attachment and neurite outgrowth in culture. We have demonstrated that modification of oligo-(polyethylene glycol) fumarate (OPF) with a positively charged monomer improves primary sensory rat neuron attachment and differentiation in a dose-dependent manner. Positively charged hydrogels also supported attachment of dorsal root ganglion (DRG) explants that contain sensory neurons, Schwann cells and neuronal support cells. Furthermore, charged hydrogels were analyzed for the appearance of myelinated structures in a co-culture containing DRG neurons and Schwann cells. DRGs and Schwann cells remained viable on charged hydrogels for a time period of three weeks and neurites extended from the DRGs. Sudan black staining revealed that neurites emerging from DRGs were accompanied by migrating Schwann cells. These findings suggest that charged OPF hydrogels are capable of sustaining both primary nerve cells and the neural support cells that are critical for regeneration.

Posttraumatic facial nerve regeneration in rabbits

Posttraumatic facial paralysis is a frequent disease. This work studies posttraumatic regeneration of the facial nerve in rabbits. Functional and histological analysis compared injured and normal nerves on opposite sides. The left facial nerve trunk of twenty rabbits were subjected to compression lesion, and sacrificed after two (subgroup AL), four (BL) and six (CL) weeks. Comparison between groups was made by analysing total and partial densities of myelinated axons.

STATISTICAL ANALYSIS

Tukey Method (p<0.05).

RESULTS

There was partial functional recovery after two weeks, and complete recovery after five weeks. Qualitative analysis demonstrated a degenerative pattern in the AL group, with an increased tissue inflammatory process. Evident regeneration signs were observed in the BL group, and almost complete regeneration was seen in the CL group. Normal nerves (N) had an average TD of 15705.59 and average PD of 21800.75. The BL group had an average TD of 10818.55 and an average PD of 15340.56. The CL group had an average TD of 13920.36 and an average PD of 16589.15. The BL group had an average TD of N equal to 68.88%, and the CL group had an average TD of N equal to 88,63% (statistically significant). N showed a significant higher PD than injured nerves. However, this was not statistically different between BL and CL subgroups. Nerve DT was a more reliable method than PD in this study.

Maximum Number of Collaterals Developed by One Axon during Peripheral Nerve Regeneration and the Influence of That Number on Reinnervation Effects

This study investigated the maximum number of collaterals that can be maintained by 1 axon during regeneration of rat peripheral nerve. The tibial nerve was transected, the proximal residual, with its variable number of axons, was fixed to the distal stump and served as the donor nerve. The number of myelinated axons was calculated after 12 weeks. An increasing ratio of distal stump axon numbers to proximal donor nerve axon numbers of 1.0, 1.83, 3.64 and 7.97 yielded ratios of regenerative myelinated axon numbers to proximal donor axon numbers of 0.98, 1.51, 2.39, 2.89, respectively, with an estimated maximum value of approximately 3.3 using the Hill function. The tibial function indexes and nerve conduction velocities of the regenerated tibial nerve were -44.1 +/- 5.1 and 43.2 +/- 5.3 m/s, -57.5 +/- 4.7 and 18.6 +/- 4.3 m/s, -80.2 +/- 7.1 and 12.7 +/- 3.7 m/s, and -85.4 +/- 5.7 and 10.5 +/- 3.9 m/s, respectively. It has been suggested that 1 axon can regenerate and maintain up to 3 or 4 collaterals in regenerated rat peripheral nerve.

Clinical and Histopathologic Study of the Use of Gangliosides for Nerve Regeneration in Rats After Axonotmesis

PURPOSE

This study involved a clinical and histopathologic evaluation of the use of gangliosides in nerve regeneration, using an experimental model with higher vertebrates.

MATERIALS AND METHODS

Forty Sprague Dawley rats had their right sciatic nerve crushed for 1 minute in a hemostatic tweezer. The animals were divided into experimental and control groups. The animals in the experimental group received an intramuscular injection of gangliosides in the left thigh for 25 days, whereas those in the control group received infiltrations of distilled water. A clinical evaluation of gait was made 24 hours and then 45 days after the surgical intervention, and a histopathologic evaluation of the sciatic nerves was performed after 45 days.

RESULTS

There were no signs that the use of gangliosides significantly altered the animals' gait after 45 days. The animals in the experimental group had a greater frequency and intensity of inflammatory response than seen in the control group.

CONCLUSION

The systemic use of gangliosides produced no improvement in gait and led to a more frequent and intense inflammatory response at the site of injury.

Anastomose do nervo facial de coelhos com cola de fibrina: estudo da velocidade de condução nervosa

OBJETIVO: Este estudo tem o objetivo de avaliar através da velocidade de condução nervosa com eletrodos de superfície a utilização da cola de fibrina na anastomose nervosa. MÉTODOS: Neste experimento, foram avaliadas as diferenças entre as velocidades de condução nervosa pré e pós-operatória do nervo facial esquerdo de 12 coelhos. Foi verificada a existência de correlação entre a velocidade de condução nervosa e o número de axônios regenerados no pós-operatório. Os nervos transeccionados foram unidos com cola de fibrina. O potencial de ação motora foi obtido com o uso de eletrodos de superfície. O eletrodo de estimulação foi colocado imediatamente à frente do pavilhão auditivo (tronco do nervo facial) e o eletrodo de gravação foi colocado no músculo quadrado do lábio inferior. RESULTADOS: A média normal da velocidade de condução nervosa foi de 36,53 m/seg. Ao final do período, a velocidade de condução nervosa atingiu um valor de aproximadamente 81% do valor normal. Não foi observada correlação significativa entre a velocidade de condução nervosa pós-operatória e o número de axônios regenerados (p=0,146). CONCLUSÃO: A anastomose com cola de fibrina pode ser utilizada para anastomose nervosa no modelo animal e nervo estudados.

Rabbit facial nerve anastomosis with fibrin glue: nerve conduction velocity evaluation

AIM

The aim of this study was to evaluate the use of fibrin glue on nerve anastomosis, and study conduction velocity obtained by surface electrodes.

METHODS

In this experimental model we evaluated nerve conduction velocity differences in the preoperative and postoperative periods, for the left facial nerve of 12 rabbits. Then, we evaluated whether there were correlations between conduction velocity and the number of postoperative regenerated axons. The sectioned nerves were anastomosed with fibrin glue. The muscle action potentials were obtained from surface electrodes. The stimulation electrode was placed immediately before the ear pinna (facial nerve trunk) and the recording surface electrode was placed on the quadratus labii inferioris muscle.

RESULTS

The facial nerve normal conduction velocity mean value was of 36.53 m/sec. On the postoperative period, the mean conduction velocity was approximately 81% of the normal mean value. A significant correlation was not observed between the postoperative conduction velocity and the number of regenerated axons (p=0.146).

CONCLUSION

The fibrin glue can be used on nerve anastomosis in this animal model and nerve.

Regeneração pós-traumática do nervo facial em coelhos

A paralisia facial periférica traumática constitui-se em afecção freqüente. OBJETIVO: estudo da regeneração pós-traumática do nervo facial em coelhos, por avaliação funcional histológica dos nervos traumatizados comparados aos normais contralaterais. METODOLOGIA: Vinte coelhos foram submetidos à compressão do tronco do nervo facial esquerdo e sacrificados após duas (grupo AL), quatro (BL) e seis (CL) semanas da lesão. A comparação entre os grupos foi feita pelas densidades total e parcial de axônios mielinizados. ESTUDO ESTATÍSTICO: método de Tukey (p < 0,05). RESULTADOS: Houve recuperação funcional parcial após duas, e completa após cinco semanas. Na análise qualitativa, verificou-se em AL um padrão degenerativo, com maior processo inflamatório tecidual. Em BL, sinais de regeneração neural, praticamente completa em CL. Os nervos normais (N) apresentaram DT média de 15705,59 e DP média de 21800,75. O grupo BL revelou DT média de 10818,55 e DP média de 15340,56 e o CL, DT média de 13920,36 e DP média de 16589,15. BL obteve 68,88%, e o grupo CL, 88,63% da DT de N. N mostrou DP maior que os lesados; porém, esta não evidenciou diferença estatística entre BL e CL. A DT dos nervos revelou-se um método analítico mais fidedigno do que a DP estudada.

Fabrication of semipermeable hollow fiber membranes with highly aligned texture for nerve guidance

In order to improve the guidance potential of a nerve entubulation bridging device, highly aligned textures were formed on the inner surface of semipermeable hollow fiber membranes (HFMs) during the wet phase inversion process. By precisely controlling the fabrication parameters, such as polymer solution flow rate, coagulant solution flow rate, and the air-gap distance, also called drop height, different-sized aligned grooves can be fabricated on the inner surface of HFMs. Preliminary studies using in vitro dorsal root ganglion (DRG) regeneration assay showed that both the alignment and outgrowth rate of regenerating axons increased significantly on HFMs with aligned textures compared to those on HFMs with a smooth inner surface. Studies in progress are evaluating axonal outgrowth and regeneration using in vivo sciatic-nerve and spinal-cord-injury models.

Agmatine treatment and vein graft reconstruction enhance recovery after experimental facial nerve injury

The rate of nerve regeneration is a critical determinant of the degree of functional recovery after injury. Here, we sought to determine whether treatment with the neuroprotective compound, agmatine, with or without nerve reconstruction utilizing a regional autogenous vein graft would accelerate the rate of facial nerve regeneration. Experiments compared the following seven groups of adult male rats: (A) Intact untreated controls. (B) Sham operation with interruption of the nerve blood supply (controls). (C) Transection of the mandibular branch of the facial nerve (generating a gap of 3 mm) followed by saline treatment. (D) Nerve transection with unsutured autogenous vein (external jugular) graft reconstruction plus saline treatment. (E) Nerve transection with sutured vein graft approximation (coaptation of the proximal and distal nerve stumps) plus saline. (F) Nerve transection with sutured vein graft followed by agmatine treatment (four daily intraperitoneal injections of 100 mg/kg agmatine sulfate). (G) Nerve transection with unsutured vein graft followed by agmatine treatment. Functional recovery, as assessed by grading vibrissae movements and by recording nerve conduction velocity and numbers of regenerated axons, indicated that either vein reconstruction or agmatine treatment resulted in accelerated and more complete recovery as compared with controls. But best results were observed in animals that underwent combined treatment, i.e., vein reconstruction plus agmatine injection. We conclude that agmatine treatment can accelerate facial nerve regeneration and that agmatine treatment together with autogenous vein graft offers an advantageous alternative to other facial nerve reconstruction procedures.

Tissue-engineering approaches for axonal guidance

Owing to the profound impact of nervous system damage, extensive studies have been carried out aimed at facilitating axonal regeneration following injury. Tissue engineering, as an emerging and rapidly growing field, has received extensive attention for nervous system axonal guidance. Numerous engineered substrates containing oriented extracellular matrix molecules, cells or channels have displayed potential of supporting axonal regeneration and functional recovery. Most attempts are focused on seeking new biomaterials, new cell sources, as well as novel designs of tissue-engineered neuronal bridging devices, to generate safer and more efficacious neuronal tissue repairs.

Facial nerve repair with epineural suture and anastomosis using fibrin adhesive: An experimental study in the rabbit

PURPOSE

An experimental model in rabbits was used to compare epineural suturing and fibrin adhesive anastomosis for facial nerve repair.

MATERIALS AND METHODS

Thirty-four facial nerves from 17 rabbits were isolated, transected, and anastomosed, with an evaluation of their electrophysiologic and histologic parameters. The rabbits were divided into 2 groups of 5 and 12 animals, respectively: a 10-mm defect was made in the right facial nerve in the first group, with transection and epineural suturing of the left nerve, followed by death after 120 days. This was the control-versus-epineural suture group. In the second group, the right facial nerve was transected and subjected to epineural suturing, while the left nerve was transected and anastomosed using fibrin adhesive. The rabbits were killed 15, 30, 60, and 120 days after the microsurgical procedure. This was the epineural suture-versus-fibrin adhesive group.

RESULTS

From day 30, the number of regenerated axons increased with time in the epineural suture and fibrin adhesive anastomotic specimens. Epineural suture showed more regenerated axons and a faster linear rate of regeneration than anastomosis with fibrin adhesive. The reduction in conduction velocity decreased significantly with time with the same linear pattern for both suture techniques.

CONCLUSIONS

Epineural suturing offered superior performance versus anastomosis with fibrin adhesive in terms of axon count but not in decrease in conduction velocity.

Optic nerve regeneration in polyglycolic acid–chitosan conduits coated with recombinant L1-Fc

Autografts have been extensively studied to facilitate optic nerve (ON) regeneration in animal experiments, but the clinical application of this approach to aid autoregeneration has not yet been attempted. This study aims to explore the guided regeneration by an artificial polyglycolic acid-chitosan conduit coated with recombinant L1-Fc. Consistent with previous studies; in vitro assay showed that both chitosan, a natural biomaterial, and the neural cell adhesion molecule L1-Fc enhanced neurite outgrowth. Rat optic nerve transection was used as an in vivo model. The implanted PGA-chitosan conduit was progressively degraded and absorbed, accompanied by significant axonal regeneration as revealed by immunohistochemistry, anterograde and retrograde tracing. The polyglycolic acid-chitosan conduit coated with L1-Fc showed more effective to promote axonal regeneration and remyelination. Taken together, our observations demonstrated that the L1-Fc coated PGA-chitosan conduits provided a compatible and supportive canal to guild the injured nerve regeneration and remyelination.

Neural tissue engineering: strategies for repair and regeneration

Nerve regeneration is a complex biological phenomenon. In the peripheral nervous system, nerves can regenerate on their own if injuries are small. Larger injuries must be surgically treated, typically with nerve grafts harvested from elsewhere in the body. Spinal cord injury is more complicated, as there are factors in the body that inhibit repair. Unfortunately, a solution to completely repair spinal cord injury has not been found. Thus, bioengineering strategies for the peripheral nervous system are focused on alternatives to the nerve graft, whereas efforts for spinal cord injury are focused on creating a permissive environment for regeneration. Fortunately, recent advances in neuroscience, cell culture, genetic techniques, and biomaterials provide optimism for new treatments for nerve injuries. This article reviews the nervous system physiology, the factors that are critical for nerve repair, and the current approaches that are being explored to aid peripheral nerve regeneration and spinal cord repair.