Enhanced peripheral nerve regeneration through a poled bioresorbable poly(lactic-co-glycolic acid) guidance channel

Development of Highly Flexible Piezoelectric PVDF-TRFE/Reduced Graphene Oxide Doped Electrospun Nano-Fibers for Self-Powered Pressure Sensor

The demand for self-powered, flexible, and wearable electronic devices has been increasing in recent years for physiological and biomedical applications in real-time detection due to their higher flexibility and stretchability. This work fabricated a highly sensitive, self-powered wearable microdevice with Poly-Vinylidene Fluoride-Tetra Fluoroethylene (PVDF-TrFE) nano-fibers using an electrospinning technique. The dielectric response of the polymer was improved by incorporating the reduced-graphene-oxide (rGO) multi-walled carbon nano-tubes (MWCNTs) through doping. The dielectric behavior and piezoelectric effect were improved through the stretching and orientation of polymeric chains. The outermost layer was attained by chemical vapor deposition (CVD) of conductive polymer poly (3,4-ethylenedioxythiophene) to enhance the electrical conductivity and sensitivity. The hetero-structured nano-composite comprises PVDF-TrFE doped with rGO-MWCNTs over poly (3,4-ethylenedioxythiophene) (PEDOT), forming continuous self-assembly. The piezoelectric pressure sensor is capable of detecting human physiological vital signs. The pressure sensor exhibits a high-pressure sensitivity of 19.09 kPa-1, over a sensing range of 1.0 Pa to 25 kPa, and excellent cycling stability of 10,000 cycles. The study reveals that the piezoelectric pressure sensor has superior sensing performance and is capable of monitoring human vital signs, including heartbeat and wrist pulse, masticatory movement, voice recognition, and eye blinking signals. The research work demonstrates that the device could potentially eliminate metallic sensors and be used for early disease diagnosis in biomedical and personal healthcare applications.

Research advancements on nerve guide conduits for nerve injury repair

Peripheral nerve injury (PNI) is one of the most serious causes of disability and loss of work capacity of younger individuals. Although PNS has a certain degree of regeneration, there are still challenges like disordered growth, neuroma formation, and incomplete regeneration. Regarding the management of PNI, conventional methods such as surgery, pharmacotherapy, and rehabilitative therapy. Treatment strategies vary depending on the severity of the injury. While for the long nerve defect, autologous nerve grafting is commonly recognized as the preferred surgical approach. Nevertheless, due to lack of donor sources, neurological deficits and the low regeneration efficiency of grafted nerves, nerve guide conduits (NGCs) are recognized as a future promising technology in recent years. This review provides a comprehensive overview of current treatments for PNI, and discusses NGCs from different perspectives, such as material, design, fabrication process, and composite function.

A mixed solvent approach to make poly(vinylidene fluoride) nanofibers with high β-phase using solution blow spinning

The excellent mechanical and piezoelectric properties of poly(vinylidene fluoride) (PVDF) are its most valuable characteristics, and improving the piezoelectric performance of PVDF is an important subject of the study. However, several existing methodological studies have been regarded as complex and ineffective. The most efficient method to produce PVDF nanofibers with high β-phase contents is still electrospinning; however, this process does not facilitate the mass production of PVDF nanofibers and produces PVDF with a relatively low fraction of β-phase. Both these issues can be solved by solution blow spinning (SBS). This work focused on the optimum ratio of solvents to produce beadless PVDF nanofibers and highlighted the relationship between the spinning solution viscosity and the average diameter of the SBS nanofibers obtained. Using Fourier transform infrared reflection, it was evaluated that the fraction of the β-phase increased after the SBS process, which was calculated to be 85%; this value was considered as a relatively high fraction of β-phase, which was similar to that obtained by electrospinning. Consequently, a simple and convenient alternative to produce PVDF nanofibers with high β-phase contents was achieved.

Nerve guide conduits for peripheral nerve injury repair: A review on design, materials and fabrication methods

Peripheral nerves can sustain injuries due to loss of structure and/or function of peripheral nerves because of accident, trauma and other causes, which leads to partial or complete loss of sensory, motor, and autonomic functions and neuropathic pain. Even with the extensive knowledge on the pathophysiology and regeneration mechanisms of peripheral nerve injuries (PNI), reliable treatment methods that ensure full functional recovery are scant. Nerve autografting is the current gold standard for treatment of PNI. Given the limitations of autografts including donor site morbidity and limited supply, alternate treatment methods are being pursued by the researchers. Neural guide conduits (NGCs) are increasingly being considered as a potential alternative to nerve autografts. The anatomy of peripheral nerves, classification of PNI, and current treatment methods are briefly yet succinctly reviewed. A detailed review on the various designs of NGCs, the different materials used for making the NGCs, and the fabrication methods adopted is presented in this work. Much progress had been made in all the aspects of making an NGC, including the design, materials and fabrication techniques. The advent of advanced technologies such as additive manufacturing and 3D bioprinting could be beneficial in easing the production of patient-specific NGCs. NGCs with supporting cells or stem cells, NGCs loaded with neurotropic factors and drugs, and 4D printed NGCs are some of the futuristic areas of interest. STATEMENT OF SIGNIFICANCE: Neural guide conduits (NGCs) are increasingly being considered as a potential alternative to nerve autografts in the treatment of peripheral nerve injuries. A detailed review on the various designs of NGCs, the different materials used for making the NGCs, and the fabrication methods (including Additive Manufacturing) adopted is presented in this work.

Repairing Transected Peripheral Nerve Using a Biomimetic Nerve Guidance Conduit Containing Intraluminal Sponge Fillers

Nerve guide conduits (NGCs) with geometric design have shown significant advantages in guidance of nerve reinnervation across the defect of injured peripheral nerves. It is realized that intraluminal fillers with distinctive structure can effectively provide an inner guidance for sprouting of axons and improve the permeability of NGC. In this work, a poly(lactic-co-glycolic acid) (PLGA) NGC is prepared containing intraluminal sponge fillers (labeled as ISF-NGC) and used for reconstruction of a rat sciatic nerve with a 10 mm gap. For comparison, the same procedure is applied to a single hollow PLGA NGC (labeled as H-NGC) and an autologous nerve. As evidenced by significantly improved nerve morphology and function, the ISF-NGC achieves a superior nerve repair effect over H-NGC, which is comparable to autologous nerve grafting. It is likely that the H-NGC only provides a protected tunnel for nerve fiber regrowth and axonal extension, while ISF-NGC offers an extracellular matrix-mimetic architecture as autograft to provide contact guidance for nerve reinnervation. This newly developed ISF-NGC is a promising candidate to aid nerve reinnervation across longer gaps commonly encountered in clinical cases.

Peripheral Nerve Conduit: Materials and Structures

Peripheral nerve injuries (PNIs) are the most common injury types to affect the nervous system. Restoration of nerve function after PNI is a challenging medical issue. Extended gaps in transected peripheral nerves are only repaired using autologous nerve grafting. This technique, however, in which nerve tissue is harvested from a donor site and grafted onto a recipient site in the same body, has many limitations and disadvantages. Recent studies have revealed artificial nerve conduits as a promising alternative technique to substitute autologous nerves. This Review summarizes different types of artificial nerve grafts used to repair peripheral nerve injuries. These include synthetic and natural polymers with biological factors. Then, desirable properties of nerve guides are discussed based on their functionality and effectiveness. In the final part of this Review, fabrication methods and commercially available nerve guides are described.

Tissue engineering for the repair of peripheral nerve injury

Peripheral nerve injury is a common clinical problem and affects the quality of life of patients. Traditional restoration methods are not satisfactory. Researchers increasingly focus on the field of tissue engineering. The three key points in establishing a tissue engineering material are the biological scaffold material, the seed cells and various growth factors. Understanding the type of nerve injury, the construction of scaffold and the process of repair are necessary to solve peripheral nerve injury and promote its regeneration. This review describes the categories of peripheral nerve injury, fundamental research of peripheral nervous tissue engineering and clinical research on peripheral nerve scaffold material, and paves a way for related research and the use of conduits in clinical practice.

Synthetic bioresorbable poly-α-hydroxyesters as peripheral nerve guidance conduits; a review of material properties, design strategies and their efficacy to date

Implantable tubular devices known as nerve guidance conduits (NGCs) have drawn considerable interest as an alternative to autografting in the repair of peripheral nerve injuries.

Poly (lactide-co-glycolide) (PLGA) Scaffold Induces Short-term Nerve Regeneration and Functional Recovery Following Sciatic Nerve Transection in Rats

Peripheral nerve injury is an important cause of incapability and has limited available treatment. Autologous donor nerve implant is the golden standard treatment, however, may cause secondary deficits. Stem cells show positive results in preclinical settings, preserving tissue and function. We tested the efficacy of stem cells derived from human exfoliated deciduous teeth seeded in poly (lactide-co-glycolide) scaffolds in sciatic nerve transection model. Seventy-two adult male Wistar rats had 7-mm nerve gap bridge using scaffolds with (or without) stem cells. Animals were randomly divided into: sham-operated; sham-operated without scaffold; sham-operated + scaffold + stem cells; sciatic transection + no treatment; sciatic transection + acellular scaffolds; sciatic transection + scaffold + stem cells. Sciatic Functional Index and Ladder Rung Walking tests were performed before (-1), 14 and 28 days after surgery. Morphometric nerve measurement and muscle weights were assessed. Scaffolds with stem cells improved function in Sciatic Functional Index. Acellular scaffold was effective, promoting functional recovery and nerve regeneration following nerve injury. Scaffolds provide better nerve regeneration and functional recovery after sciatic transection. Despite cell therapy promoting faster recovery after sciatic transection in the Sciatic Index Score, stem cells did not improve functional and morphological recovery after nerve injury. This is the first study testing the potential use of scaffolds combined with stem cells in the early stages after injury. Scaffolds with stem cells could accelerate nerve recovery and favor adjuvant therapies, evidencing the need for further studies to increase the knowledge about stem cells' mechanisms.

Scaffolds for peripheral nerve repair and reconstruction

Trauma-associated peripheral nerve defect is a widespread clinical problem. Autologous nerve grafting, the current gold standard technique for the treatment of peripheral nerve injury, has many internal disadvantages. Emerging studies showed that tissue engineered nerve graft is an effective substitute to autologous nerves. Tissue engineered nerve graft is generally composed of neural scaffolds and incorporating cells and molecules. A variety of biomaterials have been used to construct neural scaffolds, the main component of tissue engineered nerve graft. Synthetic polymers (e.g. silicone, polyglycolic acid, and poly(lactic-co-glycolic acid)) and natural materials (e.g. chitosan, silk fibroin, and extracellular matrix components) are commonly used along or together to build neural scaffolds. Many other materials, including the extracellular matrix, glass fabrics, ceramics, and metallic materials, have also been used to construct neural scaffolds. These biomaterials are fabricated to create specific structures and surface features. Seeding supporting cells and/or incorporating neurotrophic factors to neural scaffolds further improve restoration effects. Preliminary studies demonstrate that clinical applications of these neural scaffolds achieve satisfactory functional recovery. Therefore, tissue engineered nerve graft provides a good alternative to autologous nerve graft and represents a promising frontier in neural tissue engineering.

Piezoelectric Response in Electrospun Poly(vinylidene fluoride) Fibers Containing Fluoro-Doped Graphene Derivatives

Herein, graphene oxide (GO) was suitably functionalized to obtain carboxylated and fluorinated GO (GOCOOH and GOF) derivatives, respectively, via the Hunsdiecker reaction. Electrospun mats of poly(vinylidene fluoride) (PVDF)/GO, PVDF/GOCOOH, and PVDF/GOF fibers were then prepared by electrospinning from well-dispersed GO derivatives. The piezoelectric coefficient (d ₃₃), as measured using piezoelectric force measurement (PFM), enhanced by more than 2 folds with respect to the control PVDF spun mat. The piezoelectric coefficient though enhanced upon the addition of GO and GOCOOH, however, enhanced significantly in the case of GOF. For instance, a drastic increase in piezoelectric response from 30 pm V^-1(electrospun neat PVDF) to 63 pm V^-1 (for electrospun PVDF/GOF) was observed as revealed from PFM results. The phase transformation in these fibers was systematically investigated by various techniques such as Fourier transform infrared spectroscopy (FTIR), wide angle X-ray diffraction (XRD), Raman spectroscopy, and PFM. FTIR and XRD results revealed that the electrospun fiber mats showed predominantly β-PVDF. Interestingly, the highest β content was obtained in the presence of GOF. The drastic enhancement in β phase is due to the presence of highly electronegative fluorine. The addition of GOCOOH and GOF in PVDF not only increases the polar β phase but also changes the piezoelectric response significantly. More interestingly, PVDF/GOF films exhibited higher energy density and dielectric permittivity when compared with the control PVDF samples. These findings will help guide the researchers working in this field from both theoretical understanding and practical view point for energy storing device and charge storage electronics.

Electroactive biomaterials: Vehicles for controlled delivery of therapeutic agents for drug delivery and tissue regeneration

Electrical stimulation for delivery of biochemical agents such as genes, proteins and RNA molecules amongst others, holds great potential for controlled therapeutic delivery and in promoting tissue regeneration. Electroactive biomaterials have the capability of delivering these agents in a localized, controlled, responsive and efficient manner. These systems have also been combined for the delivery of both physical and biochemical cues and can be programmed to achieve enhanced effects on healing by establishing control over the microenvironment. This review focuses on current state-of-the-art research in electroactive-based materials towards the delivery of drugs and other therapeutic signalling agents for wound care treatment. Future directions and current challenges for developing effective electroactive approach based therapies for wound care are discussed.

Neuroregenerative effects of olfactory ensheathing cells transplanted in a multi-layered conductive nanofibrous conduit in peripheral nerve repair in rats

Background

The purpose of this study was to evaluate the efficacy of a multi-layered conductive nanofibrous hollow conduit in combination with olfactory ensheathing cells (OEC) to promote peripheral nerve regeneration. We aimed to harness both the topographical and electrical cues of the aligned conductive nanofibrous single-walled carbon nanotube/ poly (_L-lactic acid) (SWCNT/PLLA) scaffolds along with the neurotrophic features of OEC in a nerve tissue engineered approach.

Results

We demonstrated that SWCNT/PLLA composite scaffolds support the adhesion, growth, survival and proliferation of OEC. Using microsurgical techniques, the tissue engineered nerve conduits were interposed into an 8 mm gap in sciatic nerve defects in rats. Functional recovery was evaluated using sciatic functional index (SFI) fortnightly after the surgery. Histological analyses including immunohistochemistry for S100 and NF markers along with toluidine blue staining (nerve thickness) and TEM imaging (myelin sheath thickness) of the sections from middle and distal parts of nerve grafts showed an increased regeneration in cell/scaffold group compared with cell-free scaffold and silicone groups. Neural regeneration in cell/scaffold group was very closely similar to autograft group, as deduced from SFI scores and histological assessments.

Conclusions

Our results indicated that the tissue engineered construct made of rolled sheet of SWCNT/PLLA nanofibrous scaffolds and OEC could promote axonal outgrowth and peripheral nerve regeneration suggesting them as a promising alternative in nerve tissue engineering.

Significant enhancement of the electroactive β-phase of PVDF by incorporating hydrothermally synthesized copper oxide nanoparticles

The influence of copper oxide nanoparticles on the polymorphism of PVDF is systematically investigated. Strong interfacial interactions between the negative nanoparticle surface and positive –CH₂ dipoles of PVDF enhance the electroactive β-phase.

The multiple silicone tube device, "tubes within a tube," for multiplication in nerve reconstruction

Multiple nerve branches were created during the regeneration procedure after a nerve injury and such multiple branches are suggested to be used to control, for example, prosthesis with many degrees of freedom. Transected rat sciatic nerve stumps were inserted into a nine mm long silicone tube, which contained four, five mm long, smaller tubes, thus leaving a five mm gap for regenerating nerve fibers. Six weeks later, several new nerve structures were formed not only in the four smaller tubes, but also in the spaces in-between. The 7–9 new continuous nerve structures, which were isolated as individual free nerves after removal of the tubes, were delineated by a perineurium and contained both myelinated and unmyelinated nerve fibers as well as blood vessels. Stimulation of the proximal nerve elicited contractions in distal muscles. Thin metal electrodes, inserted initially into the smaller tubes in some experiments, became embedded in the new nerve structures and when stimulated contractions of the distal muscles were observed. The “tubes within a tube” technique, creating multiple new nerves from a single “mother” nerve, can be used to record multiple signals for prosthetic device control or as sources for supply of multiple denervated targets.

In vivo integration of poly(ε-caprolactone)/gelatin nanofibrous nerve guide seeded with teeth derived stem cells for peripheral nerve regeneration

Artificial nanofiber nerve guides have gained huge interest in bridging nerve gaps and associated peripheral nerve regeneration due to its high surface area, flexibility and porous structure. In this study, electrospun poly (ε-caprolactone)/gelatin (PCL/Gel) nanofibrous mats were fabricated, rolled around a copper wire and fixed by medical grade adhesive to obtain a tubular shaped bio-graft, to bridge 10 mm sciatic nerve gap in in vivo rat models. Stem cells from human exfoliated deciduous tooth (SHED) were transplanted to the site of nerve injury through the nanofibrous nerve guides. In vivo experiments were performed in animal models after creating a sciatic nerve gap, such that the nerve gap was grafted using (i) nanofiber nerve guide (ii) nanofiber nerve guide seeded with SHED (iii) suturing, while an untreated nerve gap remained as the negative control. In vitro cell culture study was carried out for primary investigation of SHED-nanofiber interaction and its viability within the nerve guides after 2 and 16 weeks of implantation time. Walking track analysis, plantar test, electrophysiology and immunohistochemistry were performed to evaluate functional recovery during nerve regeneration. Vascularization was also investigated by hematoxilin/eosine (H&E) staining. Overall results showed that the SHED seeded on nanofibrous nerve guide could survive and promote axonal regeneration in rat sciatic nerves, whereby the biocompatible PCL/Gel nerve guide with cells can support axonal regeneration and could be a promising tissue engineered graft for peripheral nerve regeneration.

Fabrication and characterization of biomimetic multichanneled crosslinked-urethane-doped polyester tissue engineered nerve guides

Biomimetic scaffolds that replicate the native architecture and mechanical properties of target tissues have been recently shown to be a very promising strategy to guide cellular growth and facilitate tissue regeneration. In this study, porous, soft, and elastic crosslinked urethane-doped polyester (CUPE) tissue engineered nerve guides were fabricated with multiple longitudinally oriented channels and an external non-porous sheath to mimic the native endoneurial microtubular and epineurium structure, respectively. The fabrication technique described herein is highly adaptable and allows for fine control over the resulting nerve guide architecture in terms of channel number, channel diameter, porosity, and mechanical properties. Biomimetic multichanneled CUPE guides were fabricated with various channel numbers and displayed an ultimate peak stress of 1.38 ± 0.22 MPa with a corresponding elongation at break of 122.76 ± 42.17%, which were comparable to that of native nerve tissue. The CUPE nerve guides were also evaluated in vivo for the repair of a 1 cm rat sciatic nerve defect. Although histological evaluations revealed collapse of the inner structure from CUPE TENGs, the CUPE nerve guides displayed fiber populations and densities comparable with nerve autograft controls after 8 weeks of implantation. These studies are the first report of a CUPE-based biomimetic multichanneled nerve guide and warrant future studies towards optimization of the channel geometry for use in neural tissue engineering.

Synthesis and properties of caprolactone and ethylene glycol copolymers for neural regeneration

Copolymer networks from poly(ethylene glycol) methacrylate (PEGMA) and caprolactone 2-(methacryloyloxy) ethyl ester were synthesized and the resulting structure of the copolymer network was characterized by differential scanning calorimetry, thermogravimetry, Fourier transform infrared spectroscopy, equilibrium water gain and dynamic mechanical analysis, results which were employed to conclude about the network structure of the resulting copolymers. The new material is a random copolymer with a good miscibility and increasing hydrophilicity as the PEGMA content increases in the composition. Physical data suggest an excess free volume and synergistic interactions between the lateral chains of both comonomers. Olfactory ensheathing cells were cultured on the different networks, and cell viability and proliferation were assessed by MTS assay. The copolymers with a 30 wt% of PEGMA showed the best results compared with the other compositions in this respect, indicating the relevance for biological performance of a balance of hydrophilic and hydrophobic functionalities in the polymer chain.

Neurite extension of primary neurons on electrospun piezoelectric scaffolds

Neural tissue engineering may be a promising option for neural repair treatment, for which a well-designed scaffold is essential. Smart materials that can stimulate neurite extension and outgrowth have been investigated as potential scaffolding materials. A piezoelectric polymer polyvinylidene fluoride-trifluoroethylene (PVDF-TrFE) was used to fabricate electrospun aligned and random scaffolds having nano- or micron-sized fiber dimensions. The advantage of using a piezoelectric polymer is its intrinsic electrical properties. The piezoelectric characteristics of PVDF-TrFE scaffolds were shown to be enhanced by annealing. Dorsal root ganglion (DRG) neurons attached to all fibrous scaffolds. Neurites extended radially on random scaffolds, whereas aligned scaffolds directed neurite outgrowth for all fiber dimensions. Neurite extension was greatest on aligned, annealed PVDF-TrFE having micron-sized fiber dimensions in comparison with annealed and as-spun random PVDF-TrFE scaffolds. DRG on micron-sized aligned, as-spun and annealed PVDF-TrFE also had the lowest aspect ratio amongst all scaffolds, including non-piezoelectric PVDF and collagen-coated substrates. Findings from this study demonstrate the potential use of a piezoelectric fibrous scaffold for neural repair applications.

Ciliary neurotrophic factor-coated polylactic-polyglycolic acid chitosan nerve conduit promotes peripheral nerve regeneration in canine tibial nerve defect repair

A variety of nerve conduits incorporated with chemical and biological factors have been developed to further stimulate nerve regeneration. Although most of the nerve guides in studies are basically limited to bridge a short gap of nerve defect in rat models, it is vital to evaluate effects of conduits on nerve regeneration over distance greater than 20 mm, or more clinically relevant nerve gap lengths in higher mammals. In this study, a poly(lactide-co-glycolide) (PLGA) nerve conduit, treated with pulsed plasma and coated with ciliary neurotrophic factor (CNTF) as well as chitosan, was used to repair 25-mm-long canine tibial nerve defects in eighteen cross-bred dogs. The canines were randomly divided into three groups (n = 6), a 25-mm segment of the tibial nerve was removed and replaced by a PLGA/chitosan-CNTF nerve conduit, PLGA/chitosan conduit and autologous nerve grafts were performed as the control. The results were evaluated by general observation, electromyogram testing, S-100 histological immunostaining, and image analysis at 3 months after operation. The histological results demonstrated that the PLGA/chitosan-CNTF conduits and PLGA/chitosan conduits were capable of leading the damaged axons through the lesioned area. Through the comparison of the three groups, the results in PLGA/chitosan-CNTF conduits group were better than that of PLGA/chitosan conduits group, while they were similar to autologous nerve grafts group. Therefore, CNTF-coated PLGA/chitosan nerve conduits could be an alternative artificial nerve conduit for nerve regeneration.

PLGA conduit seeded with olfactory ensheathing cells for bridging sciatic nerve defect of rats

PLGA is thought to be a promising material for nerve scaffold. OECs have been shown to promote axon outgrowth and myelination following peripheral nerve transection. This study assessed the compatibility between PLGA and OECs in vitro, and evaluated the effect of PLGA conduit filled with OECs and extracellular matrix gel (ECM) (POE group) on 10 mm-defect sciatic nerve of rats. Silicon-OECs-EMC (SOE group), PLGA-ECM (PE group), and silicon-ECM (SE group)-were used as the controls. The survival and distribution of OECs in vivo, neurohistology and neurofunction of the bridged nerve, were quantitatively evaluated from 1 week to 12 weeks after surgery. PLGA possessed complete compatibility with OECs. After implantation, OECs migrated along the axis of the nerve and survived longer in the POE group than in the SOE group. Gross recovery of the animal, like ulcerious and autophagical rate as well as relative diameter recovery rate of the fiber, was more successful in the POE group than in other groups. The number of the fiber in the middle and distal segments of bridged sites and neurons in anterior horn of the spinal cord was increased in both OECs-contained groups, but the diameter and the myeline thickness of the fiber were increased only in the POE group. The nerve conduction velocity and the amplitude of compound muscle active potential were improved much successfully in the PLGA-guided group than in the silicon-guided group, but the best improvement was encountered in the POE group. Sciatic function index was not improved in all groups at 12 weeks after surgery due to the injury model. These results suggested that PLGA filled with OECs is a significant alternative to conventional autograft in repairing peripheral nerve defects, and OECs are potential seed cells for peripheral nerve tissue engineering.

Development of a scaffoldless three-dimensional engineered nerve using a nerve-fibroblast co-culture

Nerve grafts are often required to replace tissue damaged by disease, surgery, or extensive trauma. Limitations such as graft availability, donor site morbidity, and immune rejection have led investigators to develop strategies to engineer nerve tissue. The goal of this study was to fabricate a scaffoldless three-dimensional (3D) nerve construct using a co-culture of fetal nerve cells with a fibroblast monolayer and allow the co-culture to remodel into a 3D construct with an external fibroblast layer and an internal core of interconnected neuronal cells. Primary fibroblasts were seeded on laminin-coated plates and allowed to form a confluent monolayer. Neural cells isolated from E-15 spinal cords were seeded on top of the fibroblast monolayer and allowed to form a networked monolayer across the monolayer of fibroblasts. Media shifts initiated contraction of the fibroblast monolayer and a remodeling of the co-culture into a 3D construct held statically in place by the two constraint pins. Immunohistochemistry using S100 (Schwann cell), beta3-tubulin, DAPI, and collagen I indicated an inner core of nerve cells surrounded by an external layer of fibroblasts. Conduction velocities of the 3D nerve and control (fibroblast-only) constructs were measured in vitro and compared to in vivo measures of neonatal sciatic nerve. The conduction velocities of the nerve constructs were comparable to 24-d-old neonatal nerve. The presence of Schwann cells and the ability to conduct neuronal signals in vitro suggest the scaffoldless 3D nerve constructs will be a viable option for nerve repair.

Experimental study on repair of the facial nerve with Schwann cells transfected with GDNF genes and PLGA conduits

CONCLUSIONS

Schwann cells transfected by GDNF genes + PLGA were superior to Schwann cells + PLGA and direct anastomesis. This is a new and effective strategy for repair of facial nerve defects.

OBJECTIVE

To evaluate the effect of bioactive artificial nerve conduits in the repair of facial nerve defects in Sprague-Dawley rats.

MATERIALS AND METHODS

Schwann cells were harvested and transfected with PcDNA3.1 (+)/GDNF. After injection with Schwann cells, the conduits were cultured in the culture medium for 2 weeks. Thirty female Sprague-Dawley rats were selected and randomly divided into three groups (A, B, and C), which were treated as follows: A, direct anastomesis; B, Schwann cells + PLGA conduits; C, Schwann cells transfected by GDNF genes + PLGA conduits. General observation, electrophysiological study, histological study, and image analysis were performed 2 weeks, 1 month, 2 months, and 3 months postoperatively.

RESULTS

The recovery of nerve regeneration and electrophysiological results in group C were superior to those in groups A and B; the difference was statistically significant (p < 0.01).

Approaches to neural tissue engineering using scaffolds for drug delivery

This review seeks to give an overview of the current approaches to drug delivery from scaffolds for neural tissue engineering applications. The challenges presented by attempting to replicate the three types of nervous tissue (brain, spinal cord, and peripheral nerve) are summarized. Potential scaffold materials (both synthetic and natural) and target drugs are discussed with the benefits and drawbacks given. Finally, common methods of drug delivery, including degradable/diffusion-based delivery systems, affinity-based delivery systems, immobilized drug delivery systems, and electrically controlled drug delivery systems, are examined and critiqued. Based on the current body of work, suggestions for future directions of research in the field of neural tissue engineering are presented.

In Vitro Biocompatibility of Schwann Cells on Surfaces of Biocompatible Polymeric Electrospun Fibrous and Solution-Cast Film Scaffolds

The in vitro responses of Schwann cells (RT4-D6P2T, a schwannoma cell line derived from a chemically induced rat peripheral neurotumor) on various types of electrospun fibrous scaffolds of some commercially available biocompatible and biodegradable polymers, i.e., poly(3-hydroxybutyrate) (PHB), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), polycaprolactone (PCL), poly(l-lactic acid) (PLLA), and chitosan (CS), were reported in comparison with those of the cells on corresponding solution-cast film scaffolds as well as on a tissue-culture polystyrene plate (TCPS), used as the positive control. At 24 h after cell seeding, the viability of the attached cells on the various substrates could be ranked as follows: PCL film > TCPS > PCL fibrous > PLLA fibrous > PHBV film > CS fibrous approximately CS film approximately PLLA film > PHB film > PHBV fibrous > PHB fibrous. At day 3 of cell culture, the viability of the proliferated cells on the various substrates could be ranked as follows: TCPS > PHBV film > PLLA film > PCL film > PLLA fibrous > PHB film approximately PCL fibrous > CS fibrous > CS film > PHB fibrous > PHBV fibrous. At approximately 8 h after cell seeding, the cells on the flat surfaces of all of the film scaffolds and that of the PCL nanofibrous scaffold appeared in their characteristic spindle shape, while those on the surfaces of the PHB, PHBV, and PLLA macrofibrous scaffolds also appeared in their characteristic spindle shape, but with the cells being able to penetrate to the inner side of the scaffolds.

Tissue engineered nerve constructs: where do we stand?

Driven by enormous clinical need, interest in peripheral nerve regeneration has become a prime focus of research and area of growth within the field of tissue engineering. While using autologous donor nerves for bridging peripheral defects remains today's gold standard, it remains associated with high donor site morbidity and lack of full recovery. This dictates research towards the development of biomimetic constructs as alternatives. Based on current concepts, this review summarizes various approaches including different extracellular matrices, scaffolds, and growth factors that have been shown to promote migration and proliferation of Schwann cells. Since neither of these concepts in isolation is enough, although each is gaining increased interest to promote nerve regeneration, various combinations will need to be identified to strike a harmonious balance. Additional factors that must be incorporated into tissue engineered nerve constructs are also unknown and warrant further research efforts. It seems that future directions may allow us to determine the "missing link".