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Heineman J, Bueno EM, Kiwanuka H, Carty MJ, Sampson CE, Pribaz JJ, Pomahac B, Talbot SG. All hands on deck: Hand replantation versus transplantation. SAGE Open Med 2020; 8:2050312120926351. [PMID: 32537157 PMCID: PMC7268554 DOI: 10.1177/2050312120926351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives: Our hands play a remarkable role in our activities of daily living and the
make-up of our identities. In the United States, an estimated 41,000
individuals live with upper limb loss. Our expanding experience in limb
transplantation—including operative techniques, rehabilitation, and expected
outcomes—has often been based on our past experience with replantation.
Here, we undertake a systematic review of replantation with transplantation
in an attempt to better understand the determinants of outcome for each and
to provide a summary of the data to this point. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines, we conducted PubMed searches from 1964 to 2013 for articles in
English. In total, 53 primary and secondary source articles were found to
involve surgical repair (either replantation or transplantation) for
complete amputations at the wrist and forearm levels. All were read and
analyzed. Results: Hand replantations and transplantations were compared with respect to
pre-operative considerations, surgical techniques, post-operative
considerations and outcomes, including motor, sensation, cosmesis, patient
satisfaction/quality of life, adverse events/side effects, financial costs,
and overall function. While comparison of data is limited by heterogeneity,
these data support our belief that good outcomes depend on patient
expectations and commitment. Conclusion: When possible, hand replantation remains the primary option after acute
amputation. However, when replantation fails or is not possible, hand
transplantation appears to provide at least equal outcomes. Patient
commitment, realistic expectations, and physician competence must coincide
to achieve the best possible outcomes for both hand replantation and
transplantation.
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Affiliation(s)
- John Heineman
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ericka M Bueno
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Harriet Kiwanuka
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Carty
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian E Sampson
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian J Pribaz
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Jung H, Oh ES. FK506 positively regulates the migratory potential of melanocyte-derived cells by enhancing syndecan-2 expression. Pigment Cell Melanoma Res 2016; 29:434-43. [PMID: 27060922 DOI: 10.1111/pcmr.12480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/08/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023]
Abstract
Although topical tacrolimus (FK506) is known to promote repigmentation by increasing the pigmentation and migration of melanocytes, the mechanism through which FK506 regulates cell migration remains unclear. Here, we report that FK506 treatment enhanced cell spreading on laminin-332 and increased migration in both melanocytes and melanoma cells. Interestingly, FK506 also increased the expression of syndecan-2, a transmembrane heparan sulfate proteoglycan through c-jun terminal kinase activation. Moreover, siRNA-mediated reduction of syndecan-2 expression decreased FK506-mediated cell spreading and migration in melanoma cells and decreased focal adhesion kinase phosphorylation in both melanocytes and melanoma cells. Consistent with these effects on syndecan-2 expression, FK506 enhanced the membrane and melanosome localizations of PKCβII, a regulator of tyrosinase activity. This suggests that FK506 may play a dual regulatory role by affecting both melanogenesis and migration in melanocyte-derived cells. Interestingly, however, FK506 failed to show any synergistic effect on the migration of UVB-treated melanocyte-derived cells. Taken together, these data indicate that FK506 regulates cell migration by enhancing syndecan-2 expression, further suggesting that syndecan-2 could be a potential target for the treatment of patients with vitiligo.
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Affiliation(s)
- Hyejung Jung
- Department of Life Sciences, The Research Center for Cellular Homeostasis, Ewha Womans University, Seoul, Korea
| | - Eok-Soo Oh
- Department of Life Sciences, The Research Center for Cellular Homeostasis, Ewha Womans University, Seoul, Korea
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Que J, Cao Q, Sui T, Du S, Zhang A, Kong D, Cao X. Tacrolimus reduces scar formation and promotes sciatic nerve regeneration. Neural Regen Res 2014; 7:2500-6. [PMID: 25337101 PMCID: PMC4200705 DOI: 10.3969/j.issn.1673-5374.2012.32.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/20/2012] [Indexed: 01/01/2023] Open
Abstract
A sciatic nerve transection and repair model was established in Sprague-Dawley rats by transecting the tendon of obturator internus muscle in the greater sciatic foramen and suturing with nylon sutures. The models were treated with tacrolimus gavage (4 mg/kg per day) for 0, 2, 4 and 6 weeks. Specimens were harvested at 6 weeks of intragastric administration. Masson staining revealed that the collagen fiber content and scar area in the nerve anastomosis of the sciatic nerve injury rats were significantly reduced after tacrolimus administration. Hematoxylin-eosin staining showed that tacrolimus significantly increased myelinated nerve fiber density, average axon diameter and myelin sheath thickness. Intragastric administration of tacrolimus also led to a significant increase in the recovery rate of gastrocnemius muscle wet weight and the sciatic functional index after sciatic nerve injury. The above indices were most significantly improved at 6 weeks after of tacrolimus gavage. The myelinated nerve fiber density in the nerve anastomosis and the sciatic nerve functions had a significant negative correlation with the scar area, as detected by Spearman’s rank correlation analysis. These findings indicate that tacrolimus can promote peripheral nerve regeneration and accelerate the recovery of neurological function through the reduction of scar formation.
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Affiliation(s)
- Jun Que
- Intensive Care Unit, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Quan Cao
- Intensive Care Unit, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Tao Sui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Shihao Du
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ailiang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Dechao Kong
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xiaojian Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Que J, Cao Q, Sui T, Du S, Kong D, Cao X. Effect of FK506 in reducing scar formation by inducing fibroblast apoptosis after sciatic nerve injury in rats. Cell Death Dis 2013; 4:e526. [PMID: 23470533 PMCID: PMC3613834 DOI: 10.1038/cddis.2013.56] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We previously demonstrated that FK506, a generally applied immunosuppressant in organ transplantation, could promote peripheral nerve regeneration through reducing scar formation. However, little is known about how FK506 reduces scar formation. Herein we investigated the influence of FK506 on fibroblast proliferation and its correlation with scar formation after sciatic nerve injury in rats, and further explored the effect of FK506 on fibroblast proliferation and apoptosis in vitro. Masson staining and immunohistochemistry revealed that scar area and fibroblast number in the nerve anastomosis of sciatic nerve-injured rats were significantly reduced after FK506 administration. The scar area had a significant positive correlation with the fibroblast number, as detected by linear correlation analysis. CCK-8 assay and flow cytometry indicated that FK506 also inhibited proliferation and induced apoptosis of fibroblasts in vitro. It was primarily phosphorylation of JNK and ERK that were activated during the apoptosis of fibroblast. Pretreatment of cells with JNK inhibitor, SP600125, or ERK inhibitor, PD98059, could inhibit FK506-induced fibroblast apoptosis, respectively. Moreover, simultaneous application of both inhibitors had additive roles in cell protection from apoptosis. These results suggest that FK506-induced fibroblast apoptosis contributes to the suppression of fibroblast proliferation and then results in the reduction of scar formation in sciatic nerve-injured rat, and that JNK and ERK are involved in FK506-induced fibroblast apoptosis.
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Affiliation(s)
- J Que
- Department of Intensive Care Unit, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Yan Y, Sun HH, Hunter DA, Mackinnon SE, Johnson PJ. Efficacy of Short-Term FK506 Administration on Accelerating Nerve Regeneration. Neurorehabil Neural Repair 2012; 26:570-80. [DOI: 10.1177/1545968311431965] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. The slow rate of nerve regeneration following injury can cause extended muscle denervation, leading to irreversible muscle atrophy, fibrosis, and destruction of motor endplates. The immunosuppressant FK506 (tacrolimus) has been shown to accelerate the rate of nerve regeneration and functional recovery. However, the toxic and immunosuppressive properties of FK506 make it undesirable for long-term use. Objective. To take advantage of the regeneration-enhancing effects of FK506 but avoid the potential adverse effects of long-term administration, the current study evaluates and quantifies the efficacy of short-term FK506 treatment in rat models. Methods. Clinically relevant transection and graft models were evaluated, and walking track analysis (WTA) was used to evaluate functional recovery. FK506 was administered for 5 and 10 days post transection injury and 10 and 20 days post graft injury. Both groups involving a short course were compared with the continuous administration group. Results. In the transection model, FK506 was administered for 5 and 10 days postoperatively. WTA demonstrated that 10 days of FK506 administration was sufficient to reduce functional recovery time by 29% compared with negative controls. In the graft model, FK506 was administered for 10 and 20 days postoperatively. Short treatment courses of 10 and 20 days reduced recovery time by 15% and 21%, respectively, compared with negative controls. Analysis of blood–nerve barrier (BNB) integrity demonstrated that FK506 facilitated early reconstitution of the BNB. Conclusions. The results of this study indicate that short-term FK506 delivery following nerve injury imparts a significant therapeutic effect.
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Affiliation(s)
- Ying Yan
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Hank H. Sun
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Daniel A. Hunter
- Washington University in St Louis School of Medicine, St Louis, MO, USA
| | | | - Philip J. Johnson
- Washington University in St Louis School of Medicine, St Louis, MO, USA
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Shores JT, Imbriglia JE, Lee WPA. The current state of hand transplantation. J Hand Surg Am 2011; 36:1862-7. [PMID: 22036285 DOI: 10.1016/j.jhsa.2011.09.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/01/2011] [Indexed: 02/02/2023]
Abstract
Hand transplantation is the most common form of modern composite tissue allotransplantation. Successful application of this technology requires a multidisciplinary approach incorporating not only skilled hand surgeons, transplant surgeons, and transplant immunologists, but also hand therapists, psychiatrists, medical specialists, anesthesiologists, and others. Functional outcomes can be life changing for properly selected candidates. Hand transplantation is becoming more common, with more centers offering this relatively new reconstructive modality. Its success depends on proper patient selection, a technically successful operation, postoperative rehabilitation, and an immunotherapy protocol that prevents rejection but has minimal or acceptable morbidity.
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Affiliation(s)
- Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Yan Y, Sun HH, Mackinnon SE, Johnson PJ. Evaluation of peripheral nerve regeneration via in vivo serial transcutaneous imaging using transgenic Thy1-YFP mice. Exp Neurol 2011; 232:7-14. [PMID: 21763310 DOI: 10.1016/j.expneurol.2011.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/23/2011] [Accepted: 06/23/2011] [Indexed: 12/28/2022]
Abstract
This study uses the saphenous nerve crush model in Thy1-YFP mice and serial transcutaneous imaging to evaluate the rate of nerve regeneration under various FK-506 (tacrolimus) dosing regimens and in the presence of transgenic overexpression of glial cell line-derived neurotrophic factor (GDNF). Thy1-YFP transgenic mice received saphenous nerve crush and were monitored for axonal regeneration via transcutaneous imaging for 7 days. Group A received no FK-506. Groups B and C received FK-506 at 2 or 0.5 mg/kg/day, starting three days before injury (preload). Groups D and E received FK-506 at 2 or 0.5 mg/kg/day, starting on the day of injury. Group F consisted of double transgenic mice with central overexpression of GDNF by CNS astrocytes (GFAP-GDNF/Thy1-YFP). Length and rate of axonal regeneration were measured and calculated over time. Regardless of concentration, FK-506 preload (Groups B and C) improved length and rate of axonal outgrowth compared with controls (Group A) and no preload (Groups D and E). Surprisingly, central overexpression of GDNF (GFAP-GDNF) delayed and stunted axonal outgrowth. Saphenous nerve crush in Thy1-YFP mice represents a viable model for timely evaluation of therapeutic strategies affecting the rate of nerve regeneration. FK-506 administered three days prior to injury accelerates axonal regeneration beyond injury conditioned regeneration alone and may serve as a reliable positive control for the model. GDNF overexpression in the CNS impedes early axonal outgrowth.
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Affiliation(s)
- Ying Yan
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, USA
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Gehrig SM, Lynch GS. Emerging drugs for treating skeletal muscle injury and promoting muscle repair. Expert Opin Emerg Drugs 2011; 16:163-82. [DOI: 10.1517/14728214.2010.524743] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Chapter 18: Enhancement of nerve regeneration and recovery by immunosuppressive agents. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:347-62. [PMID: 19682647 DOI: 10.1016/s0074-7742(09)87018-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinically, little can be done to induce restoration of good to excellent neurological function following nervous system trauma, and time is required before an effective technique is developed and applied clinically. However, there are novel techniques that have not been tested experimentally or clinically that may induce significantly faster, reliable, and extensive neurological recovery following nervous system trauma than is presently possible, even for techniques currently being tested on animal models. To repair peripheral nerves following trauma in which a length of the nerve pathway is destroyed, many clinicians consider autologous sensory nerve grafts to be the "gold standard" for inducing neurological recovery. However, this technique has severe limitations, such as being effective only across gaps less than 2 cm, for repairs performed less than 2 months posttrauma, and in young patients. As a consequence, many patients suffer permanent neurological deficits or recover only limited neurological function, and they frequently develop irreversible neuropathic pain. This review examines the clinical role that immunosuppressants might play, in the presence or absence of autologous, allografts, or xenografts, in increasing the rate, success, and extent of neurological recovery following nervous system trauma.
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