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Cao S, Yihao W, Qi T, Xiong A, Liu P, Chen Y, Zeng H, Yu F, Weng J. Combination of stem cells and nerve guide conduit for the treatment of peripheral nerve injury: A meta-analysis. Muscle Nerve 2024; 69:227-238. [PMID: 38063327 DOI: 10.1002/mus.28018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION/AIMS Many small-sized, single-center preclinical studies have investigated the benefits of introducing stem cells into the interior of nerve conduit. The aims of this meta-analysis are to review and contrast the effects of various types of stem cells in in vivo models used to reconstruct peripheral nerve injuries (PNIs) and to assess the reliability and stability of the available evidence. METHODS A systematic search was conducted using Cochrane Library, Embase, PubMed, and Web of Science to identify studies conducted from January 1, 2000, to September 21, 2022, and investigate stem cell therapy in peripheral nerve reconstruction animal models. Studies that met the relevant criteria were deemed eligible for this meta-analysis. RESULTS Fifty-five preclinical studies with a total of 1234 animals were incorporated. Stem cells demonstrated a positive impact on peripheral nerve regeneration at different follow-up times in the forest plots of five outcome indicators: compound muscle action potential (CMAP) amplitude, latency, muscle mass ratio, nerve conduction velocity, and sciatic functional index (SFI). In most comparisons, stem cell groups showed substantial differences compared with the control groups. The superior performance of adipose-derived stem cells (ADSCs) in terms of SFI, CMAP amplitude, and latency (p < .001) was identified. DISCUSSION The findings consistently demonstrated a favorable outcome in the reconstruction process when utilizing different groups of stem cells, as opposed to control groups where stem cells were not employed.
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Affiliation(s)
- Siyang Cao
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Wei Yihao
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Tiantian Qi
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Ao Xiong
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Peng Liu
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Yingqi Chen
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Hui Zeng
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Fei Yu
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Jian Weng
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
- National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
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Song L, Guo Q, Guo J, Xu X, Xu K, Li Y, Yang T, Gu X, Cao R, Cui S. Brachial plexus bridging with specific extracellular matrix modified chitosan/silk scaffold: a new expand of tissue engineered nerve graft. J Neural Eng 2022; 19. [PMID: 35259733 DOI: 10.1088/1741-2552/ac5b95] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Brachial plexus injuries result in serious dysfunction and are currently treated using autologous nerve graft (autograft) transplantation. With the development of tissue engineering, tissue engineered nerve grafts (TENGs) have emerged as promising alternatives to autografts but have not yet been widely applied to the treatment of brachial plexus injuries. Herein, we developed a TENG modified with extracellular matrix (ECM) generated by skin-derived precursor Schwann cells (SKP-SCs) and expand its application in upper brachial plexus defects in rats. APPROACH SKP-SCs were co-cultured with chitosan neural conduits or silk fibres and subjected to decellularization treatment. Ten bundles of silk fibres (five fibres per bundle) were placed into a conduit to obtain the TENG, which was used to bridge an 8 mm gap in the upper brachial plexus. The efficacy of this treatment was examined for TENG-, autograft- and scaffold-treated groups at several times after surgery using immunochemical staining, behavioural tests, electrophysiological measurements, and electron microscopy. MAIN RESULTS Histological analysis conducted two weeks after surgery showed that compared to scaffold bridging, TENG treatment enhanced the growth of regenerating axons. Behavioural tests conducted four weeks after surgery showed that TENG-treated rats performed similarly to autograft-treated ones, with a significant improvement observed in both cases compared with the scaffold treatment group. Electrophysiological and retrograde tracing characterisations revealed that the target muscles were reinnervated in both TENG and autograft groups, while transmission electron microscopy and immunohistochemical staining showed the occurrence of the superior myelination of regenerated axons in these groups. SIGNIFICANCE Treatment with the developed TENG allows the effective bridging of proximal nerve defects in the upper extremities, and the obtained results provide a theoretical basis for clinical transformation to expand the application scope of TENGs.
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Affiliation(s)
- Lili Song
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Qi Guo
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Jin Guo
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Xiong Xu
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Ke Xu
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Yueying Li
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Tuo Yang
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
| | - Xiaosong Gu
- China-Japan Union Hospital of Jilin University, Key Laboratory of Neuroregeneration, Nantong University, Nantong, PR China., Jiangsu Clinical Medicine Center of Tissue Engineering and Nerve Injury Repair, Co-innovation Center of Neuroregeneration, Nantong University, Nantong., Changchun, Jilin, 130031, CHINA
| | - Rangjuan Cao
- China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, 130031, CHINA
| | - Shusen Cui
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Department of Hand Surgery, China-Japan Union Hospital, Jilin University, Changchun, PR China., Changchun, Jilin, 130031, CHINA
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Mathot F, Saffari TM, Rbia N, Nijhuis TH, Bishop AT, Hovius SE, Shin AY. Functional Outcomes of Nerve Allografts Seeded with Undifferentiated and Differentiated Mesenchymal Stem Cells in a Rat Sciatic Nerve Defect Model. Plast Reconstr Surg 2021; 148:354-365. [PMID: 34153019 PMCID: PMC8373640 DOI: 10.1097/prs.0000000000008191] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mesenchymal stem cells have the potential to produce neurotrophic growth factors and establish a supportive microenvironment for neural regeneration. The purpose of this study was to determine the effect of undifferentiated and differentiated mesenchymal stem cells dynamically seeded onto decellularized nerve allografts on functional outcomes when used in peripheral nerve repair. METHODS In 80 Lewis rats, a 10-mm sciatic nerve defect was reconstructed with (1) autograft, (2) decellularized allograft, (3) decellularized allograft seeded with undifferentiated mesenchymal stem cells, or (4) decellularized allograft seeded with mesenchymal stem cells differentiated into Schwann cell-like cells. Nerve regeneration was evaluated over time by cross-sectional tibial muscle ultrasound measurements, and at 12 and 16 weeks by isometric tetanic force measurements, compound muscle action potentials, muscle mass, histology, and immunofluorescence analyses. RESULTS At 12 weeks, undifferentiated mesenchymal stem cells significantly improved isometric tetanic force measurement and compound muscle action potential outcomes compared to decellularized allograft alone, whereas differentiated mesenchymal stem cells significantly improved compound muscle action potential outcomes. The autografts outperformed both stem cell groups histologically at 12 weeks. At 16 weeks, functional outcomes normalized between groups. At both time points, the effect of undifferentiated versus differentiated mesenchymal stem cells was not significantly different. CONCLUSIONS Undifferentiated and differentiated mesenchymal stem cells significantly improved functional outcomes of decellularized allografts at 12 weeks and were similar to autograft results in the majority of measurements. At 16 weeks, outcomes normalized as expected. Although differences between both cell types were not statistically significant, undifferentiated mesenchymal stem cells improved functional outcomes of decellularized nerve allografts to a greater extent and had practical benefits for clinical translation by limiting preparation time and costs.
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Affiliation(s)
- Femke Mathot
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tiam M. Saffari
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nadia Rbia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tim H.J. Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Allen T. Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven E.R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Wu YX, Ma H, Wang JL, Qu W. Production of chitosan scaffolds by lyophilization or electrospinning: which is better for peripheral nerve regeneration? Neural Regen Res 2021; 16:1093-1098. [PMID: 33269755 PMCID: PMC8224144 DOI: 10.4103/1673-5374.300463] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/24/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
Both lyophilization and electrospinning are commonly used to make chitosan scaffolds. However, it remains unknown which method is better for cell growth. In this study, we established the following groups: (1) lyophilization group-chitosan scaffolds were prepared by lyophilization method and seeded with Schwann cells from Sprague-Dawley rats aged 3-5 days; (2) electrospinning group-chitosan scaffolds were prepared by electrospinning method and seeded with Schwann cells; (3) control group-Schwann cells were cultured on culture dishes. The growth of Schwann cells was evaluated by immunofluorescence and scanning electron microscopy. Western blot assay was performed to explore the mechanism of Schwann cell growth. Both materials were non-toxic and suitable for the growth of Schwann cells. The pores produced by electrospinning were much smaller than those produced by lyophilization. The proliferation rate and adhesion rate of Schwann cells in the electrospinning group were higher than those in the lyophilization group. Schwann cells cultured on electrospinning scaffolds formed a Bungner band-like structure, and a much greater amount of brain-derived neurotrophic factor was secreted, which can promote the growth of neurons. Our findings show that the chitosan scaffold prepared by the electrospinning method has a nanofiber structure that provides an extracellular matrix that is more favorable for cell-cell interactions. The electrospinning method is more suitable for nerve regeneration than the lyophilization method. This research was approved by the Medical Ethical Committee of Dalian Medical University (approval No. AEE1-2016-045) on March 3, 2016.
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Affiliation(s)
- Yu-Xuan Wu
- Department of Hand Microsurgery, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Hao Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Lan Wang
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Wei Qu
- Department of Hand Microsurgery, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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Aithal AP, Bairy LK, Seetharam RN. Safety and therapeutic potential of human bone marrow-derived mesenchymal stromal cells in regenerative medicine. Stem Cell Investig 2021; 8:10. [PMID: 34124233 DOI: 10.21037/sci-2020-036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/24/2021] [Indexed: 12/20/2022]
Abstract
Regenerative medicine is considered as an alternative approach to healthcare. Owing to their pluripotent abilities and their relative lack of ethical and legal issues, adult stem cells are considered as optimal candidates for use in the treatment of various diseases. Bone marrow-derived mesenchymal stem cells are among the most promising candidates for clinical applications as they have expressed a higher degree of plasticity in vitro. Many investigators have begun to examine how bone marrow stem cells might be used to rebuild damaged tissues. The systemic administration of cells for therapeutic applications requires efficient migration and homing of cells to the target site. Cell adhesion molecules and their ligands, chemokines, extracellular matrix components and specialized bone marrow niches all participate in the proper regulation of this process. MSCs suppress the pathophysiological process that is mediated by chronic inflammation and contributes to a modification of the microenvironment and tissue regeneration. Due to the intricacy of the mesenchymal stem cell, there is ever-increasing amount of data emerging about their migration and regenerative mechanisms. Many factors influence MSC mobilization and their homing to injured tissues. This review summarizes the current clinical and pre-clinical data available in literature regarding the use of MSC in tissue repair and their prospective therapeutic role in various diseases and the underlying repair mechanisms will be discussed.
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Affiliation(s)
- Ashwini P Aithal
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, India
| | - Laxminarayana K Bairy
- Department of Pharmacology, RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
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Schwann Cell Cultures: Biology, Technology and Therapeutics. Cells 2020; 9:cells9081848. [PMID: 32781699 PMCID: PMC7465416 DOI: 10.3390/cells9081848] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022] Open
Abstract
Schwann cell (SC) cultures from experimental animals and human donors can be prepared using nearly any type of nerve at any stage of maturation to render stage- and patient-specific populations. Methods to isolate, purify, expand in number, and differentiate SCs from adult, postnatal and embryonic sources are efficient and reproducible as these have resulted from accumulated refinements introduced over many decades of work. Albeit some exceptions, SCs can be passaged extensively while maintaining their normal proliferation and differentiation controls. Due to their lineage commitment and strong resistance to tumorigenic transformation, SCs are safe for use in therapeutic approaches in the peripheral and central nervous systems. This review summarizes the evolution of work that led to the robust technologies used today in SC culturing along with the main features of the primary and expanded SCs that make them irreplaceable models to understand SC biology in health and disease. Traditional and emerging approaches in SC culture are discussed in light of their prospective applications. Lastly, some basic assumptions in vitro SC models are identified in an attempt to uncover the combined value of old and new trends in culture protocols and the cellular products that are derived.
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Seyedebrahimi R, Razavi S, Varshosaz J, Vatankhah E, Kazemi M. Beneficial effects of biodelivery of brain-derived neurotrophic factor and gold nanoparticles from functionalized electrospun PLGA scaffold for nerve tissue engineering. J CLUST SCI 2020. [DOI: 10.1007/s10876-020-01822-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Wang H, Jia Y, Li J, Liu Q. Schwann cell‑derived exosomes induce bone marrow‑derived mesenchymal stem cells to express Schwann cell markers in vitro. Mol Med Rep 2020; 21:1640-1646. [PMID: 32016464 DOI: 10.3892/mmr.2020.10960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 11/27/2019] [Indexed: 11/05/2022] Open
Abstract
Following peripheral nerve injury, factors in the local microenvironment can induce the differentiation of bone marrow‑derived mesenchymal stem cells (BMSCs) into Schwann cells; however, the specific factors that participate in this process remain unclear. The present study aimed to investigate the role of Schwann cell‑derived exosomes in the differentiation of BMSCs into Schwann cells. Exosomes were extracted from Schwann cells or fibroblasts and co‑cultured with BMSCs. The morphology, as well as gene and protein expressions of the BMSCs were measured to determine the effect of exosomes on cell differentiation. The levels of Schwann cell‑specific markers in BMSCs were significantly increased by Schwann cell‑derived exosomes compared with untreated BMSCs; however, fibroblast‑derived exosomes did not demonstrate the same effects. In conclusion, Schwann cell‑derived exosomes may be involved in the differentiation of BMSCs into Schwann cells, which may provide a novel target for promoting nerve regeneration following injury.
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Affiliation(s)
- Hui Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101199, P.R. China
| | - Yanjun Jia
- Medical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, P.R. China
| | - Jiamou Li
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, P.R. China
| | - Qingsong Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101199, P.R. China
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Mathot F, Rbia N, Thaler R, Bishop AT, Van Wijnen AJ, Shin AY. Gene expression profiles of differentiated and undifferentiated adipose derived mesenchymal stem cells dynamically seeded onto a processed nerve allograft. Gene 2019; 724:144151. [PMID: 31626959 DOI: 10.1016/j.gene.2019.144151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Differentiation of mesenchymal stem cells (MSCs) into Schwann-like cells onto processed nerve allografts may support peripheral nerve repair. The purpose of this study was to understand the biological characteristics of undifferentiated and differentiated MSCs before and after seeding onto a processed nerve allograft by comparing gene expression profiles. METHODS MSCs from Lewis rats were cultured in maintenance media or differentiated into Schwann-like cells. Both treatment groups were dynamically seeded onto decellularized nerve allografts derived from Sprague-Dawley rats. Gene expression was quantified by quantitative polymerase chain reaction (qPCR) analysis of representative biomarkers, including neurotrophic (GDNF, PTN, GAP43, PMP22), angiogenic (CD31, VEGF1), extracellular matrix (ECM) (COL1A1, COL3A1, FBLN1, LAMB2) or cell cycle (CAPS3, CCBN2) genes. Gene expression values were statistically evaluated using a 2-factor ANOVA with repeated measures. RESULTS Baseline gene expression of undifferentiated and differentiated MSCs was significantly altered upon interaction with processed nerve allografts. Interaction between processed allografts and undifferentiated MSCs enhanced expression of neurotrophic (NGF, GDNF, PMP22), ECM (FBLN1, LAMB2) and regulatory cell cycle genes (CCNB2) during a 7-day time course. Interactions of differentiated MSCs with nerve allografts enhanced expression of neurotrophic (NGF, GDNF, GAP43), angiogenic (VEGF1), ECM (FBLN1) and regulatory cell cycle genes (CASP3, CCNB2) within one week. CONCLUSIONS Dynamic seeding onto processed nerve allografts modulates temporal gene expression profiles of differentiated and undifferentiated MSCs. These changes in gene expressions may support the reparative functions of MSCs in supporting nerve regeneration in different stages of axonal growth.
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Affiliation(s)
- Femke Mathot
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Plastic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Nadia Rbia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roman Thaler
- Department of Biochemistry and Molecular Biology, Mayo Clinic, MN, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andre J Van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, MN, USA.
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Determination of Electrical Stimuli Parameters To Transdifferentiate Genetically Engineered Mesenchymal Stem Cells into Neuronal or Glial Lineages. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019. [DOI: 10.1007/s40883-019-00126-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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The Use and Delivery of Stem Cells in Nerve Regeneration: Preclinical Evidence and Regulatory Considerations. Ann Plast Surg 2019; 80:448-456. [PMID: 29166311 DOI: 10.1097/sap.0000000000001259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Outcomes following peripheral nerve injury remain poor despite the regenerative capacity displayed by the peripheral nervous system. Current therapies are limited and do not provide satisfactory functional recovery in a multitude of cases. Biomaterials have decreased the need for nerve autograft across small nerve gaps in small-caliber nerves, but the lack of a cellular substrate presents a limiting factor to the effectiveness of this therapy. Schwann cells are the supportive cells in the peripheral nervous system and play an integral role in the physiological response and regeneration following nerve injury. Limitations to autologous Schwann cells include donor site morbidity during harvesting, limited expansion capability, and finite source. Stem cells are multipotent or pluripotent cells with self-renewing capabilities that show promise to improve functional recovery following nerve injury. Differentiation of stem cells into supportive Schwann cells could provide additional trophic support without the disadvantages of autologous Schwann cells, providing an avenue to improve existing therapies. A variety of stem cells have been evaluated in animal models for this clinical application; the current options, along with their clinical feasibility, are summarized in this article.
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Rink S, Bendella H, Akkin SM, Manthou M, Grosheva M, Angelov DN. Experimental Studies on Facial Nerve Regeneration. Anat Rec (Hoboken) 2019; 302:1287-1303. [DOI: 10.1002/ar.24123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral MedicineUniversity of Cologne Cologne Germany
| | - Habib Bendella
- Department of NeurosurgeryUniversity of Witten/Herdecke, Cologne Merheim Medical Center (CMMC) Cologne Germany
| | - Salih Murat Akkin
- Department of Anatomy, School of MedicineSANKO University Gaziantep Turkey
| | - Marilena Manthou
- Department of Histology and EmbryologyAristotle University Thessaloniki Thessaloniki Greece
| | - Maria Grosheva
- Department of Oto‐Rhino‐LaryngologyUniversity of Cologne Cologne Germany
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Mathot F, Shin AY, Van Wijnen AJ. Targeted stimulation of MSCs in peripheral nerve repair. Gene 2019; 710:17-23. [PMID: 30849542 DOI: 10.1016/j.gene.2019.02.078] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 02/08/2023]
Abstract
Mesenchymal stem cells (MSCs) have considerable translational potential in a wide variety of clinical disciplines and are the cellular foundation of individualized treatments of auto-immune, cardiac, neurologic and musculoskeletal diseases and disorders. While the cellular mechanisms by which MSCs exert their biological effects remain to be ascertained, it has been hypothesized that MSCs are supportive of local tissue repair through secretion of essential growth factors. Therapeutic applications of MSCs in peripheral nerve repair have recently been reported. This review focuses on how MSCs can promote nerve regeneration by conversion into Schwann-like cells, and discusses differentiation methods including delivery and dosing of naive or differentiated MSCs, as well as in vitro and in vivo outcomes. While MSC-based therapies for nerve repair are still in early stages of development, current progress in the field provides encouragement that MSCs may have utility in the treatment of patients with peripheral nerve injury.
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Affiliation(s)
- Femke Mathot
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Plastic Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andre J Van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, MN, USA.
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Uz M, Donta M, Mededovic M, Sakaguchi DS, Mallapragada SK. Development of Gelatin and Graphene-Based Nerve Regeneration Conduits Using Three-Dimensional (3D) Printing Strategies for Electrical Transdifferentiation of Mesenchymal Stem Cells. Ind Eng Chem Res 2019. [DOI: 10.1021/acs.iecr.8b05537] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Metin Uz
- Chemical and Biological Engineering, Iowa State University, Ames, Iowa 50011-2230, United States
| | - Maxsam Donta
- Chemical and Biological Engineering, Iowa State University, Ames, Iowa 50011-2230, United States
| | - Meryem Mededovic
- Chemical and Biological Engineering, Iowa State University, Ames, Iowa 50011-2230, United States
| | - Donald S. Sakaguchi
- Genetics, Development and Cell Biology, Iowa State University, Ames, Iowa 50011-1079, United States
| | - Surya K. Mallapragada
- Chemical and Biological Engineering, Iowa State University, Ames, Iowa 50011-2230, United States
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Qiao W, Lu L, Wu G, An X, Li D, Guo J. DPSCs seeded in acellular nerve grafts processed by Myroilysin improve nerve regeneration. J Biomater Appl 2018; 33:819-833. [PMID: 30449254 DOI: 10.1177/0885328218812136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Since synthetic nerve conduits do not exhibit ideal regeneration characteristics, they are generally inadequate substitutes for autologous nerve grafts in the repair of long peripheral nerve defects. To resolve this problem, in this study, a nerve regeneration acellular nerve graft (ANG) with homologous dental pulp stem cells (DPSCs) was constructed. Xenogeneic ANG was processed by Myroilysin to completely remove cells and myelin sheath, while preserving extracellular matrix (ECM) microstructure of the natural nerve. The study revealed that ANG could support cell attachment and proliferation and did not stimulate a vigorous host rejection response. After inoculation of rabbit DPSCs (r-DPSCs) onto ANG, cells were observed to align along the longitudinal axis of the acellular nerve matrix (ANM) and persistently express NGF and BDNF. Undifferentiated r-DPSCs also presented glial cell characteristics and promoted nerve regeneration after transplantation in vivo. We repaired 1 cm purebred New Zealand White Rabbits sciatic nerve defects using this nerve graft construction, and nerve gap regeneration was indicated by electrophysiological and histological analysis. Therefore, we conclude that the combination of an ANG processed by Myroilysin with DPSCs providing a microenvironment that increases nerve regeneration for repairing peripheral nerve defects.
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Affiliation(s)
- Wenlan Qiao
- Department of Orthodontics, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, PR China
- Department of Stomatology, Qilu Hospital, and Institute of Stomatology, Shandong University, Jinan, PR China
| | - Lu Lu
- Department of Orthodontics, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, PR China
| | - Guangxue Wu
- Department of Orthodontics, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, PR China
| | - Xianglian An
- Department of Stomatology, Qilu Hospital, and Institute of Stomatology, Shandong University, Jinan, PR China
| | - Dong Li
- Department of Cryomedicine Lab, Qilu Hospital of Shandong University, Jinan, PR China
| | - Jing Guo
- Department of Orthodontics, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Jinan, PR China
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Hou B, Ye Z, Ji W, Cai M, Ling C, Chen C, Guo Y. Comparison of the Effects of BMSC-derived Schwann Cells and Autologous Schwann Cells on Remyelination Using a Rat Sciatic Nerve Defect Model. Int J Biol Sci 2018; 14:1910-1922. [PMID: 30443194 PMCID: PMC6231219 DOI: 10.7150/ijbs.26765] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/08/2018] [Indexed: 12/13/2022] Open
Abstract
Schwann cells (SCs) are primarily responsible for the formation of myelin sheaths, yet bone marrow mesenchymal stem cell (BMSC)-derived SCs are often used to replace autologous SCs and assist with the repair of peripheral nerve myelin sheaths. In this study, the effects of the two cell types on remyelination were compared during the repair of peripheral nerves. Methods: An acellular nerve scaffold was prepared using the extraction technique. Rat BMSCs and autologous SCs were extracted. BMSCs were induced to differentiate into BMSC-derived SCs (B-dSCs) in vitro. Seed cells (BMSCs, B-dSCs, and autologous SCs) were cocultured with nerve scaffolds (Sca) in vitro. Rats with severed sciatic nerves were used as the animal model. A composite scaffold was used to bridge the broken ends. After surgery, electrophysiology, cell tracking analyses (EdU labeling), immunofluorescence staining (myelin basic protein (MBP)), toluidine blue staining, and transmission electron microscopy were conducted to compare remyelination between the various groups and to evaluate the effects of the seed cells on myelination. One week after transplantation, only a small number of B-dSCs expressed MBP, which was far less than the proportion of MBP-expressing autologous SCs (P<0.01) but was higher than the proportion of BMSCs expressing MBP (P<0.05). Four weeks after surgery, the electrophysiology results (latency time, conductive velocity and amplitude) and various quantitative indicators of remyelination (thickness, distribution, and the number of myelinated fibers) showed that the Sca+B-dSC group was inferior to the Sca+autologous SC group (P<0.05) but was superior to the Sca+BMSC group (P<0.05). Conclusions: Within 4 weeks after surgery, the use of an acellular nerve scaffold combined with B-dSCs promotes remyelination to a certain extent, but the effect is significantly less than that of the scaffold combined with autologous SCs.
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Affiliation(s)
- Bo Hou
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Zhuopeng Ye
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Wanqing Ji
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, 510623, China
| | - Meiqin Cai
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Cong Ling
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Chuan Chen
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Ying Guo
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
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18
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Uz M, Das SR, Ding S, Sakaguchi DS, Claussen JC, Mallapragada SK. Advances in Controlling Differentiation of Adult Stem Cells for Peripheral Nerve Regeneration. Adv Healthc Mater 2018; 7:e1701046. [PMID: 29656561 DOI: 10.1002/adhm.201701046] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 01/08/2018] [Indexed: 01/01/2023]
Abstract
Adult stems cells, possessing the ability to grow, migrate, proliferate, and transdifferentiate into various specific phenotypes, constitute a great asset for peripheral nerve regeneration. Adult stem cells' ability to undergo transdifferentiation is sensitive to various cell-to-cell interactions and external stimuli involving interactions with physical, mechanical, and chemical cues within their microenvironment. Various studies have employed different techniques for transdifferentiating adult stem cells from distinct sources into specific lineages (e.g., glial cells and neurons). These techniques include chemical and/or electrical induction as well as cell-to-cell interactions via co-culture along with the use of various 3D conduit/scaffold designs. Such scaffolds consist of unique materials that possess controllable physical/mechanical properties mimicking cells' natural extracellular matrix. However, current limitations regarding non-scalable transdifferentiation protocols, fate commitment of transdifferentiated stem cells, and conduit/scaffold design have required new strategies for effective stem cells transdifferentiation and implantation. In this progress report, a comprehensive review of recent advances in the transdifferentiation of adult stem cells via different approaches along with multifunctional conduit/scaffolds designs is presented for peripheral nerve regeneration. Potential cellular mechanisms and signaling pathways associated with differentiation are also included. The discussion with current challenges in the field and an outlook toward future research directions is concluded.
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Affiliation(s)
- Metin Uz
- Department of Chemical and Biological Engineering Iowa State University Ames IA 50011 USA
| | - Suprem R. Das
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
- Division of Materials Science and Engineering Ames Laboratory Ames IA 50011 USA
| | - Shaowei Ding
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
| | - Donald S. Sakaguchi
- Neuroscience Program Iowa State University Ames IA 50011 USA
- Department of Genetics Development and Cell Biology Iowa State University Ames IA 50011 USA
| | - Jonathan C. Claussen
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
- Division of Materials Science and Engineering Ames Laboratory Ames IA 50011 USA
| | - Surya K. Mallapragada
- Department of Chemical and Biological Engineering Iowa State University Ames IA 50011 USA
- Department of Genetics Development and Cell Biology Iowa State University Ames IA 50011 USA
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Tsui YP, Shea GK, Chan YS, Shum DKY. Derivation of Fate-Committed Schwann Cells from Bone Marrow Stromal Cells of Adult Rats. Methods Mol Biol 2018; 1739:137-148. [PMID: 29546705 DOI: 10.1007/978-1-4939-7649-2_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Our goal is to derive phenotypically stable Schwann cells from bone marrow stromal cells (BMSCs) for use in transplantation studies of central/peripheral nerve injuries. With the adult rat as model, here we describe steps that foster (1) expansion of the BMSC subpopulation of neural progenitors as neurosphere cells, (2) differentiation of the progenitors into Schwann cell-like cells in adherent culture supplemented with soluble factors, and (3) cell-intrinsic switch of Schwann cell-like cells to the Schwann cell fate following co-culture with sensory neurons purified from dorsal root ganglia. The derived Schwann cells retain marker expression despite withdrawal of supplements and neuronal cues, survive passaging and cryopreservation, and, importantly, show functional capacity for myelination.
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Affiliation(s)
- Y P Tsui
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Graham K Shea
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Y S Chan
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Daisy K Y Shum
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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20
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Eyuboglu AA, Uysal CA, Ozgun G, Coskun E, Markal Ertas N, Haberal M. The effect of adipose derived stromal vascular fraction on stasis zone in an experimental burn model. Burns 2018; 44:386-396. [DOI: 10.1016/j.burns.2017.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 01/02/2023]
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21
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Su CF, Chang LH, Kao CY, Lee DC, Cho KH, Kuo LW, Chang H, Wang YH, Chiu IM. Application of amniotic fluid stem cells in repairing sciatic nerve injury in minipigs. Brain Res 2018; 1678:397-406. [DOI: 10.1016/j.brainres.2017.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/23/2017] [Accepted: 11/12/2017] [Indexed: 01/10/2023]
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22
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Gonzalez-Perez F, Hernández J, Heimann C, Phillips JB, Udina E, Navarro X. Schwann cells and mesenchymal stem cells in laminin- or fibronectin-aligned matrices and regeneration across a critical size defect of 15 mm in the rat sciatic nerve. J Neurosurg Spine 2018; 28:109-118. [DOI: 10.3171/2017.5.spine161100] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVEArtificial nerve guides are being developed to substitute for autograft repair after peripheral nerve injuries. However, the use of conduits is limited by the length of the gap that needs to be bridged, with the success of regeneration highly compromised in long gaps. Addition of aligned proregenerative cells and extracellular matrix (ECM) components inside the conduit can be a good strategy to achieve artificial grafts that recreate the natural environment offered by a nerve graft. The purpose of this study was to functionalize chitosan devices with different cell types to support regeneration in limiting gaps in the rat peripheral nerve.METHODSThe authors used chitosan devices combined with proteins of the ECM and cells in a rat model of sciatic nerve injury. Combinations of fibronectin and laminin with mesenchymal stem cells (MSCs) or Schwann cells (SCs) were aligned within tethered collagen-based gels, which were placed inside chitosan tubes that were then used to repair a critical-size gap of 15 mm in the rat sciatic nerve. Electrophysiology and algesimetry tests were performed to analyze functional recovery during the 4 months after injury and repair. Histological analysis was performed at the midlevel and distal level of the tubes to assess the number of regenerated myelinated fibers.RESULTSFunctional analysis demonstrated that SC-aligned scaffolds resulted in 100% regeneration success in a 15-mm nerve defect in this rat model. In contrast, animals that underwent repair with MSC-aligned constructs had only 90% regeneration success, and those implanted with acellular bridges had only 75% regeneration success.CONCLUSIONSThese results indicate that the combination of chitosan conduits with ECM-enriched cellular gels represents a good alternative to the use of autografts for repairing long nerve gaps.
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Affiliation(s)
- Francisco Gonzalez-Perez
- 1Institute of Neurosciences and Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Joaquim Hernández
- 1Institute of Neurosciences and Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | | | - James B. Phillips
- 3Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, United Kingdom
| | - Esther Udina
- 1Institute of Neurosciences and Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Xavier Navarro
- 1Institute of Neurosciences and Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma de Barcelona, and CIBERNED, Bellaterra, Spain
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23
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Evaristo-Mendonça F, Carrier-Ruiz A, de Siqueira-Santos R, Campos RMP, Rangel B, Kasai-Brunswick TH, Ribeiro-Resende VT. Dual Contribution of Mesenchymal Stem Cells Employed for Tissue Engineering of Peripheral Nerves: Trophic Activity and Differentiation into Connective-Tissue Cells. Stem Cell Rev Rep 2017; 14:200-212. [DOI: 10.1007/s12015-017-9786-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Evaluation of PBS Treatment and PEI Coating Effects on Surface Morphology and Cellular Response of 3D-Printed Alginate Scaffolds. J Funct Biomater 2017; 8:jfb8040048. [PMID: 29104215 PMCID: PMC5748555 DOI: 10.3390/jfb8040048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/10/2017] [Accepted: 10/28/2017] [Indexed: 12/20/2022] Open
Abstract
Three-dimensional (3D) printing is an emerging technology for the fabrication of scaffolds to repair/replace damaged tissue/organs in tissue engineering. This paper presents our study on 3D printed alginate scaffolds treated with phosphate buffered saline (PBS) and polyethyleneimine (PEI) coating and their impacts on the surface morphology and cellular response of the printed scaffolds. In our study, sterile alginate was prepared by means of the freeze-drying method and then, used to prepare the hydrogel for 3D printing into calcium chloride, forming 3D scaffolds. Scaffolds were treated with PBS for a time period of two days and seven days, respectively, and PEI coating; then they were seeded with Schwann cells (RSC96) for the examination of cellular response (proliferation and differentiation). In addition, swelling and stiffness (Young’s modulus) of the treated scaffolds was evaluated, while their surface morphology was assessed using scanning electron microscopy (SEM). SEM images revealed significant changes in scaffold surface morphology due to degradation caused by the PBS treatment over time. Our cell proliferation assessment over seven days showed that a two-day PBS treatment could be more effective than seven-day PBS treatment for improving cell attachment and elongation. While PEI coating of alginate scaffolds seemed to contribute to cell growth, Schwann cells stayed round on the surface of alginate over the period of cell culture. In conclusion, PBS-treatment may offer the potential to induce surface physical cues due to degradation of alginate, which could improve cell attachment post cell-seeding of 3D-printed alginate scaffolds.
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25
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Repairing sciatic nerve injury with an EPO-loaded nerve conduit and sandwiched-in strategy of transplanting mesenchymal stem cells. Biomaterials 2017; 142:90-100. [DOI: 10.1016/j.biomaterials.2017.06.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 12/14/2022]
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26
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27
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Bierlein De la Rosa M, Sharma AD, Mallapragada SK, Sakaguchi DS. Transdifferentiation of brain-derived neurotrophic factor (BDNF)-secreting mesenchymal stem cells significantly enhance BDNF secretion and Schwann cell marker proteins. J Biosci Bioeng 2017; 124:572-582. [PMID: 28694020 DOI: 10.1016/j.jbiosc.2017.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 01/03/2023]
Abstract
The use of genetically modified mesenchymal stem cells (MSCs) is a rapidly growing area of research targeting delivery of therapeutic factors for neuro-repair. Cells can be programmed to hypersecrete various growth/trophic factors such as brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and nerve growth factor (NGF) to promote regenerative neurite outgrowth. In addition to genetic modifications, MSCs can be subjected to transdifferentiation protocols to generate neural cell types to physically and biologically support nerve regeneration. In this study, we have taken a novel approach by combining these two unique strategies and evaluated the impact of transdifferentiating genetically modified MSCs into a Schwann cell-like phenotype. After 8 days in transdifferentiation media, approximately 30-50% of transdifferentiated BDNF-secreting cells immunolabeled for Schwann cell markers such as S100β, S100, and p75NTR. An enhancement was observed 20 days after inducing transdifferentiation with minimal decreases in expression levels. BDNF production was quantified by ELISA, and its biological activity tested via the PC12-TrkB cell assay. Importantly, the bioactivity of secreted BDNF was verified by the increased neurite outgrowth of PC12-TrkB cells. These findings demonstrate that not only is BDNF actively secreted by the transdifferentiated BDNF-MSCs, but also that it has the capacity to promote neurite sprouting and regeneration. Given the fact that BDNF production remained stable for over 20 days, we believe that these cells have the capacity to produce sustainable, effective, BDNF concentrations over prolonged time periods and should be tested within an in vivo system for future experiments.
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Affiliation(s)
- Metzere Bierlein De la Rosa
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
| | - Anup D Sharma
- Department of Chemical and Biological Engineering, Iowa State University, Ames, IA 50011, USA; Neuroscience Program, Iowa State University, Ames, IA 50011, USA
| | - Surya K Mallapragada
- Department of Chemical and Biological Engineering, Iowa State University, Ames, IA 50011, USA; Neuroscience Program, Iowa State University, Ames, IA 50011, USA
| | - Donald S Sakaguchi
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA; Department of Genetics, Development and Cell Biology, Iowa State University, Ames, IA 50011, USA; Neuroscience Program, Iowa State University, Ames, IA 50011, USA.
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28
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Gelatin-based 3D conduits for transdifferentiation of mesenchymal stem cells into Schwann cell-like phenotypes. Acta Biomater 2017; 53:293-306. [PMID: 28213098 DOI: 10.1016/j.actbio.2017.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/08/2017] [Accepted: 02/11/2017] [Indexed: 01/02/2023]
Abstract
In this study, gelatin-based 3D conduits with three different microstructures (nanofibrous, macroporous and ladder-like) were fabricated for the first time via combined molding and thermally induced phase separation (TIPS) technique for peripheral nerve regeneration. The effects of conduit microstructure and mechanical properties on the transdifferentiation of bone marrow-derived mesenchymal stem cells (MSCs) into Schwann cell (SC) like phenotypes were examined to help facilitate neuroregeneration and understand material-cell interfaces. Results indicated that 3D macroporous and ladder-like structures enhanced MSC attachment, proliferation and spreading, creating interconnected cellular networks with large numbers of viable cells compared to nanofibrous and 2D-tissue culture plate counterparts. 3D-ladder-like conduit structure with complex modulus of ∼0.4×106Pa and pore size of ∼150μm provided the most favorable microenvironment for MSC transdifferentiation leading to ∼85% immunolabeling of all SC markers. On the other hand, the macroporous conduits with complex modulus of ∼4×106Pa and pore size of ∼100μm showed slightly lower (∼65% for p75, ∼75% for S100 and ∼85% for S100β markers) immunolabeling. Transdifferentiated MSCs within 3D-ladder-like conduits secreted significant amounts (∼2.5pg/mL NGF and ∼0.7pg/mL GDNF per cell) of neurotrophic factors, while MSCs in macroporous conduits released slightly lower (∼1.5pg/mL NGF and 0.7pg/mL GDNF per cell) levels. PC12 cells displayed enhanced neurite outgrowth in media conditioned by conduits with transdifferentiated MSCs. Overall, conduits with macroporous and ladder-like 3D structures are promising platforms in transdifferentiation of MSCs for neuroregeneration and should be further tested in vivo. STATEMENT OF SIGNIFICANCE This manuscript focuses on the effect of microstructure and mechanical properties of gelatin-based 3D conduits on the transdifferentiation of mesenchymal stem cells to Schwann cell-like phenotypes. This work builds on our recently accepted manuscript in Acta Biomaterialia focused on multifunctional 2D films, and focuses on 3D microstructured conduits designed to overcome limitations of current strategies to facilitate peripheral nerve regeneration. The comparison between conduits fabricated with nanofibrous, macroporous and ladder-like microstructures showed that the ladder-like conduits showed the most favorable environment for MSC transdifferentiation to Schwann-cell like phenotypes, as seen by both immunolabeling as well as secretion of neurotrophic factors. This work demonstrates the importance of controlling the 3D microstructure to facilitate tissue engineering strategies involving stem cells that can serve as promising approaches for peripheral nerve regeneration.
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29
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Das SR, Uz M, Ding S, Lentner MT, Hondred JA, Cargill AA, Sakaguchi DS, Mallapragada S, Claussen JC. Electrical Differentiation of Mesenchymal Stem Cells into Schwann-Cell-Like Phenotypes Using Inkjet-Printed Graphene Circuits. Adv Healthc Mater 2017; 6. [PMID: 28218474 DOI: 10.1002/adhm.201601087] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/22/2016] [Indexed: 01/05/2023]
Abstract
Graphene-based materials (GBMs) have displayed tremendous promise for use as neurointerfacial substrates as they enable favorable adhesion, growth, proliferation, spreading, and migration of immobilized cells. This study reports the first case of the differentiation of mesenchymal stem cells (MSCs) into Schwann cell (SC)-like phenotypes through the application of electrical stimuli from a graphene-based electrode. Electrical differentiation of MSCs into SC-like phenotypes is carried out on a flexible, inkjet-printed graphene interdigitated electrode (IDE) circuit that is made highly conductive (sheet resistance < 1 kΩ/sq) via a postprint pulse-laser annealing process. MSCs immobilized on the graphene printed IDEs and electrically stimulated/treated (etMSCs) display significant enhanced cellular differentiation and paracrine activity above conventional chemical treatment strategies [≈85% of the etMSCs differentiated into SC-like phenotypes with ≈80 ng mL-1 of nerve growth factor (NGF) secretion vs. 75% and ≈55 ng mL-1 for chemically treated MSCs (ctMSCs)]. These results help pave the way for in vivo peripheral nerve regeneration where the flexible graphene electrodes could conform to the injury site and provide intimate electrical simulation for nerve cell regrowth.
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Affiliation(s)
- Suprem R. Das
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
- Division of Materials Science and Engineering Ames Laboratory Department of Energy Ames IA 50011 USA
| | - Metin Uz
- Department of Chemical and Biological Engineering Iowa State University Ames IA 50011 USA
| | - Shaowei Ding
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
| | - Matthew T. Lentner
- Department of Chemical and Biological Engineering Iowa State University Ames IA 50011 USA
| | - John A. Hondred
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
| | - Allison A. Cargill
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
| | - Donald S. Sakaguchi
- Neuroscience Program Iowa State University Ames IA 50011 USA
- Department of Genetics Development and Cell Biology Iowa State University Ames IA 50011 USA
| | - Surya Mallapragada
- Division of Materials Science and Engineering Ames Laboratory Department of Energy Ames IA 50011 USA
- Department of Chemical and Biological Engineering Iowa State University Ames IA 50011 USA
| | - Jonathan C. Claussen
- Department of Mechanical Engineering Iowa State University Ames IA 50011 USA
- Division of Materials Science and Engineering Ames Laboratory Department of Energy Ames IA 50011 USA
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30
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Bunge MB, Monje PV, Khan A, Wood PM. From transplanting Schwann cells in experimental rat spinal cord injury to their transplantation into human injured spinal cord in clinical trials. PROGRESS IN BRAIN RESEARCH 2017; 231:107-133. [PMID: 28554394 DOI: 10.1016/bs.pbr.2016.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Among the potential therapies designed to repair the injured spinal cord is cell transplantation, notably the use of autologous adult human Schwann cells (SCs). Here, we detail some of the critical research accomplished over the last four decades to establish a foundation that enables these cells to be tested in clinical trials. New culture systems allowed novel information to be gained about SCs, including discovering ways to stimulate their proliferation to acquire adequately large numbers for transplantation into the injured human spinal cord. Transplantation of rat SCs into rat models of spinal cord injury has demonstrated that SCs promote repair of injured spinal cord. Additional work required to gain approval from the Food and Drug Administration for the first SC trial in the Miami Project is disclosed. This trial and a second one now underway are described.
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Affiliation(s)
- Mary B Bunge
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Department of Cell Biology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.
| | - Paula V Monje
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Aisha Khan
- The Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Patrick M Wood
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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31
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Li Y, Xu W, Cheng LY. Adipose-derived mesenchymal stem cells accelerate nerve regeneration and functional recovery in a rat model of recurrent laryngeal nerve injury. Neural Regen Res 2017; 12:1544-1550. [PMID: 29090002 PMCID: PMC5649477 DOI: 10.4103/1673-5374.215267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Medialization thyroplasty or injection laryngoplasty for unilateral vocal fold paralysis cannot restore mobility of the vocal fold. Recent studies have shown that transplantation of mesenchymal stem cells is effective in the repair of nerve injuries. This study investigated whether adipose-derived stem cell transplantation could repair recurrent laryngeal nerve injury. Rat models of recurrent laryngeal nerve injury were established by crushing with micro forceps. Adipose-derived mesenchymal stem cells (ADSCs; 8 × 105) or differentiated Schwann-like adipose-derived mesenchymal stem cells (dADSCs; 8 × 105) or extracellular matrix were injected at the site of injury. At 2, 4 and 6 weeks post-surgery, a higher density of myelinated nerve fiber, thicker myelin sheath, improved vocal fold movement, better recovery of nerve conduction capacity and reduced thyroarytenoid muscle atrophy were found in ADSCs and dADSCs groups compared with the extracellular matrix group. The effects were more pronounced in the ADSCs group than in the dADSCs group. These experimental results indicated that ADSCs transplantation could be an early interventional strategy to promote regeneration after recurrent laryngeal nerve injury.
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Affiliation(s)
- Yun Li
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otorhinolaryngology-Head Neck Surgery, Ministry of Education, Beijing, China
| | - Wen Xu
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otorhinolaryngology-Head Neck Surgery, Ministry of Education, Beijing, China
| | - Li-Yu Cheng
- Department of Otorhinolaryngology-Head Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otorhinolaryngology-Head Neck Surgery, Ministry of Education, Beijing, China
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Panagopoulos GN, Megaloikonomos PD, Mavrogenis AF. The Present and Future for Peripheral Nerve Regeneration. Orthopedics 2017; 40:e141-e156. [PMID: 27783836 DOI: 10.3928/01477447-20161019-01] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023]
Abstract
Peripheral nerve injury can have a potentially devastating impact on a patient's quality of life, resulting in severe disability with substantial social and personal cost. Refined microsurgical techniques, advances in peripheral nerve topography, and a better understanding of the pathophysiology and molecular basis of nerve injury have all led to a decisive leap forward in the field of translational neurophysiology. Nerve repair, nerve grafting, and nerve transfers have improved significantly with consistently better functional outcomes. Direct nerve repair with epineural microsutures is still the surgical treatment of choice when a tension-free coaptation in a well-vascularized bed can be achieved. In the presence of a significant gap (>2-3 cm) between the proximal and distal nerve stumps, primary end-to-end nerve repair often is not possible; in these cases, nerve grafting is the treatment of choice. Indications for nerve transfer include brachial plexus injuries, especially avulsion type, with long distance from target motor end plates, delayed presentation, segmental loss of nerve function, and broad zone of injury with dense scarring. Current experimental research in peripheral nerve regeneration aims to accelerate the process of regeneration using pharmacologic agents, bioengineering of sophisticated nerve conduits, pluripotent stem cells, and gene therapy. Several small molecules, peptides, hormones, neurotoxins, and growth factors have been studied to improve and accelerate nerve repair and regeneration by reducing neuronal death and promoting axonal outgrowth. Targeting specific steps in molecular pathways also allows for purposeful pharmacologic intervention, potentially leading to a better functional recovery after nerve injury. This article summarizes the principles of nerve repair and the current concepts of peripheral nerve regeneration research, as well as future perspectives. [Orthopedics. 2017; 40(1):e141-e156.].
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Ataman MG, Uysal CA, Ertas NM, Bayraktar N, Terzi A, Borman H. The effect of adipose stromal vascular fraction on transverse rectus abdominis musculocutaneous flap: an experimental study. J Plast Surg Hand Surg 2016; 50:272-80. [PMID: 27010192 DOI: 10.3109/2000656x.2016.1159217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the options in reconstruction after breast cancer surgery for breast reconstruction. Tissue necrosis often occurs in the third and fourth perfusion zones of the flap. A study was planned to find out the effects of adipose stromal vascular fraction (SVF) cells on viability of TRAM flap and the experimental model was designed to be applicable in clinical practice. METHODS Right inferior epigastric artery pedicled, 5 × 2.5 cm sized TRAM flap was used as a flap model in 30 rats in three groups (group 1: sham; group 2: phosphate-buffered saline (PBS); group 3: SVF cell injected). The viability of the flaps were assessed on the postoperative 7th day with photographs and software for the calculations. RESULTS The mean viable flap percentage to total flap area was recorded as 51.8% ± 11.19, 49.5% ± 10.30, 82.3% ± 9.56, in group 1, group 2, and group 3, respectively (p < 0.05). The mean capillary density was noted as 5.15 ± 0.56, 4.37 ± 0.58, and 12.40 ± 1.17 in groups 1, 2, and 3, respectively (p < 0.05). The fibrosis gradient indicated no difference between the groups (p > 0.05). The in-vivo differentiation of SVF cells to endothelial cells was noted. The blood VEGF levels showed a marked increase in the experimental group (p < 0.05). CONCLUSION The adipose SVF cells were found out to improve the TRAM flap viability and decrease necrosis, especially in zone 3 and 4.
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Affiliation(s)
- Murat Gorkem Ataman
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Cagri A Uysal
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Nilgun Markal Ertas
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Nilufer Bayraktar
- b Department of Biochemistry , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Aysen Terzi
- c Department of Pathology , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Huseyin Borman
- a Department of Plastic, Reconstructive Surgery , Baskent University Faculty of Medicine , Ankara , Turkey
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Batioglu-Karaaltin A, Karaaltin MV, Oztel ON, Ovali E, Sener BM, Adatepe T, Yigit O, Bozkurt E, Baydar SY, Bagirova M, Uzun N, Allahverdiyev A. Human olfactory stem cells for injured facial nerve reconstruction in a rat model. Head Neck 2016; 38 Suppl 1:E2011-20. [PMID: 26829770 DOI: 10.1002/hed.24371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to show the efficacy of olfactory stem cells for injured facial nerve reconstruction in a rat model. METHODS Olfactory stem cells were isolated from the olfactory mucosa of human participants. A 2-mm excision was performed on the right facial nerve of all rats. Reconstruction was performed with a conduit in group 1 (n = 9); a conduit and phosphate-buffered saline in group 2 (n = 9); and a conduit and labeled olfactory stem cell in group 3 (n = 9). Rats were followed for whisker movements and electroneuronography (ENoG) analyses. RESULTS The whisker-movement scores for group 3 were significantly different from other groups (p < .001). ENoG showed that the amplitude values for group 3 were significantly different from group 1 and group 2 (p = .030; p < .001). Group 3 showed marked olfactory stem cell under a fluorescence microscope. CONCLUSION This study suggests that olfactory stem cells may be used as a potent cellular therapy for accelerating the regeneration of peripheral nerve injuries. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2011-E2020, 2016.
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Affiliation(s)
- Aysegul Batioglu-Karaaltin
- Department of Otolaryngology, Head and Neck Surgery, Istanbul University Cerrahpasa Medicine Faculty, Istanbul, Turkey
| | - Mehmet Veli Karaaltin
- Department of Plastic and Reconstructive Surgery, Acibadem University Medicine Faculty, Istanbul, Turkey
| | - Olga Nehir Oztel
- Bioengineering Department, Yildiz Technical University, Faculty of Chemistry and Metallurgical Engineering, Istanbul, Turkey
| | | | - Belit Merve Sener
- Department of Otolaryngology, Head and Neck Surgery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Turgut Adatepe
- EMG Laboratories, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Ozgur Yigit
- Department of Otolaryngology, Head and Neck Surgery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Erol Bozkurt
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Serap Yesilkir Baydar
- Bioengineering Department, Yildiz Technical University, Faculty of Chemistry and Metallurgical Engineering, Istanbul, Turkey
| | - Melahat Bagirova
- Bioengineering Department, Yildiz Technical University, Faculty of Chemistry and Metallurgical Engineering, Istanbul, Turkey
| | - Nurten Uzun
- Department of Neurology, Istanbul University Cerrahpasa Medicine Faculty, Istanbul, Turkey
| | - Adil Allahverdiyev
- Bioengineering Department, Yildiz Technical University, Faculty of Chemistry and Metallurgical Engineering, Istanbul, Turkey
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PERIPHERAL NERVE REGENERATION: CELL THERAPY AND NEUROTROPHIC FACTORS. Rev Bras Ortop 2015; 46:643-9. [PMID: 27027067 PMCID: PMC4799329 DOI: 10.1016/s2255-4971(15)30319-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 06/16/2011] [Indexed: 12/25/2022] Open
Abstract
Peripheral nerve trauma results in functional loss in the innervated organ, and recovery without surgical intervention is rare. Many surgical techniques can be used for nerve repair. Among these, the tubulization technique can be highlighted: this allows regenerative factors to be introduced into the chamber. Cell therapy and tissue engineering have arisen as an alternative for stimulating and aiding peripheral nerve regeneration. Therefore, the aim of this review was to provide a survey and analysis on the results from experimental and clinical studies that used cell therapy and tissue engineering as tools for optimizing the regeneration process. The articles used came from the LILACS, Medline and SciELO scientific databases. Articles on the use of stem cells, Schwann cells, growth factors, collagen, laminin and platelet-rich plasma for peripheral nerve repair were summarized over the course of the review. Based on these studies, it could be concluded that the use of stem cells derived from different sources presents promising results relating to nerve regeneration, because these cells have a capacity for neuronal differentiation, thus demonstrating effective functional results. The use of tubes containing bioactive elements with controlled release also optimizes the nerve repair, thus promoting greater myelination and axonal growth of peripheral nerves. Another promising treatment is the use of platelet-rich plasma, which not only releases growth factors that are important in nerve repair, but also serves as a carrier for exogenous factors, thereby stimulating the proliferation of specific cells for peripheral nerve repair.
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Repair and regeneration of lumbosacral nerve defects in rats with chitosan conduits containing bone marrow mesenchymal stem cells. Injury 2015; 46:2156-63. [PMID: 26429103 DOI: 10.1016/j.injury.2015.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Despite the great progress in surgical treatment of lumbosacral nerve injuries caused by high-energy trauma, functional recovery remains poor and insufficient. Bone marrow mesenchymal stem cells (BMSCs), which express neurotrophic factors and can also differentiate into nerve cells, have potential as an effective alternative therapy for lumbosacral nerve defects. The aim of the present study was to evaluate the functional recovery, nerve regeneration, motor neuron survival and apoptosis after lumbosacral nerve transection in rats receiving BMSC transplantation into the chitosan conduit. METHODS The right L4-L6 nerve roots of rats were transected and bridged with three 1-cm-long chitosan conduits, which were further injected with the BMSCs (MSC-treated group) or culture medium (DMEM group). The nerve regeneration and motor function recovery were assessed by the sciatic functional index (SFI) and analysed electrophysiologically and morphologically. RESULTS At 6 and 12 weeks after surgery, the SFI values in MSC-treated group were significantly higher than those in DMEM group (P≤0.05). The peak amplitude of CMAP (compound muscle action potential) and nerve conduction velocity in MSC-treated group were significantly higher than that in DMEM group (P≤0.01), while the latency of CMAP onset in MSC-treated group was significantly shorter than that in DMEM group (P≤0.01). The diameter of the myelinated fibres and thickness of the myelin sheath in MSC-treated group were significantly higher than those in DMEM group (P≤0.05). There was no difference in the number of motor neurons in the anterior horn of the spinal cord at 6 weeks post-operation (P>0.05), while the number of motor neurons was significantly greater in MSC-treated group than that in DMEM group at 12 weeks post-operation (P≤0.001). The number of apoptotic cells was also significantly lower (P≤0.01). CONCLUSIONS The results of the present study showed that BMSCs treatment improved lumbosacral nerve regeneration and motor function. In addition, our data suggested that BMSCs inhibited motor neuron apoptosis, and improved motor neuron function and survival in the anterior horn of the spinal cord.
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Fairbairn NG, Meppelink AM, Ng-Glazier J, Randolph MA, Winograd JM. Augmenting peripheral nerve regeneration using stem cells: A review of current opinion. World J Stem Cells 2015; 7:11-26. [PMID: 25621102 PMCID: PMC4300921 DOI: 10.4252/wjsc.v7.i1.11] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/18/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
Outcomes following peripheral nerve injury remain frustratingly poor. The reasons for this are multifactorial, although maintaining a growth permissive environment in the distal nerve stump following repair is arguably the most important. The optimal environment for axonal regeneration relies on the synthesis and release of many biochemical mediators that are temporally and spatially regulated with a high level of incompletely understood complexity. The Schwann cell (SC) has emerged as a key player in this process. Prolonged periods of distal nerve stump denervation, characteristic of large gaps and proximal injuries, have been associated with a reduction in SC number and ability to support regenerating axons. Cell based therapy offers a potential therapy for the improvement of outcomes following peripheral nerve reconstruction. Stem cells have the potential to increase the number of SCs and prolong their ability to support regeneration. They may also have the ability to rescue and replenish populations of chromatolytic and apoptotic neurons following axotomy. Finally, they can be used in non-physiologic ways to preserve injured tissues such as denervated muscle while neuronal ingrowth has not yet occurred. Aside from stem cell type, careful consideration must be given to differentiation status, how stem cells are supported following transplantation and how they will be delivered to the site of injury. It is the aim of this article to review current opinions on the strategies of stem cell based therapy for the augmentation of peripheral nerve regeneration.
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Epineural Tube Repair. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mendiola A. Tissue Engineered Conduit. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kaebisch C, Schipper D, Babczyk P, Tobiasch E. The role of purinergic receptors in stem cell differentiation. Comput Struct Biotechnol J 2014; 13:75-84. [PMID: 26900431 PMCID: PMC4720018 DOI: 10.1016/j.csbj.2014.11.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 12/20/2022] Open
Abstract
A major challenge modern society has to face is the increasing need for tissue regeneration due to degenerative diseases or tumors, but also accidents or warlike conflicts. There is great hope that stem cell-based therapies might improve current treatments of cardiovascular diseases, osteochondral defects or nerve injury due to the unique properties of stem cells such as their self-renewal and differentiation potential. Since embryonic stem cells raise severe ethical concerns and are prone to teratoma formation, adult stem cells are still in the focus of research. Emphasis is placed on cellular signaling within these cells and in between them for a better understanding of the complex processes regulating stem cell fate. One of the oldest signaling systems is based on nucleotides as ligands for purinergic receptors playing an important role in a huge variety of cellular processes such as proliferation, migration and differentiation. Besides their natural ligands, several artificial agonists and antagonists have been identified for P1 and P2 receptors and are already used as drugs. This review outlines purinergic receptor expression and signaling in stem cells metabolism. We will briefly describe current findings in embryonic and induced pluripotent stem cells as well as in cancer-, hematopoietic-, and neural crest-derived stem cells. The major focus will be placed on recent findings of purinergic signaling in mesenchymal stem cells addressed in in vitro and in vivo studies, since stem cell fate might be manipulated by this system guiding differentiation towards the desired lineage in the future.
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Affiliation(s)
| | | | | | - Edda Tobiasch
- Department of Natural Sciences, Bonn-Rhine-Sieg University of Applied Sciences, Von-Liebig-Str. 20, 53359 Rheinbach, Germany
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Han KS, Ko HA, Jang NK, Song JE, Khang G. Effect of small intestinal submucosa sponges on the attachment and proliferation behavior of Schwann cells. Macromol Res 2014. [DOI: 10.1007/s13233-014-2175-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Luo H, Zhu B, Zhang Y, Jin Y. Tissue-engineered nerve constructs under a microgravity system for peripheral nerve regeneration. Tissue Eng Part A 2014; 21:267-76. [PMID: 25088840 DOI: 10.1089/ten.tea.2013.0565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Mesenchymal stem cells (MSCs) seeded in a 3D scaffold often present characteristics of low proliferation and migration, which affect the microstructure of tissue-engineered nerves (TENs) and impair the therapeutic effects of nerve defects. By promoting MSC differentiation and mass/nutrient transport, rotary cell culture systems (RCCSs) display potential for advancing the construction of MSC-based TENs. Thus, in this study, we attempted to construct a TEN composed of adipose-derived mesenchymal stem cells (ADSCs) and acellular nerve graft (ANG) utilizing an RCCS. Compared to TENs prepared in a static 3D approach, MTT and cell count results displayed an increased number of ADSCs for TENs in an RCCS. The similarity in cell cycle states and high rates of apoptosis in the static 3D culture demonstrated that the higher proliferation in the RCCS was not due to microgravity regulation but a result of preferential mass/nutrient transport. Quantitative PCR and ELISA indicated that the RCCS promoted the expression of ADSC neural differentiation-associated genes compared to the static 3D culture. Furthermore, this difference was eliminated by adding the Notch1 signaling pathway inhibitor DAPT to the 3D static culture. TEM, axon immunostaining, and retrograde labeling analysis after sciatic nerve transplantation indicated that the TENs prepared in the RCCS exhibited more regenerative characteristics for repairing peripheral nerves than those prepared in a static 3D approach. Therefore, these findings suggest that the RCCS can modulate the construction, morphology, and function of engineered nerves as a promising alternative for nerve regeneration.
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Affiliation(s)
- Hailang Luo
- 1 Research and Development Center for Tissue Engineering, Fourth Military Medical University , Xi'an, China
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43
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Neural tissue engineering scaffold with sustained RAPA release relieves neuropathic pain in rats. Life Sci 2014; 112:22-32. [DOI: 10.1016/j.lfs.2014.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/06/2014] [Accepted: 07/08/2014] [Indexed: 11/23/2022]
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Shakhbazau A, Mohanty C, Kumar R, Midha R. Sensory recovery after cell therapy in peripheral nerve repair: effects of naïve and skin precursor-derived Schwann cells. J Neurosurg 2014; 121:423-31. [DOI: 10.3171/2014.5.jns132132] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Object
Cell therapy is a promising candidate among biological or technological innovations sought to augment microsurgical techniques in peripheral nerve repair. This report describes long-term functional regenerative effects of cell therapy in the rat injury model with a focus on sensory recovery.
Methods
Schwann cells were derived from isogenic nerve or skin precursor cells and injected into the transected and immediately repaired sciatic nerve distal to the injury site. Sensory recovery was assessed at weeks 4, 7, and 10. Axonal regeneration was assessed at Week 11.
Results
By Week 10, thermal sensitivity in cell therapy groups returned to a level indistinguishable from the baseline (p > 0.05). Immunohistochemistry at 11 weeks after injury showed improved regeneration of NF+ and IB4+ axons.
Conclusions:
The results of this study show that cell therapy significantly improves thermal sensation and the number of regenerated sensory neurons at 11 weeks after injury. These findings contribute to the view of skin-derived stem cells as a reliable source of Schwann cells with therapeutic potential for functional recovery in damaged peripheral nerve.
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Affiliation(s)
- Antos Shakhbazau
- 1Department of Clinical Neuroscience, Faculty of Medicine,
- 2Hotchkiss Brain Institute, and
| | | | - Ranjan Kumar
- 1Department of Clinical Neuroscience, Faculty of Medicine,
- 2Hotchkiss Brain Institute, and
- 3Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rajiv Midha
- 1Department of Clinical Neuroscience, Faculty of Medicine,
- 2Hotchkiss Brain Institute, and
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Watanabe Y, Sasaki R, Matsumine H, Yamato M, Okano T. Undifferentiated and differentiated adipose-derived stem cells improve nerve regeneration in a rat model of facial nerve defect. J Tissue Eng Regen Med 2014; 11:362-374. [PMID: 24889763 DOI: 10.1002/term.1919] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/03/2014] [Accepted: 04/24/2014] [Indexed: 12/15/2022]
Abstract
Autologous nerve grafting is the current procedure used for repairing facial nerve gaps. As an alternative to this method, tissue engineering cell-based therapy using induced pluripotent stem cells, Schwann cells and bone marrow-derived mesenchymal stem cells has been proposed. However, these cells have major problems, including tumorigenesis in induced pluripotent stem cells and invasiveness and limited tissue associated with harvesting for the other cells. Here, we investigated the therapeutic potential of adipose-derived stem cells (ASCs), which can be harvested easily and repeatedly by a minimally invasive liposuction procedure. The ASCs had characteristics of mesenchymal tissue lineages and could differentiate into Schwann-like cells that were relatively simple to isolate and expand in culture. In an in vivo study, a silicone conduit containing undifferentiated ASCs, differentiated ASCs or Schwann cells were transplanted, embedded in a collagen gel and the efficacy of repair of a 7 mm-gap in the rat facial nerve examined. Morphometric quantification analysis of regenerated facial nerves after a regeneration period of 13 weeks showed that undifferentiated ASCs, differentiated ASCs, and Schwann cells had similar potential for nerve regeneration. Furthermore, the functional recovery of facial nerve regeneration using a rat facial palsy scoring system in the three groups was close to that in autologous nerve graft positive controls. These findings suggest that undifferentiated and differentiated ASCs may both have therapeutic potential in facial nerve regeneration as a source of Schwann cells in cell-based therapy performed as an alternative to autologous nerve grafts. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yorikatsu Watanabe
- Institute of Advanced Biomedical Engineering and Science, and Global Center for Excellence (G-COE) Programme, Tokyo Women's Medical University, Tokyo, Japan.,Department of Plastic, Reconstructive and Aesthetic Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Ryo Sasaki
- Institute of Advanced Biomedical Engineering and Science, and Global Center for Excellence (G-COE) Programme, Tokyo Women's Medical University, Tokyo, Japan.,Department of Oral and Maxillofacial Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hajime Matsumine
- Institute of Advanced Biomedical Engineering and Science, and Global Center for Excellence (G-COE) Programme, Tokyo Women's Medical University, Tokyo, Japan.,Department of Plastic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Yamato
- Institute of Advanced Biomedical Engineering and Science, and Global Center for Excellence (G-COE) Programme, Tokyo Women's Medical University, Tokyo, Japan
| | - Teruo Okano
- Institute of Advanced Biomedical Engineering and Science, and Global Center for Excellence (G-COE) Programme, Tokyo Women's Medical University, Tokyo, Japan
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Thapsukhon B, Daranarong D, Meepowpan P, Suree N, Molloy R, Inthanon K, Wongkham W, Punyodom W. Effect of topology of poly(L-lactide-co-ε-caprolactone) scaffolds on the response of cultured human umbilical cord Wharton's jelly-derived mesenchymal stem cells and neuroblastoma cell lines. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2014; 25:1028-44. [PMID: 24856087 DOI: 10.1080/09205063.2014.918457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In this study, for the first time, a biodegradable poly(L-lactide-co-ε-caprolactone), PLC 67:33 copolymer was developed for use as temporary scaffolds in reconstructive nerve surgery. The effect of the surface topology and pore architecture were studied on the biocompatibility for supporting the growth of human umbilical cord Wharton's jelly-derived mesenchymal stem cells (hWJ-MSCs) and human neuroblastoma cells (hNBCs) as cell models. Porous PLC membranes were prepared by electrospinning and phase immersion precipitation with particulate leaching and nonporous PLC membranes were prepared by solvent casting. From the results, the porous PLC membranes can support hWJ-MSCs and hNBCs cells better than the nonporous PLC membrane, and the interconnected pore scaffold prepared by electrospinning exhibited a more significant supporting attachment of the cells than the open pore and nonporous membranes. We can consider that these electrospun PLC membranes with 3-D interconnecting fiber networks and a high porosity warrant a potential use as nerve guides in reconstructive nerve surgery.
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Thapsukhon B, Daranarong D, Meepowpan P, Suree N, Molloy R, Inthanon K, Wongkham W, Punyodom W. Effect of topology of poly(L-lactide-co-ε-caprolactone) scaffolds on the response of cultured human umbilical cord Wharton’s jelly-derived mesenchymal stem cells and neuroblastoma cell lines. JOURNAL OF BIOMATERIALS SCIENCE, POLYMER EDITION 2014. [DOI: https://doi.org/10.1080/09205063.2014.918457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fan L, Yu Z, Li J, Dang X, Wang K. Schwann-like cells seeded in acellular nerve grafts improve nerve regeneration. BMC Musculoskelet Disord 2014; 15:165. [PMID: 24885337 PMCID: PMC4036644 DOI: 10.1186/1471-2474-15-165] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/15/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study evaluated whether Schwann-like cells (SLCs) induced from bone marrow-derived mesenchymal stem cells (BM-MSCs) transplanted into acellular nerve grafts (ANGs) could repair nerve defects compared with nerve isografts and ANGs with BM-MSCs. METHODS BM-MSCs extracted, separated and purified from the bone marrow of rats, and some of the BM-MSCs were cultured with mixed induction agents that could induce BM-MSCs into SLCs. Either SLCs or BM-MSCs were seeded onto 10-mm ANGs, and the isografts were chosen as the control. The walking-track test, tibialis anterior muscle weight measurement, electrophysiological examination, toluidine blue staining, transmission electron micrographs and immunostaining of S-100 and VEGF in these three groups were evaluated in a 10-mm rat sciatic injury-repair model. RESULTS The walking-track test, tibialis anterior muscle weight measurement and electrophysiological examination of the sciatic nerve suggested the groups of ANGs with SLCs and isografts obtained better results than the BM-MSC group (P<0.05). Meanwhile, the results of the SLCs and isograft groups were similar (P>0.05). All the histomorphometric analyses (toluidine blue staining, transmission electron micrographs and immunostaining of S-100 and VEGF) showed that there were more regenerating nerve fibers in the group of ANGs with SLCs than the BM-MSCs (P<0.05), but there was no significant difference between the SLC and isograft groups (P>0.05). CONCLUSIONS SLCs seeded in ANGs and isografts show better functional regeneration compared with BM-MSCs seeded in ANGs. Additionally, SLCs combined with ANGs present almost the same outcome as the isografts. Therefore, SLCs with ANGs can be a good choice in nerve defect repairs.
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Affiliation(s)
- Lihong Fan
- The first department of Orthopedics, the Second Affilliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an, Shaanxi Province 710004, China
| | - Zefeng Yu
- The first department of Orthopedics, the Second Affilliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an, Shaanxi Province 710004, China
| | - Jia Li
- The first department of Orthopedics, the Second Affilliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an, Shaanxi Province 710004, China
| | - Xiaoqian Dang
- The first department of Orthopedics, the Second Affilliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an, Shaanxi Province 710004, China
| | - Kunzheng Wang
- The first department of Orthopedics, the Second Affilliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an, Shaanxi Province 710004, China
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Hundepool CA, Nijhuis THJ, Mohseny B, Selles RW, Hovius SER. The effect of stem cells in bridging peripheral nerve defects: a meta-analysis. J Neurosurg 2014; 121:195-209. [PMID: 24816327 DOI: 10.3171/2014.4.jns131260] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED OBJECT.: For decades the gold standard for reconstructing a large peripheral nerve defect has been, and remains, the nerve autograft. Alternatives to the nerve autograft include biological conduits and vessels. Adding stem cells in the lumen of a nerve conduit has been the subject of multiple studies. The purpose of the present meta-analysis was to summarize animal experimental studies on the effect of stem cells as a luminal additive when reconstructing a peripheral nerve defect with a nerve graft. METHODS A literature search of the MEDLINE and Embase databases was performed from inception to April 2012, searching for animal experiments on peripheral nerve reconstruction models in which a nerve conduit was used with and without the support of 3 different types of stem cells. Stem cells were analyzed according to their origin: bone marrow, adipose tissue, and other origins. Included studies had consistent outcome measurements: walking track analysis, muscle mass ratio, and electrophysiology. RESULTS Forty-four studies were included in the final analysis. Forest plots of the 3 outcome measurements (walking track analysis, muscle mass ratio, and electrophysiology) showed positive effects of stem cells on the regeneration of peripheral nerves at different time points. Almost all comparisons showed significant differences for all 3 stem cells groups compared with a control group in which stem cells were not used. CONCLUSIONS The present report systematically analyzed the different studies that used stem cells as a luminal additive when bridging a large peripheral nerve defect. All 3 different stem cell groups showed a beneficial effect when used in the reconstruction compared with control groups in which stem cells were not used.
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Wrobel S, Serra SC, Ribeiro-Samy S, Sousa N, Heimann C, Barwig C, Grothe C, Salgado AJ, Haastert-Talini K. In vitro evaluation of cell-seeded chitosan films for peripheral nerve tissue engineering. Tissue Eng Part A 2014; 20:2339-49. [PMID: 24606318 DOI: 10.1089/ten.tea.2013.0621] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Natural biomaterials have attracted an increasing interest in the field of tissue-engineered nerve grafts, representing a possible alternative to autologous nerve transplantation. With the prospect of developing a novel entubulation strategy for transected nerves with cell-seeded chitosan films, we examined the biocompatibility of such films in vitro. Different types of rat Schwann cells (SCs)--immortalized, neonatal, and adult-of the chitosan substrate. Both cell types were viable on the biomaterial and showed different metabolic activities and proliferation behavior, indicating cell-type-specific cell-biomaterial interaction. Moreover, the cell types also displayed their typical morphology. In cocultures adult SCs used the BMSCs as a feeder layer and no negative interactions between both cell types were detected. Further, the chitosan films allow neurite outgrowth from dissociated sensory neurons, which is additionally supported on film preseeded with SC-BMSC cocultures. The presented chitosan films therefore demonstrate high potential for their use in tissue-engineered nerve grafts.
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Affiliation(s)
- Sandra Wrobel
- 1 Hannover Medical School, Institute of Neuroanatomy , Hannover, Germany
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