Strategic Design and Recent Fabrication Techniques for Bioengineered Tissue Scaffolds to Improve Peripheral Nerve Regeneration

Biomaterials / bioinks and extrusion bioprinting

Bioinks are formulations of biomaterials and living cells, sometimes with growth factors or other biomolecules, while extrusion bioprinting is an emerging technique to apply or deposit these bioinks or biomaterial solutions to create three-dimensional (3D) constructs with architectures and mechanical/biological properties that mimic those of native human tissue or organs. Printed constructs have found wide applications in tissue engineering for repairing or treating tissue/organ injuries, as well as in vitro tissue modelling for testing or validating newly developed therapeutics and vaccines prior to their use in humans. Successful printing of constructs and their subsequent applications rely on the properties of the formulated bioinks, including the rheological, mechanical, and biological properties, as well as the printing process. This article critically reviews the latest developments in bioinks and biomaterial solutions for extrusion bioprinting, focusing on bioink synthesis and characterization, as well as the influence of bioink properties on the printing process. Key issues and challenges are also discussed along with recommendations for future research.

Market of tissue engineering in Canada from 2011 to 2020

Tissue engineering aims to produce tissue/organ substitutes to improve upon current treatment approaches, thus providing a permanent solution to damaged tissues/organs. This project aimed to perform a market analysis for understanding and promoting the development and commercialization of tissue engineering in Canada. We searched companies that were established between October 2011 and July 2020 via publicly available information and for these companies, we collected and analyzed the corporate level information, including revenues, and number of employees and founder information. The companies assessed were mainly searched from four different industry segments, i.e., bioprinting, biomaterials, cells and biomaterials, and stem-cells related industry. Our results have demonstrated that there are twenty-five tissue-engineering companies registered in Canada. These companies generated an estimated revenue of USD $67 million in the year 2020, most generated by the tissue engineering and stem-cells related industries. Our results also show that Ontario has the largest number of headquarters of tissue engineering companies among the provinces or territories of Canada. It is expected that the number of new products undergoing clinical trials is increased, based on our results of current clinical trials. Altogether, tissue engineering in Canada has shown a huge growth in the past decade and is forecasted to be an emerging industry in Canada for the years to come.

The success of biomaterial-based tissue engineering strategies for peripheral nerve regeneration

Peripheral nerve injury is a clinically common injury that causes sensory dysfunction and locomotor system degeneration, which seriously affects the quality of the patients’ daily life. Long gapped defects in large nerve are difficult to repair via surgery and limited donor source of autologous nerve greatly challenges the successful nerve repair by transplantation. Significantly, remarkable progress has been made in repairing the peripheral nerve injury using artificial nerve grafts and a variety of products for peripheral nerve repair have emerged been approved globally in recent years. The raw materials of these commercial products includes natural/synthetic polymers, extracellular matrix. Despite a lot of effort, the desirable functional recovery still remains great challenges in long gapped nerve defects. Thus this review discusses the recent development of tissue engineering products for peripheral nerve repair and the design of bionic grafts improving the local microenvironment for accelerating nerve regeneration against locomotor disorder, which may provide potential strategies for the repair of long gaps or thick nerve defects by multifunctional biomaterials.

Citric acid cross-linked chitosan for inhibiting oxidative stress after nerve injury

Scaffold design is particularly important and necessary for soft tissue repair such as nerve tissue repair. In this article, we designed and manufactured a macroporous chitosan-based hydrogel with excellent cell compatibility and antioxidant properties. Here, the chitosan (CS) based hydrogel is obtained by repeated freezing and thawing using citric acid (CA) as a cross-linking agent. We have evaluated the effects of citric acid content on the physical and chemical properties of hydrogels through mechanical properties and scanning electron microscopy. CA-CS hydrogel shows a macroporous structure, as the citric acid increases, the mechanical strength increases and the pore size decreases. In vitro cell experiments show that CA-CS hydrogel partakes positive effects on cell survival, adhesion and proliferation, as well as antioxidant properties. All results provide a basis for the construction of porous chitosan-based hydrogels, while demonstrating a promising approach to deal with oxidative stress in nerve injury.

Preparation and characterization of conductive nerve guide conduit filled with dual drug-loaded nanofibers

Peripheral nerve injury (PNI) has become one of the common clinical diseases. How to promote the regeneration and function recovery of the damaged peripheral nerve has been the focus of attention in the medical field. Evidence suggests that the longitudinal filling of oriented fibers in nerve guide conduit (NGC) is especially beneficial to the repair of long gap PNI. In this study, polypyrrole (PPy) nanospheres (PNSs) were prepared by the soft-templating method, and mixed with poly (lactic acid) (PLA) to prepare conductive PNSs/PLA NGC, and the optimal ratio of PNSs was 4.5%. PLA and vascular endothelial growth factor (VEGF) as shell, chitosan (CS) and paeoniflorin (PF) as core, oriented coaxial nanofibers were obtained and then filled into PNSs/PLA NGC. The composite NGC has excellent mechanical properties, electrical conductivity, hydrophilic properties, and degradation properties. Besides, the successive release of VEGF and PF can play a synergistic role in promoting nerve regeneration. In vitro experiments showed that the composite NGC was nontoxic and suitable for the adhesion and proliferation of nerve cells. In addition, PNSs combined with electrical stimulation (ES) can significantly promote the differentiation and proliferation of nerve cells, which is conducive to nerve regeneration. These positive results indicate that the composite NGC is a promising candidate in the repair of long gap PNI.

3D-printed nerve guidance conduits multi-functionalized with canine multipotent mesenchymal stromal cells promote neuroregeneration after sciatic nerve injury in rats

Background

Nerve injuries are debilitating, leading to long-term motor deficits. Remyelination and axonal growth are supported and enhanced by growth factor and cytokines. Combination of nerve guidance conduits (NGCs) with adipose-tissue-derived multipotent mesenchymal stromal cells (AdMSCs) has been performing promising strategy for nerve regeneration.

Methods

3D-printed polycaprolactone (PCL)-NGCs were fabricated. Wistar rats subjected to critical sciatic nerve damage (12-mm gap) were divided into sham, autograft, PCL (empty NGC), and PCL + MSCs (NGC multi-functionalized with 10⁶ canine AdMSCs embedded in heterologous fibrin biopolymer) groups. In vitro, the cells were characterized and directly stimulated with interferon-gamma to evaluate their neuroregeneration potential. In vivo, the sciatic and tibial functional indices were evaluated for 12 weeks. Gait analysis and nerve conduction velocity were analyzed after 8 and 12 weeks. Morphometric analysis was performed after 8 and 12 weeks following lesion development. Real-time PCR was performed to evaluate the neurotrophic factors BDNF, GDNF, and HGF, and the cytokine and IL-10. Immunohistochemical analysis for the p75^NTR neurotrophic receptor, S100, and neurofilament was performed with the sciatic nerve.

Results

The inflammatory environment in vitro have increased the expression of neurotrophins BDNF, GDNF, HGF, and IL-10 in canine AdMSCs. Nerve guidance conduits multi-functionalized with canine AdMSCs embedded in HFB improved functional motor and electrophysiological recovery compared with PCL group after 12 weeks. However, the results were not significantly different than those obtained using autografts. These findings were associated with a shift in the regeneration process towards the formation of myelinated fibers. Increased immunostaining of BDNF, GDNF, and growth factor receptor p75^NTR was associated with the upregulation of BDNF, GDNF, and HGF in the spinal cord of the PCL + MSCs group. A trend demonstrating higher reactivity of Schwann cells and axonal branching in the sciatic nerve was observed, and canine AdMSCs were engrafted at 30 days following repair.

Conclusions

3D-printed NGCs multi-functionalized with canine AdMSCs embedded in heterologous fibrin biopolymer as cell scaffold exerted neuroregenerative effects. Our multimodal approach supports the trophic microenvironment, resulting in a pro-regenerative state after critical sciatic nerve injury in rats.

Nanostructured scaffolds based on bioresorbable polymers and graphene oxide induce the aligned migration and accelerate the neuronal differentiation of neural stem cells

Within the field of neural tissue engineering, there is a huge need for the development of materials that promote the adhesion, aligned migration and differentiation of stem cells into neuronal and supportive glial cells. In this study, we have fabricated bioresorbable elastomeric scaffolds combining an ordered nanopatterned topography together with a surface functionalization with graphene oxide (GO) in mild conditions. These scaffolds allowed the attachment of murine neural stem cells (NSCs) without the need of any further coating of its surface with extracellular matrix adhesion proteins. The NSCs were able to give rise to both immature neurons and supporting glial cells over the nanostructured scaffolds in vitro, promoting their aligned migration in cell clusters following the nanostructured grooves. This system has the potential to reestablish spatially oriented neural precursor cell connectivity, constituting a promising tool for future cellular therapy including nerve tissue regeneration.

The advances in nerve tissue engineering: From fabrication of nerve conduit to in vivo nerve regeneration assays

Peripheral nerve damage is a common clinical complication of traumatic injury occurring after accident, tumorous outgrowth, or surgical side effects. Although the new methods and biomaterials have been improved recently, regeneration of peripheral nerve gaps is still a challenge. These injuries affect the quality of life of the patients negatively. In the recent years, many efforts have been made to develop innovative nerve tissue engineering approaches aiming to improve peripheral nerve treatment following nerve injuries. Herein, we will not only outline what we know about the peripheral nerve regeneration but also offer our insight regarding the types of nerve conduits, their fabrication process, and factors associated with conduits as well as types of animal and nerve models for evaluating conduit function. Finally, nerve regeneration in a rat sciatic nerve injury model by nerve conduits has been considered, and the main aspects that may affect the preclinical outcome have been discussed.

Role of shortwave and microwave diathermy in peripheral neuropathy

Objective

This study was performed to review the current evidence for the efficacy of shortwave and microwave diathermy in promoting nerve regeneration after peripheral nerve injuries in both animal models and human patients.

Methods

An extensive literature search was conducted without publication data restrictions. Studies including the intervention and outcome in animal or human models were selected. Non-English studies, reviews, letters, and case reports were excluded.

Results

Eleven articles were included in this study. Shortwave diathermy at the frequency of 27.12 or 40.68 MHz was used in six of seven animal studies, while only one study utilized microwave diathermy at 915 MHz. Seven animal experiments demonstrated that shortwave or microwave diathermy produces an increased myelinated nerve fiber number, myelin sheath thickness, and axon diameter as well as improved electrophysiological parameters and locomotion. A total of 128 patients (207 wrists) were enrolled in four clinical studies. The clinical use of diathermy in human patients with carpal tunnel syndrome showed positive effects on pain, hand function, and electrophysiological findings.

Conclusions

Shortwave or microwave diathermy can improve the electrophysiological parameters, myelinated fiber number, and axon diameter of the injured nerve.

Advancements in Canadian Biomaterials Research in Neurotraumatic Diagnosis and Therapies

Development of biomaterials for the diagnosis and treatment of neurotraumatic ailments has been significantly advanced with our deepened knowledge of the pathophysiology of neurotrauma. Canadian research in the fields of biomaterial-based contrast agents, non-invasive axonal tracing, non-invasive scaffold imaging, scaffold patterning, 3D printed scaffolds, and drug delivery are conquering barriers to patient diagnosis and treatment for traumatic injuries to the nervous system. This review highlights some of the highly interdisciplinary Canadian research in biomaterials with a focus on neurotrauma applications.

Nanofiber arrangement regulates peripheral nerve regeneration through differential modulation of macrophage phenotypes

Topographical cues presented by aligned nanofibers have been demonstrated to stimulate peripheral nerve regeneration across long gaps, but the underlying mechanisms remain incompletely elucidated. Because macrophages play a crucial role in peripheral nerve regeneration and can be phenotypically modulated by topographical cues, we hypothesized that aligned nanofibers might induce the development of macrophage phenotypes that facilitate the regeneration of peripheral nerves. Here, macrophages were seeded on aligned and random poly(l-lactic acid-co-ε-caprolactone) nanofibers and their morphology and phenotypes were compared. Aligned nanofibers drastically stimulated macrophage elongation along the nanofibers, and, more importantly, induced the development of a pro-healing macrophage phenotype (M2 type), whereas random nanofibers induced a proinflammatory phenotype (M1 type). Notably, the macrophages polarized by aligned nanofibers potently promoted the proliferation and migration of Schwann cells in vitro. Thus, we constructed nerve-guidance conduits by using aligned and random nanofibers and evaluated their effects on macrophage polarization and nerve regeneration in a rat sciatic nerve defect model. Our in vivo results showed that the ratio of pro-healing macrophages was again higher in the aligned-nanofiber group, and further that Schwann cell infiltration and axon numbers were 2.0- and 2.84-fold higher in the aligned group than in the random group, respectively. This study demonstrates that nanofiber arrangement differentially regulates macrophage activation and that nerve-guidance conduits constructed from aligned nanofibers markedly facilitate peripheral nerve regeneration at least partly by promoting the pro-healing phenotype in macrophages. STATEMENT OF SIGNIFICANCE: The effect of aligned nanofibers on peripheral nerve regeneration has been well established. However, the underlying mechanism remains unclear. Since macrophages play an important role in peripheral nerve regeneration, and can be phenotypically modulated by topographical cues, we hypothesized that aligned nanofibers may exert their beneficial effects via modulating macrophage phenotypes. This study demonstrates for the first time that nanofiber arrangement differentially modulates macrophage shape and polarization, and this subsequently influences the outcome of peripheral nerve regeneration. These findings reveals a novel relationship between biomaterial structure and macrophage activation, contributes to clarifying the mechanism of surface topography in tissue regeneration, and highlight the potential application prospect of aligned nanofiber scaffolds in nerve regeneration and wound healing.

Bioprinting Schwann cell-laden scaffolds from low-viscosity hydrogel compositions

A printable hydrogel composition for Schwann cell-laden tissue scaffold bioprinting in damaged nerve regeneration.

The multiple functions of melatonin in regenerative medicine

Melatonin research has been experiencing hyper growth in the last two decades; this relates to its numerous physiological functions including anti-inflammation, oncostasis, circadian and endocrine rhythm regulation, and its potent antioxidant activity. Recently, a large number of studies have focused on the role of melatonin in the regeneration of cells or tissues after their partial loss. In this review, we discuss the recent findings on the molecular involvement of melatonin in the regeneration of various tissues including the nervous system, liver, bone, kidney, bladder, skin, and muscle, among others.

Scaffolds for peripheral nerve repair and reconstruction

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

Strategic Design and Fabrication of Nerve Guidance Conduits for Peripheral Nerve Regeneration

Nerve guidance conduits (NGCs) have been drawing considerable attention as an aid to promote regeneration of injured axons across damaged peripheral nerves. Ideally, NGCs should include physical and topographic axon guidance cues embedded as part of their composition. Over the past decades, much progress has been made in the development of NGCs that promote directional axonal regrowth so as to repair severed nerves. This paper briefly reviews the recent designs and fabrication techniques of NGCs for peripheral nerve regeneration. Studies associated with versatile design and preparation of NGCs fabricated with either conventional or rapid prototyping (RP) techniques have been examined and reviewed. The effect of topographic features of the filler material as well as porous structure of NGCs on axonal regeneration has also been examined from the previous studies. While such strategies as macroscale channels, lumen size, groove geometry, use of hydrogel/matrix, and unidirectional freeze-dried surface are seen to promote nerve regeneration, shortcomings such as axonal dispersion and wrong target reinnervation still remain unsolved. On this basis, future research directions are identified and discussed.

Establishment of nerve growth factor gradients on aligned chitosan-polylactide /alginate fibers for neural tissue engineering applications

Nerve conduits containing aligned fibrous fillers with gradiently distributed signal molecules are essential for long-gap nerve repair. This study was to develop an approach for establishing nerve growth factor (NGF) gradients onto the aligned chitosan-polylactide (CH-PLA) fibers. CH-PLA containing 37wt% of PLA was spun into fibers using a wet-spinning technique. CH-PLA fibers showed much higher wet-state tensile strength, enhanced degradation tolerance and significantly lower swelling degree in comparison to chitosan fibers. The CH-PLA fibers with diameters from 40 to 60μm were selected and segmentally coated in bundles using NGF-contained alginate solutions to establish NGF gradients lengthwise along fibers. The diameter of resulting NGF-loaded CH-PLA/alginate fibers was well controlled within a range between 60 and 120μm. Calcium ion crosslinked alginate coating layers on fibers showed abilities to administer the sustainable NGF release in a gradient distribution manner for at least 5 weeks. NGF-induced neurite outgrowth of PC12 cells confirmed that bioactivity of NGF released from fibers was well retained.

Polymeric scaffolds for three-dimensional culture of nerve cells: a model of peripheral nerve regeneration

Understanding peripheral nerve repair requires the evaluation of 3D structures that serve as platforms for 3D cell culture. Multiple platforms for 3D cell culture have been developed, mimicking peripheral nerve growth and function, in order to study tissue repair or diseases. To recreate an appropriate 3D environment for peripheral nerve cells, key factors are to be considered including: selection of cells, polymeric biomaterials to be used, and fabrication techniques to shape and form the 3D scaffolds for cellular culture. This review focuses on polymeric 3D platforms used for the development of 3D peripheral nerve cell cultures.

A brief review of extrusion-based tissue scaffold bio-printing

Extrusion-based bio-printing has great potential as a technique for manipulating biomaterials and living cells to create three-dimensional (3D) scaffolds for damaged tissue repair and function restoration. Over the last two decades, advances in both engineering techniques and life sciences have evolved extrusion-based bio-printing from a simple technique to one able to create diverse tissue scaffolds from a wide range of biomaterials and cell types. However, the complexities associated with synthesis of materials for bio-printing and manipulation of multiple materials and cells in bio-printing pose many challenges for scaffold fabrication. This paper presents an overview of extrusion-based bio-printing for scaffold fabrication, focusing on the prior-printing considerations (such as scaffold design and materials/cell synthesis), working principles, comparison to other techniques, and to-date achievements. This paper also briefly reviews the recent development of strategies with regard to hydrogel synthesis, multi-materials/cells manipulation, and process-induced cell damage in extrusion-based bio-printing. The key issue and challenges for extrusion-based bio-printing are also identified and discussed along with recommendations for future, aimed at developing novel biomaterials and bio-printing systems, creating patterned vascular networks within scaffolds, and preserving the cell viability and functions in scaffold bio-printing. The address of these challenges will significantly enhance the capability of extrusion-based bio-printing.

Fabrication of a Highly Aligned Neural Scaffold via a Table Top Stereolithography 3D Printing and Electrospinning<sup/>

Three-dimensional (3D) bioprinting is a rapidly emerging technique in the field of tissue engineering to fabricate extremely intricate and complex biomimetic scaffolds in the range of micrometers. Such customized 3D printed constructs can be used for the regeneration of complex tissues such as cartilage, vessels, and nerves. However, the 3D printing techniques often offer limited control over the resolution and compromised mechanical properties due to short selection of printable inks. To address these limitations, we combined stereolithography and electrospinning techniques to fabricate a novel 3D biomimetic neural scaffold with a tunable porous structure and embedded aligned fibers. By employing two different types of biofabrication methods, we successfully utilized both synthetic and natural materials with varying chemical composition as bioink to enhance biocompatibilities and mechanical properties of the scaffold. The resulting microfibers composed of polycaprolactone (PCL) polymer and PCL mixed with gelatin were embedded in 3D printed hydrogel scaffold. Our results showed that 3D printed scaffolds with electrospun fibers significantly improve neural stem cell adhesion when compared to those without the fibers. Furthermore, 3D scaffolds embedded with aligned fibers showed an enhancement in cell proliferation relative to bare control scaffolds. More importantly, confocal microscopy images illustrated that the scaffold with PCL/gelatin fibers greatly increased the average neurite length and directed neurite extension of primary cortical neurons along the fiber. The results of this study demonstrate the potential to create unique 3D neural tissue constructs by combining 3D bioprinting and electrospinning techniques.

Fabrication and characterization of vitamin B5 loaded poly (l-lactide-co-caprolactone)/silk fiber aligned electrospun nanofibers for schwann cell proliferation

Bioengineering strategies for peripheral nerve regeneration have been focusing on the development of alternative treatments for nerve repair. In present study we have blended the Vitamin B5 (50mg) with 8% P(LLA-CL) and P(LLA-CL)/SF solutions and produced aligned electrospun nanofiber mashes and characterized the material for its physiochemical and mechanical characteristics. The vitamin loaded composites nanofibers showed tensile strength of 8.73±1.38 and 8.4±1.37 in P(LLA-CL)/Vt and P(LLA-CL)/SF/Vt nanofibers mashes, respectively. By the addition of vitamin B5 the P(LLA-CL) nanofibers become hydrophilic and the contact angle decreased from 96° to 0° in 6min of duration. The effect of vitamin B5 on Schwann cells proliferation and viability were analyzed by using MTT assay and the number of cells cultured on vitamin loaded nanofiber mashes was significantly higher than the without vitamin loaded nanofiber samples after 5th day (p<0.05) whereas, P (LLA-CL)/SF/Vt exhibit the consistently highest cell numbers after 7th days culture as compare to P (LLA-CL)/Vt. The in vitro vitamin release behavior was observed in PBS solution and released vitamin was calculated by revers phase HPLC method. The sustain release behavior of vitamin B5 were noted higher in P(LLA-CL)/Vt (80%) nanofibers as compared to P (LLA-CL)/SF/Vt (62%) nanofibers after 24h. The present work provided a basis for further studies of this novel aligned nanofibrous material in nerve tissue repair or regeneration.

Synthesis of poly(ester-carbonate) with a pendant acetylcholine analog for promoting neurite growth

The modification of biodegradable polyesters with bioactive molecules has become an important strategy for controlling neuron adhesion and neurite outgrowth in nerve regeneration. In this study we report a biodegradable poly(ester-carbonate) with a pendant acetylcholine analog, which a neurotransmitter for the enhancement of neuron adhesion and outgrowth. The acetylcholine-functionalized poly(ester-carbonate) (Ach-P(LA-ClTMC)) was prepared by copolymerizing l-lactide (LA) and 5-methyl-5-chloroethoxycarbonyl trimethylene carbonate (ClTMC), followed by quaternization with trimethylamine. The acetylcholine analog content could be modulated by changing the molar feeding fraction of ClTMC. The incorporation of the acetylcholine analog improved the hydrophilicity of the films, but the acetylcholine analog content did not significantly influence the surface morphology of the acetylcholine-functionalized films. The results of PC12 cell culture showed that the acetylcholine analog promoted cell viability and neurite outgrowth in a concentration-dependent manner. The longest length of neurite and the percentage of cells bearing neurites were obtained on the Ach-P(LA-ClTMC)-10 film. All the results indicate that the integration of the acetylcholine analog at an appropriate fraction could be an effective strategy for optimizing the existing biodegradable polyesters for nerve regeneration applications.

Sciatic nerve regeneration using a nerve growth factor-containing fibrin glue membrane

Our previous findings confirmed that the nerve growth factor-containing fibrin glue membrane provides a good microenvironment for peripheral nerve regeneration; however, the precise mechanism remains unclear. p75 neurotrophin receptor (p75(NTR)) plays an important role in the regulation of peripheral nerve regeneration. We hypothesized that a nerve growth factor-containing fibrin glue membrane can promote neural regeneration by up-regulating p75(NTR) expression. In this study, we used a silicon nerve conduit to bridge a 15 mm-long sciatic nerve defect and injected a mixture of nerve growth factor and fibrin glue at the anastomotic site of the nerve conduit and the sciatic nerve. Through RT-PCR and western blot analysis, nerve growth factor-containing fibrin glue membrane significantly increased p75(NTR) mRNA and protein expression in the Schwann cells at the anastomotic site, in particular at 8 weeks after injection of the nerve growth factor/fibrin glue mixture. These results indicate that nerve growth factor-containing fibrin glue membrane can promote peripheral nerve regeneration by up-regulating p75(NTR) expression in Schwann cells.

Electric stimulation and decimeter wave therapy improve the recovery of injured sciatic nerves

Drug treatment, electric stimulation and decimeter wave therapy have been shown to promote the repair and regeneration of the peripheral nerves at the injured site. This study prepared a Mackinnon's model of rat sciatic nerve compression. Electric stimulation was given immediately after neurolysis, and decimeter wave radiation was performed at 1 and 12 weeks post-operation. Histological observation revealed that intraoperative electric stimulation and decimeter wave therapy could improve the local blood circulation of repaired sites, alleviate hypoxia of compressed nerves, and lessen adhesion of compressed nerves, thereby decreasing the formation of new entrapments and enhancing compressed nerve regeneration through an improved microenvironment for regeneration. Immunohistochemical staining results revealed that intraoperative electric stimulation and decimeter wave could promote the expression of S-100 protein. Motor nerve conduction velocity and amplitude, the number and diameter of myelinated nerve fibers, and sciatic functional index were significantly increased in the treated rats. These results verified that intraoperative electric stimulation and decimeter wave therapy contributed to the regeneration and the recovery of the functions in the compressed nerves.

Neural tissue engineering options for peripheral nerve regeneration

Tissue engineered nerve grafts (TENGs) have emerged as a potential alternative to autologous nerve grafts, the gold standard for peripheral nerve repair. Typically, TENGs are composed of a biomaterial-based template that incorporates biochemical cues. A number of TENGs have been used experimentally to bridge long peripheral nerve gaps in various animal models, where the desired outcome is nerve tissue regeneration and functional recovery. So far, the translation of TENGs to the clinic for use in humans has met with a certain degree of success. In order to optimize the TENG design and further approach the matching of TENGs with autologous nerve grafts, many new cues, beyond the traditional ones, will have to be integrated into TENGs. Furthermore, there is a strong requirement for monitoring the real-time dynamic information related to the construction of TENGs. The aim of this opinion paper is to specifically and critically describe the latest advances in the field of neural tissue engineering for peripheral nerve regeneration. Here we delineate new attempts in the design of template (or scaffold) materials, especially in the context of biocompatibility, the choice and handling of support cells, and growth factor release systems. We further discuss the significance of RNAi for peripheral nerve regeneration, anticipate the potential application of RNAi reagents for TENGs, and speculate on the possible contributions of additional elements, including angiogenesis, electrical stimulation, molecular inflammatory mediators, bioactive peptides, antioxidant reagents, and cultured biological constructs, to TENGs. Finally, we consider that a diverse array of physicochemical and biological cues must be orchestrated within a TENG to create a self-consistent coordinated system with a close proximity to the regenerative microenvironment of the peripheral nervous system.

3D nano/microfabrication techniques and nanobiomaterials for neural tissue regeneration

Injuries of the nervous system occur commonly among people of many different ages and backgrounds. Currently, there are no effective strategies to improve neural regeneration; however, tissue engineering provides a promising avenue for regeneration of many tissue types, including the neural context. Functional nerve conduits derived from tissue engineering techniques present bioengineered 3D artificial substitutes for implantation and rehabilitation of injured nerves. In particular, nanotechnology as a versatile vehicle to create biomimetic nanostructured tissue-engineered neural scaffolds provides great potential for the development of innovative and successful nerve grafts. Nanostructured conduits derived from traditional and novel tissue engineering techniques have been shown to be superior for successful neural function construction due to a high degree of biomimetic character. In this paper, we will focus on current progress in developing 3D nano/microstructured neural scaffolds via electrospinning, emerging 3D printing and self-assembly techniques, nanobiomaterials and bioactive cues for enhanced neural tissue regeneration.