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McMorrow LA, Czarnecki P, Reid AJ, Tos P. Current perspectives on peripheral nerve repair and management of the nerve gap. J Hand Surg Eur Vol 2024; 49:698-711. [PMID: 38603601 DOI: 10.1177/17531934241242002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
From the first surgical repair of a nerve in the 6th century, progress in the field of peripheral nerve surgery has marched on; at first slowly but today at great pace. Whether performing primary neurorrhaphy or managing multiple large nerve defects, the modern nerve surgeon has an extensive range of tools, techniques and choices available to them. Continuous innovation in surgical equipment and technique has enabled the maturation of autografting as a gold standard for reconstruction and welcomed the era of nerve transfer techniques all while bioengineers have continued to add to our armamentarium with implantable devices, such as conduits and acellular allografts. We provide the reader a concise and up-to-date summary of the techniques available to them, and the evidence base for their use when managing nerve transection including current use and applicability of nerve transfer procedures.
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Affiliation(s)
- Liam A McMorrow
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Adam J Reid
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Pierluigi Tos
- Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
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Kakinoki R, Hara Y, Yoshimoto K, Kaizawa Y, Hashimoto K, Tanaka H, Kobayashi T, Ohtani K, Noguchi T, Ikeguchi R, Akagi M, Goto K. Fabrication of Artificial Nerve Conduits Used in a Long Nerve Gap: Current Reviews and Future Studies. Bioengineering (Basel) 2024; 11:409. [PMID: 38671830 PMCID: PMC11048626 DOI: 10.3390/bioengineering11040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
There are many commercially available artificial nerve conduits, used mostly to repair short gaps in sensory nerves. The stages of nerve regeneration in a nerve conduit are fibrin matrix formation between the nerve stumps joined to the conduit, capillary extension and Schwann cell migration from both nerve stumps, and, finally, axon extension from the proximal nerve stump. Artificial nerves connecting transected nerve stumps with a long interstump gap should be biodegradable, soft and pliable; have the ability to maintain an intrachamber fibrin matrix structure that allows capillary invasion of the tubular lumen, inhibition of scar tissue invasion and leakage of intratubular neurochemical factors from the chamber; and be able to accommodate cells that produce neurochemical factors that promote nerve regeneration. Here, we describe current progress in the development of artificial nerve conduits and the future studies needed to create nerve conduits, the nerve regeneration of which is compatible with that of an autologous nerve graft transplanted over a long nerve gap.
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Affiliation(s)
- Ryosuke Kakinoki
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Yukiko Hara
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Koichi Yoshimoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopedic Surgery, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka City 553-0003, Japan
| | - Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Hiroki Tanaka
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Takaya Kobayashi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Kazuhiro Ohtani
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Takashi Noguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shougoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shougoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
| | - Koji Goto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Oono-higashi, Osaka-sayama 589-8511, Japan
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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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Ansaripour A, Thompson A, Styron JF, Javanbakht M. Cost-effectiveness analysis of Avance ® allograft for the treatment of peripheral nerve injuries in the USA. J Comp Eff Res 2024; 13:e230113. [PMID: 38031842 PMCID: PMC10842286 DOI: 10.57264/cer-2023-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Aim: Peripheral nerve injury (PNI) is a debilitating condition with significant associated morbidity, and which places a substantial socioeconomic burden on healthcare systems worldwide. Recently, allograft has emerged as a viable surgical alternative to autograft for the treatment of PNI. This study evaluated the cost effectiveness of allograft (Avance® Nerve Graft) compared with autograft for the peripheral nerve repair, from a US payer perspective. Methods: A Markov cohort model was developed to consider the treatment pathways followed by a patient population undergoing a single transected nerve repair with either allograft, or autograft. The marginal difference in meaningful recovery (MR) (effectiveness), and costs, between the two groups were estimated over a lifetime horizon. Deterministic and probabilistic sensitivity analyses (PSA) were performed to consider the uncertainty surrounding the base-case input parameter values and their effect on the overall incremental cost-effectiveness ratio (ICER). Results: The base-case analysis indicates that there is a small difference in the average probability of MR between the two groups (75.15% vs 70.46%; +4.69% with allograft). Allograft also results in cost savings ($12,677 vs $14,023; -$-1346 with allograft) compared with autograft. Deterministic sensitivity analysis shows that the costs of the initial surgical procedures are the main drivers of incremental cost, but that the intervention is likely to be cost saving compared with autograft regardless of the parameter variations made. Conclusion: The use of allograft with the Avance Nerve Graft has the potential to be a cost-effective alternative to autograft for the surgical treatment of PNI in the USA.
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Affiliation(s)
- Amir Ansaripour
- Optimax Access Ltd., Hofplein, Rotterdam, 3032AC, The Netherlands
| | | | | | - Mehdi Javanbakht
- Optimax Access Ltd, Kenneth Dibben House, Enterprise Rd, Chilworth, Southampton Science Park, Southampton, SO16 7NS, UK
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Huang H, Lin Q, Rui X, Huang Y, Wu X, Yang W, Yu Z, He W. Research status of facial nerve repair. Regen Ther 2023; 24:507-514. [PMID: 37841661 PMCID: PMC10570629 DOI: 10.1016/j.reth.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
The facial nerve, also known as the seventh cranial nerve, is critical in controlling the movement of the facial muscles. It is responsible for all facial expressions, such as smiling, frowning, and moving the eyebrows. However, damage to this nerve can occur for a variety of reasons, including maxillofacial surgery, trauma, tumors, and infections. Facial nerve injuries can cause severe functional impairment and can lead to different degrees of facial paralysis, significantly affecting the quality of life of patients. Over the past ten years, significant progress has been made in the field of facial nerve repair. Different approaches, including direct suture, autologous nerve grafts, and tissue engineering, have been utilized for the repair of facial nerve injury. This article mainly summarizes the clinical methods and basic research progress of facial nerve repair in the past ten years.
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Affiliation(s)
- Haoyuan Huang
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Qiang Lin
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Xi Rui
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Yiman Huang
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Xuanhao Wu
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Wenhao Yang
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Zhu Yu
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Wenpeng He
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
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Contreras E, Traserra S, Bolívar S, Nieto-Nicolau N, Jaramillo J, Forés J, Jose-Cunilleras E, Moll X, García F, Delgado-Martínez I, Fariñas O, López-Chicón P, Vilarrodona A, Udina E, Navarro X. Decellularized Graft for Repairing Severe Peripheral Nerve Injuries in Sheep. Neurosurgery 2023; 93:1296-1304. [PMID: 37319401 DOI: 10.1227/neu.0000000000002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Peripheral nerve injuries resulting in a nerve defect require surgical repair. The gold standard of autograft (AG) has several limitations, and therefore, new alternatives must be developed. The main objective of this study was to assess nerve regeneration through a long gap nerve injury (50 mm) in the peroneal nerve of sheep with a decellularized nerve allograft (DCA). METHODS A 5-cm long nerve gap was made in the peroneal nerve of sheep and repaired using an AG or using a DCA. Functional tests were performed once a month and electrophysiology and echography evaluations at 6.5 and 9 months postsurgery. Nerve grafts were harvested at 9 months for immunohistochemical and morphological analyses. RESULTS The decellularization protocol completely eliminated the cells while preserving the extracellular matrix of the nerve. No significant differences were observed in functional tests of locomotion and pain response. Reinnervation of the tibialis anterior muscles occurred in all animals, with some delay in the DCA group compared with the AG group. Histology showed a preserved fascicular structure in both AG and DCA; however, the number of axons distal to the nerve graft was higher in AG than in DCA. CONCLUSION The decellularized graft assayed supported effective axonal regeneration when used to repair a 5-cm long gap in the sheep. As expected, a delay in functional recovery was observed compared with the AG because of the lack of Schwann cells.
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Affiliation(s)
- Estefanía Contreras
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
- Integral Service for Laboratory Animals (SIAL), Faculty of Veterinary, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Sara Traserra
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
- Integral Service for Laboratory Animals (SIAL), Faculty of Veterinary, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Sara Bolívar
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Bellaterra , Spain
| | | | - Jessica Jaramillo
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Joaquim Forés
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
- Hand and Peripheral Nerve Unit, Hospital Clínic i Provincial, Universitat de Barcelona, Barcelona , Spain
| | - Eduard Jose-Cunilleras
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Xavier Moll
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Félix García
- Department of Animal Medicine and Surgery, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Ignacio Delgado-Martínez
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits, Barcelona , Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Patrícia López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits, Barcelona , Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank, Banc de Sang i Teixits, Barcelona , Spain
- Vall Hebron Institute of Research (VHIR), Barcelona , Spain
| | - Esther Udina
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Bellaterra , Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, Bellaterra , Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, Bellaterra , Spain
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Mahdian M, Tabatabai TS, Abpeikar Z, Rezakhani L, Khazaei M. Nerve regeneration using decellularized tissues: challenges and opportunities. Front Neurosci 2023; 17:1295563. [PMID: 37928728 PMCID: PMC10620322 DOI: 10.3389/fnins.2023.1295563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
In tissue engineering, the decellularization of organs and tissues as a biological scaffold plays a critical role in the repair of neurodegenerative diseases. Various protocols for cell removal can distinguish the effects of treatment ability, tissue structure, and extracellular matrix (ECM) ability. Despite considerable progress in nerve regeneration and functional recovery, the slow regeneration and recovery potential of the central nervous system (CNS) remains a challenge. The success of neural tissue engineering is primarily influenced by composition, microstructure, and mechanical properties. The primary objective of restorative techniques is to guide existing axons properly toward the distal end of the damaged nerve and the target organs. However, due to the limitations of nerve autografts, researchers are seeking alternative methods with high therapeutic efficiency and without the limitations of autograft transplantation. Decellularization scaffolds, due to their lack of immunogenicity and the preservation of essential factors in the ECM and high angiogenic ability, provide a suitable three-dimensional (3D) substrate for the adhesion and growth of axons being repaired toward the target organs. This study focuses on mentioning the types of scaffolds used in nerve regeneration, and the methods of tissue decellularization, and specifically explores the use of decellularized nerve tissues (DNT) for nerve transplantation.
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Affiliation(s)
- Maryam Mahdian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tayebeh Sadat Tabatabai
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zahra Abpeikar
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Leila Rezakhani
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozafar Khazaei
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Tissue Engineering, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zhang Q, Chiu Y, Chen Y, Wu Y, Dunne LW, Largo RD, Chang EI, Adelman DM, Schaverien MV, Butler CE. Harnessing the synergy of perfusable muscle flap matrix and adipose-derived stem cells for prevascularization and macrophage polarization to reconstruct volumetric muscle loss. Bioact Mater 2023; 22:588-614. [PMID: 36382023 PMCID: PMC9646752 DOI: 10.1016/j.bioactmat.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/09/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Muscle flaps must have a strong vascular network to support a large tissue volume and ensure successful engraftment. We developed porcine stomach musculofascial flap matrix (PDSF) comprising extracellular matrix (ECM) and intact vasculature. PDSF had a dominant vascular pedicle, microcirculatory vessels, a nerve network, well-retained 3-dimensional (3D) nanofibrous ECM structures, and no allo- or xenoantigenicity. In-depth proteomic analysis demonstrated that PDSF was composed of core matrisome proteins (e.g., collagens, glycoproteins, proteoglycans, and ECM regulators) that, as shown by Gene Ontology term enrichment analysis, are functionally related to musculofascial biological processes. Moreover, PDSF-human adipose-derived stem cell (hASC) synergy not only induced monocytes towards IL-10-producing M2 macrophage polarization through the enhancement of hASCs' paracrine effect but also promoted the proliferation and interconnection of both human skeletal muscle myoblasts (HSMMs) and human umbilical vein endothelial cells (HUVECs) in static triculture conditions. Furthermore, PDSF was successfully prevascularized through a dynamic perfusion coculture of hASCs and HUVECs, which integrated with PDSF and induced the maturation of vascular networks in vitro. In a xenotransplantation model, PDSF demonstrated myoconductive and immunomodulatory properties associated with the predominance of M2 macrophages and regulatory T cells. In a volumetric muscle loss (VML) model, prevascularized PDSF augmented neovascularization and constructive remodeling, which was characterized by the predominant infiltration of M2 macrophages and significant musculofascial tissue formation. These results indicate that hASCs' integration with PDSF enhances the cells' dual function in immunomodulation and angiogenesis. Owing in part to this PDSF-hASC synergy, our platform shows promise for vascularized muscle flap engineering for VML reconstruction.
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Affiliation(s)
- Qixu Zhang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yulun Chiu
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Youbai Chen
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
- Department of Plastic Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yewen Wu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Lina W. Dunne
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rene D. Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Edward I. Chang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - David M. Adelman
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Mark V. Schaverien
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Charles E. Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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9
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Mao X, Li T, Cheng J, Tao M, Li Z, Ma Y, Javed R, Bao J, Liang F, Guo W, Tian X, Fan J, Yu T, Ao Q. Nerve ECM and PLA-PCL based electrospun bilayer nerve conduit for nerve regeneration. Front Bioeng Biotechnol 2023; 11:1103435. [PMID: 36937756 PMCID: PMC10017983 DOI: 10.3389/fbioe.2023.1103435] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: The porcine nerve-derived extracellular matrix (ECM) fabricated as films has good performance in peripheral nerve regeneration. However, when constructed as conduits to bridge nerve defects, ECM lacks sufficient mechanical strength. Methods: In this study, a novel electrospun bilayer-structured nerve conduit (BNC) with outer poly (L-lactic acid-co-ε-caprolactone) (PLA-PCL) and inner ECM was fabricated for nerve regeneration. The composition, structure, and mechanical strength of BNC were characterized. Then BNC biosafety was evaluated by cytotoxicity, subcutaneous implantation, and cell affinity tests. Furthermore, BNC was used to bridge 10-mm rat sciatic nerve defect, and nerve functional recovery was assessed by walking track, electrophysiology, and histomorphology analyses. Results: Our results demonstrate that BNC has a network of nanofibers and retains some bioactive molecules, including collagen I, collagen IV, laminin, fibronectin, glycosaminoglycans, nerve growth factor, and brain-derived neurotrophic factor. Biomechanical analysis proves that PLA-PCL improves the BNC mechanical properties, compared with single ECM conduit (ENC). The functional evaluation of in vivo results indicated that BNC is more effective in nerve regeneration than PLA-PCL conduit or ENC. Discussion: In conclusion, BNC not only retains the good biocompatibility and bioactivity of ECM, but also obtains the appropriate mechanical strength from PLA-PCL, which has great potential for clinical repair of nerve defects.
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Affiliation(s)
- Xiaoyan Mao
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Ting Li
- Department of Tissue Engineering, China Medical University, Shenyang, China
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Junqiu Cheng
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Meihan Tao
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Zhiyuan Li
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Yizhan Ma
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Rabia Javed
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Jie Bao
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Fang Liang
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Weihong Guo
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Tian
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Jun Fan
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Tianhao Yu
- Liaoning Provincial Key Laboratory of Oral Diseases, The VIP Department, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Qiang Ao
- Department of Tissue Engineering, China Medical University, Shenyang, China
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Institute of Regulatory Science for Medical Device, Sichuan University, Chengdu, China
- *Correspondence: Qiang Ao,
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10
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Ye K, He A, Wu M, Qiu X, Chen Z, Yin J, Song Q, Huang Y, Xu K, Huang Y, Wei P. In vitro study of decellularized rat tissues for nerve regeneration. Front Neurol 2022; 13:986377. [PMID: 36188412 PMCID: PMC9520319 DOI: 10.3389/fneur.2022.986377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Peripheral nerve injuries cause an absence or destruction of nerves. Decellularized nerves, acting as a replacement for autografts, have been investigated in the promotion of nerve repair and regeneration, always being incorporated with stem cells or growth factors. However, such a strategy is limited by size availability. The potential application in heterotopic transplantation of other decellularized tissues needs to be further explored. In this study, rat decellularized kidney (dK) was selected to be compared with decellularized peripheral nerve (dN), since dK has aboundant ECM components and growth factors. The PC-12 cells were cultured on dK and dN scaffolds, as shown in the similar behaviors of cell metabolism and viability, but have a more regular arrangement on dN compared to dK, indicating that the natural structure plays an important role in guiding cell extension. However, we found significant upregulation of axon–growth–associated genes and proteins of PC-12 cells in the dK group compared to the dN group by qRT-PCR, immunofluorescence, and western blotting. Furthermore, various neurotrophic factors and growth factors of acellular kidney and nerve were evaluated by ELISA assay. The lower expression of neurotrophic factors but higher expression of growth factors such as VEGF and HGF from dK suggests that axon growth and extension for PC-12 cells may be partially mediated by VEGF and HGF expression from decellularized kidney, which further points to a potential application in nerve repair and regeneration.
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Affiliation(s)
- Kai Ye
- School of Medicine, Ningbo University, Ningbo, China
| | - Andong He
- Department of Respiratory and Critical Medicine, Ningbo First Hospital, Ningbo, China
| | - Miaoben Wu
- School of Medicine, Ningbo University, Ningbo, China
| | - Xiaodong Qiu
- Department of Surgery, Beilun Binhai New City Hospital, Ningbo, China
| | - Zhiwu Chen
- Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo, China
| | - Jun Yin
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Qinghua Song
- Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo, China
| | - Yi Huang
- Medical Research Center, Ningbo First Hospital, Ningbo, China
| | - Kailei Xu
- Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo, China
- The State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, China
- Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, School of Mechanical Engineering, Zhejiang University, Hangzhou, China
- Central Laboratory, Center for Medical and Engineering Innovation, Ningbo First Hospital, Ningbo, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, China
- Kailei Xu
| | - Yuye Huang
- Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo, China
- Central Laboratory, Center for Medical and Engineering Innovation, Ningbo First Hospital, Ningbo, China
- Yuye Huang
| | - Peng Wei
- Department of Plastic and Reconstructive Surgery, Ningbo First Hospital, Ningbo, China
- *Correspondence: Peng Wei
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11
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Sun S, Lu D, Zhong H, Li C, Yang N, Huang B, Ni S, Li X. Donors for nerve transplantation in craniofacial soft tissue injuries. Front Bioeng Biotechnol 2022; 10:978980. [PMID: 36159691 PMCID: PMC9490317 DOI: 10.3389/fbioe.2022.978980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Neural tissue is an important soft tissue; for instance, craniofacial nerves govern several aspects of human behavior, including the expression of speech, emotion transmission, sensation, and motor function. Therefore, nerve repair to promote functional recovery after craniofacial soft tissue injuries is indispensable. However, the repair and regeneration of craniofacial nerves are challenging due to their intricate anatomical and physiological characteristics. Currently, nerve transplantation is an irreplaceable treatment for segmental nerve defects. With the development of emerging technologies, transplantation donors have become more diverse. The present article reviews the traditional and emerging alternative materials aimed at advancing cutting-edge research on craniofacial nerve repair and facilitating the transition from the laboratory to the clinic. It also provides a reference for donor selection for nerve repair after clinical craniofacial soft tissue injuries. We found that autografts are still widely accepted as the first options for segmental nerve defects. However, allogeneic composite functional units have a strong advantage for nerve transplantation for nerve defects accompanied by several tissue damages or loss. As an alternative to autografts, decellularized tissue has attracted increasing attention because of its low immunogenicity. Nerve conduits have been developed from traditional autologous tissue to composite conduits based on various synthetic materials, with developments in tissue engineering technology. Nerve conduits have great potential to replace traditional donors because their structures are more consistent with the physiological microenvironment and show self-regulation performance with improvements in 3D technology. New materials, such as hydrogels and nanomaterials, have attracted increasing attention in the biomedical field. Their biocompatibility and stimuli-responsiveness have been gradually explored by researchers in the regeneration and regulation of neural networks.
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Affiliation(s)
- Sishuai Sun
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Di Lu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Hanlin Zhong
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Chao Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Ning Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Bin Huang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Shilei Ni
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
- *Correspondence: Shilei Ni, ; Xingang Li,
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
- *Correspondence: Shilei Ni, ; Xingang Li,
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12
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Wachs RA, Wellman SM, Porvasnik SL, Lakes EH, Cornelison RC, Song YH, Allen KD, Schmidt CE. Apoptosis-Decellularized Peripheral Nerve Scaffold Allows Regeneration across Nerve Gap. Cells Tissues Organs 2022; 212:512-522. [PMID: 36030771 DOI: 10.1159/000525704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/15/2022] [Indexed: 12/18/2023] Open
Abstract
Peripheral nerve injury results in loss of motor and sensory function distal to the nerve injury and is often permanent in nerve gaps longer than 5 cm. Autologous nerve grafts (nerve autografts) utilize patients' own nerve tissue from another part of their body to repair the defect and are the gold standard in care. However, there is a limited autologous tissue supply, size mismatch between donor nerve and injured nerve, and morbidity at the site of nerve donation. Decellularized cadaveric nerve tissue alleviates some of these limitations and has demonstrated success clinically. We previously developed an alternative apoptosis-assisted decellularization process for nerve tissue. This new process may result in an ideal scaffold for peripheral nerve regeneration by gently removing cells and antigens while preserving delicate topographical cues. In addition, the apoptosis-assisted process requires less active processing time and is inexpensive. This study examines the utility of apoptosis-decellularized peripheral nerve scaffolds compared to detergent-decellularized peripheral nerve scaffolds and isograft controls in a rat nerve gap model. Results indicate that, at 8 weeks post-injury, apoptosis-decellularized peripheral nerve scaffolds perform similarly to detergent-decellularized and isograft controls in both functional (muscle weight recovery, gait analysis) and histological measures (neurofilament staining, macrophage infiltration). These new apoptosis-decellularized scaffolds hold great promise to provide a less expensive scaffold for nerve injury repair, with the potential to improve nerve regeneration and functional outcomes compared to current detergent-decellularized scaffolds.
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Affiliation(s)
- Rebecca A Wachs
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
- Department of Biological Systems Engineering, University of Nebraska - Lincoln, Lincoln, Nebraska, USA
| | - Steven M Wellman
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Stacy L Porvasnik
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Emily H Lakes
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - R Chase Cornelison
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Young Hye Song
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Kyle D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Christine E Schmidt
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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13
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Zhang S, Zhou Y, Xian H, Shi Y, Liu Y, Li Z, Huang Y. Nerve regeneration in rat peripheral nerve allografts: An assessment of the role of endogenous neurotrophic factors in nerve cryopreservation and regeneration. Eur J Neurosci 2022; 55:1895-1916. [PMID: 35332602 DOI: 10.1111/ejn.15655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
Peripheral nerve injury is a common clinical problem that often leads to significant functional impairment or even complete paralysis. Allograft has been proposed as a potential repair strategy for peripheral nerve injuries. Furthermore, peripheral nerve cryopreservation may result in nearly unlimited supply of grafts. However, the concentration of neurotrophic factors secreted by Schwann cells (SCs) in the local microenvironment after transplantation may not be sufficient for the survival of neuronal soma and axonal regeneration. Here, we investigated the effect of endogenous neurotrophic factors (ENTFs) on nerve regeneration in rats after the allograft of a cryopreserved sciatic nerve. ENTFs were highly expressed in the sciatic nerves pretreated for 14 days. Although the number of surviving cells in the sciatic nerves and their immunogenicity were low in the 14-day group after 4 weeks of cryopreservation, they continued to express high levels of ENTFs in vitro. At one week postoperation, the 14-day Allo group showed low plasma levels of interleukin-2, interferon-gamma, and tumour necrosis factor-alpha and low cellular immune response. At 20 weeks postoperation, nerve regeneration and functional recovery in the 14-day Allo group was similar to that in the fresh isograft group but better than that in the cryopreserved fresh allograft and fresh allograft groups. Thus, ENTFs were induced in vitro after pretreatment of the sciatic nerve. Following cryopreservation, the sciatic nerves with high levels of ENTFs continued to express high levels of ENTFs in vitro. The immune response after allograft was weak, which promoted recipient nerve regeneration.
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Affiliation(s)
- Song Zhang
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China.,Yubei District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ying Zhou
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China
| | - Hua Xian
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China
| | - Yifeng Shi
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China
| | - Yunxiao Liu
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China
| | - Zijian Li
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China.,Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Yingru Huang
- Chongqing Key Laboratory of Traditional Chinese Medicine for Prevention and Cure of Metabolic Diseases, Chongqing Medical University, Chongqing, China
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14
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Bolognesi F, Fazio N, Boriani F, Fabbri VP, Gravina D, Pedrini FA, Zini N, Greco M, Paolucci M, Re MC, Asioli S, Foschini MP, D’Errico A, Baldini N, Marchetti C. Validation of a Cleanroom Compliant Sonication-Based Decellularization Technique: A New Concept in Nerve Allograft Production. Int J Mol Sci 2022; 23:ijms23031530. [PMID: 35163474 PMCID: PMC8836166 DOI: 10.3390/ijms23031530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/10/2022] Open
Abstract
Defects of the peripheral nervous system are extremely frequent in trauma and surgeries and have high socioeconomic costs. If the direct suture of a lesion is not possible, i.e., nerve gap > 2 cm, it is necessary to use grafts. While the gold standard is the autograft, it has disadvantages related to its harvesting, with an inevitable functional deficit and further morbidity. An alternative to autografting is represented by the acellular nerve allograft (ANA), which avoids disadvantages of autograft harvesting and fresh allograft rejection. In this research, the authors intend to transfer to human nerves a novel technique, previously implemented in animal models, to decellularize nerves. The new method is based on soaking the nerve tissues in decellularizing solutions while associating ultrasounds and freeze-thaw cycles. It is performed without interrupting the sterility chain, so that the new graft may not require post-production γ-ray irradiation, which is suspected to affect the structural and functional quality of tissues. The new method is rapid, safe, and inexpensive if compared with available commercial ANAs. Histology and immunohistochemistry have been adopted to evaluate the new decellularized nerves. The study shows that the new method can be applied to human nerve samples, obtaining similar, and, sometimes better, results compared with the chosen control method, the Hudson technique.
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Affiliation(s)
- Federico Bolognesi
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy; (V.P.F.); (S.A.); (M.P.F.); (N.B.)
- Correspondence: ; Tel.: +39-333-689-4116
| | - Nicola Fazio
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (N.F.); (D.G.); (M.G.)
| | - Filippo Boriani
- Department of Plastic Surgery and Microsurgery, University of Cagliari, 09124 Cagliari, Italy;
| | - Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy; (V.P.F.); (S.A.); (M.P.F.); (N.B.)
- Unit of Anatomic Pathology, Department of Oncology, Bellaria “Carlo Alberto Pizzardi” Hospital, Via Altura 3, 40139 Bologna, Italy
| | - Davide Gravina
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (N.F.); (D.G.); (M.G.)
| | - Francesca Alice Pedrini
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy;
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Nicoletta Zini
- Unit of Bologna, CNR-National Research Council of Italy, Institute of Molecular Genetics “Luigi Luca Cavalli–Sforza”, Via di Barbiano 1/10, 40136 Bologna, Italy;
- IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Michelina Greco
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (N.F.); (D.G.); (M.G.)
| | - Michela Paolucci
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (M.P.); (M.C.R.)
| | - Maria Carla Re
- Microbiology Section of the Department of Experimental, Diagnostic and Specialty Medicine, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (M.P.); (M.C.R.)
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy; (V.P.F.); (S.A.); (M.P.F.); (N.B.)
- Unit of Anatomic Pathology, Department of Oncology, Bellaria “Carlo Alberto Pizzardi” Hospital, Via Altura 3, 40139 Bologna, Italy
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy; (V.P.F.); (S.A.); (M.P.F.); (N.B.)
- Unit of Anatomic Pathology, Department of Oncology, Bellaria “Carlo Alberto Pizzardi” Hospital, Via Altura 3, 40139 Bologna, Italy
| | - Antonietta D’Errico
- Pathology Unit, Department of Specialized, Experimental and Diagnostic Medicine, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy;
| | - Nicola Baldini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy; (V.P.F.); (S.A.); (M.P.F.); (N.B.)
- BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (N.F.); (D.G.); (M.G.)
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy; (V.P.F.); (S.A.); (M.P.F.); (N.B.)
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15
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Contreras E, Bolívar S, Nieto-Nicolau N, Fariñas O, López-Chicón P, Navarro X, Udina E. A novel decellularized nerve graft for repairing peripheral nerve long gap injury in the rat. Cell Tissue Res 2022; 390:355-366. [PMID: 36114915 PMCID: PMC9722790 DOI: 10.1007/s00441-022-03682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/26/2022] [Indexed: 01/19/2023]
Abstract
Decellularized nerve allografts are an alternative to autograft for repairing severe nerve injuries, since they have higher availability and do not induce rejection. In this study, we have assessed the regenerative potential of a novel decellularization protocol for human and rat nerves for repairing nerve resections, compared to the gold standard autograft. A 15-mm gap in the sciatic nerve was repaired with decellularized rat allograft (DC-RA), decellularized human xenograft (DC-HX), or fresh autograft (AG). Electrophysiology tests were performed monthly to evaluate muscle reinnervation, whereas histological and immunohistochemical analyses of the grafts were evaluated at 4 months. A short-term study was also performed to compare the differences between the two decellularized grafts (DC-RA and DC-HX) in early phases of regeneration. The decellularization process eliminated cellularity while preserving the ECM and endoneurial tubules of both rat and human nerves. Higher amount of reinnervation was observed in the AG group compared to the DC-RA group, while only half of the animals of the DC-HX showed distal muscle reinnervation. The number of regenerating myelinated axons in the mid-graft was similar between AG and DC-RA and lower in DC-HX graft, but significantly lower in both DC grafts distally. At short term, fibroblasts repopulated the DC-RA graft, supporting regenerated axons, whereas an important fibrotic reaction was observed around DC-HX grafts. In conclusion, the decellularized allograft sustained regeneration through a long gap in the rat although at a slower rate compared to the ideal autograft, whereas regeneration was limited or even failed when using a decellularized xenograft.
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Affiliation(s)
- Estefanía Contreras
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, and CIBERNED, ISCIII, 08913 Bellaterra, Spain
| | - Sara Bolívar
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, and CIBERNED, ISCIII, 08913 Bellaterra, Spain
| | - Núria Nieto-Nicolau
- Barcelona Tissue Bank, Banc de Sang I Teixits (BST), Barcelona, Spain ,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank, Banc de Sang I Teixits (BST), Barcelona, Spain ,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Patrícia López-Chicón
- Barcelona Tissue Bank, Banc de Sang I Teixits (BST), Barcelona, Spain ,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, and CIBERNED, ISCIII, 08913 Bellaterra, Spain
| | - Esther Udina
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autònoma de Barcelona, and CIBERNED, ISCIII, 08913 Bellaterra, Spain
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16
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Engineered neural tissue made using clinical-grade human neural stem cells supports regeneration in a long gap peripheral nerve injury model. Acta Biomater 2021; 135:203-213. [PMID: 34455110 DOI: 10.1016/j.actbio.2021.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/08/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
A surgical autograft remains the clinical gold-standard therapy for gap repair following peripheral nerve injury, however, challenges remain with achieving full recovery and reducing donor-site morbidity. Engineered Neural Tissue (EngNT) manufactured using differentiated CTX0E03 human stem cells (EngNT-CTX) has been developed as a potential 'off the shelf' allogeneic autograft replacement. Ensheathed within a collagen membrane developed to facilitate biomechanical integration, EngNT-CTX was used to bridge a critical-length (15 mm) sciatic nerve gap injury in athymic nude rats. The effectiveness of EngNT-CTX was compared to an autograft using outcome measures that assessed neuronal regeneration and functional recovery at 8 and 16 weeks. At both time points EngNT-CTX restored electrophysiological nerve conduction and functional reinnervation of downstream muscles to the same extent as the autograft. Histological analysis confirmed that more motor neurons had successfully regenerated through the repair in EngNT-CTX in comparison to the autograft at 8 weeks, which was consistent with the electrophysiology, with the number of motor neurons similar in both groups by 16 weeks. The total number of neurons (motor + sensory) was greater in autografts than EngNT-CTX at 8 weeks, indicating that more sensory fibres may have sprouted in those animals at this time point. In conclusion, this study provides evidence to support the effectiveness of EngNT-CTX as a replacement for the nerve autograft, as the functional regeneration assessed through histological and electrophysiological outcome measures demonstrated equivalent performance. STATEMENT OF SIGNIFICANCE: Following injury a peripheral nerve has the capacity to regenerate naturally, however, in the case of severe damage where there is a gap the current gold-standard microsurgical intervention is an autograft. This is associated with serious limitations including tissue availability and donor-site morbidity. Tissue engineering aims to overcome these limitations by building a construct from therapeutic cells and biomaterials as a means to mimic and replace the autograft. In this study engineered neural tissue (EngNT) was manufactured using human stem cells (CTX) to bridge a critical-length gap injury. When compared to the autograft in an animal model the EngNT-CTX construct restored function to an equivalent or greater extent.
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17
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Nieto-Nicolau N, López-Chicón P, Torrico C, Bolívar S, Contreras-Carreton E, Udina E, Navarro X, Casaroli-Marano RP, Fariñas O, Vilarrodona A. "Off-the-Shelf" Nerve Matrix Preservation. Biopreserv Biobank 2021; 20:48-58. [PMID: 34542324 DOI: 10.1089/bio.2020.0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Decellularized human nerves overcome the limitations of the current treatments for large peripheral nerve injuries. However, the use of decellularized nerves requires an "off-the-shelf" availability for useful and actual clinical application. In this study, we addressed the preservation of the native and decellularized human nerve matrix in an integrative approach for tissue scaffold production. Materials and Methods: For native nerve matrix preservation analysis, we used histological examination and immunofluorescence to examine the structure, biomechanical assays to evaluate the tensile strength and Young's modulus, and analyzed the extracellular matrix (ECM) composition using enzyme-linked immunosorbent assay (ELISA) and biochemical assays for laminin, collagen and sulfated glycosaminoglycans (sGAG). After decellularization, nuclear remnants and DNA content were evaluated using 4',6-diamidino-2-phenylindole (DAPI) staining and the picogreen quantification assay, as well as immunofluorescence or ELISA for cell rests (S100 protein and myelin staining) evaluation. Decellularized cryopreserved scaffolds were assayed for biomechanics, ECM composition, and structural maintenance. Cytotoxicity assays were performed to evaluate the biocompatibility of the nerve matrix extracts after cryopreservation. Results: We compared different strategies for native nerve storage and found that preservation up to 7 days at 4°C in Roswell Park Memorial Institute medium maintained biomechanical properties, such as Young's modulus and tensile strength, along with the structure and ECM composition, regarding laminin, collagen, and sGAG. After a successful decellularization process, that eliminated cell remnants, nerve scaffolds were frozen in an "in house" formulated cryoprotectant, using an automatic controlled rate freezer. Nerve structure, ECM composition, and biomechanical properties were maintained before and after the freezing process in comparison with native nerves. The extracts of the nerve scaffolds after thawing were not cytotoxic and the freezing process sustained good viability in 3T3 cells (graphical abstract). Conclusion: Since our approach facilitates transport, storage, and provide a ready-to-use alternative, it could be used in a clinical application for the treatment of long-gap peripheral nerve injuries in regenerative medicine.
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Affiliation(s)
- Nuria Nieto-Nicolau
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Patricia López-Chicón
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Carlos Torrico
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
| | - Sara Bolívar
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autónoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Estefania Contreras-Carreton
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autónoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Esther Udina
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autónoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Institute of Neuroscience, Universitat Autónoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Ricardo P Casaroli-Marano
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain.,Department of Surgery, School of Medicine & Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
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18
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Bone marrow-derived mesenchymal stem cells transplanted into a vascularized biodegradable tube containing decellularized allogenic nerve basal laminae promoted peripheral nerve regeneration; can it be an alternative of autologous nerve graft? PLoS One 2021; 16:e0254968. [PMID: 34464381 PMCID: PMC8407554 DOI: 10.1371/journal.pone.0254968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/07/2021] [Indexed: 01/01/2023] Open
Abstract
Previously, we showed silicone nerve conduits containing a vascular bundle and decellularized allogenic basal laminae (DABLs) seeded with bone marrow-derived mesenchymal stem cells (BMSCs) demonstrated successful nerve regeneration. Nerve conduits should be flexible and biodegradable for clinical use. In the current study, we used nerve conduits made of polyglycoric acid (PGA) fiber mesh, which is flexible, biodegradable and capillary-permeable. DABLs were created using chemical surfactants to remove almost all cell debris. In part 1, capillary infiltration capability of the PGA tube was examined. Capillary infiltration into regenerated neural tissue was compared between the PGA tube with blood vessels attached extratubularly (extratubularly vascularized tube) and that containing blood vessels intratubularly (intratubularly vascularized tube). No significant difference was found in capillary formation or nerve regeneration between these two tubes. In part 2, a 20 mm gap created in a rat sciatic nerve model was bridged using the extratubularly vascularized PGA tube containing the DABLs with implantation of isogenic cultured BMSCs (TubeC+ group), that containing the DABLs without implantation of the BMSCs (TubeC- group), and 20 mm-long fresh autologous nerve graft (Auto group). Nerve regeneration in these three groups was assessed electrophysiologically and histomorphometrically. At 24 weeks, there was no significant difference in any electrophysiological parameters between TubeC+ and Auto groups, although all histological parameters in Auto group were significantly greater than those in TubeC+ and TubeC- groups, and TubeC+ group demonstrated significant better nerve regeneration than TubeC- group. The transplanted DABLs showed no signs of immunological rejection and some transplanted BMSCs were differentiated into cells with Schwann cell-like phenotype, which might have promoted nerve regeneration within the conduit. This study indicated that the TubeC+ nerve conduit may become an alternative to nerve autograft.
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19
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Taylor DA, Kren SM, Rhett K, Robertson MJ, Morrissey J, Rodriguez OE, Virk H, Chacon-Alberty L, Curty da Costa E, Mesquita FCP, Sampaio LC, Hochman-Mendez C. Characterization of perfusion decellularized whole animal body, isolated organs, and multi-organ systems for tissue engineering applications. Physiol Rep 2021; 9:e14817. [PMID: 34184419 PMCID: PMC8239446 DOI: 10.14814/phy2.14817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 01/07/2023] Open
Abstract
To expand the application of perfusion decellularization beyond isolated single organs, we used the native vasculature of adult and neonatal rats to systemically decellularize the organs of a whole animal in situ. Acellular scaffolds were generated from kidney, liver, lower limb, heart‐lung system, and a whole animal body, demonstrating that perfusion decellularization technology is applicable to any perfusable tissue, independent of age. Biochemical and histological analyses demonstrated that organs and organ systems (heart‐lung pair and lower limb) were successfully decellularized, retaining their extracellular matrix (ECM) structure and organ‐specific composition, as evidenced by differences in organ‐specific scaffold stiffness. Altogether, we demonstrated that organs, organ systems and whole animal bodies can be perfusion decellularized while retaining ECM components and biomechanics.
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Affiliation(s)
| | - Stefan M Kren
- Lillehei Heart Institute, Univeristy of Minnesota, USA
| | - Katrina Rhett
- Department of Physical Therapy and Occupational Therapy, Idaho State University, USA
| | | | | | | | - Hassan Virk
- Division of Infectious Diseases, University of Texas, Houston, USA
| | | | | | | | - Luiz C Sampaio
- Center for Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center, Houston, USA
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20
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Bengur FB, Stoy C, Binko MA, Nerone WV, Fedor CN, Solari MG, Marra KG. Facial Nerve Repair: Bioengineering Approaches in Preclinical Models. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:364-378. [PMID: 33632013 DOI: 10.1089/ten.teb.2020.0381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Injury to the facial nerve can occur after different etiologies and range from simple transection of the branches to varying degrees of segmental loss. Management depends on the extent of injury and options include primary repair for simple transections and using autografts, allografts, or conduits for larger gaps. Tissue engineering plays an important role to create artificial materials that are able to mimic the nerve itself without extra morbidity in the patients. The use of neurotrophic factors or stem cells inside the conduits or around the repair site is being increasingly studied to enhance neural recovery to a greater extent. Preclinical studies remain the hallmark for development of these novel approaches and translation into clinical practice. This review will focus on preclinical models of repair after facial nerve injury to help researchers establish an appropriate model to quantify recovery and analyze functional outcomes. Different bioengineered materials, including conduits and nerve grafts, will be discussed based on the experimental animals that were used and the defects introduced. Future directions to extend the applications of processed nerve allografts, bioengineered conduits, and cues inside the conduits to induce neural recovery after facial nerve injury will be highlighted.
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Affiliation(s)
- Fuat Baris Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Conrad Stoy
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary A Binko
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Wayne Vincent Nerone
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Nadia Fedor
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kacey G Marra
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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21
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Reconstruction of Critical Nerve Defects Using Allogenic Nerve Tissue: A Review of Current Approaches. Int J Mol Sci 2021; 22:ijms22073515. [PMID: 33805321 PMCID: PMC8036990 DOI: 10.3390/ijms22073515] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Regardless of the nerve defect length, nerve injury is a debilitating condition for the affected patient that results in loss of sensory and motor function. These functional impairments can have a profound impact on the patient’s quality of life. Surgical approaches for the treatment of short segment nerve defects are well-established. Autologous nerve transplantation, considered the gold standard, and the use of artificial nerve grafts are safe and successful procedures for short segment nerve defect reconstruction. Long segment nerve defects which extend 3.0 cm or more are more problematic for repair. Methods for reconstruction of long defects are limited. Artificial nerve grafts often fail to regenerate and autologous nerve grafts are limited in length and number. Cadaveric processed/unprocessed nerve allografts are a promising alternative in nerve surgery. This review gives a systematic overview on pre-clinical and clinical approaches in nerve allograft transplantation.
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22
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Effective decellularization of human nerve matrix for regenerative medicine with a novel protocol. Cell Tissue Res 2021; 384:167-177. [PMID: 33471198 DOI: 10.1007/s00441-020-03317-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
Injuries to the peripheral nerves represent a frequent cause of permanent disability in adults. The repair of large nerve lesions involves the use of autografts, but they have several inherent limitations. Overcoming these limitations, the use of decellularized nerve matrix has emerged as a promising treatment in tissue regenerative medicine. Here, we generate longer human decellularized nerve segments with a novel decellularization method, using nonionic, zwitterionic, and enzymatic incubations. Efficiency of decellularization was measured by DNA quantification and cell remnant analysis (myelin, S100, neurofilament). The evaluation of the extracellular matrix (collagen, laminin, and glycosaminoglycans) preservation was carried out by enzyme-linked immunosorbent assay (ELISA) or biochemical methods, along with histological and immunofluorescence analysis. Moreover, biomechanical properties and cytocompatibility were tested. Results showed that the decellularized nerves generated with this protocol have a concentration of DNA below the threshold of 50 ng/mg of dry tissue. Furthermore, myelin, S100, and MHCII proteins were absent, although some neurofilament remnants could be observed. Moreover, extracellular matrix proteins were well maintained, as well as the biomechanical properties, and the decellularized nerve matrix did not generate cytotoxicity. These results show that our method is effective for the generation of decellularized human nerve grafts. The generation of longer decellularized nerve segments would allow the understanding of the regenerative neurobiology after nerve injuries in both clinical assays and bigger animal models. Effective decellularization of human nerve matrix for regenerative medicine with a novel protocol. Combination of zwitterionic, non-ionic detergents, hyperosmotic solution and nuclease enzyme treatment remove cell remnants, maintain collagen, laminin and biomechanics without generating cytotoxic leachables.
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23
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Bae JY, Park SY, Shin YH, Choi SW, Kim JK. Preparation of human decellularized peripheral nerve allograft using amphoteric detergent and nuclease. Neural Regen Res 2021; 16:1890-1896. [PMID: 33510098 PMCID: PMC8328754 DOI: 10.4103/1673-5374.306091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Animal studies have shown that amphoteric detergent and nuclease (DNase I and ribonuclease A) is the most reliable decellularization method of the peripheral nerve. However, the optimal combination of chemical reagents for decellularization of human nerve allograft needs further investigation. To find the optimal protocol to remove the immunogenic cellular components of the nerve tissue and preserve the basal lamina and extracellular matrix and whether the optimal protocol can be applied to larger-diameter human peripheral nerves, in this study, we decellularized the median and sural nerves from the cadavers with two different methods: nonionic and anionic detergents (Triton X-100 and sodium deoxycholate) and amphoteric detergent and nuclease (3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS), deoxyribonuclease I, and ribonuclease A). All cellular components were successfully removed from the median and sural nerves by amphoteric detergent and nuclease. Not all cellular components were removed from the median nerve by nonionic and anionic detergent. Both median and sural nerves treated with amphoteric detergent and nuclease maintained a completely intact extracellular matrix. Treatment with nonionic and anionic detergent decreased collagen content in both median and sural nerves, while the amphoteric detergent and nuclease treatment did not reduce collagen content. In addition, a contact cytotoxicity assay revealed that the nerves decellularized by amphoteric detergent and nuclease was biocompatible. Strength failure testing demonstrated that the biomechanical properties of nerves decellularized with amphoteric detergent and nuclease were comparable to those of fresh controls. Decellularization with amphoteric detergent and nuclease better remove cellular components and better preserve extracellular matrix than decellularization with nonionic and anionic detergents, even in large-diameter human peripheral nerves. In Korea, cadaveric studies are not yet legally subject to Institutional Review Board review.
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Affiliation(s)
- Joo-Yul Bae
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung-si, Korea
| | - Suk Young Park
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Woo Choi
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung-si, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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24
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Ikegami Y, Ijima H. Decellularization of Nervous Tissues and Clinical Application. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1345:241-252. [PMID: 34582027 DOI: 10.1007/978-3-030-82735-9_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The nervous system is an ensemble of organs that transmit and process external information and are responsible for the adaption to the external environment and homeostasis control of the internal environment. The nervous system of vertebrates is divided into the central nervous system (CNS) and peripheral nervous system (PNS) due to its structural features. The CNS, which includes the brain and the spinal cord, processes information from external stimuli and assembles orders suitable for these stimuli. The CNS then sends signals to control other organs/tissues. On the other hand, the PNS connects the CNS to other organs/tissues and functions as a signal pathway. Therefore, the decline and loss of various functions due to injuries of the nervous system cause an impaired quality of life (QOL) and eventually the termination of life activities. Here, we report mainly on decellularized neural tissue and its application as a substrate for the regeneration of the nervous system.
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Affiliation(s)
- Yasuhiro Ikegami
- Department of Chemical Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan
| | - Hiroyuki Ijima
- Department of Chemical Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan.
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25
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Puhl DL, Funnell JL, Nelson DW, Gottipati MK, Gilbert RJ. Electrospun Fiber Scaffolds for Engineering Glial Cell Behavior to Promote Neural Regeneration. Bioengineering (Basel) 2020; 8:4. [PMID: 33383759 PMCID: PMC7823609 DOI: 10.3390/bioengineering8010004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Electrospinning is a fabrication technique used to produce nano- or micro- diameter fibers to generate biocompatible, biodegradable scaffolds for tissue engineering applications. Electrospun fiber scaffolds are advantageous for neural regeneration because they mimic the structure of the nervous system extracellular matrix and provide contact guidance for regenerating axons. Glia are non-neuronal regulatory cells that maintain homeostasis in the healthy nervous system and regulate regeneration in the injured nervous system. Electrospun fiber scaffolds offer a wide range of characteristics, such as fiber alignment, diameter, surface nanotopography, and surface chemistry that can be engineered to achieve a desired glial cell response to injury. Further, electrospun fibers can be loaded with drugs, nucleic acids, or proteins to provide the local, sustained release of such therapeutics to alter glial cell phenotype to better support regeneration. This review provides the first comprehensive overview of how electrospun fiber alignment, diameter, surface nanotopography, surface functionalization, and therapeutic delivery affect Schwann cells in the peripheral nervous system and astrocytes, oligodendrocytes, and microglia in the central nervous system both in vitro and in vivo. The information presented can be used to design and optimize electrospun fiber scaffolds to target glial cell response to mitigate nervous system injury and improve regeneration.
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Affiliation(s)
- Devan L. Puhl
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA; (D.L.P.); (J.L.F.); (D.W.N.); (M.K.G.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
| | - Jessica L. Funnell
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA; (D.L.P.); (J.L.F.); (D.W.N.); (M.K.G.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
| | - Derek W. Nelson
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA; (D.L.P.); (J.L.F.); (D.W.N.); (M.K.G.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
| | - Manoj K. Gottipati
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA; (D.L.P.); (J.L.F.); (D.W.N.); (M.K.G.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
- Center for Brain and Spinal Cord Repair, Department of Neuroscience, The Ohio State University, 460 W. 12th Avenue, Columbus, OH 43210, USA
| | - Ryan J. Gilbert
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA; (D.L.P.); (J.L.F.); (D.W.N.); (M.K.G.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY 12180, USA
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26
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Yu T, Wen L, He J, Xu Y, Li T, Wang W, Ma Y, Ahmad MA, Tian X, Fan J, Wang X, Hagiwara H, Ao Q. Fabrication and evaluation of an optimized acellular nerve allograft with multiple axial channels. Acta Biomater 2020; 115:235-249. [PMID: 32771587 DOI: 10.1016/j.actbio.2020.07.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
Acellular nerve allografts are promising alternatives to autologous nerve grafts, but still have many drawbacks which greatly limit their curative effects. Here, we developed an optimized acellular nerve allograft with multiple axial channels by a modified decellularization method. These allografts were confirmed to preserve more extracellular matrix components and factors, and remove cellular components effectively. Meanwhile, macrochannels and microchannels were introduced to optimize internal microstructure of allografts, which increases porosity and water absorption, without significant loss of mechanical strength. The in vitro experiments demonstrated that the multichannel allografts showed superior ability of facilitating proliferation and penetration of Schwann cells. Additionally, in the in vivo experiments, the multichannel allografts were used to bridge 10 mm rat sciatic nerve defects. They exhibited better capacity to guide regenerative nerve fibers through the defective segment and restore innervation of target organs, thus achieving better recovery of muscle and motor function, in comparison with conventional acellular allografts. These findings indicate that this multichannel acellular nerve allograft has great potential for clinical application and provides a new prospective for future investigations of nerve regeneration. STATEMENT OF SIGNIFICANCE: Acellular nerve allografts, with preservation of natural extracellular matrix, are officially approved to repair peripheral nerve injury in some countries. However, bioactive component loss and compact internal structure result in variable clinical effects of conventional acellular allografts. In the present study, we fabricated an optimized acellular nerve allograft with multiple axial channels, which could both enable decellularization to be easily accomplished and reduce the amount of detergents in the preparation process. Characterization of the multichannel acellular allografts was confirmed to have better preservation of ECM bioactive molecules and regenerative factors. Efficiency evaluation showed the multichannel allografts could facilitate Schwann cells to migrate inside them in vitro, and enhance regrowth and myelination of axons as well as recovery of muscle and motor function in vivo.
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27
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Choudhury D, Yee M, Sheng ZLJ, Amirul A, Naing MW. Decellularization systems and devices: State-of-the-art. Acta Biomater 2020; 115:51-59. [PMID: 32771593 DOI: 10.1016/j.actbio.2020.07.060] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023]
Abstract
Extracellular matrix (ECM) is a natural biomaterial scaffold that provides biochemical and structural support to its surrounding cells, forming tissue and respective organs. These ECM proteins can be extracted from organs and tissues through decellularization, which is the process of removing cellular content and nuclear material from the organs to obtain decellularized ECM (dECM). dECM is a versatile and functional biomaterial that can be used as the base component of bioinks for rebuilding tissue and organs. Intact dECM of whole organs can be used as a scaffold for recellularization with human stem cells to produce a functioning organ. As decellularization is a relatively new lab process, the associated technologies and devices are largely non-standardized and only available in small, lab-specific scales. Additionally, there is a lack of standardized protocols to analyze the quality and consistency of harvested dECM for medical applications. This review discusses the relevant decellularization systems and devices currently available to facilitate further development of this process for larger scales with the intention to commercialize dECM materials. STATEMENT OF SIGNIFICANCE: Extracellular matrix (ECM) is a natural cocktail of biomaterials that provides biochemical and structural support to its surrounding cells. ECM proteins are extracted from organs and tissues through decellularization. Being a versatile and functional biomaterial, decellularized extracellular matrix (dECM) is being used as base component of bioinks/hydrogels for rebuilding of tissue and organ constructs. Decellularization is a relatively new lab process with associated technologies/devices being largely non-standardized and only available in lab-specific scales. We discuss categories of decellularization systems and devices for the first time being used in academic and commercial settings. We highlight inherent challenges with the current systems and suggest possible solutions. We comment on further development of these processes for large-scale and commercial applications of dECM.
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Affiliation(s)
- Deepak Choudhury
- Biomanufacturing Technology Group, Bioprocessing Technology Institute (BTI), Agency for Science, Technology and Research (A*STAR), 138668, Singapore; Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology, and Research (A*STAR), 2 Fusionopolis Way, #08-04, Innovis 138634, Singapore.
| | - Marcus Yee
- Biomanufacturing Technology Group, Bioprocessing Technology Institute (BTI), Agency for Science, Technology and Research (A*STAR), 138668, Singapore
| | - Zach Lee Jia Sheng
- Biomanufacturing Technology Group, Bioprocessing Technology Institute (BTI), Agency for Science, Technology and Research (A*STAR), 138668, Singapore; Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology, and Research (A*STAR), 2 Fusionopolis Way, #08-04, Innovis 138634, Singapore
| | - Ahmad Amirul
- Biomanufacturing Technology Group, Bioprocessing Technology Institute (BTI), Agency for Science, Technology and Research (A*STAR), 138668, Singapore; Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology, and Research (A*STAR), 2 Fusionopolis Way, #08-04, Innovis 138634, Singapore
| | - May Win Naing
- Biomanufacturing Technology Group, Bioprocessing Technology Institute (BTI), Agency for Science, Technology and Research (A*STAR), 138668, Singapore; Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology, and Research (A*STAR), 2 Fusionopolis Way, #08-04, Innovis 138634, Singapore
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28
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Raffa P, Scattolini V, Gerli MFM, Perin S, Cui M, De Coppi P, Elvassore N, Caccin P, Luni C, Urciuolo A. Decellularized skeletal muscles display neurotrophic effects in three-dimensional organotypic cultures. Stem Cells Transl Med 2020; 9:1233-1243. [PMID: 32578968 PMCID: PMC7519766 DOI: 10.1002/sctm.20-0090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
Skeletal muscle decellularization allows the generation of natural scaffolds that retain the extracellular matrix (ECM) mechanical integrity, biological activity, and three‐dimensional (3D) architecture of the native tissue. Recent reports showed that in vivo implantation of decellularized muscles supports muscle regeneration in volumetric muscle loss models, including nervous system and neuromuscular junctional homing. Since the nervous system plays pivotal roles during skeletal muscle regeneration and in tissue homeostasis, support of reinnervation is a crucial aspect to be considered. However, the effect of decellularized muscles on reinnervation and on neuronal axon growth has been poorly investigated. Here, we characterized residual protein composition of decellularized muscles by mass spectrometry and we show that scaffolds preserve structural proteins of the ECM of both skeletal muscle and peripheral nervous system. To investigate whether decellularized scaffolds could per se attract neural axons, organotypic sections of spinal cord were cultured three dimensionally in vitro, in presence or in absence of decellularized muscles. We found that neural axons extended from the spinal cord are attracted by the decellularized muscles and penetrate inside the scaffolds upon 3D coculture. These results demonstrate that decellularized scaffolds possess intrinsic neurotrophic properties, supporting their potential use for the treatment of clinical cases where extensive functional regeneration of the muscle is required.
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Affiliation(s)
- Paolo Raffa
- Veneto Institute of Molecular Medicine, Padova, Italy.,Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Valentina Scattolini
- Veneto Institute of Molecular Medicine, Padova, Italy.,Women's and Children's Health Department, University of Padova, Padova, Italy
| | | | - Silvia Perin
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Meihua Cui
- Shanghai Institute for Advanced Immunochemical Studies (SIAIS), ShanghaiTech University, Shanghai, People's Republic of China
| | - Paolo De Coppi
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Nicola Elvassore
- Veneto Institute of Molecular Medicine, Padova, Italy.,University College London Great Ormond Street Institute of Child Health, London, UK.,Shanghai Institute for Advanced Immunochemical Studies (SIAIS), ShanghaiTech University, Shanghai, People's Republic of China.,Industrial Engineering Department, University of Padova, Padova, Italy
| | - Paola Caccin
- Biomedical Science Department, University of Padova, Padova, Italy
| | - Camilla Luni
- Shanghai Institute for Advanced Immunochemical Studies (SIAIS), ShanghaiTech University, Shanghai, People's Republic of China
| | - Anna Urciuolo
- University College London Great Ormond Street Institute of Child Health, London, UK.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
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Bulstra LF, Hundepool CA, Shin DM, Bishop AT, Shin AY. Description and validation of a simple histological nerve tissue scoring system for nerve allografts. Microsurgery 2020; 40:686-691. [PMID: 32506477 DOI: 10.1002/micr.30614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND In nerve allograft development, currently used subjective histological scoring systems to evaluate nerve structure in experimental studies are not uniform and have not been validated. The aim of this study was to describe and validate a simple, fast and inexpensive method to compare structural properties of nerve allografts on a histological level. MATERIALS AND METHODS A total of 113 histological sections of rat (sciatic nerves) and human peripheral nerve segments (thoracodorsal and long thoracic nerve for motor and sural for sensory nerve) treated with various decellularization protocols were analyzed. Slides were stained with Hematoxylin & Eosin (H&E), Toluidine Blue and Laminin. A subjective scoring system using a 5-point scale was used to score each nerve section by four independent researchers. For validation of this score both inter- and intra-rater reliability were calculated using the Intraclass Correlation Coefficient (ICC). RESULTS Overall, an excellent correlation between the different observers was found for the Toluidine Blue (ICC = 0.919, 95% CI: 0.891-0.941), H&E (ICC = 0.9, 95% CI: 0.865-0.927) and Laminin staining (ICC = 0.897, 95% CI: 0.860-0.926). Intra-rater reliability was good for all three staining techniques (ICC >0.8). CONCLUSION This study demonstrates the validity of this simple scoring system to evaluate nerve structure after different processing protocols. All three evaluated staining techniques can reliably be used for both rat and human nerve tissue. We believe this method is suitable to compare different processing techniques to create processed nerve allografts, especially when the average scores of multiple raters are used.
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Affiliation(s)
- Liselotte F Bulstra
- Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Caroline A Hundepool
- Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Delaney M Shin
- Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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Fang S, Riber SS, Hussein K, Ahlmann AH, Harvald EB, Khan F, Beck HC, Weile LKK, Sørensen JA, Sheikh SP, Riber LP, Andersen DC. Decellularized human umbilical artery: Biocompatibility and in vivo functionality in sheep carotid bypass model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 112:110955. [PMID: 32409090 DOI: 10.1016/j.msec.2020.110955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/13/2019] [Accepted: 04/08/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Shu Fang
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; The Danish Regenerative Center (danishcrm.com), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Sara Schødt Riber
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Kamal Hussein
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; The Danish Regenerative Center (danishcrm.com), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Animal Surgery, Faculty of Veterinary Medicine, Assiut University, 71526 Assiut, Egypt
| | - Alexander Høgsted Ahlmann
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Eva Bang Harvald
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; The Danish Regenerative Center (danishcrm.com), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Fazal Khan
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; The Danish Regenerative Center (danishcrm.com), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Hans Christian Beck
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Centre for Clinical Proteomics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Louise Katrine Kjær Weile
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jens Ahm Sørensen
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Plastic Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Søren Paludan Sheikh
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; The Danish Regenerative Center (danishcrm.com), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Lars Peter Riber
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Ditte Caroline Andersen
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, 5000 Odense C, Denmark; The Danish Regenerative Center (danishcrm.com), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark.
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Restoration of Neurological Function Following Peripheral Nerve Trauma. Int J Mol Sci 2020; 21:ijms21051808. [PMID: 32155716 PMCID: PMC7084579 DOI: 10.3390/ijms21051808] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.
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32
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Pan D, Mackinnon SE, Wood MD. Advances in the repair of segmental nerve injuries and trends in reconstruction. Muscle Nerve 2020; 61:726-739. [PMID: 31883129 DOI: 10.1002/mus.26797] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system.
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Affiliation(s)
- Deng Pan
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Wood
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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33
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Li T, Sui Z, Matsuno A, Ten H, Oyama K, Ito A, Jiang H, Ren X, Javed R, Zhang L, Ao Q. Fabrication and Evaluation of a Xenogeneic Decellularized Nerve-Derived Material: Preclinical Studies of a New Strategy for Nerve Repair. Neurotherapeutics 2020; 17:356-370. [PMID: 31758411 PMCID: PMC7007487 DOI: 10.1007/s13311-019-00794-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The repair and regeneration of transected peripheral nerves is an important area of clinical research, and the adhesion of anastomosis sites to surrounding tissues is a vital factor affecting the quality of nerve recovery after nerve anastomosis. This study involves the generation of a novel nerve repair membrane derived from decellularized porcine nerves using a unique, innovative technique. The decellularized nerve matrix was verified to be effective in eliminating cellular components, and it still retained some neural extracellular matrix components and bioactive molecules (collagens, glycosaminoglycans, laminin, fibronectin, TGF-β, etc.), which were mainly determined by proteomic analysis, histochemistry, immunohistochemistry, and enzyme-linked immunosorbent assay. Cytotoxicity, intracutaneous reactivity, hemolysis, and cell affinity analyses were conducted to confirm the biosecurity of the nerve repair membrane. The in vivo functionality was assessed in a rat sciatic nerve transection model, and indices of functional nerve recovery, including the measurement of the claw-spread reflex, nerve anastomosis site adhesion, electrophysiological properties, and the number of regenerated nerve fibers, were evaluated. The results indicated that the nerve repair membrane could effectively prevent adhesion between the nerve anastomosis sites and the surrounding tissues and enhance nerve regeneration, which could be attributed to its various bioactive components. In conclusion, the novel nerve repair membrane derived from xenogeneic decellularized nerves described in this study shows great potential auxiliary clinical treatment for peripheral nerve injuries.
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Affiliation(s)
- Ting Li
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Zhigang Sui
- Key Laboratory of Separation Science for Analytical Chemistry, National Chromatographic Research and Analysis Center, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Akira Matsuno
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotomo Ten
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
- Department of Judo Physical Therapy, Faculty of Health, Teikyo Heisei University, Tokyo, Japan
| | - Kenichi Oyama
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Akihiro Ito
- Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hong Jiang
- Shandong Junxiu Biotechnology Company, Limited, Yantai, China
| | - Xiaomin Ren
- Shandong Junxiu Biotechnology Company, Limited, Yantai, China
| | - Rabia Javed
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Lihua Zhang
- Key Laboratory of Separation Science for Analytical Chemistry, National Chromatographic Research and Analysis Center, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China.
| | - Qiang Ao
- Department of Tissue Engineering, China Medical University, Shenyang, China.
- Institute of Regulatory Science for Medical Devices, Engineering Research Center in Biomaterials, Sichuan University, Chengdu, China.
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34
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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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35
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Philips C, Cornelissen M, Carriel V. Evaluation methods as quality control in the generation of decellularized peripheral nerve allografts. J Neural Eng 2019; 15:021003. [PMID: 29244032 DOI: 10.1088/1741-2552/aaa21a] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nowadays, the high incidence of peripheral nerve injuries and the low success ratio of surgical treatments are driving research to the generation of novel alternatives to repair critical nerve defects. In this sense, tissue engineering has emerged as a possible alternative with special attention to decellularization techniques. Tissue decellularization offers the possibility to obtain a cell-free, natural extracellular matrix (ECM), characterized by an adequate 3D organization and proper molecular composition to repair different tissues or organs, including peripheral nerves. One major problem, however, is that there are no standard quality control methods to evaluate decellularized tissues. Therefore, in this review, a brief description of current strategies for peripheral nerve repair is given, followed by an overview of different decellularization methods used for peripheral nerves. Furthermore, we extensively discuss the available and currently used methods to demonstrate the success of tissue decellularization in terms of the cell removal, preservation of essential ECM molecules and maintenance or modification of biomechanical properties. Finally, orientative guidelines for the evaluation of decellularized peripheral nerve allografts are proposed.
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Affiliation(s)
- Charlot Philips
- Tissue Engineering and Biomaterials Group, Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium
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36
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Auto-Allo Graft Parallel Juxtaposition for Improved Neuroregeneration in Peripheral Nerve Reconstruction Based on Acellular Nerve Allografts. Ann Plast Surg 2019; 83:318-325. [DOI: 10.1097/sap.0000000000001900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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Syu WZ, Hueng DY, Chen WL, Chan JYH, Chen SG, Huang SM. Adipose-Derived Neural Stem Cells Combined with Acellular Dermal Matrix as a Neural Conduit Enhances Peripheral Nerve Repair. Cell Transplant 2019; 28:1220-1230. [PMID: 31148461 PMCID: PMC6767887 DOI: 10.1177/0963689719853512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Reconstruction to close a peripheral nerve gap continues to be a challenge for clinical
medicine, and much effort is being made to develop nerve conduits facilitate nerve gap
closure. Acellular dermal matrix (ADM) is mainly used to aid wound healing, but its
malleability and plasticity potentially enable it to be used in the treatment of nerve
gaps. Adipose-derived stem cells (ADSCs) can be differentiated into three germ layer
cells, including neurospheres. We tested the ability of ADSC-derived neural stem cells
(NSCs) in combination with ADM or acellular sciatic nerve (ASN) to repair a transected
sciatic nerve. We found that NSCs form neurospheres that express Nestin and Sox2, and
could be co-cultured with ADM in vitro, where they express the survival marker Ki67.
Following sciatic nerve transection in rats, treatment with ADM+NSC or ASN+NSC led to
increases in relative gastrocnemius weight, cross-sectional muscle fiber area, and sciatic
functional index as compared with untreated rats or rats treated with ADM or ASN alone.
These findings suggest that ADM combined with NSCs can improve peripheral nerve gap repair
after nerve transection and may also be useful for treating other types of neurological
gaps.
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Affiliation(s)
- Wei-Ze Syu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
| | - Dueng-Yuan Hueng
- Department of Biochemistry, National Defense Medical Center, Taipei.,Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei
| | - James Yi-Hsin Chan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei.,Superintendent's Office, National Defense Medical Center, Taipei
| | - Shyi-Gen Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei.,Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Shih-Ming Huang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei.,Department of Biochemistry, National Defense Medical Center, Taipei
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38
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Rbia N, Bulstra LF, Lewallen EA, Hovius SER, van Wijnen AJ, Shin AY. Seeding decellularized nerve allografts with adipose-derived mesenchymal stromal cells: An in vitro analysis of the gene expression and growth factors produced. J Plast Reconstr Aesthet Surg 2019; 72:1316-1325. [PMID: 31175032 DOI: 10.1016/j.bjps.2019.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 02/07/2019] [Accepted: 04/27/2019] [Indexed: 12/24/2022]
Abstract
Mesenchymal stromal cells (MSCs) secrete many soluble growth factors and have previously been shown to stimulate nerve regeneration. MSC-seeded processed nerve allografts could potentially be a promising method for large segmental motor nerve injuries. Further progress in our understanding of how the functions of MSCs can be leveraged for peripheral nerve repair is required before making clinical translation. The present study, therefore, investigated whether interactions of adipose-derived MSCs with decellularized nerve allografts can improve gene and protein expression of growth factors that may support nerve regeneration. Human nerve allografts (n = 30) were decellularized and seeded with undifferentiated human adipose-derived MSCs. Subsequently, the MSCs and MSC-seeded grafts were isolated on days 3, 7, 14, and 21 in culture for RNA expression analysis by qRT-PCR. Evaluated genes included NGF, BDNF, PTN, GAP43, MBP, PMP22, VEGF, and CD31. Growth factor production was evaluated and quantified using enzyme-linked immunosorbent assay (ELISA). On day 21, semi-quantitative RT-PCR analysis showed that adherence of MSCs to nerve allografts significantly enhances mRNA expression of neurotrophic, angiogenic, endothelial, and myelination markers (e.g., BDNF, VEGF, CD31, and MBP). ELISA results revealed an upregulation of BDNF and reduction of both VEGF and NGF protein levels. This study demonstrates that seeding of undifferentiated adipose-derived MSCs onto processed nerve allografts permits the secretion of neurotrophic and angiogenic factors that can stimulate nerve regeneration. These favorable molecular changes suggest that MSC supplementation of nerve allografts may have potential in improving nerve regeneration.
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Affiliation(s)
- Nadia Rbia
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Liselotte F Bulstra
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Eric A Lewallen
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA; Department of Biological Sciences, Hampton University, 100 E Queen St, Hampton, VA 23668, USA
| | - Steven E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands; Xpert Clinic, Hand and Wrist Surgery, Jan Leentvaarlaan 14-24, 3065 DC Rotterdam, the Netherlands
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
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39
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Tissue-Engineered Grafts from Human Decellularized Extracellular Matrices: A Systematic Review and Future Perspectives. Int J Mol Sci 2018; 19:ijms19124117. [PMID: 30567407 PMCID: PMC6321114 DOI: 10.3390/ijms19124117] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022] Open
Abstract
Tissue engineering and regenerative medicine involve many different artificial and biologic materials, frequently integrated in composite scaffolds, which can be repopulated with various cell types. One of the most promising scaffolds is decellularized allogeneic extracellular matrix (ECM) then recellularized by autologous or stem cells, in order to develop fully personalized clinical approaches. Decellularization protocols have to efficiently remove immunogenic cellular materials, maintaining the nonimmunogenic ECM, which is endowed with specific inductive/differentiating actions due to its architecture and bioactive factors. In the present paper, we review the available literature about the development of grafts from decellularized human tissues/organs. Human tissues may be obtained not only from surgery but also from cadavers, suggesting possible development of Human Tissue BioBanks from body donation programs. Many human tissues/organs have been decellularized for tissue engineering purposes, such as cartilage, bone, skeletal muscle, tendons, adipose tissue, heart, vessels, lung, dental pulp, intestine, liver, pancreas, kidney, gonads, uterus, childbirth products, cornea, and peripheral nerves. In vitro recellularizations have been reported with various cell types and procedures (seeding, injection, and perfusion). Conversely, studies about in vivo behaviour are poorly represented. Actually, the future challenge will be the development of human grafts to be implanted fully restored in all their structural/functional aspects.
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40
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Lovati AB, D’Arrigo D, Odella S, Tos P, Geuna S, Raimondo S. Nerve Repair Using Decellularized Nerve Grafts in Rat Models. A Review of the Literature. Front Cell Neurosci 2018; 12:427. [PMID: 30510503 PMCID: PMC6254089 DOI: 10.3389/fncel.2018.00427] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 12/22/2022] Open
Abstract
Peripheral nerve regeneration after severe traumatic nerve injury is a relevant clinical problem. Several different strategies have been investigated to solve the problem of bridging the nerve gap. Among these, the use of decellularized nerve grafts has been proposed as an alternative to auto/isografts, which represent the current gold standard in the treatment of severe nerve injury. This study reports the results of a systematic review of the literature published between January 2007 and October 2017. The aim was to quantitatively analyze the effectiveness of decellularized nerve grafts in rat experimental models. The review included 33 studies in which eight different decellularization protocols were described. The decellularized nerve grafts were reported to be immunologically safe and able to support both functional and morphological regeneration after nerve injury. Chemical protocols were found to be superior to physical protocols. However, further research is needed to optimize preparation protocols, including recellularization, improve their effectiveness, and substitute the current gold standard, especially in the repair of long nerve defects.
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Affiliation(s)
- Arianna B. Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Daniele D’Arrigo
- Cell and Tissue Engineering Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Simonetta Odella
- UOC Hand Surgery and Reconstructive Microsurgery Unit, ASST G. Pini-CTO, Milan, Italy
| | - Pierluigi Tos
- UOC Hand Surgery and Reconstructive Microsurgery Unit, ASST G. Pini-CTO, Milan, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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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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42
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Petrova ES. Differentiation Potential of Mesenchymal Stem Cells and Stimulation of Nerve Regeneration. Russ J Dev Biol 2018. [DOI: 10.1134/s1062360418040033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Epineural Sheath Jacket as a New Surgical Technique for Neuroma Prevention in the Rat Sciatic Nerve Model. Ann Plast Surg 2018; 79:377-384. [PMID: 28570461 DOI: 10.1097/sap.0000000000001117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Terminal neuromas resulting from severe nerve injuries and traumatic or surgical limb amputations can become a source of pain, and significantly impair patients' quality of life. Recently, the number of patients with peripheral nerve injuries increased due to modern war conflicts, natural disasters, and traffic accidents. This study investigated the efficacy of the epineural sheath jacket (ESJ) as a novel technique for neuroma prevention in the rat sciatic nerve model. METHODS A 20-mm segment of the right sciatic nerve was excised in 18 Lewis rats, and the animals were divided into 3 experimental groups (n = 6/group): group I-control, nerve stump without protection; group II-muscle burying group, nerve stump buried in the muscle; group III-ESJ group, nerve stump protected by ESJ. The ESJ was created from the excised sciatic nerve and applied as a "cap" over the proximal nerve stump. The presence of neuropathic pain was assessed weekly by pinprick test and Tinel sign, up to 24 weeks postsurgery. At 24 weeks, assessments, such as macroscopic evaluation, retrograde neuronal labeling analysis, histomorphometry, and neural/connective tissue ratio were performed. RESULTS Epineural sheath jacket significantly reduced neuroma formation, which was associated with decreased Tinel sign (16.7%, P < 0.05) response compared with the nerve stump control. Moreover, ESJ reduced axonal sprouting, bulb-shaped nerve ending formation and perineural adhesions, as confirmed by macroscopic evaluation. Histological evaluation confirmed that nerve stumps protected with the ESJ showed less fibrosis and presented well-organized axonal structure. Neural/connective tissue ratio and retrograde neuronal labeling analysis revealed significantly improved results in the ESJ group compared to the control nerve stump group (P = 0.032 and P = 0.042, respectively). CONCLUSIONS The protective effect of the ESJ against neuroma formation was confirmed by behavioral and histological analyses, showing outcomes comparable to the muscle burying technique-the criterion standard of neuroma management.
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Lin T, Liu S, Chen S, Qiu S, Rao Z, Liu J, Zhu S, Yan L, Mao H, Zhu Q, Quan D, Liu X. Hydrogel derived from porcine decellularized nerve tissue as a promising biomaterial for repairing peripheral nerve defects. Acta Biomater 2018; 73:326-338. [PMID: 29649641 DOI: 10.1016/j.actbio.2018.04.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/24/2022]
Abstract
Decellularized matrix hydrogels derived from tissues or organs have been used for tissue repair due to their biocompatibility, tunability, and tissue-specific extracellular matrix (ECM) components. However, the preparation of decellularized peripheral nerve matrix hydrogels and their use to repair nerve defects have not been reported. Here, we developed a hydrogel from porcine decellularized nerve matrix (pDNM-G), which was confirmed to have minimal DNA content and retain collagen and glycosaminoglycans content, thereby allowing gelatinization. The pDNM-G exhibited a nanofibrous structure similar to that of natural ECM, and a ∼280-Pa storage modulus at 10 mg/mL similar to that of native neural tissues. Western blot and liquid chromatography tandem mass spectrometry analysis revealed that the pDNM-G consisted mostly of ECM proteins and contained primary ECM-related proteins, including fibronectin and collagen I and IV). In vitro experiments showed that pDNM-G supported Schwann cell proliferation and preserved cell morphology. Additionally, in a 15-mm rat sciatic nerve defect model, pDNM-G was combined with electrospun poly(lactic-acid)-co-poly(trimethylene-carbonate)conduits to bridge the defect, which did not elicit an adverse immune response and promoted the activation of M2 macrophages associated with a constructive remodeling response. Morphological analyses and electrophysiological and functional examinations revealed that the regenerative outcomes achieved by pDNM-G were superior to those by empty conduits and closed to those using rat decellularized nerve matrix allograft scaffolds. These findings indicated that pDNM-G, with its preserved ECM composition and nanofibrous structure, represents a promising biomaterial for peripheral nerve regeneration. STATEMENT OF SIGNIFICANCE Decellularized nerve allografts have been widely used to treat peripheral nerve injury. However, given their limited availability and lack of bioactive factors, efforts have been made to improve the efficacy of decellularized nerve allograft for nerve regeneration, with limited success. Xenogeneic decellularized tissue matrices or hydrogels have been widely used for surgical applications owing to their ease of harvesting and low immunogenicity. Moreover, decellularized tissue matrix hydrogels show good biocompatibility and are highly tunable. In this study, we prepared a porcine decellularized nerve matrix (pDNM-G) and evaluated its potential for promoting nerve regeneration. Our results demonstrate that pDNM-G can support Schwann cell proliferation and peripheral nerve regeneration by means of residual primary extracellular matrix components and nano-fibrous structure features.
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Affiliation(s)
- Tao Lin
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Sheng Liu
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Shihao Chen
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Shuai Qiu
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Zilong Rao
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Jianghui Liu
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Shuang Zhu
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Liwei Yan
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China
| | - Haiquan Mao
- Institute for NanoBioTechnology, and Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, USA
| | - Qingtang Zhu
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China.
| | - Daping Quan
- PCFM Lab, GD HPPC Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China.
| | - Xiaolin Liu
- Department of Orthopedic and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Peripheral Nerve Tissue-engineering and Technology Research Center, Guangdong Provincial Functional Biomaterials Engineering Technology Research Center, Guangzhou, China.
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Wrobel MR, Sundararaghavan HG. Biomaterial Cues to Direct a Pro-regenerative Phenotype in Macrophages and Schwann Cells. Neuroscience 2018; 376:172-187. [DOI: 10.1016/j.neuroscience.2018.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/23/2018] [Accepted: 02/09/2018] [Indexed: 12/11/2022]
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46
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Spearman BS, Desai VH, Mobini S, McDermott MD, Graham JB, Otto KJ, Judy JW, Schmidt CE. Tissue-Engineered Peripheral Nerve Interfaces. ADVANCED FUNCTIONAL MATERIALS 2018; 28:1701713. [PMID: 37829558 PMCID: PMC10569514 DOI: 10.1002/adfm.201701713] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Research on neural interfaces has historically concentrated on development of systems for the brain; however, there is increasing interest in peripheral nerve interfaces (PNIs) that could provide benefit when peripheral nerve function is compromised, such as for amputees. Efforts focus on designing scalable and high-performance sensory and motor peripheral nervous system interfaces. Current PNIs face several design challenges such as undersampling of signals from the thousands of axons, nerve-fiber selectivity, and device-tissue integration. To improve PNIs, several researchers have turned to tissue engineering. Peripheral nerve tissue engineering has focused on designing regeneration scaffolds that mimic normal nerve extracellular matrix composition, provide advanced microarchitecture to stimulate cell migration, and have mechanical properties like the native nerve. By combining PNIs with tissue engineering, the goal is to promote natural axon regeneration into the devices to facilitate close contact with electrodes; in contrast, traditional PNIs rely on insertion or placement of electrodes into or around existing nerves, or do not utilize materials to actively facilitate axon regeneration. This review presents the state-of-the-art of PNIs and nerve tissue engineering, highlights recent approaches to combine neural-interface technology and tissue engineering, and addresses the remaining challenges with foreign-body response.
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Affiliation(s)
- Benjamin S Spearman
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
| | - Vidhi H Desai
- Department of Electrical and Computer Engineering, The University of Florida, 216 Larsen Hall, 116200, Gainesville, FL 32611-6200
- Nanoscience Institute for Medical and Engineering Technology, The University of Florida, 1041 Center Drive, 116621, Gainesville, FL 32611-6621
| | - Sahba Mobini
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
| | - Matthew D McDermott
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr., West Lafayette, IN 47907-2032
| | - James B Graham
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
| | - Kevin J Otto
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
- Nanoscience Institute for Medical and Engineering Technology, The University of Florida, 1041 Center Drive, 116621, Gainesville, FL 32611-6621
- Department of Neuroscience, The University of Florida, 1149 Newell Dr., Room L1-100, 100244, Gainesville, FL 32610-0244
- Department of Neurology, The University of Florida, 2000 SW Archer Rd., Third Floor, 100383, Gainesville, FL 32610
| | - Jack W Judy
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
- Department of Electrical and Computer Engineering, The University of Florida, 216 Larsen Hall, 116200, Gainesville, FL 32611-6200
- Nanoscience Institute for Medical and Engineering Technology, The University of Florida, 1041 Center Drive, 116621, Gainesville, FL 32611-6621
| | - Christine E Schmidt
- Crayton Pruitt Family Department of Biomedical Engineering, The University of Florida, 1275 Center Dr., BMS Building JG-56, 116131, Gainesville, FL 32611-6131
- Nanoscience Institute for Medical and Engineering Technology, The University of Florida, 1041 Center Drive, 116621, Gainesville, FL 32611-6621
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O'Rourke C, Day AGE, Murray-Dunning C, Thanabalasundaram L, Cowan J, Stevanato L, Grace N, Cameron G, Drake RAL, Sinden J, Phillips JB. An allogeneic 'off the shelf' therapeutic strategy for peripheral nerve tissue engineering using clinical grade human neural stem cells. Sci Rep 2018; 8:2951. [PMID: 29440680 PMCID: PMC5811594 DOI: 10.1038/s41598-018-20927-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Artificial tissues constructed from therapeutic cells offer a promising approach for improving the treatment of severe peripheral nerve injuries. In this study the effectiveness of using CTX0E03, a conditionally immortalised human neural stem cell line, as a source of allogeneic cells for constructing living artificial nerve repair tissue was tested. CTX0E03 cells were differentiated then combined with collagen to form engineered neural tissue (EngNT-CTX), stable aligned sheets of cellular hydrogel. EngNT-CTX sheets were delivered within collagen tubes to repair a 12 mm sciatic nerve injury model in athymic nude rats. Autologous nerve grafts (autografts) and empty tubes were used for comparison. After 8 weeks functional repair was assessed using electrophysiology. Further, detailed histological and electron microscopic analysis of the repaired nerves was performed. Results indicated that EngNT-CTX supported growth of neurites and vasculature through the injury site and facilitated reinnervation of the target muscle. These findings indicate for the first time that a clinically validated allogeneic neural stem cell line can be used to construct EngNT. This provides a potential 'off the shelf' tissue engineering solution for the treatment of nerve injury, overcoming the limitations associated with nerve autografts or the reliance on autologous cells for populating repair constructs.
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Affiliation(s)
- C O'Rourke
- Department of Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
- UCL Centre for Nerve Engineering, London, UK
| | - A G E Day
- Department of Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
- UCL Centre for Nerve Engineering, London, UK
| | - C Murray-Dunning
- Department of Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
| | - L Thanabalasundaram
- UCL Centre for Nerve Engineering, London, UK
- ReNeuron, Pencoed, Bridgend, Wales, UK
| | - J Cowan
- Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - N Grace
- Sartorius Stedim Biotech, Royston, UK
| | - G Cameron
- Sartorius Stedim Biotech, Royston, UK
| | | | - J Sinden
- UCL Centre for Nerve Engineering, London, UK
- ReNeuron, Pencoed, Bridgend, Wales, UK
| | - J B Phillips
- Department of Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.
- UCL Centre for Nerve Engineering, London, UK.
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, UK.
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48
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Huang J, Patel N, Lyon K. An update–tissue engineered nerve grafts for the repair of peripheral nerve injuries. Neural Regen Res 2018. [DOI: 10.4103/1673-5374.232458
expr 973353844 + 912195704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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49
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Patel NP, Lyon KA, Huang JH. An update-tissue engineered nerve grafts for the repair of peripheral nerve injuries. Neural Regen Res 2018; 13:764-774. [PMID: 29862995 PMCID: PMC5998615 DOI: 10.4103/1673-5374.232458] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Peripheral nerve injuries (PNI) are caused by a range of etiologies and result in a broad spectrum of disability. While nerve autografts are the current gold standard for the reconstruction of extensive nerve damage, the limited supply of autologous nerve and complications associated with harvesting nerve from a second surgical site has driven groups from multiple disciplines, including biomedical engineering, neurosurgery, plastic surgery, and orthopedic surgery, to develop a suitable or superior alternative to autografting. Over the last couple of decades, various types of scaffolds, such as acellular nerve grafts (ANGs), nerve guidance conduits, and non-nervous tissues, have been filled with Schwann cells, stem cells, and/or neurotrophic factors to develop tissue engineered nerve grafts (TENGs). Although these have shown promising effects on peripheral nerve regeneration in experimental models, the autograft has remained the gold standard for large nerve gaps. This review provides a discussion of recent advances in the development of TENGs and their efficacy in experimental models. Specifically, TENGs have been enhanced via incorporation of genetically engineered cells, methods to improve stem cell survival and differentiation, optimized delivery of neurotrophic factors via drug delivery systems (DDS), co-administration of platelet-rich plasma (PRP), and pretreatment with chondroitinase ABC (Ch-ABC). Other notable advancements include conduits that have been bioengineered to mimic native nerve structure via cell-derived extracellular matrix (ECM) deposition, and the development of transplantable living nervous tissue constructs from rat and human dorsal root ganglia (DRG) neurons. Grafts composed of non-nervous tissues, such as vein, artery, and muscle, will be briefly discussed.
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Affiliation(s)
| | - Kristopher A Lyon
- Texas A&M College of Medicine; Department of Neurosurgery, Baylor Scott & White Healthcare, Temple, TX, USA
| | - Jason H Huang
- Texas A&M College of Medicine; Department of Neurosurgery, Baylor Scott & White Healthcare, Temple, TX, USA
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50
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Zhu J, Lu Y, Yu F, Zhou L, Shi J, Chen Q, Ding W, Wen X, Ding YQ, Mei J, Wang J. Effect of decellularized spinal scaffolds on spinal axon regeneration in rats. J Biomed Mater Res A 2017; 106:698-705. [PMID: 28986946 DOI: 10.1002/jbm.a.36266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/17/2017] [Accepted: 09/21/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Junyi Zhu
- Department of Hand Surgery and Peripheral Neurosurgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou 325035 China
| | - Yingfeng Lu
- Department of Hand Surgery and Peripheral Neurosurgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou 325035 China
| | - Fangzheng Yu
- Department of Hand Surgery and Peripheral Neurosurgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou 325035 China
| | - Lebin Zhou
- Wenzhou Medical University; Wenzhou 325035 China
| | - Jiawei Shi
- Wenzhou Medical University; Wenzhou 325035 China
| | - Qihui Chen
- Wenzhou Medical University; Wenzhou 325035 China
| | - Weili Ding
- The People's Hospital of Yuhuan; Taizhou 317600 China
| | - Xin Wen
- Department of Hand Surgery and Peripheral Neurosurgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou 325035 China
| | - Yu-Qiang Ding
- Institute of Neuroscience, Wenzhou Medical University; Wenzhou 325035 China
| | - Jin Mei
- Institute of Neuroscience, Wenzhou Medical University; Wenzhou 325035 China
- Anatomy Department; Wenzhou Medical University; Wenzhou 325035 China
| | - Jian Wang
- Department of Hand Surgery and Peripheral Neurosurgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou 325035 China
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