Effects of nerve growth factor on the neurotization of denervated muscles

Facilitation of Cell Cycle and Cellular Migration of Rat Schwann Cells by O-Carboxymethyl Chitosan to Support Peripheral Nerve Regeneration

O-carboxymethyl chitosan (CM-chitosan), holds high potential as a valuable biomaterial for nerve guidance conduits (NGCs). However, the lack of explicit bioactivity on neurocytes and poor duration that does not match nerve repair limit the restorative effects. Herein, CM-chitosan-based NGC is designed to induce the reconstruction of damaged peripheral nerves without addition of other activation factors. CM-chitosan possesses excellent performance in vitro for nerve tissue engineering, such as increasing the organization of filamentous actin and the expression of phospho-Akt, and facilitating the cell cycle and migration of Schwann cells. Moreover, CM-chitosan exhibits increased longevity upon cross-linking (C-CM-chitosan) with 1, 4-Butanediol diglycidyl ether, and C-CM-chitosan fibers possess appropriate biocompatibility. In order to imitate the structure of peripheral nerves, multichannel bioactive NGCs are prepared from lumen fillers of oriented C-CM-chitosan fibers and outer warp-knitted chitosan pipeline. Implantation of the C-CM-chitosan NGCs to rats with 10-mm defects of peripheral nerves effectively improve nerve function reconstruction by increasing the sciatic functional index, decreasing the latent periods of heat tingling, enhancing the gastrocnemius muscle, and promoting nerve axon recovery, showing regenerative efficacy similar to that of autograft. The results lay a theoretical foundation for improving the potential high-value applications of CM-chitosan-based bioactive materials in nerve tissue engineering.

Schwann cell delivery via a novel 3D collagen matrix conduit improves outcomes in critical length nerve gap repairs

OBJECTIVE

The current clinical standard of harvesting a nerve autograft for repair of long-segment peripheral nerve injuries (PNIs) is associated with many potential complications. Guidance channels offer an alternative therapy. The authors investigate whether autologous Schwann cells (SCs) implanted within a novel collagen-glycosaminoglycan conduit will improve axonal regeneration in a long-segment PNI model.

METHODS

Novel NeuraGen 3D collagen matrix conduits were implanted with autologous SCs to investigate axonal regeneration across a critical size defect (13 mm) in male Fischer rat sciatic nerve. Reversed sciatic nerve autografts served as positive controls, and conduits filled with serum only as negative controls. Electrophysiological assessments were made in vivo. Animals were killed at 4 or 16 weeks postinjury, muscle weights were measured, and grafts underwent immunohistochemical and morphometric analysis.

RESULTS

SC survival was confirmed by the presence of green fluorescent protein-labeled SCs within regenerated fibers. Regeneration and elongation of myelinated axons in all segments of the graft were significantly enhanced at 16 weeks in the SC-filled conduits compared to the conduit alone and were statistically similar to those of the autograft. Nerves repaired with SC-filled conduits exhibited onset latencies and nerve conduction amplitudes similar to those of the contralateral controls and autograft (p < 0.05). Adding SCs to the conduit also significantly reduced muscle atrophy compared to conduit alone (p < 0.0001).

CONCLUSIONS

Repair of long-segment PNI of rat sciatic nerve is significantly enhanced by SC-filled NeuraGen 3D conduits. Improvements in the total number of myelinated axons, axon diameter, and myelin thickness throughout SC-filled conduits allow for significant recovery in nerve conduction and a decrease in muscle atrophy.

A novel nerve transection and repair method in mice: histomorphometric analysis of nerves, blood vessels, and muscles with functional recovery

Peripheral nerve transection is associated with permanent functional deficit even after advanced microsurgical repair. While it is difficult to investigate the reasons of poor functional outcomes of microsurgical repairs in humans, we developed a novel pre-clinical nerve transection method that allows reliable evaluation of nerve regeneration, neural angiogenesis, muscle atrophy, and functional recovery. Adult male C57BL/6 mice were randomly assigned to four different types of sciatic nerve transection: Simple Transection (ST), Simple Transection & Glue (TG), Stepwise Transection and Sutures (SU), and Stepwise Transection and Glue (STG). Mice were followed for 28 days for sciatic function index (SFI), and sciatic nerves and hind limb muscles were harvested for histomorphological and cellular analyses. Immunohistochemistry revealed more directional nerve fiber growth in SU and STG groups compared with ST and TG groups. Compared to ST and TG groups, optimal neural vessel density and branching index in SU and STG groups were associated with significantly decreased muscle atrophy, increased myofiber diameter, and improved SFI. In conclusion, our novel STG method represents an easily reproducible and reliable model with close resemblance to the pathophysiological characteristics of SU model, and this can be easily reproduced by any lab.

Assessments of regenerative potential of silymarin nanoparticles loaded into chitosan conduit on peripheral nerve regeneration: a transected sciatic nerve model in rat

PURPOSE

It is compulsory to make a tension-free, end-to-end repair in transected injuries. However, when it comes to longer defects, placement of an autograft or nerve conduits is required. The present study was designed to assess regenerative potential of silymarin nanoparticles loaded into chitosan conduit on peripheral nerve regeneration in a transected sciatic nerve model in rat.

METHODS

In NML group left sciatic nerve was exposed through a gluteal muscle incision and after careful hemostasis skin was closed. In TSC group left sciatic nerve was transected and stumps were fixed in adjacent muscle. In CTN group, 10-mm sciatic nerve defects were bridged using a chitosan. In CTN/NSLM group, 10-mm sciatic nerve defects were bridged using a chitosan conduit and 100 µL silymarin nanoparticles were administered into the conduit. The regenerated fibers were studied 4, 8, and 12 weeks after surgery. Assessment of nerve regeneration was based on behavioral, functional, biomechanical, histomorphometric, and immuohistochemical criteria.

RESULTS

The behavioral, functional, electrophysiological, and biomechanical studies confirmed significant recovery of regenerated axons in CTN/NSLM group (P < 0.05). Quantitative morphometric analyses of regenerated fibers showed number and diameter of myelinated fibers in CTN/NSLM group were significantly higher than in CTN group (P < 0.05).

DISCUSSION

This demonstrated potential of using chitosan-silymarin nanoparticles in peripheral nerve regeneration without limitations of donor-site morbidity associated with isolation of autograft. It is also cost saving and may have clinical implications for surgical management of patients after peripheral nerve transection.

A comparison of the use of adipose-derived and bone marrow-derived stem cells for peripheral nerve regeneration in vitro and in vivo

Background

To date, it has repeatedly been demonstrated that infusing bone marrow-derived stem cells (BMSCs) into acellular nerve scaffolds can promote and support axon regeneration through a peripheral nerve defect. However, harvesting BMSCs is an invasive and painful process fraught with a low cellular yield.

Methods

In pursuit of alternative stem cell sources, we isolated stem cells from the inguinal subcutaneous adipose tissue of adult Sprague–Dawley rats (adipose-derived stem cells, ADSCs). We used a co-culture system that allows isolated adult mesenchymal stem cells (MSCs) and Schwann cells (SCs) to grow in the same culture medium but without direct cellular contact. We verified SC phenotype in vitro by cell marker analysis and used red fluorescent protein-tagged ADSCs to detect their fate after being injected into a chemically extracted acellular nerve allograft (CEANA). To compare the regenerative effects of CEANA containing either BMSCs or ADSCs with an autograft and CEANA only on the sciatic nerve defect in vivo, we performed histological and functional assessments up to 16 weeks after grafting.

Results

In vitro, we observed reciprocal beneficial effects of ADSCs and SCs in the ADSC–SC co-culture system. Moreover, ADSCs were able to survive in CEANA for 5 days after in vitro implantation. Sixteen weeks after grafting, all results consistently showed that CEANA infused with BMSCs or ADSCs enhanced injured sciatic nerve repair compared to the acellular CEANA-only treatment. Furthermore, their beneficial effects on sciatic injury regeneration were comparable as histological and functional parameters evaluated showed no statistically significant differences. However, the autograft group was roundly superior to both the BMSC- or ADSC-loaded CEANA groups.

Conclusion

The results of the present study show that ADSCs are a viable alternative stem cell source for treating sciatic nerve injury in lieu of BMSCs.

Fabrication and transplantation of chitosan-selenium biodegradable nanocomposite conduit on transected sciatic nerve: a novel study in rat model

Purpose: The improvement of techniques using conduits that connects the ends of damaged nerves and guides the growth of nerve fibers between the stumps, including adoption of natural or synthetic materials still is a challenge in peripheral nerve repair. The aim of the present novel study was to fabricate and transplant chitosan-selenium biodegradable nanocomposite conduit on transected sciatic nerve in rat model.Methods: In NORMAL group, the left sciatic nerve was exposed through a gluteal muscle incision and after careful hemostasis skin was closed. In TRANSECTED group left sciatic nerve was transected and stumps were fixed in adjacent muscle. In CHITOSAN and CSBNC groups, 10-mm sciatic nerve defects were bridged using a chitosan and chitosan-selenium biodegradable nanocomposite conduits, respectively. The regenerated fibers were studied 4, 8 and 12 weeks after surgery. Assessment of nerve regeneration was based on behavioral, functional, biomechanical, histomorphometric and immunohistochemical criteria.Results: The behavioral, functional and biomechanical studies confirmed significant recovery of regenerated axons in CSBNC group (P < 0.05). Quantitative morphometric analyses of regenerated fibers showed the number and diameter of myelinated fibers in CSBNC group were significantly higher than in the CHITOSAN group (P < 0.05).Discussion: This demonstrates the potential of using CSBNC in peripheral nerve regeneration without limitations of donor-site morbidity associated with isolation autograft. It is also cost saving and may have clinical implications for the surgical management of patients after facial nerve transection.

Ketogenic Diet Potentiates Electrical Stimulation-Induced Peripheral Nerve Regeneration after Sciatic Nerve Crush Injury in Rats

SCOPE

Recent findings indicate that the ketogenic diet (KD) is neuroprotective and electrical stimulation (ES) can improve functional recovery from peripheral nerve injury. However, it is not clear whether KD and ES play a synergistical role in the peripheral nerve recovery following injury.

METHODS AND RESULTS

A KD consisting of a 3:1 ratio of fat to carbohydrate + protein is used and is coupled with ES treatment in a rat model of peripheral nerve crush injury. Neuromuscular recovery is evaluated by electromyography, and axonal regeneration and myelination by histological methods. The effects on insulin-like growth factor 1 (IGF-1) and IGF-1 receptor expression in peripheral nerve tissue, pre- and post-nerve injury, are also investigated. The combination of KD and ES synergistically increases muscle force in biceps femoris and gluteus maximus and prevents development of hypersensitivity in biceps femoris. It promotes peripheral nerve regeneration by increasing total axons, axon density, and axonal diameter, as well as myelin thickness and axon/fiber ratio. These effects are due to modulation of the IGF system as the treatment expression of IGF-1 and IGF-1 receptor in regenerated nerve tissue.

CONCLUSION

The results establish that KD and ES promote peripheral nerve regeneration. Patients recovering from peripheral nerve injury may benefit from this combinational approach.

Regenerative Capacities of Chitosan-Nanoselenium Conduit on Transected Sciatic Nerve in Diabetic Rats: An Animal Model Study

Objective:

To assess regenerative capacities of chitosan-nanoselenium conduit on transected sciatic nerve in diabetic rats.

Methods:

A 10-mm sciatic nerve defect was bridged using a chitosan-nanoselenium conduit filled with phosphate buffered saline. In chitosan group, the chitosan conduit was filled with phosphate buffered saline solution. In sham-operated group, sciatic nerve was exposed and closed. In transected group, right sciatic nerve was transected and nerve cut ends were fixed in the adjacent muscle. The regenerated fibers were studied within 12 weeks after surgery.

Results:

The behavioral and functional and electrophysiological tests confirmed faster recovery of the regenerated axons in chitosan-nanoselenium conduit group compared to chitosan group (p=0.001). The mean ratios of gastrocnemius muscles weight were measured. There was statistically significant difference between the muscle weight ratios of chitosan-nanoselenium conduit and chitosan groups (p=0.001). Morphometric indices of regenerated fibers showed number and diameter of the myelinated fibers were significantly higher in chitosan-nanoselenium conduit group than in chitosan group.

Conclusion:

chitosan-nanoselenium conduit resulted in acceleration of functional recovery and quantitative morphometric indices of sciatic nerve.

Local Administration of Methylprednisolone Laden Hydrogel Enhances Functional Recovery of Transected Sciatic Nerve in Rat

Objective

To determine the effects of methylprednisolone-laden hydrogel loaded into a chitosan conduit on the functional recovery of peripheral nerve using a rat sciatic nerve regeneration model was assessed.

Methods

10-mm sciatic nerve defect was bridged using a chitosan conduit (CHIT/CGP-Hydrogel) filled with CGP-hydrogel. In authograft group (AUTO) a segment of sciatic nerve was transected and reimplanted reversely. In methylprednisolone treated group (CHIT/MP) the conduit was filled with methylprednisolone-laden CGP-hydrogel. The regenerated fibers were studied within 16 weeks after surgery.

Results

The behavioral, functional and electrophysiological studies confirmed faster recovery of the regenerated axons in methylprednisolone treated group compared to CHIT/Hydrogel group (p<0.05). The mean ratios of gastrocnemius muscles weight were measured. There was statistically significant difference between the muscle weight ratios of CHIT/MP and CHIT/Hydrogel groups (p<0.05). Morphometric indices of regenerated fibers showed number and diameter of the myelinated fibers were significantly higher in CHIT/MP than in CHIT/Hydrogel group.

Conclusion

Methylprednisolone-laden hydrogel when loaded in a chitosan conduit resulted in improvement of functional recovery and quantitative morphometric indices of sciatic nerve.

Effect of electrical stimulation on motor nerve regeneration in sciatic nerve ligated-mice

The purpose of this study was to investigate the effect of electrical stimulation on sciatic nerve regeneration and functional recovery of target muscles. Mice were randomly divided into 3 groups: ligated without electrical stimulation, ligated with electrical stimulation and control (non-ligated). The unilateral peripheral mononeuropathy was produced on the right hind limb. Sciatic nerve was then electrically stimulated daily for a period of 2 weeks (duration: 0.2 msec, frequency: 100Hz, amplitude: 15mA). Evoked surface EMG was recorded from biceps femoris (BF) and gluteus maximus (GM) muscles on the 3rd, 7th, 10th and 14th day after sciatic nerve ligation. Muscle force and sensitivity was determined by processing of the recorded EMG signals in time and frequency domains respectively. The results showed electrical stimulation (ES) produced a significant increase in the EMG response of BF, and muscle force significantly increased on the 14th day (p<0.001), however no significant difference was found in GM muscle force between experimental groups. This may be due to possible innervation by inferior gluteal nerve. Frequency analysis of BF signals indicates that hyperalgesia remained after 14 days in both ligated groups. On the 14th day no difference in GM muscle sensitivity was found between groups. In conclusion, the results of this study have shown that the electrical stimulation of sciatic nerve accelerates nerve repair and indirectly improves BF muscle force to a comparable level with control without effect on muscle sensitivity. However, ES had no effect on GM muscle force and sensitivity.

Nerve growth factor and basic fibroblast growth factor promote reinnervation by nerve-muscle-endplate grafting

INTRODUCTION

This study was designed to test whether exogenous application of nerve growth factor (NGF) and basic fibroblast growth factor (FGF-2) to muscles reinnervated with nerve-muscle-endplate band grafting (NMEG) could promote specific outcomes.

METHODS

The right sternomastoid muscle in adult rats was experimentally denervated and immediately reinnervated by implanting an NMEG pedicle from the ipsilateral sternohyoid muscle. A fibrin sealant containing NGF and FGF-2 was focally applied to the implantation site. Maximal tetanic force, muscle weight, regenerated axons, and motor endplates were analyzed 3 months after treatment.

RESULTS

Mean tetanic force, wet muscle weight, and number of regenerated axons in the treated muscles were 91%, 92%, and 84% of the contralateral controls, respectively. The majority of endplates (86%) in the treated muscles were reinnervated by regenerated axons.

DISCUSSION

Focal administration of NGF and FGF-2 promotes efficacy of the NMEG technique. Muscle Nerve 57: 449-459, 2018.

Dual Inhibition of Activin/Nodal/TGF-β and BMP Signaling Pathways by SB431542 and Dorsomorphin Induces Neuronal Differentiation of Human Adipose Derived Stem Cells

Damage to the nervous system can cause devastating diseases or musculoskeletal dysfunctions and transplantation of progenitor stem cells can be an excellent treatment option in this regard. Preclinical studies demonstrate that untreated stem cells, unlike stem cells activated to differentiate into neuronal lineage, do not survive in the neuronal tissues. Conventional methods of inducing neuronal differentiation of stem cells are complex and expensive. We therefore sought to determine if a simple, one-step, and cost effective method, previously reported to induce neuronal differentiation of embryonic stem cells and induced-pluripotent stem cells, can be applied to adult stem cells. Indeed, dual inhibition of activin/nodal/TGF-β and BMP pathways using SB431542 and dorsomorphin, respectively, induced neuronal differentiation of human adipose derived stem cells (hADSCs) as evidenced by formation of neurite extensions, protein expression of neuron-specific gamma enolase, and mRNA expression of neuron-specific transcription factors Sox1 and Pax6 and matured neuronal marker NF200. This process correlated with enhanced phosphorylation of p38, Erk1/2, PI3K, and Akt1/3. Additionally, in vitro subcutaneous implants of SB431542 and dorsomorphin treated hADSCs displayed significantly higher expression of active-axonal-growth-specific marker GAP43. Our data offers novel insights into cell-based therapies for the nervous system repair.

Local Polyethylene Glycol in Combination with Chitosan Based Hybrid Nanofiber Conduit Accelerates Transected Peripheral Nerve Regeneration

OBJECTIVE

The incapability to promptly improve behavioral function after discontinuation of peripheral nerves is a current problem in clinical practice. Effect of local polyethylene glycol in combination with chitosan-based hybrid nanofiber conduit was assessed.

STUDY DESIGN

A 10-mm sciatic nerve defect was bridged using a chitosan-based hybrid nanofiber conduit (Chitosan) filled with phosphate-buffered saline. In authograft group (AUTO), a segment of sciatic nerve was transected and reimplanted reversely. In polyethylene glycol-treated group (CHIT/PEG), the conduit was filled with polyethylene glycol solution. The regenerated fibers were studied within 12 weeks after surgery.

RESULTS

The behavioral and functional tests confirmed faster recovery of the regenerated axons in PEG-treated group compared to Chitosan group (p < .05). The mean ratios of gastrocnemius muscles weight were measured. There was statistically significant difference between the muscle weight ratios of CHIT/PEG and Chitosan groups (p < .05). Morphometric indices of regenerated fibers showed number and diameter of the myelinated fibers were significantly higher in CHIT/PEG than in Chitosan. In immuohistochemistry, the location of reactions to S-100 in CHIT/PEG was clearly more positive than Chitosan group.

CONCLUSION

polyethylene glycol solution when loaded in a chitosan-based hybrid nanofiber conduit resulted in acceleration of functional recovery and quantitative morphometric indices of sciatic nerve.

Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration

BACKGROUND

This study was designed to determine the correlation between functional recovery and the extent of axonal regeneration after muscle reinnervation with our recently developed nerve-muscle-endplate band grafting (NMEG) technique in a rat model.

MATERIALS AND METHODS

The right experimentally paralyzed sternomastoid (SM) muscle by nerve transection was immediately reinnervated with an NMEG pedicle harvested from a neighboring sternohyoid muscle. The NMEG pedicle contained a muscle block (6 × 6 × 3 mm), a donor nerve branch with nerve terminals, and a motor endplate band. Three months after surgery, the tetanic force of the SM muscle was measured and the regenerated axons in the muscle were detected using neurofilament immunohistochemistry.

RESULTS

The results showed that the maximal tetanic force (a measure of muscle functional recovery) of the NMEG-reinnervated SM muscle reached up to 66.0% of the normal control. The wet weight of the reinnervated SM muscle (a measure of muscle mass recovery) was 87.2% of the control. The area fraction of the regenerating axons visualized with neurofilament staining within the NMEG-reinnervated SM muscle (a measure of muscle reinnervation) was 42.3%. A positive correlation was revealed between the extent of muscle reinnervation and maximal muscle force.

CONCLUSIONS

Our newly developed NMEG technique results in satisfactory functional outcomes and nerve regeneration. Further improvement in the functional recovery after NMEG reinnervation could be achieved by refining the surgical procedure and creating an ideal environment that favors axon-endplate connections and accelerates axonal growth and sprouting.

Sciatic nerve regeneration induced by transplantation of in vitro bone marrow stromal cells into an inside-out artery graft in rat

Traumatic injury to peripheral nerves results in considerable motor and sensory disability. Several research groups have tried to improve the regeneration of traumatized nerves by invention of favorable microsurgery. Effect of undifferentiated bone marrow stromal cells (BMSCs) combined with artery graft on peripheral nerve regeneration was studied using a rat sciatic nerve regeneration model. A 10-mm sciatic nerve defect was bridged using an artery graft (IOAG) filled with undifferentiated BMSCs (2 × 10(7) cells/mL). In control group, the graft was filled with phosphated buffer saline alone. The regenerated fibers were studied 4, 8 and 12 weeks after surgery. Assessment of nerve regeneration was based on behavioral, functional (Walking Track Analysis), electrophysiological, histomorphometric and immuohistochemical (Schwann cell detection by S-100 expression) criteria. The behavioral, functional and electrophysiological studies confirmed significant recovery of regenerated axons in IOAG/BMSC group (P < 0.05). Quantitative morphometric analyses of regenerated fibers showed the number and diameter of myelinated fibers in IOAG/BMSC group were significantly higher than in the control group (P < 0.05). This demonstrates the potential of using undifferentiated BMSCs combined with artery graft in peripheral nerve regeneration without limitations of donor-site morbidity associated with isolation of Schwann cells. It is also cost saving due to reduction in interval from tissue collection until cell injection, simplicity of laboratory procedures compared to differentiated BMSCs and may have clinical implications for the surgical management of patients after facial nerve transection.

Comparison of muscle force after immediate and delayed reinnervation using nerve-muscle-endplate band grafting

BACKGROUND

Because of poor functional outcomes of currently used reinnervation methods, we developed novel treatment strategy for the restoration of paralyzed muscles-the nerve-muscle-endplate band grafting (NMEG) technique. The graft was obtained from the sternohyoid muscle (donor) and implanted into the ipsilateral paralyzed sternomastoid (SM) muscle (recipient).

METHODS

Rats were subjected to immediate or delayed (1 or 3 mo) reinnervation of the experimentally paralyzed SM muscles using the NMEG technique or the conventionally used nerve end-to-end anastomosis. The SM muscle at the opposite side served as a normal control.

RESULTS

NMEG produced better recovery of muscle force as compared with end-to-end anastomosis. A larger force produced by NMEG was most evident for small stimulation currents.

CONCLUSIONS

The NMEG technique holds great potential for successful muscle reinnervation. We hypothesize that even better muscle reinnervation and functional recovery could be achieved with further improvement of the environment that favors axon-end plate connections and accelerates axonal growth and sprouting.

Force recovery and axonal regeneration of the sternomastoid muscle reinnervated with the end-to-end nerve anastomosis

BACKGROUND

End-to-end nerve anastomosis (EEA) is a commonly used nerve repair technique. However, this method generally results in poor functional recovery. This study was designed to determine the correlation of functional recovery to the extent of axonal reinnervation after EEA procedure in a rat model.

MATERIALS AND METHODS

Seven adult rats were subjected to the immediate reinnervation of an experimentally paralyzed sternomastoid (SM) muscle. The SM nerve was transected and immediately repaired with EEA. The SM muscle at the opposite side, without nerve transection, served as a control. Three months after EEA nerve repair, the muscle force of the SM muscle was measured and the regenerated axons in the muscle were detected using neurofilament immunohistochemistry.

RESULTS

Three months after surgery, the reinnervated SM muscle produced limited anatomical and functional recovery (calculated as the percentage of the control). Specifically, the wet weight of the operated SM muscle (a measure of muscle mass recovery) was 78.0% of the control. The maximal tetanic force (a measure of muscle functional recovery) was 56.7% of the control. The area fraction of the neurofilament stained intramuscular axons (a measure of axonal regeneration and muscle reinnervation) was measured to be only 13.4% of the control. A positive correlation was revealed between the extent of muscle reinnervation and maximal muscle force.

CONCLUSIONS

The EEA reinnervated SM muscle in the rat yielded unsatisfactory muscle force recovery as a result of mild to moderate nerve regeneration. Further work is needed to improve the surgical procedure, enhance axonal regeneration, and/or develop novel treatment strategies for better functional recovery.

Optimal time-point for neural stem cell transplantation to delay denervated skeletal muscle atrophy

INTRODUCTION

Transplantation of neural stem cells (NSCs) is a promising treatment to delay denervated skeletal muscle atrophy; however, the optimal time-point between peripheral nerve injury and NSC transplantation needs to be determined.

METHODS

Improvement in rat gastrocnemius muscle function was evaluated after NSCs were transplanted into sectioned distal tibial nerves. We also assessed survival and differentiation. ANOVA was used to compare the mean value of the number of neuron-like cells, cross-sectional area amelioration, the amount of activated fibers, and latency and amplitude of the gastrocnemius compound muscle action potential.

RESULTS

The group in which the NSCs were transplanted 1 week after tibial nerve transection had the largest number of neuron-like cells, maximum cross-sectional area amelioration, and maximum amount of activated gastrocnemius fibers compared with all other groups (P < 0.01).

CONCLUSIONS

The optimal time-point for NSC transplantation for delaying denervated skeletal muscle atrophy is 1 week after severing the nerve.

Acetyl-l-carnitine increases nerve regeneration and target organ reinnervation - a morphological study

Peripheral nerve injury frequently results in functional morbidity since standard management fails to adequately address many of the neurobiological hurdles to optimal regeneration. Neuronal survival and regeneration are neurotrophin dependent and require increased aerobic capacity. Acetyl-l-carnitine (ALCAR) facilitates this need and prevents neuronal loss. ALCAR is clinically safe and is shown here to significantly improve nerve regeneration and target organ reinnervation. Two groups of five rats underwent sciatic nerve division followed by immediate repair. One group received parenteral ALCAR (50mg/kg/day) from time of operation until termination at 12 weeks. A 'sham treatment' group received normal saline. A third group was left unoperated and did not receive any treatment. A segment of nerve was harvested between 5mm proximal and 10mm distal to the repair in operated groups, and at the corresponding level in the unoperated group. Mean axonal count in normal, non-axotomised nerve was 14,720 (SD 2378). That of the saline group (17,217 SD 1808) was not significantly different from normal nerve (P=0.0985). Mean number of myelinated axons in the ALCAR group (24,460 SD 3750) was significantly greater than both sham group (P<0.01) and normal nerve (P=0.0012). Mean myelin thickness in the saline treated group (0.408 microm SD 0.067 microm) was less than normal nerve (0.770 microm SD 0.143 microm) (P<0.001). Mean myelin thickness in the ALCAR group (0.627 microm SD 0.052 microm) was greater than the sham (saline) group (P<0.01) and not statistically different from normal nerve (P=0.07). ALCAR increased dermal PGP9.5 staining by 210% compared to sham treatment (P<0.0001) and significantly reduced the mean percentage weight loss in gastrocnemius muscle (ALCAR group 0.203% vs. 0.312% in sham group P=0.015). ALCAR not only increases the number of regenerating nerve fibres but also morphologically improves the quality of regeneration and target organ reinnervation. Adjuvant ALCAR treatment may improve both sensory and motor outcomes and merits further investigation.

Intrinsic Laryngeal Muscle Reinnervation Using the Muscle-Nerve-Muscle Technique

Objectives:

This study was performed to investigate the muscle-nerve-muscle reinnervation technique in the larynx, in which a nerve conduit implanted into an innervated muscle conducts axonal sprouting into a denervated muscle while maintaining function of the donor muscle.

Methods:

In this study, the muscle-nerve-muscle technique was used to direct superior laryngeal nerve axons to reinnervate intrinsic laryngeal muscles by implanting the recurrent laryngeal nerve stump into the cricothyroid muscle in 8 dogs. In 4 of the dogs, the recurrent laryngeal nerve trunk to the adductor muscles was divided so that all axonal sprouting was directed to the posterior cricoarytenoid muscle. Six-month electromyography data were obtained from 6 of the 8 dogs.

Results:

All 6 dogs showed evidence of successful reinnervation of the thyroarytenoid or posterior cricoarytenoid muscles with action potentials that corresponded to spontaneous respiratory efforts, while the donor cricothyroid muscles retained their phasic contraction. These responses were obliterated when the recurrent laryngeal nerve conduit was divided. Histologic examination of the intrinsic laryngeal muscles demonstrated successful reinnervation.

Conclusions:

The results confirm that intrinsic laryngeal muscles may be successfully reinnervated by the superior laryngeal nerve with the muscle-nerve-muscle technique, without sacrifice of function of the cricothyroid muscle. This method offers an alternative source of appropriately firing axons for laryngeal reinnervation procedures.

Herpes simplex virus-thymidine kinase-based suicide gene therapy as a "molecular switch off" for nerve growth factor production in vitro

Tissue-engineered constructs offer a new hope to patients suffering from functional impairment after nerve injury. An effort has been made to focus on delivery, regulation, and "molecular shutoff" of nerve growth factor (NGF) in tissue-engineered constructs. We have previously demonstrated that human embryonic kidney (HEK-293) cells can be genetically modified to secrete NGF at varying time points upon up regulation with Ponasterone A (PonA) both in vitro and in vivo. In the present study, HEK-293 cells that stably and inducibly produce NGF were further stably transfected with herpes simplex virus-thymidine kinase gene as a suicide gene (hNGF-EcR-293-TK) in order to shut off the NGF secretion and kill the cells upon treatment with ganciclovir (GCV). These cells following induction with PonA secreted NGF levels of 6659.2 +/- 489.4 pg/mL at day 10 postbooster dose at day 5, which was significantly higher than the control noninduced cells. The NGF secreted by these cells was bioactive as determined by a rat adrenal pheochromocytoma (PC-12) cell bioassay. Treatment of these cells with GCV significantly reduced the NGF levels to 645.3 +/- 16.2 pg/mL at day 10 and live cell numbers dropped to 7.95 x 10(3) +/- 278 compared to 2.73 x 10(5) +/- 6.1 x 10(4). GCV-treated cell media when transferred to the PC-12 cell bioassay demonstrated less than 10% cells differentiating into neurite-like extensions. We conclude that hNGF-EcR-293-TK cells can inducibly secrete bioactive NGF when treated with the inducing agent and can also be killed upon treatment with GCV. This double-gene transfection for gene expression and molecular shutoff mechanism will be a useful tool in tissue-engineered nerve constructs.

Short- or long-term effects of adult myoblast transfer on properties of reinnervated skeletal muscles

Skeletal muscle demonstrates a force deficit after repair of injured peripheral nerves. Data from the literature indicate that myoblast transfer enhances recovery of muscle function. Thus, we tested the hypothesis that transfer of adult myoblasts improves the properties of reinnervated rabbit tibialis anterior (TA) muscles in both the short term (4 months) and long term (14 months). Two months after transection and immediate suture of the common peroneal nerve, TA muscles were made to degenerate by cardiotoxin injection and then transplanted with adult myoblasts cultured for 13 days. Under these conditions, muscles studied at 4 months were heavier, contained larger fibers, and developed a significantly higher maximal force than muscles that had only been denervated-reinnervated. In the long term, although muscles made to degenerate were heavier and developed a significantly higher maximal force than denervated-reinnervated muscles, myoblast transfer failed to improve these parameters. However, the overall characteristics of long-term operated muscles tended clearly to approach those of the controls. Taken together, these results may have significant implications in certain orthopedic contexts, particularly after immediate or delayed muscle reinnervation.

Nerve Growth Factor Expression Response to Induction Agent Booster Dosing in Transfected Human Embryonic Kidney Cells

To assess whether nerve growth factor (NGF) expression would respond to booster dosing with the inducing agent ponasterone A, human embryonic kidney cells (HEK-293) were transfected with human NGF cDNA. Cells were cultured for 5 days in media with or without ponasterone A. On day 5, controls received a ponasterone A media replacement, whereas experimental groups received ponasterone A booster media replacement. NGF protein expression bioactivity was assessed using a PC-12 cell bioassay and the concentration of secreted NGF was quantified using NGF enzyme-linked immunosorbent assay. Cells with and without ponasterone A were left for 5 days without changing the medium. On day 5, the supernatants were collected and flash-frozen for enzyme-linked immunosorbent assay. The ponasterone A-positive and -negative booster medium was replaced in the appropriate wells. Supernatants were collected from the wells at 2, 4, and 6 days after the booster dose and removal of original supernatant. The medium was flash-frozen for enzyme-linked immunosorbent assay (1.5 ml), and the remaining 500 mul was transferred to PC-12 cells seeded onto 12-well plates to determine NGF bioactivity. All experiments were performed in quadruplicate. NGF production was measured daily by enzyme-linked immunosorbent assay over a 6-day period after the ponasterone A booster to a maximal release of 1233 +/- 130 pg/ml at day 6 (11 days after original induction). Maximal NGF production per 10(3) cells was 2.5 +/- 0.61 pg at day 6. Bioactivity was determined by percentage differentiation (per 100 cells counted) at 26, 52, and 98 percent for ponasterone A-treated wells on 2, 4, and 6 days after booster dosing (7, 9, and 11 days after induction), respectively. PC-12 cell differentiation was not visualized in the ponasterone A-negative control wells. Human NGF-EcR-293 cells can inducibly secrete bioactive NGF when exposed to the induction agent ponasterone A. Furthermore, repeated bioactive NGF expression peaks beyond that previously demonstrated can be achieved using induction agent booster dosing, indicating the ability to regulate the system over an extended period.

Enhanced reinnervation after neurotization with Schwann cell transplantation

We investigated the feasibility of using Schwann cell transplantation to enhance reinnervation after direct nerve-to-muscle neurotization (NMN). The denervated anterior tibial muscle was neurotized by tibial nerve implantation, and Schwann cell suspension (transplantation group) or an equivalent volume of culture medium (control group) was injected at the implantation site. In the control group, few axons invaded the muscle, demonstrating that skeletal muscle was poorly permissive to the advancement of axons. In the transplantation group, a large number of regenerating axons grew for a longer distance throughout the muscle, and reinnervated motor endplates were significantly more abundant. Enhanced reinnervation and functional recovery of the muscle in the transplantation group was confirmed by a significant increase in the compound muscle action potential and in muscle weight. These results suggest that intramuscular Schwann cell transplantation has potential as a cell therapy to improve functional recovery after NMN.

The effect of nerve growth factor on functional recovery after injury to the chorda tympani and lingual nerves

Nerve growth factor (NGF) is known to ameliorate central changes and enhance the regeneration of damaged axons in the early stages after peripheral nerve injury. We have assessed the long-term outcome of placing NGF at a nerve repair site by determining the functional characteristics of several groups of sensory afferent and autonomic efferent fibres in the cat lingual nerve. Six months after entubulation repair, with or without the incorporation of NGF, the recovery of secretomotor and vasomotor efferents was determined by recording salivary flow from the submandibular gland and temperature changes on the tongue surface, each evoked by stimulation of the repaired nerve. Electrophysiological recordings from the lingual and chorda tympani nerves proximal to the repair allowed characterisation of mechanosensitive, thermosensitive and gustatory afferents. When compared with data from uninjured control animals, both repair groups showed changes in spontaneous discharge and persistent reductions in conduction velocity, receptor sensitivity, proportion of gustatory units, and rate of salivary secretion. Comparisons between the outcome of repair with or without NGF revealed few differences. In the NGF group the conduction velocity of afferents in the lingual nerve was lower, and the level of spontaneous activity was higher. However, NGF appeared to preferentially enhance the regeneration of thermosensitive afferents, suggesting that it may play a role in determining the phenotypic profile of the regenerating axonal population. This suggests that future therapeutic enhancement of regeneration after peripheral nerve injury may require a combination of factors to encourage regeneration of specific fibre groups.

Human Embryonic Kidney Cells (HEK-293 Cells): Characterization and Dose-Response Relationship for Modulated Release of Nerve Growth Factor for Nerve Regeneration

The development of engineered constructs to bridge nerve gaps may hold the key to improved functional outcomes in the repair of injured peripheral nerves. These constructs must be rendered bioactive by providing the growth factors required for successful peripheral nerve regeneration. Previous studies demonstrated that harvested human and rat dermal fibroblasts could be genetically engineered to release nerve growth factor (NGF) both in vitro and in vivo. The use of fibroblasts, however, has the potential to cause scarring, and the expression of NGF from those cells was transient. To overcome these potential difficulties, human embryonic kidney cells were modified for use with the ecdysone-inducible mammalian expression system. These cells (hNGF-EcR-293) have been engineered and regulated to secrete human NGF in response to the ecdysone analogue ponasterone A. HEK-293 cells were transfected with human NGF cDNA with the ecdysone-inducible mammalian expression system (Invitrogen, Carlsbad, Calif.). Stable clones were then selected. Ponasterone A, an analogue of ecdysone, was used as the inducing agent. The secretion of NGF into the medium was analyzed with two different methods. After 24 hours of exposure to the inducing agent, cell medium was transferred to PC-12 cells seeded in 12-well plates, for determination of whether the secreted NGF was bioactive. Medium from untreated or ponasterone A-treated hNGF-EcR-293 cells was deemed bioactive on the basis of its ability to induce PC-12 cell differentiation. The concentrations of secreted NGF were also quantified with an enzyme-linked immunosorbent assay, in triplicate. NGF production was measured in successive samples of the same medium during a 9-day period, with maximal release of 9.05 +/- 2.6 ng/ml at day 9. Maximal NGF production was 8.46 +/- 2.1 pg/10(3) cells at day 9. These levels were statistically significantly different from levels in noninduced samples (p <or= 0.05). Differences in NGF secretion with the three different concentrations of ponasterone A (1, 2, and 3 microM) were not statistically significant. PC-12 cells exposed to medium from induced transfected HEK-293 cells demonstrated markedly higher levels of differentiation, compared with control levels, indicating bioactive protein secretion. It was demonstrated that this regulated delivery system could secrete bioactive NGF for up to 9 days and might be useful for in vivo applications. This regulated delivery system should be useful for tissue-engineered nerve constructs.

Transplantation of primary satellite cells improves properties of reinnervated skeletal muscles

Skeletal muscle demonstrates a force deficit after repair of injured peripheral nerves. We tested the hypothesis that transplantation of satellite cells into reinnervated rabbit tibialis anterior (TA) muscles improves their properties. Adult rabbits underwent transection and immediate suture of the common peroneal nerve. In order to provide an environment favorable for cell transplantation, TA were then made to degenerate by cardiotoxin injection, either immediately or after a 2-month delay, which is sufficient for muscle reinnervation. In both cases, the injured TA were transplanted with cultured satellite cells 5 days after induction of muscle degeneration. When cells were transferred immediately after nerve repair, drastic morphological and functional muscle alterations were observed. However, when the muscles were allowed to become reinnervated before cell transplantation, muscles were heavier and developed a significantly higher maximal force compared to denervated-reinnervated muscles. Thus, application of the cell therapy protocol improved properties of denervated muscles only when they were allowed to become innervated. These results, which represent the application of cell therapy to improve force recovery of reinnervated muscles, will be of significant interest in certain clinical contexts, particularly after immediate or delayed muscle reinnervation.