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Hanna AS, Mickelson E, Omar AH, Baer M, Sveum J, Marti T, Mishra R, Trudrung M, Hutchinson J, Attaluri P, Jacobs A, Ott E, Martinson N, Jones J, Hellenbrand D. Comparison of nylon, vicryl, and fibrin glue for nerve grafting in rats. Neurol Res 2024:1-10. [PMID: 39007696 DOI: 10.1080/01616412.2024.2376307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES For nerve injuries, not amendable to tensionless epineural coaptation of the nerve, autografts are the preferred treatment. Although absorbable sutures are not recommended for nerve repair, there is no evidence that non-absorbable sutures are superior to absorbable sutures. This study aims to assess the effectiveness of non-absorbable monofilament nylon sutures, absorbable monofilament vicryl sutures, and fibrin glue when used for nerve grafting. METHODS Lewis rats (N = 32) were subjected to a sciatic nerve transection and randomly assigned to a group: graft with Nylon, graft with Vicryl, graft with Fibrin Glue, or no graft. Motor function, sensory function, and thermal pain were assessed during a 12-week recovery period, and immunohistochemistry was used to assess macrophage response. RESULTS At 12 weeks, the Vicryl and Nylon groups had significantly larger ankle angles at to lift off, which is a measure of motor function, compared to injured controls (p < 0.05). Grafted rats displayed no difference in thermal response but hypersensitivity to mechanical stimuli compared to the uninjured hindlimb. The Nylon, Vicryl, and Fibrin Glue groups all had significantly less atrophy of the gastrocnemius muscle compared to injured controls (p < 0.0001). In the Fibrin Glue group, 3/9 grafts did not incorporate. The Nylon group had significantly less (p = 0.0004) axon growth surrounding the suture holes compared to the Vicryl group. There were no differences in the axon counts, motor neurons, or sensory neurons between all grafted rats. CONCLUSIONS These results demonstrate that vicryl sutures work just as well as nylon for nerve recovery after injury and grafting.
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Affiliation(s)
- Amgad S Hanna
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Ethan Mickelson
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed H Omar
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Faculty of Medicine, Cairo University, Giza, Egypt
| | - Matthew Baer
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jacob Sveum
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Taylor Marti
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Raveena Mishra
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Melissa Trudrung
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jacob Hutchinson
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Pradeep Attaluri
- Division of Plastic Surgery, Department of General Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Alison Jacobs
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Emily Ott
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Natalie Martinson
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jalon Jones
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Hellenbrand
- Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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2
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He L, Sato JE, Sundar P, Azimi T, Beachy PA, Bekale LA, Pepper JP. Localized application of SAG21k-loaded fibrin hydrogels for targeted modulation of the hedgehog pathway in facial nerve injury. Int J Biol Macromol 2024; 269:131747. [PMID: 38670196 DOI: 10.1016/j.ijbiomac.2024.131747] [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: 12/05/2023] [Revised: 04/02/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024]
Abstract
Given the broad biological effects of the Hedgehog (Hh) pathway, there is potential clinical value in local application of Hh pathway modulators to restrict pathway activation of target tissues and avoid systemic pathway activation. One option to limit Hh pathway activation is using fibrin hydrogels to deliver pathway modulators directly to tissues of interest, bypassing systemic distribution of the drug. In this study, we loaded the potent Hh pathway agonist, SAG21k, into fibrin hydrogels. We describe the binding between fibrin and SAG21k and achieve sustained release of the drug in vitro. SAG21k-loaded fibrin hydrogels exhibit strong biological activity in vitro, using a pathway-specific reporter cell line. To test in vivo activity, we used a mouse model of facial nerve injury. Application of fibrin hydrogels is a common adjunct to surgical nerve repair, and the Hh pathway is known to play an important role in facial nerve injury and regeneration. Local application of the Hh pathway agonist SAG21k using a fibrin hydrogel applied to the site of facial nerve injury successfully activates the Hh pathway in treated nerve tissue. Importantly, this method appears to avoid systemic pathway activation when Hh-responsive organs are analyzed for transcriptional pathway activation. This method of local tissue Hh pathway agonist administration allows for effective pathway targeting surgically accessible tissues and may have translational value in situations where supranormal pathway activation is therapeutic.
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Affiliation(s)
- Lili He
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine; 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Justine Esther Sato
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine; 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Praveen Sundar
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine; 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Tannaz Azimi
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine; 300 Pasteur Drive, Stanford, CA 94305, United States
| | - Philip Arden Beachy
- Departments of Urology, and Developmental Biology, Stanford University School of Medicine, Stanford, CA, United States; Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Laurent Adonis Bekale
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine; 300 Pasteur Drive, Stanford, CA 94305, United States.
| | - Jon-Paul Pepper
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine; 300 Pasteur Drive, Stanford, CA 94305, United States.
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Bueno CRDS, Buchaim DV, Barraviera B, Ferreira RS, Santos PSDS, Reis CHB, Cini MA, Kuga MC, Rosa GM, Buchaim RL. Delayed repair of the facial nerve and its negative impacts on nerve and muscle regeneration. J Venom Anim Toxins Incl Trop Dis 2024; 30:e20230093. [PMID: 38808073 PMCID: PMC11132725 DOI: 10.1590/1678-9199-jvatitd-2023-0093] [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: 11/24/2023] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Background In this experimental protocol, we evaluated the immediate and delayed repair of the buccal branch of the facial nerve (BBFN) with heterologous fibrin biopolymer (HFB) as a coaptation medium and the use of photobiomodulation (PBM), performing functional and histomorphometric analysis of the BBFN and perioral muscles. Methods Twenty-eight rats were divided into eight groups using the BBFN bilaterally (the left nerve was used for PBM), namely: G1 - control group, right BBFN (without injury); G2 - control group, left BBFN (without injury + PBM); G3 - Denervated right BBFN (neurotmesis); G4 - Denervated left BBFN (neurotmesis + PBM); G5 - Immediate repair of right BBFN (neurotmesis + HFB); G6 - Immediate repair of left BBFN (neurotmesis + HFB + PBM); G7 - Delayed repair of right BBFN (neurotmesis + HFB); G8 - Delayed repair of left BBFN (neurotmesis + HFB + PBM). Delayed repair occurred after two weeks of denervation. All animals were sacrificed after six weeks postoperatively. Results In the parameters of the BBFN, we observed inferior results in the groups with delayed repair, in relation to the groups with immediate repair, with a significant difference (p < 0.05) in the diameter of the nerve fiber, the axon, and the thickness of the myelin sheath of the group with immediate repair with PBM compared to the other experimental groups. In measuring the muscle fiber area, groups G7 (826.4 ± 69.90) and G8 (836.7 ± 96.44) were similar to G5 (882.8 ± 70.51). In the functional analysis, the G7 (4.10 ± 0.07) and G8 (4.12 ± 0.08) groups presented normal parameters. Conclusion We demonstrated that delayed repair of BBFN is possible with HFB, but with worse results compared to immediate repair, and that PBM has a positive influence on nerve regeneration results in immediate repair.
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Affiliation(s)
- Cleuber Rodrigo de Souza Bueno
- Department of Biological Sciences, Bauru School of Dentistry (FOB),
University of São Paulo (USP), Bauru, SP, Brazil
- Dentistry School, University Center of Adamantina (UNIFAI),
Adamantina, SP, Brazil
- Medical School, University Center of Adamantina (UNIFAI),
Adamantina, SP, Brazil
| | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina (UNIFAI),
Adamantina, SP, Brazil
- Graduate Program in Structural and Functional Interactions in
Rehabilitation, University of Marilia (UNIMAR), Marília, SP, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of
Veterinary Medicine and Animal Science (FMVZ), University of São Paulo (USP), São
Paulo, SP, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São
Paulo State University (UNESP), Botucatu, SP, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School
(FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Rui Seabra Ferreira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São
Paulo State University (UNESP), Botucatu, SP, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School
(FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru
School of Dentistry (FOB), University of São Paulo (USP), Bauru, SP, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry (FOB),
University of São Paulo (USP), Bauru, SP, Brazil
- Graduate Program in Structural and Functional Interactions in
Rehabilitation, University of Marilia (UNIMAR), Marília, SP, Brazil
- UNIMAR Beneficent Hospital (HBU), University of Marilia (UNIMAR),
Marília, SP, Brazil
| | | | - Milton Carlos Kuga
- Department of Restorative Dentistry, School of Dentistry, São Paulo
State University (UNESP), Araraquara, SP, Brazil
| | - Geraldo Marco Rosa
- Dentistry School, Faculty of the Midwest Paulista (FACOP),
Piratininga, SP, Brazil
| | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB),
University of São Paulo (USP), Bauru, SP, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of
Veterinary Medicine and Animal Science (FMVZ), University of São Paulo (USP), São
Paulo, SP, Brazil
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Tsujisaka R, Suzuki T, Shibata S, Iwamoto T, Taguchi T, Nakamura M. Effect of Alaska pollock-gelatin sheet on repair strength and regeneration of nerve. J Hand Surg Eur Vol 2024:17531934241251670. [PMID: 38780096 DOI: 10.1177/17531934241251670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The aim of the study was to investigate the repair strength and the biocompatibility of Alaska pollock-derived gelatin (ApGltn) sheet for nerve repair. Cadaveric digital nerves were repaired with double suture, single suture + ApGltn sheet, single suture + fibrin glue, single suture, ApGltn sheet and fibrin. Maximum failure loads were measured (20 nerves each). Rat sciatic nerves were repaired with double suture, single suture + ApGltn sheet, single suture, ApGltn sheet, fibrin glue and resection (10 nerves each). Macroscopic appearance, muscle weight and histopathological findings were examined 8 weeks postoperatively. The mean failure load of ApGltn sheet (0.39 N) was significantly higher than that of a fibrin (0.05 N), and that of single suture + ApGltn sheet (1.32 N) was significantly higher than that of a single suture alone (0.97 N). Functional and histological assessments showed similar nerve recovery among the suture, ApGltn and fibrin groups. ApGltn sheet has potential for clinical application as an alternative to fibrin.
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Affiliation(s)
- Ryosuke Tsujisaka
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Shibata
- Electron Microscope Laboratory, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsushi Taguchi
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Ibaraki, Japan
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, Ibaraki, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Heitzer M, Kilic K, Merfort R, Winnand P, Emonts C, Bock A, Ooms M, Steiner T, Hölzle F, Modabber A. Tensile strength of adhesives in peripheral nerve anastomoses: an in vitro biomechanical evaluation of four different neurorrhaphies. Eur J Med Res 2024; 29:264. [PMID: 38698476 PMCID: PMC11067280 DOI: 10.1186/s40001-024-01858-9] [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: 01/08/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The fundamental prerequisite for prognostically favorable postoperative results of peripheral nerve repair is stable neurorrhaphy without interruption and gap formation. METHODS This study evaluates 60 neurorrhaphies on femoral chicken nerves in terms of the procedure and the biomechanical properties. Sutured neurorrhaphies (n = 15) served as control and three sutureless adhesive-based nerve repair techniques: Fibrin glue (n = 15), Histoacryl glue (n = 15), and the novel polyurethane adhesive VIVO (n = 15). Tensile and elongation tests of neurorrhaphies were performed on a tensile testing machine at a displacement rate of 20 mm/min until failure. The maximum tensile force and elongation were recorded. RESULTS All adhesive-based neurorrhaphies were significant faster in preparation compared to sutured anastomoses (p < 0.001). Neurorrhaphies by sutured (102.8 [cN]; p < 0.001), Histoacryl (91.5 [cN]; p < 0.001) and VIVO (45.47 [cN]; p < 0.05) withstood significant higher longitudinal tensile forces compared to fibrin glue (10.55 [cN]). VIVO, with △L/L0 of 6.96 [%], showed significantly higher elongation (p < 0.001) compared to neurorrhaphy using fibrin glue. CONCLUSION Within the limitations of an in vitro study the adhesive-based neurorrhaphy technique with VIVO and Histoacryl have the biomechanical potential to offer alternatives to sutured neuroanastomosis because of their stability, and faster handling. Further in vivo studies are required to evaluate functional outcomes and confirm safety.
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Affiliation(s)
- Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany.
| | - Konrad Kilic
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Ricarda Merfort
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital of RWTH Aachen, Aachen, Germany
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Caroline Emonts
- Institute of Textile Technology, RWTH Aachen University, Otto-Blumenthal-Straße 1, 52074, Aachen, Germany
| | - Anna Bock
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Timm Steiner
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
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Verga M, Kessels RL, Bonasegale A, Del Re L, Fenaroli P, Carminati M. 3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5788. [PMID: 38712016 PMCID: PMC11073776 DOI: 10.1097/gox.0000000000005788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/18/2024] [Indexed: 05/08/2024]
Abstract
Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.
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Affiliation(s)
- Maurizio Verga
- From the Division of Plastic Surgery, Papa Giovanni XXIII Hospital, Bergamo Italy
| | - Raquel Leão Kessels
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Paesi Bassi
| | - Anna Bonasegale
- Division of General Surgery, “Ospedale Civile di Vigevano” Hospital, Pavia, Italy
| | - Luca Del Re
- Division of General Surgery, “Ospedale Civile di Vigevano” Hospital, Pavia, Italy
| | - Privato Fenaroli
- Division of Breast Surgery, “Papa Giovanni XXIII” Hospital, Bergamo Italy
| | - Marcello Carminati
- From the Division of Plastic Surgery, Papa Giovanni XXIII Hospital, Bergamo Italy
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7
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Zabbia G, Toia F, Coppola F, Cassata G, Cicero L, Giglia G, Puleio R, Cordova A. Nerve Regeneration after a Nerve Graft in a Rat Model: The Effectiveness of Fibrin Glue. J Pers Med 2024; 14:445. [PMID: 38793027 PMCID: PMC11121836 DOI: 10.3390/jpm14050445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Simulating the post-traumatic continuity defect of small human peripheral nerves, we compared the effectiveness of fibrin glue with neurorrhaphy for nerve gap restoration. METHODS In twenty-four male Wistar rats, a fifteen mm defect in one sciatic nerve only was made and immediately repaired with an inverted polarity autograft. According to the used technique, rats were divided into Group A (Control), using traditional neurorrhaphy, and Group B (Study), using fibrine glue sealing; in total, 50% of rats were sacrificed at 16 weeks and 50% at 21 weeks. Before sacrifice, an assessment of motor function was done through Walking Track Analysis and an electroneurophysiological evaluation. After sacrifice, selected muscle mass indexes and the histology of the regenerated nerves were assessed. All data were evaluated by Student's t test for unpaired data. RESULTS No significant differences were found between the two groups, with only the exception of a relative improvement in the tibialis anterior muscle's number of motor units in the study group. CONCLUSION Despite the fact that the use of fibrin glue as a nerve sealant is not superior in terms of functional recovery, its effectiveness is comparable to that of microsurgical repair. Hence, the faster and technically easier glueing technique could deserve broader clinical application.
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Affiliation(s)
- Giovanni Zabbia
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| | - Francesca Toia
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| | - Federico Coppola
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| | - Giovanni Cassata
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T), Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, 90129 Palermo, Italy; (G.C.); (L.C.)
| | - Luca Cicero
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T), Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, 90129 Palermo, Italy; (G.C.); (L.C.)
| | - Giuseppe Giglia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Section of Human Physiology, University of Palermo, 90127 Palermo, Italy;
| | - Roberto Puleio
- Laboratorio Istopatologia e Immunoistochimica, Dipartimento Ricerca Biotecnologica e Diagnostica Specialistica, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, 90129 Palermo, Italy;
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
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8
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Day EP, Johnston BR, Bazarek SF, Brown JM, Lemos N, Gibson EI, Hurban HN, Fecho SB, Holt-Bright L, Eun DD, Pontari MA, De EJ, McGovern FJ, Ruggieri MR, Barbe MF. Anatomical Location of the Vesical Branches of the Inferior Hypogastric Plexus in Human Cadavers. Diagnostics (Basel) 2024; 14:794. [PMID: 38667441 PMCID: PMC11049538 DOI: 10.3390/diagnostics14080794] [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: 03/03/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
We have demonstrated in canines that somatic nerve transfer to vesical branches of the inferior hypogastric plexus (IHP) can be used for bladder reinnervation after spinal root injury. Yet, the complex anatomy of the IHP hinders the clinical application of this repair strategy. Here, using human cadavers, we clarify the spatial relationships of the vesical branches of the IHP and nearby pelvic ganglia, with the ureteral orifice of the bladder. Forty-four pelvic regions were examined in 30 human cadavers. Gross post-mortem and intra-operative approaches (open anterior abdominal, manual laparoscopic, and robot-assisted) were used. Nerve branch distances and diameters were measured after thorough visual inspection and gentle dissection, so as to not distort tissue. The IHP had between 1 to 4 vesical branches (2.33 ± 0.72, mean ± SD) with average diameters of 0.51 ± 0.06 mm. Vesical branches from the IHP arose from a grossly visible pelvic ganglion in 93% of cases (confirmed histologically). The pelvic ganglion was typically located 7.11 ± 6.11 mm posterolateral to the ureteral orifice in 69% of specimens. With this in-depth characterization, vesical branches from the IHP can be safely located both posterolateral to the ureteral orifice and emanating from a more proximal ganglionic enlargement during surgical procedures.
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Affiliation(s)
- Emily P. Day
- MD Program, Drexel University College of Medicine, Philadelphia, PA 19129, USA;
- Center for Translational Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA; (E.I.G.); or (M.R.R.)
| | - Benjamin R. Johnston
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (B.R.J.); (S.F.B.)
| | - Stanley F. Bazarek
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (B.R.J.); (S.F.B.)
| | - Justin M. Brown
- Neurosurgery Paralysis Center, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02115, USA;
| | - Nucelio Lemos
- Department of Obstetrics and Gynecology, University of Toronto Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada;
| | - Eve I. Gibson
- Center for Translational Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA; (E.I.G.); or (M.R.R.)
| | - Helaina N. Hurban
- MD Program, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Susan B. Fecho
- School of Visual, Performing and Communication Arts, Barton College, Wilson, NC 27893, USA;
| | - Lewis Holt-Bright
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Daniel D. Eun
- Robotic Surgical Services, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
- Department of Urology, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Michel A. Pontari
- Department of Urology, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
| | - Elise J. De
- Department of Urology, Albany Medical Center, Albany, NY 12208, USA;
| | - Francis J. McGovern
- Department of Urology, Massachusetts General Hospital, Boston, MA 02115, USA;
| | - Michael R. Ruggieri
- Center for Translational Medicine, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA; (E.I.G.); or (M.R.R.)
- Neurosurgery Paralysis Center, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02115, USA;
| | - Mary F. Barbe
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA;
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine of Temple University, Philadelphia, PA 19140, USA
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9
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Schepers LE, Martindale BL, Berman AG, Cebull HL, Van Alstine W, Hollingshead SE, Novak T, Goergen CJ. Photocurable extracellular matrix sealant for cessation of venous hemorrhage. J Biomed Mater Res B Appl Biomater 2024; 112:e35401. [PMID: 38520703 DOI: 10.1002/jbm.b.35401] [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: 08/02/2023] [Revised: 01/23/2024] [Accepted: 02/18/2024] [Indexed: 03/25/2024]
Abstract
Hemorrhage is the second leading cause of death in patients under 46 years of age in the United States. Cessation of hemorrhage prevents hemorrhagic shock and tissue hypoxia. Controlling the bleed via direct pressure or tourniquet is often the first line of defense, but long-term care requires staples, hemostatic agents, or sealants that seal the vessel and restore blood flow. Here, we compare a new photocurable extracellular matrix sealant (pcECM) with low, medium, and high crosslink density formulations to a commercially available fibrin-based sealant, TISSEEL®. pcECM has potential uses in surgical and remote settings due to room temperature storage conditions and fast preparation time. Here, we determine if pcECM sealant can stop venous hemorrhage in a murine model, adhere to the wound site in vivo throughout the wound-healing process, and has the mechanical properties necessary for stopping hemorrhage. Adjusting pcECM crosslinking density significantly affected viscosity, swelling, burst strength, tensile strength, and elasticity of the sealant. 3-Dimensional ultrasound volume segmentations showed pcECM degrades to 17 ± 8% of its initial implant volume by day 28. Initially, local hemodynamic changes were observed, but returned close to baseline levels by day 28. Acute inflammation was observed near the puncture site in pcECM implanted mice, and we observed inflammatory markers at the 14-day explant for both sealants. pcECM and fibrin sealant successfully sealed the vessel in all cases, and consistently degraded over 14-28 days. pcECM is a durable sealant with tunable mechanical properties and possible uses in hemorrhage control and other surgical procedures.
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Affiliation(s)
- Luke E Schepers
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | | | - Alycia G Berman
- Product Engineering, Cook Biotech Inc., West Lafayette, Indiana, USA
| | - Hannah L Cebull
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | | | | | - Tyler Novak
- Product Engineering, Cook Biotech Inc., West Lafayette, Indiana, USA
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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10
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Fisher AH, Johnsen PH, Simon A, Burns CJ, Romiyo V, Bodofsky EB, Vega SL, Fuller DA. Fibrin Glue Acutely Blocks Distal Muscle Contraction after Confirmed Polyethylene Glycol Nerve Fusion: An Animal Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5535. [PMID: 38250205 PMCID: PMC10798741 DOI: 10.1097/gox.0000000000005535] [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: 06/29/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024]
Abstract
Background Polyethylene glycol (PEG) is a synthetic, biodegradable, and hyperosmotic material promising in the treatment of acute peripheral nerve injuries. Our team set out to investigate the impact of fibrin glue upon PEG fusion in a rat model. Methods Eighteen rats underwent sciatic nerve transection and PEG fusion. Electrophysiologic testing was performed to measure nerve function and distal muscle twitch. Fibrin glue was applied and testing repeated. Due to preliminary findings, fibrin glue was applied to an uncut nerve in five rodents and testing was conducted before and after glue application. Mann-Whitney U tests were used to compare median values between outcome measures. A Shapiro-Wilk test was used to determine normality of data for each comparison, significance set at a P value less than 0.05. Results PEG fusion was confirmed in 13 nerves with no significant change in amplitude (P = 0.054), latency (P = 0.114), or conduction velocity (P = 0.114). Stimulation of nerves following PEG fusion produced distal muscle contraction in 100% of nerves. Following application of fibrin glue, there was a significant reduction in latency (P = 0.023), amplitude (P < 0.001), and conduction velocity (P = 0.023). Stimulation of the nerve after application of fibrin glue did not produce distal muscle twitch. Five uncut nerves with fibrin glue application blocked distal muscle contraction following stimulation. Conclusions Our data suggest that fibrin glue alters the nerve's function. The immediate confirmation of PEG fusion via distal muscle twitch is blocked with application fibrin glue in this experimental model. Survival and functional outcome studies are necessary to understand if this has implications on the long-term functional outcomes.
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Affiliation(s)
- Alec H. Fisher
- From the Division of Plastic Surgery, Cooper University Hospital, Camden, N.J
| | | | - Andrew Simon
- Department of Orthopedics, Cooper University Hospital, Camden, N.J
| | | | - Vineeth Romiyo
- Department of Orthopedics, Cooper Medical School of Rowan University, Camden, N.J
| | | | - Sebastián L. Vega
- Department of Orthopedics, Cooper Medical School of Rowan University, Camden, N.J
| | - David A. Fuller
- Department of Orthopedics, Cooper University Hospital, Camden, N.J
- Department of Orthopedics, Cooper Medical School of Rowan University, Camden, N.J
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11
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Panagopoulos GN, Megaloikonomos PD, Mitsiokapa EA, Bami M, Agrogiannis G, Johnson EO, Soucacos PN, Papagelopoulos PJ, Mavrogenis AF. Adipose-Derived Stem Cells and Tacrolimus Improve Nerve Regeneration in a Rat Sciatic Nerve Defect Model. Orthopedics 2023; 46:e353-e361. [PMID: 37052592 DOI: 10.3928/01477447-20230407-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
This study compared the effect of undifferentiated adipose-derived stem cells (ADSCs) vs tacrolimus (FK506) in peripheral nerve regeneration in a rat sciatic nerve complete transection model. Forty Wistar rats were equally distributed in four groups. In the SHAM surgery group, the sciatic nerve was exposed and no further intervention was done. In the conduit-alone group (the SLN group), a 10-mm nerve gap was created and bridged with a fibrin conduit filled in with normal saline. In the FK506 group, the fibrin conduit was injected with soluble FK506. In the ADSC group, the conduit was impregnated with undifferentiated ADSCs. Nerve regeneration was assessed by means of walking track analysis, electromyography, and neurohistomorphometry. Clinically and microscopically, nerve regeneration was achieved in all groups at 12 weeks. Walking track analysis confirmed functional recovery in the FK506 and ADSC groups, but there was no difference between them. Recovery in function was also achieved in the SLN group, but it was inferior (P<.05). Electromyography demonstrated superior nerve regeneration in the FK506 and ADSC groups compared with the SLN group (P<.05), with no difference between the FK506 and ADSC groups. Similarly, histology showed no difference between the FK506 and ADSC groups, although both outperformed the SLN group (P<.05). No complications were observed. Successful peripheral nerve regeneration can be accomplished after a 10-mm nerve defect treated with nerve conduits. Superior nerve regeneration may be expected when the conduits are loaded with undifferentiated ADSCs or FK506, with similar outcomes for ADSCs and FK506. [Orthopedics. 2023;46(6):e353-e361.].
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12
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Bernard M, McOnie R, Tomlinson JE, Blum E, Prest TA, Sledziona M, Willand M, Gordon T, Borschel GH, Soletti L, Brown BN, Cheetham J. Peripheral Nerve Matrix Hydrogel Promotes Recovery after Nerve Transection and Repair. Plast Reconstr Surg 2023; 152:458e-467e. [PMID: 36946873 PMCID: PMC10461719 DOI: 10.1097/prs.0000000000010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 09/08/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Nerve transection is the most common form of peripheral nerve injury. Treatment of peripheral nerve injury has primarily focused on stabilization and mechanical cues to guide extension of the regenerating growth cone across the site of transection. The authors investigated the effects of a peripheral nerve matrix (PNM) hydrogel on recovery after nerve transection. METHODS The authors used rodent models to determine the effect of PNM on axon extension, electrophysiologic nerve conduction, force generation, and neuromuscular junction formation after nerve transection and repair. The authors complemented this work with in vivo and in vitro fluorescence-activated cell sorting and immunohistochemistry approaches to determine the effects of PNM on critical cell populations early after repair. RESULTS Extension of axons from the proximal stump and overall green fluorescent protein-positive axon volume within the regenerative bridge were increased in the presence of PNM compared with an empty conduit ( P < 0.005) 21 days after repair. PNM increased electrophysiologic conduction (compound muscle action potential amplitude) across the repair site ( P < 0.05) and neuromuscular junction formation ( P = 0.04) 56 days after repair. PNM produced a shift in macrophage phenotype in vitro and in vivo ( P < 0.05) and promoted regeneration in a murine model used to characterize the early immune response to PNM ( P < 0.05). CONCLUSION PNM, delivered by subepineural injection, promoted recovery after nerve transection with immediate repair, supporting a beneficial macrophage response, axon extension, and downstream remodeling using a range of clinically relevant outcome measures. CLINICAL RELEVANCE STATEMENT This article describes an approach for subepineural injection at the site of nerve coaptation to modulate the response to injury and improve outcomes.
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Affiliation(s)
- Megan Bernard
- From the Department of Clinical Sciences, Cornell University College of Veterinary Medicine
| | - Rebecca McOnie
- From the Department of Clinical Sciences, Cornell University College of Veterinary Medicine
| | - Joy E. Tomlinson
- From the Department of Clinical Sciences, Cornell University College of Veterinary Medicine
| | - Ethan Blum
- From the Department of Clinical Sciences, Cornell University College of Veterinary Medicine
| | | | - Mike Sledziona
- From the Department of Clinical Sciences, Cornell University College of Veterinary Medicine
| | | | - Tessa Gordon
- The Hospital for Sick Children, University of Toronto
| | | | | | | | - Jonathan Cheetham
- From the Department of Clinical Sciences, Cornell University College of Veterinary Medicine
- Renerva, LLC
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13
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Guillemot-Legris O, Girmahun G, Shipley RJ, Phillips JB. Local Administration of Minocycline Improves Nerve Regeneration in Two Rat Nerve Injury Models. Int J Mol Sci 2023; 24:12085. [PMID: 37569473 PMCID: PMC10418394 DOI: 10.3390/ijms241512085] [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: 06/16/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Peripheral nerve injuries are quite common and often require a surgical intervention. However, even after surgery, patients do not often regain satisfactory sensory and motor functions. This, in turn, results in a heavy socioeconomic burden. To some extent, neurons can regenerate from the proximal nerve stump and try to reconnect to the distal stump. However, this regenerating capacity is limited, and depending on the type and size of peripheral nerve injury, this process may not lead to a positive outcome. To date, no pharmacological approach has been used to improve nerve regeneration following repair surgery. We elected to investigate the effects of local delivery of minocycline on nerve regeneration. This molecule has been studied in the central nervous system and was shown to improve the outcome in many disease models. In this study, we first tested the effects of minocycline on SCL 4.1/F7 Schwann cells in vitro and on sciatic nerve explants. We specifically focused on the Schwann cell repair phenotype, as these cells play a central role in orchestrating nerve regeneration. Finally, we delivered minocycline locally in two different rat models of nerve injury, a sciatic nerve transection and a sciatic nerve autograft, demonstrating the capacity of local minocycline treatment to improve nerve regeneration.
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Affiliation(s)
- Owein Guillemot-Legris
- UCL Centre for Nerve Engineering, London WC1N 1AX, UK; (G.G.); (R.J.S.); (J.B.P.)
- UCL School of Pharmacy, London WC1N 1AX, UK
- UCL Mechanical Engineering, London WC1E 7JE, UK
| | - Gedion Girmahun
- UCL Centre for Nerve Engineering, London WC1N 1AX, UK; (G.G.); (R.J.S.); (J.B.P.)
- UCL School of Pharmacy, London WC1N 1AX, UK
| | - Rebecca J. Shipley
- UCL Centre for Nerve Engineering, London WC1N 1AX, UK; (G.G.); (R.J.S.); (J.B.P.)
- UCL Mechanical Engineering, London WC1E 7JE, UK
| | - James B. Phillips
- UCL Centre for Nerve Engineering, London WC1N 1AX, UK; (G.G.); (R.J.S.); (J.B.P.)
- UCL School of Pharmacy, London WC1N 1AX, UK
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14
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Bueno CRDS, Tonin MCC, Buchaim DV, Barraviera B, Ferreira Junior RS, Santos PSDS, Reis CHB, Pastori CM, Pereira EDSBM, Nogueira DMB, Cini MA, Rosa Junior GM, Buchaim RL. Morphofunctional Improvement of the Facial Nerve and Muscles with Repair Using Heterologous Fibrin Biopolymer and Photobiomodulation. Pharmaceuticals (Basel) 2023; 16:ph16050653. [PMID: 37242436 DOI: 10.3390/ph16050653] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Peripheral nerve injuries impair the patient's functional capacity, including those occurring in the facial nerve, which require effective medical treatment. Thus, we investigated the use of heterologous fibrin biopolymer (HFB) in the repair of the buccal branch of the facial nerve (BBFN) associated with photobiomodulation (PBM), using a low-level laser (LLLT), analyzing the effects on axons, muscles facials, and functional recovery. This experimental study used twenty-one rats randomly divided into three groups of seven animals, using the BBFN bilaterally (the left nerve was used for LLLT): Control group-normal and laser (CGn and CGl); Denervated group-normal and laser (DGn and DGl); Experimental Repair Group-normal and laser (ERGn and ERGl). The photobiomodulation protocol began in the immediate postoperative period and continued for 5 weeks with a weekly application. After 6 weeks of the experiment, the BBFN and the perioral muscles were collected. A significant difference (p < 0.05) was observed in nerve fiber diameter (7.10 ± 0.25 µm and 8.00 ± 0.36 µm, respectively) and axon diameter (3.31 ± 0.19 µm and 4.07 ± 0.27 µm, respectively) between ERGn and ERGl. In the area of muscle fibers, ERGl was similar to GC. In the functional analysis, the ERGn and the ERGI (4.38 ± 0.10) and the ERGI (4.56 ± 0.11) showed parameters of normality. We show that HFB and PBM had positive effects on the morphological and functional stimulation of the buccal branch of the facial nerve, being an alternative and favorable for the regeneration of severe injuries.
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Affiliation(s)
- Cleuber Rodrigo de Souza Bueno
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Dentistry School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
| | - Maria Clara Cassola Tonin
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Universidade Estadual Paulista, UNESP), Botucatu 18610-307, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Universidade Estadual Paulista), Botucatu 18618-687, Brazil
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Universidade Estadual Paulista, UNESP), Botucatu 18610-307, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Universidade Estadual Paulista), Botucatu 18618-687, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- UNIMAR Beneficent Hospital (HBU), University of Marilia (UNIMAR), Marília 17525-160, Brazil
| | | | - Eliana de Souza Bastos Mazuqueli Pereira
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
| | - Dayane Maria Braz Nogueira
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Marcelo Augusto Cini
- Medical School, University of West Paulista (UNOESTE), Guarujá 11441-225, Brazil
| | | | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo 05508-270, Brazil
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15
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Fuchs B, Birt A, Moellhoff N, Kuhlmann C, Giunta R, Wiggenhauser PS. The use of commercial fibrin glue in dermal replacement material reduces angiogenic and lymphangiogenic gene and protein expression in vitro. J Biomater Appl 2023; 37:1858-1873. [PMID: 37082911 DOI: 10.1177/08853282231171681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Commercial fibrin glue is increasingly finding its way into clinical practice in surgeries to seal anastomosis, and initiate hemostasis or tissue repair. Human biological glue is also being discussed as a possible cell carrier. To date, there are only a few studies addressing the effects of fibrin glue on the cell-molecular level. This study examines the effects of fibrin glue on angiogenesis and lymphangiogenesis, as well as adipose-derived stem cells (ASCs) with a focus on gene and protein expression in scaffolds regularly used for tissue engineering approaches. METHODS Collagen-based dermal regeneration matrices (DRM) were seeded with human umbilical vein endothelial cells (HUVEC), human dermal lymphatic endothelial cells (LECs), or adipose-derived stem cells (ASC) and fixed with or without fibrin glue according to the experimental group. Cultures were maintained for 1 and 7 days. Finally, angiogenic and lymphangiogenic gene and protein expression were measured with special regard to subtypes of vascular endothelial growth factor (VEGF) and corresponding receptors using Multiplex-qPCR and ELISA assays. In addition, the hypoxia-induced factor 1-alpha (HIF1a) mediated intracellular signaling pathways were included in assessments to analyze a hypoxic encapsulating effect of fibrin polymers. RESULTS All cell types reacted to fibrin glue application with an alteration of gene and protein expression. In particular, vascular endothelial growth factor A (VEGFA), vascular endothelial growth factor B (VEGFB), vascular endothelial growth factor C (VEGFC), vascular endothelial growth receptor 1 (VEGFR1/FLT1), vascular endothelial growth receptor 2 (VEGFR2/KDR), vascular endothelial growth receptor 3 (VEGFR3/FLT4) and Prospero Homeobox 1 (PROX1) were depressed significantly depending on fibrin glue. Especially short-term fibrin effect led to a continuous downregulation of respective gene and protein expression in HUVECs, LECs, and ASCs. CONCLUSION Our findings demonstrate the impact of fibrin glue application in dermal regeneration with special regard to angiogenesis and lymphangiogenesis. In particular, a short fibrin treatment of 24 hours led to a decrease in gene and protein levels of LECS, HUVECs, and ASCs. In contrast, the long-term application showed less effect on gene and protein expressions. Therefore, this work demonstrated the negative effects of fibrin-treated cells in tissue engineering approaches and could affect wound healing during dermal regeneration.
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Affiliation(s)
- Benedikt Fuchs
- Department of Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
| | - Alexandra Birt
- Department of Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
| | | | | | - Riccardo Giunta
- Department of Hand, Plastic and Aesthetic Surgery, LMU, Munich, Germany
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16
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Gila-Vilchez C, Mañas-Torres MC, García-García ÓD, Escribano-Huesca A, Rodríguez-Arco L, Carriel V, Rodriguez I, Alaminos M, Lopez-Lopez MT, Álvarez de Cienfuegos L. Biocompatible Short-Peptides Fibrin Co-assembled Hydrogels. ACS APPLIED POLYMER MATERIALS 2023; 5:2154-2165. [PMID: 36935654 PMCID: PMC10013376 DOI: 10.1021/acsapm.2c02164] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
Fibrin hydrogels made by self-assembly of fibrinogen obtained from human plasma have shown excellent biocompatible and biodegradable properties and are widely used in regenerative medicine. The fibrinogen self-assembly process can be triggered under physiological conditions by the action of thrombin, allowing the injection of pregel mixtures that have been used as cell carriers, wound-healing systems, and bio-adhesives. However, access to fibrinogen from human plasma is expensive and fibrin gels have limited mechanical properties, which make them unsuitable for certain applications. One solution to these problems is to obtain composite gels made of fibrin and other polymeric compounds that improve their mechanical properties and usage. Herein, we prepared composite hydrogels made by the self-assembly of fibrinogen together with Fmoc-FF (Fmoc-diphenylalanine) and Fmoc-RGD (Fmoc-arginine-glycine-aspartic acid). We have shown that the mixture of these three peptides co-assembles and gives rise to a unique type of supramolecular fiber, whose morphology and mechanical properties can be modulated. We have carried out a complete characterization of these materials from chemical, physical, and biological points of view. Composite gels have improved mechanical properties compared to pure fibrin gels, as well as showing excellent biocompatibility ex vivo. In vivo experiments have shown that these gels do not cause any type of inflammatory response or tissue damage and are completely resorbed in short time, which would enable their use as vehicles for cell, drug, or growth factor release.
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Affiliation(s)
- Cristina Gila-Vilchez
- Departamento
de Física Aplicada, Universidad de
Granada (UGR), C. U. Fuentenueva, Avenida Severo Ochoa s/n, E-18071 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Mari Carmen Mañas-Torres
- Departamento
de Química Orgánica, Unidad de Excelencia Química
Aplicada a Biomedicina y Medioambiente (UEQ), Universidad de Granada (UGR), C. U. Fuentenueva, Avenida Severo Ochoa s/n, E-18071 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Óscar Darío García-García
- Department
of Histology, Universidad de Granada (UGR), Avenida de Madrid 11, 18012 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Alfredo Escribano-Huesca
- Departamento
de Física Aplicada, Universidad de
Granada (UGR), C. U. Fuentenueva, Avenida Severo Ochoa s/n, E-18071 Granada, Spain
| | - Laura Rodríguez-Arco
- Departamento
de Física Aplicada, Universidad de
Granada (UGR), C. U. Fuentenueva, Avenida Severo Ochoa s/n, E-18071 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Víctor Carriel
- Department
of Histology, Universidad de Granada (UGR), Avenida de Madrid 11, 18012 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Ismael Rodriguez
- Department
of Histology, Universidad de Granada (UGR), Avenida de Madrid 11, 18012 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Miguel Alaminos
- Department
of Histology, Universidad de Granada (UGR), Avenida de Madrid 11, 18012 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Modesto Torcuato Lopez-Lopez
- Departamento
de Física Aplicada, Universidad de
Granada (UGR), C. U. Fuentenueva, Avenida Severo Ochoa s/n, E-18071 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
| | - Luis Álvarez de Cienfuegos
- Departamento
de Química Orgánica, Unidad de Excelencia Química
Aplicada a Biomedicina y Medioambiente (UEQ), Universidad de Granada (UGR), C. U. Fuentenueva, Avenida Severo Ochoa s/n, E-18071 Granada, Spain
- Instituto
de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid, 15, 18016, Granada, Spain
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17
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de Assis ACC, Reis ALS, Nunes LV, Ferreira LFR, Bilal M, Iqbal HMN, Soriano RN. Stem Cells and Tissue Engineering-Based Therapeutic Interventions: Promising Strategies to Improve Peripheral Nerve Regeneration. Cell Mol Neurobiol 2023; 43:433-454. [PMID: 35107689 DOI: 10.1007/s10571-022-01199-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023]
Abstract
Unlike the central nervous system, the peripheral one has the ability to regenerate itself after injury; however, this natural regeneration process is not always successful. In fact, even with some treatments, the prognosis is poor, and patients consequently suffer with the functional loss caused by injured nerves, generating several impacts on their quality of life. In the present review we aimed to address two strategies that may considerably potentiate peripheral nerve regeneration: stem cells and tissue engineering. In vitro studies have shown that pluripotent cells associated with neural scaffolds elaborated by tissue engineering can increase functional recovery, revascularization, remyelination, neurotrophin expression and reduce muscle atrophy. Although these results are very promising, it is important to note that there are some barriers to be circumvented: the host's immune response, the oncogenic properties attributed to stem cells and the duration of the pro-regenerative effects. After all, more studies are still needed to overcome the limitations of these treatments; those that address techniques for manipulating the lesion microenvironment combining different therapies seem to be the most promising and proactive ones.
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Affiliation(s)
- Ana Carolina Correa de Assis
- Department of Medicine, Federal University of Juiz de Fora (UFJF-GV), 241 Manoel Byrro St., Governador Valadares, MG, 35032-620, Brazil
| | - Amanda Luiza Silva Reis
- Department of Medicine, Federal University of Juiz de Fora (UFJF-GV), 241 Manoel Byrro St., Governador Valadares, MG, 35032-620, Brazil
| | - Leonardo Vieira Nunes
- School of Medicine, Federal University of Juiz de Fora (UFJF-JF), Eugênio do Nascimento Avenue, Juiz de Fora, MG, 36038-330, Brazil
| | - Luiz Fernando Romanholo Ferreira
- Graduate Program in Process Engineering, Tiradentes University (UNIT), 300 Murilo Dantas Ave., Aracaju, SE, 49032-490, Brazil
- Institute of Technology and Research (ITP), Tiradentes University (UNIT), 300 Murilo Dantas Ave., Aracaju, SE, 49032-490, Brazil
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian, 223003, China.
| | - Hafiz M N Iqbal
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Monterrey, Ave. Eugenio Garza Sada 2501, CP 64849, Monterrey, NL , Mexico
| | - Renato Nery Soriano
- Division of Physiology and Biophysics, Department of Basic Life Sciences, Federal University of Juiz de Fora (UFJF-GV), 1167 Moacir Paleta Ave., Governador Valadares, MG, 35020-360, Brazil.
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18
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Shi W, Wu Y, Wu J, Gao Y, Zhao P, Lu X. NPS-Crosslinked Fibrin Gels Load with EMSCs to Repair Peripheral Nerve Injury in Rats. Macromol Biosci 2023; 23:e2200381. [PMID: 36583716 DOI: 10.1002/mabi.202200381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/18/2022] [Indexed: 12/31/2022]
Abstract
Neural tissue engineering has been introduced as a novel therapeutic strategy for trauma-induced sciatic nerve defects. Here, a neuropeptide S (NPS)-crosslinked fibrin scaffolds (NPS@Fg) loaded with an ectomesenchymal stem cell (EMSC) system to bridge an 8-mm sciatic nerve defect in rats are reported. The Schwann cell-like and neural differentiation of the EMSCs on the engineered fibrin scaffolds are also assessed in vitro. These results show that the NPS@Fg promotes the differentiation of EMSCs into neuronal lineage cells, which may also contribute to the therapeutic outcome of the NPS@Fg+EMSCs strategy. After transplantation NPS@Fg+EMSCs into sciatic nerve defects in rats, nerve recovery is assessed up to 12 weeks postinjury. In vivo experiments show that the combination of NPS crosslinked fibrin scaffolds with EMSCs can significantly accelerate nerve healing and improve morphological repair. In the study, NPS@Fg+EMSCs may represent a new potential strategy for peripheral nerve reconstruction.
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Affiliation(s)
- Wentao Shi
- Brain Institute, School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, 214122, P. R. China.,Nanjing Gaochun People's Hospital, Nanjing, Jiangsu Province, 210000, P. R. China
| | - Yiqing Wu
- Brain Institute, School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, 214122, P. R. China
| | - Jiawei Wu
- Brain Institute, School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, 214122, P. R. China
| | - Yan Gao
- Brain Institute, School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, 214122, P. R. China
| | - Peng Zhao
- Brain Institute, School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, 214122, P. R. China
| | - Xiaojie Lu
- Brain Institute, School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, 214122, P. R. China.,Wuxi Second People's Hospital, Wuxi, Jiangsu Province, 214122, P. R. China
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19
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Goncharuk O, Savosko S, Tykhomyrov A, Guzyk M, Medvediev V, Tsymbaliuk V, Chaikovsky Y. Matrix Metalloproteinase-9 is Involved in the Fibrotic Process in Denervated Muscles after Sciatic Nerve Trauma and Recovery. J Neurol Surg A Cent Eur Neurosurg 2023; 84:116-122. [PMID: 34496416 DOI: 10.1055/s-0041-1731750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fibrosis of the injured muscles is a problem of recovery from trauma and denervation. The aim of the work was to investigate the interconnection of matrix metalloproteinase-9 (ММР-9) activity in denervated muscles with fibrosis and to estimate its role in nerve restoration by the epineurial suture, fibrin-based glue, and polyethylene glycol hydrogel. The activity of matrix metalloproteinases was estimated by gelatin zymography. Collagen density in muscles was determined histochemically. An increased level of the active MMP-9 is associated with the fibrous changes in the denervated skeletal muscles and after an epineurial suture. The use of fibrin glue and polyethylene glycol hydrogel resulted in a lower level of collagen and ММР-9 activity, which may be a therapeutic target in the treatment of neuromuscular lesions, and has value in fibrosis analysis following microsurgical intervention for peripheral nerve reconstruction.
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Affiliation(s)
- Oleksii Goncharuk
- Department of Neurosurgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Serhii Savosko
- Department of Histology and Embryology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Artem Tykhomyrov
- Department of Neurosurgery, Palladin Institute of Biochemistry of the National Academy of Sciences of Ukraine (NASU), Kyiv, Ukraine
| | - Mykhailo Guzyk
- Department of Neurosurgery, Palladin Institute of Biochemistry of the National Academy of Sciences of Ukraine (NASU), Kyiv, Ukraine
| | - Volodymyr Medvediev
- Department of Neurosurgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Vitaliy Tsymbaliuk
- Department of Neurosurgery, Bogomolets National Medical University, Kyiv, Ukraine
| | - Yuri Chaikovsky
- Department of Histology and Embryology, Bogomolets National Medical University, Kyiv, Ukraine
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20
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Xue W, Shi W, Kuss M, Kong Y, Alimi OA, Wang H, DiMaio DJ, Yu C, Duan B. A Dual-network Nerve Adhesive with Enhanced Adhesion Strength Promotes Transected Peripheral Nerve Repair. ADVANCED FUNCTIONAL MATERIALS 2023; 33:2209971. [PMID: 36816838 PMCID: PMC9937437 DOI: 10.1002/adfm.202209971] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 05/02/2023]
Abstract
Peripheral nerve transection has a high prevalence and results in functional loss of affected limbs. The current clinical treatment using suture anastomosis significantly limits nerve recovery due to severe inflammation, secondary damage, and fibrosis. Fibrin glue, a commercial nerve adhesive as an alternative, avoids secondary damage but suffers from poor adhesion strength. To address their limitations, a highly efficacious nerve adhesive based on dual-crosslinking of dopamine-isothiocyanate modified hyaluronic acid and decellularized nerve matrix is reported in this paper. This dual-network nerve adhesive (DNNA) shows controllable gelation behaviors feasible for surgical applications, robust adhesion strength, and promoted axonal outgrowth in vitro. The in vivo therapeutic efficacy is tested using a rat-based sciatic nerve transection model. The DNNA decreases fibrosis and accelerates axon/myelin debris clearance at 10 days post-surgery, compared to suture and commercial fibrin glue treatments. At 10 weeks post-surgery, the strong adhesion and bioactivity allow DNNA to significantly decrease intraneural inflammation and fibrosis, enhance axon connection and remyelination, aid motor and sensory function recovery, as well as improve muscle contraction, compared to suture and fibrin treatments. Overall, this dual-network hydrogel with robust adhesion provides a rapid and highly efficacious nerve transection treatment to facilitate nerve repair and neuromuscular function recovery.
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Affiliation(s)
- Wen Xue
- Department of Internal Medicine, Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Wen Shi
- Department of Internal Medicine, Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Mitchell Kuss
- Department of Internal Medicine, Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Yunfan Kong
- Department of Internal Medicine, Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Olawale A Alimi
- Department of Internal Medicine, Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Hanjun Wang
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Dominick J DiMaio
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
| | - Cunjiang Yu
- Department of Biomedical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Bin Duan
- Department of Internal Medicine, Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska 68588, USA
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21
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Talukder MAH, Elfar J, Lee J, Karuman Z, Gurjar A, Govindappa P, Guddadarangaiah J, Manto K, Wandling G, Hegarty J, Waning D. Functional recovery and muscle atrophy in pre-clinical models of peripheral nerve transection and gap-grafting in mice: effects of 4-aminopyridine. Neural Regen Res 2023; 18:439-444. [PMID: 35900443 PMCID: PMC9396510 DOI: 10.4103/1673-5374.346456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We recently demonstrated a repurposing beneficial effect of 4-aminopyridine (4-AP), a potassium channel blocker, on functional recovery and muscle atrophy after sciatic nerve crush injury in rodents. However, this effect of 4-AP is unknown in nerve transection, gap, and grafting models. To evaluate and compare the functional recovery, nerve morphology, and muscle atrophy, we used a novel stepwise nerve transection with gluing (STG), as well as 7-mm irreparable nerve gap (G-7/0) and 7-mm isografting in 5-mm gap (G-5/7) models in the absence and presence of 4-AP treatment. Following surgery, sciatic functional index was determined weekly to evaluate the direct in vivo global motor functional recovery. After 12 weeks, nerves were processed for whole-mount immunofluorescence imaging, and tibialis anterior muscles were harvested for wet weight and quantitative histomorphological analyses for muscle fiber cross-sectional area and minimal Feret’s diameter. Average post-injury sciatic functional index values in STG and G-5/7 models were significantly greater than those in the G-7/0 model. 4-AP did not affect the sciatic functional index recovery in any model. Compared to STG, nerve imaging revealed more misdirected axons and distorted nerve architecture with isografting. While muscle weight, cross-sectional area, and minimal Feret’s diameter were significantly smaller in G-7/0 model compared with STG and G-5/7, 4-AP treatment significantly increased right TA muscle mass, cross-sectional area, and minimal Feret’s diameter in G-7/0 model. These findings demonstrate that functional recovery and muscle atrophy after peripheral nerve injury are directly related to the intervening nerve gap, and 4-AP exerts differential effects on functional recovery and muscle atrophy.
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22
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Lyons M, Nunley RM, Ahmed Shokri A, Doneley T, Han HS, Harato K, Kuwasawa A, Lee DH, Qi X, Qian W, Ratanachai S, Wang W, Po-Han Chen B, Danker W. Goals, challenges and strategies for wound and bleeding management in total knee arthroplasty: A modified Delphi method. J Orthop Surg (Hong Kong) 2022; 30:10225536221138985. [PMID: 36374258 DOI: 10.1177/10225536221138985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available. METHODS Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September-October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework. RESULTS Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. CONCLUSION Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.
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Affiliation(s)
| | - Ryan M Nunley
- 12275Washington University of Medicine, St Louis, MO, USA
| | | | - Tyson Doneley
- 95053Brisbane Private Hospital, Spring Hill, QLD, Australia
| | - Hyuk-Soo Han
- 58927Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea, Republic of (South)
| | - Kengo Harato
- Keio University School of Medicine, Tokyo, Japan
| | | | - Dae-Hee Lee
- 36626Samsung Medical Center, Seoul, Korea, Republic of (South)
| | - Xin Qi
- The First Affiliated Hospital of Jilin University, Changchun City, China
| | - Wenwei Qian
- 34732Peking Union Medical College Hospital, Beijing, China
| | | | - Weijun Wang
- 66506Nanjing Drum Tower Hospital, Jiangsu Province, China
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23
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Harhaus L, Daeschler SC, Aman M, Böcker AH, Klimitz F, Bickert B. [Differential therapeutic Approaches in Treatment of Carpal Tunnel Syndrome]. HANDCHIR MIKROCHIR P 2022; 54:236-243. [PMID: 35688431 DOI: 10.1055/a-1839-8297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is one of the most common compression neuropathies. The therapeutic concept should be tailored to each patient individually, with initial non-surgical treatment being the standard of care for early CTS. Primary surgical intervention should be considered in more advanced diseases stages, in case of concomitant pathologies (including space-occupying lesions, complex regional pain syndrome or diabetic neuropathy), if non-surgical strategies have failed or in pregnancy-related CTS. This work aims to discuss common surgical approaches, their clinical application as well as benefits and disadvantages in a pragmatic style. Further, we highlight surgical strategies to address recurrent CTS following failed primary surgery. In view of the recently updated S3 guidelines "Diagnosis and Therapy of Carpal Tunnel Syndrome", this topic is timely and relevant for hand and nerve surgeons.
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Affiliation(s)
- Leila Harhaus
- BG Unfallklinik Ludwigshafen Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg
| | - Simeon C Daeschler
- BG Unfallklinik Ludwigshafen Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg
| | - Martin Aman
- BG Unfallklinik Ludwigshafen Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg
| | - Arne Hendrik Böcker
- BG Unfallklinik Ludwigshafen Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg
| | - Felix Klimitz
- BG Unfallklinik Ludwigshafen Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg
| | - Berthold Bickert
- BG Unfallklinik Ludwigshafen Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg
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Pinkiewicz M, Dorobisz K, Zatoński T. A Comprehensive Approach to Facial Reanimation: A Systematic Review. J Clin Med 2022; 11:jcm11102890. [PMID: 35629016 PMCID: PMC9143601 DOI: 10.3390/jcm11102890] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.
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25
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Kim JH, Choi YJ, Park HI, Ahn KM. The effect of FK506 (tacrolimus) loaded with collagen membrane and fibrin glue on promotion of nerve regeneration in a rat sciatic nerve traction injury model. Maxillofac Plast Reconstr Surg 2022; 44:14. [PMID: 35384616 PMCID: PMC8986941 DOI: 10.1186/s40902-022-00339-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Peripheral nerve injury is one of the most common injuries that might occur in oral and maxillofacial surgery. The purpose of this study was to determine the effect of FK506 loaded with collagen membrane and fibrin glue on the promotion of nerve regeneration after traction nerve injury in a rat model. Methods Thirty male Sprague-Dawley rats were divided into three groups: group A (n = 10), a sham group whose sciatic nerve was exposed without any injury; and groups B (n = 10) and C (n = 10), which underwent traction nerve injury using 200 g of traction force for 1 min. The injured nerve in group C was covered with a collagen membrane soaked with FK506 (0.5 mg/0.1 mL) and fibrin glue. Functional analysis and microscopic evaluation were performed at 2 and 4 weeks after injury. Results The sciatic function index was − 5.78 ± 3.07 for group A, − 20.69 ± 5.22 for group B, and − 12.01 ± 4.20 for group C at 2 weeks after injury. However, at 4 weeks, the sciatic function index was − 5.58 ± 2.45 for group A, − 19.69 ± 4.81 for group B, and − 11.95 ± 1.94 for group C. In both periods, statistically significant differences were found among the groups (p<0.017). Histomorphometric evaluation revealed improved nerve regeneration in group C compared to that in group B. However, no statistical differences in axonal density were found among the three groups (p < 0.017). Conclusion Localized FK506 with collagen membrane and fibrin glue could promote axonal regeneration in a rat model of traction nerve injury.
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Affiliation(s)
- Jin-Hong Kim
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Young-Jin Choi
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Han-Ick Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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26
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Angiogenesis is critical for the exercise-mediated enhancement of axon regeneration following peripheral nerve injury. Exp Neurol 2022; 353:114029. [DOI: 10.1016/j.expneurol.2022.114029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 02/27/2022] [Indexed: 11/21/2022]
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Mitchell EC, Haddara MM, Wu KY, Chambers SB, Ferreira LM, Gillis JA. Strength Comparison of Fibrin Glue and Suture Constructs in Upper Extremity Peripheral Nerve Coaptations: An In Vitro Study. J Hand Surg Am 2022:S0363-5023(21)00798-X. [PMID: 35232630 DOI: 10.1016/j.jhsa.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/29/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare in vitro failure loads of nerve coaptations using fibrin glue alone, a suture alone, and a combination of fibrin glue and a suture. METHODS The median, radial, and ulnar nerves of 15 fresh-frozen cadaveric upper extremity specimens (45 nerves in total) were dissected in vitro and transected 5 cm proximal to the wrist crease to simulate an injury requiring coaptation. Three coaptation techniques were used: fibrin glue alone, a suture alone, and a suture augmented with fibrin glue. The load to failure of each repair was measured using a linear servo-actuator with an in-line force sensor. The results were analyzed using 2-way repeated measures analysis of variance tests and pairwise comparisons with Bonferroni correction. RESULTS Both the nerve coaptation technique and the specific nerve that was repaired had a significant effect on failure load. Suture-glue repair had the highest load to failure, 11.2 ± 2.9 N, and significantly increased the load to failure by 2.9 ± 1.7 N compared with glue repair alone. There was no significant difference between suture-glue repair and suture repair alone or between glue repair alone and suture repair alone. CONCLUSIONS In this in vitro cadaveric model, nerve injury coaptation using both a suture and fibrin glue resulted in the strongest repair. The addition of fibrin glue may provide some benefit when used to augment suture repair, but when used in isolation, it is inferior to combined suture-and-glue constructs. CLINICAL RELEVANCE Combined suture-and-glue nerve coaptations might be useful in the early postoperative period in increasing nerve repair strength and potentially reducing rupture rates.
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Affiliation(s)
- Eric C Mitchell
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, Ontario, Canada; Division of Plastic and Reconstructive Surgery, Western University, London, Ontario, Canada
| | - Mohammad M Haddara
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Kitty Y Wu
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, Ontario, Canada; Division of Plastic and Reconstructive Surgery, Western University, London, Ontario, Canada
| | - Spencer B Chambers
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, Ontario, Canada; Division of Plastic and Reconstructive Surgery, Western University, London, Ontario, Canada
| | - Louis M Ferreira
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, Ontario, Canada; School of Biomedical Engineering, Western University, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Joshua A Gillis
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, Ontario, Canada; Division of Plastic and Reconstructive Surgery, Western University, London, Ontario, Canada.
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A systematic review and meta-analysis on the use of fibrin glue in peripheral nerve repair: Can we just glue it? J Plast Reconstr Aesthet Surg 2022; 75:1018-1033. [DOI: 10.1016/j.bjps.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/08/2021] [Accepted: 01/08/2022] [Indexed: 12/29/2022]
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Abstract
BACKGROUND Erythropoietin has neuroregenerative effects. Fibrin glue may be used for nerve repair and controlled release of substances. In this study, the authors investigated the effects of erythropoietin-containing fibrin glue on nerve repair, based on the hypothesis that erythropoietin-containing fibrin glue would positively affect nerve regeneration. METHODS Thirty-six Long-Evans rats were used. The animals were divided into six groups. Their left sciatic nerves were isolated, transected, and repaired with saline-containing fibrin glue in group 1, with erythropoietin-containing fibrin glue in group 2, with saline-containing fibrin glue and two sutures in group 3, with erythropoietin-containing fibrin glue and two sutures in group 4, with two sutures in group 5, and with four sutures in group 6. Sciatic Functional Index calculation, pin-prick test, and toe-spread test were performed on days 21, 42, and 63. All animals were killed on day 63. The nerve sections were analyzed histologically. RESULTS The Sciatic Functional Index, pin-prick test, and toe-spread test results were the best in group 4 and the worst in group 5. Group 4 showed superior Schwann cell proliferation (p < 0.05). Groups with epineural suture use (groups 3, 4, 5, and 6) had higher endoneurial collagen synthesis scores than the groups without suture use (groups 1 and 2) (p < 0.05). The myelin protein zero immunostaining results were significantly higher in the erythropoietin-treated groups (groups 2 and 4) (p < 0.05). CONCLUSION The combined use of erythropoietin-containing fibrin glue and two epineural sutures (group 4) showed a statistically significant improvement in many parameters. CLINICAL RELEVANCE STATEMENT PLEASE PROVIDE 1-2 SENTENCES (UP TO 45 WORDS) HERE.
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A Novel Alaska Pollock Gelatin Sealant Shows Higher Bonding Strength and Nerve Regeneration Comparable to That of Fibrin Sealant in a Cadaveric Model and a Rat Model. Plast Reconstr Surg 2021; 148:742e-752e. [PMID: 34705777 DOI: 10.1097/prs.0000000000008489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A novel biocompatible sealant composed of Alaska pollock-derived gelatin (ApGltn) has recently shown good burst strength and biocompatibility in a porcine aorta. The purpose of this study was to investigate the bonding strength and biocompatibility of the ApGltn sealant in transected digital nerves of fresh frozen cadavers and in the sciatic nerves of a rat model. METHODS Eighty human digital nerves of fresh frozen cadavers were transected for biomechanical traction testing. They were treated with four surgical interventions: (1) suture plus ApGltn sealant; (2) suture; (3) ApGltn sealant; and (4) fibrin sealant. Forty-three sciatic nerves of male Wistar rats were used for functional and histopathologic evaluation. They were treated with six surgical interventions: (1) suture plus ApGltn sealant; (2) suture; (3) ApGltn sealant; (4) fibrin sealant; (5) resection with a 5-mm gap (10 rats per group); and (6) sham operation (three rats). Macroscopic confirmation, muscle weight measurement, and histopathologic findings including G-ratio were examined 8 weeks after the procedure. RESULTS The maximum failure load of the ApGltn sealant was significantly higher than that of a fibrin sealant (0.22 ± 0.05 N versus 0.06 ± 0.04 N). The maximum failure load of the ApGltn sealant was significantly lower that of suture plus ApGltn sealant (1.37 N) and suture (1.27 N). Functional evaluation and histologic examination showed that sciatic nerves repaired with ApGltn sealant showed similar nerve recovery compared to repair with the suture and fibrin sealant. CONCLUSION The ApGltn sealant showed higher bonding strength and equal effect of nerve regeneration when compared with the fibrin sealant.
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Yang S, Zhu J, Lu C, Chai Y, Cao Z, Lu J, Zhang Z, Zhao H, Huang YY, Yao S, Kong X, Zhang P, Wang X. Aligned fibrin/functionalized self-assembling peptide interpenetrating nanofiber hydrogel presenting multi-cues promotes peripheral nerve functional recovery. Bioact Mater 2021; 8:529-544. [PMID: 34541418 PMCID: PMC8435993 DOI: 10.1016/j.bioactmat.2021.05.056] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/07/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
Nerve guidance conduits with hollow lumen fail to regenerate critical-sized peripheral nerve defects (15 mm in rats and 25 mm in humans), which can be improved by a beneficial intraluminal microenvironment. However, individual cues provided by intraluminal filling materials are inadequate to eliminate the functional gap between regenerated nerves and normal nerves. Herein, an aligned fibrin/functionalized self-assembling peptide (AFG/fSAP) interpenetrating nanofiber hydrogel that exerting synergistic topographical and biochemical cues for peripheral nerve regeneration is constructed via electrospinning and molecular self-assembly. The hydrogel possesses an aligned structure, high water content, appropriate mechanical properties and suitable biodegradation capabilities for nerve repair, which enhances the alignment and neurotrophin secretion of primary Schwann cells (SCs) in vitro, and successfully bridges a 15-mm sciatic nerve gap in rats in vivo. The rats transplanted with the AFG/fSAP hydrogel exhibit satisfactory morphological and functional recovery in myelinated nerve fibers and innervated muscles. The motor function recovery facilitated by the AFG/fSAP hydrogel is comparable with that of autografts. Moreover, the AFG/fSAP hydrogel upregulates the regeneration-associated gene expression and activates the PI3K/Akt and MAPK signaling pathways in the regenerated nerve. Altogether, the AFG/fSAP hydrogel represents a promising approach for peripheral nerve repair through an integration of structural guidance and biochemical stimulation. A novel aligned interpenetrating nanofiber hydrogel is first constructed for peripheral nerve regeneration. The aligned hydrogel presents synergistic topographical and biochemical cues for peripheral nerve regeneration. Nerve conduits filled with the aligned hydrogel can repair the long-distance sciatic nerve defects in 12 weeks. The function recovery facilitated by the aligned hydrogel is comparable with that of autografts. The aligned hydrogel upregulates regeneration-related genes and activates the PI3K/Akt and MAPK signaling pathways.
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Affiliation(s)
- Shuhui Yang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China
| | - Jinjin Zhu
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China.,Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine & Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, 310016, PR China
| | - Changfeng Lu
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Ministry of Education, Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, 100044, PR China
| | - Yi Chai
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, PR China
| | - Zheng Cao
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China
| | - Jiaju Lu
- School of Materials Science and Engineering, Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou, 310018, PR China
| | - Zhe Zhang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China
| | - He Zhao
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China
| | - Yin-Yuan Huang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China
| | - Shenglian Yao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, PR China
| | - Xiangdong Kong
- School of Materials Science and Engineering, Zhejiang-Mauritius Joint Research Center for Biomaterials and Tissue Engineering, Zhejiang Sci-Tech University, Hangzhou, 310018, PR China
| | - Peixun Zhang
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Ministry of Education, Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, 100044, PR China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing, 100084, PR China
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Schimoler PJ, Pope D, Kharlamov A, Tang P, Miller MC. Fibrin Glue and Conduit Form a Composite Structure in Digital Nerve Repair. J Biomech Eng 2021; 144:1115775. [PMID: 34382652 DOI: 10.1115/1.4052110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Indexed: 11/08/2022]
Abstract
Repair of severed nerves without auto- or allograft has included suture, suture with glue alone, suture with conduit and suture with glue augmentation to conduit, where use of conduit is considered for separation of the nerve ends from 5mm to 3cm. Repairs must not only serve acutely to provide apposition of nerve ends but must enable the healing of the nerve. Using biological conduit can place suture at the ends of the conduit while fibrin glue alone eliminates suture but with limited strength. The combination of conduit and glue offers the growth guidance of conduit with sufficient strength from the glue to maintain the nerve within the conduit. The role of glue in the repair integrity remains an open question, however. We sought to determine the factors in the strength of a glue-conduit-nerve construct and include consideration of standard suture repair. Fresh-frozen cadaveric digital nerves were repaired with suture alone, with glue alone or with suture and glue together and loaded to failure. Previously tested specimens with conduit, suture and glue were considered for comparison. The suture alone (2.02N) and suture with glue (2.24N) were not statistically different from each other but were statistically stronger than glue alone (0.15N). Compared to the earlier results of the strength of conduit with glue (0.65N), these results show that the glue and conduit act together. The increased area over which the glue adheres to the nerve and conduit creates a composite structure stronger than either alone.
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Affiliation(s)
- Patrick J Schimoler
- Allegheny General Hospital, Orthopaedic Surgery Department, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh PA
| | - David Pope
- Allegheny General Hospital, Orthopaedic Surgery Department, Pittsburgh, PA, USA
| | - Alexander Kharlamov
- Allegheny General Hospital, Orthopaedic Surgery Department, Pittsburgh, PA, USA
| | - Peter Tang
- Allegheny General Hospital, Orthopaedic Surgery Department, Pittsburgh, PA, USA
| | - Mark C Miller
- Allegheny General Hospital, Orthopaedic Surgery Department, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh PA
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Chen S, Gil CJ, Ning L, Jin L, Perez L, Kabboul G, Tomov ML, Serpooshan V. Adhesive Tissue Engineered Scaffolds: Mechanisms and Applications. Front Bioeng Biotechnol 2021; 9:683079. [PMID: 34354985 PMCID: PMC8329531 DOI: 10.3389/fbioe.2021.683079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
A variety of suture and bioglue techniques are conventionally used to secure engineered scaffold systems onto the target tissues. These techniques, however, confront several obstacles including secondary damages, cytotoxicity, insufficient adhesion strength, improper degradation rate, and possible allergic reactions. Adhesive tissue engineering scaffolds (ATESs) can circumvent these limitations by introducing their intrinsic tissue adhesion ability. This article highlights the significance of ATESs, reviews their key characteristics and requirements, and explores various mechanisms of action to secure the scaffold onto the tissue. We discuss the current applications of advanced ATES products in various fields of tissue engineering, together with some of the key challenges for each specific field. Strategies for qualitative and quantitative assessment of adhesive properties of scaffolds are presented. Furthermore, we highlight the future prospective in the development of advanced ATES systems for regenerative medicine therapies.
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Affiliation(s)
- Shuai Chen
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Carmen J. Gil
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Liqun Ning
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Linqi Jin
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Lilanni Perez
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Gabriella Kabboul
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Martin L. Tomov
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Vahid Serpooshan
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Children’s Healthcare of Atlanta, Atlanta, GA, United States
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Bayır Ö, Karagöz T, Alpaslan Pınarlı F, Sarıbaş GS, Özoğul C, Keseroğlu K, Saylam G, Çadallı Tatar E, Karahan S, Öcal B, Korkmaz MH. Impact of fetal brain tissue derived mesenchymal stem cell and fibrin glue on facial nerve crash injury. Turk J Med Sci 2021; 51:1481-1490. [PMID: 33244948 PMCID: PMC8283470 DOI: 10.3906/sag-2004-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/26/2020] [Indexed: 01/09/2023] Open
Abstract
Background/aim To evaluate the clinical and histopathological effects of fetal brain tissue derived mesenchymal stem cells (FBTMSC) and fibrin glue (FG) on the facial nerve (FN) regeneration in rats with traumatic FN injury. Materials and methods Twenty-eight Sprague Dawley rats were included in the study and divided into 4 groups. Traumatic FN injury (FP) was created by a surgical clamp compression to the main trunk of left FN in all groups. In the control group (group 1) no treatment was applied, in group 2 (FBTMSC group) 2 × 106 FBTMSC was injected, in group 3 (FG group) only FG was applied, in group 4 (FBTMSC and FG groups) both FBTMSC and FG were applied to the injured section of the nerve. The FN functions were evaluated clinically, immediately after the procedure and at 3rd, 5th, and 8th weeks postoperatively. The FNs of all subjects were excised after the 8th week; then the rats were sacrificed. The presence of stem cells in the injured zone was assessed using bromo-deoxyuridine (BrdU), and apoptosis was determined by the TUNEL method. Results After the damage, total FP was observed in all subjects. Statistically significant functional improvement was observed in group 4 compared to all other groups (P < 0.005). TUNEL-positive cell count was statistically significantly higher in the control group than the other groups (P < 0.001). TUNEL-positive cell count was statistically significantly lower in group 4 than the other groups. The proportion of BrdU-stained cells in group 4 (5%) was higher than group 2 (2%). Conclusion Clinically and histopathologically FBTMSC applied with FG may play a promising role as a regenerative treatment in posttraumatic FP.
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Affiliation(s)
- Ömer Bayır
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tuğba Karagöz
- Department of Otorhinolaryngology and Head and Neck Surgery, Kaman State Hospital, Kırşehir, Turkey
| | | | - Gülistan Sanem Sarıbaş
- Department of Histology and Embryology, Faculty of Medicine, Ahi Evran University, Kırşehir, Turkey
| | - Candan Özoğul
- Department of Histology and Embryology, Faculty of Medicine, University of Kyrenia, Girne, Turkish Republic of Nothern Cyprus
| | - Kemal Keseroğlu
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bülent Öcal
- Department of Otolaryngology Head and Neck Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Cicero L, Licciardi M, Cirincione R, Puleio R, Giammona G, Giglia G, Sardo P, Edoardo Vigni G, Cioffi A, Sanfilippo A, Cassata G. Polybutylene succinate artificial scaffold for peripheral nerve regeneration. J Biomed Mater Res B Appl Biomater 2021; 110:125-134. [PMID: 34180135 PMCID: PMC9290626 DOI: 10.1002/jbm.b.34896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 12/15/2022]
Abstract
Regeneration and recovery of nerve tissues are a great challenge for medicine, and positively affect the quality of life of patients. The development of tissue engineering offers a new approach to the problem with the creation of multifunctional artificial scaffolds that act on various levels in the damaged tissue, providing physical and biochemical support for the growth of nerve cells. In this study, the effects of the use of a tubular scaffold made of polybutylene succinate (PBS), surgically positioned at the level of a sciatic nerve injured in rat, between the proximal stump and the distal one, was investigated. Scaffolds characterization was carried out by scanning electron microscopy and X‐ray microcomputed tomography and magnetic resonance imaging, in vivo. The demonstration of the nerve regeneration was based on the evaluation of electroneurography, measuring the weight of gastrocnemius and tibialis anterior muscles, histological examination of regenerated nerves and observing the recovery of the locomotor activity of animals. The PBS tubular scaffold minimized iatrogenic trauma on the nerve, acting as a directional guide for the regenerating fibers by conveying them toward the distal stump. In this context, neurotrophic and neurotropic factors may accumulate and perform their functions, while invasion by macrophages and scar tissue is hampered.
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Affiliation(s)
- Luca Cicero
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T)Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”PalermoItaly
| | - Mariano Licciardi
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF)Università degli Studi di PalermoPalermoItaly
| | - Roberta Cirincione
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T)Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”PalermoItaly
| | - Roberto Puleio
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T)Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”PalermoItaly
| | - Gaetano Giammona
- Dipartimento di Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche (STEBICEF)Università degli Studi di PalermoPalermoItaly
| | - Giuseppe Giglia
- Dipartimento di BiomedicinaNeuroscienze e Diagnostica Avanzata (BiND) Università degli Studi di PalermoPalermoItaly
| | - Pierangelo Sardo
- Dipartimento di BiomedicinaNeuroscienze e Diagnostica Avanzata (BiND) Università degli Studi di PalermoPalermoItaly
| | - Giulio Edoardo Vigni
- Dipartimento di Discipline Chirurgiche, Oncologiche e StomatologicheUniversità degli Studi di PalermoPalermoItaly
| | - Alessio Cioffi
- Dipartimento di Discipline Chirurgiche, Oncologiche e StomatologicheUniversità degli Studi di PalermoPalermoItaly
| | - Antonino Sanfilippo
- Dipartimento di Discipline Chirurgiche, Oncologiche e StomatologicheUniversità degli Studi di PalermoPalermoItaly
| | - Giovanni Cassata
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T)Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”PalermoItaly
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Singh S, Srivastava AK, Baranwal AK, Bhatnagar A, Das KK, Jaiswal S, Behari S. Efficacy of Silicone Conduit in the Rat Sciatic Nerve Repair Model: Journey of a Thousand Miles. Neurol India 2021; 69:318-325. [PMID: 33904443 DOI: 10.4103/0028-3886.314576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A lot of options have been tried for bridging the two ends of the injured nerves. Researchers have used decellularized nerve grafts, artificial materials and even nerve growth factors to augment functional recovery. These materials are either costly or inaccessible in developing world. Objective The study aimed to evaluate the efficacy of the silicone conduit in a rat sciatic nerve injury model. Materials and Methods 24 healthy Sprague-Dawley (SD) rats (250-300 grams; 8-10 weeks) were used and right sciatic nerve was exposed; transected and re-anastomosed by two different methods in 16 rats. In control group, n = 8 (Group I) the sciatic nerve was untouched; Group II (reverse nerve anastomosis, n = 8): 1-centimeter of nerve was cut and re-anastomosed by using 10-0 monofilament suture; Group III (silicone conduit, n = 8) 1-centimeter nerve segment was cut, replaced by silicone conduit and supplemented by fibrin glue]. Evaluation of nerve recovery was done functionally (pain threshold and sciatic functional index) over 3 months and histologically and electron microscopically. Results Functional results showed a trend of clinical improvement in Group III and II but recovery was poor and never reached up to normal. Histopathological and electron microscopic results showed an incomplete axonal regeneration in Groups II and III. Psychological analyses showed that no outwards signs of stress were present and none of the rats showed paw biting and teeth chattering. Conclusion The silicone conduit graft may be an economical and effective alternative to presently available interposition grafts, however for short segments only.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Atul K Baranwal
- Veterinary Scientist, Animal House, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Bhatnagar
- Department of Plastic and Reconstruction Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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37
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Saffari TM, Chan K, Saffari S, Zuo KJ, McGovern RM, Reid JM, Borschel GH, Shin AY. Combined local delivery of tacrolimus and stem cells in hydrogel for enhancing peripheral nerve regeneration. Biotechnol Bioeng 2021; 118:2804-2814. [PMID: 33913523 DOI: 10.1002/bit.27799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022]
Abstract
The application of scaffold-based stem cell transplantation to enhance peripheral nerve regeneration has great potential. Recently, the neuroregenerative potential of tacrolimus (a U.S. Food and Drug Administration-approved immunosuppressant) has been explored. In this study, a fibrin gel-based drug delivery system for sustained and localized tacrolimus release was combined with rat adipose-derived mesenchymal stem cells (MSC) to investigate cell viability in vitro. Tacrolimus was encapsulated in poly(lactic-co-glycolic) acid (PLGA) microspheres and suspended in fibrin hydrogel, using concentrations of 0.01 and 100 ng/ml. Drug release over time was measured. MSCs were cultured in drug-released media collected at various days to mimic systemic exposure. MSCs were combined with (i) hydrogel only, (ii) empty PLGA microspheres in the hydrogel, (iii) 0.01, and (iv) 100 ng/ml of tacrolimus PLGA microspheres in the hydrogel. Stem cell presence and viability were evaluated. A sustained release of 100 ng/ml tacrolimus microspheres was observed for up to 35 days. Stem cell presence was confirmed and cell viability was observed up to 7 days, with no significant differences between groups. This study suggests that combined delivery of 100 ng/ml tacrolimus and MSCs in fibrin hydrogel does not result in cytotoxic effects and could be used to enhance peripheral nerve regeneration.
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Affiliation(s)
- Tiam M Saffari
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Katelyn Chan
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Engineering, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Sara Saffari
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Kevin J Zuo
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Renee M McGovern
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel M Reid
- Division of Oncology Research, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Plastic Surgery, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Lee JI, Gurjar AA, Talukder MAH, Rodenhouse A, Manto K, O'Brien M, Karuman Z, Govindappa PK, Elfar JC. Purposeful Misalignment of Severed Nerve Stumps in a Standardized Transection Model Reveals Persistent Functional Deficit With Aberrant Neurofilament Distribution. Mil Med 2021; 186:696-703. [PMID: 33499508 DOI: 10.1093/milmed/usaa344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/29/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Functional recovery following primary nerve repair of a transected nerve is often poor even with advanced microsurgical techniques. Recently, we developed a novel sciatic nerve transection method where end-to-end apposition of the nerve endings with minimal gap was performed with fibrin glue. We demonstrated that transected nerve repair with gluing results in optimal functional recovery with improved axonal neurofilament distribution profile compared to the end-to-end micro-suture repair. However, the impact of axonal misdirection and misalignment of nerve fascicles remains largely unknown in nerve-injury recovery. We addressed this issue using a novel nerve repair model with gluing. METHODS In our complete "Flip and Transection with Glue" model, the nerve was "first" transected to 40% of its width from each side and distal stump was transversely flipped, then 20 µL of fibrin glue was applied around the transection site and the central 20% nerve was completely transected before fibrin glue clotting. Mice were followed for 28 days with weekly assessment of sciatic function. Immunohistochemistry analysis of both sciatic nerves was performed for neurofilament distribution and angiogenesis. Tibialis anterior muscles were analyzed for atrophy and histomorphometry. RESULTS Functional recovery following misaligned repair remained persistently low throughout the postsurgical period. Immunohistochemistry of nerve sections revealed significantly increased aberrant axonal neurofilaments in injured and distal nerve segments compared to proximal segments. Increased aberrant neurofilament profiles in the injured and distal nerve segments were associated with significantly increased nerve blood-vessel density and branching index than in the proximal segment. Injured limbs had significant muscle atrophy, and muscle fiber distribution showed significantly increased numbers of smaller muscle fibers and decreased numbers of larger muscle fibers. CONCLUSIONS These findings in a novel nerve transection mouse model with misaligned repair suggest that aberrant neurofilament distributions and axonal misdirections play an important role in functional recovery and muscle atrophy.
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Affiliation(s)
- Jung Il Lee
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA.,Department of Orthopedic Surgery, Hanyang University College of Medicine, Hayang University Guri Hospital, Guri-si, Gyeonggi-do, 11923, South Korea
| | - Anagha A Gurjar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - M A Hassan Talukder
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Andrew Rodenhouse
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Kristen Manto
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Mary O'Brien
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Zara Karuman
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Prem Kumar Govindappa
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - John C Elfar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Abstract
Over the past century, many advancements have been made in peripheral nerve repair, yet these reconstructions still remain a challenge. Although sutures have historically been used for neurorrhaphy, they sometimes fail to provide optimal outcomes. As a result, multiple adhesive compounds are currently being investigated for their efficacy in nerve repair. Recently, fibrin glue has shown utility in peripheral nerve repair, and the body of evidence supporting its use continues to grow. Fibrin glue has been shown to reduce inflammation, improve axonal regeneration, and provide excellent functional results. This alternative to traditional suture neurorrhaphy could potentially improve outcomes of peripheral nerve reconstruction.
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Affiliation(s)
- Nathan Chow
- From the Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center
| | - Hunter Miears
- From the Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center
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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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41
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Lee JI, Gurjar AA, Talukder MAH, Rodenhouse A, Manto K, O'Brien M, Govindappa PK, Elfar JC. A novel nerve transection and repair method in mice: histomorphometric analysis of nerves, blood vessels, and muscles with functional recovery. Sci Rep 2020; 10:21637. [PMID: 33303798 PMCID: PMC7729850 DOI: 10.1038/s41598-020-78481-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Jung Il Lee
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA.,Department of Orthopedic Surgery, Hanyang University College of Medicine, Hayang University Guri Hospital, Guri, South Korea
| | - Anagha A Gurjar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA
| | - M A Hassan Talukder
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA.
| | - Andrew Rodenhouse
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA
| | - Kristen Manto
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA
| | - Mary O'Brien
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA
| | - Prem Kumar Govindappa
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA
| | - John C Elfar
- Department of Orthopaedics and Rehabilitation, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA, 17033, USA.
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42
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Qiu L, Qi See AA, Steele TWJ, Kam King NK. Bioadhesives in neurosurgery: a review. J Neurosurg 2020; 133:1928-1938. [PMID: 31731262 DOI: 10.3171/2019.8.jns191592] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgery presents unique surgical challenges arising from delicate neural structures, limited accessibility, and the risk of CSF leakage that can lead to CNS infections. Sutures and staples may have limited applicability in the complex anatomical constraints of cranial and spinal surgeries, especially in trauma settings when time is of the essence. Surgical bioadhesives are emerging as attractive alternatives because they avoid traumatic application methods, provide a stress-distributed fixation, and provide good cosmesis and outcomes. This article presents the history of the development of surgical bioadhesives, and is also a review of current applications of commercial surgical bioadhesives within neurosurgical procedures and the unmet clinical needs that should be addressed in bioadhesives technologies. METHODS A PubMed literature search was performed using the terms "(glue OR bioadhesive OR fibrin OR tisseel OR evicel OR tachosil OR cyanoacrylate OR duraseal OR bioglue) AND (neurosurgery OR spine OR spinal OR dural OR microvascular decompression OR transsphenoidal OR endovascular)." Of 2433 records screened, 168 studies were identified that described the use of bioadhesives in neurosurgical procedures. RESULTS The greatest number of studies describing the use of bioadhesives in neurosurgery were identified for endovascular embolization, followed by dural closure and transsphenoidal surgeries. Other common areas of application were for microvascular decompression, skin closure, peripheral nerve repair, and other novel uses. Numerous case reports were also identified describing complications associated with bioadhesive use. CONCLUSIONS Despite the paucity of approved indications, surgical bioadhesive use in neurosurgical procedures is prevalent. However, current bioadhesives still each have their own limitations and research is intense in the development of novel solutions.
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Affiliation(s)
- Liming Qiu
- 1Department of Neurosurgery, National Neuroscience Institute, Singapore
- 2Department of Neurosurgery, Singapore General Hospital, Singapore
- 3School of Materials Science & Engineering, Nanyang Technological University, Singapore; and
| | - Angela An Qi See
- 1Department of Neurosurgery, National Neuroscience Institute, Singapore
- 2Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Terry W J Steele
- 3School of Materials Science & Engineering, Nanyang Technological University, Singapore; and
| | - Nicolas Kon Kam King
- 1Department of Neurosurgery, National Neuroscience Institute, Singapore
- 2Department of Neurosurgery, Singapore General Hospital, Singapore
- 4Duke-NUS Medical School, Singapore
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43
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Jasmine S, Thangavelu A, Krishnamoorthy R, Alshatwi AA. Platelet Concentrates as Biomaterials in Tissue Engineering: a Review. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2020. [DOI: 10.1007/s40883-020-00165-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Suryavanshi JR, Cox C, Osemwengie BO, Jones HB, MacKay BJ. Sutureless repair of a partially transected median nerve using Tisseel glue and Axoguard nerve protector: A case report. Microsurgery 2020; 40:896-900. [PMID: 32333694 DOI: 10.1002/micr.30593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022]
Abstract
Peripheral nerve injuries in which the nerve is not completely severed often result in neuromas-in-continuity. These can cause sensory and functional deficits and must be resected and reconstructed. In defects greater than 5 mm in length, nerve graft is indicated, and suture neurorrhaphy is typically used to secure the nerve ends. However, sutures may negatively impact nerve regeneration. Fibrin glue has recently been used to mitigate the inflammatory response associated with suture neurorrhaphy. Most of the literature regarding fibrin glue covers animal models and supports its use for nerve reconstruction. Tisseel, a fibrin sealant developed as an adjunct to hemostasis, has recently shown utility in peripheral nerve repair by increasing tensile strength without additional sutures. We present the successful use of Tisseel sealant in a neuroma resection and reconstruction. In this case, a 35-year-old female presented with persistent neuropathic pain and neurologic dysfunction related to the median nerve in her hand with a history of distal forearm laceration and prior carpal tunnel release. Upon exploration, a neuroma-in-continuity involving 75% of the nerve was identified, resected, and reconstructed using processed human nerve allograft, as well as Tisseel sealant and Axoguard nerve protector to secure the repair and offload tension. At 1-year follow-up, pain was resolved, with ≤8 mm static 2-point discrimination in the median nerve distribution, and excellent improvement in hand strength compared with preoperative conditions. The outcome of this case indicates that fibrin glue may be useful to avoid excess sutures in cases of neuroma-in-continuity not involving the entire cross-section of the nerve.
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Affiliation(s)
- Joash R Suryavanshi
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Cameron Cox
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Bradley O Osemwengie
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hunter B Jones
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Brendan J MacKay
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.,Division of Orthopaedic Surgery, University Medical Center, Lubbock, Texas, USA
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45
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Wei S, Hu Q, Cheng X, Ma J, Liang X, Peng J, Xu W, Sun X, Han G, Ma X, Wang Y. Differences in the Structure and Protein Expression of Femoral Nerve Branches in Rats. Front Neuroanat 2020; 14:16. [PMID: 32322192 PMCID: PMC7156789 DOI: 10.3389/fnana.2020.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuai Wei
- Tianjin Hospital Tianjin University, Tianjin, China
- Institute of Orthopedics, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Qian Hu
- Department of Geriatrics, The Second People’s Hospital of Nantong, Nantong, China
| | - Xiaoqing Cheng
- Institute of Orthopedics, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Jianxiong Ma
- Tianjin Hospital Tianjin University, Tianjin, China
| | - Xuezhen Liang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jiang Peng
- Institute of Orthopedics, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Wenjing Xu
- Institute of Orthopedics, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Xun Sun
- Tianjin Hospital Tianjin University, Tianjin, China
| | - Gonghai Han
- The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xinlong Ma
- Tianjin Hospital Tianjin University, Tianjin, China
- *Correspondence: Xinlong Ma Yu Wang
| | - Yu Wang
- Institute of Orthopedics, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
- *Correspondence: Xinlong Ma Yu Wang
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46
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Vijayavenkataraman S. Nerve guide conduits for peripheral nerve injury repair: A review on design, materials and fabrication methods. Acta Biomater 2020; 106:54-69. [PMID: 32044456 DOI: 10.1016/j.actbio.2020.02.003] [Citation(s) in RCA: 237] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Abstract
Peripheral nerves can sustain injuries due to loss of structure and/or function of peripheral nerves because of accident, trauma and other causes, which leads to partial or complete loss of sensory, motor, and autonomic functions and neuropathic pain. Even with the extensive knowledge on the pathophysiology and regeneration mechanisms of peripheral nerve injuries (PNI), reliable treatment methods that ensure full functional recovery are scant. Nerve autografting is the current gold standard for treatment of PNI. Given the limitations of autografts including donor site morbidity and limited supply, alternate treatment methods are being pursued by the researchers. Neural guide conduits (NGCs) are increasingly being considered as a potential alternative to nerve autografts. The anatomy of peripheral nerves, classification of PNI, and current treatment methods are briefly yet succinctly reviewed. A detailed review on the various designs of NGCs, the different materials used for making the NGCs, and the fabrication methods adopted is presented in this work. Much progress had been made in all the aspects of making an NGC, including the design, materials and fabrication techniques. The advent of advanced technologies such as additive manufacturing and 3D bioprinting could be beneficial in easing the production of patient-specific NGCs. NGCs with supporting cells or stem cells, NGCs loaded with neurotropic factors and drugs, and 4D printed NGCs are some of the futuristic areas of interest. STATEMENT OF SIGNIFICANCE: Neural guide conduits (NGCs) are increasingly being considered as a potential alternative to nerve autografts in the treatment of peripheral nerve injuries. A detailed review on the various designs of NGCs, the different materials used for making the NGCs, and the fabrication methods (including Additive Manufacturing) adopted is presented in this work.
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Affiliation(s)
- Sanjairaj Vijayavenkataraman
- Division of Engineering, New York University Abu Dhabi, UAE; Department of Mechanical and Aerospace Engineering, Tandon School of Engineering, New York University, NY, USA.
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47
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Bao Z, Gao M, Sun Y, Nian R, Xian M. The recent progress of tissue adhesives in design strategies, adhesive mechanism and applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 111:110796. [PMID: 32279807 DOI: 10.1016/j.msec.2020.110796] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 04/15/2019] [Accepted: 02/29/2020] [Indexed: 02/07/2023]
Abstract
Tissue adhesives have emerged as an effective method for wound closure and hemostasis in recent decades, due to their ability to bond tissues together, preventing separation from one tissue to another. However, existing tissue adhesives still have several limitations. Tremendous efforts have been invested into developing new tissue adhesives by improving upon existing adhesives through different strategies. Therefore, highlighting and analyzing these design strategies are essential for developing the next generation of advanced adhesives. To this end, we reviewed the available strategies for modifying traditional adhesives (including cyanoacrylate glues, fibrin sealants and BioGlue), as well as design of emerging adhesives (including gelatin sealants, methacrylated sealants and bioinspired adhesives), focusing on their structures, adhesive mechanisms, advantages, limitations, and current applications. The bioinspired adhesives have numerous advantages over traditional adhesives, which will be a wise direction for achieving tissue adhesives with superior properties.
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Affiliation(s)
- Zixian Bao
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Minghong Gao
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Yue Sun
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Rui Nian
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China.
| | - Mo Xian
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China.
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48
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Abstract
As surgical techniques and technology continue to advance in shoulder surgery along with the increased use of regional anesthesia, it is important to remember that iatrogenic nerve injuries remain a possible complication. Iatrogenic nerve injuries associated with shoulder surgery lead to patient disability and distress, increased healthcare costs, and possibly additional procedures. To obtain the best possible outcome for the patient after the nerve injury has been discovered, a timely appreciation of the management options is necessary rather than expectant management. Early recognition, appropriate neurodiagnostic testing, and prompt treatment or referral are mandatory for optimal outcomes.
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49
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Wang Y, Zhang Y, Li X, Zhang Q. The progress of biomaterials in peripheral nerve repair and regeneration. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Repair and regeneration of the injured peripheral nerve (PN) is a challenging issue in clinics. Although the regeneration outcome of large PN defects is currently unsatisfactory, recently, the study of PN repair has considerably progressed. In particular, biomaterials for repairing PNs, such as nerve guidance conduits and nerve repair membranes, have been well developed. Herein, we summarize the anatomy of the PN, the pathophysiological features of the nerve injury, and the repair process post injury. Then, we highlight the progress in the development of natural and synthetic biomaterials and summarize the applications, advantages, and disadvantages of these materials. These materials can be used as nerve repair membranes and nerve conduits in the field of PN repair. Finally, we discuss the challenges encountered and development strategies for PN repair in the future.
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50
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Hussain G, Wang J, Rasul A, Anwar H, Qasim M, Zafar S, Aziz N, Razzaq A, Hussain R, de Aguilar JLG, Sun T. Current Status of Therapeutic Approaches against Peripheral Nerve Injuries: A Detailed Story from Injury to Recovery. Int J Biol Sci 2020; 16:116-134. [PMID: 31892850 PMCID: PMC6930373 DOI: 10.7150/ijbs.35653] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/22/2019] [Indexed: 12/14/2022] Open
Abstract
Peripheral nerve injury is a complex condition with a variety of signs and symptoms such as numbness, tingling, jabbing, throbbing, burning or sharp pain. Peripheral nerves are fragile in nature and can easily get damaged due to acute compression or trauma which may lead to the sensory and motor functions deficits and even lifelong disability. After lesion, the neuronal cell body becomes disconnected from the axon's distal portion to the injury site leading to the axonal degeneration and dismantlement of neuromuscular junctions of targeted muscles. In spite of extensive research on this aspect, complete functional recovery still remains a challenge to be resolved. This review highlights detailed pathophysiological events after an injury to a peripheral nerve and the associated factors that can either hinder or promote the regenerative machinery. In addition, it throws light on the available therapeutic strategies including supporting therapies, surgical and non-surgical interventions to ameliorate the axonal regeneration, neuronal survival, and reinnervation of peripheral targets. Despite the availability of various treatment options, we are still lacking the optimal treatments for a perfect and complete functional regain. The need for the present age is to discover or design such potent compounds that would be able to execute the complete functional retrieval. In this regard, plant-derived compounds are getting more attention and several recent reports validate their remedial effects. A plethora of plants and plant-derived phytochemicals have been suggested with curative effects against a number of diseases in general and neuronal injury in particular. They can be a ray of hope for the suffering individuals.
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Affiliation(s)
- Ghulam Hussain
- Neurochemicalbiology and Genetics Laboratory (NGL), Department of Physiology, Faculty of Life Sciences, Government College University, Faisalabad, 38000 Pakistan
| | - Jing Wang
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, Fujian Province, 361021 China
| | - Azhar Rasul
- Department of Zoology, Faculty of Life Sciences, Government College University, Faisalabad, 38000 Pakistan
| | - Haseeb Anwar
- Neurochemicalbiology and Genetics Laboratory (NGL), Department of Physiology, Faculty of Life Sciences, Government College University, Faisalabad, 38000 Pakistan
| | - Muhammad Qasim
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, 38000 Pakistan
| | - Shamaila Zafar
- Neurochemicalbiology and Genetics Laboratory (NGL), Department of Physiology, Faculty of Life Sciences, Government College University, Faisalabad, 38000 Pakistan
| | - Nimra Aziz
- Neurochemicalbiology and Genetics Laboratory (NGL), Department of Physiology, Faculty of Life Sciences, Government College University, Faisalabad, 38000 Pakistan
| | - Aroona Razzaq
- Neurochemicalbiology and Genetics Laboratory (NGL), Department of Physiology, Faculty of Life Sciences, Government College University, Faisalabad, 38000 Pakistan
| | - Rashad Hussain
- Department of Neurosurgery, Center for Translational Neuromedicine (SMD), School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 645, Rochester, NY 14642, USA
| | - Jose-Luis Gonzalez de Aguilar
- Université de Strasbourg, UMR_S 1118, Strasbourg, France
- INSERM, U1118, Mécanismes Centraux et Péripheriques de la Neurodégénérescence, Strasbourg, France
| | - Tao Sun
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, Fujian Province, 361021 China
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