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Schuster CR, Reiche E, Keller PR, Hu S, Soares V, Rahmayanti S, Suresh V, Harris TGW, Doloff JC, Tuffaha S, Coon D. Testosterone Promotes Nerve Tethering and Acellular Biomaterial Perineural Fibrosis in a Rat Wound Repair Model. Adv Wound Care (New Rochelle) 2024. [PMID: 38775428 DOI: 10.1089/wound.2024.0043] [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: 07/05/2024] Open
Abstract
Objective: Nerve scarring after traumatic or iatrogenic exposure can lead to impaired function and pain. Nerve-adjacent biomaterials promoting a regenerative tissue response may help reduce perineural fibrosis. Our prior work suggests that testosterone may promote fibrotic skin scarring, but it is unknown how testosterone alters nerve fibrosis or shifts the response to biomaterials. Approach: Sterilized Lewis rats received either testosterone cypionate (+T) or placebo (-T) biweekly. Fifteen days later, wounds were created over the sciatic nerve and covered with an acellular matrix (AM) or closed via primary closure (PC). At day 42, force gauge testing measured the force required to mobilize the nerve, and wound tissue was analyzed. Results: Nerve mobilization force was greater in +T versus -T wounds (p < 0.01). Nerves tore before gliding in 60% of +T versus 6% of -T rats. Epidermal gap (p < 0.01), scar width (p < 0.01), and cross-sectional scar tissue area (p = 0.02) were greater in +T versus -T rats. +T versus -T rats expressed less Col-3 (p = 0.02) and CD68 (p = 0.02). Nerve mobilization force trended nonsignificantly higher for PC versus AM wounds and for +T versus -T wounds within the AM cohort. Innovation: Testosterone increases nerve tethering in the wound healing milieu, altering repair and immune cell balances. Conclusion: Testosterone significantly increases the force required to mobilize nerves in wound beds and elevates histological markers of scarring, suggesting that testosterone-induced inflammation may increase perineural adhesion. Testosterone may reduce the potential anti-tethering protective effect of AM. Androgen receptor antagonism may represent a therapeutic target to reduce scar-related nerve morbidity.
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Affiliation(s)
- Calvin R Schuster
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erik Reiche
- Division of Plastic Surgery, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R Keller
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophia Hu
- Division of Plastic Surgery, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA
| | - Vance Soares
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Siti Rahmayanti
- Division of Plastic Surgery, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA
| | - Visakha Suresh
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas G W Harris
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua C Doloff
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sami Tuffaha
- Departments of Plastic and Reconstructive Surgery and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Devin Coon
- Division of Plastic Surgery, Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts, USA
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Yao L, Sai HV, Shippy T, Li B. Cellular and Transcriptional Response of Human Astrocytes to Hybrid Protein Materials. ACS APPLIED BIO MATERIALS 2024; 7:2887-2898. [PMID: 38632900 DOI: 10.1021/acsabm.3c01266] [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] [Indexed: 04/19/2024]
Abstract
Collagen is a major component of the tissue matrix, and soybean can regulate the tissue immune response. Both materials have been used to fabricate biomaterials for tissue repair. In this study, adult and fetal human astrocytes were grown in a soy protein isolate (SPI)-collagen hybrid gel or on the surface of a cross-linked SPI-collagen membrane. Hybrid materials reduced the cell proliferation rate compared to materials generated by collagen alone. However, the hybrid materials did not significantly change the cell motility compared to the control collagen material. RNA-sequencing (RNA-Seq) analysis showed downregulated genes in the cell cycle pathway, including CCNA2, CCNB1, CCNB2, CCND1, CCND2, and CDK1, which may explain lower cell proliferation in the hybrid material. This study also revealed the downregulation of genes encoding extracellular matrix (ECM) components, including HSPG2, LUM, SDC2, COL4A1, COL4A5, COL4A6, and FN1, as well as genes encoding chemokines, including CCL2, CXCL1, CXCL2, CX3CL1, CXCL3, and LIF, for adult human astrocytes grown on the hybrid membrane compared with those grown on the control collagen membrane. The study explored the cellular and transcriptional responses of human astrocytes to the hybrid material and indicated a potential beneficial function of the material in the application of neural repair.
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Affiliation(s)
- Li Yao
- Department of Biological Sciences, Wichita State University, 1845 Fairmount Street, Wichita, Kansas 67260, United States
| | - Haneesha Vishwa Sai
- Department of Biological Sciences, Wichita State University, 1845 Fairmount Street, Wichita, Kansas 67260, United States
| | - Teresa Shippy
- KSU Bioinformatics Center, Division of Biology, Kansas State University, Manhattan, Kansas 66506, United States
| | - Bin Li
- Department of Mechanical Engineering, Wichita State University, 1845 Fairmount Street, Wichita, Kansas 67260, United States
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Katrilaka C, Karipidou N, Petrou N, Manglaris C, Katrilakas G, Tzavellas AN, Pitou M, Tsiridis EE, Choli-Papadopoulou T, Aggeli A. Freeze-Drying Process for the Fabrication of Collagen-Based Sponges as Medical Devices in Biomedical Engineering. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4425. [PMID: 37374608 DOI: 10.3390/ma16124425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
This paper presents a systematic review of a key sector of the much promising and rapidly evolving field of biomedical engineering, specifically on the fabrication of three-dimensional open, porous collagen-based medical devices, using the prominent freeze-drying process. Collagen and its derivatives are the most popular biopolymers in this field, as they constitute the main components of the extracellular matrix, and therefore exhibit desirable properties, such as biocompatibility and biodegradability, for in vivo applications. For this reason, freeze-dried collagen-based sponges with a wide variety of attributes can be produced and have already led to a wide range of successful commercial medical devices, chiefly for dental, orthopedic, hemostatic, and neuronal applications. However, collagen sponges display some vulnerabilities in other key properties, such as low mechanical strength and poor control of their internal architecture, and therefore many studies focus on the settlement of these defects, either by tampering with the steps of the freeze-drying process or by combining collagen with other additives. Furthermore, freeze drying is still considered a high-cost and time-consuming process that is often used in a non-optimized manner. By applying an interdisciplinary approach and combining advances in other technological fields, such as in statistical analysis, implementing the Design of Experiments, and Artificial Intelligence, the opportunity arises to further evolve this process in a sustainable and strategic manner, and optimize the resulting products as well as create new opportunities in this field.
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Affiliation(s)
- Chrysoula Katrilaka
- Department of Chemical Engineering, School of Engineering, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Niki Karipidou
- Department of Chemical Engineering, School of Engineering, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Nestor Petrou
- Department of Chemical Engineering, School of Engineering, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Chris Manglaris
- Department of Chemical Engineering, School of Engineering, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - George Katrilakas
- Department of Chemical Engineering, School of Engineering, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Anastasios Nektarios Tzavellas
- 3rd Department of Orthopedics, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Maria Pitou
- School of Chemistry, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Eleftherios E Tsiridis
- 3rd Department of Orthopedics, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | | | - Amalia Aggeli
- Department of Chemical Engineering, School of Engineering, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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Carter N, Towne J, Neivandt DJ. Finite Element Analysis of Glucose Diffusivity in Cellulose Nanofibril Peripheral Nerve Conduits. CELLULOSE (LONDON, ENGLAND) 2021; 28:2791-2803. [PMID: 35382433 PMCID: PMC8979350 DOI: 10.1007/s10570-021-03724-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/23/2021] [Indexed: 06/14/2023]
Abstract
Peripheral neuropathy arising from physical trauma is estimated to afflict 20 million people in the United States alone. In one common surgical intervention, neural conduits are placed over the nerve stumps to bridge the gap and create a microenvironment conducive to regeneration. It has been proposed that a biocompatible material such as cellulose nanofiber may serve as a viable conduit material, providing a non-inflammatory and mechanically stable system. Preliminary studies have shown that cellulose nanofiber conduits successfully aid neural regeneration and further, that the dimensions of the conduit relative to the nerve gap have an impact on efficacy in murine models. It has been hypothesized that the reliance of regeneration upon the physical dimensions of the conduit may be related to modified modes of diffusion and/or distances of key cellular nutrients and waste metabolites to/from the injury site. The present work investigates the concentration profile of glucose within the conduit via finite element analysis as a function of the physical dimensions of the conduit. It was determined that the magnitude of glucose diffusion was greater through the conduit walls than through the luminal space between the nerve and the inner wall of the conduit, and that as such radial diffusion is dominant over axial diffusion.
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Affiliation(s)
- Nicklaus Carter
- Department of Chemical and Biomedical Engineering, University of Maine
- Graduate School of Biomedical Science and Engineering, University of Maine
| | - Julia Towne
- Department of Chemical and Biomedical Engineering, University of Maine
| | - David J. Neivandt
- Department of Chemical and Biomedical Engineering, University of Maine
- Graduate School of Biomedical Science and Engineering, University of Maine
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Murphy R, Faroni A, Wong J, Reid A. Protocol for a phase I trial of a novel synthetic polymer nerve conduit 'Polynerve' in participants with sensory digital nerve injury (UMANC). F1000Res 2020; 8:959. [PMID: 32685131 PMCID: PMC7355221 DOI: 10.12688/f1000research.19497.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Peripheral nerve injuries are common, with approximately 9,000 cases in the UK annually. Young working individuals are predominantly affected, leading to significant health and social implications. Functional recovery is often poor with impaired hand sensation, reduced motor function and pain and cold intolerance. Where a nerve gap exists, nerve grafting remains the gold-standard treatment but creates a second surgical site, sensory deficit at the donor site, possible neuroma formation and has limited availability. Current commercially available synthetic and resorbable nerve conduit alternatives are reported to be rigid and inflexible. This study will set out to examine the first-in-man use of a new nerve conduit device ‘Polynerve’ to repair small nerve gaps in digital sensory nerves of the hand. Polynerve is a degradable co-polymer of poly-ε-caprolactone and poly-l-lactic acid, which is shaped as a cylinder that has greater tensile strength, flexibility and less acidic degradation compared with current commercially available synthetic nerve conduits. In addition, it has a novel micro-grooved internal lumen that aids Schwann cell ingress and alignment to improve nerve regeneration. Methods: In total, 17 eligible participants will be recruited to undergo repair of a transected sensory nerve of the hand using the Polynerve device. All participants that receive the nerve conduit device will be followed for a period of 12 months post-surgery. The primary endpoint is safety of the device and the secondary endpoint is degree of sensory nerve regeneration through the conduit assessed using standard sensory testing (2-PD, WEST monofilament testing and locognosia). Discussion: The ‘UMANC’ trial is a single-centre UK-based, prospective, unblinded, phase I clinical trial of a novel nerve conduit device. We aim to demonstrate the safety of Polynerve as a synthetic, biodegradable nerve conduit and improve the treatment options available to patients with significant nerve injuries. Registration: Clinicaltrials.gov:
NCT02970864; EudraCT: 2016-001667-37.
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Affiliation(s)
- Ralph Murphy
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK.,Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alessandro Faroni
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| | - Jason Wong
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK.,Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Adam Reid
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK.,Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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6
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Dixon AR, Jariwala SH, Bilis Z, Loverde JR, Pasquina PF, Alvarez LM. Bridging the gap in peripheral nerve repair with 3D printed and bioprinted conduits. Biomaterials 2018; 186:44-63. [DOI: 10.1016/j.biomaterials.2018.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 01/14/2023]
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7
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Singh D, Harding AJ, Albadawi E, Boissonade FM, Haycock JW, Claeyssens F. Additive manufactured biodegradable poly(glycerol sebacate methacrylate) nerve guidance conduits. Acta Biomater 2018; 78:48-63. [PMID: 30075322 DOI: 10.1016/j.actbio.2018.07.055] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/09/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
Entubulating devices to repair peripheral nerve injuries are limited in their effectiveness particularly for critical gap injuries. Current clinically used nerve guidance conduits are often simple tubes, far stiffer than that of the native tissue. This study assesses the use of poly(glycerol sebacate methacrylate) (PGSm), a photocurable formulation of the soft biodegradable material, PGS, for peripheral nerve repair. The material was synthesized, the degradation rate and mechanical properties of material were assessed and nerve guidance conduits were structured via stereolithography. In vitro cell studies confirmed PGSm as a supporting substrate for both neuronal and glial cell growth. Ex vivo studies highlight the ability of the cells from a dissociated dorsal root ganglion to grow out and align along the internal topographical grooves of printed nerve guide conduits. In vivo results in a mouse common fibular nerve injury model show regeneration of axons through the PGSm conduit into the distal stump after 21 days. After conduit repair levels of spinal cord glial activation (an indicator for neuropathic pain development) were equivalent to those seen following graft repair. In conclusion, results indicate that PGSm can be structured via additive manufacturing into functional NGCs. This study opens the route of personalized conduit manufacture for nerve injury repair. STATEMENT OF SIGNIFICANCE This study describes the use of photocurable of Poly(Glycerol Sebacate) (PGS) for light-based additive manufacturing of Nerve Guidance Conduits (NGCs). PGS is a promising flexible biomaterial for soft tissue engineering, and in particular for nerve repair. Its mechanical properties and degradation rate are within the desirable range for use in neuronal applications. The nerve regeneration supported by the PGS NGCs is similar to an autologous nerve transplant, the current gold standard. A second assessment of regeneration is the activation of glial cells within the spinal cord of the tested animals which reveals no significant increase in neuropathic pain by using the NGCs. This study highlights the successful use of a biodegradable additive manufactured NGC for peripheral nerve repair.
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Affiliation(s)
- Dharaminder Singh
- Department of Materials Science and Engineering, Broad Lane, Sheffield S3 7HQ, United Kingdom
| | - Adam J Harding
- School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TN, United Kingdom
| | - Emad Albadawi
- School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TN, United Kingdom; Department of Anatomy, Faculty of Medicine, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Fiona M Boissonade
- School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TN, United Kingdom.
| | - John W Haycock
- Department of Materials Science and Engineering, Broad Lane, Sheffield S3 7HQ, United Kingdom.
| | - Frederik Claeyssens
- Department of Materials Science and Engineering, Broad Lane, Sheffield S3 7HQ, United Kingdom.
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Riccio M, Marchesini A, Pugliese P, Francesco F. Nerve repair and regeneration: Biological tubulization limits and future perspectives. J Cell Physiol 2018; 234:3362-3375. [DOI: 10.1002/jcp.27299] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| | - Andrea Marchesini
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| | - Pierfrancesco Pugliese
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| | - Francesco Francesco
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
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Chrząszcz P, Derbisz K, Suszyński K, Miodoński J, Trybulski R, Lewin-Kowalik J, Marcol W. Application of peripheral nerve conduits in clinical practice: A literature review. Neurol Neurochir Pol 2018; 52:427-435. [PMID: 30025722 DOI: 10.1016/j.pjnns.2018.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/03/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022]
Abstract
Understanding the pathomechanisms behind peripheral nerve damage and learning the course of regeneration seem to be crucial for selecting the appropriate methods of treatment. Autografts are currently the gold standard procedure in nerve reconstruction. However, due to the frequency of complications resulting from autografting and a desire to create a better environment for the regeneration of the damaged nerve, artificial conduits have become an approved alternative treatment method. The aim of this mini-review is to present the nerve scaffolds that have been applied in clinical practice to date, and the potential directions of developments in nerve conduit bioengineering. Articles regarding construction and characterization of nerve conduits were used as the theoretical background. All papers, available in PubMed database since 2000, presenting results of application of artificial nerve conduits in clinical trials were included into this mini-review. Fourteen studies including ≤10 patients and 10 trials conducted on >10 patients were analyzed as well as 24 papers focused on artificial nerve conduits per se. Taking into consideration the experiences of the authors investigating nerve conduits in clinical trials, it is essential to point out the emergence of bioresorbable scaffolds, which in the future may significantly change the treatment of peripheral nerve injuries. Also worth mentioning among the advanced conduits are hybrid conduits, which combine several modifications of a synthetic material to provide the optimal regeneration of a damaged nerve.
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Affiliation(s)
- Patrycja Chrząszcz
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 4, 40752 Katowice, Poland
| | - Kamil Derbisz
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 4, 40752 Katowice, Poland
| | - Krzysztof Suszyński
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 4, 40752 Katowice, Poland
| | - Jan Miodoński
- Department of Neurosurgery, Provincial Specialist Hospital No. 2 in Jastrzębie - Zdrój, al. Jana Pawła II 7, 44300 Jastrzębie - Zdrój, Poland
| | - Robert Trybulski
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 4, 40752 Katowice, Poland
| | - Joanna Lewin-Kowalik
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 4, 40752 Katowice, Poland
| | - Wiesław Marcol
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 4, 40752 Katowice, Poland; Department of Neurosurgery, Provincial Specialist Hospital No. 2 in Jastrzębie - Zdrój, al. Jana Pawła II 7, 44300 Jastrzębie - Zdrój, Poland.
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Efficacy and safety of novel collagen conduits filled with collagen filaments to treat patients with peripheral nerve injury: A multicenter, controlled, open-label clinical trial. Injury 2018; 49:766-774. [PMID: 29566987 DOI: 10.1016/j.injury.2018.03.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The safety and efficacy of using artificial collagen nerve conduits filled with collagen filaments to treat nerve defects has not been fully studied in humans. We conducted a multicenter, controlled, open-label study to compare the safety and efficacy of artificial nerve conduit grafts with those of autologous nerve grafts. METHODS We included patients with a sensory nerve defect of ≤30 mm, at the level of the wrist or a more distal location, with the first-line surgical methods selected according to a patient's preference. We compared sensory recovery using static two-point discrimination and adverse events between the artificial collagen nerve conduit and autologous nerve grafting. RESULTS The artificial nerve conduit group included 49 patients, with a mean age of 42 years and nerve defect of 12.6 mm. The autologous nerve graft group included 7 patients, with historical data of an additional 31 patients, with a mean age of 36 years and nerve defect of 18.7 mm. The rate of recovery of sensory function at 12 months was 75% (36/49) for the artificial nerve conduit group and 73.7% (28/38) in the autologous nerve group. No serious adverse events directly associated with use of the artificial nerve conduit were identified. CONCLUSIONS The treatment of nerve defects ≤30 mm using artificial collagen nerve conduits was not inferior to treatment using autologous nerve grafts. Based on our data, the new artificial collagen nerve conduit can provide an alternative to autologous nerve for the treatment of peripheral nerve defects.
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Golafshan N, Kharaziha M, Fathi M, Larson B, Giatsidis G, Masoumi N. Anisotropic architecture and electrical stimulation enhance neuron cell behaviour on a tough graphene embedded PVA: alginate fibrous scaffold. RSC Adv 2018; 8:6381-6389. [PMID: 35540432 PMCID: PMC9078254 DOI: 10.1039/c7ra13136d] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open
Abstract
Tough scaffolds comprised of aligned and conductive fibers are promising for peripheral nerve regeneration due to their unique mechanical and electrical properties. Several studies have confirmed that electrical stimulation can control the axonal extension in vitro. However, the stimulatory effects of scaffold architecture and electrical stimulation have not yet been investigated in detail. Here, we assessed a comparison between aligned and random fibers made of graphene (Gr) embedded sodium alginate (SA) polyvinyl alcohol (PVA) (Gr-AP scaffolds) for peripheral nerve engineering. The effects of applied electrical stimulation and orientation of the fabricated fibers on the in vitro attachment, alignment, and proliferation of PC12 cells (a rat neuronal cell line) were investigated. The results revealed that the aligned fibrous Gr-AP scaffolds closely mimicked the anisotropic structure of the native sciatic nerve. Aligned fibrous Gr-AP scaffolds significantly improved mechanical properties as well as cell-scaffold integration compared to random fibrous scaffolds. In addition, electrical stimulation significantly improved PC12 cell proliferation. In summary, our findings revealed that aligned fibrous Gr-AP scaffolds offered superior mechanical characteristics and structural properties that enhanced neural cell–substrate interactions, resulting in a promising construct for nerve tissue regeneration. Tough scaffolds comprised of aligned and conductive fibers are promising for peripheral nerve regeneration due to their unique mechanical and electrical properties.![]()
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Affiliation(s)
- Nasim Golafshan
- Department of Materials Engineering
- Isfahan University of Technology
- Isfahan 84156-83111
- Iran,
| | - Mahshid Kharaziha
- Department of Materials Engineering
- Isfahan University of Technology
- Isfahan 84156-83111
- Iran,
| | - Mohammadhossein Fathi
- Department of Materials Engineering
- Isfahan University of Technology
- Isfahan 84156-83111
- Iran,
| | - Benjamin L. Larson
- Harvard-MIT Division of Health Sciences and Technology
- Koch Institute for Integrative Cancer Research
- Massachusetts Institute of Technology
- Cambridge
- USA
| | - Giorgio Giatsidis
- Department of Surgery
- Brigham and Women Hospital
- Harvard Medical School
- Boston
- USA
| | - Nafiseh Masoumi
- Harvard-MIT Division of Health Sciences and Technology
- Koch Institute for Integrative Cancer Research
- Massachusetts Institute of Technology
- Cambridge
- USA
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Bamba R, Riley DC, Kelm ND, Cardwell N, Pollins AC, Afshari A, Nguyen L, Dortch RD, Thayer WP. A novel conduit-based coaptation device for primary nerve repair. Int J Neurosci 2017; 128:563-569. [PMID: 29098916 DOI: 10.1080/00207454.2017.1398157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Conduit-based nerve repairs are commonly used for small nerve gaps, whereas primary repair may be performed if there is no tension on nerve endings. We hypothesize that a conduit-based nerve coaptation device will improve nerve repair outcomes by avoiding sutures at the nerve repair site and utilizing the advantages of a conduit-based repair. METHODS The left sciatic nerves of female Sprague-Dawley rats were transected and repaired using a novel conduit-based device. The conduit-based device group was compared to a control group of rats that underwent a standard end-to-end microsurgical repair of the sciatic nerve. Animals underwent behavioral assessments at weekly intervals post-operatively using the sciatic functional index (SFI) test. Animals were sacrificed at four weeks to obtain motor axon counts from immunohistochemistry. A sub-group of animals were sacrificed immediately post repair to obtain MRI images. RESULTS SFI scores were superior in rats which received conduit-based repairs compared to the control group. Motor axon counts distal to the injury in the device group at four weeks were statistically superior to the control group. MRI tractography was used to demonstrate repair of two nerves using the novel conduit device. CONCLUSIONS A conduit-based nerve coaptation device avoids sutures at the nerve repair site and leads to improved outcomes in a rat model. Conduit-based nerve repair devices have the potential to standardize nerve repairs while improving outcomes.
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Affiliation(s)
- Ravinder Bamba
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA.,b Department of Surgery , Georgetown University , Washington , DC , USA
| | - D Colton Riley
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA.,c Department of Surgery , Georgetown University, School of Medicine , Washington , DC , USA
| | - Nathaniel D Kelm
- d Department of Radiology and Radiological Sciences , Vanderbilt University , Nashville , TN , USA
| | - Nancy Cardwell
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Alonda C Pollins
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Ashkan Afshari
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA.,e Department of Surgery , Palmetto Health , Columbia , SC , USA
| | - Lyly Nguyen
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA.,f Department of Surgery , Morristown Medical Center , Morristown , NJ , USA
| | - Richard D Dortch
- d Department of Radiology and Radiological Sciences , Vanderbilt University , Nashville , TN , USA
| | - Wesley P Thayer
- a Department of Plastic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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Abstract
Injuries to the peripheral nervous system are major sources of disability and often result in painful neuropathies or the impairment of muscle movement and/or normal sensations. For gaps smaller than 10 mm in rodents, nearly normal functional recovery can be achieved; for longer gaps, however, there are challenges that have remained insurmountable. The current clinical gold standard used to bridge long, nonhealing nerve gaps, the autologous nerve graft (autograft), has several drawbacks. Despite best efforts, engineering an alternative "nerve bridge" for peripheral nerve repair remains elusive; hence, there is a compelling need to design new approaches that match or exceed the performance of autografts across critically sized nerve gaps. Here an immunomodulatory approach to stimulating nerve repair in a nerve-guidance scaffold was used to explore the regenerative effect of reparative monocyte recruitment. Early modulation of the immune environment at the injury site via fractalkine delivery resulted in a dramatic increase in regeneration as evident from histological and electrophysiological analyses. This study suggests that biasing the infiltrating inflammatory/immune cellular milieu after injury toward a proregenerative population creates a permissive environment for repair. This approach is a shift from the current modes of clinical and laboratory methods for nerve repair, which potentially opens an alternative paradigm to stimulate endogenous peripheral nerve repair.
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Adams AM, VanDusen KW, Kostrominova TY, Mertens JP, Larkin LM. Scaffoldless tissue-engineered nerve conduit promotes peripheral nerve regeneration and functional recovery after tibial nerve injury in rats. Neural Regen Res 2017; 12:1529-1537. [PMID: 29090000 PMCID: PMC5649475 DOI: 10.4103/1673-5374.215265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Damage to peripheral nerve tissue may cause loss of function in both the nerve and the targeted muscles it innervates. This study compared the repair capability of engineered nerve conduit (ENC), engineered fibroblast conduit (EFC), and autograft in a 10-mm tibial nerve gap. ENCs were fabricated utilizing primary fibroblasts and the nerve cells of rats on embryonic day 15 (E15). EFCs were fabricated utilizing primary fibroblasts only. Following a 12-week recovery, nerve repair was assessed by measuring contractile properties in the medial gastrocnemius muscle, distal motor nerve conduction velocity in the lateral gastrocnemius, and histology of muscle and nerve. The autografts, ENCs and EFCs reestablished 96%, 87% and 84% of native distal motor nerve conduction velocity in the lateral gastrocnemius, 100%, 44% and 44% of native specific force of medical gastrocnemius, and 63%, 61% and 67% of native medial gastrocnemius mass, respectively. Histology of the repaired nerve revealed large axons in the autograft, larger but fewer axons in the ENC repair, and many smaller axons in the EFC repair. Muscle histology revealed similar muscle fiber cross-sectional areas among autograft, ENC and EFC repairs. In conclusion, both ENCs and EFCs promoted nerve regeneration in a 10-mm tibial nerve gap repair, suggesting that the E15 rat nerve cells may not be necessary for nerve regeneration, and EFC alone can suffice for peripheral nerve injury repair.
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Affiliation(s)
- Aaron M Adams
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Keith W VanDusen
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Tatiana Y Kostrominova
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Northwest, Gary, IN, USA
| | - Jacob P Mertens
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Lisa M Larkin
- Department of Molecular and Integrated Physiology, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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15
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Mohammadi J, Delaviz H, Mohammadi B, Delaviz H, Rad P. Comparison of repair of peripheral nerve transection in predegenerated muscle with and without a vein graft. BMC Neurol 2016; 16:237. [PMID: 27876000 PMCID: PMC5120544 DOI: 10.1186/s12883-016-0768-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite substantial research into the topic and valiant surgical efforts, reconstruction of peripheral nerve injury remains a challenging surgery. This study was conducted to evaluate the effectiveness of axonal regeneration of a transected sciatic nerve through a vein conduit containing degenerated skeletal muscle compared with axonal regeneration in a transected sciatic nerve through degenerated skeletal muscle alone. METHODS In two of the three experimental rat groups, 10 mm of the left sciatic nerve was transected and removed. The proximal and distal ends of the transected sciatic nerve were then approximated and surrounded with either (a) a degenerated skeletal muscle graft; or (b) a graft containing both degenerated skeletal muscle and vein. In the group receiving the combined vein and skeletal muscle graft, the vein walls were subsequently sutured to the proximal and distal nerve stump epineurium. Sciatic functional index (SFI) was used for assessment of functional recovery. Tracing study and histological procedures were used to assess axonal regeneration. RESULTS At 60 days, the gait functional recovery as well as the mean number of myelinated axons in the middle and distal parts of the sciatic nerve significantly increased in the group with the vein graft compared to rats with only the muscular graft (P < 0.05). Mean diameter of myelinated nerve fiber of the distal sciatic nerve was also improved with the vein graft compared to the muscle graft alone (P < 0.05). The mean number of DiI-labeled motor neurons in the L4-L5 spinal segment increased in the vein with muscle group but was not significantly different between the two groups. CONCLUSIONS These findings demonstrated that a graft consisting of not only predegenerated muscle, but also predegenerated muscle with vein more effectively supported nerve regeneration, thus promoting functional recovery after sciatic nerve injury in rats.
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Affiliation(s)
- Jamshid Mohammadi
- Medicinal Plants Research Centre, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hamdollah Delaviz
- Cellular and Molecular Research Center, Faculty of Medicine, Yasuj University of Medical Sciences, P.o.Box: 7591994799, Yasuj, Iran.
| | - Bahram Mohammadi
- Department of Pediatrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hamoun Delaviz
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Parastou Rad
- Department of Midwifery, Yasuj University of Medical, Yasuj, Iran
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16
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Muheremu A, Sun JG, Wang XY, Zhang F, Ao Q, Peng J. Combined use of Y-tube conduits with human umbilical cord stem cells for repairing nerve bifurcation defects. Neural Regen Res 2016; 11:664-9. [PMID: 27212932 PMCID: PMC4870928 DOI: 10.4103/1673-5374.180755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Given the anatomic complexity at the bifurcation point of a nerve trunk, enforced suturing between stumps can lead to misdirection of nerve axons, thereby resulting in adverse consequences. We assumed that Y-tube conduits injected with human umbilical cord stem cells could be an effective method to solve such problems, but studies focused on the best type of Y-tube conduit remain controversial. Therefore, the present study evaluated the applicability and efficacy of various types of Y-tube conduits containing human umbilical cord stem cells for treating rat femoral nerve defects on their bifurcation points. At 12 weeks after the bridging surgery that included treatment with different types of Y-tube conduits, there were no differences in quadriceps femoris muscle weight or femoral nerve ultrastructure. However, the Y-tube conduit group with longer branches and a short trunk resulted in a better outcome according to retrograde labeling and electrophysiological analysis. It can be concluded from the study that repairing a mixed nerve defect at its bifurcation point with Y-tube conduits, in particular those with long branches and a short trunk, is effective and results in good outcomes.
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Affiliation(s)
- Aikeremujiang Muheremu
- Medical Center, Tsinghua University, Beijing, China; Department of Tissue Engineering, China Medical University, Shenyang, Liaoning Province, China; Department of Orthopedics, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jun-Gang Sun
- Department of Orthopedics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xi-Yuan Wang
- Department of Tissue Engineering, China Medical University, Shenyang, Liaoning Province, China
| | - Fei Zhang
- Department of Orthopedics, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Qiang Ao
- Department of Tissue Engineering, China Medical University, Shenyang, Liaoning Province, China
| | - Jiang Peng
- Institute of Orthopaedics, General Hospital of PLA, Beijing, China
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17
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Liu F, Lin H, Zhang C. Construction of Tissue-Engineered Nerve Conduits Seeded with Neurons Derived from Hair-Follicle Neural Crest Stem Cells. Methods Mol Biol 2016; 1453:33-38. [PMID: 27431244 DOI: 10.1007/978-1-4939-3786-8_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Tissue-engineered nerve conduits are widely used for the study of peripheral nerve injury repair. With regard to repairing long nerve defects, stem-cell-derived neurons are recommended as seed cells. As hair-follicle neural crest stem cells (hfNCSCs) are easily to be harvested from patients and have the potential to differentiate into neuronal cells, hfNCSCs-derived neurons are an ideal candidate choice. Acellular nerve grafts, a type of biological material scaffold, with intact collagen structure, with biocompatibility and less toxicity are obtained through removing live cells with 1 % lysolecithin, are also an ideal choice. In the present report, we describe a tissue-engineered nerve conduit seeded with rat hfNCSCs-derived neurons into the beagle acellular sciatic nerve scaffold. Our goal is to provide a novel engineered therapeutic for repairing peripheral nerve injury with long distance defects.
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Affiliation(s)
- Fang Liu
- Department of Anatomy, Institute of Biomedical Engineering, Second Military Medical University, Shanghai, People's Republic of China.
- AntiCancer, Inc., San Diego, CA, USA.
| | - Haiyan Lin
- Department of Anatomy, Institute of Biomedical Engineering, Second Military Medical University, Shanghai, People's Republic of China
| | - Chuansen Zhang
- Department of Anatomy, Institute of Biomedical Engineering, Second Military Medical University, Shanghai, People's Republic of China.
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18
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Past, Present, and Future of Nerve Conduits in the Treatment of Peripheral Nerve Injury. BIOMED RESEARCH INTERNATIONAL 2015; 2015:237507. [PMID: 26491662 PMCID: PMC4600484 DOI: 10.1155/2015/237507] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/12/2015] [Accepted: 05/19/2015] [Indexed: 01/03/2023]
Abstract
With significant advances in the research and application of nerve conduits, they have been used to repair peripheral nerve injury for several decades. Nerve conduits range from biological tubes to synthetic tubes, and from nondegradable tubes to biodegradable tubes. Researchers have explored hollow tubes, tubes filled with scaffolds containing neurotrophic factors, and those seeded with Schwann cells or stem cells. The therapeutic effect of nerve conduits is improving with increasing choice of conduit material, new construction of conduits, and the inclusion of neurotrophic factors and support cells in the conduits. Improvements in functional outcomes are expected when these are optimized for use in clinical practice.
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19
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Sahin C, Karagoz H, Kulahci Y, Sever C, Akakin D, Kolbasi B, Ulkur E, Peker F. Minced nerve tissue in vein grafts used as conduits in rat tibial nerves. Ann Plast Surg 2015; 73:540-6. [PMID: 24691343 DOI: 10.1097/sap.0000000000000060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Peripheral nerve injuries are encountered frequently in clinical practice. In nerve repair, an end-to-end suture is the preferable choice of treatment. However, where primary closure is not possible, the defect is to be repaired with a nerve graft. METHODS A total of 21 female Wistar rats weighing 230 to 290 g were used in the study. They were classified into the following 3 groups: (I) nerve graft, (II) vein graft, and (III) minced nerve graft. In group I, after exposure of the tibial nerve, a 1-cm-long nerve gap was created on the tibial nerve, and the defect was repaired epineurally by using the autogenous nerve. In group II, the 1-cm tibial nerve defect was repaired by using an autogenous vein graft. In group III, a 1-cm nerve graft was divided to 3 equal parts, with one of the nerve parts being minced with microscissors and placed in the vein graft lumen. Thereafter, a 1-cm tibial nerve defect was repaired by the vein graft filled with minced nerve tissue. The tibial function indices (TFIs) were calculated for functional assessment using the Bain-Mackinnon-Hunter formula. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated fibers were counted in all groups. RESULTS The TFIs of group II were found to be the lowest among all the groups after the sixth week, whereas the TFI of group I was found to be better than the other groups after the sixth week. There was no difference in TFIs between group I and group III. On the basis of the number of myelinated fibers, there was no statistically significant difference between group I and group III, whereas the difference was significant (P<0.05) between groups I/III and group II. Presence of peripheral nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in all groups. The myelinated axon profile was near normal in the nerve graft group in electron microscopic evaluation. However, there were more degenerated axons with disturbed contours and vacuolizations in the vein graft group compared to the minced nerve graft group. CONCLUSIONS We can conclude that using minced nerve tissue in vein grafts as a conduit increases the regeneration of nerves (almost like the nerve graft group) and it may not be caused by donor-site morbidity. It can be used in the repair of nerve defects instead of autogenous nerve grafts after further experimental evidence and clinical trials.
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Affiliation(s)
- Cihan Sahin
- From the *Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul; †Department of Hand and Upper Extremity Surgery, Gulhane Military Medical Academy, Ankara; ‡Department of Histology and Embryology, Marmara University, Medical School; and §F&P Plastic Reconstructive and Aesthetic Surgery Center, Istanbul, Turkey
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20
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Gerth DJ, Tashiro J, Thaller SR. Clinical outcomes for Conduits and Scaffolds in peripheral nerve repair. World J Clin Cases 2015; 3:141-147. [PMID: 25685760 PMCID: PMC4317607 DOI: 10.12998/wjcc.v3.i2.141] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/05/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
The gold standard of peripheral nerve repair is nerve autograft when tensionless repair is not possible. Use of nerve autograft has several shortcomings, however. These include limited availability of donor tissue, sacrifice of a functional nerve, and possible neuroma formation. In order to address these deficiencies, researchers have developed a variety of biomaterials available for repair of peripheral nerve gaps. We review the clinical studies published in the English literature detailing outcomes and reconstructive options. Regardless of the material used or the type of nerve repaired, outcomes are generally similar to nerve autograft in gaps less than 3 cm. New biomaterials currently under preclinical evaluation may provide improvements in outcomes.
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21
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Moore AM, Wagner IJ, Fox IK. Principles of nerve repair in complex wounds of the upper extremity. Semin Plast Surg 2015; 29:40-7. [PMID: 25685102 DOI: 10.1055/s-0035-1544169] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Peripheral nerve injuries are common in the setting of complex upper extremity trauma. Early identification of nerve injuries and intervention is critical for maximizing return of function. In this review, the principles of nerve injury, patient evaluation, and surgical management are discussed. An evidence-based approach to nerve reconstruction is reviewed, including the benefits and limitations of direct repair and nerve gap reconstruction with the use of autografts, processed nerve allografts, and conduits. Further, the principles and indications of commonly used nerve transfers in proximal nerve injuries are also addressed.
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Affiliation(s)
- Amy M Moore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - I Janelle Wagner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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22
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Liang X, Cai H, Hao Y, Sun G, Song Y, Chen W. Sciatic nerve repair using adhesive bonding and a modified conduit. Neural Regen Res 2014; 9:594-601. [PMID: 25206861 PMCID: PMC4146232 DOI: 10.4103/1673-5374.130099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/05/2022] Open
Abstract
When repairing nerves with adhesives, most researchers place glue directly on the nerve stumps, but this method does not fix the nerve ends well and allows glue to easily invade the nerve ends. In this study, we established a rat model of completely transected sciatic nerve injury and repaired it using a modified 1 cm-length conduit with inner diameter of 1.5 mm. Each end of the cylindrical conduit contains a short linear channel, while the enclosed central tube protects the nerve ends well. Nerves were repaired with 2-octyl-cyanoacrylate and suture, which complement the function of the modified conduit. The results demonstrated that for the same conduit, the average operation time using the adhesive method was much shorter than with the suture method. No significant differences were found between the two groups in sciatic function index, motor evoked potential latency, motor evoked potential amplitude, muscular recovery rate, number of medullated nerve fibers, axon diameter, or medullary sheath thickness. Thus, the adhesive method for repairing nerves using a modified conduit is feasible and effective, and reduces the operation time while providing an equivalent repair effect.
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Affiliation(s)
- Xiangdang Liang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China
| | - Hongfei Cai
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China
| | - Yongyu Hao
- Wei Zikeng Clinic of General Armament Department of Chinese PLA, Beijing, China
| | - Geng Sun
- Department of Orthopedics, 252 Hospital of Chinese PLA, Hebei Province, China
| | - Yaoyao Song
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China
| | - Wen Chen
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China
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23
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Sensory recovery after primary repair of palmar digital nerves using a Revolnerv® collagen conduit: A prospective series of 27 cases. ACTA ACUST UNITED AC 2014; 33:279-85. [DOI: 10.1016/j.main.2014.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/18/2014] [Accepted: 05/19/2014] [Indexed: 11/19/2022]
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24
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Abstract
Autologous nerve grafts are the current criterion standard for repair of peripheral nerve injuries when the transected nerve ends are not amenable to primary end-to-end tensionless neurorrhaphy. However, donor-site morbidities such as neuroma formation and permanent loss of function have led to tremendous interest in developing an alternative to this technique. Artificial nerve conduits have therefore emerged as an alternative to autologous nerve grafting for the repair of short peripheral nerve defects of less than 30 mm; however, they do not yet surpass autologous nerve grafts clinically. A thorough understanding of the complex biological reactions that take place during peripheral nerve regeneration will allow researchers to develop a nerve conduit with physical and biological properties similar to those of an autologous nerve graft that supports regeneration over long nerve gaps and in large-diameter nerves. In this article, the authors assess the currently available nerve conduits, summarize research in the field of developing these conduits, and establish areas within this field in which further research would prove most beneficial.
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25
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Gu X, Ding F, Williams DF. Neural tissue engineering options for peripheral nerve regeneration. Biomaterials 2014; 35:6143-56. [PMID: 24818883 DOI: 10.1016/j.biomaterials.2014.04.064] [Citation(s) in RCA: 406] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/16/2014] [Indexed: 12/19/2022]
Abstract
Tissue engineered nerve grafts (TENGs) have emerged as a potential alternative to autologous nerve grafts, the gold standard for peripheral nerve repair. Typically, TENGs are composed of a biomaterial-based template that incorporates biochemical cues. A number of TENGs have been used experimentally to bridge long peripheral nerve gaps in various animal models, where the desired outcome is nerve tissue regeneration and functional recovery. So far, the translation of TENGs to the clinic for use in humans has met with a certain degree of success. In order to optimize the TENG design and further approach the matching of TENGs with autologous nerve grafts, many new cues, beyond the traditional ones, will have to be integrated into TENGs. Furthermore, there is a strong requirement for monitoring the real-time dynamic information related to the construction of TENGs. The aim of this opinion paper is to specifically and critically describe the latest advances in the field of neural tissue engineering for peripheral nerve regeneration. Here we delineate new attempts in the design of template (or scaffold) materials, especially in the context of biocompatibility, the choice and handling of support cells, and growth factor release systems. We further discuss the significance of RNAi for peripheral nerve regeneration, anticipate the potential application of RNAi reagents for TENGs, and speculate on the possible contributions of additional elements, including angiogenesis, electrical stimulation, molecular inflammatory mediators, bioactive peptides, antioxidant reagents, and cultured biological constructs, to TENGs. Finally, we consider that a diverse array of physicochemical and biological cues must be orchestrated within a TENG to create a self-consistent coordinated system with a close proximity to the regenerative microenvironment of the peripheral nervous system.
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Affiliation(s)
- Xiaosong Gu
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China.
| | - Fei Ding
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China
| | - David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, NC, USA.
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Carriel V, Alaminos M, Garzón I, Campos A, Cornelissen M. Tissue engineering of the peripheral nervous system. Expert Rev Neurother 2014; 14:301-18. [DOI: 10.1586/14737175.2014.887444] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Pace LA, Plate JF, Mannava S, Barnwell JC, Koman LA, Li Z, Smith TL, Van Dyke M. A human hair keratin hydrogel scaffold enhances median nerve regeneration in nonhuman primates: an electrophysiological and histological study. Tissue Eng Part A 2013; 20:507-17. [PMID: 24083825 DOI: 10.1089/ten.tea.2013.0084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A human hair keratin biomaterial hydrogel scaffold was evaluated as a nerve conduit luminal filler following median nerve transection injury in 10 Macaca fascicularis nonhuman primates (NHP). A 1 cm nerve gap was grafted with a NeuraGen® collagen conduit filled with either saline or keratin hydrogel and nerve regeneration was evaluated by electrophysiology for a period of 12 months. The keratin hydrogel-grafted nerves showed significant improvement in return of compound motor action potential (CMAP) latency and recovery of baseline nerve conduction velocity (NCV) compared with the saline-treated nerves. Histological evaluation was performed on retrieved median nerves and abductor pollicis brevis (APB) muscles at 12 months. Nerve histomorphometry showed a significantly larger nerve area in the keratin group compared with the saline group and the keratin APB muscles had a significantly higher myofiber density than the saline group. This is the first published study to show that an acellular biomaterial hydrogel conduit filler can be used to enhance peripheral nerve regeneration and motor recovery in an NHP model.
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Affiliation(s)
- Lauren A Pace
- 1 Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine , Winston-Salem, North Carolina
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28
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Meek MF, Coert JH. Recovery of two-point discrimination function after digital nerve repair in the hand using resorbable FDA- and CE-approved nerve conduits. J Plast Reconstr Aesthet Surg 2013; 66:1307-15. [DOI: 10.1016/j.bjps.2013.04.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 11/25/2022]
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Abstract
The theory of chemotaxis has been widely accepted, but its mechanisms are disputed. Chemotactic growth of peripheral nerves may be tissue, topographic and end-organ specific. Recent studies indicated that peripheral nerve regeneration lacks topographic specificity, but whether it has end-organ specificity is disputed. Chemotaxis in nerve regeneration is affected by the distance between stumps, volume, and neurotrophic support, as well as the structure of distal nerve stumps. It can be applied to achieve precise repair of nerves and complete recovery of end organ function. Small gap sleeve bridging technique, which is based on this theory shows promising effects but it is still challenging to find the perfect combination of nerve conduits, cells and neurotrophic factors to put it intoits best use. In this paper, we made a comprehensive review of mechanisms, effect factors and applications of chemotaxis.
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30
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Perán M, García MA, Lopez-Ruiz E, Jiménez G, Marchal JA. How Can Nanotechnology Help to Repair the Body? Advances in Cardiac, Skin, Bone, Cartilage and Nerve Tissue Regeneration. MATERIALS 2013; 6:1333-1359. [PMID: 28809213 PMCID: PMC5452318 DOI: 10.3390/ma6041333] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 12/15/2022]
Abstract
Nanotechnologists have become involved in regenerative medicine via creation of biomaterials and nanostructures with potential clinical implications. Their aim is to develop systems that can mimic, reinforce or even create in vivo tissue repair strategies. In fact, in the last decade, important advances in the field of tissue engineering, cell therapy and cell delivery have already been achieved. In this review, we will delve into the latest research advances and discuss whether cell and/or tissue repair devices are a possibility. Focusing on the application of nanotechnology in tissue engineering research, this review highlights recent advances in the application of nano-engineered scaffolds designed to replace or restore the followed tissues: (i) skin; (ii) cartilage; (iii) bone; (iv) nerve; and (v) cardiac.
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Affiliation(s)
- Macarena Perán
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, S/N, Jaén 23071, Spain.
| | - María Angel García
- Research Unit, University Hospital "Virgen de las Nieves", Avda. de las Fuerzas Armadas, 2, Granada 18014, Spain.
| | - Elena Lopez-Ruiz
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas, S/N, Jaén 23071, Spain.
| | - Gema Jiménez
- Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, Avda. del Conocimiento S/N. CP Armilla, Granada 18100, Spain.
| | - Juan Antonio Marchal
- Biopathology and Regenerative Medicine Institute (IBIMER), University of Granada, Avda. del Conocimiento S/N. CP Armilla, Granada 18100, Spain.
- Department of Human Anatomy and Embryology, University of Granada, Avda. De Madrid, 11, Granada 18012, Spain.
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Wolfe SW, Strauss HL, Garg R, Feinberg J. Use of bioabsorbable nerve conduits as an adjunct to brachial plexus neurorrhaphy. J Hand Surg Am 2012; 37:1980-5. [PMID: 23021171 DOI: 10.1016/j.jhsa.2012.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 07/14/2012] [Accepted: 07/17/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The use of bioabsorbable conduits in digital nerve repair has demonstrated increased efficacy compared to direct repair (for gaps ≤ 4mm) and nerve grafting (for gaps ≥ 8 mm) for sensory recovery in a level 1 human trial. Although nonhuman primate studies on mixed motor-sensory nerves have documented comparable efficacy of the bioabsorbable nerve conduits when compared to nerve repair or grafting, there is minimal human clinical data on motor recovery following bioabsorbable nerve conduit repair. This study investigates the outcomes of bioabsorbable nerve conduits in pure motor nerve reconstruction for adult traumatic brachial plexus injuries. METHODS Over a 3-year period, 21 adult patients had 1 or more nerve-to-nerve transfers for traumatic brachial plexus palsy performed using the operative microscope. Ten nerve transfers were performed by advancing the nerve ends into a semi-permeable type I collagen conduit stabilized with 8-0 nylon sutures (conduit-assisted neurorrhaphy). Twenty-eight concurrent nerve transfers were performed using standard end-to-end neurorrhaphy and 8-0 or 9-0 nylon sutures. Clinical evaluation using the Medical Research Council grading system (MRC) was performed at 1 and 2 years postoperatively. Postoperative electromyographic studies were performed in 28 of 38 transfers at final follow-up. RESULTS Thirty transfers (17 patients) were available for 2-year follow-up evaluation. All 10 transfers performed with nerve conduits demonstrated clinical recovery and electromyographic reinnervation at 2 years. Eighteen of 20 transfers performed without conduits demonstrated clinical recovery. CONCLUSIONS Although no statistical difference in functional recovery was seen in nerve transfers performed with collagen nerve conduits or by traditional neurorrhaphy, this pilot series demonstrated clinical and electromyographic recovery in 10 of 10 motor nerve repairs performed using conduits. These findings warrant continued investigation into the efficacy of conduit-assisted repair for motor nerves, especially in regards to operative time, precision of repair, and speed of nerve recovery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Scott W Wolfe
- Hospital for Special Surgery, and Weill Medical College of Cornell University, New York, USA.
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Use of adipose-derived stem cells to fabricate scaffoldless tissue-engineered neural conduits in vitro: Neuroscience: Vol. 201, pp. 349-356, 2012. Ann Neurosci 2012; 19:169. [PMID: 25205993 PMCID: PMC4117062 DOI: 10.5214/ans.0972.7531.190407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Saracino GAA, Cigognini D, Silva D, Caprini A, Gelain F. Nanomaterials design and tests for neural tissue engineering. Chem Soc Rev 2012; 42:225-62. [PMID: 22990473 DOI: 10.1039/c2cs35065c] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nanostructured scaffolds recently showed great promise in tissue engineering: nanomaterials can be tailored at the molecular level and scaffold morphology may more closely resemble features of extracellular matrix components in terms of porosity, framing and biofunctionalities. As a consequence, both biomechanical properties of scaffold microenvironments and biomaterial-protein interactions can be tuned, allowing for improved transplanted cell engraftment and better controlled diffusion of drugs. Easier said than done, a nanotech-based regenerative approach encompasses different fields of know-how, ranging from in silico simulations, nanomaterial synthesis and characterization at the nano-, micro- and mesoscales to random library screening methods (e.g. phage display), in vitro cellular-based experiments and validation in animal models of the target injury. All of these steps of the "assembly line" of nanostructured scaffolds are tightly interconnected both in their standard analysis techniques and in their most recent breakthroughs: indeed their efforts have to jointly provide the deepest possible analyses of the diverse facets of the challenging field of neural tissue engineering. The purpose of this review is therefore to provide a critical overview of the recent advances in and drawbacks and potential of each mentioned field, contributing to the realization of effective nanotech-based therapies for the regeneration of peripheral nerve transections, spinal cord injuries and brain traumatic injuries. Far from being the ultimate overview of such a number of topics, the reader will acknowledge the intrinsic complexity of the goal of nanotech tissue engineering for a conscious approach to the development of a regenerative therapy and, by deciphering the thread connecting all steps of the research, will gain the necessary view of its tremendous potential if each piece of stone is correctly placed to work synergically in this impressive mosaic.
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Affiliation(s)
- Gloria A A Saracino
- Center for Nanomedicine and Tissue Engineering, A.O. Ospedale Niguarda Cà Granda, Milan, 20162, Italy
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Tan A, Rajadas J, Seifalian AM. Biochemical engineering nerve conduits using peptide amphiphiles. J Control Release 2012; 163:342-52. [PMID: 22910143 DOI: 10.1016/j.jconrel.2012.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/05/2012] [Accepted: 08/07/2012] [Indexed: 12/30/2022]
Abstract
Peripheral nerve injury is a debilitating condition. The gold standard for treatment is surgery, requiring an autologous nerve graft. Grafts are harvested from another part of the body (a secondary site) to treat the affected primary area. However, autologous nerve graft harvesting is not without risks, with associated problems including injury to the secondary site. Research into biomaterials has engendered the use of bioartificial nerve conduits as an alternative to autologous nerve grafts. These include synthetic and artificial materials, which can be manufactured into nerve conduits using techniques inspired by nanotechnology. Recent evidence indicates that peptide amphiphiles (PAs) are promising candidates for use as materials for bioengineering nerve conduits. PAs are biocompatible and biodegradable protein-based nanomaterials, capable of self-assembly in aqueous solutions. Their self-assembly system, coupled with their intrinsic capacity for carrying bioactive epitopes for tissue regeneration, form particularly novel attributes for biochemically-engineered materials. Furthermore, PAs can function as biomimetic materials and advanced drug delivery platforms for sustained and controlled release of a plethora of therapeutic agents. Here we review the realm of nerve conduit tissue engineering and the potential for PAs as viable materials in this exciting and rapidly advancing field.
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Affiliation(s)
- Aaron Tan
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London, London, UK
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FDA approved guidance conduits and wraps for peripheral nerve injury: a review of materials and efficacy. Injury 2012; 43:553-72. [PMID: 21269624 DOI: 10.1016/j.injury.2010.12.030] [Citation(s) in RCA: 484] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/27/2010] [Indexed: 02/02/2023]
Abstract
Several nerve guidance conduits (NGCs) and nerve protectant wraps are approved by the US Food and Drug Administration (FDA) for clinical use in peripheral nerve repair. These devices cover a wide range of natural and synthetic materials, which may or may not be resorbable. This review consolidates the data pertaining to all FDA approved materials into a single reference, which emphasizes material composition alongside pre-clinical and clinical safety and efficacy (where possible). This article also summarizes the key advantages and limitations for each material as noted in the literature (with respect to the indication considered). In this context, this review provides a comprehensive reference for clinicians which may facilitate optimal material/device selection for peripheral nerve repair. For materials scientists, this review highlights predicate devices and evaluation methodologies, offering an insight into current deficiencies associated with state-of-the-art materials and may help direct new technology developments and evaluation methodologies thereof.
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Martins RS, Barbosa RA, Siqueira MG, Soares MS, Heise CO, Foroni L, Teixeira MJ. Morbidity following sural nerve harvesting: a prospective study. Clin Neurol Neurosurg 2012; 114:1149-52. [PMID: 22425460 DOI: 10.1016/j.clineuro.2012.02.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 02/02/2012] [Accepted: 02/20/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate donor site morbidity following sural nerve harvesting, with special attention to the recovery of sensory loss. METHODS We prospectively followed 38 subjects who underwent sural nerve harvest, including two with bilateral nerve excision. Symptoms related to sural nerve excision were evaluated and demarcation of the area with reduced touch sensation was quantified. Assessments were performed periodically up to 1 year after surgery and the results of different sensory evaluations were compared. RESULTS A significant reduction of sensory deficit was identified between consecutive evaluations (p<0.05). Decreases of 26.85%, 20.69% and 24.29% were observed 3, 6 and 12 months after surgery, respectively. Shock-like pain (7.5%), stabbing pain (7.5%), and numbness (5%) were the most frequently reported symptoms. All symptoms were brief and resolved spontaneously 3-6 months after surgery. CONCLUSION Sural nerve harvest can be performed with acceptable morbidity. When present, symptoms resolve between the third and sixth month after surgery and a significant reduction of sensory loss in the area innervated by the sural nerve was observed during the first year of follow-up.
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Affiliation(s)
- Roberto S Martins
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, São Paulo University, School of Medicine, Brazil.
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Use of adipose-derived stem cells to fabricate scaffoldless tissue-engineered neural conduits in vitro. Neuroscience 2011; 201:349-56. [PMID: 22119639 DOI: 10.1016/j.neuroscience.2011.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 01/17/2023]
Abstract
Peripheral nerve injuries resulting from trauma or disease often necessitate surgical intervention. Although the gold standard for such repairs uses nerve autografts, alternatives that do not require invasive harvesting of autologous nerve tissues are currently being designed and evaluated. We previously established the use of scaffoldless engineered neural conduits (ENCs) fabricated from primary cells as one such alternative in sciatic nerve repair in rats [Baltich et al. (2010) In Vitro Cell Dev Biol Anim 46(5):438-444]. The present study establishes protocols for fabricating neural conduits from adipose-derived stem cells (ASCs) differentiated to either a fibroblast or neural lineage and co-cultured into a three-dimensional (3-D) scaffoldless tissue-ENC. Addition of ascorbic acid-2-phosphate and fibroblast growth factor (FGF)-2 to the medium induced and differentiated ASCs to a fibroblast lineage in more than 90% of the cell population, as confirmed by collagen I expression. ASC-differentiated fibroblasts formed monolayers, delaminated, and formed 3-D conduits. Neurospheres were formed by culturing ASCs on non-adherent surfaces in serum-free neurobasal medium with the addition of epidermal growth factor (EGF) and FGF-2. The addition of 10 ng EGF and 10 ng FGF-2 produced larger and more numerous neurospheres than treatments of lower EGF and FGF-2 concentrations. Subsequent differentiation to glial-like cells was confirmed by the expression of S100. ASC-derived fibroblast monolayers and neurospheres were co-cultured to fabricate a 3-D scaffoldless tissue-ENC. Their nerve-like structure and incorporation of glial-like cells, which would associate with regenerating axons, may make these novel, stem cell-derived neural conduits an efficacious technology for repairing critical gaps following peripheral nerve injury.
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Peripheral neural sheath tumors (PNST)--what a radiologist should know. Eur J Radiol 2011; 82:51-5. [PMID: 21899972 DOI: 10.1016/j.ejrad.2011.04.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
Abstract
Peripheral neural sheath tumors (PNST) are rare and the common goal of management focuses on eliminating pain and maximizing function of the affected nerve. Therefore preoperative assessment of the specific morphological behaviour of such tumors regarding the nerves internal architecture is of utmost importance. PNSTs may affect one or more fascicles of a peripheral nerve resulting in a significant functional loss after resection and the necessity of functional reconstruction in one step. Enhancement of preoperative information should also address the biological behaviour of the tumor regarding its dignity and the resulting implications on amount of radical resection, additional treatment and prognosis. Since high-resolution techniques promise more and more detail resolution in many fields of imaging, delineation of intra- and extraneural processes as well as biological informations shall lead towards a well prepared and foreseeable image-guided treatment of PNSTs.
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Taras JS, Jacoby SM, Lincoski CJ. Reconstruction of digital nerves with collagen conduits. J Hand Surg Am 2011; 36:1441-6. [PMID: 21816545 DOI: 10.1016/j.jhsa.2011.06.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Digital nerve reconstruction with a biodegradable conduit offers the advantage of providing nerve reconstruction while providing a desirable environment for nerve regeneration. Many conduit materials have been investigated, but there have been few reports of human clinical trials of purified type I bovine collagen conduits. METHODS We report a prospective study of 22 isolated digital nerve lacerations in 19 patients reconstructed with a bioabsorbable collagen conduit. The average nerve gap measured 12 mm. An independent observer performed the postoperative evaluation, noting the return of protective sensation, static 2-point discrimination, and moving 2-point discrimination, and recording the patient's pain level using a visual analog scale. Minimal follow-up was 12 months and mean follow-up was 20 months after surgery. RESULTS All patients recovered protective sensation. The mean moving 2-point discrimination and static 2-point discrimination measured 5.0 and 5.2 mm, respectively, for those with measurable recovery at final follow-up visit. Excellent results were achieved in 13 of 22 digits, good results in 3 of 22 digits, and fair results in 6 of 22 digits, and there were no poor results. Reported pain scores at the last postoperative visit were measured universally as 0 on the visual analog scale. CONCLUSIONS Our data suggest that collagen conduits offer an effective method of reconstruction for digital nerve lacerations. This study confirms that collagen conduits reliably provide a repair that restores nerve function for nerve gaps measuring less than 2 cm.
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Affiliation(s)
- John S Taras
- Department of Orthopaedic Surgery, Division of Hand Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
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Lin H, Liu F, Zhang C, Zhang Z, Kong Z, Zhang X, Hoffman RM. Characterization of Nerve Conduits Seeded with Neurons and Schwann Cells Derived from Hair Follicle Neural Crest Stem Cells. Tissue Eng Part A 2011; 17:1691-8. [DOI: 10.1089/ten.tea.2010.0514] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haiyan Lin
- Department of Anatomy, Second Military Medical University, Shanghai, PR China
- Institute of Biomedical Engineering, Second Military Medical University, Shanghai, PR China
| | - Fang Liu
- Department of Anatomy, Second Military Medical University, Shanghai, PR China
- Institute of Biomedical Engineering, Second Military Medical University, Shanghai, PR China
| | - Chuansen Zhang
- Department of Anatomy, Second Military Medical University, Shanghai, PR China
- Institute of Biomedical Engineering, Second Military Medical University, Shanghai, PR China
| | - Zhiying Zhang
- Department of Anatomy, Second Military Medical University, Shanghai, PR China
- Institute of Biomedical Engineering, Second Military Medical University, Shanghai, PR China
| | - Zhengdong Kong
- Department of Anatomy, Second Military Medical University, Shanghai, PR China
- Institute of Biomedical Engineering, Second Military Medical University, Shanghai, PR China
| | - Xi Zhang
- Department of Anatomy, Second Military Medical University, Shanghai, PR China
- Institute of Biomedical Engineering, Second Military Medical University, Shanghai, PR China
| | - Robert M. Hoffman
- AntiCancer, Inc., San Diego, California
- Department of Surgery, University of California at San Diego, San Diego, California
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41
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Scott JB, Afshari M, Kotek R, Saul JM. The promotion of axon extension in vitro using polymer-templated fibrin scaffolds. Biomaterials 2011; 32:4830-9. [DOI: 10.1016/j.biomaterials.2011.03.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 03/18/2011] [Indexed: 01/03/2023]
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Lerman OZ, Haddock N, Elliott RM, Foroohar A, Levin LS. Microsurgery of the upper extremity. J Hand Surg Am 2011; 36:1092-103; quiz 1103. [PMID: 21636025 DOI: 10.1016/j.jhsa.2011.03.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 03/31/2011] [Indexed: 02/02/2023]
Abstract
In the past 50 years, hand surgeons have made considerable contributions to microsurgery. The unique demands of complex upper extremity care have driven many of the technical and scientific advances of this discipline, including functional muscle transfers, nerve transfers, and composite tissue allotransplantation. The purpose of this article was to review the current applications of microsurgery to the upper extremity.
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Affiliation(s)
- Oren Z Lerman
- Division of Plastic Surgery, Lenox Hill Hospital, and the Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
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Griffin J, Delgado-Rivera R, Meiners S, Uhrich KE. Salicylic acid-derived poly(anhydride-ester) electrospun fibers designed for regenerating the peripheral nervous system. J Biomed Mater Res A 2011; 97:230-42. [PMID: 21442724 DOI: 10.1002/jbm.a.33049] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 11/19/2010] [Accepted: 12/21/2010] [Indexed: 12/22/2022]
Abstract
Continuous biomaterial advances and the regenerating potential of the adult human peripheral nervous system offer great promise for restoring full function to innervated tissue following traumatic injury via synthetic nerve guidance conduits (NGCs). To most effectively facilitate nerve regeneration, a tissue engineering scaffold within a conduit must be similar to the linear microenvironment of the healthy nerve. To mimic the native nerve structure, aligned poly(lactic-co-glycolic acid)/bioactive polyanhydride fibrous substrates were fabricated through optimized electrospinning parameters with diameters of 600 ± 200 nm. Scanning electron microscopy images show fibers with a high degree of alignment. Schwann cells and dissociated rat dorsal root ganglia demonstrated elongated and healthy proliferation in a direction parallel to orientated electrospun fibers with significantly longer Schwann cell process length and neurite outgrowth when compared to randomly orientated fibers. Results suggest that an aligned polyanhydride fiber mat holds tremendous promise as a supplement scaffold for the interior of a degradable polymer NGC. Bioactive salicylic acid-based polyanhydride fibers are not limited to nerve regeneration and offer exciting promise for a wide variety of biomedical applications.
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Affiliation(s)
- Jeremy Griffin
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey 08854, USA
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Siemionow M, Bozkurt M, Zor F. Regeneration and repair of peripheral nerves with different biomaterials: review. Microsurgery 2011; 30:574-88. [PMID: 20878689 DOI: 10.1002/micr.20799] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peripheral nerve injury may cause gaps between the nerve stumps. Axonal proliferation in nerve conduits is limited to 10-15 mm. Most of the supportive research has been done on rat or mouse models which are different from humans. Herein we review autografts and biomaterials which are commonly used for nerve gap repair and their respective outcomes. Nerve autografting has been the first choice for repairing peripheral nerve gaps. However, it has been demonstrated experimentally that tissue engineered tubes can also permit lead to effective nerve repair over gaps longer than 4 cm repair that was previously thought to be restorable by means of nerve graft only. All of the discoveries in the nerve armamentarium are making their way into the clinic, where they are, showing great potential for improving both the extent and rate of functional recovery compared with alternative nerve guides.
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Affiliation(s)
- Maria Siemionow
- Department of Plastic Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA.
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45
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Puente-Alonso C, Pí-Folguera J, Sánchez-Flo R, Berenguer-Sánchez A, Ros-Munne V. Reparación de las lesiones nerviosas en el antebrazo con tubo de silicona. Resultados clínicos a largo plazo. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2010.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Puente-Alonso C, Pí-Folguera J, Sánchez-Flo R, Berenguer-Sánchez A, Ros-Munne V. Repair of nerve injuries in the forearm using a silicone tube. Long-term clinical results. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1988-8856(11)70286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Controlled delivery of glial cell line-derived neurotrophic factor enhances motor nerve regeneration. J Hand Surg Am 2010; 35:2008-17. [PMID: 21035963 DOI: 10.1016/j.jhsa.2010.08.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 08/13/2010] [Accepted: 08/18/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of a motor-specific neurotrophic factor, glial-derived neurotrophic factor (GDNF) on motor nerve regeneration. METHODS We used a nerve conduit filled with a fibrin-based delivery system that provided controlled release of GDNF during nerve regeneration. The motor branch of the rat femoral nerve was used to assess motor nerve regeneration across a 5-mm gap. Four experimental groups (n = 4 to n = 8) were evaluated. These included GDNF with the fibrin-based delivery system (GDNF-DS), fibrin alone, empty conduit (negative control), and nerve isograft (positive control). Nerves were harvested at 5 weeks for analysis by histomorphometry and electron microscopy. RESULTS At 5 mm distal to the conduit or isografts, the GDNF-DS group was not significantly different from the nerve isograft group in the following histomorphometric measures: total nerve fibers, percentage of neural tissue, and nerve density. Both the GDNF-DS and isograft groups had significantly more fibers and a higher percentage of neural tissue than fibrin alone and empty conduit groups. There were no differences in fiber width among all groups. By electron microscopy, the GDNF-DS and isograft groups also demonstrated more organized nerve architecture than the fibrin alone and empty conduit groups. CONCLUSIONS The delivery of GDNF from the fibrin-based delivery system promotes motor nerve regeneration at a level similar to an isograft in the femoral motor nerve model. This study gives insight into the potential beneficial role of GDNF in the treatment of motor nerve injuries.
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Rustemeyer J, Dicke U. Prefabricated nerve conduits advance histomorphological and functional outcomes in nerve regeneration of the sciatic nerve of the rat. Int J Oral Maxillofac Surg 2010; 39:889-96. [DOI: 10.1016/j.ijom.2010.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 04/04/2010] [Accepted: 05/19/2010] [Indexed: 11/15/2022]
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Treatment by collagen conduit of painful post-traumatic neuromas of the sensitive digital nerve: a retrospective study of 10 cases. ACTA ACUST UNITED AC 2010; 29:255-62. [PMID: 20727807 DOI: 10.1016/j.main.2010.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 03/23/2010] [Accepted: 07/02/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this retrospective study was to report the results of surgery in painful post-traumatic neuromas of the digital nerves treated by collagen conduits after excision of the neuromas, when two stumps were available. METHODS We retrospectively reviewed all patients operated on for painful neuroma in our institution and having undergone repair with collagen conduits. Their files were retrieved by a coding file (CCAM version 10). Ten patients involving nine digital nerves and one common digital nerve were included. Primary outcome data points were static two-point discrimination, Semmes-Weinstein monofilament testing, Quick-Dash outcome survey scores, Cold Intolerance Symptom Severity (CISS) score and recurrence of pain at final follow-up. We set up a minimum follow-up period of 6 months after surgery. RESULTS The patients' average age was 30 years. The average follow-up duration was 11.8 months. Five patients had excellent or good results (50%) at static two-point discrimination testing. Semmes-Weinstein monofilament testing results were full, diminished light touch or diminished protective sensation in nine digits (80%). The average Quick-Dash survey score was 19.3. The average CISS score was 27.8. There was no recurrence of pain. CONCLUSIONS Our findings indicate that collagen conduit is an effective treatment for post-traumatic painful neuromas of digital nerves and common digital nerves.
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Merolli A, Marceddu S, Rocchi L, Catalano F. In vivo study of ethyl-2-cyanoacrylate applied in direct contact with nerves regenerating in a novel nerve-guide. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:1979-1987. [PMID: 20300954 DOI: 10.1007/s10856-010-4036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
Stitch suture is still the most recommended method to hold a nerve-guide in place but stitch suture is a well known cause of local inflammatory response. Glues of several kinds have been proposed as an alternative but they are not easy to apply in a real surgical setting. In 2006 authors developed a new concept of nerve-guide termed "NeuroBox" which is double-halved, not-degradable and rigid, and allows the use of cyanoacrylic glues. In this study, Authors analyzed histologically the nerve-glue interface. Wistar rats were used as animal model. In group 1, animals were implanted a NeuroBox to promote the regeneration of an experimentally produced 4 mm gap in the sciatic nerve. In group 2, the gap was left without repair ("sham-operated" group). Group 3 was assembled by harvesting 10 contralateral intact nerves to document the normal anatomy. Semi-thin sections for visible light microscopy and ultra-thin sections for Transmission Electron Microscopy were analyzed. Results showed that application of ethyl-2-cyanoacrylate directly to the epineurium produced no significative insult to the underlining nerve fibers nor impaired nerve regeneration. No regeneration occurred in the "sham-operated" group.
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Affiliation(s)
- A Merolli
- Orthopaedics and Hand Surgery Unit, The Catholic University School of Medicine in Rome, Complesso "Columbus", via Moscati 31, 00168 Rome, Italy.
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