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Ismayilzade M, Ince B, Zuhour M, Oltulu P, Aygul R. The effect of a gap concept on peripheral nerve recovery in modified epineurial neurorrhaphy: An experimental study in rats. Microsurgery 2022; 42:703-713. [PMID: 35388916 DOI: 10.1002/micr.30890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/25/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several factors such as surgical approach that only consider topographic anatomy; inadequate fascicular alignment, extraepineurial sprouting in the repair zone; contact of axons with the suture area are the disadvantages of epineurial neurorrhaphy. Accordingly, axonal mismatch, neuroma, and unfavorable nerve recovery become inevitable. Neurotropism is the theory clarifying appropriate matching of the nerve fibers independently without needing surgical approach. The studies comparing the primary nerve repair with the nerve defects bridged in different ways demonstrated better outcomes of nerve recovery in the groups with a nerve gap. In this study, we aimed to demonstrate the effects of the gap concept in primary nerve repair bridged by own epineurium. We hypothesized that this technique will provide better results in terms of peripheral nerve recovery and will significantly eliminate the occurrence of a neuroma, which is quite possible in epineurial neurorrhaphy. MATERIALS AND METHODS A total of 35 Wistar female rats weighing 200 ~ 250 g were randomly divided into five groups each with seven rats. Sham controls constituted Group 1, while the rats with epineural neurorrhaphy were included in Group 2. The remaining three groups were the study groups. In Group 3, after the sciatic nerve transection, epineurium of the distal segment was sleeved and preserved. A 2-mm axonal segment was removed from the epineurium free distal ending and no any procedure was applied to the proximal ending of the transected sciatic nerve. Epineuriums of the both sides were approximated and repaired. In Group 4, a 2-mm axonal segment was removed from the proximal ending of the sciatic nerve after preservation of epineurium and no any procedure was applied to the distal part of sciatic nerve. Epineuriums of the both sides were approximated and repaired. In addition, in Group 5, after epineuriums were sleeved in the both distal and proximal stumps, a 1-mm nerve segment was removed from both endings and epineuriums were repaired in the middle bridging a 2-mm axonal gap again. After a 3 months follow-up period Sciatic Functional Index (SFI) was measured by walking track analysis; the area under the evoked compound muscle action potential (CMAP) and latency periods were calculated via electromyographic (EMG) analysis; and histopathological evaluation were performed to compare the parameters of edema, fibrosis, inflammation, vascularization, axonal degeneration, axonal density, myelination, disorganization, and neuroma occurrence. Vascular structures and nerve fibers were counted at ×200 magnification: +1, +2, and +3 indicated the presence of 0-15, 16-30, and >30 structures, respectively. For uncountable parameters (edema, disorganization, myelination, fibrosis, and inflammation): +1 indicated mild, +2 indicated moderate, and +3 indicated severe. RESULTS The differences between the groups with axonal gap repair and epineural neurorrhaphy were not significant regarding to SFI. The areas under CMAP were as follows: 27.9 ± 5.9 (Δ = 12.1%) in Group 1; 16.5 ± 5.5 (Δ = 6.3%) in Group 2; 14.1 ± 6.2 (Δ = 4.8%) in group 3; 13.8 ± 2.3 (Δ = 9.2%) in Group 4, and 22.5 ± 18.3 (Δ = 2.2%) in Group 5. Group 5 (1 mm gap in the distal +1 mm gap in the proximal segments) had a significantly better result in terms of the area under CMAP with the value of 22.5 ± 18.3 m/Mv (p = .031). Axonal density was 0.9 ± 0.6 (Δ = 2.2%) in Group 2, 2.4 ± 0.3 (Δ = 5.1%) in Group 3, 2.8 ± 0.1 (Δ = 7.7%) in Group 4, and 2.8 ± 0.2 (Δ = 4.8%) in Group 5. Myelination was 1.1 ± 0.5 (Δ = 3.4%) in group 2, 2.2 ± 0.2 (Δ = 6.7%) in group 3, 2.4 ± 0.4 (Δ = 6.0%) in Group 4, and 2.7 ± 0.3 (Δ = 4.6%) in Group 5. Disorganization was 2.3 ± 0.4 (Δ = 4.1%) in Group 2, 1.2 ± 0.2 (Δ = 7.7%) in Group 3, 1.3 ± 0.2 (Δ = 6.5%) in Group 4, and 1 ± 0.3 (Δ = 5.9%) in Group 5. And, neuroma occurrence was found 2.2 ± 0.6 (Δ = 2.8%) in Group 2 and 0.3 ± 0.2 (Δ = 0.1%) in Group 4 while neuroma was not encountered in Group 3 and Group 5. Comparison between the epineurial neurorrhaphy group and the groups with axonal defect revealed the statistically significant results in the factors of axonal density (p = .001), myelination (p = .028), disorganization (p = .016) and neuroma (p = .001). CONCLUSIONS Creating axonal gap bridged by own epineurium showed favorable results comparing with epineurial neurorrhaphy. Resection of a 1 mm axonal segment from the proximal and distal stumps following the epineurial sleeve procedure and performing the epineurium- only repair can facilitate the nerve regeneration. The feasibility of the described technique has been demonstrated in a small rat model and must be further validated in larger animals before clinical testing.
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Affiliation(s)
- Majid Ismayilzade
- Department of Plastic & Reconstructive and Aesthetic Surgery, Istinye University Faculty of Medicine, Liv Hospital Vadiistanbul, Istanbul, Turkey
| | - Bilsev Ince
- Department of Plastic & Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Moath Zuhour
- Department of Plastic & Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Pembe Oltulu
- Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Recep Aygul
- Department of Neurology, Medical Faculty of Selcuk University, Konya, Turkey
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Li C, Liu SY, Zhang M, Pi W, Wang B, Li QC, Lu CF, Zhang PX. Sustained release of exosomes loaded into polydopamine-modified chitin conduits promotes peripheral nerve regeneration in rats. Neural Regen Res 2022; 17:2050-2057. [PMID: 35142696 PMCID: PMC8848592 DOI: 10.4103/1673-5374.335167] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Exosomes derived from mesenchymal stem cells are of therapeutic interest because of their important role in intracellular communication and biological regulation. On the basis of previously studied nerve conduits, we designed a polydopamine-modified chitin conduit loaded with mesenchymal stem cell-derived exosomes that release the exosomes in a sustained and stable manner. In vitro experiments revealed that rat mesenchymal stem cell-derived exosomes enhanced Schwann cell proliferation and secretion of neurotrophic and growth factors, increased the expression of Jun and Sox2 genes, decreased the expression of Mbp and Krox20 genes in Schwann cells, and reprogrammed Schwann cells to a repair phenotype. Furthermore, mesenchymal stem cell-derived exosomes promoted neurite growth of dorsal root ganglia. The polydopamine-modified chitin conduits loaded with mesenchymal stem cell-derived exosomes were used to bridge 2 mm rat sciatic nerve defects. Sustained release of exosomes greatly accelerated nerve healing and improved nerve function. These findings confirm that sustained release of mesenchymal stem cell-derived exosomes loaded into polydopamine-modified chitin conduits promotes the functional recovery of injured peripheral nerves.
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Affiliation(s)
- Ci Li
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
| | - Song-Yang Liu
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
| | - Meng Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
| | - Wei Pi
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
| | - Bo Wang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Qi-Cheng Li
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
| | - Chang-Feng Lu
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Ministry of Education; National Center for Trauma Medicine, Beijing, China
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Smaniotto PH, Camargo CP, Kubrusly MS, Gemperli R. Comparison of three different strategies to treat sciatic nerve regeneration: an experimental study. Acta Cir Bras 2022; 37:e370501. [PMID: 35976339 PMCID: PMC9377207 DOI: 10.1590/acb370501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the effect of vein conduit filled with adipose tissue stem cells (ASC) on peripheral nerve injury regeneration. METHODS We analyzed 30 male Wistar rats surgically submitted to a 5-mm gap on the sciatic nerve. Then, the animals were divided into three groups: nerve autografting (AG, n=10), autogenous inverted glycerol-conserved vein (VG, n=10), and autogenous inverted glycerol-conserved vein + ASC (VASCG, n=10). The study endpoints were neuromotor functional analysis, gastrocnemius muscle weight, and sciatic nerve graft histomorphometry analysis. In the histologic analysis, we added a control group (naïve nerve). RESULTS Regarding functional analysis (Walking tract- score), the findings at week 3 showed a difference between the AG and the VG (-96.6 vs. -59.6, p=0.01, respectively) and between the VG and the inverted vein + VASCG (-59.9 vs. -88.92, p=0.02). At week 12, this study showed a difference between the AG and the VG (-64.8 vs. -47.3, p=0.004, respectively), and also a difference between the VG and the VASCG (-47.3 vs. -57.4, p=0.02, respectively). There was no difference in the histomorphometry analysis (nerve diameter, Schwann cells counting). The gastrocnemius muscles on the intervention side were more atrophic when compared to the gastrocnemius muscles on the control side. CONCLUSIONS Our results suggested better functional recovery in the inverted vein group when compared to control group, and inverted vein + ASC group.
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Affiliation(s)
| | - Cristina Pires Camargo
- PhD. Universidade de São Paulo - Medical School -Microsurgery and Plastic Surgery Laboratory - São Paulo (SP), Brazil
| | - Marcia Saldanha Kubrusly
- PhD. Universidade de São Paulo - Medical School -Transplantation and Liver Surgery - São Paulo (SP), Brazil
| | - Rolf Gemperli
- Full Professor. Universidade de São Paulo - Medical School - Plastic Surgeon Division - São Paulo (SP), Brazil
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ElKholy AR, Sallam AM, AlShamekh AS, Alomar N, Alghabban FA, Alzahrani BS, Bafaqih SM, AlSubaie FA, AlQadasi KS, Alturki AY, Bafaquh M. The efficacy of wrapping the neurorrhaphy site utilizing dura substitute: A case series. Surg Neurol Int 2021; 12:568. [PMID: 34877054 PMCID: PMC8645511 DOI: 10.25259/sni_586_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/04/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Different procedures have been developed to improve the surgical outcome of peripheral nerve injuries. The purpose of this study was to evaluate the efficacy of wrapping the neurorrhaphy site utilizing dura substitute graft as an alternative conduit in the management of peripheral nerve injury. METHODS This retrospective clinical case series included 42 patients with a single peripheral nerve injury. The mean age was 26.8 ± 11 years, and the mean duration of symptoms was 3 ± 1.8 months. The visual analogue score (VAS) for pain and the Medical Research Council's (MRC) grading for motor power were used to evaluate the functional outcome among our patients. All patients were operated on for primary microscopic end-to-end repair, followed by wrapping the neurorrhaphy site with dura substitute graft as a conduit. Patients were followed in the outpatient clinic with regular visits for average of 6 months. RESULTS Thirty-seven patients (83%), showed functional improvement in all aspects, the VAS for pain and the MRC for motor power, as well as the functional state. One patient (2.3%) developed a postoperative hematoma collection, which needed immediate evacuation. Superficial wound infection, reported in two patients (4.7%), was treated conservatively. No postoperative neuroma was observed among our patients during the follow-up period. CONCLUSION Wrapping the neurorrhaphy site utilizing dura substitute as conduit appears to be safe and might prove effective in managing peripheral nerve injury.
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Affiliation(s)
| | - Ahmed M. Sallam
- Department of Neurosurgery, National Neuroscience Institute, King Fahed Medical City, Riyadh, Saudi Arabia
| | - Arwa S. AlShamekh
- Department of Neurosurgery, National Neuroscience Institute, King Fahed Medical City, Riyadh, Saudi Arabia
| | - Najeeb Alomar
- Department of Neurosurgery, National Neuroscience Institute, King Fahed Medical City, Riyadh, Saudi Arabia
| | - Fatimah A. Alghabban
- Department of Neurosurgery, King Abdulaziz Specialist Hospital, Taif, Westeran, Saudi Arabia
| | - Basmah S. Alzahrani
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia
| | - Saeed M. Bafaqih
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahd A. AlSubaie
- Department of Neurosurgery, National Neuroscience Institute, King Fahed Medical City, Riyadh, Saudi Arabia
| | - Khalil S. AlQadasi
- Department of Neurosurgery, Royal Commission Hospital, Jubail, Saudi Arabia
| | - Abdulrahman Y. Alturki
- Department of Neurosurgery, National Neuroscience Institute, King Fahed Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neuroscience Institute, King Fahed Medical City, Riyadh, Saudi Arabia
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Li C, Zhang M, Liu SY, Zhang FS, Wan T, Ding ZT, Zhang PX. Chitin Nerve Conduits with Three-Dimensional Spheroids of Mesenchymal Stem Cells from SD Rats Promote Peripheral Nerve Regeneration. Polymers (Basel) 2021; 13:polym13223957. [PMID: 34833256 PMCID: PMC8620585 DOI: 10.3390/polym13223957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
Peripheral nerve injury (PNI) is an unresolved medical problem with limited therapeutic effects. Epineurium neurorrhaphy is an important method for treating PNI in clinical application, but it is accompanied by inevitable complications such as the misconnection of nerve fibers and neuroma formation. Conduits small gap tubulization has been proved to be an effective suture method to replace the epineurium neurorrhaphy. In this study, we demonstrated a method for constructing peripheral nerve conduits based on the principle of chitosan acetylation. In addition, the micromorphology, mechanical properties and biocompatibility of the chitin nerve conduits formed by chitosan acetylation were further tested. The results showed chitin was a high-quality biological material for constructing nerve conduits. Previous reports have demonstrated that mesenchymal stem cells culture as spheroids can improve the therapeutic potential. In the present study, we used a hanging drop protocol to prepare bone marrow mesenchymal stem cell (BMSCs) spheroids. Meanwhile, spherical stem cells could express higher stemness-related genes. In the PNI rat model with small gap tubulization, BMSCs spheres exhibited a higher ability to improve sciatic nerve regeneration than BMSCs suspension. Chitin nerve conduits with BMSCs spheroids provide a promising therapy option for peripheral nerve regeneration.
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Affiliation(s)
- Ci Li
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Meng Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Song-Yang Liu
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Feng-Shi Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Teng Wan
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Zhen-Tao Ding
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Peking University People’s Hospital, Beijing 100044, China
- Correspondence:
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Singh S, Srivastava AK, Baranwal AK, Bhatnagar A, Das KK, Jaiswal S, Behari S. Efficacy of Silicone Conduit in the Rat Sciatic Nerve Repair Model: Journey of a Thousand Miles. Neurol India 2021; 69:318-325. [PMID: 33904443 DOI: 10.4103/0028-3886.314576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A lot of options have been tried for bridging the two ends of the injured nerves. Researchers have used decellularized nerve grafts, artificial materials and even nerve growth factors to augment functional recovery. These materials are either costly or inaccessible in developing world. Objective The study aimed to evaluate the efficacy of the silicone conduit in a rat sciatic nerve injury model. Materials and Methods 24 healthy Sprague-Dawley (SD) rats (250-300 grams; 8-10 weeks) were used and right sciatic nerve was exposed; transected and re-anastomosed by two different methods in 16 rats. In control group, n = 8 (Group I) the sciatic nerve was untouched; Group II (reverse nerve anastomosis, n = 8): 1-centimeter of nerve was cut and re-anastomosed by using 10-0 monofilament suture; Group III (silicone conduit, n = 8) 1-centimeter nerve segment was cut, replaced by silicone conduit and supplemented by fibrin glue]. Evaluation of nerve recovery was done functionally (pain threshold and sciatic functional index) over 3 months and histologically and electron microscopically. Results Functional results showed a trend of clinical improvement in Group III and II but recovery was poor and never reached up to normal. Histopathological and electron microscopic results showed an incomplete axonal regeneration in Groups II and III. Psychological analyses showed that no outwards signs of stress were present and none of the rats showed paw biting and teeth chattering. Conclusion The silicone conduit graft may be an economical and effective alternative to presently available interposition grafts, however for short segments only.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Atul K Baranwal
- Veterinary Scientist, Animal House, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Bhatnagar
- Department of Plastic and Reconstruction Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Combined Use of Chitosan and Olfactory Mucosa Mesenchymal Stem/Stromal Cells to Promote Peripheral Nerve Regeneration In Vivo. Stem Cells Int 2021; 2021:6613029. [PMID: 33488738 PMCID: PMC7801080 DOI: 10.1155/2021/6613029] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022] Open
Abstract
Peripheral nerve injury remains a clinical challenge with severe physiological and functional consequences. Despite the existence of multiple possible therapeutic approaches, until now, there is no consensus regarding the advantages of each option or the best methodology in promoting nerve regeneration. Regenerative medicine is a promise to overcome this medical limitation, and in this work, chitosan nerve guide conduits and olfactory mucosa mesenchymal stem/stromal cells were applied in different therapeutic combinations to promote regeneration in sciatic nerves after neurotmesis injury. Over 20 weeks, the intervened animals were subjected to a regular functional assessment (determination of motor performance, nociception, and sciatic indexes), and after this period, they were evaluated kinematically and the sciatic nerves and cranial tibial muscles were evaluated stereologically and histomorphometrically, respectively. The results obtained allowed confirming the beneficial effects of using these therapeutic approaches. The use of chitosan NGCs and cells resulted in better motor performance, better sciatic indexes, and lower gait dysfunction after 20 weeks. The use of only NGGs demonstrated better nociceptive recoveries. The stereological evaluation of the sciatic nerve revealed identical values in the different parameters for all therapeutic groups. In the muscle histomorphometric evaluation, the groups treated with NGCs and cells showed results close to those of the group that received traditional sutures, the one with the best final values. The therapeutic combinations studied show promising outcomes and should be the target of new future works to overcome some irregularities found in the results and establish the combination of nerve guidance conduits and olfactory mucosa mesenchymal stem/stromal cells as viable options in the treatment of peripheral nerves after injury.
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Li C, Liu SY, Pi W, Zhang PX. Cortical plasticity and nerve regeneration after peripheral nerve injury. Neural Regen Res 2021; 16:1518-1523. [PMID: 33433465 PMCID: PMC8323687 DOI: 10.4103/1673-5374.303008] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
With the development of neuroscience, substantial advances have been achieved in peripheral nerve regeneration over the past decades. However, peripheral nerve injury remains a critical public health problem because of the subsequent impairment or absence of sensorimotor function. Uncomfortable complications of peripheral nerve injury, such as chronic pain, can also cause problems for families and society. A number of studies have demonstrated that the proper functioning of the nervous system depends not only on a complete connection from the central nervous system to the surrounding targets at an anatomical level, but also on the continuous bilateral communication between the two. After peripheral nerve injury, the interruption of afferent and efferent signals can cause complex pathophysiological changes, including neurochemical alterations, modifications in the adaptability of excitatory and inhibitory neurons, and the reorganization of somatosensory and motor regions. This review discusses the close relationship between the cerebral cortex and peripheral nerves. We also focus on common therapies for peripheral nerve injury and summarize their potential mechanisms in relation to cortical plasticity. It has been suggested that cortical plasticity may be important for improving functional recovery after peripheral nerve damage. Further understanding of the potential common mechanisms between cortical reorganization and nerve injury will help to elucidate the pathophysiological processes of nerve injury, and may allow for the reduction of adverse consequences during peripheral nerve injury recovery. We also review the role that regulating reorganization mechanisms plays in functional recovery, and conclude with a suggestion to target cortical plasticity along with therapeutic interventions to promote peripheral nerve injury recovery.
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Affiliation(s)
- Ci Li
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, China
| | - Song-Yang Liu
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, China
| | - Wei Pi
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University; National Center for Trauma Medicine, Beijing, China
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Yuan YS, Yu F, Zhang YJ, Niu SP, Xu HL, Kou YH. Changes in proteins related to early nerve repair in a rat model of sciatic nerve injury. Neural Regen Res 2021; 16:1622-1627. [PMID: 33433493 PMCID: PMC8323673 DOI: 10.4103/1673-5374.301025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Peripheral nerves have a limited capacity for self-repair and those that are severely damaged or have significant defects are challenging to repair. Investigating the pathophysiology of peripheral nerve repair is important for the clinical treatment of peripheral nerve repair and regeneration. In this study, rat models of right sciatic nerve injury were established by a clamping method. Protein chip assay was performed to quantify the levels of neurotrophic, inflammation-related, chemotaxis-related and cell generation-related factors in the sciatic nerve within 7 days after injury. The results revealed that the expression levels of neurotrophic factors (ciliary neurotrophic factor) and inflammation-related factors (intercellular cell adhesion molecule-1, interferon γ, interleukin-1α, interleukin-2, interleukin-4, interleukin-6, monocyte chemoattractant protein-1, prolactin R, receptor of advanced glycation end products and tumor necrosis factor-α), chemotaxis-related factors (cytokine-induced neutrophil chemoattractant-1, L-selectin and platelet-derived growth factor-AA) and cell generation-related factors (granulocyte-macrophage colony-stimulating factor) followed different trajectories. These findings will help clarify the pathophysiology of sciatic nerve injury repair and develop clinical treatments of peripheral nerve injury. This study was approved by the Ethics Committee of Peking University People’s Hospital of China (approval No. 2015-50) on December 9, 2015.
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Affiliation(s)
- Yu-Song Yuan
- Department of Trauma and Orthopedics, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
| | - Fei Yu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing; National & Local Joint Engineering Research Center of Orthopedic Biomaterials, Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Ya-Jun Zhang
- National Center for Trauma Medicine, Beijing, China
| | - Su-Ping Niu
- Office of Academic Research, Peking University People's Hospital, Beijing, China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedics; Diabetic Foot Treatment Center, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
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Fang X, Deng J, Zhang W, Guo H, Yu F, Rao F, Li Q, Zhang P, Bai S, Jiang B. Conductive conduit small gap tubulization for peripheral nerve repair. RSC Adv 2020; 10:16769-16775. [PMID: 35498832 PMCID: PMC9053044 DOI: 10.1039/d0ra02143a] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
Despite advances in surgical techniques, functional recovery following epineurial neurorrhaphy of transected peripheral nerves often remains quite unsatisfactory. Small gap tubulisation is a promising approach that has shown potential to traditional epineurial neurorrhaphy in the treatment of peripheral nerve injury. Thus, the goal of this study is to evaluate sciatic nerve regeneration after nerve transection, followed by small gap tubulization using a reduced graphene oxide-based conductive conduit. In vitro, the electrically conductive conduit could promote Schwann cell proliferation through PI3K/Akt signaling pathway activation. In vivo, the results of electrophysiological and walking track analysis suggest that the electrically conductive conduit could promote sensory and motor nerve regeneration and functional recovery, which is based on the mechanisms of selective regeneration and multiple-bud regeneration. These promising results illustrate electrically conductive conduit small gap tubulization as an alternative approach for transected peripheral nerve repair. rGO-based conductive nerve conduit as a scaffold to bridge peripheral nerve transected injury and 2 mm gap provides a suitable microenvironment for axons selective regeneration.![]()
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Zhao X, Li B, Guan X, Sun G, Zhang M, Zhang W, Xu J, Ren X. Peg-Enhanced Behavioral Recovery After Sciatic Nerve Transection and Either Suturing Or Sleeve Conduit Deployment in Rats. J INVEST SURG 2019; 34:524-533. [PMID: 31438740 DOI: 10.1080/08941939.2019.1654047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Polyethylene glycol (PEG) has previously been reported to improve outcomes of peripheral nerve microsuturing. However, recent studies have challenged this finding. Given its clinical importance, we investigated the potential of PEG as a facilitator of peripheral nerve restoration. The sciatic nerve of 144 rats was transected and submitted either to simple suturing (Group A), PEG-enhanced suturing (Group B), and insertion in an arterial sleeve conduit without PEG (Group C), or with PEG (Group D) in equal numbers. Behavioral recovery was assessed with the sciatic function index (SFI). Nerve impulse conduction was assessed with compound muscle action potentials (CMAPs). Histology comprised standard hematoxylin/eosin staining, electron microscopy and glial cell line-derived neurotrophic factor (GDNF) immunohistochemistry. Expression of GDNF was also assessed with western blotting. Results were evaluated at weeks 1, 4, and 8. PEG treatment significantly improved behavioral recovery and morphology of nerve restoration, particularly in the sleeve conduit group, relative to that of controls. In conclusion, PEG may improve outcomes of peripheral nerve reconstruction.
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Affiliation(s)
- Xin Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiangchen Guan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guiyin Sun
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mingzhe Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weihua Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junfeng Xu
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoping Ren
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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12
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Kou YH, Jiang BG, Yu F, Yu YL, Niu SP, Zhang PX, Yin XF, Han N, Zhang YJ, Zhang DY. Repair of long segmental ulnar nerve defects in rats by several different kinds of nerve transposition. Neural Regen Res 2019; 14:692-698. [PMID: 30632510 PMCID: PMC6352591 DOI: 10.4103/1673-5374.247473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple regeneration of axonal buds has been shown to exist during the repair of peripheral nerve injury, which confirms a certain repair potential of the injured peripheral nerve. Therefore, a systematic nerve transposition repair technique has been proposed to treat severe peripheral nerve injury. During nerve transposition repair, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively grow into the repaired distal nerve and target muscle tissues, which is conducive to the recovery of motor function. The aim of this study was to explore regeneration and nerve functional recovery after repairing a long-segment peripheral nerve defect by transposition of different donor nerves. A long-segment (2 mm) ulnar nerve defect in Sprague-Dawley rats was repaired by transposition of the musculocutaneous nerve, medial pectoral nerve, muscular branches of the radial nerve and anterior interosseous nerve (pronator quadratus muscle branch). In situ repair of the ulnar nerve was considered as a control. Three months later, wrist flexion function, nerve regeneration and innervation muscle recovery in rats were assessed using neuroelectrophysiological testing, osmic acid staining and hematoxylin-eosin staining, respectively. Our findings indicate that repair of a long-segment ulnar nerve defect with different donor nerve transpositions can reinnervate axonal function of motor neurons in the anterior horn of spinal cord and restore the function of affected limbs to a certain extent.
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13
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Kou YH, Yu YL, Zhang YJ, Han N, Yin XF, Yuan YS, Yu F, Zhang DY, Zhang PX, Jiang BG. Repair of peripheral nerve defects by nerve transposition using small gap bio-sleeve suture with different inner diameters at both ends. Neural Regen Res 2019; 14:706-712. [PMID: 30632512 PMCID: PMC6352590 DOI: 10.4103/1673-5374.247475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During peripheral nerve transposition repair, if the diameter difference between transposed nerves is large or multiple distal nerves must be repaired at the same time, traditional epineurial neurorrhaphy has the problem of high tension at the suture site, which may even lead to the failure of nerve suture. We investigated whether a small gap bio-sleeve suture with different inner diameters at both ends can be used to repair a 2-mm tibial nerve defect by proximal transposition of the common peroneal nerve in rats and compared the results with the repair seen after epineurial neurorrhaphy. Three months after surgery, neurological function, nerve regeneration, and recovery of nerve innervation muscle were assessed using the tibial nerve function index, neuroelectrophysiological testing, muscle biomechanics and wet weight measurement, osmic acid staining, and hematoxylin-eosin staining. There was no obvious inflammatory reaction and neuroma formation in the tibial nerve after repair by the small gap bio-sleeve suture with different inner diameters at both ends. The conduction velocity, muscle strength, wet muscle weight, cross-sectional area of muscle fibers, and the number of new myelinated nerve fibers in the bio-sleeve suture group were similar to those in the epineurial neurorrhaphy group. Our findings indicate that small gap bio-sleeve suture with different inner diameters at both ends can achieve surgical suture between nerves of different diameters and promote regeneration and functional recovery of injured peripheral nerves.
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Affiliation(s)
- Yu-Hui Kou
- Peking University People's Hospital, Beijing, China
| | - You-Lai Yu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ya-Jun Zhang
- Peking University People's Hospital, Beijing, China
| | - Na Han
- Peking University People's Hospital, Beijing, China
| | | | - Yu-Song Yuan
- Peking University People's Hospital, Beijing, China
| | - Fei Yu
- Peking University People's Hospital, Beijing, China
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14
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Zhang PX, Han N, Kou YH, Zhu QT, Liu XL, Quan DP, Chen JG, Jiang BG. Tissue engineering for the repair of peripheral nerve injury. Neural Regen Res 2019; 14:51-58. [PMID: 30531070 PMCID: PMC6263012 DOI: 10.4103/1673-5374.243701] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Peripheral nerve injury is a common clinical problem and affects the quality of life of patients. Traditional restoration methods are not satisfactory. Researchers increasingly focus on the field of tissue engineering. The three key points in establishing a tissue engineering material are the biological scaffold material, the seed cells and various growth factors. Understanding the type of nerve injury, the construction of scaffold and the process of repair are necessary to solve peripheral nerve injury and promote its regeneration. This review describes the categories of peripheral nerve injury, fundamental research of peripheral nervous tissue engineering and clinical research on peripheral nerve scaffold material, and paves a way for related research and the use of conduits in clinical practice.
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Affiliation(s)
| | - Na Han
- Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Peking University People's Hospital, Beijing, China
| | - Qing-Tang Zhu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiao-Lin Liu
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Da-Ping Quan
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jian-Guo Chen
- School of Life Science, Peking University, Beijing, China
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15
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Liu D, Mi D, Zhang T, Zhang Y, Yan J, Wang Y, Tan X, Yuan Y, Yang Y, Gu X, Hu W. Tubulation repair mitigates misdirection of regenerating motor axons across a sciatic nerve gap in rats. Sci Rep 2018; 8:3443. [PMID: 29467542 PMCID: PMC5821835 DOI: 10.1038/s41598-018-21652-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/06/2018] [Indexed: 01/22/2023] Open
Abstract
The repair of peripheral nerve laceration injury to obtain optimal function recovery remains a big challenge in the clinic. Misdirection of regenerating axons to inappropriate target, as a result of forced mismatch of endoneurial sheaths in the case of end-to-end nerve anastomosis or nerve autografting, represents one major drawback that limits nerve function recovery. Here we tested whether tubulation repair of a nerve defect could be beneficial in terms of nerve regeneration accuracy and nerve function. We employed sequential retrograde neuronal tracing to assess the accuracy of motor axon regeneration into the tibial nerve after sciatic nerve laceration and entubulation in adult Sprague-Dawley rats. In a separate cohort of rats with the same sciatic nerve injury/repair protocols, we evaluated nerve function recovery behaviorally and electrophysiologically. The results showed that tubulation repair of the lacerated sciatic nerve using a 3-6-mm-long bioabsorbable guidance conduit significantly reduced the misdirection of motor axons into the tibial nerve as compared to nerve autografting. In addition, tubulation repair ameliorated chronic flexion contracture. This study suggests that tubulation repair of a nerve laceration injury by utilizing a bioresorbable nerve guidance conduit represents a potential substitute for end-to-end epineurial suturing and nerve autografting.
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Affiliation(s)
- Dan Liu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.,The Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Daguo Mi
- Department of Orthopedics, Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, 226001, China
| | - Tuanjie Zhang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Yanping Zhang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.,Department of Burns and Plastic Surgery and Cosmetology, Longyan First Hospital, Longyan, Fujian, 364000, China
| | - Junying Yan
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, China
| | - Yaxian Wang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Xuefeng Tan
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001, China
| | - Ying Yuan
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.,The Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001, China
| | - Yumin Yang
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Xiaosong Gu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China
| | - Wen Hu
- Key Laboratory for Neuroregeneration of Ministry of Education and Co-innovation Center for Neuroregeneration of Jiangsu Province, Nantong University, Nantong, Jiangsu, 226001, China.
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16
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Bueno CRDS, Pereira M, Aparecido I, Buchaim RL, Andreo JC, Rodrigues ADC, Marco G. Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis. Acta Cir Bras 2017; 32:287-296. [PMID: 28538803 DOI: 10.1590/s0102-865020170040000005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/13/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose: To compare the functional result of standart vein grafts and inside-out vein graft technique on sciatic nerve repair. Methods: We used 24 male Wistar rats divided into 4 groups: control group (CG), standard vein graft group (SVG), Inside-out vein graft group (IOVG) and denervated Group (DG). SVG, IOVG and DG underwent total section of the sciatic nerve, SVG and IOVG however underwent nerve repair surgery using a graft with normal jugular vein and inside-out jugular vein, respectively. Histological analysis of the soleus and Extensor Digitorum Longus (EDL), and Sciatic Functional Index were used to compare the results after 6 weeks. Results: Both grafts acted favorably in muscle recovery and improved functionality; They were similar in all parameters, however, in more points SVG achieved similar to the CG, in the other hand IOVG more times was similar to DG. Fact that makes the graft with normal vein the most viable option between the two options. Conclusion: Both types of grafts acted beneficially wherein the graft normal vein has proved to be the best option.
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Affiliation(s)
- Cleuber Rodrigo de Souza Bueno
- Graduate student, Department of Biological Sciences, Universidade do Sagrado Coração (USC), Bauru-SP, Brazil. Technical procedures; acquisition, analysis and interpretation of data; histopathological examinations; manuscript preparation
| | - Mizael Pereira
- MSc, Department of Biological Sciences (Anatomy), Faculdade de Odontologia de Bauru, Universidade de São Paulo (FOB-USP), Bauru-SP, Brazil. Analysis and interpretation of data, histopathological examinations, manuscript preparation and writing
| | - Idvaldo Aparecido
- MSc, Department of Biological Sciences (Anatomy), FOB-USP, Bauru-SP, Brazil. Acquisition of data, technical procedures
| | - Rogerio Leone Buchaim
- PhD, Associate Professor, Department of Biological Sciences (Anatomy), FOB-USP, Bauru-SP, Brazil. Scientific and intellectual content of the study, statitics analysis
| | - Jesus Carlos Andreo
- PhD, Full Professor, Department of Biological Sciences (Anatomy), FOB-USP, Bauru-SP, Brazil. Scientific and intellectual content of the study
| | - Antônio de Castro Rodrigues
- PhD, Associate Professor, Department of Biological Sciences (Anatomy), FOB-USP, Bauru-SP, Brazil. Conception, design, scientific and intellectual content of the study; final approval
| | - Geraldo Marco
- PhD, Associate Professor, Department of Biological Sciences, USC, Bauru-SP, Brazil. Conception and design of the study, critical revision, final approval
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17
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Peixun Z, Na H, Kou Y, Xiaofeng Y, Jiang B. Peripheral nerve intersectional repair by bi-directional induction and systematic remodelling: biodegradable conduit tubulization from basic research to clinical application. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2017; 45:1464-1466. [PMID: 28884592 DOI: 10.1080/21691401.2017.1373658] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In terms of the clinical effect of peripheral nerve injury repair, the biological degradable conduit 2 mm small gap tubulization is far better than the traditional epineurial or perineurium neurorrhaphy. The assumption of the bi-directional induction between the central system and the terminal effector during peripheral nerve regeneration is purposed and proved in clinical by our group. The surgical approach of transferring a portion of or the whole contralateral C7 nerve to repair a part of or the whole ipsilateral brachial plexus injury is clinically promoted, in which the most important idea and practice is to use the cone conduit designed by the group to repair thick nerves with fine nerves. Some of the patients suffering from cerebral palsy or cerebral haemorrhage and those who got cerebral infarction yet have not reached recovery after 3-6 months could regain some functions of the ipsilateral upper limb and improve the life quality by transfer of a portion of or the whole contralateral C7 nerve and connection by cone conduit.
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Affiliation(s)
- Zhang Peixun
- a Trauma & Orthopaedics Department , Peking University People's Hospital , Beijing , China
| | - Han Na
- b Center Laboratory, Peking University People's Hospital , Beijing , China
| | - Yuhui Kou
- a Trauma & Orthopaedics Department , Peking University People's Hospital , Beijing , China
| | - Yin Xiaofeng
- a Trauma & Orthopaedics Department , Peking University People's Hospital , Beijing , China
| | - Baoguo Jiang
- a Trauma & Orthopaedics Department , Peking University People's Hospital , Beijing , China
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18
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Deng JX, Zhang DY, Li M, Weng J, Kou YH, Zhang PX, Han N, Chen B, Yin XF, Jiang BG. Autologous transplantation with fewer fibers repairs large peripheral nerve defects. Neural Regen Res 2017; 12:2077-2083. [PMID: 29323049 PMCID: PMC5784358 DOI: 10.4103/1673-5374.221167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves (10–30 mm long) were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification’ phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.
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Affiliation(s)
- Jiu-Xu Deng
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Dian-Yin Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Ming Li
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Jian Weng
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Na Han
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Bo Chen
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Xiao-Feng Yin
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
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19
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Zhang SJ, Wu WL, Yang KY, Chen YZ, Liu HC. Phenotypic changes of Schwann cells on the proximal stump of injured peripheral nerve during repair using small gap conduit tube. Neural Regen Res 2017; 12:1538-1543. [PMID: 29090001 PMCID: PMC5649476 DOI: 10.4103/1673-5374.215266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dedifferentiation of Schwann cells is an important feature of the response to peripheral nerve injury and specific negative myelination regulators are considered to have a major role in this process. However, most experiments have focused on the distal nerve stump, where the Notch signaling pathway is strongly associated with Schwann cell dedifferentiation and repair of the nerve. We observed the phenotypic changes of Schwann cells and changes of active Notch signaling on the proximal stump during peripheral nerve repair using small gap conduit tubulization. Eighty rats, with right sciatic nerve section of 4 mm, were randomly assigned to conduit bridging group and control group (epineurium suture). Glial fibrillary acidic protein expression, in myelinating Schwann cells on the proximal stump, began to up-regulate at 1 day after injury and was still evident at 5 days. Compared with the control group, Notch1 mRNA was expressed at a higher level in the conduit bridging group during the first week on the proximal stump. Hes1 mRNA levels in the conduit bridging group significantly increased compared with the control group at 3, 5, 7 and 14 days post-surgery. The change of the Notch intracellular domain shared a similar trend as Hes1 mRNA expression. Our results confirmed that phenotypic changes of Schwann cells occurred in the proximal stump. The differences in these changes between the conduit tubulization and epineurium suture groups correlate with changes in Notch signaling. This suggests that active Notch signaling might be a key mechanism during the early stage of neural regeneration in the proximal nerve stump.
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Affiliation(s)
- Shi-Jun Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Wen-Liang Wu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Kai-Yun Yang
- Laboratory of Ears, Nose, and Throat, Oral and Maxillofacial Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yun-Zhen Chen
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Hai-Chun Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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20
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Ducic I, Safa B, DeVinney E. Refinements of nerve repair with connector-assisted coaptation. Microsurgery 2016; 37:256-263. [DOI: 10.1002/micr.30151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/03/2016] [Accepted: 12/16/2016] [Indexed: 01/12/2023]
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21
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Chen SL, Chen ZG, Dai HL, Ding JX, Guo JS, Han N, Jiang BG, # HJ, Li J, Li SP, Li WJ, Liu J, Liu Y, Ma JX, Peng J, Shen YD, Sun GW, Tang PF, Wang GH, Wang XH, Xiang LB, Xie RG, Xu JG, Yu B, Zhang LC, Zhang PX, Zhou SL. Repair, protection and regeneration of peripheral nerve injury. Neural Regen Res 2015; 10:1777-98. [PMID: 26807113 PMCID: PMC4705790 DOI: 10.4103/1673-5374.170301] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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22
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Abstract
BACKGROUND Direct neurorrhaphy, nerve grafting interposition and neurotization are the options for nerve repair in children, whereas few reports about using nerve conduits (tubulization) are referred to pediatrics in the literature. The authors present their experience about nerve repairing by means of nerve tubes during the developmental age when the harvesting of nerve grafts and also vein grafts of adequate caliber for bridging nerve defects is difficult. A critical review of their case series offers indications for using nerve conduits in pediatrics. MATERIALS AND METHODS Fifteen patients were treated using the nerve tubulization; nine patients were affected by obstetrical brachial plexus palsy (OBPP) while six were suffering from peripheral nerve injuries (PNIs). RESULTS In patients suffering from OBPP, we observed 1 good, 3 fair and 5 bad results. In the PNI group, we observed 4 patients who had good results while only 2 had a bad outcome. No fair results were observed. CONCLUSIONS In peripheral nerve repairing in children by using nerve conduits, the outcome has been widely effective even when dealing with mixed and motor nerve, thus nerve tubulization might be considered as an alternative to nerve grafting. Conversely, considering the uncertain result obtained in brachial plexus repairing, the conduits cannot be considered as a first choice of treatment in brachial plexus reconstruction.
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Affiliation(s)
- Filippo Maria Sénès
- Department of Head and Neck, Microsurgery and Hand Surgery Unit, Orthopaedic and Traumatology Unit, Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147 Genova, Italy
| | - Nunzio Catena
- Department of Head and Neck, Microsurgery and Hand Surgery Unit, Orthopaedic and Traumatology Unit, Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147 Genova, Italy
| | - Jacopo Sénès
- Department of Head and Neck, Microsurgery and Hand Surgery Unit, Orthopaedic and Traumatology Unit, Istituto Giannina Gaslini, Largo G. Gaslini 5, 16147 Genova, Italy
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Zhang PX, Li-Ya A, Kou YH, Yin XF, Xue F, Han N, Wang TB, Jiang BG. Biological conduit small gap sleeve bridging method for peripheral nerve injury: regeneration law of nerve fibers in the conduit. Neural Regen Res 2015; 10:71-8. [PMID: 25788923 PMCID: PMC4357121 DOI: 10.4103/1673-5374.150709] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/04/2022] Open
Abstract
The clinical effects of 2-mm small gap sleeve bridging of the biological conduit to repair peripheral nerve injury are better than in the traditional epineurium suture, so it is possible to replace the epineurium suture in the treatment of peripheral nerve injury. This study sought to identify the regeneration law of nerve fibers in the biological conduit. A nerve regeneration chamber was constructed in models of sciatic nerve injury using 2-mm small gap sleeve bridging of a biodegradable biological conduit. The results showed that the biological conduit had good histocompatibility. Tissue and cell apoptosis in the conduit apparently lessened, and regenerating nerve fibers were common. The degeneration regeneration law of Schwann cells and axons in the conduit was quite different from that in traditional epineurium suture. During the prime period for nerve fiber regeneration (2-8 weeks), the number of Schwann cells and nerve fibers was higher in both proximal and distal ends, and the effects of the small gap sleeve bridging method were better than those of the traditional epineurium suture. The above results provide an objective and reliable theoretical basis for the clinical application of the biological conduit small gap sleeve bridging method to repair peripheral nerve injury.
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Affiliation(s)
- Pei-Xun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - A Li-Ya
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Xiao-Feng Yin
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Feng Xue
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Na Han
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Tian-Bing Wang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
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Chen B, Niu SP, Wang ZY, Wang ZW, Deng JX, Zhang PX, Yin XF, Han N, Kou YH, Jiang BG. Local administration of icariin contributes to peripheral nerve regeneration and functional recovery. Neural Regen Res 2015; 10:84-9. [PMID: 25788925 PMCID: PMC4357123 DOI: 10.4103/1673-5374.150711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 01/17/2023] Open
Abstract
Our previous study showed that systemic administration of the traditional Chinese medicine Epimedium extract promotes peripheral nerve regeneration. Here, we sought to explore the therapeutic effects of local administration of icariin, a major component of Epimedium extract, on peripheral nerve regeneration. A poly(lactic-co-glycolic acid) biological conduit sleeve was used to bridge a 5 mm right sciatic nerve defect in rats, and physiological saline, nerve growth factor, icariin suspension, or nerve growth factor-releasing microsphere suspension was injected into the defect. Twelve weeks later, sciatic nerve conduction velocity and the number of myelinated fibers were notably greater in the rats treated with icariin suspension or nerve growth factor-releasing microspheres than those that had received nerve growth factor or physiological saline. The effects of icariin suspension were similar to those of nerve growth factor-releasing microspheres. These data suggest that icariin acts as a nerve growth factor-releasing agent, and indicate that local application of icariin after spinal injury can promote peripheral nerve regeneration.
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Affiliation(s)
- Bo Chen
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Su-Ping Niu
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Yong Wang
- Health Science Center, Peking University, Beijing, China
| | - Zhen-Wei Wang
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jiu-Xu Deng
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Xiao-Feng Yin
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Na Han
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
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25
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Xue F, Wu EJ, Zhang PX, Li-Ya A, Kou YH, Yin XF, Han N. Biodegradable chitin conduit tubulation combined with bone marrow mesenchymal stem cell transplantation for treatment of spinal cord injury by reducing glial scar and cavity formation. Neural Regen Res 2015; 10:104-11. [PMID: 25788929 PMCID: PMC4357092 DOI: 10.4103/1673-5374.150715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 01/25/2023] Open
Abstract
We examined the restorative effect of modified biodegradable chitin conduits in combination with bone marrow mesenchymal stem cell transplantation after right spinal cord hemisection injury. Immunohistochemical staining revealed that biological conduit sleeve bridging reduced glial scar formation and spinal muscular atrophy after spinal cord hemisection. Bone marrow mesenchymal stem cells survived and proliferated after transplantation in vivo, and differentiated into cells double-positive for S100 (Schwann cell marker) and glial fibrillary acidic protein (glial cell marker) at 8 weeks. Retrograde tracing showed that more nerve fibers had grown through the injured spinal cord at 14 weeks after combination therapy than either treatment alone. Our findings indicate that a biological conduit combined with bone marrow mesenchymal stem cell transplantation effectively prevented scar formation and provided a favorable local microenvironment for the proliferation, migration and differentiation of bone marrow mesenchymal stem cells in the spinal cord, thus promoting restoration following spinal cord hemisection injury.
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Affiliation(s)
- Feng Xue
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Er-Jun Wu
- Graduate School of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Pei-Xun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - A Li-Ya
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Yu-Hui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Xiao-Feng Yin
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Na Han
- Central Laboratory, Peking University People's Hospital, Beijing, China
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26
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Yu Y, Zhang P, Yin X, Han N, Kou Y, Jiang B. Specificity of motor axon regeneration: a comparison of recovery following biodegradable conduit small gap tubulization and epineurial neurorrhaphy. Am J Transl Res 2015; 7:53-65. [PMID: 25755828 PMCID: PMC4346523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Functional recovery is often unsatisfactory after lesions in the peripheral nervous system despite the strong potential for regeneration and advances in microsurgical techniques. Axonal regeneration in mixed nerve into inappropriate pathways is a major contributing factor to this failure. In this study, the rat femoral nerve model of transection and surgical repair was used to evaluate the specificity of motor axon regeneration as well as functional and morphological recovery using biodegradable conduit small gap tubulization compared to epineurial neurorrhaphy. 12 weeks after nerve repair, the specificity was assessed using the retrograde neurotracers TB and DiI to backlabel motor neurons that regenerate axons into muscle and cutaneous pathways. To evaluate the functional recovery of the quadriceps muscle, the quadriceps muscle forces were examined. The quadriceps muscle and myelinated axons were assessed using electrophysiology and histology. The results showed that the specificity of motor axon regeneration (preferential reinnervation) was significantly higher when the nerve transection was treated by biodegradable conduit small gap tubulization and there was no significant difference between the two suture methods with respect to the functional and morphological recovery. This study demonstrated that the quicker and easier biodegradable conduit small gap tubulization may get more accurate reinnervation than traditional epineurial neurorrhaphy and produced functional and morphological recovery equal to traditional epineurial neurorrhaphy.
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Affiliation(s)
- Youlai Yu
- Department of Trauma and Orthopedics, Peking University People's Hospital 11th Xizhimen South Street, Beijing, China
| | - Peixun Zhang
- Department of Trauma and Orthopedics, Peking University People's Hospital 11th Xizhimen South Street, Beijing, China
| | - Xiaofeng Yin
- Department of Trauma and Orthopedics, Peking University People's Hospital 11th Xizhimen South Street, Beijing, China
| | - Na Han
- Department of Trauma and Orthopedics, Peking University People's Hospital 11th Xizhimen South Street, Beijing, China
| | - Yuhui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital 11th Xizhimen South Street, Beijing, China
| | - Baoguo Jiang
- Department of Trauma and Orthopedics, Peking University People's Hospital 11th Xizhimen South Street, Beijing, China
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27
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Wang Z, Han N, Wang J, Zheng H, Peng J, Kou Y, Xu C, An S, Yin X, Zhang P, Jiang B. Improved peripheral nerve regeneration with sustained release nerve growth factor microspheres in small gap tubulization. Am J Transl Res 2014; 6:413-421. [PMID: 25075258 PMCID: PMC4113503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the long-term results of the use of nerve growth factor (NGF)-loaded poly-D, L-lactide-co-glycolide (PLGA) microspheres for improve nerve regeneration with small gap tubulization. METHODS NGF microspheres were prepared by a modified W/O/W emulsion solvent evaporation method. Forty-eight male SD rats were separated into 4 groups and received a chitin conduit to bridge a sciatic nerve injury left a 2 mm gap. Saline (Group A), 20 ng/ml NGF solution (Group B), blank PLGA microspheres (Group C), or 40 ng/ml NGF-loaded microspheres (Group D) was injected in the gap. Each group had two study endpoints, 3 months subgroup and 1 year subgroup. RESULTS The myelinated fiber count at 2 mm distal to the conduit at 1 year was slightly less than at 3 months in all groups (P>0.05). However, the maturity of the myelinated nerves at 1 year was obviously improved. The fiber count, myelin sheath thickness, axon area of NGF microsphere group were significantly higher than the saline groups at 3 months (P=0.05, P<0.05, and P<0.05, respectively). The SFI was significantly improved in NGF microspheres group compared to the saline group and NGF solution group at 1 year (P<0.05, and P<0.05, respectively). CONCLUSIONS The results demonstrated that the release of NGF microspheres in small gap tubulization benefit on peripheral nerve injury facilitated nerve regeneration histologically, especially for the maturity of early regenerative nerve fibers and also had an effect on functional recovery in the long term.
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Affiliation(s)
- Zhenwei Wang
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Na Han
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Jiancheng Wang
- Department of Pharmaceutics, School of pharmaceutical sciences, Peking UniversityBeijing, China
| | - Hua Zheng
- Department of Pharmaceutics, School of pharmaceutical sciences, Peking UniversityBeijing, China
| | - Jianping Peng
- Department of Orthopedics, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of MedicineShanghai, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Chungui Xu
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Shuai An
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Xiaofeng Yin
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Peixun Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People’s Hospital11th Xizhimen South Street, Beijing, China
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28
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Barton MJ, Morley JW, Stoodley MA, Lauto A, Mahns DA. Nerve repair: toward a sutureless approach. Neurosurg Rev 2014; 37:585-95. [PMID: 25015388 DOI: 10.1007/s10143-014-0559-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/04/2014] [Accepted: 04/13/2014] [Indexed: 12/16/2022]
Abstract
Peripheral nerve repair for complete section injuries employ reconstructive techniques that invariably require sutures in their application. Sutures are unable to seal the nerve, thus incapable of preventing leakage of important intraneural fluids from the regenerating nerve. Furthermore, sutures are technically demanding to apply for direct repairs and often induce detrimental scarring that impedes healing and functional recovery. To overcome these limitations, biocompatible and biodegradable glues have been used to seal and repair peripheral nerves. Although creating a sufficient seal, they can lack flexibility and present infection risks or cytotoxicity. Other adhesive biomaterials have recently emerged into practice that are usually based on proteins such as albumin and collagen or polysaccharides like chitosan. These adhesives form their union to nerve tissue by either photothermal (tissue welding) or photochemical (tissue bonding) activation with laser light. These biomaterial adhesives offer significant advantages over sutures, such as their capacity to unite and seal the epineurium, ease of application, reduced invasiveness and add the potential for drug delivery in situ to facilitate regeneration. This paper reviews a number of different peripheral nerve repair (or reconstructive) techniques currently used clinically and in experimental procedures for nerve injuries with or without tissue deficit.
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Affiliation(s)
- Matthew J Barton
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, 4222, Australia,
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29
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Wang J, Ren KY, Wang YH, Kou YH, Zhang PX, Peng JP, Deng L, Zhang HB, Jiang BG. Effect of active Notch signaling system on the early repair of rat sciatic nerve injury. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2014; 43:383-9. [PMID: 24866722 DOI: 10.3109/21691401.2014.896372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
It is all known that dedifferentiated Schwann cells (SCs) play an important role in neural regeneration, and Notch signaling has complex and extensive regulatory functions in dedifferentiated SCs. So studies have focused on how to improve peripheral nerve repair by regulating proliferation and dedifferentiation in SCs with Notch signaling meloculars.We have found SCs can be activated when adding Recombinant rat jagged1/FC chimera (an activator of the Notch signaling system) in vivo. Compared with that of the control groups, at 4 weeks post-surgery nerve regeneration and functional rehabilitation in the Recombinant rat jagged1/FC chimera group were advanced significantly, and the expression of neurotrophic factors in the regenerated nerves was elevated largely. These results indicated that SCs activated by Notch signaling could promote nerve repair effectively in the early regenerative stage, suggesting the possible clinical application for the treatment of peripheral nerve defects.
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Affiliation(s)
- Jin Wang
- a Department of Pathology , Medical College, Qing Dao University , Qing Dao , P. R. China
| | - Ke-Yu Ren
- b The Affiliated Hospital of Medical College, Qing Dao University , Qing Dao , P. R. China
| | - Yan-Hua Wang
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
| | - Yu-Hui Kou
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
| | - Pei-Xun Zhang
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
| | - Jian-Ping Peng
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
| | - Lei Deng
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
| | - Hong-Bo Zhang
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
| | - Bao-Guo Jiang
- c Department of Trauma and Orthopedics , People's Hospital, Peking University , Beijing , P. R. China
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30
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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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31
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Piskin A, Altunkaynak BZ, Çitlak A, Sezgin H, Yazιcι O, Kaplan S. Immediate versus delayed primary nerve repair in the rabbit sciatic nerve. Neural Regen Res 2013; 8:3410-5. [PMID: 25206663 PMCID: PMC4146006 DOI: 10.3969/j.issn.1673-5374.2013.36.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/23/2013] [Indexed: 11/18/2022] Open
Abstract
It is well known that peripheral nerve injury should be treated immediately in the clinic, but in some instances, repair can be delayed. This study investigated the effects of immediate versus delayed (3 days after injury) neurorrhaphy on repair of transected sciatic nerve in New Zealand rabbits using stereological, histomorphological and biomechanical methods. At 8 weeks after immediate and delayed neurorrhaphy, axon number and area in the sciatic nerve, myelin sheath and epineurium thickness, Schwann cell morphology, and the mechanical property of nerve fibers did not differ obviously. These results indicate that delayed neurorrhaphy do not produce any deleterious effect on sciatic nerve repair.
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Affiliation(s)
- Ahmet Piskin
- Department of Orthopedics and Traumatology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Berrin Zühal Altunkaynak
- Department of Histology and Embryology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Atilla Çitlak
- Department of Orthopedics and Traumatology, School of Medicine, Giresun University, Giresun, Turkey
| | - Hicabi Sezgin
- Department of Orthopedics and Traumatology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ozgür Yazιcι
- Department of Orthopedics and Traumatology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Süleyman Kaplan
- Department of Histology and Embryology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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