1
|
Wang S, Wen X, Fan Z, Ding X, Wang Q, Liu Z, Yu W. Research advancements on nerve guide conduits for nerve injury repair. Rev Neurosci 2024; 35:627-637. [PMID: 38517315 DOI: 10.1515/revneuro-2023-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/19/2023] [Indexed: 03/23/2024]
Abstract
Peripheral nerve injury (PNI) is one of the most serious causes of disability and loss of work capacity of younger individuals. Although PNS has a certain degree of regeneration, there are still challenges like disordered growth, neuroma formation, and incomplete regeneration. Regarding the management of PNI, conventional methods such as surgery, pharmacotherapy, and rehabilitative therapy. Treatment strategies vary depending on the severity of the injury. While for the long nerve defect, autologous nerve grafting is commonly recognized as the preferred surgical approach. Nevertheless, due to lack of donor sources, neurological deficits and the low regeneration efficiency of grafted nerves, nerve guide conduits (NGCs) are recognized as a future promising technology in recent years. This review provides a comprehensive overview of current treatments for PNI, and discusses NGCs from different perspectives, such as material, design, fabrication process, and composite function.
Collapse
Affiliation(s)
- Shoushuai Wang
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| | - Xinggui Wen
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| | - Zheyuan Fan
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| | - Xiangdong Ding
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| | - Qianqian Wang
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| | - Zhongling Liu
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| | - Wei Yu
- China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City 130033, Jilin Province, China
| |
Collapse
|
2
|
Crabtree JR, Mulenga CM, Tran K, Feinberg K, Santerre JP, Borschel GH. Biohacking Nerve Repair: Novel Biomaterials, Local Drug Delivery, Electrical Stimulation, and Allografts to Aid Surgical Repair. Bioengineering (Basel) 2024; 11:776. [PMID: 39199733 PMCID: PMC11352148 DOI: 10.3390/bioengineering11080776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/15/2024] [Accepted: 07/26/2024] [Indexed: 09/01/2024] Open
Abstract
The regenerative capacity of the peripheral nervous system is limited, and peripheral nerve injuries often result in incomplete healing and poor outcomes even after repair. Transection injuries that induce a nerve gap necessitate microsurgical intervention; however, even the current gold standard of repair, autologous nerve graft, frequently results in poor functional recovery. Several interventions have been developed to augment the surgical repair of peripheral nerves, and the application of functional biomaterials, local delivery of bioactive substances, electrical stimulation, and allografts are among the most promising approaches to enhance innate healing across a nerve gap. Biocompatible polymers with optimized degradation rates, topographic features, and other functions provided by their composition have been incorporated into novel nerve conduits (NCs). Many of these allow for the delivery of drugs, neurotrophic factors, and whole cells locally to nerve repair sites, mitigating adverse effects that limit their systemic use. The electrical stimulation of repaired nerves in the perioperative period has shown benefits to healing and recovery in human trials, and novel biomaterials to enhance these effects show promise in preclinical models. The use of acellular nerve allografts (ANAs) circumvents the morbidity of donor nerve harvest necessitated by the use of autografts, and improvements in tissue-processing techniques may allow for more readily available and cost-effective options. Each of these interventions aid in neural regeneration after repair when applied independently, and their differing forms, benefits, and methods of application present ample opportunity for synergistic effects when applied in combination.
Collapse
Affiliation(s)
- Jordan R. Crabtree
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Chilando M. Mulenga
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Khoa Tran
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Konstantin Feinberg
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - J. Paul Santerre
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON M5S 3G9, Canada
| | - Gregory H. Borschel
- Division of Plastic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
3
|
Hazer Rosberg DB, Stenberg L, Mahlapuu M, Dahlin LB. PXL01 alters macrophage response with no effect on axonal outgrowth or Schwann cell response after nerve repair in rats. Regen Med 2024; 19:327-343. [PMID: 38957920 PMCID: PMC11346556 DOI: 10.1080/17460751.2024.2361515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024] Open
Abstract
Background: Adjunctive pharmacological treatment may improve nerve regeneration. We investigated nerve regeneration processes of PXL01 - a lactoferrin-derived peptide - after repair of the sciatic nerve in healthy Wistar rats.Materials & methods: PXL01, sodium hyaluronate (carrier) or sodium chloride was administered around the repair. After 6 days axonal outgrowth, Schwann cell response, pan- (CD68) and pro-healing (CD206) macrophages in sciatic nerve, sensory neuronal response in dorsal root ganglia (DRG) and expression of heat shock protein 27 (HSP27) in sciatic nerves and DRGs were analyzed.Results: Despite a lower number of pan-macrophages, other investigated variables in sciatic nerves or DRGs did not differ between the treatment groups.Conclusion: PLX01 applied locally inhibits inflammation through pan-macrophages in repaired sciatic nerves without any impact on nerve regeneration or pro-healing macrophages.
Collapse
Affiliation(s)
- Derya Burcu Hazer Rosberg
- Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, MalmöSE-20502, Sweden
| | - Lena Stenberg
- Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
| | - Margit Mahlapuu
- Department of Chemistry & Molecular Biology, Göteborg University , SE-40530, Göteborg, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, SE-20502, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, MalmöSE-20502, Sweden
- Department of Biomedical & Clinical Sciences, Linköping University, LinköpingSE-58183, Sweden
| |
Collapse
|
4
|
Zhao X, Deng H, Feng Y, Wang Y, Yao X, Ma Y, Zhang L, Jie J, Yang P, Yang Y. Immune-cell-mediated tissue engineering strategies for peripheral nerve injury and regeneration. J Mater Chem B 2024; 12:2217-2235. [PMID: 38345580 DOI: 10.1039/d3tb02557h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
During the process of peripheral nerve repair, there are many complex pathological and physiological changes, including multi-cellular responses and various signaling molecules, and all these events establish a dynamic microenvironment for axon repair, regeneration, and target tissue/organ reinnervation. The immune system plays an indispensable role in the process of nerve repair and function recovery. An effective immune response not only involves innate-immune and adaptive-immune cells but also consists of chemokines and cytokines released by these immune cells. The elucidation of the orchestrated interplay of immune cells with nerve regeneration and functional restoration is meaningful for the exploration of therapeutic strategies. This review mainly enumerates the general immune cell response to peripheral nerve injury and focuses on their contributions to functional recovery. The tissue engineering-mediated strategies to regulate macrophages and T cells through physical and biochemical factors combined with scaffolds are discussed. The dynamic immune responses during peripheral nerve repair and immune-cell-mediated tissue engineering methods are presented, which provide a new insight and inspiration for immunomodulatory therapies in peripheral nerve regeneration.
Collapse
Affiliation(s)
- Xueying Zhao
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Hui Deng
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Yuan Feng
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Yuehan Wang
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Xiaomin Yao
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Yuyang Ma
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Luzhong Zhang
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Jing Jie
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, 226001, Nantong, P. R. China.
| | - Pengxiang Yang
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| | - Yumin Yang
- Key Laboratory of Neuroregeneration of Jiangsu Province and Ministry of Education, Co-Innovation Center of Neuroregeneration, NMPA Key Laboratory for Research and Evaluation of Tissue Engineering Technology Products, Nantong University, 226001, Nantong, P. R. China.
| |
Collapse
|
5
|
Dahlin LB. The Dynamics of Nerve Degeneration and Regeneration in a Healthy Milieu and in Diabetes. Int J Mol Sci 2023; 24:15241. [PMID: 37894921 PMCID: PMC10607341 DOI: 10.3390/ijms242015241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Appropriate animal models, mimicking conditions of both health and disease, are needed to understand not only the biology and the physiology of neurons and other cells under normal conditions but also under stress conditions, like nerve injuries and neuropathy. In such conditions, understanding how genes and different factors are activated through the well-orchestrated programs in neurons and other related cells is crucial. Knowledge about key players associated with nerve regeneration intended for axonal outgrowth, migration of Schwann cells with respect to suitable substrates, invasion of macrophages, appropriate conditioning of extracellular matrix, activation of fibroblasts, formation of endothelial cells and blood vessels, and activation of other players in healthy and diabetic conditions is relevant. Appropriate physical and chemical attractions and repulsions are needed for an optimal and directed regeneration and are investigated in various nerve injury and repair/reconstruction models using healthy and diabetic rat models with relevant blood glucose levels. Understanding dynamic processes constantly occurring in neuropathies, like diabetic neuropathy, with concomitant degeneration and regeneration, requires advanced technology and bioinformatics for an integrated view of the behavior of different cell types based on genomics, transcriptomics, proteomics, and imaging at different visualization levels. Single-cell-transcriptional profile analysis of different cells may reveal any heterogeneity among key players in peripheral nerves in health and disease.
Collapse
Affiliation(s)
- Lars B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, SE-205 02 Malmö, Sweden; ; Tel.: +46-40-33-17-24
- Department of Hand Surgery, Skåne University Hospital, SE-205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
| |
Collapse
|
6
|
Reshamwala R, Shah M. Regenerative Approaches in the Nervous System. Regen Med 2023. [DOI: 10.1007/978-981-19-6008-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
7
|
Bergsten E, Rydberg M, Dahlin LB, Zimmerman M. Carpal Tunnel Syndrome and Ulnar Nerve Entrapment at the Elbow Are Not Associated With Plasma Levels of Caspase-3, Caspase-8 or HSP27. Front Neurosci 2022; 16:809537. [PMID: 35310100 PMCID: PMC8931660 DOI: 10.3389/fnins.2022.809537] [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: 11/05/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nerve compression disorders, such as carpal tunnel syndrome (CTS) and ulnar entrapment at the elbow (UNE), may be associated with apoptosis and neuroprotective mechanisms in the peripheral nerve that may be detected by biomarkers in the blood. The relationships between CTS and UNE and two biomarkers of apoptosis, i.e., caspase-3 and caspase-8, and the neuroprotective factor Heat Shock Protein 27 (HSP27) in plasma were examined in a population-based cohort. Method The biomarkers caspase-3, caspase-8 and HSP27 were measured in plasma at inclusion of 4,284 study participants aged 46-68 years in the population-based Malmö Diet and Cancer study (MDCS). End-point retrieval was made from national registers concerning CTS and UNE. Independent t-test was used to examine the association between caspase-3, caspase-8 and HSP27 plasma levels and incidence of CTS and UNE. Cox proportional hazards regression was used to investigate if plasma levels of caspase-3, caspase-8 and HSP27 affected time to diagnosis of CTS or UNE. Results During the mean follow-up time of 22 years, 189/4,284 (4%) participants were diagnosed with CTS and 42/4,284 (1%) were diagnosed with UNE. No associations were found between incident CTS or UNE and the biomarkers caspase-3, caspase-8 and HSP27 in plasma. Conclusion The apoptotic biomarkers caspase-3 and caspase-8 and the neuroprotective factor HSP27 in plasma, factors conceivably related to a nerve injury, are not associated with the nerve compression disorders CTS and UNE in a general population.
Collapse
Affiliation(s)
- Elin Bergsten
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
| | - Mattias Rydberg
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Lars B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Malin Zimmerman
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
- Department of Translational Medicine—Hand Surgery, Lund University, Lund, Sweden
| |
Collapse
|
8
|
Wofford KL, Shultz RB, Burrell JC, Cullen DK. Neuroimmune interactions and immunoengineering strategies in peripheral nerve repair. Prog Neurobiol 2022; 208:102172. [PMID: 34492307 PMCID: PMC8712351 DOI: 10.1016/j.pneurobio.2021.102172] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
Peripheral nerve injuries result in disrupted cellular communication between the central nervous system and somatic distal end targets. The peripheral nervous system is capable of independent and extensive regeneration; however, meaningful target muscle reinnervation and functional recovery remain limited and may result in chronic neuropathic pain and diminished quality of life. Macrophages, the primary innate immune cells of the body, are critical contributors to regeneration of the injured peripheral nervous system. However, in some clinical scenarios, macrophages may fail to provide adequate support with optimal timing, duration, and location. Here, we review the history of immunosuppressive and immunomodulatory strategies to treat nerve injuries. Thereafter, we enumerate the ways in which macrophages contribute to successful nerve regeneration. We argue that implementing macrophage-based immunomodulatory therapies is a promising treatment strategy for nerve injuries across a wide range of clinical presentations.
Collapse
Affiliation(s)
- Kathryn L Wofford
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, United States; Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States
| | - Robert B Shultz
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, United States; Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States; Axonova Medical, LLC, Philadelphia, PA, 19104, United States
| | - Justin C Burrell
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, United States; Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - D Kacy Cullen
- Center for Brain Injury & Repair, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, United States; Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States; Axonova Medical, LLC, Philadelphia, PA, 19104, United States; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, United States.
| |
Collapse
|
9
|
Dervan A, Franchi A, Almeida-Gonzalez FR, Dowling JK, Kwakyi OB, McCoy CE, O’Brien FJ, Hibbitts A. Biomaterial and Therapeutic Approaches for the Manipulation of Macrophage Phenotype in Peripheral and Central Nerve Repair. Pharmaceutics 2021; 13:2161. [PMID: 34959446 PMCID: PMC8706646 DOI: 10.3390/pharmaceutics13122161] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/18/2022] Open
Abstract
Injury to the peripheral or central nervous systems often results in extensive loss of motor and sensory function that can greatly diminish quality of life. In both cases, macrophage infiltration into the injury site plays an integral role in the host tissue inflammatory response. In particular, the temporally related transition of macrophage phenotype between the M1/M2 inflammatory/repair states is critical for successful tissue repair. In recent years, biomaterial implants have emerged as a novel approach to bridge lesion sites and provide a growth-inductive environment for regenerating axons. This has more recently seen these two areas of research increasingly intersecting in the creation of 'immune-modulatory' biomaterials. These synthetic or naturally derived materials are fabricated to drive macrophages towards a pro-repair phenotype. This review considers the macrophage-mediated inflammatory events that occur following nervous tissue injury and outlines the latest developments in biomaterial-based strategies to influence macrophage phenotype and enhance repair.
Collapse
Affiliation(s)
- Adrian Dervan
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (A.D.); (A.F.); (F.R.A.-G.); (F.J.O.)
- Trinity Centre for Bioengineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, D02 YN77 Dublin, Ireland
| | - Antonio Franchi
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (A.D.); (A.F.); (F.R.A.-G.); (F.J.O.)
- Trinity Centre for Bioengineering, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Francisco R. Almeida-Gonzalez
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (A.D.); (A.F.); (F.R.A.-G.); (F.J.O.)
- Trinity Centre for Bioengineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, D02 YN77 Dublin, Ireland
| | - Jennifer K. Dowling
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (J.K.D.); (O.B.K.); (C.E.M.)
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Ohemaa B. Kwakyi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (J.K.D.); (O.B.K.); (C.E.M.)
- School of Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Claire E. McCoy
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (J.K.D.); (O.B.K.); (C.E.M.)
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Fergal J. O’Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (A.D.); (A.F.); (F.R.A.-G.); (F.J.O.)
- Trinity Centre for Bioengineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, D02 YN77 Dublin, Ireland
| | - Alan Hibbitts
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (A.D.); (A.F.); (F.R.A.-G.); (F.J.O.)
- Trinity Centre for Bioengineering, Trinity College Dublin, D02 R590 Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, D02 YN77 Dublin, Ireland
| |
Collapse
|
10
|
de Lima GG, Júnior ELDS, Aggio BB, Shee BS, Filho EMDM, Segundo FADS, Fournet MB, Devine DM, Magalhães WLE, de Sá MJC. Nanocellulose for peripheral nerve regeneration in rabbits using citric acid as crosslinker with chitosan and freeze/thawed PVA. Biomed Mater 2021; 16. [PMID: 34330112 DOI: 10.1088/1748-605x/ac199b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
This work investigates peripheral nerve regeneration using membranes consisting of pure chitosan (CHI), which was further blended with nanofibrillated cellulose, with citric acid as crosslinker, with posterior addition of polyvinyl alcohol, with subsequent freeze thawing. Nanocellulose improves the mechanical and thermal resistance, as well as flexibility of the film, which is ideal for the surgical procedure. The hydrogel presented a slow rate of swelling, which is adequate for cell and drug delivery. A series ofin vitrotests revealed to be non-toxic for neuronal Schwann cell from the peripheral nervous system of Rattus norvegicus, while there was a slight increase in toxicity if crosslink is performed-freeze-thaw. Thein vivoresults, using rabbits with a 5 mm gap nerve defect, revealed that even though pure CHI was able to regenerate the nerve, it did not present functional recovery with only the deep pain attribute being regenerated. When autologous implant was used jointly with the biomaterial membrane, as a covering agent, it revealed a functional recovery within 15 d when cellulose and the hydrogel were introduced, which was attributed to the film charge interaction that may help influence the neuronal axons growth into correct locations. Thus, indicating that this system presents ideal regeneration as nerve conduits.
Collapse
Affiliation(s)
- Gabriel G de Lima
- Programa de Pós-Graduação em Engenharia e Ciência dos Materiais-PIPE, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Emílio L de S Júnior
- Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| | - Bruno B Aggio
- Departamento de Química, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Bor Shin Shee
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Emanuel M de M Filho
- Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| | - Francisco A de S Segundo
- Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| | - Margaret B Fournet
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Declan M Devine
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Washington L E Magalhães
- Programa de Pós-Graduação em Engenharia e Ciência dos Materiais-PIPE, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Embrapa Florestas, Colombo, Brazil
| | - Marcelo J C de Sá
- Programa de Pós-Graduação em Engenharia e Ciência dos Materiais-PIPE, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| |
Collapse
|
11
|
Stenberg L, Hazer Rosberg DB, Kohyama S, Suganuma S, Dahlin LB. Injury-Induced HSP27 Expression in Peripheral Nervous Tissue Is Not Associated with Any Alteration in Axonal Outgrowth after Immediate or Delayed Nerve Repair. Int J Mol Sci 2021; 22:ijms22168624. [PMID: 34445330 PMCID: PMC8395341 DOI: 10.3390/ijms22168624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
We investigated injury-induced heat shock protein 27 (HSP27) expression and its association to axonal outgrowth after injury and different nerve repair models in healthy Wistar and diabetic Goto-Kakizaki rats. By immunohistochemistry, expression of HSP27 in sciatic nerves and DRG and axonal outgrowth (neurofilaments) in sciatic nerves were analyzed after no, immediate, and delayed (7-day delay) nerve repairs (7- or 14-day follow-up). An increased HSP27 expression in nerves and in DRG at the uninjured side was associated with diabetes. HSP27 expression in nerves and in DRG increased substantially after the nerve injuries, being higher at the site where axons and Schwann cells interacted. Regression analysis indicated a positive influence of immediate nerve repair compared to an unrepaired injury, but a shortly delayed nerve repair had no impact on axonal outgrowth. Diabetes was associated with a decreased axonal outgrowth. The increased expression of HSP27 in sciatic nerve and DRG did not influence axonal outgrowth. Injured sciatic nerves should appropriately be repaired in healthy and diabetic rats, but a short delay does not influence axonal outgrowth. HSP27 expression in sciatic nerve or DRG, despite an increase after nerve injury with or without a repair, is not associated with any alteration in axonal outgrowth.
Collapse
Affiliation(s)
- Lena Stenberg
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden; (D.B.H.R.); (L.B.D.)
- Correspondence: ; Tel.: +46-730-49-73-76
| | - Derya Burcu Hazer Rosberg
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden; (D.B.H.R.); (L.B.D.)
- Department of Neurosurgery, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla 48100, Turkey
| | - Sho Kohyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan;
| | - Seigo Suganuma
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan;
| | - Lars B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden; (D.B.H.R.); (L.B.D.)
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| |
Collapse
|
12
|
Hazer Rosberg DB, Hazer B, Stenberg L, Dahlin LB. Gold and Cobalt Oxide Nanoparticles Modified Poly-Propylene Poly-Ethylene Glycol Membranes in Poly (ε-Caprolactone) Conduits Enhance Nerve Regeneration in the Sciatic Nerve of Healthy Rats. Int J Mol Sci 2021; 22:7146. [PMID: 34281198 PMCID: PMC8268459 DOI: 10.3390/ijms22137146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022] Open
Abstract
Reconstruction of nerve defects is a clinical challenge. Autologous nerve grafts as the gold standard treatment may result in an incomplete restoration of extremity function. Biosynthetic nerve conduits are studied widely, but still have limitations. Here, we reconstructed a 10 mm sciatic nerve defect in healthy rats and analyzed nerve regeneration in poly (ε-caprolactone) (PCL) conduits longitudinally divided by gold (Au) and gold-cobalt oxide (AuCoO) nanoparticles embedded in poly-propylene poly-ethylene glycol (PPEG) membranes (AuPPEG or AuCoOPPEG) and compared it with unmodified PPEG-membrane and hollow PCL conduits. After 21 days, we detected significantly better axonal outgrowth, together with higher numbers of activated Schwann cells (ATF3-labelled) and higher HSP27 expression, in reconstructed sciatic nerve and in corresponding dorsal root ganglia (DRG) in the AuPPEG and AuCoOPPEG groups; whereas the number of apoptotic Schwann cells (cleaved caspase 3-labelled) was significantly lower. Furthermore, numbers of activated and apoptotic Schwann cells in the regenerative matrix correlated with axonal outgrowth, whereas HSP27 expression in the regenerative matrix and in DRGs did not show any correlation with axonal outgrowth. We conclude that gold and cobalt-oxide nanoparticle modified membranes in conduits improve axonal outgrowth and increase the regenerative performance of conduits after nerve reconstruction.
Collapse
Affiliation(s)
- Derya Burcu Hazer Rosberg
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden; (L.S.); (L.B.D.)
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Neurosurgery, Mugla Sitki Kocman University, Mugla 48100, Turkey
| | - Baki Hazer
- Department of Aircraft Airflame Engine Maintenance, Kapadokya University, Ürgüp 50420, Turkey;
- Department of Chemistry, Zonguldak Bülent Ecevit University, Zonguldak 67100, Turkey
| | - Lena Stenberg
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden; (L.S.); (L.B.D.)
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
| | - Lars B. Dahlin
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden; (L.S.); (L.B.D.)
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| |
Collapse
|
13
|
Modified Hyaluronic Acid-Laminin-Hydrogel as Luminal Filler for Clinically Approved Hollow Nerve Guides in a Rat Critical Defect Size Model. Int J Mol Sci 2021; 22:ijms22126554. [PMID: 34207389 PMCID: PMC8235360 DOI: 10.3390/ijms22126554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022] Open
Abstract
Hollow nerve guidance conduits are approved for clinical use for defect lengths of up to 3 cm. This is because also in pre-clinical evaluation they are less effective in the support of nerve regeneration over critical defect lengths. Hydrogel luminal fillers are thought to improve the regeneration outcome by providing an optimized matrix inside bioartificial nerve grafts. We evaluated here a modified hyaluronic acid-laminin-hydrogel (M-HAL) as luminal filler for two clinically approved hollow nerve guides. Collagen-based and chitosan-based nerve guides were filled with M-HAL in two different concentrations and the regeneration outcome comprehensively studied in the acute repair rat sciatic nerve 15 mm critical defect size model. Autologous nerve graft (ANG) repair served as gold-standard control. At 120 days post-surgery, all ANG rats demonstrated electrodiagnostically detectable motor recovery. Both concentrations of the hydrogel luminal filler induced improved regeneration outcome over empty nerve guides. However, neither combination with collagen- nor chitosan-based nerve guides resulted in functional recovery comparable to the ANG repair. In contrast to our previous studies, we demonstrate here that M-HAL slightly improved the overall performance of either empty nerve guide type in the critical defect size model.
Collapse
|
14
|
Agarwal P, Sharma D, Nebhani D, Kukrele R, Kukrele P. Saphenous nerve to posterior tibial nerve transfer: A new approach to restore sensations of sole in diabetic sensory polyneuropathy. J Plast Reconstr Aesthet Surg 2021; 74:2110-2119. [PMID: 33612426 DOI: 10.1016/j.bjps.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Loss of sensations in the sole following diabetic sensorimotor polyneuropathy (DSPN) leads to diabetic foot ulcers and its sequelae. We hypothesized that sensory reinnervation of sole by transfer of saphenous nerve (SN) to sensory fascicles of posterior tibial nerve (PTN) in these patients may reverse the neuropathy. METHODS This prospective interventional case series included patients with advanced DSPN and intact sensory supply of SN. PTN was neurotized by transfer of SN nerve in the tarsal tunnel and postoperatively sensations of the sole were tested. Any existing ulcers on sole were noted and their healing was monitored. FINDING A total of 17 patients (22 feet), 9 male and 8 female, were included. Seven patients had ulcers in the feet. At 6 months follow-up all patients developed protective sensation in the sole. The average 2 PD improved from 60 mm to 45.5 mm, average vibration perception improved from 34.12 V to 24.33, Medical Research Council (MRC) score improved from S0 in 12 feet and S1 in 10 feet to S3+ in 13 feet, S3 in 5 feet, and S2 in 2 feet at 6 months along with healing of ulcers in all 7 feet. INTERPRETATION Transfer of SN to PTN for sensory neurotization is an innovative and simple option to prevent complications of DSPN. This procedure has the potential to change the natural history of DSPN.
Collapse
Affiliation(s)
- Pawan Agarwal
- Plastic Surgery Unit, NSCB Govt Medical College, 292/293 Napier town, Jabalpur 482001, India.
| | - D Sharma
- Department of Surgery, NSCB Govt Medical College, India
| | | | | | | |
Collapse
|
15
|
Agarwal P, Sharma D. Our experience of reinnervation of sole in diabetic sensorimotor polyneuropathy: A chance to change the natural history of disease. J Clin Orthop Trauma 2021; 17:25-29. [PMID: 33717968 PMCID: PMC7920140 DOI: 10.1016/j.jcot.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022] Open
Abstract
Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel's sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.
Collapse
Affiliation(s)
- Pawan Agarwal
- Professor, and in Charge Plastic Surgery Unit, NSCB Government Medical College, Jabalpur MP, 482003, India
- Corresponding author. 292/293, Napier Town, Jabalpur, 482001, MP, India.
| | - Dhananjaya Sharma
- Professor and Head, Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| |
Collapse
|
16
|
Niu Y, Galluzzi M. A biodegradable block polyurethane nerve-guidance scaffold enhancing rapid vascularization and promoting reconstruction of transected sciatic nerve in Sprague-Dawley rats. J Mater Chem B 2020; 8:11063-11073. [PMID: 33200763 DOI: 10.1039/d0tb02069a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Reconstruction of peripheral nerve defects with tissue engineered nerve scaffolds is an exciting field of biomedical research and holds potential for clinical application. However, due to poor neovascularization after the implantation, nerve regeneration is still not satisfactory, especially for large nerve defects. These obstacles hinder the investigation of basic neurobiological principles and development of a wide range of treatments for peripheral nerve diseases. Herein, we designed an amphiphilic alternating block polyurethane (abbreviated as PU) copolymer-based nerve guidance scaffold, which has good Schwann cell compatibility, and more importantly, a rapid vascularization of the scaffold in vivo. In the sciatic nerve transection model of SD rats, vascularized PU nerve guidance scaffolds induced rapid regeneration of nerve fibers and axons along the scaffold. Through the analysis of nerve electrophysiology, sciatic nerve functional index, histology, and immunofluorescence related to angiogenesis, we determined that PU with rapid vascularization function enhances recovery and re-obtains nerve conduction function. Our study points out a new strategy of using nerve tissue engineering scaffolds to treat large nerve defects.
Collapse
Affiliation(s)
- Yuqing Niu
- Department of Pediatric Surgery, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China.
| | - Massimiliano Galluzzi
- Materials Interface Center, Shenzhen Key Laboratory of Nanobiomechanics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, Guangdong, China
| |
Collapse
|
17
|
Dietzmeyer N, Förthmann M, Grothe C, Haastert-Talini K. Modification of tubular chitosan-based peripheral nerve implants: applications for simple or more complex approaches. Neural Regen Res 2020; 15:1421-1431. [PMID: 31997801 PMCID: PMC7059590 DOI: 10.4103/1673-5374.271668] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/02/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022] Open
Abstract
Surgical treatment of peripheral nerve injuries is still a major challenge in human clinic. Up to now, none of the well-developed microsurgical treatment options is able to guarantee a complete restoration of nerve function. This restriction is also effective for novel clinically approved artificial nerve guides. In this review, we compare surgical repair techniques primarily for digital nerve injuries reported with relatively high prevalence to be valuable attempts in clinical digital nerve repair and point out their advantages and shortcomings. We furthermore discuss the use of artificial nerve grafts with a focus on chitosan-based nerve guides, for which our own studies contributed to their approval for clinical use. In the second part of this review, very recent future perspectives for the enhancement of tubular (commonly hollow) nerve guides are discussed in terms of their clinical translatability and ability to form three-dimensional constructs that biomimick the natural nerve structure. This includes materials that have already shown their beneficial potential in in vivo studies like fibrous intraluminal guidance structures, hydrogels, growth factors, and approaches of cell transplantation. Additionally, we highlight upcoming future perspectives comprising co-application of stem cell secretome. From our overview, we conclude that already simple attempts are highly effective to increase the regeneration supporting properties of nerve guides in experimental studies. But for bringing nerve repair with bioartificial nerve grafts to the next level, e.g. repair of defects > 3 cm in human patients, more complex intraluminal guidance structures such as innovatively manufactured hydrogels and likely supplementation of stem cells or their secretome for therapeutic purposes may represent promising future perspectives.
Collapse
Affiliation(s)
- Nina Dietzmeyer
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Center for Systems Neuroscience (ZSN) Hannover, Hannover, Germany
| | - Maria Förthmann
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Center for Systems Neuroscience (ZSN) Hannover, Hannover, Germany
| | - Claudia Grothe
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Center for Systems Neuroscience (ZSN) Hannover, Hannover, Germany
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Center for Systems Neuroscience (ZSN) Hannover, Hannover, Germany
| |
Collapse
|
18
|
Kaltenborn A, Krezdorn N, Hoffmann S, Gutcke A, Haastert-Talini K, Vogt PM, Haverich A, Wiegmann B. Ex vivo limb perfusion for traumatic amputation in military medicine. Mil Med Res 2020; 7:21. [PMID: 32334640 PMCID: PMC7183706 DOI: 10.1186/s40779-020-00250-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Limb loss has a drastic impact on a patient's life. Severe trauma to the extremities is common in current military conflicts. Among other aspects, "life before limb" damage control surgery hinders immediate replantation within the short post-traumatic timeframe, which is limited in part by the ischemic time for successful replantation. Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation. PRESENTATION OF THE HYPOTHESIS The current lack of replantation possibilities in military operations with high rates of amputation can be addressed with the development of a portable ex vivo limb perfusion device, as there are several opportunities present with the introduction of this technique on the horizon. We hypothesize that ex vivo limb perfusion will enable overcoming the critical ischemic time, provide surgical opportunities such as preparation of the stump and limb, allow for spare-part surgery, enable rigorous antibiotic treatment of the limb, reduce ischemia-reperfusion injuries, enable a tissue function assessment before replantation, and enable the development of large limb transplant programs. TESTING THE HYPOTHESIS Data from in vivo studies in porcine models are limited by the relatively short perfusion time of 24 h. In the military setting, notably longer perfusion times need to be realized. Therefore, future animal studies must focus especially on long-term perfusion, since this represents the military setting, considering the time for stabilization of the patient until evacuation to a tertiary treatment center. IMPLICATIONS OF THE HYPOTHESIS The development and clinical introduction of ex vivo limb perfusion in the military setting could lead to a drastic reduction in the number of limb amputations among service members. Ex vivo limb perfusion enables replantation surgery in Role 4 facilities and changes the clinical setting from a highly urgent, life-threatening situation to a highly methodical, well-prepared starting point for optimal treatment of the wounded service member. With its introduction, the principle of "life before limb" will change to "life before limb before elective replantation/allotransplantation after ex vivo limb perfusion".
Collapse
Affiliation(s)
- Alexander Kaltenborn
- Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany. .,Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Sebastian Hoffmann
- Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany
| | - André Gutcke
- Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hannover and Center for Systems Neuroscience (ZSN), Westerstede, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Bettina Wiegmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
19
|
Carvalho CR, Costa JB, Costa L, Silva-Correia J, Moay ZK, Ng KW, Reis RL, Oliveira JM. Enhanced performance of chitosan/keratin membranes with potential application in peripheral nerve repair. Biomater Sci 2020; 7:5451-5466. [PMID: 31642822 DOI: 10.1039/c9bm01098j] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although surgical management of peripheral nerve injuries (PNIs) has improved over time, autografts are still the current "gold standard" treatment for PNIs, which presents numerous limitations. In an attempt to improve natural biomaterial-based nerve guidance conduits (NGCs), chitosan (CHT), a derivative of the naturally occurring biopolymer chitin, has been explored for peripheral nerve regeneration (PNR). In addition to CHT, keratin has gained enormous attention as a biomaterial and tissue engineering scaffolding. In this study, biomimetic CHT/keratin membranes were produced using a solvent casting technique. These membranes were broadly characterized in terms of their surface topography and physicochemical properties, with techniques such as Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), contact angle, weight loss and water uptake measurements, Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM). Biological in vitro assays were also performed, where a preliminary cytotoxicity screening with the L929 fibroblast cell line revealed that the membranes and respective materials are suitable for cell culture. In addition, Schwann cells, fibroblasts and endothelial cells were directly seeded in the membranes. Quantitative and qualitative assays revealed that the addition of keratin enhanced cell viablity and adhesion. Based on the encouraging in vitro results, the in vivo angiogenic/antiangiogenic potential of CHT and CHT/keratin membranes was assessed, using an optimized chick embryo chorioallantoic membrane assay, where higher angiogenic responses were seen in keratin-enriched materials. Overall, the obtained results indicate the higher potential of CHT/keratin membranes for guided tissue regeneration applications in the field of PNR.
Collapse
Affiliation(s)
- Cristiana R Carvalho
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Avepark - Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Pan D, Mackinnon SE, Wood MD. Advances in the repair of segmental nerve injuries and trends in reconstruction. Muscle Nerve 2020; 61:726-739. [PMID: 31883129 DOI: 10.1002/mus.26797] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system.
Collapse
Affiliation(s)
- Deng Pan
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Wood
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
21
|
Dietzmeyer N, Huang Z, Schüning T, Rochkind S, Almog M, Nevo Z, Lieke T, Kankowski S, Haastert-Talini K. In Vivo and In Vitro Evaluation of a Novel Hyaluronic Acid-Laminin Hydrogel as Luminal Filler and Carrier System for Genetically Engineered Schwann Cells in Critical Gap Length Tubular Peripheral Nerve Graft in Rats. Cell Transplant 2020; 29:963689720910095. [PMID: 32174148 PMCID: PMC7444218 DOI: 10.1177/0963689720910095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
In the current study we investigated the suitability of a novel hyaluronic acid-laminin hydrogel (HAL) as luminal filler and carrier system for co-transplanted cells within a composite chitosan-based nerve graft (CNG) in a rat critical nerve defect model. The HAL was meant to improve the performance of our artificial nerve guides by giving additional structural and molecular support to regrowing axons. We filled hollow CNGs or two-chambered nerve guides with an inserted longitudinal chitosan film (CNG[F]s), with cell-free HAL or cell-free HA or additionally suspended either naïve Schwann cells (SCs) or fibroblast growth factor 2-overexpressing Schwann cells (FGF2-SCs) within the gels. We subjected female Lewis rats to immediate 15 mm sciatic nerve gap reconstruction and comprehensively compared axonal and functional regeneration parameters with the gold standard autologous nerve graft (ANG) repair. Motor recovery was surveyed by means of electrodiagnostic measurements at 60, 90, and 120 days post-reconstruction. Upon explantation after 120 days, lower limb target muscles were harvested for calculation of muscle-weight ratios. Semi-thin cross-sections of nerve segments distal to the grafts were evaluated histomorphometrically. After 120 days of recovery, only ANG treatment led to full motor recovery. Surprisingly, regeneration outcomes revealed no regeneration-supportive effect of HAL alone and even an impairment of peripheral nerve regeneration when combined with SCs and FGF2-SCs. Furthermore, complementary in vitro studies, conducted to elucidate the reason for this unexpected negative result, revealed that SCs and FGF2-SCs suspended within the hydrogel relatively downregulated gene expression of regeneration-supporting neurotrophic factors. In conclusion, cell-free HAL in its current formulation did not qualify for optimizing regeneration outcome through CNG[F]s. In addition, we demonstrate that our HAL, when used as a carrier system for co-transplanted SCs, changed their gene expression profile and deteriorated the pro-regenerative milieu within the nerve guides.
Collapse
Affiliation(s)
- Nina Dietzmeyer
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School,
Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Zhong Huang
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School,
Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Tobias Schüning
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School,
Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Shimon Rochkind
- Research Center for Nerve Reconstruction, Department of
Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv,
Israel
| | - Mara Almog
- Research Center for Nerve Reconstruction, Department of
Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv,
Israel
| | - Zvi Nevo
- Department of Human Molecular Genetics and Biochemistry, Sackler
School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Prof. Nevo passed away
| | - Thorsten Lieke
- Transplant Laboratory, Department of General-, Visceral-, and
Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Svenja Kankowski
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School,
Hannover, Germany
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School,
Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| |
Collapse
|
22
|
Li S, Tian X, Fan J, Tong H, Ao Q, Wang X. Chitosans for Tissue Repair and Organ Three-Dimensional (3D) Bioprinting. MICROMACHINES 2019; 10:E765. [PMID: 31717955 PMCID: PMC6915415 DOI: 10.3390/mi10110765] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022]
Abstract
Chitosan is a unique natural resourced polysaccharide derived from chitin with special biocompatibility, biodegradability, and antimicrobial activity. During the past three decades, chitosan has gradually become an excellent candidate for various biomedical applications with prominent characteristics. Chitosan molecules can be chemically modified, adapting to all kinds of cells in the body, and endowed with specific biochemical and physiological functions. In this review, the intrinsic/extrinsic properties of chitosan molecules in skin, bone, cartilage, liver tissue repair, and organ three-dimensional (3D) bioprinting have been outlined. Several successful models for large scale-up vascularized and innervated organ 3D bioprinting have been demonstrated. Challenges and perspectives in future complex organ 3D bioprinting areas have been analyzed.
Collapse
Affiliation(s)
- Shenglong Li
- Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China; (S.L.); (X.T.); (J.F.); (H.T.); (Q.A.)
| | - Xiaohong Tian
- Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China; (S.L.); (X.T.); (J.F.); (H.T.); (Q.A.)
| | - Jun Fan
- Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China; (S.L.); (X.T.); (J.F.); (H.T.); (Q.A.)
| | - Hao Tong
- Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China; (S.L.); (X.T.); (J.F.); (H.T.); (Q.A.)
| | - Qiang Ao
- Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China; (S.L.); (X.T.); (J.F.); (H.T.); (Q.A.)
| | - Xiaohong Wang
- Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China; (S.L.); (X.T.); (J.F.); (H.T.); (Q.A.)
- Center of Organ Manufacturing, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
| |
Collapse
|
23
|
Jahromi M, Razavi S, Bakhtiari A. The advances in nerve tissue engineering: From fabrication of nerve conduit to in vivo nerve regeneration assays. J Tissue Eng Regen Med 2019; 13:2077-2100. [PMID: 31350868 DOI: 10.1002/term.2945] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022]
Abstract
Peripheral nerve damage is a common clinical complication of traumatic injury occurring after accident, tumorous outgrowth, or surgical side effects. Although the new methods and biomaterials have been improved recently, regeneration of peripheral nerve gaps is still a challenge. These injuries affect the quality of life of the patients negatively. In the recent years, many efforts have been made to develop innovative nerve tissue engineering approaches aiming to improve peripheral nerve treatment following nerve injuries. Herein, we will not only outline what we know about the peripheral nerve regeneration but also offer our insight regarding the types of nerve conduits, their fabrication process, and factors associated with conduits as well as types of animal and nerve models for evaluating conduit function. Finally, nerve regeneration in a rat sciatic nerve injury model by nerve conduits has been considered, and the main aspects that may affect the preclinical outcome have been discussed.
Collapse
Affiliation(s)
- Maliheh Jahromi
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Razavi
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Bakhtiari
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
24
|
Physiochemical and morphological dependent growth of NIH/3T3 and PC-12 on polyaniline-chloride/chitosan bionanocomposites. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:1304-1312. [DOI: 10.1016/j.msec.2019.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 12/30/2022]
|
25
|
Passipieri JA, Dienes J, Frank J, Glazier J, Portell A, Venkatesh KP, Bliley JM, Grybowski D, Schilling BK, Marra KG, Christ GJ. Adipose Stem Cells Enhance Nerve Regeneration and Muscle Function in a Peroneal Nerve Ablation Model. Tissue Eng Part A 2019; 27:297-310. [PMID: 30760135 DOI: 10.1089/ten.tea.2018.0244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Severe peripheral nerve injuries have devastating consequences on the quality of life in affected patients, and they represent a significant unmet medical need. Destruction of nerve fibers results in denervation of targeted muscles, which, subsequently, undergo progressive atrophy and loss of function. Timely restoration of neural innervation to muscle fibers is crucial to the preservation of muscle homeostasis and function. The goal of this study was to evaluate the impact of addition of adipose stem cells (ASCs) to polycaprolactone (PCL) nerve conduit guides on peripheral nerve repair and functional muscle recovery in the setting of a critical size nerve defect. To this end, peripheral nerve injury was created by surgically ablating 6 mm of the common peroneal nerve in a rat model. A PCL nerve guide, filled with ASCs and/or poloxamer hydrogel, was sutured to the nerve ends. Negative and positive controls included nerve ablation only (no repair), and reversed polarity autograft nerve implant, respectively. Tibialis anterior (TA) muscle function was assessed at 4, 8, and 12 weeks postinjury, and nerve and muscle tissue was retrieved at the 12-week terminal time point. Inclusion of ASCs in the PCL nerve guide elicited statistically significant time-dependent increases in functional recovery (contraction) after denervation; ∼25% higher than observed in acellular (poloxamer-filled) implants and indistinguishable from autograft implants, respectively, at 12 weeks postinjury (p < 0.05, n = 7-8 in each group). Analysis of single muscle fiber cross-sectional area (CSA) revealed that ASC-based treatment of nerve injury provided a better recapitulation of the overall distribution of muscle fiber CSAs observed in the contralateral TA muscle of uninjured limbs. In addition, the presence of ASCs was associated with improved features of re-innervation distal to the defect, with respect to neurofilament and S100 (Schwann cell marker) expression. In conclusion, these initial studies indicate significant benefits of inclusion of ASCs to the rate and magnitude of both peripheral nerve regeneration and functional recovery of muscle contraction, to levels equivalent to autograft implantation. These findings have important implications to improved nerve repair, and they provide input for future work directed to restoration of nerve and muscle function after polytraumatic injury. Impact Statement This works explores the application of adipose stem cells (ASCs) for peripheral nerve regeneration in a rat model. Herein, we demonstrate that the addition of ASCs in poloxamer-filled PCL nerve guide conduits impacts nerve regeneration and recovery of muscle function, to levels equivalent to autograft implantation, which is considered to be the current gold standard treatment. This study builds on the importance of a timely restoration of innervation to muscle fibers for preservation of muscle homeostasis, and it will provide input for future work aiming at restoring nerve and muscle function after polytraumatic injury.
Collapse
Affiliation(s)
- Juliana A Passipieri
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Jack Dienes
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Joseph Frank
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Joshua Glazier
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Andrew Portell
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia
| | - Kaushik P Venkatesh
- Department of Bioengineering and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacqueline M Bliley
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Damian Grybowski
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin K Schilling
- Department of Bioengineering and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kacey G Marra
- Department of Bioengineering and University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George J Christ
- Biomedical Engineering Department, University of Virginia, Charlottesville, Virginia.,Orthopaedics Department, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
26
|
Dietzmeyer N, Förthmann M, Leonhard J, Helmecke O, Brandenberger C, Freier T, Haastert-Talini K. Two-Chambered Chitosan Nerve Guides With Increased Bendability Support Recovery of Skilled Forelimb Reaching Similar to Autologous Nerve Grafts in the Rat 10 mm Median Nerve Injury and Repair Model. Front Cell Neurosci 2019; 13:149. [PMID: 31133803 PMCID: PMC6523043 DOI: 10.3389/fncel.2019.00149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Tension-free surgical reconstruction of transected digital nerves in humans is regularly performed using autologous nerve grafts (ANGs) or bioartificial nerve grafts. Nerve grafts with increased bendability are needed to protect regenerating nerves in highly mobile extremity parts. We have recently demonstrated increased bendability and regeneration supporting properties of chitosan nerve guides with a corrugated outer wall (corrCNGs) in the common rat sciatic nerve model (model of low mobility). Here, we further modified the hollow corrCNGs into two-chambered nerve guides by inserting a perforated longitudinal chitosan-film (corrCNG[F]s) and comprehensively monitored functional recovery in the advanced rat median nerve model. In 16 adult female Lewis rats, we bilaterally reconstructed 10 mm median nerve gaps with either ANGs, standard chitosan nerve guides (CNGs), CNGs (CNG[F]s), or corrCNG[F]s (n = 8, per group). Over 16 weeks, functional recovery of each forelimb was separately surveyed using the grasping test (reflex-based motor task), the staircase test (skilled forelimb reaching task), and non-invasive electrophysiological recordings from the thenar muscles. Finally, regenerated tissue harvested from the distal part of the nerve grafts was paraffin-embedded and cross-sections were analyzed regarding the number of Neurofilament 200-immunopositive axons and the area of newly formed blood vessels. Nerve tissue harvested distal to the grafts was epon-embedded and semi-thin cross-sections underwent morphometrical analyses (e.g., number of myelinated axons, axon and fiber diameters, and myelin thicknesses). Functional recovery was fastest and most complete in the ANG group (100% recovery rate regarding all parameters), but corrCNG[F]s accelerated the recovery of all functions evaluated in comparison to the other nerve guides investigated. Furthermore, corrCNG[F]s supported recovery of reflex-based grasping (87.5%) and skilled forelimb reaching (100%) to eventually significantly higher rates than the other nerve guides (grasping test: CNGs: 75%, CNG[F]s: 62.5%; staircase test: CNGs: 66.7%, CNG[F]s: 83.3%). Histological and nerve morphometrical evaluations, in accordance to the functional results, demonstrated best outcome in the ANG group and highest myelin thicknesses in the corrCNG[F] group compared to the CNG and CNG[F] groups. We thus clearly demonstrate that corrCNG[F]s represent promising innovative nerve grafts for nerve repair in mobile body parts such as digits.
Collapse
Affiliation(s)
- Nina Dietzmeyer
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hanover, Germany
| | - Maria Förthmann
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hanover, Germany
| | - Julia Leonhard
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany
| | | | | | | | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hanover, Germany
| |
Collapse
|
27
|
Crosio A, Fornasari BE, Gambarotta G, Geuna S, Raimondo S, Battiston B, Tos P, Ronchi G. Chitosan tubes enriched with fresh skeletal muscle fibers for delayed repair of peripheral nerve defects. Neural Regen Res 2019; 14:1079-1084. [PMID: 30762022 PMCID: PMC6404480 DOI: 10.4103/1673-5374.250628] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Nerve regeneration after delayed nerve repair is often unsuccessful. Indeed, the expression of genes associated with regeneration, including neurotrophic and gliotrophic factors, is drastically reduced in the distal stump of chronically transected nerves; moreover, Schwann cells undergo atrophy, losing their ability to sustain regeneration. In the present study, to provide a three-dimensional environment and trophic factors supporting Schwann cell activity and axon re-growth, we combined the use of an effective conduit (a chitosan tube) with a promising intraluminal structure (fresh longitudinal skeletal muscle fibers). This enriched conduit was used to repair a 10-mm rat median nerve gap after 3-month delay and functional and morphometrical analyses were performed 4 months after nerve reconstruction. Our data show that the enriched chitosan conduit is as effective as the hollow chitosan conduit in promoting nerve regeneration, and its efficacy is not statistically different from the autograft, considered the "gold standard" technique for nerve reconstruction. Since hollow tubes not always lead to good results after long defects (> 20 mm), we believe that the conduit enriched with fresh muscle fibers could be a promising strategy to repair longer gaps, as muscle fibers create a favorable three-dimensional environment and release trophic factors. All procedures were approved by the Bioethical Committee of the University of Torino and by the Italian Ministry of Health (approval number: 864/2016/PR) on September 14, 2016.
Collapse
Affiliation(s)
- Alessandro Crosio
- Department of Orthopedics and Traumatology II - Surgery for Hand and Upper Limb - AOU Città della Salute e della Scienza di Torino - CTO Hospital, Torino, Italy
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology II - Surgery for Hand and Upper Limb - AOU Città della Salute e della Scienza di Torino - CTO Hospital, Torino, Italy
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milano, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| |
Collapse
|
28
|
Hozumi K, Nomizu M. Mixed Peptide-Conjugated Chitosan Matrices as Multi-Receptor Targeted Cell-Adhesive Scaffolds. Int J Mol Sci 2018; 19:E2713. [PMID: 30208645 PMCID: PMC6165449 DOI: 10.3390/ijms19092713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 09/07/2018] [Indexed: 01/05/2023] Open
Abstract
Biomaterials are important for cell and tissue engineering. Chitosan is widely used as a scaffold because it is easily modified using its amino groups, can easily form a matrix, is stable under physiological conditions, and is inactive for cell adhesion. Chitosan is an excellent platform for peptide ligands, especially cell adhesive peptides derived from extracellular matrix (ECM) proteins. ECM proteins, such as collagen, fibronectin, and laminin, are multifunctional and have diverse cell attachment sites. Various cell adhesive peptides have been identified from the ECM proteins, and these are useful to design functional biomaterials. The cell attachment activity of peptides is influenced by the solubility, conformation, and coating efficiency to solid materials, whereas immobilization of peptides to a polysaccharide such as chitosan avoids these problems. Peptide⁻chitosan matrices promote various biological activities depending on the peptide. When the peptides are immobilized to chitosan, the activity of the peptides is significantly enhanced. Further, mixed peptide⁻chitosan matrices, conjugated with more than one peptide on a chitosan matrix, interact with multiple cellular receptors and promote specific biological responses via receptor cross-talk. Receptor cross-talk is important for mimicking the biological activity of ECM and the proteins. The mixed peptide⁻chitosan matrix approach is useful to develop biomaterials as a synthetic ECM for cell and tissue engineering.
Collapse
Affiliation(s)
- Kentaro Hozumi
- Department of Clinical Biochemistry, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan.
- Department of Applied Clinical Dietetics, Kitasato Junior College of Health and Hygienic Sciences, Minamiuonuma, Niigata 949-7241, Japan.
| | - Motoyoshi Nomizu
- Department of Clinical Biochemistry, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan.
| |
Collapse
|
29
|
Long-Term In Vivo Evaluation of Chitosan Nerve Guide Properties with respect to Two Different Sterilization Methods. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6982738. [PMID: 29967779 PMCID: PMC6008694 DOI: 10.1155/2018/6982738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/22/2018] [Indexed: 11/18/2022]
Abstract
Severe peripheral nerve injuries are reconstructed either with autologous nerve grafts (gold standard) or alternatively with clinically approved artificial nerve guides. The most common method used to sterilize these medical products is ethylene oxide gassing (EO). However, this method has several disadvantages. An alternative, which has been barely studied so far, represents beta irradiation (β). In previous studies, we developed an artificial nerve guide made of chitosan (chitosan nerve guide, CNG), a biomaterial that is known to potentially retain toxic residues upon EO sterilization. Therefore, we analyzed the long-term regeneration-supporting and mechanical properties of CNGs upon their sterilization with EO or β and their following application in unilateral repair of 12 mm gaps of the rat sciatic nerve. Over a period of 76 weeks, we serially evaluated the recovery of motor functions, the possible emergence of an inflammation in the surrounding connective tissue, the regrowth of axons into the distal nerve, and possible changes in the material properties. Our first long-term evaluation did not reveal significant differences between both sterilization methods. Thus, β is as appropriate as commonly used EO for sterilization of CNGs; however, it may slightly increase the stiffness of the biomaterial over time.
Collapse
|
30
|
Yi S, Xu L, Gu X. Scaffolds for peripheral nerve repair and reconstruction. Exp Neurol 2018; 319:112761. [PMID: 29772248 DOI: 10.1016/j.expneurol.2018.05.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/05/2018] [Accepted: 05/13/2018] [Indexed: 12/22/2022]
Abstract
Trauma-associated peripheral nerve defect is a widespread clinical problem. Autologous nerve grafting, the current gold standard technique for the treatment of peripheral nerve injury, has many internal disadvantages. Emerging studies showed that tissue engineered nerve graft is an effective substitute to autologous nerves. Tissue engineered nerve graft is generally composed of neural scaffolds and incorporating cells and molecules. A variety of biomaterials have been used to construct neural scaffolds, the main component of tissue engineered nerve graft. Synthetic polymers (e.g. silicone, polyglycolic acid, and poly(lactic-co-glycolic acid)) and natural materials (e.g. chitosan, silk fibroin, and extracellular matrix components) are commonly used along or together to build neural scaffolds. Many other materials, including the extracellular matrix, glass fabrics, ceramics, and metallic materials, have also been used to construct neural scaffolds. These biomaterials are fabricated to create specific structures and surface features. Seeding supporting cells and/or incorporating neurotrophic factors to neural scaffolds further improve restoration effects. Preliminary studies demonstrate that clinical applications of these neural scaffolds achieve satisfactory functional recovery. Therefore, tissue engineered nerve graft provides a good alternative to autologous nerve graft and represents a promising frontier in neural tissue engineering.
Collapse
Affiliation(s)
- Sheng Yi
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Lai Xu
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Xiaosong Gu
- Key laboratory of neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
| |
Collapse
|
31
|
Stößel M, Wildhagen VM, Helmecke O, Metzen J, Pfund CB, Freier T, Haastert-Talini K. Comparative Evaluation of Chitosan Nerve Guides with Regular or Increased Bendability for Acute and Delayed Peripheral Nerve Repair: A Comprehensive Comparison with Autologous Nerve Grafts and Muscle-in-Vein Grafts. Anat Rec (Hoboken) 2018; 301:1697-1713. [PMID: 29740965 DOI: 10.1002/ar.23847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 12/13/2022]
Abstract
Reconstruction of joint-crossing digital nerves requires the application of nerve guides with a much higher flexibility than used for peripheral nerve repair along larger bones. Nevertheless, collapse-resistance should be preserved to avoid secondary damage to the regrowing nerve tissue. In recent years, we presented chitosan nerve guides (CNGs) to be highly supportive for the regeneration of critical gap length peripheral nerve defects in the rat. Now, we evidently increased the bendability of regular CNGs (regCNGs) by developing a wavy wall structure, that is, corrugated CNGs (corrCNGs). In a comprehensive in vivo study, we compared both types of CNGs with clinical gold standard autologous nerve grafts (ANGs) and muscle-in-vein grafts (MVGs) that have recently been highlighted in the literature as a suitable alternative to ANGs. We reconstructed rat sciatic nerves over a critical gap length of 15 mm either immediately upon transection or after a delay period of 45 days. Electrodiagnostic measurements were applied to monitor functional motor recovery at 60, 90, 120, and 150 (only delayed repair) days postreconstruction. Upon explanation, tube properties were analyzed. Furthermore, distal nerve ends were evaluated using histomorphometry, while connective tissue specimens were subjected to immunohistological stainings. After 120 days (acute repair) or 150 days (delayed repair), respectively, compression-stability of regCNGs was slightly increased while it remained stable in corrCNGs. In both substudies, regCNGs and corrCNGs supported functional recovery of distal plantar muscles in a similar way and to a greater extent when compared with MVGs, while ANGs demonstrated the best support of regeneration. Anat Rec, 301:1697-1713, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Maria Stößel
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.,Center for Systems Neuroscience (ZSN), Hannover, 30559, Germany
| | - Vivien M Wildhagen
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Olaf Helmecke
- Medovent GmbH, Friedrich-Koenig-Str. 3, Mainz, 55129, Germany
| | - Jennifer Metzen
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Charlotte B Pfund
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Thomas Freier
- Medovent GmbH, Friedrich-Koenig-Str. 3, Mainz, 55129, Germany
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.,Center for Systems Neuroscience (ZSN), Hannover, 30559, Germany
| |
Collapse
|
32
|
Haastert-Talini K, Dahlin LB. Diabetes, its impact on peripheral nerve regeneration: lessons from pre-clinical rat models towards nerve repair and reconstruction. Neural Regen Res 2018; 13:65-66. [PMID: 29451207 PMCID: PMC5840992 DOI: 10.4103/1673-5374.224370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School; Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, Lund; Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|