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Kita A, Kedeshian K, Hong M, Hoffman L. An in vitro model for postoperative cranial nerve dysfunction and a proposed method of rehabilitation with N-acetylcysteine microparticles. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08622-z. [PMID: 38649541 DOI: 10.1007/s00405-024-08622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/16/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE When operating near cranial motor nerves, transient postoperative weakness of target muscles lasting weeks to months is often observed. As nerves are typically intact at a procedure's completion, paresis is hypothesized to result from a combination of neurapraxia and axonotmesis. As both neurapraxia and axonotmesis involve Schwann cell injury and require remyelination, we developed an in vitro RSC96 Schwann cell model of injury using hydrogen peroxide (H2O2) to induce oxidative stress and investigated the efficacy of candidate therapeutic agents to promote RSC96 viability. As a first step in developing a long-term local administration strategy, the most promising of these agents was incorporated into sustained-release microparticles and investigated for bioactivity using this assay. METHODS The concentration of H2O2 which reduced viability by 50% was determined to establish a standard for inducing oxidative stress in RSC96 cultures. Fresh cultures were then co-dosed with H2O2 and the potential therapeutics melatonin, N-acetylcysteine, resveratrol, and 4-aminopyridine. Schwann cell viability was evaluated and the most efficacious agent, N-acetylcysteine, was encapsulated into microparticles. Eluted samples of N-acetylcysteine from microparticles was evaluated for retained bioactivity. RESULTS 100 µM N-acetylcysteine improved the viability of Schwann cells dosed with H2O2. 100 µM Microparticle-eluted N-acetylcysteine also enhanced Schwann cell viability. CONCLUSION We developed a Schwann cell culture model of iatrogenic nerve injury and used this to identify N-acetylcysteine as an agent to promote recovery. N-acetylcysteine was packaged into microparticles and demonstrated promise as a locally administrable agent to reduce oxidative stress in Schwann cells.
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Affiliation(s)
- Ashley Kita
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, 10883 Le Conte Avenue, CHS 63-170, Los Angeles, CA, 90095, USA.
| | - Katherine Kedeshian
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, 10883 Le Conte Avenue, CHS 63-170, Los Angeles, CA, 90095, USA
| | - Michelle Hong
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, 10883 Le Conte Avenue, CHS 63-170, Los Angeles, CA, 90095, USA
| | - Larry Hoffman
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, 10883 Le Conte Avenue, CHS 63-170, Los Angeles, CA, 90095, USA
- Vestibular Neuroscience Laboratory, Brain Research Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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Işik ÜG, Ensari N, Sarikçioğlu L, Sonbay Yilmaz ND, Yüksel Y, Senirli RT, Yildiz M, Selçuk ÖT, Çetinkaya EA, Eyigör H, Gür ÖE. Effects of platelet-rich fibrin and dexamethasone on nerve regeneration after acute facial-nerve injury. Acta Otolaryngol 2023; 143:623-629. [PMID: 37452661 DOI: 10.1080/00016489.2023.2233085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Acute facial-nerve injury. OBJECTIVE To investigate the effects of platelet-rich fibrin (PRF) and dexamethasone on nerve regeneration. MATERIALS AND METHODS Thirty-six rats were randomly divided into six groups. Facial-nerve injury was created using a full-thickness incision in all groups except Group E. Next, primary anastomosis, PRF application, topical dexamethasone application, primary anastomosis with topical PRF and dexamethasone application, and no facial-nerve repair were performed in Groups A, B, C, D, and F, respectively. Clinical, functional, and structural improvements were evaluated at eight weeks. RESULTS The mean eye-closure movement score in Group B was significantly higher than that in Group F (p < .001). The mean whisker-movement score in Group B was significantly higher than that in Group F (p = .001). The mean amplitude of whisker movement in Group F was significantly lower than those in Groups A, B, C, and E, and the mean amplitude in Group D was significantly lower than that in Group E (p < .001). Furthermore, an improvement in nerve ultrastructure was observed in Group B. CONCLUSION PRF application has a positive effect on nerve recovery after anastomosis. SIGNIFICANCE Contribute to the literature to improve nerve regeneration.
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Affiliation(s)
- Ünal Gökalp Işik
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | - Nuray Ensari
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | | | | | - Yeşim Yüksel
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | - Rezarta Taga Senirli
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | - Muhammet Yildiz
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | - Ömer Tarik Selçuk
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | | | - Hülya Eyigör
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
| | - Özer Erdem Gür
- Otorhinolaryngology Department, Antalya Health Sciences University, Antalya, Turkey
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Abstract
It has widely been thought that in the process of nerve regeneration Schwann cells populate the injury site with myelinating, non–myelinating, phagocytic, repair, and mesenchyme–like phenotypes. It is now clear that the Schwann cells modify their shape and basal lamina as to accommodate re–growing axons, at the same time clear myelin debris generated upon injury, and regulate expression of extracellular matrix proteins at and around the lesion site. Such a remarkable plasticity may follow an intrinsic functional rhythm or a systemic circadian clock matching the demands of accurate timing and precision of signalling cascades in the regenerating nervous system. Schwann cells react to changes in the external circadian clock clues and to the Zeitgeber hormone melatonin by altering their plasticity. This raises the question of whether melatonin regulates Schwann cell activity during neurorepair and if circadian control and rhythmicity of Schwann cell functions are vital aspects of neuroregeneration. Here, we have focused on different schools of thought and emerging concepts of melatonin–mediated signalling in Schwann cells underlying peripheral nerve regeneration and discuss circadian rhythmicity as a possible component of neurorepair.
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Haggag MA, Salem AES, Elsherbini AM. Sustained Release In Situ Thermogelling Hydrogel of Cerebrolysin for Treatment of Facial Nerve Axotomy in Rats. J Oral Maxillofac Surg 2022; 80:949-959. [PMID: 35041809 DOI: 10.1016/j.joms.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The most essential principle in managing facial nerve (FN) injury is proper diagnosis and early treatment. This study evaluated local application of different concentrations and injection intervals of Cerebrolysin hydrogel (CBLH) for facial nerve axotomy (FNA) treatment. We hypothesized that local application of CBLH may provide a sustained release of Cerebrolysin and enhance neural regeneration. METHODS The authors implemented a randomized, controlled, blinded animal study. The sample was composed of the right FN. Functionally, eye-blink reflex was evaluated 2 and 4 weeks postoperatively. All rats were euthanized after 4 weeks, and nerve regeneration was evaluated histopathologically and immunohistochemically (IHC) with antibody against neurofilament (anti-NF) and S100 proteins. Descriptive and correlation statistics were computed, and the P value was set at .05. RESULTS The sample was composed of 72 adult male rats equally allocated into 8 groups. Groups I and V served as control groups and were injected with phosphate buffered saline once and four times, respectively. Rest of the groups were injected with 5%, 10%, and 15% CBLH once in groups II, III, IV and weekly in groups VI, VII, and VIII. CBLH showed statistically significant FN regeneration by enhancing Schwann and axonal growth compared to control group especially with single injection of 10%, 15%, and 5% 4-time injections, where the P value was less than .001. Significant improvement of eye-blink reflex was correlated with structural improvement associated with CBLH. CONCLUSION Finally, CBLH enhanced nerve regeneration and rehabilitation after FNA in rats. Therefore, it could be considered as an alternative treatment of FNA. More experimental and clinical trials should be considered to detect the effectiveness of CBLH in neural regeneration.
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Affiliation(s)
- Mai Ahmed Haggag
- Assistant Professor, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Amgad El-Said Salem
- Lecturer, Pharmaceutics Department, Faculty of Pharmacy, Mansoura University, Egypt
| | - Amira M Elsherbini
- Assistant Professor, Oral Biology Department, Faculty of Dentistry, Mansoura University, Egypt.
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Busa P, Kuthati Y, Huang N, Wong CS. New Advances on Pathophysiology of Diabetes Neuropathy and Pain Management: Potential Role of Melatonin and DPP-4 Inhibitors. Front Pharmacol 2022; 13:864088. [PMID: 35496279 PMCID: PMC9039240 DOI: 10.3389/fphar.2022.864088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/14/2022] [Indexed: 12/14/2022] Open
Abstract
Pre-diabetes and diabetes are growing threats to the modern world. Diabetes mellitus (DM) is associated with comorbidities such as hypertension (83.40%), obesity (90.49%), and dyslipidemia (93.43%), creating a substantial burden on patients and society. Reductive and oxidative (Redox) stress level imbalance and inflammation play an important role in DM progression. Various therapeutics have been investigated to treat these neuronal complications. Melatonin and dipeptidyl peptidase IV inhibitors (DPP-4i) are known to possess powerful antioxidant and anti-inflammatory properties and have garnered significant attention in the recent years. In this present review article, we have reviewed the recently published reports on the therapeutic efficiency of melatonin and DPP-4i in the treatment of DM. We summarized the efficacy of melatonin and DPP-4i in DM and associated complications of diabetic neuropathy (DNP) and neuropathic pain. Furthermore, we discussed the mechanisms of action and their efficacy in the alleviation of oxidative stress in DM.
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Affiliation(s)
- Prabhakar Busa
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Yaswanth Kuthati
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Niancih Huang
- Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan
- Grauate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Shung Wong
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
- Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan
- Grauate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Chih-Shung Wong,
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Charoenlux P, Utoomprurkporn N, Seresirikachorn K. The efficacy of corticosteroid after facial nerve neurorrhaphy: a systematic review and meta-analysis of randomized controlled trial. Braz J Otorhinolaryngol 2021; 89:79-89. [PMID: 34815200 PMCID: PMC9874359 DOI: 10.1016/j.bjorl.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/26/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The benefit of corticosteroids following facial nerve neurorrhaphy in the setting of complete transection is questionable. This systematic review and meta-analysis aimed to evaluate corticosteroid efficacy on facial nerve regeneration and functional recovery after complete disruption and neurorrhaphy. METHODS Randomized controlled trials on both human and animal models from Ovid MEDLINE and Ovid EMBASE studying corticosteroid efficacy in complete facial nerve disruption followed by neurorrhaphy were included. Data were extracted and pooled for meta-analysis. The outcomes were evaluated from electrophysiology, histology, and functional recovery. However, no randomized controlled trial in human was performed. Possibly, performing human trials with histopathology may not be feasible in clinical setting. RESULTS Six animal studies (248 participants) met inclusion criteria. Electrophysiologic outcomes revealed no differences in latency (Standardized Mean Difference (SMD) = -1.97, 95% CI -7.38 to 3.44, p = 0.47) and amplitude (SMD = 0.37, 95% CI -0.44 to 1.18, p = 0.37) between systemic corticosteroids and controls. When analysis compared topical corticosteroid and control, the results provided no differences in latency (Mean Difference (MD) = 0.10, 95% CI -0.04 to 0.24, p = 0.16) and amplitude (SMD = 0.01, 95% CI -0.08 to 0.10, p = 0.81). In histologic outcomes, the results showed no differences in axon diameter (MD = 0.13, 95% CI -0.15 to 0.41, p = 0.37) between systemic corticosteroid and control; however, the result in myelin thickness (MD = 0.06, 95% CI 0.04 to 0.08, p < 0.05) favored control group. When comparing systemic corticosteroid with control in eye blinking, the results favored control (MD = 1.33, 95% CI 0.60 to 2.06, p = 0.0004). CONCLUSIONS This evidence did not show potential benefits of systemic or topical corticosteroid deliveries after facial nerve neurorrhaphy in complete transection when evaluating electrophysiologic, histologic, and functional recovery outcomes in animal models.
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Affiliation(s)
- Prapitphan Charoenlux
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattawan Utoomprurkporn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,UCL Ear Institute, Faculty of Brain Science, University College London, London, United Kingdom
| | - Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Corresponding author.
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Çınar Z, Emre U, Gül M, Yiğit Ö, Mammadov E, Yiğit E, Gül S, Cırık HR. Is Decorin a Promising New Agent for Facial Nerve Regeneration? An Experimental Study. Audiol Neurootol 2021; 26:195-205. [PMID: 33677432 DOI: 10.1159/000512003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effects of systemic administration of decorin (DC) on facial nerve (FN) regeneration. METHODS A total of 32 female albino Wistar rats were divided into 4 groups: control (C) group: no bilateral FN neurorrhaphy (B-FNN), no DC application, sham-operated group: B-FNN without DC application, DC group: DC application without B-FNN, and B-FNN + DC group: B-FNN and DC application. Nerve conduction studies were performed before and after skin incisions at 1st, 3rd, 5th, and 7th weeks in all groups. The amplitude and latency of compound muscle action potentials were recorded. FN samples were obtained and were investigated under light microscopy and immunohistochemical staining. The nerve and axon diameter, number of axons, H score, Schwann cell proliferation, and myelin and axonal degeneration were recorded quantitatively. RESULTS In the sham group, the 3rd and 5th postoperative week, amplitude values were significantly lower than those of the B-FNN + DC group (p < 0.05). Nerve diameters were found to be significantly larger in the sham, DC, and B-FNN + DC groups than in the C group (p < 0.05). The number of axons, the axon diameter, and the H scores were found to be significantly higher in the B-FNN + DC group than in the sham group (p < 0.05). The Schwann cell proliferation, myelin degeneration, and axonal degeneration scores were significantly lower in the B-FNN + DC group than in the sham group (p < 0.05). CONCLUSION Electrophysiological and histopathological evaluation revealed the potential benefits provided by DC. This agent may increase FN regeneration.
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Affiliation(s)
- Zehra Çınar
- Department of Otorhinolaryngology & Head and Neck Surgery, İstanbul Training and Research Hospital, Istanbul, Turkey,
| | - Ufuk Emre
- Department of Neurology, Istanbul Training and Research Hospital, I, Istanbul, Turkey
| | - Mehmet Gül
- Department of Histology and Embryology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology & Head and Neck Surgery, İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Elshan Mammadov
- Department of Otorhinolaryngology & Head and Neck Surgery, İstanbul Training and Research Hospital, Istanbul, Turkey
| | - Enes Yiğit
- Department of Otorhinolaryngology & Head and Neck Surgery, Republic of Turkey Ministry of Health Luleburgaz State Hospital, Kırklareli, Turkey
| | - Semir Gül
- Department of Histology and Embryology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Hilal Rumeyza Cırık
- Department of Histology and Embryology, İnönü University Faculty of Medicine, Malatya, Turkey
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