Peripheral nerve regeneration using silicone rubber chambers filled with collagen, laminin and fibronectin

A 10 mm gap of rat sciatic nerve was created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes filled with an extracellular gel containing collagen, laminin and fibronectin. Empty silicone rubber tubes were used as controls. Six weeks after implantation, all extracellular elements were completely degraded and absorbed, and 90% of the animals from the extracellular gel group exhibited regeneration across the nerve gaps, whereas only 60% in the control group. Both qualitative and quantitative histology of the regenerated nerves revealed a more mature ultrastructural organization with 28% larger cross-sectional area and 28% higher number of myelinated axons in the extracellular gel group than the controls. These results showed that the gel mixture of collagen, laminin and fibronectin could offer a suitable growth medium for the regeneration of axons.     

Combined use of decellularized allogeneic artery conduits with autologous transdifferentiated adipose-derived stem cells for facial nerve regeneration in rats

Natural biological conduits containing seed cells have been widely used as an alternative strategy for nerve gap reconstruction to replace traditional nerve autograft techniques. The purpose of this study was to investigate the effects of a decellularized allogeneic artery conduit containing autologous transdifferentiated adipose-derived stem cells (dADSCs) on an 8-mm facial nerve branch lesion in a rat model. After 8 weeks, functional evaluation of vibrissae movements and electrophysiological assessment, retrograde labeling of facial motoneurons and morphological analysis of regenerated nerves were performed to assess nerve regeneration. The transected nerves reconstructed with dADSC-seeded artery conduits achieved satisfying regenerative outcomes associated with morphological and functional improvements which approached those achieved with Schwann cell (SC)-seeded artery conduits, and superior to those achieved with artery conduits alone or ADSC-seeded artery conduits, but inferior to those achieved with nerve autografts. Besides, numerous transplanted PKH26-labeled dADSCs maintained their acquired SC-phenotype and myelin sheath-forming capacity inside decellularized artery conduits and were involved in the process of axonal regeneration and remyelination. Collectively, our combined use of decellularized allogeneic artery conduits with autologous dADSCs certainly showed beneficial effects on nerve regeneration and functional restoration, and thus represents an alternative approach for the reconstruction of peripheral facial nerve defects.     

移植壳聚糖导管修复大鼠坐骨神经缺损

目的:研究移植结合了碱性成纤维细胞生长因子(bFGF)的壳聚糖导管促进周围神经损伤再生的情况。方法:成年Wistar大鼠造成10mm坐骨神经缺损后,以壳聚糖导管(移植组,10只)作桥梁桥接神经两断端,以假手术组和单纯损伤组(造成10mm坐骨神经缺损后,不加以任何干预措施)各10只分别为阳性和阴性对照,术后通过肉眼观察和神经微丝(NF)、乙酰胆碱酯酶(AChE)免疫组织化学染色方法对损伤神经局部及远端靶肌肉运动终板的再生情况进行观察。结果:移植组大鼠术后3个月,新生的神经纤维已越过缺损部位并到达损伤远端。免疫组织化学染色显示:术后3个月,移植组大鼠坐骨神经缺损处再生组织内可观察到均匀、密集分布的NF免疫阳性纤维,且在腓肠肌终板区内可见AChE免疫阳性终末,至5个月时阳性染色明显增强。在术后3个月时可见新生的运动终板,但轮廓不规则、边界不清晰;而在5个月时,新生的运动终板的形态与密度均接近假手术组水平。结论:结合了bFGF的壳聚糖导管对缺损的坐骨神经修复具有良好的桥梁作用和促进神经生长及终板再生的作用。     

Systemic BMSC homing in the regeneration of pulp-like tissue and the enhancing effect of stromal cell-derived factor-1 on BMSC homing

Pulp regeneration caused by endogenous cells homing has become the new research spot in endodontics. However, the source of functional cells that are involved in and contributed to the reconstituting process has not been identified. In this study, the possible role of systemical BMSC in pulp regeneration and the effect of stromal cell-derived factor-1 (SDF-1) on stem cell recruitment and angiogenesis were evaluated. 54 mice were divided into three groups: SDF-1 group (subcutaneous pockets containing roots with SDF-1 absorbed neutralized collagen gel and the green fluorescent protein (GFP) positive BMSCs transplantation via the tail vein), SDF-1-free group (pockets containing roots with gel alone and GFP + BMSCs transplantation) and Control group (pockets containing roots with gel alone). The animals were sacrificed after the roots were implanted into subcutaneous pockets for 3 weeks. Histomorphometric analysis was performed to evaluate the regenerated tissue in the canal by hematoxylin and eosin (HE) staining. The homing of the transplanted BMSCs was monitored with a fluorescence microscope and immunohistochemical analysis. The expression of ALP in new formed tissue was detected immunohistochemically. Dental-pulp-like tissue and new vessels were regenerated and GFP-positive BMSCs and expression of ALP could be observed in both SDF-1 group and SDF-1-free group. Furthermore, more GFP+ cells, stronger expression of ALP and stronger angiogenesis were found in the SDF-1 group than in the SDF-1-free group. To conclude, systemic BMSC can home to the root canal and participate in dental-pulp-like tissue regeneration. Intracanal application of SDF-1 may enhance BMSC homing efficiency and angiogenesis.     

带血管蒂筋膜瓣管桥接家兔面神经缺损的实验研究

目的 :探讨注入自体神经组织匀浆的带血管蒂筋膜瓣管桥接家兔面神经缺损后面神经再生效果及机制 ,旨在寻找一种替代自体神经移植的非神经组织材料。方法 :家兔 3 6只 ,随机分为 3组。A组在筋膜瓣管中注入生理盐水 ,B组在筋膜瓣管中注入自体神经组织匀浆 ,C组做神经原位移植术。术后饲养 1 2周 ,观察功能恢复情况 ,对移植体进行神经电生理 ,组织学和免疫组织化学检测。结果 :实验结果证明再生神经纤维都可以通过桥接体。在NCV、NAP、髓鞘厚度、轴突直径A组与BC组有显著性差异 ,B组与C组相近。结论 :注入自体神经组织匀浆的带血管蒂筋膜瓣管可作为替代自体神经移植修复面神经缺损的材料     

Ginsenoside Rb1 enhances peripheral nerve regeneration across wide gaps in silicone rubber chambers

Silicone rubber chambers filled with collagen containing ginsenoside Rb1 (GRb1) were used to repair lesioned rat sciatic nerves with 15-mm gaps between stumps. Six weeks after implantation, histology of the nerve regenerated in the chambers filled with GRb1 and collagen contained larger axons than those in the chambers with collagen only. This study showed that the GRb1 could exert a positive influence on nerve regeneration when using silicone rubber tubes.     

种植施万细胞的脱细胞同种异体神经移植物对大鼠坐骨神经缺损的修复作用

目的观察种植施万细胞的脱细胞同种异体神经移植物,桥接大鼠坐骨神经缺损后的神经再生。方法应用酶反复消化法与差速贴壁法体外分离培养乳鼠施万细胞;显微注射法将施万细胞种植到脱细胞同种异体神经移植物内;再应用种植施万细胞的脱细胞同种异体神经移植物桥接大鼠坐骨神经10 mm缺损。光镜、透射电镜和扫描电镜观察再生神经的形态结构、有髓神经纤维数量、平均髓鞘厚度并进行统计学分析。结果光、电镜观察到实验组(SCs+ARSN)的施万细胞在再生神经纤维中互相连结纵行排列成类似Büngner带样细胞链,对照组(ARSN)未见到施万细胞的链状排列。实验组再生有髓神经纤维的髓鞘厚度较对照组均匀且较厚,有髓神经纤维数量和平均髓鞘厚度明显多于对照组(P<0.05)。结论种植施万细胞的脱细胞同种异体神经移植物对缺损的坐骨神经再生有更加有效的促进作用。     

Ultrastructural and morphometric analysis of long-term peripheral nerve regeneration through silicone tubes

Summary Light and electron microscopy were used to investigate long-term regeneration in peripheral nerves regenerating across a 10 mm gap through silicone tubes. Schwann cells and axons co-migrated behind an advancing front of fibroblasts, bridging the 10 mm gap between 28 and 35 days following nerve transection. Myelination of regenerated fibres started between 14 and 21 days after transection and occurred in a manner similar to that reported during development. Although these early events were successful in producing morphologically normal-appearing regenerated fibres, complete maturation of many of these fibres was never achieved. Axonal distortion by neurofilaments, axonal degeneration and secondary demyelination were seen at 56 days following nerve transection. These changes progressed in severity with time as more axons advanced through the distal stump towards their peripheral target. Since regeneration occurs in the absence of endoneurial tubes, and because constrictive forces act on the nerve during regeneration, we suggest that these extrinsic factors limit the successful advancement of axons through the distal stump to their target organ.     

Influence of surface texture of polymeric sheets on peripheral nerve regeneration in a two-compartment guidance system

Synthetic guidance channels are useful tools to study the mechanisms underlying peripheral nerve regeneration. In the present study, the lumen of silicone elastomer tubes was divided into two compartments by a polymer strip 10 mm long placed along the tube length. The influence of varying the surface texture of hydrophilic and hydrophobic polymer strips on the morphology of the regenerated neural tissue was analysed. Hydrophilic nitrocellulose (NC) and hydrophobic polyvinylidene fluoride (PVDF) films with smooth (S-NC and S-PVDF) or rough (R-NC, R-PVDF) surface texture were used. Five channels of each type were used to repair transected rat sciatic nerves and analysed after 4 wk. Tissue strips bridged the nerve stumps in all R-NC and R-PVDF tubes, in five of the S-NC and three of the S-PVDF tubes. In R-NC and R-PVDF tubes, bell-shaped tissue adhering to the polymer strip was observed, whereas in S-NC and S-PVDF tubes round, free-floating nerve cables were seen. All the cables contained myelinated and unmyelinated axons and Schwann cells grouped in microfascicles and surrounded by an epineurial layer. For both rough strips, the initial cell layer consisted of macrophages adhering to the polymer surface. The epineurial nerve tissue contacting the rough surface was significantly thinner for PVDF compared with NC strips. No difference in epineurial thickness was observed for nerves facing the silicone tube or for smooth NC and PVDF strips. S-PVDF tubes contained significantly more myelinated axons than S-NC tubes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of percutaneous electrical stimulation on peripheral nerve regeneration using silicone rubber chambers

The purpose of this study was to determine whether 0.8-1 mA, 2 Hz of percutaneous electrical stimulation could affect the regeneration of a 10-mm gap of rat sciatic nerve created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes. Six weeks after implantation, though the group receiving the electrical stimulation had a lower success percentage of regeneration (57%) compared with the controls receiving no stimulation (70%), quantitative histology of the successfully regenerated nerves revealed that the mean values of the axon density, blood vessel number, blood vessel area, and percentage of blood vessel area in total nerve area in the group with the electrical stimulation were all significantly larger than those in the controls (p < 0.05). These results showed that the electrical stimulation could elicit rehabilitating effects on the regenerated nerves.     

Collagen filaments as a scaffold for nerve regeneration

This article describes repair of peripheral nerve defect using collagen filaments instead of tubes. Many tube-shaped nerve guides induce regeneration of severed peripheral nerve axons within a limited distance. Substantial regeneration of nerve axons has not been reported without a tubular conduit. Here we show the regeneration of peripheral nerve axons along filaments of collagen without a tube. Cables of collagen filaments were grafted to repair 20-mm defects of rat sciatic nerves. Nerve autografts and collagen tubes were grafted as controls. The mean number and the mean fiber diameter of regenerated myelinated axons were approximately 4800 and 3.3 microm in the distal end of the nerve autograft at 8 weeks postoperatively while in the distal end of the collagen-filaments nerve guide, they were approximately 5500 and 2.3 microm. Collagen tubes failed to bridge the nerve defect. Histologic studies suggest that nerve axons regenerated substantially along the collagen filaments.     

Mesenchymal stem cells in a polycaprolactone conduit enhance median-nerve regeneration,prevent decrease of creatine phosphokinase levels in muscle,and improve functional recovery in mice

Although the majority of peripheral-nerve regeneration studies are carried out on the sciatic nerve, lesions of the upper extremities are more common in humans and usually lead to significant physical disabilities. The present study was driven by the hypothesis that a combination of strategies, namely grafts of mesenchymal stem cells (MSC) and resorbable polycaprolactone (PCL) conduits would improve median-nerve regeneration after transection. Mouse median nerves were transected and sutured to PCL tubes that were filled with either green fluorescent protein (GFP⁺) MSC in DMEM or with DMEM alone. During the post-operative period, animals were tested weekly for flexor digitorum muscle function by means of the grasping test. After 8 weeks, the proximal and middle portions of the PCL tube and the regenerating nerves were harvested and processed for light and electron microscopy. The flexor digitorum muscle was weighed and subjected to biochemical analysis for creatine phosphokinase (CK) levels. Scanning electron microscopy of the PCL tube 8 weeks after implantation showed clear signs of wall disintegration. MSC-treated animals showed significantly larger numbers of myelinated and unmyelinated nerve fibers and blood vessels compared with DMEM-treated animals. The flexor digitorum muscle CK levels were significantly higher in the MSC-treated animals, but muscle weight values did not differ between the groups. Compared with the DMEM-treated group, MSC-treated animals showed, by the grasping test, improved functional performance throughout the period analyzed. Immunofluorescence for S-100 and GFP showed, in a few cases, double-labeled cells, suggesting that transplanted cells may occasionally transdifferentiate into Schwann cells. Our data demonstrate that the polycaprolactone conduit filled with MSC is capable of significantly improving the median-nerve regeneration after a traumatic lesion.     

Highly permeable polylactide-caprolactone nerve guides enhance peripheral nerve regeneration through long gaps.

We compared regeneration and functional reinnervation after sciatic nerve resection and tubulization repair with bioresorbable guides of poly(L-lactide-co-epsilon-caprolactone) (PLC) and permanent guides of polysulfone (POS) with different degrees of permeability, leaving a 6 mm gap in different groups of mice. Functional reinnervation was assessed to determine recovery of motor, sensory and sweating functions in the hindpaw during four months postoperation. Highly permeable PLC guides allowed for faster and higher levels of reinnervation for the four functions tested than impermeable or low-permeable PLC guides, while semipermeable 30 and 100 kDa POS tubes yielded very low levels of reinnervation. The regeneration success rate was higher with PLC than with POS tubes. Morphometrical analysis of cross-sectional nerves under light microscopy showed the highest number of regenerated myelinated fibers at mid tube and distal nerve in high-permeable PLC guides. Impermeable PLC guides allowed slightly worse levels of regeneration, while low-permeable PLC guides promoted neuroma and limited distal regeneration. The lowest number of regenerated fibers were found in POS tubes. In summary, highly permeable bioresorbable PLC guides offer a suitable alternative for repairing long gaps in injured nerves, approaching the success of autologous nerve grafts.     

Evaluation of collagen nerve guide in facial nerve regeneration

Facial nerve paralysis due to resection of tumors or as a consequence of trauma is a frequently observed complication. Thus, in the present study, we evaluated a collagen nerve guide in facial nerve regeneration across a 5-mm nerve gap. This biological tube was manufactured from 3% collagen, coated over a Teflon tube used only as a template and submitted to thermal dehydration at 105°C for 24h. The collagen tube was implanted at the dorsal ramous of the facial nerve of five adult cats over a gap of 5mm. The facial nerve of the contralateral side was kept intact and used as control. Electrophysiological study was performed from 3 weeks after surgery, and histological and horseradish peroxidase labeling examination was carried out 8 weeks after implantation. Electrophysiological study confirmed the recovery of electrical activity of the collagenimplanted regenerated nerve. Light-microscopic examination of collagen tube-implanted specimens revealed a well vascularized regenerated nerve, which under an electron microscope showed many myelinated axons surrounded by Schwann cells and unmyelinated axons. Horseradish peroxidase staining demonstrated labeling of facial motoneurons in the brainstem and facial nerve terminals in the neuromuscular junction, also confirming restoration of the whole facial nerve tract from the reinnervated muscles, passing through the regenerated site to the brainstem. The collagen tube was very efficient as a nerve guide over a 5mm facial nerve gap and shows great promise as a nerve conduit.     

A morphological study on the effects of collagen gel matrix on regeneration of severed rat sciatic nerve in silicone tubes

The present study is a chronological morphological examination on the effects of collagen gel matrix on regeneration of severed sciatic nerves. The nerves (5 mm length) were resected, and both the distal and proximal stumps were inserted into a silicone tube with 5 mm gap in between. In the test side, the gap in the tube was then injected with liquid collagen which gels in the tissue when reconstructed with a certain buffer solution. The gap space in the tube of the control side was left empty. In a chronological examination of the tissue in the tube, considerably more rapid growth of sprouting axons toward the distal stump in the test side was revealed in comparison with the control side. The cells, including both fibroblasts and larger Schwann cells, were less in number. More orderly directions were observed in the collagen matrix than in the control tube. The result indicates that regeneration of the peripheral nerves in the silicone tube can be improved, by using appropriate exogenous fine materials, collagen matrix.     

A MORPHOLOGICAL STUDY ON THE EFFECTS OF COLLAGEN GEL MATRIX ON REGENERATION OF SEVERED RAT SCIATIC NERVE IN SILICONE TUBES

The present study is a chronological morphological examination on the effects of collagen gel matrix on regeneration of severed sciatic nerves. The nerves (5 mm length) were resected, and both the distal and proximal stumps were inserted into a silicone tube with 5 mm gap in between. In the test side, the gap in the tube was then injected with liquid collagen which gells in the tissue when reconstructed with a certain buffer solution. The gap space in the tube of the control side was left empty. In a chronological examination of the tissue in the tube, considerably more rapid growth of sprouting axons toward the distal stump in the test side was revealed in comparison with the control side. The cells, including both fibroblasts and larger Schwann cells, were less in number. More orderly directions were observed in the collagen matrix than in the control tube. The result indicates that regeneration of the peripheral nerves in the silicone tube can be improved, by using appropriate exogenous fine materials, collagen matrix.     

Mesenchymal stem cells in a polycaprolactone conduit promote sciatic nerve regeneration and sensory neuron survival after nerve injury

Despite the fact that the peripheral nervous system is able to regenerate after traumatic injury, the functional outcomes following damage are limited and poor. Bone marrow mesenchymal stem cells (MSCs) are multipotent cells that have been used in studies of peripheral nerve regeneration and have yielded promising results. The aim of this study was to evaluate sciatic nerve regeneration and neuronal survival in mice after nerve transection followed by MSC treatment into a polycaprolactone (PCL) nerve guide. The left sciatic nerve of C57BL/6 mice was transected and the nerve stumps were placed into a biodegradable PCL tube leaving a 3-mm gap between them; the tube was filled with MSCs obtained from GFP+ animals (MSC-treated group) or with a culture medium (Dulbecco's modified Eagle's medium group). Motor function was analyzed according to the sciatic functional index (SFI). After 6 weeks, animals were euthanized, and the regenerated sciatic nerve, the dorsal root ganglion (DRG), the spinal cord, and the gastrocnemius muscle were collected and processed for light and electron microscopy. A quantitative analysis of regenerated nerves showed a significant increase in the number of myelinated fibers in the group that received, within the nerve guide, stem cells. The number of neurons in the DRG was significantly higher in the MSC-treated group, while there was no difference in the number of motor neurons in the spinal cord. We also found higher values of trophic factors expression in MSC-treated groups, especially a nerve growth factor. The SFI revealed a significant improvement in the MSC-treated group. The gastrocnemius muscle showed an increase in weight and in the levels of creatine phosphokinase enzyme, suggesting an improvement of reinnervation and activity in animals that received MSCs. Immunohistochemistry documented that some GFP+ -transplanted cells assumed a Schwann-cell-like phenotype, as evidenced by their expression of the S-100 protein, a Schwann cell marker. Our findings suggest that using a PCL tube filled with MSCs is a good strategy to improve nerve regeneration after a nerve transection in mice.     

Green fluorescent protein is a stable morphological marker for schwann cell transplants in bioengineered nerve conduits

Bioengineered systems incorporate cultured cells to mimic the substituted tissue. A labeling method is necessary to monitor the survival of transplanted cells within the host. This labeling method must be compatible with the histochemical methods used for morphological analysis. This study assessed (1) The in vitro characteristics of Schwann cells (SCs) labeled with green fluorescent protein (GFP), (2) the in vivo effect of transplanted GFP-SCs in a model of peripheral nerve injury, and (3) the compatibility of GFP-SCs with immunofluorescence histochemical techniques. SCs were retrovirally labeled with GFP and their growth characteristics were compared with those of nontransduced SCs (ntSCs). GFP-SCs were seeded in a resorbable nerve conduit for grafting into a 1-cm gap in rat sciatic nerve. Grafts were harvested after 2 weeks and immunofluorescent staining was performed to measure axonal and SC regeneration distances and to identify GFP-SCs. Results of GFP-SC vitality assays did not vary significantly from those of ntSC assays. GFP-SCs were readily located ex vivo and stimulated significantly better axonal and SC regeneration distances in comparison with empty conduits. These findings show that GFP labeling does not have a deleterious effect on SCs and that it is a useful labeling method for the study of bioengineered systems.     

Use of PLGA 90:10 scaffolds enriched with in vitro-differentiated neural cells for repairing rat sciatic nerve defects

Poly(lactic-co-glycolic acid) (PLGA) nerve tube guides, made of a novel proportion (90:10) of the two polymers, poly(L-lactide): poly(glycolide) and covered with a neural cell line differentiated in vitro, were tested in vivo for promoting nerve regeneration across a 10-mm gap of the rat sciatic nerve. Before in vivo testing, the PLGA 90:10 tubes were tested in vitro for water uptake and mass loss and compared with collagen sheets. The water uptake of the PLGA tubes was lower, and the mass loss was more rapid and higher than those of the collagen sheets when immersed in phosphate-buffered saline (PBS) solution. The pH values of immersing PBS did not change after soaking the collagen sheets and showed to be around 7.4. On the other hand, the pH values of PBS after soaking PLGA tubes decreased gradually during 10 days reaching values around 3.5. For the in vivo testing, 22 Sasco Sprague adult rats were divided into four groups--group 1: gap not reconstructed; group 2: gap reconstructed using an autologous nerve graft; group 3: gap reconstructed with PLGA 90:10 tube guides; group 4: gap reconstructed with PLGA 90:10 tube guides covered with neural cells differentiated in vitro. Motor and sensory functional recovery was evaluated throughout a healing period of 20 weeks using sciatic functional index, static sciatic index, extensor postural thrust, withdrawal reflex latency, and ankle kinematics. Stereological analysis was carried out on regenerated nerve fibers. Both motor and sensory functions improved significantly in the three experimental nerve repair groups, although the rate and extent of recovery was significantly higher in the group where the gap was reconstructed using the autologous graft. The presence of neural cells covering the inside of the PLGA tube guides did not make any difference in the functional recovery. By contrast, morphometric analysis showed that the introduction of N1E-115 cells inside PLGA 90:10 tube guides led to a significant lower number and size of regenerated nerve fibers, suggesting thus that this approach is not adequate for promoting peripheral nerve repair. Further studies are warranted to assess the role of other cellular systems as a foreseeable therapeutic strategy in peripheral nerve regeneration.     

Prevention and treatment of amputation neuroma by an atelocollagen tube in rat sciatic nerves

To evaluate the potential of the atelocollagen tube as a cap for amputation neuromas, the histological and histochemical characteristics of the neuroma and spinal cord were compared with those following silicone capping. Four weeks after the transection of 18 rat sciatic nerves, the amputated neuroma was resected, and the nerve stump inserted into an atelocollagen or silicone tube. The histological changes in the nerve ends and c-fos expression in the dorsal horn of the fourth lumbar spinal cord were evaluated at 4 weeks postoperatively. The regenerated nerve structure in the atelocollagen or silicone tube was very thin. In contrast, a typical bulbous neuroma was observed in the control group (the nerve stump was left in place). The atelocollagen and silicone tube groups demonstrated fewer c-fos-expressed cells in the spinal cord than the controls. These results suggest that capping by an atelocollagen tube, like that by a silicone tube, might successfully prevent an amputated neuroma from forming, and suppress induced pain. The atelocollagen tube may be a promising biomaterial for the prevention or treatment of a painful amputation neuroma.