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A Comparative Study of Acellular Nerve Xenografts and Allografts in Repairing Rat Facial Nerve Defects

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A Comparative Study of Acellular Nerve Xenografts and Allografts in Repairing Rat Facial Nerve Defects 6330 MOLECULAR MEDICINE REPORTS 12: 6330-6336, 2015 A comparative study of acellular nerve xenografts and allografts in repairing rat facial nerve defects HAITAO HUANG1,2*, HONGXI XIAO3*, HUAWEI LIU1, YU NIU4, RONGZENG YAN1 and MIN HU1 1Department of Stomatology, Chinese PLA General Hospital, Beijing 100853; 2Department of Stomatology, The 1st Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011; 3Department of Stomatology, The 309th Hospital of Chinese PLA, Beijing 100083; 4Department of Maxillofacial Surgery, The Second Hospital of Liaohe Oil Field, Panjin, Liaoning 124010, P.R. China Received October 1, 2014; Accepted June 26, 2015 DOI: 10.3892/mmr.2015.4123 Abstract. Acellular nerves are composed of a basal lamina gap is usually too large to allow primary end-to-end nerve tube, which retains sufficient bioactivity to promote axon coaptation in the absence of tension. Under these conditions, regeneration, thereby repairing peripheral nerve gaps. reconstruction of the peripheral nerve gap with grafts is neces- However, the clinical application of acellular allografts has sary, in order to avoid the complete loss of motor function and been restricted due to its limited availability. To investigate sensation of the affected area. For the past 100 years, recon- whether xenografts, a substitute to allograft acellular nerves in struction of the peripheral nerve gap has been achieved with abundant supply, could efficiently promote nerve regeneration, autografts, as these offered the highest chance of functional rabbit and rat acellular nerve grafts were used to reconstruct recovery (1). However, limited amounts of donor nerve, as 1 cm defects in Wistar rat facial nerves. Autologous peroneal well as deficitsin the donor area following nerve graft harvest nerve grafts served as a positive control group. A total of restrict the clinical application of nerve gap reconstruction 12 weeks following the surgical procedure, the axon number, using autografts (2). Therefore, current research has focused myelinated axon number, myelin sheath thickness, and nerve on identifying an alternative to autogenous nerve grafts. conduction velocity of the rabbit and rat-derived acellular Allografts have been suggested as an effective alternative nerve grafts were similar, whereas the fiber diameter of the to autogenous nerve grafts in the repair of nerve gaps, due rabbit-derived acellular xenografts decreased, as compared to their similar physical, chemical, and mechanical proper- with those of rat-derived acellular allografts. Autografts ties. A previous study reported that processed allograft has exerted superior effects on nerve regeneration; however, no similar effects on nerve function recovery, as compared with significant difference was observed between the axon number autografts in certain animal studies (3). However, the limited in the autograft group, as compared with the two acellular number of donors is unable to meet the clinical requirements groups. These results suggested that autografts perform better of the increasing number of recipients and commercial alloge- than acellular nerve grafts, and chemically extracted acellular neic nerve grafts are not yet available. Therefore, xenografts allografts and xenografts have similar effects on the regenera- are now being considered as substitutes to allografts and tion of short facial nerve defects. autografts, due to the large number of donors. Xenografts have limitations when used as transplants to Introduction repair nerve gaps, with the most significant limitation being immune rejection caused by donor antigens (4). Immune rejec- Segmental peripheral nerve defects are a clinical problem that tion may impair xenograft nerve regeneration, in a similar may occur following trauma or tumor resection, and the nerve manner to allografts (5). Two primary methods are used to achieve graft tolerance, one of which is the treatment of recipients with immunosuppressive drugs, such as FK506 or cyclosporin A (6); and the other is processing of the nerve prior to grafting in order to render it less immunogenic (7). Correspondence to: Dr Min Hu, Department of Stomatology, The systemic administration of immunosuppressive drugs is Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, necessary for whole organ transplants, but is not an efficient P. R. Ch i na solution for peripheral nerve transplants due to the side effects E-mail: [email protected] caused by the medication, which may be more severe than the *Contributed equally disease itself (8). Therefore, current research has focused on decreasing the antigenicity of xenogeneic nerves with a series Key words: nerve graft, nerve regeneration, acellular nerve, xenograft, of treatments prior to grafting, in order to inhibit the immune peripheral nerve response. A previous study reported that chemically extracted nerves were able to support axon growth in both laboratory HUANG et al: ACELLULAR NERVE XENOGRAFT 6331 and clinical settings, due to the absence of cells and myelin Surgical procedure. Following intraperitoneal injection of in the nerves, which act as major donor antigens (9). In addi- 10% chloral hydrate (0.4 ml/100 mg; Sangon Biotech Co., Ltd.), tion, chemically extracted nerves may support axon growth by a postauricular incision was made on the right side of the face, maintaining the structural integrity of the basal lamina, which and the parotid gland and facial nerve were exposed. A segment has an important role in guiding regenerating axons toward of the buccal facial nerve branch was resected leaving a 1 cm their targets (10). However, the majority of studies regarding gap. In the allograft group, the facial nerve gap was recon- acellular nerve grafts have been conducted on allotransplanta- structed using an acellular facial nerve graft from another rat. tion, and little data are available on acellular nerve grafts in In the xenograft group, the facial nerve gap was reconstructed xenotransplantation. Furthermore, before xenograft acellular using an acellular facial nerve graft from a rabbit. In the auto- nerves may be used in clinical settings, further research is graft group, an incision parallel to the femur was made, and required in order to identify appropriate animal donor species, the peroneal nerve was exposed via a gluteal muscle-splitting which includes the selection and matching of a suitable combi- approach. Subsequently, the facial nerve gap was reconstructed nation of donor grafts and host species. using an autogeneic peroneal nerve graft. The donor nerves In the present study, chemically extracted rabbit facial were trimmed to match the diameter and length of the facial acellular nerve grafts were used to repair 1 cm rat facial nerve nerve of recipients prior to grafting. The nerve grafts were defects, and the outcome of axonal regeneration and functional anastomosed to the proximal and distal nerve stumps under an restoration following nerve gap reconstruction was observed OPMI 6-SD microscope (Carl Zeiss, Oberkochen, Germany) morphologically and electrophysiologically. The present study using 9-0 nylon sutures (Shandong Sinorgmed Co., Ltd., Heze, hypothesized that acellular nerve xenografts may exhibit China). The incision was sutured and disinfected using povi- comparable histological and functional outcomes as that of done iodine. All experimental procedures were approved by the acellular nerve allografts in repairing segmental nerve defects. Ethics Committee of the Chinese PLA general hospital. Materials and methods Functional evaluation of nerve regeneration. Electrophysiological examination was conducted on the rats Donor nerve harvest. New Zealand white rabbits (weight, prior to sacrifice using an NDI‑200P+ electroneurogram device 2.0-2.4 kg; Center of Animal Experiments, Chinese PLA (Shanghai Haishen Medical Electronic Instrument Co., Ltd., General Hospital, Beijing, China) were anesthetized by Shanghai, China), in order to detect the extent of facial nerve intravenous injection of 3% pentobarbital sodium (Sangon functional recovery. The rats were anesthetized by intraperito- Biotech Co., Ltd., Shanghai, China) and Wistar rats (weight, neal injection of 10% chloral hydrate (0.4 ml/100 mg), and the 200-220 g; Center of Animal Experiments Chinese PLA buccal branches of the right facial nerves and corresponding General Hospital were anesthetized by intraperitoneal injec- orbicularisoris muscles were exposed. Excitation electrodes tion of 10% chloral hydrate (Sangon Biotech Co., Ltd.), a were placed on the proximal end of the nerve, and recording postauricular incision was made, and the facial nerve was electrodes were placed on the distal end of the graft. The exposed. A length of 4-5 cm of the rabbit facial nerves were proximal end was then stimulated with square waves, the action removed as xenograft nerves, and a length of 2 cm of rat potential caused by the stimulus was recorded, and the nerve facial nerves were removed as allograft nerves. All of the conduction velocity was calculated. tissue specimens were washed in a distilled water bath and cryopreserved. Histological and morphological evaluation of nerve regenera- tion Facial nerve acellularization. The acellular nerves were Histological staining. Hematoxylin and Eosin (HE; Beijing prepared via a chemical extraction process as described in Zhongshan Jinqiao Biotechnology Co., Ltd.) staining was our previous study (11). The facial nerve segments from both performed to observe the constitution of acellular nerves. the rats and
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