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Evaluation of the Host Immune Response and Functional Recovery in Peripheral Nerve Autografts and Allografts T ⁎ Kelly Cristine Santos Roballo, Jared Bushman

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Evaluation of the Host Immune Response and Functional Recovery in Peripheral Nerve Autografts and Allografts T ⁎ Kelly Cristine Santos Roballo, Jared Bushman Transplant Immunology 53 (2019) 61–71 Contents lists available at ScienceDirect Transplant Immunology journal homepage: www.elsevier.com/locate/trim Evaluation of the host immune response and functional recovery in peripheral nerve autografts and allografts T ⁎ Kelly Cristine Santos Roballo, Jared Bushman University of Wyoming, School of Pharmacy, Laramie, WY 82072, USA ARTICLE INFO ABSTRACT Keywords: Allogeneic peripheral nerve (PN) transplants are an effective bridge for stimulating regeneration of segmental Local immune system PN defects, but there are currently no detailed studies about the timeline and scope of the immunological Transplant response for PN allografting. In this study, the cellular immune response in PN allografts and autograft was Peripheral nerve studied during the acute and chronic phases of a 1.0 cm critical size defect in the rat sciatic nerve at 3, 7, 14, 28 and 98 days after grafting autologous or allogeneic nerves without any immunosuppressive treatment. The as- sessment was based on functional, histomorphometrical and immunohistochemical criteria. Results showed modestly better functional outcomes for autografts with coordinate and adaptive immune response represented by the presence of CD11c, CD3, CD4, NKp46 and CD8 cells at 3 days, CD45R positive cells and CD25 positive cells at seven and CD45R positive cells at 14 days which seems an adaptive immune response. In contrast, allograft in the early time points showed innate immune response instead of adaptive immune response until day 14, when there was some increase in cell-mediated immunity. In conclusion, in PN autografts the immune system is synchronic initiating with a more robust early innate response that more rapidly transitions to adaptive while for PN allografts the infiltration of immune cells is slower and more gradually progresses to a moderate adaptive response. 1. Introduction especially for larger defects [7]. Allogeneic PN grafts are as or more effective than autografts owing to that they can be mixed (motor and PNs are primarily composed of axons, Schwann cells (SCs), resident sensory axons) and more exactly matched for size and complex nerve immune cells and connective tissue [1]. When PNs are injured, the structures [8]. PN allografts, however, are rarely used clinically due to principal outcomes are loss and aberration of function, which can be the risks associated with immunosuppressive therapy used with allo- permanent and lead to lifelong disability [2]. In severe cases, termed geneic tissue grafts [9]. Improvements in immunosuppressive therapy neurotmesis by the Seddon and Sunderland classification, a nerve is that reduce or remove risks may enable more the widespread use of this completely bisected and functionality is immediately lost distal to the very effective PN regeneration strategy. injury [3,4]. Wallerian degeneration occurs distal to the injury as SCs While many reports show endpoint histology after PN allografts as dissociate from axons and the axons break down and are degraded compared to autografts, there are currently no detailed studies on the [5,6]. The result of Wallerian degeneration leaves the distal segment immunological response to PN allografts in the acute and chronic devoid of functional axons but primed for axons to reenter and for re- phases. In an effort to characterize the cellular processes occurring generation to occur [5,6]. Functional regeneration requires that sur- during the acute and chronic phases, we compared 1.0 cm critical size viving proximal axons extend into the distal PN segment and regenerate defects grafted with autologous or allogeneic PNs without im- to their target motor and sensory tissues [5,6]. munosuppressive therapy in a rat sciatic nerve model. Tissue was col- For segmental defects greater than ~0.5 cm, a bridging device must lected 3, 7, 14, 28 and 98 days (fourteen weeks) after grafting for his- be placed between the stumps in order for proximal axons to effectively tology and stained for markers of macrophages, dendritic, T cells, B regenerate into the distal segment. Autografted PNs, typically sensory cells, Natural Killers, Schwann cells and axons. Functional outcomes of segments of the sural or forelimb cutaneous nerves, are the gold stan- compound muscle action potentials (CMAPS) and muscle mass were dard for the bridging device. Biodegradable conduits and wraps are also also collected. The results indicate a substantial degree of regeneration clinically used but are fractionally effective compared to autografts, with allografts in the absence of immunosuppression, but shows ⁎ Corresponding author. E-mail address: [email protected] (J. Bushman). https://doi.org/10.1016/j.trim.2019.01.003 Received 27 August 2018; Received in revised form 24 January 2019; Accepted 25 January 2019 Available online 05 February 2019 0966-3274/ © 2019 Published by Elsevier B.V. K.C.S. Roballo, J. Bushman Transplant Immunology 53 (2019) 61–71 distinctions in the types, quantities and timing of immune cell in- 3.3. Electromyography (EMG) to measure CMAPs filtration between autograft and allograft. It is anticipated that these studies may be used as a basis of comparison for future studies assessing CMAPs were measured as described for Clements et al. 2016 study the efficacy of PN allografting. [10]. Briefly, rats were anesthetized with isoflurane 2.5% and Viking- Quest (Natus Neurology) was used to measure CMAPs of left peroneal and tibial muscles by surface stimulation near the heel, targets of the 2. Objective peroneal and sciatic branches of the sciatic nerve. The rats were posi- tioned in decubitus frontal on the working platform in order to measure The objective of these studies was to more fully characterize the compound muscle action potentials (CMAP) by EMG. The electrode was immunological response to allogeneic PN grafts in vivo. To do this, the placed in the posterior muscles group of the distal region after surgery cellular immune response to PN damage was studied during acute and and the sciatic nerve branches were stimulated at least 6 times with the chronic phases following the insertion of a 1.0 cm PN autograft or al- surface electrode. The reported findings are the average of the 3 largest lograft in the rat sciatic nerve. Assessment of immune cell response and CMAPs for each animal at each time point. The electrical stimulation nerve regeneration was based on functional, histomorphometrical and parameters were stimulus frequency 1 Hz, intensity lower than 24 mA. immunohistochemical criteria from tissue harvested on days 3, 7, 14, 28 and 98 after surgery. 3.4. Nerve collection and euthanasia AVWA Guidelines for the Euthanasia of Animals and NIH Guide for 3. Material and methods the Care and Use of Laboratory Animals were followed. Nerves were fixed in situ by exposing the nerves in isoflurane-anesthetized animals 3.1. Study design and bathing the nerve in Trumps fixative for 30 min. Nerves were then excised from the animals and placed in Trumps fixative. All experiments were conducted in accordance with the University of Wyoming Institutional Animal Care and Use Committee under ap- 3.5. Muscle wet weight analysis proved and current protocols. Female Lewis (LEW- RT1l) rats (Charles River Laboratories, Massachusetts, USA), 200–230 g, were submitted to For muscle wet weight analysis Wang et al. (2017)’s protocol was sciatic nerve transection surgery and were recipients of autograft (Auto) followed [11]. Briefly, Tibial anterior and gastrocnemius muscles were or allograft (Allo) transplantation. Donor PN tissue for allografts was dissected and isolated from right and left sides immediately after ani- harvested from deceased female Sprague–Dawley (SD—RT1b) rats mals were sacrificed, and weighed using a microbalance (Mettler To- (Charles River Laboratories, Massachusetts, USA), 200–230 g (Table 1). ledo, Columbus, OH, EUA). Affected side and unaffected side muscle For bulk cell infiltration studies, GFP expressing animals were obtained wet weight values were compared and analyzed for each time point. from Rat Resource and Research Center (RRRC) Columbia, MO, USA strain SD-Tg (UBC-EGFP) 2BalRrrc, common name SD-EGFP. GFP ex- 3.6. Sectioning and histology (immunohistolochemical analysis) pressing animals used in the study were heterozygotes from breeding SD-EGFP with SD animals obtained from Charles River. 3.6.1. Tissue processing Sciatic nerves were harvested, kept in Trump's fixative solution overnight and incubated in 20% sucrose solution for at least 16 h for 3.2. Surgery and post-operative care cryoprotection. Samples were embedded in OCT Cryo mount® (Histolab products AB, Gothenburg, Sweden) and frozen at −20 °C. The nerves Before surgery, animals were acclimatized to standard laboratory were cut in 8–10 μm thin longitudinal sections in a cryotome and col- conditions and given free access to rat chow and water. The surgical lected on superfrost plus glass (Thermo scientific, Braunschweig, approach for exposing the sciatic nerve, length and location of the Germany) [12]. segment excised from the sciatic nerve, the type and location of closing- up sutures, anesthesia and perioperative management were similar to 3.6.2. Immunohistochemistry previously described studies [10](Fig. 1). Post-operatively, animals Immunohistochemistry in frozen sections was performed for the were observed at least daily and treated with a single injection of following antibodies: Anti-Glial Fibrillary Acidic Protein (GFAP), baytril (5 mg/Kg) for up to 3 days following surgery, acetaminophen polyclonal (Millipore cat#AB5541, 1:300); Anti-β III Tubulin, poly- (64 mg/kg/day) for up to 7 days following surgery and buprenorphine clonal (Millipore cat# AB9354, 1:50); Anti-rat CD4 PE (cat#12–0040- (2×/day, 0.01–0.05 mg/Kg) for up to 3 days following surgery. Sterile 82, 1:50), Anti-CD3 (Santa Cruz sc-20,047, 1:50); Anti-CD8 (Santa Cruz paper rolls and sunflower seeds were offer ad libero to the animals for sc-1177, 1:50); FITC conjugated anti-mouse/human CD45R (B220) environmental enrichment. There was no autophagy or death that oc- antibody (eBioscience cat# 11–0452-81, 1:50); Alexa Fluor 488 con- curred in any of the animals during all experiments.
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