DOCSLIB.ORG

A Systematic Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Systematic Review cells Review Therapeutic Potential of Complementary and Alternative Medicines in Peripheral Nerve Regeneration: A Systematic Review Yoon-Yen Yow 1,* , Tiong-Keat Goh 1 , Ke-Ying Nyiew 1, Lee-Wei Lim 2,* , Siew-Moi Phang 3,4, Siew-Huah Lim 5, Shyamala Ratnayeke 1 and Kah-Hui Wong 6,* 1 Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya 47500, Malaysia; [email protected] (T.-K.G.); [email protected] (K.-Y.N.); [email protected] (S.R.) 2 Neuromodulation Laboratory, School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, L4 Laboratory Block, Hong Kong 3 Institute of Ocean and Earth Sciences, Universiti Malaya, Kuala Lumpur 50603, Malaysia; [email protected] 4 Faculty of Applied Sciences, UCSI University, Cheras, Kuala Lumpur 56000, Malaysia 5 Department of Chemistry, Faculty of Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia; [email protected] 6 Department of Anatomy, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia * Correspondence: [email protected] (Y.-Y.Y.); [email protected] (L.-W.L.); [email protected] (K.-H.W.); Tel.: +603-7491-8622 (Y.-Y.Y.); +852-3917-6830 (L.-W.L.); +603-7967-4729 (K.-H.W.) Citation: Yow, Y.-Y.; Goh, T.-K.; Nyiew, K.-Y.; Lim, L.-W.; Abstract: Despite the progressive advances, current standards of treatments for peripheral nerve Phang, S.-M.; Lim, S.-H.; injury do not guarantee complete recovery. Thus, alternative therapeutic interventions should Ratnayeke, S.; Wong, K.-H. be considered. Complementary and alternative medicines (CAMs) are widely explored for their Therapeutic Potential of therapeutic value, but their potential use in peripheral nerve regeneration is underappreciated. Complementary and Alternative The present systematic review, designed according to guidelines of Preferred Reporting Items for Medicines in Peripheral Nerve Systematic Review and Meta-Analysis Protocols, aims to present and discuss the current literature Regeneration: A Systematic Review. on the neuroregenerative potential of CAMs, focusing on plants or herbs, mushrooms, decoctions, Cells 2021, 10, 2194. https://doi.org/ and their respective natural products. The available literature on CAMs associated with peripheral 10.3390/cells10092194 nerve regeneration published up to 2020 were retrieved from PubMed, Scopus, and Web of Science. According to current literature, the neuroregenerative potential of Achyranthes bidentata, Astragalus Academic Editor: FengRu Tang membranaceus, Curcuma longa, Panax ginseng, and Hericium erinaceus are the most widely studied. Various CAMs enhanced proliferation and migration of Schwann cells in vitro, primarily through Received: 24 July 2021 Accepted: 20 August 2021 activation of MAPK pathway and FGF-2 signaling, respectively. Animal studies demonstrated Published: 25 August 2021 the ability of CAMs to promote peripheral nerve regeneration and functional recovery, which are partially associated with modulations of neurotrophic factors, pro-inflammatory cytokines, and Publisher’s Note: MDPI stays neutral anti-apoptotic signaling. This systematic review provides evidence for the potential use of CAMs in with regard to jurisdictional claims in the management of peripheral nerve injury. published maps and institutional affil- iations. Keywords: complementary and alternative medicines; natural products; peripheral nerve injury; nerve repair; nerve regeneration; functional recovery Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. 1. Introduction This article is an open access article Peripheral nerve injury (PNI) can result in partial or total loss of motor, sensory and distributed under the terms and autonomic functions at denervated regions, leading to temporary or life-long disability [1]. conditions of the Creative Commons In addition to reduced quality of life, functional deficits from PNI have a substantial Attribution (CC BY) license (https:// economic impact on the affected individuals [2]. A recent study found that, over nine years creativecommons.org/licenses/by/ (from 2009 to 2018), more than 550,000 individuals were afflicted by PNI in the United 4.0/). Cells 2021, 10, 2194. https://doi.org/10.3390/cells10092194 https://www.mdpi.com/journal/cells Cells 2021, 10, 2194 2 of 35 States. Moreover, the incidence rate has more than doubled throughout that period of time [3]. Such injuries are primarily due to vehicular and traumatic accidents, lacerations, and iatrogenic causes [4–6]. Despite progressive advances in our understanding of the processes and mecha- nisms of nerve injury, effective nerve repair and regeneration approaches that ensure complete functional recovery remain scarce [7]. Nerve autograft is considered the gold standard for repairing peripheral nerve defects [8]. However, this method is restricted by limited donor nerves and donor site morbidity, while successful recovery rates remain unsatisfactory [9]. Consequently, alternative strategies for enhancing nerve repairs have been proposed, including the application of nerve conduits and the addition of growth factors [10,11]. Likewise, the exploration of novel therapeutics, even combinatorial therapies, capable of enhancing axonal regeneration and promoting functional recovery, are of great interest. PNI often results in neuropathic pain, and when conventional treatments are inade- quate in providing relief, patients may turn to complementary and alternative medicines (CAMs), such as herbal medicines and nutritional supplements [12]. Indeed, medicinal plants, including the Acorus calamus [13], Curcuma longa [14], and Ginkgo biloba [15], have displayed ameliorating effects in animal models of neuropathic pain. Research on the potential of medicinal plants in the treatment of PNI is prompted by the notion that plants are great sources of natural products (NPs), which are small molecules produced by living organisms. Many NPs are the focus of drug development, as it is generally believed that they are largely devoid of adverse effects compared to synthetic drugs [16,17]. NPs also have the advantage of being evolutionary-driven, thus they are more likely to possess tremendous chemical and structural diversity that facilitates efficient engagement with biologically relevant targets and receptors, making them more biologically active [18]. In fact, many small-molecule drugs that have been approved by regulatory agencies were derived from natural sources [19], including Taxol from Taxus brevifolia [20] and Vinblastine from Catharanthus roseus [21]. However, compared to the extensive research on naturally derived products for other non-communicable and infectious diseases, NPs remain largely unexplored in the field of nerve repair and regeneration. A review published nearly half a decade ago has shed light on the neuroprotective effects of NPs in PNI models [22]. This review presents current research findings and evaluates the role of CAMs, focusing on plants or herbs, mushrooms, and decoctions, as well as their NPs, in peripheral nerve regeneration, to highlight their therapeutic potential for the management of PNI. 2. Materials and Methods This systematic review was designed according to guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) [23]. 2.1. Search Strategy and Data Extraction A literature search was performed to find all relevant publications up to 25 October 2020 across three electronic databases, PubMed, Scopus, and Web of Science. The fol- lowing keywords were used to search each respective database: ((“peripheral* nerve* regenera*” OR “peripheral* nerve* repair*” OR “neuroregenera*”) AND (“alga*” OR “seaweed*” OR “plant” OR “natural product*” OR “mushroom” OR “Basidiomycete*” OR “herb*” OR “Traditional Chinese Medicine*” OR “alternative medicine” OR “com- plementary medicine*”)). Cells 2021, 10, x FOR PEER REVIEW 3 of 38 Cells 2021, 10, 2194 3 of 35 2.2. Eligibility Criteria 2.2. EligibilityResearch Criteriaarticles describing the use of plants or herbs, mushrooms, algae, decoction, and theirResearch natural articles products describing in peripheral the use nerve of plants repair or and herbs, regeneration, mushrooms, written algae, in decoction, English, and theirhaving natural full-text products availability in peripheral were consid nerveered. repair Articles and regeneration, not representing written original in English, re- searchand having studies full-text and NPs availability derived were from considered. sources other Articles than not plants, representing herbs, algae, original and research mush- roomsstudies were and NPsexcluded derived (e.g., from Lumbricus sources otherrubellus than—earthworm). plants, herbs, Retrieved algae, and articles mushrooms were screenedwere excluded based (e.g.,on theirLumbricus title, abstract, rubellus and—earthworm). full-text to determine Retrieved their articles eligibility were for screened inclu- sionbased in onthis their review. title, abstract, and full-text to determine their eligibility for inclusion in this review. 3. Results 3. Results A preliminary search across the three databases yielded 560 records, of which 215 were Aduplicates preliminary (Figure search 1). across Together the three with databases18 other records yielded id 560entified records, by of other which means, 215 were the remainingduplicates articles (Figure 1were). Together screened with based 18 other on the records eligibility identified criteria, by resulting other means, in 289 the addi-
Load more

Recommended publications
  • Biomaterials for the Development of Peripheral Nerve Guidance Conduits
    TISSUE ENGINEERING: Part B Volume 18, Number 1, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/ten.teb.2011.0240 Biomaterials for the Development of Peripheral Nerve Guidance Conduits Alexander R. Nectow, B.S., M.S.,1 Kacey G. Marra, Ph.D.,2 and David L. Kaplan, Ph.D.1 Currently, surgical treatments for peripheral nerve injury are less than satisfactory. The gold standard of treatment for peripheral nerve gaps > 5 mm is the autologous nerve graft; however, this treatment is associated with a variety of clinical complications, such as donor site morbidity, limited availability, nerve site mismatch, and the formation of neuromas. Despite many recent advances in the field, clinical studies implementing the use of artificial nerve guides have yielded results that are yet to surpass those of autografts. Thus, the development of a nerve guidance conduit, which could match the effectiveness of the autologous nerve graft, would be beneficial to the field of peripheral nerve surgery. Design strategies to improve surgical outcomes have included the development of biopolymers and synthetic polymers as primary scaffolds with tailored mechanical and physical properties, luminal ‘‘fillers’’ such as laminin and fibronectin as secondary internal scaffolds, surface micropatterning, stem cell inclusion, and controlled release of neurotrophic factors. The current article highlights approaches to peripheral nerve repair through a channel or conduit, implementing chemical and physical growth and guidance cues to direct that repair process. Introduction by compression syndrome and often required secondary surgeries for removal.13 Since then, there have been a variety eripheral nerve injury affects 2.8% of patients with of different biomaterials approved for clinical use, such as trauma, presenting a critical clinical issue.1 The postinjury P type I collagen, polyglycolic acid (PGA), poly-DL-lactide-co- axonal anatomy is characterized by primary degeneration with caprolactone (PLCL), and polyvinyl alcohol (PVA).
    [Show full text]
  • Restoration of Neurological Function Following Peripheral Nerve Trauma
    International Journal of Molecular Sciences Review Restoration of Neurological Function Following Peripheral Nerve Trauma Damien P. Kuffler 1,* and Christian Foy 2 1 Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, 201 Blvd. del Valle, San Juan, PR 00901, USA 2 Section of Orthopedic Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00901, USA; [email protected] * Correspondence: dkuffl[email protected] Received: 12 January 2020; Accepted: 3 March 2020; Published: 6 March 2020 Abstract: Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery.
    [Show full text]
  • Grant Project Che 575 Friday, April 29, 2016 By: Julie Boshar, Matthew
    Grant Project ChE 575 Friday, April 29, 2016 By: Julie Boshar, Matthew Long, Andrew Mason, Chelsea Orefice, Gladys Saruchera, Cory Thomas Specific Aims The spinal cord is the body’s most important organ for relaying nerve signals to and from the brain and the body. However, when an individual's spinal cord becomes injured due to trauma, their quality of life is greatly diminished. In the United States today, there are an estimated quarter of a million individuals living with a spinal cord injury (SCI). With an additional 12,000 cases being added every year. Tragically, there is no approved FDA treatment strategy to help restore function to these individuals. SCIs are classified as either primary or secondary events. Primary injuries occur when the spinal cord is displaced by bone fragments or disk material. In this case, nerve signaling rarely ceases upon injury but in severe cases axons are beyond repair. Secondary injuries occur when biochemical processes kill neural cells and strip axons of their myelin sheaths, inducing an inflammatory immune response. In the CNS, natural repair mechanisms are inhibited by proteins and matrix from glial cells, which embody the myelin sheath of axons. This actively prevents the repair of axons, via growth cone inhibition by oligodendrocytes and axon extension inhibition by astrocytes. A promising treatment to SCI use tissue engineered scaffolds that are biocompatible, biodegradable and have strong mechanical properties in vivo. These scaffolds can secrete neurotrophic factors and contain neural progenitor cells to promote axon regeneration, but further research is required to develop this into a comprehensive treatment.
    [Show full text]
  • Peripheral Nerve Regeneration and Muscle Reinnervation
    International Journal of Molecular Sciences Review Peripheral Nerve Regeneration and Muscle Reinnervation Tessa Gordon Department of Surgery, University of Toronto, Division of Plastic Reconstructive Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; [email protected]; Tel.: +1-(416)-813-7654 (ext. 328443) or +1-647-678-1314; Fax: +1-(416)-813-6637 Received: 19 October 2020; Accepted: 10 November 2020; Published: 17 November 2020 Abstract: Injured peripheral nerves but not central nerves have the capacity to regenerate and reinnervate their target organs. After the two most severe peripheral nerve injuries of six types, crush and transection injuries, nerve fibers distal to the injury site undergo Wallerian degeneration. The denervated Schwann cells (SCs) proliferate, elongate and line the endoneurial tubes to guide and support regenerating axons. The axons emerge from the stump of the viable nerve attached to the neuronal soma. The SCs downregulate myelin-associated genes and concurrently, upregulate growth-associated genes that include neurotrophic factors as do the injured neurons. However, the gene expression is transient and progressively fails to support axon regeneration within the SC-containing endoneurial tubes. Moreover, despite some preference of regenerating motor and sensory axons to “find” their appropriate pathways, the axons fail to enter their original endoneurial tubes and to reinnervate original target organs, obstacles to functional recovery that confront nerve surgeons. Several surgical manipulations in clinical use, including nerve and tendon transfers, the potential for brief low-frequency electrical stimulation proximal to nerve repair, and local FK506 application to accelerate axon outgrowth, are encouraging as is the continuing research to elucidate the molecular basis of nerve regeneration.
    [Show full text]
  • A Tissue-Engineered Conduit for Peripheral Nerve Repair
    ORIGINAL ARTICLE A Tissue-Engineered Conduit for Peripheral Nerve Repair Tessa Hadlock, MD; Jennifer Elisseeff, BS; Robert Langer, ScD; Joseph Vacanti, MD; Mack Cheney, MD Background: Peripheral nerve repair using autograft ma- formed using a dip-molding technique. They were cre- terial has several shortcomings, including donor site mor- ated containing 1, 2, 4, or 5 sublumina, or “fascicular ana- bidity, inadequate return of function, and aberrant re- logs.” Populations of Schwann cells were isolated, ex- generation. Recently, peripheral nerve research has panded in culture, and plated onto these polymer films, focused on the generation of synthetic nerve guidance where they demonstrated excellent adherence to the poly- conduits that might overcome these phenomena to im- mer surfaces. Regeneration was demonstrated through prove regeneration. In our laboratory, we use the unique several constructs. chemical and physical properties of synthetic polymers in conjunction with the biological properties of Schwann Conclusions: A tubular nerve guidance conduit pos- cells to create a superior prosthesis for the repair of mul- sessing the macroarchitecture of a polyfascicular periph- tiply branched peripheral nerves, such as the facial nerve. eral nerve was created. The establishment of resident Schwann cells onto poly-L-lactic acid and polylactic–co- Objectives: To create a polymeric facial nerve analog glycolic acid surfaces was demonstrated, and the feasi- approximating the fascicular architecture of the extra- bility of in vivo regeneration through the conduit was temporal facial nerve, to introduce a population of shown. It is hypothesized that these tissue-engineered de- Schwann cells into the analog, and to implant the vices, composed of widely used biocompatible, biode- prosthesis into an animal model for assessment of gradable polymer materials and adherent Schwann cells, regeneration.
    [Show full text]
  • The Role of Spider Silk in Peripheral Nerve Regeneration
    W&M ScholarWorks Undergraduate Honors Theses Theses, Dissertations, & Master Projects 5-2021 The Role of Spider Silk in Peripheral Nerve Regeneration Langston Forbes-Jackson Follow this and additional works at: https://scholarworks.wm.edu/honorstheses Part of the Biomaterials Commons, and the Nanomedicine Commons Recommended Citation Forbes-Jackson, Langston, "The Role of Spider Silk in Peripheral Nerve Regeneration" (2021). Undergraduate Honors Theses. Paper 1703. https://scholarworks.wm.edu/honorstheses/1703 This Honors Thesis -- Open Access is brought to you for free and open access by the Theses, Dissertations, & Master Projects at W&M ScholarWorks. It has been accepted for inclusion in Undergraduate Honors Theses by an authorized administrator of W&M ScholarWorks. For more information, please contact [email protected]. The Role of Spider Silk in Peripheral Nerve Regeneration A thesis submitted in partial fulfillment of the requirement for the degree of Bachelor of Arts / Science in Biology from William & Mary by Langston Forbes-Jackson Accepted for ____Honors_________________________ (Honors, High Honors, Highest Honors) __Hannes Schniepp_ _________ Type in the name, Director ______________________________ Lizabeth A. Allison ________________________________________ Type in the name ________________________________________ Type in the name Williamsburg, VA May 10, 2021 Langston Forbes-Jackson The Role of Spider Silk in Peripheral Nerve Regeneration Abstract Spider silk neural guidance channels (NGCs) are highly important innovations in the field of regenerative medicine. This paper will discuss the evidence in the literature that supports their function in regenerative medicine and provide a template for future experiments in the field. While many studies within the past 15 years have demonstrated the validity of spider silk as a scaffold for peripheral nerve regeneration, the molecular mechanics that facilitate regeneration are poorly understood.
    [Show full text]
  • A Nerve Guidance Conduit with Topographical and Biochemical Cues
    Jenkins et al. Nanoscale Research Letters (2015) 10:264 DOI 10.1186/s11671-015-0972-6 NANO EXPRESS Open Access A nerve guidance conduit with topographical and biochemical cues: potential application using human neural stem cells Phillip M Jenkins1, Melissa R Laughter1, David J Lee1, Young M Lee2, Curt R Freed2 and Daewon Park1* Abstract Despite major advances in the pathophysiological understanding of peripheral nerve damage, the treatment of nerve injuries still remains an unmet medical need. Nerve guidance conduits present a promising treatment option by providing a growth-permissive environment that 1) promotes neuronal cell survival and axon growth and 2) directs axonal extension. To this end, we designed an electrospun nerve guidance conduit using a blend of polyurea and poly-caprolactone with both biochemical and topographical cues. Biochemical cues were integrated into the conduit by functionalizing the polyurea with RGD to improve cell attachment. Topographical cues that resemble natural nerve tissue were incorporated by introducing intraluminal microchannels aligned with nanofibers. We determined that electrospinning the polymer solution across a two electrode system with dissolvable sucrose fibers produced a polymer conduit with the appropriate biomimetic properties. Human neural stem cells were cultured on the conduit to evaluate its ability to promote neuronal growth and axonal extension. The nerve guidance conduit was shown to enhance cell survival, migration, and guide neurite extension. Keywords: Biomimetic; Nerve regeneration; Electrospinning; Microchannel; Human neural stem cells Background However, autographs have many clinical limitations in- Functional recovery following a severe peripheral nerve cluding donor site morbidity, mismatch of donor size, injury is a daunting challenge in the field of neuro- neuropathic pain, and limited donor nerve length [4, 5].
    [Show full text]
  • Enhancing Nerve Regeneration in the Peripheral Nervous System Using
    Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2016 Enhancing nerve regeneration in the peripheral nervous system using polymeric scaffolds, stem cell engineering and nanoparticle delivery system Anup Dutt hS arma Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Part of the Biomedical Commons, Chemical Engineering Commons, and the Nanoscience and Nanotechnology Commons Recommended Citation Sharma, Anup Dutt, "Enhancing nerve regeneration in the peripheral nervous system using polymeric scaffolds, stem cell engineering and nanoparticle delivery system" (2016). Graduate Theses and Dissertations. 15082. https://lib.dr.iastate.edu/etd/15082 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. Enhancing nerve regeneration in the peripheral nervous system using polymeric scaffolds, stem cell engineering and nanoparticle delivery system by Anup Dutt Sharma A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: Chemical Engineering Program of Study Committee: Surya K. Mallapragada, Co-Major Professor Donald S. Sakaguchi, Co-Major Professor Balaji Narasimhan Kaitlin
    [Show full text]
  • Current Micropatterning, Microfluidics and Nerve Guidance Conduit for Nerve Regeneration and Future Recommendations
    Biomaterials Research (2011) 15(4) : 159-167 Biomaterials Research C The Korean Society for Biomaterials Current Micropatterning, Microfluidics and Nerve Guidance Conduit for Nerve Regeneration and Future Recommendations MinJung Song* Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854 (Received October 26, 2011/Acccepted November 7, 2011) Each year, approximately 200,000 patients suffer from peripheral nerve injuries, resulting in tremendous medical 1) expense in the United States. The peripheral nerves are damaged by injury, disease, trauma, or other medical dis- orders. After the injury, peripheral nerves can regenerate, but when the injury is too severe, nerves degenerate and lose functionality. This review focuses on improving peripheral nerve regeneration with microfabrication techniques and biomaterials. In this review, several concepts will be introducing relating to the peripheral nervous system, microfabrication techniques (e.g., micropatterning and microfluidics) and biomaterials (e.g., drug-containing polymer) to improve nerve regeneration in the cellular and tissue levels. Key words: peripheral nerve regeneration, micropatterns, microfluidics, gradient, polyNSAID Peripheral Nervous System ous roles to support neurons. First, they produce biomolecules such as laminin, cell adhesion molecules, integrins, and neu- he nervous system is a communicating network to inte- rotrophins, which give growth signals to provide guidance for T grate and monitor the actions throughout the body. This regenerating axons and control cellular differentiation and sur- system is classified as the peripheral nervous system (PNS) and vival. Second, Schwann cells are involved in removing cell 7-11) central nervous system (CNS). The PNS senses a variety of debris after nerve injury. environmental reactions with sensory neurons and transmits the Several nerve fibers constitute a single nerve, and each nerve information to the CNS.
    [Show full text]
  • Chitosan Nerve Conduits Seeded with Autologous Bone Marrow
    www.nature.com/scientificreports OPEN Chitosan nerve conduits seeded with autologous bone marrow mononuclear cells for 30 mm goat Received: 14 July 2016 Accepted: 03 February 2017 peroneal nerve defect Published: 13 March 2017 Aikeremujiang Muheremu1,2,*, Lin Chen3,*, Xiyuan Wang4, Yujun Wei1, Kai Gong3 & Qiang Ao1 In the current research, to find if the combination of chitosan nerve conduits seeded with autologous bone marrow mononuclear cells (BM-MNCs) can be used to bridge 30 mm long peroneal nerve defects in goats, 15 animals were separated into BM-MNC group (n = 5), vehicle group (n = 5), and autologous nerve graft group (n = 5). 12 months after the surgery, animals were evaluated by behavioral observation, magnetic resonance imaging tests, histomorphological and electrophysiological analysis. Results revealed that animals in BM-MNC group and autologous nerve graft group achieved fine functional recovery; magnetic resonance imaging tests and histomorphometry analysis showed that the nerve defect was bridged by myelinated nerve axons in those animals. No significant difference was found between the two groups concerning myelinated axon density, axon diameter, myelin sheath thickness and peroneal nerve action potential. Animals in vehicle group failed to achieve significant functional recovery. The results indicated that chitosan nerve conduits seeded with autologous bone marrow mononuclear cells have strong potential in bridging long peripheral nerve defects and could be applied in future clinical trials. Although the peripheral nervous system has the ability to regenerate after injury, functional recovery after the injury is still unsatisfactory. For repairing long peripheral nerve defects, autologous nerve grafting is still the gold standard. However, this technique has several disadvantages such as limited graft supply, donor site morbidity and prolonged operation time.
    [Show full text]
  • Fundamentals and Current Strategies for Peripheral Nerve Repair and Regeneration 1
    Fundamentals and current strategies for Peripheral Nerve Repair and Regeneration 1 Fundamentals and current strategies for Peripheral Nerve Repair and Regeneration Cristiana R. Carvalhoa, b, c, Rui L. Reisa, b, c and Joaquim M. Oliveiraa, b, c Abstract A body of evidence indicates that peripheral nerves have an extraordinary yet limited capacity to regenerate after an injury. Peripheral nerve injuries have confounded professionals in this field, from neuroscientists to neurologists, plastic surgeons, and the scientific community. Despite all the efforts, full functional recovery is still seldom. The inadequate results attained with the “gold standard” autograft procedure still encourage a dynamic and energetic research around the world for establishing good performing tissue engineered alternative grafts. Resourcing to nerve guidance conduits, a variety of methods have been experimentally used to bridge peripheral nerve gaps of limited size, up to 30-40 mm in length, in humans. Herein, we aim to summarize the fundamentals related to peripheral nerve anatomy and overview the challenges and scientific evidences related to peripheral nerve injury and repair mechanisms. The most relevant reports dealing with the use of both synthetic and natural- based biomaterials used in tissue engineering strategies when treatment of nerve injuries is envisioned are also discussed in depth, along with the state-of-the-art approaches in this field. Keywords: Peripheral Nerve Regeneration, Tissue Engineering, Biomaterials 1 2 CR Carvalho, JM Oliveira and RL Reis INTRODUCTION The most significant advances in peripheral nerve repair and regeneration have been achieved over the last years with the improvement of technological tools. However, the study of nerve and its regenerative potential initiated in earlier times, possibly in the ancient Greek period [1].
    [Show full text]
  • Machine Intelligence for Nerve Conduit Design and Production Caleb E
    Stewart et al. Journal of Biological Engineering (2020) 14:25 https://doi.org/10.1186/s13036-020-00245-2 REVIEW Open Access Machine intelligence for nerve conduit design and production Caleb E. Stewart1* , Chin Fung Kelvin Kan2, Brody R. Stewart3, Henry W. Sanicola III1, Jangwook P. Jung4, Olawale A. R. Sulaiman5,6* and Dadong Wang7* Abstract Nerve guidance conduits (NGCs) have emerged from recent advances within tissue engineering as a promising alternative to autografts for peripheral nerve repair. NGCs are tubular structures with engineered biomaterials, which guide axonal regeneration from the injured proximal nerve to the distal stump. NGC design can synergistically combine multiple properties to enhance proliferation of stem and neuronal cells, improve nerve migration, attenuate inflammation and reduce scar tissue formation. The aim of most laboratories fabricating NGCs is the development of an automated process that incorporates patient-specific features and complex tissue blueprints (e.g. neurovascular conduit) that serve as the basis for more complicated muscular and skin grafts. One of the major limitations for tissue engineering is lack of guidance for generating tissue blueprints and the absence of streamlined manufacturing processes. With the rapid expansion of machine intelligence, high dimensional image analysis, and computational scaffold design, optimized tissue templates for 3D bioprinting (3DBP) are feasible. In this review, we examine the translational challenges to peripheral nerve regeneration and where machine intelligence
    [Show full text]