Acellular nerve allografts in peripheral nerve regeneration: A comparative study

Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
Muscle & Nerve (Impact Factor: 2.28). 08/2011; 44(2):221-34. DOI: 10.1002/mus.22033
Source: PubMed


Processed nerve allografts offer a promising alternative to nerve autografts in the surgical management of peripheral nerve injuries where short deficits exist.
Three established models of acellular nerve allograft (cold-preserved, detergent-processed, and AxoGen-processed nerve allografts) were compared with nerve isografts and silicone nerve guidance conduits in a 14-mm rat sciatic nerve defect.
All acellular nerve grafts were superior to silicone nerve conduits in support of nerve regeneration. Detergent-processed allografts were similar to isografts at 6 weeks postoperatively, whereas AxoGen-processed and cold-preserved allografts supported significantly fewer regenerating nerve fibers. Measurement of muscle force confirmed that detergent-processed allografts promoted isograft-equivalent levels of motor recovery 16 weeks postoperatively. All acellular allografts promoted greater amounts of motor recovery compared with silicone conduits.
These findings provide evidence that differential processing for removal of cellular constituents in preparing acellular nerve allografts affects recovery in vivo.

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    • "Peripheral nerve injury is a common disease, the proliferation of glia and extraneural connective tissue in peripheral nerve defect may hinder the growth of anagenetic axon or misguide the growth cone of axon; thus, the anagenetic axon cannot reach the target organ or even results in the formation of neuroma at the nerve stumps [1]; therefore, the defect of nerve must be bridged by graft to induce the nerve regeneration. As the golden standard of the peripheral nerve defects therapy, the autologous nerve graft was effective for nerve repair, but the source of autologous nerve graft was limited and the application of this graft was limited by several elements such as the injury to donor for graft acquisition and the limited length for nerve defect repairment [2]. Other methods, such as nerve allograft, nonnerve tissue graft, and artificial nerve tissue graft, had been used, but their effect was not satisfactory [3]. "
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    ABSTRACT: Objective: To investigate the effect of tissue engineering nerve on repair of rat sciatic nerve defect. Methods: Forty-five rats with defective sciatic nerve were randomly divided into three groups. Rats in group A were repaired by acellular nerve grafts only. Rats in group B were repaired by tissue engineering nerve. In group C, rats were repaired by autogenous nerve grafts. After six and twelve weeks, sciatic nerve functional index (SFI), neural electrophysiology (NEP), histological and transmission electron microscope observation, recovery ratio of wet weight of gastrocnemius muscle, regenerated myelinated nerve fibers number, nerve fiber diameter, and thickness of the myelin sheath were measured to assess the effect. Results: After six and twelve weeks, the recovery ratio of SFI and wet weight of gastrocnemius muscle, NEP, and the result of regenerated myelinated nerve fibers in groups B and C were superior to that of group A (P < 0.05), and the difference between groups B and C was not statistically significant (P > 0.05). Conclusion: The tissue engineering nerve composed of acellular allogenic nerve scaffold and Schwann cells-like cells can effectively repair the nerve defect in rats and its effect was similar to that of the autogenous nerve grafts.
    Neural Plasticity 07/2014; 2014:139085. DOI:10.1155/2014/139085 · 3.60 Impact Factor
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    • "Clinical treatment of brachial plexus injury is often surgical. In children, damaged peripheral components of the plexus may be repaired with donor nerve (usually the patient's own sural nerve) or other graft material, including processed cadaver nerve or tubes containing extracellular matrix [29, 30]. In adults, the distance that regenerating nerves must grow is often too lengthy for effective grafting. "
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    ABSTRACT: Injured primary sensory axons fail to regenerate into the spinal cord, leading to chronic pain and permanent sensory loss. Re-entry is prevented at the dorsal root entry zone (DREZ), the CNS-PNS interface. Why axons stop or turn around at the DREZ has generally been attributed to growth-repellent molecules associated with astrocytes and oligodendrocytes/myelin. The available evidence challenges the contention that these inhibitory molecules are the critical determinant of regeneration failure. Recent imaging studies that directly monitored axons arriving at the DREZ in living animals raise the intriguing possibility that axons stop primarily because they are stabilized by forming presynaptic terminals on non-neuronal cells that are neither astrocytes nor oligodendrocytes. These observations revitalized the idea raised many years ago but virtually forgotten, that axons stop by forming synapses at the DREZ.
    09/2012; 21(3):83-93. DOI:10.5607/en.2012.21.3.83
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    • "Reconstructive strategies following nerve sectioning are commonly used in patients with large nerve injury. These include autologous nerve grafting, silicone guidance tubes [32] and acellular nerve allografts [33]. Cell-based therapy with mesenchymental stem cells appear a promising strategy to create a favourable environment for peripheral nerve regeneration [34]. "
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    ABSTRACT: The improvement of axonal regeneration is a major objective in the treatment of peripheral nerve injuries. The aim of this study was to evaluate the effects of electro-acupuncture on the functional recovery of sensorimotor responses following left sciatic nerve crush in mice. Sciatic nerve crush was performed on seven week old female mice. Following the injury, the control group was untreated while the experimental group received an electro-acupuncture application to the injured limb under isoflurane anesthesia at acupoints GB 30 and GB 34. Mechanical and heat sensitivity tests were performed to evaluate sensory recovery. Gait analysis was performed to assess sensorimotor recovery. Our results show that normal sensory recovery is achieved within five to six weeks with a two-week period of pain preceding the recovery to normal sensitivity levels. While electro-acupuncture did not accelerate sensory recovery, it did alleviate pain-related behaviour but only when applied during this period. Application before the development of painful symptoms did not prevent their occurrence. The analysis of gait in relation to the sensory tests suggests that the electro-acupuncture specifically improved motor recovery. This study demonstrates that electro-acupuncture exerts a positive influence on motor recovery and is efficient in the treatment of pain symptoms that develop during target re-innervation.
    BMC Complementary and Alternative Medicine 08/2012; 12(1):141. DOI:10.1186/1472-6882-12-141 · 2.02 Impact Factor
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