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Allogenic Epineural Tube Nerve Repair with Bone Marrow Stromal Cells (BMSC) Supportive Therapy Yields Comparable Outcomes to Autograft Repair
Grzegorz Brzezicki, Arkadiusz Jundzill, Amanda Mendiola, Aleksandra Klimczak, James Gatherwright, Maria Siemionow
Cleveland Clinic
2010-03-30
Presenter: Grzegorz Brzezicki
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background: The aim of this study is to assess the outcome of peripheral nerve repair with allogenic tube supported with BMSC as an alternative to autografting.
Methods: 18 fully allogenic 2cm epineural tubes were transplanted into sciatic nerve gaps in 3 groups: Group 1 the tube was filled with saline, Group 2 supported with isogenic BMSC, Group 3 allogenic BMSC. Before transplantation 3.5-4x106 BMSC were stained with PKH-26 dye to assess engraftment. No immunosuppressive treatment was initiated. 6 autograft repairs were performed as a control group. Assessment methods included: pinprick (PP) and toe-spread (TS) test at 6,12,24 weeks post-transplant, Somatosensory Evoked Potentials (SSEP), Gastrocnemius Muscle Index (GMI), histomorphometry, immunostaining (NGF, Laminin B2) at 24 weeks.
Results: 6 and 12 weeks post transplantation there were no differences between experimental groups in TS and PP. At 24 weeks saline group had lower TS scores, no differences were noted in PP. Significantly higher GMI was observed in autograft group compared to Group 1; and Group 2 compared to Group 1 and 3. There were no significant differences between groups in SSEP latencies and amplitudes.
Autograft group had thicker myelin and larger nerve fibers than Group 1 and 2 but not Group 3. Saline group had significantly higher axonal density than autograft and Group 3. Immunostaining confirmed presence of BMSC expressing NGF in the tube up to 24 weeks. Laminin B2 expression was comparable in all groups.
Conclusion: Allogenic epineural tube supports nerve regeneration without immunosupression. BMSC therapy supports maturation of nerve fibers.
