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Restoration of Long Nerve Defects with Stromal Cells Epineural Sheath Conduit (SCEC). A Preliminary Report.
Presenter: Maria Madajka PhD 1, Can Oztürk MD 2, Jacek Szopinski MD PhD 3, Vlodek Siemionow PhD4, Maria Siemionow MD PhD DSc 5
Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH 1-3,5, D
Plastic Surgery
2012-02-09
Presenter: Maria Madajka PhD
Affidavit:
Presenter performed in vitro part of the project
Director Name: Maria Siemionow MD PhD
Author Category: Attending
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
Presenter will address the latest techniques for nerve regeneration.
How will your presentation be used by practicing physicians in the audience?
Presentation will cover a new technique for the regeneration of 6 cm nerve gaps. The transition from the basics science project to clinical trials will be emphasized.
Background: Current nerve allografting demonstrates poor motor recovery and requires immunosuppression. To improve outcomes, we developed an epineural sheath conduit with bone marrow stromal cells (BMSCs) to restore 6 cm nerve gaps in a sheep model. Epineural sheath is immunologically neutral and contains laminin, enhancing neuronal growth. BMSCs will contribute to structural support and secretion of growth factors.
Methods: Epineural sheath tube was created from the sheep median nerve by the pull out technique, removing all fascicles. BMSCs were obtained from donor animal by flush method, cultured, fluorescently labeled and injected into the empty epineural tube in the range of 5- 8 x 10 6. Restoration of 6cm median nerve defect was performed using the SCEC. Twelve sheep median nerves were evaluated in six animals including: autograft controls (n=2), saline control (n=2), autologous and allogenic conduits filled with BMSCs (n=1 each). At 3 and 6 month follow ups, nerve conduction velocity (NCV) and somatosensory evoked potential (SSEP) were performed. Immunohistochemistry and histomorphometry of nerves were evaluated.
Results: Immunofluorescent staining of saline filled conduit at 90 days showed fascicle-like structures in the proximal, middle, and distal parts of the conduit. The preliminary analysis of NCV and SSEP confirmed the presence of neurosensory responses in both saline and BMSC-filled conduit groups.
Conclusions: We confirmed feasibility of using SCEC to restore 6 cm nerve defects in sheep model. Preliminary results of immunohistochemical and neurosensory assessment confirmed regenerative properties of SCEC.
