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Long-Gap Median Nerve Regeneration Using Biodegradable Conduits in Non-Human Primates
Gabriella DiBernardo, Jaqueline Bliley, Deok-Yeol Kim, M. Asher Schusterman, Matthias Waldner, Ryan Schroth, Christopher Mahoney, Damian Grybowsky, Debra Bourne, Tyler Simpson, Casey Tompkins-Rhoades, Ana Taylor, Aaron Dees, Kia Washington, Alexander Spiess, Donald Crammond, Kacey Marra
University of Pittsburgh
2017-02-16
Presenter: Gabriella DiBernardo
Affidavit:
The material has not been published or presented at a major meeting and is original work.
Director Name: Gabriella DiBernardo
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background: Long gap peripheral nerve injuries are common among military and civilian patients. The gold standard of care for these injuries is autografting. The disadvantages are long operative times, sensation loss, and insufficient donor tissue. Autografting may not be possible when multiple injuries have occurred because of insufficient donor tissue. We are investigating a biodegradable poly(caprolactone) (PCL) conduit with glial cell-line derived neurotrophic factor (GDNF) to actively support nerve regeneration in non-human primates (NHPs).
Methods: A 5cm defect was created on the median nerve and repaired with an autograft, decellularized allograft, empty PCL-conduit, or PCL/GDNF-conduit. Functional return was assessed out to one year. Baseline and one-year postoperative electrophysiology was recorded to assess nerve conduction velocity, motor evoked potentials, compound nerve action potentials, and sensory nerve action potentials. Histology was performed to evaluate Schwann cell and neurofilament density.
Results: NHPs demonstrated a successful precision grip 70-80% at baseline. At POD 60 baseline pinch retrieval was observed. PCL/GDNF group had an average functional return of 58% at 1-year post operatively which is comparable to the autograft. PCL-empty had a 27% return of function at 1-year. NCV and MEPs were observed at one year in PCL/GDNF and decellularized nerve groups meaning the nerves were able to regenerate and reach the target muscle. No significant difference was found in Schwann cell density between PCL/GDNF, decellularized, or autograft at 1-year.
Conclusion: PCL/GDNF showed abilities to regenerate damaged nerves and recover impaired function. Future work will focus on manufacturing the PCL/GDNF conduit and clinical translation.
