Novel Approaches to Peripheral Nerve Repair

Chanla Tink^*
*Correspondence: Chanla Tink, Department of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong, China, Email:

Keywords

Nerve • Peripheral • Schwann • Axonal

Introduction

One of the most promising avenues in peripheral nerve repair involves the use of biomaterials to create conduits that mimic the native nerve environment. These conduits serve as scaffolds for guiding regenerating axons across the site of injury. Recent advancements in biomaterial science have led to the development of highly customizable and bioactive materials capable of providing structural support while delivering growth factors and other bioactive molecules in a controlled manner. Moreover, the integration of conductive materials within these scaffolds has shown great potential in promoting electrical signaling and enhancing axonal outgrowth [1].

Tissue engineering approaches offer a paradigm shift in peripheral nerve repair by combining biomaterial scaffolds with cells and bioactive factors to create living constructs capable of promoting regeneration. Engineered nerve grafts, composed of biodegradable scaffolds seeded with Schwann cells or stem cells, have demonstrated significant improvements in nerve regeneration and functional recovery in preclinical studies. Furthermore, the emergence of 3D bioprinting technologies allows for the precise fabrication of nervelike structures with spatial control over cellular organization and biomaterial composition, opening new avenues for personalized nerve grafts tailored to individual patients [2,3].

Biomaterial-based Nerve Guidance Conduits (NGCs) have gained attention as a promising alternative to autografts and allografts for peripheral nerve repair. NGCs provide a scaffold for guiding regenerating axons across the site of injury, facilitating nerve regeneration. These conduits can be engineered to mimic the Native Extracellular Matrix (ECM) of nerves, providing mechanical support and bioactive cues for cell adhesion, proliferation, and differentiation. Recent advancements in biomaterials science have led to the development of NGCs with enhanced properties, such as improved biocompatibility, controlled degradation kinetics, and the incorporation of growth factors or therapeutic agents to promote nerve regeneration.

Literature Review

In addition to promoting axonal regeneration, novel approaches to peripheral nerve repair aim to establish functional connections between regenerated nerves and target tissues. Neural interface technologies, such as bioelectronic devices and neural prostheses, offer innovative solutions for restoring lost sensory and motor function following nerve injury. These devices interface directly with the peripheral nervous system, either by electrically stimulating regenerated axons or by decoding neural signals to control prosthetic limbs or sensory feedback systems. Recent advancements in material science, microfabrication techniques, and neural interfacing algorithms have led to the development of next-generation neural interfaces with improved biocompatibility, selectivity, and longevity.

Discussion

Harnessing the power of gene therapy and molecular interventions presents another frontier in peripheral nerve repair. By delivering therapeutic genes or manipulating molecular signaling pathways, researchers can modulate the cellular responses involved in nerve regeneration. Gene therapy approaches targeting neurotrophic factors, guidance cues, or inflammatory mediators have shown promise in enhancing axonal growth, reducing scar formation, and promoting functional recovery in preclinical models of nerve injury. Moreover, the advent of genome editing technologies, such as CRISPRCas9, offers precise control over gene expression and holds potential for correcting genetic defects underlying inherited neuropathies.

Moving forward, the convergence of multiple therapeutic modalities is likely to yield synergistic effects and maximize the efficacy of peripheral nerve repair strategies. Combining biomaterial-based scaffolds with cell therapy, for instance, could enhance the survival and integration of transplanted cells while providing a conducive microenvironment for axonal regeneration. Similarly, integrating neural interface technologies with gene therapy approaches could enable real-time modulation of neural activity to optimize functional outcomes. By embracing a multidisciplinary approach, researchers can address the multifaceted challenges of peripheral nerve repair and pave the way for transformative clinical interventions [4-7].

Conclusion

Gene therapy holds great promise for enhancing peripheral nerve regeneration by delivering therapeutic genes to the site of injury. Viral vectors, such as Adeno-Associated Viruses (AAVs) and lentiviruses, can be engineered to deliver genes encoding growth factors, neurotrophic factors, or regulatory proteins that promote axonal growth, myelination, and synaptic connectivity. For example, gene therapy approaches targeting neurotrophins, such as Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), have shown efficacy in promoting nerve regeneration and functional recovery in animal models of peripheral nerve injury. Furthermore, advances in genome editing technologies, such as CRISPR-Cas9, offer new opportunities for precise manipulation of endogenous gene expression to enhance nerve regeneration and repair.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Zhang, Shiwen, Meiling Huang, Jincao Zhi and Shanhong Wu, et al. "Research hotspots and trends of peripheral nerve injuries based on web of science from 2017 to 2021: A bibliometric analysis."Front Neurol 13 (2022): 872261.

   Google Scholar, Crossref, Indexed at

2. Koeppen, Arnulf H. "Wallerian degeneration: History and clinical significance."J Neurol Sci 220 (2004): 115-117.

   Google Scholar, Crossref, Indexed at

3. Jessen, Kristján R., Rhona Mirsky and Alison C. Lloyd. "Schwann cells: Development and role in nerve repair."Cold Spring Harb Perspect Biol 7 (2015): a020487.

   Google Scholar, Crossref, Indexed at

4. Pogrel, M. Anthony and Aziz Maghen. "The use of autogenous vein grafts for inferior alveolar and lingual nerve reconstruction." J Oral Maxillofac Surg 59 (2001): 985-988.

   Google Scholar, Crossref, Indexed at

5. Modrak, Max, MA Hassan Talukder, Khatuna Gurgenashvili and Mark Noble, et al. "Peripheral nerve injury and myelination: Potential therapeutic strategies."J Neurosci Res 98 (2020): 780-795.

   Google Scholar, Crossref, Indexed at

6. Miller, Virginia M. and S. Mitchell Harman. "An update on hormone therapy in postmenopausal women: Mini-review for the basic scientist."Am J Physiol Heart Circ Physiol313 (2017): H1013-H1021.

   Google Scholar, Crossref, Indexed at

7. Sargin, Derya, Heidi Friedrichs, Ahmed El-Kordi and Hannelore Ehrenreich. "Erythropoietin as neuroprotective and neuroregenerative treatment strategy: Comprehensive overview of 12 years of preclinical and clinical research."Best Pract Res Clin Anaesthesiol 24 (2010): 573-594.

   Google Scholar, Crossref, Indexed at