Acellular nerve graft enriched with mesenchymal stem cells in the transfer of the phrenic nerve to the musculocutaneous nerve in a C5‐C6 brachial plexus avulsion in a rat model

Abstract

IntroductionPhrenic nerve transfer has been shown to achieve good nerve regeneration in brachial plexus avulsion. Acellular nerve allografts (ANAs) showed inferior results to autografts, which is why its use with mesenchymal stem cells (MSCs) is currently being studied. The aim is to study the effect of BM‐MSCs associated with ANAs in a rat model of phrenic nerve transfer to the musculocutaneous nerve in a C5‐C6 avulsion.Material and methods42 Wistar‐Lewis rats underwent a C5‐C6 lesion in the right forelimb by excising a 3 mm segment from both roots, followed by a phrenic nerve transfer to the musculocutaneous nerve associated with the interposition of a three types of nerve graft (randomly distributed): control (autograft) group (n = 12), ANAs group (n = 12), and ANAs + BM‐MSCs group (n = 18)After 12 weeks, amplitude and latency of the NAP and the compound motor action potential (CMAP) were measured. Biceps muscles were studied by histological analysis and nerve grafts by electron microscopy and fluorescence analysis.ResultsStatistically significant reductions were found in latency of the CMAP between groups control (2.48 ± 0.47 ms) and experimental (ANAs: 4.38 ± 0.78 ms, ANAs + BM‐MSCs: 4.08 ± 0.85 ms) and increases in the amplitude of the CMAP between groups control (0.04388 ± 0.02 V) and ANAs + BM‐MSCs (0.02275 ± 0.02 V), as well as in the thickness of the myelin sheath between groups control (0.81 ± 0.07 μm) and experimental (ANAs: 0.72 ± 0.08 μm, ANAs + BM‐MSCs: 0.72 ± 0.07 μm) and in the area of the myelin sheath between groups control (13.09 ± 2.67 μm2) and ANAs (10.01 ± 2.97 μm2) (p < .05). No statistically significant differences have been found between groups ANAs and ANAs + BM‐MSCs.ConclusionsThis study presents a model for the study of lesions of the upper trunk and validates the autologous graft as the gold standard.

Early Intervention of Cold-Water Swimming on Functional Recovery and Spinal Pain Modulation Following Brachial Plexus Avulsion in Rats

“…Furthermore, morphological and immunohistochemical measurements demonstrated improvements, including reduction of inflammatory cell infiltration and vacuole formation in injured nerves and decreased expression of SP and IBA1 in spinal dorsal horns corresponding to BPA levels, indicating CWS as a potential therapy for reducing inflammation and pain at early stage of peripheral nerve injury. Many studies reported better functional recovery by cell transplantation, immunotherapy, or nerve transfers when other forms of therapeutic interventions were also applied for management of severe peripheral nerve injury [13][14][15][16]. The present findings evidenced the potential of CWS in enhancing sensory and motor functional recovery, in addition to modulating BPA-induced neuropathic pain.…”

Adipose Tissue Uses in Peripheral Nerve Surgery

“…The group that received differentiated ADSCs showed improved compound muscle action potential and motor conduction velocity as well as histologically more neurofilament, S100, larger diameter axons, thickened myelin sheaths, and higher-density myelination [ 64 ]. Another study transferred the phrenic nerve to restore the musculocutaneous nerve in C5-C6 avulsion injury in rats but instead used bone marrow stem cells in the treatment group to seed acellular nerve grafts [ 65 ]. Interestingly, there were no differences reported between groups with acellular nerve grafts and groups where acellular nerve grafts were seeded with bone marrow stem cells (BMSCs).…”