Peripheral Nerve Injury: Stem Cell Therapy and Peripheral Nerve Transfer

Abstract

Peripheral nerve injury can lead to great morbidity in those afflicted, ranging from sensory loss, motor loss, chronic pain, or a combination of deficits. Over time, research has investigated neuronal molecular mechanisms implicated in nerve damage, classified nerve injury, and developed surgical techniques for treatment. Despite these advancements, full functional recovery remains less than ideal. In this review, we discuss historical aspects of peripheral nerve injury and introduce nerve transfer as a therapeutic option, as well as an adjunct therapy to transplantation of Schwann cells and their stem cell derivatives for repair of the damaged nerve. This review furthermore, will provide an elaborated discussion on the sources of Schwann cells, including sites to harvest their progenitor and stem cell lines. This reflects the accessibility to an additional, concurrent treatment approach with nerve transfers that, predicated on related research, may increase the efficacy of the current approach. We then discuss the experimental and clinical investigations of both Schwann cells and nerve transfer that are underway. Lastly, we provide the necessary consideration that these two lines of therapeutic approaches should not be exclusive, but conversely, should be pursued as a combined modality given their mutual role in peripheral nerve regeneration.

Local Administration of Methylprednisolone Laden Hydrogel Enhances Functional Recovery of Transected Sciatic Nerve in Rat

“…In contrary, functional recovery occurred from week 8 to week 16 in CHIT/MP supporting again this idea that selection of an appropriate method to evaluate functional recovery is crucial. This study also supported the idea that the walking track analysis (SFI) is more comprehensive and reliable than histomorphometric methods in peripheral nerve repair studies [25,28].…”

“…Castaneda et al, [25] suggested that arrival of sprouts from the proximal stump at the distal nerve stump does not necessarily imply recovery of nerve function. Walking track analysis has frequently been used to reliably determine functional recovery following nerve repair in rat models [26,27].…”

Peripheral Nerve Injury and Current Treatment Strategies

“…In cell-based therapies, neural crest cells are the main source of Schwann cells. SC seeds transplanted in a nerve conduit enhance axonal regeneration, but SC seeds have some disadvantages such as slow expansion to large numbers and being hard to obtain [129,130,140]. As a result, ideal cells to be used for neural regeneration should have the properties of being suitable for easy harvesting, not requiring immunosuppression, being able to integrate to the injury site and being non-tumorigenic.…”

“…Schwann cell cultures have mostly shown acceptable results in experimental studies; however, they are not good enough and search for an ideal cell is still ongoing. Bone marrow-derived mesenchymal cells have also demonstrated favourable results with numerous advantages like easy harvesting, high cell viability and secretion of multiple trophic factors [139,140].…”

“…Schwann cell cultures have mostly shown acceptable results in experimental studies; however, they are not good enough and search for an ideal cell is still ongoing. Bone marrow-derived mesenchymal cells have also demonstrated favourable results with numerous advantages like easy harvesting, high cell viability and secretion of multiple trophic factors [139,140].Even though cell-based therapy is promising for future, it is already associated with certain limitations. The most important issue is cell transplantation safety, and the other is that cell preparations are time consuming.…”