Abstract
Injuries to the peripheral nervous system result in devastating consequences with loss of motor and sensory function and lifelong impairments. Current treatments have largely relied on surgical procedures, including nerve autografts to repair damaged nerves. Despite improvements to the surgical procedures over the years, the clinical success of nerve autografts is limited by fundamental issues, such as low functionality and mismatching between the damaged and donor nerves. While peripheral nerves can regenerate to some extent, the resultant outcomes are often disappointing, particularly for serious injuries, and the ongoing loss of function due to poor nerve regeneration is a serious public health problem worldwide. Thus, a successful therapeutic modality to bring functional recovery is urgently needed. With advances in three-dimensional cell culturing, nerve guidance conduits (NGCs) have emerged as a promising strategy for improving functional outcomes. Therefore, they offer a potential therapeutic alternative to nerve autografts. NGCs are tubular biostructures to bridge nerve injury sites via orienting axonal growth in an organized fashion as well as supplying a supportively appropriate microenvironment. Comprehensive NGC creation requires fundamental considerations of various aspects, including structure design, extracellular matrix components and cell composition. With these considerations, the production of an NGC that mimics the endogenous extracellular matrix structure can enhance neuron–NGC interactions and thereby promote regeneration and restoration of function in the target area. The use of electrospun fibrous substrates has a high potential to replicate the native extracellular matrix structure. With recent advances in electrospinning, it is now possible to generate numerous different biomimetic features within the NGCs. This review explores the use of electrospinning for the regeneration of the nervous system and discusses the main requirements, challenges and advances in developing and applying the electrospun NGC in the clinical practice of nerve injuries.
Highlights
Despite positive results obtained in the regeneration of damaged tissue in small gap injuries, similar treatments when applied to large gap injuries often yield limited success and result in serious social and economic consequences
The most clinically applied approaches for bridging large gap nerve injuries have relied on surgical procedures, including autografts in which a donor nerve of the patient is resected and grafted into the injury site of the same person [2–4]
Studies that focus on the regeneration of dysfunctional neural tissues and restoring or improving lost tissue function have revealed that nerve conduit transplantation might have the potential to be used as alternative therapies to autografts in the treatment of nerve injury [2,7]
Summary
PNS damage can happen during traffic accidents and other trauma, resections of tumours and/or adverse iatrogenic effects of the surgery occurring in 13–20 of every. The most clinically applied approaches for bridging large gap nerve injuries have relied on surgical procedures, including autografts in which a donor nerve of the patient is resected and grafted into the injury site of the same person [2–4]. Nerve guidance conduits (NGCs) are tubular biostructures with engineered biomaterials developed to supply a nourishing and supportive microenvironment for nerve regeneration and to orient axonal growth in a correct path across the nerve injury site [8,9]. This review provides an overview of the requirements for the successful implementation of NGC and the challenges that must be addressed before these therapeutic approaches can be translated into clinical practice for the treatment of PNS injuries. The review suggests potential solutions to overcome the current limitations, which will allow the development of the generation of therapies
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