Abstract
Peripheral nerve repair and regeneration remains among the greatest challenges in tissue engineering and regenerative medicine. Even though peripheral nerve injuries (PNIs) are capable of some degree of regeneration, frail recovery is seen even when the best microsurgical technique is applied. PNIs are known to be very incapacitating for the patient, due to the deprivation of motor and sensory abilities. Since there is no optimal solution for tackling this problem up to this day, the evolution in the field is constant, with innovative designs of advanced nerve guidance conduits (NGCs) being reported every day. As a basic concept, a NGC should act as a physical barrier from the external environment, concomitantly acting as physical guidance for the regenerative axons across the gap lesion. NGCs should also be able to retain the naturally released nerve growth factors secreted by the damaged nerve stumps, as well as reducing the invasion of scar tissue-forming fibroblasts to the injury site. Based on the neurobiological knowledge related to the events that succeed after a nerve injury, neuronal subsistence is subjected to the existence of an ideal environment of growth factors, hormones, cytokines, and extracellular matrix (ECM) factors. Therefore, it is known that multifunctional NGCs fabricated through combinatorial approaches are needed to improve the functional and clinical outcomes after PNIs. The present work overviews the current reports dealing with the several features that can be used to improve peripheral nerve regeneration (PNR), ranging from the simple use of hollow NGCs to tissue engineered intraluminal fillers, or to even more advanced strategies, comprising the molecular and gene therapies as well as cell-based therapies.
Highlights
Insights of neuronal injury and repair date back to early periods, to Galen in the second century AD (Nawabi et al, 2006)
To increase this fallacy, several forged ideas increase the devaluation of this field, such as the idea that peripheral nerve injuries (PNIs) are irreversible, that peripheral nerves do not have any capacity to regenerate, and the results of peripheral nerve surgery are insignificant to the patient (Rasulic, 2018)
We aim to summarize the necessary concepts to fully understand the phenomena of PNIs and regeneration, which pose complex and demanding challenges in tissue engineering and regenerative medicine (TERM)
Summary
Insights of neuronal injury and repair date back to early periods, to Galen in the second century AD (Nawabi et al, 2006) The research on this topic has been rising continuously and several nerve repair techniques have progressed with time. Despite this fact, the status of peripheral nerve injuries (PNIs) and peripheral nerve regeneration (PNR) has always been in the shadow of the neurosurgery field. The main reason appointed to this is based on the word “peripheral” itself, as it suggests lesser relevance and difficulty To increase this fallacy, several forged ideas increase the devaluation of this field, such as the idea that PNIs are irreversible, that peripheral nerves do not have any capacity to regenerate, and the results of peripheral nerve surgery are insignificant to the patient (Rasulic, 2018). It is becoming progressively clear that peripheral nerve repair is not a “peripheral” area and the full attention by the part of clinicians and scientists is needed to overcome this public-health concern
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