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.
Highlights
With an annual incidence of approximating 13 to 23 per 100,000 persons per year [1,2,3], the consequences of peripheral nerve injuries are notoriously devastating and life-altering
Algorithms for surgical intervention are described in the literature, but for the topic of this review, we will focus on another novel technique, nerve transfers, and the role Schwann cells may play in their efficacy
The capacity of Schwann cells for proliferation, growth factor secretion, immune modulation, remyelination, and migration make them well suited for endeavors in neural repair, which have been reported in the literature for many years [32,33,34]
Summary
With an annual incidence of approximating 13 to 23 per 100,000 persons per year [1,2,3], the consequences of peripheral nerve injuries are notoriously devastating and life-altering. Peripheral nerves are comprised of myelinated and umyelinated fibers, with myelinated nerves surrounded by the specialized Schwann cells to provide insulation Injuries to these structures are typically secondary to sudden stretch of a limb, laceration, compression, or ischemia. -Axonotmesis -The axon, in addition to the myelin sheath, is disrupted by irreversible damage -Neuronal stroma (endoneurium, perineurium, and epineurium) remains intact -Seen in crush, over-stretching, and percussion (such as blast or bullet) injuries -Nerve distal to the lesion undergoes Wallerian degeneration. Surgical options may serve to realign damaged nerves, through approximation of the ends or interposition of a graft; these procedures may be limited by the location of injury and length of the graft required, providing suboptimal recovery [2,10,11]
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