Abstract
Research involving nerve transplantation has shown that tissue rejection limits the neurologic recovery unless the host is immunosuppressed. This study investigates an alternative to permanent or temporary immunosuppression using a rat model with nerve transplants from Brown- Norway rat donors to bridge defects in the sciatic nerve of Lewis rat recipients as these two inbred strains differ at both major and minor histocompatibility loci.The specific aim of this study was to evaluate if predegenerated nerve grafts decreased the tissue rejection and improved the neurologic recovery of animals with allogenic nerve grafts to avoid the problems associated with either short- or long-term immunosuppression. The animals in the experimental groups received cyclosporin-A, predegencrated grafts, both, or neither. The predegenerated grafts were produced by division of the nerve three weeks prior to grafting to allow for Wallerian degeneration to occur. The outcome was assessed by measurements stressing functional recovery (sensory testing, gait analysis, joint flexion contracture), studies of muscle recovery (muscle weight and hydroxyproline concentration), and histologic studies (axonal counts and inflammatory reaction). The animals receiving the predegenerated grafts without cyclosporin did have an improved recovery (joint flexion contracture 35° ± 8 ° and hydroxyproline ratio 1.52 ± 0.16) as compared to the joint flexion contractures and hydroxyproline ratios of the allograft group of animals without either cyclosporin- A or pretreatment and the ungrafted control group (47° ± 18°, 1.68 ± 0.34, and 53° ±15° ,4.50 ± 0.27, respectively, p < 0.01). However, all the isograft groups and allograft groups with cyclosporin-A, regardless of whether the graft had been predegenerated or not, had greater neurologic recovery than the allograft group with predegenerated grafts but without cyclosporin-A by the same parameters (p < 0.01). Allograft groups with short-term immunosuppression with cyclosporin-A did as well as isograft groups, and isograft groups with predegenerated grafts did not do any better than isografts without pretreatment (p <0.01). Clinical Relevance: Predegenerated nerve allografts will allow for greater neurologic recovery than standard nerve allografts avoiding the complications of immunosuppression, but the level of recovery is less than that of recipients of nerve allografts with immunosuppression. Nerve transplants would avoid the problems of neurologic deficits at the donor site and allow multiple large deficits to be treated easily.
Highlights
Peripheral nerve injuries are treated by autogenous nerve grafts frequently obtained from areas such as the sural nerve
Allogeneic transplantation of peripheral nerves would overcome these problems; neurologic recovery with allogeneic grafts has been limited by tissue rejection /1-4/
This study investigates graft pre-treatment using nerve graft segments that have undergone Wallerian degeneration as a means of improving the neurologic recovery of animals following transplantation without the need for immunosuppression
Summary
Many techniques have been explored to overcome these segmental deficits in peripheral nerves without requiring the use of autogenous grafts. Allogeneic transplantation of peripheral nerves would overcome these problems; neurologic recovery with allogeneic grafts has been limited by tissue rejection /1-4/. Freezing the grafts or treating them with high doses of radiation does limit the rejection response to nerve allografts. This technique eliminates the viable Schwarm cells and drastically reduces the neurologic recovery when these tissues are used for grafting /68,10,11,20/. This study investigates graft pre-treatment using nerve graft segments that have undergone Wallerian degeneration as a means of improving the neurologic recovery of animals following transplantation without the need for immunosuppression. This study stresses the functional recovery of the animal, as techniques which primarily emphasize histologic or electrophysiologic parameters do not correlate with parameters that are useful clinically/8,9,18-26/
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have