Treatment Of Nerve Injuries Research Articles

Effect and mechanism of Tetramethylpyrazine in repair of sciatic nerve injury in rats.

Observing the effects of Tetramethylpyrazine (TMP) on the expression of Collagen IV and Laminin in neurovascular basement membrane and the apoptosis of vascular endothelial cells, and to study the mechanism of TMP in the treatment of sciatic nerve injury. Compared with the NS group, the TMP group had a significant increase in the sciatic nerve function index (P < 0.01).The miss times in TMP group was significantly lower than that in NS group (P < 0.01). The HE staining results of the TMP group showed irregular arrangement of some neuronal axons and Schwann cells, and more edema and rupture of cells. The proliferation of glial cells and inflammatory cells was significantly increased in TMP group. The results of immunohistochemistry showed that the expression of type IV collagen and laminin in the TMP group group was distributed around the blood vessels, vascular endothelial cells, basal membrane and glial cells after SNI. The expression of type IV collagen and laminin in TMP group increased significantly(P < 0.05). Immunofluorescence showed that compared with NS group, the apoptosis rate of TMP group was significantly decreased (P < 0.01). Flow cytometry results showed that compared with the NS group, the number of CECs in the TMP group was significantly decreased (P < 0.01). TMP can effectively improve the sciatic nerve functional index (SFI) of Sprague Dawley (SD) rats, enhance the proliferation of sciatic nerve vascular endothelial cells, reduce apoptosis, promote the expression of Collagen IV and Laminin in sciatic nerve microvascular basal membrane components, thereby promoting angiogenesis and improving lower limb function in rats.

Bioactive ECM-Mimicking Nerve Guidance Conduit for Enhancing Peripheral Nerve Repair

Extensive research efforts are being directed towards identifying alternatives to autografts for the treatment of peripheral nerve injuries (PNIs) with engineered nerve conduits (NGCs) identified as having potential for PNI patients. These NGCs, however, may not fulfill the necessary criteria for a successful transplant, such as sufficient mechanical structural support and functionalization. To address the aforementioned limitations of NGCs, the present investigation explored the development of double cross-linked hydrogels (o-CSMA-E) that integrate the biocompatibility of porcine tendon extracellular matrix (ECM) with the antimicrobial and conductive properties of methacrylated quaternary chitosan. The hydrogels had matrices that could promote the growth of axons and the transmission of neural signals. The hydrogels were subsequently incorporated into a nanofibrous PLLA-ZnO sheath scaffold (ZnO@PLLA) to emulate the natural nerve structure, guiding cell growth and facilitating nerve regeneration. The collaboration of core and sheath materials in ZnO@PLLA/o-CSMA-E nerve guidance conduits resulted in enhanced migration of Schwann cells, formation of myelin sheaths, and improved locomotion performance in rats with sciatic nerve defects when in vivo studies were undertaken. Notably, the in vivo studies demonstrated the similarity between the newly developed engineered NGCs and autologous transplants, with the newly engineered NGCs possessing the potential to promote functional recovery by mimicking the tubular structure and ECM of nerves.

Influencing factors and repair advancements in rodent models of peripheral nerve regeneration.

Peripheral nerve injuries lead to severe functional impairments, with rodent models essential for studying regeneration. This review examines key factors affecting outcomes. Age-related declines, like reduced nerve fiber density and impaired axonal transport of vesicles, hinder recovery. Hormonal differences influence regeneration, with BDNF/trkB critical for testosterone and nerve growth factor for estrogen signaling pathways. Species and strain selection impact outcomes, with C57BL/6 mice and Sprague-Dawley rats exhibiting varying regenerative capacities. Injury models - crush for early regeneration, chronic constriction for neuropathic pain, stretch for traumatic elongation and transection for severe lacerations - provide insights into clinically relevant scenarios. Repair techniques, such as nerve grafts and conduits, show that autografts are the gold standard for gaps over 3cm, with success influenced by graft type and diameter. Time course analysis highlights crucial early degeneration and regeneration phases within the first month, with functional recovery stabilizing by three to six months. Early intervention optimizes regeneration by reducing scar tissue formation, while later interventions focus on remyelination. Understanding these factors is vital for designing robust preclinical studies and translating research into effective clinical treatments for peripheral nerve injuries.

Overview of emerging therapies for demyelinating diseases.

This paper provides an overview of autoimmune disorders of the central nervous system, specifically those caused by demyelination. We explore new research regarding potential therapeutic interventions, particularly those aimed at inducing remyelination. Remyelination is a detailed process, involving many cell types-oligodendrocyte precursor cells (OPCs), astrocytes, and microglia-and both the innate and adaptive immune systems. Our discussion of this process includes the differentiation potential of neural stem cells, the function of adult OPCs, and the impact of molecular mediators on myelin repair. Emerging therapies are also explored, with mechanisms of action including the induction of OPC differentiation, the transplantation of mesenchymal stem cells, and the use of molecular mediators. Further, we discuss current medical advancements in relation to many myelin-related disorders, including multiple sclerosis, optic neuritis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, transverse myelitis, and acute disseminated encephalomyelitis. Beyond these emerging systemic therapies, we also introduce the dimethyl fumarate/silk fibroin nerve conduit and its potential role in the treatment of peripheral nerve injuries. Despite these aforementioned scientific advancements, this paper maintains the need for ongoing research to deepen our understanding of demyelinating diseases and advance therapeutic strategies that enhance affected patients' quality of life.

Mechanism of Gastrodin against neurotoxicity based on network pharmacology, molecular docking and experimental verification

BackgroundDisorders of glutamate metabolism and excessive release participat in multiple neuronal pathologies including ischemic stroke (IS), Alzheimer's disease (AD), or Parkinson's disease (PD). Recently, herbal medicines have been widely used and have shown satisfactory results in the treatment of neurological disorders. Gastrodin is a traditional Chinese medicine (TCM) used for the treatment of nerve injuries, spinal cord injuries, and some central nervous system diseases as well. This research examines the neuroprotective effects of Gastrodin against glutamate-induced neurotoxicity in neuronal cells. MethodsThe HERB database was used to explore the active ingredients and target genes of Gastrodia Elata. The STRING database and Cytoscape software were used to screen and construct the Protein-Protein Interaction (PPI). Furthermore, we used molecular docking to predict the potential targets of Gastrodin. The effects of Gastrodin were revealed by western blot, calcium imaging, membrane clamp, CCK8 and flow cytometry. Neuronal oxidative stress and damage were assessed by measuring malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity. Neuronal morphology was examined using Golgi-Cox staining. Finally, animal behavior was examined using novel object recognition and fear conditioning tests. ResultsWe have obtained 22 components such as TM10, TM17, TM25 (Gastrodin), and 281 targets such as AKT, EGFR, and CDK1 through network pharmacology. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed these genes were significantly enriched in protein phosphorylation, protein serine/threonine/tyrosine kinase activity, apoptosis and HIF-1 signaling pathways, etc. A higher affinity between Gastrodin and AKT was revealed by PPI analysis and molecular docking. Further, Gastrodin significantly inhibited Ca2+ influxes and excitatory synaptic transmission in cortical neurons. In addition, Gastrodin effectively alleviated neuron apoptosis, oxidative stress and damage. ConclusionGastrodin has neuroprotective effects against glutamate-induced neurotoxicity.

Advances in therapies using mesenchymal stem cells and their exosomes for treatment of peripheral nerve injury: state of the art and future perspectives.

"Peripheral nerve injury" refers to damage or trauma affecting nerves outside the brain and spinal cord. Peripheral nerve injury results in movements or sensation impairments, and represents a serious public health problem. Although severed peripheral nerves have been effectively joined and various therapies have been offered, recovery of sensory or motor functions remains limited, and efficacious therapies for complete repair of a nerve injury remain elusive. The emerging field of mesenchymal stem cells and their exosome-based therapies hold promise for enhancing nerve regeneration and function. Mesenchymal stem cells, as large living cells responsive to the environment, secrete various factors and exosomes. The latter are nano-sized extracellular vesicles containing bioactive molecules such as proteins, microRNA, and messenger RNA derived from parent mesenchymal stem cells. Exosomes have pivotal roles in cell-to-cell communication and nervous tissue function, offering solutions to changes associated with cell-based therapies. Despite ongoing investigations, mesenchymal stem cells and mesenchymal stem cell-derived exosome-based therapies are in the exploratory stage. A comprehensive review of the latest preclinical experiments and clinical trials is essential for deep understanding of therapeutic strategies and for facilitating clinical translation. This review initially explores current investigations of mesenchymal stem cells and mesenchymal stem cell-derived exosomes in peripheral nerve injury, exploring the underlying mechanisms. Subsequently, it provides an overview of the current status of mesenchymal stem cell and exosome-based therapies in clinical trials, followed by a comparative analysis of therapies utilizing mesenchymal stem cells and exosomes. Finally, the review addresses the limitations and challenges associated with use of mesenchymal stem cell-derived exosomes, offering potential solutions and guiding future directions.

Cystatin C alleviates unconjugated bilirubin-induced neurotoxicity by promoting bilirubin clearance from neurocytes via exosomes, dependent on hepatocyte UGT1A1 activity.

There is an urgent need to identify effective drugs for the treatment of nerve injury caused by unconjugated bilirubin (UCB). Our previous research found that cystatin C (CST3) alleviates UCB-induced neurotoxicity by promoting autophagy in nerve cells, but that autophagy inhibitors did not completely inhibit the effects of CST3. This study investigated whether CST3 could alleviate the neurotoxicity of UCB by promoting the secretion and transport of exosomes containing UCB to the liver for metabolism. It demonstrated that hyperbilirubinemia mice treated with CST3 had a higher number of serum exosomes than those in hyperbilirubinemia mice treated with phosphate-buffered saline. CST3-mediated protection against UCB-induced damage was abolished when autophagy and extracellular vesicle inhibitors were used in combination. The number of exosomes in the CST3 overexpression group was higher than that in the control group. Molecular docking experiments showed that UCB and CST3 had high docking score (-8.2). These results suggest that UCB may be excreted from cells by exosomes, and CST3 may promote this process by binding to UCB and entering the exosomes. We demonstrated that the effect of CST3 relied on liver cells with normal UDP-glucuronyl transferase1A1 (UGT1A1) activity in a coculture system of HT22 and L02 cells. CST3 levels were lower in exosomes secreted by L02 cells than in those secreted by human umbilical vein endothelial cells (HUVECs), whereas CST3 levels were higher in the culture supernatants of L02 cells than in the culture supernatants of HUVECs. This suggests that UCB exosomes in L02 cells may be released and internalized by CST3 and that UCB is then processed by UGT1A1 to conjugate UCB, thus reducing its toxicity. These results suggest that CST3 might alleviate UCB-induced neurotoxicity by promoting the clearance of UCB from cells via exosomes and that these effects are dependent on UGT1A1 activity in liver cells.

In Supracondylar Humerus Fractures With Nerve Injury, Does Time to Surgery Impact Recovery?

Background: Supracondylar humerus (SCH) fractures are common and present with associated nerve injuries in 11% to 42% of cases. Historically, SCH fractures with neurological compromise warranted urgent surgical intervention. A recent study showed that treatment delay is acceptable in patients with isolated anterior interosseous nerve (AIN) injury. Though indications for urgent treatment are relaxing, no studies have evaluated the need for urgent surgical treatment for other nerve injuries associated with SCH fractures. The aim of this study was to determine if the timing of surgical intervention is related to the timing of neurological recovery in SCH fractures associated with any nerve injury. Methods: A retrospective review of 64 patients with surgically managed SCH fractures and concomitant neurological deficit on presentation was conducted at a single level 1 pediatric trauma hospital from 1997 to 2022. The relationship between the time to surgical intervention and the time to partial and complete nerve recovery was analyzed using linear regression. Results: Sixty-four patients with an average age of 6.9±2.0 years and an average time to surgery of 9.8±5.6 hours were analyzed. Sixty-two patients (97%) were followed to partial neurological recovery and 36 (56%) were followed to full neurological recovery. Neurological deficit included median [n=41 (64%)], radial [n=22 (34%)], and ulnar [n=15 (23%)]. Ten patients (16%) had isolated AIN injury. The average time to partial neurological recovery was 20±23 days and the time to full recovery was 93±83 days. There was a statistically significant relationship between time to partial neurological recovery and time to surgical intervention (P=0.02). There was no relationship between time to full neurological recovery and time to surgery (P=0.8). Conclusion: Earlier time to surgical intervention in pediatric SCH fractures with isolated nerve injury was associated with earlier partial recovery but not full neurological recovery. Prioritizing urgent surgery in these patients did not improve their ultimate neurological recovery. Level of Evidence: Therapeutic level III.

Single-cell profiling of cellular changes in the somatic peripheral nerves following nerve injury.

Injury to the peripheral nervous system disconnects targets to the central nervous system, disrupts signal transmission, and results in functional disability. Although surgical and therapeutic treatments improve nerve regeneration, it is generally hard to achieve fully functional recovery after severe peripheral nerve injury. A better understanding of pathological changes after peripheral nerve injury helps the development of promising treatments for nerve regeneration. Single-cell analyses of the peripheral nervous system under physiological and injury conditions define the diversity of cells in peripheral nerves and reveal cell-specific injury responses. Herein, we review recent findings on the single-cell transcriptome status in the dorsal root ganglia and peripheral nerves following peripheral nerve injury, identify the cell heterogeneity of peripheral nerves, and delineate changes in injured peripheral nerves, especially molecular changes in neurons, glial cells, and immune cells. Cell-cell interactions in peripheral nerves are also characterized based on ligand-receptor pairs from coordinated gene expressions. The understanding of cellular changes following peripheral nerve injury at a single-cell resolution offers a comprehensive and insightful view for the peripheral nerve repair process, provides an important basis for the exploration of the key regulators of neuronal growth and microenvironment reconstruction, and benefits the development of novel therapeutic drugs for the treatment of peripheral nerve injury.

Strategies for prevention and treatment of vascular and nerve injuries in mandibular anterior implant surgery

Important anatomical structures such as mandibular incisive canal, tongue foramen, and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region, which may lead to mouth floor hematoma, asphyxia, pain, paresthesia and other symptoms. In severe cases, this can be life-threatening. The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery. In case of vascular injury, airway control and hemostasis should be performed, and in case of nerve injury, implant removal and early medical treatment should be performed. To avoid vascular and nerve injury during implant surgery in the mandibular anterior region, it is necessary to be familiar with the anatomical structure, take cone-beam computed tomography, design properly before surgery, and use digital technology during surgery to achieve accurate implant placement. This article summarizes the anatomical structure of the mandibular anterior region, discusses the prevention strategies of vascular and nerve injuries in this region, and discusses the treatment methods after the occurrence of vascular and nerve injuries, to provide clinical reference.

The Combination of Proteolytic Enzyme Supplementation, Acupuncture, and Osseous Manipulation for the Treatment of Traumatic Peripheral Nerve Injury: A Case Report

This report describes the treatment of peripheral nerve injury in a 43-year-old woman using a combination of proteolytic enzymes, acupuncture, and osseous manipulation as alternatives to conventional care. Her presenting symptoms include complete loss of sensation in the superolateral left thigh and a mass of fibrotic scar tissue in the area of injury. A holistic treatment plan was created to address the underlying mechanisms of the injury. Plant-based proteolytic enzymes, bromelain and papain, were used to address tissue inflammation and reduce scar tissue formation around the nerve, acupuncture was used to regenerate the superficial nerves, and osseous manipulations were provided for structural re-alignment. After 8 weeks of treatment, the patient reported significant reduction in the size of the fibrotic mass and complete resolution of sensory loss. The fibrotic mass of tissue reduced from 6 cm to 1 cm during the treatment course. Proteolytic enzymes have wide-ranging indications; however, they have not been well studied for peripheral nerve injury, which makes this a novel indication for this natural health product. This case report found the use of proteolytic enzymes, and acupuncture, effective in treating peripheral nerve injury and provides grounds for research to treat nerve-related injuries.

Intelligent design of nerve guidance conduits: An artificial intelligence‐driven fluid structure interaction study on modelling and optimization of nerve growth

AbstractNerve guidance conduits (NGCs) have been shown to be effective in promoting nerve regeneration in a variety of clinical applications, including nerve defects resulting from a trauma or surgery. By providing a conducive environment for nerve growth, NGCs can help to restore function in nerve‐damaged patients. Challenges include limited repair length, difficulty replicating natural nerve, and rapid substance degradation affecting neurotrophic factor delivery. Considering these issues with mass transfer and fluid structure interaction (FSI) emphasizes the need for enhancing nerve regeneration efficiency. To facilitate nerve growth and deliver appropriate amount of growth factors, these conduits need to be designed with specific topological, mechanical, and biological properties. Additionally, considerations must be given to functional mass transfer FSI design. An intelligent NGC design is proposed as an evaluation‐optimization and AI‐based method. It is found that design parameters significantly impact the physical properties being optimized, including hydraulic pressure, porosity, diffusivity, water absorption, and maximum stress. The mathematical surrogate model obtained from data‐based modelling is used for artificial intelligence (AI) optimization algorithms, differential evolution (DE), and non‐dominated sorting genetic algorithm II (NSGA‐II). It is revealed that both DE and NSGA algorithms generate nearly identical solutions, ensuring the robustness of ML optimization. Our results show that NGC with the thickness of 750 μm results in more than 170% augmentation of porosity. Moreover, at a constant ovality, increasing the channel thickness results in more than 39.2% augmentation of the maximum stress. The accurate forecasting of physical characteristics on NGC regarding nerve growth factors enables a hopeful outlook for the future clinical treatment of nerve injuries and advanced tissue engineering.

THERAPEUTIC EFFICACY OF MYRTUS COMMUNIS IN SCIATIC NERVE INJURY: AN EXPERIMENTAL RESEARCH IN RATS

OBJECTIVE: Nerve injuries, often resulting from various causes, pose serious health issues that typically require prolonged rehabilitation. Conventional methods used in the treatment of these injuries are often inadequate, necessitating the exploration of new treatment approaches. Research on the effects of plant-derived active compounds on nerve regeneration may offer potential new treatment options. In this context, this study investigating the effects of Myrtus communis on nerve regeneration aims to fill an important gap in the field of nerve injury treatment. MATERIAL AND METHODS: In this study, the efficacy of Myrtus communis was evaluated in an experimental sciatic nerve injury model. Thirty-two female Wistar Albino rats were divided into four groups: Control, Sham, Group I, and Group II. Sciatic nerve injury was induced, and Myrtus communis treatment was administered via gastric lavage. The animals' motor functions, sensory functions, electrophysiological measurements, biochemical parameters, and histopathological evaluations were examined. RESULTS: The results demonstrated that Myrtus communis contributed to rapid improvement in sciatic functional index (SFI) values. Similarly, positive effects were observed in sensory assessment and electrophysiological measurements. Biochemical analyses indicated that Myrtus communis increased antioxidant capacity and reduced oxidative stress. Histopathological examinations revealed less axon degeneration, edema, and vacuolization in the groups treated with Myrtus communis. CONCLUSIONS: This study concludes that Myrtus communis could be used as a potential therapeutic agent in the treatment of sciatic nerve injury. These findings suggest that Myrtus communis may play a supportive role in post-nerve injury recovery. However, it should be noted that further research is needed before these results can be translated into clinical applications.

Tensile Strength of Nerve Bridging Models Using Collagen Nerve Conduits.

In the treatment of peripheral nerve injuries with nerve defects, second-generation collagen-based conduits, such as Renerve® (Nipro, Osaka, Japan), have shown the potential for promoting nerve regeneration. However, there is concern related to the weak material properties. No previous studies have addressed the strength of the bridging model using collagen conduits. This study aimed to investigate the tensile strength and failure patterns in nerve defect models bridged with Renerve® conduits through biomechanical research. Using fresh chicken sciatic nerves, we examined the maximum failure load of four groups: bridging models using Renerve® with one suture (group A), with two sutures (group B), with three sutures (group C), and end-to-end neurorrhaphy models with two sutures (group N). Each group had eight specimens. We also evaluated failure patterns of the specimens. Group N showed a significantly higher maximum failure load (0.96 ± 0.13 N) compared to groups A (0.23 ± 0.06 N, p < 0.0001), B (0.29 ± 0.05 N, p < 0.0001), and C (0.40 ± 0.10 N, p < 0.0001). Regarding failure patterns, all specimens in group A showed nerve-end dislocation from the conduit. Two specimens in group B and three specimens in group C failed due to circumferential cracks in the conduit. Six specimens in group B and five specimens in group C exhibited cutting out of sutures from the conduit. This study suggests that the number of sutures in synthetic collagen nerve conduits has little effect on the maximum failure load. To take advantage of its biomaterial benefits, a period of postoperative range of motion restriction may be required.

Analysis of artificial intelligence medical treatment for closed muscle skin nerve injury caused by aerobics training

In aerobics training, closed myocutaneous nerve damage needs to be paid attention to, especially high-intensity training may cause minor damage to muscles and nerves. With the help of AI medical technology and the understanding of molecular and cellular biomechanics, we can more accurately explore the mechanism of injury, such as the effects of nerve tensile stress and microenvironment changes on nerve regeneration. This helps to develop scientific rehabilitation methods, such as AI-assisted personalized training, neural regeneration technology, and real-time monitoring of training intensity to speed up athletes’ rehabilitation and reduce the risk of future injuries. Purpose: Aerobics training is very strict and requires high physical fitness of dancers. During long-term training, dancers can easily cause closed musculocutaneous nerve injury. Traditional medicine is difficult to guarantee the treatment effect of patients with musculocutaneous nerve injury. The use of artificial intelligence medicine for closed musculocutaneous nerve injury treatment can improve the treatment effect of aerobics training induced closed musculocutaneous nerve injury. Method: This article utilized artificial intelligence medicine for the treatment of musculocutaneous nerve injury, and used artificial intelligence technology to analyze patient imaging and other data to assist doctors in accurate diagnosis. Utilize intelligent algorithms to predict medication plans, reduce medication errors, and intelligently adjust the course of treatment based on the patient’s condition. In artificial intelligence healthcare, high-quality online medical services can be created through intelligent technology, providing convenient medical consultation for patients. Result: This article selected 200 patients with musculocutaneous nerve injury caused by aerobics training for grouping experiments. The average diagnostic accuracy of traditional medicine and artificial intelligence medicine were 84.2% and 95.6%, respectively. Conclusion: Artificial intelligence medicine can achieve medical informatization and intelligently analyze patients’ medical information, which helps to improve the accuracy of medical diagnosis for aerobics training injuries.

A systematic review of steroid use in peripheral nerve pathologies and treatment.

The use of corticosteroids has become a part of the standard of care in various pathologies but their use in peripheral nerve injury treatment is limited. Given corticosteroids' anti-inflammatory properties and their regulatory role in neuronal protein production and myelination, corticosteroids could serve as an adjunct therapy for peripheral nerve injuries. This review aims to systematically investigate the current use of corticosteroid treatment in peripheral nerve pathologies. The systematic search was performed on PubMed, MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science using keywords such as "corticosteroid treatment," "peripheral nerve damage," "peripheral neuropathy," and "complications." The PRISMA guidelines were used to conduct the systematic review and all articles were reviewed by the corresponding author. After the initial search, individual study titles and abstracts were further screened and categorized using an inclusion and exclusion criteria followed by a final full-text review. Out of the total 27,922 identified records, 203 studies were included based on the selection criteria. These studies focused on the use and efficacy of steroids across a spectrum of compression and non-compression peripheral neuropathies such as cubital tunnel syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Various studies noted the promising role of steroids in offering pain relief, nerve block, and nerve regeneration effects. Additionally, safety considerations and potential complications regarding steroid use in peripheral nerve injuries were analyzed. While there is currently limited clinical utilization of corticosteroids in peripheral nerve pathologies, the anti-inflammatory and regenerative effects that steroids provide may be a beneficial tool in managing various peripheral neuropathies and their associated pain. Additional clinical trials and investigation into the mechanism of action could improve the reputation of steroid use as peripheral nerve injury treatment.

Application and progress of bionic scaffolds in nerve repair: a narrative review

Nerve injury can result in severe damage and potentially permanent disability, imposing substantial physical, psychological, and economic burdens on affected individuals and their families. Despite advances in surgical repair techniques, the functional recovery of nerves remains suboptimal. The current therapeutic approaches for nerve injury exhibit limited efficacy in restoring function, underscoring the imperative for the development of innovative treatment modalities. In recent years, bionics has emerged as a promising field in medicine, particularly in the treatment and rehabilitation of nerve injuries. We review the advances in the application of bionic technology within the realm of nerve injury treatment, encompassing bionic nerve scaffolds, nerve regeneration materials, and nerve modulation techniques. We delve into how these technologies may facilitate the repair and functional restoration of nerve tissues, as well as the challenges they encounter in clinical translation and their prospective directions for future development. Furthermore, we explore the convergence of bionic technology with existing therapeutic strategies and discuss the potential for interdisciplinary collaboration to catalyze innovation in nerve injury treatment. The integration of bionics with conventional methods may offer a synergistic approach, enhancing the efficacy of nerve repair and rehabilitation processes.

Electromagnetic-responsive targeted delivery scaffold technology has better potential to repair injured peripheral nerves: a narrative review

Peripheral nerve injury with long size defects has been an urgent clinical challenge. With the development of bioengineering, nanotechnology and additive manufacturing technologies, biologic delivery systems have gradually shown great potential for the treatment of peripheral nerve injury. The main problem of general biologic delivery systems is that the loading capacity of biologics is positively correlated with the release rate, and it is more difficult to achieve long-term stable release of high biologics-loaded scaffolds; thus, it is not possible to carry out full-cycle targeted therapy for peripheral nerve injury sites. To solve these problems, the mechanisms of common neurotrophic factors, bioelectrical signals and biomagnetic signals for repairing peripheral nerve injury are discussed in this paper. Moreover, this review summarizes the mechanism of electroactive and magnetoresponsive materials that have significant ability to repair peripheral nerve injury to promote nerve regeneration and provides an overview of the biologic delivery mechanism for repairing peripheral nerve injury in different structural dimensions. It was finally concluded that electromagnetic responsive targeted delivery scaffolds (four-dimensional scaffolds) have good peripheral nerve repair ability, which provides guidance for the clinical application of targeted therapy for peripheral nerve injury.

Boronic ester bonding integrated dextran-based hydrogel patch for diabetic peripheral nerve injury treatment

Peripheral nerve injury (PNI) is a common clinical complication of diabetes, however, lacks effective clinical treatment due to complex pathological microenvironment. Considering both biomimetic remodeling and pathological reversal, we proposed a boronic ester bonding integrated strategy to develop dextran-based hydrogel patch with dopamine methacrylate-conjugated exosomes (mExo) immobilization. Aldehyde/phenylboronic acid difunctional dextran was synthesized to establish hydrogel skeleton and provide self-adhesion and ROS/glucose modulation capacities for neuroprotection. Meanwhile, mExo as therapeutic factors were immobilized into hydrogels via boronic ester bonding and released in pathologic response to target mitochondrial dysfunction and achieve neurotherapy. Through in vitro assays, the composite hydrogel patch was shown to reduce oxidative stress by ROS scavenging, thereby protecting the mitochondrial morphological and functional homeostasis of healthy RSC96 cells. Indeed, the sustained released exosome conjugates regulated bioenergy metabolism and alleviated mitochondrial dysfunction in hyperglycemia damaged RSC96 cells by the up-regulated expression of E-cadherin and AMPK proteins. In vivo experiments proved that through correcting diabetic pathology and targeted treatment of damaged mitochondria, the hydrogel patch inhibited neuronal apoptosis and finally promoted axon regeneration, remyelination and motor function recovery after PNI in diabetic rats. The synergistic “two-pronged” strategy of biomimetic remodeling and pathological reversal opens a promising opportunity for non-invasive treatment of diabetic PNI.

Bone marrow mesenchymal stem cells in treatment of peripheral nerve injury.

Peripheral nerve injury (PNI) is a common neurological disorder and complete functional recovery is difficult to achieve. In recent years, bone marrow mesenchymal stem cells (BMSCs) have emerged as ideal seed cells for PNI treatment due to their strong differentiation potential and autologous transplantation ability. This review aims to summarize the molecular mechanisms by which BMSCs mediate nerve repair in PNI. The key mechanisms discussed include the differentiation of BMSCs into multiple types of nerve cells to promote repair of nerve injury. BMSCs also create a microenvironment suitable for neuronal survival and regeneration through the secretion of neurotrophic factors, extracellular matrix molecules, and adhesion molecules. Additionally, BMSCs release pro-angiogenic factors to promote the formation of new blood vessels. They modulate cytokine expression and regulate macrophage polarization, leading to immunomodulation. Furthermore, BMSCs synthesize and release proteins related to myelin sheath formation and axonal regeneration, thereby promoting neuronal repair and regeneration. Moreover, this review explores methods of applying BMSCs in PNI treatment, including direct cell transplantation into the injured neural tissue, implantation of BMSCs into nerve conduits providing support, and the application of genetically modified BMSCs, among others. These findings confirm the potential of BMSCs in treating PNI. However, with the development of this field, it is crucial to address issues related to BMSC therapy, including establishing standards for extracting, identifying, and cultivating BMSCs, as well as selecting application methods for BMSCs in PNI such as direct transplantation, tissue engineering, and genetic engineering. Addressing these issues will help translate current preclinical research results into clinical practice, providing new and effective treatment strategies for patients with PNI.