Rochkind Shimon, Geuna Stefano, Shainberg Asher
Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel.
Int Rev Neurobiol. 2009;87:445-64. doi: 10.1016/S0074-7742(09)87025-6.
Posttraumatic nerve repair and prevention of muscle atrophy represent a major challenge of restorative medicine. Considerable interest exists in the potential therapeutic value of laser phototherapy for restoring or temporarily preventing denervated muscle atrophy as well as enhancing regeneration of severely injured peripheral nerves. Low-power laser irradiation (laser phototherapy) was applied for treatment of rat denervated muscle in order to estimate biochemical transformation on cellular and tissue levels, as well as on rat sciatic nerve model after crush injury, direct or side-to-end anastomosis, and neurotube reconstruction. Nerve cells' growth and axonal sprouting were investigated in embryonic rat brain cultures. The animal outcome allowed clinical double-blind, placebo-controlled randomized study that measured the effectiveness of 780-nm laser phototherapy on patients suffering from incomplete peripheral nerve injuries for 6 months up to several years. In denervated muscles, animal study suggests that the function of denervated muscles can be partially preserved by temporary prevention of denervation-induced biochemical changes. The function of denervated muscles can be restored, not completely but to a very substantial degree, by laser treatment initiated at the earliest possible stage post injury. In peripheral nerve injury, laser phototherapy has an immediate protective effect. It maintains functional activity of the injured nerve for a long period, decreases scar tissue formation at the injury site, decreases degeneration in corresponding motor neurons of the spinal cord, and significantly increases axonal growth and myelinization. In cell cultures, laser irradiation accelerates migration, nerve cell growth, and fiber sprouting. In a pilot, clinical, double-blind, placebo-controlled randomized study in patients with incomplete long-term peripheral nerve injury, 780-nm laser irradiation can progressively improve peripheral nerve function, which leads to significant functional recovery. A 780-nm laser phototherapy temporarily preserves the function of a denervated muscle, and accelerates and enhances axonal growth and regeneration after peripheral nerve injury or reconstructive procedures. Laser activation of nerve cells, their growth, and axonal sprouting can be considered as potential treatment for neural injury. Animal and clinical studies show the promoting action of phototherapy on peripheral nerve regeneration, which makes it possible to suggest that the time for broader clinical trials has come.
创伤后神经修复和预防肌肉萎缩是再生医学面临的一项重大挑战。激光光疗法在恢复或暂时预防失神经支配肌肉萎缩以及促进严重损伤的周围神经再生方面的潜在治疗价值引起了人们的极大兴趣。为了评估细胞和组织水平上的生化变化，以及在大鼠坐骨神经挤压伤、直接或端侧吻合以及神经管重建后的生化变化，采用低功率激光照射（激光光疗法）治疗大鼠失神经支配肌肉。在胚胎大鼠脑培养物中研究神经细胞的生长和轴突发芽。动物实验结果为一项临床双盲、安慰剂对照随机研究提供了依据，该研究测量了780纳米激光光疗法对患有不完全周围神经损伤6个月至数年的患者的有效性。在失神经支配的肌肉中，动物研究表明，通过暂时预防失神经支配引起的生化变化，可以部分保留失神经支配肌肉的功能。通过在损伤后尽早开始激光治疗，可以恢复失神经支配肌肉的功能，虽然不是完全恢复，但程度非常显著。在周围神经损伤中，激光光疗法具有直接的保护作用。它能长期维持受损神经的功能活动，减少损伤部位瘢痕组织的形成，减少脊髓相应运动神经元的退化，并显著增加轴突生长和髓鞘形成。在细胞培养中，激光照射可加速迁移、神经细胞生长和纤维发芽。在一项针对长期不完全周围神经损伤患者的初步临床双盲、安慰剂对照随机研究中，780纳米激光照射可逐步改善周围神经功能，从而实现显著的功能恢复。780纳米激光光疗法可暂时保留失神经支配肌肉的功能，并加速和促进周围神经损伤或重建手术后的轴突生长和再生。神经细胞的激光激活、其生长和轴突发芽可被视为神经损伤的潜在治疗方法。动物和临床研究表明光疗法对周围神经再生具有促进作用，这表明开展更广泛临床试验的时机已经到来。
