Gersey Zachary C, Burks S Shelby, Anderson Kim D, Dididze Marine, Khan Aisha, Dietrich W Dalton, Levi Allan D
Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
Neurosurg Focus. 2017 Mar;42(3):E2. doi: 10.3171/2016.12.FOCUS16474.
OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.
目的 大型周围神经的长节段损伤对外科医生而言是一项挑战，因为供体组织不足限制了修复。人们已经研究了多种补充方法，包括使用雪旺细胞（SCs）。作者展示了首例使用自体雪旺细胞补充人类周围神经移植修复并提供长期随访数据的2个病例。方法 两名患者参加了一项经美国食品药品监督管理局（FDA）批准的试验，以评估使用扩增的自体雪旺细胞群体补充坐骨神经长节段损伤修复的安全性。损伤机制包括船用螺旋桨伤和枪伤。雪旺细胞取自腓肠神经和受损的坐骨神经残端。通过使用这里gulinβ1和福斯可林在培养中对雪旺细胞进行扩增和纯化。使用腓肠神经移植物、悬浮的雪旺细胞和Duragen移植物来容纳构建体进行修复。病例1和病例2的患者随访时间分别为36个月和12个月。结果 病例1的患者为船用螺旋桨伤，大腿中部坐骨神经的两个分支完全横断。移植物长度约为7.5厘米。术后，患者在胫神经分布区域恢复了运动功能（医学研究委员会[MRC]5/5级），在腓总神经分布区域有部分功能（背屈时MRC 2/5级）。感觉功能也部分恢复，神经性疼痛完全缓解。病例2的患者腿部遭受枪伤，大腿中部坐骨神经胫神经分支部分断裂。移植物长度为5厘米。术后，患者恢复了胫神经的完全运动功能，感觉部分恢复。MRI和超声的长期随访显示神经移植物连续，修复部位无肿瘤形成。结论 这里展示的是首例使用自体雪旺细胞补充人类长节段损伤周围神经修复的2个病例。两名患者的运动和感觉功能均有显著改善，并伴有相关影像学表现。本研究证明了雪旺细胞移植用于周围神经修复的初步安全性和有效性。
