Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, 600 Forbes Avenue, 415 Mellon Hall, Pittsburgh, Pennsylvania, 15282, USA.
Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania, 15282, USA.
AAPS J. 2017 Sep;19(5):1304-1316. doi: 10.1208/s12248-017-0129-x. Epub 2017 Aug 4.
Accidental and iatrogenic trauma are major causes of peripheral nerve injury. Healing after nerve injury is complex and often incomplete, which can lead to acute or chronic pain and functional impairment. Current assessment methods for nerve regeneration lack sensitivity and objectivity. There is a need for reliable and reproducible, noninvasive strategies with adequate spatial and temporal resolution for longitudinal evaluation of degeneration or regeneration after injury/treatment. Methods for noninvasive monitoring of the efficacy and effectiveness of neurotherapeutics in nerve regeneration or of neuropathic pain are needed to ensure adequacy and responsiveness to management, especially given the large variability in the patient populations, etiologies, and complexity of nerve injuries. Surrogate biomarkers are needed with positive predictive correlation for the dynamics and kinetics of neuroregeneration. They can provide direct real-time insight into the efficacy and mechanisms of individualized therapeutic intervention. Here, we review the state-of-the-art tools, technologies, and therapies in peripheral nerve injury and regeneration as well as provide perspectives for the future. We present compelling evidence that advancements in nanomedicine and innovation in nanotechnology such as nanotheranostics hold groundbreaking potential as paradigm shifts in noninvasive peripheral nerve imaging and drug delivery. Nanotechnology, which revolutionized molecular imaging in cancer and inflammatory disease, can be used to delineate dynamic molecular imaging signatures of neuroinflammation and neuroregeneration while simultaneously monitoring cellular or tissue response to drug therapy. We believe that current clinical successes of nanotechnology can and should be adopted and adapted to the science of peripheral nerve injury and regeneration.
意外和医源性创伤是周围神经损伤的主要原因。神经损伤后的愈合过程复杂且往往不完全,可导致急性或慢性疼痛和功能障碍。目前的神经再生评估方法缺乏敏感性和客观性。需要可靠、可重复、非侵入性的策略,具有足够的空间和时间分辨率,以便对损伤/治疗后的变性或再生进行纵向评估。需要用于非侵入性监测神经再生或神经性疼痛的神经治疗效果和有效性的方法,以确保管理的充分性和响应性,特别是考虑到患者群体、病因和神经损伤的复杂性存在很大差异。需要具有正预测相关性的替代生物标志物来反映神经再生的动力学和动态变化。它们可以为个体化治疗干预的疗效和机制提供直接的实时见解。在这里,我们回顾了周围神经损伤和再生的最新工具、技术和疗法,并为未来提供了展望。我们提供了令人信服的证据,表明纳米医学的进步和纳米技术的创新,如纳米治疗诊断学,作为非侵入性周围神经成像和药物输送的范式转变具有开创性的潜力。纳米技术彻底改变了癌症和炎症性疾病的分子成像,可以用于描绘神经炎症和神经再生的动态分子成像特征,同时监测细胞或组织对药物治疗的反应。我们相信,纳米技术的当前临床成功可以而且应该被采用并适应周围神经损伤和再生的科学。
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