Liu Yan, Wang Huan
Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Neural Regen Res. 2020 Feb;15(2):189-198. doi: 10.4103/1673-5374.265540.
Peripheral nerve injury leads to morphological, molecular and gene expression changes in the spinal cord and dorsal root ganglia, some of which have positive impact on the survival of neurons and nerve regeneration, while the effect of others is the opposite. It is crucial to take prompt measures to capitalize on the positive effects of these reactions and counteract the negative impact after peripheral nerve injury at the level of spinal cord, especially for peripheral nerve injuries that are severe, located close to the cell body, involve long distance for axons to regrow and happen in immature individuals. Early nerve repair, exogenous supply of neurotrophic factors and Schwann cells can sustain the regeneration inductive environment and enhance the positive changes in neurons. Administration of neurotrophic factors, acetyl-L-carnitine, N-acetyl-cysteine, and N-methyl-D-aspartate receptor antagonist MK-801 can help counteract axotomy-induced neuronal loss and promote regeneration, which are all time-dependent. Sustaining and reactivation of Schwann cells after denervation provides another effective strategy. FK506 can be used to accelerate axonal regeneration of neurons, especially after chronic axotomy. Exploring the axotomy-induced changes after peripheral nerve injury and applying protective and promotional measures in the spinal cord which help to retain a positive functional status for neuron cell bodies will inevitably benefit regeneration of the peripheral nerve and improve functional outcomes.
周围神经损伤会导致脊髓和背根神经节发生形态、分子及基因表达变化，其中一些变化对神经元存活和神经再生有积极影响，而其他变化则相反。在外周神经损伤后，尤其对于严重的、靠近细胞体的、轴突再生距离长以及发生在未成熟个体的外周神经损伤，至关重要的是及时采取措施利用这些反应的积极作用，并在脊髓水平对抗其负面影响。早期神经修复、外源性供应神经营养因子和施万细胞可维持再生诱导环境并增强神经元的积极变化。给予神经营养因子、乙酰左旋肉碱、N-乙酰半胱氨酸和N-甲基-D-天冬氨酸受体拮抗剂MK-801有助于对抗轴突切断诱导的神经元丢失并促进再生，这些都是时间依赖性的。去神经后施万细胞的维持和再激活提供了另一种有效策略。FK506可用于加速神经元的轴突再生，尤其是在慢性轴突切断后。探索外周神经损伤后轴突切断诱导的变化，并在脊髓中应用有助于保持神经元细胞体积极功能状态的保护和促进措施，将不可避免地有利于外周神经再生并改善功能结局。
