Sarhane Karim A, Qiu Chenhu, Harris Thomas G W, Hanwright Philip J, Mao Hai-Quan, Tuffaha Sami H
Department of Plastic and Reconstructive Surgery, Peripheral Nerve Research Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Materials Science and Engineering, Johns Hopkins University Whiting School of Engineering; Institute for NanoBioTechnology, Johns Hopkins University; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neural Regen Res. 2023 Jun;18(6):1229-1234. doi: 10.4103/1673-5374.358616.
Peripheral nerve injuries remain a challenging problem in need of better treatment strategies. Despite best efforts at surgical reconstruction and postoperative rehabilitation, patients are often left with persistent, debilitating motor and sensory deficits. There are currently no therapeutic strategies proven to enhance the regenerative process in humans. A clinical need exists for the development of technologies to promote nerve regeneration and improve functional outcomes. Recent advances in the fields of tissue engineering and nanotechnology have enabled biomaterial scaffolds to modulate the host response to tissue repair through tailored mechanical, chemical, and conductive cues. New bioengineered approaches have enabled targeted, sustained delivery of protein therapeutics with the capacity to unlock the clinical potential of a myriad of neurotrophic growth factors that have demonstrated promise in enhancing regenerative outcomes. As such, further exploration of combinatory strategies leveraging these technological advances may offer a pathway towards clinically translatable solutions to advance the care of patients with peripheral nerve injuries. This review first presents the various emerging bioengineering strategies that can be applied for the management of nerve gap injuries. We cover the rationale and limitations for their use as an alternative to autografts, focusing on the approaches to increase the number of regenerating axons crossing the repair site, and facilitating their growth towards the distal stump. We also discuss the emerging growth factor-based therapeutic strategies designed to improve functional outcomes in a multimodal fashion, by accelerating axonal growth, improving the distal regenerative environment, and preventing end-organs atrophy.
周围神经损伤仍然是一个具有挑战性的问题，需要更好的治疗策略。尽管在手术重建和术后康复方面已尽了最大努力，但患者往往仍会留下持续的、使人衰弱的运动和感觉功能障碍。目前尚无经证实能增强人类神经再生过程的治疗策略。临床上需要开发促进神经再生并改善功能结局的技术。组织工程和纳米技术领域的最新进展使生物材料支架能够通过定制的机械、化学和导电线索来调节宿主对组织修复的反应。新的生物工程方法能够靶向、持续地递送蛋白质疗法，从而释放出众多神经营养生长因子的临床潜力，这些生长因子在改善再生结局方面已显示出前景。因此，进一步探索利用这些技术进步的联合策略可能为临床上可转化的解决方案提供一条途径，以推进对周围神经损伤患者的治疗。本综述首先介绍了可用于治疗神经间隙损伤的各种新兴生物工程策略。我们阐述了将其用作自体移植物替代物的基本原理和局限性，重点关注增加穿过修复部位的再生轴突数量以及促进其向远端残端生长的方法。我们还讨论了基于生长因子的新兴治疗策略，这些策略旨在通过加速轴突生长、改善远端再生环境和预防终末器官萎缩，以多模式方式改善功能结局。
