Nebil Selimoğlu Private Clinic, Tekirdağ, Turkey.
Faculty of Medicine, Department of Histology and Embryology, Dumlupınar University, Kütahya, Turkey.
Microsurgery. 2024 Jul;44(5):e31208. doi: 10.1002/micr.31208.
Traumatic peripheral nerve injury, with an annual incidence reported to be approximately 13-23 per 100,000 people, is a serious clinical condition that can often lead to significant functional impairment and permanent disability. Although nerve transfer has become increasingly popular in the treatment of brachial plexus injuries, satisfactory results cannot be obtained even with total nerve root transfer, especially after serious injuries. To overcome this problem, we hypothesize that the application of stem cells in conjunction with nerve transfer procedures may be a viable alternative to more aggressive treatments that do not result in adequate improvement. Similarly, some preliminary studies have shown that adipose stem cells combined with acellular nerve allograft provide promising results in the repair of brachial plexus injury. The purpose of this study was to assess the efficacy of combining adipose-derived stem cells with nerve transfer procedure in a rat brachial plexus injury model.
Twenty female Wistar rats weighing 300-350 g and aged 8-10 weeks were randomly divided into two groups: a nerve transfer group (NT group) and a nerve transfer combined adipose stem cell group (NT and ASC group). The upper brachial plexus injury model was established by gently avulsing the C5-C6 roots from the spinal cord with microforceps. A nerve transfer from the ulnar nerve to the musculocutaneous nerve (Oberlin procedure) was performed with or without seeded allogeneic adipose tissue-derived stem cells. Adipose tissue-derived stem cells at a rate of 2 × 10 cells were injected locally to the surface of the nerve transfer area with a 23-gauge needle. Immunohistochemistry (S100 and PGP 9.5 antibodies) and electrophysiological data were used to evaluate the effect of nerve repair 12 weeks after surgery.
The mean latency was significantly longer in the NT group (2.0 ± 0.0 ms, 95% CI: 1.96-2.06) than in the NT and ASC group (1.7 ± 0.0 ms, 95% CI: 1.7-1.7) (p < .001). The mean peak value was higher in the NT group (1.7 ± 0.0 mV, 95% CI: 1.7-1.7) than in the NT and ASC group (1.7 ± 0.3 mV, 95% CI: 1.6-1.9) with no significant difference (p = .61). Although S100 and PGP 9.5 positive areas were observed in higher amounts in the NT and ASC group compared to the NT group, the differences were not statistically significant (p = .26 and .08, respectively).
This study conducted on rats provides preliminary evidence that adipose-derived stem cells may have a positive effect on nerve transfer for the treatment of brachial plexus injury. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
外伤性周围神经损伤的年发病率约为每 10 万人中有 13-23 例，是一种严重的临床情况，常导致明显的功能障碍和永久性残疾。尽管神经转移术在治疗臂丛神经损伤方面越来越受欢迎，但即使进行全神经根转移术，也不能获得满意的效果，尤其是在严重损伤后。为了解决这个问题，我们假设在神经转移手术中应用干细胞可能是一种可行的替代方案，可以替代那些不能带来足够改善的更激进的治疗方法。同样，一些初步研究表明，脂肪干细胞与去细胞神经同种异体移植物联合应用在修复臂丛神经损伤方面具有良好的效果。本研究旨在评估脂肪来源干细胞与神经转移术联合应用于大鼠臂丛神经损伤模型的疗效。
20 只雌性 Wistar 大鼠，体重 300-350g，年龄 8-10 周，随机分为两组：神经转移组（NT 组）和神经转移联合脂肪干细胞组（NT 和 ASC 组）。用微夹轻轻撕脱 C5-C6 神经根，建立上臂丛神经损伤模型。通过尺神经向肌皮神经（Oberlin 手术）进行神经转移，并在有或没有种子异体脂肪组织来源干细胞的情况下进行。用 23 号针头将 2×10 个细胞的脂肪组织来源干细胞局部注射到神经转移区域的表面。术后 12 周，采用免疫组织化学（S100 和 PGP 9.5 抗体）和电生理数据评估神经修复效果。
与 NT 组（2.0±0.0ms，95%CI：1.96-2.06）相比，NT 和 ASC 组（1.7±0.0ms，95%CI：1.7-1.7）的平均潜伏期明显延长（p<0.001）。NT 组的平均峰值（1.7±0.0mV，95%CI：1.7-1.7）高于 NT 和 ASC 组（1.7±0.3mV，95%CI：1.6-1.9），但差异无统计学意义（p=0.61）。尽管与 NT 组相比，NT 和 ASC 组的 S100 和 PGP 9.5 阳性区域观察到更高的数量，但差异无统计学意义（p=0.26 和 0.08）。
本研究初步证实，脂肪来源干细胞可能对臂丛神经损伤的神经转移治疗有积极作用。需要更大样本量和更长随访时间的进一步研究来证实这些发现。
