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RESTORATION OF LONG NERVE DEFECTS WITH EPINEURAL SHEATH CONDUIT SUPPORTED WITH BONE MARROW STROMAL CELLS. A PRELIMINARY REPORT
Presenter: Presenter: Maria Madajka, PhD
Co-Authors: Uygur H; Ozturk C; Lukaszuk M; Szopinski J; Siemionow V; Siemionow M; Kwiecien G
Cleveland Clinic

Background: Nerve gaps that need conduit or allograft material tend to involve regional loss of overlying soft tissues and muscles spanning a gap of over 20 cm. Currently used autograft technique requires immunosuppression and demonstrated poor motor recovery.

Main goals: We developed epineural sheath conduit supported with bone marrow stromal cells (BMSCs) to restore 6 cm nerve defects. Epineural sheath is immunologically neutral and contains laminin, enhancing neuronal growth. Addition of BMSCs will contribute to structural support and secretion of growth factors for nerve regeneration.

Methods: Sheep model was used since sheep peripheral nerves are histologically and morphometrically similar to human nerves. Epineural sheath tube was created from the median nerve by the pull out technique, removing all fascicles. BMSCs were obtained from donor animal, purified by the buffy coat technique and cultured for 14 days. Next, cells were fluorescently labeled and injected into the empty epineural tube in the range of 5- 8 x 10 6 cells. Restoration of 6cm median nerve defect with epineural conduit was performed. Twelve sheep median nerves were evaluated in six animals including: autograft controls (n=2), saline control without BMSCs (n=2), autologous and allogenic conduits (n=2 each) filled with BMSCs. At 3 and 6 months follow up, nerve conduction velocity (NCV) and somatosensory evoked potential (SSEP) measurements were taken.

Results: All animals recovered from surgery without complications. Immunofluorescent staining at 3 months in saline filled conduit showed the presence of fascicle-like structure in the proximal, middle, and distal parts of the conduit. The preliminary analysis of NCV and SSEP confirmed the presence of neurosensory responses in both saline and BMSC-filled conduit groups.

Conclusions: We confirmed feasibility of using epineural sheath conduit to restore 6 cm nerve defects in sheep model. Preliminary results of immunohistochemical and neurosensory assessment confirmed regenerative properties of the conduit.


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