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RESTORATION OF PERIPHERAL NERVE AFTER ACUTE INJURY USING EPINEURAL SHEATH CONDUIT ENHANCED WITH BONE MARROW STROMAL CELLS IN DIABETIC CONDITIONS
Presenter: Gregorz J Kwiecien, MD
Co-Authors: Lukaszuk M; Uygur S; Madajka M; Cwykiel J; Siemionow M
Cleveland Clinic

Introduction: Currently there are over 15 million diabetic patients in the USA with emerging problem of neuropathy. Many suffer from limb injuries due to sensory function impairment, often involving nerve lesions. Nerve autografting seems to be an insufficient treatment option for these patients due to the lack of healthy donor sites and impaired healing of the restored nerve. Therefore there is a need for simple and effective repair method for neuropathic nerve injuries which are impossible to repair with tension-free simple coaptation.

Purpose: We introduced and investigated peripheral nerve repair using an immunologically inert epineural sheath conduit enhanced with isogenic bone marrow stromal cells (BMSCs) in diabetic conditions.

Material and Methods: Fifty-eight Zucker Diabetic Fatty (ZDF) rats were used in the study with inclusion criteria for established diabetes: casual glycemia >200 mg/dl (twice) and post-fasting glycemia >110 mg/dl. A 20mm sciatic nerve defect was created and rats were divided into 4 different groups based on the repair technique: epineural sheath conduit filled with BMSCs, 3-4 x 106 per injection (Group 1, n=16) or saline (Group 2, n=16), nerve autograft (Group 3, n=16) and 20mm nerve gap without repair (Group 4, n=10). Assessments included motor and sensory recovery at 3 weeks intervals. At 6 and 12 weeks follow up somatosensory evoked potentials (SSEP) were recorded and nerve samples were taken for immunohistochemistry and histomorphometric analysis. Muscle denervation atrophy was assessed by Gastrocnemius Muscle Index (GMI) and micromorphometry.

Results: Clinical evaluation, SSEP analysis and nerve and muscle morphometry confirmed significantly better recovery in groups 1 and 2 and the outcomes were comparable to nerve autograft repair. The addition of BMSCs contributed to the nerve regeneration in diabetic conditions.

Conclusions: This study confirmed feasibility of application of epineural sheath conduit in restoration of nerve function in diabetic rats. Results comparable with nerve autograft confirmed supportive role of BMSCs in diabetic nerve regeneration.


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