Autologous Unpurified Adipose Tissue Enhances Peripheral Nerve Regeneration through 20 mm Autografts
Nathan G. Lawera, BSc., Carrie A. Kubiak, M.D., Scott W. Sabbagh, BSc., Vincent Thieu, BSc., Paul S. Cederna, M.D., Stephen W. Kemp, Ph.D.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Traumatic peripheral nerve injuries are common and often result in partial or permanent paralysis, numbness of the affected limb, and debilitating neuropathic pain. Injuries to peripheral nerves vary widely in their severity, and clinical outcomes are frequently disappointing. Adipose-derived stem cells (ASCs) have been previously shown to enhance peripheral nerve regeneration. However, ASC processing leads to both clinical and regulatory burdens. Unpurified fat is whole adipose tissue that is harvested without subsequent ASC isolation. In addition, harvesting of unpurified adipose tissue is currently approved by the FDA. The purpose of the present study was to investigate the effect of unpurified adipose tissue on nerve regeneration through 20 mm long autografts in the rat.
METHODS: F344 rats were used in this study and were randomly assigned to one of four experimental groups: (1) na´ve control (no nerve injury); (2) 20 mm autograft; (3) 20 mm autograft + unpurified adipose tissue, and; (4) 20 mm autograft + purified fat. All animals were tested at baseline, and were then followed serially for 12 weeks. Outcome measures included sensorimotor (ladder rung, walking track), and sensory pain assessments (von Frey). Terminal outcome muscle measures examined EMG (compound muscle action potentials, nerve conduction velocity) and muscle force parameters (twitch and tetanic forces).
RESULTS: Animals in the autograft + unpurified fat group displayed enhanced peripheral regeneration compared to the non-fat administered autograft group. Specifically, these animals displayed increased EMG and muscle force parameters at study endpoint. Sensorimotor assessments were enhanced in these animals, and histomorphometrical assessment showed differences between autograft and autograft + unpurified fat groups.
CONCLUSION: Unpurified fat enhanced peripheral nerve regeneration through autografts. Harvesting of unpurified fat circumvents current FDA regulatory burdens, is easily obtainable, and has the potential to change current clinical management of traumatic peripheral nerve injuries.
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