Characteristics of the Human Epineural Sheath Properties for Enhancement of Nerve Regeneration – a Preliminary Report
Maria Madajka, PhD, Can Ozturk MD, Halil Uygur MD, Miroslaw Lukaszuk MD and Maria Siemionow MD PhD
Plastic Surgery, Cleveland Clinic, Cleveland, OH
Background: There is a constant search for development of new technologies and introduction of new techniques to improve nerve regeneration. Nerve allografts bear a risk of rejection and require support with toxic immunosuppression. We investigated characteristics of the human epineural sheath as a potential alternative source of allograft material available to support nerve regeneration. Materials and Methods: Cryopreserved sciatic nerves from human cadavers were provided by Musculoskeletal Transplant Foundation (MTF)) for immunohistostaining assessment. The length of provided nerves was 48 cm (cadaver 1) and 40 cm (cadaver 2). Nerves were dissected and all the fascicles were removed by the pull out technique creating empty epineural tubes. Frozen sections of epineural conduits were fluorescently stained for the presence of angiogenic (vWF, Laminin B2, CD31), neurogenic (S-100, GFAP) and immunogenic (HLA-I and HLA-II) markers. Results: Assessment of the dissected epineural conduits by fluorescent immunostaining revealed a high expression of laminin B2 on the surface of epineural sheath conduits which is crucial for the guidance of newly growing axons. There was a weak expression of vWF and CD31 indicating absence of the vessels. There was also lack of expression of the Schwann cells marker and lack of expression of the HLA I and HLA. Conclusions: The immunohistostainning assessment of the human epineural sheath confirmed presence of the proneurogenic and proangiogenic properties of the created conduit by expression of the laminin B2. In addition, the lack of expression of the Schwann cell markers as well as HLA I and HLA II markers indicated lack of immunological reaction. These results support application of human epineural sheath conduit as an alternative grafting material for repair of nerve gaps without the need for toxic immunosupression.
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