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Evaluation of the Induced Membrane for Neurotrophic Factors
Alexandria O Starks, MD1, John Owen, MS2, Satya Mallu, MD2 and Jonathan Isaacs, MD3, (1)Virginia Commonwealth University Health System, Richmond, VA, (2)Virginia Commonwealth University, Richmond, VA, (3)Department of Orthopaedics, Virginia Commonwealth University Health System, Richmond, VA

Introduction

Traumatic peripheral nerve injury resulting in segmental loss of nerve tissue causes significant morbidity. Reconstruction of these injuries currently uses processed nerve allograft or autograft with mixed results. The goal of this study was to induce a membrane around a silicone implant placed in a nerve defect, and evaluate the membrane for the presence of growth factors that may improve nerve regeneration.

Materials & Methods

We resected two centimeters of sciatic nerve in 22 male Spraque-Dawley rats, placing a silicone rod in the defect of 11 experimental rats, and only marking the edges of resected nerve with nonabsorbable suture in the remaining 11 control rats. After allowing 4 weeks for tissue maturation, tissue from the experimental group induced membrane and control group deep scar bed were compared to each other using Luminex multiplex assay to determine quantitative differences in the levels of the following neurotrophic factors: nerve growth factor (NGF), glial derived nerve factor (GDNF), brain-derived nerve factor (BDNF), vascular endothelial growth factor (VEGF), and transforming growth factor - beta1,2,3 (TGF-ß), interleukin-1 beta (IL-1ß), and monocyte chemoattractant protein 1 (MCP-1).

Results

We found no difference between the control and experimental groups in levels of VEGF and MCP-1. We did find statistically significant differences (p <0.05) between the control and experimental groups with increased levels of TGF-ß1, TGF-ß2, TGF-ß3, GDNF, and IL-1ß in the experimental group. Comparison of NGF and BDNF is pending.

Conclusions

In the setting of peripheral nerve injury, an induced membrane has higher levels of several neurotrophic factors that may support nerve regeneration compared to wound bed cicatrix. This investigation provides impetus for further study examining the utility of using the staged induced membrane technique in conjunction with nerve allograft or autograft in reconstruction of peripheral nerve defects.


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