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  • Fadia, Neil B; Bliley, Jacqueline M; DiBernardo, Gabriella A; Crammond, Donald J; Schilling, Benjamin K; Sivak, Wesley N; Spiess, Alexander M; Washington, Kia M; Waldner, Matthias; Liao, Han-Tsung; James, Isaac B; Minteer, Danielle M; Tompkins-Rhoades, Casey; Cottrill, Adam R; Kim, Deok-Yeol; Schweizer, Riccardo; Bourne, Debra A; Panagis, George E; Asher Schusterman, 2nd, M; Egro, Francesco M; Campwala, Insiyah K; Simpson, Tyler; Weber, Douglas J; Gause, 2nd, Trent; Brooker, Jack E; Josyula, Tvisha; Guevara, Astrid A; Repko, Alexander J; Mahoney, Christopher M; Marra, Kacey G

    Science translational medicine, 01/2020, Letnik: 12, Številka: 527
    Journal Article

    Severe injuries to peripheral nerves are challenging to repair. Standard-of-care treatment for nerve gaps >2 to 3 centimeters is autografting; however, autografting can result in neuroma formation, loss of sensory function at the donor site, and increased operative time. To address the need for a synthetic nerve conduit to treat large nerve gaps, we investigated a biodegradable poly(caprolactone) (PCL) conduit with embedded double-walled polymeric microspheres encapsulating glial cell line-derived neurotrophic factor (GDNF) capable of providing a sustained release of GDNF for >50 days in a 5-centimeter nerve defect in a rhesus macaque model. The GDNF-eluting conduit (PCL/GDNF) was compared to a median nerve autograft and a PCL conduit containing empty microspheres (PCL/Empty). Functional testing demonstrated similar functional recovery between the PCL/GDNF-treated group (75.64 ± 10.28%) and the autograft-treated group (77.49 ± 19.28%); both groups were statistically improved compared to PCL/Empty-treated group (44.95 ± 26.94%). Nerve conduction velocity 1 year after surgery was increased in the PCL/GDNF-treated macaques (31.41 ± 15.34 meters/second) compared to autograft (25.45 ± 3.96 meters/second) and PCL/Empty (12.60 ± 3.89 meters/second) treatment. Histological analyses included assessment of Schwann cell presence, myelination of axons, nerve fiber density, and -ratio. PCL/GDNF group exhibited a statistically greater average area occupied by individual Schwann cells at the distal nerve (11.60 ± 33.01 μm ) compared to autograft (4.62 ± 3.99 μm ) and PCL/Empty (4.52 ± 5.16 μm ) treatment groups. This study demonstrates the efficacious bridging of a long peripheral nerve gap in a nonhuman primate model using an acellular, biodegradable nerve conduit.