The capacity of the distal stump of peripheral nerve to receive growing axons after two and six months denervation.

BACKGROUND AND AIMS: Peripheral nerve injury may lead to poor recovery outcome in spite of treatment with advanced microsurgical repair techniques. Delayed cross-anastomosis paradigm was used to study the axon grow to the distal nerve stump after denervation separately from the influence of prolonged axotomy in the proximal stump. MATERIAL AND METHODS: Left common peroneal nerve of 48 rats was transected and denervated over two or six months. There were two research groups in the study. In the regeneration group (REG) the proximal stump of acutely transected tibial nerve was sutured to denervated distal stump of common peroneal nerve. To our knowledge, this is the first study in which this group was compared to degeneration group (DEG) with both nerve ends denervated over two or six months. This comparison enabled us to study the capacity of denervated distal nerve stump to receive sprouting axons. Axon density in distal nerve stump was calculated after three or six week's follow-up periods. RESULTS: There were no differences in the number of axon sprouts in the distal nerve stump between the denervation periods of two and six months. When compared REG and DEG groups, there was trend to higher axon densities in the REG group, although the differences were not statistically significant. CONCLUSIONS: We conclude that the capacity of distal nerve stump to receive the growing axons from the proximal nerve stump does not decrease significantly between two and six months denervation. Cross-anastomosis paradigm provides a useful tool for detailed study of the nerve transfer procedure.

Distinct expression of TGF-beta1 mRNA in the endo- and epineurium after nerve injury.

TGF-beta is a multifunctional regulatory protein with important effects on cell proliferation and differentiation, immune reactivity and extracellular matrix (ECM). During peripheral regeneration it can have growth promoting effects for axonal sprouting, but on the other hand, it may be involved in epineurial scarring and neuroma formation. We studied the expression of TGF-beta1 mRNA in the rat peripheral nerve with real time-PCR at 1, 3, 5, 7, 14, 21, 28, 35, and 42 days after transection. The sciatic nerve was sutured after transection to prevent axonal regeneration. Samples from both proximal and distal stumps were collected. To distinguish the possible different expression in the endo- and epineurium these two compartments were studied separately. The most significant finding was observed in the epineurium of the proximal stump 35 days after the operation. The expression of TGF-beta1 mRNA was over 700 times higher than that found in the non-operated controls. At the same time the expression of TGF-beta1 mRNA in the endoneurium was only twice as high as the values measured from the non-operated controls. Distally the TGF-beta1 mRNA expression in the endoneurium reached its peak after 2 weeks, and at weeks 3-6, the expression was two to four times higher than in the controls. This study supports the concept that TGF-beta1 can affect epineurial scarring.

Increased expression of chemokines (MCP-1, MIP-1alpha, RANTES) after peripheral nerve transection.

After nerve injury, recruitment of circulating macrophages into the endoneurium is essential for degeneration and subsequently for successful regeneration. However, the factors leading to macrophage recruitment are not known in detail. Chemokines are one of many possible factors influencing recruitment. In this study we wanted to examine, immunohistochemically, the expression of MCP-1, MIP-1alpha and RANTES from 6 hours up to 4 weeks after transection of rat sciatic nerve. An increased expression of MCP-1 was noted already 6 hours after transection, mainly in Schwann cells. Later, the MCP-1 positive staining was seen also in macrophages, fibroblast-like cells and endothelial cells. An increased number of MIP-1alpha positive cells could be noticed after 24 hours, the maximum expression in Schwann cells was noted at the 5-day timepoint. Later, part of the positive cells appeared to be macrophages. RANTES was mainly expressed in inflammatory cells. Endothelial cells in the epi- and endoneurium showed positive staining for every chemokine studied after transection. The contralateral non-operated nerves showed an increased number of positive cells for MCP-1 and MIP-1alpha. In the control nerves MCP-1 and MIP-1alpha positive cells were scattered throughout the endoneurium. This study shows that increased expression of chemokines takes place within endoneurium after peripheral nerve transection. Thus, it is probable that chemokines can take part in the recruitment of macrophages. It further shows that there is an increased expression of the studied chemokines in the non-operated contralateral nerves. Even in normal conditions chemokines are needed, probably to keep resident macrophages within endoneurium.

Cyclosporin A affects axons and macrophages during Wallerian degeneration.

A traumatic injury of a peripheral nerve leads to Wallerian degeneration. It includes the recruitment of macrophages and the phagocytosis of myelin and the remnants of axons. We have previously studied the recruitment of macrophages and now wished to determine if the immunosuppressant cyclosporin A (CsA) affects the number of macrophages at the site of nerve injury. The primary target of CsA is T-cells, but it may also have an effect on mononuclear phagocytes which exert a key role during Wallerian degeneration. Rats were divided into two groups: CsA-treated animals and control animals. Following transection of the sciatic nerve in the treatment group, the animals received 5 mg/kg CsA subcutaneously. The groups were further subdivided into a freely regenerating nerve group and a sutured nerve group. The number of macrophages and MHC class II positive cells were counted 3 days, 7 days, 2 weeks, 4 weeks, and 8 weeks posttransection; also CD4, CD8, IL-2 receptor positive cells, B cells, and the axonal sprouting were studied. In the CsA-treated group, there were more macrophages in the distal areas under 8 weeks than in the controls (p < 0.05); thus, the clearance of macrophages is delayed in the CsA-treated rats compared to the control rats. In the proximal area, the difference in macrophage number did not gain statistical significance. Additionally, CsA retarded axonal degeneration. CsA affects number of macrophages during Wallerian degeneration, while retarding axonal degeneration and subsequent reinnervation. Its mechanism of action appears to involve either direct or indirect via T-cells-mediated responses.

Peripheral nerve injury induces endoneurial expression of IFN-gamma, IL-10 and TNF-alpha mRNA.

Axotomy of a peripheral nerve leads to interruption of axon continuity with Wallerian degeneration in the distal segment and regenerative events in the proximal remaining neuron. Local inflammation is a consequence of trauma in general and signal molecules regulating inflammation, such as cytokines, participate in the outcome of nerve trauma. We studied a broad set of potent immunoregulatory cytokines after transection of rat sciatic nerve. The endoneurium of the transected rat sciatic nerve was taken from both proximal and distal stumps. The pooled endoneurium of 6 rats was studied using reverse transcription polymerase chain reaction (RT-PCR) after 14 h; 1, 3, 5, 7 days; 2 and 4 weeks after transection. A new observation was that TNF-alpha mRNA showed phasic expression pattern; three distinct peaks were seen, immediately (14 h), after 5 days and in the distal part also after 2 weeks. This phenomenon may be related to the breakdown of the blood-nerve barrier and to the recruitment of circulating macrophages. We further noticed that IFN-gamma mRNA was expressed between 5 days and 2 weeks. This suggests that T-cells may also take part in the regenerative processes. Furthermore, we observed that IL-10 mRNA is expressed continuously during Wallerian degeneration. The continuous expression of IL-10 mRNA may attenuate the production of inflammatory cytokines by macrophages and other cells.

The dynamics of macrophage recruitment after nerve transection.

In the present study rat sciatic nerves (n = 60) were transected; in half of the animals nerve was allowed to regenerate freely, in the other half the regeneration was prevented by suturing beside the point of transection. Macrophages were stained with ED-1 antibody and counted (number/mm2) in both the epi- and endoneurium 3, 7, 14, 48 and 56 days post transection. Macrophages were observed first in the epineurium; the local density of macrophages was considerably higher in the epineurium than in the endoneurium during the first few days. The number of macrophages in the epineurium was maximal at 3 days (1,000-2,000/mm2), and thereafter it declined sharply. In the endoneurium macrophages were most abundant after 2 weeks (1,000/mm2), after which their number declined steadily. A migration of epineurial macrophages appeared to take place through the perineurium from epineurial areas containing a high concentration of macrophages. Initially an endoneurial accumulation of macrophages was noted in the subperineurial area. These findings suggest an alternative route for macrophages into the endoneurial space. No statistical difference was observed between the regenerating and non-regenerating experimental groups. The present study indicates that regenerating axons do not have an effect on the number of macrophages in either the epineurium or the endoneurium.

Axonal regeneration into chronically denervated distal stump. 2. Active expression of type I collagen mRNA in epineurium.

During the first 2 weeks after an injury to peripheral nerve, endoneurial cells proliferate and express integrin beta 1 and mRNA for collagen types I and III. Clinical results for surgical repair within this time are clearly better than those obtained after delayed (months after original injury) surgery. The question of whether this is due to changes in the proliferative capacity of endoneurial cells or to changes in expression of mRNA for collagen types I and III or integrin beta 1 was studied using rats. The left common peroneal nerve was transected and allowed to degenerate for 3 and 6 months. After these times, the tibial nerve of the same animals were transected, and the fresh proximal stump of the transected tibial nerve was sutured into the chronically denervated distal stump of the common peroneal nerve. At 3 and 6 weeks after the reoperation, samples were collected from the distal stump for morphometry, immunohistochemistry and in situ hybridization. Proliferating cells and Schwann cells were identified by immunohistochemistry. These cells increased markedly in number during the axonal reinnervation. In situ hybridization revealed that in the epineurium and perineurium, which were fibrotic, especially type I but also type III collagen mRNA were highly expressed. The amount of type I collagen mRNA in the endoneurium seemed to increase with progressing axonal reinnervation. Immunostaining for integrin beta 1 was negative in these distal stumps. In the present study the proliferation of endoneurial cells and expression of type I collagen mRNA in the endoneurium were similar to those found after immediate regeneration of transected peripheral nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

The dynamics of beta 1 integrin expression during peripheral nerve regeneration.

The aim of the present study was to examine the expression of beta 1 integrin subunit after peripheral nerve transection. After sciatic nerve transection two experimental procedures were used; changes in the freely regenerating rat sciatic nerve were compared to a situation in which spontaneous regeneration was prevented by suturing both ends of the nerve to the muscle next to the point of transection. Specimens for morphological analysis were collected 6 h, 1, 3, 5, 7 days and 2, 4, 6 and 8 weeks after the axotomy. Sections from the proximal (two zones) and distal (three zones) stumps next to the point of transection were stained with antibodies against beta 1 integrin subunit, macrophages, collagen types I and III, and S-100 protein. The control nerves showed beta 1 integrin-stained cells in the perineurium and vasa nervorum but the endoneurium was negative. Positively stained endoneurial fibroblast-like cells could be seen in the proximal part of the nerve already at 24 h after transection. The number of these positively stained cells increased steadily; they were most numerous 4 weeks after transection in the distal zone 2. Subsequently, the number of positively stained endoneural cells declined sharply and 8 weeks after transection no positively stained cells could be found. The morphological appearance and the immunohistochemical properties of the cells suggest that the majority of beta 1 integrin-positive cells are endoneurial fibroblast-like cells. Thus, the process appeared to be dynamic, starting from the proximal part and continuing to the distal parts, and was similar in both experimental groups.(ABSTRACT TRUNCATED AT 250 WORDS)