When an injured peripheral nerve is treated by transplantation of a replacement nerve, the choice of transplant and the application of extracorporeal shockwave therapy (ESWT) can improve and accelerate the nerve’s regeneration. LBI scientist David Hercher is presenting the findings of his scientific work at the TERMIS world congress currently taking place in Kyoto, Japan.
The team around Hercher established an experimental model of a femoral nerve defect, mimicking what is commonly encountered in clinical practice. In this model the used of different types of nerves as well as the effect of ESWT on nerve regeneration was examined in vitro and in vivo.
For the in vitro examination the team focused on Schwann cells, specialized cells of the peripheral nerve system that wrap axons and support their regeneration. Clear differences were found between Schwann cells from motor nerves and sensory nerves. Schwann cells from the motor branch proliferated less and showed an amplified expression of myelination markers. Schwann cells from the sensory branch proliferated stronger and expressed myelination markers to a lower extent. ESWT was shown to increase proliferation rates as well as the formation of proteins promoting regeneration.
An autologous nerve transplantation in vivo was conducted with a homotopic or heterotopic transplant. Homotopic describes the treatment of an injured peripheral motor nerve by implanting another motor nerve. In the heterotopic study design the injury of a peripheral motor nerve is bridged by a sensory nerve. Following transplantation the implanted nerve is treated with ESWT in a single session. In this experiment there was again evidence for the lower proliferation of transplants from the motor branch, however the motor axons in the homotopic approach regenerated faster then in the heterotopic approach.
By applying ESWT, however, the proliferation as well as the speed of regeneration could be positively influenced in both setups. Moreover, functional recovery took place faster after the shockwave therapy. This suggests that EWST can reduce negative effects of heterotopic transplantation.
Hercher’s study impressively demonstrates, that ESWT is able to accelerate neural regeneration. Implementing ESWT into the clinical practice of surgical peripheral nerve repair presents itself as therapeutic optimization.