20 mm Autografts Supplemented with Autologous Adipose Tissue Enhances Functional Recovery Following Nerve Injury
Nathan G Lawera, BSE; Carrie A Kubiak, MD; Scott W Sabbagh, BS; Vincent Thieu, BSE; Maninder Singh, BSE; Vidhya Nadarajan, BS; Allison B Vittert, BSE; William Y Wang, BS; Jana D Moon, BS; Zachary P French, BSE; Brendon M Baker, PhD; Stephen WP Kemp, PhD; Paul S Cederna, MD
University of Michigan, Ann Arbor, MI
Introduction Traumatic peripheral nerve injuries are common and often result in partial or permanent paralysis, numbness of the affected limb, and debilitating neuropathic pain. Injuries to peripheral nerves vary widely in their severity, and clinical outcomes are frequently disappointing. Adipose-derived stem cells (ASCs) have been previously shown to enhance peripheral nerve regeneration. However, ASC processing leads to both clinical and regulatory burdens. Unpurified fat is whole adipose tissue that is harvested without subsequent ASC isolation. In addition, harvesting of unpurified adipose tissue is currently approved by the FDA and a common surgical practice. The purpose of the present study was to investigate the effect of autologous, adipose tissue on nerve regeneration through 20 mm long autografts in the rat.
Materials & Methods: F344 rats were used in this study and were randomly assigned to one of four experimental groups: (1) naïve control (no nerve injury); (2) 20 mm autograft; (3) 20 mm autograft + unpurified adipose tissue, and; (4) 20 mm autograft + purified fat. All animals were tested at baseline, and were then followed serially for 12 weeks. Outcome measures included sensorimotor (ladder rung, walking track), and sensory pain assessments (von Frey). Terminal outcome muscle measures examined EMG (compound muscle action potentials, nerve conduction velocity) and muscle force parameters (twitch and tetanic forces).
Results: Animals in both the autograft + unpurified fat group and autograft + purified fat group displayed enhanced peripheral nerve regeneration compared to the autograft only group. Specifically, these animals displayed increased muscle force parameters at study endpoint, and displayed faster recovery of sensorimotor function. Histomorphometrical assessment showed significant differences between autograft and both autograft + fat groups.
Conclusions: Autologous unpurified and purified adipose tissue enhanced peripheral nerve regeneration through 20 mm autografts. Harvesting of unpurified fat circumvents current FDA regulatory burdens, is easily obtainable, and has the potential to change current clinical management of traumatic peripheral nerve injuries.
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