Severe extremity trauma often involves significant damage to multiple tissue types, including bones, skeletal muscles, peripheral nerves, and blood vessels. Such injuries present unique challenges for reconstruction, and improving structural and functional outcomes of intervention remains a pressing, unmet clinical need. While tissue engineering/regenerative medicine (TE/RM) therapeutics offer promising potential to overcome the status quo limitations of surgical reconstruction, very few products have transitioned to clinical practice. Improving treatment options will likely require advancing our understanding of the biological interactions occurring in the repair of damaged tissues. Bone tissue is known to be innervated and highly vascularized, and both tissue types are involved in normal bone physiology. However, the degree to which these tissue relationships influence the repair of large, multi-tissue defects remains unknown. Accordingly, the goal of this thesis was to investigate tissue regeneration in two novel composite injury models. First, we characterized interactions in a composite bone and nerve injury model where a segmental bone defect was combined with a peripheral nerve gap. Our results indicated that although tissue regeneration was not impaired, the composite injury group experienced a marked functional deficit in the operated limb compared to single-tissue injury. Second, we developed a model of composite bone and vascular extremity trauma by combining a critically-sized segmental bone defect with surgically-induced hind limb ischemia to evaluate the effects on BMP-2-mediated bone repair. Interestingly, our results demonstrated a stimulatory effect of the recovery response to ischemia on bone regeneration. Finally, we investigated early vascular growth and gene expression as potential mechanisms coupling the response to ischemia with bone defect repair. Although the response to ischemia promoted robust vascular growth in the thigh, it did not directly augment vascularization at the site of bone regeneration. In addition, the stimulatory effects of ischemia on bone regeneration could not be explained by gene expression alone based on the genes and time points investigated. Taken together, this thesis presents pioneering work on a new thrust of TE/RM research – tissue regeneration in models of composite injury. This work has provided new insights on the complexity of composite tissue repair, specifically in regard to the relationship between vascular tissue growth and bone healing. Going forward, successful leverage of models of composite tissue injuries will provide valuable test beds for screening new technologies, advance the understanding of tissue repair biology, and ultimately, may produce new therapeutic interventions for limb salvage and reconstruction that improve outcomes for extremity trauma patients.

[Truncated abstract] Developmentally, the rodent retinocollicular projection is often thought of as a homogenous projection of retinal ganglion cell (RGC) axons, however the extensive period of RGC neurogenesis and sequential arrival of their axons into central targets such as the superior colliulus (SC) suggests otherwise. RGC axons are already present in the developing SC at embryonic (E) day 16.5-17. RGCs born on E15 have innervated the SC by birth, whereas axons derived from RGCs that are born last (E19) do not grow into the SC until postnatal (P) days 4-6 (Dallimore et al., 2002). These observations may go someway to explaining why, after SC lesions in rats at P2, there is greater growth distal to the lesion site compared to lesions made at P6 (Tan and Harvey, 1997b). It may be that the post lesion growth is simply de novo growth of axons from late-born RGCs rather than regeneration of pre-existing, injured axons. Early and late cohorts of growing RGC axons presumably encounter different developmental terrains as they grow from retina to central targets, possibly resulting in differences in developmental milestones and growth potentials. There may also be differences in guidance cues, further suggesting that gene expression in early vs late born RGCs may differ. To examine differences between early (E15) and late (E19) born RGCs during development, the time-course and extent of programmed RGC death in normal rat pups, and RGC death following the removal of target-derived trophic factors, was assessed. ... On the other hand, LCM captured GCL analysed for gene expression at P0 and P7 revealed decreases in AKT, Math5, Notch1, c-jun, DCC, Arginase-1 mRNA levels and a considerable decrease in GAP-43 expression. It is not surprising to see differences in gene expression between whole eye and the more specific GCL samples, as the cells in all layers of the retina have very different functions and different developmental profiles. It is important to note decreases in mRNA expression in the GCL for a number of the genes analysed at P0 and P7, reflecting cessation of RGC death and completion of axonal growth into central visual targets. I also examined at the protein level expression of DCC, Arginase1, c-Jun and Bcl-2 at birth (P0) in BrdU labeled RGCs born on E15 or E19. When comparing the percentage of double labelled cells compared to the total number of cells expressing each protein, Bcl-2, c-Jun and Arg1 were expressed more in E15 RGCs (22.90%, 72.71%, and 16.44% respectively in E15 RGCs, compared with 0.52%, 13.17% and 3.59% in E19 RGCs). In contrast, DCC was expressed more at birth in E19 RGCs (18.05% in E19 RGCs compared with 9.23% in E15 RGCs). This shows there is clearly a difference in the expression of proteins in the two cohorts of RGCs, which is consistent with PCR data and with their growth state as their axons encounter the changes in the newborn brain. The overall findings of this research suggest that seemingly homogenous populations of neurons are quite different in their developmental profile and in their response to injury. This work may provide new ways of determining better strategies for CNS repair and the most effective way of targeting cells for regeneration and survival.

Orientador: Alexandre Leite Rodrigues de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-22T12:08:40Z (GMT). No. of bitstreams: 1 Spejo_AlineBarroso_M.pdf: 5889410 bytes, checksum: 655242e3ec4018faf3f968013fd8d36d (MD5) Previous issue date: 2013 / Resumo: Estudos recentes mostram resultados promissores no tratamento de lesões ao sistema nervoso (SN) através do implante de células-tronco, atribuindo essa melhora funcional à produção de fatores tróficos pelas células. Neste trabalho, o efeito neuroprotetor e neurorregenerativo de células-tronco mesenquimais (CTM) de ratos Lewis-EGFP foi investigado após o esmagamento das raízes motoras L4, L5 e L6. Cinco ratas fêmeas Lewis foram utilizadas em cada um dos seguintes grupos: G1 - esmagamento de raízes motoras; G2 - esmagamento de raízes motoras e injeção de DMEM (Meio de Eagle modificado pela Dubelco) na interface da substância branca e cinzenta (funículo lateral); G3 - esmagamento de raízes motoras e injeção de CTM (funículo lateral). Após 4 semanas, a sobrevivência neuronal foi estudada por coloração de Nissl, onde se observou, a partir da contagem neuronal, aumento da sobrevivência no grupo tratado com CTM. A técnica de imunoistoquímica foi utilizada para avaliar a expressão de sinaptofisina, sinapsina, VGLUT1 (Transportador vesicular de glutamato-1) e GAD65 (Glutamato descarboxilase 65KDa). A expressão de sinaptofisina e sinapsina na superfície dos motoneurônios lesionados mostrou uma menor redução de inputs em animais tratados com CTM, sugerindo uma possível redução no processo de eliminação sináptica. Para detectar possíveis mudanças no equilíbrio de inputs excitatórios / inibitórios em aposição ao corpo dos neurônios motores, os anticorpos VGLUT1 (marcador de terminais glutamatérgicos) e GAD 65 (marcador de terminais GABAérgicos) foram utilizados. A redução dos terminais glutamatérgicos foi semelhante em todos os grupos. Enquanto a redução de terminais GABAérgicos ocorreu em maior proporção em G1 e G2, em relação ao grupo tratado com CTM. Os dados indicam que CTM podem proteger os neurônios contra a excitotoxicidade, resultando em menor perda de células. Com sobrevida de 12 semanas após a lesão, a regeneração nervosa foi avaliada através da análise morfológica do nervo isquiático (área do nervo, número e morfometria de fibras mielínicas) e da recuperação da função motora (walking track test). O grupo tratado com DMEM apresentou nervo com menor área e menor número de fibras mielínicas do que o tratado com CTM, porém, o grupo tratado com células obteve resultados semelhantes ao grupo que sofreu apenas esmagamento. A morfometria revelou fibras com menor mielinização nos três grupos lesionados, em comparação ao nervo contralateral à lesão, porém, para os lados ipsilaterais não houve diferença entre os tratamentos. A função motora apresentou-se melhor no grupo tratado com CTM, quando comparada com o tratado com DMEM, mas não em relação ao grupo que sofreu apenas esmagamento. O efeito das CTM na função motora foi agudo, mostrando eficiência de 4 a 6 semanas após a lesão. Assim, as CTM mostraram efeito neuroprotetor e contribuíram para a regeneração, porém a forma de administração dessas células, através de injeção diretamente na medula, apesar de resultar num maior número de células enxertadas, contribuindo com a sobrevivência dos neurônios, mostrou-se um problema quando avaliada a regeneração e função motora dos animais, indicando a necessidade de desenvolvimento de outras formas de administração / Abstract: Recent studies have shown promising results in the treatment of nervous system injuries through stem cells implantation, attributing this functional improvement to the production of trophic factors by these cells. In this study, the neuroprotective and neurorregenerative effects of mesenchymal stem cells (MSC) from Lewis-EGFP mice was investigated after crushing the motor roots L4, L5 and L6. Five female rats Lewis were used in each of the following groups: G1 - motor roots crushing; G2 - motor roots crushing and DMEM (Dulbeco's Modified Eagle Medium) injection in the white/gray matter interface; G3 - motor roots crushing and MSC injection in the white/gray matter interface. At 4 weeks after injury, neuronal survival was evaluated by Nissl staining, and revealed, by the neuronal count, increased survival in the group treated with MSC. The technique of immunohistochemistry was used to evaluate the expression of synaptophysin, synapsin, VGLUT1 (Vesicular Glutamate Transporter-1) and GAD65 (Glutamate decarboxylase 65). The expression of synaptophysin and synapsin on the surface of lesioned motoneurons, showed a smaller decrease of inputs in animals treated with MSC, suggesting a possible reduction in synaptic elimination process. To detect possible changes in the balance of excitatory / inhibitory inputs reaching the cell body of the motoneurons, antibodies for VGLUT1 (marker of glutamatergic terminals) and GAD 65 (marker of GABAergic terminals) were used. The reduction of glutamatergic terminals was similar in all groups. While the reduction of GABAergic terminals was in greater extent in G1 and G2 with respect to the group treated with MSC. The data indicate that MSC can protect neurons against excitotoxicity, resulting in decreased cell loss. With survival of 12 weeks after the injury, nerve regeneration was assessed by morphological analysis of the sciatic nerve (nerve size, number and morphology of myelinated fibers) and motor function recovery (walking track test). The group treated with DMEM showed nerve with smaller area and fewer myelinated fibers than treated with MSC, however, the group treated with cells was not better than the group that only suffered crushing. Morphometry revealed fibers with less myelination in the three injured groups, compared to the contralateral side, but there was no difference between treatments. Motor function appeared better in MSC-treated group in comparison to the DMEM-treated, but not in relation to the group which only suffered crushing. The effect of MSC in motor function was acute, demonstrating efficiency between 4 to 6 weeks after injury. Thus, the MSC shown to be neuroprotective and contributed to regeneration, but the form of administration of such cells, by direct injection into spinal cord, has to be improved or substituted by another method / Mestrado / Biologia Celular / Mestra em Biologia Celular e Estrutural

Orientador: Alexandre Leite Rodrigues de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-22T12:05:48Z (GMT). No. of bitstreams: 1 Benitez_SuzanaUlian_M.pdf: 7544701 bytes, checksum: 2e552c7219f0c635a4b0afecffd3204d (MD5) Previous issue date: 2013 / Resumo: Lesões nas raízes dorsais da medula espinal são frequentes e muitas vezes decorrentes de acidentes automobilísticos. Devido à possibilidade de geração de dor neuropática, os procedimentos cirúrgicos não priorizam o reparo do componente aferente, sendo reparado apenas o componente motor. Adicionalmente, a perda das informações sensoriais gera parestesia ou anestesia do membro lesado, bem como descoordenação motora. Nesse contexto, novas terapias precisam ser desenvolvidas para o reparo das raízes dorsais. Uma substância capaz de conectar tecidos por adesão e que promova a hemostase e estabilidade do tecido, como o selante de fibrina (SF), pode ser uma alternativa a ser empregada no reparo de raízes lesadas. Além disso, o emprego conjunto do SF com células-tronco mononuclares de medula óssea (CTMMO) pode potencializar uma eventual regeneração tecidual. Assim, o presente estudo avaliou a resposta glial, a reorganização sináptica, a morfologia das fibras sensoriais e a coordenação motora após reparo com SF e terapia celular. Para isso, foram empregados ratos Lewis fêmeas (6-8 semanas), sendo divididos em três grupos: rizotomia (RZ, n=20), rizotomia reparada com SF (RZ+SF; n=22) e rizotomia reparada com SF e CTMMO (RZ+SF+CT; n=20). O tempo de sobrevida pós-cirúrgico foi de até 8 semanas. Para imunoistoquímica, foram utilizados anticorpos anti-VGLUT1 (terminais pré-sinápticos glutamatérgicos), GAD65 (terminais pré-sinápticos gabaérgicos), sinaptofisina (terminais sinápticos), GFAP (astrócitos), Iba1 (microglia) e BDNF (fator neurotrófico). Além disso, foram realizados citoquímica com Sudan black (coloração para lipídeos) e os testes comportamentais von-Frey eletrônico e walking track test (sistema CatWalk). Os resultados demonstraram regeneração das aferências nos grupos RZ+SF e RZ+SF+CT. Porém, apenas no segundo grupo, houve crescimento axonal até lâminas mais profundas da medula espinal, o que resultou em melhor desempenho nos testes comportamentais. Concluímos que o reimplante de raízes sensitivas com SF e CTMMO pode ser uma alternativa terapêutica para o reparo de lesões dorsais na interface do SNC e SNP / Abstract: Dorsal root lesions are common and often occur in automobile accidents. Due to the possibility of generating neuropathic pain, surgical procedures do not prioritize the repair of the afferent component, focusing on the motor output instead. Moreover, the loss of sensory inputs triggers paresthesis or anesthesia of the injured limb, and motor impairments. In this context, new therapies have to be developed for dorsal root repair. A substance that can promote tissue adhesion and stability and tissue haemostasis, such as fibrin sealant (FS), could be an alternative for the repair of damaged roots. Furthermore, the combined use of FS plus bone marrow mononuclear stem cells (BMSC) may enhance tissue regeneration. Thus, the present study evaluated the glial response, synaptic changes, the cytoarchitecture of the sensory fibers and motor coordination with FS with or without cell therapy for root replantation. Female Lewis rats (6-8 weeks old) were divided into three groups: rhizotomy (RZ, n = 20), rhizotomy repaired with FS (RZ+FS, n = 22) and rhizotomy repaired with SF and BMSC (RZ+FS+SC, n = 20). The survival time after surgery was up to 8 weeks. For immunohistochemistry VGLUT 1 (presynaptic glutamatergic terminals), GAD65 (GABAergic presynaptic terminals), synaptophysin (synaptic terminals), GFAP (astrocytes), Iba1 (microglia) and BDNF (neurotrophic factor) antibodies were used. Also, cytochemistry with Sudan black (lipid staining) and the behavioral tests electronic von-Frey and Walking track test (CatWalk system) were carried out. The results showed regeneration of afferent inputs in groups RZ+FS and RZ+FS+SC. However, only in the group with BMSC, the axonal growth was able to reach deeper laminae of the spinal cord, resulting in a better performance in behavioral tests. We conclude that the sensory root replantation with FS and BMSC may be an alternative therapy for the repair of dorsal root injuries in the CNS and PNS interface / Mestrado / Biologia Celular / Mestra em Biologia Celular e Estrutural

Indiana University-Purdue University Indianapolis (IUPUI) / Retinoids play an important role in tissue patterning during development as well as in epithelial formation and health. In the mammalian central nervous system, the meninges are a source of retinoids for brain tissue. Retinoid production has been described in juvenile Axolotl ependymal cells. Retinoid effects may possess a significant role in the regeneration-permissive interaction of the meninges and ependyma of the Axolotl spinal cord after penetrating injury. During spinal cord regeneration in urodele amphibians, the pattern of retinoid production changes as the meninges interact with the injury-reactive ependymal cells reconstructing the injured spinal cord. In order to determine which components of the retinoid metabolism and intracellular signaling pathway act in Urodele spinal cord regeneration, we employed antibody/horseradish peroxidase staining of both intact and regenerating Axolotl spinal cord tissues obtained from adult animals as well as cell culture techniques to determine expression of three retinoid pathway components: Cellular Retinoic Acid Binding Protein II (CRABP 2), Cellular Retinol Binding Protein I (CRBP 1), and Retinaldehyde Dehydrogenase II (RALDH 2). Current results demonstrate the following in the intact cord: 1) CRBP 1 is expressed in the pia and dura mater meningeal layers, in gray matter neurons (including their axonal processes), and the ependymal cell radial processes that produce the glia limitans, 2) CRABP 2 is expressed in the arachnoid and/or dura mater meningeal layers surrounding the spinal cord, and 3) RALDH 2 is expressed in the meninges as well as cytoplasm of grey matter neurons and some ependymal/sub-ependymal cells. In the regenerating cord, CRBP 1 is expressed in ependymal cells that are undergoing epithelial-to-mesenchymal transition (EMT), as is CRABP 2. RALDH 2 staining is very strong in the reactive meninges; in addition, expression is also upregulated in the cytoplasmic and perinuclear regions of reactive grey matter neurons, including motor neurons and in the apical region of ependymal. Preliminary studies culturing reactive meninges and ependymal cells together suggested that the meninges could drive re-epithelialization of the reactive ependymal cells. Experiments to characterize this interaction show an unusual proliferation pattern: Proliferating Cell Nuclear Antigen (PCNA) labeling is present in intact and regenerating cord ependymal cells. However, in culture, the presence of meninges results in no proliferation proximal to the explant, but extensive proliferation in leading cell outgrowth; also, the cultured meninges is positive for RALDH2. In summary, the intact adult cord shows meningeal production of RA, which is upregulated following injury; in addition, during this time, RA production is upregulated in the adult ependymal cells as well. In culture, the reactive meninges appears to modulate the behavior of reactive ependymal cells.

研究目的：脊髓損傷是中樞神經系統的嚴重創傷，致殘率高。脊髓損傷後的再生修復一直是當前醫學的難題。迄今為止，脊髓損傷依然缺乏一種有效地治療方法。既往研究證明，胰島素樣生長因子-1對鼠和兔脊髓損傷有保護作用，為了進一步把這些發現應用到臨床方面，我們採用與人類生理更相近的豬只作為實驗動物，構建與臨床相似的脊髓損傷動物模型，并以此為基礎，系統性研究胰島素樣生長因子-1的脊髓保護作用，評估該治療的功效。 / 研究方法：以運動誘發電位為指導，通過直接壓迫和牽拉造成脊髓損傷。18頭猪只隨機分為3組：胰島素樣生長因子-1治療組、生長激素治療組及生理鹽水對照組。脊髓損傷后1小時、24小時及48小時經鞘內注射給藥。于術後第1天、第3天及第21天收集腦脊液檢測胰島素樣生長因子-1和生長激素濃度。連續21天使用修正的 Tarlov 評分標準對動物的運動功能進行評估。第21天處死動物並取材，檢測脊髓中NeuN, GFAP, caspase-3 的活性，并通過TUNEL染色觀察細胞凋亡情況，比較各組之間有無差別。 / 研究結果：通過這種方法建立的脊髓損傷動物模型穩定可靠，各組之間無明顯差異。鞘內給藥24小時及48小時后，腦脊液中胰島素樣生長因子-1和生長激素濃度明顯升高，術後21天檢測，其濃度恢復至基礎值。胰島素樣生長因子-1治療組的運動功能的恢復優於其它各組。與生理鹽水對照組比較，胰島素樣生長因子-1治療組可以明顯提高脊髓損傷后神經元的存活數量，抑制星形膠質細胞增生，減少細胞凋亡。而生長激素治療組僅抑制星形膠質細胞增生，其它方面與生理鹽水對照組無明顯差別。 / 結論：胰島素樣生長因子-1通過提高神經元存活數量，抑制星形膠質細胞增生，以及減少細胞凋亡促進脊髓損傷的恢復。 / Objective: Spinal cord injury is a devastating condition that leads to long-term disabilities. Currently, there is no effective treatment that minimizes spinal cord damage or enhances neurological recovery. Recent studies in rats or rabbits suggested that neurologic recovery after spinal cord injury could be improved with the administration of neurotropic hormones, such as insulin-like growth factor-1 (IGF-1). In order to apply such bench-side discovery to clinical practice, we conducted a study in a higher animal model, akin to human physiology, to evaluate the effectiveness of intrathecal injections of IGF-1to improve neurological recovery in a porcine model of acute traumatic spinal cord injury. / Methods: Traumatic spinal cord injury model was produced by controlled compression and distraction of the exposed T12 segment of the spinal cord. Eighteen pigs were randomly assigned to receive intrathecal injections of either IGF-1, growth hormone or saline at 1, 24 and 48 hours after spinal cord injury. Locomotor function was assessed daily using the validated modified Tarlov’s scale for 21 days. Spinal cord segments were then harvested and the survival of neurons, reactive astrogliosis and apoptosis were determined using neuronal-specific nuclear protein (NeuN), glial fibrillary acidic protein (GFAP), cleaved caspase-3 and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assays. / Results: Intrathecal injections of IGF-1 and growth hormone significantly increase the concentrations of the neurotropic hormones in the cerebrospinal fluid after injury (p < 0.01). These concentrations returned to baseline by 21 days after drug delivery. Motor deficits on the first day after injury were comparable between animals in the treatment and control groups. By the end of the third week, neurologic recovery was better in animals receiving IGF-1 treatment (p < 0.05). Immunohistological and western blot studies of the injured segments of spinal cord showed that treatment with both IGF-1 and growth hormone prevented reactive astrogliosis (p < 0.05) while only IGF-1 improved the survival of mature neurons (p < 0.05). IGF-1 also inhibited apoptosis after spinal cord injury (p < 0.05). / Conclusions: In our clinically relevant model of traumatic spinal cord injury in pigs, intrathecal injection of IGF-1 demonstrated beneficial effects on neurological and histological recovery. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wang, Qinzhou. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 105-122). / Abstract also in Chinese. / Declaration of origination --- p.I / Abstract --- p.II / Acknowledgements --- p.VI / Table of Contents --- p.VIII / List of Tables --- p.XII / List of Figures --- p.XIII / Abbreviations --- p.XVIII / Chapter Part 1 --- Spinal Cord Injury: A Review --- p.1 / Chapter Chapter 1-1 --- Acute Spinal Cord Injury: Epidemiology, Socioeconomic Impact --- p.2 / Chapter 1.1.1 --- Epidemiology of Spinal Cord Injury --- p.2 / Chapter 1.1.2 --- Socioeconomic Impact of Acute Spinal Cord Injury --- p.5 / Chapter Chapter 1-2 --- Mechanisms of Spinal Cord Injury --- p.6 / Chapter Chapter 1-3 --- Putative Treatments for Spinal Cord Injury --- p.8 / Chapter 1.3.1 --- Methylprednisolone --- p.8 / Chapter 1.3.2 --- Stem Cell Therapy --- p.11 / Chapter 1.3.3 --- Riluzole --- p.11 / Chapter 1.3.4 --- Other Pharmacological Therapies for Spinal Cord Injury --- p.12 / Chapter Chapter 1-4 --- Insulin-like Growth Factor-1 for the Treatment of Spinal Cord Injury --- p.13 / Chapter Chapter 1-5 --- Summary --- p.17 / Chapter Part 2 --- Insulin-like Growth Factor-1 and Growth Hormone for Spinal Cord Injury --- p.18 / Chapter Chapter 2-1 --- Hypothesis and Objectives --- p.19 / Chapter Chapter 2-2 --- Establishment of Animal Models for Acute Spinal Cord Injury --- p.22 / Chapter 2.2.1 --- Introduction --- p.22 / Chapter 2.2.2 --- Experimental Animals --- p.22 / Chapter 2.2.3 --- Anesthesia --- p.23 / Chapter 2.2.4 --- Transcranial Electrical Motor Evoked Potential --- p.26 / Chapter 2.2.5 --- Surgery --- p.28 / Chapter 2.2.6 --- Statistics --- p.34 / Chapter 2.2.7 --- Results --- p.34 / Chapter 2.2.8 --- Discussion --- p.38 / Chapter Chapter 2-3 --- Optimal Stimulation Protocols for Transcranial Electrical Motor Evoked Potential. --- p.42 / Chapter 2.3.1 --- Introduction --- p.42 / Chapter 2.3.2 --- Methods --- p.42 / Chapter 2.3.2.1 --- Experimental Animals and Anesthesia --- p.42 / Chapter 2.3.2.2 --- Transcranial Electrical Motor Evoked Potential Recording --- p.44 / Chapter 2.3.2.3 --- Stimulation Protocol --- p.44 / Chapter 2.3.3 --- Analyses --- p.44 / Chapter 2.3.4 --- Results --- p.45 / Chapter 2.3.5 --- Discussion --- p.52 / Chapter Chapter 2-4 --- Evaluation of the Efficacy of Insulin-like Growth Factor-1 and Growth Hormone in a Porcine Model --- p.54 / Chapter 2.4.1 --- Introduction --- p.54 / Chapter 2.4.2 --- Materials and Methods --- p.54 / Chapter 2.4.2.1 --- Study Design --- p.54 / Chapter 2.4.2.2 --- Intrathecal Injection and Collection of Cerebrospinal Fluid --- p.58 / Chapter 2.4.2.3 --- Measurements --- p.58 / Chapter 2.4.2.3.1 --- Clinical Evaluation --- p.58 / Chapter 2.4.2.3.2 --- Biochemical Assessments --- p.58 / Chapter 2.4.2.3.3 --- Spinal Cord Section, Histological and Immunochemical Staining --- p.63 / Chapter 2.4.2.3.4 --- Western Blot --- p.69 / Chapter 2.4.3 --- Statistical Analysis and Sample Size Calculation --- p.72 / Chapter 2.4.3.1 --- General Analysis --- p.72 / Chapter 2.4.3.2 --- Sample Size --- p.72 / Chapter 2.4.4 --- Results --- p.73 / Chapter 2.4.4.1 --- Changes of TceMEP --- p.73 / Chapter 2.4.4.2 --- Motor Deficit after Spinal Cord Injury at Baseline --- p.75 / Chapter 2.4.4.3 --- Insulin-like Growth Factor-1 and Growth Hormone in Cerebrospinal Fluid --- p.77 / Chapter 2.4.4.4 --- Clinical Assessment --- p.80 / Chapter 2.4.4.5 --- Demyelination, Neuron Survival and Astrocyte Reaction --- p.85 / Chapter 2.4.4.6 --- Apoptosis --- p.89 / Chapter 2.4.5 --- Discussion --- p.93 / Chapter 2.4.5.1 --- Principal Findings --- p.93 / Chapter 2.4.5.2 --- Insulin-like Growth Factor-1 and Neuroprotection after Spinal Cord Injury --- p.93 / Chapter 2.4.5.3 --- Growth Hormone and Neuroprotection after Spinal Cord Injury --- p.95 / Chapter 2.4.5.4 --- Strengths and Limitations of Our Study --- p.96 / Chapter 2.4.5.5 --- Summary --- p.97 / Chapter Part 3 --- Summary and Future Directions --- p.99 / Chapter Chapter 3-1 --- Summary --- p.100 / Chapter Chapter 3-2 --- Future Directions --- p.103 / Chapter Part 4 --- References and appendixes --- p.104 / References --- p.105 / Appendixes --- p.123

Lesioned axons do not regenerate in the adult mammalian central nervous system, owing to the overexpression of inhibitory molecules such as myelin-derived proteins or chondroitin sulphate proteoglycans. In order to overcome axon inhibition, strategies based on extrinsic and intrinsic treatments have been developed. For myelin-associated inhibition, blockage with NEP1-40, receptor bodies or IN-1 antibodies has been used. In addition, endogenous blockage of cell signalling mechanisms induced by myelin-associated proteins is a potential tool for overcoming axon inhibitory signals. We examined the participation of glycogen synthase kinase 3 (GSK3beta) and ERK1/2 in axon regeneration failure in lesioned cortical neurons. We also investigated whether pharmacological blockage of GSK3beta and ERK1/2 activities facilitates regeneration after myelin-directed inhibition in two models: i) cerebellar granule cells and ii) lesioned entorhino-hippocampal pathway in slice cultures, and whether the regenerative effects are mediated by Nogo Receptor 1 (NgR1). We demonstrate that, in contrast to ERK1/2 inhibition, the pharmacological treatment of GSK3beta inhibition strongly facilitated regrowth of cerebellar granule neurons over myelin independently of NgR1. Lastly these regenerative effects were corroborated in the lesioned EHP in NgR1 -/- mutant mice. These results provide new findings for the development of new assays and strategies to enhance axon regeneration in injured cortical connections. On the other hand, and focused in the OMgp, by using recording electrophysiological nano-devices we found that, OMgp has a role in synaptic transmission, since it can induce excitatory postsynaptic potentials (EPSPs) in cultured hippocampal neurons.

In response to high and rising amputation rates, significant advances have been made in the field of prosthetic limb design. Unfortunately, there exists a lag in the neural interfacing technology required to provide an adequate link between the nervous system and this emerging generation of advanced prosthetic devices. Novel approaches to peripheral nerve interfacing are required to establish the stable, high channel count connections necessary to provide natural, thought driven control of an external prosthesis. Here, a tissue engineering-based approach has been used to create a device capable of interfacing with a regenerated portion of amputated nerve. As part of this work, a nerve guidance channel design, in which small amounts of interior scaffolding material could be precisely positioned, was evaluated. Guidance channels containing a single thin-film sheet of aligned scaffolding were shown to support robust functional nerve regeneration across extended injury gaps by minimally supplementing natural repair mechanisms. Significantly, these "thin-film enhanced nerve guidance channels" also provided the capability to guide the course of axons regenerating from a cut nerve. This capability to control axonal growth was next leveraged to create "regenerative scaffold electrodes (RSEs)" able to interface with axons regenerating from an amputated nerve. In the RSE design, low-profile arrays of interfacing electrodes were embedded within layers of aligned scaffolding material, such that regenerating axons were topographically guided by the scaffolding through the device and directly across the embedded electrodes. Chronically implanted RSEs were successfully used to record evoked neural activity from amputated nerves in an animal model. These results demonstrate that the use of topographic cues within a nerve guidance channel might offer the potential to influence the course of nerve regeneration to the advantage of a peripheral nerve interface suitable for limb amputees.

[Truncated abstract] There is limited intrinsic potential for repair in the adult human central nervous system (CNS). Dysfunction resulting from CNS injury is persistent and requires prolonged medical treatment and rehabilitation. The retina and optic nerve are CNSderived, and adult retinal ganglion cells (RGCs) and their axons are often used as a model in which to study the mechanisms associated with injury, neuroprotection and regeneration. In this study I investigated the effects of a variety of strategies on promoting RGC survival and axonal regeneration after optic nerve injury, including the use of reconstructed chimeric peripheral nerve (PN) grafts, gene therapy, and intraocular application of pharmacological agents and other factors . . . C3 transferase is an enzyme derived from Clostridium botulinum that inactivates Rho GTPase. Because SC myelin contains MAG and PN also contains CSPGs, I tested the effects of intraocular injection of a modified form of C3 (C3-11), provided by Dr Lisa McKerracher (CONFIDENTIAL data, under IP agreement with Bioaxone Therapeutic, Montreal) on RGC axonal regeneration into PN autografts. My results showed that there was significantly more RGC survival and axonal regeneration in PN autografts after repeated intraocular injection of C3. I also tested whether intraocular injections of CPT-cAMP and/or CNTF can act in concert with the C3 to further increase RGC survival and/or regeneration. Results showed that the effect of C3 and CPT-cAMP plus CNTF were synergistic and partially additive. The use of combination therapies therefore offers the best hope for robust and substantial regeneration. The overall results from my PhD project will help determine how best to reconstruct nerve pathways and use pharmacological interventions in the clinical treatment of CNS injury, hopefully leading to improved functional outcomes after neurotrauma.

Une lésion au niveau d’un nerf périphérique peut provoquer la perte de fonction sensorielle et motrice, et dans le cas de neurotmésis, la régénération spontanée ne se produira pas. De plus, si l’espace entre les deux segments de nerf est trop important, une suture directe n’est pas possible et l’implantation d’une greffe est nécessaire afin de créer une liaison entre les deux segments de nerf. L’autogreffe de nerf est le « gold standard » pour des procédés de réparation nerveuse : une portion d’un nerf sein (qui est considéré comme un nerf moins important) est prise du même patient et implantée au site de la lésion. Cependant, il existe plusieurs désavantages avec ce procédé comme une deuxième chirurgie, la perte de fonction au site du don, la possibilité de développer un neurome sur ce même site, ainsi qu’un taux de réussite de 50% dans les cas où l’espace entre les deux segments de nerf est très important. Il reste donc, un besoin de trouver un procédé alternatif afin d’augmenter le taux de réussite et d’éliminer les désavantages de l’autogreffe. L’objectif de cette étude est d’avancer vers une solution alternative de l’autogreffon en utilisant des biomatériaux. Cette thèse se divise en trois parties. La première se focalise sur le développement d’un modèle de guide nerveux basé sur des nanofibres de fibroïne de soie. Ce matériau est composé d’une organisation complexe qui inclut deux surfaces de nanofibres alignées avec une couche de nanofibres aléatoires à l’intérieur afin d’améliorer des propriétés mécaniques du matériau sans la perte d’orientation des fibres pour la régénération nerveuse. Le matériau est ensuite manipulé pour fabriquer un tube, multi-canaux avec une « enveloppe » supplémentaire afin de faciliter le procédé d’implantation chirurgicale. Ce guide nerveux a été soumis pour l’obtention d’un brevet européen le 12 juillet 2017 et cela est le sujet d’un deuxième article qui a été soumis pour publication. La deuxième partie de cette étude explore des possibilités d’une fonctionnalisation du matériau afin d’améliorer son efficacité pour la régénération nerveuse. Cette étude explore la fonctionnalisation de la fibroïne de soie avec une deuxième protéine, plusieurs facteurs de croissance, et des nanoparticules. Chacune de ces fonctionnalisations donne une possibilité d’ajouter des propriétés favorables à la fibroïne de soie, un matériau naturel et biocompatible. La troisième partie de cette étude examine l’efficacité d’un guide nerveux composé de la fibroïne de soie fonctionnalisée avec des facteurs de croissance pour la régénération nerveuse périphérique en comparaison avec un guide nerveux composé de la fibroïne de soie sans aucune fonctionnalisation et une suture direct (qui simule une autogreffe). Trois techniques d’évaluation différentes de la régénération nerveuse ont été réalisées afin d’obtenir une analyse plus complète. Il y a de nombreux mécanismes impliqués dans la régénération nerveuse, il est donc nécessaire d’étudier différents paramètres pour analyser l’efficacité de régénération. Les résultats d’analyses histologiques, d’électromyographie, et de capture de mouvement, ont été considérées ensemble afin d’arriver à une conclusion sur la réussite d’une régénération nerveuse pendant cette étude. Pour conclure cette étude, les guides nerveux fonctionnalisés avec une combinaison de facteurs de croissance démontrent une meilleure régénération nerveuse et une récupération de fonction supérieure. / Injury to a peripheral nerve can cause loss of sensory and motor function, and if the injury is very severe where the nerve undergoes neurotmesis, unassisted nerve regeneration may not occur. In this case, where the gap between nerve segments is too large to carry out a direct end to end suture, a graft is sutured to bridge the gap between sectioned nerve segments. The autologous nerve graft, where a portion of a less important nerve from the same patient is removed and grafted between nerve segments, continues to be the gold standard procedure for nerve repair. However, there are several drawbacks of this technique including a second surgical procedure, loss of function at the donor site, possibility of developing a painful neuroma at the donor site, and the 50% success rate of autografts used in large gaps. There is therefore a need for a tissue engineered nerve graft that can replace the autograft, and this study aims to advance toward an effective autograft alternative. This PhD is presented as a three part study consisting first of the development of a novel nerve guidance conduit based on a tri-layered silk fibroin nanofiber material comprised of a complex organization including two aligned fiber surfaces and a randomly deposited fiber interior to improve the mechanical properties of the material while not compromising the guidance capabilities of aligned nanofibers for nerve regeneration. The material is then used to fabricate a multi-channeled tube with an additional “jacket layer” in order to facilitate surgical implantation. This NGC has been submitted to be patented on July 12, 2017 and is the subject of the second article submitted for review for publication. The second part of this study explores the different possibilities of the functionalization of the material in order to improve the effectiveness for nerve regeneration. This study explores functionalizing the silk fibroin with a second protein, several growth factors, and nanoparticles that all have potential to add favorable properties to the natural biocompatible silk fibroin material. The final part of this study tests the effectiveness of growth factor-embedded silk fibroin NGCs for peripheral nerve regeneration in comparison with non-functionalized silk fibroin devices and a direct suture to simulate results obtained with an autograft. Three different techniques for the evaluation of nerve regeneration were used in order to produce a more comprehensive analysis. As there are many mechanisms involved in nerve regeneration, only one or two analysis techniques cannot paint a complete picture of the success of nerve regeneration. Therefore, histological analyses, electromyography analyses, and motion capture analyses were carried out and considered together in order to make a conclusion on the level of nerve regeneration success during this study. The conclusions from this study were that a NGC functionalized with a combination of growth factors appeared to exhibit the most successful nerve regeneration and functional recovery.