Adaptive conductive electrotherapeutic scaffolds for enhanced peripheral nerve regeneration and stimulation.

Animals Swine Transcutaneous Electric Nerve Stimulation Sciatic Nerve Ultrasonography Nerve Regeneration / physiology
Foundational research electrical stimulation lead migration muscular atrophy nerve regeneration nerve repair nerve stimulation peripheral nerve rehabilitation removable electrodes

Journal

Med (New York, N.Y.)
ISSN: 2666-6340
Titre abrégé: Med
Pays: United States
ID NLM: 101769215

Informations de publication

Date de publication:
11 08 2023
Historique:
received: 21 08 2022
revised: 25 10 2022
accepted: 24 05 2023
medline: 14 8 2023
pubmed: 21 6 2023
entrez: 20 6 2023
Statut: ppublish

Résumé

While peripheral nerve stimulation (PNS) has shown promise in applications ranging from peripheral nerve regeneration to therapeutic organ stimulation, clinical implementation has been impeded by various technological limitations, including surgical placement, lead migration, and atraumatic removal. We describe the design and validation of a platform technology for nerve regeneration and interfacing: adaptive, conductive, and electrotherapeutic scaffolds (ACESs). ACESs are comprised of an alginate/poly-acrylamide interpenetrating network hydrogel optimized for both open surgical and minimally invasive percutaneous approaches. In a rodent model of sciatic nerve repair, ACESs significantly improved motor and sensory recovery (p < 0.05), increased muscle mass (p < 0.05), and increased axonogenesis (p < 0.05). Triggered dissolution of ACESs enabled atraumatic, percutaneous removal of leads at forces significantly lower than controls (p < 0.05). In a porcine model, ultrasound-guided percutaneous placement of leads with an injectable ACES near the femoral and cervical vagus nerves facilitated stimulus conduction at significantly greater lengths than saline controls (p < 0.05). Overall, ACESs facilitated lead placement, stabilization, stimulation, and atraumatic removal, enabling therapeutic PNS as demonstrated in small- and large-animal models. This work was supported by K. Lisa Yang Center for Bionics at MIT.

Sections du résumé

BACKGROUND
While peripheral nerve stimulation (PNS) has shown promise in applications ranging from peripheral nerve regeneration to therapeutic organ stimulation, clinical implementation has been impeded by various technological limitations, including surgical placement, lead migration, and atraumatic removal.
METHODS
We describe the design and validation of a platform technology for nerve regeneration and interfacing: adaptive, conductive, and electrotherapeutic scaffolds (ACESs). ACESs are comprised of an alginate/poly-acrylamide interpenetrating network hydrogel optimized for both open surgical and minimally invasive percutaneous approaches.
FINDINGS
In a rodent model of sciatic nerve repair, ACESs significantly improved motor and sensory recovery (p < 0.05), increased muscle mass (p < 0.05), and increased axonogenesis (p < 0.05). Triggered dissolution of ACESs enabled atraumatic, percutaneous removal of leads at forces significantly lower than controls (p < 0.05). In a porcine model, ultrasound-guided percutaneous placement of leads with an injectable ACES near the femoral and cervical vagus nerves facilitated stimulus conduction at significantly greater lengths than saline controls (p < 0.05).
CONCLUSION
Overall, ACESs facilitated lead placement, stabilization, stimulation, and atraumatic removal, enabling therapeutic PNS as demonstrated in small- and large-animal models.
FUNDING
This work was supported by K. Lisa Yang Center for Bionics at MIT.

Identifiants

DOI: 10.1016/j.medj.2023.05.007 PMID: 37339635
pubmed: 37339635
pii: S2666-6340(23)00165-4
doi: 10.1016/j.medj.2023.05.007
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

541-553.e5

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests S.S., L.G., P.K., A.S., R.L., and G.T. report a provisional patent application (63/240,061) describing the ACES system. Complete details of all relationships for profit and not for profit for G.T. can be found at the following link: https://dropbox.com/sh/szi7vnr4a2ajb56/AABs5N5i0q9AfT1IqIJAE-T5a?dl=0. Complete details for R.L. can be found at the following link: https://dropbox.com/s/yc3xqb5s8s94v7x/Rev%20Langer%20COI.pdf?dl=0. A.S. was chief medical officer and on the board of CareSignal Health, a digital health company, unrelated to the current work.

Auteurs

Shriya S Srinivasan (SS)

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Society of Fellows, Harvard University, Boston, MA 02115, USA. Electronic address: shriyas@mit.edu.

Lisa Gfrerer (L)

David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.

Paramesh Karandikar (P)

David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

Avik Som (A)

David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.

Amro Alshareef (A)

Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.

Sabrina Liu (S)

David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.

Haley Higginbotham (H)

Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.

Keiko Ishida (K)

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.

Alison Hayward (A)

Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.

Sanjeeva P Kalva (SP)

Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.

Robert Langer (R)

Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.

Giovanni Traverso (G)

Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Electronic address: cgt20@mit.edu.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Adaptive conductive electrotherapeutic...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Artiodactyla › Suidae › Adaptive conductive electrotherapeutic...
questionsmedicales.fr › Anesthésie et analgésie › Analgésie › Neurostimulation électrique transcutanée › Adaptive conductive electrotherapeutic...
questionsmedicales.fr › Système nerveux › Système nerveux périphérique › Nerfs périphériques › Nerfs spinaux › Plexus lombosacral › Nerf ischiatique › Adaptive conductive electrotherapeutic...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Échographie › Adaptive conductive electrotherapeutic...
questionsmedicales.fr › Phénomènes biologiques › Régénération › Régénération nerveuse › Adaptive conductive electrotherapeutic...