Nerve Reconstruction: Improving outcome using allografts and stem cells in motor nerve repair

The overarching aim of this thesis is to improve nerve reconstruction using an off the shelf peripheral nerve allograft that is unlimited in supply and can be individualized to each patient using stem cells, providing functional recovery comparable to autograft nerve.
In the first part, studies on the current clinical use of nerve grafts are presented. The clinical focus of this part is on brachial plexus injury, as these injuries typically require large amounts of donor nerve material that is frequently not available. The availability of an off the shelf alternative would be very beneficial in this field.
Before implementing new nerve reconstruction strategies in vivo in animal models, we recognized there was a need for non-invasive follow-up methods. Therefore, in the second part of this thesis, we aimed to develop an ultrasound based evaluation technique to measure muscle recovery after nerve reconstruction in animal models.
In the third part of this thesis, studies are presented that focus on the implementation and further improvement of the processed nerve allograft. Our previously optimized nerve allograft was implemented in different animal models. Results were promising, but did show there was further room for improvement. We hypothesized the need for a source of supportive and stimulating growth factors since allografts are devoid of cells that would provide this stimulus in autografts. We hypothesized that patient own adipose derived stem cells (MSCs) added to the nerve allograft could potentially produce these growth factors to further improve outcomes. A simple technique to deliver stem cells to the nerve allograft was developed. Finally, the interaction between MSCs and our optimized nerve allograft was evaluated with regard to growth factor production and gene expression.
With this work, we have taken a promising path by using allografts and stem cells on our mission to improve nerve reconstruction.