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While correcting spinal cord damage may be considered the Holy Grail of nerve repair research, a less glamorous but still important area involves the repair of peripheral nerves, or those nerves located outside of the brain and spine. With some 800,000 peripheral nerve injuries reported annually in the US and studies indicating that approximately 2-3% of the population in Canada and Australia have had a major nerve injury, many people stand to benefit from any advances in nerve repair.
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Damage to peripheral nerves can affect motion, the senses and even some normally automatic activities such as breathing and digestion. The effects of nerve damage can range from numbness and tingling sensations to burning pain and some forms of paralysis. Those who suffer a peripheral nerve injury may be treated with a nerve graft from another part of their body when the nerve damage is serious, but in most cases will have to live with the effects of the nerve damage. Even when performed, nerve repair surgery may not be completely effective as the nerves often do not fully 'rewire' in the damaged area.
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Many surgeons have stated that the technologies simply do not exist to adequately treat most forms of nerve damage, but ongoing research is attempting to change this reality. One approach to aiding nerve repair that is being investigated in several research institutions and companies is the use of scaffold-like structure to bridge the gap in a broken nerve pathway. This strategy seems to promote nerve growth by giving the nerves a structure to grow across to enable reattachment of broken nerve endings. Once the nerves regrow, the scaffolding is then reabsorbed into the body.
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In the quest to build the scaffold structures, one technique uses polymers attached to spun filaments of sugar, while another uses ultra-thin modified silk strands and a third uses seed extracts that convert from a liquid into a solid scaffold once they reach body temperature. While these techniques are very interesting science, in all cases, more than just the structure is required to promote the nerve reattachment. It seems that the nerves need some enticement to reconnect and this is where the scaffold idea is being enhanced further.
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To really encourage the nerve endings to come together, one idea being investigated is the use of simulated neurotransmitters being embedded within the scaffold. The neurotransmitters promote the growth of nerve connectors to allow adjacent nerves to wire together and the scaffold provides a structure on which the rewiring takes place. An alternate approach under investigation uses stem cells embedded within the scaffold. In this case, instead of the nerve cells being enticed to rewire, the stem cells extend themselves to fill the gap and become nerve cells themselves.
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A different spin on the whole scaffold theme that is equally interesting involves growing a net or mesh of nerves in the lab on nutrient enriched surfaces. Once the nerves have grown together, the mesh is then rolled into a tube along with growth enhancers so that the nerve cells can further connect within the tube and to surrounding nerves. This tube can then be placed directly in the damaged nerve pathway to directly connect the broken nerve endings.
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While all this scaffolding and mesh structure is being created and tested in the laboratory, at a more fundamental level, genetics research is searching for the genes to make the nerves repair themselves. A recent finding from earlier this year has apparently identified a gene responsible for promoting nerve growth. The understanding of this gene and others that might also contribute to nerve growth could also contribute to significant advancements in repairing nerve damage.
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With all the research effort directed at nerve repair, it will be very interesting to see the spin-off benefits that might be achieved along the path to rebuilding the spinal cord. Whether it is numbness, that tingling feeling, burning pain or even paralyzed extremities, many people would be happy to have that normal function and feeling return. With so much momentum in the area, its really a matter of when and not if we will see the fruits of this research.
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anonymous
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