Zusammenfassung
Der Einsatz autologer Nerventransplantate zur Überbrückung von Nervendefekten verlangt die Verwendung von gesunden Nerven. Die Entwicklung von Alternativen zum autologen Nerventransplantat ist daher gut begründet. Derartige „künstliche Nerven“ können in einem Tissue-Engineering-Verfahren auf der Basis des Einsatzes von Stroma/Matrix/Träger einerseits und Zellen und neurotrope Substanzen andererseits hergestellt werden. Dabei kann der Träger aus synthetischem oder aus biologischem Material bestehen und resorbierbar oder nicht-resorbierbar sein. Dabei ist ein Zusammenwirken mit vorkultivierten oder frisch gewonnenen Schwannschen Zellen erforderlich. Die neurotropen Substanzen, die die axonale Aussprossung stimulieren, können dabei entweder in den Träger inkorporiert oder mit den Stromazellen eingebracht werden. Bisher wurden über Tissue-Engineering hergestellte Nervenleitbahnen hauptsächlich für experimentelle Zwecke in Tierexperimenten eingesetzt. Es wächst jedoch gegenwärtig die Erfahrung für den klinischen Einsatz von Alternativen zum Nerventransplantat, bei denen es sich hauptsächlich um Röhren aus Silikon oder Polyglykolsäure (PGA), Venen, Kollagen und Basalschicht von Muskeln handelt.
Abstract
The use of autologous nerve grafts for bridging defects in nerve continuity requires the sacrifice of healthy nerves. Development of alternatives to autologous nerve grafts is therefore well motivated. Such “bioartificial nerve grafts” can be tissue-engineered on the basis of the use of a stroma/matrix/scaffold acting in concert with cells and neurotrophic factors. Such a scaffold can be of synthetic or biological nature and can be resorbable or non-resorbable. It should act together with Schwann cells which can be pre-cultured or acutely dissociated. Neurotrophic factors, stimulating axonal growth, can be incorporated in the scaffold and can also be supplied by cells which are seeded into the stroma. So far, tissue-engineered nerve conduits have been used mainly for experimental purposes in experimental animals. However, an increasing amount of experience from the clinical use of alternatives to nerve grafts now exists, mainly tubes made of silicone or poly-glycolic acid (PGA), veins, collagen and muscle basal laminae.
Schlüsselwörter
Nerven-Konduit - Nerventransplantat - künstliches Nerventransplantat
Key words
Nerve conduit - nerve graft - transplantation - bioartificial nerve graft
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Prof. Dr. med. Göran Lundborg
Department of Hand Surgery
Malmö University Hospital
20502 Malmö
Sweden
Email: goran.lundborg@hand.mas.lu.se
