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The nerve injury and the dying neurons: diagnosis and prevention
University of Manchester.
University of Manchester.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
2011 (English)In: Journal of hand surgery. European volume, ISSN 1753-1934, Vol. 36E, no 9, 730-734 p.Article, review/survey (Refereed) Published
Abstract [en]

Following distal nerve injury significant sensory neuronal cell death occurs in the dorsal root ganglia, while after a more proximal injury, such as brachial plexus injury, a sizeable proportion of spinal motoneurons also undergo cell death. This phenomenon has been undervalued for a long time, but it has a significant role in the lack of functional recuperation, as neuronal cells cannot divide and be replaced, hence the resulting nerve regeneration is usually suboptimal. It is now accepted that this cell death is due to apoptosis, as indicated by analysis of specific genes involved in the apoptotic signalling cascade. Immediate nerve repair, either by direct suturing or nerve grafting, gives a degree of neuroprotection, but this approach does not fully prevent neuronal cell death and importantly it is not always possible. Our work has shown that pharmacological intervention using either acetyl-L-carnitine (ALCAR) or N-acetyl-cysteine (NAC) give complete neuroprotection in different types of peripheral nerve injury. Both compounds are clinically safe and experimental work has defined the best dose, timing after injury and duration of administration. The efficacy of neuroprotection of ALCAR and NAC can be monitored non-invasively using MRI, as demonstrated experimentally and more recently by clinical studies of the volume of dorsal root ganglia. Translation to patients of this pharmacological intervention requires further work, but the available results indicate that this approach will help to secure a better functional outcome following peripheral nerve injury and repair.

Place, publisher, year, edition, pages
Oxford: Churchill Livingstone , 2011. Vol. 36E, no 9, 730-734 p.
Keyword [en]
ALCAR, NAC, neuroprotection, apoptosis, neuronal cell death, MRI
National Category
Orthopedics Surgery
URN: urn:nbn:se:umu:diva-50417DOI: 10.1177/1753193411422202ISI: 000296649900003OAI: diva2:464253
Available from: 2011-12-13 Created: 2011-12-08 Last updated: 2013-10-25Bibliographically approved

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Wiberg, Mikael
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