Understanding the biology of compressive neuropathies

Compressive neuropathies are highly prevalent, debilitating conditions with variable functional recovery after surgical decompression. Chronic nerve compression injury induces concurrent Schwann cell proliferation and apoptosis in the early stages of the disorder, independent of axonal injury. These proliferating Schwann cells locally demyelinate and remyelinate in the region of injury. Furthermore, Schwann cells upregulate vascular endothelial growth factor secondary to chronic nerve compression injury and induce neovascularization to facilitate the recruitment of macrophages. In contrast to Wallerian degeneration, macrophage recruitment occurs gradually with chronic nerve compression injury and continues for a longer time. Schwann cells change their gene and protein expression in response to mechanical stimuli as shear stress decreases the expression of myelin associated glycoprotein and myelin basic protein mRNA and protein for in vitro promyelinating Schwann cells. The local down-regulation of myelin associated glycoprotein in the region of compression injury creates an environment allowing axonal sprouting that may be reversed with intraneural injections of purified myelin associated glycoprotein. These studies suggest that while the reciprocal relationship between neurons and glial cells is maintained, chronic nerve compression injury is a Schwann cell-mediated disease.