Therapeutic strategies in promoting peripheral nerve regeneration

Currently, regeneration chambers, adrenocorticotropic hormone (ACTH) and related peptides, and gangliosides appear to be the most promising therapies in the promotion of peripheral nerve regeneration, growth, and repair. Regeneration chambers enhance rat sciatic nerve regeneration in vivo after transection by providing a structurally organized and protected preformed space within which nerve fibers are exposed to macromolecular compounds which direct and enhance nerve growth. ACTH and related peptides, independent of their corticotropic activities, increase the availability of structural proteins to the axon terminal in rats subjected to nerve crush injuries and demonstrate inotropic effects in adrenalectomized and/or hypophysectomized rats. Exogenously administered gangliosides promote neuronal sprouting, regeneration, and reinnervation in experimental situations and have undergone clinical testing in acute and chronic peripheral nerve disorders. At the current dosage levels and schedules, the clinical results of ganglioside therapy have been mixed. The success of the experimental studies supports further clinical testing of these therapies in peripheral nerve disorders.