gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Effects of Growth Hormone Therapy on Nerve Regeneration, Functional Recovery, and Allo-Immune Response in Vascularized Composite Allotransplantation

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  • presenting/speaker Jennifer Rath - Johns Hopkins University School of Medicine, Baltimore, United States
  • Xianyu Zhou - Johns Hopkins University School of Medicine, Baltimore, United States
  • Philip Hanwright - Johns Hopkins University School of Medicine, Baltimore, United States
  • Neha Amin - Johns Hopkins University School of Medicine, Baltimore, United States
  • Nicholas Von Guionneau - Johns Hopkins University School of Medicine, Baltimore, United States
  • Chia Na Min - Johns Hopkins University School of Medicine, Baltimore, United States
  • W. P. Andrew Lee - Johns Hopkins University School of Medicine, Baltimore, United States
  • Gerald Brandacher - Johns Hopkins University School of Medicine, Baltimore, United States
  • Sami Tuffaha - Johns Hopkins University School of Medicine, Baltimore, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1504

doi: 10.3205/19ifssh1269, urn:nbn:de:0183-19ifssh12696

Veröffentlicht: 6. Februar 2020

© 2020 Rath et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives/Interrogation: Functional recovery following upper extremity transplantation remains poor, primarily as a result of prolonged denervation and resultant muscle atrophy. Growth hormone (GH) has well-established trophic effects on neurons, myocytes, and Schwann cells and represents a promising therapeutic strategy to accelerate axonal regeneration and also maintain muscle and Schwann cells prior to reinnervation. The aims of this study were to confirm the positive effects of GH on nerve regeneration and functional recovery and to evaluate the effects of GH treatment on the immune response in the setting of vascularized composite allotransplantation.

Methods: Rats underwent orthotopic forelimb transplantation with full MHC-mismatch received either porcine-derived GH (0.6 mg/kg/day) or no treatment (n=10 per group). All animals received tacrolimus (2 mg/kg/day) for graft maintenance. Animals underwent functional assessments every four weeks using electrically-stimulated grip strength testing. Animals were monitored for clinical signs of rejection. Skin biopsies and serum cytokine levels were obtained at the mid- and end-point to evaluate for subclinical rejection. Animals were sacrificed at 16 weeks or if they demonstrated advanced rejection (grades III/IV). Quantitative histological assessments of axonal regeneration, neuromuscular junction reinnervation, muscle atrophy, and Schwann cell proliferation were performed on muscle and nerve specimens upon sacrifice.

Results and Conclusions: Grip strength was improved with GH-treatment as compared to the control group at weeks 4 and 16 (p=0.03 and p=0.05, respectively; Fig. 1). There was a greater number of regenerative axons and decreased muscle atrophy in the GH-treated group (p>0.05). Rates of clinical rejection did not significantly differ among groups. Remaining data is pending. In conclusion, GH treatment may allow for improved functional outcomes in VCA via accelerated axonal regeneration and maintenance of denervated muscle (Figure 1 [Fig. 1]).