Defining the relative impact of muscle versus Schwann cell denervation on functional recovery after delayed nerve repair.

Functional recovery following peripheral nerve injury worsens with increasing durations of delay prior to repair. From the time of injury until re-innervation occurs, denervated muscle undergoes progressive atrophy that limits the extent to which motor function can be restored. Similarly, Schwann cells (SC) in the distal nerve lacking axonal interaction progressively lose their capacity to proliferate and support regenerating axons. The relative contributions of these processes to diminished functional recovery is unclear. We developed a novel rat model to isolate the effects of SC vs. muscle denervation on functional recovery. Four different groups underwent the following interventions for 12 weeks prior to nerve transfer: 1) muscle denervation; 2) SC denervation; 3) muscle + SC denervation (negative control); 4) no denervation (positive control). Functional recovery was measured weekly using the stimulated grip strength testing (SGST). Animals were sacrificed 13 weeks post nerve transfer. Retrograde labeling was used to assess the number of motor neurons that regenerated their axons. Immunofluorescence was performed to evaluate target muscle re-innervation and atrophy, and to assess the phenotype of the SC within the distal nerve segment. Functional recovery in the muscle denervation and SC denervation groups mirrored that of the negative and positive control groups, respectively. The SC denervation group achieved better functional recovery, with a greater number of reinnervated motor endplates and less muscle atrophy, than the muscle denervation group. Retrograde labeling suggested a higher number of neurons contributing to muscle reinnervation in the muscle denervation group as compared to SC denervation (p > 0.05). The distal nerve segment in the muscle denervation group had a greater proportion of SCs expressing the proliferation marker Ki67 as compared to the SC denervation group (p < 0.05). Conversely, the SC denervation group had a higher percentage of senescent SCs expressing p16 as compared to the muscle denervation group (p < 0.05). The deleterious effects of muscle denervation are more consequential than the effects of SC denervation on functional recovery. The effects of 12 weeks of SC denervation on functional outcome were negligible. Future studies are needed to determine whether longer periods of SC denervation negatively impact functional recovery.

Time course changes in AQP4 expression patterns in progressive skeletal muscle atrophy during the early stage of denervation.

OBJECTIVES: In the skeletal muscles, water metabolism is mainly regulated by water channel aquaporin 4 (AQP4). Although the expression level of AQP4 was reduced by long-term denervation, during denervation the relationship between muscle atrophy initiation and AQP4 expression decrease initiation remains unknown. The present study examined the relationship between the timing of muscle atrophy initiation and that of AQP4 expression decrease initiation, during the early stage of denervation. METHODS: Female 344 rats (8 weeks of age) were randomly assigned to control (C), day 1 post-sciatic denervation (D1), day 4 post- sciatic denervation (D4) and day 7 post- sciatic denervation (D7) groups (n=6 per group). In the tibialis anterior (TA) muscles of each group, the expression levels of some target proteins were quantified by Western blot analysis. RESULTS: The expression level of AQP4 significantly decreased on day 4 post-denervation (p<0.05). Moreover, the beginning of the decrease in AQP4 expression level was concurrent with the timing of muscle atrophy in the skeletal muscles during the early stage of denervation. CONCLUSIONS: The present study suggested that the progression of the decrease in the AQP4 expression level is partly related to the progression of muscle atrophy during the early stage of denervation.

Quantitative ultrasound of denervated hand muscles.

INTRODUCTION: Presentations to the neuromuscular clinic commonly involve hand muscle denervation, but few studies have evaluated hand muscle ultrasound. METHODS: Ultrasound studies of abductor pollicis brevis, first dorsal interosseous, and abductor digit minimi were prospectively performed in a cohort of 34 patients (77 muscles) with electromyography (EMG)-confirmed denervation, compared with 58 healthy control subjects. RESULTS: In control subjects, muscle thickness was highly reproducible [intraclass correlation coefficient (ICC) = 0.88-0.98], and echogenicity was moderately reproducible (ICC = 0.542-0.686). Age, gender, and body mass index influenced muscle thickness and echogenicity. Ultrasound changes in denervated muscles correlated with the severity of EMG abnormalities. A z-score cutoff of 0 identified denervated muscles with a sensitivity of 100% and 89% for echogenicity and muscle thickness, respectively. CONCLUSIONS: Hand muscle ultrasound provides a noninvasive method to quantify muscle denervation and may be useful as a screening tool before EMG studies.

The Denervated Muscle: 45 years later.

Forty-five years after its publication, Ernest Gutmann's book, The Denervated Muscle, still stands as a landmark publication. It summarized the state of knowledge of the time and introduced many new researches that were continuing at the Institute of Physiology in Prague. At the time, the response of a muscle to denervation was viewed primarily through the lens of the neurotrophic theory. Advancements in our understanding of neurotrophic effects and mechanisms would now call into question some of the hypotheses and interpretations presented in the book, but many of the research findings have stood the test of time. This review will cover some of the questions asked and data presented in this book, and will place them into the context of contemporary muscle biology.