Peripheral nerve injuries are common with approximately 9,000 cases in the UK occurring each year in a predominantly young and working population1. Despite microsurgical nerve repair techniques, normal restoration of function is unattainable with resulting impaired hand sensation, reduced motor function and frequent pain and cold intolerance2. Such injuries have a profound and permanent impact on the patient and their ability to perform activities of daily living, with less than 60 % returning to work3.
Following injury, the phenotype and the morphology of neurons and Schwann cells (SC) change in order to create a suitable environment to allow the axon sprouting. In case of transection, the nerve is divided into proximal and distal stumps; the proximal stump being the point from which the regenerative process takes place, whilst the distal stump undergoes Wallerian degeneration whereupon the SC detach from the injured axons, de-differentiate and proliferate. This is fundamental towards removing myelin debris and preparing the distal stump for nerve re-generation 4,5. Axon sprouting is supported by the production of neurotrophic factors and chemokines released by SC at the distal stump, and guided by the basal lamina left behind following Wallerian degeneration6,7. SC align alongside the regenerating axon forming the bands of Büngner, which aid the axon growth towards the target organ, reducing branching outside the endoneurial tube. Following reinnervation, SC form the new myelin sheath wrapping the regenerated axons, but sensory and motor function is only partially restored8.
Dorsal root ganglia (DRG) are structures located in the intervertebral foramina of the spinal column, containing the sensory neuronal cells innervating the peripheral organs. When dissociated, they can be used as a suitable in vitro model for the study of nerve regeneration9–11, including investigations of myelin formation. In particular, adult DRG neurons mimic the in vivo characteristics of these cells and provide a formidable tool to study new strategies for peripheral nerve repair in tissue engineering.
Co-cultures represent a dynamic system that simulates in vitro the interplay of two (or more) cell types in a particular in vivo environment. One of the advantages of these cell co-culture models is the flexibility and high control that can be exerted on the extracellular environment. DRG neurons have been used frequently in co-culture systems with SC to mimic the actual interactions that occur between the two cell types in the peripheral nervous system10,12–14. It was demonstrated that SC secrete extracellular matrix (ECM) proteins and growth factors that can remarkably improve the ability of DRG neurons to survive and sprout neurites15,16. However, SC require lengthy periods of time to proliferate and, despite the advances in cell culture technique, it is still hard to generate a suitable number of cells for tissue engineering applications. In addition, the sacrifice of a healthy nerve is necessitated to harvest autologous SC. Therefore, the difference in sourcing SC is important for both tissue engineering and in vitro testing of nerve regeneration. In this view, ASC can be considered a valuable alternative for the development of a tissue-engineered construct to be used for peripheral nerve repair17,18. Previous work demonstrated the ability of these cells to differentiate into SC-like ASC, expressing characteristic glial-markers, such as S-100, p75 and glial fibrillary acidic protein (GFAP)19, as well as the myelin protein zero (P0)20. The secretion of glial growth factors, such as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and glial cell-derived neurotrophic factor (GDNF) was also observed21,22. Therefore, SC-like ASC can be used as promoter of peripheral nerve regeneration, as demonstrated by both in vitro and in vivo studies23–26. In addition, ASC can be harvested through minimally-invasive procedures in higher number compared to other stem cell types; the frequency of stem cells in adipose tissue is 100- to 1,000-fold higher than in bone marrow27,and they have a higher proliferation rate compared to SC and bone marrow mesenchymal stem cells.
This work aims to provide a detailed protocol to perform high efficient harvests of dissociated DRG neurons and ASC respectively, the latter being differentiated into SC-like cells. The co-culture of these two cell types will therefore provide a very practical system that can be used for future studies on the ability of DRG neurons to sprout neurites and the mechanisms of myelin formation on different scaffold for nerve tissue engineering.