The application of the correct method of drug administration is one of the critical factors in achieving successful therapeutic results. Despite the abundance of methods for therapeutic agent delivery to the central nervous system (CNS), only a few methods are reported for peripheral nervous system (PNS) delivery by direct nerve injection. Direct nerve injection, such as injection into the dorsal root ganglia (DRG) in rats, has been tried in preclinical studies for better understanding of pain mechanisms, drug toxicity, gene transfer1,2,3, and general method development1,4. Additional reports on direct nerve injection include spinal nerve injection4, sciatic nerve injection1, and vagus nerve injection in rats5 and mice6. Recently a method for suprachondrial injection has been proposed for the better distribution of therapeutics into the optic nerve head in rabbits7.
DRG is considered the ideal location for direct injection of transgene-loaded vectors such as adeno-associated virus (AAV) because of the sensory function of the cell bodies in the DRG2. Both surgical and non-surgical methods of DRG injections have been described1,8. However, controversial conclusions have been found about the consistency of results with the non-surgical method of DRG injection1. A surgical method involving a partial laminectomy has been suggested to be 100% successful for DRG injection in rats without any alteration in behavior outcomes3, as well as a method involving partial osteotomy in mice9. Several studies report the DRG injection methods of drug delivery, which have been used in preclinical gene therapy research in rats and mice1,2,10. Vector-based gene therapy studies involving localized injections may include the following benefits: decreased off-target expression, reduction in systemic toxicity, and smaller viral loads and injection volumes, decreased risk of immunogenic complications11,12.
Direct injection method into the sciatic nerve, the longest nerve of the body, has been tried by exposing the right sciatic nerve at the mid-thigh level of a rat. The method used a pulled glass pipette equipped with a microprocesser-controlled injection system to inject a total volume of 10 µL dye with a flow rate of 1.2 µL/min1. This experiment showed a lack of dye distribution to the level of DRG, and the distribution was mostly limited around the site of injection. Similarly, other methods of direct nerve injections, such as spinal nerve injections, have been tried with dye to evaluate the appropriate amount of injection volume and dye distribution pattern in rats. 2 µL is suggested to be optimum for spinal nerve injection, whereas 3 µL of dye by DRG injection showed the distribution in both dorsal and ventral root ganglia in rats1. The volume for DRG injection in mice has been reported to be optimum from 1.0 µL to 1.5 µL based on strain and body size2,9.
Direct vagus nerve injection method was used in rats5 and mice6 to evaluate the role of neural injury or cellular integrity in transferring human α-synuclein. These two studies, conducted by the same group of researchers, describe a brief method of directly injecting AAV vectors into the left vagus nerve at the cervical region. In rats, the method involved a glass capillary with a 60 µm tip diameter to inject 2 µL vector at a flow rate of 0.5 µL/min with a 5 µL Hamilton syringe. In mice, a total volume of 750 nL vector solution was injected at a flow rate of 160 nL/min using a 36-G blunt steel needle fitted onto a 10 µL NanoFil syringe6. These experiments showed that the transgene was delivered and expressed in axons in the pons and midbrain of the rats and mice. Similarly, the dorsal motor nucleus of the left vagus nerve showed positive immunoreaction with transgene. These pieces of evidence illustrate that the direct vagus nerve injection method might be a reliable method in gene therapy where the cellular transduction is extended into several locations of the brain, which project axons through the vagus nerve. However, these methods do not mention the use of any dye to track the injection fidelity.
Here, a method is described for direct injection into the left vagus nerve using nontoxic tracking dyes largely applicable to researchers in preclinical studies. Potential pitfalls that may cause difficulties in drug delivery and the ways to overcome them are discussed. These situations are illustrated with pictures to show what makes the delivery unsuccessful and the way to make it successful.