Validation of a new method for human nerve decellularization: toward a new tool in peripheral nerve reconstructive surgery.

Defects of the peripheral nervous system are extremely frequent in trauma and surgeries and have high socioeconomic costs. In case of peripheral nerve injury, the first approach is primary neurorrhaphy, which is direct nerve repair with epineural microsutures of the two stumps. However, this is not feasible in case of stump retraction or in case of tissue loss (gap > 2 cm), where the main surgical options are autologous grafts, allogenic grafts, or nerve conduits. While the gold standard is the autograft, it has disadvantages related to its harvesting, with an inevitable donor site morbidity and functional deficit. Fresh nerve allografts have therefore become a viable alternative option, but they require immunosuppression, which is often contraindicated. Acellular Nerve Allografts (ANA) represent a valid alternative, they do not need immunosuppression and appear to be safe and effective based on recent studies. The purpose of this study is to propose and develop an innovative method of nerve decellularization (Rizzoli method), conforming to cleanroom requirements in order to perform the direct tissue manipulation step and the nerve decellularization process within five hours, so as to accelerate the detachment of myelin and cellular debris, without detrimental effects on nerve architecture. In this study, the safety and the efficacy of the new method are evaluated in vitro and in vivo by histological, immunohistochemical, and histomorphometric studies in rabbits and humans. The new method is rapid, safe, and cheaper if compared with available commercial ANAs. The present study shows that the method, previously optimized in vitro and in vivo on animal model presented by our group, can be applied on human nerve samples. This work represents the first step in providing a novel, safe, and inexpensive tool for use by European tissue banks to democratize the use of nerve tissue transplantation for nerve injury reconstruction.

Skeletal variability of the fibular ends and evolutionary implications

This thesis investigates the morphological variations of fibular extremities in humans and non-human hominids using a 3D Geometric Morphometric approach. The study has three objectives: (1) to assess the shape, form, and size variations of fibular epiphyses within the human species, highlighting sexually dimorphic features; (2) to explore interpopulation variability of fibular extremities from the Upper Paleolithic to the 20th century, comparing subsistence, mobility, and lifestyles; and (3) to examine interspecific variations in fibular ends, testing potential associations with locomotor and positional behavior among extant hominid taxa. In terms of intraspecific variations, sex-related differences in fibular form and size were observed, suggesting distinct functional requirements for the lower limb between sexes. Interpopulation variations revealed a decline in activity level over time, influenced by terrain and footwear use. Hunter-gatherer groups exhibited greater joint mobility, loading, and range of motion compared to sedentary pre- and post-industrial populations. Interspecific variations demonstrated significant morphological differences among hominid taxa, indicating functional implications related to both phylogeny and specific loading patterns on the lower limb. The study identified features indicative of bipedalism in humans, as well as shared characteristics among non-human great apes. Furthermore, distinguishing features were found between Asian and African apes, along with unique morphological signals associated with distinct positional behavior in each hominid taxa. By comprehensively analyzing fibular morphology, this research sheds light on the importance of this bone in knee support, ankle stabilization, and overall locomotor function. The findings contribute to our understanding of the evolutionary and functional aspects of the fibula across human populations and non-human hominids throughout history.