Electromyography as a Predictor of Nerve Regeneration: Analyzing the Relationship Between Motor Unit Counts and CHAT/β-Tubulin Expression

Introduction: Immunofluorescence labeling of Choline Acetyltransferase (CHAT) and β-tubulin enables visualization of cholinergic activity and axonal integrity, respectively. CHAT serves as a biomarker for motor neuron function, while β-tubulin indicates axonal regeneration. This study investigates the correlation between the CHAT/β-tubulin ratio and electrophysiological outcomes in spinal cord injury patients.

Methods: Eighteen patients who underwent nerve transfer surgery were included. Prior to surgery, Electromyography was carried out to determine optimal donor muscles, and Motor Unit Counts (MUCs) were obtained. Immunofluorescence staining for CHAT and β-tubulin was performed on nerve tissue samples obtained during the procedures. The CHAT/β-tubulin ratio was calculated. Pearson’s correlation coefficient was utilized to analyze the relationship between the CHAT/β-tubulin ratio and MUC.

Results: Immunofluorescence analysis revealed elevated levels of both CHAT and β-tubulin. A significant relationship was observed between the CHAT/β-tubulin ratio and MUC (r = -0.49, p = 0.039). These findings suggest that these biomarkers are closely associated with electrophysiological analysis, indicating the CHAT/β-tubulin ratio's potential as an effective indicator of reinnervation and functional improvement after nerve transfer.

Conclusion : The significant correlation between the CHAT/β-tubulin ratio and MUC suggests that preoperative electromyography analysis may provide valuable insights into surgical findings related to immunofluorescence results for β-tubulin and CHAT. This relationship underscores the potential of combining electrophysiological assessments with biomarker analysis to better predict reinnervation outcomes and improve our understanding of nerve regeneration mechanisms.