Peripheral nerve injuries are common with more than 200,000 new cases reported each year in the United
States alone. Only about 10% of these individuals regain much function. There are 17,730 new U.S. spinal
cord injuries annually, and the lifetime costs can reach $5 million per person (not including lost wages). Nerve
injury and especially spinal cord injury significantly impact long-term quality of life, and most injured individuals
seek continued treatments for associated disabilities and pain. The most common explanation for poor
functional outcomes is the slow and inefficient process of axon regeneration. Axons within the spinal cord and
nerve consist of motor, sensory, and sympathetic axons, which undergo plasticity after injury. A critical
knowledge gap in neuroscience is understanding the purpose of sympathetic axon terminals within the
neuromuscular synapse, how sympathetic axons associated with neuromuscular junctions respond to neural
injuries, and what their contribution is to functional recovery or dysfunction. Preliminary evidence suggests that
the sympathetic innervation of neuromuscular junctions can modulate mitochondrial respiration and
biogenesis, synaptic stability, and muscle strength as well as control the muscle response to exercise and
activity. The overarching hypothesis of this K01 proposal is that sympathetic neurons are required for the
functional and metabolic stability of the neuromuscular unit in normal and pathological conditions. We will first
test the necessity and sufficiency of sympathetic nerve activity on metabolic and motor control using a novel
technology, BioLuminescent OptoGenetics (BL-OG) in normal, uninjured animals. My research has shown that
exercise and neuronal activity strikingly enhance peripheral axon regeneration and significantly improves
functional recovery following complete nerve and spinal cord injuries in preclinical models. However, while
clinician scientists recognize the importance of exercise to promote axon regeneration and metabolic health,
the translational potential of exercise has many limitations. Many patients are not candidates for exercise due
to co-morbidities that preclude rehabilitation, necessary immobilization of a limb following surgical nerve repair,
unknown dose requirement of exercise, and low patient compliance. Further limitations are that nearly 70% of
the skeletal muscle of people with a spinal cord injury is paralyzed, and there are no guidelines for electrically
induced exercise of paralyzed muscle. Experimental evidence also shows that sympathetic axon regrowth
may even be inhibited by certain types of treatments, such as electrical stimulation. Thus, other goals of this
work are to investigate whether increasing sympathetic activity 1) promotes or inhibits sympathetic axon
regeneration after peripheral nerve injury, and 2) can rescue the muscle bioenergetic and motor control deficits
after spinal cord injury.