Enhancing peripheral nerve regeneration in aging: the role of Schwann cells, c-Jun, and emerging therapeutic strategies

Peripheral nerve injuries (PNI) present a significant challenge, particularly in aging populations where Schwann cell dysfunction, reduced c-Jun expression, increased senescence, and impaired myelin clearance hinder regeneration. Targeted therapies aim to restore Schwann cell plasticity and improve nerve repair. These include gene therapy to upregulate c-Jun, senolytic agents to eliminate senescent Schwann cells, pharmacological activation of JNK, ferroptosis inhibition, and stem cell-based transplantation. Biomaterial advancements, such as nerve guidance conduits, extracellular matrix hydrogels, and 3D-printed scaffolds, provide structural and biochemical support. Despite these advances, clinical translation remains challenging due to patient heterogeneity, the need for personalized approaches, and regulatory considerations. Integrating multimodal strategies holds promise for optimizing peripheral nerve repair in aging individuals. Future research must refine these therapies to develop clinically viable solutions that enhance functional recovery and improve quality of life for patients with PNI.