Comparative analysis of Antigliotic Guiding Regenerative Gel (AGRG - LDP-916) for peripheral nerve reconstruction: Evidence from prospective randomized controlled studies

Introduction: Peripheral nerve injuries (PNIs) with segmental defects remain a challenge. Autologous nerve grafts (ANG) are the gold standard but are limited by donor-site morbidity and variable outcomes in long-gap repairs. Processed allografts and synthetic conduits provide alternatives but lack biological cues for optimal regeneration. Research question: This article presents a structured, author-driven narrative synthesis of published prospective randomized controlled preclinical studies evaluating the Antigliotic Guiding Regenerative Gel (AGRG), also known as LDP-916, a bioactive hydrogel designed to promote axonal growth and remyelination. It examines whether AGRG can achieve outcomes comparable to or exceeding ANG while avoiding donor-site morbidity. Methods: Data were synthesized from two published prospective randomized controlled preclinical studies: (1) acute rat sciatic nerve transection with a 15-mm critical-size defect repaired using AGRG-filled collagen conduits versus ANG and empty tubes; and (2) chronic rabbit sciatic nerve injury with a 25-mm critical-size defect repaired using AGRG-filled NeuraGen® conduits versus ANG and empty NeuraGen®. Additional observations from a rat replication study are summarized qualitatively to provide context on sensory, neuromuscular, and muscle preservation outcomes. Results: Across rat and rabbit models, AGRG supported regeneration comparable to ANG in structural outcomes. It demonstrated favorable electrophysiological and myelin-related outcomes compared with empty conduits, with histological analyses confirming organized remyelination and axonal maturation. Conclusion: AGRG shows reproducible preclinical efficacy across critical-size models and represents a clinically oriented, donor-site-sparing candidate for bridging major peripheral nerve defects. Conclusions are based on published evidence and presented as a structured narrative synthesis rather than definitive practice-changing claims.