Peripheral nerve injuries are the most common nervous system injuries, affecting 20 million people in the United States and over 300,000 people in Europe each year (
1-
3). In 2 - 5% of all trauma cases, such as sports and vehicle accidents or iatrogenic damage, peripheral nerve injury occurs, while traffic and industrial accidents, natural disasters, and war damage are the most common causes of peripheral nerve injury (
4-
7). After the injury, mature Schwann cells (SCs) can transform into repair SCs, proliferate, promote the regeneration process, and finally differentiate again (
8-
10). Schwann cells support the regeneration of injured axons by secretion of a variety of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF), glial cell-derived neurotrophic factor (GDNF), and cerebral dopamine neurotrophic factor (CDNF), which enhance the growth of regenerating axons after acute or chronic peripheral nerve injuries (
11-
13). Also, SCs arrange themselves longitudinally to form Büngner bands, which serve as axon regeneration channels (
4,
14,
15). The peripheral nerve injuries also trigger a series of factors known as Wallerian degeneration, a process of retrograde degeneration of the distal end of an axon, which results in the production of fragments of both axon and myelin (
16-
18). After Wallerian degeneration, SCs, in association with macrophages, migrate to the injury site and participate in phagocytosis of myelin debris, in addition to creating myelin sheaths (
8,
13,
19). However, based on clinical evidence, inherently slow axonal regeneration (less than 1 mm/day) and prolonged periods of denervation cause poor functional recovery after peripheral nerve injuries (
20-
23). Additionally, significant SC death occurs after cell transplantation, limiting its therapeutic efficacy (
24-
26). As a result, it is critical to improving the regenerative potential of SCs by providing either drugs or neurotrophic factors at the site of injury to enhance peripheral axon regeneration.
Some silkworm (
Bombyx mori) products are the oldest natural substances known to have accompanied humanity throughout history. In the early Neolithic period, Silkworm products were first employed more than 8500 years ago (
27). Silkworm pupae oil, chitin, and chitosan have several uses in the food industry, cosmetics, agriculture, biomedicine, textiles, biotechnology, and wound healing agents, etc. (
28). Silk (so-called Abresham) has been used in Persian medicine by Persian physicians (also called Hokama), such as Rhazes (AD8th century) and Avicenna (AD10th century). Its applications included treating and preventing neurological, cardiac, and liver diseases. Moreover, Aghili Khorasani in the book, Makhzan-al-Adawiyah, in AD18th century (
29) and Hakim Mohammad Momen in the book, Tahfato-al-Momenin in the AD17th century (
30) specified that silkworm dressing (Osro or Yasroo Zamad) is viable in repairing severed nerves and blood vessels (
31). The cocoon silk produced by the larvae of the domestic silk moth
Bombyx mori, which is made up of two major proteins, fibroin, and sericin, was used in the first experiments. However, because sericin has been shown to elicit the inflammatory response in vivo, complete removal of sericin, also known as degumming, is required before it can be used (
32). However, purified sericin has been shown to influence cartilaginous tissue regeneration, promoting cell regeneration, skin tissue regeneration, and the healing process with low levels of the inflammatory response (
33). Due to its outstanding biocompatibility and tunable degradation qualities, silk fibroin is a promising biomaterial for tissue engineering and regenerative medicine. Also, silkworms and some parts of their cycle have many growth factors and proteins, such as glycoprotein, laminin, and Bombyrin. Neurons and SCs have been successfully cultured using silk fibroin and growth factors extracted from silkworms (
34,
35). For example, Bombyrin has roles in brain development, wound healing in the brain, and the repair process of the brain, glycoprotein has roles in development and growth (
36), apolipoprotein has roles in regenerating nerve tissue in damaged rat neurons and regenerating peripheral nerve of rats (
36-
38) and arylphoring storage protein in reproduction (
36).