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.