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Daristotle JL, Lau LW, Erdi M, Hunter J, Djoum A, Srinivasan P, Wu X, Basu M, Ayyub OB, Sandler AD, Kofinas P. Sprayable and biodegradable, intrinsically adhesive wound dressing with antimicrobial properties. Bioeng Transl Med 2020; 5:e10149. [PMID: 31989038 PMCID: PMC6971445 DOI: 10.1002/btm2.10149] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/04/2019] [Accepted: 12/03/2019] [Indexed: 01/29/2023] Open
Abstract
Conventional wound dressings are difficult to apply to large total body surface area (TBSA) wounds, as they typically are prefabricated, require a layer of adhesive coating for fixation, and need frequent replacement for entrapped exudate. Large TBSA wounds as well as orthopedic trauma and low-resource surgery also have a high risk of infection. In this report, a sprayable and intrinsically adhesive wound dressing loaded with antimicrobial silver is investigated that provides personalized fabrication with minimal patient contact. The dressing is composed of adhesive and biodegradable poly(lactic-co-glycolic acid) and poly(ethylene glycol) (PLGA/PEG) blend fibers with or without silver salt (AgNO3). in vitro studies demonstrate that the PLGA/PEG/Ag dressing has antimicrobial properties and low cytotoxicity, with antimicrobial silver controllably released over 7-14 days. In a porcine partial-thickness wound model, the wounds treated with both antimicrobial and nonantimicrobial PLGA/PEG dressings heal at rates similar to those of the clinical, thin film polyurethane wound dressing, with similar scarring. However, PLGA/PEG adds a number of features beneficial for wound healing: greater exudate absorption, integration into the wound, a 25% reduction in dressing changes, and tissue regeneration with greater vascularization. There is also modest improvement in epidermis thickness compared to the control wound dressing.
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Affiliation(s)
- John L. Daristotle
- Fischell Department of BioengineeringUniversity of MarylandCollege ParkMaryland
| | - Lung W. Lau
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Metecan Erdi
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMaryland
| | - Joseph Hunter
- Fischell Department of BioengineeringUniversity of MarylandCollege ParkMaryland
| | - Albert Djoum
- Department of Chemistry and BiochemistryUniversity of MarylandCollege ParkMaryland
| | - Priya Srinivasan
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Xiaofang Wu
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Mousumi Basu
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Omar B. Ayyub
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMaryland
| | - Anthony D. Sandler
- Sheikh Zayed Institute for Pediatric Surgical InnovationJoseph E. Robert Jr. Center for Surgical Care, Children's National Medical CenterWashingtonDistrict of Columbia
| | - Peter Kofinas
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMaryland
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Repair of a Full-thickness Eyelid Defect With a Bilamellar Full-thickness Autograft in a Porcine Model (Sus scrofa). Ophthalmic Plast Reconstr Surg 2019; 36:395-398. [PMID: 31868788 DOI: 10.1097/iop.0000000000001569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE It has been demonstrated the pedicle of a tarsoconjunctival flap advancement does not appear to supply the flap itself and the vascularization of the remaining eyelid/tear film is thought to offer adequate nourishment for survival of the flap; as such, a swine model was constructed to assess the viability of a bilamellar autograft for repair of large full-thickness eyelid defects. METHODS Full-thickness defects of varying sizes were created in each lower eyelid of 4 Yorkshire/Yorkshire crossed swine. The defects were then closed with a full-thickness ipsilateral graft from the upper eyelid. Large full-thickness defects were then created in the upper and lower eyelids of 8 Yorkshire/Yorkshire crossed swine and closed with bilamellar autografts from the contralateral eyelids. The subjects were then monitored postoperatively and assessed clinically for graft viability at postoperative days 1, 7, and 30. At the conclusion of the 30-day postoperative monitoring period, necropsy was performed and histopathologic analysis utilized to assess cell morphology and vessel ingrowth of the graft sites. RESULTS In total, 28 full-thickness bilamellar grafts were constructed and examined. At the conclusion of the postoperative monitoring period, 27 of the grafts were deemed clinically viable and vascular ingrowth was determined to be equivalent to unaffected eyelid sections by histopathologic analysis. One case of postoperative hematoma was noted in the failed graft. One case of postoperative wound dehiscence required subsequent surgical repair. No clinically significant notching of the graft sites was noted. No cases of wound infection, corneal decompensation, or forniceal shortening were identified. CONCLUSIONS This analysis demonstrates the viability of a full-thickness bilamellar autograft as a surgical alternative in the repair of large full-thickness eyelid defects in a porcine model. The postoperative outcomes are consistent with the recent literature. Additional studies need to be performed to assess the procedure's clinical utility in human subjects before incorporation into clinical practice.
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Kadam S, Nadkarni S, Lele J, Sakhalkar S, Mokashi P, Kaushik KS. Bioengineered Platforms for Chronic Wound Infection Studies: How Can We Make Them More Human-Relevant? Front Bioeng Biotechnol 2019; 7:418. [PMID: 31921821 PMCID: PMC6923179 DOI: 10.3389/fbioe.2019.00418] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022] Open
Abstract
Chronic wound infections are an important cause of delayed wound healing, posing a significant healthcare burden with consequences that include hospitalization, amputation, and death. These infections most often take the form of three-dimensional biofilm communities, which are notoriously recalcitrant to antibiotics and immune clearance, contributing to the chronic wound state. In the chronic wound microenvironment, microbial biofilms interact closely with other key components, including host cellular and matrix elements, immune cells, inflammatory factors, signaling components, and mechanical cues. Intricate relationships between these contributing factors not only orchestrate the development and progression of wound infections but also influence the therapeutic outcome. Current medical treatment for chronic wound infections relies heavily on long-term usage of antibiotics; however, their efficacy and reasons for failure remain uncertain. To develop effective therapeutic approaches, it is essential to better understand the complex pathophysiology of the chronic wound infection microenvironment, including dynamic interactions between various key factors. For this, it is critical to develop bioengineered platforms or model systems that not only include key components of the chronic wound infection microenvironment but also recapitulate interactions between these factors, thereby simulating the infection state. In doing so, these platforms will enable the testing of novel therapeutics, alone and in combinations, providing insights toward composite treatment strategies. In the first section of this review, we discuss the key components and interactions in the chronic wound infection microenvironment, which would be critical to recapitulate in a bioengineered platform. In the next section, we summarize the key features and relevance of current bioengineered chronic wound infection platforms. These are categorized and discussed based on the microenvironmental components included and their ability to recapitulate the architecture, interactions, and outcomes of the infection microenvironment. While these platforms have advanced our understanding of the underlying pathophysiology of chronic wound infections and provided insights into therapeutics, they possess certain insufficiencies that limit their clinical relevance. In the final section, we propose approaches that can be incorporated into these existing model systems or developed into future platforms developed, thus enhancing their biomimetic and translational capabilities, and thereby their human-relevance.
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Affiliation(s)
- Snehal Kadam
- Institute of Bioinformatics and Biotechnology, Savitribai Phule Pune University, Pune, India
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104
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Pen OV, Antinozzi PA, Kock ND, Robinson MB, Willey JS, Bourland JD. Automated, quantitative assessment of epidermal necrosis expression resulting from skin exposure to beta radiation. Biomed Phys Eng Express 2019; 6:015007. [PMID: 33438595 DOI: 10.1088/2057-1976/ab5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Radiation skin injuries are difficult to quantitatively assess. Various scoring scales exist based on visual images and can be used in quantitative form for histological scoring. As an alternative to human scoring systems, an automated, quantitative system is proposed to provide unbiased scoring of radiation skin injury biopsy samples, with comparisons to human-based scoring systems. MATERIALS AND METHODS A unique algorithm was developed and tested on a sample pool obtained from in-vivo beta radiation experiments with a porcine model. The grading results achieved by the developed algorithm and those provided by an expert histopathologist are compared. RESULTS The extent of the epidermal necrosis is quantified in terms of the number of dead cells and their respective distribution across the length of the samples. The accuracy of the grading performed by the automated algorithm is comparable to that of a trained histopathologist, as demonstrated by statistically significant difference between the grades. CONCLUSIONS This study demonstrates the feasibility of the proposed method as a potential tool designed to aid in the histopathological analysis of the tissues affected by beta radiation exposure. An expanded study with a larger sample pool is recommended to further improve the accuracy of the proposed algorithm.
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Affiliation(s)
- Olga V Pen
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America. Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Sciences and Engineering, Winston-Salem, NC, United States of America
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105
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Jalili RB, Pourghadiri A, Li Y, Cleversey C, Kilani RT, Ghahary A. Split Thickness Grafts Grow From Bottom Up in Large Skin Injuries. J Burn Care Res 2019; 40:727-733. [PMID: 31314104 DOI: 10.1093/jbcr/irz123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Autologous split thickness skin graft is necessary for the survival of patients with large burns and skin defects. It is not clear how a thin split thickness skin graft becomes remarkably thicker within a few weeks following transplantation. Here, we hypothesized that growth of split thickness graft should be from bottom up probably through conversion of immune cells into collagen producing skin cells. We tested this hypothesis in a preclinical porcine model by grafting split thickness meshed skin (0.508 mm thickness, meshed at 3:1 ratio) on full thickness wounds in pigs. New tissue formation was evaluated on days 10 and 20 postoperation through histological analysis and co-staining for immune cell markers (CD45) and type I collagen. The findings revealed that a split thickness graft grew from bottom up and reached to almost the same level as uninjured skin within 60 days postoperation. The result of immune-staining identified a large number of cells, which co-expressed immune cell marker (CD45) and collagen on day 10 postoperation. Interestingly, as the number of these cells reduced on day 20, most of these cells became positive for collagen production. In another set of experiments, we tested whether immune cells can convert to collagen producing cells in vitro. The results showed that mouse adherent immune cells started to express type 1 procollagen and α-smooth muscle actin when cultured in the presence of fibroblast conditioned media. In conclusion, the early thickening of split thickness graft is likely happening through a major contribution of infiltrated immune cells that convert into mainly collagen producing fibroblasts in large skin injuries.
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Affiliation(s)
- Reza B Jalili
- BC Professional Firefighters' Burn and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Amir Pourghadiri
- BC Professional Firefighters' Burn and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Yunyuan Li
- BC Professional Firefighters' Burn and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Chantell Cleversey
- BC Professional Firefighters' Burn and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Ruhangiz T Kilani
- BC Professional Firefighters' Burn and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Aziz Ghahary
- BC Professional Firefighters' Burn and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
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Zhou R, Wang C, Liang Y, Li X, Li Q. Anti-miR-200b promotes wound healing by regulating fibroblast functions in a novel mouse model. Acta Biochim Biophys Sin (Shanghai) 2019; 51:1049-1055. [PMID: 31553422 DOI: 10.1093/abbs/gmz091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022] Open
Abstract
MicroRNA-200b (miR-200b) down-regulation has been found in wound-healing tissues. Fibroblasts are the predominant cells that orchestrate the production of collagen in wound healing. However, it is still unclear whether miR-200b can affect the wound healing by regulating the fibroblasts' function. The current rodent wound-healing models are not ideal due to their marked difference in structure compared with the human skin. In this study, we demonstrated that the murine plantar skin had similar anatomical features to the human skin. Using this model, the gain/loss-of-function studies showed that miR-200b caused a significantly delayed wound healing in vivo. Furthermore, using cell proliferation, migration and collagen synthesis assays, we found that miR-200b attenuated cell proliferation, migration and collagen synthesis of fibroblasts, which are critical aspects of wound healing. miR-200b also decreased the expression of Zeb1. Collectively, we established a new murine plantar skin model for the investigation of wound healing, and based on it we found that miR-200b affected the wound healing by regulating the biological function of fibroblasts, which provided a new insight for wound healing.
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Affiliation(s)
- Renpeng Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimin Liang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangqi Li
- Department of Endocrine, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zuo Y, Wei J, Chen H. Utilizing Human Dermal Fibroblast Heterogeneity in Autologous Dermal Fibroblast Therapy: An Overcomplicated Strategy or a Promising Approach? Anat Rec (Hoboken) 2019; 302:2126-2131. [PMID: 31433908 DOI: 10.1002/ar.24232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/27/2019] [Accepted: 05/28/2019] [Indexed: 12/25/2022]
Abstract
Although human dermal fibroblast heterogeneity has been acknowledged for several decades and a large body of in vitro studies has been performed with zonal dermal fibroblast, current autologous dermal fibroblast therapies do not reflect human dermal fibroblast heterogeneity. To determine if the utilization of human dermal fibroblast heterogeneity in autologous dermal fibroblast therapy is more of a translational perspective that may thus be more likely to make it to the clinic, this article critically reviews the previous studies on dermal fibroblast heterogeneity performed to date. We found that in vitro studies of human dermal fibroblast heterogeneity have run nearly parallel to the in vivo study of autologous dermal fibroblast therapy. Although several human to nude mice xenotransplantation experiments have been performed in different layers of human dermal fibroblast, their clinical significance remains to be considered. We conclude that there is still a great gap between basic experiments and the clinical employment of human dermal fibroblast heterogeneity. To overcome this, it is necessary to conduct clinical trials, which might be restricted by ethical issues. Alternatively, it might be easier to conduct in vivo studies in animal models. Based on our previous study of dermal fibroblast heterogeneity in pigs, we propose the use of pigs as a good animal model for dermal fibroblast heterogeneity. Time will show whether the utilization of human dermal fibroblast heterogeneity in autologous dermal fibroblast therapy is an overcomplicated strategy or a promising approach. Anat Rec, 302:2126-2131, 2019. © 2019 American Association for Anatomy.
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Affiliation(s)
- Yanhai Zuo
- Department of Orthopedics, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Jianjun Wei
- Department of Orthopedics, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Chen
- Department of Orthopedics, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
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Tipton CD, Sanford NE, Everett JA, Gabrilska RA, Wolcott RD, Rumbaugh KP, Phillips CD. Chronic wound microbiome colonization on mouse model following cryogenic preservation. PLoS One 2019; 14:e0221565. [PMID: 31442275 PMCID: PMC6707584 DOI: 10.1371/journal.pone.0221565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 08/10/2019] [Indexed: 01/06/2023] Open
Abstract
Chronic wound infections are increasingly recognized to be dynamic and polymicrobial in nature, necessitating the development of wound models which reflect the complexities of infection in a non-healing wound. Wound slough isolated from human chronic wounds and transferred to mice was recently shown to create polymicrobial infection in mice, and there is potential this tool may be improved by cryogenic preservation. The purpose of this study was to investigate the application of cryogenic preservation to transferring polymicrobial communities, specifically by quantifying the effects of cryopreservation and wound microbiome transplantation. Slough from an established murine polymicrobial surgical excision model and five patients were subjected to three preservation strategies: refrigeration until infection, freezing in liquid nitrogen, or freezing in liquid nitrogen with glycerol solution prior to infection in individual mice. Four days following inoculation onto mice, wound microbiota were quantified using either culture isolation or by 16s rRNA gene community profiling and quantitative PCR. Cryogenic preservation did not significantly reduce bacterial viability. Reestablished microbial communities were significantly associated with patient of origin as well as host context (i.e., originally preserved from a patient versus mouse infection). Whereas preservation treatment did not significantly shape community composition, the transfers of microbiomes from human to mouse were characterized by reduced diversity and compositional changes. These findings indicated that changes should be expected to occur to community structure after colonization, and that compositional change is likely due to the rapid change in infection context as opposed to preservation strategy. Furthermore, species that were present in higher relative abundance in wound inoculate were more likely to colonize subsequent wounds, and wound inoculate with higher bacterial load established wound communities that were more compositionally similar. Results inform expectations for the complementation of chronic wound in vivo modeling with cryogenic preservation archives.
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Affiliation(s)
- Craig D. Tipton
- Department of Biological Sciences, Texas Tech University, Lubbock, Texas, United States of America
- RTL Genomics, Research and Testing Laboratories, Lubbock, Texas, United States of America
- * E-mail:
| | - Nicholas E. Sanford
- Southwest Regional Wound Care Center, Lubbock, Texas, United States of America
| | - Jake A. Everett
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Rebecca A. Gabrilska
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Randall D. Wolcott
- Southwest Regional Wound Care Center, Lubbock, Texas, United States of America
| | - Kendra P. Rumbaugh
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Caleb D. Phillips
- Department of Biological Sciences, Texas Tech University, Lubbock, Texas, United States of America
- Natural Science Research Laboratory, Texas Tech University, Lubbock, Texas, United States of America
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Mouritzen MV, Andrea A, Qvist K, Poulsen SS, Jenssen H. Immunomodulatory potential of Nisin A with application in wound healing. Wound Repair Regen 2019; 27:650-660. [PMID: 31287619 DOI: 10.1111/wrr.12743] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
Antimicrobial peptides can have a dual role with both antimicrobial activity against a broad range of bacteria and immunomodulatory effect, making them attractive as therapeutic treatment of difficult wounds. Nisin A is widely known for its antimicrobial activity, and a preliminary study demonstrated that it increased wound closure, but the mechanism behind its effect is unknown. The aim of this study is to elucidate the wound healing potential of Nisin A and the mechanism behind. First, an epithelial and endothelial cell line, human keratinocyte (HaCaT) and human umbilical vein endothelial cell, were used to demonstrate migration and proliferation effects in vitro. From HaCaT cells and peripheral blood mononuclear cell, changes in cytokine levels were shown by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. Second, the ex vivo porcine wound healing model was used to investigate the re-epithelization potential of Nisin A. Finally, the model Galleria mellonella was used to confirm antimicrobial activity and to investigate potential immunomodulatory effects in vivo. Here, we demonstrated that Nisin A affected migration significantly of both human umbilical vein endothelial cell and HaCaT cells (p < 0.05) but not proliferation, potentially by decreasing the levels of proinflammatory cytokines tumor necrosis factor-α, interleukin-6, and interleukin-8 (p < 0.001). Furthermore, Nisin A treatment diminished lipopolysaccharide-induced tumor necrosis factor-α levels from peripheral blood mononuclear cells and monocyte chemoattractant protein-1 from HaCaT cells (p < 0.001). Furthermore, Nisin A did not affect proliferation ex vivo either but increased re-epithelization of the porcine skin. Nisin A improved survival of G. mellonella significantly from Staphylococcus epidermidis (p < 0.001) but not from Escherichia coli, indicating that Nisin A did not help the larvae to survive the infection in a different than direct antimicrobial way. All together this makes Nisin A a potential treatment to use in wound healing, as it increases the mobility of skin cells, dampens the effect of lipopolysaccharide and proinflammatory cytokines, and decreases bacterial growth.
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Affiliation(s)
| | - Athina Andrea
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Katrine Qvist
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Steen S Poulsen
- Department of Biomedical Science, University of Copenhagen, Copenhagen, Denmark
| | - Håvard Jenssen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
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Roche ED, Woodmansey EJ, Yang Q, Gibson DJ, Zhang H, Schultz GS. Cadexomer iodine effectively reduces bacterial biofilm in porcine wounds ex vivo and in vivo. Int Wound J 2019; 16:674-683. [PMID: 30868761 PMCID: PMC6850490 DOI: 10.1111/iwj.13080] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 12/25/2022] Open
Abstract
Biofilms are prevalent in non-healing chronic wounds and implicated in delayed healing. Tolerance to antimicrobial treatments and the host's immune system leave clinicians with limited interventions against biofilm populations. It is therefore essential that effective treatments be rigorously tested and demonstrate an impact on biofilm across multiple experimental models to guide clinical investigations and protocols. Cadexomer iodine has previously been shown to be effective against biofilm in various in vitro models, against methicillin-resistant Staphylococcus aureus biofilm in mouse wounds, and clinically in diabetic foot ulcers complicated by biofilm. Similarities between porcine and human skin make the pig a favoured model for cutaneous wound studies. Two antiseptic dressings and a gauze control were assessed against mature biofilm grown on ex vivo pig skin and in a pig wound model. Significant reductions in biofilm were observed following treatment with cadexomer iodine across both biofilm models. In contrast, silver carboxymethylcellulose dressings had minimal impact on biofilm in the models, with similar results to the control in the ex vivo model. Microscopy and histopathology indicate that the depth of organisms in wound tissue may impact treatment effectiveness. Further work on the promising biofilm efficacy of cadexomer iodine is needed to determine optimal treatment durations against biofilm.
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Affiliation(s)
- Eric D. Roche
- Advanced Wound Management R&D, Smith & NephewFort WorthTexas
| | - Emma J. Woodmansey
- Clinical, Scientific and Medical Affairs, Smith & NephewKingston upon HullUK
| | - Qingping Yang
- Department of Obstetrics and Gynecology, Institute for Wound ResearchUniversity of FloridaGainesvilleFlorida
| | - Daniel J. Gibson
- Department of Obstetrics and Gynecology, Institute for Wound ResearchUniversity of FloridaGainesvilleFlorida
| | - Hongen Zhang
- Department of Obstetrics and Gynecology, Institute for Wound ResearchUniversity of FloridaGainesvilleFlorida
| | - Gregory S. Schultz
- Department of Obstetrics and Gynecology, Institute for Wound ResearchUniversity of FloridaGainesvilleFlorida
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Acevedo CA, Sánchez E, Orellana N, Morales P, Olguín Y, Brown DI, Enrione J. Re-Epithelialization Appraisal of Skin Wound in a Porcine Model Using a Salmon-Gelatin Based Biomaterial as Wound Dressing. Pharmaceutics 2019; 11:pharmaceutics11050196. [PMID: 31027353 PMCID: PMC6571591 DOI: 10.3390/pharmaceutics11050196] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 01/04/2023] Open
Abstract
The design of new functional materials for skin tissue engineering is an area of constant research. In this work, a novel wound-dressing biomaterial with a porous structure, previously formulated using salmon-gelatin as main component (called salmon-gelatin biomaterial (SGB)), was tested in vivo using pigs as skin wound models. Four weeks after cutaneous excision and implantation in the animals, the healing process did not show apparent symptoms of inflammation or infection. Interestingly, the temporal evolution of wound size from 100% to around 10% would indicate a faster recovery when SGB was compared against a commercial control. Histological analysis established that wounds treated with SGB presented similar healing and epithelialization profiles with respect to the commercial control. Moreover, vascularized granulation tissue and epithelialization stages were clearly identified, indicating a proliferation phase. These results showed that SGB formulation allows cell viability to be maintained. The latter foresees the development of therapeutic alternatives for skin repair based on SGB fabricated using low cost production protocols.
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Affiliation(s)
- Cristian A Acevedo
- Centro de Biotecnología, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
- Departamento de Física, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
| | - Elizabeth Sánchez
- Centro de Biotecnología, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
| | - Nicole Orellana
- Centro de Biotecnología, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
| | - Patricio Morales
- Centro de Biotecnología, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
| | - Yusser Olguín
- Centro de Biotecnología, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
- Departamento de Física, Universidad Técnica Federico Santa María, Avenida España 1680, Valparaíso 2340000, Chile.
| | - Donald I Brown
- Instituto de Biología, Universidad de Valparaíso, Avenida Gran Bretaña 1111, Valparaíso 2340000, Chile.
| | - Javier Enrione
- Biopolymer Research and Engineering Lab, Facultad de Medicina, Universidad de los Andes, Monseñor Álvaro del Portillo 12455, Las Condes, Santiago 7550000, Chile.
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Pyruvate-depleting conditions induce biofilm dispersion and enhance the efficacy of antibiotics in killing biofilms in vitro and in vivo. Sci Rep 2019; 9:3763. [PMID: 30842579 PMCID: PMC6403282 DOI: 10.1038/s41598-019-40378-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/14/2019] [Indexed: 01/09/2023] Open
Abstract
The formation of biofilms is a developmental process initiated by planktonic cells transitioning to the surface, which comes full circle when cells disperse from the biofilm and transition to the planktonic mode of growth. Considering that pyruvate has been previously demonstrated to be required for the formation of P. aeruginosa biofilms, we asked whether pyruvate likewise contributes to the maintenance of the biofilm structure, with depletion of pyruvate resulting in dispersion. Here, we demonstrate that the enzymatic depletion of pyruvate coincided with the dispersion of established biofilms by S. aureus and laboratory and clinical P. aeruginosa isolates. The dispersion response was dependent on pyruvate fermentation pathway components but independent of proteins previously described to contribute to P. aeruginosa biofilm dispersion. Using porcine second-degree burn wounds infected with P. aeruginosa biofilm cells, we furthermore demonstrated that pyruvate depletion resulted in a reduction of biofilm biomass in vivo. Pyruvate-depleting conditions enhanced the efficacy of tobramycin killing of the resident wound biofilms by up to 5-logs. Our findings strongly suggest the management of pyruvate availability to be a promising strategy to combat biofilm-related infections by two principal pathogens associated with wound and cystic fibrosis lung infections.
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Sami DG, Heiba HH, Abdellatif A. Wound healing models: A systematic review of animal and non-animal models. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.wndm.2018.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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114
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Lin C, Chiu P, Hsueh Y, Shieh S, Wu C, Wong T, Chuong C, Hughes MW. Regeneration of rete ridges in Lanyu pig (
Sus scrofa
): Insights for human skin wound healing. Exp Dermatol 2019; 28:472-479. [DOI: 10.1111/exd.13875] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Chein‐Hong Lin
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Department of Basic MedicineCollege of MedicineNational Cheng Kung University Tainan Taiwan
| | - Po‐Yuan Chiu
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Institute of Clinical MedicineNational Cheng Kung University Hospital Tainan Taiwan
| | - Yuan‐Yu Hsueh
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Division of Plastic and Reconstructive SurgeryDepartment of SurgeryNational Cheng Kung University Hospital Tainan Taiwan
| | - Shyh‐Jou Shieh
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Division of Plastic and Reconstructive SurgeryDepartment of SurgeryNational Cheng Kung University Hospital Tainan Taiwan
| | - Chia‐Ching Wu
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Department of Basic MedicineCollege of MedicineNational Cheng Kung University Tainan Taiwan
| | - Tak‐Wah Wong
- Department of DermatologyNational Cheng Kung University Hospital Tainan Taiwan
| | - Cheng‐Ming Chuong
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Department of Basic MedicineCollege of MedicineNational Cheng Kung University Tainan Taiwan
- Institute of Clinical MedicineNational Cheng Kung University Hospital Tainan Taiwan
- Department of PathologyUniversity of Southern California Los Angeles California
| | - Michael W. Hughes
- International Center for Wound Repair and RegenerationNational Cheng Kung University Tainan Taiwan
- Institute of Clinical MedicineNational Cheng Kung University Hospital Tainan Taiwan
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115
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Aljghami ME, Jeschke MG, Amini-Nik S. Examining the contribution of surrounding intact skin during cutaneous healing. J Anat 2019; 234:523-531. [PMID: 30786015 DOI: 10.1111/joa.12941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 12/20/2022] Open
Abstract
Severe cutaneous wounds expose the body to the external environment, which may lead to impairments in bodily functions and increased risk of infection. There is a need to develop skin substitutes which could effectively promote complete skin regeneration following an injury. Murine models are used to test such skin substitutes, but their healing involves contraction of the dermis not found in human wounds. We have previously described a device called a dome, which comes in two models, that is used to prevent skin contraction in mice. One model provides a physical barrier to minimize contraction, and the other model has additional perforations in the barrier to allow cellular contribution from the surrounding intact skin. Taking advantage of an enhanced version of these two models, we compared granulation tissue formation, the extent of vascularization, and the transition to myofibroblastic phenotype between the models. We enhanced the dome by developing a twist open cap dome and applied the two models of the dome into the excisional wound biopsy in mice. We demonstrate that the dome can be used to prevent skin contraction in mice. The control model prevented skin contraction while barricading the contribution of surrounding intact skin. When not barricaded, the intact skin enhances wound healing by increasing the number of myofibroblasts and neovascularization. Using a novel model of inhibition of skin contraction in rodents, we examined the contribution from the surrounding intact skin to granulation tissue formation, myofibroblastic differentiation, and neovascularization during the course of skin healing in mice.
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Affiliation(s)
- Makram E Aljghami
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Saeid Amini-Nik
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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116
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Stanley JRL, Keating JH, San Souci KJ. An Overview on the Considerations for the Planning of Nonclinical Necropsies for Medical Device Studies. Toxicol Pathol 2019; 47:213-220. [PMID: 30727861 DOI: 10.1177/0192623319825821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The terminal collection and histological processing of medical devices is an expensive, labor-, and material-intensive endeavor, which requires adequate experience, innovation, and preparation for success. It is also an exciting endeavor that continually challenges, intellectually engages, and improves the skills and knowledge of the pathologist. Awareness of the importance of the medical device pathologist's involvement, communication, and oversight throughout the development, implementation, and execution of a nonclinical assessment of a medical device is in the best interest of the test facility, the histopathology laboratory, the pathologist, the sponsor, and, ultimately, the patients. This article serves to present as a primer of key considerations for the approach and conduct of "nontoxicological" studies, defined as studies involving animal models of deployment or implantation of medical devices as well as surgical animal models.
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117
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Supp DM. Animal Models for Studies of Keloid Scarring. Adv Wound Care (New Rochelle) 2019; 8:77-89. [PMID: 31832272 DOI: 10.1089/wound.2018.0828] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 01/16/2023] Open
Abstract
Significance: Keloid scarring is a disfiguring fibroproliferative disorder that can significantly impair the quality of life in affected individuals. The mechanisms that initiate keloid scarring are incompletely understood, and keloids remain one of the most challenging skin conditions to treat. Keloids are unique to humans; thus, the lack of adequate animal models has hindered research efforts aimed at prevention and effective therapeutic intervention. Recent Advances: In the absence of a suitable animal model, keloid researchers often rely on studying excised keloid scar tissue and keloid-derived cultured cells. Recently, in vivo models have been described that involve transplantation to mice of reconstructed skin containing keloid-derived fibroblasts and/or keratinocytes. These mouse-human hybrid animal models display some similarities with keloids and may enable investigation of novel therapies, although no model yet recapitulates all the features of human keloid scarring. Critical Issues: Differences in skin physiology and modes of healing contribute to challenges in modeling keloids in laboratory animals. Furthermore, recent studies suggest that cells of the immune system contribute to keloid pathology. The need to use immunodeficient hosts for transplanted human keloid cells in recently described animal models precludes studying the role of the immune system in keloid scarring. Future Directions: Future animal models may take advantage of humanized mice with immune systems reconstituted using human immune cells. Such models, when combined with grafted tissues prepared using keloid-derived cells, might enable investigation of complex interactions between systemic and local factors that combine to promote keloid scar formation and may aid in the development of novel therapies.
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Affiliation(s)
- Dorothy M. Supp
- Research Department, Shriners Hospitals for Children—Cincinnati, Cincinnati, Ohio
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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118
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119
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Delivery of External Volume Expansion through Microdeformational Interfaces Safely Induces Angiogenesis in a Murine Model of Intact Diabetic Skin with Endothelial Cell Dysfunction. Plast Reconstr Surg 2019; 143:453-464. [DOI: 10.1097/prs.0000000000005267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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120
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Effect of n-3 long-chain polyunsaturated fatty acids on wound healing using animal models – a review. ACTA VET BRNO 2019. [DOI: 10.2754/avb201887040309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The present review summarizes results of experiments, mostly performed on rodents, regarding the effects of fish oil (FO) and its biologically active constituents, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on the healing of cutaneous wounds, but also of selected other types of injury. Structure, metabolism and functions of EPA/DHA in an organism are briefly mentioned, with an emphasis on the ability of these long-chain polyunsaturated fatty acids to modulate inflammation. Wound healing as a complex programmed sequence of cellular and molecular processes including inflammation, cell migration, angiogenesis, synthesis of provisional matrix, collagen deposition and reepithelialisation is briefly described. Markers for evaluation of the healing process include planimetry indices, tensile strength, quantification of collagen synthesis including hydroxyproline determination, histopathology/immunohistochemistry and genomic/proteomic markers. As far as effects on wound healing are concerned, the main emphasis is put on the outcomes of experiments using a dietary FO/DHA/EPA administration, but the results of experiments with a parenteral application are also mentioned, together with selected relevantin vitrostudies. An important conclusion from the above-mentioned studies is an inconsistency of FO/DHA/EPA effects on wound healing: decreased/increased collagen deposition; lower/higher counts of the inflammatory cells in the healing tissue; increased/decreased concentration of both pro- and anti-inflammatory cytokines; DHA accelerated/delayed wound healing process. Some experiments indicate superiority of DHA over EPA regarding wound healing.
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121
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Namviriyachote N, Lipipun V, Akkhawattanangkul Y, Charoonrut P, Ritthidej GC. Development of polyurethane foam dressing containing silver and asiaticoside for healing of dermal wound. Asian J Pharm Sci 2019; 14:63-77. [PMID: 32104439 PMCID: PMC7032128 DOI: 10.1016/j.ajps.2018.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/04/2018] [Accepted: 09/21/2018] [Indexed: 11/19/2022] Open
Abstract
Polyurethane foam dressings for dermal wounds were formulated with natural polyols in order to improve the foam characteristics and the release of 2 active agents, silver and asiaticoside (AS) as an antimicrobial agent and an herbal wound healing agent, respectively. The foam was instantly formed by interaction of polyols and diisocyanate. Hydroxypropyl methylcellulose, chitosan and sodium alginate were individually mixed with the main polyols, polypropylene glycol, in the formulation while the active components were impregnated into the obtained foam dressing sheets. Although the type and amount of the natural polyols slightly affected the pore size, water sorption-desorption profile and compression strength of the obtained foam sheets, a prominent effect was found in the release of both active components. Among natural polyols formulations, foam sheets with alginate showed the highest silver and AS release. Non-cytotoxicity of these foam sheets to human fibroblast cells was confirmed. Antimicrobial testing on four bacteria strains showed that 1 mg/cm2 silver in formulations with 6% of natural polyols and without natural polyols had sufficient content of the silver release with comparable inhibition zone and significantly larger zone than other formulations. In pig study, the foam dressing with 6% alginate, 1 mg/cm2 silver and 5% AS could improve wound healing in both the percentage of the wound closure and histological parameters of the dermal wound without any dermatologic reactions. In conclusion, this innovative foam dressing had potential to be a good candidate for wound treatment.
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Affiliation(s)
| | - Vimolmas Lipipun
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Phingphol Charoonrut
- Faculty of Veterinary Science, Mahidol University, Nakhon Pathom 73170, Thailand
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122
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Milho C, Andrade M, Vilas Boas D, Alves D, Sillankorva S. Antimicrobial assessment of phage therapy using a porcine model of biofilm infection. Int J Pharm 2018; 557:112-123. [PMID: 30590127 DOI: 10.1016/j.ijpharm.2018.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/17/2022]
Abstract
Antibiotic resistant bacterial communities persist in many types of wounds, chronic wounds in particular, in the form of biofilms. Biofilm formation is a major cause of severe infections and the main reason for a negative treatment outcome and slow healing progression. Chronic wounds are a silent epidemic essentially affecting people with co-morbid conditions such as diabetes and obesity and elderly persons particularly those with movement limitations. The development of complementary and alternative effective strategies to antibiotics for the treatment of chronic wounds is highly desired. Phage therapy constitutes a very promising approach in the control of topical microbial populations. In this work newly isolated phages were tested for their efficacy to control bacterial species that predominate in chronic wounds. Phage effectiveness was studied on 24-h old biofilms formed in polystyrene microplates and in porcine skin explants using two treatment approaches: individual phage and a cocktail of phages against four main pathogens commonly isolated from chronic wounds. The two models produced variations in the surface colonization ability, assessed by viable bacterial counts and microscopy visualization after using peptide nucleic acid (PNA) or locked nucleic acid probes (LNA) and 2'-O-methyl (2'-OMe) in fluorescence in situ hybridization (FISH), and in the phage-host interactions. Phages alone and combined caused greater reductions in the number of viable cells when biofilms had been formed on porcine skins and with greater variations detected at 4 h and 24 h of sampling. These results suggest that porcine skin models should be preferentially used to assess the use of phages and phage cocktails intended for topical use in order to understand the fate, throughout treatment time, of the population when dealing with biofilm-related infections.
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Affiliation(s)
- C Milho
- Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
| | - M Andrade
- Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
| | - D Vilas Boas
- Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
| | - D Alves
- Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal
| | - S Sillankorva
- Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal.
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123
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Darwin E, Tomic-Canic M. Healing Chronic Wounds: Current Challenges and Potential Solutions. CURRENT DERMATOLOGY REPORTS 2018; 7:296-302. [PMID: 31223516 PMCID: PMC6585977 DOI: 10.1007/s13671-018-0239-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to raise awareness, examine the challenges faced by wound care researchers and explore opportunities for potential improvements. RECENT FINDINGS Chronic wounds are associated with significant morbidity and mortality, and they represent a major medical and financial burden. Despite this, no new therapy has received FDA efficacy approval for the treatment of chronic wounds since 1997. Previous preclinical studies using animal models did not translate to human wounds due to inherent limitations of experimental models, variability in assessment methods and overall experimental design. Clinical trials continued to be challenged by the balance of the inclusion and exclusion criteria, the high cost and time expenditure of the trials, and the constraint of a single FDA-acceptable outcome of complete wound closure. SUMMARY Wound research faces multiple challenges in both pre-clinical and clinical research that slowed progress and development of efficacious therapies. Solutions to such challenges will provide new opportunities for improved study design in the future.
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Affiliation(s)
- Evan Darwin
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave., RMSB 2023, Miami, FL, 33136, USA
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave., RMSB 2023, Miami, FL, 33136, USA
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124
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Grada A, Mervis J, Falanga V. Research Techniques Made Simple: Animal Models of Wound Healing. J Invest Dermatol 2018; 138:2095-2105.e1. [DOI: 10.1016/j.jid.2018.08.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 01/15/2023]
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125
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Development of an easy-to-handle murine model for the characterization of radiation-induced gross and molecular changes in skin. Arch Plast Surg 2018; 45:403-410. [PMID: 30282410 PMCID: PMC6177636 DOI: 10.5999/aps.2018.00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Radiation-induced skin injury is a dose-limiting complication of radiotherapy. To investigate this problem and to develop a framework for making decisions on treatment and dose prescription, a murine model of radiation-induced skin injury was developed. METHODS The dorsal skin of the mice was isolated, and irradiation was applied at single doses of 15, 30, and 50 Gy. The mice were followed for 12 weeks with serial photography and laser Doppler analysis. Sequential skin biopsy samples were obtained and subjected to a histological analysis, immunostaining against transforming growth factor beta (TGF-β), and Western blotting with Wnt-3 and β-catenin. Increases in the levels of TGF-β, Wnt, and β-catenin were detected after irradiation. RESULTS All tested radiation doses caused progressive dermal thickening and fibrosis. The cause of this process, however, may not be radiation alone, as the natural course of wound healing may elicit a similar response. The latent appearance of molecular and histological markers that induce fibrosis in the 15 Gy group without causing apparent gross skin injuries indicates that 15 Gy is an appropriate dose for characterizing the effects of chronic irradiation alone. Thus, this model best mimics the patterns of injury that occur in human subjects. CONCLUSIONS This animal model can be used to elucidate the gross and molecular changes that occur in radiation-induced skin injury and provides an effective platform for studying this adverse effect without complicating the process of wound healing.
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126
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Johnson TR, Gómez BI, McIntyre MK, Dubick MA, Christy RJ, Nicholson SE, Burmeister DM. The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing. Int J Mol Sci 2018; 19:ijms19092699. [PMID: 30208569 PMCID: PMC6164292 DOI: 10.3390/ijms19092699] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/16/2022] Open
Abstract
The ecological community of microorganisms in/on humans, termed the microbiome, is vital for sustaining homeostasis. While culture-independent techniques have revealed the role of the gut microbiome in human health and disease, the role of the cutaneous microbiome in wound healing is less defined. Skin commensals are essential in the maintenance of the epithelial barrier function, regulation of the host immune system, and protection from invading pathogenic microorganisms. In this review, we summarize the literature derived from pre-clinical and clinical studies on how changes in the microbiome of various acute and chronic skin wounds impact wound healing tissue regeneration. Furthermore, we review the mechanistic insights garnered from model wound healing systems. Finally, in the face of growing concern about antibiotic-resistance, we will discuss alternative strategies for the treatment of infected wounds to improve wound healing and outcomes. Taken together, it has become apparent that commensals, symbionts, and pathogens on human skin have an intimate role in the inflammatory response that highlights several potential strategies to treat infected, non-healing wounds. Despite these promising results, there are some contradictory and controversial findings from existing studies and more research is needed to define the role of the human skin microbiome in acute and chronic wound healing.
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Affiliation(s)
- Taylor R Johnson
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - Belinda I Gómez
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Matthew K McIntyre
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
- School of Medicine, New York Medical College, Valhalla, New York, NY 10595, USA.
| | - Michael A Dubick
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Robert J Christy
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Susannah E Nicholson
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - David M Burmeister
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
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Farias C, Lyman R, Hemingway C, Chau H, Mahacek A, Bouzos E, Mobed-Miremadi M. Three-Dimensional (3D) Printed Microneedles for Microencapsulated Cell Extrusion. Bioengineering (Basel) 2018; 5:E59. [PMID: 30065227 PMCID: PMC6164407 DOI: 10.3390/bioengineering5030059] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cell-hydrogel based therapies offer great promise for wound healing. The specific aim of this study was to assess the viability of human hepatocellular carcinoma (HepG2) cells immobilized in atomized alginate capsules (3.5% (w/v) alginate, d = 225 µm ± 24.5 µm) post-extrusion through a three-dimensional (3D) printed methacrylate-based custom hollow microneedle assembly (circular array of 13 conical frusta) fabricated using stereolithography. With a jetting reliability of 80%, the solvent-sterilized device with a root mean square roughness of 158 nm at the extrusion nozzle tip (d = 325 μm) was operated at a flowrate of 12 mL/min. There was no significant difference between the viability of the sheared and control samples for extrusion times of 2 h (p = 0.14, α = 0.05) and 24 h (p = 0.5, α = 0.05) post-atomization. Factoring the increase in extrusion yield from 21.2% to 56.4% attributed to hydrogel bioerosion quantifiable by a loss in resilience from 5470 (J/m³) to 3250 (J/m³), there was no significant difference in percentage relative payload (p = 0.2628, α = 0.05) when extrusion occurred 24 h (12.2 ± 4.9%) when compared to 2 h (9.9 ± 2.8%) post-atomization. Results from this paper highlight the feasibility of encapsulated cell extrusion, specifically protection from shear, through a hollow microneedle assembly reported for the first time in literature.
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Affiliation(s)
- Chantell Farias
- Department of Bioengineering, Santa Clara University, Santa Clara, CA 95053-0583, USA.
| | - Roman Lyman
- Department of Bioengineering, Santa Clara University, Santa Clara, CA 95053-0583, USA.
| | - Cecilia Hemingway
- Department of Bioengineering, Santa Clara University, Santa Clara, CA 95053-0583, USA.
| | - Huong Chau
- Department of Bioengineering, Santa Clara University, Santa Clara, CA 95053-0583, USA.
| | - Anne Mahacek
- SCU Maker Lab, Santa Clara University, Santa Clara, CA 95053-0583, USA.
| | - Evangelia Bouzos
- Department of Bioengineering, Santa Clara University, Santa Clara, CA 95053-0583, USA.
| | - Maryam Mobed-Miremadi
- Department of Bioengineering, Santa Clara University, Santa Clara, CA 95053-0583, USA.
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128
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Kado M, Tanaka R, Arita K, Okada K, Ito-Hirano R, Fujimura S, Mizuno H. Human peripheral blood mononuclear cells enriched in endothelial progenitor cells via quality and quantity controlled culture accelerate vascularization and wound healing in a porcine wound model. Cell Transplant 2018; 27:1068-1079. [PMID: 29974793 PMCID: PMC6158547 DOI: 10.1177/0963689718780307] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The transplantation of endothelial progenitor cells (EPCs) is used to promote wound angiogenesis. In patients with chronic wounds and accompanying morbidities, EPCs are often compromised in number and function. To overcome these limitations, we previously developed a quality and quantity controlled (QQ) culture system to enrich peripheral blood mononuclear cells (PBMNCs) in EPCs. To evaluate the wound healing efficacy of mononuclear cells (MNCs) harvested after QQ culture (QQMNCs), preclinical studies were performed on large animals. MNCs harvested from the blood of healthy human subjects were cultured in the presence of angiogenic cytokines and growth factors in a serum-free medium for 7 days. A total of 5 × 106 QQMNCs per full-thickness skin defect or control saline was injected into wounds induced in cyclosporine-immunosuppressed pigs. EPC colony-forming assays revealed a significantly higher number of definitive (partially differentiated) EPC colony-forming units in QQMNCs. Flow cytometry evaluation of QQMNC surface markers showed enrichment of CD34+ and CD133+ stem cell populations, significant reduction in CCR2+ cell percentages, and a greater than 10-fold increase in the percentage of anti-inflammatory M2-type macrophages (CD206+ cells) compared with PBMNCs. Wounds treated with QQMNCs had a significantly higher closure rate. Wounds were harvested, frozen, and sectioned at day 21 postoperatively. Hematoxylin and eosin staining revealed that the epithelization of QQMNC-treated wounds was more advanced than in controls. Treated wounds developed granulation tissue with more mature collagen and larger capillary networks. CD31 and human mitochondrial co-staining confirmed the presence of differentiated human cells within newly formed vessels. Real-time polymerase chain reaction (PCR) showed upregulation of interleukin 6 (IL-6), IL-10, and IL-4 in the wound bed, suggesting paracrine activity of the transplanted QQMNCs. Our data demonstrate for the first time that QQ culture of MNCs obtained from a small amount of peripheral blood yields vasculogenic and therapeutic cells effective in wound healing.
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Affiliation(s)
- Makiko Kado
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Rica Tanaka
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kayo Arita
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kayoko Okada
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Rie Ito-Hirano
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoshi Fujimura
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Mizuno
- 1 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Alves DR, Booth SP, Scavone P, Schellenberger P, Salvage J, Dedi C, Thet NT, Jenkins ATA, Waters R, Ng KW, Overall ADJ, Metcalfe AD, Nzakizwanayo J, Jones BV. Development of a High-Throughput ex-Vivo Burn Wound Model Using Porcine Skin, and Its Application to Evaluate New Approaches to Control Wound Infection. Front Cell Infect Microbiol 2018; 8:196. [PMID: 29963501 PMCID: PMC6013584 DOI: 10.3389/fcimb.2018.00196] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/25/2018] [Indexed: 12/05/2022] Open
Abstract
Biofilm formation in wounds is considered a major barrier to successful treatment, and has been associated with the transition of wounds to a chronic non-healing state. Here, we present a novel laboratory model of wound biofilm formation using ex-vivo porcine skin and a custom burn wound array device. The model supports high-throughput studies of biofilm formation and is compatible with a range of established methods for monitoring bacterial growth, biofilm formation, and gene expression. We demonstrate the use of this model by evaluating the potential for bacteriophage to control biofilm formation by Staphylococcus aureus, and for population density dependant expression of S. aureus virulence factors (regulated by the Accessory Gene Regulator, agr) to signal clinically relevant wound infection. Enumeration of colony forming units and metabolic activity using the XTT assay, confirmed growth of bacteria in wounds and showed a significant reduction in viable cells after phage treatment. Confocal laser scanning microscopy confirmed the growth of biofilms in wounds, and showed phage treatment could significantly reduce the formation of these communities. Evaluation of agr activity by qRT-PCR showed an increase in activity during growth in wound models for most strains. Activation of a prototype infection-responsive dressing designed to provide a visual signal of wound infection, was related to increased agr activity. In all assays, excellent reproducibility was observed between replicates using this model.
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Affiliation(s)
- Diana R Alves
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom.,The Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, United Kingdom.,The Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Simon P Booth
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom.,The Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Paola Scavone
- Department of Microbiology, Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay
| | - Pascale Schellenberger
- Electron Microscopy Imaging Centre, School of Life Sciences, University of Sussex, Brighton, United Kingdom
| | - Jonathan Salvage
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom
| | - Cinzia Dedi
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom
| | - Naing-Tun Thet
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - A Toby A Jenkins
- Department of Chemistry, University of Bath, Bath, United Kingdom
| | - Ryan Waters
- The Pirbright Institute, Woking, United Kingdom
| | - Keng W Ng
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom.,School of Pharmacy, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Andrew D J Overall
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom
| | - Anthony D Metcalfe
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom.,The Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, United Kingdom.,School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Nzakizwanayo
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom
| | - Brian V Jones
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom.,The Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.,Department of Biology and Biological Sciences, University of Bath, Bath, United Kingdom
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130
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Deng X, Chen Q, Qiang L, Chi M, Xie N, Wu Y, Yao M, Zhao D, Ma J, Zhang N, Xie Y. Development of a Porcine Full-Thickness Burn Hypertrophic Scar Model and Investigation of the Effects of Shikonin on Hypertrophic Scar Remediation. Front Pharmacol 2018; 9:590. [PMID: 29922164 PMCID: PMC5996232 DOI: 10.3389/fphar.2018.00590] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/17/2018] [Indexed: 01/10/2023] Open
Abstract
Hypertrophic scars formed after burns remain a challenge in clinical practice. Development of effective scar therapies relies on validated animal models that mimic human hypertrophic scars. A consistent porcine full-thickness burn hypertrophic scar model has yet to be developed. We have previously reported that Shikonin induces apoptosis and reduces collagen production in hypertrophic scar fibroblasts in vitro and may therefore hold potential as a novel scar remediation therapy. In this study, we aimed to validate the potential of Shikonin on scar remediation in vivo. A novel porcine hypertrophic scar model was created after full-thickness burn wounds, and the effect of Shikonin on scar remediation was investigated. Clinical scar assessments, histology, and immunohistochemistry were used to evaluate scar appearance, morphology, and protein expression. Eight weeks after scar formation, clinical scar assessment indicated that the score of hypertrophic scars treated with Shikonin was significantly lower than that of the control group. Hypertrophic scars treated with Shikonin appeared flat, pink, and pliable. In addition, histological analysis indicated that hypertrophic scars treated with Shikonin exhibited reduced thickness of the epidermis and dermis, thin and even epithelial layers, reduced numbers of keratinocytes, uniform distribution of fibroblasts, and a parallel and loose arrangement of collagen fibers in the dermis. Moreover, immunohistochemical analysis indicated that Shikonin inhibited the expression of p63, cytokeratin 10, alpha-smooth muscle actin, transforming growth factor-beta 1, and collagen I, which play important roles in hypertrophic scar formation. Based on these results, we conclude that Shikonin has potential as a novel scar therapy.
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Affiliation(s)
- Xingwang Deng
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Qian Chen
- Department of Burns and Plastic Surgery, Xinyang Central Hospital, Xinyang, China
| | - Lijuan Qiang
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Mingwei Chi
- Medical Department, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Nan Xie
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yinsheng Wu
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ming Yao
- Department of Burns and Plastic Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Dan Zhao
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jiaxiang Ma
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ning Zhang
- Department of Pathology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yan Xie
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Yinchuan, China.,Clinical Medical School, Ningxia Medical University, Yinchuan, China.,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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131
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Irons RF, Cahill KW, Rattigan DA, Marcotte JH, Fromer MW, Chang S, Zhang P, Behling EM, Behling KC, Caputo FJ. Acceleration of diabetic wound healing with adipose-derived stem cells, endothelial-differentiated stem cells, and topical conditioned medium therapy in a swine model. J Vasc Surg 2018; 68:115S-125S. [PMID: 29753580 DOI: 10.1016/j.jvs.2018.01.065] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/13/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of our study was to investigate the effect of adipose-derived stem cells (ASCs), endothelial-differentiated ASCs (EC/ASCs), and various conditioned media (CM) on wound healing in a diabetic swine model. We hypothesized that ASC-based therapies would accelerate wound healing. METHODS Diabetes was induced in four Yorkshire swine through intravenous injection of streptozotocin. ASCs were harvested from flank fat and cultured in either M199 or EGM-2 medium. A duplicate series of seven full-thickness dorsal wounds were surgically created on each swine. The wounds in the cellular treatment group underwent injection of low-dose or high-dose ASCs or EC/ASCs on day 0, with a repeat injection of one half of the initial dose on day 15. Wounds assigned to the topical CM therapy were covered with 2 mL of either serum-free M199 primed by ASCs or human umbilical vein endothelial cells every 3 days. Wounds were assessed at day 0, 10, 15, 20, and 28. The swine were sacrificed on day 28. ImageJ software was used to evaluate the percentage of wound healing. The wounded skin underwent histologic, reverse transcription polymerase chain reaction, and enzyme-linked immunosorbent assay examinations to evaluate markers of angiogenesis and inflammation. RESULTS We found an increase in the percentage of wound closure rates in cell-based treatments and topical therapies at various points compared with the untreated control wounds (P < .05). The results from the histologic, messenger RNA, and protein analyses suggested the treated wounds displayed increased angiogenesis and a diminished inflammatory response. CONCLUSIONS Cellular therapy with ASCs, EC/ASCs, and topical CM accelerated diabetic wound healing in the swine model. Enhanced angiogenesis and immunomodulation might be key contributors to this process.
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MESH Headings
- Adipose Tissue/cytology
- Administration, Topical
- Animals
- Cell Differentiation/drug effects
- Cells, Cultured
- Culture Media, Conditioned/metabolism
- Culture Media, Conditioned/pharmacology
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Endothelial Progenitor Cells/metabolism
- Endothelial Progenitor Cells/transplantation
- Gene Expression Regulation
- Human Umbilical Vein Endothelial Cells/metabolism
- Humans
- Male
- Multipotent Stem Cells/metabolism
- Multipotent Stem Cells/transplantation
- Neovascularization, Physiologic
- Phenotype
- Skin/blood supply
- Skin/drug effects
- Skin/injuries
- Skin/metabolism
- Sus scrofa
- Time Factors
- Wound Healing/drug effects
- Wounds, Penetrating/etiology
- Wounds, Penetrating/metabolism
- Wounds, Penetrating/pathology
- Wounds, Penetrating/therapy
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Affiliation(s)
- Robin F Irons
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Kevin W Cahill
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | | | | | - Marc W Fromer
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Shaohua Chang
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Ping Zhang
- Department of Surgery, Cooper University Hospital, Camden, NJ
| | - Eric M Behling
- Department of Pathology, Cooper University Hospital, Camden, NJ
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132
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Brash DE, Goncalves LCP, Bechara EJH. Chemiexcitation and Its Implications for Disease. Trends Mol Med 2018; 24:527-541. [PMID: 29751974 DOI: 10.1016/j.molmed.2018.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/27/2018] [Accepted: 04/06/2018] [Indexed: 12/20/2022]
Abstract
Quantum mechanics rarely extends to molecular medicine. Recently, the pigment melanin was found to be susceptible to chemiexcitation, in which an electron is chemically excited to a high-energy molecular orbital. In invertebrates, chemiexcitation causes bioluminescence; in mammals, a higher-energy process involving melanin transfers energy to DNA without photons, creating the lethal and mutagenic cyclobutane pyrimidine dimer that can cause melanoma. This process is initiated by NO and O2- radicals, the formation of which can be triggered by ultraviolet light or inflammation. Several chronic diseases share two properties: inflammation generates these radicals across the tissue, and the diseased cells lie near melanin. We propose that chemiexcitation may be an upstream event in numerous human diseases.
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Affiliation(s)
- Douglas E Brash
- Departments of Therapeutic Radiology and Dermatology, and Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06520-8040, USA.
| | - Leticia C P Goncalves
- Departments of Therapeutic Radiology and Dermatology, and Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06520-8040, USA
| | - Etelvino J H Bechara
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo 05513-970 SP, and Departamento de Ciências Exatas e da Terra, Universidade Federal de São Paulo, Diadema, São Paulo 09972-270 SP, Brazil
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133
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Bellare A, Epperly MW, Greenberger JS, Fisher R, Glowacki J. Development of tensile strength methodology for murine skin wound healing. MethodsX 2018; 5:337-344. [PMID: 30050753 PMCID: PMC6058076 DOI: 10.1016/j.mex.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/05/2018] [Indexed: 12/18/2022] Open
Abstract
In this study, a methodology was evaluated and improved to quickly measure the tensile strength of murine skin in a biomechanical assay for an incisional wound healing model. The aim was to streamline and enhance the wound model, skin specimen preparation, and tensile test so that large numbers of fresh tissue could be tested reliably and rapidly. Linear incisions of 25-mm length were made in the dorsal skin of mice along the spine and metallic staples were used to close the wound. After 20 days, the mice were sacrificed, and a square-shaped section of skin containing the linear incision was excised. Two metallic punches were fabricated and used to punch 15-mm long strips of skin of 2 mm width whose length was orthogonal to the direction of incision. The tensiometer configuration was modified to expedite tensile measurements on fresh skin, and load-to-failure was measured for each strip of skin from the cephalad to the caudal region. We evaluated sources of error in the animal model and the testing protocol and developed procedures to maximize speed and reproducibility in tensile strength measurements. This report provides guidance for efficient and reproducible tensile strength measurement of large numbers of skin specimens from freshly sacrificed animals. Tattoo placement to identify the two ends of the healing incisional wound assisted in decreasing error in the position and orientation of tensile strips. Custom-made punches to prepare skin strips for tensile testing helped conduct tensile tests of fresh tissue rapidly. Alteration of the manual grips of the tensile tester enabled specimens to be gripped rapidly to significantly accelerate testing for each skin strip.
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Affiliation(s)
- Anuj Bellare
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael W Epperly
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Renee Fisher
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Julie Glowacki
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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134
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Desmet CM, Préat V, Gallez B. Nanomedicines and gene therapy for the delivery of growth factors to improve perfusion and oxygenation in wound healing. Adv Drug Deliv Rev 2018; 129:262-284. [PMID: 29448035 DOI: 10.1016/j.addr.2018.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 12/16/2022]
Abstract
Oxygen plays a key role in wound healing, and hypoxia is a major cause of wound healing impairment; therefore, treatments to improve hemodynamics and increase wound oxygenation are of particular interest for the treatment of chronic wounds. This article describes the roles of oxygen and angiogenesis in wound healing as well as the tools used to evaluate tissue oxygenation and perfusion and then presents a review of nanomedicines and gene therapies designed to improve perfusion and oxygenation and accelerate wound healing.
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135
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Golchin A, Hosseinzadeh S, Ardeshirylajimi A. The exosomes released from different cell types and their effects in wound healing. J Cell Biochem 2018; 119:5043-5052. [DOI: 10.1002/jcb.26706] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/23/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Ali Golchin
- Department of Tissue engineering and Applied Cell SciencesSchool of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Simzar Hosseinzadeh
- Department of Tissue engineering and Applied Cell SciencesSchool of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Abdolreza Ardeshirylajimi
- Department of Tissue engineering and Applied Cell SciencesSchool of Advanced Technologies in MedicineShahid Beheshti University of Medical SciencesTehranIran
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136
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Serve R, Sturm R, Schimunek L, Störmann P, Heftrig D, Teuben MPJ, Oppermann E, Horst K, Pfeifer R, Simon TP, Kalbas Y, Pape HC, Hildebrand F, Marzi I, Relja B. Comparative Analysis of the Regulatory T Cells Dynamics in Peripheral Blood in Human and Porcine Polytrauma. Front Immunol 2018; 9:435. [PMID: 29593715 PMCID: PMC5859958 DOI: 10.3389/fimmu.2018.00435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Severely injured patients experience substantial immunological stress in the aftermath of traumatic insult, which often results in systemic immune dysregulation. Regulatory T cells (Treg) play a key role in the suppression of the immune response and in the maintenance of immunological homeostasis. Little is known about their presence and dynamics in blood after trauma, and nothing is known about Treg in the porcine polytrauma model. Here, we assessed different subsets of Treg in trauma patients (TP) and compared those to either healthy volunteers (HV) or data from porcine polytrauma. Methods Peripheral blood was withdrawn from 20 TP with injury severity score (ISS) ≥16 at the admittance to the emergency department (ED), and subsequently on day 1 and at day 3. Ten HV were included as controls (ctrl). The porcine polytrauma model consisted of a femur fracture, liver laceration, lung contusion, and hemorrhagic shock resulting in an ISS of 27. After polytrauma, the animals underwent resuscitation and surgical fracture fixation. Blood samples were withdrawn before and immediately after trauma, 24 and 72 h later. Different subsets of Treg, CD4+CD25+, CD4+CD25+FoxP3+, CD4+CD25+CD127-, and CD4+CD25+CD127-FoxP3+ were characterized by flow cytometry. Results Absolute cell counts of leukocytes were significantly increasing after trauma, and again decreasing in the follow-up in human and porcine samples. The proportion of human Treg in the peripheral blood of TP admitted to the ED was lower when compared to HV. Their numbers did not recover until 72 h after trauma. Comparable data were found for all subsets. The situation in the porcine trauma model was comparable with the clinical data. In porcine peripheral blood before trauma, we could identify Treg with the typical immunophenotype (CD4+CD25+CD127-), which were virtually absent immediately after trauma. Similar to the human situation, most of these cells expressed FoxP3, as assessed by intracellular FACS stain. Conclusion Despite minor percental differences in the recovery of Treg populations after trauma, our findings show a comparable decrease of Treg early after polytrauma, and strengthen the immunological significance of the porcine polytrauma model. Furthermore, the Treg subpopulation CD4+CD25+CD127- was characterized in porcine samples.
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Affiliation(s)
- Rafael Serve
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Ramona Sturm
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Lukas Schimunek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - David Heftrig
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Michel P. J. Teuben
- Department of Orthopaedic Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elsie Oppermann
- Department of Abdominal and Visceral Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Roman Pfeifer
- Department of Orthopaedic Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tim P. Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - Yannik Kalbas
- Department of Orthopaedic Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frank Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Borna Relja
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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137
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Sieker JT, Proffen BL, Waller KA, Chin KE, Karamchedu NP, Akelman MR, Perrone GS, Kiapour AM, Konrad J, Fleming BC, Murray MM. Transcriptional profiling of synovium in a porcine model of early post-traumatic osteoarthritis. J Orthop Res 2018; 36:10.1002/jor.23876. [PMID: 29460983 PMCID: PMC6102098 DOI: 10.1002/jor.23876] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/15/2018] [Indexed: 02/04/2023]
Abstract
To determine the transcriptional profile of synovium during the molecular phase of post-traumatic osteoarthritis, anterior cruciate ligament transections (ACL) were performed in 36 Yucatan minipigs. Equal numbers were randomly assigned to no further treatment, ACL reconstruction or repair. Perimeniscal synovium for histopathology and RNA-sequencing was harvested at 1 and 4 weeks post-operatively and from six healthy control animals. Microscopic synovitis scores significantly worsened at 1 (p < 0.001) and 4 weeks (p = 0.003) post-surgery relative to controls, and were driven by intimal hyperplasia and increased stromal cellularity without inflammatory infiltrates. Synovitis scores were similar between no treatment, reconstruction, and repair groups (p ≥ 0.668). Relative to no treatment at 1 week, 88 and 367 genes were differentially expressed in the reconstruction and repair groups, respectively (227 and 277 at 4 weeks). Relative to controls and with the treatment groups pooled, 1,683 transcripts were concordantly differentially expressed throughout the post-surgery time-course. Affected pathways included, proteolysis_connective tissue degradation (including upregulations of protease-encoding MMP1, MMP13, and ADAMTS4), and development_cartilage development (including upregulations of ACAN, SOX9, and RUNX2), among others. Using linear regression, significant associations of post-surgery synovial expression levels of 20 genes with the articular cartilage glycosaminoglycan loss were identified. These genes were predominantly related to embryonic skeletal system development and included RUNX2. In conclusion, this study confirmed an increased synovial expression of genes that may serve as targets to prevent cartilage degradation, including MMP1, MMP13, and ADAMTS4, in knees with microscopic synovitis and cartilage proteoglycan loss. Attractive novel targets include regulators of embryonic developmental processes in synovium. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Jakob T. Sieker
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Kimberly A. Waller
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Kaitlyn E. Chin
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Matthew R. Akelman
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Ata M. Kiapour
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Johannes Konrad
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Braden C. Fleming
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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138
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Klein P, Sojka M, Kucera J, Matonohova J, Pavlik V, Nemec J, Kubickova G, Slavkovsky R, Szuszkiewicz K, Danek P, Rozkot M, Velebny V. A porcine model of skin wound infected with a polybacterial biofilm. BIOFOULING 2018; 34:226-236. [PMID: 29405092 DOI: 10.1080/08927014.2018.1425684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/02/2018] [Indexed: 06/07/2023]
Abstract
A clinically relevant porcine model of a biofilm-infected wound was established in 10 minipigs. The wounds of six experimental animals were infected with a modified polymicrobial Lubbock chronic wound biofilm consisting of Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa and Bacillus subtilis. Four animals served as uninfected controls. The wounds were monitored until they had healed for 24 days. The biofilm persisted in the wounds up to day 14 and significantly affected healing. The control to infected healed wound area ratios were: 45%/21%, 66%/37%, and 90%/57% on days 7, 10 and 14, respectively. The implanted biofilm prolonged inflammation, increased necrosis, delayed granulation and impaired development of the extracellular matrix as seen in histological and gene expression analyses. This model provides a therapeutic one-week window for testing of anti-biofilm treatments and for research on the pathogenesis of wound infections in pig that is clinically the most relevant animal wound healing model.
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Affiliation(s)
- Pavel Klein
- a Biomedical Center, Faculty of Medicine in Pilsen , Charles University , Pilsen , Czech Republic
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
| | - Martin Sojka
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- c Faculty of Medicine , Slovak Medical University , Bratislava , Slovakia
| | - Jan Kucera
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- d Institute of Histology and Embryology, Faculty of Medicine in Hradec Kralove , Charles University , Hradec Kralove , Czech Republic
- e Czech Centre for Phenogenomics , Institute of Molecular Genetics/BIOCEV , Vestec , Czech Republic
| | - Jana Matonohova
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
| | - Vojtech Pavlik
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- f Department of Dermatology, Third Faculty of Medicine , Charles University , Prague , Czech Republic
| | - Jan Nemec
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
| | | | - Rastislav Slavkovsky
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- g Institute of Molecular and Translational Medicine , Palacky University , Olomouc , Czech Republic
| | - Katarzyna Szuszkiewicz
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
- h Department of Analytical Chemistry, Faculty of Chemical Technology , University of Pardubice , Pardubice , Czech Republic
| | - Petr Danek
- i Department of Pig Breeding , Institute of Animal Science , Kostelec nad Orlici , Czech Republic
| | - Miroslav Rozkot
- i Department of Pig Breeding , Institute of Animal Science , Kostelec nad Orlici , Czech Republic
| | - Vladimir Velebny
- b R&D Department , Contipro, a.s. , Dolni Dobrouc , Czech Republic
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139
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Effects of Autologous Fat and ASCs on Swine Hypertrophic Burn Scars: A Multimodal Quantitative Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1547. [PMID: 29263956 PMCID: PMC5732662 DOI: 10.1097/gox.0000000000001547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 12/14/2022]
Abstract
Background: Hypertrophic scar formation is unpredictable and poorly understood, afflicting both the pediatric and adult populations. Treatment methods with conservative and invasive approaches have low rates of compliance and high rates of morbidity. The purpose of this study was to test a reproducible scar model and investigate a new technique of scar modification through the use of adipose- derived progenitor stromal cells (ASCs). Methods: Twenty thermal deep-partial thickness contact burns were created on the dorsum of three 8-week-old domestic swine and allowed to mature for 10 weeks. Scars were then injected with 2 cc saline, expanded autologous ASCs, or 2 cc fresh lipoaspirate and sampled at 2 week intervals up to 10 weeks postinjection. Volumetric analysis with a 3-D scanner, mechanical elasticity testing through negative pressure transduction, and standardized photography evaluation with Image J was performed. RNA sequencing was performed on scar tissue samples, cultured cells, and fresh lipoaspirate to determine relevant gene transcription regulation. Immunohistochemistry was used to verify expression level changes within the scars. Results: Volumetric analysis demonstrates a reduction in average scar thickness at 6 weeks when injected with ASCs (−1.6 cc3) and autologous fat (−1.95 cc3) relative to controls (−0.121 cc3; P < 0.05). A decrease in overall tissue compliance is observed with fat or ASC injection when compared with unburned skin at 8 weeks (35.99/37.94 versus 49.36 mm Hg × mm; P < 0.01). RNA sequencing demonstrates altered regulation of fibroblast gene expression and a decreased inflammatory profile when scars are injected with autologous fat/ASCs over controls. Conclusion: Early results suggest that autologous fat and/or ASCs may improve healing of hypertrophic scarring by altering the cellular and structural components during wound remodeling up to 20 weeks after injury. This may have beneficial applications in early treatment of large or cosmetically sensitive immature burn scars.
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140
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Hauzenberger JR, Hipszer BR, Loeum C, McCue PA, DeStefano M, Torjman MC, Kaner MT, Dinesen AR, Chervoneva I, Pieber TR, Joseph JI. Detailed Analysis of Insulin Absorption Variability and the Tissue Response to Continuous Subcutaneous Insulin Infusion Catheter Implantation in Swine. Diabetes Technol Ther 2017; 19:641-650. [PMID: 28981324 PMCID: PMC5689134 DOI: 10.1089/dia.2017.0175] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Worldwide, ∼1 million people manage their type 1 diabetes with an insulin pump and a continuous subcutaneous insulin infusion (CSII) catheter. Patients routinely insert a new catheter every 2-3 days due to increasing variability of insulin absorption over time. Catheter insertion and maintenance damage capillaries, lymphatics, cells, and connective tissue leading to an acute inflammatory response. METHODS We compared an investigational CSII catheter (IC) and a commercial CSII catheter (CC) regarding insulin absorption pharmacokinetics (PK) and tissue inflammation. The two different catheter designs were implanted into the subcutaneous tissue of six swine for 5 days. Insulin boluses were given on days 1, 3, and 5 of wear-time to assess PK. Tissue around catheters was excised and stained to visualize inflammation and morphological changes of adjacent tissue. RESULTS Insulin absorption was better when infused through a CC with highest Cmax and fastest tmax values on day 5 of catheter wear-time. Both catheter types produced high intra- and intersubject day-to-day insulin absorption variability. The IC caused significantly more tissue disruption and lead to irregular changes in tissue morphology. Both catheter types were surrounded by a layer of inflammatory tissue that varied in composition, thickness, and density over time. A catheter that was manually inserted by pushing a sharp tip through the skin caused more trauma and variability than a 90° Teflon cannula with automated insertion. CONCLUSIONS Insulin absorption variability could be attributed to the layer of inflammatory tissue, which may function as a mechanical barrier to insulin flow into adjacent vascular tissue. The impact of the acute inflammatory tissue response on insulin absorption has to be considered in future catheter designs. A catheter that was manually inserted by pushing a sharp tip through the skin caused more trauma and variability than a 90° Teflon cannula with automated insertion.
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Affiliation(s)
- Jasmin R. Hauzenberger
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Brian R. Hipszer
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Channy Loeum
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Peter A. McCue
- Department of Pathology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Marc C. Torjman
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahmut T. Kaner
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alek R. Dinesen
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Inna Chervoneva
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jeffrey I Joseph
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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141
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Jensen LK, Johansen ASB, Jensen HE. Porcine Models of Biofilm Infections with Focus on Pathomorphology. Front Microbiol 2017; 8:1961. [PMID: 29067019 PMCID: PMC5641329 DOI: 10.3389/fmicb.2017.01961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/22/2017] [Indexed: 12/20/2022] Open
Abstract
Bacterial biofilm formation is one of the main reasons for a negative treatment outcome and a high recurrence rate for many chronic infections in humans. The optimal way to study both the biofilm forming bacteria and the host response simultaneously is by using discriminative, reliable, and reproducible animal models of the infections. In this review, the advantages of in vivo studies are compared to in vitro studies of biofilm formation in infectious diseases. The pig is the animal of choice when developing and applying large animal models of infectious diseases due to its similarity of anatomy, physiology, and immune system to humans. Furthermore, conventional pigs spontaneously develop many of the same chronic bacterial infections as seen in humans. Therefore, in this review porcine models of five different infectious diseases all associated with biofilm formation and chronicity in humans are described. The infectious diseases are: chronic wounds, endocarditis, pyelonephritis, hematogenous osteomyelitis, and implant-associated osteomyelitis (IAO).
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Affiliation(s)
- Louise K Jensen
- Section for Experimental Animal Models, Department of Veterinary and Animal Science, Faculty of Health and Medical Science, University of Copenhagen, Frederiksberg, Denmark
| | - Anne S B Johansen
- Section for Experimental Animal Models, Department of Veterinary and Animal Science, Faculty of Health and Medical Science, University of Copenhagen, Frederiksberg, Denmark
| | - Henrik E Jensen
- Section for Experimental Animal Models, Department of Veterinary and Animal Science, Faculty of Health and Medical Science, University of Copenhagen, Frederiksberg, Denmark
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142
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Yu COL, Leung KS, Jiang JL, Wang TBY, Chow SKH, Cheung WH. Low-Magnitude High-Frequency Vibration Accelerated the Foot Wound Healing of n5-streptozotocin-induced Diabetic Rats by Enhancing Glucose Transporter 4 and Blood Microcirculation. Sci Rep 2017; 7:11631. [PMID: 28912573 PMCID: PMC5599683 DOI: 10.1038/s41598-017-11934-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/30/2017] [Indexed: 01/13/2023] Open
Abstract
Delayed wound healing is a Type 2 diabetes mellitus (DM) complication caused by hyperglycemia, systemic inflammation, and decreased blood microcirculation. Skeletal muscles are also affected by hyperglycemia, resulting in reduced blood flow and glucose uptake. Low Magnitude High Frequency Vibration (LMHFV) has been proven to be beneficial to muscle contractility and blood microcirculation. We hypothesized that LMHFV could accelerate the wound healing of n5-streptozotocin (n5-STZ)-induced DM rats by enhancing muscle activity and blood microcirculation. This study investigated the effects of LMHFV in an open foot wound created on the footpad of n5-STZ-induced DM rats (DM_V), compared with no-treatment DM (DM), non-DM vibration (Ctrl_V) and non-DM control rats (Ctrl) on Days 1, 4, 8 and 13. Results showed that the foot wounds of DM_V and Ctrl_V rats were significantly reduced in size compared to DM and Ctrl rats, respectively, at Day 13. The blood glucose level of DM_V rats was significantly reduced, while the glucose transporter 4 (GLUT4) expression and blood microcirculation of DM_V rats were significantly enhanced in comparison to those of DM rats. In conclusion, LMHFV can accelerate the foot wound healing process of n5-STZ rats.
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Affiliation(s)
- Caroline Oi-Ling Yu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kwok-Sui Leung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jonney Lei Jiang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tina Bai-Yan Wang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.,The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China
| | - Wing-Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, PR China.
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143
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Dhand C, Venkatesh M, Barathi VA, Harini S, Bairagi S, Goh Tze Leng E, Muruganandham N, Low KZW, Fazil MHUT, Loh XJ, Srinivasan DK, Liu SP, Beuerman RW, Verma NK, Ramakrishna S, Lakshminarayanan R. Bio-inspired crosslinking and matrix-drug interactions for advanced wound dressings with long-term antimicrobial activity. Biomaterials 2017; 138:153-168. [DOI: 10.1016/j.biomaterials.2017.05.043] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 01/19/2023]
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144
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Lohmann N, Schirmer L, Atallah P, Wandel E, Ferrer RA, Werner C, Simon JC, Franz S, Freudenberg U. Glycosaminoglycan-based hydrogels capture inflammatory chemokines and rescue defective wound healing in mice. Sci Transl Med 2017; 9:9/386/eaai9044. [PMID: 28424334 DOI: 10.1126/scitranslmed.aai9044] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/17/2017] [Accepted: 03/29/2017] [Indexed: 12/31/2022]
Abstract
Excessive production of inflammatory chemokines can cause chronic inflammation and thus impair cutaneous wound healing. Capturing chemokine signals using wound dressing materials may offer powerful new treatment modalities for chronic wounds. Here, a modular hydrogel based on end-functionalized star-shaped polyethylene glycol (starPEG) and derivatives of the glycosaminoglycan (GAG) heparin was customized for maximal chemokine sequestration. The material is shown to effectively scavenge the inflammatory chemokines MCP-1 (monocyte chemoattractant protein-1), IL-8 (interleukin-8), and MIP-1α (macrophage inflammatory protein-1α) and MIP-1β (macrophage inflammatory protein-1β) in wound fluids from patients suffering from chronic venous leg ulcers and to reduce the migratory activity of human monocytes and polymorphonuclear neutrophils. In an in vivo model of delayed wound healing (db/db mice), starPEG-GAG hydrogels outperformed the standard-of-care product Promogran with respect to reduction of inflammation, as well as increased granulation tissue formation, vascularization, and wound closure.
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Affiliation(s)
- Nadine Lohmann
- Department of Dermatology, Venerology, and Allergology, Leipzig University, 04103 Leipzig, Germany.,Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany
| | - Lucas Schirmer
- Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany.,Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, 01069 Dresden, Germany
| | - Passant Atallah
- Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany.,Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, 01069 Dresden, Germany
| | - Elke Wandel
- Department of Dermatology, Venerology, and Allergology, Leipzig University, 04103 Leipzig, Germany.,Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany
| | - Ruben A Ferrer
- Department of Dermatology, Venerology, and Allergology, Leipzig University, 04103 Leipzig, Germany.,Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany
| | - Carsten Werner
- Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany.,Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, 01069 Dresden, Germany.,Technische Universität Dresden, Center for Regenerative Therapies Dresden, Fetscherstraße 105, 01307 Dresden, Germany
| | - Jan C Simon
- Department of Dermatology, Venerology, and Allergology, Leipzig University, 04103 Leipzig, Germany.,Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany
| | - Sandra Franz
- Department of Dermatology, Venerology, and Allergology, Leipzig University, 04103 Leipzig, Germany. .,Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany
| | - Uwe Freudenberg
- Collaborative Research Center (SFB-TR67) "Functional Biomaterials for Controlling Healing Processes in Bone and Skin-From Material Science to Clinical Application," Leipzig and Dresden, Germany. .,Leibniz Institute of Polymer Research Dresden, Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, 01069 Dresden, Germany
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145
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Meyerholz DK, Reznikov LR. Simple and reproducible approaches for the collection of select porcine ganglia. J Neurosci Methods 2017; 289:93-98. [PMID: 28602889 DOI: 10.1016/j.jneumeth.2017.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND The anatomy and physiology of the pig nervous system is more similar to humans compared to traditional rodent models. This makes the pig an attractive model to answer questions relating to human health and disease. Yet the technical and molecular tools available to pig researchers are limited compared to rodent researchers. NEW METHOD We developed simple and rapid methods to isolate the trigeminal, nodose (distal vagal), and dorsal root ganglia from neonatal pigs. We selected these ganglia due to their broad applicability to basic science researchers and clinicians. RESULTS Use of these methods resulted in reproducible isolation of all three types of ganglia as validated by histological examination. COMPARISON WITH EXISTING METHOD(S) There are currently no methods that describe a step-by-step protocol to isolate these porcine ganglia. CONCLUSIONS In conclusion, these methods for ganglia collection will facilitate and accelerate future neuroscience investigations in pig models of human disease.
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Affiliation(s)
- David K Meyerholz
- Department of Pathology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Leah R Reznikov
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA.
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146
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Chen S, Liu B, Carlson MA, Gombart AF, Reilly DA, Xie J. Recent advances in electrospun nanofibers for wound healing. Nanomedicine (Lond) 2017; 12:1335-1352. [PMID: 28520509 PMCID: PMC6661929 DOI: 10.2217/nnm-2017-0017] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/23/2017] [Indexed: 01/08/2023] Open
Abstract
Electrospun nanofibers represent a novel class of materials that show great potential in many biomedical applications including biosensing, regenerative medicine, tissue engineering, drug delivery and wound healing. In this work, we review recent advances in electrospun nanofibers for wound healing. This article begins with a brief introduction on the wound, and then discusses the unique features of electrospun nanofibers critical for wound healing. It further highlights recent studies that have used electrospun nanofibers for wound healing applications and devices, including sutures, multifunctional dressings, dermal substitutes, engineered epidermis and full-thickness skin regeneration. Finally, we finish with conclusions and future perspective in this field.
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Affiliation(s)
- Shixuan Chen
- Department of Surgery–Transplant & Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Bing Liu
- Department of Surgery–Transplant & Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Mark A Carlson
- Departments of Surgery & Genetics, Cell Biology & Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Surgery, VA Nebraska–Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Adrian F Gombart
- Department of Biochemistry & Biophysics & Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, USA
| | - Debra A Reilly
- Departments of Surgery–Plastic & Reconstructive Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jingwei Xie
- Department of Surgery–Transplant & Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE 68198, USA
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147
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Yu COL, Leung KS, Fung KP, Lam FFY, Ng ESK, Lau KM, Chow SKH, Cheung WH. The characterization of a full-thickness excision open foot wound model in n5-streptozotocin (STZ)-induced type 2 diabetic rats that mimics diabetic foot ulcer in terms of reduced blood circulation, higher C-reactive protein, elevated inflammation, and reduced cell proliferation. Exp Anim 2017; 66:259-269. [PMID: 28413186 PMCID: PMC5543247 DOI: 10.1538/expanim.17-0016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Delayed foot wound healing is a major complication attributed to hyperglycemia in type 2
diabetes mellitus (DM) patients, and these wounds may develop into foot ulcers. There are
at least two types of DM wound models used in rodents to study delayed wound healing.
However, clinically relevant animal models are not common. Most models use type 1 DM
rodents or wounds created on the back rather than on the foot. An open full-thickness
excision wound on the footpad of type 2 DM rats is more clinically relevant, but such a
model has not yet been characterized systematically. The objective of this study was to
investigate and characterize how DM affected a full-thickness excision open foot wound in
n5-streptozotocin (n5-STZ)-induced type 2 DM rats. We hypothesized that elevated
inflammation, reduced blood circulation, and cell proliferation due to hyperglycemia could
delay the wound healing of DM rats. The wounds of DM rats were compared with those of
non-DM rats (Ctrl) at Days 1 and 8 post wounding. The wound healing process of the DM rats
was significantly delayed compared with that of the Ctrl rats. The DM rats also had higher
C-reactive protein (CRP) and lower blood circulation and proliferating cell nuclear
antigen (PCNA) in DM wounds. This confirmed that elevated inflammation and reduced blood
flow and cell proliferation delayed foot wound healing in the n5-STZ rats. Hence, this
open foot wound animal model provides a good approach to study the process of delayed
wound healing.
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Affiliation(s)
- Caroline Oi-Ling Yu
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, P.R. China
| | - Kwok-Sui Leung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, P.R. China
| | - Kwok-Pui Fung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, P.R. China
| | - Francis Fu-Yuen Lam
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, P.R. China
| | - Ethel Sau-Kuen Ng
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, P.R. China
| | - Kit-Man Lau
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, P.R. China.,State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, Hong Kong, P.R. China
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, P.R. China.,The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, 10 Yue Xin Er Dao, Shenzhen, P.R. China
| | - Wing-Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, P.R. China.,The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, 10 Yue Xin Er Dao, Shenzhen, P.R. China
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148
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McIntyre MK, Peacock TJ, Akers KS, Burmeister DM. Initial Characterization of the Pig Skin Bacteriome and Its Effect on In Vitro Models of Wound Healing. PLoS One 2016; 11:e0166176. [PMID: 27824921 PMCID: PMC5100914 DOI: 10.1371/journal.pone.0166176] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/24/2016] [Indexed: 02/01/2023] Open
Abstract
Elucidating the roles and composition of the human skin microbiome has revealed a delicate interplay between resident microbes and wound healing. Evolutionarily speaking, normal cutaneous flora likely has been selected for because it potentiates or, at minimum, does not impede wound healing. While pigs are the gold standard model for wound healing studies, the porcine skin microbiome has not been studied in detail. Herein, we performed 16S rDNA sequencing to characterize the pig skin bacteriome at several anatomical locations. Additionally, we used bacterial conditioned-media with in vitro techniques to examine the paracrine effects of bacterial-derived proteins on human keratinocytes (NHEK) and fibroblasts (NHDF). We found that at the phyla level, the pig skin bacteriome is similar to that of humans and largely consists of Firmicutes (55.6%), Bacteroidetes (20.8%), Actinobacteria (13.3%), and Proteobacteria (5.1%) however species-level differences between anatomical locations exist. Studies of bacterial supernatant revealed location-dependent effects on NHDF migration and NHEK apoptosis and growth factor release. These results expand the limited knowledge of the cutaneous bacteriome of healthy swine, and suggest that naturally occurring bacterial flora affects wound healing differentially depending on anatomical location. Ultimately, the pig might be considered the best surrogate for not only wound healing studies but also the cutaneous microbiome. This would not only facilitate investigations into the microbiome’s role in recovery from injury, but also provide microbial targets for enhancing or accelerating wound healing.
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Affiliation(s)
- Matthew K. McIntyre
- Damage Control Resuscitation, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Trent J. Peacock
- Dental Trauma Research Detachment, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Kevin S. Akers
- Extremity Trauma and Regenerative Medicine, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - David M. Burmeister
- Damage Control Resuscitation, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
- * E-mail:
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149
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Development of a precise experimental burn model. Burns 2016; 42:1507-1512. [DOI: 10.1016/j.burns.2016.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 12/14/2022]
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150
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Amundsen T, Sørhaug S, Leira HO, Tyvold SS, Langø T, Hammer T, Manstad-Hulaas F, Mattsson E. A new removable airway stent. Eur Clin Respir J 2016; 3:30010. [PMID: 27608269 PMCID: PMC5015637 DOI: 10.3402/ecrj.v3.30010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 08/02/2016] [Indexed: 11/20/2022] Open
Abstract
Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use.
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Affiliation(s)
- Tore Amundsen
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway.,Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway;
| | - Sveinung Sørhaug
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway.,Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | - Håkon Olav Leira
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway.,Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway
| | | | - Thomas Langø
- Department of Medical Technology, SINTEF, Trondheim, Norway.,Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St Olavs Hospital, Trondheim, Norway
| | - Tommy Hammer
- Department of Radiology, St, Olavs Hospital, Trondheim, Norway
| | - Frode Manstad-Hulaas
- Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.,Department of Radiology, St, Olavs Hospital, Trondheim, Norway
| | - Erney Mattsson
- Faculty of Medicine, Institute of Circulation and Medical Imaging, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.,Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
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