Biocompatible, drug-loaded anti-adhesion barrier using visible-light curable furfuryl gelatin derivative

Barrier materials for prevention of surgical adhesions: systematic review

BACKGROUND

Postoperative surgical adhesions constitute a major health burden internationally. A wide range of materials have been evaluated, but despite constructive efforts and the obvious necessity, there remains no specific barrier widely utilized to prevent postoperative adhesion formation. The aim of this study was to highlight and characterize materials used for prevention of postoperative surgical adhesions in both animal and human studies.

METHODS

A systematic review was performed of all original research articles presenting data related to the prevention of postoperative adhesions using a barrier agent. All available observational studies and randomized trials using animal models or human participants were included, with no restrictions related to type of surgery. PubMed and Embase databases were searched using key terms from inception to August 2019. Standardized data collection forms were used to extract details for each study and assess desirable characteristics of each barrier and success in animal and/or human studies.

RESULTS

A total of 185 articles were identified for inclusion in the review, with a total of 67 unique adhesion barrier agents (37 natural and 30 synthetic materials). Desirable barrier characteristics of an ideal barrier were identified on review of the literature. Ten barriers achieved the primary outcome of reducing the incidence of postoperative adhesions in animal studies followed with positive outputs in human participants. A further 48 materials had successful results from animal studies, but with no human study performed to date.

DISCUSSION

Multiple barriers showed promise in animal studies, with several progressing to success, and fulfilment of desirable qualities, in human trials. No barrier is currently utilized commonly worldwide, but potential barriers have been identified to reduce the burden of postoperative adhesions and associated sequelae.

Terahertz Spectral Properties of PEO-Based Anti-Adhesion Films Cross-Linked by Electron Beam Irradiation

We investigated the spectral property changes in anti-adhesion films, which were cross-linked and surface-modified through electron beam irradiation, using terahertz time-domain spectroscopy (THz-TDS). Polyethylene oxide (PEO), which is a biocompatible and biodegradable polymer, was the main component of these anti-adhesion films being manufactured for testing. The terahertz characteristics of the films were affected by the porosity generated during the freeze-drying and compression processes of sample preparation, and this was confirmed using optical coherence tomography (OCT) imaging. An anti-adhesion polymer film made without porosity was measured by using the THz-TDS method, and it was confirmed that the refractive index and absorption coefficient were dependent on the crosslinking state. To our knowledge, this is the first experiment on the feasibility of monitoring cross-linking states using terahertz waves. The THz-TDS method has potential as a useful nondestructive technique for polymer inspection and analysis.

Photopolymerization of Bio-Based Polymers in a Biomedical Engineering Perspective

Photopolymerization is an effective method to covalently cross-link polymer chains that can be shaped into several biomedical products and devices. Additionally, polymerization reaction may induce a fluid-solid phase transformation under physiological conditions and is ideal for in vivo cross-linking of injectable polymers. The photoinitiator is a key ingredient able to absorb the energy at a specific light wavelength and create radicals that convert the liquid monomer solution into polymers. The combination of photopolymerizable polymers, containing appropriate photoinitiators, and effective curing based on dedicated light sources offers the possibility to implement photopolymerization technology in 3D bioprinting systems. Hence, cell-laden structures with high cell viability and proliferation, high accuracy in production, and good control of scaffold geometry can be biofabricated. In this review, we provide an overview of photopolymerization technology, focusing our efforts on natural polymers, the chemistry involved, and their combination with appropriate photoinitiators to be used within 3D bioprinting and manufacturing of biomedical devices. The reviewed articles showed the impact of different factors that influence the success of the photopolymerization process and the final properties of the cross-linked materials.

Sequential release of double drug (graded distribution) loaded gelatin microspheres/PMMA bone cement

Drugs are loaded into PMMA bone cement to reduce the risk of infection in freshly implanted prostheses or to promote the differentiation and growth of osteoblasts. However, the same method of loading of drugs in the bone cement cannot simultaneously achieve an effective antibacterial response and long-term treatment outcomes for osteoporosis based on a patient's clinical needs. In the present study, gentamicin sulfate (GS)/alendronate (ALN)-dual-loaded gelatin modified PMMA bone cement (GAPBC) was fabricated to provide rapid and continuous antibiotic release and long-term anti-osteoporotic therapy. Specifically, the gelatin microspheres were loaded with the drugs using separate methodologies, namely, ALN was loaded during fabrication of the gelatin microspheres after which GS was absorbed onto the gelatin from solution. The results demonstrate that sequential release of the GS and ALN was achieved, GS release playing a major role over the first 24 hours and ALN release dominant after 3 weeks of immersion in PBS, resulting from the graded distribution within the gelatin microspheres, and the final drug release ratio of GS (73.6%) and ALN (68.5%) from the modified bone cement was significantly higher than from PMMA bone cement. Therefore, GAPBC represents a potential drug carrier for future clinical applications.

Advancement of Biomaterial-Based Postoperative Adhesion Barriers

Postoperative peritoneal adhesion (PPA) is a prevalent incidence that generally happens during the healing process of traumatized tissues. It causes multiple severe complications such as intestinal obstruction, chronic abdominal pain, and female infertility. To prevent PPA, several antiadhesion materials and drug delivery systems composed of biomaterials are used clinically, and clinical antiadhesive is one of the important applications nowadays. In addition to several commercially available materials, like film, spray, injectable hydrogel, powder, or solution type have been energetically studied based on natural and synthetic biomaterials such as alginate, hyaluronan, cellulose, starch, chondroitin sulfate, polyethylene glycol, polylactic acid, etc. Moreover, many kinds of animal adhesion models, such as cecum abrasion models and unitary horn models, are developed to evaluate new materials' efficacy. A new animal adhesion model based on hepatectomy and conventional animal adhesion models is recently developed and a new adhesion barrier by this new model is also developed. In summary, many kinds of materials and animal models are studied; thus, it is quite important to overview this field's current progress. Here, PPA is reviewed in terms of the species of biomaterials and animal models and several problems to be solved to develop better antiadhesion materials in the future are discussed.

Combination of Polypropylene Mesh and in Situ Injectable Mussel-Inspired Hydrogel in Laparoscopic Hernia Repair for Preventing Post-Surgical Adhesions in the Piglet Model

Polypropylene (PP) mesh has been used successfully for a long time in clinical practice as an impressive prosthesis for ventral hernia repair. To utilize a physical barrier for separating mesh from viscera is a general approach for preventing adhesions in clinical practice. However, a serious abdominal adhesion between the mesh and viscera can possibly occur post-hernia, especially with the small intestine; this can lead to a series of complications, such as chronic pain, intestinal obstruction, and fistula. Thus, determining how to prevent abdominal adhesions between the mesh and viscera is still an urgent clinical problem. In this study, a dopamine-functionalized polysaccharide derivative (oxidized-carboxymethylcellulose-g-dopamine, OCMC-DA) was synthesized; this was blended with carboxymethylchitosan (CMCS) to form a hydrogel (OCMC-DA/CMCS) in situ at the appropriate time. The physical and chemical properties of the hydrogel were characterized successfully, and its excellent biocompatibility was presented by the in vitro cell test. The combination of this hydrogel and PP mesh was used in laparoscopic surgery for repairing the abdominal wall defect, where the hydrogel could become fixed in situ on the PP mesh to form an anti-adhesion gel-mesh. The results showed that the gel-mesh could prevent abdominal adhesions effectively in the piglet model. Moreover, the histology and immunohistochemical staining proved that the gel-mesh could effectively alleviate the inflammation reaction and deposition of collagen around the mesh, and it did not disturb the integration between mesh and abdominal wall. Thus, the gel-mesh has superior tissue compatibility.

Cross-linked cartilage acellular matrix film decreases postsurgical peritendinous adhesions

Cartilage extracellular matrix contains antiadhesive and antiangiogenic molecules such as chondromodulin-1, thrombospondin-1, and endostatin. We have aimed to develop a cross-linked cartilage acellular matrix (CAM) barrier for peritendinous adhesion prevention. CAM film was fabricated using decellularized porcine cartilage tissue powder and chemical cross-linking. Biochemical analysis of the film showed retention of collagen and glycosaminoglycans after the fabrication process. Physical characterization of the film showed denser collagen microstructure, increased water contact angle, and higher tensile strength after cross-linking. The degradation time in vivo was 14 d after cross-linking. The film extract and film surface showed similar cell proliferation, while inhibiting cell migration and cell adhesion compared to standard media and culture plate, respectively. Application of the film after repair resulted in similar tendon healing and significantly less peritendinous adhesions in a rabbit Achilles tendon injury model compared to repair only group, demonstrated by histology, ultrasonography, and biomechanical testing. In conclusion, the current study developed a CAM film having biological properties of antiadhesion, together with biomechanical properties and degradation profile suitable for prevention of peritendinous adhesions.

Comparison of Honey versus Polylactide Anti-Adhesion Barrier on Peritoneal Adhesion and Healing of Colon Anastomosis in Rabbits

BACKGROUND:

Postoperative adhesion is still a consequence of intra-abdominal surgeries, which results in bowel obstruction and abdominopelvic pain. Bowel anastomosis as a common abdominal surgery has the incidence of leakage in up to 30% of patients that increase morbidity and mortality. Due to similar pathways of adhesion formation and wound healing, it is important to find a way to reduce adhesions and anastomosis leakage.

AIM:

This study was designed to compare antiadhesive as well as anastomosis healing improvement effect of honey and polylactide anti-adhesive barrier film.

METHODS:

Forty-five rabbits divided into three groups of honey, adhesion barrier film, and control group in an animal study. Under a similar condition, rabbits underwent resection and anastomosis of cecum under general anaesthesia. In the first group, honey was used at the anastomosis site, in the second one polylactide adhesion barrier film utilised, and the third one was the control group. Adhesion, as well as anastomosis leakage, was assessed after 21 days. Data were analysed using the Statistical Package for Social Scientists (SPSS) for Windows version 25.

RESULTS:

Three groups of 15 rabbits were studied. The results showed that mean peritoneal adhesion score (PAS) was lower in the honey group (1.67) in comparison to the adhesion barrier film group (3.40) and the control group (6.33).

CONCLUSION:

Bio-absorbable polylactide barrier has an anti-adhesion effect but is not suitable for intestinal anastomosis in rabbits. Further studies needed to evaluate these effects on human beings.

Mussel-inspired copolymer-coated polypropylene mesh with anti-adhesion efficiency for abdominal wall defect repair

Construction of anti-adhesive polypropylene meshes through the in situ copolymerization grafting of poly(ethylene glycol) methacrylate and dopamine methacrylamide.