1
|
Kennewell TL, Haidari H, Mashtoub S, Howarth GS, Wormald PJ, Cowin AJ, Vreugde S, Kopecki Z. Deferiprone and Gallium-Protoporphyrin Chitogel as an antimicrobial treatment: Preclinical studies demonstrating antimicrobial activity for S. aureus infected cutaneous wounds. Int J Biol Macromol 2024; 276:133874. [PMID: 39013511 DOI: 10.1016/j.ijbiomac.2024.133874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/18/2024]
Abstract
Staphylococcus aureus (S. aureus) is one of the most common wound pathogens with increased resistance towards currently available antimicrobials. S. aureus biofilms lead to increase wound chronicity and delayed healing. Chitosan-dextran hydrogel (Chitogel) loaded with the hydroxypyridinone-derived iron chelator Deferiprone (Def) and the heme analogue Gallium-Protoporphyrin (GaPP) have previously been shown to have antimicrobial effects in clinical sinusitis. In this study, the efficacy of Chitogel loaded with Def, GaPP and a combination of Def and GaPP, were investigated in an S. aureus biofilm infected wound murine model over 10 days of treatment. Bacterial wound burden was monitored daily showing a significant decrease in bacterial bioburden on days 6 and 8 when treated with Def-GaPP Chitogel (log10 1.0 and 1.2 reduction vs control, respectively). The current study demonstrates that the combination of Def-GaPP delivered in a Chitogel in vivo is not only effective in reducing S. aureus biofilm infection, but also improves cutaneous healing via effects on reduced inflammation, promotion of anti-inflammatory macrophage phenotype and marked early collagen deposition in the wound bed. This delivery platform presents a promising alternative non-toxic, antibacterial, wound-promoting treatment as a novel approach for the management of S. aureus wound infections that warrants further clinical investigation.
Collapse
Affiliation(s)
- T L Kennewell
- Future Industries Institute, University of South Australia, Mawson Lakes, SA, Australia
| | - H Haidari
- Future Industries Institute, University of South Australia, Mawson Lakes, SA, Australia
| | - S Mashtoub
- School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia; Department of Gastroenterology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - G S Howarth
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
| | - P J Wormald
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - A J Cowin
- Future Industries Institute, University of South Australia, Mawson Lakes, SA, Australia
| | - S Vreugde
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Z Kopecki
- Future Industries Institute, University of South Australia, Mawson Lakes, SA, Australia.
| |
Collapse
|
2
|
Wu X, Yang Y. Neutrophil extracellular traps (NETs) and fibrotic diseases. Int Immunopharmacol 2024; 133:112085. [PMID: 38626550 DOI: 10.1016/j.intimp.2024.112085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/18/2024]
Abstract
Fibrosis, a common cause and serious outcome of organ failure that can affect any organ, is responsible for up to 45% of all deaths in various clinical settings. Both preclinical models and clinical trials investigating various organ systems have shown that fibrosis is a highly dynamic process. Although many studies have sought to gain understanding of the mechanism of fibrosis progression, their findings have been mixed. In recent years, increasing evidence indicates that neutrophil extracellular traps (NETs) are involved in many inflammatory and autoimmune disorders and participate in the regulation of fibrotic processes in various organs and systems. In this review, we summarize the current understanding of the role of NETs in fibrosis development and progression and their possibility as therapeutic targets.
Collapse
Affiliation(s)
- Xiaojiao Wu
- School of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Yang Yang
- Department of Gastroenterology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China.
| |
Collapse
|
3
|
Qiu R, Cai K, Zhang K, Ying Y, Hu H, Jiang G, Luo K. The current status and development trend of hydrogel application in spinal surgery. J Mater Chem B 2024; 12:1730-1747. [PMID: 38294330 DOI: 10.1039/d3tb02613b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Spinal diseases often result in compromised mobility and diminished quality of life due to the intricate anatomy surrounding the nervous system. Medication and surgical interventions remain the primary treatment methods for spinal conditions. However, currently available medications have limited efficacy in treating spinal surgical diseases and cannot achieve a complete cure. Furthermore, surgical intervention frequently results in inevitable alterations and impairments to the initial anatomical integrity of the spinal structure, accompanied by the consequential loss of certain physiological functionalities. Changes in spine surgery treatment concepts and modalities in the last decade have led to a deepening of minimally invasive treatment, with treatment strategies focusing more on repairing and reconstructing the patient's spine and preserving physiological functions. Therefore, developing novel and more efficient treatment strategies to reduce spinal lesions and iatrogenic injuries is essential. In recent years, significant advancements in biomedical research have led to the discovery that hydrogels possess excellent biocompatibility, biodegradability, and adjustable mechanical properties. The application of hydrogel-based biotechnology in spinal surgery has demonstrated remarkable therapeutic potential. This review presents the therapeutic strategies for spinal diseases based on hydrogel tissue engineering technology.
Collapse
Affiliation(s)
- Rongzhang Qiu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Kaiwen Cai
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kai Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Yijian Ying
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Hangtian Hu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Guoqiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| | - Kefeng Luo
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China.
| |
Collapse
|
4
|
Mascarenhas AR, Vediappan RS, Jukes AK, Bouras G, Kaukas LM, Chryssidis S, Manavis J, Finnie J, Moratti S, Vreugde S, Psaltis AJ, Wormald PJ. Haemostatic efficacy and inflammatory response of a novel beta-chitin patch in a cerebral small vessel injury model - A pilot study. J Clin Neurosci 2023; 114:70-76. [PMID: 37321020 DOI: 10.1016/j.jocn.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Rapid and efficacious haemostasis is paramount in neurosurgery. Assessing the efficacy and short- and long-term safety of haemostatic agents utilised within cerebral tissue is essential. This pilot study investigates the haemostatic efficacy and long-term safety of a novel beta-chitin patch against traditionally used agents, bipolar and Floseal, within cerebral tissue. METHODS Eighteen Merino sheep underwent standardised distal cortical vessel injury via temporal craniotomy. Sheep were randomised to receive 2 mls Floseal, 2 cm novel beta-chitin patch, or bipolar cautery to manage bleeding. All sheep underwent cerebral magnetic resonance imaging (MRI) at three months, before euthanasia and brain harvesting for histological assessment. RESULTS Beta-chitin demonstrated a trend towards a faster mean time to haemostasis (TTH) compared to Floseal (223.3 ± 199 s v. 259.8 ± 186.4 s), albeit non-significant (p = 0.234). Radiologically, cerebrocortical necrosis (p = 0.842) and oedema (p = 0.368) were noted slightly more frequently in the beta-chitin group. Histologically, severe fibrotic (p = 0.017) and granulomatous changes at the craniotomy sites were only present in the beta-chitin group (p = 0.002). Neuronal degeneration was seen in all with Floseal, but beta-chitin showed a trend towards more severe reaction when present. Bipolar use predominantly showed an inflammatory cortical reaction with substantial microvascular proliferation, and Floseal showed worse severity and depth of subpial oedema, however no statistical significance was reached. CONCLUSION All haemostats controlled bleeding, with beta-chitin demonstrating a non-inferior TTH compared to Floseal. However, it resulted in intense granulomatous and fibrotic changes, including degenerative neuronal reactions. More extensive studies are needed to assess these trends, to make further clinical inferences.
Collapse
Affiliation(s)
- Annika R Mascarenhas
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia.
| | - Rajan S Vediappan
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Alistair K Jukes
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - George Bouras
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Lola M Kaukas
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Steve Chryssidis
- Department of Medical Imaging, Flinders Medical Centre, Adelaide, Australia
| | - Jim Manavis
- Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - John Finnie
- Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Stephen Moratti
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Sarah Vreugde
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| |
Collapse
|
5
|
Vediappan RS, Bennett C, Cooksley C, Bassiouni A, Scott JR, Al Suliman YA, Lumyongsatien J, Moratti S, Psaltis AJ, Vreugde S, Wormald PJ. Wound healing in endoscopic sinus surgery: Phase 1 clinical trial evaluating the role of Chitogel with adjuvants. Clin Otolaryngol 2023; 48:158-166. [PMID: 36317791 DOI: 10.1111/coa.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/07/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to determine the safety and efficacy of Chitogel, with and without Deferiprone (Def) and Gallium Protoporphyrin (GaPP), as a promoter of wound healing to improve surgical outcomes after endoscopic sinus susgery. DESIGN A double-blinded, randomised control human clinical trial was conducted in patients undergoing ESS as a treatment for chronic rhinosinusitis. Participants underwent functional ESS or FESS with drill out as required and were randomised to receive test product Chitogel, Chitogel in combination with Def or Def-GaPP versus no packing (control). SETTING Ostial stenosis and persistent inflammation are the main reasons for revision endoscopic sinus surgery (ESS). Post-operative (PO) dressings can improve PO wound healing and patient outcomes after ESS. PARTICIPANTS Eighty two patients were included in this study with 79 patients completing the study with 40 undergoing full house FESS and 39 FESS plus frontal drillout. MAIN OUTCOME MEASURES Patients were followed up at 2, 6 and 12 weeks PO, and outcome scores such as SNOT-22, VAS and LKS, pre and post-surgery (12 weeks) were compared. RESULTS Seventy nine patients completed the study, there was a significant reduction in SNOT-22 score and improvement of VAS at 12 weeks in patients treated with Chitogel compared to control (p < .05). In those patients, the mean ostium area for the Chitogel and the Chitogel + Def + GaPP groups was higher across all three sinuses compared to the no-treatment control group, without statistical significance. Sphenoid sinus ostium was significantly more patent in patients treated with Chitogel compared to the control at the 12-week time point (p < .05). CONCLUSION Chitogel as a PO dressing after ESS results in the best patient-reported symptom scores and objective measurements. The combination of Def and GaPP to Chitogel though proving safe, had no effect on the ostium patency or mucosal healing.
Collapse
Affiliation(s)
- Rajan Sundaresan Vediappan
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of ENT, Unit-1, Head & Neck, Skull Base Surgery, Christian Medical College, Vellore, India
| | - Catherine Bennett
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Clare Cooksley
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ahmed Bassiouni
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - John R Scott
- Department of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yazeed A Al Suliman
- Department of Otolaryngology, Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Jate Lumyongsatien
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Stephen Moratti
- Department of Chemistry, Otago University, Dunedin, New Zealand
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology Head and Neck Surgery, Central Adelaide Health Network, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology Head and Neck Surgery, Central Adelaide Health Network, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology Head and Neck Surgery, Central Adelaide Health Network, Adelaide, Australia
| |
Collapse
|
6
|
Hosseini S, Niakan A, Dehghankhalili M, Dehdab R, Shahjouei S, Rekabdar Y, Shaghaghian E, Shaghaghian A, Ghaffarpasand F. Effects of adhesion barrier gel on functional outcomes of patients with lumbar disc herniation surgery; A systematic review and meta-analysis of clinical trials. Heliyon 2021; 7:e07286. [PMID: 34189319 PMCID: PMC8220332 DOI: 10.1016/j.heliyon.2021.e07286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/21/2021] [Accepted: 06/07/2021] [Indexed: 11/09/2022] Open
Abstract
Failed Back Surgery Syndrome (FBSS) is persistent pain and disability following lumbar laminectomy which is associated with decreased quality of life and disability and has been reported in up to 40% of the patients undergoing lumbar laminectomy. Several approaches have been introduced to reduce the rate of the FBSS. Among these, applying anti-adhesive barrier gels have been studied with interest with controversial results. The aim of the current study was to determine the effects of anti-adhesive barrier gels on functional outcome and recurrence of patients undergoing lumbar disc surgery. We searched databases including EMBASE, PUBMED, Web of Science, Scopus, Cochrane Library, and scholar databases until November 2019. To assess the heterogeneity across included studies was used Cochran's Q and I-square (I2) statistics. Standardized mean difference (SMD) and 95% CI between were used to estimate pooled effect sizes. Out of 4507, 10 clinical trials found to be appropriate for current meta-analysis. The pooled results of included clinical trials indicated that adhesion barrier gel significantly decreased leg pain (LP) (SMD = −0.31; 95% CI, −0.60, −0.03; P = 0.032; I2: 59.2%) among patients with lumbar disc herniation surgery. Back pain (BP) (SMD = −0.03; 95% CI, −0.23, 0.16; P = 0.734; I2: 40.2%), and Oswestry disability index (ODI) (SMD = −0.11; 95% CI, −0.27, 0.05; P = 0.178; I2: 0.0%), were not significantly affected following adhesion barrier gel application. Application of adhesion barrier gel in single level lumbar disc surgery is associated with deceased leg pain. However, its application does not affect the low back pain, disability and gate. Further, larger randomized clinical trials are required.
Collapse
Affiliation(s)
- Seyedmorteza Hosseini
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Niakan
- Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Dehdab
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shima Shahjouei
- Neuroscience Institute, Geisinger Health System, Pennsylvania, USA
| | - Yasamin Rekabdar
- Young Researchers and Elite Club, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Elaheh Shaghaghian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
7
|
Vediappan RS, Bennett C, Cooksley C, Finnie J, Trochsler M, Quarrington RD, Jones CF, Bassiouni A, Moratti S, Psaltis AJ, Maddern G, Vreugde S, Wormald PJ. Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model. PLoS One 2021; 16:e0244503. [PMID: 33444337 PMCID: PMC7808615 DOI: 10.1371/journal.pone.0244503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/10/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction Adhesions are often considered to be an inevitable consequence of abdominal and pelvic surgery, jeopardizing the medium and long-term success of these procedures. Numerous strategies have been tested to reduce adhesion formation, however, to date, no surgical or medical therapeutic approaches have been successful in its prevention. This study demonstrates the safety and efficacy of Chitogel with Deferiprone and/or antibacterial Gallium Protoporphyrin in different concentrations in preventing adhesion formation after abdominal surgery. Materials and methods 112 adult (8–10 week old) male Wistar albino rats were subjected to midline laparotomy and caecal abrasion, with 48 rats having an additional enterotomy and suturing. Kaolin (0.005g/ml) was applied to further accelerate adhesion formation. The abrasion model rats were randomized to receive saline, Chitogel, or Chitogel plus Deferiprone (5, 10 or 20 mM), together with Gallium Protoporphyrin (250μg/mL). The abrasion with enterotomy rats were randomised to receive saline, Chitogel or Chitogel with Deferiprone (1 or 5 mM). At day 21, rats were euthanised, and adhesions graded macroscopically and microscopically; the tensile strength of the repaired caecum was determined by an investigator blinded to the treatment groups. Results Chitogel with Deferiprone 5 mM significantly reduced adhesion formation (p<0.01) when pathologically assessed in a rat abrasion model. Chitogel with Deferiprone 5 mM and 1 mM also significantly reduced adhesions (p<0.05) after abrasion with enterotomy. Def-Chitogel 1mM treatment did not weaken the enterotomy site with treated sites having significantly better tensile strength compared to control saline treated enterotomy rats. Conclusions Chitogel with Deferiprone 1 mM constitutes an effective preventative anti-adhesion barrier after abdominal surgery in a rat model. Moreover, this therapeutic combination of agents is safe and does not weaken the healing of the sutured enterotomy site.
Collapse
Affiliation(s)
- Rajan Sundaresan Vediappan
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Catherine Bennett
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Clare Cooksley
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - John Finnie
- SA Pathology and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Markus Trochsler
- Department of Surgery, The University of Adelaide, Adelaide, Australia
| | - Ryan D. Quarrington
- Adelaide Spinal Research Group, Centre for Orthopaedic and Trauma Research, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Claire F. Jones
- Adelaide Spinal Research Group, Centre for Orthopaedic and Trauma Research, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- School of Mechanical Engineering, University of Adelaide, Adelaide, Australia
| | - Ahmed Bassiouni
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Stephen Moratti
- Department of Chemistry, Otago University, Dunedin, New Zealand
| | - Alkis J. Psaltis
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Guy Maddern
- Department of Surgery, The University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - P. J. Wormald
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
- * E-mail:
| |
Collapse
|