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Waldron MG, Judge C, Farina L, O’Shaughnessy A, O’Halloran M. Barrier materials for prevention of surgical adhesions: systematic review. BJS Open 2022; 6:6602139. [PMID: 35661871 PMCID: PMC9167938 DOI: 10.1093/bjsopen/zrac075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Michael Gerard Waldron
- Correspondence to: Michael Gerard Waldron, Translational Medical Device Lab, Galway University Hospital, Newcastle Road, Galway, Ireland H91YR71 (e-mail: )
| | - Conor Judge
- Translational Medical Device Laboratory, National University of Ireland Galway, Galway, Ireland
| | - Laura Farina
- Translational Medical Device Laboratory, National University of Ireland Galway, Galway, Ireland
| | - Aoife O’Shaughnessy
- Translational Medical Device Laboratory, National University of Ireland Galway, Galway, Ireland
| | - Martin O’Halloran
- Translational Medical Device Laboratory, National University of Ireland Galway, Galway, Ireland
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
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Li Z, Liu L, Chen Y. Dual dynamically crosslinked thermosensitive hydrogel with self-fixing as a postoperative anti-adhesion barrier. Acta Biomater 2020; 110:119-128. [PMID: 32438111 DOI: 10.1016/j.actbio.2020.04.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Tissue adhesion is a severe postoperative complication. Various strategies have been developed to minimize postoperative adhesion, but the clinical efficacy is still far from satisfactory. Herein, we present a dual dynamically crosslinked hydrogel to serve as a physical postoperative anti-adhesion barrier. The hydrogel was generated by dynamic chemical oxime bonding from alkoxyamine-terminated Pluronic F127 (AOP127) and oxidized hyaluronic acid (OHA), as well as hydrophobic association of AOP127. Rheological analysis demonstrated that the hydrogel exhibits temperature sensitivity. At 37 °C, it shows much higher modulus and higher stability than the Pluronic F127 hydrogel. Hemolytic assays suggested that the hydrogel undergoes low hemolysis. In addition, it exhibited anti-adhesion to blood cells in blood cell adhesion tests. It also showed an anti-attachment effect to fibroblasts and biocompatibility in vitro cell studies. Macroscopic evaluation and lap-shear tests revealed that the hydrogel has a moderate adhesive capacity to tissue, which is important for self-fixation. A rat model of sidewall defect-bowel abrasion was established to evaluate the anti-adhesion effect in vivo. The gross observation and pathological analysis revealed a significant reduction in postoperative peritoneal adhesion in the AOP127/OHA hydrogel-treated group than those treated with normal saline or Pluronic F127 hydrogel. Hence, the dual dynamically crosslinked hydrogel with self-fixable capacity may be suitable as a physical barrier for postoperative adhesion prevention. STATEMENT OF SIGNIFICANCE: Despite the development of numerous postoperative anti-adhesion barriers, their anti-adhesion efficacy is still limited in clinical trials due to poor tissue adhesion and rapid clearance from injured areas. Herein, we have developed a dual dynamic crosslinked hydrogel, generated by dynamic oxime bonds and hydrophobic interactions. The hydrogel is temperature-sensitive and demonstrates moderate tissue adhesion capacity, which allows for self-fixation when applied to defects. The introduction of dynamic covalent bonds improves the stability of the hydrogel. Moreover, the hydrogel not only displays appropriate hemocompatibility, cytocompatibility and anti-adhesion of blood cells and fibroblasts, but it also effectively contributes to preventing postoperative peritoneal adhesions in vivo. Hence, this dual dynamic crosslinked hydrogel may have potential applications as a physical barrier in clinical practice.
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Affiliation(s)
- Ziyi Li
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Lixin Liu
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Yongming Chen
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China.
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Cheng F, Wu Y, Li H, Yan T, Wei X, Wu G, He J, Huang Y. Biodegradable N, O-carboxymethyl chitosan/oxidized regenerated cellulose composite gauze as a barrier for preventing postoperative adhesion. Carbohydr Polym 2019; 207:180-190. [DOI: 10.1016/j.carbpol.2018.10.077] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
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Wang Q, Newby BMZ. Layer-by-layer Polyelectrolytes Coating of Alginate Microgels for Sustained Release of Sodium Benzoate and Zosteric Acid. J Drug Deliv Sci Technol 2018; 46:46-54. [PMID: 30555539 PMCID: PMC6289541 DOI: 10.1016/j.jddst.2018.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The potential of sustaining release of very small (Mw < 250 g/mol) hydrophilic drugs up to several days from layer-by-layer (LbL) polyelectrolyte coated alginate microgels (Alg-Ms) was investigated. One purpose is to minimize post-surgical adhesions, which develop in 12 h to 3 days after surgery. The LbL polyelectrolyte layer would serve as a diffusion barrier for their release. The LbL polyelectrolyte bilayers were prepared using poly(allylamine) (PAH) and poly(styrene sulfonate) (PSS). Sodium benzoate (NaB, Mw = 144 g/mol) and zosteric acid (ZA, Mw = 244 g/mol), two anti-inflammatory and anti-microbial compounds, were used as model drugs. A higher number of PAH/PSS bilayer lead to a greater sustained release of both drugs, and with 4 bilayers, the release of NaB and ZA was prolonged from 24 h to 72 h and 120 h, respectively. Fitting the data to the Ritger-Peppas' equation showed that as the bilayer number increased, the release constant and/or exponent decreased, indicating the LbL PAH/PSS bilayer effectively reduced the permeability of these two very small hydrophilic drugs. The ability to prolong the release of such small hydrophilic molecules, which has rarely been investigated previously, would find broad applications in fields such as anti-adhesion treatment and antifouling coatings.
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Affiliation(s)
- Qing Wang
- Department of Chemical and Biomolecular Engineering, The University of Akron, Akron, OH, 44325-3906, United States
| | - Bi-min Zhang Newby
- Department of Chemical and Biomolecular Engineering, The University of Akron, Akron, OH, 44325-3906, United States
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Amano Y, Qi P, Nakagawa Y, Kirita K, Ohta S, Ito T. Prevention of Peritoneal Adhesions by Ferric Ion-Cross-Linked Hydrogels of Hyaluronic Acid Modified with Iminodiacetic Acids. ACS Biomater Sci Eng 2018; 4:3405-3412. [DOI: 10.1021/acsbiomaterials.8b00456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yuki Amano
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Pan Qi
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yoshiyuki Nakagawa
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Katsuhisa Kirita
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Seiichi Ohta
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Taichi Ito
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
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8
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Horii T, Tsujimoto H, Miyamoto H, Yamanaka K, Tanaka S, Torii H, Ozamoto Y, Takamori H, Nakamachi E, Ikada Y, Hagiwara A. Physical and biological properties of a novel anti-adhesion material made of thermally cross-linked gelatin film: Investigation of the usefulness as anti-adhesion material. J Biomed Mater Res B Appl Biomater 2017; 106:689-696. [DOI: 10.1002/jbm.b.33880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 02/01/2017] [Accepted: 02/28/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Tsunehito Horii
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroyuki Tsujimoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroe Miyamoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Koki Yamanaka
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Shota Tanaka
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroko Torii
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Yuki Ozamoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hideki Takamori
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Eiji Nakamachi
- Division of Biomedical Engineering, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Yoshito Ikada
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Akeo Hagiwara
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
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Jalalvandi E, Cabral J, Hanton LR, Moratti SC. Cyclodextrin-polyhydrazine degradable gels for hydrophobic drug delivery. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:144-53. [DOI: 10.1016/j.msec.2016.06.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 01/19/2023]
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10
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Hsu DZ, Jou IM. 1,4-Butanediol diglycidyl ether-cross-linked hyaluronan inhibits fibrosis in rat primary tenocytes by down-regulating autophagy modulation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:84. [PMID: 26968759 DOI: 10.1007/s10856-016-5689-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
Epidural fibrosis, an inevitable part of the postoperative healing process, is one of the important causes of failed back surgery syndrome after spinal surgery. The aim of this study was to examine the inhibitory effect of a novel material 1,4-butanediol diglycidyl ether-cross-linked hyaluronan (cHA) on fibrosis in primary tenocytes. cHA inhibited migration, cell proliferation, and suppressed the expression of fibronectin, but not transforming growth factor-β, in primary tenocytes. cHA significantly increased matrix metalloproteinase-3 but decreased collagen-1 and microtubule-associated protein light chain 3-II expression in a dose-dependent manner compared with control groups. We therefore concluded that suppressing autophagy activity may be involved in the anti-fibrotic effect of cHA in primary tenocytes. Further, cHA may have the potential for preventing epidural fibrosis and subsequent failed back syndrome in patients with laminectomy in the future.
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Affiliation(s)
- Dur-Zong Hsu
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
- Department of Orthopedics, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
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11
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Konar S, Guha R, Kundu B, Nandi S, Ghosh TK, Kundu SC, Konar A, Hazra S. Silk fibroin hydrogel as physical barrier for prevention of post hernia adhesion. Hernia 2016; 21:125-137. [DOI: 10.1007/s10029-016-1484-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/16/2016] [Indexed: 12/25/2022]
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12
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Wu CY, Huang YH, Lee JS, Tai TW, Wu PT, Jou IM. Efficacy of topical cross-linked hyaluronic acid hydrogel in preventing post laminectomy/laminotomy fibrosis in a rat model. J Orthop Res 2016. [PMID: 26222496 DOI: 10.1002/jor.23001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Post-laminectomy/laminotomy epidural fibrosis (EF) has been implicated as an important cause of failed back syndrome (FBS). The various clinical approaches used to control EF yield mixed outcomes. Cross-linked hyaluronic acid hydrogel (cHA) was synthesized to increase mechanical stability and residence time. We evaluated the therapeutic attenuation of proliferative EF in laminectomy/laminotomy groups treated and not treated with cHA. A bilateral T11-L1 total laminectomy or unilateral T12 laminotomy was done on four groups (n = 10 each) of Sprague-Dawley rats and then histologically examined 2 months post-surgery: (I) laminectomy group treated with and (II) not treated with cHA, (III) laminotomy group treated with and (IV) not treated with cHA. The grade of EF, the diameters within the spinal canal, dura mater thickness, and the area of the epidural space, subarachnoid space, and conus medullaris space were assessed. The cHA-treated subgroups (I, III) had a significantly lower grade of EF, thinner dura mater, and larger epidural and subarachnoid spaces than did the control subgroups (II, IV) (p < 0.05). The cHA formed a solid interpositional membrane barrier that prevented invasive fibrosis, and also helped reduce pathological changes to the adjacent structures. In conclusion, topically applied cHA is effective for reducing EF.
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Affiliation(s)
- Cheng-Yi Wu
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Orthopedics, Chia Yi Christian Hospital, Chia Yi, Taiwan
| | - Yi-Hung Huang
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Orthopedics, Chia Yi Christian Hospital, Chia Yi, Taiwan
| | - Jung-Shun Lee
- National Cheng Kung University Hospital, Surgery, Division of Neurosurgery, Tainan, Taiwan
| | - Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
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Zhang S, Xu K, Ge L, Darabi MA, Xie F, Derakhshanfar S, Liu Y, Xing MMQ, Wei H. A novel nano-silver coated and hydrogel-impregnated polyurethane nanofibrous mesh for ventral hernia repair. RSC Adv 2016. [DOI: 10.1039/c6ra10014g] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patches for hernia repair have two existing concerns: antibacterial and tissue adhesion.
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Affiliation(s)
- Shibin Zhang
- Laboratory Animal Center
- Zunyi Medical College
- Zunyi
- China
- Department of Laboratory Animal Science
| | - Kaige Xu
- Department of Mechanical Engineering
- Biochemistry and Medical Genetics
- University of Manitoba
- Children's Research Institute of Manitoba
- Winnipeg
| | - Liangpeng Ge
- Chongqing Academy of Animal Sciences
- Chongqing
- China
| | - Mohammad Ali Darabi
- Department of Mechanical Engineering
- Biochemistry and Medical Genetics
- University of Manitoba
- Children's Research Institute of Manitoba
- Winnipeg
| | - Fei Xie
- Department of Laboratory Animal Science
- College of Basic Medical Science
- Third Military Medical University
- Chongqing
- China
| | - Soroosh Derakhshanfar
- Department of Mechanical Engineering
- Biochemistry and Medical Genetics
- University of Manitoba
- Children's Research Institute of Manitoba
- Winnipeg
| | - Yu Liu
- Department of Laboratory Animal Science
- College of Basic Medical Science
- Third Military Medical University
- Chongqing
- China
| | - Malcolm M. Q. Xing
- Department of Mechanical Engineering
- Biochemistry and Medical Genetics
- University of Manitoba
- Children's Research Institute of Manitoba
- Winnipeg
| | - Hong Wei
- Department of Laboratory Animal Science
- College of Basic Medical Science
- Third Military Medical University
- Chongqing
- China
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14
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Wu W, Ni Q, Xiang Y, Dai Y, Jiang S, Wan L, Liu X, Cui W. Fabrication of a photo-crosslinked gelatin hydrogel for preventing abdominal adhesion. RSC Adv 2016. [DOI: 10.1039/c6ra21435e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A photocrosslinkable gelatin-based hydrogel membrane of easy-handling and non-toxic degradation was developed for preventing intra-abdominal adhesion formation.
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Affiliation(s)
- Wei Wu
- Department of General Surgery
- Yangzhou No. 1 People's Hospital Affiliated Hospital of Yangzhou University
- Yangzhou
- P. R. China
- Department of General Surgery
| | - Qing Ni
- Department of General Surgery
- Yangzhou No. 1 People's Hospital Affiliated Hospital of Yangzhou University
- Yangzhou
- P. R. China
| | - Yi Xiang
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Yong Dai
- Department of General Surgery
- Yangzhou No. 1 People's Hospital Affiliated Hospital of Yangzhou University
- Yangzhou
- P. R. China
| | - Su Jiang
- Department of General Surgery
- Yangzhou No. 1 People's Hospital Affiliated Hospital of Yangzhou University
- Yangzhou
- P. R. China
| | - Liping Wan
- Department of General Surgery
- Yangzhou No. 1 People's Hospital Affiliated Hospital of Yangzhou University
- Yangzhou
- P. R. China
| | - Xinnong Liu
- Department of General Surgery
- Yangzhou No. 1 People's Hospital Affiliated Hospital of Yangzhou University
- Yangzhou
- P. R. China
| | - Wenguo Cui
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
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Warembourg S, Huberlant S, Garric X, Leprince S, de Tayrac R, Letouzey V. Prévention et traitement des synéchies endo-utérines : revue de la littérature. ACTA ACUST UNITED AC 2015; 44:366-79. [DOI: 10.1016/j.jgyn.2014.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/16/2014] [Accepted: 10/23/2014] [Indexed: 12/25/2022]
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Cabral JD, Roxburgh M, Shi Z, Liu L, McConnell M, Williams G, Evans N, Hanton LR, Simpson J, Moratti SC, Robinson BH, Wormald PJ, Robinson S. Synthesis, physiochemical characterization, and biocompatibility of a chitosan/dextran-based hydrogel for postsurgical adhesion prevention. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:2743-2756. [PMID: 25085242 DOI: 10.1007/s10856-014-5292-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/21/2014] [Indexed: 06/03/2023]
Abstract
An amine-functionalized succinyl chitosan and an oxidized dextran were synthesized and mixed in aqueous solution to form an in situ chitosan/dextran injectable, surgical hydrogel for adhesion prevention. Rheological characterization showed that the rate of gelation and moduli were tunable based on amine and aldehyde levels, as well as polymer concentrations. The CD hydrogels have been shown to be effective post-operative aids in prevention of adhesions in ear, nose, and throat surgeries and abdominal surgeries in vivo. In vitro biocompatibility testing was performed on CD hydrogels containing one of two oxidized dextrans, an 80 % oxidized (CD-100) or 25 % (CD-25) oxidized dextran. However, the CD-100 hydrogel showed moderate cytotoxicity in vitro to Vero cells. SC component of the CD hydrogel, however, showed no cytotoxic effect. In order to increase the biocompatibility of the hydrogel, a lower aldehyde level hydrogel was developed. CD-25 was found to be non-cytotoxic to L929 fibroblasts. The in vivo pro-inflammatory response of the CD-25 hydrogel, after intraperitoneal injection in BALB/c mice, was also determined by measuring serum TNF-α levels and by histological analysis of tissues. TNF-α levels were similar in mice injected with CD-25 hydrogel as compared to the negative saline injected control; and were significantly different (P < 0.05) as compared to the positive, lipopolysaccharide, injected control. Histological examination revealed no inflammation seen in CD hydrogel injected mice. The results of these in vitro and in vivo studies demonstrate the biocompatibility of the CD hydrogel as a post-operative aid for adhesion prevention.
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Affiliation(s)
- Jaydee D Cabral
- Department of Chemistry, University of Otago, Dunedin, 9054, New Zealand,
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Aziz MA, Cabral JD, Brooks HJL, McConnell MA, Fitzpatrick C, Hanton LR, Moratti SC. In vitrobiocompatibility and cellular interactions of a chitosan/dextran-based hydrogel for postsurgical adhesion prevention. J Biomed Mater Res B Appl Biomater 2014; 103:332-41. [DOI: 10.1002/jbm.b.33206] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/27/2014] [Accepted: 05/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Manal A. Aziz
- Department of Chemistry; University of Otago; Dunedin New Zealand
- Department of Microbiology and Immunology; Otago School of Medical Sciences, University of Otago; Dunedin New Zealand
| | - Jaydee D. Cabral
- Department of Chemistry; University of Otago; Dunedin New Zealand
| | - Heather J. L. Brooks
- Department of Microbiology and Immunology; Otago School of Medical Sciences, University of Otago; Dunedin New Zealand
| | - Michelle A. McConnell
- Department of Microbiology and Immunology; Otago School of Medical Sciences, University of Otago; Dunedin New Zealand
| | - Clare Fitzpatrick
- Department of Microbiology and Immunology; Otago School of Medical Sciences, University of Otago; Dunedin New Zealand
| | - Lyall R. Hanton
- Department of Chemistry; University of Otago; Dunedin New Zealand
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20
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Hoare T, Yeo Y, Bellas E, Bruggeman JP, Kohane DS. Prevention of peritoneal adhesions using polymeric rheological blends. Acta Biomater 2014; 10:1187-93. [PMID: 24365709 DOI: 10.1016/j.actbio.2013.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/25/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
The effectiveness of rheological blends of high molecular weight hyaluronic acid (HA) and low molecular weight hydroxypropyl methylcellulose (HPMC) in the prevention of peritoneal adhesions post-surgery is demonstrated. The physical mixture of the two carbohydrates increased the dwell time in the peritoneum while significantly improving the injectability of the polymer compared with HA alone. HA-HPMC treatment decreased the total adhesion area by ∼ 70% relative to a saline control or no treatment in a repeated cecal injury model in the rabbit. No significant cytotoxicity and minimal inflammation were associated with the blend. Furthermore, no chemical or physical processing was required prior to their use beyond simple mixing.
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21
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Prevention of intra-abdominal adhesion by bi-layer electrospun membrane. Int J Mol Sci 2013; 14:11861-70. [PMID: 23736693 PMCID: PMC3709760 DOI: 10.3390/ijms140611861] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare the anti-adhesion efficacy of a bi-layer electrospun fibrous membrane consisting of hyaluronic acid-loaded poly(ε-caprolactone) (PCL) fibrous membrane as the inner layer and PCL fibrous membrane as the outer layer with a single-layer PCL electrospun fibrous membrane in a rat cecum abrasion model. The rat model utilized a cecal abrasion and abdominal wall insult surgical protocol. The bi-layer and PCL membranes were applied between the cecum and the abdominal wall, respectively. Control animals did not receive any treatment. After postoperative day 14, a visual semiquantitative grading scale was used to grade the extent of adhesion. Histological analysis was performed to reveal the features of adhesion tissues. Bi-layer membrane treated animals showed significantly lower adhesion scores than control animals (p < 0.05) and a lower adhesion score compared with the PCL membrane. Histological analysis of the bi-layer membrane treated rat rarely demonstrated tissue adhesion while that of the PCL membrane treated rat and control rat showed loose and dense adhesion tissues, respectively. Bi-layer membrane can efficiently prevent adhesion formation in abdominal cavity and showed a significantly decreased adhesion tissue formation compared with the control.
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22
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Na SY, Oh SH, Song KS, Lee JH. Hyaluronic acid/mildly crosslinked alginate hydrogel as an injectable tissue adhesion barrier. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:2303-13. [PMID: 22661246 DOI: 10.1007/s10856-012-4689-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/21/2012] [Indexed: 05/25/2023]
Abstract
Although hyaluronic acid (HA) has been conventionally utilized as a tissue adhesion barrier material, its rapid clearance in the body still remains as a big challenge in the clinical practice. In this study, we prepared a hydrogel of HA embedded in mildly crosslinked alginate (HA/mcALG hydrogel), which is injectable, easily covers injured tissues, and remains stably at the applied site during wound healing (by muco-adhesive HA embedded in the network structure of the mcALG hydrogel). The HA/mcALG hydrogel was highly effective for the prevention of peritoneal tissue adhesion compared to HA and mcALG hydrogels, and did not lead to any abnormal tissue responses during wound healing. The HA/mcALG hydrogel can be a good candidate as an injectable tissue adhesion barrier for clinical applications.
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Affiliation(s)
- Seung Yeon Na
- Department of Advanced Materials, Hannam University, 461-6 Jeonmin Dong, Yuseong Gu, Daejeon, 305-811, Republic of Korea
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23
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Diamond MP, Burns EL, Accomando B, Mian S, Holmdahl L. Seprafilm® adhesion barrier: (1) a review of preclinical, animal, and human investigational studies. ACTA ACUST UNITED AC 2012; 9:237-245. [PMID: 22837732 PMCID: PMC3401296 DOI: 10.1007/s10397-012-0741-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 02/13/2012] [Indexed: 01/30/2023]
Abstract
The aim of this study was to provide a single site resource for investigators, clinicians, and others seeking preclinical, animal, and human investigational studies concerning the postsurgical, anti-adhesion barrier Seprafilm™ (Genzyme Corporation, Cambridge, MA). All published preclinical, animal, human extra-abdominal research as of July 2011 have been summarized and included in this document. Searches of Medline and EMBASE Drugs and Pharmaceuticals databases were conducted for original preclinical, animal, and human extra-abdominal studies involving Seprafilm. Preclinical, animal, and extra-abdominal human investigational studies are the study selection for this manuscript. Intraabdominal use is discussed in the accompanying manuscript. Data extraction includes systematic manuscript review. Summary of preclinical, animal, and extra-abdominal human investigational use of Seprafilm by surgical discipline were gathered for data synthesis. The clinical use of Seprafilm, which was approved by the FDA for intra-abdominal procedures, is supported by preclinical and animal studies relating to general surgical and obstetrical/gynecological applications. Findings from preclinical, animal, and human investigational studies at other sites throughout the body raises the potential for additional human clinical trials to assess efficacy and safety following surgical procedures at non-abdominal locations.
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Affiliation(s)
- Michael P. Diamond
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University, 60 West Hancock, Detroit, MI 48201 USA
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24
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Maciver AH, McCall MD, Edgar RL, Thiesen AL, Bigam DL, Churchill TA, Shapiro AJ. Sirolimus drug-eluting, hydrogel-impregnated polypropylene mesh reduces intra-abdominal adhesion formation in a mouse model. Surgery 2011; 150:907-15. [DOI: 10.1016/j.surg.2011.06.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 06/15/2011] [Indexed: 11/26/2022]
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25
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Liu Z, Wang L, Bao C, Li X, Cao L, Dai K, Zhu L. Cross-Linked PEG via Degradable Phosphate Ester Bond: Synthesis, Water-Swelling, and Application as Drug Carrier. Biomacromolecules 2011; 12:2389-95. [DOI: 10.1021/bm2004737] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | - Lei Cao
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
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26
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Biodegradable and thermoreversible PCLA-PEG-PCLA hydrogel as a barrier for prevention of post-operative adhesion. Biomaterials 2011; 32:4725-36. [PMID: 21482434 DOI: 10.1016/j.biomaterials.2011.03.046] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 03/20/2011] [Indexed: 11/21/2022]
Abstract
Biodegradable polymers can serve as barriers to prevent the post-operative intestinal adhesion. Herein, we synthesized a biodegradable triblock copolymer poly(ɛ-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ɛ-caprolactone-co-lactide) (PCLA-PEG-PCLA). The concentrated polymeric aqueous solution was injectable, and a hydrogel could be rapidly formed due to percolation of a self-assembled micelle network at the body temperature without requirement of any chemical reactions. This physical hydrogel retained its integrity in vivo for a bit more than 6 weeks and was eventually degraded due to hydrolysis. The synthesized polymer exhibited little cytotoxicity and hemolysis; the acute inflammatory response after implanting the hydrogel was acceptable, and the degradation products were less acidic than those of other polyester-containing materials. A rabbit model of sidewall defect-bowel abrasion was employed, and a significant reduction of post-operative peritoneal adhesion has been found in the group of in situ formed PCLA-PEG-PCLA hydrogels.
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27
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Zhang H, Qadeer A, Chen W. In situ gelable interpenetrating double network hydrogel formulated from binary components: thiolated chitosan and oxidized dextran. Biomacromolecules 2011; 12:1428-37. [PMID: 21410248 DOI: 10.1021/bm101192b] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In situ gelable interpenetrating double-network hydrogels composed of thiolated chitosan (Chitosan-NAC) and oxidized dextran (Odex), completely devoid of potentially cytotoxic small molecule cross-linkers and that do not require complex maneuvers or catalysis, have been formulated. The interpenetrating network structure is created by Schiff base formations and disulfide bond inter-cross-linkings through exploiting the disparity of their reaction times. Compared with the autogelable thiolated chitosan hydrogels that typically require a relatively long time span for gelation to occur, the Odex/Chitosan-NAC composition solidifies rapidly and forms a well-developed 3D network in a short time span. Compared with typical hydrogels derived from natural materials, the Odex/Chitosan-NAC hydrogels are mechanically strong and resist degradation. The cytotoxicity potential of the hydrogels was determined by an in vitro viability assay using fibroblast as a model cell, and the results reveal that the hydrogels are noncytotoxic. In parallel, in vivo results from subdermal implantation in mice models demonstrate that this hydrogel is not only highly resistant to degradation but also induces very mild tissue response.
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Affiliation(s)
- Hanwei Zhang
- Division of Wound Healing and Regenerative Medicine, Department of Surgery, New York University School of Medicine, New York, New York 10016, USA
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28
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Zhang H, Qadeer A, Mynarcik D, Chen W. Delivery of rosiglitazone from an injectable triple interpenetrating network hydrogel composed of naturally derived materials. Biomaterials 2010; 32:890-8. [PMID: 20947157 DOI: 10.1016/j.biomaterials.2010.09.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 09/23/2010] [Indexed: 11/19/2022]
Abstract
An in situ gelable and biodegradable triple-interpenetrating network (3XN) hydrogel, completely devoid of potentially cytotoxic extraneous small molecule crosslinkers, is formulated from partially oxidized dextran (Odex), teleostean and N-carboxyethyl chitosan (CEC). Both the rheological profile and mechanical strength of the 3XN hydrogel approximate the combined characteristics of the three individual hydrogels composed of the binary partial formulations (i.e., Odex/CEC, Odex/teleostean, and CEC/teleostean). The 3XN hydrogel is considerably more resistant to fibroblast-mediated degradation compared to each partial formulation in cell culture models; this is attributable to the interpenetrating triple-network structure. The presence of teleostean in the 3XN hydrogel imparts cell affinity, constituting an environment amenable to fibroblast growth. in vivo subdermal injection into mouse model shows that the 3XN hydrogel does not induce extensive inflammatory response nor is there any evidence of tissue necrosis, further confirming the non-cytotoxicity of the hydrogel and its degradation byproducts. Importantly, the capability of the 3XN hydrogel to serve as a sustained drug delivery vehicle is confirmed using rosiglitazone as a model drug. The presence of rosiglitazone profoundly changes the cell/tissue interactions with the subdermally injected 3XN hydrogel. Rosiglitazone suppresses both the inflammatory response and tissue repair in a dose-dependent manner and considerably moderated the hydrogel degradation.
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Affiliation(s)
- Hanwei Zhang
- Division of Wound Healing and Regenerative Medicine, Department of Surgery, New York University School of Medicine, New York, NY 10016, USA
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29
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Abstract
Fetal wound healing occurs rapidly and without scar formation early in gestation. Studying the mechanisms of scarless repair can lead to novel scar-preventive approaches. In fetal wounds, collagen is deposited early and is fine and reticular with less cross-linking. Several important differences of fetal vs. postgestational wound-healing response have been determined, such as the presence of less inflammation, higher hyaluronic acid concentration and a greater ratio of collagen type III to type I. Compared with typical wounds, there are also altered ratios of signaling molecules, such as higher ratios of transforming growth factor (TGF)-β3 to TGF-β1 and -β2, and matrix metalloproteinases to tissue inhibitors of metalloproteinases. Furthermore, fetal fibroblasts do not exhibit TGF-β1-induced collagen production compared with their mature counterparts. Patterning genes (homeobox genes) involved in organogenesis are more active in the fetal period and are believed to be the "first domino" in the fetal cutaneous wound repair regulatory cascade. The recommended scar-preventive agents, such as Scarguard MD®, silicone gel and sheet, Seprafilm® Bioresorbable Membrane, topical hyaluronan, onion extract, oral tamoxifen and 585-nm pulsed dye laser are reviewed in this study. Despite the lack of supporting evidence, there is a widespread false presumption that the acceleration of healing with the widely assumed scar-preventive commercial agents is associated with decreased scar formation. Humans are erroneously inclined to make a negative correlation between the healing rate and the degree of scar formation, while such a correlation does not exist in reality. Despite the importance of scar prevention, no FDA-approved therapy for this purpose is available in the 21st century, which reflects the important challenges, such as the presence of redundant pathways, that these approaches are facing.
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Affiliation(s)
- Mohammad Reza Namazi
- Stem Cell and Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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30
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Yuan Z, Zakhaleva J, Ren H, Liu J, Chen W, Pan Y. Noninvasive and high-resolution optical monitoring of healing of diabetic dermal excisional wounds implanted with biodegradable in situ gelable hydrogels. Tissue Eng Part C Methods 2010; 16:237-47. [PMID: 19496703 DOI: 10.1089/ten.tec.2009.0152] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Closure of diabetic dermal chronic wounds remains a clinical challenge. Implant-assisted healing is emerging as a potential class of therapy for dermal wound closure; this advancement has not been paralleled by the development in complementary diagnostic techniques to objectively monitor the wound-healing process in conjunction with assessing/monitoring of implant efficacy. Biopsies provide the most objective morphological assessments of wound healing; however, they not only perpetuate the wound presence but also increase the risk of infection. A noninvasive and high-resolution imaging technique is highly desirable to provide objective longitudinal diagnosis of implant-assisted wound healing. We investigated the feasibility of deploying optical coherence tomography (OCT) for noninvasive monitoring of the healing of full-thickness excisional dermal wounds implanted with a novel in situ gelable hydrogel composed of N-carboxyethyl chitosan, oxidized dextran, and hyaluronan, in both normal and db/db mice. The results showed that OCT was able to differentiate the morphological differences (e.g., thickness of dermis) between normal and diabetic mice as validated by their corresponding histological evaluations (p < 0.05). OCT could detect essential morphological changes during wound healing, including re-epithelization, inflammatory response, and granulation tissue formation as well as impaired wound repair in diabetic mice. Importantly, by tracking specific morphological changes in hydrogel-assisted wound healing (e.g., implants' degradation and resorption, cell-mediated hydrogel degradation, and accelerated re-epithelization), OCT could also be deployed to monitor and evaluate the transformation of implanted biomaterials, thus holding the promise for noninvasive and objective monitoring of wound healing longitudinally and for objective efficacy assessment of implantable therapeutics in tissue engineering.
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Affiliation(s)
- Zhijia Yuan
- Department of Biomedical Engineering, State University of New York at Stony Brook, Stony Brook, New York 11794-8181, USA
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