Postoperative anti-adhesion ability of a novel carboxymethyl chitosan from silkworm pupa in a rat cecal abrasion model

Tissue-mimicking composite barrier membranes to prevent abdominal adhesion formation after surgery

Postoperative abdominal adhesions often occur after abdominal surgery; barrier membranes which mimic peritoneal tissue can be constructed to prevent abdominal adhesions. To this end, silk fibroin (SF) sheets were coated with polyvinyl alcohol (PVA) and agarose (AGA) at PVA:AGA ratios of 100:0, 70:30, 50:50, 30:70, and 0:100 to create a composite anti-adhesive barrier and allow us to identify a suitable coating ratio. The membranes were characterized in terms of their molecular organization, structure, and morphology using Fourier transform Infrared spectrometer (FT-IR), differential scanning calorimeter (DSC), and scanning electron microscope (SEM), respectively. The physical and mechanical properties of the membranes and their biological performance (i.e., fibroblast proliferation and invasion) were tested in vitro. Each membrane showed both smooth and rough surface characteristics. Membranes coated with PVA:AGA at ratios of 100:0, 70:30, 50:50, and 30:70 exhibited more -OH and amide III moieties than those coated with 0:100 PVA:AGA, which consequently affected structural organization, degradation, and fibroblast viability. The 0:100 PVA:AGA-coated degraded the fastest. Barrier membranes coated with 100:0 and 70:30 PVA: AGA demonstrated reduced fibroblast proliferation and attachment. The membrane coated with 70:30 PVA:AGA exhibited a stable appearance, and did not curl under wet conditions. Therefore, SF sheets coated with 70:30 PVA:AGA show promise as anti-adhesive barrier membranes for further development.

Advances in Organoid Culture Research

Organoids are powerful systems to facilitate the study of individuals' disorders and personalized treatments because they mimic the structural and functional characteristics of organs. However, the full potential of organoids in research has remained unrealized and the clinical applications have been limited. One of the reasons is organoids are most efficient grown in reconstituted extracellular matrix hydrogels from mouse-derived, whose poorly defined, batch-to-batch variability and immunogenicity. Another reason is that organoids lack host conditions. As a component of the tumor microenvironment, microbiota and metabolites can regulate the development and treatment in several human malignancies. Here, we introduce several engineering matrix materials and review recent advances in the coculture of organoids with microbiota and their metabolites. Finally, we discuss current trends and future possibilities to build more complex cocultures.

Injectable adhesive self-healing biocompatible hydrogel for haemostasis, wound healing, and postoperative tissue adhesion prevention in nephron-sparing surgery

Nephron-sparing surgery is a well-established treatment in patients with T1a renal cell carcinoma; however, the complex suturing process prolongs warm ischaemia time, affects the preservation of normal renal parenchymal function, and causes avoidable postoperative tissue adhesion complications, including chronic abdominal pain, intestinal obstruction, and female infertility. Hence, the design of multifunctional biomaterials with haemostasis, postoperative wound management, and postoperative tissue adhesion prevention properties for nephron-sparing surgeries is urgently needed. In this study, a series of injectable adhesive multifunctional biocompatible hydrogels were designed based on the free-radical polymerisation of monomers acryloyl-6-aminocaproic acid (AA) and N-acryloyl 2-glycine (NAG), and the ionic coordination between Ca²⁺ and the abundant carboxyl groups in AA and NAG. AA/NAG/Ca (AA, NAG, and Ca refer to acryloyl-6-aminocaproic acid, N-acryloyl 2-glycine and calcium chloride, respectively) hydrogel exhibited good mechanical properties, swelling and adhesion properties, flexibility, in vitro blood-clotting ability, and cytocompatibility. In vivo experiments on liver injury models and rat/rabbit nephron-sparing surgery models elucidated that the AA/NAG/Ca hydrogel had haemostasis performance and wound healing properties that led to short bleeding time, reduced bleeding volume, and well-organised nephron structures. An abdomen-caecum adhesion model indicated that the AA/NAG/Ca hydrogel showed excellent anti-adhesion properties. In summary, this multifunctional hydrogel exhibited potential for improving haemostasis and wound management in nephron-sparing surgeries, showing potential for clinical application. STATEMENT OF SIGNIFICANCE: Extended warm ischemia time during nephron sparing surgery negatively affected postoperative renal function due to the need for hemostasis at the wound with abundant blood supply, and postoperative wound healing and additional adhesions caused by the surgical procedure deserve attention. Based on the efficient and stable adhesion properties of hydrogels and the ability to promote wound healing. Herein, a series of adhesive self-healing biocompatible hydrogels were prepared based on free-radical polymerization of acryloyl-6-aminocaproic acid (AA) and N-acryloyl 2-glycine (NAG) and the ionic coordination between Ca²⁺ with the abundant carboxyl groups in AA and NAG. AA/NAG/Ca hydrogel showed hemostasis property in nephron sparing surgery model, promote kidney wound healing, and could perform anti-postoperative adhesion efficacy in an abdomen-caecum adhesion model.

Thermosensitive Hydrogels and Advances in Their Application in Disease Therapy

Thermosensitive hydrogels, having unique sol–gel transition properties, have recently received special research attention. These hydrogels exhibit a phase transition near body temperature. This feature is the key to their applications in human medicine. In addition, hydrogels can quickly gel at the application site with simple temperature stimulation and without additional organic solvents, cross-linking agents, or external equipment, and the loaded drugs can be retained locally to improve the local drug concentration and avoid unexpected toxicity or side effects caused by systemic administration. All of these features have led to thermosensitive hydrogels being some of the most promising and practical drug delivery systems. In this paper, we review thermosensitive hydrogel materials with biomedical application potential, including natural and synthetic materials. We describe their structural characteristics and gelation mechanism and briefly summarize the mechanism of drug release from thermosensitive hydrogels. Our focus in this review was to summarize the application of thermosensitive hydrogels in disease treatment, including the postoperative recurrence of tumors, the delivery of vaccines, the prevention of postoperative adhesions, the treatment of nervous system diseases via nasal brain targeting, wound healing, and osteoarthritis treatment.

N, O-carboxymethyl chitosan/oxidized cellulose composite sponge containing ε-poly-l-lysine as a potential wound dressing for the prevention and treatment of postoperative adhesion

Herein, we designed and fabricated a biodegradable composite sponge which main component contained N, O-carboxymethyl chitosan (N,O-CS) and oxidized cellulose nanocrystals (TOCN) as a potential wound dressing for the prevention and treatment of postoperative adhesion. In order to improve antimicrobial properties of N,O-CS/TOCN composite sponges, natural antimicrobial agents (ε-Poly-l-Lysine，EPL) were successfully introduced and the EPL/N,O-CS/TOCN composite sponge exhibited excellent antibacterial properties and biological security. The EPL/N,O-CS/TOCN composite sponge can be degraded in vivo within 3 weeks. Finally, we analyzed the anti-adhesion performance of EPL/N,O-CS/TOCN composite sponge through a rat model of sidewall defect-cecum abrasion. These results demonstrated that EPL/N,O-CS/TOCN-treated group can effectively reduce the peritoneal adhesion formation than the commercial soluble gauze group and normal saline group, which mainly attribute to the excellent hemostatic function and tissue repair function of EPL/N,O-CS/TOCN composite sponge. It is believed that the EPL/N,O-CS/TOCN composite sponge will prove to be as a new medical device treat the internal tissue/organ repair and simultaneous prevention of postoperative adhesion.

Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies

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.

Biomaterials to Prevent Post-Operative Adhesion

Surgery is performed to treat various diseases. During the process, the surgical site is healed through self-healing after surgery. Post-operative or tissue adhesion caused by unnecessary contact with the surgical site occurs during the normal healing process. In addition, it has been frequently found in patients who have undergone surgery, and severe adhesion can cause chronic pain and various complications. Therefore, anti-adhesion barriers have been developed using multiple biomaterials to prevent post-operative adhesion. Typically, anti-adhesion barriers are manufactured and sold in numerous forms, such as gels, solutions, and films, but there are no products that can completely prevent post-operative adhesion. These products are generally applied over the surgical site to physically block adhesion to other sites (organs). Many studies have recently been conducted to increase the anti-adhesion effects through various strategies. This article reviews recent research trends in anti-adhesion barriers.

Thermal stimuli-responsive hyaluronic acid loaded cellulose based physical hydrogel for post-surgical de novo peritoneal adhesion prevention

Effective strategies for post-surgical adhesion prevention have increasingly focused on injectable adhesion barriers due to their minimal invasiveness and wider applicability. In this study, a thermo-reversible hydrogel was developed by combining high molecular weight hyaluronic acid (HA) at various concentrations (0.05, 0.25, and 0.45% w/v) with tempo-oxidized nanocellulose (TOCN), methyl cellulose (MC) and polyethylene glycol (PEG) for anti-adhesion application. The hydrogel preparation time was short and did not require any chemical modification. TOCN ensured the mechanical stability of the hydrogel. MC confirmed thermo-sensitive feature. Higher amounts of HA increased the rate of hydrogel degradation. The HA 0.25 hydrogel was free-flowing, injectable at ambient temperature, capable of faster (40 ± 2 s), and reversible sol-gel (4 °C-37 °C) transition. A rat side-wall cecum abrasion model was used to confirm the complete de novo adhesion prevention efficacy of optimized HA 0.25 hydrogel, where the scratched abdominal wall of animals treated with HA 0.25 hydrogel healed after 14 days. During in vivo experiment, PEG in the hydrogel played a crucial role in adhesion prevention by minimizing friction between the surgical site and nearby organs. In a nutshell, HA 0.25 hydrogel, fabricated without crosslinking agent, is a potential candidate for tissue adhesion prevention strategies.

TEMPO oxidized nano-cellulose containing thermo-responsive injectable hydrogel for post-surgical peritoneal tissue adhesion prevention

The objective of this study was to present an effective injectable adhesion barrier comprised of TEMPO-oxidized cellulose nanofiber (TOCN), methyl cellulose, carboxymethyl cellulose, and polyethylene glycol. Hydrogels with different concentrations (0.2, 0.5, 0.8, 1% w/v) of bio compatible TOCN were investigated to determine their abilities to prevent post-surgical peritoneal adhesion using a rat cecal wall abrasion model. Sol-gel transition at body temperature (37 °C) was optimized by adjusting concentration of sodium ions (Na⁺), with a gelation time of 45 ± 7 s. These TOCN containing hydrogels showed non cytotoxicity to rat bone marrow mesenchymal stem cells (RBMSCs) and L929 fibroblast cells as cell models during in vitro assessment. Degradation studies revealed that, TOCN concentration in hydrogel was inversely proportional to hydrolytic degradation rate. From in vivo evaluations, TOCN 0.2 hydrogel significantly reduced peritoneal adhesion in rat (n = 8) compared to untreated controls based on gross observation, histological analysis, and expression analysis of marker proteins. By taking advantages of thermo gelling, high stability, non-invasive way of application and rapid recovery potential, TOCN containing bio compatible hydrogel could be used as a cost-effective barrier to efficiently inhibit post-surgical peritoneal adhesions.

Properties of a novel carboxymethyl chitosan derived from silkworm pupa

In this study, a carboxymethyl chitosan derived from silkworm pupa (SP-carboxymethyl chitosan) was prepared. The physical characteristics of the SP chitin, chitosan, and carboxymethyl chitosan were analyzed. The scanning electron microscopy results showed that the surfaces of the samples from SP were more uneven, with more surface fractures compared with those of the reference substance (RS). Thermal analysis, X-ray photoelectron spectroscopy, and Fourier transform infrared spectroscopy analysis showed that the main molecular chain structures of SP samples and RSs had no substantial differences. However, the crystallinity and thermal decomposition temperature of the SP samples were lower compared with those of the RSs. All of these results provide a theoretical basis for the development of applications for the SP-carboxymethyl chitosan.

Transglutaminase-catalyzed preparation of crosslinked carboxymethyl chitosan/carboxymethyl cellulose/collagen composite membrane for postsurgical peritoneal adhesion prevention

Peritoneal adhesion is a general complication following pelvic and abdominal surgery, which may lead to chronic abdominal pain, bowel obstruction, organ injury, and female infertility. Biodegradable polymer membranes have been suggested as physical barriers to prevent peritoneum adhesion. In this work, a transglutaminase (TGase)-catalyzed crosslinked carboxymethyl chitosan/carboxymethyl cellulose/collagen (CMCS/CMCL/COL) composite anti-adhesion membrane with various proportions of CMCS, CMCL, and COL (40/40/20, 35/35/30, 25/25/50) was developed. After crosslinking by TGase, the composite anti-adhesion membranes shown enhanced mechanical properties and improved biodegradability. Meanwhile, the high cytocompatibility of anti-adhesion membranes was proved by in vitro cell culture study. Moreover, the anti-adhesion membrane with the proportion of 25/25/50 was implanted between the artificially defected cecum and peritoneal wall in rats and following by general observation, histological examination, and inflammatory factors assay. The results indicated that the anti-adhesion membrane can significantly prevent peritoneal adhesion with negligible immunogenicity. Therefore, the composite membrane crosslinked by TGase had satisfactory anti-adhesive effects with high biocompatibility and low antigenicity, which could be used as a preventive barrier for peritoneal adhesion.

The sticky business of adhesion prevention in minimally invasive gynecologic surgery

PURPOSE OF REVIEW

The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention.

RECENT FINDINGS

Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents.

SUMMARY

There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.

Preparation and characterization of gelatin/sericin/carboxymethyl chitosan medical tissue glue

Background:

The development and application of medical glue has been continuously expanding and advancing. However, there are few glues that combine low-cost with excellent biocompatibility.

Methods:

We have prepared a medical tissue glue using a gelatin (Gel), sericin (SS) and carboxymethyl chitosan (CMCS) blend solution, cross-linked with 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC). The combination’s characteristics and microstructure morphology were observed by Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscope (SEM). Bond strength tests were used to measure the bond strength of the glue. To assay blood compatibility, a hemolytic test, dynamic coagulation test and platelet adherence test were also investigated. Further, the cellular behavior of L-929 and a systemic acute toxicity test on the Gel/SS/CMCS tissue glue were also investigated by MTT and H&E staining.

Results:

Characterization analysis showed that there was stable binding between raw materials, forming an amide bond with homogeneous holes. The bond strength of the tissue glue reached 2.50 ± 0.04 N in 10 minutes, slightly higher than the alpha-cyanoacrylate biological glue (2.25 ± 0.05 N). Blood compatibility tests revealed that the glue had outstanding blood compatibility. Further, cytotoxicity test and systemic acute toxicity test both showed that the glue was without cytotoxicity and not toxic to the body.

Conclusions:

The Gel/SS/CMCS tissue glue we prepared at low cost had excellent biocompatibility and structural characteristics. It could be a better candidate for tissue engineering in biomedical applications applied in clinical practice to promote skin wound healing and to further reduce the formation of skin wound scars.

Evaluation of a series of silk fibroin protein-based nonwoven mats for use as an anti-adhesion patch for wound management in robotic surgery

A novel anti-adhesion nonwoven mat mainly composed of silk fibroin protein (SFP) was fabricated via the single-spinneret electrospinning technique. A series of SFP-based electrospun nonwoven mats containing additives of different synthetic polymer ratios, such as pure SFP, SFP/poly(vinyl alcohol) (PVA), SFP/polyethylene glycol (PEG), and SFP/polyethylene oxide (PEO) were produced and compared. All membranes were porous and had diameters of 324.02 ± 113.7, 308.86 ± 74.02, 366.22 ± 115.81, and 341.82 ± 119.42 nm, respectively. The average pore size for each membrane was 1.132 ± 0.99, 0.811 ± 0.424, 0.975 ± 0.741, and 0.784 ± 0.497 μm² . No nonwoven mats showed significant cytotoxicity toward fibroblast cells based on the results of MTT assays. Surprisingly, for all groups of SFP-based nonwoven mats, nitrate formation was reduced by up to 94.55 ± 14.50%, 92.16 ± 19.38%, 91.28 ± 28.375%, and 92.00 ± 12.64% in lipopolysaccharide-induced RAW 264.7 macrophages model. Tissue anti-adhesion potential was evaluated in an in vitro fibroblast cell adhesion model and in vivo wounded mice model. In vitro, the mean cell anti-adhesion percentage of fibroblast cells changed over time in the following order: PVA/SFP > SFP > PEG/SFP∼PEO/SFP. In vivo, SFP and PVA/SFP-treated groups both showed superior collagen regeneration and wound closure. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 221-230, 2018.

Marine polysaccharides: therapeutic efficacy and biomedical applications

The ocean contains numerous marine organisms, including algae, animals, and plants, from which diverse marine polysaccharides with useful physicochemical and biological properties can be extracted. In particular, fucoidan, carrageenan, alginate, and chitosan have been extensively investigated in pharmaceutical and biomedical fields owing to their desirable characteristics, such as biocompatibility, biodegradability, and bioactivity. Various therapeutic efficacies of marine polysaccharides have been elucidated, including the inhibition of cancer, inflammation, and viral infection. The therapeutic activities of these polysaccharides have been demonstrated in various settings, from in vitro laboratory-scale experiments to clinical trials. In addition, marine polysaccharides have been exploited for tissue engineering, the immobilization of biomolecules, and stent coating. Their ability to detect and respond to external stimuli, such as pH, temperature, and electric fields, has enabled their use in the design of novel drug delivery systems. Thus, along with the promising characteristics of marine polysaccharides, this review will comprehensively detail their various therapeutic, biomedical, and miscellaneous applications.

Prevention of postoperative adhesions by biodegradable cryogels from pectin and chitosan polysaccharides

The main complication that may arise after surgery is the formation of adhesions. The current trend in the prevention of postoperative adhesions is the application of anti-adhesive barrier materials for the separation of wound tissue during the critical period of mesothelial repair and healing. In this work, cryogels based on pectin and chitosan were obtained by the ionic cryotropic gelation method. It was found that the Heracleum L. pectin cryogels are more elastic (73 ± 6 kPa) than the apple pectin cryogels (29 ± 11 kPa). The addition of chitosan with different physical and chemical characteristics did not significantly affect the elasticity of pectin–chitosan cryogels. The greatest swelling ability was achieved during in vivo incubation of Heracleum L. pectin cryogels and Heracleum L. pectin with reacetylated chitosan cryogels (17.1 ± 1.6 and 14.2 ± 2.0 g/g, respectively). It was found that the complete biodegradation of apple pectin cryogels occurred within 24 h of incubation in the rat abdominal cavity. Heracleum L. pectin cryogels were encapsulated in a fibrous capsule and detected in the abdominal cavity after 168 h. Maximum anti-adhesion effect was observed through the use of apple pectin cryogels (0 ± 0.5 score). Significant anti-adhesive effect was also observed through the use of apple pectin–reacetylated chitosan cryogels (1 ± 0.5 score). Due to the high anti-adhesive activity, such cryogels can be recommended for the development of a new barrier material for use in surgery. The potential anti-adhesive mechanism of apple pectin cryogels which may be attributed to a combination of barrier function and bioactivity of cryogels components was discussed.

Sustained Local Release of NGF from a Chitosan-Sericin Composite Scaffold for Treating Chronic Nerve Compression

Chronic nerve compression (CNC), a common form of peripheral nerve injury, always leads to chronic peripheral nerve pain and dysfunction. Current available treatments for CNC are ineffective as they usually aim to alleviate symptoms at the acute phase with limited capability toward restoring injured nerve function. New approaches for effective recovery of CNC injury are highly desired. Here we report for the first time a tissue-engineered approach for the repair of CNC. A genipin cross-linked chitosan-sericin 3D scaffold for delivering nerve growth factor (NGF) was designed and fabricated. This scaffold combines the advantages of both chitosan and sericin, such as high porosity, adjustable mechanical properties and swelling ratios, the ability of supporting Schwann cells growth, and improving nerve regeneration. The degradation products of the composite scaffold upregulate the mRNA levels of the genes important for facilitating nerve function recovery, including glial-derived neurotrophic factor (GDNF), early growth response 2 (EGR2), and neural cell adhesion molecule (NCAM) in Schwann cells, while down-regulating two inflammatory genes' mRNA levels in macrophages, tumor necrosis factor alpha (TNF-α), and interleukin-1 beta (IL-1β). Importantly, our tissue-engineered strategy achieves significant nerve functional recovery in a preclinical CNC animal model by decreasing neuralgia, improving nerve conduction velocity (NCV), accelerating microstructure restoration, and attenuating gastrocnemius muscles dystrophy. Together, this work suggests a promising clinical alternative for treating chronic peripheral nerve compression injury.

Macrophage infiltration of electrospun polyester fibers

Ibuprofen (IBU)-loaded fibrous PLA membranes can prevent peritendinous adhesion/granuloma formation and inflammation by reducing macrophage infiltration.