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Jagdale S, Agarwal B, Dixit A, Gaware S. Chitosan as excellent bio-macromolecule with myriad of anti-activities in biomedical applications - A review. Int J Biol Macromol 2024; 257:128697. [PMID: 38096939 DOI: 10.1016/j.ijbiomac.2023.128697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/31/2023]
Abstract
The aim of the study is to explore the myriad of anti-activities of chitosan - deacylated derivative of chitin in biomedical applications. Chitosan consists of reactive residual amino groups, which can be modified chemically to obtain wide range of derivatives. These derivatives exhibit the controlled physicochemical characteristics, which in turn improve its functional properties. Such derivatives find numerous applications in the field of biomedical science, agriculture, tissue engineering, bone regeneration and environmental science. This study presents a comprehensive overview of the multifarious anti-activities of chitosan and its derivatives in the field of biomedical science including anti-microbial, antioxidant, anti-tumor, anti-HIV, anti-fungal, anti- inflammatory, anti-Alzheimer's, anti-hypertensive and anti-diabetic activity. It briefly details these anti-activities with respect to its mode of action, pharmacological effects and potential applications. It also presents the overview of current research exploring novel derivatives of chitosan and its anti- activities in the recent past. Finally, the review projects the prospective potential of chitosan and its derivatives and expects to encourage the readers to develop new drug delivery systems based on such chitosan derivatives and explore its applications in biomedical science for benefit of mankind.
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Affiliation(s)
- Sachin Jagdale
- Department of Pharmaceutics, Marathwada Mitra Mandal's College of Pharmacy, Thergaon-Pune, Maharashtra 411033, India.
| | - Babita Agarwal
- Department of Pharmaceutical Chemistry, Marathwada Mitra Mandal's College of Pharmacy, Thergaon-Pune, Maharashtra 411033, India
| | - Abhishek Dixit
- Department of Pharmaceutics, Marathwada Mitra Mandal's College of Pharmacy, Thergaon-Pune, Maharashtra 411033, India
| | - Saurabh Gaware
- Department of Pharmaceutics, Marathwada Mitra Mandal's College of Pharmacy, Thergaon-Pune, Maharashtra 411033, India
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2
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Ashbell I, Agam N, Katzir A, Basov S, Platkov M, Avital I, Nisky I, Netz U. Laser tissue soldering of the gastrointestinal tract: A systematic review LTS of the gastrointestinal tract. Heliyon 2023; 9:e16018. [PMID: 37205994 PMCID: PMC10189270 DOI: 10.1016/j.heliyon.2023.e16018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Background Laser Tissue Soldering (LTS) is a promising tissue bonding technique in which a solder is applied between the tissues and then irradiated by laser, causing it to solidify and form links with the tissue. Methods A comprehensive systematic review summarizing the state of research of LTS in the gastrointestinal tract. Results Most studies were conducted on large animal tissues, using liquid proteinaceous solder, and irradiated by a continuous wave laser at 808 nm. LTS can provide better sealing and burst pressure than conventional methods. The application of LTS on top of or in addition to sutures showed an impressive increase in burst pressures. LTS may decrease the inflammatory and foreign body reaction caused by sutures. Conclusions LTS has strong potential to be applied in a clinical setting in leak prevention and in closure of gastrointestinal structures as an adjunct or additional anastomotic technology, decreasing leak rates, morbidity, and mortality.
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Affiliation(s)
- Ido Ashbell
- Goldman School of Medicine, Ben Gurion University, Beer-Sheva, Israel
| | - Nadav Agam
- Goldman School of Medicine, Ben Gurion University, Beer-Sheva, Israel
| | - Abraham Katzir
- School of Physics & Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - Svetlana Basov
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Max Platkov
- Nuclear Research Center Negev, Beer-Sheva, Israel
| | - Itzhak Avital
- Goldman School of Medicine, Ben Gurion University, Beer-Sheva, Israel
- Department of Surgery A, Soroka University Medical Center, Beer-Sheva, Israel
- Legacy-Heritage Oncology Center, Larry Norton Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ilana Nisky
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Uri Netz
- Goldman School of Medicine, Ben Gurion University, Beer-Sheva, Israel
- Department of Surgery A, Soroka University Medical Center, Beer-Sheva, Israel
- Corresponding author. Department of Surgery A, Soroka University Medical Center, Beer-Sheva, Israel.
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3
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Correia C, Reis RL, Pashkuleva I, Alves NM. Adhesive and self-healing materials for central nervous system repair. BIOMATERIALS ADVANCES 2023; 151:213439. [PMID: 37146528 DOI: 10.1016/j.bioadv.2023.213439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
The central nervous system (CNS) has a limited ability to regenerate after a traumatic injury or a disease due to the low capacity of the neurons to re-grow and the inhibitory environment formed in situ. Current therapies include the use of drugs and rehabilitation, which do not fully restore the CNS functions and only delay the pathology progression. Tissue engineering offers a simple and versatile solution for this problem through the use of bioconstructs that promote nerve tissue repair by bridging cavity spaces. In this approach, the choice of biomaterial is crucial. Herein, we present recent advances in the design and development of adhesive and self-healing materials that support CNS healing. The adhesive materials have the advantage of promoting recovery without the use of needles or sewing, while the self-healing materials have the capacity to restore the tissue integrity without the need for external intervention. These materials can be used alone or in combination with cells and/or bioactive agents to control the inflammation, formation of free radicals, and proteases activity. We discuss the advantages and drawbacks of different systems. The remaining challenges that can bring these materials to clinical reality are also briefly presented.
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Affiliation(s)
- Cátia Correia
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Iva Pashkuleva
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Natália M Alves
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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4
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Medical Adhesives and Their Role in Laparoscopic Surgery—A Review of Literature. MATERIALS 2022; 15:ma15155215. [PMID: 35955150 PMCID: PMC9369661 DOI: 10.3390/ma15155215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/15/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023]
Abstract
Laparoscopic surgery is undergoing rapid development. Replacing the traditional method of joining cut tissues with sutures or staples could greatly simplify and speed up laparoscopic procedures. This alternative could undoubtedly be adhesives. For decades, scientists have been working on a material to bond tissues together to create the best possible conditions for tissue regeneration. The results of research on tissue adhesives achieved over the past years show comparable treatment effects to traditional methods. Tissue adhesives are a good alternative to surgical sutures in wound closure. This article is a review of the most important groups of tissue adhesives including their properties and possible applications. Recent reports on the development of biological adhesives are also discussed.
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Hamedi H, Moradi S, Hudson SM, Tonelli AE, King MW. Chitosan based bioadhesives for biomedical applications: A review. Carbohydr Polym 2022; 282:119100. [DOI: 10.1016/j.carbpol.2022.119100] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 11/02/2022]
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Tan J, Foster LJR, Lovicu FJ, Watson SL. New thin-film adhesive for sealing full-thickness corneal incisions in rabbits. J Cataract Refract Surg 2022; 48:355-362. [PMID: 34415863 PMCID: PMC8868184 DOI: 10.1097/j.jcrs.0000000000000751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the repair of penetrating corneal incisions in an in vivo rabbit model using a laser-activated thin-film adhesive, sutures, or self-seal. SETTING The University of Sydney, Camperdown, Australia. DESIGN Animal studies. METHODS Under an operating microscope, 2.0 mm penetrating incisions were created in 162 right eyes. Incisions in one group were repaired with the adhesive, the second group received a single 10-0 nylon suture, and the third group was left to self-seal. Rabbits were killed humanely at predetermined timepoints over 2 weeks, and wound healing was assessed using burst pressure and immunohistological studies. A modified McDonald-Shadduck scoring was used to assess eyes. RESULTS The mean burst pressure of the adhesive group was significantly higher than the sutured or self-sealed groups at all timepoints within the first 72 hours. At 0 hour, the burst pressure was 98.0 (±17.0) mm Hg, 30.6 (±2.1) mm Hg, and 3.8 (±0.6) mm Hg (P < .00001) for adhesive-treated (n = 5), sutured (n = 5), and self-sealed wounds (n = 5), respectively. These increased to 229.0 (±53.7) mm Hg, 12.4 (±2.9) mm Hg, and 27.3 (±4.0) mm Hg (P = .0011) at 72 hours. The modified McDonald-Shadduck score was significantly higher for eyes repaired using the adhesive than those sutured or left to self-seal for the first 72 hours. On histology and immunofluorescence, adhesive treatment demonstrated better wound approximation and higher myofibroblastic activation than the other groups. CONCLUSIONS The adhesive was efficacious in sealing penetrating corneal incisions and tolerated higher burst pressures than sutures or self-seal. The adhesive was biocompatible in rabbits, and incisions demonstrated a rapid gain in wound strength that sustained over the study period.
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7
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A Review on Chitosan's Uses as Biomaterial: Tissue Engineering, Drug Delivery Systems and Cancer Treatment. MATERIALS 2020; 13:ma13214995. [PMID: 33171898 PMCID: PMC7664280 DOI: 10.3390/ma13214995] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
Chitosan, derived from chitin, is a biopolymer consisting of arbitrarily distributed β-(1-4)-linked D-glucosamine and N-acetyl-D-glucosamine that exhibits outstanding properties— biocompatibility, biodegradability, non-toxicity, antibacterial activity, the capacity to form films, and chelating of metal ions. Most of these peculiar properties are attributed to the presence of free protonable amino groups along the chitosan backbone, which also gives it solubility in acidic conditions. Moreover, this biopolymer can also be physically modified, thereby presenting a variety of forms to be developed. Consequently, this polysaccharide is used in various fields, such as tissue engineering, drug delivery systems, and cancer treatment. In this sense, this review aims to gather the state-of-the-art concerning this polysaccharide when used as a biomaterial, providing information about its characteristics, chemical modifications, and applications. We present the most relevant and new information about this polysaccharide-based biomaterial’s applications in distinct fields and also the ability of chitosan and its various derivatives to selectively permeate through the cancer cell membranes and exhibit anticancer activity, and the possibility of adding several therapeutic metal ions as a strategy to improve the therapeutic potential of this polymer.
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8
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Application of a Novel Film Sealant Technology for Penetrating Corneal Wounds: An Ex-Vivo Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10093193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim: To compare the burst pressures of corneal wounds closed with a laser-activated, chitosan-based thin film adhesive against self-seal, sutures and cyanoacrylate. Methods: 2, 4 or 6 mm penetrating corneal wounds were created on 100 freshly enucleated bovine eyes. The wounds were closed using a laser-activated chitosan adhesive (n = 30), self-sealed (control) (n = 30), sutures (n = 20) or cyanoacrylate glue (Histoacryl®) (n = 20). The corneoscleral rim was dissected and mounted onto a custom burst pressure testing chamber. Water was pumped into the chamber at 9ml/hr. The fluid pressure prior to wound leakage was recorded as the ‘burst pressure’. Results: The burst pressure for the 2, 4 and 6 mm wounds were 239.2 mmHg (SD = ±102.4), 181.7 mmHg (SD = ±72.8) and 77.4 mmHg (SD = ±37.4) (p < 0.00001), respectively, for chitosan adhesive. Burst pressure was 36.4 mmHg (SD = ±14.7), 4.8 mmHg (SD = ±4.9) and 2.7 mmHg (SD = ±1.3) (p < 0.00001), respectively, for the self-sealed group. For 4 and 6mm wounds, burst pressures with sutures were 33.0 mmHg (SD = ±19) and 23.5 mmHg (SD = ±17.4) (p = 0.0087), respectively. For cyanoacrylate, burst pressures for 2 and 4 mm wounds were 698 mmHg (SD = ±240.3) and 494.3 mmHg (SD = ±324.6) (p = 0.020087), respectively. Conclusion: This laser-activated chitosan-based adhesive sealed bovine corneal wounds up to 6 mm in length. Burst pressure was higher for the adhesive than sutured or self-sealed wounds, but lower than for cyanoacrylate.
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Geuna S, Muratori L, Fregnan F, Manfredi M, Bertolo R, Porpiglia F. Strategies to improve nerve regeneration after radical prostatectomy: a narrative review. MINERVA UROL NEFROL 2018; 70:546-558. [PMID: 30037210 DOI: 10.23736/s0393-2249.18.03157-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peripheral nerves are complex organs that spread throughout the entire human body. They are frequently affected by lesions not only as a result of trauma but also following radical tumor resection. In fact, despite the advancement in surgical techniques, such as nerve-sparing robot assisted radical prostatectomy, some degree of nerve injury may occur resulting in erectile dysfunction with significant impairment of the quality of life. The aim of this review was to provide an overview on the mechanisms of the regeneration of injured peripheral nerves and to describe the potential strategies to improve the regeneration process and the functional recovery. Yet, the recent advances in bio-engineering strategies to promote nerve regeneration in the urological field are outlined with a view on the possible future regenerative therapies which might ameliorate the functional outcome after radical prostatectomy.
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Affiliation(s)
- Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy - .,Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, Turin, Italy -
| | - Luisa Muratori
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, Turin, Italy
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Bertolo
- Department of Oncology, University of Turin, Orbassano, Turin, Italy.,Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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10
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Eren A, Atalar H, Seymen CM, Alpaslan Pınarlı F, Take Kaplanoglu G, Turanlı S. Sutureless approach with vein grafts and mesenchymal stem cells in primary nerve repair: Functional and immunohistological results. Microsurgery 2018; 38:780-789. [DOI: 10.1002/micr.30315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Ali Eren
- Department of Orthopedics and Traumatology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Hakan Atalar
- Department of Orthopedics and Traumatology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Cemile Merve Seymen
- Department of Histology and Embryology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Ferda Alpaslan Pınarlı
- Center of Cell Research and Genetic Diagnosis; Dıskapı Yıldırım Beyazıt Research Hospital; Etlik Ankara 06010 Turkey
| | - Gulnur Take Kaplanoglu
- Department of Histology and Embryology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Sacit Turanlı
- Department of Orthopedics and Traumatology, Faculty of Medicine; Gazi University; Ankara Turkey
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11
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Frost SJ, Mawad D, Wuhrer R, Myers S, Lauto A. Semitransparent bandages based on chitosan and extracellular matrix for photochemical tissue bonding. Biomed Eng Online 2018; 17:7. [PMID: 29357892 PMCID: PMC5778659 DOI: 10.1186/s12938-018-0444-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracellular matrices (ECMs) are often used in reconstructive surgery to enhance tissue regeneration and remodeling. Sutures and staples are currently used to fix ECMs to tissue although they can be invasive devices. Other sutureless and less invasive techniques, such as photochemical tissue bonding, cannot be coupled to ECMs because of their intrinsic opacity to light. RESULTS We succeeded in fabricating a biocompatible and adhesive device that is based on ovine forestomach matrix (OFM) and a chitosan adhesive. The natural opacity of the OFM has been overcome by adding the adhesive into the matrix that allows for the light to effectively penetrate through it. The OFM-chitosan device is semitransparent (attenuation length ~ 106 µm) and can be photoactivated by green light to bond to tissue. This device does not require sutures or staples and guarantees a bonding strength of ~ 23 kPa. CONCLUSIONS A new semitransparent and biocompatible bandage has been successfully fabricated and characterized for sutureless tissue bonding.
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Affiliation(s)
- Samuel J Frost
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Damia Mawad
- School of Materials Science and Engineering, UNSW Sydney, Sydney, NSW, 2052, Australia.,Australian Centre for NanoMedicine and ARC Centre of Excellence in Convergent BioNano Science and Technology, UNSW Sydney, Sydney, NSW, 2052, Australia.,Centre for Advanced Macromolecular Design, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Richard Wuhrer
- Advanced Materials Characterization Facility (AMCF), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Simon Myers
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Antonio Lauto
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Biomedical Engineering & Neuroscience Research Group, The MARCS Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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12
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Bhagat V, Becker ML. Degradable Adhesives for Surgery and Tissue Engineering. Biomacromolecules 2017; 18:3009-3039. [DOI: 10.1021/acs.biomac.7b00969] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Vrushali Bhagat
- Department
of Polymer Science and ‡Department of Biomedical Engineering, The University of Akron, Akron, Ohio 44325, United States
| | - Matthew L. Becker
- Department
of Polymer Science and ‡Department of Biomedical Engineering, The University of Akron, Akron, Ohio 44325, United States
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13
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Turner NJ, Johnson SA, Foster LJR, Badylak SF. Sutureless nerve repair with ECM bioscaffolds and laser-activated chitosan adhesive. J Biomed Mater Res B Appl Biomater 2017; 106:1698-1711. [DOI: 10.1002/jbm.b.33975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/21/2017] [Accepted: 07/29/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Neill J. Turner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Scott A. Johnson
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Leslie J. R. Foster
- Biopolymer Research Group; School of Biotechnology and Bimolecular Sciences, The University of New South Wales; Sydney Australia
- Save Sight Institute, Faculty of Medicine, University of Sydney; Sydney Australia
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania 15260
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14
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Bhatt NK, Khan TR, Mejias C, Paniello RC. Nerve transection repair using laser-activated chitosan in a rat model. Laryngoscope 2017; 127:E253-E257. [PMID: 28349572 DOI: 10.1002/lary.26583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/03/2017] [Accepted: 02/20/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES/HYPOTHESIS Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study. STUDY DESIGN Animal study. DESIGN Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks. RESULTS At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups-KTP alone, KTP + chitosan, and microsuture + chitosan-were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively. CONCLUSIONS In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery. LEVEL OF EVIDENCE NA Laryngoscope, 127:E253-E257, 2017.
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Affiliation(s)
- Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Taleef R Khan
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Christopher Mejias
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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15
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Characterisation of a novel light activated adhesive scaffold: Potential for device attachment. J Mech Behav Biomed Mater 2016; 62:433-445. [PMID: 27281161 DOI: 10.1016/j.jmbbm.2016.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 11/20/2022]
Abstract
The most common methods for attaching a device to the internal tissues of the human body are via sutures, clips or staples. These attachment techniques require penetration and manipulation of the tissue. Tears and leaks can often be a complication post-attachment, and scarring usually occurs around the attachment sites. To resolve these issues, it is proposed to develop a soft tissue scaffold impregnated with Rose Bengal/Chitosan solution (RBC-scaffold, 0.01% w/v Rose Bengal, 1.7% w/v Medium Molecular Weight Chitosan). This scaffold will initially attach to the tissue via a light activation method. The light activates the dye in the scaffold which causes cross-links to form between the scaffold and tissue, thus adhering them together. This is done without mechanically manipulating the surrounding tissue, thus avoiding the issues associated with current techniques. Eventually, the scaffold will be resorbed and tissue will integrate for long-term attachment. A variety of tests were performed to characterise the RBC-scaffold. Porosity, interconnectivity, and mechanical strength were measured. Light activation was performed with a broad spectrum (380-780nm) 10W LED lamp exposed to various time lengths (2-15min, Fluence range 0.4-3J/cm(2) ). Adhesive strength of the light-activated bond was measured with lap-shear tests performed on porcine stomach tissue. Cell culture viability was also assessed to confirm tissue integration potential. These properties were compared to Variotis™, an aliphatic polyester soft tissue scaffold which has proven to be viable for soft tissue regeneration. The RBC-scaffolds were found to have high porosity (86.46±2.95%) and connectivity, showing rapid fluid movement. The elastic modulus of the RBC-scaffolds (3.55±1.28MPa) was found to be significantly higher than the controls (0.15±0.058MPa, p<0.01) and approached reported values for human gastrointestinal tissue (2.3MPa). The maximum adhesion strength achieved of the RBC-scaffolds was 8.61±2.81kPa after 15min of light activation, this is comparable to the adhesion strength of fibrin glue on scaffolds. Cell attachment was seen to be similar to the controls, but cells appeared to have better cell survivability. In conclusion, the RBC-scaffolds show promise for use as a novel light activated attachment device with potential applications in attaching an anti-reflux valve in the lower oesophagus and also in wound healing applications for stomach ulcers.
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Shaikh S, Shortland P, Lauto A, Barton M, Morley JW, Mahns DA. Sensory perturbations using suture and sutureless repair of transected median nerve in rats. Somatosens Mot Res 2016; 33:20-8. [PMID: 26899181 DOI: 10.3109/08990220.2016.1142438] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effects of changes to cold, mechanical, and heat thresholds following median nerve transection with repair by sutures (Su) or Rose Bengal adhesion (RA) were compared to sham-operated animals. Both nerve-injured groups showed a transient, ipsilateral hyposensitivity to mechanical and heat stimuli followed by a robust and long-lasting hypersensitivity (6-7 weeks) with gradual recovery towards pre-injury levels by 90 days post-repair. Both tactile and thermal hypersensitivity were seen in the contralateral limb that was similar in onset but differed in magnitude and resolved more rapidly compared to the injured limb. Prior to injury, no animals showed any signs of aversion to cold plate temperatures of 4-16 °C. After injury, animals showed cold allodynia, lasting for 7 weeks in RA-repaired rats before recovering towards pre-injury levels, but were still present at 12 weeks in Su-repaired rats. Additionally, sensory recovery in the RA group was faster compared to the Su group in all behavioural tests. Surprisingly, sham-operated rats showed similar bilateral behavioural changes to all sensory stimuli that were comparable in onset and magnitude to the nerve-injured groups but resolved more quickly compared to nerve-injured rats. These results suggest that nerve repair using a sutureless approach produces an accelerated recovery with reduced sensorimotor disturbances compared to direct suturing. They also describe, for the first time, that unilateral forelimb nerve injury produces mirror-image-like sensory perturbations in the contralateral limb, suggesting that the contralateral side is not a true control for sensory testing. The potential mechanisms involved in this altered behaviour are discussed.
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Affiliation(s)
- Sumaiya Shaikh
- a School of Medicine, Western Sydney University , NSW , Australia
| | - Peter Shortland
- b School of Science and Health, Western Sydney University , NSW , Australia
| | - Antonio Lauto
- b School of Science and Health, Western Sydney University , NSW , Australia
| | - Matthew Barton
- a School of Medicine, Western Sydney University , NSW , Australia
| | - John W Morley
- a School of Medicine, Western Sydney University , NSW , Australia
| | - David A Mahns
- a School of Medicine, Western Sydney University , NSW , Australia
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Frost SJ, Mawad D, Hook J, Lauto A. Micro- and Nanostructured Biomaterials for Sutureless Tissue Repair. Adv Healthc Mater 2016; 5:401-14. [PMID: 26725593 DOI: 10.1002/adhm.201500589] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/23/2015] [Indexed: 01/01/2023]
Abstract
Sutureless procedures for wound repair and closure have recently integrated nanostructured devices to improve their effectiveness and clinical outcome. This review highlights the major advances in gecko-inspired bioadhesives that relies mostly on van der Waals bonding forces. These are challenged by the moist environment of surgical settings that weaken adherence to tissue. The incorporation of nanoparticles in biomatrices and their role in tissue repair and drug delivery is also reviewed with an emphasis on procedures involving adhesives that are laser-activated. Nanostructured adhesive devices have the advantage of being minimally invasive to tissue, can seal wounds, and deliver drugs in situ. All these tasks are very difficult to accomplish by sutures or staples that are invasive to host organs and often cause scarring.
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Affiliation(s)
- Samuel J. Frost
- School of Science and Health; University of Western Sydney; Penrith NSW 2751 Australia
| | - D. Mawad
- Department of Materials; Imperial College London; SW7 2AZ UK
- School of Materials Science and Engineering; University of New South Wales; Sydney 2052 Australia
| | - J. Hook
- School of Chemistry; University of New South Wales; Sydney 2052 Australia
| | - Antonio Lauto
- School of Science and Health; University of Western Sydney; Penrith NSW 2751 Australia
- The Biomedical Engineering and Neuroscience (BENS) Research Group; The MARCS Institute; Penrith NSW 2751 Australia
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Barton MJ, Morley JW, Stoodley MA, Shaikh S, Mahns DA, Lauto A. Long term recovery of median nerve repair using laser-activated chitosan adhesive films. JOURNAL OF BIOPHOTONICS 2015; 8:196-207. [PMID: 24132983 DOI: 10.1002/jbio.201300129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/06/2013] [Accepted: 09/22/2013] [Indexed: 06/02/2023]
Abstract
Sutures remain the standard peripheral nerve repair technique, whether applied directly or indirectly to nerve tissue. Unfortunately, significant postoperative complications can result, such as inflammation, neuroma formation and foreign body reactions. Photochemical-tissue-bonding (PTB) using rose Bengal (RB) integrated into a chitosan bioadhesive is an alternative nerve repair device that removes the need for sutures. Rats were arranged into three groups: RB-chitosan adhesives-repair, end-to-end epineural suture-repair (surgical standard) and sham laser-irradiated control. Groups were compared through histological assessment, electrophysiological recordings and grip motor strength. RB-chitosan adhesive repaired nerves displayed comparable results when compared to the standard suture-repair based on histological and electrophysiological findings. Functionally, RB-chitosan adhesive was associated with a quicker and more pronounced recovery of grip force when compared to the suture-repair.
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Affiliation(s)
- Matthew J Barton
- School of Medicine, University of Western Sydney, Locked Bag 1797 Penrith, NSW, 2751, Australia
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Barton MJ, Morley JW, Mahns DA, Mawad D, Wuhrer R, Fania D, Frost SJ, Loebbe C, Lauto A. Tissue repair strength using chitosan adhesives with different physical-chemical characteristics. JOURNAL OF BIOPHOTONICS 2014; 7:948-955. [PMID: 24395818 DOI: 10.1002/jbio.201300148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/21/2013] [Accepted: 11/06/2013] [Indexed: 06/03/2023]
Abstract
A range of chitosan-based biomaterials have recently been used to perform sutureless, laser-activated tissue repair. Laser-activation has the advantage of bonding to tissue through a non-contact, aseptic mechanism. Chitosan adhesive films have also been shown to adhere to sheep intestine strongly without any chemical modification to chitosan. In this study, we continue to investigate chitosan adhesive films and explore the impact on the tissue repair strength and tensile strength characteristics of four types of adhesive film based on chitosan with different molecular weight and degree of deacetylation. Results showed that adhesives based on chitosan with medium molecular weight achieved the highest bonding strength, tensile strength and E-modulus when compared to the other adhesives.
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Affiliation(s)
- Matthew J Barton
- School of Medicine, University of Western Sydney, Locked Bag 1797 Penrith, NSW, 2751, Australia
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Annabi N, Tamayol A, Shin SR, Ghaemmaghami AM, Peppas NA, Khademhosseini A. Surgical Materials: Current Challenges and Nano-enabled Solutions. NANO TODAY 2014; 9:574-589. [PMID: 25530795 PMCID: PMC4266934 DOI: 10.1016/j.nantod.2014.09.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Surgical adhesive biomaterials have emerged as substitutes to sutures and staples in many clinical applications. Nano-enabled materials containing nanoparticles or having a distinct nanotopography have been utilized for generation of a new class of surgical materials with enhanced functionality. In this review, the state of the art in the development of conventional surgical adhesive biomaterials is critically reviewed and their shortcomings are outlined. Recent advancements in generation of nano-enabled surgical materials with their potential future applications are discussed. This review will open new avenues for the innovative development of the next generation of tissue adhesives, hemostats, and sealants with enhanced functionality for various surgical applications.
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Affiliation(s)
- Nasim Annabi
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA ; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Ali Tamayol
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Su Ryon Shin
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA ; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Amir M Ghaemmaghami
- Division of Immunology, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - Nicholas A Peppas
- Department of Biomedical Engineering, Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Ali Khademhosseini
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA ; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA ; Department of Biomedical Engineering, Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA ; Department of Maxillofacial Biomedical Engineering and Institute of Oral Biology, School of Dentistry, Kyung Hee University, Seoul 130-701, Republic of Korea ; Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
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Barton MJ, Morley JW, Stoodley MA, Lauto A, Mahns DA. Nerve repair: toward a sutureless approach. Neurosurg Rev 2014; 37:585-95. [PMID: 25015388 DOI: 10.1007/s10143-014-0559-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/04/2014] [Accepted: 04/13/2014] [Indexed: 12/16/2022]
Abstract
Peripheral nerve repair for complete section injuries employ reconstructive techniques that invariably require sutures in their application. Sutures are unable to seal the nerve, thus incapable of preventing leakage of important intraneural fluids from the regenerating nerve. Furthermore, sutures are technically demanding to apply for direct repairs and often induce detrimental scarring that impedes healing and functional recovery. To overcome these limitations, biocompatible and biodegradable glues have been used to seal and repair peripheral nerves. Although creating a sufficient seal, they can lack flexibility and present infection risks or cytotoxicity. Other adhesive biomaterials have recently emerged into practice that are usually based on proteins such as albumin and collagen or polysaccharides like chitosan. These adhesives form their union to nerve tissue by either photothermal (tissue welding) or photochemical (tissue bonding) activation with laser light. These biomaterial adhesives offer significant advantages over sutures, such as their capacity to unite and seal the epineurium, ease of application, reduced invasiveness and add the potential for drug delivery in situ to facilitate regeneration. This paper reviews a number of different peripheral nerve repair (or reconstructive) techniques currently used clinically and in experimental procedures for nerve injuries with or without tissue deficit.
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Affiliation(s)
- Matthew J Barton
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, 4222, Australia,
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Sabri F, Gerth D, Tamula GRM, Phung TCN, Lynch KJ, Boughter Jr JD. Novel Technique for Repair of Severed Peripheral Nerves in Rats Using Polyurea Crosslinked Silica Aerogel Scaffold. J INVEST SURG 2014; 27:294-303. [DOI: 10.3109/08941939.2014.906688] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Peng HT, Shek PN. Novel wound sealants: biomaterials and applications. Expert Rev Med Devices 2014; 7:639-59. [DOI: 10.1586/erd.10.40] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Barton M, Morley JW, Stoodley MA, Ng KS, Piller SC, Duong H, Mawad D, Mahns DA, Lauto A. Laser-activated adhesive films for sutureless median nerve anastomosis. JOURNAL OF BIOPHOTONICS 2013; 6:938-949. [PMID: 23712961 DOI: 10.1002/jbio.201300054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 06/02/2023]
Abstract
A novel chitosan adhesive film that incorporates the dye 'Rose Bengal' (RB) was used in conjunction with a green laser to repair transected rat median nerves in vivo. Histology and electrophysiological recording assessed the impact of the laser-adhesive technique on nerves. One week post-operatively, the sham-control group (laser-adhesive technique applied on un-transected nerves) conserved the average number and size of myelinated fibres in comparison to its contralateral side and electrophysiological recordings demonstrated no significant difference with un-operated nerves. Twelve weeks after the laser-adhesive anastomoses, nerves were in continuity with regenerated axons that crossed the anastomotic site.
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Affiliation(s)
- Mathew Barton
- School of Medicine, University of Western Sydney, Locked Bag 1797 Penrith, NSW, 2751, Australia
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Gnavi S, Barwig C, Freier T, Haastert-Talini K, Grothe C, Geuna S. The use of chitosan-based scaffolds to enhance regeneration in the nervous system. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 109:1-62. [PMID: 24093605 DOI: 10.1016/b978-0-12-420045-6.00001-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Various biomaterials have been proposed to build up scaffolds for promoting neural repair. Among them, chitosan, a derivative of chitin, has been raising more and more interest among basic and clinical scientists. A number of studies with neuronal and glial cell cultures have shown that this biomaterial has biomimetic properties, which make it a good candidate for developing innovative devices for neural repair. Yet, in vivo experimental studies have shown that chitosan can be successfully used to create scaffolds that promote regeneration both in the central and in the peripheral nervous system. In this review, the relevant literature on the use of chitosan in the nervous tissue, either alone or in combination with other components, is overviewed. Altogether, the promising in vitro and in vivo experimental results make it possible to foresee that time for clinical trials with chitosan-based nerve regeneration-promoting devices is approaching quickly.
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Affiliation(s)
- Sara Gnavi
- Department of Clinical and Biological Sciences, Neuroscience Institute of the Cavalieri Ottolenghi Foundation (NICO), University of Turin, Ospedale San Luigi, Regione Gonzole 10, Orbassano (TO), Italy
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Geuna S, Gnavi S, Perroteau I, Tos P, Battiston B. Tissue Engineering and Peripheral Nerve Reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 108:35-57. [DOI: 10.1016/b978-0-12-410499-0.00002-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lauto A, Stoodley M, Barton M, Morley JW, Mahns DA, Longo L, Mawad D. Fabrication and application of rose bengal-chitosan films in laser tissue repair. J Vis Exp 2012:4158. [PMID: 23117629 DOI: 10.3791/4158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Photochemical tissue bonding (PTB) is a sutureless technique for tissue repair, which is achieved by applying a solution of rose bengal (RB) between two tissue edges(1,2). These are then irradiated by a laser that is selectively absorbed by the RB. The resulting photochemical reactions supposedly crosslink the collagen fibers in the tissue with minimal heat production(3). In this report, RB has been incorporated in thin chitosan films to fabricate a novel tissue adhesive that is laser-activated. Adhesive films, based on chitosan and containing ~0.1 wt% RB, are fabricated and bonded to calf intestine and rat tibial nerves by a solid state laser (λ=532 nm, Fluence~110 J/cm(2), spot size~0.5 cm). A single-column tensiometer, interfaced with a personal computer, is used to test the bonding strength. The RB-chitosan adhesive bonds firmly to the intestine with a strength of 15 ± 6 kPa, (n=30). The adhesion strength drops to 2 ± 2 kPa (n=30) when the laser is not applied to the adhesive. The anastomosis of tibial nerves can be also completed without the use of sutures. A novel chitosan adhesive has been fabricated that bonds photochemically to tissue and does not require sutures.
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Affiliation(s)
- Antonio Lauto
- Bioelectronics and Neuroscience (BENS) research group, University of Western Sydney, NSW Australia.
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Foster LJR, Karsten E. A chitosan based, laser activated thin film surgical adhesive, 'SurgiLux': preparation and demonstration. J Vis Exp 2012:3527. [PMID: 23117533 PMCID: PMC3580237 DOI: 10.3791/3527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Sutures are a 4,000 year old technology that remain the 'gold-standard' for wound closure by virtue of their repair strength (~100 KPa). However, sutures can act as a nidus for infection and in many procedures are unable to effect wound repair or interfere with functional tissue regeneration.(1) Surgical glues and adhesives, such as those based on fibrin and cyanoacrylates, have been developed as alternatives to sutures for the repair of such wounds. However, current commercial adhesives also have significant disadvantages, ranging from viral and prion transfer and a lack of repair strength as with the fibrin glues, to tissue toxicity and a lack of biocompatibility for the cyanoacrylate based adhesives. Furthermore, currently available surgical adhesives tend to be gel-based and can have extended curing times which limit their application.(2) Similarly, the use of UV lasers to facilitate cross-linking mechanisms in protein-based or albumin 'solders' can lead to DNA damage while laser tissue welding (LTW) predisposes thermal damage to tissues.(3) Despite their disadvantages, adhesives and LTW have captured approximately 30% of the wound closure market reported to be in excess of US $5 billion per annum, a significant testament to the need for sutureless technology.(4) In the pursuit of sutureless technology we have utilized chitosan as a biomaterial for the development of a flexible, thin film, laser-activated surgical adhesive termed 'SurgiLux'. This novel bioadhesive uses a unique combination of biomaterials and photonics that are FDA approved and successfully used in a variety of biomedical applications and products. SurgiLux overcomes all the disadvantages associated with sutures and current surgical adhesives (see Table 1). In this presentation we report the relatively simple protocol for the fabrication of SurgiLux and demonstrate its laser activation and tissue weld strength. SurgiLux films adhere to collagenous tissue without chemical modification such as cross-linking and through irradiation using a comparatively low-powered (120 mW) infrared laser instead of UV light. Chitosan films have a natural but weak adhesive attraction to collagen (~3 KPa), laser activation of the chitosan based SurgiLux films emphasizes the strength of this adhesion through polymer chain interactions as a consequence of transient thermal expansion.(5) Without this 'activation' process, SurgiLux films are readily removed.(6-9) SurgiLux has been tested both in vitro and in vivo on a variety of tissues including nerve, intestine, dura mater and cornea. In all cases it demonstrated good biocompatibility and negligible thermal damage as a consequence of irradiation.(6-10).
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Affiliation(s)
- L John R Foster
- Bio/Polymer Research Group, School of Biotechnology & Biomolecular Sciences, University of New South Wales.
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Schmitt T, Talley J, Chang J. New Concepts and Technologies in Reconstructive Hand Surgery. Clin Plast Surg 2012; 39:445-51. [DOI: 10.1016/j.cps.2012.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Barton M, Piller SC, Mahns DA, Morley JW, Mawad D, Longo L, Lauto A. In vitro cell compatibility study of rose bengal-chitosan adhesives. Lasers Surg Med 2012; 44:762-8. [DOI: 10.1002/lsm.22076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 01/01/2023]
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Duarte A, Coelho J, Bordado J, Cidade M, Gil M. Surgical adhesives: Systematic review of the main types and development forecast. Prog Polym Sci 2012. [DOI: 10.1016/j.progpolymsci.2011.12.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Shahbazi J, Marçal H, Watson S, Wakefield D, Sarris M, Foster LJR. Sutureless sealing of penetrating corneal wounds using a laser-activated thin film adhesive. Lasers Surg Med 2012; 43:490-8. [PMID: 21761419 DOI: 10.1002/lsm.21076] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES To demonstrate the feasibility of a novel, thin film, laser-activated adhesive in sealing penetrative corneal wounds with a view to replacing sutures in ophthalmic operations. METHODS A previously described thin film adhesive composed of chitosan and indocyanine green activated by infrared laser (808 nm) was used to seal penetrating corneal wounds ranging from 1 to 6 mm in size in enucleated bovine eyes. The excised corneas were subjected to pressure tests to evaluate the strength of the corneal repairs and compared to sutures and commercial fibrin glue, Tisseel®. Temperatures at the adhesive-tissue interface were measured and histological examinations of the repairs performed to investigate potential tissue damage. Biodegradability of the films was monitored in lysozyme solutions at concentrations reported in tears. RESULTS The adhesive effectively sealed corneal wounds, withstanding pressures of 140-320 mmHg, far in excess of the normal intraocular pressure. In contrast, pressures of 40-80 mm Hg were determined using a combination of sutures with Tisseel® as a sealant. The laser-activation process was 1.5-5 times faster than other procedures studied and required no curing time. A transient, mean temperature of 56 ± 2°C was measured at the adhesive-tissue interface while histology showed no tissue damage as a consequence of the irradiation process. Irradiation had no significant influence on adhesive biodegradation in vitro, which lost approximately 30% of their initial weight in a lysozyme solution (6 mg ml(-1)). CONCLUSIONS The thin film adhesive was found to be an effective in sealing corneal wounds with considerable advantages over sutures, including speed of application and sealing strength and biodegradability.
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Affiliation(s)
- Jeyran Shahbazi
- Bio/Polymer Research Group, Centre for Advanced Macromolecular Design, School of Biotechnology & Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
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Chimutengwende-Gordon M, Khan W. Recent advances and developments in neural repair and regeneration for hand surgery. Open Orthop J 2012; 6:103-7. [PMID: 22431954 PMCID: PMC3293168 DOI: 10.2174/1874325001206010103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 09/30/2011] [Accepted: 10/02/2011] [Indexed: 11/22/2022] Open
Abstract
End-to-end suture of nerves and autologous nerve grafts are the 'gold standard' for repair and reconstruction of peripheral nerves. However, techniques such as sutureless nerve repair with tissue glues, end-to-side nerve repair and allografts exist as alternatives. Biological and synthetic nerve conduits have had some success in early clinical studies on reconstruction of nerve defects in the hand. The effectiveness of nerve regeneration could potentially be increased by using these nerve conduits as scaffolds for delivery of Schwann cells, stem cells, neurotrophic and neurotropic factors or extracellular matrix proteins. There has been extensive in vitro and in vivo research conducted on these techniques. The clinical applicability and efficacy of these techniques needs to be investigated fully.
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Affiliation(s)
- Mukai Chimutengwende-Gordon
- University College London Institute of Orthopaedic and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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Foster LJR, Thomson K, Marçal H, Butt J, Watson SL, Wakefield D. Chitosan-vancomysin composite biomaterial as a laser activated surgical adhesive with regional antimicrobial activity. Biomacromolecules 2010; 11:3563-70. [PMID: 21080623 DOI: 10.1021/bm101028g] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have used laser irradiation to enhance the natural adhesiveness of chitosan to form a thin film surgical adhesive. Prevention of infection at surgical sites often utilizes systemic provision of antibiotics with reduced local efficacy and potential side effects. In the work reported here, we investigate the bactericidal properties of laser-irradiated chitosan films and their impregnation with the antibiotic vancomycin. Despite strong efficacy in solution, chitosan films showed no antimicrobial activity against representatives of common pathogens Escherichia coli , Staphylococcus aureus , and S. epidermidis . In contrast, a composite of chitosan adhesive and the antibiotic vancomycin showed therapeutically significant release profiles greater that the Minimum Bactericidal Concentrations (MBCs) for the Staphylococci over a 28 day period. These composite films had greater crystallinity, up to 28 ± 3 compared to 8.9 ± 2%, for its unblended counterpart. Despite a significant increase in material strength from 31.4 ± 4 to 77.5 ± 5 MPa, flexibility was still maintained with an elongation to break around 5 ± 2% and fold endurance of approximately 30 ± 3-folds. Laser irradiation had no apparent effect on the release or activity of the antibiotic which survived transient temperatures at the film-tissue interface during infrared irradiation of around 54 °C. Furthermore, significant adhesive strength was still apparent, 15.6 ± 2 KPa. Thus, we have developed a laser-activated bioadhesive with the potential to close wounds while facilitating the prevention of microbial infection through local release of antibiotic targeted to the site of potential infection.
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Affiliation(s)
- L John R Foster
- Bio/Polymer Research Group, Centre for Advanced Macromolecular Design, School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia.
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Lauto A, Mawad D, Barton M, Gupta A, Piller SC, Hook J. Photochemical tissue bonding with chitosan adhesive films. Biomed Eng Online 2010; 9:47. [PMID: 20825632 PMCID: PMC2949880 DOI: 10.1186/1475-925x-9-47] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/08/2010] [Indexed: 11/10/2022] Open
Abstract
Background Photochemical tissue bonding (PTB) is a promising sutureless technique for tissue repair. PTB is often achieved by applying a solution of rose bengal (RB) between two tissue edges, which are irradiated by a green laser to crosslink collagen fibers with minimal heat production. In this study, RB has been incorporated in chitosan films to create a novel tissue adhesive that is laser-activated. Methods Adhesive films, based on chitosan and containing ~0.1 wt% RB were manufactured and bonded to calf intestine by a solid state laser (λ = 532 nm, Fluence~110 J/cm2, spot size~0.5 cm). A single-column tensiometer, interfaced with a personal computer, tested the bonding strength. K-type thermocouples recorded the temperature (T) at the adhesive-tissue interface during laser irradiation. Human fibroblasts were also seeded on the adhesive and cultured for 48 hours to assess cell growth. Results The RB-chitosan adhesive bonded firmly to the intestine with adhesion strength of 15 ± 2 kPa, (n = 31). The adhesion strength dropped to 0.5 ± 0.1 (n = 8) kPa when the laser was not applied to the adhesive. The average temperature of the adhesive increased from 26°C to 32°C during laser exposure. Fibroblasts grew confluent on the adhesive without morphological changes. Conclusion A new biocompatible chitosan adhesive has been developed that bonds photochemically to tissue with minimal temperature increase.
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Affiliation(s)
- Antonio Lauto
- School of Biomedical and Health Sciences, School of Medicine, University of Western Sydney, NSW, Australia.
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Lauto A. Integration of extracellular matrix with chitosan adhesive film for sutureless tissue fixation. Lasers Surg Med 2009; 41:366-71. [DOI: 10.1002/lsm.20774] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Muzzarelli RA. Chitins and chitosans for the repair of wounded skin, nerve, cartilage and bone. Carbohydr Polym 2009. [DOI: 10.1016/j.carbpol.2008.11.002] [Citation(s) in RCA: 632] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Chiono V, Tonda-Turo C, Ciardelli G. Chapter 9: Artificial scaffolds for peripheral nerve reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:173-98. [PMID: 19682638 DOI: 10.1016/s0074-7742(09)87009-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Posttraumatic peripheral nerve repair is one of the major challenges in restorative medicine and microsurgery. Despite the recent progresses in the field of tissue engineering, functional recovery after severe nerve lesions is generally partial and unsatisfactory. Autograft is still the best method to treat peripheral nerve lesions, although it has several drawbacks and does not allow complete functional recovery. Full recovery of nerve functionality could ideally be achieved by proper guiding axon regeneration toward the original target tissues, through the use of purposely engineered artificial nerve guidance channels (NGCs). In the last decade, artificial NGCs have been produced using a variety of both natural and synthetic, biodegradable and nonbiodegradable polymers. Several techniques have been developed to obtain porous and nonporous NGCs and to realize and incorporate bioactive fillers for NGCs. Some of the developed products have been approved for clinical applications. Many other NGC typologies have been object of interest and are currently under investigation. The current trend of nerve tissue engineering is the realization of biomimetic NGCs, providing chemotactic, topological, and haptotactic signalling to cells, respectively by surface functionalization with cell binding domains, the use of internal-oriented matrices/fibres and the sustained release of neurotrophic factors. The present contribution provides a balanced integration of the most recent achievements of tissue engineering in the field of peripheral nerve repair. By an accurate evaluation of the status of research, the review delineates the most promising directions to which research should address for consistent progress in the field of peripheral nerve repair.
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Affiliation(s)
- Valeria Chiono
- Department of Mechanics, Politecnico di Torino, Torino, Italy
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