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Zhang Z, Yin C, Song X, Liu X, Zhong C, Zheng J, Ni Y, Shen R, Guo Y, Li X, Lin C, Zhang Y, Hu G. A self-fused peptide-loaded hydrogel with injectability and tissue-adhesiveness for preventing postoperative peritoneal adhesions. Mater Today Bio 2024; 28:101205. [PMID: 39221222 PMCID: PMC11364900 DOI: 10.1016/j.mtbio.2024.101205] [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: 04/23/2024] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
Peritoneal adhesions commonly occur following abdominal or pelvic surgery and can cause serious complications. Currently, physical barriers are the primary approach used in clinical practice to prevent adhesion, although their effectiveness is frequently inadequate. In this study, we developed an injectable peptide-loaded hydrogel with multiple functions, including self-fusion, tissue-adhesiveness, anti-inflammation, anti-cell adhesion and anti-angiogenesis. To assess the effectiveness of these hydrogels, which are stabilized by dynamic imine bonds and acetal connections, in preventing postoperative abdominal adhesions, we utilized both a rat abdominal adhesion model and a rat model simulating repeated-injury adhesions. In comparison to the commercially available HA hydrogel, as-prepared hydrogels exhibited significant reductions in inflammation, fibrosis, and angiogenesis, leading to an obvious decrease in peritoneal adhesions. Moreover, this peptide-loaded hydrogel demonstrated an ideal degradation time, maintaining an in vivo viability for about 10 days. We believe this peptide-loaded hydrogel presents a promising solution for the challenging clinical issue of postoperative abdominal adhesions.
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Affiliation(s)
- Zequn Zhang
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Chao Yin
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, China
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830011, China
| | - Xianwen Song
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, China
| | - Xi Liu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Chonglei Zhong
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Jun Zheng
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, China
| | - Yaqiong Ni
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, China
| | - Rujuan Shen
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha, 410083, China
| | - Yihang Guo
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Xiaorong Li
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Changwei Lin
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Yi Zhang
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, China
- National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou, 450002, China
| | - Gui Hu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
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Lu W, Wang X, Kong C, Chen S, Hu C, Zhang J. Hemoadhican-Based Bioabsorbable Hydrogel for Preventing Postoperative Adhesions. ACS APPLIED MATERIALS & INTERFACES 2024; 16:17267-17284. [PMID: 38556996 DOI: 10.1021/acsami.4c01088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Postoperative peritoneal adhesions are a prevalent clinical issue following abdominal and pelvic surgery, frequently resulting in heightened personal and societal health burdens. Traditional biomedical barriers offer limited benefits because of practical challenges for doctors and their incompatibility with laparoscopic surgery. Hydrogel materials, represented by hyaluronic acid gels, are receiving increasing attention. However, existing antiadhesive gels still have limited effectiveness or carry the risk of complications in clinical applications. Herein, we developed a novel hydrogel using polysaccharide hemoadhican (HD) as the base material and polyethylene glycol diglycidyl ether (PEGDE) as the cross-linking agent. The HD hydrogels exhibit appropriate mechanical properties, injectability, and excellent cytocompatibility. We demonstrate resistance to protein adsorption and L929 fibroblast cell adhesion to the HD hydrogel. The biodegradability and efficacy against peritoneal adhesion are further evaluated in C57BL/6 mice. Our results suggest a potential strategy for anti-postoperative tissue adhesion barrier biomaterials.
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Affiliation(s)
- Weiling Lu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Nanjing 210094, China
| | - Xianjin Wang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Nanjing 210094, China
| | - Changchang Kong
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Nanjing 210094, China
| | - Shijunyin Chen
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Nanjing 210094, China
| | - Chengtao Hu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Nanjing 210094, China
| | - Jianfa Zhang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Nanjing 210094, China
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Flutur IM, Păduraru DN, Bolocan A, Palcău AC, Ion D, Andronic O. Postsurgical Adhesions: Is There Any Prophylactic Strategy Really Working? J Clin Med 2023; 12:3931. [PMID: 37373626 DOI: 10.3390/jcm12123931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Postoperative adhesions are a frequent complication encountered after surgical procedures, mainly after intraperitoneal interventions. To this day, the pathophysiological mechanism behind the process of adhesions formation is not completely known. There are many strategies proposed as prophylaxis methods, involving surgical techniques, drugs or materials that prevent adhesions and even state of the art technologies such as nanoparticles or gene therapy. The aim of our review is to present these innovative approaches and techniques for postoperative adhesions prevention. After a thorough scientific database query, we selected 84 articles published in the past 15 years that were relevant to our topic. Despite all the recent groundbreaking discoveries, we are at an early stage of understanding the complexity of the adhesion formation mechanism. Further investigations should be made in order to create an ideal product for safe clinical use for prevention.
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Affiliation(s)
- Irina-Maria Flutur
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dan Nicolae Păduraru
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Alexandra Bolocan
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Alexandru Cosmin Palcău
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Daniel Ion
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Octavian Andronic
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
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Zeng H, Liu X, Zhang Z, Song X, Quan J, Zheng J, Shen Z, Ni Y, Liu C, Zhang Y, Hu G. Self-healing, injectable hydrogel based on dual dynamic covalent cross-linking against postoperative abdominal cavity adhesion. Acta Biomater 2022; 151:210-222. [PMID: 35995405 DOI: 10.1016/j.actbio.2022.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/01/2022]
Abstract
Clinically, increasing the peritoneal barrier is an effective adjunct to reducing postoperative peritoneal adhesion. This study presents a facile template for preparing a supramolecular hybrid hydrogel through dynamic covalent cross-linking between carboxymethyl chitosan (CMCS), 2-formylphenylboronic acid (2-FPBA), and quercetin (Que). The as-prepared complex CMCS/2-FPBA/Que (CFQ) hydrogel exhibited favorable antibacterial, anti-inflammatory, and antioxidant effects. A L929 cytotoxicity evaluation confirmed the favorable cytocompatibility of the CFQ hydrogel. The postoperative anti-adhesion ability of the CFQ hydrogel was further evaluated in rats with lateral wall defects and cecal abrasions. Compared with control groups, the tissue adhesion rate was significantly reduced by increasing the Que concentration in all the hydrogel-treated groups. Additionally, the sustained-release time of the C3F0.8Q0.08 hydrogel can exceed 14 days, which is highly desirable for clinical wound treatment. STATEMENT OF SIGNIFICANCE: Postoperative adhesions are a very common postoperative complication that seriously affects the quality of life of patients. The currently commonly used methods for preventing adhesion mainly use degradable barrier materials for physical separation. In this study, we prepared a dual dynamic covalently cross-linked CFQ hydrogel, which is not only degradable and injectable, but also has multiple properties such as antibacterial, antioxidant and anti-inflammatory, which can effectively prevent postoperative adhesion and promote wound healing.
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Affiliation(s)
- Huihui Zeng
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Xi Liu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Zequn Zhang
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Xianwen Song
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Jun Quan
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Jun Zheng
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Zhaolong Shen
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Yaqiong Ni
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Chuntai Liu
- National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China
| | - Yi Zhang
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China.
| | - Gui Hu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China.
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Nishiguchi A, Ichimaru H, Ito S, Nagasaka K, Taguchi T. Hotmelt tissue adhesive with supramolecularly-controlled sol-gel transition for preventing postoperative abdominal adhesion. Acta Biomater 2022; 146:80-93. [PMID: 35500814 DOI: 10.1016/j.actbio.2022.04.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/05/2022] [Accepted: 04/21/2022] [Indexed: 11/01/2022]
Abstract
Postoperative adhesion is a serious and frequent complication, but there is currently no reliable anti-adhesive barrier available due to low tissue adhesiveness, undesirable chemical reactions, and poor operability. To overcome these problems, we report a single-syringe hotmelt tissue adhesive that dissolves upon warming over 40 °C and coheres at 37 °C as a postoperative barrier. Tendon-derived gelatin was conjugated with the ureidopyrimidinone unit to supramolecularly control the sol-gel transition behavior. This functionalization improved bulk mechanical strength, tissue-adhesive properties, and stability under physiological conditions through the augmentation of intermolecular hydrogen bonding by ureidopyrimidinone unit. This biocompatible adhesive prevented postoperative adhesion between cecum and abdominal wall in adhesion models of rats. This hotmelt tissue adhesive has enormous potential to prevent postoperative complications and may contribute to minimally invasive surgery. STATEMENT OF SIGNIFICANCE: There is a strong need to develop medical tissue adhesives with high biocompatibility, tissue adhesiveness, and operatability to prevent postoperative complications. In this report, single syringe, hotmelt-type tissue adhesive was developed by controlling sol-gel transition behavior of gelatin through supramolecular approach. The functionalization of gelatin with quadruple hydrogen bonding improved key features necessary for anti-adhesive barrier including bulk mechanical strength, tissue adhesive property, stability under physiological conditions, and anti-adhesive property. The hotmelt tissue adhesive can be used for a sealant, hemostatic reagent, and wound dressing to prevent postoperative complications including delayed bleeding, perforation, and inflammation and contribute to minimally invasive surgery.
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A review of recent developments of polypropylene surgical mesh for hernia repair. OPENNANO 2022. [DOI: 10.1016/j.onano.2022.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gholami A, Abdoluosefi HE, Riazimontazer E, Azarpira N, Behnam M, Emami F, Omidifar N. Prevention of Postsurgical Abdominal Adhesion Using Electrospun TPU Nanofibers in Rat Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9977142. [PMID: 34993249 PMCID: PMC8727164 DOI: 10.1155/2021/9977142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/29/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Intra-abdominal adhesions following surgery are a challenging problem in surgical practice. This study fabricated different thermoplastic polyurethane (TPU) nanofibers with different average diameters using the electrospinning method. The conditions were evaluated by scanning electron microscopy (SEM), atomic force microscope (AFM), and Fourier transform infrared spectrometer (FTIR) analysis. A static tensile test was applied using a strength testing device to assess the mechanical properties of the electrospun scaffolds. By changing the effective electrospinning parameters, the best quality of nanofibers could be achieved with the lowest bead numbers. The electrospun nanofibers were evaluated in vivo using a rat cecal abrasion model. The macroscopic evaluation and the microscopic study, including the degree of adhesion and inflammation, were investigated after three and five weeks. The resultant electrospun TPU nanofibers had diameters ranging from about 200 to 1000 nm. The diameters and morphology of the nanofibers were significantly affected by the concentration of polymer. Uniform TPU nanofibers without beads could be prepared by electrospinning through reasonable control of the process concentration. These nanofibers' biodegradability and antibacterial properties were investigated by weight loss measurement and microdilution methods, respectively. The purpose of this study was to provide electrospun nanofibers having biodegradability and antibacterial properties that prevent any adhesions or inflammation after pelvic and abdominal surgeries. The in vivo experiments revealed that electrospun TPU nanofibers reduced the degree of abdominal adhesions. The histopathological study confirmed only a small extent of inflammatory cell infiltration in the 8% and 10% TPU. Conclusively, nanofibers containing 8% TPU significantly decreased the incidence and severity of postsurgical adhesions, and it is expected to be used in clinical applications in the future.
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Affiliation(s)
- Ahmad Gholami
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Elham Riazimontazer
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medicinal Chemistry, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Azarpira
- Organ Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamadali Behnam
- Nano Opto-Electronic Research Center, Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran
| | - Farzin Emami
- Nano Opto-Electronic Research Center, Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran
| | - Navid Omidifar
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
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Nogueira Neto J, Carmo ADOD, Lima LSC, Gomes LMRDS, Moura ECR, Oliveira CMBD, Raymundo TS, Melo GCFD, Leal PDC. Use of hypertonic glucose (10%) in the prevention of postoperative adhesions in rats. Acta Cir Bras 2021; 36:e360504. [PMID: 34190774 PMCID: PMC8232060 DOI: 10.1590/acb360504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of hypertonic glucose (10%), alone or in combination
with the corticoid dexamethasone, to prevent peritoneal adhesion following
hysterectomy in rats. Methods Forty-two adult rats underwent hysterectomy with peritoneal lavage: G1 –
glucose (10%); G2 – glucose (10%) and dexamethasone 3 mg·kg–1;
and G3 – physiological saline (PS) 0.9%. Results In the macroscopic analysis after 14 days, G1 had a median score of 1, G2 of
1, and G3 of 2.5 (p < 0.0001), G3 compared to G1 and G2. There was no
difference between groups after 28 days. In the microscopic analysis, the
median vascular proliferation after 14 days was 2 for G1, 1 for G2, and 3
for G3 (p = 0.0037, G3 vs. G1 and G2). After 28 days, G1 showed a median
vascular proliferation score of 2, G2 of 2.5, and G3 of 3 (p < 0.0001, G3
vs. G1 and G2). Regarding the inflammatory reaction after 14 days, G1 had a
median score of 2, G2 of 1, and G3 of 3 (p = 0.7916). After 28 days, G1 had
a median score of 0.5 (0–1.75), G2 of 1.5, and G3 of 2.5 (p < 0.0001, G3
vs. the others and G2 vs. G1). In the evaluation of fibrosis after 14 days,
G1 had a median score of 1, G2 of 1, and G3 of 2.5 (p < 0.0001, G3 vs.
G1and G2). After 28 days, G1 had a median fibrosis score of 1, G2: 2, and
G3: 2.5 (p < 0.0001), G3 vs. the others andG2 vs. G1). Conclusions The use of hypertonic glucose (10%) solution seems to reduce macroscopic and
microscopic pelvic adhesions.
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Li H, Wei X, Yi X, Tang S, He J, Huang Y, Cheng F. Antibacterial, hemostasis, adhesive, self-healing polysaccharides-based composite hydrogel wound dressing for the prevention and treatment of postoperative adhesion. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111978. [PMID: 33812606 DOI: 10.1016/j.msec.2021.111978] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
Herein, we fabricated novel self-healing, in situ injectable, biodegradable, and non-toxic hydrogels anti-adhesion barrier materials composed of N, O-carboxymethyl chitosan (N,O-CS) and oxidized dextran (ODA) without requiring any chemical cross-linking agent or external stimuli triggers for the prevention and treatment of post-operative peritoneal adhesions. The N,O-CS/ODA hydrogels have a good suitable gelation time, good cytocompatibility and hemocompatibility, good antibacterial activity, excellent biodegradable and biocompatible, and can effectively inhibit the adhesion of fibroblasts to the wound, thereby suggesting that N,O-CS/ODA hydrogels are suitable for preventing post-operative adhesion. Meanwhile, a rat injury sidewall-cecum abrasion model is developed to investigate the efficacy of these hydrogels in achieving post-operative anti-adhesion. A significant reduction of peritoneal adhesions (10% rat with lower score adhesion) is observed in the N,O-CS/ODA-hydrogel-treated group compared with the commercial hydrogel and control groups. These results demonstrated that N,O-CS/ODA hydrogel could effectively prevent post-operative peritoneal adhesion without side effects. Therefore, the N,O-CS/ODA hydrogels with multi-functional properties exhibit great potential for the prevention and treatment of postoperative adhesion.
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Affiliation(s)
- Hongbin Li
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China; College of Light Industry and Textile, Qiqihar University, Qiqihar, Heilongjiang, 161000, PR China
| | - Xinjing Wei
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Xiaotong Yi
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Shize Tang
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Jinmei He
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China.
| | - Yudong Huang
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Feng Cheng
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China.
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Zhang E, Song B, Shi Y, Zhu H, Han X, Du H, Yang C, Cao Z. Fouling-resistant zwitterionic polymers for complete prevention of postoperative adhesion. Proc Natl Acad Sci U S A 2020; 117:32046-32055. [PMID: 33257542 PMCID: PMC7749340 DOI: 10.1073/pnas.2012491117] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Postoperative adhesions are most common issues for almost any types of abdominal and pelvic surgery, leading to adverse consequences. Pharmacological treatments and physical barrier devices are two main approaches to address postoperative adhesions but can only alleviate or reduce adhesions to some extent. There is an urgent need for a reliable approach to completely prevent postoperative adhesions and to significantly improve the clinical outcomes, which, however, is unmet with current technologies. Here we report that by applying a viscous, cream-like yet injectable zwitterionic polymer solution to the traumatized surface, postoperative adhesion was completely and reliably prevented in three clinically relevant but increasingly challenging models in rats. The success rate of full prevention is over 93% among 42 animals tested, which is a major leap in antiadhesion performance. Clinically used Interceed film can hardly prevent the adhesion in any of these models. Unlike current antiadhesion materials serving solely as physical barriers, the "nonfouling" zwitterionic polymer functioned as a protective layer for antiadhesion applications with the inherent benefit of resisting protein/cell adhesions. The nonfouling nature of the polymer prevented the absorption of fibronectins and fibroblasts, which contribute to the initial and late-stage development of the adhesion, respectively. This is the key working mechanism that differentiated our "complete prevention" approach from current underperforming antiadhesion materials. This work implies a safe, effective, and convenient way to fully prevent postoperative adhesions suffered by current surgical patients.
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Affiliation(s)
- Ershuai Zhang
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Boyi Song
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Yuanjie Shi
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Hui Zhu
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Xiangfei Han
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Hong Du
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Chengbiao Yang
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
| | - Zhiqiang Cao
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI 48202
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Mi Y, Yang F, Bloomquist C, Xia Y, Sun B, Qi Y, Wagner K, Montgomery SA, Zhang T, Wang AZ. Biologically Targeted Photo-Crosslinkable Nanopatch to Prevent Postsurgical Peritoneal Adhesion. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1900809. [PMID: 31592414 PMCID: PMC6774057 DOI: 10.1002/advs.201900809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/31/2019] [Indexed: 05/12/2023]
Abstract
Peritoneal adhesion occurs in a majority of patients following abdominal surgery and can result in significant side effects and complications. Current strategies to minimize adhesions involve the use of nontargeted anatomical barriers that are either inefficient in protecting injured areas or lacking the adequate residence time to prevent adhesions. Herein, the development of a biologically targeted photo-crosslinkable nanopatch (pCNP) is reported that can prevent postsurgical adhesion. It is demonstrated that pCNP can form a compact protective barrier over surfaces with exposed collagen IV. Using a rat parietal peritoneal excision adhesion model, it is showed that pCNP is highly effective and safe in preventing postsurgical adhesions. This work presents a novel approach to preventing peritoneal adhesion with nanomaterials.
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Affiliation(s)
- Yu Mi
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
| | - Feifei Yang
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
- Institute of Medicinal Plant Development (IMPLAD)Chinese Academy of Medical Sciences & Peking Union Medical CollegeHaidian DistrictBeijing100193P. R. China
| | - Cameron Bloomquist
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
- School of PharmacyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
| | - Youli Xia
- Department of GeneticsUniversity of North Carolina at Chapel HillChapel HillNC27599USA
| | - Bo Sun
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
| | - Yanfei Qi
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
- School of Public HealthJilin UniversityChangchunJilin130021P. R. China
| | - Kyle Wagner
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
| | - Stephanie A. Montgomery
- Department of Pathology and Laboratory MedicineUniversity of North Carolina at Chapel HillChapel HillNC27599USA
| | - Tian Zhang
- Department of Medical OncologyDepartment of MedicineDuke University Medical CenterDurhamNC27710USA
| | - Andrew Z. Wang
- Laboratory of Nano‐ and Translational MedicineCarolina Center for Cancer Nanotechnology ExcellenceCarolina Institute of NanomedicineLineberger Comprehensive Cancer CenterDepartment of Radiation OncologyUniversity of North Carolina at Chapel HillChapel HillNC27599USA
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13
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Cheng F, Wu Y, Li H, Yan T, Wei X, Wu G, He J, Huang Y. Biodegradable N, O-carboxymethyl chitosan/oxidized regenerated cellulose composite gauze as a barrier for preventing postoperative adhesion. Carbohydr Polym 2019; 207:180-190. [DOI: 10.1016/j.carbpol.2018.10.077] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
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Hosseini A, Akhavan S, Menshaei M, Feizi A. Effects of Streptokinase and Normal Saline on the Incidence of Intra-abdominal Adhesion 1 Week and 1 Month after Laparotomy in Rats. Adv Biomed Res 2018; 7:16. [PMID: 29456987 PMCID: PMC5812088 DOI: 10.4103/abr.abr_225_16] [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] [Indexed: 11/28/2022] Open
Abstract
Background: Intra-abdominal adhesions after surgery are usually in the form of bands and can annoy the patient throughout life causing repeated surgical procedures. Therefore, any action to prevent adhesions after surgery can increase longevity and quality of life. For this aim, this study investigates the effect of streptokinase and normal saline on the 7th day and 1 month after laparotomy. Materials and Methods: Experimental study was conducted on thirty healthy male Wistar rats weighing 200–250 g with age of 3 months divided into three groups of 10. Group I: No treatment, Group II: Received normal saline, and Group III: Received normal saline and streptokinase at the same time. One week and 1 month after laparotomy, the frequency of the presence or absence of adhesion bands was performed by a person who was unaware of the sample grouping. The collected information was analyzed with the SPSS software (version 16; SPSS Inc., Chicago, IL, USA). Results: Adhesion frequency was found to be 20% on the 7th day (early) and 1 month after laparotomy (late) for Group 1, and it was 40% on early and late for Group II, while 0% on the early and late for Group III. Hence, in the group receiving streptokinase, no early or late adhesion was observed; therefore, it had a significant role in the prevention of intra-abdominal adhesions (P < 0.05). However, adhesions in the group receiving normal saline had no remarkable difference with the group receiving no drug (P > 0.05). Conclusion: According to the results of our study, we believe that streptokinase could be a good antiadhesive agent considering its effectiveness.
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Affiliation(s)
- Ali Hosseini
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Akhavan
- Department of General Physician, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maziar Menshaei
- DUM Dental Science Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Harlow CR, Wu X, van Deemter M, Gardiner F, Poland C, Green R, Sarvi S, Brown P, Kadler KE, Lu Y, Mason JI, Critchley HOD, Hillier SG. Targeting lysyl oxidase reduces peritoneal fibrosis. PLoS One 2017; 12:e0183013. [PMID: 28800626 PMCID: PMC5553776 DOI: 10.1371/journal.pone.0183013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 07/30/2017] [Indexed: 01/07/2023] Open
Abstract
Background Abdominal surgery and disease cause persistent abdominal adhesions, pelvic pain, infertility and occasionally, bowel obstruction. Current treatments are ineffective and the aetiology is unclear, although excessive collagen deposition is a consistent feature. Lysyl oxidase (Lox) is a key enzyme required for crosslinking and deposition of insoluble collagen, so we investigated whether targeting Lox might be an approach to reduce abdominal adhesions. Methods Female C57Bl/6 mice were treated intraperitoneally with multiwalled carbon nanotubes (NT) to induce fibrosis, together with chemical (ß-aminoproprionitrile–BAPN) or miRNA Lox inhibitors, progesterone or dexamethasone. Fibrotic lesions on the diaphragm, and expression of fibrosis-related genes in abdominal wall peritoneal mesothelial cells (PMC) were measured. Effects of BAPN and dexamethasone on collagen fibre alignment were observed by TEM. Isolated PMC were cultured with interleukin-1 alpha (IL-1α) and progesterone to determine effects on Lox mRNA in vitro. Results NT-induced fibrosis and collagen deposition on the diaphragm was ameliorated by BAPN, Lox miRNA, or steroids. BAPN and dexamethasone disrupted collagen fibres. NT increased PMC Lox, Col1a1, Col3a1 and Bmp1 mRNA, which was inhibited by steroids. Progesterone significantly inhibited IL-1α induced Lox expression by PMC in vitro. Conclusion Our results provide proof-of-concept that targeting peritoneal Lox could be an effective approach in ameliorating fibrosis and adhesion development.
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Affiliation(s)
- Christopher R. Harlow
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
- * E-mail:
| | - Xuan Wu
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Marielle van Deemter
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Fiona Gardiner
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Craig Poland
- MRC/University of Edinburgh Centre for Inflammation Research, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Rebecca Green
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Sana Sarvi
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Pamela Brown
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Karl E. Kadler
- University of Manchester, Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, Michael Smith Building, Manchester, United Kingdom
| | - Yinhui Lu
- University of Manchester, Wellcome Trust Centre for Cell-Matrix Research, Faculty of Life Sciences, Michael Smith Building, Manchester, United Kingdom
| | - J. Ian Mason
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Hilary O. D. Critchley
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
| | - Stephen G. Hillier
- MRC/University of Edinburgh Centre for Reproductive Health, Edinburgh Medical School, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, United Kingdom
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16
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Zhang E, Li J, Zhou Y, Che P, Ren B, Qin Z, Ma L, Cui J, Sun H, Yao F. Biodegradable and injectable thermoreversible xyloglucan based hydrogel for prevention of postoperative adhesion. Acta Biomater 2017; 55:420-433. [PMID: 28391053 DOI: 10.1016/j.actbio.2017.04.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022]
Abstract
Peritoneal adhesion is very common after abdominal and pelvic surgery, which leads to a variety of severe complications. Although numerous pharmacological treatments and barrier-based devices have been investigated to minimize or prevent postoperative adhesion, the clinical efficacy is not very encouraging. In this work, a biodegradable and thermoreversible galactose modified xyloglucan (mXG) hydrogel was developed and the efficacy of mXG hydrogel in preventing postoperative peritoneal adhesion was investigated. The 4% (w/v) mXG solution was a free flowing sol at low temperature, but could rapidly convert into a physical hydrogel at body temperature without any extra additives or chemical reactions. In vitro cell tests showed that mXG hydrogel was non-toxic and could effectively resist the adhesion of fibroblasts. Moreover, in vitro and in vivo degradation experiments exhibited that mXG hydrogel was degradable and biocompatible. Finally, the rat model of sidewall defect-cecum abrasion was employed to evaluate the anti-adhesion efficacy of the mXG hydrogel. The results demonstrated that mXG hydrogel could effectively prevent postoperative peritoneal adhesion without side effects. The combination of suitable gel temperature, appropriate biodegradation period, and excellent postoperative anti-adhesion efficacy make mXG hydrogel a promising candidate for the prevention of postsurgical peritoneal adhesion. STATEMENT OF SIGNIFICANCE Despite numerous drugs or barrier-based devices have been developed to prevent postoperative adhesion, few solutions have proven to be uniformly effective in subsequent clinical trials. In the present study, we developed a biodegradable and thermoreversible galactose modified xyloglucan (mXG) hydrogel by green enzymatic reaction without using any organic reagents. The developed physical mXG hydrogel not only showed excellent injectability, appropriate gelation time and temperature, but also exhibited excellent biocompatibility and biodegradability both in vitro and in vivo. In addition, mXG hydrogel was easy to handle and could effectively prevent postoperative adhesion without side effects in a rat model of sidewall defect-bowel abrasion. Our study provide a safe and effective postoperative anti-adhesion material which may have potential applications in clinical practice.
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Affiliation(s)
- Ershuai Zhang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China; Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Junjie Li
- Department of Advanced Interdisciplinary Studies, Institute of Basic Medical Sciences and Tissue Engineering Research Center, Academy of Military Medical Sciences, Beijing 100850, China
| | - Yuhang Zhou
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Pengcheng Che
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Bohua Ren
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Zhihui Qin
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Litao Ma
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Jing Cui
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Hong Sun
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China; School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China.
| | - Fanglian Yao
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China; Key Laboratory of Systems Bioengineering of Ministry of Education, Tianjin University, Tianjin 300350, China.
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17
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He T, Zou C, Song L, Wang N, Yang S, Zeng Y, Wu Q, Zhang W, Chen Y, Gong C. Improving Antiadhesion Effect of Thermosensitive Hydrogel with Sustained Release of Tissue-type Plasminogen Activator in a Rat Repeated-Injury Model. ACS APPLIED MATERIALS & INTERFACES 2016; 8:33514-33520. [PMID: 27960405 DOI: 10.1021/acsami.6b13184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Tao He
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Chang Zou
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Linjiang Song
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Ning Wang
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Suleixin Yang
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Yan Zeng
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Qinjie Wu
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Wenli Zhang
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
| | - Yingtai Chen
- Cancer
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, China National Cancer Center, Beijing 100021, P. R. China
| | - Changyang Gong
- State
Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, P. R. China
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18
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Effect of the Bioadhesive, BioGlue, on Impaired Colonic Anastomose Healing in Rats. Int Surg 2015. [DOI: 10.9738/intsurg-d-15-00085.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Colonic anastomotic leakage is still a problem in general surgery practice. We sought to investigate the effect of a new tissue adhesive, BioGlue, on the healing of normal and impaired colonic anastomoses. Sixty-four rats were randomized into 4 groups. In all animals, a 1-cm segment of the left colon was resected, and an end-to-end sutured anastomosis was created. Animals were then divided into 2 groups: normal and impaired anastomosis. These 2 groups were further subdivided into 2 additional groups: animals that received BioGlue and those that did not. All rats received intraperitoneal injections of either 0.9% NaCl or 5-fluorouracil (5-FU). Anastomotic evaluation was done 7 days after surgery. Macroscopic healing, mechanical strength, and histopathologic healing parameters were evaluated. Leakage of the anastomosis was significantly higher in rats in the impaired group compared with those in the BioGlue groups (P = 0.043). The adhesion formation score was significantly higher in rats in the impaired anastomosis group compared with the other groups. Bursting pressures were significantly lower in the impaired anastomosis group than in the other ones (P = 0.001). Neoangiogenesis and fibroblast activity were different among the groups (P = 0.001). Inflammatory cell infiltration and collagen deposition did not differ among the groups (P = 0.07). Immediate postoperative intraperitoneal administration of 5-FU after colonic anastomosis inhibits intestinal wound healing. Covering colon anastomoses with BioGlue after suturing conferred beneficial effect on healing.
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19
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Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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20
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Cakir M, Tekin A, Kucukkartallar T, Yılmaz H, Belviranlı M, Kartal A. Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions. Int J Surg 2013; 11:487-91. [DOI: 10.1016/j.ijsu.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/12/2013] [Accepted: 04/07/2013] [Indexed: 11/17/2022]
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21
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Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today 2013; 44:405-20. [PMID: 23657643 DOI: 10.1007/s00595-013-0591-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 02/07/2013] [Indexed: 12/20/2022]
Abstract
Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40-68 %), and was 66 % (95 % CI 38-94 %) after gastrointestinal surgery, 51 % (95 % CI 40-63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7-38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.
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22
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Panahi F, Sadraie SH, Khoshmohabat H, Shahram E, Kaka G, Hosseinalipour M. Macroscopic and pathological assessment of methylene blue and normal saline on postoperative adhesion formation in a rat cecum model. Int J Surg 2012; 10:537-41. [DOI: 10.1016/j.ijsu.2012.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 08/15/2012] [Accepted: 08/18/2012] [Indexed: 10/27/2022]
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23
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Maciver AH, McCall M, James Shapiro AM. Intra-abdominal adhesions: cellular mechanisms and strategies for prevention. Int J Surg 2011; 9:589-94. [PMID: 21964216 DOI: 10.1016/j.ijsu.2011.08.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
Postoperative intra-abdominal adhesions represent a serious clinical problem. In this review, we have focused on recent progress in the cellular and humoral mechanisms underpinning adhesion formation, and have reviewed strategies that interfere with these pathways as a means to prevent their occurrence. Current and previous English-language literature on the pathogenesis of adhesion formation was identified. As the burden of surgical disease in the world population increases, and the frequency of reoperation increases, prevention of adhesion formation has become a pressing goal in surgical research.
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Affiliation(s)
- Allison H Maciver
- Department of Surgery, University of Alberta Hospitals, 2000 College Plaza, 8215 112th Street, Edmonton, Alberta, Canada T6G 2C8
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24
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Cheung M, Chapman M, Kovacik M, Noe D, Ree N, Fanning J, Fenton BW. A method for the consistent creation and quantitative testing of postoperative pelvic adhesions in a porcine model. J INVEST SURG 2009; 22:56-62. [PMID: 19191158 DOI: 10.1080/08941930802566672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The assessment of methods for the prevention of postoperative pelvic adhesions is hampered by the lack of a quantifiable adhesion measurement technique. Currently available methods for adhesion model assessment rely on qualitative grading scales; a quantitative method would have many attendant benefits, including standardized reporting. METHODS A technique was developed to generate consistent and significant adhesions in a swine model that are suitable for quantitative assessment using a Material Testing System (MTS) machine platform. In this method, the uterine horns are cannulated and then attached to the pelvic sidewall using loose silk sutures. The underlying sidewall and adjacent uterine serosa are injured with electrocautery. Following a two-week survival the entire complex of uterine horn and sidewall are excised en bloc and prepared for MTS testing. RESULTS Extrication of the adhesion, as measured by the MTS platform, generates a quantitative assessment of adhesion strength that can be scaled and analyzed to produce several continuous variable descriptions. DISCUSSION This technique represents a novel quantitative method for adhesion assessment in an animal model. This quantitative technique may then be applied to accurately assess a range of adhesion prevention techniques, producing results which can be standardized for comparison.
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Affiliation(s)
- Maureen Cheung
- Division of Surgical Research, Summa Health System/Akron City Hospital, Akron, Ohio, USA
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25
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A comparison of the local effectiveness of mitomycin C, aprotinin, and Adcon-L in experimental peridural fibrosis. ACTA ACUST UNITED AC 2008; 70:608-13; discussion 613. [DOI: 10.1016/j.surneu.2007.07.071] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 07/18/2007] [Indexed: 11/19/2022]
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26
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Ozer MT, Uzar AI, Eryilmaz M, Altinel O, Demirbas S, Arslan I, Tufan CT. A novel laparoscopic suction device for applying precise aspiration during laparoscopic surgery: sponge-tip suction tube. J Laparoendosc Adv Surg Tech A 2008; 18:747-50. [PMID: 18699755 DOI: 10.1089/lap.2008.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aspiration of the intra-abdominal fluid and debris is usually needed during different stages of the operation. This is necessary to protect the intra-abdominal space from contamination and/or to remove blood or tissue fluids occurring during the operation. It is also essential for obtaining a clean surgical area. Aspiration of the intra-abdominal fluid is relatively more difficult in laparoscopic surgery because of the suctioning of the omentum and intestine with the aspirator. In this paper, we report on a new suction device (sponge tip suction tube; STST), which allows the surgeon easier suctioning of intra-abdominal fluid. STST has an additional sponge tip and air channel, which prevents the device from suctioning intra-abdominal organs, such as the intestine and omentum. We tested the efficacy of STST in a simulated intra-abdominal space, such as a large transparent plastic bag with fresh sheep intestine-omentum and with 2000 cc of physiologic saline solution and 14 mm Hg of air pressure. Whereas the suctioning of all the fluid was difficult and time consuming when the conventional suction unit was used, all of the saline solution was easily and quickly suctioned when STST was used. In conclusion, STST provides a safe, fast, and complete fluid extraction.
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Affiliation(s)
- M Tahir Ozer
- Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
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Akyildiz H, Akcan A, Sozuer E, Kucuk C, Yilmaz N, Deniz K. The preventive effect of Met-RANTES on postoperative intraperitoneal adhesion formation in the rat model. Surgery 2008; 144:404-9. [PMID: 18707039 DOI: 10.1016/j.surg.2008.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 04/16/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chemokines are proinflammatory proteins that participate in immune and inflammatory responses through chemoattraction and leukocyte activation. The chemokine antagonist Met-RANTES (Regulated upon Activation Normal T cell Expressed and Secreted) has been shown to be efficacious in decreasing inflammation in several animal disease models. The purpose of this study was to investigate the effects of administration of Met-RANTES on intra-abdominal adhesion formation after abdominal operation. MATERIALS AND METHODS A 42 and 4-month-old female Wistar-Albino rats were subjected to standardized lesions by cauterization of the cecum and uterine horn. They were divided randomly into 3 groups containing 14 rats each: group 1 (control), operative procedure without further treatment; group 2 (Seprafilm), operative procedure with an antiadhesive membrane; 2 x 1 cm of Seprafilm was interposed beneath the peritoneal incision, and group 3 (Met-RANTES), operative procedure with the chemokine antagonist Met-RANTES. The extent and severity of adhesions at the operative site were evaluated. Light microscopic examination was performed to determine semiquantitative scores of VEGF expression. RESULTS Rats in the control group formed extensive adhesions. In comparison with the control group, the adhesion scores were significantly lower in the 2 other groups. The immunohistochemical grading scores of vascular endothelial growth factor correlated closely with the total adhesion scores and were less in groups 2 and 3 (P < .005). CONCLUSIONS Selective chemokine suppression with Met-RANTES seems to decrease rates, extent, and severity of postoperative intraperitoneal adhesions.
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Affiliation(s)
- Hizir Akyildiz
- Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey.
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Tarhan OR, Barut I, Sezik M. An Evaluation of Normal Saline and Taurolidine on Intra-Abdominal Adhesion Formation and Peritoneal Fibrinolysis. J Surg Res 2008; 144:151-7. [DOI: 10.1016/j.jss.2007.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 08/21/2007] [Accepted: 09/10/2007] [Indexed: 12/01/2022]
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Nikeghbalian S, Atefi S, Kazemi K, Roshan N, Tanideh N, Jalaeian H. Effect of oral d-penicillamine vs. colchicine on experimentally induced peritoneal adhesions in rats. Fertil Steril 2007; 88:1187-9. [PMID: 17555753 DOI: 10.1016/j.fertnstert.2007.01.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 01/22/2007] [Accepted: 01/22/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effects of d-penicillamine on prevention or reduction of adhesion band formation and to compare its effects with those of colchicine in an animal model. DESIGN A prospective experimental study. SETTING Rats in an academic research environment. ANIMAL(S) Eighty female rats were randomly divided into four equal groups. In the end, group 4 was excluded because of high mortality rates. INTERVENTION(S) Adhesion bands were induced by intraperitoneal injection of 2.5 mL of a 10% sterile talc solution. The first group served as control, group 2 received oral D-penicillamine (35 mg/kg per day), group 3 received oral colchicines (0.02 mg/kg per day), and group 4 received both drugs for 3 consecutive weeks. MAIN OUTCOME MEASURE(S) Formation of adhesion bands was quantitatively graded according to the Nair classification. RESULT(S) The proportion of control rats with substantial adhesion bands was significantly higher than that of rats in groups 2 or 3 (84.2%, 20%, and 33.3%). No difference regarding the grades of adhesion bands was found between the D-penicillamine and colchicine groups. CONCLUSION(S) Oral D-penicillamine is as effective as oral colchicine in prevention of peritoneal adhesion band formation in rats. Use of D-penicillamine for this purpose should be weighed against its possible side effects.
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Affiliation(s)
- Saman Nikeghbalian
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Medina-Tamayo J, Sánchez-Miranda E, Balleza-Tapia H, Ambriz X, Cid ME, González-Espinosa D, Gutiérrez AA, González-Espinosa C. Super-oxidized solution inhibits IgE-antigen-induced degranulation and cytokine release in mast cells. Int Immunopharmacol 2007; 7:1013-24. [PMID: 17570318 DOI: 10.1016/j.intimp.2007.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 03/02/2007] [Accepted: 03/19/2007] [Indexed: 11/26/2022]
Abstract
Activation of the high affinity IgE receptor (Fc epsilonRI) through IgE-antigen complexes induces mast cell degranulation, synthesis of lipid mediators and cytokine production. These effects are involved in Type I hypersensitivity reactions and controlling them has been the main objective of many anti-allergic therapies. Here we report that pretreatment of murine bone marrow derived mast cells (BMMC) with super-oxidized solution (SOS) inhibits Fc epsilonRI dependent-beta hexosaminidase and cytokine release. This effect is exerted without altering total protein tyrosine phosphorylation, MAPK activation, cytokine mRNA accumulation or calcium mobilization after Fc epsilonRI triggering. Our data suggest that this neutral pH-SOS acts like a mast cell-membrane stabilizer inhibiting the cell machinery for granule secretion without altering the signal transduction pathways induced by IgE-antigen receptor crosslinking.
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Affiliation(s)
- J Medina-Tamayo
- Pharmacobiology Department, Cinvestav, South Campus, Mexico City, Mexico
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Yeo Y, Kohane DS. Polymers in the prevention of peritoneal adhesions. Eur J Pharm Biopharm 2007; 68:57-66. [PMID: 17881201 PMCID: PMC2228410 DOI: 10.1016/j.ejpb.2007.03.027] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/22/2007] [Accepted: 03/22/2007] [Indexed: 11/20/2022]
Abstract
Peritoneal adhesions are serious complications of surgery, and can result in pain, infertility, and potentially lethal bowel obstruction. Pharmacotherapy and barrier devices have reduced adhesion formation to varying degrees in preclinical studies or clinical trials; however, complete prevention of adhesions remains to be accomplished. We and others have hypothesized that the limitations of the two approaches could be overcome by combining their strengths in the context of controlled drug delivery. Here we review the role of polymeric systems in the prevention of peritoneal adhesions, with an emphasis on our recent work in developing and applying polymeric drug delivery systems such as nano- or microparticles, hydrogels, and hybrid systems for peritoneal use.
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Affiliation(s)
- Yoon Yeo
- Department of Chemical Engineering, 77 Massachusetts Avenue, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel S Kohane
- Department of Chemical Engineering, 77 Massachusetts Avenue, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Laboratory for Biomaterials and Drug Delivery, Bartlett Extension 413, Division of Pediatric Intensive Care, Massachusetts General Hospital, 55 Fruit St. Boston, MA 02114, USA
- * To whom correspondence should be addressed: Phone: (617) 724-4380 FAX: (617) 724-4391
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Yeo Y, Adil M, Bellas E, Astashkina A, Chaudhary N, Kohane DS. Prevention of peritoneal adhesions with an in situ cross-linkable hyaluronan hydrogel delivering budesonide. J Control Release 2007; 120:178-85. [PMID: 17582645 DOI: 10.1016/j.jconrel.2007.04.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Revised: 04/17/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
Peritoneal adhesions are tissue connections that form within the abdominopelvic cavity following surgery or other injuries. They can cause major medical complications. Barrier devices and pharmacological agents have been used to prevent adhesion formation, with mixed success. We hypothesize that an adhesion barrier which also delivers anti-adhesion drugs can address both physical and physiological causes for adhesion formation. Here, we describe an in situ cross-linking hyaluronan hydrogel (barrier device) containing the glucocorticoid receptor agonist budesonide. Budesonide was chosen because of the known role of inflammation in adhesion formation, hyaluronan because of its known biocompatibility in the peritoneum. The system, consisting of two cross-linkable precursor liquids, was applied using a double-barreled syringe, forming a flexible and durable hydrogel in less than 5 s. We applied this formulation or controls to the injured sites after the second injury in a severe repeat sidewall defect-cecum abrasion model of peritoneal adhesion formation in the rabbit. Large adhesions (median area 15.4 cm(2)) developed in all saline-treated animals. Adhesion formation and area were slightly mitigated in animals treated with budesonide in saline (median area 5.0 cm(2)) or the hydrogel without budesonide (median area 4.9 cm(2)). The incidence and area of adhesions were dramatically reduced in animals treated with budesonide in the hydrogel (median area 0.0 cm(2)). In subcutaneous injections in rats, budesonide in hydrogel reduced inflammation compared to hydrogel alone. In summary, budesonide in a hyaluronan hydrogel is easy to use and highly effective in preventing adhesions in our severe repeated injury model. It is a potentially promising system for post-surgical adhesion prevention, and suggests that the effectiveness of barrier devices can be greatly enhanced by concurrent drug delivery.
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Affiliation(s)
- Yoon Yeo
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Mantzoros I, Kanellos I, Angelopoulos S, Koliakos G, Pramateftakis MG, Kanellos D, Zacharakis E, Zaraboukas T, Betsis D. The effect of insulin-like growth factor I on healing of colonic anastomoses in cortisone-treated rats. Dis Colon Rectum 2006; 49:1431-8. [PMID: 16826333 DOI: 10.1007/s10350-006-0603-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE This study was designed to investigate whether intraperitoneally injected insulin-like growth factor I is able to protect colonic healing from the adverse effects of hydrocortisone therapy. METHODS Eighty female Wistar rats were randomized into four groups (20 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. Hydrocortisone (5 mg/kg body weight) was injected intramuscularly in rats of cortisone (Group B) and insulin-like growth factor I + cortisone (Group D) groups once daily for seven days before and after the operation. Insulin-like growth factor I (2 mg/kg body weight) was intraperitoneally injected in rats of the insulin-like growth factor I (Group C) and the insulin-like growth factor I + Cortisone (Group D) groups immediately after operation and on the second, fourth, and sixth postoperative days. Rats were killed on the seventh postoperative day. Anastomoses were graded macroscopically and histologically, and bursting pressures and anastomotic hydroxyproline levels were recorded. Statistical analyses were performed by using Fisher's exact test for the comparison of proportions and ANOVA for the comparison of means among groups with subsequent post-hoc analysis using Bonferroni correction. RESULTS Leakage rate was significantly higher in the cortisone (Group B) group. Bursting pressures were significantly lower in the cortisone group, whereas they were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups (Group C and D). Histology revealed a significant decrease of inflammatory cell infiltration, neoangiogenesis, and fibroblast activity in the cortisone group compared with the control group, whereas these parameters were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups. Hydroxyproline levels were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups. CONCLUSIONS Hydrocortisone inhibits the healing of colonic anastomoses. However, insulin-like growth factor I given intraperitoneally mediates the deleterious effects of cortisone and protects colonic healing in rats.
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Affiliation(s)
- I Mantzoros
- 4th Department of Surgery, Aristotle University of Thessaloniki, G. Papanokolaou General Hospital, Exohi, Thessaloniki 57010, Greece. mantzor-@otenet.gr
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Bulbuloglu E, Ezberci F, Gul M, Kurutas EB, Bozkurt S, Kale IT, Ciragil P. Effects of the intraperitoneal lornoxicam on the formation of intraperitoneal adhesions in rat peritonitis model. ANZ J Surg 2005; 75:1115-9. [PMID: 16398822 DOI: 10.1111/j.1445-2197.2005.03623.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the effects of intraperitoneally administered lornoxicam on adhesion formation, bursting pressure, tissue antioxidant levels, morbidity and mortality after ileocolic anastomosis in a rat bacterial peritonitis model. METHODS Thirty-six rats were divided into three random groups. Bacterial peritonitis was induced by performing a cecal ligation and puncture, then the cecal was resected and ileocolic anastomosis was performed. Rats of groups 1, 2 and 3 were given 2 mL normal saline, 2 mL lornoxicam, and nothing, respectively. All groups were killed at day 14. Adhesions were scored, and the presence of intra-abdominal abscesses and fistulas were noted. Anastomotic healing was assessed by bursting pressure. Tissue antioxidant levels were tested from left abdominal walls. RESULTS One day after cecal ligation and puncture, microbiological examination showed polymicrobial bacterial peritonitis. The rats treated with lornoxicam had significantly lower adhesion scores than did the saline and nothing treated rats (P = 0.007). Bursting pressures of groups were unaffected by the treatment. Tissue antioxidant levels of groups were affected by the treatment. Morbidity and mortality were similar in all groups. CONCLUSIONS The present study demonstrated that a single intraperitoneal instillation of lornoxicam in buffer solution at the end of the surgery reduces adhesion formation in rats bacterial peritonitis model. It was also determined that lornoxicam had no negative effect on the healing of intestinal anastomosis, abscess and anastomotic leakage. Use of lornoxicam in peritonitis was effective in decreasing the oxidative stress of tissue during peritonitis.
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Affiliation(s)
- Ertan Bulbuloglu
- Department of Surgery, University of Kahramanmaras, Faculty of Medicine, Kahramanmaras, Turkey.
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