Beneficial effects of Ankaferd Blood Stopper on dermal wound healing: an experimental study

Determination of the Effects of Ankaferd Wound Dressing on the Wound Healing Process in Rats

Objectives

The effects of a composite nanofiber wound dressing material consisting of a polyvinylidene alcohol and polyvinylidene pyrrolidone polymer mixture with a hemostatic agent doped with Ankaferd Blood Stopper (ABS) on the healing of experimentally induced dermal wounds in rats were examined.

Materials and Methods

Rats were divided into 4 groups (n= 6). Histological material was examined on tissues taken from the wound site, whereas total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) analyses were performed on blood samples taken from the cardia. The material that was produced had hydrophilic properties, and both the ABS-doped and-undoped forms of the material positively affected wound healing.

Results

In the histopathological examinations, macroscopic evaluations revealed a statistically significant difference between the groups in terms of wound diameter, reepithelialization, and inflammation formation (p= 0.019). In parallel with wound healing and histological outcomes, TAS values increased in the ABS-doped groups, and TOS and OSI values decreased in the wound dressing groups (p < 0.05).

Conclusion

It was concluded that the ABS-dopped dressing did not have a negative effect on wound healing, it accelerated healing, and it could be used effectively and safely to treat skin injuries. However, further studies are needed to evaluate the clinical and histopathological benefits and potential adverse effects of wound dressings produced using ABS-doped polymers on wound healing.

Current Advances in Wound Healing and Regenerative Medicine

Treating chronic wounds is a common and costly challenge worldwide. More advanced treatments are needed to improve wound healing and prevent severe complications such as infection and amputation. Like other medical fields, there have been advances in new technologies promoting wound healing potential. Regenerative medicine as a new method has aroused hope in treating chronic wounds. The technology improving wound healing includes using customizable matrices based on synthetic and natural polymers, different types of autologous and allogeneic cells at different differentiation phases, small molecules, peptides, and proteins as a growth factor, RNA interference, and gene therapy. In the last decade, various types of wound dressings have been designed. Emerging dressings include a variety of interactive/ bioactive dressings and tissue-engineering skin options. However, there is still no suitable and effective dressing to treat all chronic wounds. This article reviews different wounds and common treatments, advanced technologies and wound dressings, the advanced wound care market, and some interactive/bioactive wound dressings in the market.

Evaluation of the effects of three natural products and a hemostatic agent on wound healing: an experimental study

BACKGROUND

People have used many natural materials such as plant leaves, roots, liquids derived from plants, and animal products to treat wounds throughout history. It can be said that the research on wound care in recent years have focused on traditional and natural products again. This study aimed to investigate the effects of sweetgum oil, propolis, silk protein, and Ankaferd Blood Stopper (ABS) on wound healing in an experimental excisional wound model.

METHODS

: Including 36 Balb/c inbreed mice in the study were divided equally into four groups. Two circular excisional wounds were created on the dorsal skin of mice under anesthesia using a punch biopsy device. The wounds of the first group of mice were topically dressed with sweetgum oil, the second group mice with propolis, the third group mice with silk protein, and the fourth group mice with ABS daily. Tissue samples were taken from the wounds of mice on the 7th and 14th day of wound formation, and histological examinations were performed. On the 14th day, the wounds created in all mice were healed, and the experiment was terminated.

RESULTS

Mice in the silk protein group had faster wound healing. There was no statistical difference between the groups in immunohistochemical examinations. In the ABS group, the findings of the inflammatory process were more prominent.

DISCUSSION

In conclusions, propolis, sweetgum oil, silk protein, and ABS positively affect different parameters in wound healing and support wound healing.

The effect of Ankaferd blood stopper on liver damage in experimental obstructive jaundice

Background/aims

To evaluate the potential protective effects of Ankaferd blood stopper (ABS) in an experimental obstructive jaundice (OJ) model.

Materials and methods

The study included 26 female rats, which were divided into 3 groups. The sham group, consisting of 10 rats, (group 1) only received solely laparotomy. In the control group, consisting of 8 rats, (group 2), ligation was applied to the biliary tract and no treatment was implemented. In the treatment group, consisting of 8 rats, (group 3), following ligation of biliary tract, 0.5 mL/day ABS was given for 10 days. Liver tissue and blood samples were taken for histopathological and biochemical examination.

Results

Compared to group 2, group 3 had higher aspartate aminotransferase (AST), total oxidant status (TOS) malondialdehyde (MDA), fluorescent oxidant products (FOP), and lower expression of albumin and total antioxidant status (TAS) (P < 0.05). In histopathological analysis, the mean scores of all histopathological parameters (fibrosis, portal inflammation, confluent necrosis, interphase activity, bile duct proliferation) have statistical significance between group 2 and group 3 (P < 005).

Conclusions

ABS has promising results in the treatment of experimental OJ because of its antioxidant and antiinflammatory properties. It may be used in clinical practice after more extensive studies about the effects of ABS on OJ.

The effect of caffeic acid phenethyl ester and Ankaferd Blood Stopper on the diabetic and nondiabetic gingival wound healing: an experimental study

Background/aim

Healthy wound healing is very important for patient comfort. Diabetes is one of the factors that negatively affect wound healing. Ankaferd Blood Stopper (ABS) and caffeic acid phenethyl ester (CAPE) are antiinflammatory and antimicrobial agents and may have positive effects on wound healing.

Materials and methods

In this study, 72 male Wistar albino rats were used. Rats; control, CAPE, ABS, diabetes + control, diabetes + ABS and diabetes + CAPE groups were divided into 6 groups. A healthy 36 rats created diabetes using streptozotocin (STZ). A gingival wound was created using a 4-mm punch biopsy in the gingival tissue under the lower anterior incisors of the rats.

Results

The comparison between the nondiabetic groups had a statistically significant positive effect compared to the control group of CAPE and ABS (P ˂ 0.05). In the comparison between ABS and diabetes + ABS groups and in the comparison between CAPE and diabetes + CAPE groups, a decrease in vascularization in diabetes + CAPE groups was observed and it was statistically significant (P ˂ 0.005).

Conclusion

ABS and CAPE have been found to have positive effects on gingival wound healing in the nondiabetic group. We think that this situation is caused by its antiinflammatory and antimicrobial properties.

Histopathological and mechanical effects of Ankaferd Blood Stopper® on wound healing in rats: an experimental model

Background/aim

To evaluate the histopathological and mechanical effects of Ankaferd Blood Stopper (ABS) application on wound healing.

Materials and methods

A total of 24 Wistar albino rats were randomly divided into three equal groups. In each group, a 3 cm-long midline vertical skin incision was performed in the back of the rats. In Group 1, the incision was sutured primarily. In Group 2, incision was left to secondary healing. In Group 3, ABS was applied to the incision. On the 10th day, burst pressure width was measured, and rats were sacrificed. The tissue samples were examined histopathologically. Statistical analysis was conducted with IBM SPSS program. P < 0.05 was considered significant.

Results

The mean burst pressure widths of wound separation were 13.66 ± 0.457, 7.18 ± 2.599, and 13.66 ± 1.11 mm for Groups 1–3, respectively. The difference in burst pressure width between Groups 1 and 3 was not significant (P > 0.05) but was significant between Groups 2 and 3 (P = 0.000). The vascular proliferation median values were 1, 2, and 2, for Groups 1–3, respectively. Although the difference was significant between Groups 1 and 2 in terms of vascular proliferation score (P = 0.047), no significant difference was observed between Group 3 and others. No statistically significant difference was observed among the groups in terms of collagen score, mononuclear cell infiltration, and polymorphonuclear cell proliferation (P > 0.05). The median values of fibroblast proliferation score were 1, 2, and 3, in Groups 1–3, respectively. Fibroblast proliferation score significantly differed between Groups 1 and 3 (P = 0.003).

Conclusion

ABS application results in a clean wound healing that is as strong as primary repair. However, additional studies are required to evaluate the late results of increased fibroblastic activity in the early period of ABS application alone.

Ankaferd blood stopper accelerates deep second degree burn wound healing in rats

In this study, the effects of Ankaferd Blood Stopper (ABS) and silver sulphadiazine (SSD) cream on burn wound healing were investigated in rats. A total of 24 outbred, male, Sprague-Dawley rats were randomly allocated to (1) ABS, (2) SSD, and (3) control groups. Bilateral burn wounds were created near the caudal border of the scapula. Wounds in each group were treated daily with sponges soaked in ABS solution, 1% SSD cream, or saline, respectively. On days 0, 7, 14, 21, and 28, unhealed wound area was measured and biopsy samples were taken for histopathological examination (except day 0). At the end of day 28, all rats in the ABS and SSD groups had complete coverage of the wounds with granulation tissue and epithelialization, whereas wounds in the control group were not completely epithelialized. On day 7, the mean unhealed wound areas and the mean percentages of wound contraction were not significantly different among the groups. However, the mean percentage of wound contraction in the ABS and SSD groups was significantly higher than in the control group on days 14, 21, and 28. Histopathologically, wound healing was characterized by a decrease in neutrophil counts and an increase in vessel counts. Our results suggest that ABS can be successfully used for burn wound healing besides SSD.

Platelet-rich plasma promotes cell viability of human hair dermal papilla cells (HHDPCs) in vitro

PURPOSE

This study aimed to clarify the effect of platelet-rich plasma (PRP) on human hair dermal papilla cell (HHDPC) viability and expression levels of alkaline phosphatase (ALP) and versican.

METHODS

Eight healthy volunteers were enrolled, and different concentrations of PRP and platelet-poor plasma (PPP) were preparedby 2-step centrifugation method. HHDPCs were thencultivated. To identify the best incubating time of HHDPCs and plasmaconcentration, cell viability was investigated by MTT assays. In PRP- or PPP-treated HHDPCs, the mRNA levels of versican and ALP were checked by real-time quantitative PCR (qRT-PCR).

RESULTS

Both PRP (5% and 10%) and PPP (5% and 10%) could significantly promote cell viability of the HHDPCs (p4) in 72 h group, while the effect of 10% PRP on HHDPC viability was less than that of 5% PRP. qRT-PCR showed that PRP could significantly increase mRNA levels of ALP and versican in HHDPCs (p4) when compared with the control group. Meanwhile,Western blot indicated an obviously increased protein level of ALP and versican in PRP-treated HHDPCs (p4).

CONCLUSION

PRP could promote cell viability of HHDPCs. Besides, 5% PRP could significantly increase ALP and versican expression in both mRNA and protein levels in HHDPCs (p4).

Proteomic and transcriptomic analyses to explain the pleiotropic effects of Ankaferd blood stopper

Ankaferd blood stopper is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica and has been used as a topical hemostatic agent and with its clinical application established in randomized controlled trials and case reports. Ankaferd has been successfully used in gastrointestinal endobronchial mucosal and cutaneous bleedings and also in abdominal, thoracic, dental and oropharyngeal, and pelvic surgeries. Ankaferd’s hemostatic action is thought to form a protein complex with coagulation factors that facilitate adhesion of blood components. Besides its hemostatic action, Ankaferd has demonstrated pleiotropic effects, including anti-neoplastic and anti-microbial activities and tissue-healing properties; the underlying mechanisms for these have not been well studied. Ankaferd’s individual components were determined by proteomic and chemical analyses. Ankaferd also augments transcription of some transcription factors which is shown with transcriptomic analysis. The independent effects of these ingredients and augmented transcription factors are not known precisely. Here, we review what is known of Ankaferd blood stopper components from chemical, proteomic, and transcriptomic analyses and propose that individual components can explain some pleiotropic effects of Ankaferd. Certainly more research is needed focusing on individual ingredients of Ankaferd to elucidate their precise and effects.

Effects of Ankaferd BloodStopper on dermal healing in diabetic rats

BACKGROUND/AIM

Diabetes mellitus inhibits wound-induced angiogenesis, impairs the wound healing process, and leads to the development of chronic wounds. Ankaferd BloodStopper (ABS) is a new and promising local haemostatic agent. Although the mechanism of ABS-mediated haemostasis is well established, little is known about the associated histological and biochemical tissue reactions. The aim of this study was to evaluate the effects of this new-generation local haemostatic agent on short-term soft-tissue healing in streptozotocin (STZ)-treated rats.

MATERIALS AND METHODS

The 24 Wistar albino rats used in this study were divided into STZ-treated (STZ, n = 12) and nontreated groups (control, n = 12). Four days prior to surgery, rats in the STZ group were subcutaneously administered 60 mg/kg STZ intraperitoneally, while rats in the control group were administered 1 mL saline/kg. An incision was made in the dorsal dermal tissue of all rats, and either ABS or no haemostatic agent (NHAA) was applied to the wound before suturing. All of the rats were euthanised on postoperative day 4. Blood and skin samples were evaluated biochemically and histologically.

RESULTS

The results showed that STZ treatment impaired soft-tissue healing, assessed by measuring glutathione and lipid peroxidation levels. Moreover, while good histological results were obtained in the control group treated with ABS, there were fewer benefits in the STZ-treated group.

CONCLUSION

ABS's benefits in the control group seemed to lose their effectiveness under STZ medication.

Collagen/gold nanoparticle nanocomposites: A potential skin wound healing biomaterial

In this study, nanocomposite collagen scaffolds incorporating gold nanoparticles (AuNPs) were prepared for wound healing applications. Initially, dose (<20 ppm) and size (>20 nm) of AuNPs that were not cytotoxic on HaCat keratinocytes and 3T3 fibroblasts were determined. Both collagen sponges and AuNP-incorporated nanocomposites (CS-Au) were cross-linked with glutaraldehyde (CS-X and CS-AuX). Incorporation of AuNPs into cross-linked scaffolds enhanced their stability against enzymatic degradation and increased the tensile strength. Hydrolytic degradation of CS-Au group was also less than CS after seven days. Upon confirming in vitro biocompatibility of the scaffolds with cytotoxicity assays, cell attachment and proliferation tests and the in vivo efficacy for healing of full-thickness skin wounds were investigated by applying CS-X, CS-AuX or a commercial product (Matriderm®) onto defect sites and covering with Ioban® drapes. Defects were covered only with drapes for untreated control group. The wound areas were examined with histopathological and biomechanical tests after 14 days of operation. CS-AuX group was superior to untreated control and Matriderm®; it suppressed the inflammation while significantly promoting granulation tissue formation. Inflammatory reaction against CS-AuX was milder than CS-X. Neovascularization was also higher in CS-AuX than other groups, though the result was not significant. Wound closure in CS-X (76%), CS-AuX (69%), and Matriderm® (65%) were better than untreated control (45%). CS-AuX group had the highest tensile strength (significantly higher than Matriderm®) and modulus (significantly higher than Matriderm® and CS-X), indicating a faster course of dermal healing. Further studies are also needed to investigate whether higher loading of AuNPs affects these results positively in a statistically meaningful manner. Overall, their contribution to the enhancement of degradation profiles and mechanical properties, their excellent in vitro biocompatibility, and tendency to accelerate wound healing are encouraging the use of AuNPs in collagen sponges as potent skin substitutes in the future.

Comparison of the Efficiencies of Buffers Containing Ankaferd and Chitosan on Hemostasis in an Experimental Rat Model with Femoral Artery Bleeding

OBJECTIVE

In the first assessment of trauma patients with major vascular injuries, we need effective and rapid-acting homeostatic materials. In this study we compare the efficiencies of Ankaferd Blood Stopper® and a chitosan linear polymer (Celox®) in an experimental rat model with femoral artery bleeding.

MATERIALS AND METHODS

Thirty male Wistar albino rats weighing 200-250 g were divided into 3 groups: control, Ankaferd, and chitosan. The femoral artery and vein were visualized and bleeding was started by an incision. The bleeding time was recorded and categorized as 'bleeding stopped at the second minute', 'bleeding stopped at the fourth minute', and 'unsuccessful' if bleeding continued after the fourth minute.

RESULTS

In the control group, 60% of the bleeding did not stop. In the first 4 min in the Ankaferd group, the bleeding stopped in all rats; only in 1 of the rats in the chitosan group did the bleeding not stop. In stopping the bleeding in the first 4 min, Ankaferd was similar to chitosan but better than the control group; the chitosan group was similar to the control, but the p-value was close to significance.

CONCLUSION

For major arterial bleeding, the main treatment is surgical bleeding control, but outside of the hospital we can use buffers containing Ankaferd and chitosan on the bleeding region. The results of this study should be supported with larger studies. Furthermore, in our study, healthy rats were used. New studies are needed to evaluate the results of hypovolemic and hypotensive cases with major artery bleeding.

Qualitative/Chemical Analyses of Ankaferd Hemostat and Its Antioxidant Content in Synthetic Gastric Fluids

Introduction. Ankaferd hemostat (ABS) is the first topical haemostatic agent involving the red blood cell-fibrinogen interactions. The antihemorrhagic efficacy of ABS has been tested in controlled clinical trials. The drug induces the formation of an encapsulated complex protein web with vital erythroid aggregation. The aim of this study is to detect the essential toxicity profile and the antioxidant molecules inside ABS. Methods. The pesticides were analyzed by GC-MS and LC-MS. The determination by ICP-MS after pressure digestion was performed for the heavy metals. HPLC was used for the detection of mycotoxins. Dioxin Response Chemically Activated Luciferase Gene Expression method was used for the dioxin evaluation. TOF-MS and spectra data were evaluated to detect the antioxidants and other molecules. Results. TOF-MS spectra revealed the presence of several antioxidant molecules (including tocotrienols, vitamin E, tryptophan, estriol, galangin, apigenin, oenin, 3,4-divanillyltetrahydrofuran, TBHQ, thymol, BHA, BHT, lycopene, glycyrrhetinic acid, and tomatine), which may have clinical implications in the pharmacobiological actions of ABS. Conclusion. The safety of ABS regarding the presence of heavy metals, pesticides, mycotoxins, GMO and dioxins, and PCBs was demonstrated. Thus the present toxicological results indicated the safety of ABS. The antioxidant content of ABS should be investigated in future studies.

Wet electrospun silk fibroin/gold nanoparticle 3D matrices for wound healing applications

The effectiveness of a silk fibroin/gold nanoparticle 3D nanofibrous matrix on a rat model of full-thickness dermal wound healing was investigated.

Antibacterial Activities of Ankaferd Hemostat (ABS) on Shiga Toxin-Producing Escherichia coli and Other Pathogens Significant in Foodborne Diseases

OBJECTIVE

Ankaferd hemostat (Ankaferd Blood Stopper®, ABS)-induced pharmacological modulation of essential erythroid proteins can cause vital erythroid aggregation via acting on fibrinogen gamma. Topical endoscopic ABS application is effective in the controlling of gastrointestinal (GI) system hemorrhages and/or infected GI wounds. Escherichia coli O157:H7, the predominant serotype of enterohemorrhagic E. coli, is a cause of both outbreaks and sporadic cases of hemorrhagic colitis. The aim of this study is to examine the effects of ABS on 6 different Shiga toxigenic E. coli serotypes including O26, O103, O104, O111, O145, and O157 and on other pathogens significant in foodborne diseases, such as Salmonella Typhimurium, Campylobacter jejuni, and Listeria monocytogenes, were also assessed.

MATERIALS AND METHODS

All strains were applied with different amounts of ABS and antimicrobial effect was screened. S. Typhimurium groups were screened for survival using the fluorescence in situ hybridization technique.

RESULTS

The relative efficacy of ABS solutions to achieve significant logarithmic reduction in foodborne pathogens E. coli O157:H7 and non-O157 serogroups and other emerging foodborne pathogens is demonstrated in this study. ABS has antibacterial effects.

CONCLUSION

Our present study indicated for the first time that ABS may act against E. coli O157:H7, which is a cause of thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, and hemorrhagic colitis. The interrelationships between colitis, infection, and hemostasis within the context of ABS application should be further investigated in future studies.

Mucosal trauma induced apoptosis in guinea pig middle ear: comparision of hemostatic agents

OBJECTIVE

The aim of this study is to compare the effects of the absorbable gelatin sponge (AGS), microporous polysaccharide hemospheres (MPH), and Ankaferd on wound healing after middle ear trauma and to evaluate their ototoxicity in an experimental guinea pig model.

METHODS

Middle ear mucosal trauma was created in 21 healthy adult guinea pigs. MPH, Ankaferd, and AGS were applied into the right tympanic bulla of the guinea pigs (7 ears for each treatment modality). The left ears of the seven animals were used as the sham group. At the fourth postoperative week (28-30 days), the guinea pigs were decapitated. Apoptosis was investigated, and the expression of Bcl-xl, Apaf, p53, cytochrome 3, and caspase 3 were evaluated.

RESULTS

The Ankaferd and AGS groups demonstrated significantly lower epithelial thickness, inflammation, and capillary dilatation than did the control group (p<0.001, <0.001, /0.001, <0.001/, 0.005, and 0.005, respectively). A statistically significant decrease in Bcl-xl staining was observed in the middle ears of animals treated with MPH (p=0.003). There was significantly higher caspase 3 expression in the Ankaferd and AGS groups than in the control group (p<0.001 and p=0.002, respectively).

CONCLUSION

Light microscopy indicates that Ankaferd and AGS create less inflammation and increased caspase expression, which seems to induce inflammatory cell apoptosis. Ankaferd seems to be a promising hemostatic agent in otology.

Effects of energy drinks on soft tissue healing

The aim of the present study was to investigate the effects of an energy drink (ED) on soft tissue wound healing in the rat model. Thirty-six male Wistar albino rats were randomly divided into 2 groups. A full-thickness paravertebral linear incision wound model was created. The experimental group (EG) received an ED (Red Bull), and the control group (CG) received water. Red Bull (3.57 mL/kg/d) was administered to the rats by the oral gavage method on the day before the skin incision and continued for 14 days. The rats were sacrificed (n = 6 in each group) on the 3rd, 7th, and 14th day of the study. Sections were obtained from excised linear wound healing site and stained with hematoxylin-eosin and Masson trichrome for morphological analysis. To assess angiogenesis on the sections, immunohistochemical studies were carried out using vascular endothelial growth factor antibody and alpha smooth muscle actin Ab-1. The breaking strength of the wound healing site was measured in Newtons using a tensiometer. Morphological analysis showed that collagen deposition in the wound areas was statistically higher in the EG compared with that of the CG at both the third and seventh days (P < 0.05). Re-epithelialization on healing sites in the EG was statistically higher than in the CG on the seventh day (P < 0.05). The results of the immunohistochemical studies indicated that the numbers of new blood vessels in the wound healing sites of the EG were significantly higher at the 7th and 14th days when compared with the CG (P < 0.05). The breaking strength of the wound healing sites was also significantly higher on the 7th and 14th days in the EG (P < 0.05). The results demonstrate that ED accelerates soft tissue wound healing and that its effect may be due to increased collagen deposition, re-epithelialization, and new blood vessel formation in the wound.