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Donaldson RI, Armstrong JK, Buchanan OJ, Graham TL, Cambridge JS, Cristerna NN, Goldenberg D, Tanen CDA, Fisher TC, Tolles J, Burns CJ, Ross JD. A novel, reverse-phase-shifting, thermoreversible foaming hydrogel containing antibiotics for the treatment of thermal burns in a swine model - A pilot study. Burns 2024; 50:1578-1585. [PMID: 38582695 DOI: 10.1016/j.burns.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND This study compared a novel topical hydrogel burn dressing (CI-PRJ012) to standard of care (silver sulfadiazine) and to untreated control in a swine thermal burn model, to assess for wound healing properties both in the presence and absence of concomitant bacterial inoculation. METHODS Eight equal burn wounds were created on six Yorkshire swine. Half the wounds were randomized to post-burn bacterial inoculation. Wounds were subsequently randomized to three treatments groups: no intervention, CI-PRJ012, or silver sulfadiazine cream. At study end, a blinded pathologist evaluated wounds for necrosis and bacterial colonization. RESULTS When comparing CI-PRJ012 and silver sulfadiazine cream to no treatment, both agents significantly reduced the amount of necrosis and bacteria at 7 days after wound creation (p < 0.01, independently for both). Further, CI-PRJ012 was found to be significantly better than silver sulfadiazine (p < 0.02) in reducing bacterial colonization. For wound necrosis, no significant difference was found between silver sulfadiazine cream and CI-PRJ012 (p = 0.33). CONCLUSIONS CI-PRJ012 decreases necrosis and bacterial colonization compared to no treatment in a swine model. CI-PRJ012 appeared to perform comparably to silver sulfadiazine. CI-PRJ012, which is easily removed with the application of room-temperature water, may provide clinical advantages over silver sulfadiazine.
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Affiliation(s)
- Ross I Donaldson
- Critical Innovations LLC, 4228 Marine Avenue, Los Angeles, CA 90260, USA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Box 21, 1000 West Carson Street, Torrance, CA 90509, USA; Department of Epidemiology, UCLA - Fielding School of Public Health, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA.
| | | | - Oliver J Buchanan
- Critical Innovations LLC, 4228 Marine Avenue, Los Angeles, CA 90260, USA
| | - Todd L Graham
- Benchmark Biotech LLC, 1225 NE 2nd Ave, DCM 2nd Floor, Portland, OR 97232, USA
| | - John S Cambridge
- Critical Innovations LLC, 4228 Marine Avenue, Los Angeles, CA 90260, USA
| | - Nely N Cristerna
- Critical Innovations LLC, 4228 Marine Avenue, Los Angeles, CA 90260, USA
| | - Diane Goldenberg
- Critical Innovations LLC, 4228 Marine Avenue, Los Angeles, CA 90260, USA
| | - Captain David A Tanen
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Box 21, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Timothy C Fisher
- Critical Innovations LLC, 4228 Marine Avenue, Los Angeles, CA 90260, USA
| | - Juliana Tolles
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Box 21, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Christopher J Burns
- Brigham and Women's Hospital, Division of Trauma, Burn and Surgical Critical Care, 45 Francis Street, Boston, MA 02115, USA
| | - James D Ross
- Benchmark Biotech LLC, 1225 NE 2nd Ave, DCM 2nd Floor, Portland, OR 97232, USA
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Deng J, Gao S, Liu M, Xie W, Pan GY. Antioxidant and antibacterial hydrogel formed by protocatechualdehyde-ferric iron complex and aminopolysaccharide for infected wound healing. Int J Biol Macromol 2024; 268:131642. [PMID: 38641283 DOI: 10.1016/j.ijbiomac.2024.131642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
To better treat bacteria-infected wounds and promote healing, new wound dressings must be developed. In this study, we obtained PA@Fe by chelating iron trivalent ions (Fe3+) with protocatechualdehyde (PA), which has a catechol structure. Subsequently, we reacted it with ethylene glycol chitosan (GC) via a Schiff base reaction and loaded vancomycin to obtain an antibacterial Gel@Van hydrogel with a photothermal response. The as-prepared Gel@Van hydrogel exhibited good injectability, self-healing, hemostasis, photothermal stability, biocompatibility, and antioxidant and antibacterial properties. Moreover, Gel@Van hydrogel achieved highly synergistic antibacterial efficacy through photothermal and antibiotic sterilization. In a mouse skin-damaged infection model, Gel@Van hydrogel had a strong ability to promote the healing of methicillin-resistant Staphylococcus aureus (MRSA)-infected wounds, indicating the great potential application value of Gel@Van hydrogel in the field of treating and promoting the healing of infected wounds.
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Affiliation(s)
- Jianbin Deng
- School of Pharmacy, Guilin Medical University, Guilin 541100, PR China
| | - Shiqi Gao
- School of Pharmacy, Guilin Medical University, Guilin 541100, PR China
| | - Mengqi Liu
- School of Pharmacy, Guilin Medical University, Guilin 541100, PR China
| | - Weiquan Xie
- School of Pharmacy, Guilin Medical University, Guilin 541100, PR China.
| | - Guang-Yu Pan
- School of Pharmacy, Guilin Medical University, Guilin 541100, PR China; School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin 541100, PR China; Key Laboratory of Biochemistry and Molecular Biology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, Guilin 541100, PR China.
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Vase H, Nemattalab M, Rohani M, Hesari Z. Comparison of chitosan and SLN nano-delivery systems for antibacterial effect of tea tree (Melaleuca alternifolia) oil against P. aeruginosa and S. aureus. Lett Appl Microbiol 2023; 76:ovad130. [PMID: 37989849 DOI: 10.1093/lambio/ovad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 11/23/2023]
Abstract
Treatment of wounds is challenging due to bacterial infections, including Staphylococcus aureus and Pseudomonas aeruginosa. Using the merits of alternative antimicrobials like tea tree oil (TTO) and nanotechnology, they can be helpful in combatting bacterial infections. Solid lipid nanoparticle (SLN) and chitosan (CS) nanoparticles show great potential as carriers for enhancing the stability and therapeutic benefits of oils. The aim of this study is to compare the influence of nanocarriers in enhancing the antibacterial effects of TTO. The study evaluates the physicochemical and antibacterial properties of TTO-SLN and TTO-CS against P. aeruginosa and S. aureus. The TTO-SLN nanoparticles showed a clear round shape with the average diameter size of 477 nm, while the TTO-CS nanoparticles illustrated very homogeneous morphology with 144 nm size. The encapsulation efficiency for TTO-CS and TTO-SLN was ∼88.3% and 73.5%, respectively. Minimum inhibitory concentration against S. aureus and P. aeruginosa for TTO-CS, TTO-SLN, and pure TTO were 35 and 45 µg ml-1, 130 and 170 µg ml-1, and 380 and 410 µg ml-1, respectively. Since TTO-CS revealed an impressively higher antimicrobial effects in comparison with TTO-SLN and TTO alone, it can be considered as a nanocarrier that produces the same antimicrobial effects with lower required amounts of the active substance.
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Affiliation(s)
- Hasti Vase
- Department of Pharmaceutics, School of Pharmacy, Guilan University of Medical Sciences, 73774-41941 Rasht, Iran
| | - Mehran Nemattalab
- Department of Pharmaceutics, School of Pharmacy, Guilan University of Medical Sciences, 73774-41941 Rasht, Iran
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, 73774-41941 Rasht, Iran
| | - Masoumeh Rohani
- Department of Pharmaceutics, School of Pharmacy, Guilan University of Medical Sciences, 73774-41941 Rasht, Iran
| | - Zahra Hesari
- Department of Pharmaceutics, School of Pharmacy, Guilan University of Medical Sciences, 73774-41941 Rasht, Iran
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Alexander P L, Jonathan R, Gunnar K, Johan P E J. Amino acid buffered hypochlorite facilitates debridement of porcine infected burn wounds. Burns 2023; 49:1363-1371. [PMID: 36543728 DOI: 10.1016/j.burns.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/21/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model. METHOD A total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 107 colony-forming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time. RESULTS After one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p < 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 105 CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride. CONCLUSION Our results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full-thickness burns.
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Affiliation(s)
- Larsson Alexander P
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University Hospital, SE-581 85, Linköping, Sweden; Department of Reconstructive Plastic Surgery, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
| | - Rakar Jonathan
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-583 30, Linköping, Sweden
| | - Kratz Gunnar
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Department of Hand Surgery, Plastic Surgery, and Burns, Linköping University Hospital, SE-581 85, Linköping, Sweden
| | - Junker Johan P E
- Laboratory for Experimental Plastic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden; Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-583 30, Linköping, Sweden
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Eriksson E, Griffith GL, Nuutila K. Topical Drug Delivery in the Treatment of Skin Wounds and Ocular Trauma Using the Platform Wound Device. Pharmaceutics 2023; 15:pharmaceutics15041060. [PMID: 37111546 PMCID: PMC10145636 DOI: 10.3390/pharmaceutics15041060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023] Open
Abstract
Topical treatment of injuries such as skin wounds and ocular trauma is the favored route of administration. Local drug delivery systems can be applied directly to the injured area, and their properties for releasing therapeutics can be tailored. Topical treatment also reduces the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. This review article highlights the Platform Wound Device (PWD) (Applied Tissue Technologies LLC, Hingham, MA, USA) for topical drug delivery in the treatment of skin wounds and eye injuries. The PWD is a unique, single-component, impermeable, polyurethane dressing that can be applied immediately after injury to provide a protective dressing and a tool for precise topical delivery of drugs such as analgesics and antibiotics. The use of the PWD as a topical drug delivery platform has been extensively validated in the treatment of skin and eye injuries. The purpose of this article is to summarize the findings from these preclinical and clinical studies.
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Muhrbeck M, Wladis A, Lampi M, Andersson P, Junker JPE. Efficacy of topical honey compared to systemic gentamicin for treatment of infected war wounds in a porcine model: A non-inferiority experimental pilot study. Injury 2022; 53:381-392. [PMID: 34756413 DOI: 10.1016/j.injury.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. MATERIAL AND METHODS 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. RESULTS Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 - 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0-67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p<0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. CONCLUSION At the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non-inferior to intramuscular gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.
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Affiliation(s)
- Måns Muhrbeck
- Department of Surgery in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden.
| | - Andreas Wladis
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Lampi
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Peter Andersson
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan P E Junker
- Department of Biomedical and Clinical Sciences, Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Laboratory of Experimental Plastic Surgery, Linköping University, Linköping, Sweden
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7
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Singh B, Singh J, Rajneesh. Application of tragacanth gum and alginate in hydrogel wound dressing's formation using gamma radiation. CARBOHYDRATE POLYMER TECHNOLOGIES AND APPLICATIONS 2021. [DOI: 10.1016/j.carpta.2021.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Nikahval B, Oryan A, Memarian P, Kamali A. Use of ovine acellular peritoneal matrix combined with honey and ovine fetal skin extract in the healing of full-thickness infected burn wounds in a rat model. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2020; 11:355-363. [PMID: 33643588 PMCID: PMC7904127 DOI: 10.30466/vrf.2018.92422.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/20/2018] [Indexed: 11/23/2022]
Abstract
Treatment of infected burn wounds remains a challenge in burn units. Silver-sulfadiazine (SSD) is the most commonly used topical antimicrobial agent in managing these wounds. We aimed to accelerate the healing of burn wounds by combined application of ovine acellular peritoneal matrix (OAPM), honey (H), and ovine fetal skin extract (OFSE). Sixty-four standardized burn wounds were created on the dorsum of 16 rats and were subsequently inoculated with Staphyloccocus aureus and Pseudomonas aeruginosa. After 48 hr, the wounds were surgically debrided and received either physiologic saline (control group) or SSD, OAPM+SSD, OAPM+H+SSD, and OAPM+H+OFSE+SSD. The healing wounds were evaluated for size, bacterial counts, histopathology, and biomechanical properties on days 3, 7, 14, 21, and 28 after surgery. All treatments had effectively reduced the level of S. aureus and P. aeruginosa on wounds compared to the control group by day 3 and 7. The wounds treated with combined application of OAPM+H+OFSE+SSD demonstrated considerable inflammation reduction, fibroplasia, complete re-epithelialization, and wound contraction together with significantly lesser scar tissue formation. Treatment with OAPM+H+OFSE+SSD showed superior biomechanical properties of the healing wounds. The findings suggested that the synergistic effect of dressing the wounds with OAPM, H, and OFSE was a very effective approach in accelerating the healing process of the experimentally induced infected full-thickness burn wounds in rats.
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Affiliation(s)
- Behrooz Nikahval
- Department of Clinical Studies, School of Veterinary Medicine, Shiraz University, Shiraz, Iran;
| | - Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
| | - Parastoo Memarian
- Department of Clinical Studies, School of Veterinary Medicine, Shiraz University, Shiraz, Iran;
| | - Amir Kamali
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
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Grolman JM, Singh M, Mooney DJ, Eriksson E, Nuutila K. Antibiotic-Containing Agarose Hydrogel for Wound and Burn Care. J Burn Care Res 2020; 40:900-906. [PMID: 31250003 DOI: 10.1093/jbcr/irz113] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Wound infections cause inflammation, tissue damage, and delayed healing that can lead to invasive infection and even death. The efficacy of systemic antibiotics is limited due to poor tissue penetration that is especially a problem in burn and blast wounds where the microcirculation is disrupted. Topical administration of antimicrobials is an attractive approach because it prevents infection and avoids systemic toxicity, while hydrogels are an appealing vehicle for topical drug delivery. They are easy to apply to the wound site by being injectable, the drug release properties can be controlled, and their many characteristics, such as biodegradation, mechanical strength, and chemical and biological response to stimuli can be tailored. Hydrogels also create a moist wound environment that is beneficial for healing. The purpose of this study was to formulate an agarose hydrogel that contains high concentrations of minocycline or gentamicin and study its characteristics. Subsequently, the minocycline agarose hydrogel was tested in a porcine burn model and its effect as a prophylactic treatment was studied. The results demonstrated that 0.5% agarose in water was the optimal concentration in terms of viscosity and pH. Bench testing at room temperature demonstrated that both antibiotics remained stable in the hydrogel for at least 7 days and both antibiotics demonstrated sustained release over the time of the experiment. The porcine burn experiment showed that prophylactic treatment with the agarose minocycline hydrogel decreased the burn depth and reduced the number of bacteria as efficiently as the commonly used silver sulfadiazine cream.
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Affiliation(s)
- Joshua M Grolman
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts.,John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Mansher Singh
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David J Mooney
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts.,John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | - Kristo Nuutila
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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McDaniel JS, Scott LLF, Rebeles J, Bramblett GT, Eriksson E, Johnson AJ, Griffith GL. Treatment of Corneal Infections Utilizing an Ocular Wound Chamber. Transl Vis Sci Technol 2020; 9:4. [PMID: 33200046 PMCID: PMC7645231 DOI: 10.1167/tvst.9.12.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/31/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To demonstrate that the ocular wound chamber (OWC) can be used for the treatment of bacterial keratitis (BK). Methods A blepharotomy was performed on anesthetized, hairless guinea pigs to induce exposure keratopathy 72 hours before corneal wound creation and Pseudomonas aeruginosa inoculation. Twenty-four hours postinoculation, eyes were treated with an OWC filled with 500 µL 0.5% moxifloxacin hydrochloride ophthalmic solution (OWC), 10 µL 0.5% moxifloxacin hydrochloride drops (DROPS) four times daily, or not treated (NT). White light, fluorescein, and spectral domain optical coherence tomography (SD-OCT) images; ocular and periocular tissues samples for colony-forming units (CFU) quantification; and plasma samples were collected at 24 and 72 hours posttreatment. Results White light, fluorescein, and SD-OCT imaging suggests OWC-treated eyes are qualitatively healthier than those in DROPS or NT groups. At 24 hours, the median number of CFUs (interquartile range) measured was 0 (0-8750), 150,000 (106,750-181,250), and 8750 (2525-16,000) CFU/mL for OWC, NT, and DROPS, respectively. While 100% of NT and DROPS animals remained infected at 24 hours, only 25% of OWC-treated animals showed infection. Skin samples at 24 hours showed infection percentages of 50%, 75%, and 0% in DROPS, NT, and OWC groups, respectively. OWC-treated animals had higher moxifloxacin plasma concentrations at 24 and 72 hours than those treated with drops. Conclusions OWC use resulted in a more rapid decrease of CFUs when compared to DROPS or NT groups and was associated with qualitatively healthier ocular and periocular tissue. Translational Relevance The OWC could be used clinically to continuously and rapidly deliver antimicrobials to infected ocular and periocular tissues, effectively lowering bacterial bioburdens and mitigating long-term complications.
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Affiliation(s)
- Jennifer S McDaniel
- Laulima Government Solutions, LLC, c/o Sensory Trauma, United States Army Institute of Surgical Research, San Antonio, TX, USA
| | - Laura L F Scott
- Epidemiology and Biostatistics Branch, United States Army Institute of Surgical Research, San Antonio, TX, USA
| | - Jennifer Rebeles
- BioAffinity Technologies, Science Research Laboratories (SRL) 1.424, San Antonio, TX, USA
| | - Gregory T Bramblett
- Department of Sensory Trauma, United States Army Institute of Surgical Research, San Antonio, TX, USA
| | | | - Anthony J Johnson
- Department of Sensory Trauma, United States Army Institute of Surgical Research, San Antonio, TX, USA
| | - Gina L Griffith
- Department of Sensory Trauma, United States Army Institute of Surgical Research, San Antonio, TX, USA
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11
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Maslova E, Shi Y, Sjöberg F, Azevedo HS, Wareham DW, McCarthy RR. An Invertebrate Burn Wound Model That Recapitulates the Hallmarks of Burn Trauma and Infection Seen in Mammalian Models. Front Microbiol 2020; 11:998. [PMID: 32582051 PMCID: PMC7283582 DOI: 10.3389/fmicb.2020.00998] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
The primary reason for skin graft failure and the mortality of burn wound patients, particularly those in burn intensive care centers, is bacterial infection. Several animal models exist to study burn wound pathogens. The most commonly used model is the mouse, which can be used to study virulence determinants and pathogenicity of a wide range of clinically relevant burn wound pathogens. However, animal models of burn wound pathogenicity are governed by strict ethical guidelines and hindered by high levels of animal suffering and the high level of training that is required to achieve consistent reproducible results. In this study, we describe for the first time an invertebrate model of burn trauma and concomitant wound infection. We demonstrate that this model recapitulates many of the hallmarks of burn trauma and wound infection seen in mammalian models and in human patients. We outline how this model can be used to discriminate between high and low pathogenicity strains of two of the most common burn wound colonizers Pseudomonas aeruginosa and Staphylococcus aureus, and multi-drug resistant Acinetobacter baumannii. This model is less ethically challenging than traditional vertebrate burn wound models and has the capacity to enable experiments such as high throughput screening of both anti-infective compounds and genetic mutant libraries.
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Affiliation(s)
- Evgenia Maslova
- Division of Biosciences, Centre for Inflammation Research and Translational Medicine, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom
| | - Yejiao Shi
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary, University of London, London, United Kingdom
| | - Folke Sjöberg
- The Burn Centre, Department of Hand and Plastic Surgery, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Helena S Azevedo
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary, University of London, London, United Kingdom
| | - David W Wareham
- Antimicrobial Research Group, Blizard Institute, Queen Mary, University of London, London, United Kingdom
| | - Ronan R McCarthy
- Division of Biosciences, Centre for Inflammation Research and Translational Medicine, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, United Kingdom
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12
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Nuutila K, Yang L, Broomhead M, Proppe K, Eriksson E. PWD: Treatment Platform for Both Prolonged Field Care and Definitive Treatment of Burn-Injured Warfighters. Mil Med 2020; 184:e373-e380. [PMID: 30252082 DOI: 10.1093/milmed/usy242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/14/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Burns are a very frequent injury type in the battlefield, comprising 5-20% of combat casualties in the recent conflicts. Almost 80% of the burns occur to the face, in part because the face is often not protected. Immediate treatment is critical in the first hours after severe burn injury in order to prevent infection and wound progression. Immediate treatment in the battlefield can be a serious challenge especially if the injury occurs in a remote area with limited transport options. Therefore, novel treatment modalities for prolonged field care when transport to the definitive care is delayed are needed. The purpose of this study was to utilize the platform wound device (PWD) with negative pressure capabilities for the immediate and definitive treatment of porcine full-thickness head burns. MATERIALS AND METHODS Full-thickness burn wounds were created on foreheads of seven Yorkshire pigs. Burns were created on day 0, immediately enclosed with the PWD and treated topically with minocycline and lidocaine. On day 3, the burns were surgically debrided. Subsequently, new PWDs were placed on the wounds and continuous negative pressure wound therapy was initiated with either -50 mmHg or -80 mmHg. On day 7, the animals were euthanized and wounds were harvested for analyses. Control wounds were treated with silver sulfadiazine cream. RESULTS The PWD treatment with negative pressure significantly reduced erythema and edema in the injured tissue and promoted granulation tissue and neocollagen formation by day 7 in comparison to control wounds. In addition, the PWD with both topical minocycline and negative pressure (-80 mmHg or -50 mmHg) reduced bacterial counts in the wounds similar to the current standard of care. CONCLUSION This study demonstrates that the PWD is an effective platform for delivery of antibiotics and negative pressure wound therapy for the treatment of full-thickness burns. Therefore, the PWD may be utilized for both prolonged field care and definitive treatment of burn- and blast-injured warfighters.
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Affiliation(s)
| | - Lu Yang
- Applied Tissue Technologies LLC, Hingham, MA
| | | | - Karl Proppe
- Applied Tissue Technologies LLC, Hingham, MA
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Nuutila K, Grolman J, Yang L, Broomhead M, Lipsitz S, Onderdonk A, Mooney D, Eriksson E. Immediate Treatment of Burn Wounds with High Concentrations of Topical Antibiotics in an Alginate Hydrogel Using a Platform Wound Device. Adv Wound Care (New Rochelle) 2020; 9:48-60. [PMID: 31903298 DOI: 10.1089/wound.2019.1018] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 01/17/2023] Open
Abstract
Objective: There is an unmet need to improve immediate burn care, particularly when definitive treatment is delayed. Therefore, the purpose of this project was to formulate a hydrogel that contains very high concentrations of antibiotics and validate its use together with a platform wound device (PWD) for the immediate care of burns. Approach: The hydrogel properties were optimized by using a rheometer, differential scanning calorimetry, and liquid chromatography-mass spectrometry and were tested in an infected porcine burn model. Immediately, after burn creation, the burns were infected with different bacteria. Subsequently, the burns infected with Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii were covered with the PWD and treated with a single dose of hydrogel containing 1000 × minimum inhibitory concentration of vancomycin, gentamicin, and minocycline, respectively. On day 7 or 45, the animals were euthanized, and the burns were harvested for histology and quantitative bacteriology. Results: 0.625% was the best alginate concentration for the hydrogel in terms of viscosity, stability, and drug release. The porcine studies demonstrated that vancomycin-, gentamicin-, and minocycline-treated tissues contained significantly less bacteria and reduced depth of tissue necrosis in comparison to controls. Innovation: The PWD represents a platform technology that begins at the point of the first treatment by protecting the wound and allowing administration of topical therapeutics. The device can be adapted to enclose any size burn over any contour of the body. Conclusion: Antibiotics can be delivered safely in very high concentrations in a hydrogel using the PWD, and burn infections can be treated successfully with this method.
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Affiliation(s)
| | - Josh Grolman
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Lu Yang
- Applied Tissue Technologies LLC, Hingham, Massachusetts
| | | | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Onderdonk
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Mooney
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Elof Eriksson
- Applied Tissue Technologies LLC, Hingham, Massachusetts
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Dijksteel GS, Ulrich MMW, Vlig M, Nibbering PH, Cordfunke RA, Drijfhout JW, Middelkoop E, Boekema BKHL. Potential factors contributing to the poor antimicrobial efficacy of SAAP-148 in a rat wound infection model. Ann Clin Microbiol Antimicrob 2019; 18:38. [PMID: 31796055 PMCID: PMC6891976 DOI: 10.1186/s12941-019-0336-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We investigated the efficacy of a synthetic antimicrobial peptide SAAP-148, which was shown to be effective against Methicillin-resistant Staphylococcus aureus (MRSA) on tape-stripped mice skin. Unexpectedly, SAAP-148 was not effective against MRSA in our pilot study using rats with excision wounds. Therefore, we investigated factors that might have contributed to the poor efficacy of SAAP-148. Subsequently, we optimised the protocol and assessed the efficacy of SAAP-148 in an adapted rat study. METHODS We incubated 100 µL of SAAP-148 with 1 cm2 of a wound dressing for 1 h and determined the unabsorbed volume of peptide solution. Furthermore, 105 colony forming units (CFU)/mL MRSA were exposed to increasing dosages of SAAP-148 in 50% (v/v) human plasma, eschar- or skin extract or PBS. After 30 min incubation, the number of viable bacteria was determined. Next, ex vivo skin models were inoculated with MRSA for 1 h and exposed to SAAP-148. Finally, excision wounds on the back of rats were inoculated with 107 CFU MRSA overnight and treated with SAAP-148 for 4 h or 24 h. Subsequently, the number of viable bacteria was determined. RESULTS Contrary to Cuticell, Parafilm and Tegaderm film, < 20% of peptide solution was recovered after incubation with gauze, Mepilex border and Opsite Post-op. Furthermore, in plasma, eschar- or skin extract > 20-fold higher dosages of SAAP-148 were required to achieve a 2-log reduction (LR) of MRSA versus SAAP-148 in PBS. Exposure of ex vivo models to SAAP-148 for 24 h resulted in a 4-fold lower LR than a 1 h or 4 h exposure period. Additionally, SAAP-148 caused a 1.3-fold lower mean LR at a load of 107 CFU compared to 105 CFU MRSA. Moreover, exposure of ex vivo excision wound models to SAAP-148 resulted in a 1.5-fold lower LR than for tape-stripped skin. Finally, SAAP-148 failed to reduce the bacterial counts in an adapted rat study. CONCLUSIONS Several factors, such as absorption of SAAP-148 by wound dressings, components within wound exudates, re-colonisation during the exposure of SAAP-148, and a high bacterial load may contribute to the poor antimicrobial effect of SAAP-148 against MRSA in the rat model.
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Affiliation(s)
- Gabrielle S. Dijksteel
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ Beverwijk, The Netherlands
- Dept. of Plastic Reconstructive & Hand Surgery, Amsterdam University Medical Centres, Free University of Amsterdam, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Magda M. W. Ulrich
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ Beverwijk, The Netherlands
- Dept. of Plastic Reconstructive & Hand Surgery, Amsterdam University Medical Centres, Free University of Amsterdam, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marcel Vlig
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ Beverwijk, The Netherlands
| | - Peter H. Nibbering
- Dept. of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Robert A. Cordfunke
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jan W. Drijfhout
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Esther Middelkoop
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ Beverwijk, The Netherlands
- Dept. of Plastic Reconstructive & Hand Surgery, Amsterdam University Medical Centres, Free University of Amsterdam, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Nuutila K, Yang L, Broomhead M, Proppe K, Eriksson E. Novel negative pressure wound therapy device without foam or gauze is effective at −50 mmHg. Wound Repair Regen 2018; 27:162-169. [DOI: 10.1111/wrr.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/09/2018] [Accepted: 09/05/2018] [Indexed: 01/23/2023]
Affiliation(s)
| | - Lu Yang
- Applied Tissue Technologies LLC; Hingham Massachusetts
| | | | - Karl Proppe
- Applied Tissue Technologies LLC; Hingham Massachusetts
| | - Elof Eriksson
- Applied Tissue Technologies LLC; Hingham Massachusetts
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Singh B, Rajneesh. Gamma radiation synthesis and characterization of gentamicin loaded polysaccharide gum based hydrogel wound dressings. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Cambiaso-Daniel J, Boukovalas S, Bitz GH, Branski LK, Herndon DN, Culnan DM. Topical Antimicrobials in Burn Care: Part 1-Topical Antiseptics. Ann Plast Surg 2018; Publish Ahead of Print:10.1097/SAP.0000000000001297. [PMID: 29319571 PMCID: PMC6037606 DOI: 10.1097/sap.0000000000001297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Burn wounds disrupt the body's primary defense against invasion and colonization by microorganisms. Topical antimicrobials are one component in burn wound care. These agents suppress microbial growth to advantage skin cells and wound healing. Topical antimicrobials can be divided into 2 superclasses: antiseptics and antibiotics. We review the 4 main classes of topical antiseptics (emulsifiers, acids, oxidizers, and heavy metals) and antiseptic-impregnated dressings in current clinical use and address the mechanisms, as well as the advantages and disadvantages of each antiseptic for burn wound management.
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Affiliation(s)
- Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, Texas, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Stafanos Boukovalas
- Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Genevieve H. Bitz
- JMS Burn and Reconstructive Center, Merit Health Central Hospital, Jackson, Mississippi, USA
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, Texas, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - David N. Herndon
- Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, Texas, USA
- Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Derek M. Culnan
- JMS Burn and Reconstructive Center, Merit Health Central Hospital, Jackson, Mississippi, USA
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Yang L, Broomhead M, Nuutila K, Proppe K, Eriksson E. Topically Delivered Minocycline Penetrates a Full-Thickness Burn Eschar and Reduces Tissue Bacterial Counts. J Burn Care Res 2017; 39:790-797. [DOI: 10.1093/jbcr/irx051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lu Yang
- Applied Tissue Technologies LLC, Hingham, MA
| | | | | | - Karl Proppe
- Applied Tissue Technologies LLC, Hingham, MA
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Olekson MA, Rose LF, Carlsson AH, Fletcher JL, Leung KP, Chan RK. Ultrahigh dose gentamicin alters inflammation and angiogenesis in vivo and in vitro. Wound Repair Regen 2017; 25:632-640. [PMID: 28665034 DOI: 10.1111/wrr.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/25/2017] [Indexed: 12/17/2022]
Abstract
Skin quality outcome after skin grafting is adversely affected by wound bed inflammation. Neomycin, gentamicin, and other aminoglycoside antibiotics are known to modulate inflammation, and topical application affords the use of higher doses than are possible to use systemically. Previous data suggest that clinically relevant doses of neomycin, but not gentamicin, may impair angiogenesis, which is critical to the durable survival of skin grafts. The role of gentamicin at ultrahigh doses compared with clinically relevant neomycin doses in regulating inflammatory expression and angiogenesis has been examined. In a porcine skin replacement excisional wound model, continuous exposure to gentamicin increased anti-angiogenic and inflammatory expression at 7 days postgrafting. In in vitro studies, gentamicin also impaired angiogenesis in a human umbilical vein endothelial cell (HUVEC) tube formation model, increased the expression of the anti-angiogenic gene C-X-C motif chemokine 10 (CXCL10) in HUVECs and macrophages, and increased pro-inflammatory cytokine expression of macrophages in a dose-dependent manner. Neomycin exerted similar effects in vitro at clinically relevant doses on HUVEC tube formation and macrophage pro-inflammatory expression. CXCL10 was upregulated in macrophages, but did not exhibit a change in HUVECs with neomycin treatment. Ultrahigh doses of gentamicin and clinically relevant doses of neomycin affect inflammation and angiogenesis in in vivo and in vitro models. These findings suggest that topical administration of aminoglycosides have the potential to adversely influence early skin graft survival.
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Affiliation(s)
- Melissa A Olekson
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate, United States Army Institute of Surgical Research, JBSA Fort Sam Houston
| | - Lloyd F Rose
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate, United States Army Institute of Surgical Research, JBSA Fort Sam Houston
| | - Anders H Carlsson
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate, United States Army Institute of Surgical Research, JBSA Fort Sam Houston.,Q-SCARR (Quality Skin Composite and Adnexa Regeneration and Reconstruction) Initiative, San Antonio, Texas
| | - John L Fletcher
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate, United States Army Institute of Surgical Research, JBSA Fort Sam Houston.,Q-SCARR (Quality Skin Composite and Adnexa Regeneration and Reconstruction) Initiative, San Antonio, Texas
| | - Kai P Leung
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate, United States Army Institute of Surgical Research, JBSA Fort Sam Houston
| | - Rodney K Chan
- Dental and Craniofacial Trauma Research & Tissue Regeneration Directorate, United States Army Institute of Surgical Research, JBSA Fort Sam Houston.,Q-SCARR (Quality Skin Composite and Adnexa Regeneration and Reconstruction) Initiative, San Antonio, Texas
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Singh B, Varshney L, Francis S, Rajneesh. Synthesis and characterization of tragacanth gum based hydrogels by radiation method for use in wound dressing application. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.01.044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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