Tetracycline Impregnation Delays Collagen Membrane Degradation In Vivo

In Vivo Study of Nasal Bone Reconstruction with Collagen, Elastin and Chitosan Membranes in Abstainer and Alcoholic Rats

The aim of the present study was to evaluate the use of collagen, elastin, or chitosan biomaterial for bone reconstruction in rats submitted or not to experimental alcoholism. Wistar male rats were divided into eight groups, submitted to chronic alcohol ingestion (G5 to G8) or not (G1 to G4). Nasal bone defects were filled with clot in animals of G1 and G5 and with collagen, elastin, and chitosan grafts in G2/G6, G3/G7, and G4/G8, respectively. Six weeks after, all specimens underwent radiographic, tomographic, and microscopic evaluations. Bone mineral density was lower in the defect area in alcoholic animals compared to the abstainer animals. Bone neoformation was greater in the abstainer groups receiving the elastin membrane and in abstainer and alcoholic rats receiving the chitosan membrane (15.78 ± 1.19, 27.81 ± 0.91, 47.29 ± 0.97, 42.69 ± 1.52, 13.81 ± 1.60, 18.59 ± 1.37, 16.54 ± 0.89, and 37.06 ± 1.17 in G1 to G8, respectively). In conclusion, osteogenesis and bone density were more expressive after the application of the elastin matrix in abstainer animals and of the chitosan matrix in both abstainer and alcoholic animals. Chronic alcohol ingestion resulted in lower bone formation and greater formation of fibrous connective tissue.

Differential Biodegradation Kinetics of Collagen Membranes for Bone Regeneration

Native collagen-based membranes are used to guide bone regeneration; but due to their rapid biodegradation, this treatment is often unpredictable. The purpose of this study was to investigate the biodegradability of natural collagen membranes. Three non-cross-linked resorbable collagen barrier membranes were tested: Derma Fina (porcine dermis), Evolution Standard (equine pericardium) and Duo-Teck (equine lyophilized collagen felt). 10 × 10 mm² pieces of membranes were submitted to three different degradation procedures: (1) hydrolytic degradation in phosphate buffer solution, (2) enzyme resistance, using a 0.25% porcine trypsin solution, and (3) bacterial (Clostridium histolyticum) collagenase resistance test. Weight measurements were performed with an analytic microbalance. Thickness was measured with a digital caliper. Membranes were analyzed at different time-points, up to 21 d of immersion. A stereomicroscope was used to obtain membranes’ images. ANOVA and Student Newman Keuls were used for mean comparisons (p < 0.05), except when analyzing differences between time-points within the same membrane and solution where pair-wise comparisons were applied (p < 0.001). Derma Fina attained the highest resistance to all degradation challenges. Duo-Teck was the most susceptible membrane to degradation, complete degradation occurred as soon as 8 h. The bacterial collagenase solution performed as the most aggressive test as all membranes presented 100% degradation before 21 d.

Modifications of Polymeric Membranes Used in Guided Tissue and Bone Regeneration

Guided tissue/bone regeneration (GTR/GBR) is a widely used procedure in contemporary dentistry. To achieve the required results of tissue regeneration, soft tissues that reproduce quickly are separated from the slow-growing bone tissue by membranes. Many types of membranes are currently in use, but none of them fulfil all of the desired features. To address this issue, further research on developing new membranes with better separation characteristics, such as membrane modification, is needed. Many of the current innovative modified materials are still in the phase of in vitro and experimental studies. A collective review on new trends in membrane modification to GTR/GBR is needed due to the widespread use of polymeric membranes and the constant development in the field of dentistry. Therefore, the aim of this review was to present an overview of polymeric membrane modifications to the GTR/GBR reported in the literature. The authors searched databases, including PubMed, SCOPUS, Web of Science, and OVID, for relevant studies that were published during 1999-2019. The following keywords were used: guided tissue regeneration, membranes, coating, and modification. A total of 17 papers were included in this review. Furthermore, the articles were divided into three groups that were based on the type of membrane modification: antibiotic coating, ion-use modifications, and others modifications, thus providing an overview of current existing knowledge in the field and encouraging further research. The results of included studies on modified barrier membranes seem to be promising, both in terms of safety and benefits for patients. However, modifications result in a large spectrum of effects. Further clinical studies are needed on a large group of patients to clearly confirm the effects that were observed in animal and in vitro studies.

Degradation pattern of a porcine collagen membrane in an in vivo model of guided bone regeneration

BACKGROUND AND OBJECTIVE

Although collagen membranes have been clinically applied for guided tissue/bone regeneration for more than 30 years, their in vivo degradation pattern has never been fully clarified. A better understanding of the different stages of in vivo degradation of collagen membranes is extremely important, considering that the biology of bone regeneration requires the presence of a stable and cell/tissue-occlusive barrier during the healing stages in order to ensure a predictable result. Therefore, the aim of this study was to investigate the degradation pattern of a porcine non-cross-linked collagen membrane in an in vivo model of guided bone regeneration (GBR).

MATERIAL AND METHODS

Decalcified and paraffin-embedded specimens from calvarial defects of 18, 10-month-old Wistar rats were used. The defects were treated with a double layer of collagen membrane and a deproteinized bovine bone mineral particulate graft. At 7, 14 and 30 days of healing, qualitative evaluation with scanning electron microscopy and atomic force microscopy, and histomorphometric measurements were performed. Markers of collagenase activity and bone formation were investigated using an immunofluorescence technique.

RESULTS

A significant reduction of membrane thickness was observed from 7 to 30 days of healing, which was associated with progressive loss of collagen alignment, increased collagen remodeling and progressive invasion of woven bone inside the membranes. A limited inflammatory infiltrate was observed at all time points of healing.

CONCLUSION

The collagen membrane investigated was biocompatible and able to promote bone regeneration. However, pronounced signs of degradation were observed starting from day 30. Since successful regeneration is obtained only when cell occlusion and space maintenance exist for the healing time needed by the bone progenitor cells to repopulate the defect, the suitability of collagen membranes in cases where long-lasting barriers are needed needs to be further reviewed.

Efficacy of doxycycline release collagen membrane on surgically created and contaminated defects in rat tibiae: A histopathological and microbiological study

BACKGROUND

The effects of systemic antibiotics on controlling infective pathogens after guided bone regeneration(GBR) procedures especially in membrane exposures are limited. However, local administrations of antibiotics are rare in GBR techniques.

AIM

The aim of this study was to investigate the osteogenesis potential and the antibacterial effect of a doxycycline releasing collagen membrane in surgically created and contaminated defects in rat tibiae.

MATERIAL AND METHODS

Defects were created in 20 rats that were randomly divided in to two groups: control group (defect contaminated by Porphyromonas gingivalis, filled with bone graft and covered by collagen membrane); test group (defect contaminated by P. gingivalis filled with bone graft and covered by collagen membrane containing 1mg/cm(2) doxycycline. Animals were sacrificed post surgically on the 14th day for microbiologic evaluation and on the 28th day for histopathological evaluation.

RESULTS

The degree of osteogenesis in the test group was seen to be significantly higher than control group (p: 0.011; p<0.05). Furthermore in test group, no bacterial growth was observed. The bacteria counts were determined between 1×104 and 268×104CFU/g with a median of 1.32×104 for control group.

CONCLUSIONS

Within the limitations of this study, the results of the present study suggests that the use of a doxycycline releasing membrane has a positive effect on contaminated GBR procedures for limiting P. gingivalis infections leading to bone formation following GBR procedures in a rat model.

Accelerated degradation of collagen membranes in diabetic rats is associated with increased infiltration of macrophages and blood vessels

OBJECTIVES

Increased collagenolytic activity in diabetes may compromise collagen membrane (CM) survival. Tetracycline (TTC) possesses anti-collagenolytic properties and delays CM degradation. This study evaluated macrophage and capillary infiltration within CMs in diabetic rats.

MATERIALS AND METHODS

Diabetes was induced in 20 Wistar rats by streptozotocin and 20 served as controls. Biotin-labeled CM discs were immersed in either TTC (50 mg/ml) or PBS. In each animal, 2 discs (TTC and control) were implanted under the parietal periosteum and rats were sacrificed at 2 or 4 weeks post-implantation. The area and thickness of the residual disc collagen were measured following staining with streptavidin, and the number of macrophages and blood vessels within the membranes was determined using specific antibodies (to CD68 and transglutaminase II, respectively).

RESULTS

Diabetes significantly reduced the area and thickness of the CMs, while TTC increased CM thickness significantly in both groups of rats at 2 and 4 weeks. Diabetes increased the number of macrophages (∼eightfold at 2 weeks and ∼fourfold at 4 weeks), but TTC had no significant effect. Finally, diabetes increased the number of blood vessels within the discs (∼threefold at 2 weeks and ∼twofold at 4 weeks), while TTC had no effect.

CONCLUSIONS

Diabetes increases degradation of native CMs and the number of blood vessels and macrophages within them. TTC immersion delays CM degradation without an apparent effect on macrophage and blood vessel penetration.

CLINICAL RELEVANCE

Enhanced CM degradation in diabetic conditions which impair guided regenerative procedure outcome is apparently related to increased blood vessel formation and macrophage infiltration.

Tetracycline impregnation affects degradation of porcine collagen matrix in healthy and diabetic rats

OBJECTIVES

The present study evaluated the degradation of collagen matrix (CM) immersed in tetracycline (TTC) or phosphate-buffered saline (PBS) in diabetic and normoglycemic rats.

MATERIALS AND METHODS

Diabetes was induced in 15 rats by systemic streptozotocin (STZ) (experimental); 15 healthy rats served as controls. One day before implantation 60 CM disks, 5 mm in diameter, were labeled with biotin: 30 were immersed in tetracycline (TTC) and 30 in PBS. One disk of each type was implanted subdermally in each rat. Animals were euthanized after 3 weeks, and tissue specimens containing the disks were prepared for histologic analysis. Horseradish peroxidase (HRP)-conjugated streptavidin was used to detect the remaining biotinylated collagen. Residual collagen area within the CM disks was analyzed and compared to baseline.

RESULTS

Diabetes significantly increased the CM degradation. Immersion of the CM disks in a 50-mg/mL TTC solution before implantation decreased its degradation both in diabetic and normoglycemic rats.

CONCLUSIONS

Diabetes significantly increases collagen matrix degradation; immersion of collagen matrix in TTC before implantation decreases its degradation in both diabetic and normoglycemic conditions.

CLINICAL RELEVANCE

Immersion of medical collagen devices in TTC may be an effective means to decrease their resorption rate and increase their effectiveness, especially in situations with increased degradation such as diabetes.

The effects of tetracycline-loaded silk fibroin membrane on proliferation and osteogenic potential of mesenchymal stem cells

BACKGROUND

The main objective of this study was to investigate the effect of tetracycline-loaded silk fibroin membranes (TC-SFMs) on the proliferation and the osteogenic differentiation of human mesenchymal stem cells.

MATERIALS AND METHODS

Four groups (0, 1, 5, and 10% concentration) of TC-SFMs were prepared for the experiments. We investigated cumulative tetracycline (TC) release profile for 7 d. Human gingiva-derived mesenchymal stem cells (GMSCs) were isolated from our previous study and seeded to the TC-SFMs. WST-8 assay (Cell Counting Kit-8; SigmaeAldrich Co, St. Louis, MO), staining of Phalloidin-FITC, and scanning electron microscope analyzed the cellular attachment and viability. Staining of Alizarin Red S (Sigma-Aldrich Co.) and osteogenic marker (osteocalcin) analyzed osteogenic differentiation. Additionally, quantitative polymerase chain reaction measured the expression of osteogenic lineage genes, including bone gamma-carboxyglutamic acid protein, bone sialoprotein, runt-related transcription factor 2, and collagen type I α1 according to TC concentration (0.05, 0.1, 0.25, and 0.5 mg/mL).

RESULTS

The release of TC from TC-SFMs plateaued and neared completion in 24 h. Significantly higher viability was noted achieved in 1% and 5% TC-SFMs. The morphology of GMSCs on TC-SFMs at 0% and 1% concentration showed spindle shapes, but cells in 10% TC-SFMs appeared spheroid. During Alizarin Red S staining at 21 d of osteogenic differentiation, calcium and osteocalcin formation were significantly lower in the 10% TC-SFM group than in the 0, 1, and 5 groups. Compared with the control group, bone gamma-carboxyglutamic acid protein showed significantly low expression rate at TC concentration ≥0.05 mg/mL. Bone sialoprotein was low at TC concentration ≥0.1 mg/mL. Likewise, runt-related transcription factor 2 and collagen type I α1 were low at TC concentration of 0.5 mg/mL.

CONCLUSIONS

Within the limits of this study, 1% and 5% TC-SFMs showed higher proliferation and osteogenic potential of GMSCs than 10% TC-SFM. Therefore, the use of 1% to 5% range of TC may be more suitable to silk fibroin membrane for stem cell tissue engineering.

Bacterial adhesion to antibiotic-loaded guided tissue regeneration membranes - a scanning electron microscopy study

BACKGROUND/PURPOSE

Bacterial contamination of sites undergoing guided tissue regeneration (GTR) therapy may reduce the efficiency of periodontal regeneration. This study compared bacterial adhesion onto various GTR membranes incorporated with antibiotics.

METHODS

Three barrier membranes, including expanded polytetrafluoroethylene (ePTFE) membrane, collagen membrane, and glycolide fiber membrane, were loaded with tetracycline or amoxicillin. The adhesion of Streptococcus mutans and Aggregatibacter actinomycetemcomitans onto the GTR membranes with or without antibiotics was analyzed using the scanning electron microscopy (SEM) analysis.

RESULTS

The SEM analysis showed no apparent alteration in the physical structure of the membranes loaded with antibiotics. Both S. mutans and A. actinomycetemcomitans attached best on the collagen membranes, followed by the ePTFE membranes, and then the glycolide fiber membranes without antibiotics. Moreover, higher numbers of bacteria were observed on the fibril areas than on the laminar areas of the ePTFE membranes. The amounts of attached bacteria on the GTR membranes increased after longer incubation. Incorporation of tetracycline or amoxicillin greatly reduced the adhesion of S. mutans and A. actinomycetemcomitans onto all of the GTR membranes examined.

CONCLUSION

Incorporation of tetracycline or amoxicillin greatly reduced adhesion of S. mutans or A. actinomycetemcomitans on the ePTFE, glycolide fiber, or collagen membranes. This finding indicates that it is valuable and effective to use the antibiotic-loaded GTR membranes for periodontal regeneration therapy.

Opposing effects of diabetes and tetracycline on the degradation of collagen membranes in rats

BACKGROUND

Increased collagenolytic activity, characteristic of uncontrolled diabetes, may compromise collagen membrane (CM) survival. Tetracycline (TCN) possesses anticollagenolytic properties and delays CM degradation in healthy animals. This study evaluates the degradation of TCN--immersed and -non-immersed CMs in rats with diabetes compared to those with normoglycemia.

METHODS

Diabetes was induced in 15 12-week-old male Wistar rats by injection of 65 mg/kg streptozotocin. The control group consisted of 15 rats with normoglycemia. Sixty bilayered CM disks were labeled before implantation with aminohexanoyl-biotin-N-hydroxy-succinimide ester, of which 30 were immersed in 50 mg/mL TCN solution (experimental) or phosphate-buffered saline (PBS) (control). In each animal, two disks (control and experimental) were implanted in two midsagittal calvarial defects in the parietal bone. Similar non-implanted disks served as baseline. After 3 weeks, animals were euthanized, and the calvaria and overlying soft tissues were processed for demineralized histologic analysis. Horseradish peroxidase-conjugated streptavidin was used to detect the biotinylated collagen. The area of residual collagen within the membrane disks was measured and analyzed with a digital image analysis system. Several slides from each specimen were also stained with hematoxylin and eosin. Statistical analysis consisted of paired and unpaired t tests.

RESULTS

The amount of residual collagen in PBS-immersed disks was lower in rats with diabetes compared to rats with normoglycemia (69% of baseline versus 93%, respectively, P <0.001). TCN immersion increased the amount of residual collagen contents in both diabetic (83% of baseline) and healthy (97.5% of baseline) animals (P <0.0001).

CONCLUSION

Diabetes increases CM degradation, whereas immersion in 50 mg/mL TCN solution before implantation presents an opposite effect.

Bio-degradation of a resorbable collagen membrane (Bio-Gide) applied in a double-layer technique in rats

OBJECTIVE

The aim of this study was to evaluate histologically the bio-degradation of two layers of Bio-Gide((R)) (BG) membrane, as compared with that of a single layer.

MATERIAL AND METHODS

Two circular calvarial bony defects, 5 mm in diameter, were made in 24 Wistar rats. BG membrane, labeled with biotin, was cut into 5-mm-diameter disks, and placed in defects either as a mono-layer membrane (MLM) or as a double-layer membrane (DLM). Rats were sacrificed after 4 or 9 weeks and histology was performed. Membranes were stained with horseradish peroxidase-conjugated streptavidin and aminoethyl carbazole as a substrate for detection of biotinylated collagen. The area of collagen and thickness of the residual membranes were measured by image analysis software. Statistical analysis was performed using the non-parametric Wilcoxon's signed-ranks test.

RESULTS

At 4-week collagen area per measurement window within the DLM sites (0.09+/-0.05 mm(2)) was significantly greater (P<0.01) than that in the MLM sites (0.047+/-0.034 mm(2)). At 9 weeks, the collagen area was also greater in the DLM sites (0.037+/-0.026 mm(2)) compared with that of the MLM sites (0.025+/-0.016 mm(2)); however, this difference did not reach statistical significance. The rate of membrane degradation, calculated as percent membrane lost compared with baseline, was similar for the DLM and MLM at both time points ( approximately 60% at 4 weeks and approximately 80% at 9 weeks). In addition, the residual DLM thickness at 4 weeks (475.5+/-73.77 mum) was significantly (P<0.01) greater than that of MLM (262.38+/-48.01 mum). At 9 weeks, membrane thickness was also greater in the DLM sites (318.22+/-70.45 mum) compared with that of the MLM sites (183.32+/-26.72 mum); however, this difference did not reach statistical significance. The reduction in thickness between 4 and 9 weeks was 30% for MLM and 33% for DLM.

DISCUSSION

The use of a double layer of BG membrane results in a barrier of increased collagen area and thickness, compared with application of a single layer.

Effect of systemic tetracycline on the degradation of tetracycline-impregnated bilayered collagen membranes: an animal study

BACKGROUND

Premature collagen membrane degradation may compromise the outcome of osseous regenerative procedures. Tetracyclines (TTCs) inhibit the catalytic activities of human metalloproteinases. Preprocedural immersion of collagen membranes in TTC and systemic administration of TTC may be possible alternatives to reduce the biodegradation of native collagen membranes.

AIM

To evaluate the in vivo degradation of collagen membranes treated by combined TTC immersion and systemic administration.

MATERIALS AND METHODS

Seventy-eight bilayered porcine collagen membrane disks were divided into three groups and were immersed in 0, 50, or 100 mg/mL TTC solution. Three disks, one of each of the three groups, were implanted on the calvaria of each of 26 Wistar rats. Thirteen (study group) were administered with systemic TTC (10 mg/kg), while the remaining 13 received saline injections (control group). Calvarial tissues were retrieved after 3 weeks, and histological sections were analyzed by image analysis software.

RESULTS

Percentage of remaining collagen area within nonimpregnated membranes was 52.26 ± 20.67% in the study group, and 32.74 ± 13.81% in the control group. Immersion of membranes in 100 mg/mL TTC increased the amount of residual collagen to 63.46 ± 18.19% and 42.82 ± 12.99% (study and control groups, respectively). Immersion in 50 mg/mL TTC yielded maximal residual collagen values: 80.75 ± 14.86% and 59.15 ± 8.01% (study and control groups, respectively). Differences between the TTC concentrations, and between the control and the study groups were statistically significant.

CONCLUSIONS

Immersion of collagen membranes in TTC solution prior to their implantation and systemic administration of TTC significantly decreased the membranes' degradation.

Degradation of collagen-guided tissue regeneration membranes by proteolytic enzymes of Porphyromonas gingivalis and its inhibition by antibacterial agents

Previous studies have shown that whole cells of several periodontal pathogenic bacteria including Porphyromonas gingivalis may degrade the clinically used regeneration membranes Biomend Extend and Bio-Gide. Fractionation of P. gingivalis cells revealed that cell membrane-associated proteases are responsible for the in vitro degradation of the collagen membranes. In the present study, the specific role of extracellular vesicles and the purified Arg-gingipain enzyme of P. gingivalis in the degradation of three differently cross-linked collagen membranes (Ossix; Bio-Gide and Biomend Extend) was examined. In addition, the inhibitory effect of antibacterial agents and antibiotics used in local periodontal therapy on the enzymatic degradation was evaluated. The data presented show that while all tested collagen membranes, are prone to lysis by oral bacterial proteases, cross-linked membranes are more resistant to proteolysis. Furthermore, therapeutical concentrations of the antibacterial and antibiotic agents chlorhexidine, cetylpyridiniumchloride, minocycline and doxycycline were found to partially inhibit the enzymatic breakdown of the membranes, while metronidazole had no such effect. These results suggest that the presence of P. gingivalis cells, extracellular vesicles and enzymes in the vicinity of regeneration membranes in the periodontium, may change their physical structure and therefore alter their biological properties. Furthermore, the use of cross-linked collagen membranes and antibacterial agents may significantly inhibit this proteolytic process.

Biodegradation of three different collagen membranes in the rat calvarium: a comparative study

BACKGROUND

Collagen barrier membranes are commonly applied in periodontal and bone-regenerative procedures. Membranes differ in their resorption pattern following implantation, thus influencing clinical outcome. The purpose of this study was to quantitatively evaluate the biodegradation of three different commercially available collagen membranes.

METHODS

Collagen membranes were cut into 5-mm-diameter disks and labeled with aminohexanoyl-biotin-N-hydroxy-succinimide ester. One membrane disk of each type (non-cross-linked [NCL], glutaraldehyde cross-linked [GCL], and ribose cross-linked [RCL]) was implanted on the calvaria of 20 Wistar rats. Block sections were retrieved after 2 days (baseline, two animals), 14 days (10 animals), or 28 days (eight animals). Decalcified histologic sections were stained with streptavidin horseradish peroxidase. Residual membrane thickness and area were measured. Statistical analysis consisted of analysis of variance (ANOVA) with repeated measures.

RESULTS

Statistically significant differences in the amount of residual membrane material were recorded within each membrane (among different time points) and among different membranes at the same time points (P <0.001). At 28 days, the least amount of residual collagen area, expressed as the percentage of baseline, was observed in the NCL group (13.9% +/- 10.25%), followed by the GCL (24.7% +/- 35.11%) and RCL (91.3% +/- 10.35%) groups. Residual membrane thickness, expressed as the percentage of baseline thickness, presented a similar pattern (31% +/- 16.55%, 37% +/- 41.90%, and 94.1% +/- 12.22%, respectively). ANOVA with repeated measures showed a significant interaction between membranes and time (P <0.001).

CONCLUSIONS

The tested membranes differed in their degradation patterns and collagen contents. Membranes should be chosen for each clinical case according to the desired biodegradation characteristics.

Future treatment and diagnostic strategies for periodontal diseases

Many new technologies have been developed or are being developed that could enhance the ability to diagnose, predict, and treat periodontitis. Newer treatment strategies may allow clinicians to achieve limited or more robust regeneration of the periodontium. New or refreshed approaches to disease control are being pursued that will benefit those suffering from chronic periodontal disease. In addition to novel therapeutics, there has been increasing focus on the development of more sensitive and specific diagnostic tests for periodontal diseases. Such tests will allow the clinician to determine whether a patient has active disease and what sort of attachment loss might be expected if the patient is not treated. By developing newer diagnostic tests, it also may be possible to detect and monitor active disease during therapy.