Effect of Activated Charcoal on Endotoxin Adsorption Part I. An in Vitro Study

Silver-based wound dressings reduce bacterial burden and promote wound healing

Various types of wound dressings have been designed for different purposes and functions. Controlling bacterial burden in a wound during the early phase is important for successful wound repair. Once bacterial burden is under control, the active promotion of wound healing is another important factor for efficient wound healing. This study investigated the potential of three silver-containing dressings, namely KoCarbonAg(®) , Aquacel(®) Ag and Acticoat 7, in reducing bacterial survival and promoting wound healing. The ability of these dressings to block the entry of bacteria from external environment and retain intrinsic bacteria was studied in vitro. In addition, the study used a rat model to compare the healing efficiencies of the three dressings and investigate the quantity of collagen synthesis in vivo. In vitro results indicated that the silver-containing dressings prevented bacterial growth in wounds by blocking the entry of external bacteria and by retaining the bacteria in the dressing. In vivo study indicated that reduction in bacterial burden accelerated wound healing. Wounds treated by the silver-containing dressings showed better healing than those treated with gauze. Moreover, KoCarbonAg(®) further accelerated wound healing by promoting collagen synthesis and arrangement.

Evaluation of silver-containing activated carbon fiber for wound healing study: In vitro and in vivo

Silver has antiseptic properties, anti-inflammatory properties, and is a broad-spectrum antibiotic for multidrug-resistant strains of bacteria. The commercially available product, Silverlon®, is a silver-plated three-dimensional polyamide fabric with a high silver concentration of 546 mg/100 cm(2). Thus, fibroblast cell growth is affected when exposed to the Silverlon® treated cell medium. Our study produced an activated carbon fiber wound dressing that incorporated various silver concentrations (in cooperation of Bio-Medical Carbon Technology) to examine antimicrobial properties and determine fibroblast cell viability upon exposure to the silver impregnated dressing material as compared to other commercially available products such as calcium alginate dressing, Sorbalgon®, and silver-polyamide fabric dressing, Silverlon®. The silver impregnated activated carbon fiber dressing induced less damage to fibroblast cells compared to the effect produced by Silverlon® and exhibited similar antibacterial abilities in vitro. An in vivo analysis showed that various silver concentrations impregnated activated carbon fiber dressings promoted tissue reconstruction for wound healing in rats with Pseudomonas aeruginosa infected wounds.

Development of fibroblast culture in three-dimensional activated carbon fiber-based scaffold for wound healing

This work developed a novel bi-layer wound dressing composed of 3D activated carbon fibers that allows facilitates fibroblast cell growth and migration to a wound site for tissue reconstruction, and the gentamicin is incorporated into a poly(γ-glutamic acid)/gelatin membrane to prevent bacterial infection. In an in vitro, field emission scanning electron microscopy shows that rat skin fibroblasts appeared and spread on the surface of activated carbon fibers, and penetrated the interior and exterior of the 3D activated carbon fiber construct to a depth of roughly 200 μm. An in vivo analysis shows that fibroblast cells containing the proposed 3D scaffold had the potential of a biologically functionalized dressing to accelerate wound closure. Additionally, fibroblasts migrated to the wound site in a bi-layer wound dressing containing fibroblasts, enhancing fibronectin and type I collagen expression, resulting in faster skin regeneration than that achieved with a Tegaderm™ hydrocolloid dressing or gauze.

Feeding activated charcoal from bark containing wood vinegar liquid (nekka-rich) is effective as treatment for cryptosporidiosis in calves

The effect of activated charcoal containing wood vinegar liquid (Nekka-Rich) on Cryptosporidium parvum was evaluated in vitro and in vivo. First, the adsorption of C. parvum by the activated charcoal component of Nekka-Rich was examined. When mixed, C. parvum oo-cysts were effectively adsorbed by activated charcoal. Next, the effect of the wood vinegar liquid component of Nekka-Rich was assessed. Wood vinegar liquid had an antiprotozoan activity against C. parvum oocysts. Finally, the anticryptosporidial effect of Nekka-Rich was evaluated in calves experimentally infected with C. parvum. Six neonatal calves at 7 d of age were orally infected with 1 x 10(5) oocysts of C. parvum. When diarrhea was observed (on d 3 after the experimental infection), 3 calves received a milk replacer containing 10 g of Nekka-Rich at 8-h intervals for 4 consecutive days, and 3 control calves were given a milk replacer without Nekka-Rich at 8-h intervals for 4 consecutive days. Calves fed milk with Nekka-Rich showed recovery from diarrhea 1 d after the start of treatment. Significantly less fecal excretion of C. parvum oocysts was observed 1 d after treatment in calves fed Nekka-Rich. On d 2 from the beginning of treatment with Nekka-Rich (on d 5 after the experimental infection), oocysts were not isolated from fecal samples. On the other hand, nontreated control calves developed severe diarrhea, and fecal excretion of oocysts was consistently observed. Calves in both groups were killed for collection of samples, which were subjected to scanning electron microscopy. Scanning electron microscopy revealed adherence of C. parvum oocysts to the intestinal epithelial surface of nontreated control calves, whereas a lack of C. parvum adhesion was observed in calves fed Nekka-Rich. These results suggest that Nekka-Rich would be useful for the treatment of cryptosporidiosis in neonatal calves.

Advances in wound dressings

Wound dressings have undergone an evolutionary process from natural materials that simply covered and concealed the wound, to materials that focused on moisture management, and more recently, to materials that either deliver active ingredients or interact directly with cells or specific chemicals in the local wound environment. Advances in dressings technology have led to a new proliferation of topical products that do more than just cover and conceal, but that also can facilitate the healing process as well as address specific issues in nonhealing wounds. Dressings may play an important adjunctive role in concert with overall efforts to manage the underlying causes of chronic nonhealing wounds.

Compression modalities and dressings: their use in venous ulcers

Among the standard of care for venous ulcer treatment are the use of compression therapy to reverse the effect of venous hypertension and the use of occlusive dressings to maintain a moist wound-healing environment and for treatment of abnormalities of the ulcer bed. The use of multilayered elastic bandages for compression in patients with normal arterial flow currently provides the treatment with the highest level of evidence for treatment of venous ulcers. Additionally, treatment of the ulcer bed, especially with cadexemer iodine dressings, is also supported by evidence from randomized controlled trials, whereas newer dressings provide less well proven alternative opportunities to speed the healing of venous ulcers.

Eliminating the carriage of Salmonella enterica serovar Enteritidis in domestic fowls by feeding activated charcoal from bark containing wood vinegar liquid (Nekka-Rich)

The protective efficacy of activated charcoal containing wood vinegar liquid (Nekka-Rich) against intestinal infection with Salmonella enterica serovar Enteritidis was sought. In the present study, the adsorption effects of activated charcoal of Nekka-Rich on S. Enteritidis and normal bacterial flora in the intestine, Enterococcus faecium, were examined. S. Enteritidis was effectively adsorbed by activated charcoal of Nekka-Rich. On the other hand, activated charcoal of Nekka-Rich showed lower binding capacity to E.faecium. The effects of wood vinegar liquid included in Nekka-Rich on the growth of S. Enteritidis and normal bacterial flora in the intestine, E. faecium and Bifidobacterium thermophilum, were also assessed. Wood vinegar liquid had an inhibitory effect on the S. Enteritidis growth, whereas growth of E. faecium and B. thermophilum was enhanced by wood vinegar liquid. Furthermore, the protective effects of Nekka-Rich were evaluated in a challenge chicken model with S. Enteritidis. Chickens were fed a basal diet containing Nekka-Rich or immunized with commercially obtained S. Enteritidis vaccine and challenged with S. Enteritidis. Significantly less fecal excretion of S. Enteritidis was observed in chickens fed Nekka-Rich for 10 d after challenge. On d 15 after challenge, S. Enteritidis was not isolated from fecal samples. On the other hand, immunization of chickens with S. Enteritidis vaccine did not fully inhibit bacterial growth. Fecal excretion of S. Enteritidis was consistently observed in the vaccinated chickens after challenge. These results suggest that Nekka-Rich would be a good product for eliminating the carriage of S. Enteritidis in domestic fowl.

Adsorption effect of activated charcoal on enterohemorrhagic Escherichia coli

The adsorption property of activated charcoal on verotoxin (VT)-producing Escherichia coli (VTEC) was examined using E. coli O157:H7. In the present study, E. coli O157:H7 strains were effectively adsorbed by activated charcoal. Adsorption was dose-dependent, and the maximum adsorption occurred within 5 min. At 10 mg of activated charcoal, bacteria tested were completely adsorbed. Activated charcoal also had the capacity to adsorb toxin (verotoxin 2) activity from the bacterial extract. Furthermore, the adsorption efficiency of activated charcoal for the normal bacterial flora in the intestine was assessed using Enterococcus faecium, Bifidobacterium thermophilum, and Lactobacillus acidophilus. Activated charcoal showed lower binding capacity to the normal bacterial flora tested than that to E. coli O157:H7 strains. These results suggest that activated charcoal could be a good adsorbent system for the removal of VTEC and verotoxin.

Evaluation of heparin immobilized chitosan-PEG microbeads for charcoal encapsulation and endotoxin removal

A technique is described to encapsulate activated charcoal for hemoperfusion to be used in an artificial liver support. Activated charcoal was encapsulated within chitosan-PEG matrix and subsequently surface modified with PGE1 or heparin (hep-AC-PEGCB) via the glutaraldehyde functionalities. This novel matrix was used as the supports for perfusion of endotoxin, under a flow rate of 30 ml/mt. Endotoxin adsorption was quantitatively measured by the method of Limulus Amebocyte lysate test. It seems, the hep-AC-PEGCB may be a good adsorbent system for the removal of toxic endotoxin, and the system may be useful for detoxification of blood. The hep-AC-PEGCB matrix had improved biocompatibility as demonstrated from their hemolytic potential and charcoal release. However, further studies are needed to determine their behaviour under clinical conditions.

Activated charcoal microcapsules and their applications

Activated charcoal, long known to the ancients as a substance of therapeutic value in a variety of maladies, has recently been "rediscovered" to be of great value in medical applications. Activated charcoal hemoperfusion is effective in blood purification for removal of various circulating toxic materials and waste metabolites, directly. However, particulate release and platelet adhesion prevent its continued clinical use. Polymeric coatings or microencapsulation of charcoal within polymers have improved their blood compatibility. Chitosan encapsulated activated charcoal (ACCB) beads have been extensively investigated in our group for the removal of various toxins such as urea, creatinine, uric acid, bilirubin, etc. This article highlights various methods of microencapsulation procedures of activated charcoal and the importance of this novel material for a variety of biomedical applications. Further, this review provides an insight to the future perspectives for using them in clinical practice.

Extracorporeal adsorbent-based strategies in sepsis

Gram-negative bacterial sepsis remains a challenging diagnostic and therapeutic dilemma to the practicing clinician. Bacterial-derived products (eg, gram-negative bacterial lipopolysaccharide or endotoxin) and host inflammatory mediators (eg, tumor necrosis factor-alpha and interleukin-1) are believed to play a pivotal role in the pathogenesis of sepsis and septic shock. Despite the many advances in the treatment of sepsis, mortality rates in septic patients remain high. Indeed, numerous clinical trials using biologically engineered immunotherapies targeting specific inflammatory mediators have proven unsuccessful. This lack of success has led to a renewed interest in blood purification techniques using extracorporeal therapies. During sepsis, circulating bacterial-derived products as well as inflammatory mediators can be reduced and/or eliminated by various extracorporeal adjunctive therapies such as plasma exchange, continuous renal replacement, and adsorbent-based therapies. Adsorbents have commonly been used orally for gastrointestinal removal of toxins or drugs. However, their potential use in sepsis has received little attention. The incorporation of adsorbents in hemoperfusion columns has allowed their use for the removal of toxic compounds from the circulatory system. Adsorbents developed for use in sepsis can bind toxins in a nonselective (eg, charcoal), selective (eg, polymyxin B-immobilized polystyrene-derivative fiber), or specific (eg, antibody-coated microsphere-based detoxification system) way. However, despite an explosive development in the experimental use of these promising therapies, randomized clinical trials are currently lacking. In summary, a multi-disciplinary complex therapeutic approach remains a prerequisite to the successful treatment of sepsis.