Biochemical and biomechanical characterization of an autologous protein-based fibrin sealant for regenerative medicine

Accidental events or surgical procedures usually lead to tissue injury. Fibrin sealants have proven to optimize the healing process but have some drawbacks due to their allogeneic nature. Autologous fibrin sealants present several advantages. The aim of this study is to evaluate the performance of a new autologous fibrin sealant based on Endoret®PRGF® technology (E-sealant). One of the most widely used commercial fibrin sealants (Tisseel®) was included as comparative Control. E-sealant´s hematological and biological properties were characterized. The coagulation kinetics and the microstructure were compared. Their rheological profile and biomechanical behavior were also recorded. Finally, the swelling/shrinkage capacity and the enzymatic degradation of adhesives were determined. E-sealant presented a moderate platelet concentration and physiological levels of fibrinogen and thrombin. It clotted 30 s after activation. The microstructure of E-sealant showed a homogeneous fibrillar scaffold with numerous and scattered platelet aggregates. In contrast, Control presented absence of blood cells and amorphous protein deposits. Although in different order of magnitude, both adhesives had similar rheological profiles and viscoelasticity. Control showed a higher hardness but both adhesives presented a pseudoplastic hydrogel nature with a shear thinning behavior. Regarding their adhesiveness, E-sealant presented a higher tensile strength before cohesive failure but their elastic stretching capacity and maximum elongation was similar. While E-sealant presented a significant shrinkage process, Control showed a slight swelling over time. In addition, E-sealant presented a high enzymatic resorption rate, while Control showed to withstand the biodegradation process in a significant way. E-sealant presents optimal biochemical and biomechanical properties suitable for its use as a fibrin sealant with regenerative purposes.

Biological and Adhesive Properties of an Autologous Protein-Based Fibrin Sealant for Ophthalmological Applications

Purpose

The aim of this study was to evaluate the biological and adhesive properties of a new autologous sealant based on plasma rich in growth factors (PRGF), named E-Sealant.

Methods

Conventional PRGF and a commercial fibrin sealant (Tisseel) were included as controls. The hematological and protein content of E-Sealant was determined. Its bioactivity and biocompatibility were tested for human keratocytes (HKs). To evaluate its adhesion and regenerative capacity, E-Sealant was used on an animal model of conjunctival autograft surgery and compared to Tisseel.

Results

E-Sealant presented a high growth factor content with levels similar to those of conventional PRGF. E-Sealant induced proliferative and migratory activity on HK cells equivalent to PRGF. Although autologous membranes induced the proliferation of HKs, cells cultured over Tisseel did not adhere nor proliferate. HK cells showed increased number and flattened morphology over PRGF and E-Sealant compared to scarce and round-shape cells detected in Tisseel. Conjunctival autograft glued with E-Sealant adhered successfully, whereas Tisseel application formed irregular clots. During follow-up, both adhesives showed good integration and no dehiscence. However, Tisseel-treated samples presented slightly increased hemorrhage and inflammation. In contrast to Tisseel, E-Sealant-treated autografts presented a continuous layer of non-keratinized stratified squamous epithelium. Inflammatory infiltrates were minimal in E-Sealant-treated conjunctiva, whereas the Tisseel group showed noticeable immune reactions. Unlike Tisseel-treated grafts, E-Sealant presented low immunoreactivity for smooth muscle actin (SMA), suggesting decreased fibrotic tissue formation.

Conclusions

E-Sealant presents optimal biological and adhesive properties suitable for use as an ophthalmic glue, with regenerative purposes superior to commercial fibrin sealants.

Translational Relevance

Our study analyzed the characterization and biological activity of a new autologous fibrin sealant in ocular surface cells and in an animal model in which the adhesive and regenerative properties of the fibrin sealant were evaluated.

Plasma Rich in Growth Factors as an Adjuvant Treatment for the Management of Frontal Fibrosing Alopecia: A Retrospective Observational Clinical Study

BACKGROUND

Frontal fibrosing alopecia (FFA) is a scarring alopecia in which the exact etiopathogenesis has not been completely elucidated and the available treatments are not very effective. Plasma rich in growth factors (PRGF) has shown to induce folliculogenesis in hair loss related disorders. However, the scientific evidence when facing FFA is scarce.

OBJECTIVES

The aim of this study was to retrospectively analyze the adjuvant use of PRGF compared to the conventional treatment in the management of FFA.

METHODS

Participants with clinically diagnosed FFA who had been treated with either conventional therapy (Control Group) or conventional therapy combined with PRGF (PRGF Group) were identified from the center's medical records. The clinical assessment was based on the "Frontal Fibrosing Alopecia Severity Score" (FFASS), which was fulfilled during a period of two and 4 years.

RESULTS

This study included 118 patients with clinically diagnosed FFA (Control Group: 57 and PRGF Group: 61). No adverse effects related to the treatments were observed. Both treatments showed to halt the steady progression of hair loss compared to baseline. PRGF treatment also induced significant hair regrowth compared to the Control Group. The scalp inflammation was reduced in response to treatments. The FFASS score indicated that PRGF Group improved the symptoms and severity of FFA in a significant manner.

CONCLUSIONS

The adjuvant use of PRGF may exert long-term beneficial effects on hair loss reduction and might reduce the symptoms and severity of FFA.

Combined Therapy with Laser and Autologous Topical Serum for Facial Rejuvenation: A Multiple Case Series Report

Background

Lasers require several sessions to achieve significant results and may lead to adverse reactions. Platelet-rich plasma (PRP) therapy is a good adjuvant to laser therapies; however, repeated blood extractions and invasive injections are needed. A 100% autologous topical formulation based on the patient's proteins has been recently developed, known as Endoret-Serum (ES). Unlike other PRPs, ES provides a home care, storable, and topical needle-free application.

Objective

Preliminarily assess the clinical performance of a single session of the combined therapy with nonablative laser and ES in the management of cutaneous pigmented and vasculature lesions.

Materials and Methods

Nine patients with clinical signs of skin aging received a single session of nonablative laser. ES was topically applied twice daily. They were clinically assessed after 1 and 8 weeks. VISIA-CR System was used for high-resolution topographic analysis. Subjects were asked to complete a self-assessment questionnaire and an impression of improvement survey. An investigator's global assessment scale was fulfilled.

Results

The combined treatment improved cutaneous spots, wrinkles, and texture after 8 weeks, whereas significant pore reduction was observable at 1 week. Ultraviolet (UV) spots and porphyrins decreased at 1 week, whereas red area improvement was noticeable after 8 weeks. Overall wrinkle amelioration, periorbital hyperpigmentation decrease, softened skin, and tone recovery was observed. Patients referred to be very satisfied and felt that their cutaneous condition was much better. At the end of the study, subjects presented minimal dermatological symptoms like pigmented lesions, redness, or capillaries. No side effects were reported.

Conclusion

Results presented herein suggest that one session of laser in combination with ES provides a good clinical outcome.

Therapeutic Efficacy of a Plasma Rich in Growth Factors Gel Combined with Fractional Ablative Laser in the Management of Post-acne Scars

Background

Acne vulgaris is a common condition that often results in secondary cutaneous damage in the form of scarring. Scars require shape-specific scaffolds. Recently, a new 3D gel derived from plasma rich in growth factors technology (PRGF) has been developed with the aim of overcoming these limitations.

Objective

The aim of this study was to preliminarily assess the clinical performance of the combination therapy with PRGF-gel (PG) and fractional ablative laser for post-acne scar amelioration.

Materials and Methods

Nine patients suffering from post-acne scars received a combination of PG and fractional ablative laser therapy. Macrophotographs were taken and patients completed a satisfaction survey. Images were also analyzed following the ECCA score. Clinicians were also asked to fulfill a clinical improvement score and any undesired side effects were recorded.

Results

Patients were referred to be highly satisfied as an 8.7 ± 0.9 satisfaction score was achieved. Healthcare specialists objectivated that the scar reduction and overall skin quality at the end of the study had noticeably improved. The ECCA score showed a significant 55% of improvement compared with baseline. No major side effects were recorded, and the tolerance of the treatment was excellent.

Conclusion

The combined therapy with PG and fractional ablative laser might help in the management of post-acne scars and overall skin rejuvenation.

Differential Protein Content between Fresh and Freeze-Dried Plasma Rich in Growth Factors Eye Drops

The purpose of this study was to analyze the proteomic composition of plasma rich in growth factors eye drops (PRGF) in comparison to lyophilized PRGF eye drops (PRGF lyo). The differential protein expression of keratocyte (HK) cells after PRGF or PRGF lyo treatment was also determined. Blood from different donors was collected and processed to obtain PRGF and PRGF lyo eye drops. Then, HK cells were treated with both formulations. A proteomic analysis was performed to evaluate the differential proteomic profile between PRGF and PRGF lyo, and the differential protein expression by HK cells after treatment with both blood-derived products. About 280 proteins were detected between both blood-derived formulation, with only 8 of them reaching significant differences. Furthermore, 101 out of 3213 proteins showed statistically significant deregulation in HK cells after treatment with PRGF or PRGF lyo. Gene Ontology analysis showed that these significant deregulated proteins were involved in 30 functional processes. However, the Ingenuity Pathway Analysis showed that no significant differences were found in any of the identified processes. In summary, the present study show that no significant differences were found in the proteomic profile or in the signaling pathways activation in HK cells between PRGF and PRGF lyo.

An Autologous Topical Serum Derived from Platelet-Rich Plasma Therapy for the Management of Sensitive Skin Alterations: A Case Series Report

Background

Although the underlying pathophysiology of sensitive skin remains unknown, it presents clinical symptoms like erythema, burning and dryness associated with other inflammatory dermatoses such as dermatitis or rosacea.

Objective

The aim of the present report was to provide preliminary data about the efficacy of Endoret-Serum (ES) as an autologous therapy for the topical management of sensitive skin alterations.

Materials and Methods

Five patients underwent a daily topical ES treatment that was maintained for three months. Clinical assessment was carried out using validated dermatological surveys (DLQI, IGA, Likert, PGI-I). Additionally, skin hydration measurement and high-resolution topographic and reflectance confocal imaging analysis were carried out.

Results

No adverse events were observed during the treatment. At the end of the follow-up period, surveys highlighted a significant therapeutic effect compared to baseline. Skin hydration was also improved, and topographic images showed a decrease in patient’s underlying inflammatory and vascular condition.

Conclusion

This preliminary report suggests that Endoret-Serum may be useful in the management of clinical symptoms derived from sensitive skin alterations.

Portomesenteric vein thrombosis following sleeve gastrectomy: Case report focusing on the role of pathogenetic factors

INTRODUCTION

Sleeve gastrectomy has currently become the most commonly performed bariatric. procedure worldwide according to the last IFSO survey, overtaking gastric bypass with. a share of more than 50% of all primary bariatric-metabolic surgery. Gastric leak, intraluminal bleeding, bleeding from the staple-line and strictures are the most common complications. Portomesenteric vein thrombosis (PMVT)after sleeve gastrectomy is. another complication that has been increasingly reported in case-series in recent.years, although it remains uncommon. In this case report is described an extended portomesenteric vein thrombosis after. sleeve gastrectomy interesting splenic vein too with a favorable course and an. uneventful follow-up. We try to search in this case for pathogenetic factors involved in. this complication.

CASE REPORT

A 42-year old man, with a body mass index (BMI) of 45 kg/m2, with a medical history of Obstructive Sleep Apnea Sindrome (OSAS) underwent laparoscopic sleeve gastrectomy. Early postoperative course was uneventful. Six days after discharge he complained abdominal pain and was admitted at the Emergency Department. A CT scan with intravenous contrast showed an occlusion of the portal vein, of the intrahepatic major branches and an extension to the superior mesenteric vein and the splenic vein. The patient received heparin and oral anticoagulation together with intravenous hydration and proton pump inhibitors. Considering the favourable course the patient was discharged after six days with long-term oral anticoagulation therapy. Anticoagulation with acenocumarol was continued for six months after a CT scan showed resolution of the PMVT without cavernoma. He had no recurrence of symptoms.

DISCUSSION

Porto-mesenteric thrombosis after sleeve gastrectomy is a rare complication but it has been increasingly reported over the last 10 years along with the extensive use of sleeve gastrectomy. Because PMVT is closely associated with sleeve gastrectomy in comparison with other bariatric procedures, we need to investigate what pathogenetic factors are involved in sleeve gastrectomy. Thrombophylic state, prolonged duration of surgery, high levels of pneumoperitoneum, thermal injury of the gastroepiploic vessels during greater curvature dissection, high intragastric pressure, inadequate antithrombotic prophylaxis and delayed mobilization of the patient after surgery have been reported as pathogenetic factors of portmesenteric vein thrombosis. Most of the cases presented in the literature such as our clinical case resolve with medical therapy, although portal vein thrombus extends into the superior mesenteric vein and the splenic vein.

CONCLUSION

Portomesenteric venous thrombosis is a rare but serious complication of bariatric surgery, especially associated with sleeve gastrectomy. Diagnosis is based on CT examination with intravenous contrast, and initial therapy is anticoagulation. Etiologic factors reported in the literature include a long duration of surgery, a high degree of pneumoperitoneum, high intragastric pressure after sleeve gastrectomy and thermal injury to the short gastric vessels and gastroepiploic arcade. Limited operative time, controlled values of pneumoperitoneum, careful dissection with energy device of gastric greater curvature, appropriate prophylaxis with low molecular weight heparin may be useful tools to prevent and limit this complication. Nonetheless we have to search which factors may condition the evolution of an extended PMVT as that described in this case towards resolution or to a further worsening clinical state. Early diagnosis? Correct treatment? Undiscovered patientrelated factors?

Proteomic Characterization of Plasma Rich in Growth Factors and Undiluted Autologous Serum

Over the last three decades, there has been special interest in developing drugs that mimic the characteristics of natural tears for use it in the treatment of several ocular surface disorders. Interestingly, the composition of blood plasma is very similar to tears. Therefore, different blood-derived products like autologous serum (AS) and plasma rich in growth factors (PRGF) have been developed for the treatment of diverse ocular pathologies. However, scarce studies have been carried out to analyze the differences between both types of blood-derived products. In the present study, blood from three healthy donors was drawn and processed to obtain AS and PRGF eye drops. Then, human corneal stromal keratocytes (HK) were treated with PRGF or undiluted AS. Proteomic analysis was carried out to analyze and characterize the differential protein profiles between PRGF and AS, and the differentially expressed proteins in HK cells after PRGF and AS treatment. The results obtained in the present study show that undiluted AS induces the activation of different pathways related to an inflammatory, angiogenic, oxidative stress and scarring response in HK cells regarding PRGF. These results suggest that PRGF could be a better alternative than AS for the treatment of ocular surface disorders.

An Autologous Protein-Based Topical Ointment for Hard-to-Heal Skin Wounds: A Multiple Case Series

BACKGROUND

There is increasing evidence regarding the wound healing potential of platelet-derived autologous by-products. We provide preliminary data regarding the use of a new plasma rich in growth factors-derived autologous topical ointment for the management of hard-to-heal wounds.

CASES

Four patients suffering from difficult-to-heal wounds were treated with the autologous ointment. Within 2 to 8 weeks, all wounds healed completely with no signs of infection or functional impairment of the affected limbs. No adverse events were reported.

CONCLUSION

Randomized and controlled trials are needed to determine the clinical efficacy of the autologous ointment. Nevertheless, results from this multiple case series indicate that this approach may be useful for accelerating the re-epithelization of difficult-to-heal wounds.

In vitro and in vivo Effect of Platelet-Rich Plasma-Based Autologous Topical Serum on Cutaneous Wound Healing

INTRODUCTION

Skin injury and wound healing is an inevitable event during lifetime. However, several complications may hamper the regeneration of the cutaneous tissue and lead to a chronic profile that prolongs patient recovery. Platelet-rich plasma is rising as an effective and safe alternative to the management of wounds. However, this technology presents some limitations such as the need for repeated blood extractions and health-care interventions.

OBJECTIVE

The aim of this study was to assess the use of an endogenous and storable topical serum (ES) derived from plasma rich in growth factors promoting wound healing, and to obtain preliminary data regarding its clinical and experimental effect over ulcerated skin models and patient care.

METHODS

Human dermal fibroblast and 3D organotypic ulcerated skin models were used to assess ES over the main mechanisms of wound healing including cell migration, edge contraction, collagen synthesis, tissue damage, extracellular matrix remodeling, cell death, metabolic activity, and histomorphometry analysis. Additionally, 4 patients suffering from skin wounds were treated and clinically assessed.

RESULTS

ES promoted dermal fibroblast migration, wound edge contraction, and collagen synthesis. When topically applied, ES increased collagen and elastin deposition and reduced tissue damage. The interstitial edema, structural integrity, and cell activity were also maintained, and apoptotic levels were reduced. Patients suffering from hard-to-heal wounds of different etiologies were treated with ES, and the ulcers healed completely within few weeks with no reported adverse events.

CONCLUSION

This preliminary study suggests that ES might promote cutaneous wound healing and may be useful for accelerating the re-epithelization of skin ulcers.

Anti-inflammatory effect of different PRGF formulations on cutaneous surface

Cutaneous autoimmune and inflammatory diseases are a major burden of global disease and many lack effective treatments that can derive in different dermatoses like atopic dermatitis. Despite the increase prevalence and the high health-care costs worldwide, the heterogeniety and multifactoriality of these diseases mean that effective treatment options are scarce. Plasma rich in growth factors (PRGF) technology could be an alternative approach that may help in the management of this cutaneous condition. The aim of this study was to assess the effect of two different PRGF formulations (just activated and autologous topical serum (ATS)) for the management of skin inflammation. Additionally, ATS was assessed over two patients suffering from radiotherapy induced dermatitis. Human organotypic skin explant cultures (hOSECs) were used as human skin models. To induce atopic dermatitis-like conditions, skin explants were treated with both interleukin-4 (IL-4) and interleukin-13 (IL-13). PRGF and ATS were intradermally and topically applied, respectively. Metabolic activity, reactive oxigen species (ROS), necrosis and inflammatory cytokine production were determined. Both PRGF formulations increased tissue viability and significantly reduced the excessive free radical accumulation and the cutaneous cytokine production such as TNF-α and IL-1β. Case reports showed a positive response after ATS treatment in terms of skin quality improvement, local erythema decrease and burning and itching amelioration. The oedema, swelling and desquamation caused by radiation induced dermatitis was also reduced and the patients referred ceased pruritus and pain. This preliminary study suggests that PRGF might aid in the management of inflammatory skin conditions.

Combined therapy with Endoret-Gel and plasma rich in growth factors vs Endoret-Gel alone in the management of facial rejuvenation: A comparative study

BACKGROUND

Skin suffers progressive decrement. An endogenous regenerative technology has been developed that has the versatility to provide an autologous injectable gel (Endoret-Gel) or a liquid plasma rich in growth factors (PRGF) based on the patient´s own platelet-rich plasma.

AIMS

To compare the efficacy of the combined therapy with Endoret-Gel and PRGF versus Endoret-Gel alone in the management of facial rejuvenation.

METHODS

Twenty clinically diagnosed patients with aged skin received either Endoret-Gel monotherapy or Endoret-Gel + PRGF combined therapy. Patients underwent three sessions at one-month intervals and were clinically assessed for six months. Corneometry, sebumetry, and high-resolution topographic analysis were carried out. Patient self-assessment questionnaires and clinical improvement scores were also performed.

RESULTS

The combined therapy showed to promote a higher hydration index. These results were also significant for spot improvement at three months, while conversely, monotherapy with Endoret-Gel demonstrated higher UV spot improvement. A significant decrease of sebum production and wrinkle development was observed for both treatment groups. Red areas also improved in a similar way at the end of the follow-up period. After Endoret-Gel or Endoret-Gel + PRGF therapy, 30% and 70% of patients referred to be very satisfied, respectively. Accordingly, 40% and 80% showed a "very improved" esthetic performance. None of the patients reported a negative change and no adverse events were recorded.

CONCLUSION

Both Endoret-Gel monotherapy and the combined treatment with PRGF were shown to promote facial rejuvenation and to palliate the age-related cutaneous atrophy. The combined therapy may exert a synergistic effect that addresses both skin quality improvement and soft tissue restoration in a shorter period.

Long-term stability of a novel platelet-rich plasma-based topical serum for cutaneous applications

BACKGROUND

Skin alterations are usually related to chronic diseases that demand sustained and long-term dosages; hence, it is pivotal that the stability of treatments is preserved. A novel storable and endogenous topical serum (ES) based on the patient's own blood has been recently developed.

AIMS

To investigate the long-term stability of the formulation and to provide preliminary data of its biologic potential.

METHODS

Samples from six donors were obtained and either used as fresh samples or cold-stored for 6 months. Physicochemical, rheological, and biological stability of the formulation was determined.

RESULTS

Endogenous topical serum maintained unaltered its organoleptic properties, viscosity, pH, spreadability index, and sterility. The growth factor content including TGFβ-I, EGF, PDGF-AB, HGF, and Ang-I showed no decrease. In contrast, ES showed lower levels of IGF-I once stored. Dermal fibroblasts showed no change in their proliferative activity.

CONCLUSION

Endogenous topical serum showed to maintain its physicochemical and biological properties after six months of storage. ES might reduce the frequency of blood extractions and would enable patients with chronic disorders to maintain a daily use of the product in a minimally invasive way.

Plasma rich in growth factor gel as an autologous filler for facial volume restoration

BACKGROUND

Skin aging is characterized by moderate to severe wrinkles, laxity, roughness, and volume loss as a result of cutaneous atrophy and connective tissue degradation. Plasma rich in growth factor gel (PRGF-gel) is a novel formulation obtained from the patient's own blood that has demonstrated optimal biomechanical and bioactive properties for soft tissue restoration.

OBJECTIVES

Following a retrospective design, the clinical safety and efficacy of PRGF-gel for facial volume restoration and skin rejuvenation were evaluated.

METHODS

Twenty women clinically diagnosed for aged skin symptoms were treated with PRGF-gel. Participants received an individualized regimen depending on their therapeutic needs. At the end of the follow-up periods, clinical performance analysis was evaluated by standardized macrophotographs along with clinical and patient surveys based on Likert's scales.

RESULTS

Based on their initial expectations, patients referred to be highly satisfied after PRGF-gel treatment in terms of fine line amelioration, wrinkle reduction, and sagging improvement (overall satisfaction of 8/10). Pre/post-photograph clinical evaluation showed an improvement of 2.5/3 and patients presented a noticeable face rejuvenation due to the soft tissue augmentation effect which was translated into surface texture softening and tone recovery.

CONCLUSIONS

Although additional randomized clinical trials should be carried out, this study provides preliminary data supporting the use of PRGF-gel for facial volume restoration.

In vitro characterization and clinical use of platelet-rich plasma-derived Endoret-Gel as an autologous treatment for atrophic scars

BACKGROUND

Normal healing process becomes severely dysregulated in pathophysiological conditions such as inflammation, infection or underlaying diseases. These scenarios hamper the standard healing pattern and dermal fibrotic tissue develops.

OBJECTIVE

In the present study a novel three-dimensional formulation (Endoret-Gel) based on plasma rich in growth factors technology (Endoret-PRGF) has been assessed for atrophic scar management.

MATERIALS AND METHODS

Microstructure analysis, growth factor content, and projection capacity of both formulations (Endoret-Gel and Endoret-PRGF) was assessed. Additionally, a clinical evaluation of Endoret-Gel treatment was also performed in a case of an extense atrophic scar.

RESULTS

Endoret-Gel presented high molecular weight plasmatic proteins that formed solid thermal aggregates enclosed by a stable fibrin network. This formulation has a higher cutaneous projection capacity compared with Endoret-PRGF. Both formulations presented a high load of bioactive proteins such as EGF, PDGF-AB, and IGF-I being higher in liquid Endoret-PRGF. Clinical results evidenced that infiltrations of Endoret-Gel derived in an early volumetric disposal that was maintained for several months. The treatment provided and immediate soft tissue augmentation and scar amelioration effect that was translated into a noticeable clinical improvement of the injury. No side effects or adverse events were reported during ten-month follow-up period.

CONCLUSION

These preliminary findings suggest that Endoret-Gel may act not only as a temporary volumizer but also as soft tissue stimulator that might be used as a monotherapy for scar management.

A novel protein-based autologous topical serum for skin regeneration

BACKGROUND

As skin ages, a functional decrement occurs. To avoid future vulnerability to dermatologic diseases, an optimal cutaneous regeneration is mandatory. Biological therapies based on blood-derived autologous proteins are gaining attention of scientists and dermatologists.

OBJECTIVES

A novel 100% autologous topical serum has been developed using plasma rich in growth factors technology. The physicochemical characterization and the biologic potential of the novel formulation have been studied.

METHODS

Rheological and mechanical properties and the biological capacity of the formulation were characterized. Human dermal fibroblast culture and 3D organotypic skin explants were used as in vitro and ex vivo cutaneous models, respectively.

RESULTS

The autologous topical serum presented an optimal spreadability index and appropriate shear thinning behavior that allowed an easy handling and rapid integration within the cutaneous tissue. The formulation has a high growth factor load with the ability to progressively penetrate into the dermal/epidermal layers of the skin. It is biocompatible and promotes cell proliferation and chemotactic activity. The autologous topical serum promotes the biosynthetic activity of cells by the stimulation of collagen and hyaluronic acid expression.

CONCLUSIONS

These findings present an in situ and easy to prepare autologous topical serum based on the patient's own blood with physicochemical and bioactive properties that may be used for skin regeneration purposes.

Biological Stability of Plasma Rich in Growth Factors-Derived Autologous Topical Serum After Three-Months Storage

In this study, the stability of a novel autologous topical serum (ATS) derived from plasma rich in growth factors technology (PRGF) has been evaluated. As skin ages, mechanical, protective and restorative properties decrease leading to multiple clinical conditions. In recent years, topical administration of growth factors has emerged as a promising therapeutic alternative to promote wound healing and skin regeneration. Determination of stability is a crucial step in the formulation process in order to develop an effective product. Blood from 8 healthy donors was harvested and the autologous topical serum was obtained. Resulting ATS samples were either kept fresh or stored for 1, 2, and 3 months at 4ºC. Physical properties and growth factor content were determined in ATS samples at each time of storage. The effect on human dermal fibroblast proliferation and the sterility of the samples was also studied. All the analyzed parameters remained stable along the storage time while pH values increased slightly with respect to fresh samples. No microbial contamination was detected in any of the samples. Preservation of the autologous topical serum up to 3 months under refrigeration does not affect either its physical or mechanical properties or neither alters the growth factors´ composition, thus preserving its biological potential. This achievement enables patients with chronic disorders to maintain their treatment with a lower frequency of blood extractions without affecting the efficacy of PRGF therapy. J Drugs Dermatol. 2018;17(10):1115-1121.

Platelet rich plasma for the management of hair loss: Better alone or in combination?

Platelet-rich plasma (PRP) and autologous protein-based treatments have recently emerged as a potential therapeutic approach for hair loss-related disorders including androgenetic alopecia and alopecia areata. The safety and efficacy of repeated intradermal injections of PRP has proved to promote hair growth in a number of randomized clinical trials. Biologically active proteins and cytokines released upon platelet activation have shown to induce folliculogenesis and activate the anagen growing phase of dormant bulbs. Interestingly, further studies have revealed that combining PRP with other hair loss-related products may enhance the final performance of the treatment. These synergistic approaches include Food and Drug Administration (FDA) approved drugs such as finasteride or minoxidil, bioactive macromolecules and cell-based therapies. Here, recent research involving alone or combined therapy with platelet-rich plasma for the management of hair loss-related disorders are outlined and future prospects are discussed.

A novel personalized 3D injectable protein scaffold for regenerative medicine

Biomaterials should be designed to closely resemble the characteristics and functions of the native extracellular matrix to provide mechanical support and signals to direct biological events. Here we have developed a novel injectable plasma rich in growth factors (PRGF-Endoret)-based formulation that combines a thermal-denaturation step of plasma with an autologous fibrin crosslinking. Rheological and mechanical properties were evaluated. Additionally, the microstructure and biological capacity of the biomaterial was also characterized. This novel formulation exhibited ideal mechanical properties and a gel-like behavior with the ability to progressively release its growth factor load over time. The results also suggested that the novel injectable formulation is non-cytotoxic, biocompatible and suitable for cell ingrowth as it is deduced from the fibroblast proliferation within the scaffold. Finally, stimulation of both cell proliferation and matrix proteins synthesis demonstrated the regenerative potential of this autologous protein based injectable scaffold.

Opening new horizons in regenerative dermatology using platelet-based autologous therapies

Biological therapeutic therapies are gaining the attention of scientists and medical doctors. Accumulating evidence suggests that blood-derived autologous therapies are safe and effective treatments for skin repair and wound healing. The fibrin network formed after plasmatic activation and the autologous growth factors released when platelets degranulate constitute a real biological medicine that has been shown to promote cell recruitment, stimulate new blood vessel formation, reduce inflammation as well as protect from local infections. This perspective highlights recent basic and clinical results published on blood-derived autologous therapies in the field of regenerative dermatology and discusses potential challenges and future prospects.

Implementation of a more physiological plasma rich in growth factor (PRGF) protocol: Anticoagulant removal and reduction in activator concentration

Plasma rich in growth factors (PRGF) is a biological therapy that uses patient's own growth factors for promoting tissue regeneration. Given the current European regulatory framework in which anticoagulant solution in blood extraction tubes could be considered as a medicinal product, a new PRGF protocol has been developed. The actual protocol (PRGF-A) and the new one (PRGF-B) have been performed and compared under Good Laboratory Practices. PRGF-A protocol uses extraction tubes with 0.9 mL of trisodium citrate as anticoagulant and 50 μL of calcium chloride/mL PRGF to activate it. The PRGF-B reduces the amount of sodium citrate and calcium chloride to 0.4 mL and to 20 μL, respectively. Basic hematological parameters, platelet function, the scaffold obtaining process, growth factors content, and the biological effect were compared between both PRGF obtaining protocols.

RESULTS

PRGF-B protocol led to a statistically significant higher enrichment and recovery of platelets regarding to the PRGF-A. Hypotonic stress response by platelets was significantly better in the new protocol. A statistically significant decrease in the basal platelet activation status of PRGF-B compared to PRGF-A was also observed. The duration of the lag phase in the platelet aggregation assay was statistically lower for the PRGF-B protocol. Both the clotting and the clot retraction time were significantly reduced in the B protocol. A higher growth factor concentration was detected in the plasma obtained using the PRGF-B protocol. The new PRGF obtaining protocol, with a reduction in the amount of anticoagulant and activator, has even improved the actual one.

Probiotic supplementation in systemic nickel allergy syndrome patients: study of its effects on lactic acid bacteria population and on clinical symptoms

AIMS

The study aimed to evaluate the effects of probiotic Lactobacillus reuteri DSM 17938 strain supplementation in patients suffering from systemic nickel allergy syndrome, in terms of modulation of faecal LAB population linked to a reduction of GI and cutaneous symptoms and to an increase of patient's quality of life.

METHODS AND RESULTS

A preliminary double-blind randomized placebo-controlled study was planned and a culture-independent method based on denaturing gradient gel electrophoresis (DGGE) analysis coupled to the 16S rRNA gene sequencing was applied to investigate on the dynamics of faecal LAB communities before and during a low-Ni diet, supplemented with the probiotic strain. Moreover, the severity and the frequency of GI and cutaneous reactions as well as patient's clinical condition perception (VAS scores) were estimated by statistical analysis. PCR-DGGE fingerprinting obtained using LAB-specific primers revealed significant shift in faecal community with an increase in biodiversity in patients supplemented with probiotic Lact. reuteri strain. In addition, GI reactions such as symptoms related to meals and type of stools significantly improved only in patients treated with Lact. reuteri, while severity and frequency of cutaneous symptoms (urticaria, itch and eczema) and recurrent abdominal pain (RAP) as well as VAS scores statistically decreased in both groups.

CONCLUSIONS

Our preliminary findings suggest that probiotic Lact. reuteri could be a useful supplementation during a low-Ni diet of patients with SNAS, to increase LAB population diversity, which could contribute to restore the intestinal homoeostasis conditions.

SIGNIFICANCE AND IMPACT OF THE STUDY

To date, no information is available on probiotics application and on their effects, in terms of intestinal microbiota modulation, on patients suffering from SNAS. Therefore, the identification of dominant LAB community and the study of its shift during the probiotic supplementation could enhance the knowledge of the SNAS syndrome.

Serum elements and oxidative status in clinically isolated syndromes: imbalance and predictivity

BACKGROUND

Metals are suspected of being involved in the pathogenesis of various neurologic diseases. We previously found a complex imbalance in serum chemical elements and oxidative status in patients with clinically definite multiple sclerosis (CDMS).

OBJECTIVE

To understand whether this imbalance affects people with clinically isolated syndrome (CIS) and, if so, whether it predicts conversion to CDMS.

METHODS

We studied 22 chemical elements and the oxidative status in 49 patients with CIS, 49 patients with CDMS, and 49 healthy donors (HD). Univariate and multivariate approaches were used to identify profiles for each group. A logistic regression analysis was used to identify the predictive potential of baseline data (elements, oxidative status, and MRI findings) for conversion to CDMS over 36 months.

RESULTS

Several elements and oxidative status values differed significantly among the 3 groups. Discriminant analysis revealed a major contribution of Ca, Fe, Sn, Zn, serum antioxidant capacity, and serum oxidative status, which resulted in distinct profiles (the prediction of group membership was 96% [cross-validated 92%] for HD, 92% [cross-validated 92%] for CDMS, and 90% [cross-validated 86%] for CIS). A weighted combination of element concentrations and oxidative status values, adjusting for all other predictors, would predict a reduction in the risk of conversion to CDMS within 3 years (odds ratio 0.37; 95% confidence interval 0.18-0.76; p = 0.007), thereby proving more effective than MRI at baseline.

CONCLUSIONS

The peculiar imbalance in serum elements and oxidative status that characterizes patients with CIS and may predict conversion to CDMS warrants studies on larger sample sizes.

Risperidone long-acting injectable (RLAI) administration in deltoid muscle…. really is an improvement?

Introduction

In the treatment of psychotic disorders, any such instrument or way that could help to improve their prognosis should be valued and taken into account.

Objectives

To determine the impact of the administration of RLAI in the deltoid, assessing patient satisfaction and acceptance, as well as efficacy and tolerability.

Material and methods

Prospective, naturalistic and descriptive, 20 patients with chronic psychosis treated with RLAI, performing a change in administration (gluteal to deltoid muscle).

We realize 2 valuations:1

Analysis SPSS v15.0.

Results

In subscales TSQM, punctuations very raised for deltoid: Efficiency 75, 55 %; adverse events 94, 38 %; Administration 75, 27 %; Global satisfaction 74, 64%. The VAS of satisfaction with deltoid was of 7′ 4 ± 1′ 3 (0–10).

Opinion patients

less pain, adverse events and more normal (100%), more capacity decision (80%), less stigmatizing (85%).

No differences in efficacy, but better tolerated.

Conclusions

The administration of the deltoid RLAI in can be a useful tool for the treatment of psychotic disorders because it can allow the patient to engage in certain therapeutic decisions (to be able to choose the way), promote adherence, may improve the perception of treatment to be associated deltoid administration to something less traumatic and stigmatizing, that is “more normal.”

[Anatomical repercussion on the zonular apparatus after a capsular tension ring insertion in swine eyes]

PURPOSE

To carry out an experimental and descriptive study that exhibits the anatomical repercussions on the zonular apparatus after a capsular tension ring (CTR) is inserted.

METHODS

CTRs were inserted in five swine eyes (four with forceps, one with an injector). Two additional eyes were left untouched for control purposes. The integrity of the suspensory ligament was examined by scanning electron microscopy.

RESULTS

We did not observe alterations in the integrity of the zonular apparatus. The suspensory ligaments adopted a new fold configuration.

CONCLUSIONS

CTR insertion is a safe therapeutic tool to maintain the integrity of the lens zonules in elastic, large diameter capsular bags.

Metal changes in CSF and peripheral compartments of parkinsonian patients

BACKGROUND

Involvement of metals in the risk of developing Parkinson's disease (PD) has been suggested. In the present study, concentration of metals in cerebrospinal fluid (CSF), blood, serum, urine and hair of 91 PD patients and 18 controls were compared.

METHODS

Blood and hair were microwave digested, while CSF, serum and urine were water-diluted. Elements quantification was achieved by Inductively Coupled Plasma Atomic Emission Spectrometry and Sector Field Inductively Coupled Plasma Mass Spectrometry.

RESULTS

Some metal imbalances in PD were observed: i), in CSF, lower Fe and Si; ii), in blood, higher Ca, Cu, Fe, Mg and Zn; iii), in serum, lower Al and Cu; iv), in urine, lower Al and Mn, higher Ca and Fe; and v), in hair, lower Fe. The ROC analysis suggested that blood Ca, Fe, Mg and Zn were the best discriminators between PD and controls. In addition, hair Ca and Mg were at least 1.5 times higher in females than in males of patients and controls. A decrement with age of patients in hair and urine Ca and, with less extent, in urine Si was observed. Magnesium concentration in CSF decreased with the duration and severity of the disease. Elements were not influenced by the type of antiparkinsonian therapy.

CONCLUSIONS

Variation in elements with the disease do not exclude their involvement in the neurodegeneration of PD.

Status of oral healthcare in long-term care facilities

Oral health is a fundamental component in the overall well-being and quality of life for elders living in long-term care facilities. Effective oral care interventions must not only involve recognising the importance of oral health in this population, but giving oral hygiene the same priority as other care practices in long-term care settings.

[Early onset Münchausen's syndrome]

This study presents a clinical case description of a factitious disorder in a woman whose diagnosis was made during her childhood. The onset of the disorder took place at 12 years of age and the fundamental clinical characteristics are: limited frequency with which the diagnosis is made in this period of life as well as the multiple symptoms manifested by the patient, both abdominal as well as neurological and hemorrhaging ones. A careful analysis of the personality traits and biographic history of the patient was also performed. The characteristics of the factitious disorder in childhood, as well as the relationship of this syndrome with the personality disorders, are discussed.

[Adaptation of the clinician-administered rating scale for mania]

INTRODUCTION

There is no mania rating scale properly adapted in Spain, and it's a true problem in research.

METHODS

The adaptation process has been the following one: The authors start from CARS-M of Altman et al. First the carry out the translation and back translation which was revised by the author of the scale. Then they fullfill some previous training with video filming and lastly they apply the scale to a group of 24 patients.

RESULTS

The Clinician-Administered Rating Scale for Mania (CARS-M) shows good psychometric proprieties among those its internal consistency of the scale, the interobservers reliability, and the item-total correlation. These results are lightly worse in the psychoticism sub-scale.

CONCLUSIONS

This rating scale for mania show itself as a useful instrument in clinic and research.

Profiles of chemically-induced tumors in rodents: quantitative relationships

The rodent carcinogenicity bioassay has been used for several decades for evaluating hundreds of chemicals, with the two aims of better understanding the etiologies of cancer, and of assessing the hazard posed by environmental and industrial chemicals. This has generated an enormous wealth of data and information on the phenomenon of chemical carcinogenicity. However, this information cannot be appreciated easily, since too many details may obscure the general trends present in the data; on the contrary, the use of computerized data analysis techniques suitable for the exploration of large databases makes its investigation much more fruitful, and its results more reliable. For this work, we collected a database of 536 rodent carcinogens, and we investigated the profiles of tumors (target organs) induced in the four experimental systems which are usually employed (rat and mouse, male and female). The analysis was performed with an Artificial Neural Network called Kohonen Self-Organizing Map, which is a computer-intensive method aimed at making the relevant information emerge automatically from the data itself. The analysis generated a global view, as well as a quantitative measure of the associations among the individual tumor types, and among the tumor profiles induced by the chemicals. In the complex interplay between the organ and species specificity of tumor induction, the species specificity generally overcame organ specificity, except for a few tumors (namely Lymphatic System, Brain, Forestomach, Stomach and Thyroid Gland). Moreover, the species specificity was remarkably stronger than the trans-species sex specificity. For three chemical classes (Aromatic Amines, Electrophilic/Alkylating Agents, Nitroarenes) most represented in the database, we investigated the hypothesis that a single mechanism of interaction with DNA would produce one, or a few very similar tumor profiles. Our analysis pointed out that no obvious association exists between chemical/mode of action class, and tumor profile. On the contrary, none of these classes induces a single tumor or pattern of tumors, but rather it appears that each class produces tumors at a wide range of sites. This suggests that an important determinant of the differences in tumor profile are the events that surround the ultimate mechanism of interaction with DNA.

Atmospheric degradation of HFCs and HCFCs: chemistry and noxiousness

Hydrohaloalkanes are potential alternatives to the fully halogenated compounds (CFCs) that are believed to be responsible for depletion of the stratospheric ozone. In order to establish whether hydrofluorocarbons (HFCs) and hydrochlorofluorocarbons (HCFCs) are actually more environmentally acceptable, it is extremely important to know, in addition to ODP and HGWP, their atmospheric degradation mechanism, tropospheric lifetime, and toxicity and noxiousness of their atmospheric degradation products. The primary atmospheric sink for hydrohaloalkanes is the reaction with hydroxyl radicals (OH), so that laboratory measurements or a reliable estimation of the rate constants (kOH) of these reactions is essential in order to assess their atmospheric lifetimes. The previsional models for kOH developed in our laboratory allow the estimation of the atmospheric lifetimes of as many as 449 halocarbons (i.e., all the halocarbons containing F and/or Cl with one, two, and three carbon atoms). The harmful character of some degradation products halogenated and oxygenated is also discussed.

Modelling physico-chemical properties of halogenated benzenes: QSAR optimisation through variables selection

Abstract This paper describes the development of multivariate QSAR models for halogenated benzenes. Four physico-chemical properties have been modelled: Boiling Point (BP), Melting Point (MP), Flash Point (FP) and Density (D). For the multivariate characterisation of this class of compounds 90 topological indices derived from the chemical formula were used. The models were calibrated on training sets selected by a D-optimal design and were optimised by a statistical procedure of selection of the most informative variables. The predictive capacity of the resulting models measured in terms of the parameter SDEP (Standard Deviation of the Errors of Predictions) were as follows; MP: ± 21 ±C (with MP ranging from -48° to 181°C); BP: ±13°C (75° to 286°C); D: ±0.14 (1.02 to 2.52 g/cm(3)); FP: ±17°C (-12 to 126°C). These data were confirmed "experimentally", i.e., on external validation sets of compounds, the experimental values of the standard deviation of prediction errors were in fact as follows; MP: ±30°C; BP: ±16°C D: ±0.18 g/cm(3); FP: ±16°C. The developed models therefore provide a valuable tool for estimating physico-chemical properties relevant to environmental chemistry.

Fasting and postprandial phenylalanine and leucine kinetics in liver cirrhosis

To investigate body protein turnover and the pathogenesis of increased concentration of plasma phenylalanine in liver cirrhosis, we have studied phenylalanine and leucine kinetics in cirrhotic (diabetic and nondiabetic) patients, and in normal subjects, both in the postabsorptive state and during a mixed meal, using combined intravenous and oral isotope infusions. Postabsorptive phenylalanine concentration and whole body rate of appearance (Ra) were approximately 40% greater (P < 0.05) in patients than in controls. Leucine concentrations were comparable, but intracellular leucine Ra was also increased (P < 0.05), suggesting increased whole body protein breakdown. Postprandial phenylalanine Ra was also greater (P < 0.05) in the patients. This difference was due to a diminished fractional splanchnic uptake of the dietary phenylalanine (approximately 40% lower in the cirrhotics vs. controls, P < or = 0.05). Postprandial leucine Ra was also increased in the patients, but splanchnic uptake of dietary leucine was normal. Thus both increased body protein breakdown and decreased splanchnic extraction of dietary phenylalanine can account for the increased phenylalanine concentrations in liver cirrhosis.

Micronucleus formation in fetal maternal rat erythroblasts after norfloxacin transplacental administration

Single oral doses of norfloxacin (4, 2, 1, 0.5 mmole/kg) administered to pregnant rats significantly increase the frequency of micronucleated polychromatic erythrocytes both in fetal liver and in maternal bone marrow. Therefore norfloxacin in this work has been found to be a genotoxic agent.

Induction of sperm abnormalities in mice by norfloxacin

Norfloxacin was tested in the mouse sperm morphology test. Data obtained suggest that norfloxacin may have 2 different effects on sperm development: a stimulating effect on spermatogenesis and a possible mutagenic effect that results in an increase in sperm abnormalities. The first effect might be caused by a hormonal action. A dose-response relationship was not observed in sperm morphology changes. Consequently norfloxacin cannot with certainty be judged a positive inducer of abnormal sperm, but further studies are essential to clarify the obtained results.

Evaluation of DNA damage induced by norfloxacin in liver and kidney of adult rats and in fetal tissues after transplacental exposure

Norfloxacin, a recently developed antimicrobial fluoroquinolone, was investigated for DNA-damaging activity in rat liver and kidney. After oral administration of single doses ranging from 1 to 8 mmole/kg, DNA fragmentation was absent in liver and kidney both 2 and 6 h after treatment. However, when administered to pregnant rats, the highest doses produced a detectable amount of DNA damage in fetal tissues. This damage appears to be an aspecific consequence of maternal and fetal toxicity rather than a specific genotoxic effect.