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Kim H, Dutta SD, Randhawa A, Patil TV, Ganguly K, Acharya R, Lee J, Park H, Lim KT. Recent advances and biomedical application of 3D printed nanocellulose-based adhesive hydrogels: A review. Int J Biol Macromol 2024; 264:130732. [PMID: 38479658 DOI: 10.1016/j.ijbiomac.2024.130732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Nanocellulose-based tissue adhesives show promise for achieving rapid hemostasis and effective wound healing. Conventional methods, such as sutures and staples, have limitations, prompting the exploration of bioadhesives for direct wound adhesion and minimal tissue damage. Nanocellulose, a hydrolysis product of cellulose, exhibits superior biocompatibility and multifunctional properties, gaining interest as a base material for bioadhesive development. This study explores the potential of nanocellulose-based adhesives for hemostasis and wound healing using 3D printing techniques. Nanocellulose enables the creation of biodegradable adhesives with minimal adverse effects and opens avenues for advanced wound healing and complex tissue regeneration, such as skin, blood vessels, lungs, cartilage, and muscle. This study reviews recent trends in various nanocellulose-based 3D printed hydrogel patches for tissue engineering applications. The review also introduces various types of nanocellulose and their synthesis, surface modification, and bioadhesive fabrication techniques via 3D printing for smart wound healing.
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Affiliation(s)
- Hojin Kim
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Sayan Deb Dutta
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Institute of Forest Science, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Aayushi Randhawa
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Tejal V Patil
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Keya Ganguly
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Rumi Acharya
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Jieun Lee
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Hyeonseo Park
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea
| | - Ki-Taek Lim
- Department of Biosystems Engineering, Kangwon University, Chuncheon 24341, Gangwon-do, Republic of Korea; Interdisciplinary Program in Smart Agriculture, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea; Institute of Forest Science, Kangwon National University, Chuncheon 24341, Gangwon-do, Republic of Korea.
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Leong MY, Kong YL, Harun MY, Looi CY, Wong WF. Current advances of nanocellulose application in biomedical field. Carbohydr Res 2023; 532:108899. [PMID: 37478689 DOI: 10.1016/j.carres.2023.108899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Nanocellulose (NC) is a natural fiber that can be extracted in fibrils or crystals form from different natural sources, including plants, bacteria, and algae. In recent years, nanocellulose has emerged as a sustainable biomaterial for various medicinal applications including drug delivery systems, wound healing, tissue engineering, and antimicrobial treatment due to its biocompatibility, low cytotoxicity, and exceptional water holding capacity for cell immobilization. Many antimicrobial products can be produced due to the chemical functionality of nanocellulose, such disposable antibacterial smart masks for healthcare use. This article discusses comprehensively three types of nanocellulose: cellulose nanocrystals (CNC), cellulose nanofibrils (CNF), and bacterial nanocellulose (BNC) in view of their structural and functional properties, extraction methods, and the distinctive biomedical applications based on the recently published work. On top of that, the biosafety profile and the future perspectives of nanocellulose-based biomaterials have been further discussed in this review.
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Affiliation(s)
- M Y Leong
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, 47500, Subang Jaya, Selangor Darul Ehsan, Malaysia
| | - Y L Kong
- Department of Engineering and Applied Sciences, American Degree Program, Taylor's University Lakeside Campus, 47500, Subang Jaya, Selangor Darul Ehsan, Malaysia.
| | - M Y Harun
- Department of Chemical and Environmental Engineering, Faculty of Engineering, Universiti Putra Malaysia, 43400, UPM Serdang, Selangor Darul Ehsan, Malaysia
| | - C Y Looi
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, 47500, Subang Jaya, Selangor Darul Ehsan, Malaysia
| | - W F Wong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Wei G, Wang Z, Liu R, Zhou C, Li E, Shen T, Wang X, Wu Y, Li X. A combination of hybrid polydopamine-human keratinocyte growth factor nanoparticles and sodium hyaluronate for the efficient prevention of postoperative abdominal adhesion formation. Acta Biomater 2022; 138:155-167. [PMID: 34653692 DOI: 10.1016/j.actbio.2021.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022]
Abstract
Postoperative abdominal adhesion (PAA) is one of the more universal complications of abdominal surgery with a frequent incidence. Currently available keratinocyte growth factor (KGF)-based glues for the prevention of adhesions remain a great bottleneck since their long-term biological activity in vivo is insufficient. In this study, we fabricated hybrid polydopamine (PDA)-KGF nanoparticles (PDA-KGF NPs) by using an in situ self-assembly and polymerization method. The physicochemical properties of the PDA-KGF nanoparticles were systematically characterized. The effect of preventing PAA in rats was evaluated by using hybrid PDA-KGF NPs combined with hyaluronate (Ha). The expression levels of inflammatory factors and the degree of inflammatory cell infiltration in the injured peritoneum were evaluated by enzyme-linked immunosorbent assays and hematoxylin-eosin staining, respectively. The levels of phospho-Src expression were revealed by Western blotting. The degree of fibrosis and the density of deposited collagen fibers were measured with real-time reverse-transcription polymerase chain reaction and picrosirius red staining. The results indicated that the PDA-KGF NPs combined with Ha greatly prevented the incidence of abdominal adhesion s and promoted the repair of mesothelial cells in injured peritoneum. More importantly, the PDA-KGF NPs combined with Ha obviously reduced collagen deposition and fibrosis and inhibited the inflammatory response. Our results suggest that PDA-KGF NPs combined with Ha are promising barrier-like biomaterials for the effective prevention of postoperative tissue adhesion. STATEMENT OF SIGNIFICANCE: Postoperative abdominal adhesion (PAA) as an inevitable postoperative complication affected the quality of life of patients. Currently available methods for preventing adhesions mainly employ degradable biomaterials. Previous research demonstrated that a hybrid keratinocyte growth factor (KGF)-sodium hyaluronate (Ha) gel could prevent the formation of PAAs. However, its clinical outcomes are not satisfactory since their bioactivity in vivo is too short. In this article, we fabricated hybrid polydopamine (PDA)-KGF nanoparticles (PDA-KGF NPs), which extend KGF bioactivity, effectively prevent PAA. Moreover, PDA-KGF NPs could remarkably reduce both collagen deposition and fibrosis, inhibit the inflammatory response, and promote mesothelial regeneration. Overall, the PDA-KGF NPs combined with Ha exhibit efficient antiadhesion properties, may provide a promising clinical protocol for the prevention of PAA.
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Affiliation(s)
- Guangbing Wei
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Zijun Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Ruilin Liu
- College of Pharmacy, Xuzhou Medical University, Xuzhou 221004, PR China; College of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, PR China.
| | - Cancan Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Enmeng Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Tianli Shen
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Xingjie Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China
| | - Yunhua Wu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China; Department of General Surgery, Shaanxi Provincial People's Hospital, Xi' an 710068, PR China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China; Department of Talent Highland, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, PR China.
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Nicu R, Ciolacu F, Ciolacu DE. Advanced Functional Materials Based on Nanocellulose for Pharmaceutical/Medical Applications. Pharmaceutics 2021; 13:1125. [PMID: 34452086 PMCID: PMC8399340 DOI: 10.3390/pharmaceutics13081125] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
Nanocelluloses (NCs), with their remarkable characteristics, have proven to be one of the most promising "green" materials of our times and have received special attention from researchers in nanomaterials. A diversity of new functional materials with a wide range of biomedical applications has been designed based on the most desirable properties of NCs, such as biocompatibility, biodegradability, and their special physicochemical properties. In this context and under the pressure of rapid development of this field, it is imperative to synthesize the successes and the new requirements in a comprehensive review. The first part of this work provides a brief review of the characteristics of the NCs (cellulose nanocrystals-CNC, cellulose nanofibrils-CNF, and bacterial nanocellulose-BNC), as well as of the main functional materials based on NCs (hydrogels, nanogels, and nanocomposites). The second part presents an extensive review of research over the past five years on promising pharmaceutical and medical applications of nanocellulose-based materials, which have been discussed in three important areas: drug-delivery systems, materials for wound-healing applications, as well as tissue engineering. Finally, an in-depth assessment of the in vitro and in vivo cytotoxicity of NCs-based materials, as well as the challenges related to their biodegradability, is performed.
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Affiliation(s)
- Raluca Nicu
- Department of Natural Polymers, Bioactive and Biocompatible Materials, “Petru Poni” Institute of Macromolecular Chemistry, 700487 Iasi, Romania;
| | - Florin Ciolacu
- Department of Natural and Synthetic Polymers, “Gheorghe Asachi” Technical University of Iasi, 700050 Iasi, Romania
| | - Diana E. Ciolacu
- Department of Natural Polymers, Bioactive and Biocompatible Materials, “Petru Poni” Institute of Macromolecular Chemistry, 700487 Iasi, Romania;
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Cavalcanti ADD, Melo BAGD, Ferreira BAM, Santana MHA. Performance of the main downstream operations on hyaluronic acid purification. Process Biochem 2020. [DOI: 10.1016/j.procbio.2020.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Vigani B, Rossi S, Sandri G, Bonferoni MC, Caramella CM, Ferrari F. Hyaluronic acid and chitosan-based nanosystems: a new dressing generation for wound care. Expert Opin Drug Deliv 2019; 16:715-740. [PMID: 31215823 DOI: 10.1080/17425247.2019.1634051] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The main goal in the management of chronic wounds is the development of multifunctional dressings able to promote a rapid recovery of skin structure and function, improving patient compliance. AREAS COVERED This review discusses the use of nanosystems, based on hyaluronic acid and chitosan or their derivatives for the local treatment of chronic wounds. The bioactive properties of both polysaccharides will be described, as well as the results obtained in the last decade by the in vitro and in vivo evaluation of the wound healing properties of nanosystems based on such polymers. EXPERT OPINION In the last decades, there has been a progressive change in the local treatments of chronic wounds: traditional inert dressings have been replaced by more effective bioactive ones, based on biopolymers taking part in wound healing and able to release the loaded active agents in a controlled way. With the advance of nanotechnologies, the scenario has further changed: nanosystems, characterized by a large area-to-volume ratio, show an improved interaction with the biological substrates, amplifying the activity of the constituent biopolymers. In the coming years, a deeper insight into wound healing mechanisms and the development of new techniques for nanosystem manufacturing will results in the design of new scaffolds with improved performance.
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Affiliation(s)
- Barbara Vigani
- a Department of Drug Science, University of Pavia , Pavia , Italy
| | - Silvia Rossi
- a Department of Drug Science, University of Pavia , Pavia , Italy
| | | | | | | | - Franca Ferrari
- a Department of Drug Science, University of Pavia , Pavia , Italy
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Luo J, Liu C, Wu J, Zhao D, Lin L, Fan H, Sun Y. In situ forming gelatin/hyaluronic acid hydrogel for tissue sealing and hemostasis. J Biomed Mater Res B Appl Biomater 2019; 108:790-797. [PMID: 31225694 DOI: 10.1002/jbm.b.34433] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Jing‐Wan Luo
- Shenzhen Institutes of Advanced TechnologyChinese Academy of Sciences Shenzhen China
| | - Chang Liu
- Shenzhen Institutes of Advanced TechnologyChinese Academy of Sciences Shenzhen China
| | | | | | - Long‐Xiang Lin
- Shenzhen Institutes of Advanced TechnologyChinese Academy of Sciences Shenzhen China
| | - Hai‐Ming Fan
- Shenzhen Institutes of Advanced TechnologyChinese Academy of Sciences Shenzhen China
| | - Yu‐Long Sun
- Shenzhen Institutes of Advanced TechnologyChinese Academy of Sciences Shenzhen China
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Song Z, Zhang Y, Shao H, Ying Y, Chen X, Mei L, Ma X, Chen L, Ling P, Liu F. Effect of xanthan gum on the prevention of intra-abdominal adhesion in rats. Int J Biol Macromol 2019; 126:531-538. [DOI: 10.1016/j.ijbiomac.2018.12.233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/12/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
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Yin F, Lin L, Zhan S. Preparation and properties of cellulose nanocrystals, gelatin, hyaluronic acid composite hydrogel as wound dressing. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:190-201. [PMID: 30556771 DOI: 10.1080/09205063.2018.1558933] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gelatin (GA), hyaluronic acid (HA) and cellulose nanocrystals (CNC) are promising materials for skin wound care. In this study the GA-HA-CNC hydrogels were prepared by cross-linking and freeze-drying. The composition and mechanism of GA-HA-CNC hydrogels were confirmed by FTIR. The morphology and pore size were obtained by SEM. We accessed the physical property from rheological results and swelling ratio. NIH-3T3 cells were inoculated into the hydrogels and cultured for different days, then we analyzed the cytotoxicity of the prepared hydrogels by CCK-8 methods and live/dead pictorial diagram using staining kits. FTIR revealed the combination between GA, HA and CNC was attributed to the amide bond and hydrogen bonding. SEM results showed that the drying GA-HA-CNC hydrogels were spongy, with the pore diameter about 80-120 µm. CNC significantly enhanced the property of the hydrogels and play a vital role according to the rheology and swelling results. The cells culture results showed that NIH-3T3 cells can attached to, grow, and proliferate well on the GA-HA-CNC hydrogels. In conclusion, the natural GA-HA-CNC hydrogel has great potential for the skin wound repair.
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Affiliation(s)
| | - Lanfang Lin
- b Linyi Lanshan Center for Disease Control and Prevention , Linyi , China
| | - Shijuan Zhan
- c Second Department of Oncology , Linyi People's Hospital , Linyi , China
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Kuckelman J, Barron M, Kniery K, Kay J, Kononchik J, Hoffer Z, Sohn V. Crystalloid fluid suspension results in decreased adhesion burden when compared to bioresorbable membranes in a rat model. Am J Surg 2018; 217:954-958. [PMID: 30580934 DOI: 10.1016/j.amjsurg.2018.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Adhesion formation represents a major cause of long-term morbidity. Suspension of intra-abdominal contents in fluid medium may effectively prevent adhesion formation. We compare saline hydro-flotation (NS) to hyaluronate bioresorbable membranes (HBM) for adhesion prevention following surgery. METHODS Animals were randomized to four groups: sham (no injury, n = 5), control (injury without intervention, n = 5), HBM (n = 20) or 10 cc NS (n = 21). Interventions were administered after standardized surgical trauma to the cecum and abdominal wall. Necropsies at two weeks were completed to compare adhesion burden using a customary scoring algorithm. RESULTS Significant adhesion burden was noted in all rats. HBM sustained a more significant adhesion burden with higher total adhesion scores (HBM = 10 vs NS = 8.1/15, p = 0.02). Gross adhesion scores were lower with NS (5.6/9) compared to HBM (7.1/9, p = 0.01). Neo-vascularity was more common in HBM at 2.6/3 versus 1.9/3 with NS (p = 0.01). Percent of the cecum encased with adhesion was higher with HBM (42%) compared to NS (31%, p = 0.05). DISCUSSION Fluid based anti-adhesion methods should be considered for abdominal adhesion formation prevention.
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Affiliation(s)
- John Kuckelman
- Department of General Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Morgan Barron
- Department of General Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Kevin Kniery
- Department of General Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Jeffrey Kay
- Department of Pathology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Joseph Kononchik
- Department of Clinical Investigations, Madigan Army Medical Center, Tacoma, WA, USA
| | - Zachary Hoffer
- Department of Pathology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Vance Sohn
- Department of General Surgery, Madigan Army Medical Center, Tacoma, WA, USA.
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Kenar H, Ozdogan CY, Dumlu C, Doger E, Kose GT, Hasirci V. Microfibrous scaffolds from poly(l-lactide-co-ε-caprolactone) blended with xeno-free collagen/hyaluronic acid for improvement of vascularization in tissue engineering applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 97:31-44. [PMID: 30678916 DOI: 10.1016/j.msec.2018.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/03/2018] [Accepted: 12/05/2018] [Indexed: 02/08/2023]
Abstract
Success of 3D tissue substitutes in clinical applications depends on the presence of vascular networks in their structure. Accordingly, research in tissue engineering is focused on the stimulation of angiogenesis or generation of a vascular network in the scaffolds prior to implantation. A novel, xeno-free, collagen/hyaluronic acid-based poly(l-lactide-co-ε-caprolactone) (PLC/COL/HA) (20/9.5/0.5 w/w/w) microfibrous scaffold was produced by electrospinning. Collagen types I and III, and hyaluronic acid were isolated from human umbilical cords and blended with the GMP grade PLC. When compared with PLC scaffolds the PLC/COL/HA had higher water uptake capacity (103% vs 66%) which may have contributed to the decrease in its Young's Modulus (from 1.31 to 0.89 MPa). The PLC/COL/HA better supported adipose tissue-derived mesenchymal stem cell (AT MSC) adhesion; within 24 h the cell number on the PLC/COL/HA scaffolds was 3 fold higher. Co-culture of human umbilical vein endothelial cells and AT MSCs induced capillary formation on both scaffold types, but the PLC/COL/HA led to formation of interconnected vessels whose total length was 1.6 fold of the total vessel length on PLC. Clinical use of this scaffold would eliminate the immune response triggered by xenogeneic collagen and transmission of animal-borne diseases while promoting a better vascular network formation.
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Affiliation(s)
- Halime Kenar
- Experimental and Clinical Research Center, Diabetes and Obesity Research Laboratory, Kocaeli University, Turkey; Polymer Science and Technology Dept., Graduate School of Natural and Applied Sciences, Kocaeli University, Turkey; BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey.
| | - Candan Yilmaz Ozdogan
- Experimental and Clinical Research Center, Diabetes and Obesity Research Laboratory, Kocaeli University, Turkey; Department of Biology, Graduate School of Natural and Applied Sciences, Kocaeli University, Turkey
| | - Cansu Dumlu
- Polymer Science and Technology Dept., Graduate School of Natural and Applied Sciences, Kocaeli University, Turkey
| | - Emek Doger
- Department of Gynecology and Obstetrics, Kocaeli University, Turkey
| | - Gamze Torun Kose
- BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey; Department of Genetics and Bioengineering, Yeditepe University, Istanbul, Turkey
| | - Vasif Hasirci
- BIOMATEN, METU Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey; Department of Biological Sciences, Middle East Technical University (METU), Ankara, Turkey
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The sticky business of adhesion prevention in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2018; 29:266-275. [PMID: 28582326 DOI: 10.1097/gco.0000000000000372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention. RECENT FINDINGS Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents. SUMMARY There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.
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Human-Derived Amniotic Membrane Is Associated With Decreased Postoperative Intraperitoneal Adhesions in a Rat Model. Dis Colon Rectum 2018. [PMID: 29521830 DOI: 10.1097/dcr.0000000000001037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Complications from adhesions after intra-abdominal surgery accounts for ~6% of hospital admissions. Currently, hyaluronate/carboxymethylcellulose represents the main option to prevent postoperative adhesion formation. Human amniotic membrane contains inherent anti-inflammatory properties that mitigate adhesion formation. OBJECTIVE This study aimed to evaluate adhesion generation after surgical trauma with amniotic membranes compared with standard intraperitoneal adhesion barriers. DESIGN This study is a double-blinded, prospective evaluation. SETTING This study was conducted at an animal research facility. ANIMALS Forty male rats were studied. INTERVENTION Laparotomy was performed with peritoneal disruption to the cecum. Animals were randomly assigned to 1 of 5 groups: sham, control, saline, hyaluronic acid membrane, or amniotic membrane. Animals were euthanized at 14 days. MAIN OUTCOME MEASURES Independent gross and histological assessments of adhesions were analyzed between groups by using adhesion scoring and microscopy. Scoring was based on the percentage of the cecum involved (0-4), vascularity of adhesions (0-3), strength (0-3), inflammation (0-3), and fibrosis (0-3). Adhered tissue was harvested for polymerase chain reaction analysis for gene regulation activity. RESULTS All rats survived 14 days. Adhesions were observed in all animals. There were significantly fewer adhesions in the amniotic membrane group (2) versus hyaluronic acid (3) group (p = 0.01). The percentage of adhesion to the cecum was lower in the amniotic membrane group (29%) than in the hyaluronic acid group (47%, p = 0.04). Histological examination showed no significant difference between or within the 3 groups for inflammation or fibrosis. Genetic analysis of adhered tissues supported high rates of epithelialization and inhibition of fibrosis in the amniotic membrane group. LIMITATIONS We are limited by the small sample size and the preclinical nature of the study. CONCLUSION Human-derived amniotic membrane is effective at reducing intraperitoneal adhesion after surgical trauma and is superior to the current antiadhesion barriers. Amniotic membranes are well absorbed and demonstrate short-term safety. See Video Abstract at http://links.lww.com/DCR/A554.
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Gao Q, Wei G, Wu Y, Yao N, Zhou C, Wang K, Wang K, Sun X, Li X. Paeoniflorin prevents postoperative peritoneal adhesion formation in an experimental rat model. Oncotarget 2017; 8:93899-93911. [PMID: 29212197 PMCID: PMC5706843 DOI: 10.18632/oncotarget.21333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022] Open
Abstract
Although materials and modern surgical techniques have been developed to suppress postoperative adhesions, adhesion formation can still occur, and thus, a novel effective anti-adhesion drug is greatly needed. In the present study, we explored the efficacy of paeoniflorin treatment against postoperative peritoneal adhesions and examined the anti-oxidative stress and anti-inflammatory properties of PE. Forty-eight male Sprague-Dawley rats were randomly divided into 6 groups for the study: the sham, control, hyaluronan and three concentrations (10, 20 and 40 mg/kg/d) paeoniflorin groups. Abdominal adhesions were created by abrasion of the caecum and its opposite abdominal wall. In the paeoniflorin groups, the rats were administered daily oral doses of paeoniflorin for 7 days. The abdominal cavities of the rats were reopened with a U-shaped incision to macroscopically grade the adhesions. Histologic analysis was performed, and oxidative stress, inflammatory cytokine, collagen fiber degradation and cytokeratin levels were measured. Macroscopic and histopathological measurements revealed that paeoniflorin reduced peritoneal adhesion and inflammation. Notably, treatment with paeoniflorin reduced the protein levels of TGF-β1, IL-6 and COX-2. The collagen fiber fractions were distinctly lower in the PE groups than in the control group. Western blotting analyses showed that paeoniflorin increased MMP-9 and superoxide dismutase-2 protein expression and sharply reduced α-SMA and COX-2 protein expression. Peritoneal mesothelium cells were more continuous and complete in animals treated with paeoniflorin. Our study suggests that paeoniflorin can be used to ameliorate peritoneal adhesions via anti-oxidative stress and anti-inflammatory actions during the postoperative period.
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Affiliation(s)
- Qi Gao
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Guangbing Wei
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Yunhua Wu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Na Yao
- College of Nursing, Shaanxi University of Chinese Medicine, Xianyang 712046, Shaanxi, China
| | - Cancan Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Kai Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Kang Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xuejun Sun
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
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15
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Lin LX, Luo JW, Yuan F, Zhang HH, Ye CQ, Zhang P, Sun YL. In situ cross-linking carbodiimide-modified chitosan hydrogel for postoperative adhesion prevention in a rat model. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 81:380-385. [PMID: 28887987 DOI: 10.1016/j.msec.2017.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/14/2017] [Accepted: 07/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative intra-abdominal adhesion often causes many complications. Chitosan fluid has been used in clinic to prevent intra-abdominal adhesion. However, fluid can be easily diluted and cannot stay on the wound site. As hydrogel is able to form stable physical barrier to separate injured tissues, we developed a chitosan hydrogel for better prevention of intra-abdominal adhesion in this study. METHODS We synthesized a carbodiimide-derivatized chitosan gelatin (cd-CS-gelatin) hydrogel and investigated its rheological properties. A rat model was used to compare the anti-adhesion effect of chitosan hydrogel and fluid. The wounds were created with damage of the underlying muscle of the abdominal wall and the serosal layer of the cecum. They were coated with chitosan fluid or cd-CS-gelatin hydrogel. At day 14 after surgery, the animals were euthanized and intra-abdominal adhesion was assessed. RESULTS The cd-CS-gelatin hydrogel solidified within 3min after the mixing of the reagents. The cecum-abdomen adhesion occurred in all rats without anti-adhesion treatment. The application of cd-CS-gelatin significantly reduced the adhesion rate from 100% to 50%, compared the chitosan fluid only to 88%. The decrease of adhesion breaking strength also manifested that cd-CS-gelatin was more effective than chitosan fluid to reduce postsurgical intra-abdominal adhesion formation. CONCLUSIONS Chitosan hydrogel is more effective than chitosan fluid to prevent postoperative cecum-abdomen adhesion. It indicates that hydrogel could be a more promising state than liquid to prevent postoperative intra-abdominal adhesion.
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Affiliation(s)
- Long-Xiang Lin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Fujian Province University Key Laboratory of Green Energy and Environment Catalysis, Ningde Normal University, Ningde 352100, PR China
| | - Jing-Wan Luo
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fang Yuan
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hui-Hui Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chen-Qing Ye
- Fujian Province University Key Laboratory of Green Energy and Environment Catalysis, Ningde Normal University, Ningde 352100, PR China
| | - Peng Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yu-Long Sun
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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16
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Evaluation of surgical anti-adhesion products to reduce postsurgical intra-abdominal adhesion formation in a rat model. PLoS One 2017; 12:e0172088. [PMID: 28207824 PMCID: PMC5312873 DOI: 10.1371/journal.pone.0172088] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/31/2017] [Indexed: 11/29/2022] Open
Abstract
Background Adhesions frequently occur after abdominal surgery. Many anti-adhesion products have been used in clinic. However, the evidences are short for surgeons to reasonably choose the suitable anti-adhesion produces in clinical practice. This study provided such evidence by comparing the efficiency of five products to prevent abdominal adhesion formation in a rat model. Methods Fifty-six Sprague-Dawley rats were randomly divided into seven groups: sham-operation group, adhesion group, and five product groups (n = 8). The abdomens of rats were opened. The injuries were created on abdominal wall and cecum in the adhesion and product groups. The wounds on abdominal wall and cecum of rats in the adhesion group were not treated before the abdomens were closed. The wounds on abdominal wall and cecum of rats in the product groups were covered with anti-adhesion product: polylactic acid (PLA) film, Seprafilm®, medical polyethylene glycol berberine liquid (PEG), medical sodium hyaluronate gel (HA), or medical chitosan (Chitosan). Fourteen days after surgery, the adhesions were evaluated by incidence, severity, adhesion area on abdominal wall and adhesion breaking strength. Results The application of PLA film and Seprafilm® significantly reduced the incidence, severity, adhesion area and breaking strength of cecum-abdomen adhesion (P<0.05). HA, PEG and Chitosan failed to significantly reduce the cecum-abdomen adhesion (P>0.05). The statistical significances in the incidence and severity of abdomen-adipose adhesion between adhesion group and the product groups were not achieved. However, Seprafilm® was more effective to reduce abdomen-adipose adhesion than PLA film. Furthermore, it was found that the products tested in this study did not effectively reduce cecum-adipose adhesion. The application of PEG could result in abdomen-small intestine adhesion. Conclusion Based on the results of this study, the preference order of anti-adhesion products used to reduce postsurgical intra-abdominal adhesion formation is Seprafilm > PLA >> HA > Chitosan > PEG.
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Yang X, Liu W, Li N, Wang M, Liang B, Ullah I, Luis Neve A, Feng Y, Chen H, Shi C. Design and development of polysaccharide hemostatic materials and their hemostatic mechanism. Biomater Sci 2017; 5:2357-2368. [DOI: 10.1039/c7bm00554g] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The formation of stable blood clots or hemostasis is essential to prevent major blood loss and death from excessive bleeding.
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Keratinocyte Growth Factor Combined with a Sodium Hyaluronate Gel Inhibits Postoperative Intra-Abdominal Adhesions. Int J Mol Sci 2016; 17:ijms17101611. [PMID: 27669222 PMCID: PMC5085644 DOI: 10.3390/ijms17101611] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/02/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022] Open
Abstract
Postoperative intra-abdominal adhesion is a very common complication after abdominal surgery. One clinical problem that remains to be solved is to identify an ideal strategy to prevent abdominal adhesions. Keratinocyte growth factor (KGF) has been proven to improve the proliferation of mesothelial cells, which may enhance fibrinolytic activity to suppress postoperative adhesions. This study investigated whether the combined administration of KGF and a sodium hyaluronate (HA) gel can prevent intra-abdominal adhesions by improving the orderly repair of the peritoneal mesothelial cells. The possible prevention mechanism was also explored. The cecum wall and its opposite parietal peritoneum were abraded after laparotomy to induce intra-abdominal adhesion formation. Animals were randomly allocated to receive topical application of HA, KGF, KGF + HA, or normal saline (Control). On postoperative day 7, the adhesion score was assessed with a visual scoring system. Masson’s trichrome staining, picrosirius red staining and hydroxyproline assays were used to assess the magnitude of adhesion and tissue fibrosis. Cytokeratin, a marker of the mesothelial cells, was detected by immunohistochemistry. The levels of tissue plasminogen activator (tPA), interleukin-6 (IL-6), and transforming growth factor β1 (TGF-β1) in the abdominal fluid were determined using enzyme-linked immunosorbent assays (ELISAs). Western blotting was performed to examine the expression of the TGF-β1, fibrinogen and α-smooth muscle actin (α-SMA) proteins in the rat peritoneal adhesion tissue. The combined administration of KGF and HA significantly reduced intra-abdominal adhesion formation and fibrin deposition and improved the orderly repair of the peritoneal mesothelial cells in the rat model. Furthermore, the combined administration of KGF and HA significantly increased the tPA levels but reduced the levels of IL-6, tumor necrosis factor α (TNF-α) and TGF-β1 in the abdominal fluid. The expression levels of TGF-β1, fibrinogen and α-SMA protein and mRNA in the rat peritoneum or adhesion tissues were also down-regulated following the combined administration of KGF and HA. The combined administration of KGF and HA can significantly prevent postoperative intra-abdominal adhesion formation by maintaining the separation of the injured peritoneum and promoting mesothelial cell regeneration. The potential mechanism may be associated with rapid mesothelial cell repair in the injured peritoneum. This study suggests that combined administration of KGF and HA may be a promising pharmacotherapeutic strategy for preventing abdominal adhesions, which is worth further study, and has potential value in clinical applications.
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