Growth modulation of fibroblasts by chitosan-polyvinyl pyrrolidone hydrogel: implications for wound management?

Synergistic antibacterial and wound healing effects of chitosan nanofibers with ZnO nanoparticles and dual antibiotics

One concern that has been considered potentially fatal is bacterial infection. In addition to the development of biocompatible antibacterial dressings, the screening and combination of new antibiotics effective against antibiotic resistance are crucial. In this study, designing hemostasis electrospun composite nanofibers containing chitosan (CS), polyvinyl pyrrolidone (PVP) and Gelatin (G) as the major components of hydrogel and natural nanofibrillated sodium alginate (SA)/polyvinyl alcohol (PVA) and ZnO nanoparticles (ZnONPs) combination as the nanofiller ingredient, has been investigated which demonstrated significant potential for accelerating wound healing. The hydrogels were developed for the delivery of the amikacin and cefepime antibiotics, along with zinc oxide nanoparticles that were applied to an electrospun layer. Amikacin is a highly effective aminoglycoside antibiotic, particularly for hospital-acquired infections, but its use is limited due to its toxicity. By utilizing it in low concentrations in the form of nanofibers and combining it with cefepime, which exhibits synergistic effects, enhanced efficacy against bacterial pathogens is achieved while potentially minimizing cytotoxicity compared to individual antibiotics. This dressing demonstrated efficient drug release, flexibility, and good swelling properties, indicating its suitable mechanical properties for therapeutic applications. After applying the biocompatible hydrogel to wounds, a significant acceleration in wound closure was observed within 14 days compared to the control group. Furthermore, the notable antibiotic and anti-inflammatory properties underscore its effectiveness in wound healing, making it a promising candidate for medical applications.

Functional Analysis of Injectable Substance Treatment on Surgically Injured Rabbit Vocal Folds

OBJECTIVES

The objective of this study was to evaluate the efficacy of immediate injection treatments of dexamethasone, hyaluronic acid (HA)/gelatin (Ge) hydrogel and glycol-chitosan solution on the phonatory function of rabbit larynges at 42 days after surgical injury of the vocal folds, piloting a novel ex vivo phonatory functional analysis protocol.

METHODS

A modified microflap procedure was performed on the left vocal fold of 12 rabbits to induce an acute injury. Animals were randomized into one of four treatment groups with 0.1 mL injections of dexamethasone, HA/Ge hydrogel, glycol-chitosan or saline as control. The left mid vocal fold lamina propria was injected immediately following injury. The right vocal fold served as an uninjured control. Larynges were harvested at Day 42 after injection, then were subjected to airflow-bench evaluation. Acoustic, aerodynamic and laryngeal high-speed videoendoscopy (HSV) analyses were performed. HSV segments of the vibrating vocal folds were rated by three expert laryngologists. Six parameters related to vocal fold vibratory characteristics were evaluated on a Likert scale.

RESULTS

The fundamental frequency, one possible surrogate of vocal fold stiffness and scarring, was lower in the dexamethasone and HA/Ge hydrogel treatment groups compared to that of the saline control (411.52±11.63 Hz). The lowest fundamental frequency value was observed in the dexamethasone group (348.79±14.99 Hz). Expert visual ratings of the HSV segments indicated an overall positive outcome in the dexamethasone treatment group, though the impacts were below statistical significance.

CONCLUSION

Dexamethasone injections might be used as an adjunctive option for iatrogenic vocal fold scarring. An increased sample size, histological correlate, and experimental method improvements will be needed to confirm this finding. Results suggested a promising use of HSV and acoustic analysis techniques to identify and monitor post-surgical vocal fold repair and scarring, providing a useful tool for future studies of vocal fold scar treatments.

Fabrication and evaluation of Cs/PVP sponge containing platelet-rich fibrin as a wound healing accelerator: An in vitro and in vivo study

Despite significant advances in surgery and postoperative care, there are still challenges in the treatment of wounds. In the current study, a freeze-dried chitosan (Cs)/polyvinylpyrrolidone (PVP) sponges containing platelet-rich fibrin (PRF at 1, 1.5 and 2% w/v) for wound dressing application is fabricated and fully characterized. Addition of 1% w/v of PRF to Cs/PVP (CS/PVP/1PRF) sample significantly increased the tensile strength (from 0.147 ± 0.005 to 0.242 ± 0.001 MPa), elastic modulus (from 0.414 ± 0.014 to 0.611 ± 0.022 MPa) and strain at break (from 53.4 ± 0.9 to 61.83 ± 1.17%) compared to Cs sample, and was hence selected as the optimal sample. The antibacterial activity of Cs/PVP/1PRF sponge wound dressing against E. coli and S. aureus was confirmed to be effective. Enzyme-linked immunosorbent assays revealed that the release of both VEGF and PDGF-AB from PRF powder, as well as PDGF-AB from Cs/PVP/1PRF sample was time-independent, but the release of VEGF from Cs/PVP/1PRF sample increased significantly with time. According to MTT and CAM assays, the Cs/PVP/1PRF sample significantly increased proliferation and angiogenic potential, respectively. Furthermore, in vivo studies demonstrated a 97.16 ± 1.55% wound closure for Cs/PVP/1PRF group after 14 days.

Electrospun Nanofibers for Manipulating the Soft Tissue Regeneration

Soft tissue damage is a common clinical problem that affects the lives of a large number of patients all over the world. It is of great importance to develop functional...

RETRACTED: Investigation of the Potential of Nebivolol Hydrochloride-Loaded Chitosomal Systems for Tissue Regeneration: In Vitro Characterization and In Vivo Assessment

In this study, we evaluated the synergistic effect of nebivolol hydrochloride (NVH), a third-generation beta-blocker and NO donor drug, and chitosan on the tissue regeneration. Ionic gelation method was selected for the preparation of NVH-loaded chitosomes using chitosan lactate and sodium tripolyphosphate. The effect of different formulation variables was studied using a full factorial design, and NVH entrapment efficiency percentages and particle size were selected as the responses. The chosen system demonstrated high entrapment efficiency (73.68 ± 3.61%), small particle size (404.05 ± 11.2 nm), and good zeta potential value (35.6 ± 0.25 mV). The best-achieved formula demonstrated spherical morphology in transmission electron microscopy and amorphization of the crystalline drug in differential scanning calorimetry and X-ray diffraction. Cell culture studies revealed a significantly higher proliferation of the fibroblasts in comparison with the drug suspensions and the blank formula. An in vivo study was conducted to compare the efficacy of the proposed formula on wound healing. The histopathological examination showed the superiority of NVH-loaded chitosomes on the wound proliferation and the non-significant difference in the collagen deposition after 15 days of the injury to that of intact skin. In conclusion, NVH-loaded chitosomes exhibited promising results in enhancing skin healing and tissue regeneration.

Fibroblasts treated with macrophage conditioned medium results in phenotypic shifts and changes in collagen organization

In tissue regeneration, the goal is to regenerate tissue similar to what was damaged or missing while preventing fibrotic scarring, which may lead to decreased mechanical strength and dissimilar tissue characteristics compared to native tissue. We believe collagen orientation plays a critical role in wound contraction and scarring and that it is modulated by myofibroblasts. We used macrophage conditioned medium to simulate complex events that can influence the fibroblast phenotype during the wound healing process. In addition to examining the effect of macrophage phenotype on fibroblasts, we inhibited focal adhesion kinase (FAK), Rho-associated protein kinase (ROCK), and myosin II for fibroblasts cultured on both tissue culture plastic and methacrylated gellan gum to understand how different pathways and materials influence fibroblast responses. Collagen orientation, α-SMA expression, focal adhesion area, and cell migration were altered by inhibition of FAK, ROCK, or myosin II and macrophage phenotype, along with the substrate. An increase in either focal adhesion area or α-smooth muscle actin (α-SMA) expression correlated with an aligned collagen orientation. Gellan gum hydrogels upregulated α-SMA expression in ROCK inhibited conditioned media and downregulated the FAK area in FAK and ROCK inhibited conditioned media. Myosin II had no impact on the α-SMA expression on the substrate compared to coverslip except for M2 conditioned medium. Gellan gum hydrogel significantly increased cell migration under FAK and Myosin II mediated conditioned media and unconditioned media. Collectively, our study examined how macrophage phenotype influences fibroblast response, which would be beneficial in controlling scar tissue formation.

Fabrication of asymmetric nanostarch reinforced Chitosan/PVP membrane and its evaluation as an antibacterial patch for in vivo wound healing application

Starch is an abundant, relatively inexpensive and ecofriendly materials which can be easily convert into nanoparticle and also as filler for the preparation of bionanocomposite for wound dressing application. Symmetric and asymmetric Chitosan(C)/PVP(P) films containing porous structure supported with nanostarch (NS) were prepared by salt leaching method for wound dressing application. Symmetric Chitosan/PVP/Nanostarch (CPNS) film with 1% and 3% wt nanostarch was prepared without coating of stearic acid whereas asymmetric Chitosan/PVP/Nanostarch-Stearic acid (CPNS-S) film was prepared by coating of stearic acid. The stearic acid coated surface possesses hydrophobic water repellent, microporous, bacterial anti adhesion property and the stearic acid uncoated hydrophilic surface shows superior antibacterial and noncytotoxicity property with highly porous character. All the symmetric and asymmetric films exhibit almost same mechanical, barrier, swelling and hemolytic property reveals that the stearic acid does not affect the physical and hemolytic property whereas the concentration of nanostarch greatly influence the above property. The reinforcement of nanostarch with chitosan and PVP was proved by TEM and SEM analysis. The CPNS1%-S film shows excellent S. aureus anti adhesion property. Furthermore, the in vivo excision-type wound healing proved that the CPNS1%-S film enhanced the healing effect and increased re-epithelialization and collagen formation.

Chitosan and thiolated chitosan: Novel therapeutic approach for preventing corneal haze after chemical injuries

Corneal haze, commonly caused by deep physical and chemical injuries, can greatly impair vision. Growth factors facilitate fibroblast proliferation and differentiation, which leads to haze intensity. In this study, the potential effect of chitosan (CS) and thiolated-chitosan (TCS) nanoparticles and solutions on inhibition of fibroblast proliferation, fibroblast to myofibroblast differentiation, neovascularization, extracellular matrix (ECM) deposition, and pro-fibrotic cytokine expression was examined. Transforming growth factor beta-1 (TGFβ₁) was induced by interleukin-6 (IL6) in human corneal fibroblasts and expression levels of TGFβ₁, Platelet-derived growth factor (PDGF), α-smooth muscle actins (α-SMA), collagen type I (Col I), fibronectin (Fn) and vascular endothelial growth factor (VEGF) were quantified using qRT-PCR. To assess wound-healing capacity, TCS-treated mice were examined for α-SMA positive cells, collagen deposition, inflammatory cells and neovascularization through pathological immunohistochemistry. The results revealed that CS and TCS could down-regulate the expression levels of TGFβ₁ and PDGF comparable to that of TGFβ₁ knockdown experiment. However, down-regulation of TGFβ₁ was not regulated through miR29b induction. Neovascularization along with α-SMA and ECM deposition were significantly diminished. According to these findings, CS and TCS can be considered as potential anti-fibrotic and anti-angiogenic therapeutics. Furthermore, TCS, thiolated derivative of CS, will increase mucoadhesion of the polymer at the corneal surface which makes the polymer efficient and non-toxic therapeutic approach for corneal injuries.

Effect of a Chitosan Gel on Hemostasis and Prevention of Adhesion After Endoscopic Sinus Surgery

OBJECTIVES

Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). The former sometimes can be life threatening and the latter is the most common reason requiring revision surgery. This study was designed to evaluate the effect of newly developed chitosan gel (8% carboxymethyl chitosan, Surgi shield) on hemostasis and wound healing after ESS.

METHODS

A prospective, randomized, double-blind controlled trial was conducted in 33 patients undergoing symmetric ESS. At the conclusion of the operation, Surgi shield was randomly applied on one side of the nasal cavity, with the opposite side acting as control and the bleeding quantity of the surgical field was evaluated every 2 minutes. And then, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Surgi shield was applied to the Merocel of intervention side and saline was applied to the other side. Merocel in both nasal cavities was removed and 5 mL of Surgi shield was applied again to the intervention side on the second day after surgery. The nasal cavity was examined using a nasal endoscope and the degree of adhesion, crusting, mucosal edema, infection, and granulations were graded at 1, 2, and 4 weeks after surgery.

RESULTS

Complete hemostasis was rapidly achieved in the Surgi shield applied side compared with the control side at 2, 4, 6, 8, and 10 minutes after application of Surgi shield (P=0.007, P=0.004, P<0.001, P=0.001, and P<0.001, respectively). There were significantly less adhesions on the Surgi shield applied side at postoperative 1, 2, and 4 weeks (P=0.001, P<0.001, and P<0.001, respectively). The degree of mucosal edema, infection, crusting, or granulation formation assessed by the endoscopic features in the Surgi shield applied side was not significantly different from that of the control side (P>0.05). No adverse effects were noted in the patient series.

CONCLUSION

Surgi shield containing chitosan can be used safely to achieve rapid hemostasis immediately after ESS and to prevent adhesion formation.

Morphological study of burn wound healing with the use of collagen-chitosan wound dressing

Experiments on the model of thermal skin burn in rats showed that the use of wound dressing based on collagen-chitosan complex Kollakhit-Bol in local treatment of grade IIIb skin burns increased healing rate by accelerating the formation of granulation and fibrous connective tissues and reducing crust thickness in comparison with Kollakhit coating. Kollakhit-Bol provided targeted stimulation of reparative processes in the treatment of grade IIIb burns by creating favorable conditions for grafting full thickness skin transplant or dermal-epidermal skin equivalent. In the topical treatment of thermal burn, Kollakhit-Bol application shortened the phases of alteration and exudation and accelerated transition to the productive phase of the inflammatory process with phagocytosis and neoangiogenesis activation.

Visible light cured thiol-vinyl hydrogels with tunable degradation for 3D cell culture

We report here a synthetically simple yet highly tunable and diverse visible light mediated thiol-vinyl gelation system for fabricating cell-instructive hydrogels. Gelation was achieved via a mixed-mode step-and-chain-growth photopolymerization using functionalized 4-arm poly(ethylene glycol) as backbone macromer, eosin-Y as photosensitizer, and di-thiol containing molecule as dual purpose co-initiator/cross-linker. N-vinylpyrrolidone (NVP) was used to accelerate gelation kinetics and to adjust the stiffness of the hydrogels. Visible light (wavelength: 400-700 nm) was used to initiate rapid gelation (gel points: ~20s) that reached completion within a few minutes. The major differences between current thiol-vinyl gelation and prior visible light mediated photopolymerization are that: (1) the co-initiator triethanolamine (TEA) used in the previous systems was replaced with multifunctional thiols and (2) mixed-mode polymerized gels contain less network heterogeneity. The gelation kinetics and gel properties at the same PEG macromer concentration could be tuned by changing the identity of vinyl groups and di-thiol cross-linkers, as well as concentration of cross-linker and NVP. Specifically, acrylate-modified PEG afforded the fastest gelation rate, followed by acrylamide and methacrylate-functionalized PEG. Increasing NVP concentration also accelerated gelation and led to a higher network cross-linking density. Further, increasing di-thiol peptide concentration in the gel formulation increased hydrogel swelling and decreased gel stiffness. Due to the formation of thiol-ether-ester bonds following thiol-acrylate reaction, the gels degraded hydrolytically following a pseudo first order degradation kinetics. Degradation rate was controlled by adjusting thiol or NVP content in the polymer precursor solution. The cytocompatibility and utility of this hydrogel system were evaluated using in situ encapsulation of human mesenchymal stem cells (hMSC). Encapsulated hMSCs remained alive (>90%) throughout the duration of the study and the cells were differentiated down osteogenic lineage with varying degrees by controlling the rate and mode of gel degradation.

Cytotoxicity of PVPAC-treated bovine pericardium: a potential replacement for glutaraldehyde in biological heart valves

Acellular biological tissues, including bovine pericardium (BP), have been proposed as biomaterial for tissue engineering. BP is usually modified chemically to improve mechanical and biological properties using glutaraldehyde, the standard reagent for preservation of fresh bioprosthetic materials. Glutaraldehyde-fixed BP (Glut-BP), the most widely used material in heart valve manufacture, has been associated with calcification in vivo. In an attempt to reduce this issue and maintain its biocompatibility, this study assesses the physical properties and cytotoxicity of lyophilized BP treated with poly (vinylpyrrolidone-co-acrolein) (PVPAC-BP), a novel copolymer, as a substitute for glutaraldehyde. For that, PVPAC-BP surface ultrastructure, elastic function, water uptake and tissue calcification were evaluated. For the analysis of biocompatibility, fibroblasts (3T3-L1) and endothelial cells (HUVEC) were cultured on PVPAC-BP, Untreated-BP and Glut-BP. Nitric oxide (NO) release assay, fluorescence and SEM images of endothelial cells adhered on scaffolds were also performed. As results, the data show some advantages of PVPAC-BP over the Glut-BP. The PVPAC-BP maintains partially the original ultrastructure and elastic properties, improves scaffold hydration, and presents less calcium phosphate deposits. The cells demonstrated strong attachment, high proliferation rate, and formation of a monolayer on PVPAC-BP. Attached cells were also able to release NO de-monstrating regular metabolism. In conclusion, PVPAC may be considered as a promising alternative to BP treatment improving the efficiency of cell attachment and proliferation and also avoid immunogenicity.

The effect of nanotopography on modulating protein adsorption and the fibrotic response

Understanding and modulating the cellular response to implanted biomaterials is crucial for the field of tissue engineering and regenerative medicine. Since cells typically reside in an extracellular matrix containing nanoscale architecture, identifying synthetic nanostructures that induce desirable cellular behaviors could greatly impact the field. Using nanoimprint lithography, nanostructured patterns were generated on thin film polymeric materials. The ability of these surfaces to influence protein adsorption, fibroblast proliferation and morphology, and fibrotic markers was investigated. Nanostructured features with aspect ratios greater than five allowed for less protein adsorption, resulting in decreased fibroblast proliferation and rounded cellular morphology. These nanofeatures also induced significantly lower gene expression of collagen 1α2, collagen 3α1, and growth factors such as connective tissue growth factor, integrin linked kinase, transforming growth factor β1 (TGF-β1), and epidermal growth factor, key factors associated with a fibrotic response. The results demonstrate that select nanostructured surfaces could be used to modulate the fibrotic behavior in cells and have the potential to be used as antifibrotic architecture for medical implants or tissue engineering scaffolds.

Thermally reversible colloidal gels for three-dimensional chondrocyte culture

Healthy cells are required in large numbers to form a tissue-engineered construct and primary cells must therefore be increased in number in a process termed 'expansion'. There are significant problems with existing procedures, including cell injury and an associated loss of phenotype, but three-dimensional culture has been reported to offer a solution. Reversible gels, which allow for the recovery of cells after expansion would therefore have great value in the expansion of chondrocytes for tissue engineering applications, but they have received relatively little attention to date. In this study, we examined the synthesis and use of thermoresponsive polymers that form reversible three-dimensional gels for chondrocyte cell culture. A series of polymers comprising N-isopropylacrylamide (NIPAM) and styrene was synthesized before studying their thermoresponsive solution behaviour and gelation. A poly(NIPAM-co-styrene-graft-N-vinylpyrrolidone) variant was also synthesized in order to provide increased water content. Both random- and graft-copolymers formed particulate gels above the lower critical solution temperature and, on cooling, re-dissolved to allow enzyme-free cell recovery. Chondrocytes remained viable in all of these materials for 24 days, increased in number and produced collagen type II and glycosaminoglycans.

Microporous polysaccharide hemospheres do not increase synechiae after sinus surgery: randomized controlled study

BACKGROUND

Many surgeons use absorbable packing materials after endoscopic sinus surgery (ESS). Despite their popularity, some of these agents have been shown to contribute to synechiae formation. Microporous polysaccharide hemospheres (MPH) is a plant-based hemostatic powder that does not interfere with regenerating sinus mucosa in the animal model. The goal of this study was to examine the impact of MPH on healing and synechiae formation after ESS in human subjects.

METHODS

A prospective, randomized, controlled, double-blind study was performed. Forty consenting adult patients with chronic sinusitis requiring symmetric ESS were randomized to receive MPH unilaterally at the conclusion of surgery. The opposite side was untreated. Standard postoperative care was performed bilaterally. Outcomes measured included blinded observer ratings for synechiae formation, edema, and infection. Each side was examined endoscopically and scored at postoperative days 7, 14, and 30.

RESULTS

Twenty men and 20 women with an average age of 48.2 years were included. There were no complications and all patients were discharged home the same day. There was no significant difference in synechiae formation at any point postoperatively. The rate of synechiae formation was determined to be 10% (4/40) on the MPH-treated side versus 7.5% (3/40) on the untreated side (p = 0.7639). In addition, there were no significant differences observed in edema (p = 0.7480) or infection (p = 0.5533).

CONCLUSION

The use of MPH after sinus surgery does not increase synechiae formation and does not appear to deleteriously affect the healing of postoperative sinus cavities.

Nasal packing and stenting

Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue.

Use of a modified chitosan-dextran gel to prevent peritoneal adhesions in a rat model

BACKGROUND

Intra-abdominal adhesions are a major cause of morbidity and a significant drain on healthcare resources. Numerous anti-adhesion products have reached clinical use but none has been wholly satisfactory. This study examines the application of a modified chitosan-dextran (CD) gel to the intraperitoneal cavity to reduce adhesion formation. This is a unique synthetic gel, its active ingredients being succinyl chitosan and dextran aldehyde.

MATERIALS AND METHODS

Eighty adult male Wistar albino rats were randomized to undergo surgery alone or to receive CD gel at the time of surgery. Control groups using modified dextran only gel were also included. The surgical procedures comprised of laparotomy and either cecal abrasion or anastomotic simulation by enterotomy of the cecum with primary closure. At postoperative d 21 rats were euthanized by CO2 inhalation, and adhesions graded by an investigator blinded to the treatment groups, using a predetermined adhesion measurement score.

RESULTS

Adhesions were significantly reduced in the cecal abrasion group with median adhesion scores for the treatment group of 0 versus 3 in the control group (P<0.001, Fisher's exact test). Further reduction in adhesion formation was noted in the enterotomy group with median scores of 2 versus 5 for treatment and control groups respectively (P=0.003, Fisher's exact test).

CONCLUSIONS

Chitosan-dextran gel appears to significantly reduce the formation of intra-abdominal adhesions without adversely affecting wound healing. This is a noteworthy advancement in the safe prevention of post operative, intra-abdominal adhesions.

Gentamicin-loaded wound dressing with polyvinyl alcohol/dextran hydrogel: gel characterization and in vivo healing evaluation

To develop a gentamicin-loaded wound dressing, cross-linked hydrogel films were prepared with polyvinyl alcohol (PVA) and dextran using the freezing-thawing method. Their gel properties such as gel fraction, swelling, water vapor transmission test, morphology, tensile strength, and thermal property were investigated. In vitro protein adsorption test, in vivo wound healing test, and histopathology were performed. Dextran decreased the gel fraction, maximum strength, and thermal stability of hydrogels. However, it increased the swelling ability, water vapor transmission rate, elasticity, porosity, and protein adsorption. The drug gave a little positive effect on the gel properties of hydrogels. The gentamicin-loaded wound dressing composed of 2.5% PVA, 1.13% dextran, and 0.1% drug was more swellable, flexible, and elastic than that with only PVA because of its cross-linking interaction with PVA. In particular, it could provide an adequate level of moisture and build up the exudates on the wound area. From the in vivo wound healing and histological results, this gentamicin-loaded wound dressing enhanced the healing effect more compared to conventional product because of the potential healing effect of gentamicin. Thus, this gentamicin-loaded wound dressing would be used as a potential wound dressing with excellent forming and improved healing effect in wound care.

The efficacy of a novel chitosan gel on hemostasis and wound healing after endoscopic sinus surgery

BACKGROUND

Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). Continued bleeding risks airway compromise from the inhalation of blood clots and from the aspiration of blood-stained vomitus. Additionally, adhesion formation is the most common reason for patients requiring revision surgery. This study aimed to determine the efficacy of a novel chitosan/dextran (CD) gel on hemostasis and wound healing after ESS.

METHODS

A randomized controlled trial was performed involving 40 patients undergoing ESS for chronic rhinosinusitis. Immediately after surgery a baseline Boezaart Surgical Field Grading Scale was taken. Computer randomization was performed with one side receiving CD gel and the other side receiving no treatment (control). Boezaart bleeding scores were then calculated for each side every 2 minutes. Patient's endoscopic features of wound healing were assessed at 2, 6, and 12 weeks after surgery.

RESULTS

CD gel achieved rapid hemostasis with the mean time to hemostasis at 2 minutes (95% CI, 2-4 minutes) compared with 10 minutes (95% CI, > or =6 minutes) for the control (p < 0.001). There were significantly less adhesions at all time points with CD gel versus control: 2 versus 18 at 2 weeks (p < 0.001), 3 versus 16 at 6 weeks (p < 0.001), and 2 versus 12 at 3 months (p < 0.001). There was no significant difference between CD gel and control with respect to crusting, mucosal edema, infection, or granulation tissue formation.

CONCLUSION

CD gel is rapidly hemostatic immediately after ESS and prevents adhesion formation, addressing two of the most common complications of sinus surgery.

Preventive effects of chemically-modified chitosan film with sodium hyalurate on the ischemia-induced peritoneal adhesion

AIM: To comparatively study the preventive effects of chemically-modified chitosan film with sodium hyalurate on the ischemia-induced peritoneal adhesion in rats.

METHODS: Sixty Sprague-Dawley rats were randomly divided into saline-control group (Group A), chemically-modified chitosan film group (Group B) and sodium hyalurate group (Group C), respectively. The ischemia-induced peritoneal adhesive model was established in the caecums of vermiform processes of the rats, and the ischemia surfaces were correspondingly treated with saline, chemically-modified chitosan film and sodium hyalurate in Group A, B and C. After two and four weeks of the treatments, the abdominal cavities were reopened and the adhesive severity was graded blindly according to the Phillips' method. The caecums of vermiform processes were resected for hydroxyproline (OHP) measurement.

RESULTS: After two and four weeks of the treatments in group B and C, the adhesions were significantly lighter (2 wk: U = 3.000, 8.500, P < 0.001, P = 0.001; 4 wk: U = 2.000, 14.000, P < 0.001, P = 0.003) and the OHP levels were significantly lower (2 wk: 0.193 ± 0.029 mg/mg pr, 0.253 ± 0.028 mg/mg pr vs 0.296 ± 0.031 mg/mg pr, both P < 0.01; 4 wk: 0.179 ± 0.034 mg/mg pr, 0.237 ± 0.035 mg/mg pr vs 0.286 ± 0.036 mg/mg pr, both P < 0.01) than those of Group A, respectively. When group B was compared with group C, the former's adhesions were significantly lighter (P = 0.038, P = 0.015) and the OHP levels were significantly lower (P < 0.001, P = 0.001).

CONCLUSION: The chemically-modified chitosan film is more effective in preventing peritoneal adhesion induced by ischemia than that of sodium hyalurate.

Effects of a novel chitosan gel on mucosal wound healing following endoscopic sinus surgery in a sheep model of chronic rhinosinusitis

INTRODUCTION

Postoperative bleeding and adhesion formation remain the two major problems after endoscopic sinus surgery (ESS). This study investigates the effect on adhesion formation and wound healing in a sheep model of chronic sinusitis of three topical agents: recombinant tissue factor (rTF, Dade Innovin, Marburg, Germany), poly-ethylene glycol (SprayGel, Confluent Surgical, Waltham, MA), and a novel chitosan-dextran derivative gel (CD, Department of Chemistry, University of Otago, Dunedin, New Zealand).

METHODS

Twenty sheep with chronic sinusitis underwent ESS with standardized mucosal injuries created on the lateral nasal wall and the ethmoid region. Injured areas were divided into four groups, and one of the three agents or control (no treatment) was randomly applied. The presence and severity of adhesions were noted and the healing was evaluated by taking brushings for ciliary beat frequency and biopsies of the injured regions at day 28, 56, 84, and 112 post initial surgery. The biopsy specimens were assessed for re-epithelialisation using light microscopy and scanning electron microscopy for reciliation. The cytobrush specimens assessed cilial function by measuring ciliary beat frequency.

RESULTS

CD significantly decreased lateral nasal wall and ethmoidal adhesions compared to tissue factor at all time points (5% vs. 25%, and 0 vs. 50%, respectively). There was a noticeable trend toward decreased adhesions on the lateral nasal wall and ethmoids in the SprayGel group (10% and 14%) and the CD group (10% and 0%) compared to controls (15% and 40%). The CD group had a significantly greater percentage of re-epithelialisation at day 28 and day 84 compared to the rTF group (70% vs. 33%, P < .001; 84.5% vs. 61%, P < 0.05). At day 28, the CD group was significantly more ciliated than control (62% vs. 31%, P < .01) and than rTF (62% vs. 23%, P < .001). This difference between CD and rTF reciliation remained significant at day 56 (67% vs. 40%, P < .05). In addition, the mean cilial grade for CD at day 112 was significantly better than control (1.9 vs. 2.7, P < .05).

CONCLUSION

In the sheep model of chronic sinusitis, CD significantly improves microscopic wound healing and reduces adhesion formation after ESS.

Enhancement of fibroblastic proliferation on chitosan surfaces by immobilized epidermal growth factor

Chitosan membranes were modified with mouse epidermal growth factor (EGF) by a photochemical technique. Photochemical immobilization was performed via a two-step process, in which EGF was first reacted with a heterobifunctional cross-linker sulfo-SANPAH (sulfosuccinimidyl 6(4'-azido-2'-nitrophenyl-amino)hexanoate) and then immobilized on the chitosan membrane by UV irradiation. The success of immobilization process was checked by Fourier transform infrared attenuated total reflection spectroscopy and X-ray photoelectron spectroscopy. Atomic force microscopy was used to evaluate the surface topography. The mitogenic effect of the EGF-modified chitosan membrane was investigated using mouse fibroblasts (L929 cell line), and cell proliferation was investigated by MTT and crystal violet assays. The results obtained from cell culture experiments showed that immobilized EGF stimulated fibroblast growth on chitosan membranes, and a considerable difference in cell proliferation was detected on EGF-modified chitosan membranes.

Vascular cell viability on polyvinyl alcohol hydrogels modified with water-soluble and -insoluble chitosan

Polyvinyl alcohol (PVA) hydrogels blended with chitosan or other biological macromolecules have shown promise for cell culture and tissue engineering. This study investigates the attachment and growth of bovine aortic endothelial (BAEC) and smooth muscle cells (BASMC) on the PVA hydrogels modified with water soluble and water insoluble chitosan. Cell adhesion on the surface of the membranes was examined by phase contrast microscopy while cell morphologies were studied using immunocytochemistry staining with EC and SMC specific biomarkers (F-actin and alpha actin respectively). Cells cultured on 6% PVA, 0.4% chitosan (water soluble and insoluble) hydrogel membranes displayed excellent adhesion and spreading characteristics, in addition to negligible cell structural morphological changes in comparison to a polystyrene control. Similar vascular cell adhesion features were apparent on PVA membranes blended with water-soluble and -insoluble chitosan. Fluorescent activated cell sorter (FACS) analysis was used to determine BAEC and BASMC proliferation and cell viability. Apoptotic levels in BAEC after 7 days were 12.8% +/- 2.5% on the PVA- chitosan WS-1 membrane and 10.1% +/- 1.5% on the control well (n = 3) while comparable results were also noted for BASMC. Equivalent proliferative activity was apparent for BAEC on the control and PVA-chitosan membrane after 7 days, while BASMC showed increased proliferative activity on the membranes. These results indicate that the PVA-chitosan blended hydrogel membranes show promise for cell culture and tissue engineering applications.

Evaluation of L929 fibroblast attachment and proliferation on Arg-Gly-Asp-Ser (RGDS)-immobilized chitosan in serum-containing/serum-free cultures

In this study, chitosan membranes prepared by the solvent casting method were modified with the Arg-Gly-Asp-Ser (RGDS) sequence of fibronectin using the photochemical immobilization technique. The results obtained from attenuated total reflection-Fourier transform infrared spectra and X-ray photoelectron spectroscopy studies confirmed the successful immobilization of RGDS on chitosan membranes. The immobilized peptide concentration was determined by ninhydrin analysis on the order of 10(-7) mol/cm(2). In vitro cell culture studies were performed with L929 mouse fibroblasts to investigate the effect of biomodification on fibroblast cell behaviour in serum-free and 10% serum-containing media. The results obtained from cell culture studies pointed out the specific interactions between biosignal RGDS molecules and fibroblast cells. A triggered cell attachment and proliferation were observed on RGDS-modified chitosan membranes that were more distinguishable in serum-free medium. In addition, the photochemical immobilization technique was realized in the presence of a photomask that was used to immobilize the RGDS molecules in a defined micropattern. L929 mouse fibroblasts attached on the RGDS-micropatterned areas indicating integrin-mediated interactions.

Preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesion of different types

AIM: To comparatively study the preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesions induced by four different factors in rats.

METHODS: Chitosan was chemically modified by gelatinization, and made into films of 60 μm in thickness, and sterilized. Two hundred Sprague-Dawley rats were randomly divided into five groups, Sham-operation group (group A), wound-induced adhesion group (group B), purified talc-induced adhesion group (group C), vascular ligation-induced adhesion group (group D), and infection-induced adhesion group (group E), respectively. In each group, the rats were treated with different adhesion-inducing methods at the cecum of vermiform processes and then were divided into control and experimental subgroups. Serous membrane surface of vermiform processes were covered with the films in the experimental subgroups, and no films were used in the control subgroups. After 2 and 4 wk of treatments, the abdominal cavities were reopened and the adhesive severity was graded blindly according to Bhatia’s method. The cecum of vermiform processes were resected for hydroxyproline (OHP) measurement and pathological examination.

RESULTS: Adhesion severity and OHP level: After 2 and 4 wk of the treatments, in the experimental subgroups, the adhesions were significantly lighter and the OHP levels were significantly lower than those of the control subgroups in group B (2 wk: 0.199 ± 0.026 vs 0.285 ± 0.041 μg/mg pr, P < 0.001; 4 wk: 0.183 ± 0.034 vs 0.276 ± 0.03 μg/mg pr, P < 0.001), D (2 wk: 0.216 ± 0.036 vs 0.274 ± 0.040 μg/mg pr, P = 0.004; 4 wk: 0.211 ± 0.044 vs 0.281 ± 0.047 μg/mg pr, P = 0.003) and E (2 wk: 0.259 ± 0.039 vs 0.371 ± 0.040 μg/mg pr, P < 0.001; 4 wk: 0.242 ± 0.045 vs 0.355 ± 0.029 μg/mg pr, P < 0.001), but there were no significant differences in groups A (2wk: 0.141 ± 0.028 vs 0.137 ± 0.026 μg/mg pr, P = 0.737; 4 wk: 0.132 ± 0.031 vs 0.150 ± 0.035 μg/mg pr, P = 0.225) and C (2 wk: 0.395 ± 0.044 vs 0.378 ± 0.043 μg/mg pr, P = 0.387; 4 wk: 0.370 ± 0.032 vs 0.367 ± 0.041 μg/mg pr, P = 0.853); Pathological changes: In group B, the main pathological changes were fibroplasias in the treated serous membrane surface and in group D, the fibroplasia was shown in the whole layer of the vermiform processes. In group E, the main pathological changes were acute and chronic suppurative inflammatory reactions. These changes were lighter in the experimental subgroups than those in the control subgroups in the three groups. In group C, the main changes were foreign body giant cell and granuloma reactions and fibroplasias in different degrees, with no apparent differences between the experimental and control subgroups.

CONCLUSION: The gelatinizedly-modified chitosan film is effective on preventing peritoneal adhesions induced by wound, ischemia and infection, but the effect is not apparent in foreign body-induced adhesion.

Effects of chitosan solution concentration and incorporation of chitin and glycerol on dense chitosan membrane properties

The aim of this work was to perform a systematic study about the effects induced by chitosan solution concentration and by chitin or glycerol incorporation on dense chitosan membranes with potential use as burn dressings. The membrane properties analyzed were total raw material cost, thickness, morphology, swelling ratio, tensile strength, percentage of strain at break, crystallinity, in vitro enzymatic degradation with lysozyme, and in vitro Vero cells adhesion. While the use of the most concentrated chitosan solution (2.5% w/w) increased membrane cost, it also improved the biomaterial mechanical resistance and ductility, as well as reduced membrane degradation when exposed for 2 months to lysozyme. The remaining evaluated properties were not affected by initial chitosan solution concentration. Chitin incorporation, on the other hand, reduced the membranes cost, swelling ratio, mechanical properties, and crystallinity, resulting in thicker biomaterials with irregular surface more easily degradable when exposed to lysozyme. Glycerol incorporation also reduced the membranes cost and crystallinity and increased membranes degradability after exposure to lysozyme. Strong Vero cells adhesion was not observed in any of the tested membrane formulations. The overall results indicate that the majority of the prepared membranes meet the performance requirements of temporary nonbiodegradable burn dressings (e.g. adequate values of mechanical resistance and ductility, low values of in vitro cellular adhesion on their surfaces, low extent of degradation when exposed to lysozyme solution, and high stability in aqueous solutions).

Application of chitosan gel in the treatment of chronic periodontitis

Local administration of antibiotics in periodontal therapy can be provided with an appropriate delivery system. The purpose of this study was to evaluate the clinical effectiveness of chitosan, both as a carrier in gel form and as an active agent in the treatment of chronic periodontitis (CP). The chitosan gel (1% w/w) incorporated with or without 15% metronidazole was prepared and applied adjunctive to scaling and root planing (SRP) in comparison to SRP alone (control group-C), in CP patients. The clinical parameters such as probing depth (PD), clinical attachment level, the amount of gingival recession, plaque index, gingival index, and gingival bleeding time index were recorded at baseline and at weeks 6, 12, and 24. In all groups, significant improvements were observed in clinical parameters between baseline and week 24 (p < 0.05). The reductions in PD values were 1.21 mm for Ch, 1.48 mm for Ch + M, and 0.94 mm for C groups. No complications related to the chitosan were observed in patients throughout the study period. It is suggested that chitosan itself is effective as well as its combination with metronidazole in CP treatment due to its antimicrobial properties.

Examination of the effects of poly(N-vinylpyrrolidinone) hydrogels in direct and indirect contact with cells

Poly(N-vinylpyrrolidinone) (PNVP) has been used in various biomedical applications for many years. This study explores two PNVP hydrogels for their biocompatibility with skin cells and their ability to support the growth of skin cells in direct and indirect contact with the cells. Two crosslinked PNVP's were investigated, one crosslinked with ethylene glycol dimethacrylate (EGDMA) and the other crosslinked with diethylene glycol bisallylcarbonate (DEGBAC). The different crosslinkers lead to hydrogels with different mechanical and slightly different biological properties. While neither hydrogel proved to be a suitable substrate for culturing cells (based on fibroblasts and a range of other cells), indirect contact with both showed them to be biocompatible and even stimulatory to fibroblasts. The P(NVP-co-DEGBAC) hydrogel stimulated fibroblast viability more reliably than the P(NVP-co-EGDMA) hydrogel when in indirect contact with cells. This effect was shown to be independent of the presence of foetal calf serum in the culture media, and could not be explained by any hydrogel breakdown products during the course of these experiments. Rather the phenomenon was observed to be the result of a dynamic interaction between the hydrogels and the cells.

Effects of different sterilization methods on the morphology, mechanical properties, and cytotoxicity of chitosan membranes used as wound dressings

The aim of this work was to compare the effects induced by two different sterilization methods (exposure to gamma radiation or ethylene oxide) and an antiseptic technique (immersion in 70% ethanol aqueous solution) on the morphology, tensile strength, percentage of strain at break, and in vitro cytotoxicity to Vero cells on chitosan membranes designed for wound healing. Four distinct membrane compositions were evaluated, with chitosan, glycerol, and chitin used as components. Gamma radiation, in spite of being one of the most commonly employed sterilizing agents, negatively affected the morphology of membranes composed solely by chitosan as well as the percentage of strain at break of the chitosan-membranes containing glycerol on their composition. Moreover, its use affected the color of the chitosan membranes. The use of 70% ethanol aqueous solution did not change the chitosan-membrane characteristics significantly, but its use has limitations concerning the process scale up. With ethylene oxide (EtO), chitosan-membrane morphology, percentage of strain at break, and in vitro cytotoxicity to Vero cells were not significantly affected. The tensile strength of the membranes containing chitin were reduced after the treatment with ethylene oxide; however, the obtained values were comprised in the range verified for normal human skin. Therefore, because the final characteristics of the membranes treated with ethylene oxide are appropriate when considering their use as wound healing devices, and because this sterilization process is easily adjusted to use on an industrial scale, EtO can be considered the most adequate sterilizing agent for chitosan membranes. However, it should be considered that this chemical is associated with toxicity, flammability, and environmental risks, as well as with possible material contamination with ethylene oxide residues.

Tissue engineering of cartilage with the use of chitosan-gelatin complex scaffolds

Chitosan has been shown to be a promising scaffold for various applications in tissue engineering. In this study, a chitosan-gelatin complex was fabricated as a scaffold by a freezing and lyophilizing technique. Chitosan's structure and characteristics are similar to those of glycosaminoglycan (GAG) and its analogs, and possesses various biological activities, whereas gelatin can serve as a substrate for cell adhesion, differentiation, and proliferation. With the use of autologous chondrocytes isolated from pig's auricular cartilage and seeded onto the chitosan-gelatin scaffold, elastic cartilages have been successfully engineered at the porcine abdomen subcutaneous tissue. After 16 weeks of implantation, the engineered elastic cartilages have acquired not only normal histological and biochemical, but also mechanical properties. The tissue sections of the engineered elastic cartilages showed that the chondrocytes were enclosed in the lacuna, similar to that of native cartilage. The presence of elastic fibers in the engineered cartilages was also demonstrated by Vehoeff's staining, and immunohistochemical staining confirmed the presence of type II collagen in the engineered cartilages. Quantitatively, the GAG in the engineered cartilages reached 90% of the concentration in native auricular cartilage. Furthermore, biomechanical analysis demonstrated that the extrinsic stiffness of the engineered cartilages reached 85% of the level in native auricular cartilage when it was harvested at 16 weeks. Thus, this study demonstrated that the chitosan-gelatin complex may serve as a suitable scaffold for cartilage tissue engineering.

Structure and interactions in covalently and ionically crosslinked chitosan hydrogels for biomedical applications

This review presents a critical analysis of covalently and ionically crosslinked chitosan hydrogels and related networks for medical or pharmaceutical applications. The structural basis of these hydrogels is discussed with reference to the specific chemical interactions, which dictate gel formation. The synthesis and chemistry of these hydrogels is discussed using specific pharmaceutical examples. Covalent crosslinking leads to formation of hydrogels with a permanent network structure, since irreversible chemical links are formed. This type of linkage allows absorption of water and/or bioactive compounds without dissolution and permits drug release by diffusion. pH-controlled drug delivery is made possible by the addition of another polymer. Ionically crosslinked hydrogels are generally considered as biocompatible and well-tolerated. Their non-permanent network is formed by reversible links. Ionically crosslinked chitosan hydrogels exhibit a higher swelling sensitivity to pH changes compared to covalently crosslinked chitosan hydrogels. This extends their potential application, since dissolution can occur in extreme acidic or basic pH conditions.

Islet immunoisolation: experience with biopolymers

Incidence of Type I diabetes is increasing globally and has become a major health concern. There is enough evidence suggesting involvement of autoimmunity in destruction of insulin-producing islets of langerhans which leads to impaired glucose homeostasis. Islet transplantation is one of the approaches that received wide attention. Due to the autoimmune nature of the disease. strategies to protect transplanted islet graft from rejection are sought. Immunoisolation of islets inside semipermeable biocompatible materials is amongst them. Natural biopolymers have been used extensively as immunoisolation materials due to their satisfactory biocompatiblity and tissue tolerance. Here we attempt to address the need for islet immunoisolation and our experience in using natural biopolymers such as chitosan, cellulose and alginate for this application.

Effect of chitosan-polyvinyl pyrrolidone hydrogel on proliferation and cytokine expression of endothelial cells: implications in islet immunoisolation

Earlier we have shown the suitability of chitosan-polyvinyl pyrrolidone (PVP) hydrogel for islet immunoisolation and its inability to activate macrophages. Biomaterials that support vascularization without activating immune competent endothelial cells are desirous in islet immunoisolation. The aim of the present study was to evaluate effect of chitosan-PVP hydrogel on proliferation and activation of endothelial cells. Hydrogel did not allow the majority of cells to adhere well but maintained their viability. Hydrogel leachouts were nontoxic to the cells, as confirmed by tetrazolium reduction (MTT) and Neutral red uptake assays. Exposure to leachouts also did not alter their functionality as seen from normal expression of von Willebrand factor. 3H-thymidine incorporation revealed that hydrogel leachouts did not induce endothelial cell proliferation. Cells cultured on hydrogel and polystyrene control showed comparable expression of interleukin (IL) 6, IL-10, and transforming growth factor beta, with higher expression of tumor necrosis factor alpha as determined by reverse transcription-polymerase chain reaction. Taken together these results point out that hydrogel is compatible with endothelial cells and maintains their nonactivated status and hence is suitable as immunoisolation matrix.