The Influence of Fibrin Stabilizing Factor on the Growth of Fibroblats in vitro and Wound Healing

Deciphering the crosstalk between inflammation and biofilm in chronic wound healing: Phytocompounds loaded bionanomaterials as therapeutics

In terms of the economics and public health, chronic wounds exert a significant detrimental impact on the health care system. Bacterial infections, which cause the formation of highly resistant biofilms that elude standard antibiotics, are the main cause of chronic, non-healing wounds. Numerous studies have shown that phytochemicals are effective in treating a variety of diseases, and traditional medicinal plants often include important chemical groups such alkaloids, phenolics, tannins, terpenes, steroids, flavonoids, glycosides, and fatty acids. These substances are essential for scavenging free radicals which helps in reducing inflammation, fending off infections, and hastening the healing of wounds. Bacterial species can survive in chronic wound conditions because biofilms employ quorum sensing as a communication technique which regulates the expression of virulence components. Fortunately, several phytochemicals have anti-QS characteristics that efficiently block QS pathways, prevent drug-resistant strains, and reduce biofilm development in chronic wounds. This review emphasizes the potential of phytocompounds as crucial agents for alleviating bacterial infections and promoting wound healing by reducing the inflammation in chronic wounds, exhibiting potential avenues for future therapeutic approaches to mitigate the healthcare burden provided by these challenging conditions.

Effects of topical negative pressure therapy on perfusion and microcirculation of human skin

BACKGROUND

Topical negative pressure wound therapy (TNPWT) is one of the most frequently used techniques in wound treatment. But some of the underlying mechanisms still remain unclear. One possible explanation is an improved microcirculation by TNPWT.

OBJECTIVE

This study investigated the influence of TNPWT on microcirculation on intact skin in real-time.

METHODS

In healthy individuals, we performed a combined tissue - laser/photo - spectrometry technique to monitor changes of 4 different microcirculation parameters in real-time: The local blood flow, the capillary-venous oxygen saturation, the blood flow velocity and the relative amount of hemoglobin. We compared these parameters using two different protocols: a continuously (VAC ON 60/OFF 60) and discontinuously (VAC ON 30/OFF 60/ON 5) application.

RESULTS

Our results demonstrate a significant increase of all four measured parameters during the active TNPWT and the pressure free period. The comparison of two different protocols shows an advantage of the examined parameters using a discontinuous TNPWT application.

CONCLUSIONS

Our study demonstrated the changes of the microvascular tissue perfusion in intact human skin under the conditions of negative pressure and may thereby offer a broader understanding of mechanisms underlying the TNPWT.

Lock Stock and Barrel of Wound Healing

Any kind of injury may lead to wound formation. As per World Health Organization Report, "more than 5 million people die each year due to injuries. This accounts for 9% of the world's population death, nearly 1.7 times the number of fatalities that result from HIV/AIDS, tuberculosis and malaria combined. In addition, ten million people suffer from non-fatal injuries which require treatment". This scenario leads to increased health and economic burden worldwide. Rapid wound healing is exigent subject-field in the health care system. It is imperative to be updated on wound care strategies as impaired wound healing may lead to chronic, non-healing wounds and thus further contributes to the national burden. This article is a comprehensive review of wound care strategies. The first and second part of this review article focuses on the understanding of wound, its types and human body's healing mechanism. Wound healing is natural, highly coordinated process that starts on its own, immediately after the injury. However, individual health condition influences the healing process. Discussion of factors affecting wound healing has also been included. Next part includes the detailed review of diverse wound healing strategies that have already been developed for different types of wound. A detailed description of various polymers that may be used has been discussed. Amongst drug delivery systems, oligomers, dendrimers, films, gels, different nano-formulations, like nanocomposites, nanofibers, nanoemulsions and nanoparticles are discussed. Emphasis on bandages has been made in this article.

Factor XIII: a coagulation factor with multiple plasmatic and cellular functions

Factor XIII (FXIII) is unique among clotting factors for a number of reasons: 1) it is a protransglutaminase, which becomes activated in the last stage of coagulation; 2) it works on an insoluble substrate; 3) its potentially active subunit is also present in the cytoplasm of platelets, monocytes, monocyte-derived macrophages, dendritic cells, chondrocytes, osteoblasts, and osteocytes; and 4) in addition to its contribution to hemostasis, it has multiple extra- and intracellular functions. This review gives a general overview on the structure and activation of FXIII as well as on the biochemical function and downregulation of activated FXIII with emphasis on new developments in the last decade. New aspects of the traditional functions of FXIII, stabilization of fibrin clot, and protection of fibrin against fibrinolysis are summarized. The role of FXIII in maintaining pregnancy, its contribution to the wound healing process, and its proangiogenic function are reviewed in details. Special attention is given to new, less explored, but promising fields of FXIII research that include inhibition of vascular permeability, cardioprotection, and its role in cartilage and bone development. FXIII is also considered as an intracellular enzyme; a separate section is devoted to its intracellular activation, intracellular action, and involvement in platelet, monocyte/macrophage, and dendritic cell functions.

Advantages of hyaluronic acid as a component of fibrin sheet for care of acute wound

Skin injury is followed by accumulation of a fibrin based provisional matrix which normally drives the process of wound repair. Exogenous fibrin with extra cellular matrix (ECM) components can also favor the wound healing process. In a preliminary study we found that lyophilized fibrin sheet (FS) arrest bleeding from rabbit skin wound but it remained dry during the repair period and did not accelerate the healing process better than untreated control. In the current study, hyaluronic acid (HA) was incorporated into FS and the resultant HA-FS promoted water retention and improved wound healing process. Gross-morphology, histopathology and histomorphometry were employed to compare qualitative and quantitative difference of wound healing in treated group against controls. In experimental sites (HA-FS), re-epithelialization was completed by 14 days with neo-vascularization and deposition of wavy bundles of collagen in the treated sites. Rate of healing process was different in treated and untreated wounds and most striking difference was the appearance of appendages, sebaceous gland and hair follicle at some locations in HA-FS treated sites. Therefore, HA with fibrin can create an effective wound care matrix which promotes water retention and wound healing potential.

The Basic Science of Wound Healing

Understanding wound healing today involves much more than simply stating that there are three phases: "inflammation, proliferation, and maturation." Wound healing is a complex series of reactions and interactions among cells and "mediators." Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise report of the current literature on wound healing by first reviewing the phases of wound healing followed by "the players" of wound healing: inflammatory mediators (cytokines, growth factors, proteases, eicosanoids, kinins, and more), nitric oxide, and the cellular elements. The discussion will end with a pictorial essay summarizing the wound-healing process.

Wound Healing: An Overview

Understanding wound healing today involves much more than simply stating that there are three phases: inflammation, proliferation, and maturation. Wound healing is a complex series of reactions and interactions among cells and "mediators." Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise overview on wound healing and wound management.

Effects of Tissucol and epsilon aminocaproic acid in the healing process following dental extraction in dehydrated rats

A histological study was conducted of the alveolar bone healing process following tooth extraction of dehydrated rats after the implantation of fibrin adhesive (TISSUCOL) associated to previous irrigation of the wound with a 5% epsilon aminocaproic acid solution (EACA). Seventy two rats were used, divided into three groups receiving different treatments after the surgical procedure. In group I, the gingival mucosa was sutured after extraction of the right upper incisor. In groups II and III, chronic dehydration was produced by water deprivation for 9 days (3 days in the preoperative period and 6 days in the postoperative period). In the animals of Group II, after tooth extraction, the gingival mucosa was sutured in the same way as performed in group I. In group III, after extraction, the dental socket was irrigated with 5% EACA, followed by implantation of the fibrin adhesive (TISSUCOL). The mucosa was sutured in the same way as performed in the other groups. At 3, 7, 15 and 21 postoperative days, the animals were sacrificed in number of 6 for each group. Specimens containing the dental socket were removed and fixed in 10% formalin and decalcified in an equal part formic acid and sodium citrate solution. After routine processing, the specimens were embedded in paraffin for microtomy. We obtained 6 microm semi-serial slices that were stained with hematoxylin and eosin for histological evaluation. The results showed that the water deprivation in the pre- and postoperative periods caused a delay in the alveolar bone healing process. The use of the fibrin adhesive (TISSUCOL) produced an improvement in the fibrinolytic picture caused by dehydration.

The Treatment of Refractory Pneumothorax in Diffuse Panbronchiolitis by Intravenous Administration of Coagulation Factor XIII Concentrate

This case report presents a patient with advanced diffuse panbronchiolitis accompanied by chronic respiratory failure, marked cachexia, and refractory spontaneous pneumothorax. Because instillation of a pleurodesis agent and thoracoscopy were considered highly risky and invasive, we instead treated the patient with intravenous administration of a coagulation factor XIII concentrate, and the pneumothorax resolved. This case suggests refractory pneumothorax in a restrictive ventilatory disorder can be effectively treated with noninvasive intravenous administration of coagulation factor XIII concentrate.

Intrapleural administration of a large amount of diluted fibrin glue for intractable pneumothorax. A clinical study based on 57 cases: including 2 unsuccessful cases

OBJECTIVE

Pleurodesis using chemical agents has been applied to high-risk patients with pneumothorax. This treatment, however, is sometimes unsuccessful in patients with intractable pneumothorax. We have developed intrapleural administration of diluted fibrin glue as an effective treatment for such patients.

METHODS

Fibrin glue was diluted 4-fold with saline and/or contrast media. Pleurodesis with a large amount of the diluted fibrin glue was performed in 55 high risk patients (57 cases, bil.2 patients) with intractable pneumothorax.

RESULTS

The air leaks were stopped by administration of the glue in all except 2 patients. During the follow-up period, a recurrence rate of 10.5% was observed. These recurrent pneumothoraces were successfully treated using the same procedure with no further recurrence. Pyrexia (12.3%) and chest discomfort (8.8%) were observed as side effects, and there was no occurrence of severe chest pain or thoracic empyema.

CONCLUSIONS

These results suggested that intrapleural administration of a large amount of diluted fibrin glue was an effective treatment for intractable pneumothoraces in high-risk patients.

Type XVI collagen is expressed in factor XIIIa+ monocyte-derived dermal dendrocytes and constitutes a potential substrate for factor XIIIa

We have previously reported that connective tissue cells in the superficial dermis preferentially express alpha1(XVI) collagen rather than those in the lower dermis. Double immunofluorescence labeling using the antibodies for alpha1(XVI) collagen and factor XIIIa (plasma transglutaminase), which is a marker of dermal dendrocytes, demonstrated that both antibodies reacted with the same cells in the superficial dermis of normal skin as well as the lesional skins of dermal dendrocyte-related disorders, dermatofibroma, and psoriasis. Dermal dendrocytes are considered to be established by a culture of peripheral blood monocytes in the presence of granulocyte macrophage-colony stimulating factor and interleukin-4. Reverse transcription--polymerase chain reaction, metabolic labeling, and immunofluorescence studies demonstrated that treatment of CD14+ peripheral blood monocytes with granulocyte macrophage-colony stimulating factor/interleukin-4 over a period of 8 d resulted in the induction of alpha1(XVI) collagen as well as factor XIIIa. The physiologic significance of colocalization of alpha1(XVI) collagen and factor XIIIa in the tissue and their coordinate induction in CD14+ monocyte-derived dendritic cells in vitro was studied. Considerable incorporation of [3H]putrescine by factor XIIIa into recombinant noncollagenous domain (NC) 11 but not into collagenous domain (COL) 1.NC1 domain of the alpha1(XVI) polypeptide was found. Incubation of recombinant NC11 of alpha1(XVI) polypeptide with factor XIIIa in vitro produced a covalent cross-linking complex on sodium dodecylsulfate-polyacrylamide gel electrophoresis. The results indicate that alpha1(XVI) collagen is constitutively expressed by most dermal dendrocytes in the skin and dendritic cells differentiated from peripheral blood monocytes in vitro. Type XVI collagen is expressed in factor XIIIa+ dermal dendrocytes and may form an intermolecular cross-linking through NC11 domain by the reaction catalyzed by factor XIIIa contributing to the structural integrity of factor XIIIa+ dendritic cell-rich tissues.

Repair of fistulas-in-ano using autologous fibrin tissue adhesive

PURPOSE

Our goal was to determine if autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing, could be used to completely close both simple and complex fistulas-in-ano.

METHODS

A 26-patient pilot study was performed in which 100 ml of a patient's blood was drawn 90 minutes before surgery. Autologous fibrin tissue adhesive was prepared. In the operating room the patient underwent an examination under anesthesia, and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted, and autologous fibrin tissue adhesive was injected into the secondary fistula tract opening until fibrin glue was seen coming from the primary opening. A petroleum jelly gauze was then applied over the secondary opening, and the patient was sent home. Follow-up visits were scheduled for one week, one month, three months, and one year later.

RESULTS

Twenty-six patients received autologous fibrin tissue adhesive fistula injections, with a mean follow-up of 3.5 months. Initial results were encouraging. Twenty-one of 26 patients (81 percent) had successful initial closure of their fistulas. Two of five failures were injected a second time, and one closed, giving an overall successful closure rate of 85 percent (22/26 patients). Of five patients who failed, mean time to failure was 3.8 weeks. In addition, there was no evidence of infection or complications related to the procedure.

CONCLUSION

Our initial results are optimistic and require further support through longer follow-up data. Fibrin glue treatment of anorectal fistulas offers a unique mode of management that is safe, simple, and easy for the surgeon to perform. By using autologous fibrin tissue adhesive the patient avoids the risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.

Factor XIII insufficiency in a patient with severe psoriasis vulgaris, arthritis, and infirmity

Factor XIII (FXIII) links soluble fibrin monomers and collagen fibres to stable fibrin connections. Deficiency of FXIII, caused by dyspoiesis or increased consumption, results in a bleeding tendency and wound healing complications. Although the decrease of FXIII and successful replacement in patients with wound healing complications after surgery have been described by several authors, it is rarely considered that patients with autoimmune diseases, bleeding or healing complications may suffer from FXIII deficiency. We report a patient with severe psoriasis vulgaris generalisata with large, painful erythemas, bleeding tendency, joint contractions and infirmity, whose FXIII activity was 19%. After successful replacement the bleeding tendency vanished, and a marked improvement of skin and joint mobility allowed mobilisation and administration of physical therapy, whereby some independence and mobility were restored to the patient.

General principles of wound healing

Wound healing is a complex process involving different biologic and immunologic systems. Despite improvements in diagnostics and therapy, wound failures remain a clinical problem. The approach to a nonhealed wound is an interdisciplinary challenge that should not be underestimated. Better understanding of the complex wound-healing cascade helps our approach to wound healing and its possible failure. Manipulations of the involved immunologic features offer future therapeutic strategies.

Fibrin sealant: scientific rationale, production methods, properties, and current clinical use

Fibrin sealant is a complex plasma-derived product which is increasingly used as a biodegradable tissue adhesive or sealant to stop or control bleeding or provide air and fluid tightness in many surgical situations. This review describes the historical development of current fibrin sealant preparations and the scientific rationale behind the alleged physiological benefits of its major plasma-derived components. A comparison in the extraction methods and viral reduction treatments applied to current commercial products and autologous preparations, and their respective advantages and limits, are discussed. Application devices used for surgical applications are described. A survey of the major clinical applications in various surgical areas is presented. Current issues in terms of viral safety, definition of optimal fibrin sealant composition, and regulatory concerns, especially to demonstrate clinical efficacy, are also included.

Novel aspects of blood coagulation factor XIII. I. Structure, distribution, activation, and function

Blood coagulation factor XIII (FXIII) is a protransglutaminase that becomes activated by the concerted action of thrombin and Ca2+ in the final stage of the clotting cascade. In addition to plasma, FXIII also occurs in platelets, monocytes, and monocyte-derived macrophages. While the plasma factor is a heterotetramer consisting of paired A and B subunits (A2B2), its cellular counterpart lacks the B subunits and is a homodimer of potentially active A subunits (A2). The gene coding for the A and B subunits has been localized to chromosomes 6p24-25 and 1q31-32.1, respectively. The genomic as well as the primary protein structure of both subunits has been established, and most recently the three-dimensional structure of recombinant cellular FXIII has also been revealed. Monocytes/macrophages synthesize their own FXIII, and very likely FXIII in platelets is synthesized by the megakaryocytes. Cells of bone marrow origin seem to be the primary site for the synthesis of subunit A in plasma FXIII, but hepatocytes might also contribute. The B subunit of plasma FXIII is synthesized in the liver. Plasma FXIII circulates in association with its substrate precursor, fibrinogen. Fibrin(ogen) has an important regulatory role in the activation of plasma FXIII. The most important steps of the activation of plasma FXIII are the proteolytic removal of activation peptide by thrombin, the dissociation of subunits A and B, and the exposure of the originally buried active site on the free A subunits. The end result of this process is the formation of an active transglutaminase, which cross-links peptide chains through epsilon(gamma-glutamyl)lysyl isopeptide bonds. Cellular FXIII in platelets becomes activated through a nonproteolytic process. When intracytoplasmic Ca2+ is raised during platelet activation, the zymogen--in the absence of subunit B--assumes an active configuration. The protein substrates of activated FXIII include components of the clotting-fibrinolytic system, adhesive and contractile proteins. The main physiological function of plasma FXIII is to cross-link fibrin and protect it from the fibrinolytic plasmin. The latter effect is achieved mainly by covalently linking alpha 2 antiplasmin, the most potent physiological inhibitor of plasmin, to fibrin. Plasma FXIII seems to be involved in wound healing and tissue repair, and it is essential to maintaining pregnancy. Cellular FXIII, if exposed to the surface of the cells, might support or perhaps take over the hemostatic functions of plasma FXIII; however, its intracellular role has remained mostly unexplored.

Fibrin sealant in laparoscopic adhesion prevention in the rabbit uterine horn model

OBJECTIVE

To assess the effects of fibrin sealant on adhesions after laparoscopic surgery.

DESIGN

Standardized surgical trauma was induced in 60 female rabbits. The animals were randomized in three groups for different adhesion prevention treatment.

SETTING

University research laboratory.

INTERVENTIONS

After standardized trauma was induced, group 1 (n = 20) received no treatment, group 2 animals (n = 20) were injected in the abdominal cavity with 60 mL of Ringer's lactate, and human fibrin sealant was applied on the surgical lesions under laparoscopic vision in group 3 (n = 20).

MAIN OUTCOME MEASURES

Five weeks after laparoscopy, a laparotomy was performed, and the adhesions were scored.

RESULTS

Fourteen of 20 rabbits in the control group (70%) presented postoperative adhesions, 11 of 20 (55%) in the Ringer's group, and 5 of 20 (25%) in the fibrin sealant group. High-score adhesions were seen in 15% of cases in control and Ringer's group and in 5% of cases in the fibrin sealant group.

CONCLUSIONS

When used during laparoscopic surgery, fibrin sealant has a preventive effect on de novo postsurgical adhesions. To assess the efficacy in reproductive surgery, a trial on recurrent postsurgical adhesions is required.

Analytical and clinical utility of a photometric assay for blood coagulation factor XIII

A new photometric assay for factor XIII was evaluated for its analytical performance and clinical usefulness. The test showed good performance characteristics: intra-assay coefficients of variation between 0.83 and 2.68%, inter-assay coefficients of variation from 3.4 to 4.5%. The test can be conducted rapidly on an automated analyser such as the Cobas Bio. The reference values (mean +/- 2 SD) ranged from 67 to 147% and there was no gender difference. The comparability of the photometric test with a clot lysis factor XIII test showed an acceptable coefficient of correlation r = 0.87 (p < 0.0001). The diagnostic conformity of both tests was 76.7%. Factor XIII concentrations were assessed in seven patient groups. In liver cirrhosis, M. Crohn and during pregnancy noticeable percentages of lowered values were found: i.e. 18.2%, 11.8% and 10.0% respectively. Elevated values were seen in hypertensive patients (16%) and in the small group of patients with carcinoma of the ovarium (22.2%). These results show that the incidence of acquired factor XIII deficiencies is relative low. The clinical meaning of reduced or enhanced factor XIII needs to be clarified by more extensive patient studies.

Angiogenic activity of fibrin degradation products is located in fibrin fragment E

The source of angiogenic activity of fibrin degradation products has been sought in a series of experiments, applying degradation products from different types of fibrin and fibrinogen to the chick chorioallantoic membrane. The presence of platelets or fibronectin during clotting was not essential for activity, and neither was crosslinking. Fibrinogen degradation products were non-stimulatory, as was serum. Molecular sieve column chromatography indicated a range of active fragments. Admixture of active fibrin degradation products with antifibrin fragment E, but not D, antiserum neutralized activity. Preparations containing only fibrin fragment E retained activity. A commercial preparation of fibrinogen fragment E was inactive until treated with thrombin. These experiments point to fibrin fragment E being the source of angiogenic activity, with thrombin cleavage being the essential step in generating activity.

Marked and prolonged depression of factor XIII after esophageal resection

Anastomotic leakage is one of the most common complications of esophagectomy and, since Factor XIII is required for normal wound healing, we investigated the temporal changes in plasma Factor XIII following esophagectomy and hepatectomy. A control group of patients undergoing other abdominal operations was also studied. Factor XIII activity was determined before surgery and on postoperative days (POD) 1, 3, 7 and 14. The plasma levels of acute phase protein were also measured. The plasma Factor XIII activity decreased significantly in both the hepatectomy and control groups until POD 7, reaching the lowest level on POD 3. In contrast, the esophagectomy group showed significant decreases in Factor XIII levels throughout the postoperative study period, with a nadir with an average activity of 56 per cent on POD 7. Preoperative transferrin levels had a positive correlation with Factor XIII levels measured on POD 3 and there was also a positive significant correlation between Factor XIII activity and alpha 2-macroglobulin levels on POD 3. These results suggest that there is a marked and prolonged depression of plasma Factor XIII activity following esophagectomy which may be attributed to accelerated tissue demands, inadequate synthesis or increased degradation. Moreover, the severe and sustained decrease in Factor XIII activity may be related to poor wound healing after esophagectomy.

Immunocytochemical observations on macrophage populations in normal fetal and adult human liver

Phenotypic expression of macrophages was studied immunocytochemically in 25 human fetal livers at various stages of development and in 20 normal human adult livers. A panel of commercially available polyclonal and monoclonal antibodies (KP1, Mac387, LN3, CR3/43, and antibodies against muramidase, alpha-1-antitrypsin, and factor XIIIa) was applied to paraffin sections. From the seventh week of gestation macrophages in the fetal liver showed differences in distribution with the various antibodies. Macrophages in adult liver similarly varied in morphology and phenotypic expression. In the light of these results, we conclude that the population of human liver macrophages is heterogeneous from an early stage of fetal development and that this heterogeneity extends into adult life.

Factor XIIIa in the hamartomas of tuberous sclerosis

Factor XIII is a blood coagulation factor which may also be produced in an intracellular location. The 'a' subunit of this factor has been found in a number of different cell types and has been shown to stimulate the proliferation of fibroblasts in vitro. We have examined cutaneous, central nervous system and renal lesions from persons with tuberous sclerosis using a standard immunohistochemical assay to see if factor XIIIa is expressed in these hamartomatous growths. We found factor XIIIa in most of the stromal cells composing the skin lesions of tuberous sclerosis as well as in cells of subependymal giant cell astrocytoma of the brain and the stromal cells in renal angiomyolipoma. Expression of factor XIIIa may be of significance in the formation of fibrous growths in tuberous sclerosis.

Distribution of factor XIIIa-containing cells and collagenous components in radicular cysts: histochemic and immunohistochemic studies

The distribution of subunit A of Factor XIII (FXIIIa) and of collagenous components was investigated by the avidin-biotin-peroxidase complex (ABC) method for FXIIIa and by the Sirius red F3BA method, respectively, in 43 cases of radicular cysts. Besides the covering epithelial layer, the radicular cyst wall was composed of the following three layers: an inner granulomatous layer, an outer fibrous connective tissue layer, and an intermediate layer. In each layer, a positive reaction for FXIIIa was observed in certain connective tissue cells. These FXIIIa-containing cells were few in number in the inner layer where collagenous components were also sparse. In the slightly to moderately fibrous intermediate layer, these cells markedly increased in number and were dendritic or stellate in shape. In the outer densely fibrous connective tissue layer, they decreased slightly in number and were slender and spindle-shaped. The results obtained in the present study indicate the close relationship between the distribution of FXIIIa-containing cells and of collagenous components. Such a relationship suggests that these cells play an important role in the process of fibrosis occurring in the radicular cyst wall.

Biochemical and physical properties of a solvent-detergent-treated fibrin glue

A fibrin glue preparation has been obtained from pooled human plasma using a procedure which includes a solvent-detergent (SD) treatment to inactivate lipid-enveloped viruses. The SD treatment inactivated greater than or equal to 5.5 log10 of HIV in less than 45 min, and greater than or equal to 5 log10 and greater than or equal to 6.5 log10 of VSV and Sindbis virus, respectively, in less than 2 h. The product was found to contain high quantities of fibrinogen (116 +/- 2.49 g/l; n = 12), factor XIII (35 +/- 2.88 U/ml) and von Willebrand factor (23 +/- 1.9 U/ml ristocetin cofactor activity), and relatively low levels of fibronectin (5.9 +/- 0.51 g/l). Plasminogen, the precursor of plasmin, which may play a negative role by decreasing the resistance of the fibrin clot, was at only 0.03 g/l. Cellulose acetate electrophoresis showed 95% gamma-proteins and 5% alpha-2-beta proteins. Sodium dodecyl sulfate polyacrylamide gel electrophoresis under reducing conditions detected three main protein bands with apparent molecular weights of 65, 56 and 47 kilodaltons, probably corresponding to the alpha, beta, and gamma fibrinogen subunits. Other characteristics of the product included (1) high clottability of fibrinogen (over 85%); (2) absence of low molecular weight fibrin degradation products; (3) rapid solubilization at room temperature (less than 10 min); (4) high tensile strength (202 +/- 27 g/cm2 after 2 h of application), and (5) high elasticity of the fibrin clot. In addition, scanning electron microscopy revealed a highly organized structure showing tridimensional arrangement of the fibrin fibers. SD treated fibrin glue should efficiently replace autologous fibrinogen or cryoprecipitate preparations for surgical application.

Factor XIIIa-containing cells and fibrosis in oral and maxillofacial lesions: an immunohistochemical study

The distribution of subunit A of blood coagulation factor XIII (FXIIIa) was investigated by the avidin-biotin-peroxidase complex (ABC) method in various oral and maxillofacial tissues. These tissues were from normal tongue, gingiva, lip, and submandibular gland, and from Dilantin gingival hyperplasia (one case), pyogenic granuloma (three cases), peripheral fibroma (four cases), squamous cell carcinoma (seven cases), chronic sclerosing submandibular adenitis (two cases), and fibrous dysplasia of the mandibular bone (one case). The distribution of collagenous components was examined in the same tissues by means of the Sirius red F3BA method. By means of the ABC method, FXIIIa was detected in the cytoplasm of certain connective tissue cells in each of the tissues examined. These FXIIIa-containing cells were sparse in the normal tissues but evidently abundant in the fibrous connective tissue of inflammatory and neoplastic lesions. In the present study, the close relationship between the distribution of FXIIIa-containing cells and that of collagenous components is demonstrated. The role that FXIIIa-containing cells play in the process of fibrosis is discussed.

Histiocytoma cutis: a tumour of dermal dendrocytes (dermal dendrocytoma)

The histogenesis of histiocytoma (dermatofibroma) was investigated using new antibodies that demonstrate factor XIIIa (FXIIIa) positive cells and the monocyte macrophage cell series (MAC 387), in formalin fixed tissue. The distribution of S100 protein, vimentin and Ulex europaeus agglutinin I (UEA-I) were also studied. The antibody against FXIIIa labelled the normal dermal population of fixed connective tissue cells (dermal dendrocytes) emphasizing their dendritic processes; cells that are widely distributed, but are most numerous in the papillary dermis. In contrast, the antibody, MAC 387 against monocyte derived macrophages, did not label this cell population. In 30 histiocytomas, intense labelling for FXIIIa was found peripherally, but labelling was rather weaker in cells situated centrally. Only a few cells labelled for S100 protein and with the monoclonal antibody MAC 387, but vimentin positivity was universal. UEA-I labelled only vessels in histiocytomas. However, FXIIIa labelling was negative in 16 dermatofibrosarcomas, three keloids and several other fibroproliferative lesions. These contrasting results with FXIIIa labelling have practical implications for diagnosis of benign and malignant spindle cell tumours of the skin. We conclude that histiocytomas (dermal dendrocytomas) take their origin from dermal fixed connective tissue cells, (dermal dendrocytes), but other spindle cell tumours may differ in histogenesis.

Hemostasis in Crohn's disease: low factor XIII levels in active disease

Massive gastrointestinal hemorrhage sometimes occurs in Crohn's disease. To examine the possible role of acquired disorders of hemostasis contributing to such events, several laboratory indicators of hemostasis (APT time, Normotest, platelet count, bleeding time, fibrinogen, factor VIII activity, vWF:Ag, factor X, factor XIII, antithrombin III, fibrinopeptide A, and B beta(15-42] were studied in 10 patients with active Crohn's disease (Crohn's disease activity index (CDAI) greater than 150) and 10 patients with quiescent disease (CDAI less than 150). Marked thrombocytosis was seen in three patients with active disease. Factor VIII activity and fibrinogen levels were significantly elevated in patients with Crohn's disease (p less than 0.001), and the factor VIII activity levels were significantly higher (p less than 0.05) in the patients with active disease than in those with quiescent disease. Factor XIII levels were significantly lower (p less than 0.02) in patients with active disease. Three of the patients with active disease had factor XIII levels below the lower reference limit. The two patients with the lowest levels had hemorrhagic diarrhea and spontaneous bleeding from the rectal mucosa. Fibrinopeptide A and B beta(15-42) levels were significantly elevated in both groups. The other coagulation analyses were essentially normal in both patient groups. The results suggest that factor XIII deficiency acquired through gastrointestinal leakage may contribute to gastrointestinal hemorrhage in some patients with active Crohn's disease.

Morphometric studies on wound healing after systemic administration of adriamycin and local application of fibrin sealant. Application of a new wound healing model using spongiosa implants

For investigations on the development of regenerative granulation tissue in wound healing a new model using bone spongiosa ("Kieler Spongiosa") implants is presented. Particular attention was devoted to developing a model which permits studies on wound healing without disturbance by foreign body reaction and infections. Two test groups of rats received four blocks of "Kieler Spongiosa" each in a symmetrical fashion in a paramedian region underneath the dorsal skin. The spongiosa blocks had previously been treated with glutaraldehyde to achieve cross-linkage of the collagenous structures of the surfaces of the spongiosa trabeculae. After one week (group 1) and two weeks (group 2) the animals were sacrificed. The spongiosa blocks were removed, fixed and evaluated in layered serial sections after decalcification. Two blocks which had been removed randomly from the back and front served for morphometric determination of the total volume of bony substance and the developed granulation tissue. Moreover, the cellular composition of the granulation tissue was morphometrically examined with regard to its content of capillaries, granulation tissue cells and inflammatory cells. The two other blocks were examined for DNA and hydroxyproline content of granulation tissue. Comparison of the two experimental groups yielded marked differences in spongiosa space infiltrated by granulation tissue and its composition. Our model was used to assess the influence of systemic administration of adriamycin and/or local application of a fibrin sealant system on granulation tissue formation and its morphologic structure.(ABSTRACT TRUNCATED AT 250 WORDS)

Perineurial cell tumor and the significance of the perineurial cells in neurofibroma

The authors attempted to clarify the exact cell components of neurofibroma by immunohistochemical and ultrastructural studies. Materials were randomly selected, 40 cases of neurilemoma and neurofibroma (-tosis) in addition to 2 cases of tumors composed exclusively of perineurial cells and three cases of normal peripheral nerve. The applied markers included antisera of S-100 protein for Schwann cells, blood coagulation factor XIIIa for endoneurial fibroblasts or perineurial cells, and laminin and collagen type IV for the basement membrane. S-100 protein was demonstrated only in normal or neoplastic Schwann cells, but not in perineurial cells. On the other hand, factor XIIIa was often recognized in endoneurial fibroblasts and perineurial cells, but not in Schwann cells. Neurofibroma was basically composed of a mixture of Schwann cells, perineurial cells, and endoneurial fibroblasts, the population of each type of cell differing according to the case and area within a given tumor. Perineurial cell tumor exclusively composed of perineurial cells, though rare, appears to be a definite entity, and its characteristic histological and ultrastructural features were described.

Immobilization of factor XIII on collagen membranes

Factor XIII from placenta was successfully grafted onto collagen membranes by the acyl-azide procedure. The transamidase activity retained on collagen membranes was determined by measuring the increase of fluorescence resulting from dansylcadaverine incorporation into casein. We studied the effect of different factors on the grafting: concentration and composition of the factor XIII preparation in the coupling solution and influence of the preactivation of factor XIII by thrombin. Stability studies have shown that the activity of factor XIII grafted on collagen membranes was almost constant over a period of 8 months. Sterilization by gamma-irradiation of factor XIII revealed a drastic loss of activity while the use of high-energized electron bombardment caused a reduced loss of activity. The potential of such a material for biomedical use is presently under investigation.

Bone healing stimulated by plasma factor XIII. Osteotomy experiments in sheep

Sheep had their right metatarsals osteotomized midshaft and stabilized by plate and screws. One group was injected with 1250 units of Factor Thirteen for 9 days postoperatively, and a control group received placebo injections. After 8 weeks, the bones were evaluated biomechanically, histomorphologically and by densitometry. The bones of the treated group had a significantly higher tensile strength than the bones of the control animals. The correlation of biomechanical and morphological results demonstrated that the tensile strength increased with an increasing number of osteons crossing the osteotomy gap. The hydroxyapatite content of the bone healing zone was 7.3 per cent higher for the treated bones than for the control bones.

Specific binding of human fibrinogen to cultured human fibroblasts. Evidence for the involvement of the E domain

Highly purified human fibrinogen was labelled with radioactive iodine and its interaction with cultured human embryo lung fibroblasts (MRC5) was examined. The cell monolayer was incubated at 37 degrees C with 125I-fibrinogen in phosphate/saline buffer containing 1 mM Ca2+ and 1 mM Mg2+. A direct interaction between 125I-fibrinogen and MRC5 was observed. The binding was time-dependent, reached saturation at 10 min and was regulated by the density of the cell monolayer. Non-labelled fibrinogen inhibited the interaction but unrelated proteins, including fibronectin, ovalbumin or myoglobin, did not. Monospecific Fab fragments, directed to fibrinogen, inhibited binding by 55.3% at a 50/1 molar ratio while non-immune Fab produced a 1.5% inhibition at similar concentration. Autoradiography of the display of fibroblast-bound 125I on a 7.5% polyacrylamide gel showed that the extract exhibited electrophoretic bands characteristic of the constitutive B beta and gamma chains of the fibrinogen molecule. An apparent affinity constant, Ka = 6.7 +/- 0.2 X 10(6) M-1, was estimated from binding isotherms. After a 30-min incubation time the interaction between 125I-fibrinogen and the cells was completely reversible and displaceable by a large molar excess of non-labelled fibrinogen. When compared to fibroblasts (MRC5 or W138), cultures of human embryo epithelial cells (EUE) failed to interact with 125I-fibrinogen, providing evidence for the specificity of binding for fibroblast monolayers. Plasmin-degradation fragments D and E, of 100000 and 50000 relative molecular mass respectively, were tested for their capacity to inhibit fibrinogen binding. At a 1/400 125I-fibrinogen/fragment molar ratio, fragment E inhibited binding by 30% while fragment D produced a 3% inhibition only. Altogether, the results demonstrate that human fibroblasts possess specific binding sites for fibrinogen, which exhibit the characteristics of a receptor system regulated by the culture state of the cells. In addition the structural features, which are necessary for the interaction of fibrinogen with the cells, are probably located in the E domain of the molecule.

The maximization of wound healing with fibrin glue

Our experience in the application of so-called fibrin glue in 304 patients submitted to a variety of operations in plastic surgery from January 1981 to May 1982 is presented. The results seem to be much better than without this substance and afford greater comfort for the patient. Addition of factor XIII seems to be unnecessary.

The influence of fibrin stabilization and fibrinolysis on the fibrin-adhesive system. A clinical study using radioactively marked fibrinogen as a tracer

In many fields of surgery the use of highly concentrated human fibrinogen, which forms a fibrin clot when thrombin is added, is gaining increasing importance for tissue adhesion. A number of experimental and clinical reports on fibrin sealing have been published during recent years. The question underlying our present investigations is as follows: What happens to the tissue adhesive after its application to a wound in clinical use, i.e., how much time is required for complete resorption of the seal due to fibrinolytic processes? Skin graftings of the face (required to close defects caused by the excision of basal or spinal cell carcinomas) were performed by glueing rhomboid flaps or full thickness skin grafts to the wounds with the tissue adhesive to which 125I-marked fibrinogen has been added. Activity counts were recorded daily and CPM were plotted versus time to obtain summation curves. The physiological processes of fibrin stabilization and fibrinolysis are extensively discussed as both factors influence the tissue adhesive and thus have to be accounted for in clinical practice.

Pseudointima in expanded polytetrafluoroethylene graft implanted in the inferior vena cava of normal and defibrinogenated dogs

The pseudointimal formation in an expanded polytetrafluoroethylene graft implanted in the canine inferior vena cava was studied by light and transmission electron microscopy. Five of 6 grafts in the control group and all of the 10 grafts in the batroxobin-defibrinogenated group were patent, and provided for the investigation. The thickness of the mural thrombus formed within 3 days was significantly decreased in the severely defibrinogenated dogs, in which the fibrinogen concentration was below 0.40 gm/L, as compared to the controls and the moderately defibrinogenated dogs, in which the fibrinogen concentration was at highest 0.72-0.87 gm/L. In spite of reducing the fibrinogen concentration to unmeasurable levels after 3 days, there was no obvious difference in the process of pseudointimal formation between the moderately defibrinogenated dogs and the controls. In the severely defibrinogenated dogs, loose and spongoid mural thrombus required a longer time to be reorganized.

Growth regulation of fibroblasts by thrombin, factor XIII and fibronectin

The stimulation of fibroblast proliferation by thrombin and factor XIII is accompanied by an intracellular increase of cGMP. In contrast fibronectin inhibits the 3H-thymidine uptake of fibroblasts. Pre-treatment of fibroblasts with neuraminidase eliminates the stimulating effect of thrombin completely and induces a shift of the optimum stimulating effect of factor XIII to higher concentrations. It is discussed that thrombin and factor XIII stimulate the proliferation of fibroblasts as growth hormones and regulate in combination with the inhibiting fibronectin the growth of fibroblasts in thrombus organization, wound healing and in the arteriosclerotic vessel wall process.

Fracture healing under factor XIII medication

Following application of factor XIII for 3 weeks bone healing was studied in Sprague-Dawley rats on the 20th postoperatively day qualitatively (radiographs, scintigraphy) and quantitatively (determination of callus thickness, of bone mineral content, and scintillation counting). No significant difference could be detected between animals treated with factor XIII and animals which served as controls. Therefore, a stimulating effect of factor XIII upon bone healing can not be expected in case of a normal factor XIII serum-level. The application of factor XIII is indicated only in high risk patients with a low factor XIII serum-level.

Clot retraction in a factor XIII free system

The role of Factor XIII in clot retraction was studied using the plasma from Factor XIII-deficient patients. Time course experiments revealed no significant difference in clot retraction between a plasma deficient in Factor XIII and one to which purified Factor XIII had been added. Using Factor XIII-free fibrinogen and Factor XIII-deficient platelets, it is shown that there is no significant difference in clot retraction with or without added Factor XIII.

Transurethral resection in a patient with a dysfibrinogen: fibrinogen cleveland I

A case of a congenitally abnormal fibrinogen that resulted in surgical wound dehiscence is reported. The patient underwent successful transurethral resection for benign prostatic hypertrophy while being treated with epsilon aminocaproic acid to prevent fibrinolysis of the abnormal fibrin clot.