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Azzopardi EA, Conlan RS, Whitaker IS. Polymer therapeutics in surgery: the next frontier. ACTA ACUST UNITED AC 2016; 1:19-29. [PMID: 27588210 PMCID: PMC4985703 DOI: 10.1002/jin2.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/18/2015] [Accepted: 11/20/2015] [Indexed: 01/13/2023]
Abstract
Polymer therapeutics is a successful branch of nanomedicine, which is now established in several facets of everyday practice. However, to our knowledge, no literature regarding the application of the underpinning principles, general safety, and potential of this versatile class to the perioperative patient has been published. This study provides an overview of polymer therapeutics applied to clinical surgery, including the evolution of this demand‐oriented scientific field, cutting‐edge concepts, its implications, and limitations, illustrated by products already in clinical use and promising ones in development. In particular, the effect of design of polymer therapeutics on biophysical and biochemical properties, the potential for targeted delivery, smart release, and safety are addressed. Emphasis is made on principles, giving examples in salient areas of demand in current surgical practice. Exposure of the practising surgeon to this versatile class is crucial to evaluate and maximise the benefits that this established field presents and to attract a new generation of clinician–scientists with the necessary knowledge mix to drive highly successful innovation.
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Affiliation(s)
- Ernest A Azzopardi
- Reconstructive Surgery and Regenerative Medicine Research Unit, Institute for Life Science Swansea University Medical School, Swansea University Singleton Park Campus SwanseaSA2 8PP UK; The Welsh Centre for Burns and Plastic Surgery Moriston Hospital Swansea Swansea SA6 6NL UK; Institute for Life Science and Centre for NanoHealth Swansea University Medical School, Swansea University Singleton Park Campus Swansea SA2 8PP UK
| | - R Steven Conlan
- Institute for Life Science and Centre for NanoHealth Swansea University Medical School, Swansea University Singleton Park Campus Swansea SA2 8PP UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Unit, Institute for Life Science Swansea University Medical School, Swansea University Singleton Park Campus SwanseaSA2 8PP UK; The Welsh Centre for Burns and Plastic Surgery Moriston Hospital Swansea Swansea SA6 6NL UK; Institute for Life Science and Centre for NanoHealth Swansea University Medical School, Swansea University Singleton Park Campus Swansea SA2 8PP UK
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Teixeira SR, Lloyd C, Yao S, Whitaker IS, Francis L, Conlan RS, Azzopardi E. Polyaniline-graphene based α-amylase biosensor with a linear dynamic range in excess of 6 orders of magnitude. Biosens Bioelectron 2016; 85:395-402. [PMID: 27196256 DOI: 10.1016/j.bios.2016.05.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/21/2016] [Accepted: 05/08/2016] [Indexed: 11/19/2022]
Abstract
α-amylase is an established marker for diagnosis of pancreatic and salivary disease, and recent research has seen a substantial expansion of its use in therapeutic and diagnostic applications for infection, cancer and wound healing. The lack of bedside monitoring devices for α-amylase detection has hitherto restricted the clinical progress of such applications. We have developed a highly sensitive α-amylase immunosensor platform, produced via in situ electropolymerization of aniline onto a screen-printed graphene support (SPE). Covalently binding an α-amylase specific antibody to a polyaniline (PANI) layer and controlling device assembly using electrochemical impedance spectroscopy (EIS), we have achieved a highly linear response against α-amylase concentration. Each stage of the assembly was characterized using a suite of high-resolution topographical, chemical and mechanical techniques. Quantitative, highly sensitive detection was demonstrated using an artificially spiked human blood plasma samples. The device has a remarkably wide limit of quantification (0.025-1000IU/L) compared to α-amylase assays in current clinical use. With potential for simple scale up to volume manufacturing though standard semiconductor production techniques and subsequently clinical application, this biosensor will enable clinical benefit through early disease detection, and better informed administration of correct therapeutic dose of drugs used to treat α-amylase related diseases.
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Affiliation(s)
- Sofia Rodrigues Teixeira
- College of Engineering, Swansea University, Bay Campus, Swansea SA1 8QQ, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
| | - Catherine Lloyd
- College of Engineering, Swansea University, Bay Campus, Swansea SA1 8QQ, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Seydou Yao
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Iain S Whitaker
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
| | - Lewis Francis
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - R Steven Conlan
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Ernest Azzopardi
- Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA66NL, UK
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Azzopardi E, Lloyd C, Teixeira SR, Conlan RS, Whitaker IS. Clinical applications of amylase: Novel perspectives. Surgery 2016; 160:26-37. [PMID: 27117578 DOI: 10.1016/j.surg.2016.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/20/2015] [Accepted: 01/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Amylase was the first enzyme to be characterized, and for the previous 200 years, its clinical role has been restricted to a diagnostic aid. Recent interface research has led to a substantial expansion of its role into novel, viable diagnostic, and therapeutic applications to cancer, infection, and wound healing. This review provides a concise "state-of-the-art" overview of the genetics, structure, distribution, and localization of amylase in humans. METHOD A first-generation literature search was performed with the MeSH search string "Amylase AND (diagnost∗ OR therapeut$)" on OVIDSP and PUBMED platforms. A second-generation search was then performed by forward and backward referencing on Web of Knowledge™ and manual indexing, limited to the English Language. RESULTS "State of the Art" in amylase genetics, structure, function distribution, localisation and detection of amylase in humans is provided. To the 4 classic patterns of hyperamylasemia (pancreatic, salivary, macroamylasemia, and combinations) a fifth, the localized targeting of amylase to specific foci of infection, is proposed. CONCLUSIONS The implications are directed at novel therapeutic and diagnostic clinical applications of amylase such as the novel therapeutic drug classes capable of targeted delivery and "smart release" in areas of clinical need. Future directions of research in areas of high clinical benefit are reported.
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Affiliation(s)
- Ernest Azzopardi
- Reconstructive Surgery and Regenerative Medicine Group, Swansea University, Swansea, United Kingdom; Centre for Nanohealth, Swansea University, Swansea, United Kingdom; The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom; Swansea University Medical School, Swansea University, Swansea, United Kingdom.
| | - Catherine Lloyd
- Reconstructive Surgery and Regenerative Medicine Group, Swansea University, Swansea, United Kingdom; Centre for Nanohealth, Swansea University, Swansea, United Kingdom
| | | | - R Steven Conlan
- Centre for Nanohealth, Swansea University, Swansea, United Kingdom; Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Group, Swansea University, Swansea, United Kingdom; The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom; Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, Dickson WA, Whitaker IS. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. PLoS One 2014; 9:e95042. [PMID: 24751699 PMCID: PMC3994014 DOI: 10.1371/journal.pone.0095042] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.
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Affiliation(s)
- Ernest A. Azzopardi
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Elayne Azzopardi
- Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom
| | - Liberato Camilleri
- Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta
| | - Jorge Villapalos
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - Dean E. Boyce
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Peter Dziewulski
- St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - William A. Dickson
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
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