1
|
Effect of topical rifamycin application on epidural fibrosis in rats. Turk J Phys Med Rehabil 2019; 65:24-29. [PMID: 31453541 DOI: 10.5606/tftrd.2019.2442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/01/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives This study aims to investigate the effects of topical rifamycin SV application on epidural fibrosis formation in a rat model. Materials and methods Between March 2015 and April 2015, a total of 20 Wistar rats were equally and randomly divided into laminectomy only group (control group) and laminectomy and rifamycin SV group (treatment group). Laminectomy was performed between L3-L5 in all rats. Surgical field was irrigated with 1 mL rifamycin SV (1 mL). After four weeks, vertebral columns of the rats were removed en bloc between the L1 and L5 levels, and epidural fibrosis and arachnoid involvement were histopathologically evaluated and graded. Results Grade 3 epidural fibrosis formation ratio was lower in the treatment group (40%) compared to the control group (80%). However, there was no statistically significant difference between the treatment and control groups in terms of epidural fibrosis (p=0.164) and arachnoid involvement (p=0.303). Conclusion Intraoperative rifamycin irrigation tends to reduce epidural fibrosis formation risk, although not statistically significant.
Collapse
|
2
|
Zeng L, Sun Y, Li X, Wang J, Yan L. 10‑Hydroxycamptothecin induces apoptosis in human fibroblasts by regulating miRNA‑23b‑3p expression. Mol Med Rep 2019; 19:2680-2686. [PMID: 30720099 PMCID: PMC6423607 DOI: 10.3892/mmr.2019.9927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022] Open
Abstract
10-Hydroxycamptothecin (HCPT) effectively controls epidural fibrosis, but the exact underlying mechanisms remain ambiguous. Abnormal microRNA (miR)-23b-3p expression has been detected in various types of fibrotic tissues that are present in different diseases. The aim of the present study was to elucidate the mechanisms through which HCPT induces fibroblast apoptosis. Reverse transcription-quantitative polymerase chain reactions were performed on six traumatic scar samples and matched normal skin samples; traumatic scar formation was revealed to be significantly inversely associated with miR-23b-3p expression. In addition, the miR-23b-3p expression level in human fibroblasts was examined following HCPT treatment. The effects of HCPT and miR-23b-3p on fibroblast apoptosis were assessed using terminal deoxynucleotidyl-transferase-mediated dUTP nick-end labeling, flow cytometry and western blot analysis. The results demonstrated that HCPT treatment notably increased miR-23b-3p expression levels and accelerated fibroblast apoptosis. Therefore, upregulation of miR-23b-3p expression was demonstrated to promote fibroblast apoptosis, consistently with the effects of HCPT. The results of the present study indicated that HCPT may induce fibroblast apoptosis by regulating miR-23b-3p expression.
Collapse
Affiliation(s)
- Lingrong Zeng
- Department of Orthopedics, The Second Affiliated Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410012, P.R. China
| | - Yu Sun
- Orthopedic Institute, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Xiaolei Li
- Orthopedic Institute, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Jingcheng Wang
- Orthopedic Institute, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Lianqi Yan
- Department of Orthopedics, The Second Affiliated Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410012, P.R. China
| |
Collapse
|
3
|
Efficacy of Poly(D,L-Lactic Acid-co-Glycolic acid)-Poly(Ethylene Glycol)-Poly(D,L-Lactic Acid-co-Glycolic Acid) Thermogel As a Barrier to Prevent Spinal Epidural Fibrosis in a Postlaminectomy Rat Model. Clin Spine Surg 2017; 30:E283-E290. [PMID: 28323713 DOI: 10.1097/bsd.0000000000000221] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
STUDY DESIGN Experimental animal study. OBJECTIVE The authors conducted a study to determine the efficacy and safety of the poly(D,L-lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(D,L-lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) thermogel to prevent peridural fibrosis in an adult rat laminectomy model. SUMMARY OF BACKGROUND DATA Peridural fibrosis often occurs after spinal laminectomy. It might cause persistent back and/or leg pain postoperatively and make a reoperation more difficult and dangerous. Various materials have been used to prevent epidural fibrosis, but only limited success has been achieved. MATERIALS AND METHODS The PLGA-PEG-PLGA thermogel was synthesized by us. Total L3 laminectomies were performed on 24 rats. The PLGA-PEG-PLGA thermogel or chitosan (CHS) gel (a positive control group) was applied to the operative sites in a blinded manner. In the control group, the L3 laminectomy was performed and the defect was irrigated with the NS solution 3 times. All the rats were killed 4 weeks after the surgery. RESULTS The cytotoxicity of this thermogel was evaluated in vitro and the result demonstrated that no evidence of cytotoxicity was observed. The extent of epidural fibrosis, the area of epidural fibrosis, and the density of the fibroblasts and blood vessel were evaluated histologically. There were statistical differences among the PLGA-PEG-PLGA thermogel or CHS gel group compared with the control group. Although there was no difference between the PLGA-PEG-PLGA thermogel and CHS gel, the efficiency of the PLGA-PEG-PLGA thermogel was shown to be slightly improved compared with the CHS gel. CONCLUSIONS The biocompatibility of the PLGA-PEG-PLGA thermogel was proven well. The application of this thermogel effectively reduced epidural scarring and prevented the subsequent adhesion to the dura mater. No side effects were noted in the rats.
Collapse
|
4
|
Dai J, Sun Y, Yan L, Wang J, Li X, He J. Upregulation of NOXA by 10-Hydroxycamptothecin plays a key role in inducing fibroblasts apoptosis and reducing epidural fibrosis. PeerJ 2017; 5:e2858. [PMID: 28097065 PMCID: PMC5237371 DOI: 10.7717/peerj.2858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/03/2016] [Indexed: 12/16/2022] Open
Abstract
The fibrosis that develops following laminectomy or discectomy often causes serious complications, and the proliferation of fibroblasts is thought to be the major cause of epidural fibrosis. 10-Hydroxycamptothecin (HCPT) has been proven to be efficient in preventing epidural fibrosis, but the exact mechanism is still unclear. NOXA is a significant regulator of cell apoptosis, which has been reported to be beneficial in the treatment of fibrosis. We performed a series of experiments, both in vitro and in vivo, to explore the intrinsic mechanism of HCPT that underlies the induction of apoptosis in fibroblasts, and also to investigate whether HCPT has positive effects on epidural fibrosis following laminectomy in rats. Fibroblasts were cultured in vitro and stimulated by varying concentrations of HCPT (0, 1, 2, 4 µg/ml) for various durations (0, 24, 48, 72 h); the effect of HCPT in inducing the apoptosis of fibroblasts was investigated via Western blots and TUNEL assay. Our results showed that HCPT could induce apoptosis in fibroblasts and up-regulate the expression of NOXA. Following the knockdown of NOXA in fibroblasts, the results of Western blot analysis showed that the level of apoptotic markers, such as cleaved-PARP and Bax, was decreased. The results from the TUNEL assay also showed a decreased rate of apoptosis in NOXA-knocked down fibroblasts. For the in vivo studies, we performed a laminectomy at the L1-L2 levels in rats and applied HCPT of different concentrations (0.2, 0.1, 0.05 mg/ml and saline) locally; the macroscopic histological assessment, hydroxyproline content analysis and histological staining were performed to evaluate the effect of HCPT on reducing epidural fibrosis. The TUNEL assay in epidural tissues showed that HCPT could obviously induce apoptosis in fibroblasts in a dose-dependent manner. Also, immunohistochemical staining showed that the expression of NOXA increased as the concentrations of HCPT increased. Our findings are the first to demonstrate that upregulation of NOXA by HCPT plays a key role in inducing fibroblast apoptosis and in reducing epidural fibrosis. These findings might provide a potential therapeutic target for preventing epidural fibrosis following laminectomy.
Collapse
Affiliation(s)
- Jihang Dai
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Yu Sun
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| | - Jun He
- Department of Orthopedics, Clinical medical college of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yang Zhou, China
| |
Collapse
|
5
|
Shin SJ, Lee JH, So J, Min K. Anti-adhesive effect of poloxamer-based thermo-sensitive sol-gel in rabbit laminectomy model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:162. [PMID: 27646404 DOI: 10.1007/s10856-016-5773-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
Poloxamer-based thermo-sensitive sol-gel has been developed to reduce the incidence of postoperative scar formation at the laminectomy site. The purpose of this study was to evaluate the anti-adhesive effect of poloxamer based thermo-sensitive sol-gel compared to hyaluronate based solution after laminectomy, using a rabbit model. A thermo-sensitive anti-adhesive with a property of sol-gel transition was manufactured by a physical mixture of Poloxamer188/407, Chitosan and Gelatin. The viscosity in different temperatures was assessed. 72 adult New Zealand rabbits underwent lumbar laminectomy and were randomly divided into experimental (treated with the newly developed agent), positive (treated with hyaluronate based solution), and negative control groups. Each group was subdivided into 1 and 4-week subgroups. Gross and histological evaluations were performed to assess the extent of epidural adhesion. The experimental group showed significantly higher viscosity compared to the positive control group and showed a significant increase of viscosity as the temperature increased. Gross evaluation showed no statistically significant differences between the 1- and 4-week subgroups. However, histologic evaluation showed significant differences both in 1- and 4-week subgroups. Although the 4-week histologic results of the experimental and the positive control subgroups showed no significant difference, both subgroups revealed higher value compared to the negative control subgroup with regard to the ratio of adhesion less than 50 %. The new poloxamer based thermo-sensitive agent showed superior efficacy over the hyaluronate based agent at 1 week postoperatively. At 4 weeks postoperatively, there were no statistically significant differences between the two agents, although both showed efficacy over the sham group.
Collapse
Affiliation(s)
- Sung Joon Shin
- Department of Orthopedic Surgery, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Seoul, 156-707, Korea
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Seoul, 156-707, Korea.
- Institute of Medical and Biological Engineering, Seoul National University Medical Research Center, Seoul, 110-799, Korea.
| | - Jungwon So
- Research & Development Center, CGbio Co., Ltd. Seongnam-si, Gyeonggi-do, 462-120, Korea
| | - Kyungdan Min
- Research & Development Center, CGbio Co., Ltd. Seongnam-si, Gyeonggi-do, 462-120, Korea
| |
Collapse
|
6
|
Dai J, Li X, Yan L, Chen H, He J, Wang S, Wang J, Sun Y. The effect of suramin on inhibiting fibroblast proliferation and preventing epidural fibrosis after laminectomy in rats. J Orthop Surg Res 2016; 11:108. [PMID: 27716371 PMCID: PMC5045610 DOI: 10.1186/s13018-016-0443-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022] Open
Abstract
Background Epidural fibrosis often causes serious complications in patients after lumbar laminectomy and discectomy and is associated with the proliferation of fibroblasts. Suramin is known to have an obvious inhibitory effect on the coactions of many growth factors and their receptors, but little was previously known about the effect of suramin on fibroblast proliferation and the progress of epidural fibrosis. Methods We illustrated the effect of suramin on cultured fibroblasts of rats with different concentrations (0, 200, 400, 600 mg/l). The proliferation of suramin-treated fibroblasts was evaluated by CCK-8 and western blot analysis. Additionally, in a rat model of laminectomy, different concentrations of suramin (100, 200, and 300 mg/ml) and saline were applied to the laminectomy sites locally. The effect of suramin on preventing epidural fibrosis was detected by the Rydell classification, hydroxyproline content, histological analysis, and collagen density analyses. Results The results of CCK-8 shown that suramin could significantly inhibit fibroblasts proliferation in a dose-dependent manner. The western blotting shown that the expression levels of the cell proliferation markers such as cyclin D1, cyclin E, and PCNA were down-regulated. Moreover, in a rat model, we found that suramin could reduce epidural fibrosis as well as inhibit fibroblast proliferation, and 300 mg/ml suramin had better effect. Conclusions Topical application of suramin could reduce epidural fibrosis after laminectomy, and the application of suramin could inhibit the proliferation of fibroblasts in rats. This study indicates that suramin is a potent antifibrotic agent that may have therapeutic potential for patients with epidural fibrosis.
Collapse
Affiliation(s)
- Jihang Dai
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Xiaolei Li
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Lianqi Yan
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Hui Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Jun He
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Shuguang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China.
| | - Yu Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Orthopaedic Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, 225001, China.
| |
Collapse
|
7
|
Nguyen C, Palazzo C, Grabar S, Feydy A, Sanchez K, Zee N, Quinquis L, Ben Boutieb M, Revel M, Lefèvre-Colau MM, Poiraudeau S, Rannou F. Tumor necrosis factor-α blockade in recurrent and disabling chronic sciatica associated with post-operative peridural lumbar fibrosis: results of a double-blind, placebo randomized controlled study. Arthritis Res Ther 2015; 17:330. [PMID: 26596627 PMCID: PMC4655494 DOI: 10.1186/s13075-015-0838-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/27/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess the efficacy and safety of tumor necrosis factor (TNF)-α inhibition with infliximab (IFX) in treating recurrent and disabling chronic sciatica pain associated with post-operative peridural lumbar fibrosis. METHOD A double-blind, placebo-controlled study randomized 35 patients presenting with sciatica pain associated with post-operative peridural lumbar fibrosis to two groups: IFX (n = 18), a single intravenous injection of 3 mg/kg IFX; and placebo (n = 17), a single saline serum injection. The primary outcome was a 50 % reduction in sciatica pain on a visual analog scale (VAS) at day 10. Secondary outcomes were radicular and lumbar VAS pain at day 0 and radicular and lumbar VAS pain, Québec disability score, drug-sparing effect and tolerance at days 10, 30, 90, and 180. RESULTS At day 10, the placebo and IFX groups did not differ in the primary outcome (50 % reduction in sciatica pain observed in three (17.6 %) versus five (27.8 %) patients; p = 0.69). The number of patients reaching the patient acceptable symptom state for radicular pain was significantly higher in the placebo than IFX group after injection (12 (70.6 %) versus five (27.8 %) patients; p = 0.01). The two groups were comparable for all other secondary outcomes. CONCLUSION Treatment with a single 3 mg/kg IFX injection for post-operative peridural lumbar fibrosis-associated sciatica pain does not significantly reduce radicular symptoms at day 10 after injection. TRIAL REGISTRATION ClinicalTrials.gov NCT00385086 ; registered 4 October 2006 (last updated 15 October 2015).
Collapse
Affiliation(s)
- Christelle Nguyen
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
- Univ. Paris Descartes, PRES Sorbonne Paris, Cité Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France.
| | - Clémence Palazzo
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
- Univ. Paris Descartes, PRES Sorbonne Paris, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France.
| | - Sophie Grabar
- Univ. Paris Descartes, PRES Sorbonne Paris, Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France.
- INSERM UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F-75013, Paris, France.
| | - Antoine Feydy
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Radiologie B, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Katherine Sanchez
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Nathalie Zee
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Radiologie B, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Laurent Quinquis
- Univ. Paris Descartes, PRES Sorbonne Paris, Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Myriam Ben Boutieb
- Univ. Paris Descartes, PRES Sorbonne Paris, Biostatistics and Epidemiology Unit, Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Michel Revel
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Marie-Martine Lefèvre-Colau
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Serge Poiraudeau
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
- Univ. Paris Descartes, PRES Sorbonne Paris, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France.
| | - François Rannou
- Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de Rééducation et Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.
- Univ. Paris Descartes, PRES Sorbonne Paris, Cité Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France.
| |
Collapse
|
8
|
Sun Y, Ge Y, Fu Y, Yan L, Cai J, Shi K, Cao X, Lu C. Mitomycin C induces fibroblasts apoptosis and reduces epidural fibrosis by regulating miR-200b and its targeting of RhoE. Eur J Pharmacol 2015; 765:198-208. [DOI: 10.1016/j.ejphar.2015.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/13/2015] [Accepted: 08/04/2015] [Indexed: 01/28/2023]
|
9
|
Zhang K, Zhao J, Su W, Lu R, Lv P. Immunomodulatory effectiveness of licofelone in preventing epidural fibrosis in post-laminectomy rat. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25 Suppl 1:S63-8. [PMID: 25200318 DOI: 10.1007/s00590-014-1534-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/03/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The object of this study was to investigate the effects of licofelone on the prevention of epidural fibrosis (EF) formation in post-laminectomy rat models. METHODS A controlled double-blinded study was conducted in sixty, healthy adult Wistar rats that underwent laminectomy at the L1-L2 vertebrae levels. All the rats were divided randomly into three groups according to the treatment (via oral gavage): (1) licofelone treatment group; (2) vehicle treatment group; (3) sham group (laminectomy without treatment). All rats were euthanized humanely 4 weeks postoperatively. The macroscopic assessment of EF, hydroxyproline content in epidural scar tissue, histological analysis, and the mRNA measurements of interleukin-6 (IL-6) and transforming growth factor-β1 were performed. RESULTS The Rydell score, hydroxyproline content, epidural scar density, and inflammatory factors expressions all suggested better results in licofelone group than the other two groups. CONCLUSION The application of licofelone could reduce hydroxyproline deposits, inflammatory factors expressions and prevent epidural adhesions in post-laminectomy rats.
Collapse
Affiliation(s)
- Kun Zhang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | | | | | | | | |
Collapse
|
10
|
Zhang C, Kong X, Liu C, Liang Z, Zhao H, Tong W, Ning G, Shen W, Yao L, Feng S. ERK2 small interfering RNAs prevent epidural fibrosis via the efficient inhibition of collagen expression and inflammation in laminectomy rats. Biochem Biophys Res Commun 2014; 444:395-400. [DOI: 10.1016/j.bbrc.2014.01.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
|
11
|
An Experimental Novel Study: Angelica sinensis Prevents Epidural Fibrosis in Laminectomy Rats via Downregulation of Hydroxyproline, IL-6, and TGF- β 1. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:291814. [PMID: 24069047 PMCID: PMC3773456 DOI: 10.1155/2013/291814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/22/2013] [Accepted: 07/31/2013] [Indexed: 12/13/2022]
Abstract
With laminectomy being widely accepted as the treatment for lumbar disorders, epidural fibrosis (EF) is a common complication for both the patients and the surgeons alike. Currently, EF is thought to cause recurrent postoperative pain after laminectomy or after discectomy. Angelica sinensis is a traditional Chinese medicine which has shown anti-inflammatory, antifibrotic, and antiproliferative properties. The object of this study was to investigate the effects of Angelica sinensis on the prevention of post-laminectomy EF formation in a rat model. A controlled double-blinded study was conducted in sixty healthy adult Wistar rats that underwent laminectomy at the L1-L2 levels. They were divided randomly into 3 groups according to the treatment method, with 20 in each group: (1) Angelica sinensis treatment group, (2) saline treatment group, and (3) sham group (laminectomy without treatment). All rats were euthanized humanely 4 weeks after laminectomy. The hydroxyproline content, Rydell score, vimentin cells density, fibroblasts density, inflammatory cells density, and inflammatory factors expressions all suggested better results in Angelica sinensis group than the other two groups. Topical application of Angelica sinensis could inhibit fibroblasts proliferation and TGF-β1 and IL-6 expressions and prevent epidural scar adhesion in postlaminectomy rat model.
Collapse
|
12
|
The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:971-9. [PMID: 22160098 DOI: 10.1007/s00586-011-2098-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 11/17/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE In the laminectomy model in rats, to verify anti-adhesive effectiveness of the new material, a mixture composed of poloxamer 407, calcium chloride, and xanthorrhizol, we compared it with that of commercially used solution form anti-adhesive agent GUARDIX-SL, Biorane. MATERIALS AND METHODS A total of 108 Sprague-Dawley rats (SD rats) were divided equally into three groups: negative control group (NCG), positive control group (PCG), and experimental group (EG). After exposing the dura on L4 level, we closed the wound shortly after hemostasis, after administering the anti-adhesive agent. To evaluate effectiveness, 18 SD rats from each group were killed after 1 week of rearing. Nine were examined by grading of gross adhesion and the other nine, by grading of histological adhesion. The degree of adhesion in the remainder of 18 SD rats in each group was examined with the same method after four weeks of rearing. RESULTS Comparing the degree of adhesion after growth for 1 week, the gross and histological adhesion of the EG was lower than that of the NCG. There was no statistical significance in the gross score (P = 0.63), but there was statistical significance in the histological score (P = 0.04). The EG showed similar or improved degrees of adhesion in comparison with the PCG. In comparison after growth for 4 weeks, although gross adhesion of the EG was not significantly lower than the NCG, histological adhesion was remarkably low in the EG (P = 0.01). The EG showed similar or improved degrees of gross and histological adhesion in comparison to that of the PCG. (P = 0.20, 0.07). CONCLUSION The new anti-adhesive material showed similar or improved effectiveness with the existing agents for commercial use. This result suggests that the new anti-adhesive material will be a successful candidate as a future product for clinical use.
Collapse
|
13
|
Postlaminectomy osteopontin expression and associated neurophysiological findings in rat peridural scar model. Spine (Phila Pa 1976) 2011; 36:378-85. [PMID: 20838370 DOI: 10.1097/brs.0b013e3181d12ef4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
14
|
Beckmann DV, Mazzanti A, Cunha MGM, Souza GS, Festugatto R, Santos RP, Neto DP, Baumhardt R. A musculatura epaxial e a fibrose epidural na compressão medular em cães submetidos à laminectomia dorsal modificada. PESQUISA VETERINARIA BRASILEIRA 2010. [DOI: 10.1590/s0100-736x2010000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo deste experimento foi isolar a musculatura epaxial da medula espinhal de cães submetidos à laminectomia dorsal modificada (LDM) e averiguar se os músculos influenciaram na formação da fibrose epidural, na compressão medular e no aparecimento dos sinais neurológicos. Para isso, dez cães hígidos foram submetidos à LDM entre as vértebras T13 e L1 e distribuídos aleatoriamente em dois grupos denominados controle (I) onde a medula espinhal permaneceu exposta sem a presença de implante, e tratado (II)onde foi colocado um im-plante a base de alumínio entre a musculatura epaxial adjacente e a medula espinhal exposta pela LDM. As avaliações constaram de exames neurológicos diários até 180 dias de pós-operatório (PO); mielografia, decorridos 15, 30 e 60 dias de PO; e avaliação macroscópica mediante a reintervenção cirúrgica. Não houve diferença durante as avaliações neurológicas. Aos 15 dias de PO, foi verificado na mielografia, que o grau de compressão da linha de contraste foi maior no grupo tratado (P<0,05) quando comparado ao grupo controle, não havendo diferença dos demais tempos estudados. Na avaliação macroscópica, pode-se observar que no Grupo II, a musculatura epaxial adjacente à medula espinhal não estava em contato com a fibrose epidural, diferentemente do grupo controle. O implante pôde ser removido facilmente e apresentava discreto grau de deformidade crânio-dorsal. Pode-se concluir que a musculatura epaxial adjacente é isolada da medula espinhal pelo implante à base de alumínio em cães submetidos à LDM, e esta não influencia na formação da fibrose epidural, compressão medular e no aparecimento dos sinais neurológicos.
Collapse
|
15
|
Mo F, Yue J, Zhang J, Howk K, Williams A. Evaluation of Perivascular Adhesion Formation in New Zealand White Rabbits Using Oxiplex and DuraSeal Xact Adhesion Barrier System. SAS JOURNAL 2009. [DOI: 10.1016/s1935-9810(09)70009-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Evaluation of Perivascular Adhesion Formation in New Zealand White Rabbits Using Oxiplex and DuraSeal Xact Adhesion Barrier System. Int J Spine Surg 2009; 3:68-76. [PMID: 25802630 PMCID: PMC4365594 DOI: 10.1016/sasj-2009-0006-nt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 05/27/2009] [Indexed: 11/21/2022] Open
Abstract
Background Adhesion formation after spine surgery is a result of normal wound healing that may place patients at increased risk for complications during revision surgery. Preventing adhesions could reduce the risk of complications during revision surgery, and possibly reduce the need for revision procedures. This study evaluates the ability of DuraSeal Xact Adhesion Barrier System (DSX) (Covidien, Mansfield, Massachusetts) and Oxiplex/SP gel (OX) (FzioMed, San Luis Obispo, California) to affect the extent and severity of postoperative perivascular adhesion development in an anterior spinal surgical rabbit model. Methods We determined the extent and severity of postoperative adhesion development 34 days after surgery in 12 male New Zealand White rabbits randomly assigned to intraoperative treatment with either DSX or OX, or to an untreated control group. Adhesion severity and extent were scored on scale from 0 (none) to 3 (severe). Results The extent and severity of adhesions in the DSX group were significantly less than in the untreated control group. The DSX group mean extent score was 1.3 ± 0.5 (vs 2.5, P = .01) and the mean severity score was 1.25 ± 0.5 (vs 2.8, P = .005). The extent and severity of adhesions in the OX group were not significantly different from the control group. Conclusion In this study, we found DSX to be the most effective compound in preventing adhesion formation after anterior spine surgery. Clinical Relevance Extrapolating these results in rabbits to humans, less scarring between the major blood vessels could decrease the rate of complications in revision spine procedures.
Collapse
|
17
|
Sun Y, Wang L, Sun S, Liu B, Wu N, Cao X. The effect of 10-hydroxycamptothecine in preventing fibroblast proliferation and epidural scar adhesion after laminectomy in rats. Eur J Pharmacol 2008; 593:44-8. [DOI: 10.1016/j.ejphar.2008.07.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 06/25/2008] [Accepted: 07/08/2008] [Indexed: 12/22/2022]
|
18
|
Rodrigues FF, Dozza DC, de Oliveira CR, de Castro RG. Failed back surgery syndrome: casuistic and etiology. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 64:757-61. [PMID: 17057881 DOI: 10.1590/s0004-282x2006000500011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 06/14/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS From the 121 patients submitted to spine surgical intervention, 47 (38.8%) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7%) had presented FBSS; of the 83 with disc herniation, 31 (37.3%) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3%) had failure of the back surgery. CONCLUSION The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.
Collapse
Affiliation(s)
- Flávio Freinkel Rodrigues
- Instituto de Neurologia Deolindo Couto, Serviço de Neurocirurgia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rua Buarque de Macedo 14/606, 22220-030 Rio de Janeiro RJ, Brazil
| | | | | | | |
Collapse
|
19
|
Yildiz KH, Gezen F, Is M, Cukur S, Dosoglu M. Mitomycin C, 5-fluorouracil, and cyclosporin A prevent epidural fibrosis in an experimental laminectomy model. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1525-30. [PMID: 17387523 PMCID: PMC2200739 DOI: 10.1007/s00586-007-0344-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 02/21/2007] [Accepted: 03/01/2007] [Indexed: 11/25/2022]
Abstract
This study examined the preventive effects of the local application of mitomycin C (MMC), 5-fluorouracil (5-FU), and cyclosporine A (CsA) in minimizing spinal epidural fibrosis in a rat laminectomy model. Thirty-two 2-year-old male Wistar albino rats, each weighing 400 +/- 50 g, were divided into four equal groups: sham, MMC, 5-FU, and CsA. Each rat underwent laminectomy at the L5-L6 lumbar level. Cotton pads (4 x 4 mm2) soaked with MMC (0.5 mg/ml), 5-FU (5 ml/mg), or CsA (5 mg/ml) were placed on the exposed dura for 5 min. Thirty days after surgery, the rats were killed and the epidural fibrosis, fibroblast density, inflammatory cell density, and arachnoid fibrosis were quantified. The epidural and arachnoid fibroses were reduced significantly in the treatment groups compared to the sham group. Fibroblast cell density and inflammatory cell density were decreased significantly in the MMC and 5-FU groups, but were similar in the sham and CsA groups. The decreased rate of epidural fibrosis was promising. Further studies in humans are needed to determine the short- and long-term complications of the agents used here.
Collapse
Affiliation(s)
- Kartal Hakan Yildiz
- Department of Neurosurgery, School of Medicine, Duzce University, 81620 Konuralp, Duzce, Turkey
| | - Ferruh Gezen
- Department of Neurosurgery, School of Medicine, Duzce University, 81620 Konuralp, Duzce, Turkey
| | - Merih Is
- Department of Neurosurgery, School of Medicine, Duzce University, 81620 Konuralp, Duzce, Turkey
| | - Selma Cukur
- Department of Pathology, Izzet Baysal State Hospital, Bolu, Turkey
| | - Murat Dosoglu
- Department of Neurosurgery, School of Medicine, Duzce University, 81620 Konuralp, Duzce, Turkey
| |
Collapse
|
20
|
Kato T, Haro H, Komori H, Shinomiya K. Evaluation of hyaluronic acid sheet for the prevention of postlaminectomy adhesions. Spine J 2005; 5:479-88. [PMID: 16153573 DOI: 10.1016/j.spinee.2005.01.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 01/26/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Various materials have been tested for their ability to maintain a barrier between muscles and epidural space in order to physically or chemically inhibit scar ingrowths. Hyaluronic acid (HA) solution and gel have been reported to be effective in preventing adhesions postlaminectomy; however, neither has been used clinically after spinal surgery. PURPOSE To determine the efficacy of HA sheet for the prevention of postlaminectomy adhesions compared with that of HA gel or another sheet. STUDY DESIGN/SETTING An animal model of lumbar laminectomy in rabbits was used to study postoperative scar tissue formation around the spinal cord. The histologic effects of HA sheet were compared with those of Gelfoam (GF) and further evaluated by an inflammation model using rhTNF-alpha. PATIENT SAMPLE Rabbit. OUTCOME MEASURES Histologic examination. METHODS Five rabbits were killed at 2, 4, 8, and 24 weeks after laminectomy, respectively. Another 18 rabbits were examined in an environment of active inflammation experimentally induced by rhTNF-alpha to compare the effects of HA sheet with those of GF or HA gel. Histologic examination was performed to quantitatively assess invasive scar formation or inflammation postlaminectomy, and then, the histologic effects of HA sheet were compared with those of GF or HA gel. RESULTS In the HA group, significantly, the area of subarachnoid space was larger, distance from the surface of dura to scar tissues was greater, the number of inflammatory cells in the scar tissues at the site of laminectomy was less, and enlargement of dura was suppressed. Using an inflammation model, we also demonstrated the efficacy of HA sheet treatment. CONCLUSIONS In an experimental laminectomy model, HA sheet formed a solid interpositional membrane barrier and exhibited anti-inflammatory activity. Further investigations will be needed for HA sheet to be used clinically.
Collapse
Affiliation(s)
- Tsuyoshi Kato
- Department of Spinal and Orthopaedic Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-5819, Japan
| | | | | | | |
Collapse
|
21
|
Alkalay RN, Kim DH, Urry DW, Xu J, Parker TM, Glazer PA. Prevention of postlaminectomy epidural fibrosis using bioelastic materials. Spine (Phila Pa 1976) 2003; 28:1659-65. [PMID: 12897488 DOI: 10.1097/01.brs.0000083161.67605.40] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The use of elastic protein-based polymers for the prevention of epidural fibrosis following lumbar spine laminectomy was investigated in a rabbit model. OBJECTIVES To determine the safety and efficacy of two bioelastic polymers in matrix and gel forms as interpositional materials in preventing postlaminectomy epidural fibrosis. SUMMARY OF BACKGROUND DATA Postlaminectomy epidural fibrosis complicates revision spine surgery and is implicated in cases of "failed back syndrome." Materials employed as mechanical barriers to limit tethering of neural elements by the fibrosis tissue have met with little success. A recent family of protein-based polymers, previously reported to prevent postoperative scarring and adhesions, may hold promise in treating this condition. METHODS Sixteen female New Zealand White rabbits underwent laminectomy at L4 and L6. Two polymer compositions, each in membrane and gel forms, were implanted at a randomly assigned level in four rabbits each, with the remaining level serving as an internal control. The animals were killed at 8 weeks, and qualitative and quantitative histology and gross pathologic examination were performed for both the control and the experimental sites to assess the polymers' efficacy in preventing dorsal epidural fibrosis. RESULTS The use of the polymers caused no adverse effects. Compared to the control sites, both polymers in either gel or membrane form significantly reduced the formation of epidural fibrosis and its area of contact with the dura postlaminectomy. However, no significant difference in efficacy was detected between either the polymers or their respective forms in preventing epidural fibrosis. CONCLUSIONS The selected compositions of biosynthetic, bioelastic polymers were safe and effective in the limiting the direct contact and consequent tethering of the underlying neural elements by the postlaminectomy epidural fibrosis in rabbits.
Collapse
Affiliation(s)
- Ron N Alkalay
- Harvard Medical School, Orthopaedic Biomechanics Laboratory, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
22
|
Bora H, Aykol SV, Akyürek N, Akmansu M, Ataoglu O. Inhibition of epidural scar tissue formation after spinal surgery: external irradiation vs. spinal membrane application. Int J Radiat Oncol Biol Phys 2001; 51:507-13. [PMID: 11567827 DOI: 10.1016/s0360-3016(01)01647-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The scar tissue that forms after lumbar dissection is a severe complication and a cause of lumbar and radicular pain. It was recently shown that radiotherapy could inhibit peridural fibrosis after laminectomy. In this study, the efficiency of external irradiation was compared with spinal membrane application. METHOD AND MATERIALS Thirty male New Zealand rabbits underwent L5 laminectomy. Ten rabbits each received a single fraction of 900-cGy external irradiation administered by 9-MeV electron beam 24 h after the surgery. Ten other rabbits each had spinal membrane applied during laminectomy. The remaining 10 rabbits constituted the control group. All of the rabbits were killed 30 days after the laminectomy. Axial histologic sections through the laminectomy defect were evaluated. Each specimen was scored for the extent and density of fibrosis and arachnoidal adherence. RESULTS The extent and density of fibrosis and arachnoidal adherence differed significantly between the control group and the treatment groups (p < 0.05). However, the extent and density of fibrosis and arachnoidal adherence did not differ significantly between the spinal membrane and irradiation groups (p > 0.05). CONCLUSION This preliminary study showed that high-single-fraction/low-total-dose administered postoperatively can successfully inhibit postsurgical epidural fibrosis as effectively as applied spinal membrane.
Collapse
Affiliation(s)
- H Bora
- Department of Radiation Oncology, Gazi University, Ankara, Turkey
| | | | | | | | | |
Collapse
|