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Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion.

ABSTRACT: Postoperative peritoneal adhesions were frequent complications for almost any types of abdominal and pelvic surgery. This led to numerous medical problems and huge financial burden to the patients. Current anti-adhesion strategies focused mostly on physical barriers including films and hydrogels. However, they can only alleviate or reduce adhesions to certain level and their applying processes were far from ideal. This work reported the development of a biodegradable zwitterionic cream gel presenting a series of characters for an idea anti-adhesion material, including unique injectable yet malleable and self-supporting properties, which enabled an instant topical application, no curing, waiting or suturing, no hemostasis requirement, protein/cell resistance and biodegradability. The cream gel showed a major advancement in anti-adhesion efficacy by completely and reliably preventing a primary and a more severe recurrent adhesion in rat models.

SUBMITTER: Zhang E

PROVIDER: S-EPMC7942753 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion.

Zhang Ershuai E Yang Jianhai J Wang Ke K Song Boyi B Zhu Hui H Han Xiangfei X Shi Yuanjie Y Yang Chengbiao C Zeng Zhipeng Z Cao Zhiqiang Z

Advanced functional materials 20201218 10

Postoperative peritoneal adhesions were frequent complications for almost any types of abdominal and pelvic surgery. This led to numerous medical problems and huge financial burden to the patients. Current anti-adhesion strategies focused mostly on physical barriers including films and hydrogels. However, they can only alleviate or reduce adhesions to certain level and their applying processes were far from ideal. This work reported the development of a biodegradable zwitterionic cream gel prese ...[more]

PMID: 33708034

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Project description:ObjectivesPostoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). The former sometimes can be life threatening and the latter is the most common reason requiring revision surgery. This study was designed to evaluate the effect of newly developed chitosan gel (8% carboxymethyl chitosan, Surgi shield) on hemostasis and wound healing after ESS.MethodsA prospective, randomized, double-blind controlled trial was conducted in 33 patients undergoing symmetric ESS. At the conclusion of the operation, Surgi shield was randomly applied on one side of the nasal cavity, with the opposite side acting as control and the bleeding quantity of the surgical field was evaluated every 2 minutes. And then, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Surgi shield was applied to the Merocel of intervention side and saline was applied to the other side. Merocel in both nasal cavities was removed and 5 mL of Surgi shield was applied again to the intervention side on the second day after surgery. The nasal cavity was examined using a nasal endoscope and the degree of adhesion, crusting, mucosal edema, infection, and granulations were graded at 1, 2, and 4 weeks after surgery.ResultsComplete hemostasis was rapidly achieved in the Surgi shield applied side compared with the control side at 2, 4, 6, 8, and 10 minutes after application of Surgi shield (P=0.007, P=0.004, P<0.001, P=0.001, and P<0.001, respectively). There were significantly less adhesions on the Surgi shield applied side at postoperative 1, 2, and 4 weeks (P=0.001, P<0.001, and P<0.001, respectively). The degree of mucosal edema, infection, crusting, or granulation formation assessed by the endoscopic features in the Surgi shield applied side was not significantly different from that of the control side (P>0.05). No adverse effects were noted in the patient series.ConclusionSurgi shield containing chitosan can be used safely to achieve rapid hemostasis immediately after ESS and to prevent adhesion formation.

Project description:A fully biodegradable zwitterionic polymer and the corresponding conjugate with paclitaxel (PTX) were synthesized as promising biomaterials. Allyl-functionalized polylactide (PLA) was employed as the precursor of polymer backbones. UV-induced thiol-ene reaction was conducted to conjugate thiol-functionalized sulfobetaine (SB) with the PLA-based backbone. The resulting zwitterionic polymer did not exhibit considerable cytotoxicity. A polymer-drug conjugate was also obtained by thiol-ene reaction of both thiol-functionalized SB and PTX with allyl-functionalized PLA. The conjugate could readily form narrowly-dispersed nanoparticles in aqueous solutions with a volume-average hydrodynamic diameter (Dh,V) of 19.3 ± 0.2 nm. Such a polymer-drug conjugate-based drug delivery system showed full degradability, well-suppressed non-specific interaction with biomolecules, and sustained drug release. In vitro assessments also confirmed the significant anti-cancer efficacy of the conjugate. After 72 h incubation with PLA-SB/PTX containing 10 µg/mL of PTX, the cell viabilities of A549, MCF7, and PaCa-2 cells were as low as 20.0 ± 2.5%, 1.7 ± 1.7%, and 14.8 ± 0.9%, respectively. Both flow cytometry and confocal microscopy suggested that the conjugates could be easily uptaken by A549 cells before the major release of PTX moieties. Overall, this work elucidates promising potentials of biodegradable zwitterionic polymer-based materials in biomedical applications.Statement of significanceThe applicability of FDA-approved biodegradable aliphatic polyesters has been significantly restricted because they are hydrophobic and lack functionalities. Recently zwitterionic polymers have emerged as promising hydrophilic biomaterials, but most of the reported zwitterionic polymers are non-biodegradable. This study reports a novel aliphatic polyester-based zwitterionic polymer and the corresponding polymer-drug conjugate. Their aliphatic polyester and zwitterionic components provide them with high enzymatic degradability and low nonspecific interactions with biomolecules, respectively. While the zwitterionic polymer did not show noticeable cytotoxicity, the corresponding polymer-anticancer drug conjugate exhibited acid-sensitive sustained drug release, remarkable effectiveness in killing cancer cells, as well as the ready cellular internalization. This work lays a foundation for the further development of synthetic biodegradable zwitterionic polymer-based materials which potentially may have broad and significant biomedical applications.

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Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion.

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Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion.

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