Antifibrotic Effect of Bletilla striata Polysaccharide-Resveratrol-Impregnated Dual-Layer Carboxymethyl Cellulose-Based Sponge for The Prevention of Epidural Fibrosis after Laminectomy.

Hsuan-Yu Chen,Chih-Hao Chang,Tzu-Chieh Lin,Chih-Yung Chiang,Ming-Hsiao Hu,Kai-Chiang Yang,Feng-Huei Lin,Shiuan-Li Wey

doi:10.3390/polym13132129

Abstract

The application of antifibrotic materials can alleviate epidural fibrosis by restricting excessive fibroblast proliferation and mitigating scar tissue formation. Here, a biodegradable carboxymethyl cellulose (CMC)-Bletilla striata polysaccharide (BSP)-resveratrol (RES) sponge was fabricated to inhibit scar tissue formation post laminectomy surgery. Fibroblasts NIH/3T3, myoblasts C2C12, neural cells PC-12, and Schwann cells RSC96 were used to evaluate the in vitro cytocompatibility. Laminectomies on 10 Sprague–Dawley rats with/without the application of the CMC-BSP-RES sponge were performed. The severity of adhesion between the dura mater and formed scar tissue was qualitatively scored. All cell lines exhibited good viability with no significant difference in cytotoxicity when cultured with variable extractions of the CMC-BSP-RES sponge. S100a4 and P4hb expressions were downregulated in NIH/3T3 cultured in the CMC-BSP-RES sponge, implying that this sponge potentially inhibits fibroblast activity. No post-operative shrinkage or dura mater expansion along the surgical site was detected. The peel-off tests revealed that the tenacity of adhesion de-creased. Histopathological examinations verified that the average number of fibroblasts in the CMC-BSP-RES group considerably decreased. The CMC-BSP-RES sponge is a biocompatible and effective material for alleviating post-operative epidural fibrosis and mitigating fibroblast expression following laminectomy.

Highlights

Laminectomy is a surgical procedure typically employed in the treatment of numerous spinal disorders such as lumbar disk herniation, spinal stenosis, and tumor excision [1]
The aforementioned adhesions potentially contribute to 20–36% of the reported failed back surgery syndrome (FBSS) cases, by inducing nerve irritation, dura sac compression, and back pain [8] and increase the technical difficulty and risks associated with revision surgery
PC-12 neural cells and NIH/3T3 fibroblasts presented good viability only when cultured in 0.1 mg/mL carboxymethyl cellulose (CMC)-Bletilla striata polysaccharide (BSP)-RES sponge extraction media (Figure 5c)

Summary

Introduction

Laminectomy is a surgical procedure typically employed in the treatment of numerous spinal disorders such as lumbar disk herniation, spinal stenosis, and tumor excision [1]. This treatment is generally effective and relieves neural compression, 8–40% of patients suffer from failed back surgery syndrome (FBSS), with 4–9% undergoing revision surgery [2,3]. The above-described exaggerated and dysregulated “healing” mechanisms, as a response to trauma, culminate in local acute inflammations, extracellular matrix deposition, fibrosis, and neo-angiogenesis [7] Several factors, such as individual variability, wound healing process, hematoma, soft tissue amount, and bone traumatization are involved in the process, and they have important roles in the pathogenesis of epidural fibrosis. The number of patients suffering from epidural fibrosis is increasing, especially given the substantially higher rates of spine surgery in the past few decades [9]

Methods

Results

Conclusion