Abstract
Treatment of tracheal stenosis is occasionally performed in combination with wound healing modulators to manipulate new extracellular matrix (ECM) formation and prevent fibrosis. Hyaluronic acid (HA) and collagen-polyvinylpyrrolidone (collagen-PVP) decrease fibrosis in experimental tracheal healing. However, they have not been used clinically as their effect on ECM components, which modify tracheal scarring, has not been described. Objective. To evaluate the effect of the application of HA, collagen-PVP, a mixture of HA and collagen-PVP (HA+collagen-PVP), and mitomycin C on the expression of decorin, matrix metalloproteinase 1 (MMP1), and MMP9, as well as the type of collagen and deposits formed in the scar after resection and end-to-end anastomosis (REEA) of the cervical trachea using an experimental model. Materials and Methods. Thirty dogs underwent REEA of the cervical trachea and were treated with different wound healing modulators: group I (n = 6), control; group II (n = 6), HA; group III (n = 6), collagen-PVP; group IV (n = 6), HA+collagen-PVP; and group V (n = 6), mitomycin C. The dogs were evaluated clinically and endoscopically for 4 weeks. Subsequently, macroscopic and microscopic changes, expression of ECM proteins, and collagen deposition in tracheal scars were analysed. Results. Groups II, III, and IV showed reduced endoscopic, macroscopic, and microscopic inflammation, improved neovascularization, high decorin expression (p < 0.01, analysis of variance (ANOVA)), and moderate expression of MMP1 (p < 0.003, ANOVA) and type I and III collagen (p < 0.05, Kruskal–Wallis). Groups IV and V developed fewer collagen deposits (p < 0.001, ANOVA). Conclusion. Treatment with HA and collagen-PVP improved post-REEA healing by increasing neovascularization, stimulating the expression of decorin, and regulating the expression of MMP1, as well as type I and III collagen and their deposition.
Highlights
Posttraumatic tracheal stenosis (TS) and tracheal restenosis are disproportionate fibrotic tracheal wounds that obstruct the lumen and prevent airflow [1]. They are the result of pathological wound healing processes in which chronic inflammation and ischaemic necrosis alter the production of cytokines, growth factors, and matrix metalloproteinases (MMPs)
Since TS is the result of pathological scarring, treatment is occasionally performed in combination with the application of wound healing modulators (WHMs), such as mitomycin C (MMC), to pharmacologically manipulate the formation of the new extracellular matrix (ECM) and prevent fibrosis
The objective of this study was to evaluate the effect of Hyaluronic acid (HA), collagen-PVP, HA+collagen-PVP, and MMC on the expression of decorin, matrix metalloproteinase 1 (MMP1), and MMP9, as well as the deposition and type of collagen formed in the scar after resection and end-to-end anastomosis (REEA) of cervical trachea (CT) using an experimental model
Summary
Posttraumatic tracheal stenosis (TS) and tracheal restenosis are disproportionate fibrotic tracheal wounds that obstruct the lumen and prevent airflow [1] They are the result of pathological wound healing processes in which chronic inflammation and ischaemic necrosis alter the production of cytokines, growth factors, and matrix metalloproteinases (MMPs). Since TS is the result of pathological scarring, treatment is occasionally performed in combination with the application of wound healing modulators (WHMs), such as mitomycin C (MMC), to pharmacologically manipulate the formation of the new ECM and prevent fibrosis Of note, these treatments are not 100% effective, as they do not prevent restenosis [1, 5]. It is necessary to evaluate alternative WHMs
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