Gilbert M Erik, Kirker Kelly R, Gray Steven D, Ward P Daniel, Szakacs Juliana G, Prestwich Glenn D, Orlandi Richard R
Division of Otolaryngology--Head and Neck Surgery, University of Utah Medical Center, School of Medicine, Salt Lake City, UT 84132, USA.
Laryngoscope. 2004 Aug;114(8):1406-9. doi: 10.1097/00005537-200408000-00017.
OBJECTIVES/HYPOTHESIS: Chondroitin sulfate (CS) is a glycosaminoglycan in the extracellular matrix of all vertebrates. A biocompatible, nonimmunogenic, pliable hydrogel preparation of CS has recently been produced and has shown benefit in wound healing in murine and porcine epidermis. The objective of the current experiment is to compare the wound healing properties of CS hydrogel versus no treatment in wounds of the maxillary sinus mucosa.
Prospective investigation in an animal model.
A 6 mm wound was created in bilateral maxillary sinuses of 17 New Zealand white rabbits. CS hydrogel (case) and no dressing (control) were randomly assigned to one side each as wound treatment. Wounds were examined ex vivo at 2, 4, 6, 10, and 14 day postinjury intervals. Wound diameter was measured microscopically by a blinded investigator. Representative specimens were examined histologically.
The CS disc was partially integrated into the wounds at the 4-day interval and completely integrated by the 6-day interval. The average wound diameters for the case versus control side were similar at 2 days (3.75 mm vs. 4.42 mm) but differed significantly at 4 days (2.86 mm. vs. 3.80 mm., P =.035). At 6 days, the wounds could not be discerned on either the case or control sides. However, histologic analysis revealed accelerated healing with the CS treatment. The treated wounds displayed respiratory epithelium as opposed to the squamous epithelium exhibited on the untreated sides.
Despite some limitations, the New Zealand white rabbit is an effective model for the study of sinonasal wound healing. CS hydrogel accelerates wound healing in sinonasal mucosa at a 4-day endpoint. We propose that the CS hydrogel acts as a surrogate extracellular matrix, serving as a repository for cytokines and growth factors produced by the regenerating mucosa. It may also provide a structural framework for fibroblasts and epithelial regeneration. Further study is necessary to establish this relationship.
目的/假设：硫酸软骨素（CS）是所有脊椎动物细胞外基质中的一种糖胺聚糖。最近制备了一种生物相容性、非免疫原性、柔韧的CS水凝胶制剂，并已显示出对小鼠和猪表皮伤口愈合有益。本实验的目的是比较CS水凝胶与未治疗对上颌窦黏膜伤口愈合特性的影响。
在动物模型中的前瞻性研究。
在17只新西兰白兔的双侧上颌窦中制造一个6毫米的伤口。将CS水凝胶（病例组）和不进行敷料处理（对照组）随机分配到每侧作为伤口治疗方法。在损伤后的第2、4、6、10和14天间隔对伤口进行离体检查。由一位不知情的研究者通过显微镜测量伤口直径。对代表性标本进行组织学检查。
CS盘在4天时间间隔时部分融入伤口，到6天时间间隔时完全融入。病例组与对照组在第2天的平均伤口直径相似（3.75毫米对4.42毫米），但在第4天有显著差异（2.86毫米对3.80毫米，P = 0.035）。在第6天，病例组和对照组的伤口均无法辨认。然而，组织学分析显示CS治疗可加速愈合。经治疗的伤口显示为呼吸道上皮，而未治疗侧为鳞状上皮。
尽管存在一些局限性，但新西兰白兔是研究鼻窦伤口愈合的有效模型。CS水凝胶在4天的观察终点时可加速鼻窦黏膜伤口的愈合。我们认为CS水凝胶起到了替代细胞外基质的作用，作为再生黏膜产生的细胞因子和生长因子的储存库。它还可能为成纤维细胞和上皮再生提供结构框架。需要进一步研究来确立这种关系。
