Evaluation of polysaccharide-based nanofibrous membranes as intra-abdominal adhesion barriers

The study aims to produce nanofibrous membranes from polysaccharide-based polymers as novel surgical adhesion barriers and to test the clinical efficiency of developed nanofibrous anti-adhesive barriers in vivo conditions. The anti-adhesive effects of electrospun nanofibrous membranes made of hyaluronic acid/carboxymethyl cellulose (HA/CMC) and hyaluronic acid/sodium alginate (HA/NaAlg) were investigated in comparison with a commercial adhesion barrier. HA/CMC and HA/NaAlg nanofibrous membranes were prepared by electrospinning, followed by cross-linking with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride/N-hydroxysulfosuccinimide (EDC/NHS). The effects of electrospun nanofibrous membranes on the formation of adhesion, fibrosis, inflammation, and neovascularization post-operation were evaluated in a rat model. Scanning electron microscope (SEM) and atomic force microscope (AFM) images showed that the beadless and continuous nanofibers were produced for both membranes. The groups that used HA/CMC and HA/NaAlg nanofibrous membranes were not statistically different in macroscopic adhesion formation, fibrosis, and inflammation (P > 0.05), except for in neovascularization (P < 0.05). On the other hand, the HA/NaAlg nanofibrous membrane was distinctly decreased inflammation, fibrosis and neovascularization and, was statistically different in all parameters except for fibrosis, compared with Seprafilm and control groups. The results suggested that electrospun nanofibrous membranes were more effective in preventing the adhesion process than the commercial product. It was emphasized that the mesh material frequently used in abdominal surgery causes severe adhesion and as a result there is a need to use nanofibrous adhesion barrier.

Graphical Abstract