An alternative sutureless repair technique with amelogenin for duodenal perforation.

BACKGROUND: Among the various sutureless techniques, fibrin glue has proved to be effective in the treatment of peptic ulcer perforation as an alternative to classical suture repair. Albeit rare, a potential disadvantage of fibrin glue use is viral transmission or anaphylaxis. The aim of this study is to introduce a new technique for the closure of duodenal perforation using a novel recombinant enamel protein called amelogenin. METHODS: In this case-control experimental study, 32 adult male Wistar Albino rats weighing 250-300 g were randomly divided into four groups, each containing 8 rats. Duodenal perforation of 0.2 cm were performed in the postpyloric region in all rats. Each group received primary repair, primary repair with omentoplasty, fibrin glue, and amelogenin, respectively. All animals were killed on the postoperative day five and the bursting pressure measurements, hydroxyproline levels and histopathologic values of the wound site were evaluated. RESULTS: Bursting pressure levels of the fibrin glue and amelogenin groups were significantly lower than the primary repair and primary repair with omentoplasty groups (P < 0.05) However, no significant difference existed between the fibrin glue and amelogenin groups in this respect (P > 0.05). There was also no statistically significant difference among all groups regarding tissue hydroxyproline levels and histopathologic values (P > 0.05). CONCLUSION: Application of amelogenin as an alternative sutureless repair technique did not improve wound healing in this animal model of duodenal perforation.

Effect of amelogenin ECM protein on the healing of chronic leg ulcers with atrophie blanche.

OBJECTIVE: To determine the effect of topically applied amelogenin extracellular matrix protein(AEMP) in patients with non-healing venous leg ulcers combined with atrophie blanche. METHOD: This retrospective case series of patients with non-healing venous leg ulcers with atrophie blanche of the distal proportion of their lower legs, where non-healing was defined as no progress toward healing for 3 months previously, under standard therapy. Patient records were reviewed for associated diseases, wound diagnoses, distal blood pressure, previous treatments and changes in wound area. Patients were treated with AEMP once a week, for a period of 12 weeks, or until full healing. RESULTS: Eleven patient records were reviewed retrospectively. The median age of the patients was 81 years (range 40-95 years), with a mean wound size of 4.7 ± 3.Scm2 and median wound duration of 6 months (range 3-444 months).AII patients had venous or combined arterial/venous insufficiency. After 12 weeks' treatment with AEMP, complete healing, defined as I 00% re-epithelialisation, was documented in four patients (36%), marked improvement(> SO% epithelialisation) in three patients (54%, 55% and 83% wound closure, respectively), slight improvement in one patient (9.4% wound closure), no change for two patients and worsening in one.AEMP was well tolerated, and no patients reported side effects. CONCLUSION: The results of this retrospective study suggest that AEMP improves healing in chronic venous leg ulcers combined with atrophie blanche.

Amelogenin (an extracellular matrix protein) application on ischemic colon anastomosis in rats.

BACKGROUND: Ischemia is a troublesome problem that can cause intestinal emergencies and complicate the treatment. Identification of a chemical agent with beneficial effects on the healing process in risky colon anastomosis with the aim of reducing leakage rates is a popular topic in the era of surgical research. Data is lacking about the role of amelogenin, an extracellular matrix protein, during the healing process of gastrointestinal anastomosis. In this study, the effects of amelogenin treatment on ischemic colon anastomosis were evaluated. METHODS: Adult male Wistar Albino rats weighing 200-250 g were divided into three weight-matched groups as normal colon anastomosis group (n=8), ischemic colon anastomosis group (n=8), and amelogenin-treated ischemic colon anastomosis group (n=8). Sufficient equal volume of amelogenin to cover the anastomosis area entirely was applied topically. All animals were sacrificed on postoperative day four. Bursting pressure levels were measured. Peri-anastomotic colon tissue hydroxyproline levels were also assessed. RESULTS: Bursting pressure level of the ischemic colon anastomosis group was significantly lower than the normal colon anastomosis and the amelogenin-treated ischemic colon anastomosis groups, respectively (p=0.006, p=0.008). CONCLUSION: Amelogenin treatment supports the physical strength of ischemic colon anastomosis.

The effect of amelogenins (Xelma) on hard-to-heal venous leg ulcers.

With an aging population venous ulceration is likely to become an increasing problem. Despite improvements in care and the widespread introduction of compression bandaging, the mainstay of current management, a significant proportion of venous leg ulcers remain hard to heal. Therefore, a single-blinded, randomized multicenter study was performed to compare wound size reduction using amelogenin proteins (Xelma) formulated into a solution which forms a temporary extracellular matrix on contact with the wound bed. Propylene glycol alginate 7% served as a control. Patients were randomized to receive either amelogenin protein or control treatment. The investigational products were applied weekly under soft silicone secondary dressings for up to a maximum of 12 weeks. Compression therapy was maintained throughout the investigation. Wound size reduction was measured by tracing and all wounds were photographed. In total 123 patients were recruited, 62 patients in the amelogenin group, and 61 in the control group, respectively. Subgroup analyses were performed for ulcers with a size>10 cm2 at baseline and for ulcers of duration of >12 months. The wound size reduction was greatest in the group treated with amelogenin (33.8 vs. 25.6%, n=117), this difference being greatest for larger ulcers (25 vs. 7.9% for ulcers>10 cm(2), n=61) and those of long duration (29.3 vs. 10.9% for ulcers>12-month duration, n=61). We conclude that this product may be clinically useful in the treatment of these venous leg ulcers.

Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation.

BACKGROUND: Ginigival recession can be successfully treated with coronally positioned flaps. Twelve-month data failed to demonstrate that topical application of enamel matrix derivative (EMD) used in combination with the coronally positioned flap enhances clinical outcomes of the surgical technique used alone. This study was designed to examine the effects of EMD combined with the coronally positioned flap over an 18-month postoperative period. METHODS: Thirty patients presenting with Miller Class I or II gingival recessions on single-rooted teeth participated in this parallel-design clinical study. Six weeks after phase I therapy, recession areas were surgically treated with a coronally positioned flap for root coverage. Teeth in the experimental group received EMD treatment of the exposed root, whereas control teeth did not. Clinical parameters evaluated at baseline and 18 months postoperatively included gingival recession, clinical attachment level, probing depth, and the apico-coronal dimension of the keratinized tissue. RESULTS: Compared to baseline, 18-month measurements showed a significant reduction in probing depth, gain in attachment level, and decrease in gingival recession for control and experimental groups. When the results of the two treatment groups were compared, the experimental group presented with significantly greater root coverage than the control group (2.66 +/- 0.61 mm versus 1.73 +/- 0.70 mm, respectively), more gain in clinical attachment than the control group (2.80 +/- 0.76 mm versus 2.06 +/- 0.70 mm, respectively), and a greater gain in the apico-coronal dimension of the keratinized tissue than the control group (0.13 +/- 0.06 mm versus -0.06 +/- 0.01 mm, respectively). CONCLUSION: The results of this study indicate that topical application of EMD is beneficial in augmenting the effects of the coronally positioned flap in terms of amount of root coverage, gain in clinical attachment, and in increasing the apico-coronal dimension of the keratinized tissue.