The Use of Human Amnion/Chorion for the Enhancement of Collagen Synthesis and Acceleration of Wound Healing in a Diabetic Rat Model

Abstract

Diabetic patients have impaired wound repair due to decreased fibroblast infiltration, growth factor production, and angiogenesis. Decellularized human amnion/chorion placental connective tissue matrix (PCTM) has high levels of extracellular matrix components, is rich in growth factors that promote angiogenesis, and has anti-inflammatory properties, so it was hypothesized that PCTM could enhance healing in diabetic rats. Fibroblasts were cultured in a 10% PCTM solution, and controls were unaugmented. Real-time PCR and thymidine and proline uptake were used to determine fibroblast proliferation and collagen type I synthesis, respectively. Two dorsal dermal lesions were subsequently induced in eighteen diabetic rats. One lesion was untreated; the other was covered with PCTM or porcine small intestinal submucosa (SIS) and secured with sutures. Rats were sacrificed 1, 2, or 3\xa0weeks postoperatively and analyzed on macroscopic appearance, fibrosis, epithelialization, and inflammation. In vitro placental augmentation resulted in a six-fold increase in collagen synthesis and a significant increase in fibroblast proliferation. In vivo PCTM treatments significantly increased epithelialization without increasing inflammation. PCTM-treated wounds had re-epithelialized within 2\xa0weeks, whereas SIS treatments required three. These results indicate that PCTM accelerates healing due to enhanced fibroblast proliferation and collagen type I production. Diabetes is a challenging wound repair model; as such PCTM may have implications for treating injuries in both diabetic and healthy patients.