Giuseppe Rettura

Impaired wound healing in streptozotocin diabetes. Prevention by supplemental vitamin A.

Goodson and Hunt showed that wound healing is impaired in streptozotocin (Sz) diabetic rats; we speculated that this impairment results from defective early inflammatory responses to wounding. Because we had shown that supplemental vitamin A stimulates the early inflammatory response to wounding in nondiabetic rats, we studied the effect of supplemental vitamin A on wound healing in rats with Sz-induced diabetes. Male Sprague-Dawley rats were fed a commercial rat chow containing twice the amount of vitamin A recommended by the NRC for healthy rats. The rats ate and drank (tap water) ad libitum. Two-thirds of the rats were injected (intravenously) with Sz 60 mg/kg body weight. All of these rats became diabetic (hyperglycemia greater than 350 mg/dl, hyperphagic, polydipsic, polyuric, glycosuric greater than 2%). Seven days later, half of the Sz-injected rats were continued on the chow (Group 2) while the other half (Group 3) were switched to the chow supplemented with 150,000 units of vitamin A/kg chow. The next day, all were wounded (7 cm skin incisions and s.c. polyvinyl alcohol sponge implants). Similarly wounded saline injected nondiabetic rats ingesting the unsupplemented chow served as controls (Group 1). The wounds of Group 2 rats healed poorly compared to Group 1 (breaking strength of skin incisions, 308 +/- 19 g vs 584 +/- 23 g, p less than 0.001; hydroxyproline of the sponge reparative tissue, 0.87 mg vs 2.40 mg/100 mg sponge p less than 0.001). Supplemental vitamin A (Group 3) did not affect the hyperglycemia, hyperphagia, polydipsia or glycosuria, but increased the breaking strengths of the incisions of the diabetic rats (468 +/- 40 g, p less than 0.001), and the sponge hydroxyproline (2.38 mg/100 mg sponge, p less than 0.001). In another experiment, in which the wounding and start of supplemental vitamin A were delayed until 28 days after streptozotocin administration (50 mg/kg body weight), similar results were obtained. Streptozotocin diabetes also caused a decrease in the cross-linking of reparative collagen as judged by the ratio of breaking strengths of skin incisions before and after formalin fixation. Supplemental vitamin A did not influence this defect. Sz also caused peripheral lymphocytopenia, adrenal hypertrophy and thymic involution which responded to the supplemental vitamin A. Based upon experimental data and theoretical considerations we conclude Sz diabetes causes two defects in wound healing: a) quantitatively (reduction in reparative collagen accumulation) and b) qualitative reduction in the degree of cross-linking of reparative wound collagen. The action of supplemental vitamin A in correcting the impaired wound healing, adrenal enlargement, thymic involution and lymphocytopenia of Sz-diabetic rats is independent of an effect on their disturbed carbohydrate metabolism.

Immunostimulatory effects of arginine in normal and injured rats

Abstract We have shown in the present experiments that femoral fractures, particularly bilateral fractures, lead to impaired thymic function in rats as assessed by thymic size, numbers of thymic lymphocytes, and ability of thymic lymphocytes to respond to mitogenic stimulation. The in vitro depression in T-cell function appears to be a primary one since it is also observed in serum-free microculture systems. We have also shown that 1% dietary arginine supplementation largely prevents or minimizes the thymolysis and T-cell dysfunction that appear post-trauma. In addition, dietary supplemental arginine significantly increases thymic weight, cellularity, and T-cell blastogenic responsiveness in uninjured rats. This suggests that arginine may be a safe nutritional means of correcting immune depression in injured and/or stressed patients.

Supplemental vitamin A prevents the acute radiation-induced defect in wound healing.

Acute radiation injury leads to thymic involution, adrenal enlargement, leukopenia, thrombocytopenia, gastrointestinal ulceration, and impaired wound healing. The authors hypothesized that supplemental vitamin A would mitigate these adverse effects in rats exposed to acute whole-body radiation. This hypothesis was based on previous experiments in their laboratory that showed that supplemental vitamin A is thy-motropic for normal rodents and lessens the thymic involution, lymphopenia, and adrenal enlargement that follows stress, trauma, and neoplasia, largely obviates the impaired wound healing induced by the radlomimetic drugs streptozotocin and cyclophosphamide, lessens the systemic response (thymic involution, adrenal enlargement, leukopenia, lymphocytopenia) to local radiation, and shifts the median lethal dose (LD50/30) following whole-body radiation to the right. To test their hypothesis, dorsal skin incisions and subcutaneous implantation of polyvinyl alcohol sponges were performed in anesthetized Sprague-Dawley rats at varying times following sham radiation or varying doses of whole-body radiation (175–850 rad). In each experiment, the control diet [which contains about 18,000 IU vit. A/kg chow (3 X the NRC RDA for normal rats)] was supplemented with 150,000 IU vit. A/kg diet beginning at, before, or after sham radiation and wounding or radiation and wounding. The supplemental vitamin A prevented the impaired wound healing and lessened the weight loss, leukopenia, thrombocytopenia, thymic involution, adrenal enlargement, decrease in splenic weight, and gastric ulceration of the radiated (750–850 rad) wounded rats. This was true whether the supplemental vitamin A was begun before (2 or 4 days) or after (1–2 hours to 4 days) radiation and wounding; the supplemental vitamin A was more effective when started before or up to 2 days after radiation and wounding. The authors believe that prevention of the impaired wound healing following radiation by supplemental vitamin A is due to its 1) enhancing the early inflammatory reaction to wounding, including increasing the number of monocytes and macrophages at the wound site; 2) possible

Cyclosporine A Impairs Wound Healing in Rats

Cellular immune responses may play an important role in the early inflammatory and cellular phases of wound healing. Cyclosporine A (CSA), a new immunosuppressive agent, impairs cellular immunity and T-cell-dependent humoral immunity. Therefore, the effect of CSA-induced immunosuppression in a rat wound-healing model was studied. Sprague-Dawley rats underwent a standardized skin incision and subcutaneous implantation of sterile polyvinyl alcohol sponges. CSA was dissolved in olive oil and given by gavage to one group of animals at a total dose of 125 mg/kg/10 days. The control group received an equivalent volume of olive oil. Ten-day-old wounds were weaker in CSA-treated animals, both in the fresh state (282 +/- 19 g vs 380 +/- 27 g, P less than 0.01), and after formalin fixation (1111 +/- 74 g vs 1419 +/- 57 g, P less than 0.01). In addition, CSA-treated rats accumulated significantly less hydroxyproline in the wound sponge granuloma, an index of reparative collagen deposition. The impairment in wound healing occurred without differences in body weight gain or organ weights. There was a profound immunosuppression in the animals receiving CSA as determined by thymic lymphocyte blastogenesis in response to Con A and PHA. These findings suggest that immunosuppression in otherwise healthy animals impairs wound healing.

Thymic stimulatory actions of arginine.

Various arginine HCl supplements (0.5-3%), half added to a basal commercial rodent chow (1.8% arginine) and half to the drinking water, were given to 8- to 9-week-old male CBA/J mice for 6 days. Control animals were fed the basal chow and drank tap water. All mice ate and drank ad libitum. Weight gain and food intake were similar in all groups. All arginine supplements increased significantly: thymic weight (average 22%), thymic lymphocyte content (average 45%), and the in vitro reactivity of thymic lymphocytes judged by the incorporation of 3H-leucine into the TCA-precipitable protein fraction in response to stimulation by phytohemagglutinin and concanavalin A. All these thymic effects resulted from the 0.5% arginine hydrochloride supplement; further increases in arginine supplementation did not increase these effects. These data suggest that supplemental arginine may improve host defence mechanisms and thereby may play an important role in the care of severely injured or ill patients, since it is well established that their defense mechanisms are reduced.

Influence of vitamin A on wound healing in rats with femoral fracture.

Groups of healthy wounded rats with and without comminuted femoral fractures, and maintained on nutritionally complete commercial rat chow with and without supplemental vitamin A, were studied. The test wounds were standard dorsal skin incisions and s.c. polyvinyl alcohol sponge implants. In some experiments the rats were pair-fed; the rats with femoral fracture not receiving supplemental vitamin A were the lead group for determining food allowanced. In other experiments, the rats were allowed food ad libitum. We found that wound healing of rats with femoral fracture was increased when supplemental vitamin A was given, but the supplemental vitamin A did not completely obviate the adverse effects of fracture. The ratio of the breaking strengths of the skin incisions after formalin fixation to the breaking strengths of the incisions in the fresh state was higher in the unsupplemented rats, supporting the results of our earlier experiments that vitamin A increases the rate of collagen cross-linking.

Inhibitory action of vitamin A on a murine sarcoma.

Abstract High doses of vitamin A decrease the incidence and severity of tumor development in mice inoculated with a murine sarcoma virus.

White Cell Involvement in the Inflammatory, Wound Healing, and Immune Actions of Vitamin A

Stress or injury-induced phenomena, such as impaired wound healing and immune depression, may be related to impaired function of certain leukocyte populations. Since vitamin A prevents some aspects of stress, we studied its effect on various white cell populations in normal and injured rats. Supplemental vitamin A (150,000 IU/kg chow) to normal rats resulted in marked increases in thymic weight and lymphocytes without any effct on adrenal weight. The basal chow contains 13,700 IU vitamin A per kg. In rats subjected to moderately severe injury (dorsal wounding or unilateral femoral fracture), supplemental vitamin A greatly diminished the thymic involution observed in chow-fed controls and delayed or minimized the accompanying adrenal hypertrophy. In uninjured rats, supplemental vitamin A induced in three to four days a temporary circulatory leukocytosis characterized by lymhocytosis, monocytosis, and a relative neutropenia. These changes in the blood picture persisted one day after femoral fracture. On the second and third day postfracture the lymphocyte and neutrophil values returned to normal while the monocytosis persisted. Polyvinyl alcohol sponges implanted next to the fracture site demonstrated that supplemental vitamin A consistently increased the number of white blood cells migrating into the wound area and showed significantly larger numbers of monocytes/macrophages. These data suggest that vitamin A influences the numbers and nature of white cells involved in immune, inflammatory, and wound healing processes. In addition to the known antiglucocorticoid activity of vitamin A, these effects may represent a direct beneficial action of dietary vitamin A supplements for stressed and injured animals.

Thymic inhibition of wound healing: Abrogation by adult thymectomy

Abstract It has been previously observed that the thymus and wound respond in a similar manner, i.e., agents that enhance thymic function increase wound healing, while factors which decrease thymic function impair healing. In order to elucidate if the thymus has a direct influence on wounds, we have studied wound healing in adult rats who have undergone thymectomy at 4–8 weeks of age. In three separate experiments we found that thymectomized rats had fresh wound breaking strengths significantly greater than sham-thymectomized rats. There were no differences noted in the amount of reparative collagen accumulated in subcutaneously implanted polyvinyl alcohol sponges or in the breaking strength of wound strips fixed in 10% formalin, which maximally cross-links the collagen present; the ratios of fixed to fresh wound breaking strengths were significantly greater in sham-thymectomized rats. Rats who had undergone thymectomy with immediate intraperitoneal placement of Millipore chambers containing autologous thymic fragments had wound breaking strengths similar to sham-thymectomized or intact animals. We conclude that thymectomy at 4–8 weeks of age increases wound maturation and collagen cross-linking. This suggests that the thymus normally has an inhibitory effect on wound healing and a role of T-suppressor cells on this process is postulated.

Combined treatment with radioestradiol-lucanthone in mouse C3HBA mammary adenocarcinoma and with estradiol-lucanthone in an estrogen bioassay

Abstract C3H female mice bearing transplantable estrogen-nondependent adenocarcinomas were treated subcutaneously with either estradiol, tritiated ( 3 H)estradiol, lucanthone, 3 H-estradiol followed by lucanthone, or lucanthone followed by 3 H-estradiol. Tumor growth and host survival were ascertained. As single agents, lucanthone or 3 H-estradiol had slight tutor-inhibiting effects with small tumors. Combined treatment with radioestrogen followed by htcatlthone 4 hrs later blocked early tumor growth for several days and permanently reduced the growth rate thereafter; it also lengthened survival by some 67%. On the other hand, combined treatment with lucanthone followed 1 hr later by 3 H-estradiol did not have the same effect. The increase in adrenal gland weight that occurs as this tumor grows was significantly reduced by treatment with lucanthone, and more so by 3 HE2…..+Lu; both of these treatmelnts also depressed the lymphatic system. It is suggested that the antitumor effects observed may be mediated-systemically via the adrenal. None of the treatments were effective against advanced tumors. Lucantbone was also administered subcutaneously to w female Swiss mice in conjunction with estradiol. Evidence showed that lucanthone interferes with the immature mouse uterine weight response to estrogen, especially what given 1 hr before the hormone. Although an estrogen dose-response relationship was demonstrated for all groups, the hormone and the DNA intercalating agent interfered with each other in a way that suggests possiblle steric or competitive inhibition. Thus lucanthone modulates two estrogen effects, namely, the effect of estrogen out an estrogen-response tissue (uterine weight, especially when given prior to the hormone), and the effect of radioestrogen on an estrogen-nondependent antonomous tumor (when given after the hormone). A novel antitumor strategy, here called radiocytochemotherapy , is described, and possible applications to human tumors are discussed.