The Effect of 1-Ethyl-3-(3-Dimethylaminopropyl) Carbodiimide Suture Coating on Tendon Repair Strength and Cell Viability in a Canine Model

Abstract

Purpose To determine if impregnating a suture with a cross-linking agent, f 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), improved suture pull-out strength and cell viability. Methods Canine flexor digitorum profundus tendons were cut in canine zone D, and a single suture loop was placed in each end, with sutures soaked in either saline or in an EDC solution with a concentration of 1%, 10%, or 50%. Suture pull-out strength, stiffness, and elongation to failure was determined by pulling the loop until failure. Cytotoxicity of the EDC treatment was evaluated by suspending treated sutures over cultured tenocytes. Results Mechanical properties for the EDC-treated side were improved over controls when treated with the 10% and 50% EDC solutions. The ratio of dead to live cells was significantly increased at all distances from the suture for the 50%-EDC-treated group. Conclusions Suture treated with a 10% EDC solution provided the best combination of mechanical reinforcement and limited toxicity. Clinical Relevance Sutures so treated may improve the ability of a tendon repair to sustain early mobilization.

Thiolation and characterization of regenerated Bombyx mori silk fibroin films with reduced glutathione

“…Comparing the leaching liquor from water annealed SF film, the leaching liquor from GSH-modified SF film decreased the HEK293 cell viability slightly. This difference perhaps to be relative with the presence of EDC trace residue within the sample, and the previous study demonstrated that EDC had negative effects on the cell viability [34]. Apart from that, both water annealed and GSH-modified SF films exhibited high biocompatibility as their cell viabilities were higher than 100% relative to control.…”

Genipin crosslinker releasing sutures for improving the mechanical/repair strength of damaged connective tissue

“…Adoption of this technology by surgeons would be facilitated by the fact that it would not modify current clinical suture techniques. In a similar study by Thoreson et al the authors used 1‐Ethyl‐3‐(3‐Dimethylaminopropyl) Carbodiimide (EDC) as the crosslinking agent, in contrast to the nontoxic cross linking agent, genipin (GP) used in the present study. Notably, the repair stiffness and repair strength obtained by the genipin‐loaded sutures were significantly higher compared to the EDC study results.…”

“…In a similar study by Thoreson evaluated for their loading efficiency, release profiles, and mechanical properties. The crosslinking agent GP was used in this study due to its beneficial effect on connective tissues, 30,37,38 well-studied pharmacological properties, 53,54 its low toxicity compared to other crosslinking agents, 55,56 and our prior experience with this specific agent. 30 PGA was chosen for the suture material because it is one of the most common clinically used suture materials.…”

“…Other studies suggest that the minuscule amount of unreacted genipin that might remain unbound to the matrix would not have any toxic effect on the surrounding tissues. [53][54][55][56] Sutures with GP loaded coatings were applied to ex vivo tendons and their effect on the mechanical properties of the repair construct was determined. The crosslinking of the tendon repair construct using an exogenous crosslinking agent would not only provide resistance to the complete pullout of the suture at the failure load but would also provide increased resistance to the initial gap formation that might occur during tensile loading.…”

Cell and Biologic-Based Treatment of Flexor Tendon Injuries

“…42 Experimental crosslinking agents coating sutures, including 1-ethyl-3-(3-dimethylaminopropyl) carbo-diimide hydrochloride (EDC) and cyanoacrylate, also increase suture-tendon interactions and crosslink the tendon tissue immediately adjacent to the suture. 43,44 These mechanical approaches offer an opportunity to improve repair strength, but do not inherently decrease adhesions or enhance the healing process.…”