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

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 weeks 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 weeks, 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.