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Application of snail mucin dispersed in detarium gum gel in wound healing

July 2007
Scientific Research and Essays 2(6):195-198

Authors:

University of Nigeria

This study is aimed at describing the effects of snail mucin dispersed in detarium gum gel on wound healing in rats. The gels were prepared from a mixture of snail mucin and honey and the detraium gum gel. A similar gel containing only the mucin was also formulated. It was observed that the gels containing both the snail mucin and the honey had greater healing effect than the gel containing the mucin alone. Complete wound healing was observed on day 13 in all the cases studied with mucin and honey combinations and over 80 percent healing was achieved for all the cases with mucin alone dispersed in the gum gel.

. Effect of various gel preparations of mucin and honey on wound size of the rats.

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Scientific Research and Essay Vol. 2 (6), pp. 195-198, June 2007

Available online at http://www.academicjournals.org/SRE

Full Length Research Paper

Application of snail mucin dispersed in detarium gum

gel in wound healing

M. U. Adikwu and B. U. Alozie

Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka 410001, Nigeria.

Accepted 25 April, 2007

This study is aimed at describing the effects of snail mucin dispersed in detarium gum gel on wound

healing in rats. The gels were prepared from a mixture of snail mucin and honey and the detraium

gum gel. A similar gel containing only the mucin was also formulated. It was observed that the gels

containing both the snail mucin and the honey had greater healing effect than the gel containing the

mucin alone. Complete wound healing was observed on day 13 in all the cases studied with mucin

and honey combinations and over 80 percent healing was achieved for all the cases with mucin alone

dispersed in the gum gel.

Key words: Snail mucin, honey, detarium gum, gel, wound healing.

INTRODUCTION

Many factors affect wound healing. Bacteria infection is

one of the major factors that affect wound healing. The

invasion of bacteria directly to the wound produces inf-

lammation and fluid exudation which interferes with hea-

ling. In addition, bacteria toxins cause tissue damage and

delays fibroplasias as well as collagen synthesis (Obase-

ki-Ebor et al., 1983).

Deficiency resulting from nutritional constituents’ espe-

cially protein, vitamin A, B and C also delays wound hea-

ling (Hunt et al., 1969). Protein is essential for body rep-

airs through the reaction of its constituent amino acids.

Building and repairing issue require adequate amounts of

calories and protein to fuel the repair mechanisms, as the

skin and underlying tissues are made of protein. Vitamin

A stimulates fibroplasias and may be especially useful in

a topical preparation for skin injuries in people taking

corticosteroids. Vitamin C is needed to make collagen

(connective tissue) that strengthens skin, muscles, and

blood vessel and to ensure proper wound healing. Sev-

ere injury appears to increase vitamin C requirements

and vitamin C deficiency causes delayed healing. Topical

application of vitamin E is sometimes recommended for

preventing or treating post-injury scars (Levine, 1986).

Some drugs affect wound healing; for example, long

term, high doses of corticosteroids (Jenkins et al., 1986).

A topical preparation of chamomile combined with corti-

costeroids and antihistamines has been used to speed-

*Corresponding author. E-mail: adikwum@yahoo.com.

up wound healing in elderly people with stasis ulcers

caused by inadequate circulation (Jenkins et al., 1986).

Horse chestnut contains a compound called aescin that

acts as an anti-inflammatory and reduces oedema follo-

wing trauma (Guillaume and Padioleau, 1994).

It is important that wounds be properly cleaned and

dressed before any preparations are applied. This pre-

vents infection. Bacterial appear to contaminate all surgi-

cal wound, but not all wound may be affected. Infection of

surgical wounds depends on the bacterial inoculums, the

virulence of the bacteria and the duration after contami-

nation. Apart from the bacterial factors, is the impaired

host defense due to old age, poor physical state, malnut-

rition and systemic diseases. Necrotic tissue and reduced

blood supply to the wound are other factors (Romito,

1995; Roberts et al., 1998). Since bacterial growth flouris-

hes in dead tissues, the presence of dead or devitalized

tissues in a wound is an invitation to infection. Where

dead space is present fluid accumulates and serves as a

culture media for bacterial growth. In addition, fluid accu-

mulation within the tissue limits migration of reparative

cells. In spite of improved aseptic techniques to avoid

wound contamination as well as the use of antimicrobial

agents, wound contamination and infection remain a post

operative complication which could lead to even post-

surgical death.

If animal skin integrity is compromised by accidental or

surgery trauma, infectious agents have access into the

wound to cause contamination and infection of the soft

tissue locally. The infectious agents can as well get entra-

196 Sci. Res. Essays

nce into the blood stream which carries it to distant

organs to set up other foci of infection.

The sources of contamination and infection are the skin

of the patient, the surgical equipment, theatre (hospital

environment), patient, the surgeon and the type of sur-

gery performed (Forest, 1982).

For around 2000 years, honey has been used to treat a

variety of ailments through topical application. Modern

research into the use of honey as an antimicrobial agent

has revealed its potential for treating a variety of ail-

ments. Anti-bacterial properties of honey are the result of

the low water activity causing osmosis, hydrogen pero-

xide effect and high acidity (Cooper et al., 1999; Khristov

and Mladenov, 1961).

Honey is a poor environment for the growth of organi-

sms since it has a low water activity. Additionally, the use

of honey reduces odours, reduces swelling and reduces

scarring; it also prevents the dressing from sticking to the

healing wound. It acts as an antiseptic/antibacterial

agent. It is an excellent natural preservative. In ancient

history, the Ancient Egyptian and Middle-Eastern people

also used honey for embalming the dead. However, only

rich and powerful people had the luxury of this type of

funeral.

The pH of honey is commonly between 4 –5. This rela-

tively acidic pH level prevents the growth of many bacte-

ria responsible for infections (Khristov and Mladenov,

1961; Adikwu and Ndu, 2006).

Mucins are a family of large glycosylated proteins (50

%w/w carbohydrate). Mucins are group of nitrogenous

substances secreted by a mucous gland. Although some

mucins are membrane-bound due to the presence of a

hydrophobic membrane – spanning domain that favours

retention in the plasma-membrane, the concentration

here is on those mucins that are secreted on mucosal

surfaces and saliva. Mucin protein backbones are cha-

racterized by numerous tandem repeats that contain pro-

line and are high in serine asparagine, hydroxylysine

and/or threonine residues (Adikwu, 2006). The structures

occur in many life forms, and are prevalent and important

in mammalian tissues.

The attached carbohydrate may have several effects; it

may help the protein to fold in the proper geometry,

stabilize the protein, attract physical properties such as

solubility or viscosity, help it to orient correctly in mem-

branes or, make it recognizable to another biochemical or

cell. Many proteins released by cells to the blood and

other fluids are glycoproteins.

Mucins are secreted as massive aggregate of proteins

with molecular masses of roughly 1 to 10 million Da.

Within these aggregates, monomers are linked to one

another mostly by non-covalent interactions, although

intermolecular disulfide bonds may also play a role in this

process. They are mainly secreted in the intestine but

also in airways and other body membranes (Adikwu et

al., 2005).

Snails produce copious mucin which is often referred to

as slime. The wound healing property of snail mucin has

been reported (Adikwu and Ikejiuba, 2005). Similarly, its

physiological and toxicological properties have been

documented (Adikwu and Nnamani, 2005). The use of

the mucin in a muco-adhesive gel preparation and when

fortified with honey and its effect on wound is reported in

this work.

EXPERIMENTAL

Materials

Acetone (BDH Chemicals); Diazepam injection (GlaxoWellcome),

methylated spirit (Hardis and Dromedras) and distilled water were

from an all glass still. The mucin was obtained from a batch

prepared in our laboratory following earlier established procedures

(Adikwu et al., 2005). Purified honey was obtained from the local

market and diluted with sterile, distilled water to obtain a viscosity

grade that was equivalent to that stated in the Pharmaceutical

Codex (The Pharmaceutical Codex, 1979).

Preparation of detarium gum

The seeds of the plant were fried in hot air oven, soaked for 12 h,

peeled and milled into small particles. The milled particles were

soaked for 12 h and sieved with muslin cloth, precipitated with

acetone and left under room temperature for 3 h. The precipitate

was collected on a Buchner funnel by means of pressure from a

vacuum pump. It was placed in a vacuum desiccator for 4 days until

dried. The dried material was then milled into smaller particles and

was sieved with 250 m sieve and the fine particles were collected

into a clean, amber-coloured bottle and stored in a cool condition

until used. This procedure is in accordance with an earlier reported

one (Chukwu, 1992; Ozumba and Bandgudu, 1992).

Formulation of the gels

A 1.5 g quantity of fine particle of detarium gum was weighed into 8

different clean beakers and 50 ml of distilled water was added into

each of the 8 beaker and vigorously shaken until uniformly disper-

sed. Mucin which ranged from 200, 400, 800, to 1000 mg, was

added in appropriate beakers and stirred for 5 min, and the gelation

was allowed to further take place for three hours undisturbed. For

the formulations containing the honey, the required quantity of the

honey was added to the mixed gum gel containing the mucin and

stirred gently again, continuously until a homogenous production

was obtained (Table 1). Each product was placed in a clean, wide-

mouthed bottle and labeled. The preparations were all stored in

refrigerated environment until used.

The formulae above were in the production of the various gels.

Each gel was prepared basically with variations of the materials as

indicated in the table except for detarium gum which was kept

constant (Table 2).

Animals

Sixteen male healthy albino rats obtained from Animal Laboratory

of the Department of Pharmacology and Toxicology, University of

Nigeria, Nsukka, were used in the study. The animals were quaran-

tined for a period of one week to ensure stabilization before use.

Adikwu and Alozie 197

Table 1. Quantities of the ingredients used in the formulation of the gels.

Batch Detarium microcarpum (G)

Mucin (MG)

Honey (MG) Water (ML)

1.5 g D.M.G + 200 mg Mucin + 200 mg Honey 1.5 200 200 50

1.5 g D.M.G + 400 mg Mucin + 400 mg Honey 1.5 400 400 50

1.5 g D.M.G + 800 mg Mucin + 800 mg Honey 1.5 800 800 50

1.5 g D.M.G + 1000 mg Mucin + 1000 mg Honey 1.5 1000 1000 50

1.5 g D.M.G + 200 mg Mucin 1.5 200 - 50

1.5 g D.M.G + 400 mg Mucin 1.5 400 - 50

1.5 g D.M.G + 800 mg Mucin 1.5 800 - 50

1.5 g D.M.G + 1000 mg Mucin 1.5 1000 - 50

Table 2. Effect of various gel preparations of mucin and honey on wound size of the rats.

Mean wound size (MM) on days post surgery ± S.EM Batch

1ST 4th 7TH 10TH 13TH

1.5 g D.M.G +200 mg Mucin + 200 mg Honey 20±3.64 16±3.04 11.5±1.65 6.3 ±2.11 0

1.5 g D.M.G + 400 mg Mucin + 400 mg Honey 20±2.88 13.5±6.48 11.5±1.05 0 0

1.5 g D.M.G + 800 mg Mucin + 800 mg Honey 20±2.88 13±2.27 9±1.29 0±0.00 0

1.5 g D.M.G + 1000 mg Mucin + 1000 mg Honey 20±2.88 10.5±2.22 7.5±1.06 0.00 0

1.5 g D.M.G + 200 mg Mucin 20±2.88 14.5±2.08 12±1.69 7.5±0.46 2.5±0.69

1.5 g D.M.G + 400 mg Mucin 20±2.88 13±1.87 9.5±1.77 4.5±0.41 1.5±0.08

1.5 g D.M.G + 800 mg Mucin 20±2.88 9±1.30 3.3±0.41 1.3±0.16 0

1.5 g D.M.G + 1000 mg Mucin 20. 0±0 7.5±1.72 2.0±1.15 0 0

Feeds consist of grower’s marsh and water was provided for the

albino rats. The weights range from 247 – 358 g.

Preparation of wound site in experimental animals

The wound site was prepared following the incision wound model

(Glowania et al., 1987). The albino rats were anaesthetized with

diazepam (0.2 mg/kg body weight) and the hairs on the skin of the

animals’ back were shaved with a sterilized razor blade. A circle of

diameter 20 mm was marked on each right side of the thigh of the

animal’s skin surface, and the skin dissected out. The area was

measured immediately by tracing out the wound area using a

transparent tracing paper and the squares counted and the area

recorded.

Determination of the rate of wound healing

Treatment was initiated immediately after the incision was made by

applying the gel on the wound and then once in every two days. All

the gels were applied topically using sterile cotton wool. The wound

area of each animal was measured while the animals were under

diazepam anesthesia on the days following post surgery. Each

application was evaluated in 4 rats per group and the results shown

are a mean of 4 determinations. All the procedures followed World

Health Organization (WHO) Procedures for Biomedical Research

Involving Animal Subjects, 1982.

RESULTS AND DISCUSSION

There was a general and progressive decrease in wound

radius of the animals with time (Table 3). By the 13th day

the wound area of all the animals treated with a mixture

of the mucin and honey in the gels had rescinded.

The combination of the mucin and the honey in the

gum gel produced better wound healing than when the

mucin was used alone. Healing of wound is a complex

phenomenon involving various phases, coagulation, infla-

memation, collagenation, wound contraction, epithaliali-

zation and remodeling. The phases between coagulation

and collagenation are intimately related while that of

wound contraction and epitheliazation is independent of

each other but run concurrently (Prudden and Allen,

1965). The process of wound healing may be aided by

the use of adhesive materials such as the detarium gel

since it enables intimate contact of the healing materials

with the wound surface. Moreover, it has been observed

that honey and snail mucin have adequate wound healing

properties (Cooper et al., 1999; Adikwu and Ikejiuba,

2005). Honey when used for wound healing produces

little or no side effect. Snail mucin has also been reported

to heal wounds (Adikwu and Ikejiuba, 2005). It was

observed in this study that snail mucin promotes regene-

ration of hairs when combined with honey in the animal

experiment.

Snail mucin played an important role in wound healing

as it enhances the skin natural regenerative response on

the formation of new tissues, probably through immune

response. The smoothness observed in the healing may

indicate that the preparation may prevent kelloid forma-

tion.

198 Sci. Res. Essays

Table 3. Percentage size reduction of the wounds.

Wound size reduction (%) Batch

4TH Day 7TH Day 10TH Day 13TH Day

1.5 g D.M.G +200 mg Mucin + 200 mg Honey 20±3.64 47.5±7.91 68.5 100

1.5 g D.M.G + 400 mg Mucin + 400 mg Honey 32.5±4.67 47.5±9.61 100 100

1.5 g D.M.G + 800 mg Mucin + *00 mg Honey 52.5±3.95 62.5±8.94 100 100

1.5 g D.M.G + 1000 mg Mucin + 1000 mg Honey 50±3.18 72.5±6.09 92.5±5 100

1.5 g D.M.G + 200 mg Mucin 30.8±4.43 40.0±5.51 62.5±4.11 87.5 ± 6.82

1.5 g D.M.G + 400 mg Mucin 35.0±5.04 57.5±5.04 77.5±2.00 92.5± 3.41

1.5 g D.M.G + 800 mg Mucin 55.0±7.92 82.5±7.11 95.35±2.00 100

1.5 g D.M.G + 1000 mg Mucin 62.5±8.80 90±7.48 100.35±4.79 100

Honey has been shown to have several advantages in

healing of wound. It is known to prevent infections and

reduce the inflammation, swelling, pain and foul-smell of

wounds rapidly. It is reported to induce sloughing of nec-

rotic tissue, thereby hastening granulation and epithelia-

zation. Wound is regarded as healed if there is a restora-

tion of the wounded or inflamed tissue to normal condi-

tion. Wound healing processes are generally classified

into:

a) Healing by first intention

b) Healing by second intention; and

c) Healing by third intention; depending on the nature of

the edges of the healed wounds (Mazzotta, 1994).

When mucin is combined with honey, and applied to a

clear incised wound, healing could be said to occur by

first intention., that is, the healing occurs by a process

that closes the wound edges with little or no inflammatory

reaction, and in such manner that no scar is left. The aim

of modern surgery is to effect healing by first intention

with little post surgical tissue necrosis, as wound edges

are united firmly, granulation tissue are not visible and

hence the scar is minimal. No suppuration was noticed

throughout the treatment and healing period when mucin

was used alone and in combination with honey.

ACKNOWLEDGEMENTS

This research was supported by the International Foun-

dation for Science, Stockholm, Sweden, through a grant

to Dr. M. U. Adikwu. He is grateful to the authorities of the

International Foundation for Science, Sweden, for gran-

ting him the research award used for this studies (Gran-

tee No. F/3560-2F). The author is also grateful to God

who created the snail that produces the mucin.

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Snail mucus is composed of bioactive compounds thought to have different biological properties for the treatment of some skin problems. Although Helix aspersa mucus is used in several cosmetic products, a detailed characterization of Eremina desertorum mucus composition and its biological activities is still missing. Mucus extracts (MEs) from H. aspersa and E. desertorum were prepared and tested for their antimicrobial and anti-inflammatory activities with their potencies in wound healing. Also, chemical characterization was performed by GC–MS analysis. Results showed that ME of E. desertorum gave higher inhibitory activity against resistant strains related to burn wound infections compared to ME of H. aspersa . Additionally, it revealed a significant anti-inflammatory activity. Moreover, we found that ME of E. desertorum lacked cytotoxicity and was able to significantly induce cell proliferation and migration through up-regulation of TGF-β1 and VEGF gene expression. Our results suggested that MEs of E. desertorum have higher biological effects than H. aspersa, which are attributable to antimicrobial, anti-inflammatory activities, cell proliferation and pave the way for further investigating its potential effect as a human therapeutic agent.

Human health and snails

Article

Nov 2020

Snails can provide a considerable variety of bioactive compounds for cosmetic and pharmaceutical industries, useful for the development of new formulations with less toxicity and post effects compared to regular compounds used for the purpose. Compounds from crude extract, mucus, slime consist of glycans, polypeptides, proteins, etc., and can be used for curing diseases like viral lesions, warts, and different dermal problems. Some particular uses of snails involve treating post-traumatic stress. Micro RNA of Lymnaea stagnalis, was known to be responsible for the development of long-term memory and treatment of Alzheimer’s and Dementia like diseases. This review explores the application of various bioactive compounds from snails with its potential as new translational medicinal and cosmetic applications. Snail bioactive compounds like ω-MVIIA, μ-SIIIA, μO-MrVIB, Xen2174, δ-EVIA, α-Vc1.1, σ-GVIIA, Conantokin-G, and Contulakin-G, conopeptides can be used for the development of anti-cancer drugs. These compounds target the innate immunity and improve the defense system of humans and provide protection against these life-threatening health concerns. AbbreviationsFDA: Food and Drug Administration; UTI: urinal tract infection; nAChRs: nicotinic acetylcholine receptors; NMDA: N-methyl-D-aspartate; CNS: central nervous system; CAR T: chimeric antigen receptors therapy; Micro RNA: micro ribonucleic acid.

Giant African snail genomes provide insights into molluscan whole‐genome duplication and aquatic–terrestrial transition

Article

Full-text available

Oct 2020

Whole‐genome duplication (WGD), contributing to evolutionary diversity and environmental adaptability, has been observed across a wide variety of eukaryotic groups, but not in molluscs. Molluscs are the second largest animal phylum in terms of species numbers, and among the organisms that have successfully adapted to the nonmarine realm through aquatic–terrestrial (A‐T) transition. We assembled a chromosome‐level reference genome for Achatina immaculata, a globally invasive species, and compared the genomes of two giant African snails (A. immaculata and Achatina fulica) to other available mollusc genomes. Macrosynteny, colinearity blocks, Ks peak and Hox gene clusters collectively suggested a WGD event in the two snails. The estimated WGD timing (~70 million years ago) was close to the speciation age of the Sigmurethra–Orthurethra (within Stylommatophora) lineage and the Cretaceous–Tertiary (K‐T) mass extinction, indicating that the WGD may have been a common event shared by all Sigmurethra–Orthurethra species and conferred ecological adaptability allowing survival after the K‐T extinction event. Furthermore, the adaptive mechanism of WGD in terrestrial ecosystems was confirmed by the presence of gene families related to the respiration, aestivation and immune defence. Several mucus‐related gene families expanded early in the Stylommatophora lineage, and the haemocyanin and phosphoenolpyruvate carboxykinase families doubled during WGD, and zinc metalloproteinase genes were highly tandemly duplicated after WGD. This evidence suggests that although WGD may not have been the direct driver of the A‐T transition, it played an important part in the terrestrial adaptation of giant African snails.

NOVEL ZINC OXIDE NANO-HYDROGEL AND MUCIN CO-FORMULATION FOR DIABETIC WOUND HEALING: A SYNERGISTIC APPROACH

Article

Full-text available

Sep 2020

WOUND HEALING: USING NANOTECHNOLOGY

Biophysical properties of mucin and its use as a mucoadhesive agent in drug delivery: current development and future concepts

Article

Jan 2005

Studies on Detarium microcarpium gum. I. Comparative evaluation as a binder in tablets containing tartrazine dye

Article

Jan 1992

Amarauche Chukwu

A polysaccharide gum derived from the ripe and edible seeds of Detarium microcarpium (family Caesalpicnaceae) was investigated for use as a binder in tablet formulations containing tartrazine dye. Acacia gum and gelatin binders were used as standards. Batches of granules containing 2 to 8% (w/w) of each of the binders were prepared and compressed at fixed pressures using a Manesty F3 single-punch tabletting machine fitted with 9.5 mm concave punchs. The in vitro tablet characteristics investigated were crushing strength, friability, disintegration time and dissolution profile 24 h after compression and after 44 weeks of storage in the dark at 28 ± 2°C. Detarium gum gave tablets with the lowest mean crushing strength and high friability values at each binder concentration level. Surprisingly, these batches of tablets containing Detarium gum possessed relatively very long disintegration and dissolution times. There was no significant change in the tablet characteristics after the 44 weeks of storage.

The Clinical Acceleration of Healing With a Cartilage Preparation: A Controlled Study

Article

May 1965

John F. Prudden

A controlled study of the wound acceleration induced by fine-grind acid-pepsin digested calf tracheal cartilage has been made in 15 human volunteers. Small paired skin incisions were made in precisely corresponding anatomical sites, and one wound treated with the powder by atomization while the other wound served as the control. Closure was identical. After varying (7 to 14 days) intervals of time, the wounds were excised with a margin and the resulting defects closed. The tensile strengths of the wounds were then determined. In 12 of the 15 wound pairs, the treated wound was stronger. The overall percentage increase in tensile strength resulting from the treatment was 42%, and the difference is statistically highly significant. The effectiveness of this material in the acceleration of human wound healing is considered established.

Editorial- MUCINS AND THEIR POTENTIALS

Article

Michael Adikwu

Failure of Topical Steroids and Vitamin E to Reduce Postoperative Scar Formation Following Reconstructive Surgery

Article

Jul 1986
J Burn Care Rehabil

One hundred fifty-nine operative procedures for postburn contractures of interdigital webs (96), the axilla (46), or the neck (17) were prospectively randomized to be treated postoperatively for four months with a topical steroid (Aristocort A), topical vitamin E, or the base cream carrier for these drugs. The nature of the medication was blinded both to the patient and to the evaluator. Patients were followed for one year. Observations were made for range of motion, scar thickness, change in graft size, and ultimate cosmetic appearance. No beneficial effect of either vitamin E or topical steroid could be demonstrated. However, adverse reactions occurred in 16.4% of patients receiving active drug, compared to 5.9% treated only with base cream. Interestingly, the grafts initially contracted and subsequently grew to be a size larger (about 20%) than the original graft by one year. It is concluded that neither topical steroid nor topical vitamin E is effective in reducing scar formation after grafting procedures for reconstruction for postburn contractures.

Effect of chamomile on wound healing - A clinical double-blind study

Article

Oct 1987

In a double-blind trial, the therapeutic efficacy of chamomile extract was tested on 14 patients. As objective parameters served the epithelial and drying effect on weeping wound area after dermabrasion of tattoos. The period of the healing and drying process was judged by the doctor. The decrease of the weeping wound area as well as the drying tendency was statistically significant.

Concepts in the biology and biochemistry of ascorbic acid

Article

May 1986

Mark Levine

This article has no abstract; the first 100 words appear below. ASCORBIC acid, originally called vitamin C, is required for human health.¹ In human beings deprived of ascorbic acid, the deficiency disease scurvy develops and can be life threatening. Although a disease remarkably similar to scurvy was described by the ancient Egyptians,²,³ it was not until 1753 that a Scottish physician, James Lind, systematically described scurvy and its prevention by dietary means.⁴ Even then, the dietary requirements were controversial. For four decades the British navy refused to accept Lind's findings, and countless sailors continued to die unnecessarily from scurvy until lemon juice was finally included in sailors' rations. Research since Lind's . . . I am indebted to David Blank for editorial assistance, to Gordon Cutler for encouragement, and to Shelley Sturman and Harvey Pollard in particular for helpful suggestions and consistent wholehearted support. Source Information From the Laboratory of Cell Biology and Genetics, National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md. Address reprint requests to Dr. Levine at Bldg. 4, Rm. 312, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

Effect of Vitamin A on Reversing the Inhibitory Effect of Cortisone on Healing of Open Wounds in Animals and Man

Article

Nov 1969
ANN SURG

Preliminary report on the antimicrobial activity of honey distillate

Article

Dec 1983

Romito RA. Early administration of enteral nutrients in critically ill patients. AACN Clin Issues 6, 242-256

Article

Jun 1995

Rochelle A. Romito

Aggressive nutrition intervention has become an essential component in the therapy of critically ill patients. Early provision of enteral nutrients within 24 hours of injury or surgery appears optimal and is associated with benefits such as a reduction in septic complications, a decrease in the hypermetabolic response to severe burn injury, and improved wound healing. Early enteral nutrient administration has a significant impact on preserving gastrointestinal integrity and barrier function and maintaining intestinal immunologic defenses, which may have a role in decreasing infectious outcomes in critically ill patients. Establishing an enteral access becomes a priority with early feeding. Small intestine feeding usually is preferred to gastric nutrient administration, yet some declare biologic superiority with intragastric feedings. The optimal enteral product for use in critically ill patients remains unknown. Key nutrients, such as glutamine, arginine, fiber, and alternative lipids, may have potential benefits and need to be considered when formulating an enteral regimen in this patient population.