Materials
The materials used in this project were purchased as the following: polycaprolactone (PCL) (Sigma–Aldrich, Germany), chitosan (Easter Holding Group, China, MW: 100 KDa, deacetylaton degree: 93%), Cinnamomum zeylanicum (CiZ) essential oil (Zardband Pharmaceutcals Co, Iran), tripolyphosphate (TPP), tween 80, tween 20, HFIP, hematoxylin and eosin stain (Merck, Germany), glacial acetic acid and ethanol (>99.7 %, Dr. Mojallali, Iran), and masson’s trichrome staining kit (Asiapajohesh, Iran).
PCL fabrication
Electrospun PCL NFs were prepared as previously described [32], with slight modifications. The PCL solution was prepared by dissolving the granules in HFIP (15% w/v) at room temperature for overnight. The prepared polymer was loaded into a 10 mL syringe with stainless steel needle (22 gauge), which connected to 17 kV DC voltage in an electrospinning apparatus (Fnm co. Ltd., Tehran, Iran). The polymer solution was injected with a feed rate of 0.5 mL/h at the distance of 140 mm from the needle tip to collector rotating at a speed of 100 rpm. For easy separation of formed NFs on the collector, an aluminum foil was wrapped on it.
Surface morphology analysis
The surface morphology of polycaprolactone nanofibers was analyzed using field emission scanning electron microscopy (FESEM) (MIRA3, TESCAN Co, Czech). The images were taken after the gold plating process at an acceleration voltage of 20 kV (Q150R ES, Quorum Technologies, UK). Then, the average diameter of nanofibers was measured using ImageJ (National Institute of Health, USA) software with a sample size of 100 nanofibers.
Synthesis of µCS-CiZ
Chitosan microcapsules (µCS) containing CiZ essential oils (µCS-CiZ) was prepared as previously published [33]. Briefly, chitosan solution was provided by dissolving chitosan (1.5 w/v) in a dilute solution of acetic acid (1% v/v). The chitosan solution, tween 80 (2% w/v), tween 20 (8% w/v) was mixed to form a homogeneous solution and then the essential oil (1% w/v) was added for 5 min and 1500 rpm. Finally, aqueous solution of TPP (0.3% w/v) was drop-wisely added and stirred for another 40 min, and left for few days to increase the viscosity and form a gel.
Size measurement of µCS-CiZ
Particle size and particle size distribution of µCS-CiZ were evaluated using dynamic light scattering (DLS, scatteroscope-I, K-ONE, Korea). d50 (d: median diameter of particles at 50 cumulative percent) as reported by the DLS instrument was considered as particle size and particle size distribution was calculated using below equation.
FTIR
FT-IR (Nicolet iS10 FT-IR spectrometer, USA) was used to confirm CiZ loading in the chitosan microcapsules. The FT-IR spectra of CiZ, chitosan, Tween 20, Tween 80, and microcapsules without CiZ were recorded in wavenumber range of 400–4000 cm−1, using KBr pellets.
In vivo study
In this study, 48 male Wistar rats, which were about 2 months old and weighed 200-250 g, were obtained from animal house of Fasa medical school and used as wound healing model. The rats were kept in polystyrene cages according to the rules of keeping and observing animal rights, with a light cycle of 12 hours, standard temperature conditions (25±2 °C) and humidity and free access to food and water. All procedures and experiments involving animals were approved by Bioethics Committee of Fasa University of Medical Sciences (Ethics code: IR.FUMS.REC.1400.070) performed in accordance with the guideline for the care and use of laboratory animals in Iran. All methods are reported in accordance with ARRIVE guidelines.
Prior to the experiments, the cages and chambers were exposed to ultraviolet radiation for 24 hours and disinfected using ditol to create a pathogen-free environment. The rats were anesthetized by intraperitoneally injection of ketamine-xylzine (70:30). Then, the animal's back hair was shaved and thoroughly cleaned on the wound area. The expected wound area was disinfected with 10% betadine solution. Then, using a stencil ruler, a 2 × 2 cm wound was created by a full-thickness surgical razor. Finally, the treatments were applied directly to the newly created wound at the same time of surgery.
Study groups
Rats were randomly divided into four groups. In each of these groups, there were 4 rats for the study on days 3, 7 and 14. The study groups were studied as follows.
- Control group (wound washing with normal saline and bandage with common sterile gas)
- The rats treated with chitosan microcapsules containing cinnamon essential oil (µCS-CiZ group)
- The rats treated with nanofibers (PCL group)
- The rats treated with microcapsules + nanofibers (PCL+µCS-CiZ group)
The same amount of 2.5 ml of microcapsules and 2.5 × 2.5 cm of nanofibers were used for the experimental groups. This value was selected for the nanofibers based on the size of the wound and for the microcapsules to the extent that it can cover the entire wound. Then, they were kept in separate cages and a special room until the end of the study.
Macroscopic assessment of the wounds
Wound healing rate was assessed by measuring the length and width of the wound with a caliper on days 7, 14, and 21. Wound closure area was performed in different groups with 4 repetitions and the results were reported as mean ± standard deviation.
Histology study
After sacrificing the animals by CO2 euthanasia on day 21, about 2 mm of the area around the wound was removed with scissors and forceps in full-thickness. Then, the wound tissue was fixed in 10% formalin solution, dehydrated in ascending grade of alcohols, embedded in paraffin, sectioned and mounted on the slides for Hematoxylin-Eosin and Masson’s Trichrome staining and further histological examination. Qualitative scoring was performed according to Table 1.
Table 1. Histopathological scoring of the wound area according to the repairing process
No.
|
Score
|
Granulation tissue
|
Fibrotic tissue
|
Masson's trichrome staining
|
Edema
|
Vascularity
|
Inflammation
|
1
|
0
|
Not seen
|
Not seen
|
Not seen
|
2
|
0-1
|
Slight
|
Slight
|
Slight
|
3
|
1
|
Mild
|
Mild
|
Mild
|
4
|
1-2
|
Mild to moderate
|
Mild to moderate
|
Mild to moderate
|
5
|
2
|
Moderate
|
Moderate
|
Moderate
|
6
|
2-3
|
Moderate to marked
|
Moderate to marked
|
Moderate to marked
|
7
|
3
|
Marked
|
Marked
|
Marked
|
8
|
3-4
|
Moderately marked
|
Moderately marked
|
Moderately marked
|
9
|
4
|
Very marked
|
Very marked
|
Very marked
|
Statistical analysis
Statistical analyzes were performed using GraghPad Prism 6.0 software. The normality of the data was measured by Kolmogorov-Smirnov test. One-way ANOVA and Tukey post hoc test was performed to compare the mean ± standard deviation (SD) of more than two groups (wound size and re-epithelialization). The Edema, inflammation, vascularity, fibrosis tissue, and Masson's trichrome staining severity were analyzed by Kruskal-Wallis test and Mann–Whitney U test was used to determine significance among the groups. Significance level in all analyzes was considered less than 0.05 (p <0.05).