Effects of wound healing and activation of tissue regeneration for the management of hemorrhoids and anal fissures

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OBJECTIVE

To analyze experimental data and scientific articles on the possibility of controlling wound healing processes and activating tissue regeneration mechanisms using bacterial components for hemorrhoids and anal fissures management.

KEY POINTS

Accumulated data on the effects of the Escherichia coli (E. coli) bacterial culture suspension (BCS) as a therapeutic agent demonstrate the following positive impacts, which are in demand for the treatment of hemorrhoids and anal fissures: reduction of exudation and inflammation, acceleration of wound healing, tissue regeneration, and immune stimulation. The intricate mechanisms of these effects include complex, complementary reactions of cell receptors in the anorectal area with microbial components: metabolites, enzymes, heat shock proteins, and nucleic acids, NOD-ligands, leading to the production of various cytokines by immunocytes, colonocytes, and endothelial cells of the hemorrhoidal plexus, activation of innate and adaptive immunity mechanisms, dendritic cells, and fibroblasts, enhancing sanogenesis and accelerating the healing of tissue injuries.

CONCLUSION

Based on modern concepts, it can be reasonably argued that the biologically active components of E. coli BCS are capable of exerting both positive local and systemic effects, which deepens the understanding and justification of its use in hemorrhoidal disease and anal fissure. The effectiveness of drugs with E. coli BCS components is confirmed by their application in real clinical practice according to indications, both as conservative therapy and after surgical interventions.

Keywords:

hemorrhoids

Escherichia coli

bacterial culture suspension

wound healing

tissue regeneration

Authors:

Knorring G.Yu.

Russian University of Medicine

ORCID: 0000-0003-4391-2889

Received:

20.03.2024

Accepted:

09.04.2024

List of references:

De Schepper H, Coremans G, Denis MA, Dewint P, Duinslaeger M, Gijsen I, Haers P, Komen N, Remue C, Roelandt P, Somers M, Surmont M, Van de Putte D, Van den Broeck S, Van Kemseke C, De Looze D. Belgian consensus guideline on the management of hemorrhoidal disease. Acta Gastro-enterologica Belgica. 2021;84(1): 101-120. https://doi.org/10.51821/84.1.497
Pata F, Sgró A, Ferrara F, Vigorita V, Gallo G, Pellino G. Anatomy, Physiology and Pathophysiology of Haemorrhoids. Reviews on Recent Clinical Trials. 2021;16(1):7580. https://doi.org/10.2174/1574887115666200406115150
Shelygin YuA, Titov AYu, Blagodarny LA, Achkasov SI. Gemorroj. Diagnostika i lechenie. M.: GEOTAR-Media; 2022. (In Russ.).
Aleksandrova MV, Radchenko VV, Lipkin VM. Inactivated E. coli bacterial culture suspension as active component in pharmacological preparations. Ratsional’noe pitanie, pishchevye dobavki i biostimulyatory. 2014;2:11-11. (In Russ).
Knorring GYu. Justification and experience of using ointments with immunomodulating properties in hemorrhoids and anal fissures. Ambulatornaya khirurgiya. Statsionarozameshchayushchie tekhnologii. 2019;(1-2):124-130. (In Russ.). https://doi.org/10.21518/1995-1477-2019-1-2-124-130
Isakov DV, Tsar’kov PV, Markar’ian DR, Garmanova TN, Kazachenko EA, Knorring GYu. E. coli bacterial suspension in the treatment of hemorrhoids. Pirogov Russian Journal of Surgery. 2020; 5:102-108. (In Russ.). https://doi.org/10.17116/hirurgia2020051102
Wienert V, Heusinger JH. Local treatment of hemorrhoidal disease and perianal eczema. Meta-analysis of the efficacy and safety of an Escherichia coli culture suspension alone or in combination with hydrocortisone. Arzneimittel-Forschung. 2002;52(7):515-523. https://doi.org/10.1055/s-0031-1299924
Knorring GYu. Rationale and effectiveness of combination therapy of chronic anal fissures and hemorrhoids. Ambulatornaya khirurgiya. 2022;19(2):106-110. (In Russ.). https://doi.org/10.21518/1995-1477-2022-19-2-106-110
Frank W, Reichel U. Die konservative Behandlung der analen Kryptitis mit einer topischen Vakzine. Colo-Proct. 1983;3:83.
Inagaki H, Kusama S, Hayashi F. Posterisan — PrOfung Ober den Effekt der Posterisan Salbe bei Hamorrhoiden im Doppelblindversuch. Japanese Pharmacology and Therapeutics. 1974;2:103.
Colosimo DA, Kohn JA, Luo PM, Piscotta FJ, Han SM, Pickard AJ, Rao A, Cross JR, Cohen LJ, Brady SF. Mapping Interactions of Microbial Metabolites with Human G-Protein-Coupled Receptors. Cell Host and Microbe. 2019;26(2):273-282.e7. https://doi.org/10.1016/j.chom.2019.07.002
Ménard S, Cerf-Bensussan N, Heyman M. Multiple facets of intestinal permeability and epithelial handling of dietary antigens. Mucosal Immunology. 2010;3(3):247-259. https://doi.org/10.1038/mi.2010.5
Mazurov VI, Lila AM, Stolov SV, Klimko NN, Glazanova TV, Knorring GJu. Immunological aspects of systemic enzyme therapy. Tsitokiny i vospalenie. 2002;1(2):169-170. (In Russ).
Caruso R, Warner N, Inohara N, Núñez G. NOD1 and NOD2: signaling, host defense, and inflammatory disease. Immunity. 2014; 41(6):898-908. https://doi.org/10.1016/j.immuni.2014.12.010
Akashi M, Loussararian AH, Adelman DC, Saito M, Koeffler HP. Role of Lymphotoxin in Expression of Interleukin 6 in Human Fibroblasts, Stimulation and Regulation. Journal of Clinical Investigation. 1990;85(1):121-129. https://doi.org/10.1172/JCI114401
Bray MA, Morley J. The Pharmacology of Lymphocytes. Handbook of Experimental Pharmacology. London: Springer; 1988.
Everson MP, McDuffie DS, Lemak DG, Koopman WJ, Mc-Ghee JR, Beagley KW. Dendritic cells from different tissues induce production of different T-cell cytokine profiles. Journal of Leukocyte Biology. 1996;59(4):494-498. https://doi.org/10.1002/jlb.59.4.494
Bubnova NA, Shatil MA, Knorring GYu, Suprun KS, Ivanova OI, Akinchits LG. Results of assessment of immune status in patients with erysipelas. Hospital-replacing technologies. Ambulatornaya khirurgiya. 2005;3:40-42. (In Russ.).
Whibley N, Tucci A, Powrie F. Regulatory T cell adaptation in the intestine and skin. Nature Immunology. 2019;20(4):386-396. https://doi.org/10.1038/s41590-019-0351-z
Ferrand A, Al Nabhani Z, Tapias NS, Mas E, Hugot JP, Barreau F. NOD2 Expression in Intestinal Epithelial Cells Protects Toward the Development of Inflammation and Associated Carcinogenesis. Cellular and Molecular Gastroenterology and Hepatology. 2019;7(2):357-369. https://doi.org/10.1016/j.jcmgh.2018.10.009
Wu X, Lahiri A, Haines GK 3rd, Flavell RA, Abraham C. NOD2 regulates CXCR3-dependent CD8+ T cell accumulation in intestinal tissues with acute injury. Journal of Immunology. 2014;192(7): 3409-3418. https://doi.org/10.4049/jimmunol.1302436
Goltsche TZ. Medikamentose Therapie haufiger anorektaler Beschwerden. Allgemeine Medizin.1990;66:432.
Lindhal G, Sjobring U, Johnsson E. Human complement regulators: a major target for pathogenic micro-organisms. Current Opinion in Immunology. 1980;12(1):44-51. https://doi.org/10.1016/s0952-7915(99)00049-7
Gainutdinov FM, Khadyeva AA, Khadyev RF, Gumerova GT. Comparative morphological analysis of the effectiveness of treatment of acute anal fissure. Permskij meditsinskij zhurnal. 2010;27(3): 75-78. (In Russ.).
Nekhrikova SV, Titov AYu, Veselov AV. The influence of posterisan on the healing of the postoperative wounds of the anal canal and perineum. Russian Journal of Evidence-Based Gastroenterology. 2017;6(2):59-65. (In Russ.). https://doi.org/10.17116/dokgastro20176259-65
Nekhrikova SV, Titov AYu, Kashnikov VN, Romanov RI, Veselov AV. Anal canal and perianal diseases treatment in an outpatient setting. Russian Journal of Evidence-Based Gastroenterology. 2019;8(3):27-37. (In Russ.). https://doi.org/10.17116/dokgastro2019803127
Gainutdinov FM, Gumerova GT, Khadyeva AA, Khadyev RF. Complex treatment of patients with an anal fissure using immunomodulatory drugs. Materials of the International Joint Congress of the Association of Coloproctologists of Russia and the first ESCP/ECCO regional master class, April 16-18, 2015, Moscow. Koloproktologiya. 2015;1(51)(Suppl):19-20. (In Russ.).
Frolov SA, Nekhrikova SV, Maksimova L, Korneva TK. Treatment of wounds after hemorrhoidectomy. Vrach. 2008;8:65-67. (In Russ.).
Groshilin VS, Khoronko YuV, Bashankaev BN, Perepechaeva AV, Lukash YuV. Prospects for the use of restorative topical therapy in minimally invasive coloproctology. Russian Journal of Evidence-Based Gastroenterology. 2019;8(2):12-19. (In Russ.). https://doi.org/10.17116/dokgastro2019802112
Danilov MA, Khachaturian AA, Abdulatipova ZM, Leontiev AV, Baychorov AB, Saakian GG. Advantages of using BCS (bacterial culture suspension) in healing wounds after hemorrhoidectomy. Vestnik khirurgicheskoj gastroenterologii. 2020;4:49-55. (In Russ.).

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