A comparison of the efficacy of 5-fluorouracil/triamcinolone, carnitine and dexamethasone therapy on wound healing in tracheal injury: potential for preventing tracheal stenosis?

Abstract

The aim of the study was to investigate the efficacy of 5-flourouracil/triamcinolone acetonide (5-FU/TA), carnitine and dexamethasone on wound healing in an animal model of tracheal injury. Twenty-eight rats underwent surgical injury of the tracheal mucosa and perichondrium under general anesthesia, and were randomized into four groups. Group I (the control group) received nothing after tracheal trauma. Group II received intratracheal 5 mg 5-FU/TA combined with 0.2 ml sodium hyaluronic acid once. Group III received intraperitoneal carnitine 100 mg/kg/day for 20 days. Group IV received intramuscular dexamethasone 0.1 mg/day for 20 days. After 1 month, the levels of superoxide dismutase enzyme activity (SOD) and levels of malondialdehide (MDA) and nitric oxide (NO) in serum were measured and the tracheal specimens were harvested for histopathologic examination. SOD was significantly lower in the carnitine group compared to the control group. A statistically significant decrease in MDA levels were observed in the 5-FU/TA and carnitine groups compared to the control group. NO levels were significantly lower in the 5-FU/TA group, but significantly higher in the dexamethasone group, compared to the control group. The fibrotic tissue volumes of tracheal specimens were significantly lower in both the 5-FU/TA and carnitine groups than those of the control group, but trended toward higher volumes in the dexamethasone group when compared to controls. We concluded that 5-FU/TA and carnitine diminish the occurrence of tracheal stenosis (TS) secondary to experimentally induced tracheal trauma.

Successful treatment of bronchial obstruction by flexible bronchoscopy and isoniazid: A case report

“…Previous studies have revealed that mitomycin, corticosteroid and 5-fluorouracil also reduce the recurrence rate of stenosis (17,18). However, these drugs are complex to administer in clinical applications due to significant toxicity, including myelosuppression.…”

Prevention of tracheal stenosis with pirfenidone after tracheotomy: An experimental study

“…As adjuncts to the surgical interventions, primarily mitomycin C has been used in the treatment of TS, followed by several other pharmacological agents including the steroids, antibiotics, anti‐reflux medications, halofuginone, 5‐FU (fluorouracil), and carnitine . These treatment options were used in order to be effective on one or more stages of wound healing, including inflammation, proliferation, maturation, and remodeling …”

“…15 As adjuncts to the surgical interventions, primarily mitomycin C 16,17 has been used in the treatment of TS, followed by several other pharmacological agents including the steroids, 2,18 antibiotics, 1,19 anti-reflux medications, 20 halofuginone, 21 5-FU 22 (fluorouracil), and carnitine. 14,22 These treatment options were used in order to be effective on one or more stages of wound healing, including inflammation, proliferation, maturation, and remodeling. 2 The corticosteroids and antibiotics are effective during the stages of inflammation and proliferation; mitomycin C, the combination of 5-FU and triamcinolone acetate, and carnitine are effective during the proliferation stage; and halofuginone, β-aminopropionitrile, colchicine, penicillamine, and N-acetyl-L-cysteine are effective during the maturation stage.…”

The Role of Systemic Steroids in Postintubation Tracheal Stenosis: A Randomized Clinical Trial

“…Regarding these healing processes, any treatment modalities should be used before the beginning or at an early stage to suppress the constricting phase and prevent the development of tracheal stenosis [7,8]. Corticosteroids, as one of the oldest agents used in this process, suppress the inflammation and proliferation phase and consequently prevent fibroblast proliferation, collagen synthesis, and macrophage response [7].…”

“…In another experimental study on 18 dogs, Doolin and colleagues [10] found that steroids had no significant effect on the formation of any type of collagen, and therefore reported that corticosteroids had no effect in preventing subglottic stenosis. A study on rats and another one on rabbits also showed that steroids offered no significant advantage in preventing tracheal or subglottic stenosis [8,11]. Perepelitsyn and Shapshay [12] by performing 47 procedures in their patients showed no benefit for using intraoperative local steroid injections as an adjunct to laser for treatment of laryngeal and tracheal stenosis.…”