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Applications and Functions of γ-Poly-Glutamic Acid and its Derivatives in


Medicine

Article in Current Pharmaceutical Biotechnology · November 2020


DOI: 10.2174/1389201021999201118161155

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Current Pharmaceutical Biotechnology, 2021, 22, 000-000 1

RESEARCH ARTICLE

Applications and Functions of γ-Poly-Glutamic Acid and its Derivatives in


Medicine

Guoliang Wang1,†, Qing Liu1,†,*, Young Mok Yang2, Soo-Ung Lee3, Jee-Soo Han4,
Kyoung-Jin Jang2, Dong Young Kang2, Nipin Sp2, Zhandong Li5 and Tao Tong6,*

1
Jilin Green Food Engineering Research Institute, Changchun 130022, China; 2Department of Pathology, School of
Medicine, Institute of Biomedical Science and Technology, Konkuk University, Chungju 27478, Korea; 3Chuncheon
Bioindustry Foundation, Chuncheon 24232, Korea; 4Korea Research Institute of Standards and Science, Daejeon
34113, Korea; 5Measurement Biotechnique Research Center, Jilin Engineering Normal University, Changchun 130052,
China; 6College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China

Abstract: Background: γ-Poly-glutamic acid (γ-PGA) is a naturally occurring homo-polyamide pro-


duced by various strains of Bacillus. It is made from repeating units of L-glutamic acid, D-glutamic ac-
id, or both connected through amide linkages between α-amino and γ-carboxylic acid groups. As a bi-
opolymer substance, the attractive properties of γ-PGA are that it is water-soluble, biodegradable, bio-
ARTICLE HISTORY compatible, non-toxic, non-immunogenic, and edible. Therefore, it can be used as a green and envi-
ronmentally friendly biological material.
Methods: The review concentrates on the reports revealing the functions and potential use of γ-PGA
Received: August 13, 2020
Revised: October 23, 2020
and its derivatives in medicine.
Accepted: October 23, 2020
Results & Discussion: γ-PGA is described to possess several properties that may be exploited in medi-
DOI:
cine. The biopolymer reportedly has been successfully applied not only as a metal chelator, drug carri-
10.2174/1389201021999201118161155 er/deliverer, and gene vector, but also used safely as a vaccine adjuvant, tissue engineering material,
and contrast agent.
Conclusion: γ-PGA could be potentially considered as a potential biomedical material in the field of
medicine.

Keywords: γ-Poly-glutamic acid, biopolymer, application, function, medicine, biological material.

1. INTRODUCTION characteristics of water solubility, biodegradability, biocom-


patibility, non-toxicity, non-immunogenicity, and edibility
γ-Poly-glutamic acid (γ-PGA) is a particular anionic pol-
towards humans and environments [5]. Therefore, γ-PGA
ypeptide in which D- and L-glutamic acid monomers are
could be used as a type of green and environmentally friend-
connected via γ-amide linkages (Fig. 1) [1]. It can be found
ly biological material. To date, γ-PGA has been applied as
in an edible ferment (Natto) fermented by the species of Ba-
food supplement [6], thickener [7], texture enhancer [8],
cillus [2-4]. Following the discovery of γ-PGA, it has been
cryoprotectant [9], oil-reducing agent [10], and animal feed
the subject of much interest in modern homo-polyamide re-
additives [11, 12]. Furthermore, γ-PGA has also been used as
search. Suitable methods for production, detection, purifica-
a biopolymer flocculant [13] and dye removal [14] in the
tion, and determination of γ-PGA were well established.
field of environmental protection. γ-PGA has also been ex-
Based on the glutamic acid residues present, γ-PGAs are plored for use in agriculture [15, 16], cosmetics [17], feasible
classified into three categories (γ-D-PGA, γ-L-PGA, and γ- bio-nylon [18], and biodegradable plastics [19], and as an
DL-PGA). Regardless of its stereochemistry, γ-PGA shows antibacterial agent [20] and protective agent for beneficial
viruses [21]. γ-PGA is a potential source of energy, and it is
*Address correspondence to these authors at the Jilin Green Food Engineer-
important in brain metabolism [22, 23]. By initiating and
ing Research Institute, Floor 11, Building B, Brilliant Plaza, No. 1119, propagating free radical chain reactions, they can damage the
Nanhu Avenue, Changchun 130022, Jilin, China; cells and may be involved in the progression of plenty of
E-mail: jl_greenfood@hotmail.com; College of Food Science and Nutri- diseases, such as diabetes, hyperlipidemia, neurodegenera-
tional Engineering, China Agricultural University, No. 17, Qinghua Donglu,
Beijing 100083, China; E-mail: tongtao1028@163.com
tion, heart disease and cancer [24, 25]. Free radicals formed

1389-2010/21 $65.00+.00 © 2021 Bentham Science Publishers


2 Current Pharmaceutical Biotechnology, 2021, Vol. 22, No. 0 Wang et al.

by irradiation in γ-PGA and its derivatives have been studied large amount of metals [33]. The electric charge distribution
[26-29]. of γ-PGA conducted with HyperChem and the structure of γ-
PGA coordinating with metal ions are shown in Fig. 2 and 3,
O respectively [34, 35]. Interestingly, γ-PGA-SPIONs (SPI-
ONs, superparamagnetic iron oxide nanoparticles), contain-
H
N ing the coating of γ-PGA (7%) on SPIONs with a spherical
*
n shape, also showed excellent property of lead and cadmium
removal, but the addition of essential metals (e.g., copper,
C OH
iron, zinc, magnesium, calcium, and potassium) significantly
O
reduced the binding of cadmium [31].
Fig. (1). Structure of γ-PGA. *, the chiral carbon; n, degree of
-0.575
polymerization.

In spite of its wide usages, reviews on the comprehensive -0.244 0.032 0.517
applications and functions of γ-PGA in medicine are sparse * -0.069
to date [5, 7, 19, 30]. In this review, we have broadly sum- -0.209 n
marized the accumulated knowledge of γ-PGA and its deriv- 0.374
atives applied in medicine and related areas (Table 1). We -0.333
also foresee the potential use of γ-PGA and its derivatives as
various types of agents in medicine and other areas. -0.422

2. METAL CHELATOR Fig. (2). Electric charge distribution of γ-PGA. *, the chiral carbon;
n, degree of polymerization; eV, energy unit.
Agricultural and industrial practices worldwide have led
to the accumulation of poisonous heavy metals (e.g., lead, O
arsenic, mercury, chromium, and cadmium) in the human
body via the food chains. These heavy metals are toxic to the N+
nervous, hematopoietic, immunological, cardiovascular, gen- *
n
ital, and gastrointestinal systems in the human body, causing
severe health problems in human, including kidney dysfunc- M C OH
tion, anemia, liver toxicity, cancer, and Alzheimer’s disease
O
[31].
As a chelating agent, γ-PGA was effective in mitigating Fig. (3). Structure of γ-PGA coordinating with metal ions. *, the
lead-induced toxicity in mice through the reduction of lead chiral carbon; n, degree of polymerization; M, metal ions.
accumulation in various organs, decrease of thiobarbituric
acid reactive substances (TBARS) formation, and prevention It is worth mentioning that γ-PGA-VO (VO, vanadium
of δ-amino-γ-levulinic acid dehydrase (ALAD) inactivation oxide), the vanadyl-γ-PGA complex with a VO(O4) coordi-
and liver damage [32]. Applied in the treatment of metal nation mode (Fig. 4) [36], was demonstrated to be a potent
intoxication in humans, the γ-PGA dose-activity relationship insulin-mimetic and antidiabetic vanadyl complex in both
revealed that a low dose of γ-PGA was efficient in binding a type 1 and type 2 diabetic animals [37, 38], in which γ-PGA

Table 1. Functions of γ-PGA and its derivatives in medicinal applications.

Function Details Refs.

Removal of heavy metals and radionuclides. [31-33]


Metal chelator Developing the insulin mimetic complex. [37, 38]
Promotion of absorption of bioavailable minerals, such as Ca2+. [39]
Drug carrier/deliverer Improving the therapeutic effect of anticancer and antidiabetic drugs. [41-49]
Gene vector Use for gene therapy. [55-58]
Vaccine adjuvant Enhancing host immune responses to specific antigens. [62-67]
Possessing the improved mechanical properties, e.g., being easily removed and more hydrophilic and
Tissue engineering material [70-76]
cytocompatible.
Contrast agent Improving the diagnosis of diseases. [78-82]
Substitutes of fibrin with the increased bonding strength, higher hemostatic capability, lung adhesion and
Biological adhesive [83-87]
air-leak sealing.
Coating material Increasing the stability of the drug in the microcapsule. [88]
Applications and Functions of γ-Poly-Glutamic Acid Current Pharmaceutical Biotechnology, 2021, Vol. 22, No. 0 3

is proposed to be a promising carrier for developing the insu- Although cis-dichlorodiamineplatinum(II) (CDDP) is one
lin-mimetic vanadyl complexes. Furthermore, the nutritive of the extensively used chemotherapeutic agents for the
role of calcium in the maintenance of skeletal health has long treatments of different cancers, (e.g., testicular cancer, ovari-
been recognized. Noticeably, the γ-PGA-Ca complex dra- an cancer, bladder cancer, lymphoma, and glioma), severe
matically enhances the calcium absorption in the small intes- side effects (i.e., acute nephrotoxicity and chronic neurotoxi-
tine and prevents further bone loss [39]. city) have greatly limited the clinical use of CDDP [44]. To
reduce these side effects and enhance its anticancer activi-
O ties, carboxyl groups of the γ-PGA-g-mPEG (mPEG, meth-
oxy poly(ethylene glycol)) were used to conjugate with cis-
H
N
platin to form complex nanoparticles (NPs), which showed a
* much longer blood retention profile as compared with the
n
free CDDP and significantly inhibited the proliferation of
O C HeLa, MCF-7, and A549 cancer cells [45].
O
Li et al. successfully synthesized folate-modified pH-
O OH2 sensitive copolymer mPEG2K-PCL4K-γ-PGA1K (PCL, ε-poly-
V caprolactone) for co-delivering hydrophilic drugs doxorubi-
cin hydrochloride and verapamil hydrochloride, which
O OH2 demonstrated a high efficiency in reversing the multidrug
resistance by inhibiting the expression of P-glycoprotein and
O C targeting folic acid receptor to improve the anticancer effects
[46]. When the gel-forming γ-PGA-collagen hydrogels load-
*
ed with mesenchymal stem cells and α-lipoic acid were ad-
N n ministered to a mouse model of renal dysfunction in situ, the
H
levels of blood urea nitrogen and creatinine were remarkably
O decreased [47].
Fig. (4). Structure of the γ-PGA-VO complex. *, the chiral carbon; Phloridzin (PRZ) is expected to be used as an antidiabetic
n, degree of polymerization. drug owing to its property of inhibiting glucose transport
competitively through the binding of the glucose moiety to
the Na+/glucose cotransporter [48]. However, the PRZ is not
3. DRUG CARRIER/DELIVERER used orally due to the release of toxic phloretin through the
Many anti-cancer drugs show highly toxic side effects in hydrolysis of a glucoside bond. A neoteric γ-PGA-PRZ con-
addition to the disadvantages of weak solubility and target- jugate was designed and constructed to inhibit glucose
ing and short-acting time. To increase the therapeutic effica- transport from mucosal to serosal sides of the everted small
cy and the selectivity of delivery, these drugs have been con- intestines of rats, showing an inhibitory effect equivalent to
jugated to water-soluble macromolecular polymers [40]. intact PRZ [49]. In conclusion, γ-PGA is practically useful as
Unlike the synthetic polymers, γ-PGA is composed of natu- a biodegradable polymeric prodrug to conjugate with a drug,
rally occurring glutamic acid linked through amide bonds well establishing the foundation for an oral drug delivery
rather than a non-degradable C-C backbone. The free car- system.
boxyl groups in repeating units provide functionality for
drug attachment. These advantageous features make γ-PGA 4. GENE VECTOR
a promising candidate as a carrier of polymer-drug conju- Gene therapy is expected to be an effective method to
gates. combat cancers, immunodeficiency, and neurological, mon-
In order to maximize the therapeutic effect of 5- ogenic, ocular, cardiovascular, and infectious diseases [50].
fluorouracil and minimize its adverse effects, γ-poly(α- The success of gene therapy highly relies on the develop-
hydroxymethyl-5-fluorouracil-glutamate) was constructed to ment of secure and effective delivery vehicles, i.e., vectors.
control the time of releasing the 5-fluorouracil in vitro rang- Gene delivery vectors are categorized into two groups, viral
ing from a few hours to over 20 days [41]. Additionally, it and non-viral vectors. The use of viral vectors is generally
was indicated that the model drug naproxen was efficiently considered a powerful technique. However, humans have an
loaded and released in a controlled manner from poly immune system to fight off the viral vectors, and our at-
NIPAAm-co-γ-PGA-AGE (NIPAAm, N- tempts to deliver genes in viral vectors have been obstructed
isopropylacrylamide; AGE, allyl glycidyl ether) hydrogels, by these host responses [51]. Among non-viral vectors, the
which not only showed effective thermal response sensitivi- cationic polymer is widely accepted due to its capability of
ties, but also responded to pH response sensitivities and deg- efficiently condensing DNA and interacting with cells [52].
radation activities [42]. Recently, Nie et al. synthesized a However, several unsolved problems in the process of shut-
porous γ-PGA-CS (CS, chitosan) hydrogel, prepared by
tling genes into the cells surrounding its toxicity, lack of
polymerization of electrostatic contacts of CS with γ-PGA
biodegradability, low field of gene transfection, biocompati-
without a linker, with the high swelling capacity of water and
high adsorption efficiency for bovine serum albumin [43]. bility, and in particular, low transfection efficiency strongly
Given these characteristics, the γ-PGA-CS hydrogel has po- prohibit its use in practice [53]. Furthermore, it should be
tential applications in smart drug carriers. emphasized that the strength of electrostatic interactions be-
4 Current Pharmaceutical Biotechnology, 2021, Vol. 22, No. 0 Wang et al.

tween cationic polymer and DNA prevent their dissociation regulation of the costimulatory molecules CD80 and CD86
within cells, thus precluding the transcription of DNA and and the chemokine receptor CCR7 [65].
resulting in low transfection [54]. Furthermore, intranasal immunization with the mixture of
Therefore, approaches have been developed to eliminate γ-PGA NPs and hemagglutinin vaccine from an influenza
the disadvantages of cationic polymer/DNA complexes by virus strain A/PR/8/34 (H1N1) or A/New Caledonia/20/99
modifying their internal structure by incorporating a nega- (H1N1) enhanced the protection of mice from A/PR/8/34
tively charged γ-PGA. Although they are advantageous for infection [66]. A single dose of Japanese encephalitis (JE)
DNA packing and protection, the CS-based complexes may vaccine with γ-PGA NPs significantly enhanced the neutral-
cause difficulties in DNA release once arriving at the site of izing antibody titer, as evidenced by the perfect survival rate
action. Consequently, after incorporating γ-PGA in CS-DNA of the immunized mice receiving a normally lethal JE virus
complexes, a significant increase in their transfection effi- infection, in comparison to only 50% survival rate of the
ciency and an enhancement in their cellular uptake was mice receiving a single dose of JE vaccine without γ-PGA
achieved [55]. The γ-PGA-CS-siRNA complexes may facili- NPs [67].
tate the intracellular release of siRNA, while the incorpora-
tion of γ-PGA into these complexes significantly expedite 6. TISSUE ENGINEERING MATERIAL
the onset of gene knockdown, enhance their inhibition effi-
As the commonly used scaffolding materials in tissue
ciency, and prolong the duration of gene silencing [56].
engineering, hydrogels are water-swollen and cross-linked
Once incorporated into a chitosan-g-stearic acid (CSSA)- polymeric 3D hydrophilic polymeric networks with excellent
based gene delivery system, the PEG-b-γ-PGA played multi- biocompatibility and characterized by high water-content,
ple important roles in enhancing the transfection efficiency porous structure, and elasticity, making fast exchange and
of CSSA-PEG-b-γ-PGA-pDNA complexes [57]. Kurosaki et transportation of bioactive substances, nutrients, and cell
al. prepared a tripartite complex composed of pDNA, poly- metabolites [68, 69]. However, applications of conventional
ethylenimine (PEI) and γ-PGA, which was taken up by the γ- hydrogels as load-bearing scaffolds were greatly hindered by
PGA-specific receptor-mediated energy-dependent process, their lack of bioactivity and superior mechanical properties.
showing improved uptake, gene expression, and transfection In the past decades, γ-PGA has been used as suitable materi-
efficiency, and decreased toxicity [58]. als in the clinical field of tissue engineering due to its fine
swelling ability and biocompatibility.
5. VACCINE ADJUVANT Studies have shown that the surface hydrophilicity, water
Vaccines are generally an effective tool for modulating absorption rate, swelling ratio, mechanical strength, and cell
host immune responses to specific antigens, especially mi- density of γ-PGA-CS composite tissue engineering matrices
crobial pathogen-associated antigens. Some of the most ef- were much higher than those of the unmodified CS matrices
fective and safe vaccines are live, attenuated variants of the [70]. Its suitable moisture content and these sound mechani-
targeted pathogen, while the attenuated vaccines have not cal properties are favorable for allowing the dressing to be
been successfully developed for many pathogens [59]. How- easily stripped off from the wound surface without damaging
newly regenerated tissue [71]. Wang et al. revealed that γ-
ever, immunization with nonliving vaccine antigens, such as
PGA-Ag hydrogels continuously released antibacterial fac-
proteins and peptides alone in the absence of adjuvants, often
tors (silver) and successfully helped reconstruct intact epi-
fails to induce effective immune responses [60]. Studies have
dermis and collagen deposition in 14 days of impaired
shown that most, if not all, adjuvants enhance T and B cell wound healing in mice [72]. As scar inhibitors towards hy-
responses by engaging the components of the innate immune pertrophic scarring, a versatile fabrication of γ-PGA based
system, rather than by directly affecting the lymphocytes on electrospun photocrosslinkable hydrogel fibrous scaffolds
themselves [61]. As a type of vaccine adjuvant, γ-PGA NPs incorporated with ginsenoside Rg3 accelerates fibroblasts to
are safe and efficient antigen carriers with unique immuno- sprout and grow and further promote cell communication
logical properties. and skin regeneration [73].
Matsuo et al. demonstrated that using a combinational As a particular tissue lacking blood supply to support
approach based on the antigen-delivery system using γ-PGA repair and remodeling, articular cartilage contains the limited
NPs and endoplasmic reticulum (ER)-transport system con- capacity to restore defects caused by joint injury and aging.
taining an ER-insertion signal sequence significantly en- The γ-PGA-g-CHS-PCL (CHS, chondroitin sulfate) compo-
hanced the ability of a peptide vaccine to induce cellular site biomaterial was developed as a scaffold for cartilage
immune responses, including cytotoxic T-lymphocyte activi-
tissue engineering to offer an alternative method for treating
ty [62]. Similarly, the immunization with γ-PGA-OVA
arthritis [69]. As well as γ-PGA polymerized in situ with β-
(OVA, ovalbumin) NPs induce significant expansion of anti-
Ca3(PO4)2, γ-PGA-Ca with the tripeptide arginine-glycine-
gen-specific CD8+ T cells [63]. Meanwhile, mice vaccinated
intranasally with γ-PGA-OVA NPs gained resistance to aspartic acid (RGD)-modified alginate is suitable for applica-
E.G7-OVA tumor cells, while the lung metastasis of B16- tion in the field of bone tissue engineering [74, 75]. Remark-
OVA cells was prominently suppressed by γ-PGA-OVA NPs ably, a self-healing polymer composed of γ-PGA network
[64]. In mice, after the subcutaneous injection of fluorescein- physically cross-linked via grafted self-assembling β-sheet
5-isothiocyanate (FITC)-labeled γ-PGA NPs or FITC-OVA- peptides with tailorable mechanical properties is becoming a
carrying γ-PGA NPs, dendritic cells migrated from the skin promising platform for future tissue-engineering scaffolds
to the lymph nodes and maturated, resulting in the up- and biomedical applications [76].
Applications and Functions of γ-Poly-Glutamic Acid Current Pharmaceutical Biotechnology, 2021, Vol. 22, No. 0 5

7. CONTRAST AGENT Moreover, urea was regarded as a promising additive to pre-


vent spontaneous physical gelation of the mixed gelatin and
The utilization of nanosystems as improved contrast
agents for medical imaging has generated considerable scien- the γ-PGA aqueous solution without changing the chemical
tific activities in the past few years because of their potential properties of WSC-induced cross-linking and tissue adhesion
applications in the diagnosis of diseases. Compared with of the formed hydrogel [86].
conventional organic fluorophores, the inorganic NPs have Air leak is a problem commonly occurring in lung and
several advantages used as optical imaging probes, including thoracic operations. Otani et al. designed and prepared a
low photo-bleaching, high quantum yields, multiplexed de- novel γ-PGA-gelatin hydrogel glue, which was significantly
tection capability, and unique surface plasmon properties more effective in sealing the lung air leak than the fibrin
[77]. However, the potential toxicities of non-degradable glue. Specifically, approximately 80% of the lungs treated
inorganic NPs limit their utility in practical clinical applica- with the hydrogel glue exhibited no air leak at the lung pres-
tions. Excitingly, the properties of non-toxicity and biodeg- sure of 50 cm H2O [87].
radability make γ-PGA a promising contrast agent.
Besides, the stability of nattokinase microencapsulated in
The γ-PGA-[Gd-DOTA] (DOTA, 1,4,7,10-tetraazacyclo- high-molecular-weight γ-PGA-Na against temperature and
dodecane-1,4,7,10-tetraacetic acid) conjugated with cysta- its pH values were found to be higher than those of the free
mine (a cleavable disulfide spacer) was used as a contrast form [88]. Prospectively, using γ-PGA as a coating material
agent for magnetic resonance imaging (MRI) and enhanced for microencapsulation needs to be further investigated in
blood pool imaging and cancer imaging [78]. Similarly, the future studies.
pharmacokinetics and elimination profile of γ-PGA-benzyl-
DTPA-Gd (DTPA, diethylenetramine pentaacetic acid) in CONCLUSION
rhesus monkeys indicated that this agent could be used as a
blood-pool MRI agent, which could be excreted from the γ-PGA has been known in the scientific fields for more
body within several days after administration [79]. Both the than 80 years, and numerous studies have been conducted on
self-assembled γ-PGA-PLL (PLL, poly-L-lysine) and γ- this polymer. In this review, we have presented the applica-
PGA-CS NPs cross-linked by glutaraldehyde exhibited tions and functions of γ-PGA and its derivatives in human
strong fluorescence signals and outstanding improvements medicine as various types of agents, e.g., metal chelator,
for optical imaging through the selection of appropriate drug carrier/deliverer, gene vector, vaccine adjuvant, tissue
wavelengths [80]. Potentially used as the MRI contrast engineering material, contrast agent, and others.
agents, the stable and folate-targeted NPs were obtained by Advances in science and technology have therefore
the self-assembly of γ-PGA and CS biopolymers containing helped optimize the production and performance of γ-PGA
paramagnetic Gd3+, and the nanocarrier provided a proper and expanded its range of applications. We foresee that
means for the early diagnosis of tumors based on the overex- much work remains to be done in this commercially and ac-
pression of folate receptors [81]. The developed γ-PGA- ademically important field of investigation. Therefore, we
[(Au0)200-PEI·NH2-mPEG] nanogels with a relative uniform
speculate that, with an upward trend in investigating the re-
spherical morphology displayed sound water dispersibility,
markable properties of γ-PGA, further efforts should be de-
colloid stability, and cytocompatibility within the Au con-
centration range and showed great potential to be employed voted to its applications as a moisturizer, biocontrol agent,
as an efficient contrast agent for computed tomography (CT) bacteriostatic agent, biodegradable material, and functional
imaging of cancer cells in vitro and the xenografted tumor membrane.
model in vivo due to its advantageous X-ray attenuation
properties and the ability to be significantly taken up by can- CONSENT FOR PUBLICATION
cer cells [82]. Not applicable.

8. OTHERS FUNDING
In surgical operations, suturing has been the most com- This study was supported by the Jilin Green Industry
mon technique for control of bleeding, wound closure, and Technology Introduction Project of China (No.
tissue adaptation. More importantly, many kinds of applica- L20192200011).
tions of biological glues have been reported in surgery, in-
cluding tissue adhesion, hemostasis, controlling oozing from CONFLICT OF INTEREST
organs, and sealing of air from the lung [83]. However, cur-
rently available glues show several drawbacks requiring sig- The authors declare no conflict of interest, financial or
nificant improvement for clinical use. otherwise.
A cohesive plug composed of γ-PGA and collagen fibrils
ACKNOWLEDGEMENTS
cross-linked with water-soluble carbodiimide (WSC) re-
tained its native specific D-period structure, possessed much We would like to express our gratitude to Dr. Helong
stronger bonding strength and higher hemostatic capability Quan, Exercise and Metabolism Research Center, College of
than the fibrin adhesive, and degraded gradually after subcu- Physical Education and Health Sciences, Zhejiang Normal
taneous implantation in the backs of rats over a period of 8 University, for his valuable editorial support. All the materi-
weeks, without any severe inflammatory response [84, 85]. als used in this paper are dually acknowledged.
6 Current Pharmaceutical Biotechnology, 2021, Vol. 22, No. 0 Wang et al.

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