Application of the novel polysaccharide “colanic acid (CA)” in submucosal injection and wound repair for endoscopic submucosal dissection

Abstract

Endoscopic submucosal dissection (ESD) is currently an important minimally invasive treatment for early gastrointestinal tumors. However, there remains a lack of ideal materials that can not only provide good injectability and submucosal lifting performance during ESD but also promote wound repair after ESD. This study aims to evaluate the properties of a novel polysaccharide material—colanic acid (CA). A comprehensive comparison was conducted between CA and clinically commonly used materials (normal saline and hyaluronic acid (HA)) in terms of physicochemical characteristics, submucosal lifting capacity, and biocompatibility. The results showed that CA exhibited better injectability, adhesiveness, and lifting performance than HA, and it showed no detectable cytotoxicity, hemolytic activity, or adverse local/systemic tissue reactions in our experiments. Additionally, CA demonstrates superior biological activities than HA, such as promoting angiogenesis, exerting antioxidant effects, inhibiting the secretion of IL-6, TNF-α, and IL-1β to achieve anti-inflammatory effects, and facilitating the migration of gastric epithelial cells. In an in vivo ESD model in pigs, it was verified that CA has better lifting performance than HA, and it could shorten the cutting time and reduce the number of injections during ESD. Furthermore, transcriptomic results suggest that CA promotes the enrichment of pathways related to wound healing compared with HA. This finding was further validated in a gastric ulcer model in rats, and the results indicate that CA has a better ulcer repair effect than HA. In conclusion, by integrating excellent physicochemical properties and multi-dimensional biological activities, the CA polysaccharide achieves synergistic optimization of procedural convenience, operational safety, and efficient wound healing across pre-, intra-, and post-operative phases of ESD, demonstrating promising clinical application prospects.