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Shin CM, Cho S, Kim DH, Ha Y, Shin HJ, Shin N, Kim DW, Choi CH, Cho WK, Oh SH. Zwitterionic polydopamine coatings suppress silicone implant-induced capsule formation. Biomater Sci 2021; 9:3425-3432. [PMID: 33949402 DOI: 10.1039/d0bm02215b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A synthetic zwitterionic dopamine derivative (ZW-DOPA) containing both catechol and amine groups was recently shown to exhibit excellent antifouling activity on marine surfaces. Here, we have extended these analyses to investigate the effects of ZW-DOPA coating on silicone implants. Successful formation of ZW-DOPA coatings on silicone implants was confirmed based on a combination of decreased static water contact angles on silicone implants, evidence of new peaks at 400.2 (N 1s), 232.2 (S 2s), and 168.0 (S 2p) eV, and increased quantitative atomic composition of C 1s with a concurrent decrease of Si 2p. Anti-biofilm formation assays revealed that ZW-DOPA coating prevented biofilm formation on silicone at a non-lethal concentration (0.5 mg mL-1). Capsule formation was also significantly inhibited by ZW-DOPA coating in vivo and the differentiation of fibroblasts into myofibroblasts was significantly suppressed. Together, these data suggest that silicone implants coated with ZW-DOPA may prevent capsular contracture after insertion when used in breast surgery.
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Affiliation(s)
- Chung Min Shin
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea.
| | - Soojeong Cho
- Department of Chemistry, Chungnam National University, Daejeon 34134, Republic of Korea.
| | - Dong Ho Kim
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Yooseok Ha
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea.
| | - Hyo Jung Shin
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Anatomy and Cell Biology, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Nara Shin
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Anatomy and Cell Biology, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Dong Woon Kim
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Anatomy and Cell Biology, Brain Research Institute, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Chul Hee Choi
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea and Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Woo Kyung Cho
- Department of Chemistry, Chungnam National University, Daejeon 34134, Republic of Korea.
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon 35015, Republic of Korea.
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Akyürek M, Orhan E, Aydın MŞ, Uysal Ö, Karşıdağ S. The effects of human amniotic membrane on silicone related capsule formation in rats. J Plast Surg Hand Surg 2020; 54:284-289. [PMID: 32427012 DOI: 10.1080/2000656x.2020.1766476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Silicone breast implants are commonly used materials in plastic surgery for breast augmentation and reconstruction and the most severe complication of silicone implants are capsule contraction which occurs in 40% of patients. The aim of our study is to evaluate how the amniotic membrane alters the capsule formation effects of silicone 24 wistar rats were used in the study. We placed a bare silicone block into the left side (Subgroup A) and single layer amniotic membrane coated silicone block into the right side (Subgroup B) of the rats back. The rats were then separated into three groups and in group 1 rats were euthanized after 3 weeks, in group 2 after 12 weeks and in group 3 after 24 weeks. Then capsule thickness, fibroblast and lymphocyte cell counts were evaluated for each sample. In Group 2 and group 3, the capsule thickness in Subgroup B was detected to be statistically significantly lower than that in Subgroup A. In Group 1, 2, and 3, the lymphocyte count in the capsule tissue taken from Subgroup B was lower than Subgroup A but the difference was not statistically significant. In Group 2 and 3, the fibrocyte count detected in the capsule tissue in Subgroup B was found to be statistically significantly lower than Subgroup A. the amniotic membrane was demonstrated to reduce capsule thickness by the antifibrinolytic effect in our study.
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Affiliation(s)
- Mustafa Akyürek
- Department of Plastic Surgery, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Erkan Orhan
- Department of Plastic Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Şerif Aydın
- Department of Histology and Embryology, School of Medicine, İstanbul Medipol University, İstanbul, Turkey
| | - Ömer Uysal
- Department of Biostatistics and Medicine Informatics, School of Medicine, Bezmialem Foundation University, İstanbul, Turkey
| | - Semra Karşıdağ
- Department of Plastic Surgery, School of Medicine, Sağlık Bilimleri University, İstanbul, Turkey
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Effect of Botulinum Toxin Type A on TGF-β/Smad Pathway Signaling: Implications for Silicone-Induced Capsule Formation. Plast Reconstr Surg 2017; 138:821e-829e. [PMID: 27391832 DOI: 10.1097/prs.0000000000002625] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of the most serious complications of breast surgery using implants is capsular contracture. Several preventive treatments have been introduced; however, the mechanism of capsule formation has not been resolved completely. The authors previously identified negative effects of botulinum toxin type A on capsule formation, expression of transforming growth factor (TGF)-β1, and differentiation of fibroblasts into myofibroblasts. Thus, the authors investigated how to prevent capsule formation by using botulinum toxin type A, particularly by means of TGF-β1 signaling, in human fibroblasts. METHODS In vitro, cultured human fibroblasts were treated with TGF-β1 and/or botulinum toxin type A. Expression of collagen, matrix metalloproteinase, and Smad was examined by Western blotting. The activation of matrix metalloproteinase was observed by gelatin zymography. In vivo, the effect of botulinum toxin type A on the phosphorylation of Smad2 in silicone-induced capsule formation was evaluated by immunocytochemistry. RESULTS In vitro, the phosphorylation of Smad2 was inhibited by botulinum toxin type A treatment. The expression levels of collagen types 1 and 3 were inhibited by botulinum toxin type A treatment, whereas those of matrix metalloproteinase-2 and matrix metalloproteinase-9 were enhanced. Gelatin zymography experiments confirmed enhanced matrix metalloproteinase-2 activity in collagen degradation. In vivo, botulinum toxin type A treatment reduced capsule thickness and Smad2 phosphorylation in silicone-induced capsules. CONCLUSION This study suggests that botulinum toxin type A plays an important role in the inhibition of capsule formation through the TGF-β/Smad signaling pathway. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Tatar S, Sarybaeva A, Fındıkcıoğlu K, Seymen CM, Elmas Ç, Latifoğlu O. The Effect of Hyaluronic Acid Application on the Perisilicon Capsule Structure. Aesthetic Plast Surg 2016; 40:938-946. [PMID: 27766403 DOI: 10.1007/s00266-016-0718-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Silicon implants constitute a major part of plastic surgery practice. Although materials with high biocompatibility have been used around the implants, capsule formation still develops and progressive nature of this process results in capsule contraction. The aim of this study is to evaluate the effects of hyaluronic acid injected around the silicon block on the capsule structure. METHODS Twenty Wistar albino rats were used in the study. Rats were divided into two main groups (group 1 and group 2) and two subgroups. Rats in group 1 were sacrificed in week 4 and rats in group 2 were sacrificed in week 8. A subcutaneous pouch was created in the dorsum of the rats and a silicon block was placed into the pouch in groups 1A and 2A. 0.2 ml of hyaluronic acid was injected around the silicon block in group 1B and group 2B. Rats were sacrificed and capsule structure and thickness were analyzed following macroscopic evaluation. Concentrations of transforming growth factor-β1 (TGF-β1) and heat shock protein-47 (HSP-47) were evaluated immunohistochemically, and statistical comparisons were made. RESULT Capsule structure consisted of three layers in all the groups. A more intense collagen structure was observed in the middle layer. The capsule was thinnest in group 1A and thickest in group 2B; the difference between the groups was statistically significant. TGF-β1 was most intense in group 2B and it was correlated with the amount of collagen. Involvement of HSP-47 was observed mainly in collagen and also in fibroblasts and vascular structures, and its concentration was found to be lower in groups 2A and 2B. CONCLUSION Exogenously added cross-linked hyaluronic acid increased the capsular thickness and may increase the risk of developing capsular contracture around silicone implants. LEVEL OF EVIDENCE II Evidence was obtained from the well-designed controlled trials without randomization.
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Affiliation(s)
- Sedat Tatar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kayseri Research and Training Hospital, Kayseri, Turkey.
| | - Ainura Sarybaeva
- Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kemal Fındıkcıoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cemile Merve Seymen
- Department of Histology and Embriology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Çiğdem Elmas
- Department of Histology and Embriology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Osman Latifoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Human Embryonic Stem Cell-Derived Endothelial Precursor Cell Conditioned Medium Reduces the Thickness of the Capsule Around Silicone Implants in Rats. Ann Plast Surg 2016; 75:348-52. [PMID: 25803327 DOI: 10.1097/sap.0000000000000123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We postulated that the fibrotic capsule around a silicone implant could be induced by ischemic conditions, based on previous reports that hypoxia is an important microenvironmental factor in the development of tissue fibrosis. OBJECTIVE This study aimed to determine the effect of human embryonic stem cell (hESC)-derived endothelial precursor cell (EPC) conditioned medium (CM), which has strong angiogenic potential, on the development of capsule around the silicone implant in a rat model. METHODS AND MATERIALS Three groups had a mini-silicone implant with a smooth surface inserted. In 2 experimental groups, hESC-EPC CM was administered into the subcutaneous pocket either 1 or 2 times. After 2 months, the capsules were harvested and analyzed by histologic examination. RESULTS There was a significant reduction in the thickness of the peri-implant capsules (P < 0.05) between the control and experimental groups. There is no tendency that hESC-EPC CM reduces inflammatory reaction in early postoperative periods. The experimental group showed increased angiogenesis compared to the control group (P < 0.05). CONCLUSIONS Tissue hypoxia around the implant may be another cause for the peri-implant capsule. A preventive or therapeutic strategy to decrease capsular contracture by relieving the ischemic condition around the implant can be investigated in the future.
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Effects of Different Concentrations of Injectable Collagenase Enzyme on Capsular Tissue Around Silicone Implants: A Preliminary Experimental Study for the Development of a New Treatment Strategy. Aesthetic Plast Surg 2016; 40:164-73. [PMID: 26715576 DOI: 10.1007/s00266-015-0600-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES In recent studies, collagen organization was blamed for the formation of capsular contracture which is still a challenging problem after silicone implant-based breast operations. In this study, effects of different concentrations of collagenase enzyme derived from Clostridium histolyticum on the capsular tissue formation around the silicone implants were investigated. The injectable form of collagenase has a routine clinical use in the treatment of both Dupuytren's and Peyronie's diseases. MATERIALS AND METHODS Thirty-two Wistar albino rats were randomized into four groups. A 2 × 1 × 0.3-cm-sized silicone block was inserted inside a dorsal subcutaneous pocket in all groups. After 2 months of insertion, capsule thicknesses around the implants were detected under ultrasonography. This was followed by injection of isotonic saline, 150, 300, and 600 IU in Gr-1, 2, 3, and 4, respectively. All the animals were sacrificed at the end of the first week for histologic sampling to determine fibroblast proliferation, vessel density of the tissue, necrosis, edema, inflammation, and capsule thickness. All the data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests and compared for significance of the results. RESULTS There was no significant difference in terms of capsule thinning between the 300 and 600 IU groups but in both groups thinning was significantly higher than the sham group. In the 150 IU group there was no significant thinning as compared to the sham group (p > 0.05). However, complications such as skin necrosis, infection, and seroma formation were seen only in the 600 IU injection group. The optimal safe and effective dose of the enzyme was accepted as 300 IU. The 300 IU injection provided up to 89 % thinning in the capsule tissue. There was thinning of the collagen bundles parallel to capsule thickness. In the 600 IU group, micro-pores were encountered at the thinnest points. CONCLUSION However, the late results and recurrence rates of capsular contracture were not included in this study; collagenase seemed effective for the reduction of capsular tissue around the implants. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Abstract
Clinicians and investigators have been implanting biomedical devices into patients and experimental animals for centuries. There is a characteristic complex inflammatory response to the presence of the biomedical device with diverse cell signaling, followed by migration of fibroblasts to the implant surface and the eventual walling off of the implant in a collagen capsule. If the device is to interact with the surrounding tissues, the collagen envelope will eventually incapacitate the device or myofibroblasts can cause capsular contracture with resulting distortion, migration, or firmness. This review analyzes the various tactics used in the past to modify or control capsule formation with suggestions for future investigative approaches.
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Lee SD, Yi MH, Kim DW, Lee Y, Choi Y, Oh SH. The effect of botulinum neurotoxin type A on capsule formation around silicone implants: the in vivo and in vitro study. Int Wound J 2014; 13:65-71. [PMID: 24602064 DOI: 10.1111/iwj.12228] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/03/2014] [Indexed: 01/05/2023] Open
Abstract
This study confirms that botulinum neurotoxin type A (BoNT-A) decreases capsular contracture and elucidates a possible mechanism. Silicone blocks were implanted subcutaneously in 20 mice. The experimental groups received BoNT-A (1, 2·5 or 5 U) instilled into the subcutaneous pocket. After 30 days, periprosthetic capsules were harvested and evaluated. The effect of BoNT-A on the differentiation of human dermal fibroblasts to myofibroblasts in culture was examined by Western blot analysis. Changes in transforming growth factor-beta1 (TGF-β1) expression in cultured fibroblasts were determined by enzyme-linked immunosorbent assay (ELISA). In in vivo study, the thickness of capsules (P < 0·05) and the number of alpha-smooth muscle actin (α-SMA)(+) cells in capsules (P < 0·05) were significantly decreased in the experimental groups. TGF-β1 was significantly underexpressed in the experimental groups (P < 0·05). In in vitro study, BoNT-A did not significantly affect fibroblast viability. Western blot analysis showed that α-SMA protein levels were significantly decreased in the experimental groups (P < 0·05). Based on ELISA, the amount of TGF-β1 was significantly decreased in the experimental groups (P < 0·05), especially cells treated with a high dose of BoNT-A (P < 0·001). This study confirms that BoNT-A prevents capsular formation around silicone implants, possibly by blocking TGF-β1 signalling and interrupting the differentiation of fibroblasts to myofibroblasts.
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Affiliation(s)
- Sang D Lee
- Department of Physiology, College of Medicine, Chungnam National University, Daejeon, Korea.,Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min-Hee Yi
- Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong W Kim
- Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Lee
- Department of Plastic Surgery, Sanggye Piak Hospital, School of Medicine, Inje University, Seoul, Korea
| | - YoungWoong Choi
- Department of Plastic Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Ha Oh
- Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea.,Department of Anatomy, College of Medicine, Chungnam National University, Daejeon, Korea.,BiO & J Inc., Daejeon, Korea
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Vieira VJ, dʼAcampora AJ, Marcos ABW, Di Giunta G, de Vasconcellos ZAA, Bins-Ely J, dʼEça Neves R, Figueiredo CP. Vascular Endothelial Growth Factor Overexpression Positively Modulates the Characteristics of Periprosthetic Tissue of Polyurethane-Coated Silicone Breast Implant in Rats. Plast Reconstr Surg 2010; 126:1899-1910. [DOI: 10.1097/prs.0b013e3181f446d5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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