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Ko H, Kim D, Shin C, Gong NY, You B, Oh HS, Lee J, Oh SH. In Vivo Efficacy of an Injectable Human Acellular Dermal Matrix. Aesthetic Plast Surg 2023; 47:2833-2840. [PMID: 37069348 DOI: 10.1007/s00266-023-03353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/02/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Human acellular dermal matrix (hADM) has found applications in a variety of settings, particularly in breast surgery. The most common hADM is a sheet. Recently, an injectable hADM has been introduced; we compared the biocompatibility and long-term structural integrity of, an injectable hADM and a sheet-type hADM in mice. METHODS An injectable hADM (experimental group) and a sheet-type hADM (control group) were implanted into sub-panniculus pockets on the backs of 50 mice. The animals were sacrificed 2, 4, 8, 12, or 24 weeks later and the hADMs and surrounding tissues were recovered and stained for histopathological analyses. The microscopic endpoints included the thickness of the hADM and capsule around the hADM, and the extents of fibroblast proliferation and neovascularization. RESULTS No animal developed a complication or infection. The capsule was significantly thinner in the experimental than the control group. There were no significant differences between groups in the hADM thickness. Microscopically, the fibroblast density inside the hADM was significantly higher in the experimental group. The fibroblasts inside of the hADM lay significantly deeper in the experimental group. Similarly, the experimental group exhibited significantly deeper microvessels inside the hADM. CONCLUSIONS The injectable hADM had a thinner capsule thickness (more biocompatible), than the sheet-type hADM. It maintained its thickness as well as the sheet-type hADM and had a more fibroblast proliferation and neovascularization. This means the tissue incorporation and long-term structural integrity of the injectable hADM may be as good as or better than that of the sheet-type hADM. 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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Affiliation(s)
- Hyemi Ko
- Department of General Surgery, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Donghyun Kim
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Chungmin Shin
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Na Young Gong
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Boram You
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Han Seul Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Jinsun Lee
- Department of General Surgery, Chungnam National University College of Medicine, Daejeon, 35015, 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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Hwang P, Shin CM, Sherwood JA, Kim D, Vijayan VM, Josyula KC, Millican RC, Ho D, Brott BC, Thomas V, Choi CH, Oh SH, Kim DW, Jun HW. A multi-targeting bionanomatrix coating to reduce capsular contracture development on silicone implants. Biomater Res 2023; 27:34. [PMID: 37087537 PMCID: PMC10122329 DOI: 10.1186/s40824-023-00378-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Capsular contracture is a critical complication of silicone implantation caused by fibrotic tissue formation from excessive foreign body responses. Various approaches have been applied, but targeting the mechanisms of capsule formation has not been completely solved. Myofibroblast differentiation through the transforming growth factor beta (TGF-β)/p-SMADs signaling is one of the key factors for capsular contracture development. In addition, biofilm formation on implants may result chronic inflammation promoting capsular fibrosis formation with subsequent contraction. To date, there have been no approaches targeting multi-facted mechanisms of capsular contracture development. METHODS In this study, we developed a multi-targeting nitric oxide (NO) releasing bionanomatrix coating to reduce capsular contracture formation by targeting myofibroblast differentiation, inflammatory responses, and infections. First, we characterized the bionanomatrix coating on silicon implants by conducting rheology test, scanning electron microcsopy analysis, nanoindentation analysis, and NO release kinetics evaluation. In addition, differentiated monocyte adhesion and S. epidermidis biofilm formation on bionanomatrix coated silicone implants were evaluated in vitro. Bionanomatrix coated silicone and uncoated silicone groups were subcutaneously implanted into a mouse model for evaluation of capsular contracture development for a month. Fibrosis formation, capsule thickness, TGF-β/SMAD 2/3 signaling cascade, NO production, and inflammatory cytokine production were evaluated using histology, immunofluorescent imaging analysis, and gene and protein expression assays. RESULTS The bionanomatrix coating maintained a uniform and smooth surface on the silicone even after mechanical stress conditions. In addition, the bionanomatrix coating showed sustained NO release for at least one month and reduction of differentiated monocyte adhesion and S. epidermidis biofilm formation on the silicone implants in vitro. In in vivo implantation studies, the bionanomatrix coated groups demonstrated significant reduction of capsule thickness surrounding the implants. This result was due to a decrease of myofibroblast differentiation and fibrous extracellular matrix production through inhibition of the TGF-β/p-SMADs signaling. Also, the bionanomatrix coated groups reduced gene expression of M1 macrophage markers and promoted M2 macrophage markers which indicated the bionanomatrix could reduce inflammation but promote healing process. CONCLUSIONS In conclusion, the bionanomatrix coating significantly reduced capsular contracture formation and promoted healing process on silicone implants by reducing myfibroblast differentiation, fibrotic tissue formation, and inflammation. A multi-targeting nitric oxide releasing bionanomatrix coating for silicone implant can reduce capsular contracture and improve healing process. The bionanomatrix coating reduces capsule thickness, α-smooth muscle actin and collagen synthesis, and myofibroblast differentiation through inhibition of TGF-β/SMADs signaling cascades in the subcutaneous mouse models for a month.
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Affiliation(s)
- Patrick Hwang
- Endomimetics, LLC, Birmingham, AL, 35242, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA
| | - Chung Min Shin
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | | | - DongHo Kim
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Vineeth M Vijayan
- Department of Biomedical Engineering, Alabama State University, Montgomery, AL, 36104, USA
| | - Krishna C Josyula
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA
| | | | - Donald Ho
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Brigitta C Brott
- Endomimetics, LLC, Birmingham, AL, 35242, USA
- Department of Medicine and Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Vinoy Thomas
- Department of Material Science and Engineering, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Chul Hee Choi
- Department of Microbiology, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea
| | - Dong Woon Kim
- Department of Anatomy and Cell Biology, Brain Research Institute, College of Medicine, Chungnam National University College of Medicine, Daejeon, 35015, Republic of Korea.
| | - Ho-Wook Jun
- Endomimetics, LLC, Birmingham, AL, 35242, USA.
- Department of Biomedical Engineering, University of Alabama at Birmingham, 806 Shelby, 1825 University Boulevard, Birmingham, AL, 35294, USA.
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Chau Nguyen TT, Shin CM, Lee SJ, Koh ES, Kwon HH, Park H, Kim DH, Choi CH, Oh SH, Kim DW, Yang SY. Ultrathin Nanostructured Films of Hyaluronic Acid and Functionalized β-Cyclodextrin Polymer Suppress Bacterial Infection and Capsular Formation of Medical Silicone Implants. Biomacromolecules 2022; 23:4547-4561. [PMID: 36130109 PMCID: PMC9667880 DOI: 10.1021/acs.biomac.2c00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/08/2022] [Indexed: 11/29/2022]
Abstract
A type of ultrathin films has been developed for suppressing capsule formation induced by medical silicone implants and hence reducing the inflammation response to such formation and the differentiation to myofibroblasts. The films were each fabricated from hyaluronic acid (HA) and modified β-cyclodextrin (Mod-β-CyD) polymer which was synthesized with a cyclodextrin with partially substituted quaternary amine. Ultrathin films comprising HA and Mod-β-CyD or poly(allylamine hydrochloride) (PAH) were fabricated by using a layer-by-layer dipping method. The electrostatic interactions produced from the functional groups of Mod-β-CyD and HA influenced the surface morphology, wettability, and bio-functional activity of the film. Notably, medical silicone implants coated with PAH/HA and Mod-β-CyD multilayers under a low pH condition exhibited excellent biocompatibility and antibiofilm and anti-inflammation properties. Implantation of these nanoscale film-coated silicones showed a reduced capsular thickness as well as reduced TGFβ-SMAD signaling, myofibroblast differentiation, biofilm formation, and inflammatory response levels. We expect our novel coating system to be considered a strong candidate for use in various medical implant applications in order to decrease implant-induced capsule formation.
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Affiliation(s)
- Thi Thuy Chau Nguyen
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| | - Chung Min Shin
- Department
of Plastic Surgery, Chungnam National University
School of Medicine, 266 Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Su Jin Lee
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| | - Eun Seo Koh
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
| | - Hyeok Hee Kwon
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Hyewon Park
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Dong Ho Kim
- Department
of Microbiology, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Chul Hee Choi
- Department
of Microbiology, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
- Department
of Medical Science, Chungnam National University
School of Medicine, 266
Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Sang-Ha Oh
- Department
of Plastic Surgery, Chungnam National University
School of Medicine, 266 Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Dong Woon Kim
- Department
of Anatomy and Cell Biology, Chungnam National
University School of Medicine, 266 Munhwa-Ro, Chung-Gu, Daejeon 35015, Republic of Korea
| | - Sung Yun Yang
- Department
of Polymer Science and Engineering, Graduate
School of Chungnam National University, 99 Daehak-Ro, Yuseong-gu, Daejeon 34134, Republic
of Korea
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Ishihara K. Biomimetic materials based on zwitterionic polymers toward human-friendly medical devices. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2022; 23:498-524. [PMID: 36117516 PMCID: PMC9481090 DOI: 10.1080/14686996.2022.2119883] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/01/2023]
Abstract
This review summarizes recent research on the design of polymer material systems based on biomimetic concepts and reports on the medical devices that implement these systems. Biomolecules such as proteins, nucleic acids, and phospholipids, present in living organisms, play important roles in biological activities. These molecules are characterized by heterogenic nature with hydrophilicity and hydrophobicity, and a balance of positive and negative charges, which provide unique reaction fields, interfaces, and functionality. Incorporating these molecules into artificial systems is expected to advance material science considerably. This approach to material design is exceptionally practical for medical devices that are in contact with living organisms. Here, it is focused on zwitterionic polymers with intramolecularly balanced charges and introduce examples of their applications in medical devices. Their unique properties make these polymers potential surface modification materials to enhance the performance and safety of conventional medical devices. This review discusses these devices; moreover, new surface technologies have been summarized for developing human-friendly medical devices using zwitterionic polymers in the cardiovascular, cerebrovascular, orthopedic, and ophthalmology fields.
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Affiliation(s)
- Kazuhiko Ishihara
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Osaka, Japan
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Hong Y, Kim B, Jeong J, Bisht H, Park S, Hong D. Antifouling Surface Coating on Various Substrates by Inducing Tyrosinase-Mediated Oxidation of a Tyrosine-Conjugated Sulfobetaine Derivative. Biomacromolecules 2022; 23:4349-4356. [PMID: 36049071 DOI: 10.1021/acs.biomac.2c00804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inspired by the melanogenesis occurring in nature, we report tyrosinase-mediated antifouling surface coating by synthesizing a tyrosine-conjugated sulfobetaine derivative (Tyr-SB). Synthetic Tyr-SB contains zwitterionic sulfobetaine and tyrosine, whose phenolic amine group acts as a dormant coating precursor. In contrast to catecholamine derivatives, tyrosine derivatives are stable against auto-oxidation and are enzymatically oxidized only in the presence of tyrosinase to initiate melanin-like oxidation. When the surface of interest was applied during the course of Tyr-SB oxidation, a superhydrophilic poly(Tyr-SB) film was coated on the surfaces, thereby showing antifouling performance against proteins or adherent cells. Because the oxidation of Tyr-SB occurred under mild aqueous conditions (pH 6-7) without the use of any chemical oxidants, such as sodium periodate or ammonium persulfate, we anticipate that the coating method described herein will serve as a biocompatible tool in the field of biosensors, cell surface engineering, and medical devices, whose interfaces differ in chemistry.
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Affiliation(s)
- Yubin Hong
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Byeol Kim
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Jaehoon Jeong
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Himani Bisht
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Suho Park
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Daewha Hong
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
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