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Sutthiwanjampa C, Kang SH, Kim MK, Hwa Choi J, Kim HK, Woo SH, Bae TH, Kim WJ, Kang SH, Park H. Tumor necrosis factor-α-treated human adipose-derived stem cells enhance inherent radiation tolerance and alleviate in vivo radiation-induced capsular contracture. J Adv Res 2024:S2090-1232(24)00295-9. [PMID: 39019109 DOI: 10.1016/j.jare.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Post-mastectomy radiotherapy plays a crucial role in breast cancer treatment but can lead to an inflammatory response causing soft tissue damage, particularly radiation-induced capsular contracture (RICC), impacting breast reconstruction outcomes. Adipose-derived stem cells (ADSCs), known for their regenerative potential via paracrine capacity, exhibit inherent radiotolerance. The influence of tumor necrosis factor-alpha (TNF-α) on ADSCs has been reported to enhance the paracrine effect of ADSCs, promoting wound healing by modulating inflammatory responses. OBJECTIVE This study investigates the potential of TNF-α-treated human ADSCs (T-hASCs) on silicone implants to alleviate RICC, hypothesizing to enhance suppressive effects on RICC by modulating inflammatory responses in a radiation-exposed environment. METHODS In vitro, T-hASCs were cultured on various surfaces to assess viability after exposure to radiation up to 20 Gy. In vivo, T-hASC and non-TNF-α-treated hASC (C-hASCs)-coated membranes were implanted in mice before radiation exposure, and an evaluation of the RICC mitigation took place 4 and 8 weeks after implantation. In addition, the growth factors released from T-hASCs were assessed. RESULTS In vitro, hASCs displayed significant radiotolerance, maintaining consistent viability after exposure to 10 Gy. TNF-α treatment further enhanced radiation tolerance, as evidenced by significantly higher viability than C-hASCs at 20 Gy. In vivo, T-hASC-coated implants effectively suppressed RICC, reducing capsule thickness. T-hASCs exhibited remarkable modulation of the inflammatory response, suppressing M1 macrophage polarization while enhancing M2 polarization. The elevated secretion of vascular endothelial growth factor from T-hASCs is believed to induce macrophage polarization, potentially reducing RICC. CONCLUSION This study establishes T-hASCs as a promising strategy for ameliorating the adverse effects experienced by breast reconstruction patients after mastectomy and radiation therapy. The observed radiotolerance, anti-fibrotic effects, and immune modulation suggest the possibility of enhancing patient outcomes and quality of life. Further research and clinical trials are warranted for broader clinical uses.
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Affiliation(s)
- Chanutchamon Sutthiwanjampa
- School of Integrative Engineering, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea; College of Medicine, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea
| | - Seung Hyun Kang
- College of Medicine, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea; Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Mi Kyung Kim
- College of Medicine, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea; Departments of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Jin Hwa Choi
- College of Medicine, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea; Department of Radiation Oncology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Soo Hyun Woo
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Tae Hui Bae
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Woo Joo Kim
- Department of Plastic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Gyeonggi-do 14353, Republic of Korea
| | - Shin Hyuk Kang
- College of Medicine, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea; Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea.
| | - Hansoo Park
- School of Integrative Engineering, Chung-Ang University, 84 Heukseok-ro, Heukseok-dong, Dongjak-gu, Seoul 06974, Republic of Korea.
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Park BY, Wu D, Kwon KR, Kim MJ, Kim TG, Lee JH, Park DY, Kim IK. Implantation and tracing of green fluorescent protein-expressing adipose-derived stem cells in peri-implant capsular fibrosis. Stem Cell Res Ther 2023; 14:22. [PMID: 36750973 PMCID: PMC9906918 DOI: 10.1186/s13287-023-03248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Adipose-derived stem cells (ASCs) have been reported to reduce fibrosis in various tissues. In this study, we investigated the inhibitory role of ASCs on capsule formation by analyzing the histologic, cellular, and molecular changes in a mouse model of peri-implant fibrosis. We also investigated the fate and distribution of ASCs in the peri-implant capsule. METHODS To establish a peri-implant fibrosis model, customized silicone implants were inserted into the dorsal site of C57BL/6 wild-type mice. ASCs were harvested from the fat tissues of transgenic mice that express a green fluorescent protein (GFP-ASCs) and then injected into the peri-implant space of recipient mice. The peri-implant tissues were harvested from postoperative week 2 to 8. We measured the capsule thickness, distribution, and differentiation of GFP-ASCs, as well as the cellular and molecular changes in capsular tissue following ASC treatment. RESULTS Injected GFP-ASCs were distributed within the peri-implant capsule and proliferated. Administration of ASCs reduced the capsule thickness, decreased the number of myofibroblasts and macrophages in the capsule, and decreased the mRNA level of fibrogenic genes within the peri-implant tissue. Angiogenesis was enhanced due to trans-differentiation of ASCs into vascular endothelial cells, and tissue hypoxia was relieved upon ASC treatment. CONCLUSIONS We uncovered that implanted ASCs inhibit capsule formation around the implant by characterizing a series of biological alterations upon ASC treatment and the fate of injected ASCs. These findings highlight the value of ASCs for future clinical applications in the prevention of capsular contracture after implant-based reconstruction surgery.
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Affiliation(s)
- Bo-Yoon Park
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Dirong Wu
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Kyoo-Ri Kwon
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Mi-Jin Kim
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Tae-Gon Kim
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Jun-Ho Lee
- grid.413028.c0000 0001 0674 4447Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415 Korea
| | - Do Young Park
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.
| | - Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.
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Optimal Timing of Expander-to-Implant Exchange after Irradiation in Immediate Two-Stage Breast Reconstruction. Plast Reconstr Surg 2022; 149:185e-194e. [PMID: 35077405 DOI: 10.1097/prs.0000000000008712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Time intervals for expander-to-implant exchange from radiation therapy have been reported to reduce device failure. This study investigated the optimal timing of expander-to-implant exchange after irradiation in terms of short- and long-term outcomes. METHODS This retrospective review enrolled consecutive patients who underwent immediate two-stage breast reconstruction and radiation therapy to tissue expanders from 2010 to 2019. Receiver operating characteristic curves and the Youden index were used to estimate the optimal time from radiation therapy to implant placement in terms of 49-day (early) and 2-year (late) complications. Logistic regression analysis was performed to identify the risk factors for each complication. RESULTS Of the 1675 patients, 133 were included. The 49-day and 2-year complication rates were 8.3 percent and 29.7 percent, respectively. Capsular contracture was the most common 2-year complication. The Youden index indicated that implant placement at 131 days after radiation therapy was most effective in reducing the 49-day complications, but that the 2-year complication was less significant, with lower sensitivity and area under the curve. Modified radical mastectomy, expander fill volume at radiation therapy, and size of permanent implant increased the odds of 49-day complications; none of them was associated with the odds of 2-year complications. CONCLUSIONS To reduce short-term complications, the best time point for permanent implant placement was 131 days after radiation therapy. However, there was no significant time interval for reducing long-term complications. Capsular contracture was an irreversible complication of radiation injury that was not modified by postirradiation variables including the time from irradiation or size of permanent implant. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Shi XH, Zhou X, Lei ZY, Tian Y, Chen Y, Zhang YM, Mao TC, Fan DL, Zhou SW. Novel silicone rubber with carboxyl grafted polyhedral oligomeric silsesquioxane (POSS-COOH) as a potential scaffold for soft tissue filling. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1999951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xiao-hua Shi
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Ze-yuan Lei
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yuan Tian
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yao Chen
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Yi-ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Tong-chun Mao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Dong-li Fan
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Army Medical University, Chong Qing, China
| | - Shi-wen Zhou
- Base for Drug Clinical Trial, Xinqiao Hospital, The Army Medical University, Chong Qing, China
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Strategy for salvaging infected breast implants: lessons from the recovery of seven consecutive patients. Arch Plast Surg 2021; 48:165-174. [PMID: 33765733 PMCID: PMC8007469 DOI: 10.5999/aps.2020.01578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/13/2020] [Indexed: 11/08/2022] Open
Abstract
Background In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness. Methods The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed. Results The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant Staphylococcus aureus, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation. Conclusions In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.
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Angiotensin-Converting Enzyme Inhibitor Reduces Radiation-Induced Periprosthetic Capsular Fibrosis. J Surg Res 2021; 263:167-175. [PMID: 33667872 DOI: 10.1016/j.jss.2021.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The capsular contracture is one of the main complications after radiotherapy in patients with implant-based reconstruction. The aim of this study is to evaluate the efficacy of ramipril for the prevention of radiation-induced fibrosis around the silicone implant. MATERIALS AND METHODS Thirty Wistar rats in 5 groups were used. Group 1: implant; group 2: implant + radiation; group 3: ramipril + implant; group 4: ramipril + implant + radiation; group 5: sham. Ramipril treatment was started 5 d before surgery and continued for 12 wk after surgery. A mini silicone implant was placed in the back of the rats. A single fraction of 21.5 Gy radiation was applied. Tissues were examined histologically and immunohistochemically (TGF-β1, MMP-2, and TIMP-2 expression). The alteration of plasma TGF-β1 levels was examined before and after the experiment. RESULTS After applying implant or implant + radiation, capsular thickness, percentage of fibrotic area, tissue and plasma TGF-β1 levels significantly increased, and MMP-2/TIMP-2 ratio significantly decreased compared with the sham group. In ramipril-treated groups, the decrease in capsular thickness, fibrosis, TGF-β1 positivity, and an increase in MMP-2/TIMP-2 ratio were found significant. In the ramipril + implant + radiation group, the alteration values of TGF-β1 dramatically decreased. CONCLUSIONS Our results show that ramipril reduces radiation-induced fibrosis and contracture. The results of our study may be important for the design of the clinical trials required to investigate the effective and safe doses of ramipril, which is an inexpensive and easily tolerated drug, on humans.
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Ham J, Kim Y, An T, Kang S, Ha C, Wufue M, Kim Y, Jeon B, Kim S, Kim J, Choi TH, Seo JH, Kim DW, Park JU, Lee Y. Covalently Grafted 2-Methacryloyloxyethyl Phosphorylcholine Networks Inhibit Fibrous Capsule Formation around Silicone Breast Implants in a Porcine Model. ACS APPLIED MATERIALS & INTERFACES 2020; 12:30198-30212. [PMID: 32574031 DOI: 10.1021/acsami.0c07629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The surface of human silicone breast implants is covalently grafted at a high density with a 2-methacryloyloxyethyl phosphorylcholine (MPC)-based polymer. Addition of cross-linkers is essential for enhancing the density and mechanical durability of the MPC graft. The MPC graft strongly inhibits not only adsorption but also the conformational deformation of fibrinogen, resulting in the exposure of a buried amino acid sequence, γ377-395, which is recognized by inflammatory cells. Furthermore, the numbers of adhered macrophages and the amounts of released cytokines (MIP-1α, MIP-1β, IL-8, TNFα, IL-1α, IL-1β, and IL-10) are dramatically decreased when the MPC network is introduced at a high density on the silicone surface (cross-linked PMPC-silicone). We insert the MPC-grafted human silicone breast implants into Yorkshire pigs to analyze the in vivo effect of the MPC graft on the capsular formation around the implants. After 6 month implantation, marked reductions of inflammatory cell recruitment, inflammatory-related proteins (TGF-β and myeloperoxidase), a myoblast marker (α-smooth muscle actin), vascularity-related factors (blood vessels and VEGF), and, most importantly, capsular thickness are observed on the cross-linked PMPC-silicone. We propose a mechanism of the MPC grafting effect on fibrous capsular formation around silicone implants on the basis of the in vitro and in vivo results.
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Affiliation(s)
- Jiyeon Ham
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Youngmin Kim
- Interdisciplinary Program in Stem Cell Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Taeyang An
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sunah Kang
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Cheolmin Ha
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Maierdanjiang Wufue
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yumin Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Byoungjun Jeon
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Seulah Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jungah Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Tae Hyun Choi
- Department of Plastic and Reconstructive Surgery, Institute of Human-Environment Interface Biology, College of Medicine, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Ji-Hun Seo
- Department of Materials Science and Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Dae Woo Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, 5 Gil 20, Boramae-ro, Dongjak-gu, Seoul 07061, Republic of Korea
| | - Yan Lee
- Department of Chemistry, College of Natural Sciences, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Republic of Korea
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DeFazio MV, Clemens MW. Commentary on: Pro-Fibrotic CD26-Positive Fibroblasts Are Present in Greater Abundance in Breast Capsule Tissue of Irradiated Breasts. Aesthet Surg J 2020; 40:380-382. [PMID: 31201772 DOI: 10.1093/asj/sjz134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael V DeFazio
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
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Truong JL, Liu M, Tolg C, Barr M, Dai C, Raissi TC, Wong E, DeLyzer T, Yazdani A, Turley EA. Creating a Favorable Microenvironment for Fat Grafting in a Novel Model of Radiation-Induced Mammary Fat Pad Fibrosis. Plast Reconstr Surg 2019; 145:116-126. [PMID: 31881612 DOI: 10.1097/prs.0000000000006344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofibrosis of breast tissue compromises breast reconstruction by interfering with tissue viability and healing. Autologous fat transfer may reduce radiotherapy-related tissue injury, but graft survival is compromised by the fibrotic microenvironment. Elevated expression of receptor for hyaluronan-mediated motility (RHAMM; also known as hyaluronan-mediated motility receptor, or HMMR) in wounds decreases adipogenesis and increases fibrosis. The authors therefore developed RHAMM peptide mimetics to block RHAMM profibrotic signaling following radiation. They propose that this blocking peptide will decrease radiofibrosis and establish a microenvironment favoring adipose-derived stem cell survival using a rat mammary fat pad model. METHODS Rat mammary fat pads underwent a one-time radiation dose of 26 Gy. Irradiated (n = 10) and nonirradiated (n = 10) fat pads received a single intramammary injection of a sham injection or peptide NPI-110. Skin changes were examined clinically. Mammary fat pad tissue was processed for fibrotic and adipogenic markers using quantitative polymerase chain reaction and immunohistochemical analysis. RESULTS Clinical assessments and molecular analysis confirmed radiation-induced acute skin changes and radiation-induced fibrosis in rat mammary fat pads. Peptide treatment reduced fibrosis, as detected by polarized microscopy of picrosirius red staining, increased collagen ratio of 3:1, reduced expression of collagen-1 crosslinking enzymes lysyl-oxidase, transglutaminase 2, and transforming growth factor β1 protein, and increased adiponectin, an antifibrotic adipokine. RHAMM was expressed in stromal cell subsets and was downregulated by the RHAMM peptide mimetic. CONCLUSION Results from this study predict that blocking RHAMM function in stromal cell subsets can provide a postradiotherapy microenvironment more suitable for fat grafting and breast reconstruction.
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Affiliation(s)
- Jessica L Truong
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Muhan Liu
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Cornelia Tolg
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Meredith Barr
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Cecilia Dai
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Thomas C Raissi
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Eugene Wong
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Tanya DeLyzer
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Arjang Yazdani
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
| | - Eva A Turley
- From the Division of Plastic and Reconstructive Surgery, the Schulich School of Medicine and Dentistry, and the Department of Physics and Astronomy, Western University; and the London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital
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Li T, Liu Y, Zhang W. Botulinum Toxin A Plays an Important Role in the Placement of Implants Deep Within the Pectoralis Major Muscle for Mammaplasty: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2018; 42:1519-1530. [PMID: 30083802 DOI: 10.1007/s00266-018-1203-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breast prosthesis implants have been safely and efficiently used in the plastic surgery department. With the increasing demand for aesthetics, these silicon implants were not only used in breast augmentation surgery but also in breast reconstruction after mastectomy. Nevertheless, breast prosthesis implantation brings a lot of complications, such as: postoperative chronic pain, capsule contracture, prosthesis displacement and prosthesis rupture and infection in severe cases. From the year 1998, botulinum toxin A (BTX-A), a neurotoxin, has been reported to be effective for pain control, capsule contracture lessening, expander enlargement and so on. However, those articles included all kinds of study types: randomized, double-blinded controlled trial (RCT), nonrandomized trial, retrospective analysis and case series, besides the outcomes were varied. To clarify how BTX-A acts at the mammaplasty field, we made this systematic review and meta-analysis. PURPOSE To review how BTX-A acts in the field of mammaplasty as well as discuss the relative mechanisms of BTX-A and the related research progress. METHODS We searched Pubmed, Embase, Cochrane, Web of science, Clinical trials, Wanfang Database and VIP from inception until March 2018 for papers reporting the use of BTX-A in the breast surgery using implants deep within the pectoralis major muscle. System review, viewpoints and case reports were excluded. RESULTS Ten articles met the criteria for inclusion including six prospective controlled (2 RCT; 4 other trails), three retrospective cohorts and one case series. These studies were all about patients using BTX-A during or after breast surgery with expanders or prostheses. A total of 682 patients were enrolled, 543 (79.61%) accepted BTX-A injection, 185 underwent mastectomies with immediate reconstruction, 13 with delayed reconstruction, 295 mastectomies with either immediate or delayed reconstruction and 189 with breast augmentation using silicone prostheses. The study time ranging from 4 months to 13 years, 15 patients (2.76%) received BTX-A injection more than two times, 9.2% received less than 75 U BTX-A, 34.3% 75-100 U, 0.18% 250 U, and in 56.4% the dosage was not stated. No complications associated with BTX-A were mentioned, almost all the studies reported efficacy for pain control. Other assessments included increased speed of expander enlargement and volume were mentioned in four papers, two articles analyzed the visual analogue scores, three suggested relief of capsular contracture, two reported lower narcotic use, three mentioned shorter hospital stays and one proved lowering the rate of unplanned expander. It seems all the studies demonstrate the valid usage of BTX-A, but the quality of this evidence still under the line. CONCLUSION We could try to use BTX-A as a new method in the field of mammaplasty. There are so many advantages such as postoperative pain relief, reducing the hospital stay, and increasing operation success rate, but rigorous methodological evidence is still lacking. A lot of studies were retrospective, only two studies used the RCT method. Therefore, to obtain strong evidence to clarify the usage of BTX-A, more randomized double-blinded controlled trials will be required, meanwhile the mechanism study adds to the evidence. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. 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)
- Tian Li
- Breast Surgery Department, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201900, China
| | - Yan Liu
- Jingjiang Hospital of Traditional Chinese Medicine, Jingjiang, China
| | - Weihong Zhang
- Breast Surgery Department, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201900, China.
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