1
|
Sezer A, Ozalp H, Imge Ucar-Goker B, Gencer A, Ozogul E, Cennet O, Yazici G, Arica Yegin B, Yabanoglu-Ciftci S. Protective role of transforming growth factor-Β3 (TGF-Β3) in the formation of radiation-induced capsular contracture around a breast implant: In vivo experimental study. Int J Pharm 2024; 665:124715. [PMID: 39284424 DOI: 10.1016/j.ijpharm.2024.124715] [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: 07/05/2024] [Revised: 08/27/2024] [Accepted: 09/11/2024] [Indexed: 09/21/2024]
Abstract
Postmastectomy radiotherapy causes capsular contracture due to fibroproliferation of the capsular tissue around the implant. In fibrosis, unlike normal wound healing, structural and functional disorders are observed in the tissues caused by excessive/irregular accumulation of extracellular matrix proteins. It has been reported that transforming growth factor-β3 (TGF-β3) prevents and reverses fibrosis in various tissues or provides scarless healing with its antifibrotic effect. Additionally, TGF-β3 has been shown to reduce fibrosis in radiotherapy-induced fibrosis syndrome. However, no study in the literature investigates the effects of exogenously applied TGF-β3 on capsular contracture in aesthetic or reconstructive breast implant application. TGF-β3, which has a very short half-life, has low bioavailability with parenteral administration. Within the scope of this study, free TGF-β3 was loaded into the nanoparticles to increase its low bioavailability and extend its duration of action by providing controlled release. The aim of this study is to investigate the preventive/improving effects of radiation induced capsular contracture using chitosan film formulations containing TGF-β3 loaded poly(lactic-co-glycolic acid)-b-poly(ethylene glycol) (PLGA-b-PEG) nanoparticles in implant-based breast reconstruction. In the characterization studies of nanoparticles, the particle size and zeta potential of the TGF-β3-loaded PLGA-b-PEG nanoparticle formulation selected to be used in the treatment group were found to be 123.60 ± 2.09 nm and -34.87 ± 1.42 mV, respectively. The encapsulation efficiency of the formulation was calculated as 99.91 %. A controlled release profile was obtained in in vitro release studies. Chitosan film formulations containing free TGF-β3 or TGF-β3-loaded PLGA-b-PEG nanoparticles were used in in vivo studies. In animal studies, rats were randomly distributed into 6 groups (n = 8) as sham, implant, implant + radiotherapy, implant + radiotherapy + chitosan film containing unloaded nanoparticles, implant + radiotherapy + chitosan film containing free TGF-β3, implant + radiotherapy + chitosan film containing TGF-β3 loaded nanoparticle. In all study groups, a 2 cm incision was made along the posterior axillary line at the thoracic vertebral level in rats to reach the lateral edge of the latissimus dorsi. The fascial attachment to the chest wall was then bluntly dissected to create a pocket for the implants. In the treatment groups, the wound was closed after films were placed on the outer surface of the implants. After administering prophylactic antibiotics, rats were subjected to irradiation with 10 Gy photon beams targeted to each implant site. Each implant and the surrounding excised tissue were subjected to the necessary procedures for histological (capsule thickness, cell density), immunohistochemical, and biochemical (α-SMA, vimentin, collagen type I and type III, TGF-β1 and TGF-β3: expression level/protein level) examinations. It was determined that the levels of TGF-β1 and TGF-β3 collagen type III, which decreased as a result of radiotherapy, were brought to the control level with free TGF-β3 film and TGF-β3 nanoparticle film formulations. Histological analyses, consistent with biochemical analyses, showed that thick collagen and fibrosis, which increased with radiotherapy, were brought to the control level with free TGF-β3 film and TGF-β3 nanoparticle film treatments. In biochemical analyses, the decrease in thick collagen was compatible with the decrease in the collagen type I/type III ratio in the free TGF-β3 film and TGF-β3 nanoparticle film groups. Changes in protein expression show that TGF-β3 loaded nanoparticles are more successful than free TGF-β3 in wound healing. In line with these results and the literature, it is thought that the balance of TGF-β1 and TGF-β3 should be maintained to ensure scarless wound healing with no capsule contracture.
Collapse
Affiliation(s)
- Aysima Sezer
- Hacettepe University, Faculty of Pharmacy, Department of Biochemistry, 06100 Ankara, Turkey
| | - Hulya Ozalp
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Biotechnology, 06100 Ankara, Turkey
| | - Bercis Imge Ucar-Goker
- Kütahya Health Sciences University, Faculty of Medicine, Department of General Surgery, 43000 Kutahya, Turkey
| | - Ayse Gencer
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06100 Ankara, Turkey
| | - Ece Ozogul
- Hacettepe University, Department of Pathology, 06100 Ankara, Turkey
| | - Omer Cennet
- Hacettepe University, Faculty of Medicine, Department of General Surgery, 06100 Ankara, Turkey
| | - Gozde Yazici
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, 06100 Ankara, Turkey
| | - Betul Arica Yegin
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Biotechnology, 06100 Ankara, Turkey; Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, 06100 Ankara, Turkey
| | - Samiye Yabanoglu-Ciftci
- Hacettepe University, Faculty of Pharmacy, Department of Biochemistry, 06100 Ankara, Turkey; Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Biotechnology, 06100 Ankara, Turkey; Hacettepe University, Institute of Health Sciences, Department of One Health, 06100 Ankara, Turkey.
| |
Collapse
|
2
|
Wright MA, Miller AJ, Dong X, Karinja SJ, Samadi A, Lara DO, Mukherjee S, Veiseh O, Spector JA. Reducing Peri-implant Capsule Thickness in Submuscular Rodent Model of Breast Reconstruction With Delayed Radiotherapy. J Surg Res 2023; 291:158-166. [PMID: 37421826 DOI: 10.1016/j.jss.2023.04.015] [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: 08/24/2022] [Revised: 04/05/2023] [Accepted: 04/29/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Capsular contracture remains the most common complication following device-based breast reconstruction, occurring in up to 50% of women who also undergo adjuvant radiotherapy either before or after device-based reconstruction. While certain risk factors for capsular contracture have been identified, there remains no clinically effective method of prevention. The purpose of the present study is to determine the effect of coating the implant with the novel small molecule Met-Z2-Y12, with and without delayed, targeted radiotherapy, on capsule thickness and morphologic change around smooth silicone implants placed under the latissimus dorsi in a rodent model. METHODS Twenty-four female Sprague Dawley rats each had 2 mL smooth round silicone breast implants implanted bilaterally under the latissimus dorsi muscle. Twelve received uncoated implants and twelve received implants coated with Met-Z2-Y12. Half of the animals from each group received targeted radiotherapy (20 Gray) on postoperative day ten. At three and 6 months after implantation, the tissue surrounding the implants was harvested for analysis of capsular histology including capsule thickness. Additionally, microCT scans were qualitatively analyzed for morphologic change. RESULTS Capsules surrounding Met-Z2-Y12-coated implants were significantly thinner (P = 0.006). The greatest difference in capsule thickness was seen in the irradiated 6-month groups, where mean capsule thickness was 79.1 ± 27.3 μm for uncoated versus 50.9 ± 9.6 μm for Met-Z2-Y12-coated implants (P = 0.038). At the time of explant, there were no capsular morphologic differences between the groups either grossly or per microCT. CONCLUSIONS Met-Z2-Y12 coating of smooth silicone breast implants significantly reduces capsule thickness in a rodent model of submuscular breast reconstruction with delayed radiotherapy.
Collapse
Affiliation(s)
- Matthew A Wright
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Andrew J Miller
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Xue Dong
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Sarah J Karinja
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Arash Samadi
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Daniel O Lara
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Sudip Mukherjee
- Veiseh Lab, Department of Bioengineering, Rice University, Houston, Texas
| | - Omid Veiseh
- Veiseh Lab, Department of Bioengineering, Rice University, Houston, Texas
| | - Jason A Spector
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York; Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.
| |
Collapse
|
3
|
Quintero Sierra LA, Busato A, Zingaretti N, Conti A, Biswas R, Governa M, Vigato E, Parodi PC, Bernardi P, Sbarbati A, Conti G. Tissue-Material Integration and Biostimulation Study of Collagen Acellular Matrices. Tissue Eng Regen Med 2022; 19:477-490. [PMID: 35244884 PMCID: PMC9130448 DOI: 10.1007/s13770-021-00420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Breast reconstruction after mastectomy using silicone implants is a surgical procedure that occasionally leads to capsular contracture formation. This phenomenon constitutes an important and persistent cause of morbidity, and no successful therapies are available to date. Recently, the use of acellular membranes as a protective material for silicone prostheses has been gaining attention due to their ability to prevent this adverse outcome. For this reason, the evaluation of the tissue-material integration and the induced biostimulation by acellular membranes results crucial. Evaluation of in vivo tissue integration and biostimulation induced by three different natural acellular collagen membranes. Methods: Scanning electron microscopy was performed to analyse the membrane porosity and cells-biomaterial interaction in vitro, both in dry and wet conditions. Adipose-derived stem cells were cultured in the presence of membranes, and the colonisation capacity and differentiation potential of cells were assessed. In vivo tests and ex vivo analyses have been performed to evaluate dermal integration, absorption degree and biostimulation induced by the evaluated membrane. Results: Analysis performed in vitro on the three different acellular dermal matrices evidenced that porosity and the morphological structure of membranes influence the liquid swelling ratio, affecting the cell mobility and the colonisation capacity. Moreover, the evaluated membranes influenced in different manner the adipose derived stem cells differentiation and their survival. In vivo investigation indicated that the absorption degree and the fluid accumulation surrounding the implant were membrane-dependent. Finally, ex vivo analysis confirmed the membrane-dependent behavior revealing different degree of tissue integration and biostimulation, such as adipogenic stimulation. Conclusion: The physico-chemical characteristics of the membranes play a key role in the biostimulation of the cellular environment inducing the development of well-organized adipose tissue.
Collapse
Affiliation(s)
| | - Alice Busato
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Nicola Zingaretti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy.,Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Anita Conti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Reetuparna Biswas
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Maurizio Governa
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Enrico Vigato
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Paolo Bernardi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Giamaica Conti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| |
Collapse
|
4
|
Ganon S, Morinet S, Serror K, Mimoun M, Chaouat M, Boccara D. Epidemiology and Prevention of Breast Prosthesis Capsular Contracture Recurrence. Aesthetic Plast Surg 2021; 45:15-23. [PMID: 32696162 DOI: 10.1007/s00266-020-01876-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Baker grade III and IV breast prosthesis capsular contractures represent a major problem for patients undergoing mammoplasties. The risk factors involved in recurrence are debated, and the best surgical approach for their prevention is not established. The objective was to identify these. MATERIALS AND METHODS We carried out a retrospective study of patients operated on for capsular contracture at the Saint-Louis Hospital in Paris from 2012 to 2014. The characteristics at inclusion were compared so as to determine the risk factors of recurrence. The surgical approaches were compared between the patients with recurrence and those without at 5 years. RESULTS Of the 100 patients included, 24 had a recurrence. The minimal follow-up was 5 years. No risk factors of recurrence of capsular contracture were identified. The surgical approach associated with the lowest rate of recurrence was anterior capsulectomy [OR total capsulectomy = 2.36 (0.73; 8.037) OR capsulotomy = 4.33 (1.37; 14.81)] (p < 0.040) with alteration of the volume of the implant, whether greater or less than initially [OR greater volume = 0.30 (0.096; 0.83); OR smaller volume = 0.14 (0.008; 0.85)] (p < 0.018). CONCLUSION The occurrence of capsular contracture is a major problem with prosthetic breast surgery. The main risk factors identified to date are essentially in regard to the occurrence of a first episode. No significant risk factors for recurrence were identified. The best prevention appears to be an anterior capsulectomy with reducing the volume of the implant. LEVEL OF EVIDENCE IV 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 . IV.
Collapse
|