1
|
Evin N, Guray Evin S. Camouflage of Postburn Scarring Alopecia Using Nanofat Grafting and Follicular Unit Hair Transplantation. Plast Reconstr Surg 2024; 154:207-215. [PMID: 37253046 DOI: 10.1097/prs.0000000000010759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Postburn scarring alopecia on hair-bearing aesthetic subunits causes cosmetic disfiguring and psychological problems. Follicular unit extraction (FUE) hair transplantation is an effective technique for camouflaging postburn scarring alopecia. However, poorly vascularized and fibrotic scar tissue limits the viability of grafts. The mechanical and vascular characteristics of scar tissue can be improved by nanofat grafting. This study aimed to present the results of postburn scarring alopecia treatment using nanofat-assisted FUE hair transplantation. METHODS Eighteen patients who had postburn scarring alopecia in and around the beard were enrolled. Patients underwent single-session nanofat grafting and FUE hair transplantation at 6-month intervals. Twelve months after hair transplantation, the survival rate of transplanted follicular graft, scar improvement, and patient satisfaction were assessed by counting each transplanted follicle individually, using the Patient and Observer Scar Assessment Scale, and using a 5-point Likert satisfaction scale, respectively. RESULTS Nanofat grafting and hair transplantation were successfully performed without complication. All scars significantly improved in mature characteristics ( P < 0.00001 for patients; P < 0.00001 for observers). The survival and density rates of transplanted follicular units ranged from 77.4% to 87.9% (mean, 83.2% ± 2.5%) and 10.7% to 19.6% (mean, 15.2% ± 2.46%), respectively. All patients reported significantly satisfying cosmetic results ( P < 0.00001). CONCLUSIONS Scarring alopecia is an inevitable and challenging late complication of deep burned hair-bearing units. Combining nanofat injection and FUE hair transplantation is among the most innovative and effective treatments for postburn scarring alopecia. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
Affiliation(s)
- Nuh Evin
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Bezmialem Vakif University Faculty of Medicine
| | - Seyda Guray Evin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University Faculty of Medicine
| |
Collapse
|
2
|
Binici S, Güven M, Özdemir A, İlik ZA, Demirhan B, Uygur S, İliklerden ÜH. Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management. Histochem Cell Biol 2024:10.1007/s00418-024-02267-z. [PMID: 38282055 DOI: 10.1007/s00418-024-02267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.
Collapse
Affiliation(s)
- Serhat Binici
- General Surgery Department, Şırnak State Hospital, Şırnak, Turkey.
| | - Mustafa Güven
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Abdulselam Özdemir
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| | - Zehra Akman İlik
- Department of Pathology, Van Education and Research Hospital, Van, Turkey
| | - Birhan Demirhan
- Faculty of Medicine, Department of Radiation Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Serhat Uygur
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Ümit Haluk İliklerden
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| |
Collapse
|
3
|
Pattani N, Sanghera J, Langridge BJ, Frommer ML, Abu-Hanna J, Butler P. Exploring the mechanisms behind autologous lipotransfer for radiation-induced fibrosis: A systematic review. PLoS One 2024; 19:e0292013. [PMID: 38271326 PMCID: PMC10810439 DOI: 10.1371/journal.pone.0292013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/11/2023] [Indexed: 01/27/2024] Open
Abstract
AIM Radiation-induced fibrosis is a recognised consequence of radiotherapy, especially after multiple and prolonged dosing regimens. There is no definitive treatment for late-stage radiation-induced fibrosis, although the use of autologous fat transfer has shown promise. However, the exact mechanisms by which this improves radiation-induced fibrosis remain poorly understood. We aim to explore existing literature on the effects of autologous fat transfer on both in-vitro and in-vivo radiation-induced fibrosis models, and to collate potential mechanisms of action. METHOD PubMed, Cochrane reviews and Scopus electronic databases from inception to May 2023 were searched. Our search strategy combined both free-text terms with Boolean operators, derived from synonyms of adipose tissue and radiation-induced fibrosis. RESULTS The search strategy produced 2909 articles. Of these, 90 underwent full-text review for eligibility, yielding 31 for final analysis. Nine conducted in-vitro experiments utilising a co-culture model, whilst 25 conducted in-vivo experiments. Interventions under autologous fat transfer included adipose-derived stem cells, stromal vascular function, whole fat and microfat. Notable findings include downregulation of fibroblast proliferation, collagen deposition, epithelial cell apoptosis, and proinflammatory processes. Autologous fat transfer suppressed hypoxia and pro-inflammatory interferon-γ signalling pathways, and tissue treated with adipose-derived stem cells stained strongly for anti-inflammatory M2 macrophages. Although largely proangiogenic initially, studies show varying effects on vascularisation. There is early evidence that adipose-derived stem cell subgroups may have different functional properties. CONCLUSION Autologous fat transfer functions through pro-angiogenic, anti-fibrotic, immunomodulatory, and extracellular matrix remodelling properties. By characterising these mechanisms, relevant drug targets can be identified and used to further improve clinical outcomes in radiation-induced fibrosis. Further research should focus on adipose-derived stem cell sub-populations and augmentation techniques such as cell-assisted lipotransfer.
Collapse
Affiliation(s)
| | | | - Benjamin J. Langridge
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
- Division of Surgery & Interventional Sciences, University College London, London, United Kingdom
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Marvin L. Frommer
- Division of Surgery & Interventional Sciences, University College London, London, United Kingdom
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Jeries Abu-Hanna
- Division of Surgery & Interventional Sciences, University College London, London, United Kingdom
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
- Division of Medical Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter Butler
- Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom
- Division of Surgery & Interventional Sciences, University College London, London, United Kingdom
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| |
Collapse
|
4
|
Ziegler ME, Staben A, Lem M, Pham J, Alaniz L, Halaseh FF, Obagi S, Leis A, Widgerow AD. Targeting Myofibroblasts as a Treatment Modality for Dupuytren Disease. J Hand Surg Am 2023; 48:914-922. [PMID: 37480917 DOI: 10.1016/j.jhsa.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Currently, no treatment corrects the contractile nature of Dupuytren myofibroblasts (DMFs) or prevents recurrence following surgery. Antifibrotic and proadipogenic growth factors are released when adipose-derived stem cells (ASCs) are cultured with platelet-rich plasma (PRP), a platelet concentration from whole blood. Reprograming myofibroblasts into adipocytes via growth factors is proposed as a powerful potential tool to target fibrosis. We aimed to assess whether the combination of ASCs and PRP reprograms DMFs into adipocytes in vitro and alters their contractile nature in vivo. METHODS Normal human dermal fibroblasts (NHDFs) and DMFs from Dupuytren patients were isolated and cocultured with ASCs and PRP either alone or together. Adipocytes were detected by Oil Red O and perilipin staining. DMFs and NHDFs were transplanted into the forepaws of rats (Rowett Nude [rnu/rnu]) and treated with saline, PRP+ASCs, or collagenase Clostridium histolyticum (clinical comparison) 2 months later. After 2 weeks, the tissue was harvested and subjected to Masson trichrome staining, and collagen I and III and alpha-smooth muscle actin detection by immunohistochemistry. RESULTS Myofibroblasts transform into adipocytes upon coculture with PRP+ASCs. DMFs show increased alpha-smooth muscle actin expression in vivo compared with NHDFs, which is significantly decreased after PRP+ASCs and collagenase Clostridium histolyticum treatments. DMFs induce collagen I and III expressions in rat paws compared with NHDFs, with a type III to I ratio increase. Treatment with PRP+ASC reduced the ratio, but collagenase Clostridium histolyticum did not. CONCLUSIONS Treating DMFs with PRP+ASCs provides factors that induce myofibroblast to adipocyte transformation. This treatment reduces the contractile phenotype and fibrosis markers in vivo. Future studies should detail the mechanism of this conversion. CLINICAL RELEVANCE The combination of PRP and ASCs to induce the differentiation of DMFs into adipocytes may serve to limit surgery to a percutaneous contracture release and biological injection, rather than a moderate or radical fasciectomy, and reduce the recurrence of Dupuytren contracture.
Collapse
Affiliation(s)
- Mary E Ziegler
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Andres Staben
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Melinda Lem
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Jason Pham
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Leonardo Alaniz
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Faris F Halaseh
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Sabine Obagi
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Amber Leis
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA
| | - Alan D Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Orange, CA.
| |
Collapse
|
5
|
Wei H, Yang S, Yi T, Xu X, Liu C, Shen C, Guo Y, Li Q, Jin P. CircAGK regulates high dihydrotestosterone-induced apoptosis in DPCs through the miR-3180-5p/BAX axis. FASEB J 2023; 37:e22728. [PMID: 36607259 DOI: 10.1096/fj.202200849r] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
The incidence of androgen alopecia (AGA), also known as seborrheic alopecia, has surged in recent years, and onset is occurring at younger ages. Dermal papilla cells (DPCs) are key to maintaining hair cycling, and apoptosis-driven processes in DPCs are closely related to hair follicle regeneration. Circular RNAs (circRNAs) are widely present in the human body and are closely related to the occurrence and development of many diseases. Currently, the biological functions of circRNAs in AGA are largely unknown. Whole-transcriptome sequencing was used to screen differential circRNA expression profiles between AGA patients and non-AGA patients. We found that hsa_circ_0002980 (circAGK) was significantly highly expressed in the AGA group. CircAGK promoted DPC apoptosis in the presence of high dihydrotestosterone (DHT) (15 nmol/L). By regulating the miR-3180-5p/BAX axis, circAGK promotes DPC apoptosis in a high DHT environment in vitro and inhibits hair growth in AGA mice in vivo, indicating that circAGK is a potential target for the clinical treatment of AGA.
Collapse
Affiliation(s)
- Hanxiao Wei
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuai Yang
- The First College of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
| | - Tian Yi
- The First College of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
| | - Xiaoyu Xu
- The First College of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
| | - Chang Liu
- The First College of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
| | - Caiqi Shen
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yanping Guo
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qiang Li
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Peisheng Jin
- Department of Plastic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
6
|
Schneider I, Calcagni M, Buschmann J. Adipose-derived stem cells applied in skin diseases, wound healing and skin defects: a review. Cytotherapy 2023; 25:105-119. [PMID: 36115756 DOI: 10.1016/j.jcyt.2022.08.005] [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: 04/06/2022] [Revised: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 01/18/2023]
Abstract
Adipose tissue presents a comparably easy source for obtaining stem cells, and more studies are increasingly investigating the therapeutic potential of adipose-derived stem cells. Wound healing, especially in chronic wounds, and treatment of skin diseases are some of the fields investigated. In this narrative review, the authors give an overview of some of the latest studies concerning wound healing as well as treatment of several skin diseases and concentrate on the different forms of application of adipose-derived stem cells.
Collapse
Affiliation(s)
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Johanna Buschmann
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
7
|
Li Z, Gan H, Liang A, Wang X, Hu X, Liang P, Xu G, Huang Q, Li J, Li H. Promoting repair of highly purified stromal vascular fraction gel combined with advanced platelet-rich fibrin extract for irradiated skin and soft tissue injury. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:933. [PMID: 36172108 PMCID: PMC9511193 DOI: 10.21037/atm-22-3956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
Background To evaluate the effect of highly purified stromal vascular fraction gel (SVFG) combined with advanced platelet-rich fibrin extract (APRFE) in treatment of irradiated skin and soft tissue injury. Methods The subcutaneous fat and whole blood of 4 rabbits were collected to isolate the SVFG and APRFE, respectively. Forty-eight rabbits were divided into 4 groups to prepare irradiated skin injury models with 25 Gy for 24 hours; corresponding dose were performed subcutaneously injected into wounds. In group A, the rabbits were treated with 0.3 mL APRFE combined with 1 mL SVFG. In group B, the rabbits were treated with 1 mL SVFG. In group C, the rabbits were treated with 0.3 mL APRFE, and group D was treated with 1 mL normal saline. The wound healing was detected on the 2, 5, 9 and 14 d after intervention. The wounds tissue was cut for hematoxylin and eosin (HE) staining to observe the structure and Masson staining to observe the collagen content. The expression of CD31 in each group was detected by immunohistochemistry (IHC), the protein and mRNA levels of K19, hypoxia inducible factor-1 alpha (HIF-1α), vascular endothelial growth factor (VEGF), interleukin 8 (IL-8) and interleukin 10 (IL-10) were detected respectively by Western blot (WB) and reverse transcription-polymerase chain reaction (RT-PCR) on 7, 14 and 28 d after intervention. Results It is revealed that wound healing rates from 5 to 14 d in group A was significantly higher than that of control. The wounds healing rates in group B and C were significantly higher than that of control after 12 d. Masson staining results showed that the collagen content in group A was significantly higher than that of the other 3 groups on the 7, 14 and 28 d. The results of IHC showed that the expression of CD31 in group A was significantly higher than that of the other 3 groups on 7, 14 and 28 d. WB and RT-PCR results showed that relative expression levels of K19, HIF-1α, VEGF, IL-10 in group A were significantly higher than that of the other 3 groups on 7, 14 and 28 d. However, the relative expression levels of IL-8 in group A was significantly lower than that of the other 3 groups on 7, 14 and 28 d. Conclusions SVFG combined with APRFE can promote the repair of irradiated skin and soft tissue injury by accelerating angiogenesis, promoting collagen synthesis and reducing inflammation.
Collapse
Affiliation(s)
- Zhou Li
- Department of Oncology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huimin Gan
- Department of Oncology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Anru Liang
- Department of Plastic Surgery, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Kangjiu Biotechnology Co., Ltd., Nanning, China
| | - Xiyue Wang
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application, Guangxi Medical University, Nanning, China
| | - Xiaohao Hu
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application, Guangxi Medical University, Nanning, China
| | - Ping Liang
- Department of Oncology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guoding Xu
- Department of Oncology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qianwen Huang
- Nanning Wilking Biotechnology Co., Ltd., Nanning, China
| | - Junjun Li
- Department of Pediatrics, The People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Hospital Management and Medical Prevention Collaborative Innovation, Guangxi Academy of Medical Sciences, Nanning, China
| | - Hongmian Li
- Department of Plastic and Reconstructive Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region & Research Center of Medical Sciences, Guangxi Academy of Medical Sciences, Nanning, China
| |
Collapse
|
8
|
Li ZJ, Wang LQ, Li YZ, Wang CY, Huang JZ, Yu NZ, Long X. Application of adipose-derived stem cells in treating fibrosis. World J Stem Cells 2021; 13:1747-1761. [PMID: 34909121 PMCID: PMC8641015 DOI: 10.4252/wjsc.v13.i11.1747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/18/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Fibrosis is the hyperactivation of fibroblasts that results in excessive accumulation of extracellular matrix, which is involved in numerous pathological changes and diseases. Adipose-derived stem cells (ASCs) are promising seed cells for regenerative medicine due to their bountiful source, low immunogenicity and lack of ethical issues. Their anti-fibrosis, immunomodulation, angiogenesis and other therapeutic effects have made them suitable for treating fibrosis-related diseases. Here, we review the literature on ASCs treating fibrosis, elaborate and discuss their mechanisms of action, changes in disease environment, ways to enhance therapeutic effects, as well as current preclinical and clinical studies, in order to provide a general picture of ASCs treating fibrotic diseases.
Collapse
Affiliation(s)
- Zhu-Jun Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Li-Quan Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yun-Zhu Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chen-Yu Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jiu-Zuo Huang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Nan-Ze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao Long
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|