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Nguyen T, Kim T, Ting W. Evaluating patient perception and outcomes of surgical excision followed by superficial radiation therapy for keloid treatment - a retrospective study. Arch Dermatol Res 2024; 316:535. [PMID: 39158602 DOI: 10.1007/s00403-024-03253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Trina Nguyen
- School of Medicine, Case Western Reserve University, 9501 Euclid Ave, Cleveland, OH, 44106,, USA.
- California Dermatology Care, San Ramon, CA, USA.
| | - Tom Kim
- California Dermatology Care, San Ramon, CA, USA
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Ishikawa H, Goto Y, Hirooka C, Katayama E, Baba N, Kaneko M, Saito Y, Kobayashi T, Koga K. Role of inflammation and immune response in the pathogenesis of uterine fibroids: Including their negative impact on reproductive outcomes. J Reprod Immunol 2024; 165:104317. [PMID: 39154624 DOI: 10.1016/j.jri.2024.104317] [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: 05/28/2024] [Revised: 07/31/2024] [Accepted: 08/11/2024] [Indexed: 08/20/2024]
Abstract
Uterine fibroids (UFs), the most common tumors in women of reproductive age, are characterized by sex steroid-dependent growth and excessive deposition of extracellular matrix (ECM) surrounding UF smooth muscle cells. Women with symptomatic UFs experience heavy menstrual bleeding and consequent iron-deficiency anemia. They also have a risk of recurrent pregnancy loss, preterm birth, and cesarean delivery, indicating that UFs can negatively affect reproductive outcomes. Various types of immune cells, including innate and adaptive cells, are observed in UFs; however, the impact of these cells on the pathophysiology of UFs remains unclear. Inflammation may play important roles in the growth of UFs, and expression levels of proinflammatory and inflammatory cytokines, such as interleukin (IL)-1, IL-6, IL-10, TNF-α, and TGF-β, are upregulated in UFs. These cytokines play important roles in the interaction between growth factors and ECM that is regulated by the sex steroids estrogen and progesterone. Furthermore, proinflammatory mediators are upregulated in females with UFs, with higher expression levels in the endometrium with submucosal and intramural UFs than in the endometrium without UFs, indicating that these proinflammatory cytokines may impair endometrial receptivity, leading to implantation failure in in vitro fertilization programs. Hormonal treatments using gonadotropin releasing hormone analogs and the selective progesterone receptor modulator ulipristal acetate significantly shrink UFs and improve UF-related symptoms. These compounds can regulate local inflammation in UFs and adjacent myometrium. Controlling and improving local inflammation caused by UFs may represent a novel therapeutic strategy for UFs and potentially improve reproductive outcomes in women with symptomatic UFs.
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Affiliation(s)
- Hiroshi Ishikawa
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Yuki Goto
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Chigusa Hirooka
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eri Katayama
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nao Baba
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Meika Kaneko
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiko Saito
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Kobayashi
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Regulatory Science, Research Promotion Unit, School of Medical Science, Fujita Health University, Aichi, Japan; Fujita Health University Haneda clinic, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Han XM, Jiang SQ, Hu CX, Du M, Zhao L. Triple Surgical Technique for the Repair of Auricular Keloids: Achieving Perfect Restoration of the Ear Contour. Aesthetic Plast Surg 2024:10.1007/s00266-024-04306-5. [PMID: 39143304 DOI: 10.1007/s00266-024-04306-5] [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: 02/07/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Ear keloids, often resulting from ear piercing or other traumas, significantly alter appearance, adversely impacting patients' quality of life and psychological well-being. Thus, developing an effective and esthetically pleasing surgical repair technique is crucial for enhancing patient quality of life. METHODS This study introduces a novel tripartite surgical approach, which includes arcuate incision design, blind dissection for scar flap, and centrifugal keloid core serial shave excision (ABC for short). This technique is particularly suited for keloids induced by ear piercing that are inoperable for direct suturing or where direct suturing significantly alters the ear contour. RESULTS In this study, 17 patients underwent the surgical treatment without observing special complications such as infection or necrosis. Long-term postoperative follow-up demonstrated good restoration of the ear contour, with only one case of recurrence. Patients expressed satisfaction with both the surgical process and outcomes. CONCLUSIONS The triple surgical technique (ABC surgery method) for treating auricular keloids has demonstrated excellent repair results, significantly improving auricle shape. Despite relying on the surgeon's experience, keloid characteristics, and patient comorbidities, it provides an effective treatment option. When combined with local radiotherapy, the recurrence rate is also significantly controlled. 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 .
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Affiliation(s)
- Xiao-Mei Han
- Department of Dermatology, The Fourth Affiliated Hospital of Hebei Medical University, No.12 healthy road, Changan District, Shijiazhuang, Hebei, China.
| | - Shao-Qian Jiang
- Department of Dermatology, The Fourth Affiliated Hospital of Hebei Medical University, No.12 healthy road, Changan District, Shijiazhuang, Hebei, China
| | - Cai-Xia Hu
- Department of Dermatology, The Fourth Affiliated Hospital of Hebei Medical University, No.12 healthy road, Changan District, Shijiazhuang, Hebei, China
| | - Ming Du
- Department of Dermatology, The Fourth Affiliated Hospital of Hebei Medical University, No.12 healthy road, Changan District, Shijiazhuang, Hebei, China
| | - Lu Zhao
- Department of Dermatology, The Fourth Affiliated Hospital of Hebei Medical University, No.12 healthy road, Changan District, Shijiazhuang, Hebei, China
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Chu X, Sun J, Dai S, Liang Y, Qian X, Xu J, Zhang J. AURKA Activates FOXO3a to Form a Positive Feedback Loop in the Proliferation and Migration of Keloid Fibroblasts. Adv Wound Care (New Rochelle) 2024. [PMID: 39078320 DOI: 10.1089/wound.2024.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Objective: Keloids are benign fibroproliferative disorders with invasive growth exceeding the wound boundary. Aurora kinase A (AURKA) is a serine/threonine kinase highly expressed in various tumors, facilitating tumor growth and invasion. Currently, the role of AURKA in keloid remains unclear. Approach: Fibroblasts were isolated from keloid and normal skin samples. AURKA was evaluated by qPCR, Western blot, and immunohistochemistry. Transcriptome sequencing and dual-luciferase reporter assays were applied to figure out targets of AURKA. Following expression alteration and MLN8237 (an AURKA kinase inhibitor, AKI) treatment, phenotypical experiments were conducted to clarify biological functions of AURKA along with its target, and to probe into the clinical potential of AURKA inhibition. Results: AURKA was upregulated in keloid tissues and fibroblasts. Forkhead box O 3a (FOXO3a) was verified as a downstream of AURKA. Further experiments demonstrated that AURKA transactivated FOXO3a by binding to FOXO3a, while FOXO3a directly transactivated AURKA. Functionally, AURKA and FOXO3a cooperated in enhancing the proliferation and migration of keloid fibroblasts via protein kinase B (AKT) phosphorylation. Although MLN8237 weakened the proliferation and migration in keloid fibroblasts, the transactivation of AURKA on FOXO3a was independent of kinase activity. Innovation: This study reveals that AURKA and FOXO3a compose a transactivation loop in enhancing the proliferative and migrative properties of keloid fibroblasts, and proposes AURKA as a promising target. Conclusion: AURKA/FOXO3a loop promotes the proliferation and migration of keloid fibroblasts via AKT signaling. Despite the anti-keloid effects of AKIs, AURKA acts as a transcription factor independently of kinase activity, deepening our understanding on AKI insensitivity.
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Affiliation(s)
- Xi Chu
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Jiaqi Sun
- Department of Plastic Surgery, The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Siya Dai
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yehua Liang
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xifei Qian
- School of Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinghong Xu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jufang Zhang
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China
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Huang Y, Ren S, Yang Q. Efficacy and Safety of Excision Combination Therapies for Earlobe Keloids: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024; 48:2757-2770. [PMID: 38789810 DOI: 10.1007/s00266-024-04092-0] [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: 12/22/2023] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Different combinations of excision and adjuvant therapies have been applied to improve outcomes for earlobe keloids, though evidence in this field is still lacking. OBJECTIVES This study sought to systematically investigate efficacy and safety of these treatments. METHODS We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane Library to find all relevant studies. Meta-analysis of recurrence rates (RRs) and adverse event rates with 95% confidence intervals, and individual participants data (IPD) were calculated for each intervention when possible. Otherwise, narrative syntheses were performed. RESULTS A total of 85 articles, covering 23 treatments for earlobe keloids, were included, indicating a preference for multiple combination therapy. The estimated RRs for 6 interventions (i.e., excision monotherapy, combinations of excision with imiquimod, pressure therapy, radiotherapy, steroids, and steroids with pressure therapy) appeared to be comparable. Electron radiotherapy was found to have potential advantages over X-ray treatment, contributing to the observed heterogeneity. Further meta-analysis using IPD revealed that both combination therapies of excision plus steroid therapy (p=0.003) and excision plus radiotherapy (p=0.003) yielded better recurrence-free survival compared to excision alone. The median recurrence-free interval for combination therapy was 10 months. Adverse event rates were similar among different intervention groups. CONCLUSIONS This study suggests that combining excision with radiotherapy or perioperative steroid therapy has the potential to improve prognosis of earlobe keloids without increasing the risk of adverse events. Overall evaluation of patients' conditions and further studies with sufficient follow-up are warranted for clinical practice. 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 .
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Affiliation(s)
- Ying Huang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China
| | - Shuofang Ren
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qinghua Yang
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Badachu Road 33, Beijing, People's Republic of China.
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Pei Y, Wu Y, Zhang M, Su X, Cao H, Zhao J. Identification and Analysis of Immune Microenvironment-Related Genes for Keloid Risk Prediction and Their Effects on Keloid Proliferation and Migration. Biochem Genet 2024; 62:3174-3197. [PMID: 38085498 DOI: 10.1007/s10528-023-10598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 07/31/2024]
Abstract
Keloid is a kind of proliferative scar with continuous growth, no restriction and easy recurrence, which cannot be cured and bring serious physical injury and psychological burden to patients. The main reason is that the pathological mechanism is not clear. Therefore, this project is expected to reveal the immune microenvironment-related genes and their functions in keloid progression, and provide effective targets for the treatment of keloid. Firstly, 8 kinds of immune infiltrating cells and 19 potential characteristic genes were identified by immune infiltration analysis, ssGSEA, LASSO regression (glmnet algorithm and lars algorithm) and WGCNA, indicating that keloid was closely related to the changes of immune microenvironment. Then, 4 pathological biomarkers of keloid (MAPK1, PTPRC, STAT3 and IL1R1) were identified by differentially analysis, univariate analysis, LASSO regression (lars algorithm), support vector machine recursive feature elimination (SVM-REF) algorithm, multivariate logical regression analysis and six machine learning algorithms. Based on the 4 feature genes, the risk prediction model and nomogram were constructed. Calibration curve and ROC analysis (AUC = 0.930) showed that the model had reliable clinical value. Subsequently, consistent cluster analysis was used to find that there were 2 immune microenvironment subsets in keloid patients, of which subgroup II was immune subgroup. Multiple independent datasets and RT-qPCR showed that the expression trend of the 4 genes was consistent with the analysis. Cell gain-loss experiment confirmed that 4 genes regulated the proliferation and migration of keloid cells. The above data shows that MAPK1, PTPRC, STAT3 and IL1R1 may be personalized therapeutic targets for keloid patients.
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Affiliation(s)
- Yongyan Pei
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University. Zhongshan Campus, Guangdong Pharmaceutical University, No.13 Changmingshui Avenue, Wuguishan, Zhongshan, Guangdong, China.
| | - Yikai Wu
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University. Zhongshan Campus, Guangdong Pharmaceutical University, No.13 Changmingshui Avenue, Wuguishan, Zhongshan, Guangdong, China
| | - Mengqi Zhang
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University. Zhongshan Campus, Guangdong Pharmaceutical University, No.13 Changmingshui Avenue, Wuguishan, Zhongshan, Guangdong, China
| | - Xuemin Su
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University. Zhongshan Campus, Guangdong Pharmaceutical University, No.13 Changmingshui Avenue, Wuguishan, Zhongshan, Guangdong, China
| | - Hua Cao
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University. Zhongshan Campus, Guangdong Pharmaceutical University, No.13 Changmingshui Avenue, Wuguishan, Zhongshan, Guangdong, China
| | - Jiaji Zhao
- School of Chemistry and Chemical Engineering, Guangdong Pharmaceutical University. Zhongshan Campus, Guangdong Pharmaceutical University, No.13 Changmingshui Avenue, Wuguishan, Zhongshan, Guangdong, China.
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George RE, Bay CC, Thornton SM, Knazze JT, Kane NC, Ludwig KA, Donnelly DT, Poore SO, Dingle AM. Can Electrical Stimulation Prevent Recurrence of Keloid Scars? A Scoping Review. Adv Wound Care (New Rochelle) 2024. [PMID: 38888004 DOI: 10.1089/wound.2023.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Objective: Keloids represent a symptomatic, aberrant healing process that is difficult to treat with high recurrence rates spanning from 55% to 100% if treated via excision without adjuvant therapy. Electrical stimulation (ES) has demonstrated findings that suggest it could reduce the recurrence rate of keloids after resection. Therefore, the aim of this study is to conduct a scoping review to investigate ES as an adjuvant therapy for decreasing keloid recurrence after excision. Approach: A scoping review was performed using PubMed and Web of Science databases. The search strategy encompassed terms linking keloids and various aspects of electrical stimulation. Results: Our search yielded 2,229 articles, of which 115 articles were analyzed as full text and 1 article met inclusion criteria. Despite this, ES has demonstrated other evidence that suggests its utility. ES has been shown to counter keloidic features by reducing mast cell counts, shifting wound composition from M2 to M1 macrophages, promoting angiogenesis, and controlling fibroblast orientation and location. An alternating current will orient fibroblasts perpendicular to the current without unintended migration. Innovation: Our study indicates that, based on a compilation of clinical and preclinical in vitro data, the optimal scenario for ES in the role of keloid treatment is after excision with a biphasic pulsed application and square waveform. Conclusions: ES could serve as a multifaceted, adjuvant treatment after keloid excision, steering the healing process away from keloid-associated characteristics. Its cost-effectiveness means it could be adopted globally, providing a strategy to mitigate the burden of keloids irrespective of other available treatments or economic conditions.
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Affiliation(s)
- Robert E George
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Caroline C Bay
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sarah M Thornton
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jessieka T Knazze
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole C Kane
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kip A Ludwig
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin Institute for Translational Neuroengineering, Madison, Wisconsin, USA
| | - D'Andrea T Donnelly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samuel O Poore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Aaron M Dingle
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Fu Z, Wu N, Pei X, Cai W, Ding X, Zhou J, Lu W. Fluoroscopy-Guided Balloon Dilation for Severe Nasopharyngeal Stenosis Resulting from Radiotherapy for Nasopharyngeal Carcinoma. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03798-7. [PMID: 39028350 DOI: 10.1007/s00270-024-03798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Zanmei Fu
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Na Wu
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinru Pei
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Weiguo Cai
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xun Ding
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Zhou
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Lu
- Interventional Diagnostic and Therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Kim JM, Cheon JS, Choi WY. Ear keloid and epidermal cyst following auricular cartilage harvest for rhinoplasty: A case report. World J Clin Cases 2024; 12:4434-4439. [PMID: 39015904 PMCID: PMC11235563 DOI: 10.12998/wjcc.v12.i20.4434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/05/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND This case report highlights a rare instance of concurrent keloid and epidermal cyst development at an ear cartilage harvest site following rhinoplasty in a 25-year-old woman. Both conditions, which typically stem from skin trauma, seldom occur together, demonstrating the exceptional characteristics of this case. CASE SUMMARY The patient underwent successful surgical removal of both the keloid and the epidermal cyst. Postoperative treatment included the use of silicone sheets, gel, and oral tranilast to reduce scarring. No recurrence was observed over a 6-mo follow-up period, indicating effective management of the condition. CONCLUSION The effective management of complex skin trauma cases underscores the need for individualized treatment strategies in plastic surgery.
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Affiliation(s)
- Jun Mo Kim
- Department of Plastic Reconstructive Surgery, Chosun University College of Medicine, Gwangju 61453, South Korea
| | - Ji Seon Cheon
- Department of Plastic and Reconstructive Surgery, Chosun University College of Medicine, Gwangju 61453, South Korea
| | - Woo Young Choi
- Department of Plastic Reconstructive Surgery, Chosun University College of Medicine, Gwangju 61453, South Korea
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Almier N, Leibowitz K, Gower AC, To S, Keller MR, Connizzo BK, Roh DS, Alani RM, Collard M. Targeting the Epigenome Reduces Keloid Fibroblast Cell Proliferation, Migration, and Invasion. J Invest Dermatol 2024:S0022-202X(24)01872-4. [PMID: 39009280 DOI: 10.1016/j.jid.2024.06.1274] [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: 07/18/2023] [Revised: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
Keloids are pathological fibroproliferative scars resulting from abnormal collagen deposition within and beyond the margins of the initial cutaneous insult. Keloids negatively impact QOL functionally and cosmetically, with current treatment modalities unsatisfactory. Recent studies indicate that epigenetic dysregulation is central to the development and progression of keloids. In this study, we evaluate the functional significance of epigenetic targeting strategies in vitro using patient-derived keloid fibroblasts treated with small-molecule inhibitors of histone deacetylases, LSD1, CoREST, and p300, as potential therapies for keloids. We find that both the dual-acting CoREST inhibitor corin and the histone deacetylase inhibitor entinostat reduce fibroblast proliferation more than the LSD1 inhibitor GSK-LSD1; in addition, corin was the most effective inhibitor of migration and invasion across keloid fibroblasts. RNA-sequencing analysis of keloid fibroblasts treated with corin demonstrates coordinate upregulation of many genes, including key mediators of cell adhesion such as claudins. Corin also downregulates gene sets involved in cell cycle progression, including reduced expression of cyclins A1 and B2 compared with that of DMSO. These results highlight a significant role for epigenetic regulation of pathologic mediators of keloidal scarring and suggest that inhibitors of the epigenetic CoREST repressor complex may prove beneficial in the prevention and/or treatment of keloidal scarring in patients.
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Affiliation(s)
- Nedaa Almier
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kassidy Leibowitz
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Adam C Gower
- Clinical and Translational Science Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Samantha To
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Madelyn R Keller
- Department of Biomedical Engineering, Boston University College of Engineering, Boston, Massachusetts, USA
| | - Brianne K Connizzo
- Department of Biomedical Engineering, Boston University College of Engineering, Boston, Massachusetts, USA
| | - Daniel S Roh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Rhoda M Alani
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
| | - Marianne Collard
- Department of Dermatology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
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11
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Li Q, Chen Z, Zou X, Sha X, Wei Z, Chen M, Liu Q, Cai Z, Jiang Z. Effectiveness of postoperative superficial radiotherapy following the keloid-cross-flap surgery for auricular keloid: A prospective cohort study. Radiother Oncol 2024; 199:110425. [PMID: 39002572 DOI: 10.1016/j.radonc.2024.110425] [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: 04/22/2024] [Revised: 06/23/2024] [Accepted: 06/30/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND AND PURPOSE Retaining partial keloid skin to make cross flaps (keloid-cross-flap surgery) is a modification of the core excision. This study aimed to compare the effectiveness of superficial radiotherapy versus compression therapy after keloid-cross-flap surgery. MATERIALS AND METHODS In this prospective cohort study, auricular keloid patients were consecutively screened from January 2019 to December 2021. They underwent keloid-cross-flap surgery and then enter either the superficial radiotherapy or the compression treatment group. The primary outcome was the one-year keloid recurrence rate. Secondary outcomes included: non-completion rate of adjuvant treatment; Patient and Observer Scar Assessment Scale (POSAS) scores and auricular aesthetics scores, evaluated by a four-point Likert scale (1 = poor to 4 = excellent) of non-recurring patients. Propensity score matching (PSM) was used to eliminate potential confounding factors. RESULTS 123 patients were included in the superficial radiotherapy group and 128 in the compression treatment group. Non-completion rate was significantly higher in the compression treatment group (17.97 %), while the loss rate was comparable between the two groups. Overall, 13 patients (13.54 %) relapsed in superficial radiotherapy group, while 22 patients (25.58 %) in compression group (p < 0.05). After PSM, 59 patients in each group were analyzed, and the recurrence rate was lower in the superficial radiotherapy group (13.56 %). Of relapse-free patients, no significant difference was found in PSAS scores, OSAS scores or aesthetic scores between the two groups. CONCLUSION Keloid-cross-flap surgery could provide favorable morphologic repair of the auricular keloid, and postoperative superficial radiotherapy shows higher compliance and lower recurrence rate comparing to compression treatment.
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Affiliation(s)
- Qingqing Li
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zaihong Chen
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuyuan Zou
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaowei Sha
- Department of Dermatology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhongbin Wei
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Maohua Chen
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Quan Liu
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Zhen Cai
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Zhiyuan Jiang
- Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Wen J, Li Z, Liu W, Yu N, Wang X. Dual-wavelength dye laser combined with betamethasone injection for treatment of keloids: protocol of a randomised controlled trial. BMJ Open 2024; 14:e084939. [PMID: 38986560 PMCID: PMC11268050 DOI: 10.1136/bmjopen-2024-084939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Keloids, benign fibroproliferative tumours characterised by excessive fibroblast proliferation and over-deposition of extracellular matrix, pose a therapeutic challenge with high recurrence rates. Betamethasone (diprospan) injection (BI) is one of the most common non-invasive therapies for keloids. Pulsed dye laser (PDL) has the function of closing microvessels, which may become one of the auxiliary treatment methods of BI and may enhance its curative effect. Some studies suggest that the combination of a dual-wavelength dye laser (DWL) and BI may offer superior efficacy. This randomised controlled trial aims to evaluate whether the combined therapy of DWL+BI outperforms BI alone in treating keloids. METHODS AND ANALYSIS This single-centre, parallel positive control, randomised trial evaluates the efficacy and safety of DWL (585 nm PDL+1064 nm neodymium-doped yttrium aluminium garnet) combined with BI for keloid treatment. Enrolling 66 adult patients, participants are randomised into DWL+BI or BI groups in a 1:1 ratio. Over 12 weeks, each group undergoes four treatment sessions, ensuring blinding for outcome assessors. Data collection occurs at multiple time points (4, 12, 24 and 52 weeks), with primary outcomes assessing the Vancouver Scar Scale (VSS) improvement rate 24 weeks after the last intervention. Secondary outcomes include VSS improvement rates, changes in keloid volume, changes in relative perfusion index measured by laser speckle contrast imaging, Patient and Observer Scar Assessment Scale results and patient satisfaction. Safety assessments include vital signs, laboratory tests, pregnancy tests and self-reports of adverse reactions. ETHICS AND DISSEMINATION The results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Register (ChiCTR2400080148).
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Affiliation(s)
- Junxian Wen
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhijin Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weida Liu
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Department of International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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13
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James AJ, Torres-Guzman RA, Chaker SC, Sigel ME, Perdikis G, Supp DM, Dale Slater EL. Global insights into keloid formation: An international systematic review of regional genetic risk factors and commonalities. Wound Repair Regen 2024. [PMID: 38958095 DOI: 10.1111/wrr.13203] [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: 02/02/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024]
Abstract
Keloid disorder is a morbid and disfiguring benign fibroproliferative disease with a higher incidence in groups with darker skin pigmentation. Predicting keloidogenesis in patients is difficult with treatment primarily aimed at preventing further scar expansion and improving aesthetics without addressing their unknown underlying pathophysiology. We aimed to identify potential genetic predispositions to keloid scarring in the literature. A search was conducted on 21 August 2023, by the first and second authors independently from 1985 to August 2023 using PubMed, MEDLINE, Embase, Web of Science, Scopus and CINAHL. The following MeSH terms were used: 'Keloid', 'Risk' and 'Genetic'. Two researchers independently searched for studies based on titles and abstracts and screened filtered articles by reviewing full text. If no agreement could be reached, a third senior author designated whether the article should be included. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement as the basis of our organisation. Human studies with genetic analysis to determine an association of a protein or gene to keloidogenesis were selected for inclusion. Studies in languages other than English, reviews, conference articles, and book chapters were excluded. Fifty studies met inclusion criteria. The human leukocyte antigen (HLA) system was broadly implicated, and the DRB1*15 allele was associated with an increased risk of keloid in three separate ethnic groups. Some HLA Class I alleles were associated with keloid in one population but not in others. Additionally, polymorphisms in the E3 ubiquitin-protein ligase (NEDD4) signal cascade and vitamin D receptor (VDR) have been implicated in diverse groups. No current genetic test can predict keloid risk. Our review identified candidate predisposing genes, including NEDD4, VDR and components of the HLA system. Further studies in heterogeneous populations are needed to identify reliable screening targets.
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Affiliation(s)
- Andrew J James
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo A Torres-Guzman
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara C Chaker
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dorothy M Supp
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Shriners Children's Ohio, Dayton, Ohio, USA
| | - Elizabeth L Dale Slater
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Yang L, Li X, Wang Y. Ferrostatin-1 inhibits fibroblast fibrosis in keloid by inhibiting ferroptosis. PeerJ 2024; 12:e17551. [PMID: 38887622 PMCID: PMC11182022 DOI: 10.7717/peerj.17551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Background Keloid is a chronic proliferative fibrotic disease caused by abnormal fibroblasts proliferation and excessive extracellular matrix (ECM) production. Numerous fibrotic disorders are significantly influenced by ferroptosis, and targeting ferroptosis can effectively mitigate fibrosis development. This study aimed to investigate the role and mechanism of ferroptosis in keloid development. Methods Keloid tissues from keloid patients and normal skin tissues from healthy controls were collected. Iron content, lipid peroxidation (LPO) level, and the mRNA and protein expression of ferroptosis-related genes including solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4), transferrin receptor (TFRC), and nuclear factor erythroid 2-related factor 2 (Nrf2) were determined. Mitochondrial morphology was observed using transmission electron microscopy (TEM). Keloid fibroblasts (KFs) were isolated from keloid tissues, and treated with ferroptosis inhibitor ferrostatin-1 (fer-1) or ferroptosis activator erastin. Iron content, ferroptosis-related marker levels, LPO level, mitochondrial membrane potential, ATP content, and mitochondrial morphology in KFs were detected. Furthermore, the protein levels of α-smooth muscle actin (α-SMA), collagen I, and collagen III were measured to investigate whether ferroptosis affect fibrosis in KFs. Results We found that iron content and LPO level were substantially elevated in keloid tissues and KFs. SLC7A11, GPX4, and Nrf2 were downregulated and TFRC was upregulated in keloid tissues and KFs. Mitochondria in keloid tissues and KFs exhibited ferroptosis-related pathology. Fer-1 treatment reduced iron content, restrained ferroptosis and mitochondrial dysfunction in KFs, Moreover, ferrostatin-1 restrained the protein expression of α-SMA, collagen I, and collagen III in KFs. Whereas erastin treatment showed the opposite results. Conclusion Ferroptosis exists in keloid. Ferrostatin-1 restrained ECM deposition and fibrosis in keloid through inhibiting ferroptosis, and erastin induced ECM deposition and fibrosis through intensifying ferroptosis.
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Affiliation(s)
- Liu Yang
- Plastic & Cosmetics Surgery Department, Zibo Central Hospital, Zibo, China
| | - Xiuli Li
- Plastic & Cosmetics Surgery Department, Zibo Central Hospital, Zibo, China
| | - Yanli Wang
- Plastic & Cosmetics Surgery Department, Zibo Central Hospital, Zibo, China
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15
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Brooks SG, Yosipovitch G. Unmet needs in treating itch: reaching beyond eczema. J DERMATOL TREAT 2024; 35:2351487. [PMID: 38945542 DOI: 10.1080/09546634.2024.2351487] [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: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Pruritus is an unpleasant sensation that creates the urge to scratch. In many chronic conditions, relentless pruritus and scratching perpetuates a vicious itch-scratch cycle. Uncontrolled itch can detrimentally affect quality of life and may lead to sleep disturbance, impaired concentration, financial burden, and psychological suffering. Recent strides have been made to develop guidelines and investigate new therapies to treat some of the most common severely pruritic conditions, however, a large group of diseases remains underrecognized and undertreated. The purpose of this article is to provide a comprehensive review of the challenges hindering the treatment of pruritus. METHODS An online search was performed using PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov from 1994 to 2024. Included studies were summarized and assessed for quality and relevance in treating pruritus. RESULTS Several barriers to treating pruritus emerged, including variable presentation, objective measurement of itch, and identifying therapeutic targets. Itch associated with autoimmune conditions, connective tissue diseases, genodermatoses, cutaneous T-cell lymphoma, and pruritus of unknown origin were among the etiologies with the greatest unmet needs. CONCLUSION Treating pruritus poses many challenges and there are many itchy conditions that have no yet been addressed. There is an urgent need for large-scale controlled studies to investigate potential targets for these conditions and novel therapies.
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Affiliation(s)
- Sarah G Brooks
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Mattioli F, Serafini E, Andreani A, Cappiello G, De Maria F, Marchioni D, Pinelli M, Marchioni A. Lipoaspirate Injection in Relapsing Idiopathic Subglottic Stenosis: Preliminary Results. Ann Otol Rhinol Laryngol 2024; 133:618-624. [PMID: 38444374 DOI: 10.1177/00034894241237021] [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] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The management of idiopathic subglottic stenosis (iSGS) poses a clinical challenge due to high recurrence rates following both endoscopic and open approaches, often leading to tracheostomy. The activation of abnormal T-cells and cytokine pathways has been linked to iSGS pathogenesis. Autologous adipose tissue centrifugation yields lipoaspirate, offering optimal anti-inflammatory effects and biocompatibility widely utilized in various medical settings. This report presents the first 3 cases employing endoscopic dilation (ED) in combination with local lipoaspirate injection to address recurrent iSGS. METHODS A prospective observational study was conducted, involving multidisciplinary evaluation by the Tracheal Team at the University of Modena. Patients meeting specific criteria were directed to undergo ED + lipoaspirate injection. RESULTS Three patients fulfilled the inclusion criteria. The mean number of prior endoscopic procedures performed was 8. Endoscopic examination revealed 90% stenosis in patient A, 60% stenosis in patient B, and 60% stenosis in patient C. All patients presented inflammatory tissue or incipient granulations at the stenotic site, with an average time of 6 months between previous procedures. After 15 months, none of the patients required further procedures, and endoscopic examination revealed a significant reduction or disappearance of inflammatory tissue with a stable airway lumen. CONCLUSIONS The observed results are encouraging in terms of reducing local inflammation and halting stenosis progression, especially in cases of short-term relapsing iSGS.
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Affiliation(s)
- Francesco Mattioli
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alessandro Andreani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Gaia Cappiello
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
| | - Federico De Maria
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Massimo Pinelli
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Alessandro Marchioni
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy
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17
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Nguyen T, Ting P, Freeny I. Exploring Intralesional Cryotherapy for Keloid Treatment: A Retrospective Analysis of Patient Perception, Satisfaction, and Clinical Outcomes. Dermatol Surg 2024; 50:593-594. [PMID: 38382081 DOI: 10.1097/dss.0000000000004124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Trina Nguyen
- Case Western Reserve University School of Medicine , Cleveland , Ohio
| | - Patrick Ting
- California Dermatology Care , San Ramon , California
| | - Ingrid Freeny
- California Dermatology Care , San Ramon , California
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18
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Işık H, Yaşar EK, Alagöz MŞ. A Novel Method for Patients With Ear Keloid: Enucleation and Fat Grafting. Ann Plast Surg 2024; 92:635-641. [PMID: 38747571 DOI: 10.1097/sap.0000000000004003] [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: 05/21/2024]
Abstract
BACKGROUND Keloid is a dermal fibroproliferative disease unique to humans. Due to the ambiguity in its pathophysiology and the frequent recurrence of keloid, there is no clear consensus on the treatment of keloid and there are many treatment methods defined. In order to benefit from the positive effects of fat grafting on pathological scars, we applied fat grafting to patients who underwent keloid enucleation. METHODS Fifteen ear keloid patients included in the study. All patients underwent the same surgical procedure by the same surgeon. Routine follow-ups and examinations were performed to evaluate the results and in addition, the Patient and Observer Scar Assessment Scale (POSAS) survey was used. RESULTS In the study, 15 patients were followed for a median (IQR) period of 21 (13-28) months. No recurrence was observed in any patient during follow-up, which occurred for a median of 21 (13-28) months. In the questionnaire filled out by the patients, the preoperative median value was found to be 48 (IQR: 12), whereas the postoperative median value was found to be 14 (IQR: 8). According to the patients, there was a statistically significant ( P < 0.05) positive improvement after surgery. CONCLUSIONS Historically, surgical procedures were avoided because the surgical recurrence rate was very high, but today, recurrence rates are decreasing with combined treatments. These treatment combinations may require more than one intervention and require frequent clinical follow-ups. With our technique of fat grafting after enucleation, the treatment was completed with a single operation and no additional intervention was required.
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Affiliation(s)
- Halil Işık
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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19
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Song YH, Zhu HM, Chen D, Qu ZL, Zhang L, Wei L. Successful treatment of Giant keloid on the right toes using trepanation combined with superficial radiotherapy (SRT-100): a case report with literature review. Front Med (Lausanne) 2024; 11:1369953. [PMID: 38863885 PMCID: PMC11166125 DOI: 10.3389/fmed.2024.1369953] [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: 01/13/2024] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Abstract
In dermatology, a keloid is one of the most common skin morphological abnormalities caused by excessive proliferation of fibroblasts. Keloids that are large or occur near important joint sites often cause varying degrees of physiological dysfunction in patients, therefore requiring medical treatment. A boy with congenital syndactyly developed huge keloids at the surgical site after undergoing surgical correction treatment. After treatment using trepanation combined with superficial radiotherapy (SRT-100) in our hospital, most of the boy's keloids shrank and flattened. The affected foot returned to its normal appearance, and the boy could wear shoes normally. The boy did not complain of pain, numbness, or any other distinctive discomfort after completing the treatment. This suggested that the combination of trepanation and SRT-100 may be one of the options for treating hypertrophic keloids that cannot be treated by surgical excision.
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Affiliation(s)
- Ying-hua Song
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Hui-min Zhu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Dan Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Zi-lu Qu
- Hubei Province and Key Laboratory of Skin Infection and Immunity, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Liang Zhang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
| | - Li Wei
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, Hubei, China
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Ningsih SS, Fadilah F, Jusman SWA, Syaidah R, Yashiro T. Profibrotic Inflammatory Cytokines and Growth Factors Are Predicted as the Key Targets of Uncaria gambir (Hunter) Roxb. in Keloids: An Epistatic and Molecular Simulation Approach. Pharmaceuticals (Basel) 2024; 17:662. [PMID: 38931330 PMCID: PMC11206663 DOI: 10.3390/ph17060662] [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: 04/17/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Abstract
Keloid is characterized as the fibrotic tissue resulting from the increase of fibroblast activity. Uncaria gambir (Hunter) Roxb. possesses bioactive compounds that have potential as antifibrotic agents, while the mechanism of action in keloid has not yet been elucidated. The aim of this study was to investigate the interaction of gambir bioactive compounds with keloid target proteins using an epistatic and molecular simulation approach. The known bioactive compounds of gambir targets and keloid-related protein targets were screened using databases. The network was constructed and analyzed to obtain the core protein targets. The targets were enriched to describe the Gene Ontology (GO) and pathway related to the proteins. Eleven targets were defined as the main targets of gambir bioactive compounds related to keloid disease. Gambiriin C, Isogambirine, and Procyanidin B1 were identified as the most promising compounds with the highest binding energy to transforming growth factor beta 1 (TGFβ1), AKT serine/threonine kinase 1 (AKT1), and matrix metallopeptidase 1 (MMP1) as the target proteins. GO enrichment and pathway analysis found that gambir bioactive compounds may act on keloid-related target proteins to regulate cell proliferation, migration, transcription, and signal transduction activity via profibrotic cytokine and growth factor signaling pathways. This study provides a reference for potential targets, compounds, and pathways to explain the mechanism of gambir against keloid.
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Affiliation(s)
- Sri Suciati Ningsih
- Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (S.S.N.); (F.F.)
- Faculty of Medicine, Universitas Muhammadiyah Prof. Dr. Hamka, Jakarta 12130, Indonesia
| | - Fadilah Fadilah
- Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (S.S.N.); (F.F.)
- Department of Medical Chemistry, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Sri Widia A. Jusman
- Department of Biochemistry, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia;
- Center of Hypoxia and Oxidative Stress Studies, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Rahimi Syaidah
- Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia; (S.S.N.); (F.F.)
- Department of Histology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Takashi Yashiro
- Department of Histology, Jichi Medical University School of Medicine, Tochigi 329-0498, Japan;
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Ross R, Guo Y, Walker RN, Bergamaschi D, Shaw TJ, Connelly JT. Biomechanical Activation of Keloid Fibroblasts Promotes Lysosomal Remodeling and Exocytosis. J Invest Dermatol 2024:S0022-202X(24)00374-9. [PMID: 38763173 DOI: 10.1016/j.jid.2024.04.015] [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: 11/02/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
Keloids are a severe form of scarring for which the underlying mechanisms are poorly understood, and treatment options are limited or inconsistent. Although biomechanical forces are potential drivers of keloid scarring, the direct cellular responses to mechanical cues have yet to be defined. The aim of this study was to examine the distinct responses of normal dermal fibroblasts and keloid-derived fibroblasts (KDFs) to changes in extracellular matrix stiffness. When cultured on hydrogels mimicking the elasticity of normal or scarred skin, KDFs displayed greater stiffness-dependent increases in cell spreading, F-actin stress fiber formation, and focal adhesion assembly. Elevated actomyosin contractility in KDFs disrupted the normal mechanical regulation of extracellular matrix deposition and conferred resistance on myosin inhibitors. Transcriptional profiling identified mechanically regulated pathways in normal dermal fibroblasts and KDFs, including the actin cytoskeleton, Hippo signaling, and autophagy. Further analysis of the autophagy pathway revealed that autophagic flux was intact in both fibroblast populations and depended on actomyosin contractility. However, KDFs displayed marked changes in lysosome organization and an increase in lysosomal exocytosis, which was mediated by actomyosin contractility. Together, these findings demonstrate that KDFs possess an intrinsic increase in cytoskeletal tension, which heightens the response to extracellular matrix mechanics and promotes lysosomal exocytosis.
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Affiliation(s)
- Rosie Ross
- Centre for Cell Biology and Cutaneous Research, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Yiyang Guo
- Centre for Cell Biology and Cutaneous Research, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Rebecca N Walker
- Centre for Cell Biology and Cutaneous Research, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Daniele Bergamaschi
- Centre for Cell Biology and Cutaneous Research, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Tanya J Shaw
- Centre for Inflammation Biology and Cancer Immunology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - John T Connelly
- Centre for Cell Biology and Cutaneous Research, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
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22
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Wang M, Zhao J, Li J, Meng M, Zhu M. Insights into the role of adipose-derived stem cells and secretome: potential biology and clinical applications in hypertrophic scarring. Stem Cell Res Ther 2024; 15:137. [PMID: 38735979 PMCID: PMC11089711 DOI: 10.1186/s13287-024-03749-6] [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: 03/03/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
Scar tissue is the inevitable result of repairing human skin after it has been subjected to external destructive stimuli. It leads to localized damage to the appearance of the skin, accompanied by symptoms such as itching and pain, which reduces the quality of life of the patient and causes serious medical burdens. With the continuous development of economy and society, there is an increasing demand for beauty. People are looking forward to a safer and more effective method to eliminate pathological scarring. In recent years, adipose-derived stem cells (ADSCs) have received increasing attention from researchers. It can effectively improve pathological scarring by mediating inflammation, regulating fibroblast proliferation and activation, and vascular reconstruction. This review focuses on the pathophysiological mechanisms of hypertrophic scarring, summarizing the therapeutic effects of in vitro, in vivo, and clinical studies on the therapeutic effects of ADSCs in the field of hypertrophic scarring prevention and treatment, the latest application techniques, such as cell-free therapies utilizing ADSCs, and discussing the advantages and limitations of ADSCs. Through this review, we hope to further understand the characterization of ADSC and clarify the effectiveness of its application in hypertrophic scarring treatment, so as to provide clinical guidance.
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Affiliation(s)
- Menglin Wang
- Department of Plastic Surgery, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China
| | - Jianyu Zhao
- Department of Orthopaedics, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China
| | - Jiacheng Li
- Department of Plastic Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Meng Meng
- Department of Orthopaedics, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China.
| | - Mengru Zhu
- Department of Plastic Surgery, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China.
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23
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Nguyen DA, Thai E, Weis SE. Management of Keloid-Associated Pruritus With Topical Crisaborole 2% Ointment: A Case Report. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:139-143. [PMID: 38984218 PMCID: PMC11229606 DOI: 10.36518/2689-0216.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Introduction The pathophysiology of keloid formation is poorly understood, and current treatments, including intralesional corticosteroids, cryotherapy, and surgery, are often associated with high resistance to treatment and recurrence. The multifactorial pathogenesis of keloid formation suggests that aberrant inflammatory cytokine signaling associated with keratinocyte dysregulation may contribute to keloid-associated pruritus. Case Presentation In this paper, we report 2 cases of keloid-associated pruritus that were successfully treated with topical crisaborole 2% ointment, a phosphodiesterase 4 (PDE4) inhibitor. Both patients had previously undergone multiple unsuccessful treatments before being treated with crisaborole 2% ointment. In both cases, the patients experienced complete relief of pruritus with no significant change in keloid size, thickness, or appearance. Conclusion We propose that PDE4 inhibitors, such as crisaborole, may be an effective therapy for keloid- associated pruritus.
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Affiliation(s)
- Daniel A Nguyen
- Medical City Fort Worth, Fort Worth, TX
- The University of North Texas Health Science Center, Fort Worth, TX
| | - Elizabeth Thai
- The University of North Texas Health Science Center, Fort Worth, TX
| | - Stephen E Weis
- Medical City Fort Worth, Fort Worth, TX
- The University of North Texas Health Science Center, Fort Worth, TX
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Liu B, Lin H, Zhang M. The clinical efficacy of single-hole punch excision combined with intralesional steroid injection for nodular keloid treatment: a self-controlled trial. Sci Rep 2024; 14:9793. [PMID: 38684804 PMCID: PMC11058828 DOI: 10.1038/s41598-024-60670-x] [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: 12/22/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
There are many methods to treat keloid, including various excision operations, laser, injection and radiotherapy. However, few studies have explored the effectiveness of single-hole punch excision in keloid treatment. This study aimed to investigate the efficacy and safety of lateral punch excision combined with intralesional steroid injection for keloid treatment through self-control trial. In this self-controlled trial, 50 patients meet the diagnosis of nodular keloid, and try to choose left-right symmetrical control, one skin lesion in the control group (50 skin lesionsin total) and the other in the observation group (50 skin lesions in total).The keloids in the treatment group were initially treated with punch excision combined with intralesional steroid injection, followed by injection treatment alone. Keloids in the control group received intralesional steroid injection alone. The Vancouver Scar Scale (VSS) of the keloid before and after the punch excision was evaluated; the keloid scores at different time points and the number of injection treatments required in both groups were compared, and adverse reactions were observed. The effective rate of the observation group was 86.0%, which was significantly higher than that of the control group (66.0%), and the recurrence rate of 22% was lower than that of the control group (χ2 = 4.141,63417), all of which were statistically significant (all P < 0.05). At the end of treatment, the VSS and total injection times in the observation group were significantly lower than those in the control group (t = 5.900,3.361), with statistical significance (P < 0.01). The combination of single-hole punch excision and intralesional steroid injection is an effective method to treat multiple nodular keloids, shortening the treatment course of tralesional steroid injection without obvious adverse reactions.
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Affiliation(s)
- Bingbing Liu
- Department of Dermatology, Chaohu Hospital Affiliated to Anhui Medical University, Chaohu, 238000, Anhui, China
| | - Haoying Lin
- Department of Dermatology, Chaohu Hospital Affiliated to Anhui Medical University, Chaohu, 238000, Anhui, China
| | - Minghai Zhang
- Department of Dermatology, Chaohu Hospital Affiliated to Anhui Medical University, Chaohu, 238000, Anhui, China.
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Murakami T, Shigeki S. Pharmacotherapy for Keloids and Hypertrophic Scars. Int J Mol Sci 2024; 25:4674. [PMID: 38731893 PMCID: PMC11083137 DOI: 10.3390/ijms25094674] [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: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
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Affiliation(s)
- Teruo Murakami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan;
| | - Sadayuki Shigeki
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan
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Lohasammakul S, Jyot A, Chaiyasate K. An approach to achieve tension-free closure and mitigate recurrence in the management of recurrent cervical keloids. J Surg Case Rep 2024; 2024:rjae222. [PMID: 38605696 PMCID: PMC11007642 DOI: 10.1093/jscr/rjae222] [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: 03/10/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Keloid is a burdensome condition that negatively affects patient's quality of life. It is influenced by a spectrum of risk factors, including tension. We propose an approach to address the tension-free closure and optimize surgical outcomes in neck keloid. A retrospective review of neck keloid patients who underwent surgical treatment between 2014 and 2022 was performed. Five patients underwent surgical interventions. Two patients had sufficient and three had insufficient tissue redundancy. The former underwent keloid excision with tension-free closure. The latter underwent keloid excision with full thickness skin graft for tension-free closure. One patient required re-excision with free flap coverage. All patients received postoperative low dose radiation. All patients were satisfied with the results and there were no signs of keloid recurrence during the follow-up period. Tension during closure following keloid excision is a modifiable risk factor. An appropriate algorithm providing tension-free closure can minimize the recurrence.
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Affiliation(s)
- Suphalerk Lohasammakul
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, 2 Thanon Wang Lang, Bangkok Noi, Bangkok 10700, Thailand
- Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, 3555 W 13 Mile Road Suite N120, Royal Oak, MI 48073, United States
| | - Apram Jyot
- Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, 3555 W 13 Mile Road Suite N120, Royal Oak, MI 48073, United States
| | - Kongkrit Chaiyasate
- Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, 3555 W 13 Mile Road Suite N120, Royal Oak, MI 48073, United States
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Li X, Wang X, Shen T, Xiong J, Ma Q, Guo G, Zhu F. Advances in photodynamic therapy of pathologic scar. Photodiagnosis Photodyn Ther 2024; 46:104040. [PMID: 38462122 DOI: 10.1016/j.pdpdt.2024.104040] [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: 12/13/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Pathologic scars include keloids and hypertrophic scars due to abnormal wound healing. Both cause symptoms of itching and pain; they also affect one's appearance and may even constrain movement. Such scars place a heavy burden on the individual's physical and mental health; moreover, treatment with surgery alone is highly likely to leave more scarring. Therefore, there is an urgent need for a treatment that is both minimally invasive and convenient. Photodynamic therapy (PDT) is an emerging safe and noninvasive technology wherein photosensitizers and specific light sources are used to treat malignant tumors and skin diseases. Research on PDT from both the laboratory and clinic has been reported. These findings on the treatment of pathologic scars using photosensitizers, light sources, and other mechanisms are reviewed in the present article.
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Affiliation(s)
- Xing Li
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Xin Wang
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Tuo Shen
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jianxiang Xiong
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qimin Ma
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Guanghua Guo
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang 330006, China.
| | - Feng Zhu
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
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Wang J, Patel P, Jagdeo J. An analysis of keloid patient questions on Reddit. Wound Repair Regen 2024; 32:164-170. [PMID: 38372454 DOI: 10.1111/wrr.13160] [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: 09/26/2023] [Revised: 12/15/2023] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
Reddit is one of the world's leading social media platforms, fostering active community discussions on a variety of topics including keloids. The prevalence and reach of conversations on Reddit underscore the need to investigate and understand patient perspectives and gaps in knowledge. Herein, we present an in-depth analysis of questions and concerns of Reddit users on keloids, offering valuable insights into patient experiences, knowledge gaps and treatment preferences. The study presents a distinct approach by harnessing the power of social media data to understand patient perspectives, which may not be readily apparent in clinical settings. All posts on the 'Hot' page of the subreddit r/Keloids were analyzed. Questions were categorized and subcategorized to reveal common themes. A total of 644 questions from 513 posts between 26 March 2017 and 28 August 2023 were identified and analyzed. Reddit users most frequently asked questions regarding keloid management (57.5%). Other common categories included uncertainty regarding diagnosis or symptoms (15.1%), living with keloids (7.5%) and causes or triggers (6.2%). This analysis highlights critical areas of patient knowledge gaps and potential misconceptions regarding keloids. For dermatologists, understanding these patient questions is crucial. Such insights allow for patient-centric education and treatments, ensuring more effective and comprehensive care.
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Affiliation(s)
- Jennifer Wang
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, USA
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
| | - Paras Patel
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, New York, USA
- Dermatology Service, Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York, USA
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Wang W, Chen L, Zhang Y, Wang H, Dong D, Zhu J, Fu W, Liu T. Adipose-derived stem cells enriched with therapeutic mRNA TGF-β3 and IL-10 synergistically promote scar-less wound healing in preclinical models. Bioeng Transl Med 2024; 9:e10620. [PMID: 38435824 PMCID: PMC10905533 DOI: 10.1002/btm2.10620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 03/05/2024] Open
Abstract
Skin wound healing often leads to scar formation, presenting physical and psychological challenges for patients. Advancements in messenger RNA (mRNA) modifications offer a potential solution for pulsatile cytokine delivery to create a favorable wound-healing microenvironment, thereby preventing cutaneous fibrosis. This study aimed to investigate the effectiveness of human adipose-derived stem cells (hADSCs) enriched with N 1-methylpseudouridine (m1ψ) modified transforming growth factor-β3 (TGF-β3) and interleukin-10 (IL-10) mRNA in promoting scar-free healing in preclinical models. The results demonstrated that the modified mRNA (modRNA)-loaded hADSCs efficiently and temporarily secreted TGF-β3 and IL-10 proteins. In a dorsal injury model, hADSCs loaded with modRNA TGF-β3 and IL-10 exhibited multidimensional therapeutic effects, including improved collagen deposition, extracellular matrix organization, and neovascularization. In vitro experiments confirmed the ability of these cells to markedly inhibit the proliferation and migration of keloid fibroblasts, and reverse the myofibroblast phenotype. Finally, collagen degradation mediated by matrix metalloproteinase upregulation was observed in an ex vivo keloid explant culture model. In conclusion, the synergistic effects of the modRNA TGF-β3, IL-10, and hADSCs hold promise for establishing a scar-free wound-healing microenvironment, representing a robust foundation for the management of wounds in populations susceptible to scar formation.
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Affiliation(s)
- Wei Wang
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Liang Chen
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Yuxin Zhang
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Heng Wang
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Dong Dong
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Jingjing Zhu
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
| | - Wei Fu
- Institute of Pediatric Translational Medicine, Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Tianyi Liu
- Department of Plastic and Aesthetic SurgeryHuadong Hospital, Shanghai Medical College, Fudan UniversityShanghaiChina
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Qiu ZK, Yang E, Yu NZ, Zhang MZ, Zhang WC, Si LB, Wang XJ. The biomarkers associated with epithelial-mesenchymal transition in human keloids. Burns 2024; 50:474-487. [PMID: 37980270 DOI: 10.1016/j.burns.2023.09.009] [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: 11/08/2022] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION A keloid is a type of benign fibrotic disease with similar features to malignancies, including anti-apoptosis, over-proliferation, and invasion. Epithelial-mesenchymal transition (EMT) is a crucial mechanism that regulates the metastatic behavior of tumors. Thus, identifying EMT biomarkers is paramount in comprehensively understanding keloid pathogenesis. METHODS To identify the differentially expressed genes (DEGs) GSE92566 dataset, with 3 normal skin and 4 keloid tissues, was downloaded from GEO databases to identify the differentially expressed genes (DEGs). Further, EMT-related genes were downloaded from dbEMT 2.0 databases and intersected with GSE92566 DEGs to identify EMT-related-DEGs (ERDEGs). Subsequently, the ERDEGs were used for GO, KEGG, gene set enrichment analysis (GSEA), protein-protein interaction (PPI), and miRNAs-mRNAs network analysis. To predict small molecules for EMT inhibition, the ERDEGs were imported to cMAP databases, whereas hub genes were imported to DGidb databases. Finally, we carried out qRT-PCR and in vitro experiments to validate our findings. RESULTS A total of 122 ERDEGs were identified, including 59 upregulated and 63 down-regulated genes. Moreover, enrichment analysis revealed that focal adhesion, AMPK signal pathway, Wnt signal pathway, and EMT biological process were significantly enriched. STRING databases and Cytoscape software were used to construct the PPI network and EMT-related hub genes. Further, 3 modules were explored from the PPI network using the Molecular Complex Detection (MCODE) plugin. In the Cytohubba plugin, 10 hub genes were explored, including FN1, EGF, SOX9, CDH2, PROM1, EPCAM, KRT19, ITGB1, CD24, and KRT18. These genes were then enriched for the focal adhesion pathway. We constructed a microRNA (miRNA)-mRNA network, which predicted hsa-miR-155-5p (8 edges), hsa-miR-124-3p (7 edges), hsa-miR-145-5p (5 edges), hsa-miR-20a-5p (5 edges) and hsa-let-7b-5p (4 edges) as the most connected miRNAs regulating EMT. Based on the ERDEGs and 10 hub genes mentioned above, ribavirin demonstrated high drug-targeting relevance. Subsequently, qRT-PCR confirmed that the expression of FN1, ITGB1, CDH2, and EPCAM corroborated with previous findings. qRT-PCR also showed that the expression levels of hsa-miR-124-3p and hsa-miR-145-5p were significantly lower in keloids and hsa-miR-155-5p was upregulated in keloids. Finally, by treating human keloid fibroblasts (HKFs) with ribavirin in vitro, we confirmed that ribavirin could inhibit HKFs proliferation and EMT. CONCLUSION In summary, this work provides novel EMT biomarkers in keloids and predicts new small target molecules for keloid therapy. Our findings improve the understanding of keloid pathogenesis, providing new treatment options.
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Affiliation(s)
- Zi-Kai Qiu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Elan Yang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Nan-Ze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming-Zi Zhang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wen-Chao Zhang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lou-Bin Si
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Jun Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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31
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Mozafari N, Mollaabasi F, Mansouri P, Robati RM. The Combined Application of Bleomycin and Triamcinolone for Treating Refractory Keloids. Dermatol Surg 2024; 50:267-271. [PMID: 38113179 DOI: 10.1097/dss.0000000000004056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Triamcinolone acetate injections are considered the first treatment option for keloids, but quite high proportions of keloids either do not respond to triamcinolone or develop recurrence. Beneficial effects of intralesional bleomycin have been recently shown in the treatment of keloids and hypertrophic scars. However, the efficacy of combination therapy using intralesional triamcinolone and bleomycin remains undetermined. OBJECTIVE The purpose of this study was to evaluate the efficacy of using bleomycin and triamcinolone mixture to treat refractory keloids. MATERIALS AND METHODS In total, 33 patients with resistant keloids (including 8 men and 25 women) and a mean age of 36.52 years (age range of 18-65 years) were enrolled in this study. A mixture of bleomycin (1 u/cc) with triamcinolone acetonide (13.3 mg/cc) was injected intralesionally into the keloids every 4 to 6 weeks for a maximum of 6 cycles. The clinical improvement was evaluated using the Japan Scar Scale (JSS) and the physician's global assessment of the flattening of the lesions. Side effects were also noted and recorded. RESULTS In all patients, the total JSS scores decreased significantly after treatment (2.33 ± 1.05), compared with baseline (11.61 ± 2.59), ( p < .001); 26 keloids (78.8%) showed an excellent response (75%-100% flattening), 7 keloids (21.2%) showed a fair response (25%-75% flattening), and 0 keloids (0%) showed a poor response (<25% flattening). Observed side effects were ulceration (33.3%), hyperpigmentation (33.3%), hypopigmentation (15.15%), secondary infection (33.3%), and telangiectasis (15.15%). CONCLUSION The combined use of bleomycin and triamcinolone offers a promising treatment option for individuals who have not responded well to traditional therapies.
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Affiliation(s)
- Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeghe Mollaabasi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mansouri
- Medical Laser Research Centers, Academic Center of Education, Culture and Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chen S, Zhang W, Xia Z, Xie J, Li Z, Liu Z, Yu N, Wang X. MicroRNAs Associated with Keloids Identified by Microarray Analysis and In Vitro Experiments. Mol Biotechnol 2024:10.1007/s12033-024-01058-0. [PMID: 38393632 DOI: 10.1007/s12033-024-01058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 02/25/2024]
Abstract
MicroRNAs (miRNAs) play a crucial role in gene regulation and the development of keloid. This research aimed to identify and verify miRNAs associated with keloids by microarray analysis and in vitro experiments, shedding light on seeking for potential therapeutic molecular targets. In this study, the weighted gene co-expression network analysis was performed based on the GSE113620. The key miRNA module most relevant to the keloid was further screened to identify hub miRNAs, and then hub miRNAs was verified by the microarray analysis and qRT-PCR experiments. Additionally, targeted genes of hub miRNAs were predicted and verified. Gene ontology (GO) analysis and KEGG enrichment analysis were also conducted. Five miRNA modules were divided, and the blue module exhibited the highest correlation with keloids. Then, hsa-miR-127-3p, hsa-miR-214-3p, hsa-miR-155-5p, hsa-miR-409-5p, and hsa-miR-542-5p were identified as the hub miRNAs. Subsequently, the microarray analysis and qRT-PCR results demonstrated that the expression of five miRNAs were upregulated in keloid tissues. The GO analysis revealed that the target genes of these miRNAs were mainly enriched in biological processes including gene transcription, protein phosphorylation and the MAPK (mitogen-activated protein kinase) cascade, and the KEGG pathway enrichment analysis showed that the PI3K-AKT signaling pathway were significantly enriched. In conclusion, these five miRNAs (hsa-miR-127-3p, hsa-miR-155-5p, hsa-miR-214-3p, hsa-miR-409-5p, and hsa-miR-542-5p) play vital roles in the pathogenesis of keloid and might be potential therapeutic targets. These miRNAs might regulate genes enriched in gene transcription, protein phosphorylation, the MAPK cascade, and the PI3K-Akt signaling pathway.
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Affiliation(s)
- Sichao Chen
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenchao Zhang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zenan Xia
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangmiao Xie
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhijin Li
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeming Liu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nanze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of International Medical Service, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xiaojun Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical college Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Jiang H, Hu X, Xiang H, Kou H, Zhang J, Zhang X, Li X, He K, Lu Y. Efficacy and safety of fractional carbon dioxide laser followed by 5-aminolevulinic acid photodynamic therapy for keloids. Photodiagnosis Photodyn Ther 2024; 45:103979. [PMID: 38242189 DOI: 10.1016/j.pdpdt.2024.103979] [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: 12/13/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Keloids are aggressive fibroproliferative disorders that cause aesthetic and functional damage. Photodynamic therapy (PDT) has shown promise as a novel treatment for keloids. However, the limited penetration of 5-aminolevulinic acid (ALA) and unsatisfactory outcomes in dense scars hinder its effectiveness as a monotherapy. The objective of this study is to assess the efficacy and safety of fractional CO2 laser followed by 5-ALA PDT for keloids. METHODS A total of 12 patients with keloid were included in our study. Each lesion was pretreated by fractional CO2 laser with 26-28 W to create microthermal zones. After topical application of 5-ALA solution, an irradiation of 635 nm red light with 120 J/cm2 was performed. The treatment was repeated at least every 2 weeks. Efficacy and safety were evaluated using the Vancouver Scar Scale (VSS), the Visual Analogue Scale (VAS) for keloid-related symptoms and documentation of postoperative complications. Statistical analysis was performed to compare VSS and keloid-related symptom VAS scores of the baseline and final treatment sessions. RESULTS The final treatment resulted in a statistically significant decrease in all parameters of VSS and VAS for pruritus and pain compared to the baseline. Except for postoperative hyperpigmentation, no infections, scar aggravation, or recurrence were observed during at least 6 months of follow-up. Overall, patients expressed a high level of satisfaction with the treatment outcome. CONCLUSIONS Fractional CO2 laser followed by 5-ALA PDT is a promising method for treating keloids. However, its synergetic effects need to be validated through clinical trials involving larger patient cohorts.
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Affiliation(s)
- Hao Jiang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Xiuhua Hu
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Haiyan Xiang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Huiling Kou
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Junbo Zhang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Xingcun Zhang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Xinying Li
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Kunqian He
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Yuangang Lu
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China.
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Shao J, Hu M, Wang W, Pan Z, Zhao D, Liu J, Lv M, Zhang Y, Li Z. Indocyanine green based photodynamic therapy for keloids: Fundamental investigation and clinical improvement. Photodiagnosis Photodyn Ther 2024; 45:103903. [PMID: 37989473 DOI: 10.1016/j.pdpdt.2023.103903] [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: 10/10/2023] [Revised: 11/05/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Keloid, a prevalent pathological skin lesion, presents significant challenges in terms of treatment efficacy. Photodynamic therapy (PDT), an increasingly popular adjuvant treatment, has shown significant potential in the management of various disorders, including cancer. However, the therapeutic potential of indocyanine green-mediated photodynamic therapy (ICG-PDT) for keloids has not yet been demonstrated. METHODS In this study, we divided the experimental groups into control group, Photothermal Therapy group, Photodynamic Therapy group, and Combined Therapy group. The in vitro investigation aimed to optimize the clinical application of PDT for keloid treatment by elucidating its underlying mechanism. Subsequently, on this basis, we endeavored to manage a clinical case of keloid by employing surgical intervention in conjunction with modified ICG-PDT. RESULTS Our investigation revealed an unexpected outcome that ICG-PDT maximally inhibited the cellular activity and migration of keloid fibroblasts only when photodynamic mechanism took effect. Additionally, the induction of autophagy and apoptosis, as well as the inhibition of collagen synthesis, were particularly evident in this experimental group. Furthermore, the above therapeutic effect could be achieved at remarkably low drug concentrations. Building upon the aforementioned experimental findings, we successfully optimized the treatment modality for the latest case and obtained a more favorable treatment outcome. CONCLUSIONS This study investigated the mechanism of ICG-PDT treatment and optimized the in vivo treatment regimen, demonstrating the significant therapeutic potential of ICG-PDT treatment in clinical keloid treatment.
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Affiliation(s)
- Junyi Shao
- Department of Dermatology and Venereology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Murong Hu
- Department of Dermatology and Venereology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, 310000, China
| | - Wenwen Wang
- Department of Dermatology and Venereology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Zhaoqi Pan
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University,Wenzhou, Zhejiang, 325000, China
| | - Dewei Zhao
- Department of Urology, Wenzhou Central Hospital, Wenzhou, Zhejiang, 325000, China
| | - Jingjing Liu
- Department of Dermatology and Venereology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Mingfen Lv
- Department of Dermatology and Venereology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yi Zhang
- Department of Dermatology and Venereology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
| | - Zhiming Li
- Department of Dermatology and Venereology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Boo YC. Insights into How Plant-Derived Extracts and Compounds Can Help in the Prevention and Treatment of Keloid Disease: Established and Emerging Therapeutic Targets. Int J Mol Sci 2024; 25:1235. [PMID: 38279232 PMCID: PMC10816582 DOI: 10.3390/ijms25021235] [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: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Keloid is a disease in which fibroblasts abnormally proliferate and synthesize excessive amounts of extracellular matrix, including collagen and fibronectin, during the healing process of skin wounds, causing larger scars that exceed the boundaries of the original wound. Currently, surgical excision, cryotherapy, radiation, laser treatment, photodynamic therapy, pressure therapy, silicone gel sheeting, and pharmacotherapy are used alone or in combinations to treat this disease, but the outcomes are usually unsatisfactory. The purpose of this review is to examine whether natural products can help treat keloid disease. I introduce well-established therapeutic targets for this disease and various other emerging therapeutic targets that have been proposed based on the phenotypic difference between keloid-derived fibroblasts (KFs) and normal epidermal fibroblasts (NFs). We then present recent studies on the biological effects of various plant-derived extracts and compounds on KFs and NFs. Associated ex vivo, in vivo, and clinical studies are also presented. Finally, we discuss the mechanisms of action of the plant-derived extracts and compounds, the pros and cons, and the future tasks for natural product-based therapy for keloid disease, as compared with existing other therapies. Extracts of Astragalus membranaceus, Salvia miltiorrhiza, Aneilema keisak, Galla Chinensis, Lycium chinense, Physalis angulate, Allium sepa, and Camellia sinensis appear to modulate cell proliferation, migration, and/or extracellular matrix (ECM) production in KFs, supporting their therapeutic potential. Various phenolic compounds, terpenoids, alkaloids, and other plant-derived compounds could modulate different cell signaling pathways associated with the pathogenesis of keloids. For now, many studies are limited to in vitro experiments; additional research and development are needed to proceed to clinical trials. Many emerging therapeutic targets could accelerate the discovery of plant-derived substances for the prevention and treatment of keloid disease. I hope that this review will bridge past, present, and future research on this subject and provide insight into new therapeutic targets and pharmaceuticals, aiming for effective keloid treatment.
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Affiliation(s)
- Yong Chool Boo
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea;
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, The Graduate School, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
- Cell and Matrix Research Institute, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
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Huang F, Zhang E, Lei Y, Yan Q, Xue C. Tripterine Inhibits Proliferation and Promotes Apoptosis of Keloid Fibroblasts by Targeting ROS/JNK Signaling. J Burn Care Res 2024; 45:104-111. [PMID: 37436955 PMCID: PMC11023317 DOI: 10.1093/jbcr/irad106] [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: 04/19/2023] [Indexed: 07/14/2023]
Abstract
Keloids are benign skin tumors characterized by excessive fibroblast proliferation and collagen deposition. The current treatment of keloids with hormone drug injection, surgical excision, radiotherapy, physical compression, laser therapy, cryotherapy often have unsatisfactory outcomes. The phytochemical compounds have shown great potential in treating keloids. Tripterine, a natural triterpene derived from the traditional Chinese medicine Thunder God Vine (Tripterygium wilfordii), was previously reported to exhibit an anti-scarring bioactivity in mouse embryonic fibroblast NIH/3T3 cells. Accordingly, our study was dedicated to explore its role in regulating the pathological phenotypes of keloid fibroblasts. Human keloid fibroblasts were treated with tripterine (0-10 μM) for 24 hours. Cell viability, proliferation, migration, apoptosis, and extracellular matrix (ECM) deposition were determined by CCK-8, EdU, wound healing, Transwell, flow cytometry, western blotting, and RT-qPCR assays. The effects of tripterine treatment on reactive oxygen species (ROS) generation and JNK activation in keloid fibroblasts were assessed by DCFH-DA staining and western blotting analysis. Tripterine at the concentrations higher than 4 μM attenuated the viability of human keloid fibroblasts in a dose-dependent manner. Treatment with tripterine (4, 6, and 8 μM) dose-dependently inhibited cell proliferation and migration, promoted cell apoptosis, reduced α-SMA, Col1, and Fn expression, induced ROS production, and enhanced JNK phosphorylation in keloid fibroblasts. Collectively, tripterine ameliorates the pathological characteristics of keloid fibroblasts that are associated with keloidformation and growth by inducing ROS generation and activating JNK signalingpathway.
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Affiliation(s)
- Fang Huang
- School Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Enjing Zhang
- Department of Pharmacy, Third Municipal Hospital, Wuhan, China
| | - Yan Lei
- School Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Yan
- School Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Chengbin Xue
- Department of Pharmacy, Hospital of Huazhong University of Science and Technology, Wuhan, China
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Bae JS, Park ES, Nam SM, Cha HG, Choi CY. Dermal hinge flap with adjuvant corticosteroid injection for ear keloid. J Cosmet Dermatol 2024; 23:76-78. [PMID: 37530091 DOI: 10.1111/jocd.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Joon Suk Bae
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Han Gyu Cha
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Chang Yong Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Wang J, Yu N, Wang G, Wang R, Li L, Jiang Y, Sui H, Sun Y, Li Z, Long X, Zhu Z. 68 Ga-FAPI-04 PET/CT in Assessment of Fibroblast Activation in Keloids : A Prospective Pilot Study. Clin Nucl Med 2024; 49:16-22. [PMID: 38015039 DOI: 10.1097/rlu.0000000000004913] [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: 11/29/2023]
Abstract
PURPOSE Keloids are benign fibroproliferative disorders characterized by the massive proliferation of fibroblasts. Fibroblast activation plays a key role in the invasive growth of keloids. Therefore, a prospective pilot study was conducted to explore the value of 68 Ga-FAPI-04 PET/CT in the assessment of keloids activity. PATIENTS AND METHODS Twenty-five patients with keloid were enrolled to conduct 68 Ga-FAPI-04 PET/CT. All patients accepted surgery to remove part of the lesions within 1 week. SUV mean and SUV max were measured for semiquantitative analysis and compared with the Vancouver Scar Scale, Laser Speckle Contrast Imaging, pathology, and immunohistochemical stains. RESULTS A total of 123 lesions were detected in 25 patients, most of which were distributed in the anterior chest wall. The 68 Ga-FAPI-04 uptake was significantly different at different sites ( P < 0.0001). There was uptake heterogeneity within the keloid lesions, and a significant difference was found between the edge and center of some large lesions. The SUV max of 68 Ga-FAPI-04 showed significantly correlation with the Vancouver Scar Scale ( r = 0.565, P < 0.0001) moderately and the Laser Speckle Contrast Imaging parameters mildly. The SUV max of 68 Ga-FAPI-04 had a moderate correlation with FAPI expression ( r = 0.520, P = 0.022). Moreover, collagen, fibroblast activator protein, and Ki-67 expression were found higher at the edges of keloid tissue than in the center. CONCLUSIONS 68 Ga-FAPI-04 PET/CT can reflect the distribution characteristics of activated fibroblasts in keloid tissue and may provide a novel method for keloid evaluation for further fibroblast-related therapies.
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Affiliation(s)
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | | | | | | | | | | | - Yixin Sun
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhijin Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
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Liu Y, Xiong X, Cao N, Zhao Y. Diagnosis and Treatment of Keloid: Method Summary and Effect Evaluation. Clin Cosmet Investig Dermatol 2023; 16:3775-3783. [PMID: 38170138 PMCID: PMC10759814 DOI: 10.2147/ccid.s446018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Keloid is a prevalent skin disorder characterized by the abnormal growth of keloid tissue, which usually occurs following wound healing or surgical incisions. It typically progresses through several stages: the inflammatory stage, the proliferative stage, collagen remodeling, and ultimately the formation of keloid. This review aims to summarize the diagnostic and therapeutic methods for keloid, and evaluate their effectiveness. The diagnosis of keloid is usually based on medical history and clinical manifestations such as pain, itching, erythema, and induration. Other commonly used diagnostic methods include tissue biopsy and ultrasound examination. Various treatment options for keloid exist, including physical therapy, medication, surgical treatment, and radiation therapy. Physical therapy includes pressure therapy, laser therapy, such as silicone sheets, elastic bandages, and laser irradiation. Medication treatment mainly involves the application of topical medications or intralesional injections, such as topical corticosteroids, 5-fluorouracil, and others. Radiation therapy can be administered using applicators and superficial radiation therapy, among other methods. The treatment outcomes of keloid vary from person to person and recurrence is common. Therefore, a comprehensive treatment approach may be the most effective strategy. Individualized treatment plans should consider factors such as the patient's age, gender, medical history, and the severity of the condition. In conclusion, the diagnosis and treatment of keloid require consideration of multiple factors and the implementation of individualized treatment plans. Future research should focus on identifying the molecular mechanisms underlying the occurrence and progression of keloid in order to develop more effective treatment methods.
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Affiliation(s)
- Yu Liu
- Nuclear Medicine Department, Jilin University Second Hospital, Changchun, Jilin Province, People’s Republic of China
| | - Xiaoliang Xiong
- Nuclear Medicine Department, Jilin University Second Hospital, Changchun, Jilin Province, People’s Republic of China
| | - Nan Cao
- Nuclear Medicine Department, Jilin University Second Hospital, Changchun, Jilin Province, People’s Republic of China
| | - Yinlong Zhao
- Nuclear Medicine Department, Jilin University Second Hospital, Changchun, Jilin Province, People’s Republic of China
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40
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Alfurayh N, Alqahtani R, AlFada M. Keloid Scar Resistance to Intralesional Steroid Injections: Should We Look for Foreign Bodies? A Case Report. Clin Cosmet Investig Dermatol 2023; 16:3693-3697. [PMID: 38146404 PMCID: PMC10749577 DOI: 10.2147/ccid.s443813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
Keloid is a challenging pathological condition characterized by abnormal scarring that extends beyond the boundaries of the original wound. Despite the available treatment options, keloid scars remain difficult to manage. This case report discusses a 10-year-old boy with a keloid scar on his neck following branchial anomaly repair surgery. The patient underwent multiple treatments, including triamcinolone injections, cryotherapy, and a pulsed dye laser session, with limited improvement. Subsequently, an X-ray and ultrasound were performed revealing the presence of metallic clips over the surgical site. To our knowledge, the effect of the presence of foreign bodies within the keloid scar on its response to treatment is not well understood yet. The findings of this case encourage performing imaging studies on post-surgical keloid scars resistant to treatment to rule out the presence of any foreign material. However, more trials to investigate the effect of the presence of foreign bodies on the treatment of keloid scar are required before it can be set as a mandatory investigation.
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Affiliation(s)
- Nuha Alfurayh
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reem Alqahtani
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mohammed AlFada
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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41
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Hu XY, Yang Q, Guan XY, Li JY, Wang LL, Li K, Zhang XT. Efficacy of surgical resection and ultra-reduced tension suture combined with superficial radiation in keloid treatment. World J Clin Cases 2023; 11:8310-8319. [PMID: 38130623 PMCID: PMC10731203 DOI: 10.12998/wjcc.v11.i35.8310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND There are many available treatment options for keloid; however, single treatments are usually less effective. Therefore, more scientifically rational and effective combined treatment methods should be sought to solve the pain associated with keloids. AIM To explore the efficacy and safety of surgical resection and ultra-reduced tension suture combined with superficial radiation as keloid treatment. METHODS Fifteen keloid patients admitted to Qingdao Eighth People's Hospital from June 2020 to January 2022 were enrolled in this retrospective analysis. All patients underwent a comprehensive treatment approach comprising surgical resection, ultra-reduced tension suture incision, and superficial radiation therapy within 24 h postoperatively. The modified Vancouver Scar Scale (mVSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate the treatment effect, whereas the efficacy, adverse effects, and recurrence rate were observed according to the 12-mo follow-up after treatment. RESULTS The mVSS and POSAS scores at 1 and 6 mo after combination treatment decreased compared to before treatment (P < 0.001), and the overall response rate was 93.3%. Only one case recurred, yielding a 6.7% recurrence rate. The incidence of local chromour sedimentation rate in 1-3 mo after radiotherapy was 33.3% (5 patients), all subsiding after 6-9 mo, without complications, such as delayed wound healing or dermatitis. CONCLUSION Surgical resection, super subtraction sutures, and superficial radiotherapy are treatment methods with short courses, low recurrence rates, and good safety profiles.
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Affiliation(s)
- Xiao-Ying Hu
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Qiao Yang
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Xiao-Yu Guan
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Jin-Ying Li
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, China
| | - Ling-Ling Wang
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Kun Li
- Department of Cosmetic Medicine, Qingdao Eighth People’s Hospital, Qingdao 266100, Shandong Province, China
| | - Xiao-Tao Zhang
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao 266042, Shandong Province, China
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42
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Won P, Cooper M, Justin Gillenwater T, Yenikomshian HA. Treatment of Hypertrophic Burn Scars With Laser Therapy: A Review of Adverse Events. Ann Plast Surg 2023; 91:715-719. [PMID: 37856225 PMCID: PMC10840736 DOI: 10.1097/sap.0000000000003712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ABSTRACT Hypertrophic scarring, characterized by excessive scar tissue formation, is a debilitating outcome that significantly impairs physical and psychosocial recovery after burn injury. Hypertrophic scarring affects a substantial proportion of burn survivors, with reported prevalence as high as 70%. Fractional CO 2 laser (FCL) therapy, a therapy commonly used in acne scar treatment or skin rejuvenation, has become popular in treating hypertrophic scars. Little is known regarding FCL's adverse events for burn scar treatment. We hypothesize that FCL is a safe treatment modality with minimal adverse events in the management of hypertrophic burn scars. This is a retrospective chart review of adverse events after FCL at 2 centers within a single institution. Burn patients undergoing FCL between May 1, 2019, and June 1, 2021 were included. Demographics, injury etiology, laser treatment details, and adverse events were collected. A total of 170 patients, 77 (45.3%) males and 93 (54.7%) females, underwent 544 FCL therapies for burn scars. The average number of treatments per patient was 3 ± 2.23, with a range of 1 to 17 sessions. From the total 544 laser therapy sessions, 13 adverse events (2.4%) were reported. There were 5 reports (0.9%) of increased postprocedural pain and 1 report (0.2%) of increased paresthesia/numbness to laser site. Three instances (0.6%) of increased erythema and 4 reports (0.7%) of epidermal sloughing or blistering were reported. All but 5 patients (2.9%) reported improvements to scar symptoms. This study demonstrates minimal adverse events associated with FCL for hypertrophic burn scar treatment.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Cooper
- LAC+USC Hospital, University of Southern California, Los Angeles, CA, USA
| | - T. Justin Gillenwater
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Haig A. Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
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Li Z, Zhang W, Zhang H. Hsa_circ_0000129 knockdown attenuates proliferation and migration in keloid fibroblasts by targeting miR-485-3p/SGMS2 pathway. Burns 2023; 49:2007-2017. [PMID: 37407394 DOI: 10.1016/j.burns.2023.06.006] [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: 09/02/2022] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Aberrant biofunction of circular RNAs (circRNAs) is potently implicated in keloid formation. However, their roles have been underinvestigated. Recent evidence has demonstrated the pro-tumor role of circ_0000129 in cancers, and yet its role in keloid remains elusive. METHODS RT-qPCR analysis and or western blotting of miR-485-3p, circ_0000129, and SGMS2 in keloid tissues and keloid fibroblasts was implemented. CCK8, EdU, scratch wound healing, and Transwell migration assays were perfomed to determine the keloid fibroblast proliferation and migration. Luciferase reporter and RIP assays were adopted to analyze the interaction among circ_0000129, miR-485-3p and SGMS2. RESULTS In keloid tissues and keloid fibroblasts, circ_0000129 and SGMS2 were amplified, although miR-485-3p expression was downregulated. Furthermore, siRNAs-targeting endogenous circ_0000129 resulted in proliferation and migration defect of keloid fibroblasts. MiR-485-3p was simultaneously recognized by circ_0000129 and SGMS2 3'UTR. Rescued functional assays also illustrated that miR-485-3p loss was beneficial to the proliferation and migration of keloid fibroblasts, and these promoting changes were nullified by accompanied silence circ_0000129 or SGMS2. CONCLUSION Circ_0000129 sponges miR-485-3p and releases expression of SGMS2 from the miR-485-3p suppression, promoting migration and proliferation of keloid fibroblasts, suggesting targeting circ_0000129/miR-485-3p/SGMS2 might be a promising strategy against keloid fibroblasts. AVAILABILITY OF DATA AND MATERIAL All data generated or analyzed during this study are included in this article.
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Affiliation(s)
- Zi Li
- Department of Orthopedics & Plastic Surgery, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan 430015, Hubei, China
| | - Wenhui Zhang
- Department of Plastic & Cosmetic Surgery, Tongji Medical College Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Heting Zhang
- Department of Plastic Surgery, Union Jiangbei Hospital, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China.
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Wu D, Liu X, Jin Z. Placental mesenchymal stem cells-secreted proenkephalin suppresses the p38 MAPK signaling to block hyperproliferation of keloid fibroblasts. Tissue Cell 2023; 85:102218. [PMID: 37913601 DOI: 10.1016/j.tice.2023.102218] [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: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Thanks to their multi-potency and secretory functions, mesenchymal stem cells (MSCs) have long been established as an ideal cell type for skin wound healing and a candidate therapeutic strategy for excessive pathological scarring in the meantime. This study focuses on the effect of placental MSCs (PMSCs) on the activity of keloid fibroblasts (KFs) and the potential involvement of proenkephalin (PENK). METHODS Secretory protein of PMSC that are lowly expressed in KFs were predicted by bioinformatics analyses. The expression of PENK in KFs was detected by RT-qPCR and western blot analysis. PMSCs were co-cultured with KFs and dermal fibroblasts (DFs) to examine their effect on proliferation, migration, invasion, and apoptosis of the distinct cell types. PENK secretion by PMSCs and its uptake by KFs were examined by ELISA, WB, and immunofluorescence staining. Loss-of-functions of PENK and p38-MAPK were induced to examine the activity of KFs in vitro and in mice. RESULTS PENK, a secretory protein of PMSCs, was conspicuously downregulated in KFs compared to normal DFs. PMSC stimulation suppressed proliferation, migration, invasion, and resistance to apoptosis of the co-cultured KFs but not DFs, which was ascribed to the upregulation of PENK protein in KFs. PMSCs-secreted PENK suppressed p38 phosphorylation in KFs. The proliferative and aggressive properties of KFs in vitro and the nodule-forming capacity of KFs in vivo were promoted upon PENK downregulation but suppressed by the p38 MAPK inhibitor SB202190. CONCLUSION This work unravels that PMSCs-secreted PENK suppresses the p38 MAPK signaling to block hyperproliferation of KFs.
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Affiliation(s)
- Di Wu
- Department of Dermtology, Jilin Central Hospital, Jilin 132001, Jilin, PR China; Department of Dermtology, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin, PR China
| | - Xiao Liu
- Department of Dermtology, Jilin Central Hospital, Jilin 132001, Jilin, PR China
| | - Zhehu Jin
- Department of Dermtology, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin, PR China.
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Ma QY, Yang YT, Chen ZA, Xie CH, Wang WB, Lin X, Xia LL, Zhao Q, Gao Z, Wu XL. Laser Combined with Radiotherapy for Keloid Treatment: A Novel and Efficient Comprehensive Therapy with a Lower Recurrence Rate. Plast Reconstr Surg 2023; 152:1022e-1029e. [PMID: 36877761 DOI: 10.1097/prs.0000000000010376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Keloids are a fibroproliferative skin disorder with a high recurrence rate. Combined therapies are often used in clinical treatment, but, in addition to the relatively high risk of relapse and complexity of the treatment process, side effects remain unknown for combination therapies. METHODS A total of 99 patients with keloids in 131 positions were included in this retrospective study. Fractional CO 2 laser therapy was first applied with energy ranging from 360 to 1008 mJ; then, 6-Mev, 900-cGy electron beam irradiation was applied twice. The first pass was initiated within 24 hours after the laser therapy, and the second pass was performed on the seventh day after laser therapy. The Patient and Observer Scar Scale evaluated the lesions before the treatment and at 6, 12, and 18 months after treatment. At each follow-up visit, the patients filled out a questionnaire on recurrence, side effects, and satisfaction. RESULTS The authors found a significant decrease in total Patient and Observer Scar Scale score [29 (23, 39) versus 61.2 ± 13.4; P < 0.001] at the 18-month follow-up compared with the baseline value (before the therapy). A total of 12.1% of the patients had recurrences during the 18-month follow-up period (11.1% partial recurrence and 1.0% complete recurrence). The total satisfaction rate was 97.0%. No severe adverse effects were observed during the follow-up period. CONCLUSIONS Laser combined with radiotherapy is a new comprehensive therapy comprising ablative lasers and radiotherapy for keloids. It had excellent clinical efficacy, low recurrence rate, and no serious adverse effects. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Qian-Yu Ma
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Ya-Ting Yang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zong-An Chen
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Chun-Hui Xie
- Department of Burns Surgery, The First Hospital of Jilin University
| | - Wen-Bo Wang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Xiang Lin
- Department of Burn and Plastic Surgery, Shandong Heze Municipal Hospital
| | - Ling-Ling Xia
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Qiong Zhao
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhen Gao
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Xiao-Li Wu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
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46
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Zhang X, Wu X, Li D. The Communication from Immune Cells to the Fibroblasts in Keloids: Implications for Immunotherapy. Int J Mol Sci 2023; 24:15475. [PMID: 37895153 PMCID: PMC10607157 DOI: 10.3390/ijms242015475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Keloids are a type of fibrotic disease characterized by excessive collagen production and extracellular matrix (ECM) deposition. The symptoms of pain and itching and frequent recurrence after treatment significantly impact the quality of life and mental health of patients. A deeper understanding of the pathogenesis of keloids is crucial for the development of an effective therapeutic approach. Fibroblasts play a central role in the pathogenesis of keloids by producing large amounts of collagen fibers. Recent evidence indicates that keloids exhibit high immune cell infiltration, and these cells secrete cytokines or growth factors to support keloid fibroblast proliferation. This article provides an update on the knowledge regarding the keloid microenvironment based on recent single-cell sequencing literature. Many inflammatory cells gathered in keloid lesions, such as macrophages, mast cells, and T lymphocytes, indicate that keloids may be an inflammatory skin disease. In this review, we focus on the communication from immune cells to the fibroblasts and the potential of immunotherapy for keloids. We hope that this review will trigger interest in investigating keloids as an inflammatory disease, which may open up new avenues for drug development by targeting immune mediators.
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Affiliation(s)
- Xiya Zhang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
| | - Xinfeng Wu
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
| | - Dongqing Li
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China;
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China
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Rosa-Nieves PM, Plampton K, Evans T, Whitley MJ. Successful Treatment of a Keloid With Surgical Excision Followed by Pentoxifylline, Intralesional Corticosteroid, and Intralesional 5-Fluorouracil. Dermatol Surg 2023; 49:972-974. [PMID: 37466207 DOI: 10.1097/dss.0000000000003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Priscilla M Rosa-Nieves
- Department of Dermatology, University of Nebraska Medical Center, Omaha Nebraska
- Ponce Health Sciences University, School of Medicine, Ponce Puerto Rico
| | - Katherine Plampton
- Department of Dermatology, University of Nebraska Medical Center, Omaha Nebraska
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Tyler Evans
- Department of Dermatology, University of Nebraska Medical Center, Omaha Nebraska
| | - Melodi Javid Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha Nebraska
- Department of Dermatology, Duke University School of Medicine, Durham North Carolina
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48
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Biazus Soares G, Mahmoud O, Yosipovitch G. Pruritus in keloid scars: mechanisms and treatments. Ital J Dermatol Venerol 2023; 158:401-407. [PMID: 37916400 DOI: 10.23736/s2784-8671.23.07554-0] [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: 11/03/2023]
Abstract
Keloids occur after cutaneous injury and can cause distress due to physical appearance and associated symptoms such as pain and pruritus. Keloid-associated pruritus is a common manifestation and has negative impacts on quality of life. The mechanism underlying this type of pruritus is multifactorial and thought to involve small nerve fiber damage, neurogenic inflammation, and a Th2-predominant inflammatory response. Various agents have been shown to reduce keloid pruritus, including intralesional corticosteroids, botulinum toxin A, 5-fluorouracil, and bleomycin. Other treatment modalities such as cryotherapy and hyperbaric oxygen therapy are also effective. Future treatments targeting the mechanisms involved in keloid-associated itch could provide improvements in pruritus and quality of life in these patients, but further studies on the efficacy of these agents are needed.
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Affiliation(s)
- Georgia Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Mahmoud
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA -
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49
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Anggawirya BY, Wardhani PH, Indramaya DM, Listiawan MY. Combination of Fractional Er:YAG Laser, Pulsed Dye Laser, and Intralesional Triamcinolone With 5-Fluorouracil for Keloid Treatment. J Lasers Med Sci 2023; 14:e30. [PMID: 37744013 PMCID: PMC10517570 DOI: 10.34172/jlms.2023.30] [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: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023]
Abstract
Introduction: Benign fibroproliferative scars that are larger than the initial lesion are called keloids. Keloids treatment in clinical practice is still difficult. Although there are various therapy choices, none is embraced by everyone or is relapse-free. Various treatment modalities such as intralesional corticosteroid injection with 5-fluorouracil (5-FU), fractional Er:YAG laser, pulsed dye laser (PDL), and others can be used either as monotherapies or combined therapies. Therefore, efforts should be made to select the treatment that will provide the best results. Case Presentation: A 6-year-old boy with keloids on the lower lips extending to the chin was successfully treated with a 2940-nm fractional Er:YAG laser alternated with a 595-nm long-PDL followed by the combined intralesional injection of corticosteroid and 5-FU. The patient was followed up for 1 year with no lesion recurrence. Conclusion: Our case supports a combined therapy to successfully treat a patient with a keloid on the chin. Therapy using a combination of these four modalities seems safe and effective and may have a synergistic effect with minimal downtime.
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Affiliation(s)
- Bonnie Yudistha Anggawirya
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Putri Hendria Wardhani
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Diah Mira Indramaya
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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50
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李 政, 田 保, 梁 海. [Keloid nomogram prediction model based on weighted gene co-expression network analysis and machine learning]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:725-735. [PMID: 37666763 PMCID: PMC10477384 DOI: 10.7507/1001-5515.202212048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/02/2023] [Indexed: 09/06/2023]
Abstract
Keloids are benign skin tumors resulting from the excessive proliferation of connective tissue in wound skin. Precise prediction of keloid risk in trauma patients and timely early diagnosis are of paramount importance for in-depth keloid management and control of its progression. This study analyzed four keloid datasets in the high-throughput gene expression omnibus (GEO) database, identified diagnostic markers for keloids, and established a nomogram prediction model. Initially, 37 core protein-encoding genes were selected through weighted gene co-expression network analysis (WGCNA), differential expression analysis, and the centrality algorithm of the protein-protein interaction network. Subsequently, two machine learning algorithms including the least absolute shrinkage and selection operator (LASSO) and the support vector machine-recursive feature elimination (SVM-RFE) were used to further screen out four diagnostic markers with the highest predictive power for keloids, which included hepatocyte growth factor (HGF), syndecan-4 (SDC4), ectonucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2), and Rho family guanosine triphophatase 3 (RND3). Potential biological pathways involved were explored through gene set enrichment analysis (GSEA) of single-gene. Finally, univariate and multivariate logistic regression analyses of diagnostic markers were performed, and a nomogram prediction model was constructed. Internal and external validations revealed that the calibration curve of this model closely approximates the ideal curve, the decision curve is superior to other strategies, and the area under the receiver operating characteristic curve is higher than the control model (with optimal cutoff value of 0.588). This indicates that the model possesses high calibration, clinical benefit rate, and predictive power, and is promising to provide effective early means for clinical diagnosis.
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Affiliation(s)
- 政宇 李
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 保华 田
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 海霞 梁
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
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