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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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Jafarzadeh A, PourMohammad A, Goodarzi A. A systematic review of the efficacy, safety and satisfaction of regenerative medicine treatments, including platelet-rich plasma, stromal vascular fraction and stem cell-conditioned medium for hypertrophic scars and keloids. Int Wound J 2024; 21:e14557. [PMID: 38126221 PMCID: PMC10961894 DOI: 10.1111/iwj.14557] [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: 11/19/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
The primary objective of this study is to examine the efficiency of various regenerative medicine approaches, such as platelet-rich plasma, cell therapy, stromal vascular fraction, exosomes and stem cell-conditioned medium, in the process of healing hypertrophic and keloid scars. Major databases including PubMed, Scopus and Web of Science were systematically searched, and based on the content of the articles and the inclusion and exclusion criteria, eight articles were selected. Out of these eight articles, there were two non-randomized clinical trial studies (25%), one randomized, single-blinded comparative study (12.5%), one retrospective clinical observational study (12.5%) and four randomized clinical trial studies (50%). We employed EndNote X8 and Google Sheets to conduct article reviews and extract relevant data. Following the review phase, the studies underwent analysis and categorization. In all eight reviewed studies, the effectiveness of regenerative medicine in treating hypertrophic scars and keloids has been proven. Out of these studies, five (62.5%) focused on the effectiveness of platelet-rich plasma, two study (25%) examined the effectiveness of stromal vascular fraction and one study (12.5%) explored the efficacy of stem cell-conditioned medium. In two studies (25%), the treatment methods were added to standard treatment, while in six studies (75%), regenerative medicine was used as the sole treatment method and compared with standard treatment. The use of these treatment methods did not result in any serious side effects for the patients. Regenerative medicine is an effective method with minimal side effects for the treatment of hypertrophic scars and keloids. It can be used as a monotherapy or in combination with other treatment methods. However, further studies are needed to thoroughly evaluate the effectiveness of all sub-branches of this method.
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Affiliation(s)
- Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | | | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of MedicineIran University of Medical Sciences (IUMS)TehranIran
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3
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Gao H, Zhao Z, Li J, Guo Z, Zhang F, Wang K, Bai X, Wang Q, Guan Y, Wang Y, Zhang P, Lv N, Zhu H, Li Z. Platelet-rich plasma promotes skeletal muscle regeneration and neuromuscular functional reconstitution in a concentration-dependent manner in a rat laceration model. Biochem Biophys Res Commun 2023; 672:185-192. [PMID: 37354612 DOI: 10.1016/j.bbrc.2023.05.123] [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: 04/23/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
Abnormal function of injured muscle with innervation loss is a challenge in sports medicine. The difficulty of rehabilitation is regenerating and reconstructing the skeletal muscle tissue and the neuromuscular junction (NMJ). Platelet-rich plasma (PRP) releases various growth factors that may provide an appropriate niche for tissue regeneration. However, the specific mechanism of the PRP's efficacy on muscle healing remains unknown. In this study, we injected PRP with different concentration gradients (800, 1200, 1600 × 109 pl/L) or saline into a rat gastrocnemius laceration model. The results of histopathology and neuromyography show that PRP improved myofibers regeneration, facilitated electrophysiological recovery, and reduced fibrosis in a concentration-dependent manner. Furthermore, we found that PRP promotes the activity of satellite cells by upregulating the expression of the myogenic regulatory factor (MyoD, myogenin). Meanwhile, PRP promotes the regeneration and maturation of acetylcholine receptor (AChR) clusters of the Neuromuscular junction (NMJ) on the regenerative myofibers. Finally, we found that the expression of the Agrin, LRP4, and MuSK was upregulated in the PRP-treated groups, which may contribute to AChR cluster regeneration and functional recovery. The conclusions proposed a hypothesis for PRP treatment's efficacy and mechanism in muscle injuries, indicating promising application prospects.
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Affiliation(s)
- Huayi Gao
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China; Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China.
| | - Zhidong Zhao
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China; Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China.
| | - Ji Li
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China; Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China.
| | - Zheng Guo
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China; Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China.
| | - Fei Zhang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Ketao Wang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Xiaowei Bai
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Qi Wang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Yu Guan
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Yaoting Wang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Pengli Zhang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Ningyu Lv
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Heng Zhu
- Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China.
| | - Zhongli Li
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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4
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Guo R, Xuan W, He X, Xu K. Safety and efficacy of CO 2 dot matrix laser combined with platelet-rich plasma on depressed scar after acne vulgaris and influencing factors of its repair effect: A retrospective analysis. J Cosmet Dermatol 2023; 22:850-861. [PMID: 36606396 DOI: 10.1111/jocd.15501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acne vulgaris (AV) is the most pervasive inflammatory disease of hair follicle and sebaceous gland in the dermatology department, and depressed scar (DS) is the most common and serious sequela of AV. AIMS To explore the clinical value of CO2 dot matrix laser combined with platelet-rich plasma (PRP)-treated AV. METHODS Total 81 patients with DS at the rear of AV from December 2018 to October 2019 were selected, randomly divided into observation group (OG, n = 39) and control group (CG, n = 42). Patients in the OG group were treated with CO2 dot matrix laser combined with PRP, and those in the CG group were treated with CO2 dot matrix laser. To observe clinical outcomes in both groups. RESULTS According to experimental analysis, compared with the CG group, CO2 dot matrix laser combined with PRP can more strongly improve the clinical efficacy on patients, shorten the scar scabbing time and decrustation time, more effectively contributed to their scar repair, comfort, skin condition, psychological state and satisfaction, and reduced their pain. The subsequent follow-up results also showed that patients in the OG group experienced better quality of life. Moreover, according to the logistic regression analysis, the course of disease, scar degree, and staying up late were independent risk factors for the repair effect, and the repair method of CO2 dot matrix laser combined with PRP was an independent protection factor. CONCLUSION To sum up, CO2 dot matrix laser combined with PRP can strongly enhance the scar repair effect, psychological state, and life quality of patients with DS after AV, so it is worth popularizing in clinical practice.
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Affiliation(s)
- Rong Guo
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenxia Xuan
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao He
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Kai Xu
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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Mony MP, Harmon KA, Hess R, Dorafshar AH, Shafikhani SH. An Updated Review of Hypertrophic Scarring. Cells 2023; 12:cells12050678. [PMID: 36899815 PMCID: PMC10000648 DOI: 10.3390/cells12050678] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
Hypertrophic scarring (HTS) is an aberrant form of wound healing that is associated with excessive deposition of extracellular matrix and connective tissue at the site of injury. In this review article, we provide an overview of normal (acute) wound healing phases (hemostasis, inflammation, proliferation, and remodeling). We next discuss the dysregulated and/or impaired mechanisms in wound healing phases that are associated with HTS development. We next discuss the animal models of HTS and their limitations, and review the current and emerging treatments of HTS.
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Affiliation(s)
- Manjula P. Mony
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kelly A. Harmon
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ryan Hess
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Amir H. Dorafshar
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sasha H. Shafikhani
- Department of Medicine, Division of Hematology and Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL 60612, USA
- Cancer Center, Rush University Medical Center, Chicago, IL 60612, USA
- Correspondence:
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Chhabra A, Pandey S, Rathore Y, Kaur G, Lakhanpal T, Singh Tanwar K, Kumaran MS, De D, Shukla J. Nuclear medicine in the management of superficial skin abnormalities and institutional experience. Nucl Med Commun 2022; 43:625-630. [PMID: 35362693 DOI: 10.1097/mnm.0000000000001549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Keloid, hypertrophic scars and basal cell carcinoma (BCC) falls under the category of non-melanoma skin cancer. Intralesional steroids, external beam radiation therapy, 5-Fluorouracil, cryotherapy, laser, etc are the available treatment options. However, recurrence has been reported with each type of treatment mode. In the present article, various treatment modes have been discussed and institutional experience of Rhenium-188 skin patches for the treatment of keloids and BCC has been discussed.
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Affiliation(s)
| | | | | | | | | | | | - M Sendhil Kumaran
- Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Karina K, Ekaputri K, Biben JA, Hadi P, Andrew H, Sadikin PM. Therapeutic Effect of Autologous Activated Platelet-rich Plasma Therapy on Mid-dermal to Full-thickness Burns: A Case Series. Arch Plast Surg 2022; 49:405-412. [PMID: 35832167 PMCID: PMC9142229 DOI: 10.1055/s-0042-1744423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Although modern medicine has made great strides in the management of burn injuries, associated complications such as pain, infection, dyspigmentation, and scarring have yet to be fully dealt with. Although skin grafting and meshing are routinely performed on burn patients, this method poses a risk for adverse effects. Activated autologous platelet-rich plasma (aaPRP), which is increasingly used in the field of plastic surgery, contains growth factors beneficial for wound regeneration. Seven cases of burns with varying severity and conditions that were treated with intralesional subcutaneous injection and intravenous aaPRP are presented and discussed herein. This case series indicates that subcutaneous and intravenous aaPRP is a safe procedure with the potential to be an alternative when skin grafting cannot be done or as an adjunct treatment to skin grafting.
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Affiliation(s)
- Karina Karina
- Klinik Hayandra, Yayasan Hayandra Peduli, Jakarta Pusat, Indonesia
- HayandraLab, Yayasan Hayandra Peduli, Jakarta Pusat, Indonesia
- Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
- Pusat Kajian Stem Cell, Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
| | - Krista Ekaputri
- Klinik Hayandra, Yayasan Hayandra Peduli, Jakarta Pusat, Indonesia
| | | | - Pritha Hadi
- Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia
- Raden Mattaher Regional Hospital, Jambi, Indonesia
| | - Hubert Andrew
- HayandraLab, Yayasan Hayandra Peduli, Jakarta Pusat, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia
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Minaev SV, Grigorova AN, Vladimirova OV, Timofeev SI, Sirak AG, Vladimirov VI, Pogosyan AA, Zelenskaya MV. [Influence of connective tissue differentiation on scar tissue formation in children]. Khirurgiia (Mosk) 2021:72-77. [PMID: 33977701 DOI: 10.17116/hirurgia202105172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the immunohistochemical features of various scar tissues in children without connective tissue pathology and with undifferentiated connective tissue dysplasia syndrome. MATERIAL AND METHODS Tissue biopsy was performed in 217 children who underwent surgical treatment for various lesions, such as injuries, burns, as well as other procedures. There were 127 boys (58.5%) and 90 (41.5%) girls. The main group consisted of 98 (48.2%) children with scar tissue; group of UCTD syndrome - 65 (30.0%) children; control group - 43 (24.8%) patients without pathological scars. Histological examination of scar tissue and intact skin was carried out during primary or redo reconstructive surgery. Immunohistochemical study of antibodies against CD34, CD105, CD140b, PDGFs, COL types I, III and IV was performed. RESULTS The study showed a quantitative characteristic of expression of COL type I in hypertrophic scar with predominance in the main group (77.5±5.4%; p<0.05), and decrease in COL type IV. Keloid form was associated with predominance of granulation tissue in all layers of dermis and high levels of all types of collagen. In the group of UCTD, COL type III prevailed in all pathological forms of the scar. We determined quantitative indicators of expression of vascularization factors (CD34; CD105) and fibroblastic activity (CD140b; PDGFs). CONCLUSION Understanding the process of fibrinogenesis and analysis of stages of triggering mechanisms are essential for development of preventive algorithms. Individualized approach should be considered in the treatment. These studies are especially important in children with UCTD syndrome as high-risk group for pathological scarring. Thus, further research is required.
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Affiliation(s)
- S V Minaev
- Stavropol State Medical University, Stavropol, Russia
| | - A N Grigorova
- Stavropol State Medical University, Stavropol, Russia
| | | | - S I Timofeev
- Magadan Regional Children's Hospital, Magadan, Russia
| | - A G Sirak
- Stavropol State Medical University, Stavropol, Russia
| | - V I Vladimirov
- Pyatigorsk Interdistrict Oncology Dispensary, Pyatigorsk, Russia
| | - A A Pogosyan
- Stavropol State Medical University, Stavropol, Russia
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Zhang J, Xia Z, Zhou S, Luo W, Peng Z, Yang R. Effect of Artesunate Combined With Fractional CO 2 Laser on the Hypertrophic Scar in a Rabbit Model. Lasers Surg Med 2021. [PMID: 33644924 DOI: 10.1002/lsm.23384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/08/2020] [Accepted: 01/10/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Hypertrophic scar (HS), a common complication in wound healing, is characterized by the disarrangement of collagen, fibers, and extracellular matrix. Artesunate (ART) can inhibit the abnormal formation of fibroblasts and collagens. Fractional CO2 laser (FCO2 L) can facilitate tissue remodeling and the absorption of drugs into ablative microthermal columns in HS. So far, no research has investigated the efficacy of ART combined with an FCO2 L in treating HS. To investigate the theoretical basis and clinical significance of this combination, we established a rabbit model of HS to observe the change in the expression of transforming growth factor β1 (TGF-β1) and proliferating cell nuclear antigen (PCNA). STUDY DESIGN/MATERIALS AND METHODS Forty New Zealand white rabbits were randomly divided into four groups: control group, ART group, FCO2 L group, and ART + FCO2 L (combination) group. Four wounds were surgically established in the ear of each rabbit and allowed to develop into HS. ART (20 μL/cm2 ) was injected in ART and combination groups, and FCO2 L (combo mode, deep energy:10m J, super energy: 50 mJ) in FCO2 L and combination groups on the 28th day after HS occurred. Three rounds of treatment were applied (once every 14 days). HS samples were measured by hematoxylin and eosin staining, Van Gieson staining, immunohistochemistry, and Western blot analysis on the 70th day. RESULTS The morphological and histopathological changes in HS were significant. HSs were smoother and smaller and the collagen fibers were thinner and less disordered in the combination group than those in ART and FCO2 L groups. Meanwhile, the hypertrophic index (HI), fiber density (NA), and collagen fiber content (AA) were lower in the combination group (1.54 ± 0.15, 3.30 ± 0.22, 30.37 ± 1.41%) than in the ART group (2.51 ± 0.22, 4.69 ± 0.16, 44.68 ± 2.30%) and FCO2 L group (1.99 ± 0.14, 4.13 ± 0.12, 37.74 ± 1.38%) (P < 0.01). Additionally, the expressions of TGF-β1 and PCNA protein were suppressed in the ART group (0.30 ± 0.03, 0.25 ± 0.03) and FCO2 L group (0.35 ± 0.03, 0.32 ± 0.05), and the suppression was more significant in the combination group(0.07 ± 0.02, 0.07 ± 0.02) (P < 0.01). CONCLUSIONS The combination of ART and FCO2 L can effectively reduce HS in the rabbit model. This is the first report about this combination in the treatment of HS. A novel treatment is expected to be based on our findings. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Jinxia Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510282, China
- The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Zhikuan Xia
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510282, China
- The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Shuanglin Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510282, China
- The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Wanting Luo
- The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Zhuoying Peng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510282, China
| | - Rongya Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510282, China
- The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
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10
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Liquid Platelet-Rich Fibrin and Heat-Coagulated Albumin Gel: Bioassays for TGF-β Activity. MATERIALS 2020; 13:ma13163466. [PMID: 32781631 PMCID: PMC7475845 DOI: 10.3390/ma13163466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023]
Abstract
Liquid platelet-rich fibrin (PRF) can be prepared by high centrifugation forces separating the blood into a platelet-poor plasma (PPP) layer and a cell-rich buffy coat layer, termed concentrated PRF (C-PRF). Heating the liquid PPP was recently introduced to prepare an albumin gel (Alb-gel) that is later mixed back with the concentrated liquid C-PRF to generate Alb-PRF. PRF is a rich source of TGF-β activity; however, the overall TGF-β activity in the PPP and the impact of heating the upper plasma layer remains unknown. Here, we investigated for the first time the in vitro TGF-β activity of all fractions of Alb-PRF. We report that exposure of oral fibroblasts with lysates of PPP and the buffy coat layer, but not with heated PPP, provoked a robust increase in the TGF-β target genes interleukin 11 and NADPH oxidase 4 by RT-PCR, and for IL11 by immunoassay. Consistent with the activation of TGF-β signaling, expression changes were blocked in the presence of the TGF-β receptor type I kinase inhibitor SB431542. Immunofluorescence and Western blot further confirmed that lysates of PPP and the buffy coat layer, but not heated PPP, induced the nuclear translocation of Smad2/3 and increased phosphorylation of Smad3. The immunoassay further revealed that PPP and particularly BC are rich in active TGF-β compared to heated PPP. These results strengthen the evidence that not only the cell-rich C-PRF but also PPP comprise a TGF-β activity that is, however, heat sensitive. It thus seems relevant to mix the heated PPP with the buffy coat C-PRF layer to regain TGF-β activity, as proposed during the preparation of Alb-PRF.
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11
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Betarbet U, Blalock TW. Keloids: A Review of Etiology, Prevention, and Treatment. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:33-43. [PMID: 32308783 PMCID: PMC7158916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Keloids are abnormal scars that cause significant emotional and physical distress in patients when inadequately treated. Keloid formation is theorized to occur as a result of an imbalance between an increased synthesis of collagen and extracellular matrix and decreased degradation of these products. Inflammatory mediators- namely, transforming growth factor beta-have been proposed to influence the dysregulation of collagen remodeling in the scar healing process. Though limited, current knowledge of keloid pathophysiology has guided clinicians to explore novel therapies for keloid prevention and treatment. In addition to conducting research refining the use of common therapies, such as steroids and radiation, clinicians have evaluated the potential of anti-inflammatory and chemotherapeutic molecules to suppress keloid recurrence. Procedural focused therapies, such as cryotherapy and lasers, have also found a role in reducing keloid symptomatology. The purpose of this report is to examine the current literature and review the mechanisms of action, efficacy, and side effects of different keloid therapies. Despite the growing literature investigating reliable methods for keloid management, there are no standardized guidelines or treatment protocols supported by academic governing bodies. Stronger evidence with high-fidelity randomized clinical trials will be needed to determine the optimal therapy regimens for keloids.
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Affiliation(s)
- Udayan Betarbet
- Dr. Betarbet is with the Emory University School of Medicine in Atlanta, Georgia and the Division of Plastic Surgery at The University of Texas Medical Branch in Galveston, Texas
- Dr. Blalock is with the Department of Dermatology at Emory University School of Medicine in Atlanta, Georgia
| | - Travis W Blalock
- Dr. Betarbet is with the Emory University School of Medicine in Atlanta, Georgia and the Division of Plastic Surgery at The University of Texas Medical Branch in Galveston, Texas
- Dr. Blalock is with the Department of Dermatology at Emory University School of Medicine in Atlanta, Georgia
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12
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Tian J, Cheng L, Cui X, Lei X, Tang J, Cheng B. Investigating the effect of age on platelet ultrastructure using transmission electron microscopy. Int Wound J 2019; 16:1457-1463. [PMID: 31486290 PMCID: PMC7949169 DOI: 10.1111/iwj.13214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022] Open
Abstract
In the present study, the age- and sex-related differences in platelet ultrastructure were investigated using transmission electron microscopy (TEM). A total of 15 healthy volunteers were grouped according to age, with 5 people in each of the following groups: young group (25-45 years), middle-aged group (46-65 years), and old-aged group (> 65 years). In the TEM micrographs, the internal components, specifically the α-granules, dense granules, and lysosomal granules, of 20 platelets were counted for each group. Two-way analysis of variance of age and sex variance was used to compare the results. The ultrastructure of the platelets in the old-aged group was observed to be quite different from those of the young and middle-aged groups. Specifically, with ageing, the platelet membrane becomes more irregular in shape and non-smooth, and multiple platelet membrane ruptures are observed. Furthermore, the pseudopodia and protuberances become more numerous and slender, and the number of α-granules is significantly reduced. These morphological changes indicate that ageing may affect the function of platelets, which in turn affects the efficacy of platelet concentrates. Thus, the effects of age should be considered when using platelet concentrates prepared from elderly autologous blood.
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Affiliation(s)
- Ju Tian
- Department of Plastic SurgeryZhongshan City People's HospitalZhongshanGuangdongChina
- Department of Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouGuangdongChina
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLAGuangzhouGuangdongChina
| | - Liu‐Hang‐Hang Cheng
- Key Laboratory of Tissue Repair and Regeneration of PLA, and Beijing Key Research Laboratory of Skin Injury, Repair and RegenerationThe Fourth Medical Center of General Hospital of PLABeijingChina
- Institute of Basic Medical SciencesGeneral Hospital of PLABeijingChina
| | - Xiao Cui
- Department of Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouGuangdongChina
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLAGuangzhouGuangdongChina
- Guangdong Provincial Hospital of Chinese MedicineGuangzhouGuangdongChina
| | - Xiao‐Xuan Lei
- Department of Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouGuangdongChina
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLAGuangzhouGuangdongChina
| | - Jian‐Bing Tang
- Department of Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouGuangdongChina
| | - Biao Cheng
- Department of Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouGuangdongChina
- The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLAGuangzhouGuangdongChina
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García C, Pino A, Jimenez N, Truchuelo M, Jaén P, Anitua E. In vitro characterization and clinical use of platelet-rich plasma-derived Endoret-Gel as an autologous treatment for atrophic scars. J Cosmet Dermatol 2019; 19:1607-1613. [PMID: 31709744 DOI: 10.1111/jocd.13212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/10/2019] [Accepted: 10/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Normal healing process becomes severely dysregulated in pathophysiological conditions such as inflammation, infection or underlaying diseases. These scenarios hamper the standard healing pattern and dermal fibrotic tissue develops. OBJECTIVE In the present study a novel three-dimensional formulation (Endoret-Gel) based on plasma rich in growth factors technology (Endoret-PRGF) has been assessed for atrophic scar management. MATERIALS AND METHODS Microstructure analysis, growth factor content, and projection capacity of both formulations (Endoret-Gel and Endoret-PRGF) was assessed. Additionally, a clinical evaluation of Endoret-Gel treatment was also performed in a case of an extense atrophic scar. RESULTS Endoret-Gel presented high molecular weight plasmatic proteins that formed solid thermal aggregates enclosed by a stable fibrin network. This formulation has a higher cutaneous projection capacity compared with Endoret-PRGF. Both formulations presented a high load of bioactive proteins such as EGF, PDGF-AB, and IGF-I being higher in liquid Endoret-PRGF. Clinical results evidenced that infiltrations of Endoret-Gel derived in an early volumetric disposal that was maintained for several months. The treatment provided and immediate soft tissue augmentation and scar amelioration effect that was translated into a noticeable clinical improvement of the injury. No side effects or adverse events were reported during ten-month follow-up period. CONCLUSION These preliminary findings suggest that Endoret-Gel may act not only as a temporary volumizer but also as soft tissue stimulator that might be used as a monotherapy for scar management.
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Affiliation(s)
| | - Ander Pino
- BTI Biotechnology Institute, Vitoria, Spain
| | - Natalia Jimenez
- Grupo de Dermatología Pedro Jaén, Madrid, Spain.,University Hospital Ramon y Cajal, Madrid, Spain
| | - MªTeresa Truchuelo
- Grupo de Dermatología Pedro Jaén, Madrid, Spain.,Vithas Hospital Nuestra Señora de América, Madrid, Spain
| | - Pedro Jaén
- Grupo de Dermatología Pedro Jaén, Madrid, Spain.,University Hospital Ramon y Cajal, Madrid, Spain
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14
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In vitro evidence supporting applications of platelet derivatives in regenerative medicine. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 18:117-129. [PMID: 31657710 DOI: 10.2450/2019.0164-19] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/05/2019] [Indexed: 11/21/2022]
Abstract
The role of platelets in haemostasis has long been known, but understanding of these cells' involvement in wound healing/tissue repair is more recent and has given rise to a multitude of translational studies. Tissue repair processes consist of complex, regulated interactions between cells modulated by biologically active molecules, most of which are growth factors released by activated platelets: this aspect represents the rationale on which the use of platelet derivatives for clinical purposes is based. In the last years, many in vitro studies have focused on the mechanisms of action by which these growth factors affect the biological activities of cells, thus supporting tissue healing. Although limited by some drawbacks (two-dimensional in vitro monocultures cannot replicate the tissue architecture and organisation of organs or the continuous interplay between different cell types), in vitro studies do have the advantages of giving rapid results and allowing precise control of platelet concentrations and other parameters.This review offers an updated overview of the data obtained from the most recent bench-top studies focused on the effects of platelet derivatives on a wide variety of human cells, highlighting their possible impact for in vivo applications. The heterogeneity of the data obtained so far is very evident. This can be explained by the different experimental settings used in each study, which may be the cause of the variability in clinical outcomes. In fact, in vitro studies suggest that the composition of platelet derivatives and the method used for their production and activation (or not) and the platelet concentration used can have profound effects on the final results.
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Park GS, An MK, Yoon JH, Park SS, Koh SH, Mauro TM, Cho EB, Park EJ, Kim KH, Kim KJ. Botulinum toxin type A suppresses pro-fibrotic effects via the JNK signaling pathway in hypertrophic scar fibroblasts. Arch Dermatol Res 2019; 311:807-814. [PMID: 31501922 DOI: 10.1007/s00403-019-01975-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/01/2019] [Accepted: 08/30/2019] [Indexed: 01/23/2023]
Abstract
Hypertrophic scar is a dermal fibroproliferative disease characterized by the overproduction and deposition of extracellular matrix, and the hyperproliferation and enhanced angiogenesis of fibroblasts, along with their enhanced differentiation to myofibroblasts. Botulinum toxin type A shows potential for prevention of hypertrophic scar formation; however, its effectiveness in attenuating skin fibrosis and the related mechanism are unclear. In this study, human scar fibroblasts were cultured and stimulated with botulinum toxin type A, and the changes in fibroblast proliferation, migration, and protein expression of pro-fibrotic factors were evaluated with colorimetric, scratch, and enzyme-linked immunosorbent assays and western blotting, respectively. Botulinum toxin type A treatment decreased the proliferation and migration of human scar fibroblasts compared with those of untreated controls. Protein expression levels of pro-fibrotic factors (transforming growth factor β1, interleukin-6, and connective tissue growth factor) were also inhibited by botulinum toxin type A, whereas the JNK phosphorylation level was increased. Activation of the JNK pathway demonstrated the inhibitory effects of the toxin on human scar fibroblast proliferation and production of pro-fibrotic factors, suggesting that the suppressive effects of botulinum toxin type A are closely associated with JNK phosphorylation. Overall, this study showed that botulinum toxin type A has a suppressive effect on extracellular matrix production and scar-related factors in human scar fibroblasts in vitro, and that regulation of JNK signaling plays an important role in this process. Our results provide a theoretical basis, at the cellular level, for the therapeutic use of botulinum toxin type A.
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Affiliation(s)
- Gil Soon Park
- Department of Dermatology, Hallym Institute for Translational Medicine, Anyang, South Korea
| | - Min Kyun An
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Ji Ha Yoon
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Seok Soon Park
- Department of Convergence Medicine, Asan Medical Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Hoon Koh
- Department of Plastic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, South Korea
| | - Theodora M Mauro
- Department of Dermatology, VA Medical Center, University of California, San Francisco, CA, USA
| | - Eun Byul Cho
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea.
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea
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16
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Nam SM, Kim YB. The effects of platelet-rich plasma on hypertrophic scars fibroblasts. Int Wound J 2018; 15:547-554. [PMID: 29781178 DOI: 10.1111/iwj.12896] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 01/25/2023] Open
Abstract
We hypothesised that a feedback mechanism of the transforming growth factor (TGF)-β1 signalling pathway, triggered by high-level TGF-β1, activates platelet-rich plasma (PRP) release to reduce connective tissue growth factor (CTGF) production and expression of CTGF mRNA in hypertrophic scar dermal fibroblasts. Primary dermal fibroblasts were isolated from cultures of hypertrophic scars. Cells were cultured after addition of serum-free Dulbecco's modified Eagle's medium supplemented with 5% (wt/vol) PRP or platelet-poor plasma (PPP). At 1, 4, 6, 8, 11, and 13 days after addition of PRP or PPP, the TGF-β1 and CTGF levels in supernatants were determined using solid-phase enzyme-linked immunosorbent assays. Quantitative reverse transcription polymerase chain reactions were performed to quantify TGF-β1 and CTGF mRNA expression levels. TGF-β1 mRNA expression in the PRP groups was lower than in the PPP groups from 4 to 13 days of culture, and there was statistically significant difference (P < .01). CTGF level and mRNA expression in the PRP groups was lower than in the PPP groups, and there were statistically significant differences (P < .01). Although further experiments will focus on clarifying the second messenger of the TGF-β1 negative feedback mechanism, the in vitro data presented show that PRP can potentially reduce CTGF and CTGF gene transcription by triggering the TGF-β1 signalling negative feedback mechanism.
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Affiliation(s)
- Seung Min Nam
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon, Republic of Korea
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