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Leaker BD, Sojoodi M, Tanabe KK, Popov YV, Tam J, Anderson RR. Increased susceptibility to ischemia causes exacerbated response to microinjuries in the cirrhotic liver. FASEB J 2024; 38:e23585. [PMID: 38661043 DOI: 10.1096/fj.202301438rr] [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: 07/14/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
Fractional laser ablation is a technique developed in dermatology to induce remodeling of skin scars by creating a dense pattern of microinjuries. Despite remarkable clinical results, this technique has yet to be tested for scars in other tissues. As a first step toward determining the suitability of this technique, we aimed to (1) characterize the response to microinjuries in the healthy and cirrhotic liver, and (2) determine the underlying cause for any differences in response. Healthy and cirrhotic rats were treated with a fractional laser then euthanized from 0 h up to 14 days after treatment. Differential expression was assessed using RNAseq with a difference-in-differences model. Spatial maps of tissue oxygenation were acquired with hyperspectral imaging and disruptions in blood supply were assessed with tomato lectin perfusion. Healthy rats showed little damage beyond the initial microinjury and healed completely by 7 days without scarring. In cirrhotic rats, hepatocytes surrounding microinjury sites died 4-6 h after ablation, resulting in enlarged and heterogeneous zones of cell death. Hepatocytes near blood vessels were spared, particularly near the highly vascularized septa. Gene sets related to ischemia and angiogenesis were enriched at 4 h. Laser-treated regions had reduced oxygen saturation and broadly disrupted perfusion of nodule microvasculature, which matched the zones of cell death. Our results demonstrate that the cirrhotic liver has an exacerbated response to microinjuries and increased susceptibility to ischemia from microvascular damage, likely related to the vascular derangements that occur during cirrhosis development. Modifications to the fractional laser tool, such as using a femtosecond laser or reducing the spot size, may be able to prevent large disruptions of perfusion and enable further development of a laser-induced microinjury treatment for cirrhosis.
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Affiliation(s)
- Ben D Leaker
- Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mozhdeh Sojoodi
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth K Tanabe
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Yury V Popov
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - R Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
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Tsai J, Gori S, Alt J, Tiwari S, Iyer J, Talwar R, Hinsu D, Ahirwar K, Mohanty S, Khunt C, Sutariya B, Jani K, Venkatasubbaiah V, Patel A, Meghapara J, Joshi K, Sahu R, Rana V, Nigade P, Talluri RS, Murty KVSN, Joshi K, Ramanathan V, Li A, Islam N, Snajdr I, Majer P, Rais R, Slusher BS, Garza LA. Topical SCD-153, a 4-methyl itaconate prodrug, for the treatment of alopecia areata. PNAS NEXUS 2023; 2:pgac297. [PMID: 36712931 PMCID: PMC9832969 DOI: 10.1093/pnasnexus/pgac297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/15/2022] [Indexed: 06/18/2023]
Abstract
Alopecia areata is a chronic hair loss disorder that involves autoimmune disruption of hair follicles by CD8+ T cells. Most patients present with patchy hair loss on the scalp that improves spontaneously or with topical and intralesional steroids, topical minoxidil, or topical immunotherapy. However, recurrence of hair loss is common, and patients with extensive disease may require treatment with oral corticosteroids or oral Janus kinase (JAK) inhibitors, both of which may cause systemic toxicities with long-term use. Itaconate is an endogenous molecule synthesized in macrophages that exerts anti-inflammatory effects. To investigate the use of itaconate derivatives for treating alopecia areata, we designed a prodrug of 4-methyl itaconate (4-MI), termed SCD-153, with increased lipophilicity compared to 4-MI (CLogP 1.159 vs. 0.1442) to enhance skin and cell penetration. Topical SCD-153 formed 4-MI upon penetrating the stratum corneum in C57BL/6 mice and showed low systemic absorption. When added to human epidermal keratinocytes stimulated with polyinosinic-polycytidylic acid (poly I:C) or interferon (IFN)γ, SCD-153 significantly attenuated poly I:C-induced interleukin (IL)-6, Toll-like receptor 3, IL-1β, and IFNβ expression, as well as IFNγ-induced IL-6 expression. Topical application of SCD-153 to C57BL/6 mice in the resting (telogen) phase of the hair cycle induced significant hair growth that was statistically superior to vehicle (dimethyl sulfoxide), the less cell-permeable itaconate analogues 4-MI and dimethyl itaconate, and the JAK inhibitor tofacitinib. Our results suggest that SCD-153 is a promising topical candidate for treating alopecia areata.
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Affiliation(s)
- Jerry Tsai
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sadakatali Gori
- Johns Hopkins Drug Discovery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jesse Alt
- Johns Hopkins Drug Discovery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sandhya Tiwari
- In Vitro Biology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Jitesh Iyer
- In Vitro Biology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Rashmi Talwar
- In Vitro Biology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Denish Hinsu
- Preclinical Pharmacology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Kailash Ahirwar
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research Ahmedabad, Gandhinagar 382355, India
| | - Swayam Mohanty
- Preclinical Pharmacology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Chintan Khunt
- Preclinical Pharmacology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Brijesh Sutariya
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, IA 52242, USA
| | - Kaushal Jani
- Preclinical Pharmacology, Sun Pharma Advanced Research Company, Savli, 391770, India
| | | | - Ashok Patel
- Drug Metabolism and Pharmacokinetics, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Jasmin Meghapara
- Drug Metabolism and Pharmacokinetics, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Kaushal Joshi
- Drug Metabolism and Pharmacokinetics, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Rajanikanta Sahu
- Drug Metabolism and Pharmacokinetics, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Vijay Rana
- Drug Metabolism and Pharmacokinetics, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Prashant Nigade
- Drug Metabolism and Pharmacokinetics, Sun Pharma Advanced Research Company, Savli, 391770, India
| | - Ravi S Talluri
- Clinical Pharmacology, Sun Pharma Advanced Research Company, Mahakali, Mumbai 400093, India
| | | | - Kiritkumar Joshi
- Medicinal Chemistry, Sun Pharma Advanced Research Company, Savli 391770, India
| | - Vikram Ramanathan
- Translational Development, Sun Pharma Advanced Research Company, Savli 391770, India
| | - Ang Li
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nasif Islam
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ivan Snajdr
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic v.v.i., Prague 166 10, Czech Republic
| | - Pavel Majer
- Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic v.v.i., Prague 166 10, Czech Republic
| | - Rana Rais
- To whom correspondence should be addressed:
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Leaker BD, Fuchs C, Tam J. When Wounds Are Good for You: The Regenerative Capacity of Fractional Resurfacing and Potential Utility in Chronic Wound Prevention. Adv Wound Care (New Rochelle) 2019; 8:679-691. [PMID: 31750016 DOI: 10.1089/wound.2019.0945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/03/2019] [Indexed: 12/24/2022] Open
Abstract
Significance: Fractional resurfacing involves producing arrays of microinjuries on the skin, by thermal or mechanical means, to trigger tissue regeneration. Originally developed for cosmetic enhancement, fractional resurfacing induces a broad array of improvements in the structural and functional qualities of the treated skin and is especially effective at returning defective skin to a more normal state. In addition to fascinating questions about the nature of this remarkable regenerative capacity, there may be potential utility in ulcer prevention by halting or even reversing the progressive decline in overall skin quality that usually precedes chronic wound development. Recent Advances: Photoaging and scarring are the two skin defects most commonly treated by fractional resurfacing, and the treatment produces profound and long-lasting improvements in skin quality, both clinically and at the cellular/histologic level. Chronic wounds usually occur in skin that is compromised by various pathologic factors, and many of the defects found in this ulcer-prone skin are similar to those that have seen improvements after fractional resurfacing. Critical Issues: The mechanisms responsible for the regenerative capacity of fractional resurfacing are mostly unknown, as is how ulcer-prone skin, which is usually afflicted by stressors external to the skin tissue itself, would respond to fractional resurfacing. Future Directions: Better understanding of the cellular and molecular mechanisms underlying the unique healing response to fractional resurfacing could reveal fundamental information about adult tissue regeneration, lead to improvements in current applications, as well as new therapies in other pathologic conditions.
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Affiliation(s)
- Ben D. Leaker
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- The Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christiane Fuchs
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Kauvar AN, Kubicki SL, Suggs AK, Friedman PM. Laser Therapy of Traumatic and Surgical Scars and an Algorithm for Their Treatment. Lasers Surg Med 2019; 52:125-136. [DOI: 10.1002/lsm.23171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Arielle N.B. Kauvar
- Department of DermatologyNew York Laser & Skin Care1044 Fifth Avenue (between 85th and 86th St.) New York New York 10028
- Department of DermatologyNew York University School of Medicine240 E 38th St. New York New York 10016
| | - Shelby L. Kubicki
- Department of Dermatology, University of Texas MD Anderson Cancer CenterUniversity of Texas, McGovern Medical School6655 Travis St. #700 Houston Texas 77030
| | - Amanda K. Suggs
- Department of Dermatology, University of Texas MD Anderson Cancer CenterUniversity of Texas, McGovern Medical School6655 Travis St. #700 Houston Texas 77030
- Department of DermatologyDermatology & Laser Surgery Center6400 Fannin St., Suite 2720 Houston Texas 77030
| | - Paul M. Friedman
- Department of Dermatology, University of Texas MD Anderson Cancer CenterUniversity of Texas, McGovern Medical School6655 Travis St. #700 Houston Texas 77030
- Department of DermatologyDermatology & Laser Surgery Center6400 Fannin St., Suite 2720 Houston Texas 77030
- Department of Dermatology, Weill Cornell Medical CollegeHouston Methodist Hospital6550 Fannin St., Suite 1001 Houston Texas 77030
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Issler‐Fisher AC, Fisher OM, Haertsch P, Li Z, Maitz PK. Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter? Lasers Surg Med 2019; 52:149-158. [DOI: 10.1002/lsm.23166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Andrea C. Issler‐Fisher
- Burns & Reconstructive SurgeryConcord Repatriation General HospitalConcord, Sydney NSW 2139 Australia
- The University of Sydney School of Medicine, Faculty of MedicineUniversity of SydneyFaculty of Medicin Camperdown, Sydney NSW 2050 Australia
- ANZAC Research InstituteConcord Repatriation General HospitalGate, 3 Hospital Road Concord, Sydney NSW 2139 Australia
| | - Oliver M. Fisher
- Department of Surgery, St. George HospitalUniversity of New South WalesGrey Street Kogarah NSW 2217 Australia
- School of MedicineUniversity of Notre DameSydney NSW 2010 Australia
- St. George & Sutherland Clinical SchoolUNSW AustraliaKensington NSW 2217 Australia
| | - Peter Haertsch
- Burns & Reconstructive SurgeryConcord Repatriation General HospitalConcord, Sydney NSW 2139 Australia
- The University of Sydney School of Medicine, Faculty of MedicineUniversity of SydneyFaculty of Medicin Camperdown, Sydney NSW 2050 Australia
| | - Zhe Li
- Burns & Reconstructive SurgeryConcord Repatriation General HospitalConcord, Sydney NSW 2139 Australia
- The University of Sydney School of Medicine, Faculty of MedicineUniversity of SydneyFaculty of Medicin Camperdown, Sydney NSW 2050 Australia
- ANZAC Research InstituteConcord Repatriation General HospitalGate, 3 Hospital Road Concord, Sydney NSW 2139 Australia
| | - Peter K.M. Maitz
- Burns & Reconstructive SurgeryConcord Repatriation General HospitalConcord, Sydney NSW 2139 Australia
- The University of Sydney School of Medicine, Faculty of MedicineUniversity of SydneyFaculty of Medicin Camperdown, Sydney NSW 2050 Australia
- ANZAC Research InstituteConcord Repatriation General HospitalGate, 3 Hospital Road Concord, Sydney NSW 2139 Australia
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Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term evaluation. Lasers Med Sci 2017; 32:2047-2054. [PMID: 28894992 DOI: 10.1007/s10103-017-2322-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the efficacy and safety of fractional carbon dioxide laser for the treatment of acne scars. Thirty-one participants, 15 female and 16 male, whose mean age was 34.84 ± 10.94 years, were included in this prospective study. The study took place between 2012 and 2016. Participants were evaluated with the "ECCA Grading Scale" before the first session, 3 months (short-term evaluation) and 3 years after the last session (long-term evaluation). Participants received two or three treatment sessions at 4-week intervals, with a 10,600 nm fractional carbon dioxide laser with pulse energies ranging between 100 and 160 mJ, 120 spot type, 75-100 spot/cm2 density, and 30 W power. Self-assessments by the participants were done 3 months and 3 years after the last session. The mean ECCA score was 107.90 ± 39.38 before the first session, and 82.17 ± 36.23 at the time of short-term evaluation (p = 0.000). The grade of improvement at the short-term evaluation was as follows: no improvement, mild, moderate, and significant improvement for 7 (22.6%), 11 (35.5%), 9 (29%), and 4 (12.9%) of the participants, respectively. Regarding self-assessments, 80.6 and 61.3% of the participants rated themselves as having at least mild improvement at the short-term and the long-term follow-up periods, respectively. The results of this study suggest that fractional carbon dioxide laser is an efficient treatment option for acne scars. Furthermore, self-assessment results show that more than half of the participants still experience at least mild improvement at the end of 3 years.
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Golberg A, Villiger M, Felix Broelsch G, Quinn KP, Albadawi H, Khan S, Watkins MT, Georgakoudi I, Austen WG, Bei M, Bouma BE, Mihm MC, Yarmush ML. Skin regeneration with all accessory organs following ablation with irreversible electroporation. J Tissue Eng Regen Med 2017; 12:98-113. [PMID: 27976527 DOI: 10.1002/term.2374] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 11/12/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022]
Abstract
Skin scar formation is a complex process that results in the formation of dense extracellular matrix (ECM) without normal skin appendages such as hair and glands. The absence of a scarless healing model in adult mammals prevents the development of successful therapies. We show that irreversible electroporation of skin drives its regeneration with all accessory organs in normal adult rats. Pulsed electric fields at 500 V, with 70 μs pulse duration and 1000 pulses delivered at 3 Hz, applied through two electrodes separated by 2 mm lead to massive cell death. However, the ECM architecture of the skin was preserved. Six months after the ablation, the epidermis, sebaceous glands, panniculus carnosus, hair follicles, microvasculature and arrector pili muscle were altogether re-formed in the entire ablated area. These results suggest a key role of the ECM architecture in the differentiation, migration and signalling of cells during scarless wound healing. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alexander Golberg
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and the Shriners Burns Hospital, Boston, MA, 02114, USA.,Porter School of Environmental Studies, Tel Aviv University, Tel Aviv, Israel
| | - Martin Villiger
- Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Boston, Massachusetts, 02114, USA
| | - G Felix Broelsch
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Kyle P Quinn
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA.,Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, 72701, USA
| | - Hassan Albadawi
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Saiqa Khan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Michael T Watkins
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Irene Georgakoudi
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA
| | - William G Austen
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Marianna Bei
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and the Shriners Burns Hospital, Boston, MA, 02114, USA
| | - Brett E Bouma
- Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Boston, Massachusetts, 02114, USA.,Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, Massachusetts, 02142, USA
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Martin L Yarmush
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and the Shriners Burns Hospital, Boston, MA, 02114, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, 08854, USA
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8
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Issler-Fisher AC, Fisher OM, Smialkowski AO, Li F, van Schalkwyk CP, Haertsch P, Maitz PKM. Ablative fractional CO 2 laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort. Burns 2016; 43:573-582. [PMID: 27707636 DOI: 10.1016/j.burns.2016.09.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The introduction of ablative fractional CO2 lasers (CO2-AFL) for burn scar management shows promising results. Whilst recent studies have focused on objective scar outcomes following CO2-AFL treatment, to date no data on patient subjective factors such as quality of life are available. METHODS A prospective study was initiated to analyze the safety and efficacy of the CO2-AFL. Various objective and subjective outcome parameters were prospectively collected from the date of first consultation and follow-up following treatment. Objective factors include the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and ultrasound measurements of the thickness of the scar. Subjective parameters included the assessment of neuropathic pain and pruritus, as well as the evaluation of improvement of quality of life following CO2-AFL with the Burns Specific Health Scale (BSHS-B). For treatment effect analysis, patients were stratified according to scar maturation status (> or <2 years after injury). RESULTS 47 patients with 118 burn scars completed at least one treatment cycle. At a median of 55 days (IQR 32-74) after CO2-AFL treatment all analyzed objective parameters decreased significantly: intra-patient normalized scar thickness decreased from a median of 2.4mm to 1.9mm (p<0.001) with a concomitant VSS-drop from a median of 7 to 6 (p<0.001). The overall POSAS patient scale decreased from a median of 9 to 5 (p<0.001) with similar effects documented in POSAS observer scales. Both pain and pruritus showed significant reduction. Quality of life increased significantly by 15 points (median 120 to 135; p<0.001). All of the identified changes following CO2-AFL were equally significant irrespective of scar maturation status. CONCLUSION Our preliminary results confirm significant improvement in thickness, texture, colour, and symptoms following treatment with CO2-AFL. Foremost, quality of life of patients with both immature and mature scars (up to 23 years after injury) improved significantly after just one treatment session. To our knowledge, this is the first study to document such holistic treatment effects in burn patients treated by CO2-AFL.
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Affiliation(s)
| | - Oliver M Fisher
- St. Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Frank Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | | | - Peter Haertsch
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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Tam J, Wang Y, Vuong LN, Fisher JM, Farinelli WA, Anderson RR. Reconstitution of full-thickness skin by microcolumn grafting. J Tissue Eng Regen Med 2016; 11:2796-2805. [PMID: 27296503 PMCID: PMC5697650 DOI: 10.1002/term.2174] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 12/23/2022]
Abstract
In addition to providing a physical barrier, skin also serves a diverse range of physiological functions through different specialized resident cell types/structures, including melanocytes (pigmentation and protection against ultraviolet radiation), Langerhans cells (adaptive immunity), fibroblasts (maintaining extracellular matrix, paracrine regulation of keratinocytes), sweat glands (thermoregulation) and hair follicles (hair growth, sensation and a stem cell reservoir). Restoration of these functional elements has been a long-standing challenge in efforts to engineer skin tissue, while autologous skin grafting is limited by the scarcity of donor site skin and morbidity caused by skin harvesting. We demonstrate an alternative approach of harvesting and then implanting μm-scale, full-thickness columns of human skin tissue, which can be removed from a donor site with minimal morbidity and no scarring. Fresh human skin microcolumns were used to reconstitute skin in wounds on immunodeficient mice. The restored skin recapitulated many key features of normal human skin tissue, including epidermal architecture, diverse skin cell populations, adnexal structures and sweat production in response to cholinergic stimulation. These promising preclinical results suggest that harvesting and grafting of microcolumns may be useful for reconstituting fully functional skin in human wounds, without donor site morbidity. © 2016 The Authors Journal of Tissue Engineering and Regenerative Medicine Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
- Department of DermatologyHarvard Medical SchoolBostonMAUSA
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
- Department of DermatologyHarvard Medical SchoolBostonMAUSA
| | - Linh N. Vuong
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
| | - Jeremy M. Fisher
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
| | | | - R. Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
- Department of DermatologyHarvard Medical SchoolBostonMAUSA
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10
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Fractional Skin Harvesting: Autologous Skin Grafting without Donor-site Morbidity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e47. [PMID: 25289241 PMCID: PMC4174164 DOI: 10.1097/gox.0b013e3182a85a36] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/18/2013] [Indexed: 11/26/2022]
Abstract
Background: Conventional autologous skin grafts are associated with significant donor-site morbidity. This study was conducted to determine feasibility, safety, and efficacy of a new strategy for skin grafting based on harvesting small columns of full-thickness skin with minimal donor-site morbidity. Methods: The swine model was used for this study. Hundreds of full-thickness columns of skin tissue (~700 µm diameter) were harvested using a custom-made harvesting device, and then applied directly to excisional skin wounds. Healing in donor and graft sites was evaluated over 3 months by digital photographic measurement of wound size and blinded, computer-aided evaluation of histological features and compared with control wounds that healed by secondary intention or with conventional split-thickness skin grafts (STSG). Results: After harvesting hundreds of skin columns, the donor sites healed rapidly without scarring. These sites reepithelialized within days and were grossly and histologically indistinguishable from normal skin within 7 weeks. By contrast, STSG donor sites required 2 weeks for reepithelialization and retained scar-like characteristics in epidermal and dermal architecture throughout the experiment. Wounds grafted with skin columns resulted in accelerated reepithelialization compared with ungrafted wounds while avoiding the “fish-net” patterning caused by STSG. Conclusion: Full-thickness columns of skin can be harvested in large quantities with negligible long-term donor-site morbidity, and these columns can be applied directly to skin wounds to enhance wound healing.
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Beasley K, Dai JM, Brown P, Lenz B, Hivnor CM. Ablative Fractional Versus Nonablative Fractional Lasers—Where Are We and How Do We Compare Differing Products? CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0043-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Sobanko JF, Imadojemu S, Miller CJ. Epidemiology of Cosmetic Procedures: An Update for Dermatologists. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-011-0006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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