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Wojtkiewicz M, Stachura A, Roszkowski B, Winiarska N, Kazimierska K, Stachura K. Are We Overlooking Harms of BDDE-Cross-Linked Dermal Fillers? A Scoping Review. Aesthetic Plast Surg 2024:10.1007/s00266-024-04262-0. [PMID: 39107664 DOI: 10.1007/s00266-024-04262-0] [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: 05/04/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024]
Abstract
1,4-Butanediol ether (BDDE) is widely used as a cross-linker for hyaluronic acid in dermal fillers. The purpose of this scoping review was to determine the state of knowledge about the behaviour of cross-linked substances and safety of BDDE application. The rationale behind the review came from the clinical experience of one of the authors (KS), who noticed adverse reactions after BDDE-linked hyaluronan application. The scoping review was conducted according to PRISMA-ScR guidelines. Out of 399 articles, 52 met the inclusion criteria. Data on study design, sample/population, aims, methodology, outcomes and funding were extracted. Results were charted according to 6 subtopics: rheological properties, hydrogel stability, BDDE toxicity, immunogenicity, tissue interactions and clinical studies. In vitro, cross-linked hydrogels were characterized as effective fillers in terms of viscosity and elasticity; however, previously uncharacterized by-products of the cross-linking reaction were found. Most in vivo studies reported increased dermis regeneration, vascularization and anti-inflammatory cytokine release after implantation of BDDE-cross-linked substances. In clinical studies, BDDE was shown to sensitize subjects to 1,6-hexanediol ether and other substances found in epoxy resin systems. Occupational dermatitis and hypersensitivity reactions were documented. Our review shows that BDDE may have long-term adverse effects, which are overlooked in the safety assessment of fillers. Reviews on BDDE conducted so far have mostly been sponsored by the industry, potentially leading to incomplete reporting of adverse effects. A review of the occurrence of allergic reactions after commercial dermal filler use and analysis of possibly harmful by-products of BDDE hyaluronan degradation are needed.Level of Evidence III 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)
- Marta Wojtkiewicz
- Department of Methodology, Medical University of Warsaw, 1B Banacha Street, 02-091, Warsaw, Poland
| | - Albert Stachura
- Department of Methodology, Medical University of Warsaw, 1B Banacha Street, 02-091, Warsaw, Poland.
| | - Bartłomiej Roszkowski
- Department of Methodology, Medical University of Warsaw, 1B Banacha Street, 02-091, Warsaw, Poland
| | - Natalia Winiarska
- Department of Methodology, Medical University of Warsaw, 1B Banacha Street, 02-091, Warsaw, Poland
| | - Karolina Kazimierska
- Department of Methodology, Medical University of Warsaw, 1B Banacha Street, 02-091, Warsaw, Poland
- National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Street, 02-507, Warsaw, Poland
| | - Kamilla Stachura
- Dr Stachura Clinic, Jagiellońska 87 Street, 70-437, Szczecin, Poland
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Hyon W, Hyon SH, Matsumura K. Evaluation of the optimal dose for maximizing the anti-adhesion performance of a self-degradable dextran-based material. CARBOHYDRATE POLYMER TECHNOLOGIES AND APPLICATIONS 2022. [DOI: 10.1016/j.carpta.2022.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Wang K, Li XL, Liu J, Sun X, Yang H, Gao X. Using cross-linked hyaluronic acid gel to prevent postoperative lumbar epidural space adhesion: in vitro and in vivo studies. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:129-140. [PMID: 31630264 DOI: 10.1007/s00586-019-06193-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Hyaluronic acid prevents tissue adhesion after different surgeries. Physical barriers and inflammatory regulation have been suggested to be involved in the mechanism of these clinical effects. However, the molecular mechanism by which hyaluronic acid prevents epidural adhesion has not yet been reported. METHODS In the current in vivo studies, we investigated cross-linked hyaluronic acid gel in the regulation of scar gene expression, the accumulation of fibroblasts in scar tissue, and the prevention of epidural adhesion. The effect of cross-linked hyaluronic acid gel on the secretion of inflammatory factors was observed in vitro. In addition, to ensure the accuracy and reliability of the in vivo gene expression results, we used a cell model to detect the target genes in vitro. RESULTS The expression levels of TGFβ1 and COL1A1 mRNA were decreased in the cross-linked hyaluronic acid gel-treated group, and the protein expression of levels TGFβ1 and COL1A1 were also reduced, as detected by Western blotting in vitro and in vivo (P < 0.05). Histomorphometry results demonstrated that the number of fibroblasts in the experimental group was significantly lower than that in the control group 2 weeks postoperatively. Micro-CT scans showed that the cross-linked hyaluronic acid gel could reduce adhesion in the epidural space after laminectomy. Additionally, the cross-linked hyaluronic acid gel could inhibit IL-6 secretion. CONCLUSIONS These results indicate that cross-linked hyaluronic acid gel can prevent epidural adhesion by inhibiting inflammatory factors, such as IL-6, and downregulating TGFβ1 and COL1A1 mRNA expression. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kun Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.,Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Xiao Long Li
- Department of Orthopedics, The People's Hospital of Wujin Affiliated with Jiangsu University, Changzhou, 213017, China
| | - Jinbo Liu
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Xiaoliang Sun
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Xin Gao
- Department of Orthopedics, The People's Hospital of Wujin Affiliated with Jiangsu University, Changzhou, 213017, China.
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Murakami T, Hijikuro I, Yamashita K, Tsunoda S, Hirai K, Suzuki T, Sakai Y, Tabata Y. Antiadhesion effect of the C17 glycerin ester of isoprenoid-type lipid forming a nonlamellar liquid crystal. Acta Biomater 2019; 84:257-267. [PMID: 30529080 DOI: 10.1016/j.actbio.2018.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 12/17/2022]
Abstract
Postoperative adhesion is a relevant clinical problem that causes a variety of clinical complications after abdominal surgery. The objective of this study is to develop a liquid-type antiadhesion agent and evaluate its efficacy in preventing tissue adhesion in a rat peritoneal adhesion model. The liquid-type agent was prepared by submicron-sized emulsification of C17 glycerin ester (C17GE), squalene, pluronic F127, ethanol, and water with a high-pressure homogenizer. The primary component was C17GE, which is an amphiphilic lipid of one isoprenoid-type hydrophobic chain and can form two phases of self-assembly nonlamellar liquid crystals. The C17GE agent consisted of nanoparticles with an internal inverted hexagonal phase when evaluated by small-angle X-ray scattering (SAXS) and cryo-transmission electron microscopy (cryo-TEM). Upon contact with the biological tissue, this agent formed a thin membrane with a bioadhesive property. After this agent was applied to a sidewall injury of rats, it showed a percentage average of adhesion significantly less than that obtained with the Seprafilm® antiadhesion membrane in a rat model. Additionally, the retention of the agent prolonged at the applied site in the peritoneal cavity of rats. In conclusion, the C17GE agent is promising as an antiadhesion material. STATEMENT OF SIGNIFICANCE: Postoperative adhesion remains a common adverse effect. Although various materials have been investigated, there are few products commercially available to prevent adhesion. For the sheet-type agent, it is inconvenient to be applied through small laparotomy, especially in laparoscopic surgery. Additionally, the liquid-type agent currently used requires a complicated procedure to spray at the targeted site. Our liquid-type antiadhesion agent can form liquid crystals and act as a thin membrane-like physical barrier between the peritoneum and tissues to prevent adhesion. Indeed, the antiadhesion agent used in our present study significantly prevents adhesion compared with the antiadhesion membrane most used clinically. Moreover, our agent is highly stable by itself and easy to use in laparoscopic surgery, thus leading to a promising new candidate as an antiadhesion material.
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Affiliation(s)
- Takahide Murakami
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Ichiro Hijikuro
- Farnex Incorporated, Tokyo Institute of Technology Yokohama Venture Plaza, 4259 - 3, Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, Japan
| | - Kota Yamashita
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenjiro Hirai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Suzuki
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiko Tabata
- Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.
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Wu W, Cheng R, das Neves J, Tang J, Xiao J, Ni Q, Liu X, Pan G, Li D, Cui W, Sarmento B. Advances in biomaterials for preventing tissue adhesion. J Control Release 2017; 261:318-336. [DOI: 10.1016/j.jconrel.2017.06.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
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Kim SJ, Shin JM, Lee EJ, Park IH, Lee HM, Kim KS. Efficacy of hyaluronic acid and hydroxyethyl starch in preventing adhesion following endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2017; 274:3643-3649. [PMID: 28707086 DOI: 10.1007/s00405-017-4669-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
Abstract
Adhesion is a major complication of endoscopic sinus surgery that may lead to recurrence of chronic rhinosinusitis, necessitating revision surgery. The purpose of this study was to evaluate the effect of hyaluronic acid and hydroxyethyl starch (HA-HES) relative to hyaluronic acid and carboxymethylcellulose (HA-CMC) with regard to anti-adhesion effect. In this multi-center, prospective, single-blind, randomized controlled study, 77 consecutive patients who underwent bilateral endoscopic sinus surgery were enrolled between March 2014 and March 2015. HA-HES and HA-CMC were applied to randomly assigned ethmoidectomized cavities after the removal of middle meatal packing. At the 1st, 2nd and 4th weeks after surgery, the presence and grades of adhesion, edema, and infection were, respectively, examined via endoscopy by a blinded assessor. The incidence and grades of adhesion at the 2-week follow-up were significantly less in the HA-CMC group than in the HA-HES group (p < 0.05). However, with the exception of week 2, there were no significant differences in the incidence or grades of adhesion, edema, and infection between the two groups. When the primary endpoint-the presence of adhesion at the 4-week follow-up-was compared between two groups, the incidence of adhesion in HA-HES group at the 4-week follow-up was 32% and in HA-CMC was 41.3%, indicating that HA-HES was not inferior to HA-CMC in terms of anti-adhesive effect. No severe adverse reactions were noted during the study period. In conclusion, HA-HES is a safe substitutional anti-adhesion agent that has equivalent effect as HA-CMC after endoscopic sinus surgery.
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Affiliation(s)
- Su-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, South Korea
| | - Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, South Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, South Korea
| | - Heung-Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul, 152-703, South Korea. .,Division of Brain Korea 21 Program for Biomedical Science, Korea University College of Medicine, Seoul, South Korea. .,In vitro Diagnostic Medical Devices Support Center, Korea University Guro Hospital, Seoul, South Korea.
| | - Kyung-Su Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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Sheu C, Shalumon KT, Chen CH, Kuo CY, Fong YT, Chen JP. Dual crosslinked hyaluronic acid nanofibrous membranes for prolonged prevention of post-surgical peritoneal adhesion. J Mater Chem B 2016; 4:6680-6693. [DOI: 10.1039/c6tb01376g] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A HA NFM crosslinked with FeCl3and BDDE shows prolonged degradation to prevent peritoneal adhesion.
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Affiliation(s)
- Chialin Sheu
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - K. T. Shalumon
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
- Chang Gung Memorial Hospital
- Taoyuan 33305
- Republic of China
| | - Chang-Yi Kuo
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Yi Teng Fong
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
- Chang Gung Memorial Hospital
- Taoyuan 33305
- Republic of China
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
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Glade MJ, Meguid MM. A glance at … dietary emulsifiers, the human intestinal mucus and microbiome, and dietary fiber. Nutrition 2015; 32:609-14. [PMID: 26899163 DOI: 10.1016/j.nut.2015.12.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Affiliation(s)
| | - Michael M Meguid
- Professor Emeritus, Surgery, Neuroscience and Nutrition, Department of Surgery, University Hospital, Upstate Medical University, Syracuse, NY, USA
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