Long-Term Effects of the Collagenase of the Bacterium Clostridium histolyticum for the Treatment of Capsular Fibrosis After Silicone Implants
Long-Term Effects of the Collagenase of the Bacterium Clostridium histolyticum for the Treatment of Capsular Fibrosis After Silicone Implants
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DOI：
10.1007/s00266-016-0724-8
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发表时间：
2017-02-01
影响因子：
2.4
通讯作者：
Pomahac, Bohdan
中科院分区：
文献类型：
--
作者：
Fischer, Sebastian;Diehm, Yannick;Pomahac, Bohdan
包囊挛缩仍然是硅胶假体隆乳术后最常见的长期并发症。因此，纤维化囊的主要部分是胶原蛋白。细菌溶组织梭菌的胶原酶被批准用于治疗纤维化疾病，并已被证明在短期内对包囊纤维化治疗有效。48只大鼠接受微型硅胶植入物，并在植入后120天注射胶原酶（治疗组）或普通溶剂溶液（对照组）。注射后10天和60天，大鼠接受7特斯拉磁共振成像（MRI）和高分辨率超声（HR-US）。收集囊组织，通过组织学评价囊厚度和胶原密度。此外，使用qRT-PCR分析炎性（CD 68、IL 4、IL 10、IL 12、IL 13）、促纤维化和抗纤维化（TGFb 1、TGFb 3、Smad 3、Col 1 -4）基因的表达水平。在注射胶原酶后第10天和第60天，组织学显示，与对照组相比，治疗组的包膜厚度显著降低（p < 0.05）。通过MRI和HR-US分析验证厚度测量。胶原酶注射后2例发生皮肤穿孔。胶原酶注射后10天，促纤维化和炎症基因的初始上调并没有长期持续。同样，在第60天，在治疗组中检测到轻微的表达水平降低的趋势，同时TGF β 3的表达显著下调。histolyticum可有效降解硅胶植入体周围的包囊纤维化，注射后60天内结局稳定。皮肤穿孔和植入物囊袋内充分均匀的药物分布是需要解决的问题。进一步的研究是必要的，以澄清胶原酶注射是否有可能成为一个可行的治疗选择包囊挛缩。该杂志要求作者46分配的证据等级每篇文章。有关这些循证医学评级的完整描述，请参阅目录或在线作者说明。www.springer.com/00266.
Capsular contracture remains the most frequent long-term complication after augmentation mammoplasty with silicone implants. Thereby, the main part of the fibrotic capsule is collagen. The collagenase of the bacterium Clostridium histolyticum is approved for the treatment of fibrotic diseases and has been demonstrated to be effective for capsular fibrosis treatment in the short term. However, long-term effectiveness is currently unknown but mandatory for clinical utilization.Forty-eight rats received miniature silicone implants and an injection with either collagenase (treatment group) or plain solvent solution (control group) 120 days post insertion. Ten and 60 days after the injections, the rats underwent 7-Tesla magnetic resonance imaging (MRI) and high-resolution ultrasound (HR-US). Capsule tissue was harvested, and capsule thickness and collagen density were evaluated through histology. Furthermore, the expression levels of inflammatory (CD68, IL4, IL10, IL12, IL13), pro-, and anti-fibrotic (TGFb1, TGFb3, Smad3, Col1-4) genes were analyzed using qRT-PCR.On days 10 and 60 after injection of collagenase, histology showed that capsule thickness was significantly reduced in the treatment group when compared with the control (p < 0.05). Thickness measurements were verified by MRI and HR-US analysis. Skin perforation occurred in two cases after collagenase injection. The initial up-regulation of pro-fibrotic and inflammatory genes 10 days after collagenase injection did not persist in the long term. Contrarily, on day 60, a slight trend towards lower expression levels with a significant down-regulation of TGFb3 was detected in the treatment group.The collagenase of the bacterium C. histolyticum effectively degrades capsular fibrosis around silicone implants with stable outcomes throughout 60 days post injection. Skin perforation and adequate and uniform drug distribution within the implant pocket are issues that need to be addressed. Further studies are warranted to clarify whether collagenase injections have the potential to become a viable treatment option for capsular contracture.This journal requires that authors 46 assign a level of evidence to each article. For a full 47 description of these Evidence-Based Medicine ratings, 48 please refer to the Table of Contents or the online 49 Instructions to Authors. www.springer.com/00266.