Low-level laser therapy (LLLT) does not reduce subcutaneous adipose tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism

Photobiomodulation therapy induces NG2 activation through dermal adipocyte lipolysis during wound healing

Photobiomodulation therapy (PBMT) is a rapidly advancing approach for restoring damaged tissues, particularly in skin and mucosal wounds. While its application is promising, the role of mature adipocytes in regenerating mesenchymal tissues after PBMT remains largely unexplored. This study demonstrates that PBMT applied to skin wounds significantly reduces the number and size of mature adipocytes. Additionally, PBMT modulates the upregulation of peroxisome proliferator-activated receptor γ (PPARγ), increasing the gene expression of fatty acid binding protein 4 (Fabp4) and perilipin 1, which are linked to enhanced lipolysis. The molecular activation of neural/glial antigen 2 (NG2) indicates the recruitment of progenitor cells following mature adipocytes lipolysis. In vitro, PBMT improved dermal skin cell proliferation, migration, inflammatory regulation, and differentiation capacities. These findings reveal a novel mechanistic pathway for skin regeneration, emphasizing the therapeutic potential of PBMT in modulating dermal fat tissue to facilitate wound healing. Collectively, this emerging knowledge provides valuable insights into managing dermal fat tissue to support wound healing.

Efficacy and Safety of TANIT Platform Combining Dampened Bioactive Current and Functional Dermal Stimulation for the Treatment of Adipose Tissue in Patients with Stage I or II Lipedema

Purpose: The study's main objective was to assess the efficacy and safety of TANIT, a platform combining functional dermal stimulation with damped bioactive current and mechanical stimulation to reduce adipose tissue (AT) in patients with stage I (SI) or II (SII) lipedema. Methods: A single-center, before-after clinical trial without a control group was conducted on adult women diagnosed with SI or SII lipedema. Patients underwent a treatment protocol for 5 weeks, with weekly sessions. Blood tests, AT thickness, pain threshold, and anthropometric measurements were assessed at baseline and the end of the study, and a satisfaction survey was conducted after treatment. Results: Twenty-three women were enrolled with a mean age of 44.91 (standard deviation 11.58) and a median of 46.00 (Q25 = 36.50, Q75 = 51.50). Seven (30.4%) patients had SI lipedema and 16 (69.6%) had SII. The pain threshold increased in 78.3% of patients at the knee level and 80.0% at the ankle level. Lower limb volume decreased in 78.3% of patients. AT thickness decreased in all treated areas, with a mean decrease of 26.1% at the ankles, 14.5% at the knees, and 17.4% at the trochanter level. Patients reported high satisfaction with the results obtained after the treatment sessions, and no unexpected adverse effects were found. Conclusions: The TANIT platform provided an effective and safe conservative treatment option for patients with S and SII lipedema, reducing leg volume, AT thickness, and pain. However, additional randomized clinical trials and standardized assessment tools would be necessary.

Non-invasive Body Contouring Technologies: An Updated Narrative Review

INTRODUCTION

Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices.

METHODS

We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring.

RESULTS

Totally 193 references were used in 11 main topics.

CONCLUSION

In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section.

LEVEL OF EVIDENCE I

This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .

Can the use of photobiomodulation for localized fat reduction induce changes in lipid profile? A critical integrative review

The objective of this study is to clarify whether PBM for measures reduction can cause significant changes in the lipid profile. This is an integrative review and only original articles, both in vivo and clinical trials, that were published between 2010 and 2022 were selected. The article references were also analyzed to identify additional studies. A total of 15 articles were critically analyzed. The wavelength used ranged from 532 nm (green) to 956 nm (near infrared), and many authors failed to describe dosimetric parameters properly, as well as other important characteristics for the reproducibility of those found. Although it is not fully clear about the PBM interference level on the lipid profile, in general, there was no significant difference in lipid parameters when PBM was used alone, and when associated with techniques that promote beta-oxidation, there was an improvement in these biochemical variables. PBM use for localized fat reduction do not affect lipid serum levels. Clinical trials using standardized parameters are crucial to obtain more reliable results.

Effects of LED photobiomodulation therapy on the subcutaneous fatty tissue of obese individuals - histological and immunohistochemical analysis

Photobiomodulation therapy (PBMT) has become an adjuvant therapeutic possibility in body remodeling procedures. Given this scenario, this study was proposed with the aim of evaluating the effects of PBMT to Light Emitting Diode (LED) associating the red (630 nm) and infrared (850 nm) wavelengths in the subcutaneous fatty tissue. This controlled study of comparative intervention that evaluated a sample of subcutaneous fatty tissue from women with grade II obesity. The participants received the LED PBMT treatment with associated red and infrared wavelengths sequentially on the left side of the abdomen and the right side was considered as control, with the collection of biological material performed at the time of bariatric surgery. For histological and immunohistochemical evaluation, Caspase 3, Cleaved Caspase 3, CD68+, HSL and adipophilin markers were used. The participants showed positivity in the expression of Caspase 3 and Cleaved Caspase (p < .0001), CD68+ macrophages (p < .0001), HSL (p < .0001) and adipophilin (p < .0013) in the intervention sample when compared to the control. PBMT and LED associating red and infrared wavelengths were able to promote autophagic lipolysis induced by adipocyte cell apoptosis in the subcutaneous tissue of obese individuals.

Efficacy of a Novel Injection Lipolysis to Induce Targeted Adipocyte Apoptosis: A Randomized, Phase IIa Study of CBL-514 Injection on Abdominal Subcutaneous Fat Reduction

BACKGROUND

CBL-514 is a novel injectable drug that may be safe and efficacious for localized abdominal subcutaneous fat reduction.

OBJECTIVES

The aim of this study was to assess the safety and efficacy of CBL-514 in reducing abdominal subcutaneous fat volume and thickness.

METHODS

This Phase IIa, open-label, random allocation study consisted of a 6-week treatment period and follow-up at 4 and 8 weeks following the last treatment. Participants were randomly allocated to receive 1.2 mg/cm2 (180 mg), 1.6 mg/cm2 (240 mg), or 2.0 mg/cm2 (300 mg) of CBL-514 with up to 4 treatments, each comprising 60 injections into the abdominal adipose layer. Changes in abdominal subcutaneous fat were assessed by ultrasound at follow-up visits. Treatment-emergent adverse events were recorded.

RESULTS

Higher doses of CBL-514 (unit dose, 2.0 and 1.6 mg/cm2) significantly improved the absolute and percentage reduction in abdominal fat volume (P < 0.00001) and thickness (P < 0.0001) compared with baseline. Although the COVID-19 pandemic halted some participant recruitment and follow-ups, analysis was unaffected, even after sample size limitations.

CONCLUSIONS

CBL-514 injection at multiple doses up to 300 mg with a unit dose of 2.0 mg/cm2 is safe, well-tolerated, and reduced abdominal fat volume and thickness by inducing adipocyte apoptosis. Although other procedures exist to treat abdominal fat, they have limitations and may cause complications. At a dose of 2.0 mg/cm2, CBL-514 safely and significantly reduced abdominal fat volume by 24.96%, making it a promising new treatment for routine, nonsurgical abdominal fat reduction in dermatologic clinics.

LEVEL OF EVIDENCE: 4

Modifying the Microbiome as a Potential Mechanism of Photobiomodulation: A Case Report

Objective: The objective of this case study was to elucidate the effect of photobiomodulation (PBM) on the microbiome. Background: The gut microbiome has been identified as a key component of health, with gut dysbiosis, characterized by decreased microbial diversity and an altered microbial composition, being recognized as instrumental in many diseases and disorders. Previous research has suggested that the gut microbiome can be favorably altered in animal models using PBM. Materials and methods: The participant had their microbiome tested on nine occasions, three times before any treatment, three times after radiotherapy and commencement of immunotherapy for breast cancer, and three times after PBM treatment. The PBM treatment consisted of infrared laser treatment (904 nm; 700 Hz pulse frequency, 861.3 total joules) to the abdomen three times per week for 11 weeks. Results: The microbiome of the participant showed significant changes in diversity after PBM treatment, but not after cancer therapy, with an increase in the number of known beneficial bacteria (Akkermansia, Faecalibacterium, and Roseburia) and decrease in the number of potentially pathogenic genera. Conclusions: The results suggested the possibility that PBM may alter the microbiome and thus it represents a therapeutic avenue for chronic diseases with otherwise limited treatment options.

Evaluation of lipolysis and toxicological parameters of low-level laser therapy at different wavelengths and doses in the abdominal subcutaneous tissue

Investigate the effects of low-level lasers therapy (LLLT) aiming abdominal lipolysis. Female Wistar rats received applications of LLLT directly in the abdominal skin twice a week (5 weeks). Except the control group (n = 5), animals received treatments with red wavelength 660 nm being (I) R3.3 group (n = 5): 3.3 J/cm², and (II) R5 group (n = 5): 5 J/cm², or infrared wavelength 808 nm being (III) IR3.3 group (n = 5): 3.3 J/cm², and (IV) IR5 group (n = 5): 5 J/cm². Abdominal subcutaneous and liver tissues were evaluated histologically. Levels of thiobarbituric acid reactive substances (TBARS) and catalase (CAT) activity were analyzed in liver tissue. In the peripheral blood aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and total cholesterol were investigated. Micronucleus assay was performed in the bone marrow. Except for the IR3.3 group, all treated groups reduced the body weight (p < 0.001). The R5 group reduced the abdominal subcutaneous tissue weight and thickness (p < 0.05), even though all treated groups reduced the number of adipocytes and its size (p < 0.001). No histological changes in the liver. There were no alterations in the triglycerides and LDL levels. The IR5 group increased the total cholesterol levels and decreased the HDL, ALT (both p < 0.05), and AST levels (p < 0.001). The group IR3.3 showed higher levels of ALP (p < 0.01). The R3.3 group increased the TBARS and CAT activity (p < 0.05). No mutagenic effects were found. The red laser treatment at 5 J/cm² led to lipolysis and did not alter the liver's parameters.

Photobiomodulation: The Clinical Applications of Low-Level Light Therapy

BACKGROUND

Low-level light therapy (LLLT) is a recent addition to the pantheon of light-based therapeutic interventions. The absorption of red/near-infrared light energy, a process termed "photobiomodulation," enhances mitochondrial ATP production, cell signaling, and growth factor synthesis, and attenuates oxidative stress. Photobiomodulation is now highly commercialized with devices marketed directly to the consumer. In the gray area between the commercial and therapeutic sectors, harnessing the clinical potential in reproducible and scientifically measurable ways remains challenging.

OBJECTIVES

The aim of this article was to summarize the clinical evidence for photobiomodulation and discuss the regulatory framework for this therapy.

METHODS

A review of the clinical literature pertaining to the use of LLLT for skin rejuvenation (facial rhytids and dyschromias), acne vulgaris, wound healing, body contouring, and androgenic alopecia was performed.

RESULTS

A reasonable body of clinical trial evidence exists to support the role of low-energy red/near-infrared light as a safe and effective method of skin rejuvenation, treatment of acne vulgaris and alopecia, and, especially, body contouring. Methodologic flaws, small patient cohorts, and industry funding mean there is ample scope to improve the quality of evidence. It remains unclear if light-emitting diode sources induce physiologic effects of compararable nature and magnitude to those of the laser-based systems used in most of the higher-quality studies.

CONCLUSIONS

LLLT is here to stay. However, its ubiquity and commercial success have outpaced empirical approaches on which solid clinical evidence is established. Thus, the challenge is to prove its therapeutic utility in retrospect. Well-designed, adequately powered, independent clinical trials will help us answer some of the unresolved questions and enable the potential of this therapy to be realized.

Electrochemical degradation and saponification of porcine adipose tissue

Body contouring achieved via subcutaneous adipose tissue reduction has notably advanced over the past century, from suction assisted lipectomy to techniques with reduced degrees of invasiveness including laser, radiofrequency, high frequency focused ultrasound, cryolipolysis, and drug-based injection approaches. These costly techniques have focused on damaging adipocyte cell membranes, hydrolyzing triglycerides (TGs), or inducing apoptosis. Here, we present a simple, low-cost technique, termed electrochemical lipolysis (ECLL). During ECLL, saline is injected into the subcutaneous adipose tissue, followed by insertion of needle electrodes and application of an electrical potential. Electrolysis of saline creates localized pH gradients that drive adipocyte death and saponification of TGs. Using pH mapping, various optical imaging techniques, and biochemical assays, we demonstrate the ability of ECLL to induce acid and base injury, cell death, and the saponification of triglycerides in ex vivo porcine adipose tissue. We define ECLL's potential role as a minimally-invasive, ultra-low-cost technology for reducing and contouring adipose tissue, and present ECLL as a potential new application of an emerging electrochemical redox based treatment modality.

Biostimulative effect of laser on growth of mesenchymal stem/stromal cells in vitro

Introduction

Human adipose tissue-derived mesenchymal stem/stromal cells (hAT-MSCs) are multipotent stromal cells with a high potential application in tissue engineering and regenerative medicine. Laser irradiation of the place where the cells were implanted can stimulate their proliferation, increase the secretion of growth factors and thus increase the therapeutic effect.

Aim

To evaluate the influence of two lasers: Er:YAG and diode on the growth of hAT-MSCs in vitro.

Material and methods

hAT-MSCs were isolated from human subcutaneous adipose tissue. Immunophenotype of hAT-MSCs was confirmed by flow cytometry. Multipotency of hAT-MSCs was confirmed by differentiation into adipogenic, osteogenic and chondrogenic lineages. hAT-MSCs were irradiated with Er:YAG laser (wavelength 2940 nm, frequency 5, 10 Hz, doses: 0.1–1.2 J/cm²) for 2 s and 4 s and diode laser (wavelength 635 nm and doses: 1–8 J/cm²) for 5, 10, 20, 30 and 40 s. Cell viability was analysed 24 h after the exposure using MTT assay.

Results

Growth stimulation of hAT-MSCs after 5 Hz Er:YAG laser exposure, 0.1 J/cm² dose for 4 s and 0.3 J/cm² dose for 4 s was shown in comparison with the control group. Significant growth stimulation of hAT-MSCs after diode laser irradiation in doses of 1–4 J/cm² was demonstrated compared to the control group.

Conclusions

The presented results indicate that both lasers, Er:YAG and diode can be used to stimulate stem/stromal cell growth in vitro. The biostimulative effect of laser therapy on stromal cells may be used in the future in aesthetic dermatology in combined laser and cell therapy.

Effect of 808-nm Laser Photobiomodulation Treatment in Blepharitis Rat Model

PURPOSE

Blepharitis, simply defined as eyelid inflammation, is one of the common ocular conditions associated with discomfort and irritation. Because blepharitis causes meibomian gland dysfunction and dry eye, this study aimed to confirm the effect of photobiomodulation (PBM) on blepharitis.

METHODS

A total of 20 rats were randomly assigned to 4 equal groups, including control, blepharitis, PBM, and eye drop. Blepharitis was induced in rats by injecting complete Freund's adjuvant in the eyelid margins. PBM intervention was given every 3 days after blepharitis induction. Clinical signs including tear volume, tear breakup time (TBUT), meibomian gland swelling, fluorescein, telangiectasia, and meibomian gland secretion scores were measured every week, and the rats were killed for histological analysis after 4 weeks. Immunohistochemistry was performed to compare the level of inflammatory cytokines, interleukin-1β and tumor necrosis factor-α, and terminal deoxynucleotidyl transferase dUTP nick end labeling staining on retina was performed to observe any retinal damage.

RESULTS

Tear volume and TBUT increased with PBM intervention, and with improved eyelid swelling, corneal staining, telangiectasia, and meibomian gland secretion scores increased. Hematoxylin and eosin staining showed no structural abnormalities of meibomian gland caused by blepharitis induction. Immunohistochemistry revealed that the levels of inflammatory cytokines interleukin-1β and tumor necrosis factor-α were lowered with PBM treatment in both eyelid and conjunctiva. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining showed no retinal damage.

CONCLUSIONS

Laser PBM at 808 nm was effective in alleviating ocular signs and controlling inflammation in blepharitis rat model. The in vivo results suggest that PBM has the potential to be used in treating blepharitis patients.

Effect of one session of aerobic exercise associated with abdominal laser therapy in lipolytic activity, lipid profile, and inflammatory markers

BACKGROUND

Increased abdominal fat and sedentary lifestyles contribute to cardiovascular disease risk. The combination of exercise and low-level laser therapy (LLLT) appears to be an innovative method to increase the lipolytic rate of abdominal adipocytes, in order to reduce abdominal fat.

OBJECTIVES

To evaluate the effect of one session of aerobic exercise associated with abdominal laser therapy in lipolytic activity, profile lipid, and inflammatory markers (C-reactive protein-CRP).

METHODS

Experimental randomized controlled study in 36 participants of female sex divided into three groups: placebo group (PG) (n = 12), experimental group 1 (EG1) (n = 11), and experimental group 2 (EG2) (n = 13). The EG1 and EG2 performed the laser therapy protocol followed by 50 minutes of aerobic exercise on cycle ergometer, of 45%-55% of reserve heart rate; however, in EG2 the laser therapy was applied without power. The PG only performed the laser therapy protocol without power. The anthropometric measures were evaluated, and all participants were subject to blood samples at the beginning and at the end of the intervention for measure glycerol, lipid profile (total cholesterol, triglycerides, HDL, and LDL), and CRP. One-way ANOVA was used to compare the groups in the quantitative variables and Fisher's test to compare the groups in the qualitative variables. To compare the variables between moments (M0 and M1), we used the t test for paired samples.

RESULTS

In the group that performed physical exercise and lipolytic laser and in the group that performs only physical exercise, there was a significant increase in glycerol mobilization between M0 and M1 (P < .001). The same did not occur in the placebo group. Regarding the CRP levels and lipidic profile, no significant differences were observed between moments in the experimental groups.

CONCLUSION

It is concluded that one session of aerobic exercise associated with LLLT and one session of aerobic exercise appears to be able to increase the lipolytic activity. However, it appears that LLLT does not provide increased value to the aerobic physical exercise by itself in lipolysis process.

Study protocol for the use of photobiomodulation with red or infrared LED on waist circumference reduction: a randomised, double-blind clinical trial

INTRODUCTION

The search for non-invasive procedures to reduce localised adiposity in aesthetics clinics has recently been increasing. In this context, procedures, such as cryolipolysis, ultracavitation, photobiomodulation (PBM) and other techniques have been proposed. Some studies have shown that PBM can be used in body contouring. However, there is no standardisation of the protocol. More than that, as in other techniques for reducing adipose tissue, the availability of triacylglycerol may affect the lipid profile in the blood, bringing consequences to the general health of an individual. This work will aim to compare the light wavelengths when using PBM as a technique for reducing the abdominal waist circumference, while also evaluating the efficacy of the method. Changes in the lipid profile in the blood, with a long-term follow-up, will also be appraised.

METHODS AND ANALYSIS

This will be a controlled, randomised, double-blind, single-centred clinical trial. 174 patients will be recruited at the Nove de Julho University, Brazil, and then divided into three groups: Group A-RED PBM; Group B-INFRARED PBM; Group C-PLACEBO (Sham) treatment. The treatments will consist of eight sessions, two times a week, for 4 weeks. At each session, the participants will receive 30 minutes PBM (using a radiant exposure of 127 J/cm²), with an abdominal strap containing 4 LED clusters, with 72 devices each, following the indication of randomisation. All of the groups will receive 30 min of Aussie Current, at 4 kHz, modulated at 10 Hz, 40-60 mA. The main outcome of this study will be waist circumference reduction. The secondary variables will be anthropometric data, lipid profile, liver function and adipose tissue thickness, changes in the local microcirculation, and the quality of life and self-esteem. The analyses will be performed at four stages of the research, D0, end of the eighth session (D30), 15 days after the last session (FU15), 90 days after the last session (FU90) and 180 days after the last session (FU180).

ETHICS AND DISSEMINATION

The Ethics Committee of the Nove de Julho University, Brazil, approved the modified version of this project under No. 3414146 on 26 June 2019. This study is not yet recruiting. The results obtained will be published in a peer-reviewed journal in the related field.

TRIAL REGISTRATION NUMBER

Brazilian Registry of Clinical Trials-ReBec (RBR-9bwxcx).

A Randomized, Controlled Trial on the Effectiveness of Photobiomodulation Therapy and Non-Contact Selective-Field Radiofrequency on Abdominal Adiposity in Adolescents With Obesity

BACKGROUND AND OBJECTIVES

Structured physical activities and dietary control have traditionally been used with the aim of controlling obesity. However, effective auxiliary modalities still needed to reduce local obesity, specifically abdominal obesity. This study examined the adjunct effect of photobiomodulation therapy (PBMT), and non-contact selective-field radiofrequency (NcRF) on abdominal adiposity in adolescents with obesity.

STUDY DESIGN/MATERIALS AND METHODS

Fifty-four adolescents with obesity (33 females and 21 males) took part in this study and were distributed randomly into three treatment-based groups. Control group (n = 18, age; 14.61 ± 1.14 years), PBMT group (n = 18, age; 14.22 ± 0.88 years), and NcRF group (n = 18, age; 15.11 ± 0.96 years). A dietary control plan of 1,000-1,200 kcal/day, and a 60-minute aerobic exercise program conducted day-by-day over 4 weeks were provided for all participants. Additionally, the PBMT group received 12 20-minute PBMT on the abdominal area (energy/session ~4.08 J/cm² ) thrice/week, and the NcRF group underwent four 30-minute treatments with NcRF on the abdominal area once/week. Waist/hip ratio (W-to-H ratio), intra-abdominal fat thickness (IAFT), and the subcutaneous-abdominal fat thickness (SAFT) were observed at the baseline and after 4 weeks.

RESULTS

The W-to-H ratio and SAFT reduced significantly in the PBMT group compared with either the control group (P = 0.001 and 0.001, respectively) or the NcRF group (P < 0.001 and P = 0.046, respectively) post-intervention. However, the IAFT and IAFT/SAFT ratio did not differ significantly among the study groups (P > 0.05).

CONCLUSION

Our analysis shows that PBMT is more efficient than NcRF for the reduction of W-to-H ratio and SAFT in adolescents with obesity. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

The Anti-Inflammatory and Anti-Oxidant Mechanisms of the Keap1/Nrf2/ARE Signaling Pathway in Chronic Diseases

Oxidative stress is defined as an imbalance between production of free radicals and reactive metabolites or [reactive oxygen species (ROS)] and their elimination by through protective mechanisms, including (antioxidants). This Such imbalance leads to damage of cells and important biomolecules and cells, with hence posing a potential adverse impact on the whole organism. At the center of the day-to-day biological response to oxidative stress is the Kelch-like ECH-associated protein 1 (Keap1) - nuclear factor erythroid 2-related factor 2 (Nrf2)- antioxidant response elements (ARE) pathway, which regulates the transcription of many several antioxidant genes that preserve cellular homeostasis and detoxification genes that process and eliminate carcinogens and toxins before they can cause damage. The redox-sensitive signaling system Keap1/Nrf2/ARE plays a key role in the maintenance of cellular homeostasis under stress, inflammatory, carcinogenic, and pro-apoptotic conditions, which allows us to consider it as a pharmacological target. Herein, we review and discuss the recent advancements in the regulation of the Keap1/Nrf2/ARE system, and its role under physiological and pathophysiological conditions, e.g. such as in exercise, diabetes, cardiovascular diseases, cancer, neurodegenerative disorders, stroke, liver and kidney system, etc. and such.