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Chu SY, Chou CH, Huang HD, Yen MH, Hong HC, Chao PH, Wang YH, Chen PY, Nian SX, Chen YR, Liou LY, Liu YC, Chen HM, Lin FM, Chang YT, Chen CC, Lee OK. Mechanical stretch induces hair regeneration through the alternative activation of macrophages. Nat Commun 2019; 10:1524. [PMID: 30944305 PMCID: PMC6447615 DOI: 10.1038/s41467-019-09402-8] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/04/2019] [Indexed: 12/28/2022] Open
Abstract
Tissues and cells in organism are continuously exposed to complex mechanical cues from the environment. Mechanical stimulations affect cell proliferation, differentiation, and migration, as well as determining tissue homeostasis and repair. By using a specially designed skin-stretching device, we discover that hair stem cells proliferate in response to stretch and hair regeneration occurs only when applying proper strain for an appropriate duration. A counterbalance between WNT and BMP-2 and the subsequent two-step mechanism are identified through molecular and genetic analyses. Macrophages are first recruited by chemokines produced by stretch and polarized to M2 phenotype. Growth factors such as HGF and IGF-1, released by M2 macrophages, then activate stem cells and facilitate hair regeneration. A hierarchical control system is revealed, from mechanical and chemical signals to cell behaviors and tissue responses, elucidating avenues of regenerative medicine and disease control by demonstrating the potential to manipulate cellular processes through simple mechanical stimulation.
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Affiliation(s)
- Szu-Ying Chu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, 112, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chih-Hung Chou
- Department of Biological Science and Technology, Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Hsien-Da Huang
- Warshel Institute for Computational Biology, School of Life and Health Sciences, School of Sciences and Engineering, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Meng-Hua Yen
- Department of Electronic Engineering, National Chin-Yi University of Technology, Taichung, 411, Taiwan
| | - Hsiao-Chin Hong
- Department of Biological Science and Technology, Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Po-Han Chao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Yu-Hsuan Wang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, 999077, China.,Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Po-Yu Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, 112, Taiwan
| | - Shi-Xin Nian
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, 112, Taiwan
| | - Yu-Ru Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Li-Ying Liou
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, 112, Taiwan
| | - Yu-Chen Liu
- Department of Biological Science and Technology, Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Hui-Mei Chen
- Department of Biological Science and Technology, Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Feng-Mao Lin
- Department of Biological Science and Technology, Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chih-Chiang Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, 112, Taiwan. .,Department of Dermatology, National Yang-Ming University, Taipei, 112, Taiwan.
| | - Oscar K Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, 112, Taiwan. .,Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, 999077, China. .,Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong, 999077, China.
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Pascal S, Philandrianos C, Bertrand B, Bardot J, Degardin N, Casanova D. [The complications of skin expansion in paediatrics: Diagnostic, taking over and prevention]. ANN CHIR PLAST ESTH 2016; 61:750-763. [PMID: 27289549 DOI: 10.1016/j.anplas.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
Skin expansion is a difficult and long process in which can occur more or less serious complications. Overall complications rates describe in the literature vary between 13 and 37%. We can categorize them in major complications, which can lead to a failure maybe even an aggravation of the anterior status, and in minor complications that do not compromise the expansion process but can alter it. The main major complications are infection, skin suffering and necrosis which can lead to prosthesis exposition, leaks and technical problems with equipment dysfunctions that may cause difficulties or a failure of the inflations. The main minor complications are hematomas, seromas, valve or tube exposition, pains with paraesthesias caused by neighbouring organs compression, pathologic and unsightly scares and can lead to an important psychological impact. These complications can be due to a precarious skin's state, a material dysfunction or unpredictable technical problems but also by an inappropriate preoperative indication or planning. The emerging of a complication, however, is not synonymous to a failure of the procedure; a satisfactory reconstruction may still be obtained in 75% of all cases. The purpose of this article is to help to identify the situations at risk of complications in order to prevent, detect and treat them early.
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Affiliation(s)
- S Pascal
- Chirurgie plastique reconstructrice et esthétique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - C Philandrianos
- Chirurgie plastique reconstructrice et esthétique, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - B Bertrand
- Chirurgie plastique reconstructrice et esthétique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - J Bardot
- Chirurgie plastique reconstructrice et esthétique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - N Degardin
- Chirurgie plastique pédiatrique, hôpital de la Timone Enfants, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - D Casanova
- Chirurgie plastique reconstructrice et esthétique, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France.
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Huang C, Du Y, Nabzdyk CS, Ogawa R, Koyama T, Orgill DP, Fu X. Regeneration of hair and other skin appendages: A microenvironment-centric view. Wound Repair Regen 2016; 24:759-766. [PMID: 27256925 DOI: 10.1111/wrr.12451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/20/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022]
Abstract
Advances in skin regeneration have resulted in techniques and products that have allowed regeneration of both the dermis and epidermis. Yet complete skin regeneration requires the adnexal skin structures. Thus it is crucial to understand the regenerative potential of hair follicles where genetic, nutritional, and hormonal influences have important effects and are critical for skin regeneration. The follicular stem cell niche serves as an anatomical compartment, a structural unit, a functional integrator, and a dynamic regulator necessary to sustain internal homeostasis and respond to outside stimuli. In particular, mechanics such as pressure, compression, friction, traction, stretch, shear, and mechanical wounding can influence hair loss or growth. Relevant niche signaling pathways such as Wnt, bone morphogenetic protein, fibroblast growth factor, Shh, and Notch may yield potential targets for therapeutic interventions.
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Affiliation(s)
- Chenyu Huang
- Department of Plastic, Reconstructive and Aesthetic Surgery, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
| | - Yanan Du
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Christoph S Nabzdyk
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiaobing Fu
- Institute of Basic Medical Science, The General Hospital of PLA, Beijing, China.
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Agrawal K, Agrawal S. Tissue regeneration during tissue expansion and choosing an expander. Indian J Plast Surg 2012; 45:7-15. [PMID: 22754146 PMCID: PMC3385404 DOI: 10.4103/0970-0358.96566] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper reviews the various aspects of tissue regeneration during the process of tissue expansion. “Creep” and mechanical and biological “stretch” are responsible for expansion. During expansion, the epidermis thickens, the dermis thins out, vascularity improves, significant angiogenesis occurs, hair telogen phase becomes shorter and the peripheral nerves, vessels and muscle fibres lengthen. Expansion is associated with molecular changes in the tissue. Almost all these biological changes are reversible after the removal of the expander.This study is also aimed at reviewing the difficulty in deciding the volume and dimension of the expander for a defect. Basic mathematical formulae and the computer programmes for calculating the dimension of tissue expanders, although available in the literature, are not popular. A user-friendly computer programme based on the easily available Microsoft Excel spread sheet has been introduced. When we feed the area of defect and base dimension of the donor area or tissue expander, this programme calculates the volume and height of the expander. The shape of the expander is decided clinically based on the availability of the donor area and the designing of the future tissue movement. Today, tissue expansion is better understood biologically and mechanically. Clinical judgement remains indispensable in choosing the size and shape of the tissue expander.
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Affiliation(s)
- K Agrawal
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjang Hospital, New Delhi, India
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Nazerani S, Motamedi MHK, Keramati MR, Nazerani T. Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the "spiral" reconstruction technique. Strategies Trauma Limb Reconstr 2010; 5:115-20. [PMID: 21286355 PMCID: PMC2994632 DOI: 10.1007/s11751-010-0090-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/16/2010] [Indexed: 11/29/2022] Open
Abstract
We present an expanded latissimus dorsi musculocutaneus (LDMC) flap to treat circumferential upper extremity defects via resurfacing and “spiral reconstruction” in 5 patients during a 17-year period. Five patients with different indications for tissue expansion from burns to congenital hairy nevi were operated. The expansion was done in a longitudinal direction, and a rectangular tissue expander (TE) was inserted under the LD muscle to expand the flap in a longitudinal direction thereby forming a “long” flap rather than a “wide” one. After excising the circumferential lesion, the expanded “elongated” flap was wrapped spirally around the extremity to cover the defect; the donor site was closed as usual. The 5 patients we treated via LDMC flaps in a spiral fashion were free of complications, and all were satisfied with the outcome. All the flaps survived and the spiral reconstruction allowed for a tension-free donor site closure and near complete recipient coverage. This technique is indicated for large circumferential extremity skin defects and deformities. Application of expanded LDMC flaps in a spiral fashion can be used by the reconstructive surgeon to resurface large circumferential upper extremity lesions when indicated. The idea of a long and thinned expansion flap must be in a longitudinal direction and we need this long expanded and thin flap to “spiral” it around the extremity to cover a large defect. The “spiral” flap coverage introduced here for large circumferential extremity defects enables the surgeon to cover the defect with simultaneous donor site closure and good results.
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Affiliation(s)
- Shahram Nazerani
- Deptartment of Surgery, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Hosein Kalantar Motamedi
- Trauma Research Center, Baqiyatallah Medical Sciences University, Tehran, Islamic Republic of Iran
- Azad University of Medical Sciences, Tehran, Islamic Republic of Iran
- Africa Expressway, Golestan St., Giti Blvd. No. 11, 19667 Tehran, Islamic Republic of Iran
| | | | - Tara Nazerani
- Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Abstract
The laser depilation system, cleared by the Food and Drug Administration since 1995, is evolving rapidly. However, the parameters in the hair removal function of these devices emphasize use for white people with fair skin (Fitzpatrick types I, II, or III). The characteristics of oriental skin and hair are black, coarse hairs in darker skin (Fitzpatrick types IV or V). As seen, the higher the skin melanin content, the more difficult to remove hair by laser. The authors report 146 oriental patients (156 body sites) who underwent treatment with the long-pulse alexandrite laser (wavelength, 755 nm) depilation system since November 1997. Percentage of hair removal (clearance rate) was assessed, and the histological change from laser pulse damage was observed. After two treatments, the clearance rates in the axillae and the leg were 61% and 62% respectively in the 15 to 20-J group (N = 47), and were 66% and 67% respectively in 21 to 25-J group (N = 64). After five treatments, 59 patients (37 axillae and 22 legs, all of which received 21-25 J per square centimeter of laser energy treatment during the course) had an average clearance rate of 91% (axillae) and 86% (leg), and the clearance rates have been maintained near 90% after long-term follow-up (average follow-up, 17 months). Minimal and transient complications are noted. In conclusion, using a combination of longer wavelength (but still in the optimal window of 630-870 nm), long pulse duration (10-40 msec), high fluence (but limited up to 25 J per square centimeter), multiple treatments, and concomitant direct cooling applied to the skin of oriental patients (Fitzpatrick types IV and V) with black, moderately coarse hair shafts achieves satisfying long-term hair removal results.
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Affiliation(s)
- S Y Lu
- Division of Plastic Surgery, Cathay General Hospital, Taipei, Taiwan
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