Cyclophosphamide effect on collagen metabolism in granulation tissue, skin, and aorta of rats

The impact of chemotherapy and radiation therapy on the remodeling of acellular dermal matrices in staged, prosthetic breast reconstruction

BACKGROUND

An acellular dermal matrix will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients who require chemotherapy and radiation, which influence neovascularization and cellular proliferation.

METHODS

Multiple biopsy specimens were procured from 86 women (n = 94 breasts) undergoing exchange of a tissue expander for a breast implant. These were divided by biopsy location: submuscular capsule (control) as well as superiorly, centrally, and inferiorly along the paramedian acellular dermis. Specimens were assessed for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, and type I and III collagen. Patients were compared based on five oncologic treatment groups: no adjuvant therapy (untreated), neoadjuvant chemotherapy with or without radiation, and chemotherapy with or without radiation.

RESULTS

Biopsy specimens were procured 45 to 1805 days after implantation and demonstrated a significant reduction in type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation (p = 0.03). Chemotherapy with or without radiation adversely impacted type I collagen (p = 0.02), cellular infiltration (p < 0.01), extracellular matrix deposition (p < 0.04), and neovascularization (p < 0.01). Radiation exacerbated the adverse impact of chemotherapy for several remodeling parameters. Neoadjuvant chemotherapy also caused a reduction in type I (p = 0.01) and III collagen (p = 0.05), extracellular matrix deposition (p = 0.03), and scaffold degradation (p = 0.02).

CONCLUSION

Chemotherapy and radiation therapy limit acellular dermal matrix remodeling.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Distinct functions of chemokine receptor axes in the atherogenic mobilization and recruitment of classical monocytes

We used a novel approach of cytostatically induced leucocyte depletion and subsequent reconstitution with leucocytes deprived of classical (inflammatory/Gr1^hi) or non-classical (resident/Gr1^lo) monocytes to dissect their differential role in atheroprogression under high-fat diet (HFD). Apolipoprotein E-deficient (Apoe^−/−) mice lacking classical but not non-classical monocytes displayed reduced lesion size and macrophage and apoptotic cell content. Conversely, HFD induced a selective expansion of classical monocytes in blood and bone marrow. Increased CXCL1 levels accompanied by higher expression of its receptor CXCR2 on classical monocytes and inhibition of monocytosis by CXCL1-neutralization indicated a preferential role for the CXCL1/CXCR2 axis in mobilizing classical monocytes during hypercholesterolemia. Studies correlating circulating and lesional classical monocytes in gene-deficient Apoe^−/− mice, adoptive transfer of gene-deficient cells and pharmacological modulation during intravital microscopy of the carotid artery revealed a crucial function of CCR1 and CCR5 but not CCR2 or CX₃CR1 in classical monocyte recruitment to atherosclerotic vessels. Collectively, these data establish the impact of classical monocytes on atheroprogression, identify a sequential role of CXCL1 in their mobilization and CCR1/CCR5 in their recruitment.

Melanin Light Absorption as the Necessary but Not Sufficient Condition for Photoepilation: Intra-Anagen Variability of Hair Follicle Light Sensitivity

Several well-known, contradictive photoepilation phenomena cannot be reliably explained within the framework of traditional theory. Counted among are the contradiction between the total number of anagen hairs and the number of light sensitive hairs as well as the paradoxical, regional variations in the light sensitivity of anatomically similar hairs. These and some other phenomena can, however, be explained by intra-anagen variability of the hair follicle (HF) sensitivity to light. Melanin content in the hair matrix is important for the initial temperature increase at the distal portion of the growing HF, where strong epithelial and mesenchymal remodeling processes take place, thus being the necessary condition for photoepilation. This condition is, however, not sufficient for effective hair removal. We discuss the variation of intra-anagen light sensitivity and its possible correlation with sonic hedgehog activity, which is strongly responsible for the remodeling processes at the distal end of the growing HF. It is concluded that the theory needs much modification, along with revision of the optimal treatment strategy.

Delaying effect of cyclophosphamide on bone fracture healing chemical analyses of rat femora

Hydroxyproline, calcium and inorganic phosphate contents of osteotomised rat femora were compared with those from rats treated with cyclophosphamide. The treatment consisted of 10 mg/kg/body weight injected intraperitoneally daily for 14 days after (group II) and before (group III) operation. The obtained results indicated a reduction in the hydroxyproline content of the callus and a diminution of the calcium and phosphate deposition upon it, thus inhibiting collagen formation and delaying mineralisation, retarding the healing process of the fraction. The degree of inhibition was decreased when the cyclophosphamide treatment discontinued before osteotomy was performed (group III). We would like to draw attention to these results, and suggest that cyclophosphamide treatment should not coincide with the healing of bone fracture.

Effects of different cyclophosphamide treatment schedules on collagen and collagenolytic activity in granulation tissue

Cyclophosphamide was injected intraperitoneally into rats in doses of 6 or 10 mg/kg/day. The controls had daily intraperitoneal injections of physiological saline. After 14 days of treatment, granulation tissue was produced by subcutaneous implantation of viscose cellulose sponges. The treatment with cyclophosphamide and physiological saline was continued in different sequences for a further one or two 14-day periods. The rats were killed 14 or 28 days after the sponge implantation. Cyclophosphamide caused a decrease in body weight, in the number of leucocytes, in granuloma dry weight and in the granuloma content of free OH-proline while the water percentage increased. Ten mg/kg/day of cyclophosphamide had a more pronounced effect than 6 mg/kg/day. The results are consistent with an inhibitory effect of cyclophosphamide on granuloma formation and on the degradation of collagen. Accordingly, measurements of collagenolytic activity in granulation tissue after culture in vitro suggested an inhibition of collagenolysis after cyclophosphamide treatment. No effect of pretreatment was observed, and the effect of cyclophosphamide was independent of whether cyclophosphamide was given during the early or late phase of granulation tissue production.

Reversibility of the effects of cyclophosphamide on collagen: biochemical studies on skin and granulation tissue and determination of thermal stability of tail tendons of rats

Granulation tissue was produced in rats by subcutaneous implantation of viscose cellulose sponges. Treatment with cyclophosphamide in a dose of 10 mg/kg/day for 14 days caused an increase in acid soluble OH-proline and a decrease in alpha/beta ratio of acid soluble collagen of granulation tissue. Forty-two days of continuous cyclophosphamide treatment caused a decrease in dry weight, in free OH-proline, and in salt soluble OH-proline in granulation tissue. These findings are in accordance with previous observations of a decreased collagen synthesis and an inhibited collagen degradation in granulation tissue after cyclophosphamide treatment. In skin, the only change after cyclophosphamide was a decrease in total content of OH-proline and an increase in alpha/beta ratio of acid soluble collagen after 42 days of treatment. No effect of the subcutaneous sponge implantation was observed on the collagen variables in the skin. In comparison with unstarved controls, a reduction in dry weight and in free OH-proline in granulation tissue, as well as an increase in salt soluble OH-proline in the skin were observed 28 days after a 14-day treatment with cyclophosphamide. These observations indicate a sustained effect of cyclophosphamide on collagen 28 days after cessation of treatment. In addition the thermal stability of rat tail tendons was decreased 28 days after withdrawal of cyclophosphamide to the same extent as after starvation for 42 days and after 42 days of continuous cyclophosphamide treatment. It is concluded that the cyclophosphamide-induced collagen alterations, which may be of importance in the anti-inflammatory action of cyclophosphamide, are only in part reversible, 28 days after cessation of 14 days of cyclophosphamide treatment.