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Murakami T, Shigeki S. Pharmacotherapy for Keloids and Hypertrophic Scars. Int J Mol Sci 2024; 25:4674. [PMID: 38731893 PMCID: PMC11083137 DOI: 10.3390/ijms25094674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
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Affiliation(s)
- Teruo Murakami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan;
| | - Sadayuki Shigeki
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima 731-2631, Japan
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Joo S, Lee SY, Lee SY, Hwang Y, Kim M, Jeong JW, Jang SI, Fang S. Triamcinolone acetonide alleviates benign biliary stricture by ameliorating biliary fibrosis and inflammation. BMB Rep 2024; 57:200-205. [PMID: 38523372 PMCID: PMC11058357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 03/26/2024] Open
Abstract
We conducted a comprehensive series of molecular biological studies aimed at unraveling the intricate mechanisms underlying the anti-fibrotic effects of triamcinolone acetonide (TA) when used in conjunction with fully covered self-expandable metal stents (FCSEMS) for the management of benign biliary strictures (BBS). To decipher the molecular mechanisms responsible for the anti-fibrotic effects of corticosteroids on gallbladder mucosa, we conducted a comprehensive analysis. This analysis included various methodologies such as immunohistochemistry, ELISA, real-time PCR, and transcriptome analysis, enabling us to examine alterations in factors related to fibrosis and inflammation at both the protein and RNA levels. Overall, our findings revealed a dose-dependent decrease in fibrosisrelated signaling with higher TA concentrations. The 15 mg of steroid treatment (1X) exhibited anti-fibrosis and anti-inflammatory effects after 4 weeks, whereas the 30 mg of steroid treatment (2X) rapidly reduced fibrosis and inflammation within 2 weeks in BBS. Transcriptomic analysis results consistently demonstrated significant downregulation of fibrosis- and inflammation-related pathways and genes in steroid-treated fibroblasts. Use of corticosteroids, specifically TA, together with FCSEMS was effective for the treatment of BBS, ameliorating fibrosis and inflammation. Our molecular biological analysis supports the potential development of steroid-eluted FCSEMS as a therapeutic option for BBS in humans resulting from various surgical procedures. [BMB Reports 2024; 57(4): 200-205].
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Affiliation(s)
- Seyeon Joo
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Biomedical Sciences, Yonsei University College of Medicine, Seoul 03722, Korea
| | - See Young Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Su Yeon Lee
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Yeseong Hwang
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Biomedical Sciences, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Minki Kim
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Biomedical Sciences, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jae Woong Jeong
- Department of Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sung Ill Jang
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Sungsoon Fang
- Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul 03722, Korea
- Department of Biomedical Sciences, Yonsei University College of Medicine, Seoul 03722, Korea
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Mubin NF, Mubin AN, Fogel J, Morrison E. Progression From Steroid Injection to Surgery in Carpal Tunnel Syndrome Patients With Concurrent Ulnar Nerve Compression: A Retrospective Analysis. Hand (N Y) 2023:15589447231198270. [PMID: 37746706 DOI: 10.1177/15589447231198270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Steroid injections are a common treatment option in the management of carpal tunnel syndrome (CTS). This study assesses various prognostic factors for progression to carpal tunnel release (CTR) after a first-time steroid injection for CTS with specific focus on concomitant ulnar nerve compression (UNC). METHODS This is a retrospective study of 426 hands with CTS treated with a first-time steroid injection in the Long Island region of New York. The main predictor variable was UNC measured in two analytical models of positive UNC and location of UNC (wrist or elbow). Multivariate logistic regression analyses adjusted for demographic, medical, and CTS-related variables for 2 study outcomes occurring within 1 year: (1) CTR; and (2) steroid reinjection. RESULTS Overall progression to CTR within 1 year of steroid injection was 23.0%. Ulnar nerve compression was present in 16.7% of patients and was significantly associated with increased odds for CTR but not with steroid reinjection. These results were further localized to be specific for UNC at the elbow. A moderate or severe result on electrodiagnostic studies was associated with increased odds for CTR. Increased age was associated with slightly increased odds of steroid reinjection while a history of distal radius fracture was associated with decreased odds of steroid reinjection. CONCLUSIONS Carpal tunnel syndrome patients with UNC may benefit from earlier definitive treatment with CTR rather than attempting steroid injections, as they are more likely to seek reintervention within 1 year of their initial injection.
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Affiliation(s)
| | | | - Joshua Fogel
- Nassau University Medical Center, East Meadow, NY, USA
- Brooklyn College, Brooklyn, NY, USA
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Ahn Y, Moon YS, Park GY, Cho SC, Lee YJ, Kwon DR, Lee SC. Efficacy of Intra-articular Triamcinolone and Hyaluronic Acid in a Frozen Shoulder Rat Model. Am J Sports Med 2023; 51:2881-2890. [PMID: 37551671 DOI: 10.1177/03635465231188524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Intra-articular corticosteroid or hyaluronic acid (HA) is commonly prescribed for frozen shoulder. However, few studies have investigated histological and molecular changes after injection. PURPOSE To compare the effectiveness of intra-articular injections of triamcinolone and HA in a frozen shoulder rat model and verify a greater effect of triamcinolone in passive shoulder abduction compared with HA. STUDY DESIGN Controlled laboratory study. METHODS Twenty male Sprague-Dawley rats were randomly allocated into 4 groups (n = 5 in each): control group, which did not receive cast immobilization or injection, and 3 experimental groups, which received 3 weeks of unilateral shoulder immobilization followed by intra-articular injections (normal saline, triamcinolone, or HA) at the immobilized shoulder. Passive shoulder abduction angle, histological and immunohistochemical staining, and Western blotting results were assessed 2 weeks after injection. The intensity and extent of staining were converted to semiquantitative scores for further analysis. RESULTS Shoulder abduction angles before sacrifice were 153.0°± 2.7° (control group), 107.0°± 5.7° (saline group), 139.0°± 9.6° (triamcinoline group), and 110.0°± 10.6° (HA group), showing significant differences between control and saline groups, control and HA groups, saline and triamcinoline groups, and triamcinoline and HA groups (P < .001) but not between control and triamcinoline groups (P = .053). Histologic evaluation revealed an increase in synovial folds and thickening of the capsular membrane in the saline and HA groups; this change was not evident in the triamcinolone group. A comparison of semiquantitative scores revealed greater expression levels of proteins involved in fibrosis and angiogenesis in the saline and HA groups compared with the control and triamcinolone groups. In Western blotting, the expression of inflammatory cytokines and the receptor for advanced glycation end products was significantly lower in the triamcinolone and HA groups than in the saline group. CONCLUSION Triamcinolone injection was more effective than normal saline or HA injection in improving range of motion and reversing fibrotic and angiogenic features of frozen shoulder. Both triamcinolone and HA injections elicited anti-inflammatory effects. CLINICAL RELEVANCE The antifibrotic and antiangiogenic properties of triamcinolone and the anti-inflammatory properties of both triamcinolone and HA should be considered when performing injections in clinical settings.
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Affiliation(s)
- Yongjin Ahn
- Department and Research Institute of Rehabilitation Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Yong Suk Moon
- Department of Anatomy, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Gi-Young Park
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sung Cheol Cho
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Yoon-Jin Lee
- Department of Biochemistry, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Rho JH, Yoon CD, Kim G, Kang HY. A new technique for controlling intractable pain in lumbar spinal stenosis using steroid injection to ligamentum flavum: A case series. Pain Pract 2023; 23:123-126. [PMID: 35638334 DOI: 10.1111/papr.13133] [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: 01/10/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lumbar spinal stenosis is a common degenerative disease that causes low back and lower-extremity pain that increases with age. The treatment of lumbar spinal stenosis is either conservative or surgical. ESI is a commonly performed conservative treatment, but evidence of its effectiveness in lumbar spinal stenosis is limited. CASE SERIES We encountered the three patients with back pain and claudication due to lumbar spinal stenosis, which could not be controlled by conservative therapy including ESIs. Trimacinolone acetonide was injected into the patients' ligamentum flavum. All patients experienced dramatic improvement in their symptoms. CONCLUSIONS Trimacinolone acetonide injection into the ligamentum flavum may be effective for lumbar spinal stenosis that does not improve with ESIs.
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Affiliation(s)
- Jeong Ho Rho
- Spine and Pain Center, Okcheon St. Mary's Hospital, Okcheon, South Korea
| | - Chung Dae Yoon
- Department of Radiology, Okcheon St. Mary's Hospital, Okcheon, South Korea
| | - Gahee Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, South Korea
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de Sire A, Marotta N, Ferrillo M, Agostini F, Sconza C, Lippi L, Respizzi S, Giudice A, Invernizzi M, Ammendolia A. Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms23052528. [PMID: 35269681 PMCID: PMC8910188 DOI: 10.3390/ijms23052528] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 02/07/2023] Open
Abstract
To date, the application of oxygen-ozone (O2O3) therapy has significantly increased in the common clinical practice in several pathological conditions. However, beyond the favorable clinical effects, the biochemical effects of O2O3 are still far from being understood. This comprehensive review aimed at investigating the state of the art about the effects of O2O3 therapy on pro-inflammatory cytokines serum levels as a modulator of oxidative stress in patients with musculoskeletal and temporomandibular disorders (TMD). The efficacy of O2O3 therapy could be related to the moderate oxidative stress modulation produced by the interaction of ozone with biological components. More in detail, O2O3 therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune overactivation. In this context, most musculoskeletal and temporomandibular disorders (TMD) share these two pathophysiological processes. Despite the paucity of in vivo studies, this comprehensive review suggests that O2O3 therapy might reduce serum levels of interleukin 6 in patients with TMD, low back pain, knee osteoarthritis and rheumatic diseases with a concrete and measurable interaction with the inflammatory pathway. However, to date, further studies are needed to clarify the effects of this promising therapy on inflammatory mediators and their clinical implications.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (A.A.)
- Correspondence: ; Tel.: +39-0961712819
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (A.A.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.F.); (A.G.)
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Cristiano Sconza
- IRCCS Humanitas Research Center, Via Manzoni 56, 20089 Rozzano, Italy; (C.S.); (S.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Stefano Respizzi
- IRCCS Humanitas Research Center, Via Manzoni 56, 20089 Rozzano, Italy; (C.S.); (S.R.)
| | - Amerigo Giudice
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (M.F.); (A.G.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (A.A.)
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Coentro JQ, May U, Prince S, Zwaagstra J, Ritvos O, Järvinen TAH, Zeugolis DI. Adapting the Scar-in-a-Jar to Skin Fibrosis and Screening Traditional and Contemporary Anti-Fibrotic Therapies. Front Bioeng Biotechnol 2021; 9:756399. [PMID: 34765594 PMCID: PMC8576412 DOI: 10.3389/fbioe.2021.756399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Skin fibrosis still constitutes an unmet clinical need. Although pharmacological strategies are at the forefront of scientific and technological research and innovation, their clinical translation is hindered by the poor predictive capacity of the currently available in vitro fibrosis models. Indeed, customarily utilised in vitro scarring models are conducted in a low extracellular matrix milieu, which constitutes an oxymoron for the in-hand pathophysiology. Herein, we coupled macromolecular crowding (enhances and accelerates extracellular matrix deposition) with transforming growth factor β1 (TGFβ1; induces trans-differentiation of fibroblasts to myofibroblasts) in human dermal fibroblast cultures to develop a skin fibrosis in vitro model and to screen a range of anti-fibrotic families (corticosteroids, inhibitors of histone deacetylases, inhibitors of collagen crosslinking, inhibitors of TGFβ1 and pleiotropic inhibitors of fibrotic activation). Data obtained demonstrated that macromolecular crowding combined with TGFβ1 significantly enhanced collagen deposition and myofibroblast transformation. Among the anti-fibrotic compounds assessed, trichostatin A (inhibitors of histone deacetylases); serelaxin and pirfenidone (pleiotropic inhibitors of fibrotic activation); and soluble TGFβ receptor trap (inhibitor of TGFβ signalling) resulted in the highest decrease of collagen type I deposition (even higher than triamcinolone acetonide, the gold standard in clinical practice). This study further advocates the potential of macromolecular crowding in the development of in vitro pathophysiology models.
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Affiliation(s)
- João Q Coentro
- Regenerative, Modular and Developmental Engineering Laboratory (REMODEL) and Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway (NUI Galway), Galway, Ireland
| | - Ulrike May
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Stuart Prince
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - John Zwaagstra
- Human Health Therapeutics Research Centre, National Research Council Canada, Montreal, QC, Canada
| | | | - Tero A H Järvinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere University Hospital, Tampere, Finland
| | - Dimitrios I Zeugolis
- Regenerative, Modular and Developmental Engineering Laboratory (REMODEL) and Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway (NUI Galway), Galway, Ireland.,Regenerative, Modular and Developmental Engineering Laboratory (REMODEL), Charles Institute of Dermatology, Conway Institute of Biomolecular and Biomedical Research and School of Mechanical and Materials Engineering, University College Dublin (UCD), Dublin, Ireland
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Yamanaka Y, Tajima T, Tsujimura Y, Kosugi K, Mano Y, Zenke Y, Hachisuka A, Aoki T, Sakai A. Molecular and Clinical Elucidation of the Mechanism of Action of Steroids in Idiopathic Carpal Tunnel Syndrome. J Bone Joint Surg Am 2021; 103:1777-1787. [PMID: 34398862 DOI: 10.2106/jbjs.20.02096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Carpal tunnel steroid injection is a nonoperative intervention for the treatment for idiopathic carpal tunnel syndrome (CTS). The antifibrotic, anti-inflammatory, and antiedematous properties of steroids account for their therapeutic effects in the context of CTS; however, their relative contribution has not been clarified. METHODS Fibroblasts from subsynovial connective tissues (SSCT) were intraoperatively collected from patients with idiopathic CTS and were incubated with or without the steroid triamcinolone acetonide (TA) for 1, 3, and 7 days; the expression of fibrosis-related genes and inflammatory cytokines was evaluated using quantitative reverse transcription-polymerase chain reaction. A clinical prospective study was conducted with patients who received carpal tunnel TA injections. We performed clinical and electrophysiological evaluations before and 1, 3, and 5 months after TA injection; and we compared the median nerve, flexor tendon, and SSCT areas and the median nerve flattening ratio before and 1 month after TA injection using 3-T magnetic resonance imaging (MRI). RESULTS TA induced downregulation of the fibrosis-related genes Col1A1 (collagen type I alpha 1 chain), Col1A2, and Col3A1 but not the inflammation-related genes. The nerve flattening ratio did not change after TA injection according to the MRI-based observation of the median nerve, flexor tendon, and SSCT areas. CONCLUSIONS The therapeutic effects of injected TA are apparently mediated by its antifibrotic rather than its anti-inflammatory and antiedematous properties. TA probably alters the properties but not the morphology of SSCT. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Takafumi Tajima
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshitaka Tsujimura
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kenji Kosugi
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yosuke Mano
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yukichi Zenke
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Takatoshi Aoki
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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9
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Slater RR. What Actually Happens After One Injects a Steroid into the Carpal Tunnel of a Patient?: Commentary on an article by Yoshiaki Yamanaka, MD, PhD, et al.: "Molecular and Clinical Elucidation of the Mechanism of Action of Steroids in Idiopathic Carpal Tunnel Syndrome". J Bone Joint Surg Am 2021; 103:e78. [PMID: 34612852 DOI: 10.2106/jbjs.21.00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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10
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Lo IN, Hsu PC, Huang YC, Yeh CK, Yang YC, Wang JC. Dynamic Ultrasound Assessment of Median Nerve Mobility Changes Following Corticosteroid Injection and Carpal Tunnel Release in Patients With Carpal Tunnel Syndrome. Front Neurol 2021; 12:710511. [PMID: 34512520 PMCID: PMC8432503 DOI: 10.3389/fneur.2021.710511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/14/2021] [Indexed: 12/31/2022] Open
Abstract
Decreased median nerve (MN) mobility was found in patients with carpal tunnel syndrome (CTS) and was inversely associated with symptom severity. It is unclear whether MN mobility can be restored with interventions. This study compared the changes in MN mobility and clinical outcomes after interventions. Forty-six patients with CTS received an injection (n = 23) or surgery (n = 23). Clinical outcomes [Visual Analogue Scale; Boston Carpal Tunnel Questionnaire (BCTQ), which includes the Symptom Severity Scale and Functional Status Scale; median nerve cross-sectional area; and dynamic ultrasound MN mobility parameters (amplitude, and R2 value and curvature of the fitted curves of MN transverse sliding)] were assessed at baseline and 12 weeks after the interventions. At baseline, the BCTQ-Functional Status Scale and median nerve cross-sectional area showed significant inter-treatment differences. At 12 weeks, both treatments had significant improvements in BCTQ-Symptom Severity Scale and Visual Analogue Scale scores and median nerve cross-sectional area, but with greater improvements in BCTQ-Functional Status Scale scores observed in those who received surgery than in those who received injections. MN mobility was insignificantly affected by both treatments. The additional application of dynamic ultrasound evaluation may help to discriminate the severity of CTS initially; however, its prognostic value to predict clinical outcomes after interventions in patients with CTS is limited.
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Affiliation(s)
- I-Ning Lo
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, National Yang-Ming University, Taipei, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chao Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Orthopaedics, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
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11
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Treviño-Villarreal JH, Reynolds JS, Langston PK, Thompson A, Mitchell JR, Franco RA. Down-Regulation of a Profibrotic Transforming Growth Factor-β1/Cellular Communication Network Factor 2/Matrix Metalloprotease 9 Axis by Triamcinolone Improves Idiopathic Subglottic Stenosis. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1412-1430. [PMID: 34111429 DOI: 10.1016/j.ajpath.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
Idiopathic subglottic stenosis (iSGS) is a progressive fibrotic disease characterized by life-threatening airway narrowing. Although the molecular underpinnings are unknown, previous reports showing that subglottic serial intralesional steroid injections (SILSIs) improve clinical outcomes suggest a steroid-sensitive pathway in iSGS. Herein, a prospective study was conducted to determine the changes in profibrotic markers during SILSI to identify steroid-sensitive profibrotic drivers. Seven newly diagnosed patients with iSGS were recruited for SILSI. Subglottic biopsies before and after SILSI treatments were evaluated for histologic and molecular markers by confocal microscopy and RT-qPCR. At baseline, iSGS subglottises contained abundant vimentin-positive/α-smooth muscle actin-negative fibroblasts, intermingled with a matrix of fibronectin and types I and VI collagen. Transforming growth factor (TGF)-β1 was up-regulated primarily in glandular epithelium. Cellular communication network factor 2 (CCN2) was mainly up-regulated in stromal fibroblasts surrounding TGF-β1-positive glandular structures. SILSI improved iSGS by reducing fibroblast infiltration and increasing matrix remodeling. Mechanistically, SILSI counteracted the effects of TGF-β1 by inducing matrix metalloprotease 9 (MMP9) expression while repressing CCN2 expression, without affecting TGFβ1 levels. Treatment of primary iSGS-derived fibroblasts with TGF-β1 recapitulated aspects of the disease in vivo, demonstrating that the induction in CCN2 and repression of MMP9 are caused by changes in histone acetylation induced by TGF-β1. Triamcinolone counteracted the coregulation of these genes by impairing SMAD2/3 binding to promoter regions, and not through histone acetylation. In conclusion, this study shows that SILSI counteracts a dysregulated TGF-β1/CCN2/MMP9 axis involved in iSGS development.
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Affiliation(s)
| | - Justin S Reynolds
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - P Kent Langston
- Department of Immunology, Harvard Medical School and Evergrande Center for Immunologic Diseases, Harvard Medical School, Boston, Massachusetts
| | - Andrew Thompson
- Dana Farber Cancer Institute/Harvard Medical School Rodent Histopathology Core Facility, Harvard Medical School, Boston, Massachusetts
| | - James R Mitchell
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ramon A Franco
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Laryngology, Department of Otolaryngology, Mass Eye and Ear and Harvard Medical School, Boston, Massachusetts.
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