The Effects and Mechanisms of Botulinum Toxin Type A on Hypertrophic Scars and Keloids.

IF 2 3区医学 Q2 SURGERY

Aesthetic Plastic Surgery Pub Date : 2025-06-10 DOI:10.1007/s00266-025-04945-2

Yeheng Lu, Yuyan Pan, Junhao Zeng, Fazhi Qi

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引用次数: 0

Abstract

Background: Keloids and hypertrophic scars are characterized by pathologically excessive dermal fibrosis and aberrant wound healing. These pathological scars are characterized by continuous and histologically localized inflammation of the reticular dermis. Although several treatments have been used for hypertrophic scar and keloid, there is still no consensus and for the majority of patients, management is driven by individual clinical experience. Injection of intralesional botulinum toxin type A (BTX) was more effective in the treatment of hypertrophic scar and keloid than injection of placebo. However, little is known about the mechanism of BTX in the treatment of hypertrophic scar and keloid.

Methods: We used mice wound healing model to track the response of fibrous repair. The histological changes of the fibrous repair were measured by H&E, Masson and immunohistochemical staining. The quantitative analysis macrophages and angiogenesis were measured by immunohistochemical staining. The expression of Th1- and Th2-associated cytokines was measured by qPCR. We also measured oxoglutarate dehydrogenase (OGDH) and pyruvate dehydrogenase (PDH) activity, OGDH positive cells and mRNA used enzyme activity assay kits, immunohistochemical staining and qPCR, respectively.

Results: We discovered that BTX injection disrupted wound healing and fibrous repair, and reduced M1 macrophages infiltration and M2 macrophages polarization, while increased total macrophages number. BTX injection reduced Il1b, Il6 and TNF-alpha mRNA level, and induced Il13 and Il4 mRNA level. BTX injection reduced OGDH activity.

Conclusions: BTX alter the pattern of immunometabolism that change the phenotype of macrophages, which inhibits keloids and hypertrophic scars.

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

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A型肉毒毒素对增生性疤痕和瘢痕疙瘩的作用及其机制。

背景：瘢痕疙瘩和增生性疤痕的特点是病理上过度的真皮纤维化和异常的伤口愈合。这些病理性疤痕的特点是网状真皮的持续和组织学上的局部炎症。尽管已有几种治疗方法用于治疗增生性瘢痕和瘢痕疙瘩，但仍未达成共识，对大多数患者而言，治疗取决于个人临床经验。病灶内注射A型肉毒毒素（BTX）治疗增生性瘢痕和瘢痕疙瘩比注射安慰剂更有效。然而，对BTX治疗增生性瘢痕和瘢痕疙瘩的机制知之甚少。方法：采用小鼠创面愈合模型，追踪纤维修复反应。采用H&E、Masson、免疫组化染色检测纤维修复体的组织学变化。定量分析免疫组化染色检测巨噬细胞和血管生成。qPCR检测Th1-和th2相关细胞因子的表达。采用酶活性测定试剂盒、免疫组化染色和qPCR分别检测OGDH和PDH活性、OGDH阳性细胞和mRNA。结果：我们发现BTX注射破坏伤口愈合和纤维修复，减少M1巨噬细胞浸润和M2巨噬细胞极化，增加巨噬细胞总数。注射BTX可降低Il1b、Il6、tnf - α mRNA水平，诱导Il13、Il4 mRNA水平升高。BTX注射降低OGDH活性。结论：BTX改变免疫代谢模式，改变巨噬细胞表型，抑制瘢痕疙瘩和增生性疤痕。证据等级iii：本刊要求作者为每篇文章指定证据等级。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。

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来源期刊

Aesthetic Plastic Surgery 医学-外科

CiteScore

4.40

自引率

25.00%

发文量

479

审稿时长

3 months

期刊介绍： Aesthetic Plastic Surgery is a publication of the International Society of Aesthetic Plastic Surgery and the official journal of the European Association of Societies of Aesthetic Plastic Surgery (EASAPS), Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica (SICPRE), Vereinigung der Deutschen Aesthetisch Plastischen Chirurgen (VDAPC), the Romanian Aesthetic Surgery Society (RASS), Asociación Española de Cirugía Estética Plástica (AECEP), La Sociedad Argentina de Cirugía Plástica, Estética y Reparadora (SACPER), the Rhinoplasty Society of Europe (RSE), the Iranian Society of Plastic and Aesthetic Surgeons (ISPAS), the Singapore Association of Plastic Surgeons (SAPS), the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), the Egyptian Society of Plastic and Reconstructive Surgeons (ESPRS), and the Sociedad Chilena de Cirugía Plástica, Reconstructiva y Estética (SCCP). Aesthetic Plastic Surgery provides a forum for original articles advancing the art of aesthetic plastic surgery. Many describe surgical craftsmanship; others deal with complications in surgical procedures and methods by which to treat or avoid them. Coverage includes "second thoughts" on established techniques, which might be abandoned, modified, or improved. Also included are case histories; improvements in surgical instruments, pharmaceuticals, and operating room equipment; and discussions of problems such as the role of psychosocial factors in the doctor-patient and the patient-public interrelationships. Aesthetic Plastic Surgery is covered in Current Contents/Clinical Medicine, SciSearch, Research Alert, Index Medicus-Medline, and Excerpta Medica/Embase.