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000163679 1001_ $$aDiehm, Yannick F$$b0
000163679 245__ $$aThe Treatment of Capsular Contracture Around Breast Implants Induced by Fractionated Irradiation: The Collagenase of the Bacterium Clostridium Histolyticum as a Novel Therapeutic Approach.
000163679 260__ $$aBerlin$$bSpringer$$c2021
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000163679 520__ $$aIrradiation therapy limits the utilization of silicone implants for breast reconstruction due to a significant risk for capsular contracture. The injection of the collagenase of the bacterium Clostridium histolyticum (CCH) might trivialize this risk by providing a minimal-invasive treatment option by capsular contracture degradation. However, efficacy in degrading breast implant capsules induced by fractionated irradiation remains unclear.Twenty-four rats in three groups received miniature silicone implants in a submuscular pocket. After 3D dose calculation and treatment field definition, rats of two groups underwent fractionated radiotherapy (6 × 8 Gy) using a linear accelerator. A third group served as control. On day 120, one irradiated group received injections of 0.3 mg/ml collagenase. Administration of plain solvent solution served as control in the two other groups. Outcome parameters included CT-imaging, histology, vessel wall analysis, immunohistochemistry, chemical collagen quantification and gene expression analysis.Fractioned irradiation leads to a significant increase in collagen deposition around silicone implants with higher capsule thickness and collagen density when comparing all groups. Additionally, significant alterations of collagen fiber deposition were evident. Vessel wall thickness was significantly increased after radiotherapy. The injection of collagenase led to a significant reduction of capsule thickness, collagen density and content. However, the collagenase application induced a significant overexpression of TGFβ1. No side effects were monitored.The CCH proved to be a safe and effective approach to degrade capsule tissue induced by fractionated irradiation in an animal model. This may pave its way for clinical application in implant-based breast reconstruction patients.This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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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000163679 7001_ $$aJost, Yanic$$b1
000163679 7001_ $$aKotsougiani-Fischer, Dimitra$$b2
000163679 7001_ $$aHaug, Valentin$$b3
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000163679 7001_ $$0P:(DE-HGF)0$$aHäring, Peter$$b5
000163679 7001_ $$0P:(DE-He78)7e60033e3eaaebb9ba30c905ade4a676$$aBerger, Martin R$$b6$$udkfz
000163679 7001_ $$aDebus, Jürgen$$b7
000163679 7001_ $$aKneser, Ulrich$$b8
000163679 7001_ $$00000-0003-3445-1902$$aFischer, Sebastian$$b9
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