Role of mechanical and thermal damage in pericapsular inflammatory response to injectable silicone in a rabbit model

PLoS One. 2019 May 14;14(5):e0216926. doi: 10.1371/journal.pone.0216926. eCollection 2019.

Abstract

Silicone is used widely for tissue augmentation in humans. However, late complications, such as delayed inflammation and capsular contracture, remain uncharacterized, despite their importance. In the present study, we aimed to determine whether mechanical and thermal damage induce capsular inflammation around a foreign body, and elucidate the biological mechanism underlying this phenomenon. We injected silicone into the subcutaneous layer of the skin of New Zealand white rabbits. The rabbits were divided into two groups: the control group received no treatment; in the experimental group, external force was applied near the injection silicone using high-intensity focused ultrasound (HIFU). Tissues near the injected silicone were harvested from both groups on Days 4, 7, and 30 after HIFU treatment for comparative analysis. Visual and histological examinations showed clearly increased inflammation in the experimental group compared with that in the control group. Furthermore, capsular tissue from the experimental group displayed markedly increased collagen production. Immunofluorescence revealed marked activation of macrophages in the early stages of inflammation (Days 4 and 7 after HIFU treatment), which decreased on Day 30. Assessment of cytokine activation showed significantly increased expression of heat shock protein (HSP)27, HSP60, HSP70, toll-like receptor (TLR)2, TLR4, and interleukin-8 in the experimental group. The expression of transforming growth factor-β1 did not increase significantly in the experimental group. In conclusion, damage to tissues around the injected silicone induced capsular inflammation. Macrophages and damage-associated molecular pattern molecules were involved in the early stages of inflammation. HSP release activated TLRs, which subsequently activated innate immunity and induced the inflammatory response.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Biomarkers / metabolism
  • Biomechanical Phenomena
  • Chaperonin 60 / genetics
  • Chaperonin 60 / immunology
  • Female
  • Gene Expression / drug effects
  • Gene Expression / radiation effects
  • HSP27 Heat-Shock Proteins / genetics
  • HSP27 Heat-Shock Proteins / immunology
  • HSP70 Heat-Shock Proteins / genetics
  • HSP70 Heat-Shock Proteins / immunology
  • Humans
  • Implant Capsular Contracture / etiology
  • Implant Capsular Contracture / genetics
  • Implant Capsular Contracture / immunology
  • Implant Capsular Contracture / pathology*
  • Implants, Experimental*
  • Injections, Subcutaneous
  • Interleukin-8 / genetics
  • Interleukin-8 / immunology
  • Rabbits
  • Silicone Gels / administration & dosage
  • Silicone Gels / adverse effects*
  • Temperature
  • Toll-Like Receptor 2 / genetics
  • Toll-Like Receptor 2 / immunology
  • Toll-Like Receptor 4 / genetics
  • Toll-Like Receptor 4 / immunology
  • Ultrasonic Waves / adverse effects

Substances

  • Biomarkers
  • Chaperonin 60
  • HSP27 Heat-Shock Proteins
  • HSP70 Heat-Shock Proteins
  • Interleukin-8
  • Silicone Gels
  • Toll-Like Receptor 2
  • Toll-Like Receptor 4

Grants and funding

Dr. Joon Seok is generously funded by the “Health Fellowship Foundation”, Republic of Korea. Health Fellowship Foundation had no direct role in the study design, collection, analysis and interpretation of data; writing the report; or the final decision to submit the report for publication.