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Tissue Remodeling After Implantation with Polymethylmethacrylate: An Experimental Study in Mice

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  • Basic Science/Experimental
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Abstract

Polymethylmethacrylate (PMMA) is a filler used for aesthetic and/or repair purposes. The response to the implantation of biomaterials varies according to factors related to the patient, the professional responsible for the application and the material used. In vitro and in vivo experimental models have been used to study aspects such as the organism/biomaterial interface and the role of macrophages, dendritic cells and neutrophils. This study aimed to characterize the inflammatory reactions related to polymer concentration, implantation depth and exposure time. Different concentrations of PMMA were implanted in different anatomical planes in mice. The consequences of contact with PMMA, from structural changes to the inflammatory characteristic of tissue damage, were histologically evaluated. The implantation interfered in the morphological structure of the region where it was implanted, expanding it and due to the inflammatory reaction generated, by the presence of the vehicle in the initial phase and by the collagen produced in the chronic phase. The 30% concentration of PMMA induced a greater presence of foreign body giant cells both subcutaneously, at 7, 30 and 90 days after implantation (DAI), and intramuscular at 30DAI. Tissue remodeling was more expressive in the subcutaneous region with significant density of the extracellular matrix at 90DAI. In conclusion, the foreign body reaction resulting from the implantation process acquires different characteristics depending on the anatomical plane and the concentration of implanted product, where the more superficial the implantation plane, the greater the inflammatory reaction. Moreover, PMMA concentration and the depth of implantation did not influence the collagen production.

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References

  1. Ali U, Karim KJBA, Buang NA (2015) A review of the properties and applications of poly (Methylmethacrylate) (PMMA). Polym Rev 55:678–705

    Article  CAS  Google Scholar 

  2. Abdo Filho RCC, Oliveira TM, Lourenço Neto N et al (2011) Reconstruction of bony facial contour deficiencies with polymethylmethacrylate implants: case report. J Appl Oral Sci 19:426–430

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kwarcinski J, Boughton P, Ruys A et al (2017) Cranioplasty and craniofacial reconstruction: a review of implant material, manufacturing method and infection risk. Appl Sci 7:276

    Article  Google Scholar 

  4. Milhomem AC, de Jorge IMS, da Costa EL et al (2020) Polymethylmethacrylate (PMMA) in the treatment of a case of hemifacial microsomia. Aesthetic Surg J Open Forum 2:1–5

    Article  Google Scholar 

  5. Jones D (2005) HIV facial lipoatrophy: causes and treatment options. Dermatol Surg 31:1519–1529

    Article  CAS  PubMed  Google Scholar 

  6. Sun HL, Li CD, Yang ZC et al (2016) Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis. Beijing Da Xue Xue Bao 48:1019–1025

    CAS  PubMed  Google Scholar 

  7. Xu X, He L, Zhu B et al (2017) Advances in polymeric materials for dental applications. Polym Chem 8:807–823

    Article  CAS  Google Scholar 

  8. Grzybowski A, Wasinska-Borowiec W, Alio JL et al (2017) Intraocular lenses in age-related macular degeneration. Graefe’s Arch Clin Exp Ophthalmol 255:1687–1696

    Article  Google Scholar 

  9. Casavantes L, Lemperle G, Morales P (2016) Penile girth enhancement with Polymethylmethacrylate-based soft tissue fillers. J Sex Med 13:1414–1422

    Article  PubMed  Google Scholar 

  10. Romero-Otero J, Manfredi C, Ralph D et al (2021) Non-invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review. BJU Int 127:269–291

    Article  PubMed  Google Scholar 

  11. McCarthy CM, VanLaeken N, Lennox P et al (2010) The efficacy of Artecoll injections for the augmentation of nipple projection in breast reconstruction. Eplasty 10:e7

    PubMed  PubMed Central  Google Scholar 

  12. Lemperle G, Knapp TR, Sadick NS et al (2010) ArteFill® permanent injectable for soft tissue augmentation: I. Mechanism of action and injection techniques. Aesthetic Plast Surg 34:264–272

    Article  PubMed  Google Scholar 

  13. Lemperle G, Knapp TR, Sadick NS et al (2010) ArteFill® permanent injectable for soft tissue augmentation: II. Indications and applications. Aesthetic Plast Surg 34:273–286

    Article  PubMed  Google Scholar 

  14. Solomon P, Sklar M, Zener R (2012) Facial soft tissue augmentation with Artecoll®: a review of eight years of clinical experience in 153 patients. Can J Plast Surg 20:28–32

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li D, Luo S-K, Wang Y-C et al (2017) Facial volume restoration with permanent dermal filler (Artecoll-4) in Chinese women. Facial Plast Surg 33:537–544

    Article  CAS  PubMed  Google Scholar 

  16. Solomon P, Ng CL, Kerzner J et al (2021) Facial soft tissue augmentation with bellafill: a review of 4 years of clinical experience in 212 patients. Plast Surg (Oakv) 29:98–102

    Article  PubMed  Google Scholar 

  17. Klopfleisch R, Jung F (2017) The pathology of the foreign body reaction against biomaterials. J Biomed Mater Res Part A 105:927–940

    Article  CAS  Google Scholar 

  18. Veiseh O, Vegas AJ (2019) Domesticating the foreign body response: recent advances and applications. Adv Drug Deliv Rev 144:148–161

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Franz S, Rammelt S, Scharnweber D et al (2011) Immune responses to implants—a review of the implications for the design of immunomodulatory biomaterials. Biomaterials 32:6692–6709

    Article  CAS  PubMed  Google Scholar 

  20. De Boulle K, Heydenrych I (2015) Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clin Cosmet Investig Dermatol 8:205–214

    Article  PubMed  PubMed Central  Google Scholar 

  21. Montealegre G, Uribe R, Martínez-Ceballos MA et al (2021) ASIA syndrome symptoms induced by gluteal biopolymer injections: case-series and narrative review. Toxicol Rep 8:303–314

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lemperle G (2018) Biocompatibility of injectable microspheres. Biomed J Sci Tech Res 2:2296–2306

    Google Scholar 

  23. Lemperle G, Gauthier-Hazan N, Wolters M et al (2009) Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes. Plast Reconstr Surg 123:1842–1863

    Article  CAS  PubMed  Google Scholar 

  24. Carlos-Fabuel L, Marzal-Gamarra C, Martí-Álamo S et al (2012) Foreign body granulomatous reactions to cosmetic fillers. J Clin Exp Dent 4:e244

    Article  PubMed  PubMed Central  Google Scholar 

  25. Paulucci BP (2020) PMMA safety for facial filling: review of rates of granuloma occurrence and treatment methods. Aesthetic Plast Surg 44:148–159

    Article  PubMed  Google Scholar 

  26. DeLorenzi C (2013) Complications of injectable fillers Part I. Aesthetic Surg J 33:561–575

    Article  Google Scholar 

  27. Alijotas-Reig J, Fernández-Figueras MT, Puig L (2013) Late-onset inflammatory adverse reactions related to soft tissue filler injections. Clin Rev Allergy Immunol 45:97–108

    Article  CAS  PubMed  Google Scholar 

  28. Funt D, Pavicic T (2013) Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol 6:295–316

    PubMed  PubMed Central  Google Scholar 

  29. Haneke E (2019) Adverse effects of fillers. Dermatol Ther 32:e12676

    Article  PubMed  Google Scholar 

  30. Costa EL, Milhomem AC, De Moura Filho RM et al (2016) Polymethyl methacrylate (Linnea Safe) causes local inflammatory response after intramuscular implant in BALB/c mice but it is not observed in distant organs. J Bras Patol e Med Lab 52:400–406

    CAS  Google Scholar 

  31. d’Eça NR, Herdt MA, Wohlgemuth FB et al (2012) Possible migration and histopathological analysis of injections of Polymethylmethacrylate in Wistar rats. ISRN Dermatol 2012:1–9

    Google Scholar 

  32. Lemperle G, Morhenn VB, Pestonjamasp V et al (2004) Migration studies and histology of injectable microspheres of different sizes in mice. Plast Reconstr Surg 113:1380–1390

    Article  PubMed  Google Scholar 

  33. Jhunjhunwala S, Aresta-DaSilva S, Tang K et al (2015) Neutrophil responses to sterile implant materials. PLoS ONE 10:e0137550

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jesus LH, Hildebrand LC, Martins MD et al (2015) Location of injected polymethylmethacrylate microspheres influences the onset of late adverse effects: an experimental and histopathologic study. Clin Cosmet Investig Dermatol 8:431–436

    Article  PubMed  PubMed Central  Google Scholar 

  35. Moure SP, De Vargas KF, Borghetti RL et al (2012) Clinical and pathological characteristics of polymethylmethacrylate and hyaluronic acid in the rat tongue. Int J Oral Maxillofac Surg 41:1296–1303

    Article  CAS  PubMed  Google Scholar 

  36. Hubrecht RC, Carter E (2019) The 3Rs and humane experimental technique: implementing change. Animals (Basel) 9(10):754. https://doi.org/10.3390/ani9100754

    Article  PubMed  Google Scholar 

  37. Christo SN, Diener KR, Bachhuka A et al (2015) Innate immunity and biomaterials at the nexus: friends or foes. Biomed Res Int 2015:342604

    Article  Google Scholar 

  38. Brooks PJ, Glogauer M, McCulloch CA (2019) An overview of the derivation and function of multinucleated giant cells and their role in pathologic processes. Am J Pathol 189:1145–1158

    Article  CAS  PubMed  Google Scholar 

  39. Miron RJ, Bosshardt DD (2018) Multinucleated giant cells: good guys or bad guys? Tissue Eng Part B Rev 24:53–65

    Article  PubMed  Google Scholar 

  40. Dondossola E, Holzapfel BM, Alexander S et al (2016) Examination of the foreign body response to biomaterials by nonlinear intravital microscopy. Nat Biomed Eng 1:0007

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was funded by Company Bioplasty Brasil—Protocol No. 01/2017; Coordination for the Improvement of Higher Education Personnel—Brazil (CAPES)—Protocol Number: 88882.461654/2019-01.

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Authors and Affiliations

  1. Tropical Medicine and Public Health Post-graduation programme, Tropical Pathology and Public Health Institute, Federal University of Goias, Goiania, Goias, Brazil

    Anália Cirqueira Milhomem, Isabella Mendes de Souza Jorge, Felipe dos Santos Arruda & Fernanda Dias Tomé

  2. Bioplastia Brasil, Goiania, Goias, Brazil

    Eduardo Luiz da Costa

  3. Tropical Pathology and Public Health Institute, Federal University of Goias, Rua 235 s/n, Setor Leste Universitário, Goiania, Goias, CEP: 74605-050, Brazil

    Marina Clare Vinaud, Jonathas Xavier Pereira & Ruy de Souza Lino Júnior

Authors
  1. Anália Cirqueira Milhomem
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  2. Isabella Mendes de Souza Jorge
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  3. Felipe dos Santos Arruda
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  4. Fernanda Dias Tomé
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  5. Eduardo Luiz da Costa
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  6. Marina Clare Vinaud
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  8. Ruy de Souza Lino Júnior
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Correspondence to Ruy de Souza Lino Júnior.

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Human and animal rights

Animal rights were completely respected and this study followed the regulations of the ethical committee in animal use, approval protocol number 027/2017 (CEUA/UFG).

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Milhomem, A.C., de Souza Jorge, I.M., dos Santos Arruda, F. et al. Tissue Remodeling After Implantation with Polymethylmethacrylate: An Experimental Study in Mice. Aesth Plast Surg 47, 1205–1216 (2023). https://doi.org/10.1007/s00266-022-03179-w

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  • DOI: https://doi.org/10.1007/s00266-022-03179-w

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