Immunogenicity a me nā hopena o ka hyaluronic acid fillers

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ʻO Agnieszka Owczarczyk-Saczonek, Natalia Zdanowska, Ewa Wygonowska, Waldemar Placek Keʻena o Dermatology, nā maʻi i hoʻouna ʻia i ke kāne a me nā maʻi maʻi maʻi, Warmia a me Mazury University ma Olsztyn, Polani Newsletter: Agnieszka Owczarczykzyk-Sacmitology, Keʻena ʻo Sexually Transmitted and Clinical Immunology. Ke Kulanui o Warmia a me Mazury, Olsztyn, Polani.Wojska Polskiego 30, Olsztyn, 10-229, PolishTel +48 89 6786670 Fax +48 89 6786641 Email [email protected] Abstract: Hyaluronic acid (HA) he glycosaminoglycan, he mea maoli o ka matrix extracellular.ʻO ke ʻano like o ka mole i loko o nā mea ola a pau kona pono nui no ka mea ʻoi aku ka liʻiliʻi o ka hiki ke hoʻololi ʻia i immunogenicity.No laila, ma muli o kona biocompatibility a me ka paʻa ʻana ma ka pūnaewele implantation, ʻo ia ka hoʻolālā kūpono loa e hoʻohana ʻia i mea hoʻopihapiha.Aia kēia ʻatikala i kahi kūkākūkā e pili ana i ke ʻano kumu o ka pane ʻino ʻole o HA, a me ke ʻano pane ma hope o ka hoʻopaʻa ʻana iā SARS-CoV-2.Wahi a ka moʻolelo, ua hoʻāʻo mākou e hoʻonohonoho i ka pane ʻino ʻole me nā hōʻike ʻōnaehana i HA.ʻO ka loaʻa ʻana o nā hopena i manaʻo ʻole ʻia i ka hyaluronic acid e hōʻike ana ʻaʻole hiki ke manaʻo ʻia he kūʻokoʻa a i ʻole allergenic.ʻO ka hoʻololi ʻana i ka hoʻolālā kemika HA, nā mea hoʻohui, a me ke ʻano o kēlā me kēia kanaka i nā maʻi ke kumu o nā hopena hiki ʻole ke ʻike ʻia, e alakaʻi ana i nā hopena olakino koʻikoʻi.ʻO ka hoʻomākaukau ʻana i ʻike ʻole ʻia, hoʻomaʻemaʻe maikaʻi ʻole, a i ʻole i loko o ka DNA bacteria he mea weliweli loa.No laila, he mea nui loa ka hahai ʻana i nā maʻi a me ke koho ʻana o ka FDA a i ʻole EMA i hoʻomākaukau ʻia.ʻAʻole ʻike pinepine ka poʻe maʻi i ka hopena o nā hana maʻalahi i hana ʻia e ka poʻe me ka ʻike ʻole i ka hoʻohana ʻana i nā huahana i hoʻopaʻa ʻole ʻia, no laila e hoʻonaʻauao ʻia ka lehulehu a hoʻokomo ʻia nā kānāwai a me nā lula.Hua'ōlelo: Hyaluronic acid, hoʻopiha, hoʻopaneʻe ʻia ka mumū, autoimmune/auto-inflammatory adjuvant-induced syndrome, SARS-CoV-2
ʻO ka Hyaluronic acid (HA) he glycosaminoglycan, kahi mea kūlohelohe o ka matrix extracellular.Hana ʻia ia e nā fibroblasts dermal, synovial cell, endothelial cell, smooth muscle cell, adventitia cell a me oocytes a hoʻokuʻu ʻia i loko o ka wahi extracellular a puni.1,2 ʻO ke ʻano hoʻokahi o nā molekala i loko o nā mea ola a pau kona pono nui, e pili ana me ka liʻiliʻi liʻiliʻi o ka immunogenicity.ʻO ka biocompatibility a me ka paʻa o ka pūnaewele implantation e lilo ia i kahi koho kūpono loa no ka moʻo hoʻopihapiha holoʻokoʻa.Ma muli o ka hoʻonui ʻia ʻana o ka ʻiʻo ma hope o ka injection a me ka hoʻāla ʻana o nā fibroblasts ʻili, loaʻa iā ia ka waiwai nui o ka hiki ke hoʻoulu i ka hana ʻana o ka collagen hou.ʻO 2-4 Hyaluronic acid he hydrophilic nui, loaʻa nā hiʻohiʻona kūikawā o ka hoʻopaʻa ʻana i nā molekala wai (ʻoi aku ma mua o 1000 mau manawa i kona kaumaha ponoʻī), a hana i kahi conformation lōʻihi me ka nui nui i hoʻohālikelike ʻia i ke kaumaha.Hiki iā ia ke hana i ka condensation ma nā haʻahaʻa haʻahaʻa loa.kāpili.He mea ia e hoʻomaʻemaʻe koke ai nā ʻiʻo a hoʻonui i ka nui o ka ʻili.3,5,6 Eia kekahi, hiki i ka hoʻomaʻemaʻe ʻana i ka ʻili a me ka hiki antioxidant o ka hyaluronic acid ke hoʻoikaika i ka hoʻoulu hou ʻana o ka ʻili a hoʻoulu i ka hana collagen.5
I loko o nā makahiki, ua ʻike ʻia ke kaulana o nā kaʻina hana hoʻonaninani me ka hoʻohana ʻana i nā mea e like me HA e hoʻomau i ka hoʻonui.Wahi a ka ʻikepili mai ka International Society of Aesthetic Plastic Surgery (ISAPS), ʻoi aku ma mua o 4.3 miliona mau kaʻina hana hoʻonaninani i hana ʻia me ka hoʻohana ʻana i ka HA ma 2019, kahi piʻi o 15.7% i hoʻohālikelike ʻia me 2018. Ua hōʻike ka American Society of Dermatology (ASDS) ua hana nā dermatologists i 2.7 miliona dermal filler injections i ka makahiki 2019. 8 ʻO ka hoʻokō ʻana i ia mau kaʻina hana ke lilo nei i mea waiwai loa o ka hana uku.No laila, ma muli o ka nele o nā kānāwai a me nā hoʻoponopono i nā ʻāina/'āpana he nui, ʻoi aku ka nui o nā poʻe e hāʻawi i ia mau lawelawe, maʻamau me ka ʻole o ke aʻo ʻana a i ʻole nā ​​​​kuleana kūpono.Eia kekahi, aia nā papa hoʻokūkū ma ka mākeke.He ʻoi aku ka liʻiliʻi, ʻoi aku ka haʻahaʻa, a ʻaʻole i ʻae ʻia e ka FDA a i ʻole EMA, kahi kumu pilikia no ka hoʻomohala ʻana i nā ʻano hopena ʻino.Wahi a kahi noiʻi i hana ʻia ma Belgium, ʻo ka hapa nui o nā 14 i manaʻo ʻia i nā laʻana hewa ʻole i hoʻāʻo ʻia he ʻoi aku ka liʻiliʻi o nā huahana ma mua o ka mea i hōʻike ʻia ma ka ʻeke.9 Nui nā ʻāina i nā ʻāpana hina o nā kaʻina hana hoʻonaninani ʻole.Eia kekahi, ʻaʻole i hoʻopaʻa inoa ʻia kēia mau kaʻina hana a ʻaʻohe ʻauhau e uku ʻia.
No laila, nui nā hōʻike o nā hanana ʻino i ka palapala.ʻO kēia mau hanana ʻino e alakaʻi pinepine i nā maʻi maʻi a me nā pilikia lapaʻau a me nā hopena i manaʻo ʻole ʻia no nā maʻi.7,8 He mea nui loa ka hypersensitivity i ka hyaluronic acid.ʻAʻole i wehewehe piha ʻia ka pathogenesis o kekahi mau hopena, no laila ʻaʻole like nā huaʻōlelo i loko o ka palapala, a ʻaʻole i hoʻokomo ʻia nā manaʻo he nui i ka mālama ʻana i nā pilikia.10,11
Aia kēia ʻatikala i nā ʻikepili mai ka loiloi puke.E ʻike i nā ʻatikala loiloi ma ka ʻimi ʻana iā PubMed me ka hoʻohana ʻana i kēia mau ʻōlelo: hyaluronic acid, fillers, a me nā hopena ʻaoʻao.Ke hoʻomau nei ka ʻimi a hiki i Malaki 30, 2021. Loaʻa 105 ʻatikala a nānā ʻia he 42 o lākou.
ʻAʻole ʻo ka hyaluronic acid ka mea kikoʻī, no laila hiki ke manaʻo ʻia ʻaʻole ia he hopena maʻi.12 Eia naʻe, he mea nui e hoʻomanaʻo i ka mea i hoʻokomo ʻia i loko o nā mea hoʻohui, a loaʻa ka hyaluronic acid ma o ka biosynthesis bacteria.
Ua hōʻike pū ʻia e hiki i kēlā me kēia mea ke alakaʻi i ka pilikia o ka lohi, immune-mediated adverse reactions pili me nā dermal fillers i nā maʻi e lawe ana i nā haplotypes HLA-B*08 a me DR1*03.Hoʻopili ʻia kēia hui ʻana o nā subtypes HLA me ka piʻi ʻana o ʻehā mau piʻi o ka hopena o nā hopena ʻino (OR 3.79).13
Aia ka hyaluronic acid ma ke ʻano o nā multiparticulates, maʻalahi kona hoʻolālā, akā he biomolecule multifunctional.Hoʻopili ka nui o HA i ka hopena ʻē aʻe: hiki ke loaʻa iā ia nā waiwai pro-inflammatory a i ʻole anti-inflammatory, hoʻoikaika a keʻakeʻa paha i ka neʻe ʻana o ke kelepona, a hoʻāla a hoʻōki i ka māhele cell a me ka ʻokoʻa.14-16 Minamina, ʻaʻohe manaʻo kuʻikahi ma ka māhele ʻana o HA.Ka hua'ōlelo no ka nui mole.14,16,17
I ka hoʻohana ʻana i nā huahana HMW-HA, pono e hoʻomanaʻo i ka hyaluronidase kūlohelohe e hoʻoulu i kona degradation a hāpai i ka hoʻokumu ʻana o LMW-HA.Hoʻokaʻawale ʻo HYAL2 (i hoʻopaʻa ʻia ma ka membrane cell) kiʻekiʻe molecular kaumaha HA (>1 MDa) i loko o 20 kDa mau ʻāpana.Eia hou, inā hoʻomaka ka hypersensitivity HA, e hoʻonui ka mumū i kona hōʻino hou (Figure 1).
I ka hihia o nā huahana HA, aia kekahi mau ʻokoʻa i ka wehewehe ʻana o ka nui mole.No ka laʻana, no ka hui o nā huahana Juvederm (Allergan), ua manaʻo ʻia nā molekala> 500 kDa LMW-HA, a me> 5000 kDa - HMW-HA.E pili ana ia i ka hoʻomaikaʻi ʻana i ka palekana o ka huahana.18
I kekahi mau hihia, hiki i ke kaumaha molekala ha'aha'a (LMW) HA ke ho'oulu i ka hypersensitivity 14 (Figure 2).Ua manaʻo ʻia he mole pro-inflammatory.Loaʻa ia i loko o nā wahi catabolism kino ikaika, no ka laʻana, ma hope o ka hōʻeha, hoʻoulu ia i ka mumū ma o ka hoʻopili ʻana i nā mea hoʻokipa Toll-like (TLR2, TLR4).14-16,19 Ma kēiaʻano, hoʻolaha ka LMW-HA i ka hoʻouluʻana a me ka uluʻana o nā pūnaewele dendritic (DC), a hoʻoulu i nāʻano pūnaewele likeʻole e hana i nā cytokines pro-inflammatory, e like me IL-1β, IL-6, IL-12 , TNF-α a me TGF-β, e hoʻomalu i ka'ōlelo o nā chemokines a me ka neʻeʻana o nā pūnaewele.Hiki i ka 14,17,20 LMW-HA ke hana ma ke ʻano he kumu hoʻohālike molekala pili i ka pōʻino (DAMP) no ka hoʻomaka ʻana i nā mīkini pale kūlohelohe, e like me nā protein bacterial a i ʻole nā ​​​​protein haʻalulu wela.14,21 CD44 lawelawe ma ke ʻano he ʻano o ka ʻike kumu hoʻokipa no LMW-HA.Aia ia ma ka ʻili o nā pūnaewele kanaka āpau a hiki ke launa pū me nā ligand ʻē aʻe e like me osteopontin, collagen, a me matrix metalloproteinases (MMP).14,16,17.
Ma hope o ka emi ʻana o ka mumū a hoʻopau ʻia nā koena o ka ʻiʻo i hōʻino ʻia e nā macrophages, hoʻoneʻe ʻia ka mole LMW-HA e ka endocytosis hilinaʻi CD44.ʻO ka ʻokoʻa, pili ka mumū mau loa me ka piʻi ʻana o ka nui o LMW-HA, no laila hiki ke manaʻo ʻia he biosensors kūlohelohe o ke kūlana kūpaʻa o ka ʻiʻo.14,20,22,23 Ua hōʻike ʻia ke kuleana o ka mea hoʻokipa CD44 o HA i nā haʻawina e pili ana i ka hoʻoponopono ʻana o ka mumū ma lalo o nā kūlana vivo.I loko o nā kiʻi ʻiole o ka dermatitis atopic, hoʻopaʻa ʻia ka anti-CD44 i ka ulu ʻana o nā kūlana e like me ka collagen-induced arthritis a i ʻole ka pōʻino ʻili.iwakāluakūmāhā
He mea maʻamau ke kaumaha molekala kiʻekiʻe (HMW) HA i nā ʻiʻo paʻa.Kāohi ia i ka hana ʻana o nā mea hoʻolaha pro-inflammatory (IL-1β, IL-8, IL-17, TNF-α, metalloproteinases), hoʻemi i ka hōʻike TLR a hoʻoponopono i ka angiogenesis.Hoʻopilikia pū ka 14,19 HMW-HA i ka hana o nā macrophages kuleana no ka hoʻoponopono ʻana ma o ka hoʻoulu ʻana i kā lākou hana anti-inflammatory e hoʻomaikaʻi ai i ka mumū kūloko.15,24,25
ʻO ka nui o ka hyaluronic acid i loko o ke kanaka he 70 kg e pili ana i 15 grams, a ʻo ka awelika o ka huli ʻana he 5 grams i kēlā me kēia lā.Ma kahi o 50% o ka hyaluronic acid i loko o ke kino o ke kanaka e paʻa i ka ʻili.ʻO kona hapalua ola he 24-48 mau hola.22,26 No laila, ʻo ka hapalua o ke ola o ka HA maoli i hoʻololi ʻole ʻia ma mua o ka hoʻokaʻawale ʻia ʻana e ka hyaluronidase, nā enzymes kūlohelohe maoli a me nā ʻano oxygen reactive he 12 mau hola wale nō.27,28 Ua hoʻomohala ʻia ke kaulahao HA e hoʻonui i kona kūpaʻa a hana i nā molekala nui a paʻa, me ka lōʻihi o ka noho ʻana i loko o ke kino (e pili ana i kekahi mau mahina), a me nā mea biocompatibility like a me ka viscoelastic filling properties.28 Loaʻa i ka hoʻopili ʻana i kahi ʻāpana kiʻekiʻe o ka HA hui ʻia me nā molekala kaumaha haʻahaʻa haʻahaʻa a me kahi haʻahaʻa haʻahaʻa o ke kaumaha molekala kiʻekiʻe.Hoʻololi kēia hoʻololi i ka conformation kūlohelohe o ka mole HA a pili paha i kona immunogenicity.18
Hoʻopili nui ʻia ka hoʻopili ʻana o nā polymers e hana i nā mea paʻa covalent, ʻo ia hoʻi me nā iwi (-COOH) a/a i ʻole hydroxyl (-OH).Hiki i kekahi mau pūhui ke hoʻoikaika i ka crosslinking, e like me 1,4-butanediol diglycidyl ether (BDDE) (Juvederm, Restylane, Princess), divinyl sulfone (Captique, Hylaform, Prevelle) a i ʻole diepoxy octane (Puragen).29 Eia naʻe, hoʻokaʻawale ʻia nā pūʻulu epoxy o BDDE ma hope o ka hoʻopili ʻana me HA, no laila, hiki ke loaʻa i loko o ka huahana nā ʻāpana ʻāpana o ka BDDE i hana ʻole ʻia (<2 ʻāpana o ka miliona).26 Cross-linked ha hydrogel he mea hiki ke hoʻololi ʻia i hiki ke alakaʻi i ka hoʻokumu ʻana i nā hale 3D me nā waiwai kūʻokoʻa (rheology, degradation, applicability).Hoʻoikaika kēia mau hiʻohiʻona i ka hāʻawi maʻalahi o ka huahana a ma ka manawa like e hoʻoulu i ka hana ʻana o nā ʻāpana mole o ka matrix extracellular.30,31<>
I mea e hoʻonui ai i ka hydrophilicity o ka huahana, hoʻohui kekahi mau mea hana i nā pūhui ʻē aʻe, e like me dextran a mannitol.Hiki i kēlā me kēia o kēia mau mea hoʻohui ke lilo i antigen e hoʻoulu i ka pane immune.
I kēia manawa, hoʻomākaukau ʻia ka HA mai nā ʻano kikoʻī o Streptococcus ma o ka fermentation bacteria.(Streptococcus equi a i ʻole Streptococcus zooepidemicus).Ke hoʻohālikelike ʻia me ka hoʻomākaukau ʻana o nā holoholona i hoʻohana mua ʻia, hoʻemi ia i ka hopena o ka immunogenicity, akā ʻaʻole hiki ke hoʻopau i ka hoʻohaumia ʻana o nā molekole protein, nā meaʻona nucleic bacteria a me nā stabilizers.Hiki iā lākou ke lilo i antigens a hoʻoulu i ka pane immune o ka mea hoʻokipa, e like me ka hypersensitivity i nā huahana HA.No laila, ʻo nā ʻenehana hana hoʻopihapiha (e like me Restylane) e kālele ana i ka hōʻemi ʻana i ka haumia huahana.32
Wahi a kekahi kuhiakau, ʻo ka pane ʻana o ka immune i ka HA ma muli o ka mumū i hoʻokumu ʻia e nā mea biofilm bacterial, i hoʻoili ʻia i nā ʻiʻo i ka wā i hoʻopaʻa ʻia ai ka huahana.33,34 Aia ka biofilm me ka bacteria, kā lākou mau meaʻai a me nā metabolites.Loaʻa ka nui o ka bacteria non-pathogenic nui e noho ana i ka ʻili olakino a i ʻole nā ​​mucous membranes (no ka laʻana, Dermatobacterium acnes, Streptococcus oralis, Staphylococcus epidermidis).ʻO kēia Ua hōʻoia ʻia ke kānana e ka hoʻāʻo ʻana i ke kaulahao polymerase.33-35
Ma muli o kā lākou mau hiʻohiʻona lohi lohi a me kā lākou mau ʻano i kapa ʻia ʻo nā kolone liʻiliʻi, paʻakikī pinepine ka ʻike ʻana i nā pathogens i ka moʻomeheu.Eia kekahi, hiki ke lohi i kā lākou metabolism i ka biofilm, e kōkua ana e pale i nā hopena o nā lāʻau antibiotic.35,36 Eia kekahi, ʻo ka hiki ke hana i ka matrix extracellular o extracellular polysaccharides (me ka HA) he mea pale no ka phagocytosis.Hiki i kēia mau bacteria ke noho moe no nā makahiki he nui, a laila e ho'ālaʻia e nā mea o waho a hoʻoulu i ka hopena.35-37 Loaʻa pinepine ʻia nā macrophages a me nā cell pilikua ma kahi kokoke i kēia mau microorganism.Hiki iā lākou ke ho'ā wikiwiki a hoʻoulu i kahi pane inflammatory.38 Hiki i kekahi mau mea, e like me ka ma'i bacteria me ka ma'i bacteria e like ana me ka biofilms, hiki ke ho'ā i nā microorganism moe ma o ka mimicry mechanisms.Hiki ke ho'āla ʻia ma muli o ka pōʻino i hana ʻia e kekahi kaʻina hana hoʻopihapiha dermal.38
He mea paʻakikī ke hoʻokaʻawale ma waena o ka mumū a me ka hypersensitivity lohi i hoʻokumu ʻia e nā biofilm bacterial.Inā ʻike ʻia kahi ʻeha sclerotic ʻulaʻula i kēlā me kēia manawa ma hope o ke ʻoki ʻana, me ka nānā ʻole i ka lōʻihi, pono ke kānalua koke ʻia ka biofilm.38 He asymmetrical a hoʻohālikelike paha ia, a i kekahi manawa e pili ana i nā wahi āpau kahi e lawelawe ʻia ai ka HA i ka wā o ke kaʻa.ʻOiai inā maikaʻi ʻole ka hopena o ka moʻomeheu, pono e hoʻohana ʻia kahi lāʻau antibiotic ākea me ke komo maikaʻi ʻana i ka ʻili.Inā loaʻa nā nodules fibrous me ka piʻi ʻana o ke kūʻē, ʻo ia paha he granuloma kino haole.
Hiki i ka HA ke hoʻoulu i ka mumū ma o ka hana o nā superantigens.ʻAʻole pono kēia pane i nā pae mua o ka mumū.Hoʻomaka ka 12,39 Superantigens i ka 40% o nā cell T mua a me ka hoʻoulu ʻana o ka clonal NKT.ʻO ka hoʻouluʻana o kēia mau lymphocytes e alakaʻi i kahiʻino cytokine, kahi iʻikeʻia e ka hoʻokuʻuʻana i ka nui o nā cytokines pro-inflammatory, e like me IL-1β, IL-2, IL-6 a me TNF-α40.
ʻO ka maʻi pneumonia koʻikoʻi, i hele pinepine ʻia me ka hāʻule ʻana o ka hanu nui, he laʻana ia o ka pane pathological i ka superantigen bacteria (staphylococcal enterotoxin B), e hoʻonui ai i ka LMW-HA i hana ʻia e nā fibroblasts i loko o ka ʻiʻo māmā.Hoʻoulu ʻo HA i ka hana ʻana o nā chemokines IL-8 a me IP-10, kahi mea nui i ka hoʻoulu ʻana i nā cell inflammatory i ka māmā.40,41 Ua ʻike ʻia nā ʻano hana like i ka wā o ka hānō, ka maʻi obstructive pulmonary a me ka pneumonia.ʻO ka hoʻonui nui ʻana o COVID-19.41 LMW-HA e alakaʻi i ka overstimulation o CD44 a me ka hoʻokuʻu ʻana o nā cytokines pro-inflammatory a me nā chemokines.40 Hiki ke ʻike ʻia kēia ʻano hana i ka mumū i hana ʻia e nā mea biofilm.
I ka wā ʻaʻole pololei loa ka ʻenehana hana hoʻopihapiha i ka makahiki 1999, ua hoʻoholo ʻia ka pilikia o ka lohi ʻana ma hope o ka haʻi ʻana o HA he 0.7%.Ma hope o ka hoʻokomo ʻia ʻana o nā huahana maʻemaʻe kiʻekiʻe, ua hāʻule ka nui o nā hanana ʻino i ka 0,02%.3,42,43 Eia naʻe, ʻo ka hoʻokomo ʻana i nā mea hoʻopihapiha HA e hui pū ana i nā kaulahao HA kiʻekiʻe a me ka haʻahaʻa haʻahaʻa i loaʻa i nā pākēneka AE kiʻekiʻe.44
Ua ʻike ʻia ka ʻikepili mua e pili ana i ia mau hopena i kahi hōʻike e pili ana i ka hoʻohana ʻana iā NASHA.ʻO kēia ka hopena erythema a me ka edema, me ka infiltration a me ka edema ma nā wahi a puni a hiki i 15 mau lā.Ua ʻike ʻia kēia hopena ma 1 o 1400 mau maʻi.3 Ua hōʻike nā mea kākau ʻē aʻe i nā nodules inflammatory lōʻihi loa, e kū ana ma 0.8% o nā maʻi.45 Ua koʻikoʻi lākou i ka etiology e pili ana i ka hoʻohaumia ʻana i ka protein ma muli o ka fermentation bacteria.Wahi a ka palapala, ʻo ka pinepine o nā hopena ʻino ʻo 0.15-0.42%.3,6,43
I ka hihia o ka hoʻohana ʻana i ka manawa maʻamau, nui nā hoʻāʻo e hoʻokaʻawale i nā hopena ʻino o HA.46
Bitterman-Deutsch et al.hoʻokaʻawale i nā kumu o nā hopena ʻino a me nā pilikia ma hope o ke kaʻina me ka hoʻomākaukau ʻana i ka waikawa hyaluronic.Aia lākou
Ua ho'āʻo ka hui loea e wehewehe i ka pane i ka hyaluronic acid e pili ana i ka manawa o ka ʻike ʻana ma hope o ka ʻoki ʻana: "mua" (<14 mau lā), "hope" (> 14 mau lā i 1 makahiki) a i ʻole "hoʻopanee" (> 1 makahiki).47-49 Ua hoʻokaʻawale nā ​​mea kākau ʻē aʻe i ka pane i ka mua (a hiki i hoʻokahi pule), waena (lōʻihi: hoʻokahi pule a hoʻokahi mahina), a me ka hope (ʻoi aku ma mua o hoʻokahi mahina).50 I kēia manawa, manaʻo ʻia nā pane lohi a hoʻopaneʻe ma ke ʻano he hui hoʻokahi, i kapa ʻia ʻo delayed inflammatory response (DIR), no ka mea, ʻaʻole i wehewehe maopopo ʻia ko lākou kumu a ʻaʻole pili nā lāʻau lapaʻau i ke kumu.42 Hiki ke noi ʻia ka hoʻokaʻawale ʻana o kēia mau hopena ma muli o ka palapala (Figure 3).
ʻO ka edema liʻiliʻi ma ka wahi i hoʻopaʻa ʻia ma hope koke o ke ʻoki ʻana ma muli paha o ka histamine hoʻokuʻu ʻana i nā mea maʻi i hoʻopaʻa ʻia i ka maʻi maʻi type 1, ʻoi aku ka poʻe me ka mōʻaukala o nā maʻi ʻili.51 He mau minuke wale nō ma hope o ka hoʻoponopono ʻana e hoʻopōʻino ʻia nā mast cell a hoʻokuʻu i nā mea hoʻoponopono pro-inflammatory e hoʻoulu i ka edema a me ka hoʻokumu ʻana o ka makani.Inā loaʻa kahi pane e pili ana i nā mast cell, ua lawa ka papa o ka antihistamine therapy.51
ʻOi aku ka nui o ka pōʻino o ka ʻili i hana ʻia e ka hoʻomaʻamaʻa ʻana, ʻoi aku ka nui o ka edema, a hiki i ka 10-50%.52 E like me ka randomized double-blind multicenter maʻi diaries, ka pinepine o ka edema ma hope o Restylane injection ua manaʻo ʻia he 87% o ka haʻawina 52,53
ʻO nā wahi ma ka maka e ʻike nui ʻia i ka edema ʻo ia nā lehelehe, periorbital a me nā wahi papalina.52 I mea e hōʻemi ai i ka pilikia, ua ʻōlelo ʻia e pale aku i ka hoʻohana ʻana i ka nui o nā mea hoʻopihapiha, infiltration anesthesia, massage ikaika a me nā hoʻomākaukau hygroscopic nui.Nā mea hoʻohui (mannitol, dextran).52
ʻO ka Edema ma ka wahi i hoʻopaʻa ʻia no kekahi mau minuke a hiki i 2-3 mau lā ma muli o ka hygroscopicity o HA.ʻIke pinepine ʻia kēia hopena ma ka perilip a me ka periorbital area.49,54 ʻaʻole pono e kuhi hewa no ka edema i hoʻokumu ʻia e kahi ʻano kakaikahi o ka hopena maʻi koke (angioedema).49
Ma hope o ka hoʻokomo ʻia ʻana o Restylane (NASHA) ma ka lehelehe luna, ua wehewehe ʻia kahi hihia o ka hypersensitivity i ka angioedema.Eia nō naʻe, ua lawe ka mea maʻi i ka 2% lidocaine, hiki ke hoʻoulu i nā hopena hypersensitivity type I.ʻO ka hoʻohana ʻana i nā corticosteroids i hoʻopau i ka edema i loko o 4 mau lā.32
ʻO ka hoʻololi wikiwiki ʻana paha ma muli o ka hypersensitivity i ke koena o ka protein i hoʻohaumia ʻia o HA synthesizing bacteria.ʻO ka pilina ma waena o ka HA i hoʻopaʻa ʻia a me ke koena mast cell i loko o ka ʻiʻo he ʻano hana ʻē aʻe e wehewehe i ka hanana pane koke.ʻO ka mea loaʻa CD44 ma ka ʻili o nā mast cell ka mea loaʻa no HA, a he mea nui paha kēia pilina no ko lākou neʻe ʻana.32,55
Hoʻopili koke ʻia ka mālama ʻana i nā antihistamines, systemic GCS, a i ʻole epinephrine.46
ʻO ka hōʻike mua, i paʻiʻia e Turkmani et al., ua wehewehe i nā wāhine i piha i ka makahiki 22-65 i hana i ka hana HA i hanaʻia e nā hui likeʻole.39 Hōʻike ʻia nā ʻili ʻili e ka erythema a me ka edema ʻeha ma ka wahi hoʻopihapiha hoʻopihapiha ma ka maka.Ma nā hihia a pau, hoʻomaka ka pane i nā lā 3-5 ma hope o ka maʻi e like me ka maʻi maʻi (ke kuni, ka ʻeha ʻeha, ka ʻāʻī, ka ʻū, a me ka luhi).Eia kekahi, ua loaʻa i nā maʻi āpau ka hoʻokele HA (2 a 6 mau manawa) i nā makahiki 4 ma mua o ka ʻike ʻana o nā hōʻailona ma nā ʻāpana like ʻole o ka maka.39
ʻO ka hōʻike lapaʻau o ka hopena i wehewehe ʻia (erythema a me ka edema a i ʻole urticaria-like rash me nā hōʻike ʻōnaehana) like me ke ʻano III reaction-he pseudoserum sickness reaction.ʻO ka mea pōʻino, ʻaʻohe hōʻike i loko o nā palapala e hōʻoia i kēia kuhiakau.Hōʻike ʻia kahi hōʻike hihia i ka mea maʻi me ka ʻeha like ʻole i ka wā o Sweet Syndrome, ʻo ia kahi hōʻailona pathological e ʻike ʻia ma 24-48 mau hola ma hope o ke kahua hoʻokele HA.56
Manaʻo kekahi mau mea kākau ʻo ke ʻano o ka hopena ma muli o ke ʻano hypersensitivity IV.ʻO ka haʻuki HA mua i hoʻoulu i ka hoʻokumu ʻana i nā lymphocytes hoʻomanaʻo, a ʻo ka hoʻoponopono ʻana o ka hoʻomākaukau ʻana i hoʻomaka koke i ka pane o nā cell CD4 + a me nā macrophages.39
Ua loaʻa i ka mea maʻi ka prednisolone waha 20-30 mg a i ʻole methylprednisolone 16-24 mg i kēlā me kēia lā no 5 mau lā.A laila ua hoʻemi ʻia ka dosage no 5 mau lā.Ma hope o 2 pule, nalo loa nā hōʻailona o nā maʻi he 10 i loaʻa i nā steroid waha.ʻO nā maʻiʻehā i koe i hoʻomau i ka loaʻaʻana o ka edema māmā.Hoʻohana ʻia ka Hyaluronidase no hoʻokahi mahina ma hope o ka hoʻomaka ʻana o nā hōʻailona.39
Wahi a ka moʻolelo, nui nā pilikia lohi e hiki mai ma hope o ka hoʻokomo ʻana i ka hyaluronic acid.Eia naʻe, ua hoʻokaʻawale kēlā me kēia mea kākau iā lākou ma muli o ka ʻike lapaʻau.ʻAʻole i kūkulu ʻia kahi huaʻōlelo hoʻokahi a i ʻole ka hoʻokaʻawale ʻana e wehewehe i nā hopena ʻino.Ua wehewehe ʻia ka huaʻōlelo ʻo continuous intermittent delayed swelling (PIDS) e nā dermatologists Brazilian ma 2017. 57 Beleznay et al.hoʻolauna i kekahi huaʻōlelo e wehewehe i kēia ʻano maʻi ma 2015: hoʻopaneʻe i ka nodule 15,58 a me Snozzi et al.: Advanced inflammatory response syndrome (LI).58 I ka makahiki 2020, ua noi ʻia kahi huaʻōlelo ʻē aʻe: hoʻopaneʻe ʻia ka hoʻoulu ʻana (DIR).48
ʻO Chung et al.Ua ho'okūpa'a 'o DIR i 'ehā 'ano o ka hopena: 1) DTH pane (kapa pololei 'ia: ho'opane'e 'ano IV hypersensitivity reaction);2) ka pane granuloma kino haole;3) biofilm;4) ka maʻi atypical.ʻO ka hopena DTH kahi lohi ʻana o ka maʻi immune cellular, ʻo ia ka pane i nā allergens.59
Wahi a nā kumu like ʻole, hiki ke ʻōlelo ʻia he loli ke alapine o kēia pane.Ua paʻi hou ʻia kahi pepa i kākau ʻia e nā mea noiʻi ʻIseraʻela.Ua loiloi lākou i ka helu o nā hanana ʻino ma ke ʻano o DIR ma muli o ka nīnau nīnau.Ua hoʻopau ʻia ka nīnau nīnau e nā kauka 334 nāna i hāʻawi i nā inikini HA.Ua hōʻike nā hopena i ka aneane ʻaʻole i ʻike ʻia ka hapalua o ka poʻe me DIR, a ua pane ʻo 11.4% ua ʻike lākou i kēia hopena ma mua o 5 mau manawa.48 I ka hoʻopaʻa inoa ʻana e loiloi i ka palekana, ua kākau maikaʻi ʻia nā hopena i hoʻoiho ʻia e nā huahana i hana ʻia e Allergan.Ma hope o ka lawe ʻana iā Juvederm Voluma® no 24 mau mahina, ma kahi o 1% o nā maʻi 103 i nānā ʻia i hōʻike i nā hopena like.60 I loko o kahi 68-malama loiloi retrospective o nā kaʻina hana 4702, ua ʻike ʻia kahi ʻano pane like i ka 0.5% o nā maʻi.Ua hoʻohana ʻia ʻo Juvederm Voluma® i nā maʻi 2342.15 Ua ʻike ʻia kahi pākēneka kiʻekiʻe i ka wā i hoʻohana ʻia ai nā huahana Juvederm Volbella® ma ka ʻāpana waimaka a me ka lehelehe.Ma hope o ka awelika o 8 mau pule, 4.25% (n=17) i loaʻa hou i ka 11 mahina (awelika 3.17 mau ʻāpana).42 ʻO ka loiloi hou loa o nā mea maʻi ʻoi aku ma mua o hoʻokahi kaukani e mālama ana i ka mālama ʻana iā Vycross no kahi 2-makahiki ukali me nā mea hoʻopiha i hōʻike ʻia he 1%.57 He koʻikoʻi loa ka pane pinepine ʻana o Chung et al i ka hōʻike.Wahi a ka helu ʻana o nā haʻawina e hiki mai ana, ʻo 1.1% ka hopena o ka pane ʻana i ka inflammatory i kēlā me kēia makahiki, ʻoiai ma nā haʻawina retrospective, ʻoi aku ka liʻiliʻi ma mua o 1% i ka manawa o 1 a 5.5 mau makahiki.ʻAʻole nā ​​hihia i hōʻike ʻia he DIR maoli no ka mea ʻaʻohe wehewehe kikoʻī.59
Hoʻopaneʻe ka pane inflammatory (DIR) lua i ka hoʻoponopono ʻana i ka hoʻopiha piha ʻana ma kahi o 2-4 mau pule a i ʻole ma hope ma hope o ka hoʻokomo ʻana iā HA.42 ʻO nā hōʻike maʻi ma ke ʻano o nā manawa hou o ka edema paʻa kūloko, i hui pū ʻia me ka erythema a me ka palupalu, a i ʻole nā ​​​​nodules subcutaneous ma kahi wahi i hoʻopaʻa ʻia ai.42,48 He mahana paha ka ʻili i ka hoʻopā ʻana, a he poni a ʻeleʻele paha ka ʻili a puni.Loaʻa i ka hapa nui o nā maʻi nā hopena ma nā wahi āpau i ka manawa like.I ka hihia o ka hoʻohana ʻana iā HA ma mua, me ka nānā ʻole i ke ʻano o ka hoʻopihapiha a i ʻole ka helu o nā injections, he mea nui ia e hōʻike ana i nā hōʻike lapaʻau.15,39 He mea maʻamau ka maʻi ʻili i ka poʻe i hoʻokomo mua i ka nui o ka HA.43 Eia kekahi, ʻike ʻia ka edema ma hope o ke ala ʻana, a hoʻomaikaʻi iki i ka lā.42,44,57 ʻO kekahi mau maʻi (~ 40%) loaʻa nā hōʻike like me ka maʻi maʻi ʻōnaehana concomitant.15
Hiki ke pili kēia mau hopena i ka haumia o DNA, protein, a me ka endotoxin bacteria, ʻoiai inā ʻoi aku ka haʻahaʻa o ka ʻike ma mua o ka HA.15 Eia nō naʻe, hiki ke loaʻa ka LMW-HA i loko o nā poʻe maʻi genetically a i ʻole ma o nā molekele infectious e pili ana (biofilms).15,44 Eia naʻe, ʻo ka ʻike ʻana o nā nodules inflammatory ma kahi mamao mai ka pūnaewele injection, ke kūʻē ʻana o ka maʻi i ka lāʻau antibiotic lōʻihi a me ka haʻalele ʻana i nā pathogens infectious (moʻomeheu a me ka hoʻāʻo PCR)) hāpai i nā kānalua e pili ana i ka hana o nā biofilms. .Eia kekahi, ʻo ka maikaʻi o ka mālama ʻana i ka hyaluronidase a me ka hilinaʻi ʻana i ka dosis HA e hōʻike ana i ke ʻano o ka hypersensitivity lohi.42,44
ʻO kahi pane ma muli o ka maʻi a i ʻole ka hōʻeha hiki ke alakaʻi i ka piʻi ʻana o ka serum interferon, kahi e hoʻonui ai i ka ʻeha mua.15,57,61 Eia kekahi, hoʻoulu ʻo LMW-HA i nā mea hoʻokipa CD44 a i ʻole TLR4 ma ka ʻili o nā macrophages a me nā cell dendritic.Hoʻola ia iā lākou a hāʻawi i nā hōʻailona costimulatory i nā cell T.15,19,24 Inflammatory nodules e pili ana me DIR i loko o 3 a 5 mau mahina ma hope o ka hoʻokomo ʻana i ka HMW-HA filler (me nā waiwai anti-inflammatory), a laila decompose a hoʻololi i LMW- me nā waiwai pro-inflammatory HA.15
Hoʻomaka pinepine ʻia ka hoʻomaka ʻana o ka hopena e kekahi kaʻina maʻi ʻē aʻe (sinusitis, maʻi urinary tract, maʻi hanu, maʻi niho), ʻeha maka, a me ke ʻoki niho.57 Ua hana ʻia kēia hopena ma muli o ka hoʻopaʻa ʻana a hoʻi hou ʻia ma muli o ke kahe koko ʻana.15, 57 Hiki ke kumu i kēlā me kēia ʻāpana e nā mea hoʻoheheʻe infectious.
Ua wehewehe pū kekahi mau mea kākau i ka genetic predisposition o ka poʻe me kēia mau ʻano subtypes e pane ai: HLA B * 08 a i ʻole DRB1 * 03.4 (ʻehā mau piʻi o ka pilikia).13,62
Hōʻike ʻia nā maʻi e pili ana i ka DIR e nā nodules inflammatory.Pono lākou e hoʻokaʻawale ʻia mai nā nodules, abscesses (softening, fluctuations), a me granulomatous reactions (hard inflammatory nodules) i hoʻokumu ʻia e nā biofilms.58
ʻO Chung et al.manaʻo e hoʻohana i nā huahana HA no ka hoʻāʻo ʻana i ka ʻili ma mua o ke kaʻina hana i hoʻolālā ʻia, ʻoiai ʻo ka manawa e pono ai e wehewehe i nā hopena hōʻike he 3-4 mau pule.59 Manaʻo nui lākou i kēlā mau hoʻokolohua i ka poʻe i loaʻa i nā hanana ʻino.Ua ʻike mua wau.Inā maikaʻi ka hōʻike ʻana, ʻaʻole pono e mālama hou ʻia ka mea maʻi me ka mea hoʻopiha HA like.Eia nō naʻe, ʻaʻole hiki ke hoʻopau i nā hopena āpau no ka mea maʻamau ke kumu ia e nā mea hoʻouluulu, e like me nā maʻi like ʻole e hiki mai ana i kēlā me kēia manawa.59