The Effect of PRF Membrane Administration on TGF-β and IL-6 Expression in the Superior Rectus Muscle Post-Strabismus Surgery (An Experimental Study on New Zealand Rabbits): A Literature Review
DOI:
https://doi.org/10.52783/jns.v14.1852Keywords:
Ocular Misalignment, Strabismus Surgery, Fibrosis, Wound Healing, Platelet-Rich Fibrin (PRF), Transforming Growth Factor-beta (TGF-β), Interleukin-6 (IL-6)Abstract
Strabismus surgery is a common treatment for correcting ocular misalignment. However, postoperative complications, such as fibrosis, often arise and affect recovery and surgical outcomes. Fibrosis is influenced by inflammatory mediators, including Transforming Growth Factor-beta (TGF-β) and Interleukin-6 (IL-6). Platelet-Rich Fibrin (PRF), a platelet concentrate known for its regenerative properties, has been studied for its potential to modulate these inflammatory pathways. This review explores the effect of PRF membranes on TGF-β and IL-6 expression in the superior rectus muscle following strabismus surgery. Findings from experimental studies on New Zealand white rabbits suggest that PRF application can reduce these cytokines' levels, thereby limiting fibrosis and promoting better wound healing. PRF's ability to release growth factors may improve surgical outcomes by supporting tissue repair and reducing inflammation. Although promising evidence from animal studies exists, further clinical research is needed to evaluate PRF's effectiveness and safety in human applications. This review highlights the potential of incorporating PRF into surgical protocols to enhance recovery and minimize complications in strabismus surgery.
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Indriaswati L, Hermawan D. Effect of Asiatic acid and dexamethasone administration to interleukin (IL)-1 expression and number of mononuclear cells in extraocular muscle post-strabismus surgery. Bali Med J. 2023;12(2):2258-63. https://doi.org/10.15562/bmj.v12i2.4644
Gunton KB. Impact of strabismus surgery on health-related quality of life in adults. Curr Opin Ophthalmol. 2014;25(5):406-10. https://doi.org/10.1097/ICU.0000000000000087
Biernacka A, Dobaczewski M, Frangogiannis NG. TGF-β signaling in fibrosis. Growth Factors. 2011;29(5):196-202. https://doi.org/10.3109/08977194.2011.595714
Jung KI, Choi JS, Kim HK, Shin SY. Effects of an anti-transforming growth factor-β agent (pirfenidone) on strabismus surgery in rabbits. Curr Eye Res. 2012;37(9):770-6. https://doi.org/10.3109/02713683.2012.681748
Tanaka T, Narazaki M, Kishimoto T. Il-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295. https://doi.org/10.1101/cshperspect.a016295
Johnson BZ, Stevenson AW, Prele CM, Fear MW, Wood FM. The role of IL-6 in skin fibrosis and cutaneous wound healing. Biomedicines. 2020;8(5). https://doi.org/10.3390/biomedicines8050101
Leask A, Abraham DJ. TGF‐β signaling and the fibrotic response. FASEB J. 2004;18(7):816-27. https://doi.org/10.1096/fj.03-1273rev
Shu DY, Lovicu FJ. Myofibroblast transdifferentiation: The dark force in ocular wound healing and fibrosis. Prog Retin Eye Res. 2017;60:44-65. https://doi.org/10.1016/j.preteyeres.2017.08.001
Al Shehri F, Duan L, Ratnapalan S. Psychosocial impacts of adult strabismus and strabismus surgery: A review of the literature. Can J Ophthalmol. 2020;55(5):445-51. https://doi.org/10.1016/j.jcjo.2016.08.013
Feuillade V, Bourcier T, Gaucher D, Speeg C, Sauer A. The effect of strabismus surgery on the learning abilities of school-aged children. Acta Ophthalmol. 2023;101(5):546-52. https://doi.org/10.1111/aos.15634
Naik B, Karunakar P, Jayadev M, Marshal VR. Role of platelet-rich fibrin in wound healing: A critical review. J Conserv Dent. 2013;16(4):284-93. https://doi.org/10.4103/0972-0707.114344
Nababan AR, Suryowati DI, Komaratih E, Primitasari Y, Legowo D, Notopuro PB, Notobroto HB. Platelet-rich fibrin (PRF) graft and amniotic membrane graft on transforming growth factor-β (TGF-β) and type 1 collagen post conjunctival excision. Bali Medical Journal (Bali MedJ). 2022;11(3). http://doi.org/10.15562/bmj.v11i3.3733
Gunton KB, Wasserman BN, DeBenedictis C. Strabismus. Prim Care. 2015;42(3):393-407. https://doi.org/10.1016/j.pop.2015.05.006
Kanukollu VM, Sood G. Strabismus. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 32809617. Available from: https://europepmc.org/article/nbk/nbk560782
Lavrich JB. Intermittent exotropia: Continued controversies and current management. Curr Opin Ophthalmol. 2015;26(5):375-81. https://doi.org/10.1097/ICU.0000000000000188
Cotter SA, Foster NC, Holmes JM, Melia BM, Wallace DK, Repka MX, et al. Optical treatment of strabismic and combined strabismic–anisometropic amblyopia. Ophthalmology. 2012;119(1):150-8. https://doi.org/10.1016/j.ophtha.2011.06.043
Osborne DC, Greenhalgh KM, Evans MJE, Self JE. Atropine penalization versus occlusion therapies for unilateral amblyopia after the critical period of visual development: A systematic review. Ophthalmol Ther. 2018;7(2):323-32. https://doi.org/10.1007/s40123-018-0151-9
Repka MX, Kraker RT, Holmes JM, Summers AI, Glaser SR, Barnhardt CN, et al. Atropine vs patching for treatment of moderate amblyopia: Follow-up at 15 years of age of a randomized clinical trial. JAMA Ophthalmol. 2014;132(7):799-805. https://doi.org/10.1001/jamaophthalmol.2014.392
Gray LS. The prescribing of prisms in clinical practice. Graefes Arch Clin Exp Ophthalmol. 2008;246(5):627-9. https://doi.org/10.1007/s00417-008-0799-2
Ozkan SB, Topaloglu A, Aydin S. The role of botulinum toxin A in augmentation of the effect of recession and/or resection surgery. J AAPOS. 2006;10(2):124-7. https://doi.org/10.1016/j.jaapos.2005.11.011
Indriaswati L, Suhendro G, Handajani R. Time-dependent Expression of Caspase-3 and Degeneration of Lateral Rectus Muscle on Experimental Esotropia in Rabbits. Indian Journal of Forensic Medicine & Toxicology. 2021 Apr 1;15(2). https://doi.org/10.37506/ijfmt.v15i2.14785
Shah VS. Strabismus surgery. Neuro-Ophthalmology. 2021;46(3):207. https://doi.org/10.1080/01658107.2021.1951770
Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219-29. https://doi.org/10.1177/0022034509359125
Adline F, Prastyani R, Wahyuni I. Potential therapy of Asiatic acid to prevent scar remodeling post-strabismus surgery. surgery. 2024 Jan 1;1:2. https://doi.org/10.48309/ecc.2024.424451.1727
Ciprandi G, Crucianelli S, Grussu F, Spuntarelli G, Marino SFM, Urbani U, Bernaschi P, et al. Meeting the challenges in pediatric wound care: Our 15-year experience with dialkylcarbamoyl chloride-coated dressing technology in acute and chronic wounds. Chronic Wound Care Manag Res. 2022;9:23-33. https://doi.org/10.2147/cwcmr.S376889
Sanchez J, Antonicelli F, Tuton D, Dorval SM, Francois C. [Specificities in children wound healing]. Ann Chir Plast Esthet. 2016;61(5):341-7. https://doi.org/10.1016/j.anplas.2016.05.001
Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;341(10):738-46. https://doi.org/10.1056/NEJM199909023411006
Singh P, Tyagi M, Kumar Y, Gupta K, Sharma PD. Ocular chemical injuries and their management. Oman J Ophthalmol. 2013;6(2). https://doi.org/10.4103/0974-620X.116624
Liechty KW, MacKenzie TC, Shaaban AF, Radu A, Moseley AB, Deans R, Marshak DR, Flake AW. Human mesenchymal stem cells engraft and demonstrate site-specific differentiation after in utero transplantation in sheep. Nat Med. 2000;6(11):1282-6. https://doi.org/10.1038/81395
Cañedo-Dorantes L, Cañedo-Ayala M. Skin acute wound healing: A comprehensive review. Int J Inflamm. 2019;2019:3706315. https://doi.org/10.1155/2019/3706315
Bian Y, Hall B, Sun ZJ, Molinolo A, Chen W, Gutkind JS, Waes CV, Kulkarni AB. Loss of TGF-β signaling and PTEN promotes head and neck squamous cell carcinoma through cellular senescence evasion and cancer-related inflammation. Oncogene. 2012;31(28):3322-32. https://doi.org/10.1038/onc.2011.494
Saika S, Yamanaka O, Okada Y, Tanaka S, Miyamoto T, Sumioka T, Kitano A, et al. TGF-beta in fibroproliferative diseases in the eye. Front Biosci. 2009;1(1):376-90. https://doi.org/10.2741/S32
Choi SU, Kim KW, Moon NJ. Effective treatment for prevention of post-operative adhesion after strabismus surgery in experimental rabbit model: 0.5% tranilast ophthalmic solution. BMC Ophthalmol. 2016;16(1):166. https://doi.org/10.1186/s12886-016-0344-8
Wright HL, Cross AL, Edwards SW, Moots RJ. Effects of IL-6 and IL-6 blockade on neutrophil function in vitro and in vivo. Rheumatology (Oxford). 2014;53(7):1321-31. https://doi.org/10.1093/rheumatology/keu035
Shen TNY, Kanazawa S, Kado M, Okada K, Luo L, Hayashi A, Mizuno H, et al. Interleukin-6 stimulates akt and p38 mapk phosphorylation and fibroblast migration in non-diabetic but not diabetic mice. PLoS One. 2017;12(5). https://doi.org/10.1371/journal.pone.0178232
Han G, Ceilley R. Chronic wound healing: A review of current management and treatments. Adv Ther. 2017;34(3):599-610. https://doi.org/10.1007/s12325-017-0478-y
Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A. The hidden cost of skin scars: Quality of life after skin scarring. J Plast Reconstr Aesthet Surg. 2008;61(9):1049-1058. https://doi.org/10.1016/j.bjps.2008.03.020
Kaczmarek A, Vandenabeele P, Krysko DV. Necroptosis: The release of damage-associated molecular patterns and its physiological relevance. Immunity. 2013;38(2):209-223. https://doi.org/10.1016/j.immuni.2013.02.003
Bosurgi L, Cao YG, Cabeza-Cabrerizo M, Tucci A, Hughes LD, Kong Y, Weinstein JS, et al. Macrophage function in tissue repair and remodeling requires IL-4 or IL-13 with apoptotic cells. Science. 2017;356(6342):1072-1076. https://doi.org/10.1126/science.aai8132
Prame Kumar K, Nicholls AJ, Wong CHY. Partners in crime: Neutrophils and monocytes/macrophages in inflammation and disease. Cell Tissue Res. 2018;371(3):551-565. https://doi.org/10.1007/s00441-017-2753-2
Yang R, Masters AR, Fortner KA, Champagne DP, Yanguas-Casás N, Silberger DJ, Weaver CT, et al. IL-6 promotes the differentiation of a subset of naive CD8+ T cells into IL-21-producing B helper CD8+ T cells. J Exp Med. 2016;213(11):2281-2291. https://doi.org/10.1084/JEM.20160417
Masuki H, Okudera T, Watanabe T, Suzuki M, Nishiyama K, Okudera H, Nakata K, et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent. 2016;2(1). https://doi.org/10.1186/s40729-016-0052-4
Nicoletti G, Saler M, Villani L, Rumolo A, Tresoldi MM, Faga A. Platelet-rich plasma enhancement of skin regeneration in an ex-vivo human experimental model. Front Bioeng Biotechnol. 2019;7. https://doi.org/10.3389/fbioe.2019.00002
Varkey M, Ding J, Tredget EE. Fibrotic remodeling of tissue-engineered skin with deep dermal fibroblasts is reduced by keratinocytes. Tissue Eng Part A. 2014;20(3-4):716-727. https://doi.org/10.1089/ten.tea.2013.0434
Dufour AM, Alvarez M, Russo B, Chizzolini C. Interleukin-6 and type-I collagen production by systemic sclerosis fibroblasts are differentially regulated by interleukin-17A in the presence of transforming growth factor-beta 1. Front Immunol. 2018;9. https://doi.org/10.3389/fimmu.2018.01865
Martinez FO, Gordon S. The M1 and M2 paradigm of macrophage activation: Time for reassessment. F1000Prime Rep. 2014;6. https://doi.org/10.12703/P6-13
Canady J, Arndt S, Karrer S, Bosserhoff AK. Increased KGF expression promotes fibroblast activation in a double paracrine manner resulting in cutaneous fibrosis. J Invest Dermatol. 2013;133(3):647-657. https://doi.org/10.1038/jid.2012.389
Peng Y, Wu S, Tang Q, Li S, Peng C. KGF-1 accelerates wound contraction through the TGF-β1/Smad signaling pathway in a double-paracrine manner. J Biol Chem. 2019;294(21):8361-8370. https://doi.org/10.1074/jbc.RA118.006189
Intifada, Indriaswati L, Hermawan D. Effect of Asiatic acid and dexamethasone administration to interleukin (IL)-1 expression and number of mononuclear cells in extraocular muscle post-strabismus surgery. Bali Medical Journal. 2023;12(2):2258-63. http://doi.org/10.15562/bmj.v12i2.4644
Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol. 2015;60(5):406-434. https://doi.org/10.1016/j.survophthal.2015.03.003
Putra OS, Indriaswati L, Primitasari Y, Sudrajat N, Nurhidayat BR, Widiyatno TV. Effect of Platelet-Rich Fibrin (PRF) Membrane on the Expression of Matrix Metalloproteinase 9 (MMP-9) and Tissue Inhibitor of Metalloproteinase 1 (TIMP-1) in Corneal Wound Healing: Pseudomonas aeruginosa Keratitis. Journal of Medicinal and Chemical Sciences. 2024 Mar;7(3):482-91. http://doi.org/10.26655/JMCHEMSCI.2024.3.3
Ramadhan A, Agustini L, Hermawan D, Zuhria I, Prastyani R, Notobroto HB, Legowo D. Effect of Platelet Rich Fibrin Membrane (PRF) or Conjunctival Autograft on VEGF Expression and Microvascular Density Post Conjunctival Excision. http://doi.org/10.26655/JMCHEMSCI.2024.2.9
Sanchez-Avila RM, Merayo-Lloves J, Riestra AC, Berisa S, Lisa C, Sánchez JA, Muruzabal F, et al. Plasma rich in growth factors membrane as coadjuvant treatment in the surgery of ocular surface disorders. Medicine (Baltimore). 2018;97(17):97-97. https://doi.org/10.1097/MD.0000000000010242
Wahyuni I, Prastyani R, Wiratama AB, Zuhria I, Widiyatno TV. Comparison of α-Smooth Muscle Actin (α-SMA) and Collagen Type III Expression after Conjunctival Excision Between Platelet-Rich Fibrin (PRF) Membrane and Conjunctival Autograft Treatment: An Animal Model Experimental Study on Oryctolagus cuniculus. Pakistan Journal of Ophthalmology. 2024 Apr 1;40(2). https://doi.org/10.36351/pjo.v40i2.1760
Karisma IN, Sasono W, Fatmariyanti S. The role of Platelet Rich Fibrin (PRF) membrane and conjunctival autograft on TGF-β and collagen type 1 expression in conjunctival wound healing: a literature review. Bali Medical Journal. 2023;12(2):1612-21. https://doi.org/10.15562/bmj.v12i2.4310
Sudrajat N, Nurhidayat BR, Putra OS, Loebis R, Zuhria I. Relation between Blood Parameters and Platelet-Rich Fibrin Membrane Size for Ocular Graft. NeuroQuantology. 2022;20(4):454. https://doi.org/10.14704/nq.2022.20.4.NQ22258
Sharma V, Kumar A, Puri K, Bansal M, Khatri M. Application of platelet-rich fibrin membrane and collagen dressing as palatal bandage for wound healing: A randomized clinical control trial. Indian J Dent Res. 2019;30(6):881-888. https://doi.org/10.4103/ijdr.IJDR_370_17
Dohan Ehrenfest DM, Pinto NR, Pereda A, Jiménez P, Corso MD, Kang BS, Nally M, et al. The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane. Platelets. 2018;29(2):171-184. https://doi.org/10.1080/09537104.2017.1293812
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: From pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27(3):158-167. https://doi.org/10.1016/j.tibtech.2008.11.009
Dipayana PR, Prastyani R, Widjaja SA, Plumeriastuti H. Determining the healing effect of platelet rich fibrin (PRF) membranes by measurement of Interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) expression on corneal chemical trauma caused by sodium hydroxide (NaOH). Journal of Medicinal and Pharmaceutical Chemistry Research. 2025 Jul;7(7):1293-301. https://doi.org/10.48309/JMPCR.2025.465776.1309
Nurhidayat BR, Komaratih E, Legowo D, Indriani D. The Effect ofPlatelet Rich Fibrin Membrane onExpression of Alpha Smooth Muscle Actin and Transforming Growth Factor Beta in Pseudomonas aeruginosa Keratitis: An Experimental Study inOryctalogus cuniculus. NeuroQuantology. 2022;20(11):7605. https://doi.org/10.14704/NQ.2022.20.11.NQ66758
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