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A Serum-Free Study

Elbert T. Cheng, MD; Kenneth C. Nowak, MD; R. James Koch, MD

Arch Facial Plast Surg. 2001;3:252-257.

Background  A serum-free in vitro model was used to determine the effect of combined carbon dioxide (CO₂) and erbium (Er):YAG laser (Derma K; ESC/Sharplan Medical Systems, Yokneam, Israel) irradiation on keloid-producing fibroblasts (KFs) from 2 distinct facial sites. Transforming growth factor ß1 (TGF-ß1) and basic fibroblast growth factor (bFGF) play an integral part in wound healing and were assayed using this model. It has always been a clinical impression that fibroblasts from different regions of the face behave differently. This is exemplified by patients prone to lobule keloid formation after ear piercing, who heal normally after a facial incision.

Design  Laboratory-based wound healing.

Methods  Human KF cell lines were established from operative specimens using standard explant techniques. At 48 hours after seeding, 20% of each well was exposed to 1.7 J/pulse of Er:YAG laser energy and CO₂ delivered at 3 or 5 W and at a duty cycle of 25%, 50%, or 100%. Using a quantitative enzyme-linked immunosorbent assay, TGF-ß1 and bFGF were assayed from collected supernatants.

Results  Laser-treated ear lobule KFs demonstrated decreased TGF-ß1 production when compared with preauricular KFs. Statistical significance (P<.005) was seen in the 3-W CO₂ 25% duty cycle; a trend was seen in the 3-W CO₂ 50% duty cycle (P<.08). Preauricular KFs secreted increased bFGF when compared with lobule KFs. Significance was seen in the 3-W CO₂ 25% and 50% duty cycles (P<.05). Laser-treated preauricular KFs had increased bFGF secretion when compared with non–laser-treated preauricular KFs in the 3-W CO₂ 25%, 50%, and 100% duty cycles.

Conclusions  Combined CO₂ and Er:YAG laser treatment decreases the production of TGF-ß1 in preauricular and ear lobule KFs. This laser may have clinical promise in the treatment of keloids. Finally, the different growth factor profiles obtained suggest that KFs from the ear lobule and preauricular regions are different.

From the Wound Healing and Tissue Engineering Laboratory, Division of Otolaryngology–Head and Neck Surgery, Stanford University Medical Center, Stanford, Calif.

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