Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar 5;42(1):5.
doi: 10.1186/s40902-020-00249-4. eCollection 2020 Dec.

Immunomodulation for Maxillofacial Reconstructive Surgery

Affiliations
Free PMC article
Review

Immunomodulation for Maxillofacial Reconstructive Surgery

Seong-Gon Kim. Maxillofac Plast Reconstr Surg. .
Free PMC article

Abstract

Immunomodulation is a technique for the modulation of immune responses against graft material to improve surgical success rates. The main target cell for the immunomodulation is a macrophage because it is the reaction site of the graft and controls the healing process. Macrophages can be classified into M1 and M2 types. Most immunomodulation techniques focus on the rapid differentiation of M2-type macrophage. An M2 inducer, 4-hexylresorcinol, has been recently identified and is used for bone grafts and dental implant coatings.

Keywords: 4-Hexylresorcinol; Immunomodulation; Macrophage; Wound healing.

Conflict of interest statement

Competing interestsThe author declares that there are no competing interests.

Figures

Fig. 1
Fig. 1
Classical way of immunomodulation. The immunomodulation technique can be applied to achieve a desirable host response to grafts. Modification of surface roughness and porosity is a simple method for immunomodulation. Some trace elements have also been considered for helping wound healing
Fig. 2
Fig. 2
Role of M1/M2-type macrophages in angiogenesis. M1-type macrophages are responsible for host defenses again invasion. Thus, cytokines secreted from M1-type macrophages recruit leukocytes through vasodilatation and increasing vascular permeability. However, M2-type macrophages are responsible for regeneration. Accordingly, they secrete cytokines for capillary regeneration. Some cytokines are overlapped between M1 and M2 macrophages, and their final role is determined by the interaction with other cytokines
Fig. 3
Fig. 3
M1/M2/foreign body giant cell (FBGC) inducers. There are many kinds of M1/M2/FBGC inducers. Some of them are not determinant, and the outcome is influenced by the environment
Fig. 4
Fig. 4
Hypothesis for M1/M2/foreign body giant cell (FBGC) formation. Cellular stress induced by a foreign body may be the driving force for macrophage differentiation. Reactive oxygen species (ROS) may also be a key factor for macrophage differentiation. Slow or nondegradable grafts accumulate stress in the macrophages. To reduce intracellular stress, increasing the volume of cytoplasm via cellular fusion can be a useful strategy for survival. If the graft is degraded appropriately, intracellular stress is reduced thereafter. M2 transition will occur after reduced stress
Fig. 5
Fig. 5
Accelerated tissue regeneration by incorporating 4-hexylresorcinol (4HR). a Silk and hydroxyapatite grafts were implanted into calvarial defects of rabbits. There was no bone regeneration at 8 weeks postoperation (Masson trichrome stain, original magnification ×100). b A silk fibroin, hydroxyapatite, and 4HR graft were implanted into the calvarial defect of a rabbit. There were numerous osteoid islands at 8 weeks postoperation (Masson trichrome stain, original magnification ×100). c A silk fibroin graft was implanted into the dermal pocket of a rat. There were many foreign body giant cells (asterisks) with silk fiber remnants at 12 weeks postoperation (HE stain, original magnification ×400). d A silk fibroin and 4HR graft were implanted into the dermal pocket of a rat. There were few foreign body giant cells (asterisks) at 12 weeks postoperation. Interestingly, capillary regenerations were prominent (arrow heads) (HE stain, original magnification ×400)
Fig. 6
Fig. 6
Smart delivery of 4-hexylresorcinol (4HR) using hydrophobic and hydrophilic domains of silk fibroin. Silk fibroin is a macromolecule composed of hydrophilic and hydrophobic domains. As 4HR is composed of a long alkyl group (hydrophobic) and 2 hydroxyl groups (hydrophilic), 4HR can be bound to each domain according to its molecular interaction. As hydrophilic interactions are much weaker than hydrophobic interactions, 4HR in the hydrophilic domain of silk fibroin is released first. 4HR in the hydrophobic domain is released during proteolysis

Similar articles

See all similar articles

References

    1. Kang DW, Yun PY, Choi YH, Kim YK. Sinus bone graft and simultaneous vertical ridge augmentation: case series study. Maxillofac Plast Reconstr Surg. 2019;41:36. doi: 10.1186/s40902-019-0221-5. - DOI - PMC - PubMed
    1. Koo CH, Lee JH. Evaluation of mandibular cortical bone ratio on computed tomography images in patients taking bisphosphonates. Maxillofac Plast Reconstr Surg. 2018;40:17. doi: 10.1186/s40902-018-0153-5. - DOI - PMC - PubMed
    1. Kang DW, Kim SH, Choi YH, Kim YK. Repeated failure of implants at the same site: a retrospective clinical study. Maxillofac Plast Reconstr Surg. 2019;41:27. doi: 10.1186/s40902-019-0209-1. - DOI - PMC - PubMed
    1. Kweon H, Lee SW, Hahn BD, Lee YC, Kim SG. Hydroxyapatite and silk combination-coated dental implants result in superior bone formation in the peri-implant area compared with hydroxyapatite and collagen combination-coated implants. J Oral Maxillofac Surg. 2014;72:1928–1936. doi: 10.1016/j.joms.2014.06.455. - DOI - PubMed
    1. Takebe J, Champagne CM, Offenbacher Ishibashi SK, Cooper LF. Titanium surface topography alters cell shape and modulates bone morphogenetic protein 2 expression in the J774A.1 macrophage cell line. J Biomed Mater Res Part A. 2003;64:207–216. doi: 10.1002/jbm.a.10275. - DOI - PubMed

LinkOut - more resources

Feedback