SLR - March 2019 - Harshil Patel
The Effect of Antiseptics on Adipose-Derived Stem Cells
Reference: Kim B, Ott1 V, Boecker A, Stromps J, Paul N, Alharbi Z, Cakmak E, Bernhagen J, Bucala R, Pallua N. The Effect of Antiseptics on Adipose-Derived Stem Cells. Plast Reconstr Surg. 2017 March; 139(3): 625–637.
Scientific Literature Review
Reviewed By: Harshil Patel, DPM
Residency Program: Bethesda Hospital East, Boynton Beach, FL
Podiatric Relevance: Podiatrists treat a wide variety of wounds, ranging from acute traumatic wounds to chronic infected diabetic foot ulcers. For the vast number of wounds that occur every year, topical antiseptics are the primary treatment in routine care. Although antiseptics are effective and come at a low cost, some are found to have a toxic effect on keratinocytes and fibroblasts, as well as detrimental effects on adipose-derived stem cells (ASCs). Some antiseptics are found to increase ASC death and decrease the viability, proliferation and adipogenic differentiation of ASCs, as well as reduce the expression of stem cell markers. ASCs are known to have a beneficial role in wound healing due to their regenerative characteristics, and therefore, those antiseptics that have the least harmful effects on ASCs should be given preference.
Methods: Adipose tissue was harvested from a total of 13 healthy patients that were undergoing surgery. ASCs were isolated by collagenase digestion and then were treated with different concentrations of five antiseptics, Betaisodona, Lavasept, Mafenide acetate, Octenisept and Prontosan, as well as undiluted saline. Growth medium was used as a negative control. ASC viability was measured using alamarBlue and Hoechst staining. ASC proliferation was measured using BrdU ELISA. ASC cell death was measured using apoptosis/necrosis assay. Adipogenic differentiation was measured using Oil red O staining. Stem cell marker expression of CD29, CD34, CD73, CD90 and CD105 was measured using real-time polymerase chain reaction (RT-PCR).
Results: ASCs survived treatment with Mafenide acetate even at the highest concentrations when compared to the other antiseptics, and there were found to be minimal negative effects on the proliferation, adipogenic differentiation, cell death and stem cell marker expression of ASCs. ASCs treated with Octenisept and Betaisodona were found to have significantly decreased ASC viability, proliferation and adipogenic differentiation, as well as a high incidence of ASC necrosis and reduced the expression of all stem cell markers. Octenisept was found to reduce ASC viability even at the lowest concentrations. Although Lavasept and Prontosan both reduced ASC viability, proliferation, adipogenic differentiation and increased apoptosis/necrosis, the effects were less pronounced than those of Octenisept and Betaisodona.
Conclusions: Antiseptics influence the viability, proliferation, apoptosis and necrosis, adipogenic differentiation and the expression of stem cell markers of ASCs. Lavasept and Prontosan had moderately toxic effects on ASCs. Octenisept and Betaisodona were found to significantly decrease ASC viability, proliferation and differentiation and caused considerable ASC necrosis. Of the five antiseptics studied, mafenide acetate had the least detrimental effect on ASCs, and therefore, it is the better option in the treatment of wounds with exposed adipose tissue.