TISSUE ENGINEERING AND ANTI-AGING - Intelligent Scaffolds for Tissue Engineering and Regenerative Medicine - page 727

cultured and expanded autogous fibroblasts with saline solution; it
is used as a filler material for dermis and subcutaneous tissue that
have lost collagen. 6 Skin contains a relatively thick layer of dense,
irregularconnectivetissueinthedermis,calledthereticularordeep
layerofthedermis.Collagenandothernoncellularcomponents(i.e.,
reticular and elastic fibers and ground substance) of connective tis-
sue are synthesized by fibroblasts. The underlying mechanisms of
skin repair by fibroblasts are stillnotfully understood.
We used gingival fibroblast for winkle treatment instead of der-
mal fibroblasts. In our method, a gingival rather than a skin biopsy
can be easily achieved in a regular dental practice, using local anes-
thesia. The donor site can be sutured without any tension, heals
withinoneweekusuallywithoutscarformation,andisundetectable
externally. These features of the gingiva demonstrate the advan-
tages of using gingival (mucosal) fibroblasts for treatment. Also,
the gingival autologous cell system does not require extensive sur-
gical extraction—a small biopsy is performed on a nonvisible oral
cavity, and the fibroblast cells are cultured, multiplying to millions.
Unused cells can be stored in liquid nitrogen for new and repeat
procedures. The characteristics of gingival fibroblasts are almost
identical to those of skin fibroblasts, although there are several
knowndifferences.Thesedifferencesincludeincreasedextracellular
matrix(ECM)reorganizationalability,cellularmigration,andexper-
imentalwoundrepopulationincomparisonwithskinfibroblasts. 7 - 9
The profile of growth factors is also known to be different, such
that keratinocyte growth factor (KGF) is the growth factor that pro-
motes epithelial cell turnover, and vascular endothelial growth fac-
tor (VEGF) is the growth factor that facilitates neovascularization at
theinjectedsite.Thesefactorsmaycontributetothepositiveeffects
on the skin in the area ofthe injected sites.
To enhance the effect of gingival fibroblasts, we routinely use
HA as a scaffold with the cells. In recent years, HA derivatives have
been used as injectable filler materials. Unlike collagen, HA is iden-
tical in all species; therefore, it is biocompatible and does not cause
a foreign-body reaction. To maintain the longevity, cross-linked HA
preparations are used. HA has the ability to bind water and form
hydrated polymers of high viscosity. It has an isovolemic pattern
of degradation; as the concentration in the dermis decreases, its