The effect of combination of triamcinolone acetonide and methotrexate on keloidfibroblast activity in dermis equivalent

Abstract

Background: Triamcinolone acetonid (TA) intralesion has been a standard treatment for keloids for many
years, due to its effect in inhibiting collagen synthesis and fibroblast proliferation. However, until now the
clinical result is unsatisfactory. Keloid flattening is slow and sometimes adverse reactions may occur.
Methotrexate (MTX) is a chemotherapeutic agent having an antiproliferating effect which act as an antifolic
acid. Because of this effect, MTX is potential to be used in combination with TA for the treatment in
keloid. Fibroblast populated collagen lattice (FPCL) was a dermal equivalent usually used for fibroblast
activity measurement.
Objective: To understand the inhibition of fibroblast keloid activities of MTX in vitro on FPCL contraction,
compared to TA and MTX plus TA.
Methods: This research used simple parallel multigroups experimental study design, and conducted on third
passage keloid fibroblast culture, which was isolated from one patient. Fibroblast was cultivated in collagen
type 1 from rat tail (FPCL). Keloid fibroblasts was classified into 16 groups, and treated with 5, 10, 20
mM TA, 1.75, 3.5, 7 mM MTX, combination of TA and MTX, and a control negative. FPCL contraction
indicating activities of fibroblast was measured using Scion Image software. Mean of FPCL contraction
was analyzed using one way analysis of variance (ANOVA).
Results: All treatments could inhibit FPCL contraction until day 2 (p<0.05). The highest inhibition of FPCL
was found in combination of TA 20 mM + MTX 7 mM (p<0.05). The treatment that could inhibit FPCL
contraction until day 3 was only group MTX 3.5 mM + TA 20 mM. This result indicated that a combination
of TA and MTX was stronger in inhibiting keloid fibroblast activities compared with TA and MTX alone.
Key words: keloid fibroblast - growth factors - triamcinolone acetonid - methotrexate - FPCL contraction