Action of Sodium Deoxycholate on Subcutaneous Human Tissue

Human Immunodeficiency Virus–Associated Lipohypertrophy (Buccal Fat Pad Lipoma-Like Lesions) Reduced with Subcutaneously Injected Sodium Deoxycholate

“…One author (AMR) has observed reductions in solitary truncal and extremity lipomas up to 6 months after injection 8 . What may account for this delayed effect is prolonged subclinical healing, because adipose tissue treated with deoxycholate remains inflamed histologically even at 6 months 51 . The re‐accumulation of our patient's lesions (from <1.0 to 1.5 cm) suggests the influence of growth factors related to HIV lipohypertrophy.…”

“…After subcutaneous injection, host scavenging of damaged adipocytes and healing with fibrosis account for modest fat reduction and skin retraction, respectively 11,46 . Deoxycholate lyses fat in vitro, ex vivo, and in vivo in isolation from phosphatidylcholine, 18,44,45,50,51 with which it is conventionally combined. According to recent experimental data, phosphatidylcholine appears inert with respect to fat reduction because it produces neither adipolytic (ablative) nor lipolytic (nonablative) effects, 18,45 although it may buffer the effects of deoxycholate 10,13,18 .…”

Commentary

“…Deoxycholate destroys nonadipose cells in vitro 21–25 . While this finding would appear to explain isolated reports of skin ulceration after injectable fat treatments, 4,11 it is noteworthy that ulceration is nonexistent in clinical studies and case series 13–20 . Researchers have recently demonstrated that deoxycholate's ability to lyse cells is inversely related to the amount of protein surrounding and within tissue with which it comes into contact 22 .…”

“…Nevertheless, according to numerous investigations, injections of a detergent‐based medication can reduce small collections of fat with an acceptable safety profile 12–20 . Until the recent release of Phase II study data, 20 only two published studies were prospective 14,15 ; others were retrospective, and all lacked placebo controls.…”

“…Injections of minute amounts of deoxycholate (with or without phosphatidylcholine) directly into subcutaneous fat produces necrosis and granulomatous reactions 4,9,16,17 . These inflammatory foci can be perceived clinically as firm, variably tender subcutaneous nodules at the injection site 9,14–16,19 .…”