Collagenase in wound healing: effect of wound age and type

Matrix metalloproteinase activity and immunohistochemical profile of matrix metalloproteinase-2 and -9 and tissue inhibitor of metalloproteinase-1 during human dermal wound healing

Proteolytic activity is required for the turnover of the extracellular matrix during wound healing. Matrix metalloproteinases can collectively cleave all components of the extracellular matrix, with the endogenous tissue inhibitor of metalloproteinase-1 regulating their activity. Breast tissue taken at varying postoperative times (n= 92) or during surgery (controls, n= 17), was used to investigate the temporal and spatial activity of matrix metalloproteinase-2 and -9 and tissue inhibitor of metalloproteinase-1 during human wound healing. Matrix metalloproteinase activity, determined using a quenched fluorescence substrate assay, increased during early healing (3-8 weeks) compared to controls, and then decreased between 24 and 36 weeks after surgery (p < 0.05 until 24 weeks, Mann-Whitney U-test). Immunohistochemistry scores for matrix metalloproteinase-9 expression were significantly elevated compared to controls in scar endothelial cells and fibroblasts from 2 until 12 and 20 weeks, respectively. Matrix metalloproteinase-2 staining was observed exclusively in fibroblasts, reaching maximum levels 8-12 weeks after surgery, decreasing by 1.5 years but remaining significantly increased. Tissue inhibitor of metalloproteinase-1 staining was relatively sparse but was significantly increased until 8 weeks after surgery. These results show that matrix metalloproteinases are present at elevated levels during early wound healing, when angiogenesis occurs, and suggest that matrix metalloproteinase-9 may play a significant role. The later expression of matrix metalloproteinase-2 and -9 in fibroblasts suggests a role in extracellular matrix remodeling.

Molecular, histologic, and gross phenotype of skin wound healing in red Duroc pigs reveals an abnormal healing phenotype of hypercontracted, hyperpigmented scarring

This study examined dermal wound healing in juvenile red Duroc pigs and determined that these animals exhibit a unique healing phenotype at multiple levels. Gross and histologic analysis revealed that full-thickness and deep dermal (1.8 mm deep) wounds both heal via formation of hypercontracted, hyperpigmented scars. Molecular analysis using reverse-transcriptase polymerase chain reaction and porcine-specific primer sets revealed that types I and III collagen, heat shock protein 47, bone morphogenetic protein-1, several proteoglycans, and tissue inhibitor of metalloproteinases 1-3 all showed a unique biphasic pattern of mRNA expression compared to previous results with Yorkshire pigs. This pattern was characterized by an initial peak of expression early after wounding, followed by a return to near-normal levels by days 28-42, and then a second increase in mRNA levels at days 56-70. The second phase of increased gene expression correlated with an increased collagen deposition as observed by picrosirius red staining and polarizing light microscopy. Reverse-transcriptase polymerase chain reaction analysis also revealed a prolonged expression of matrix metalloproteinase-2 compared to previous findings in the Yorkshire strain. Further characterization of the genetics and molecular biology associated with the red Duroc phenotype may provide insight into aberrant human wound healing.

Effect of systemic matrix metalloproteinase inhibition on periodontal wound repair: a proof of concept trial

BACKGROUND

The adjunctive use of matrix metalloproteinase (MMP) inhibitors with scaling and root planing (SRP) promotes new attachment in patients with periodontal disease. This pilot study was designed to examine aspects of the biological response brought about by the MMP inhibitor low dose doxycycline (LDD) combined with access flap surgery (AFS) on the modulation of periodontal wound repair in patients with severe chronic periodontitis.

METHODS

Twenty-four subjects were enrolled into a 12-month, randomized, placebo-controlled, double-masked trial to evaluate clinical, biochemical, and microbial measures of disease in response to 6 months therapy of either placebo capsules + AFS or LDD (20 mg b.i.d.) + AFS. Clinical measures including probing depth (PD), clinical attachment levels (CAL), and bleeding on probing (BOP) as well as gingival crevicular fluid bone marker assessment (ICTP) and microbial DNA analysis (levels and proportions of 40 bacterial species) were performed at baseline and 3, 6, 9, and 12 months.

RESULTS

Patients treated with LDD + AFS showed more potent reductions in PD in surgically treated sites of >6 mm (P<0.05, 12 months). Furthermore, LDD + AFS resulted in greater reductions in ICTP levels compared to placebo + AFS. Rebounds in ICTP levels were noted when the drug was withdrawn. No statistical differences between the groups in mean counts were found for any pathogen tested.

CONCLUSIONS

This pilot study suggests that LDD in combination with AFS may improve the response of surgical therapy in reducing probing depth in severe chronic periodontal disease. LDD administration also tends to reduce local periodontal bone resorption during drug administration. The use of LDD did not appear to contribute to any significant shifts in the microbiota beyond that of surgery alone.

Matrix metalloproteinases and their role in pancreatic cancer: a review of preclinical studies and clinical trials

Matrix metalloproteinases (MMPs) have received much attention in recent years for their role in a variety of malignancies. Pancreatic cancer is no exception; MMP-2 and MMP-9 show high levels of expression in clinical and experimental models. Inhibition of MMPs has shown great promise with synthetic inhibitors, such as BB-94, as tumorostatic agents in preclinical models, particularly when these are combined with gemcitabine. These findings have led to several clinical trials using the MMP inhibitors Marimastat and BAY12-9566. Herein, we discuss the roles of MMPs and their inhibition in pancreatic cancer.

Inflammation. 1: Its role in the healing of acute wounds

The inflammatory response is an essential part of the wound-healing process. This article discusses inflammation in acute wounds and the part played by the migration of cells including neutrophils, macrophages and T-lymphocytes.

MMP-2 and TIMP-1 are derived from, not in response to, pancreatic cancer

INTRODUCTION

Genetic therapy aimed at disturbing the balance between matrix metalloproteinases (MMP) and their natural tissue inhibitors (TIMP) in treatment of pancreatic cancer requires an understanding of whether MMP and TIMP are tumor- or host-derived. This study was undertaken to determine whether production of MMP-2 and TIMP-1 is by, or in response to, pancreatic cancer.

METHODS

PANC-1 (poorly differentiated human pancreatic cancer) or CD-1 (PANC cells transfected to overproduce TIMP-1) cells were implanted into the pancreata of 20 nude mice. After sacrifice, tumors and peritumoral stroma underwent immunohistochemical staining for human and murine MMP-2 and TIMP-1. Normal murine pancreas served as control. All stains were reviewed in a "blinded" manner by a pathologist and graded relative to normal control pancreata.

RESULTS

Control pancreata displayed faint murine MMP-2 and TIMP-1 staining and no human MMP-2 or TIMP-1. MMP-2 was most prominent in peritumoral stroma, while TIMP-1 was most prominent in tumors. CD-1 tumors contained very high levels of TIMP-1 compared to PANC-1 tumors and control pancreata. Tumoral and peritumoral MMP-2 were overwhelmingly human. As well, tumoral TIMP-1 was predominantly human.

CONCLUSIONS

In a murine model for human pancreatic cancer, nearly all TIMP-1 and MMP-2 expression is tumor-derived (i.e., human). Pharmacologic and gene therapy aimed at disturbing the MMP/TIMP balance in pancreatic cancer should be targeted toward tumor-specific mechanisms and warrants continued investigation.

Topical synthetic inhibitor of matrix metalloproteinases delays epidermal regeneration of human wounds

Matrix metalloproteinases (MMPs) degrade extracellular proteins during epithelialization of wounds. To evaluate the biological significance of MMPs in epidermal healing, the synthetic broad-spectrum MMP inhibitor GM 6001 (also called Galardin and Ilomastat) was applied topically to standardized human wounds. GM 6001 (10 microg/microl) or vehicle alone was applied every second day onto 4 de-roofed 6 mm suction blister wounds on the volar forearm of healthy male volunteers for 12 days. GM 6001 delayed healing by 2-4 days as assessed macroscopically and microscopically. In situ hybridization or immunohistochemistry showed that MMP-1 (interstitial collagenase) was present in and MMP-2 (gelatinase A) close to laterally migrating keratinocytes whereas MMP-9 (gelatinase B) was seen during maturation of new epidermis. MMP-1 was undetectable in blister roofs (normal epidermis) and found in low levels in normal skin. Total MMP-1 activities increased about 100-fold in wounds, independent of treatment, compared to normal skin as analyzed by specific ELISA-based activity assay. By gelatin zymography, MMP-2, but not MMP-9, was detected in blister roofs and wound healing was associated with increased active MMP-2 and latent MMP-9 levels. GM 6001 prevented activation of MMP-2 and increased latent MMP-9 levels. GM 6001 delayed re-appearance of laminin-5, the synthesis of which correlated with epidermal regeneration. Restoration of stratum corneum, measured indirectly by transepidermal water loss, was also impaired (P<0.05) in the GM 6001 group. In conclusion, pharmacological MMP inhibition delayed epidermal regeneration in vivo, suggesting that MMPs are required to restore epidermis after epidermal ablation in humans.

Occlusion versus air exposure on full-thickness biopsy wounds

The benefits of moisture-retaining dressings on wound healing are well documented in experimental animal models but not in humans. To examine the effect of occlusion, the effects of three brands of synthetic occlusive dressings (Comfeel Plus, DuoDerm CGF, OpSite) were compared with air exposure in epithelial resurfacing and proliferation in acute, full-thickness skin wounds in humans. In 10 healthy males, four 4 mm standardised wounds were made with a sterile punch biopsy on each lower extremity. Epithelialisation of the wounds was assessed histologically and blindly postwounding on days 7 and 14. Wound margin epidermal proliferation was evaluated immunohistochemically with Ki67. Epithelial percentage coverage increased significantly (p = 0.007) with the occlusive dressings (62 +/- 6%, mean +/- SEM), compared with air exposure, (39 +/- 7%) on day 7 but not on day 14 (p = 0.500). Epidermal cell proliferation showed no significant intergroup difference on either day. Treatment with occlusive dressings increased early epithelial migration of acute full-thickness biopsy wounds compared with air exposure in healthy men.

Incorporation of fluorescent enzyme substrates in agarose gel for in situ zymography

The currently available methods for the detection of proteases in tissue sections are characterized by limited substrate specificity and low sensitivity and are also cumbersome. We have developed a novel in situ zymography method that uses a synthetic substrate conjugated to a fluorescent tag for detection of proteases in tissue sections. In the presence of active enzyme, the fluorescent tag is cleaved off from the substrate peptide chain resulting in an approximately 100-fold increase in the fluorescent signal. In order to minimize the diffusion of the fluorescent tag, the substrate is incorporated into 1% agarose prior to overlaying onto the tissue section. This method retains the morphological details of the tissue section, is highly sensitive and specific for the designated peptide sequence, and provides information regarding the functional status of the enzyme. Thus, this method could be used for detection and monitoring of enzymatic activity in tissue sections for a variety of applications.

Interleukin 13 blocks the release of collagen from bovine nasal cartilage treated with proinflammatory cytokines

OBJECTIVE

To investigate whether interleukin 13 (IL13) could act in a chondroprotective manner and protect cartilage stimulated to resorb with a combination of IL1alpha and oncostatin M (OSM), in a similar way to the anti-inflammatory cytokine, IL4.

METHODS

IL13 was added to explant cultures of bovine nasal cartilage stimulated to resorb with IL1alpha and OSM, and the release of collagen and proteoglycan determined. Collagenolytic and tissue inhibitors of metalloproteinase (TIMP) activities were determined by bioassay. Northern blot analyses were performed to determine the effects of IL13 on the induction of matrix metalloproteinase-1 (MMP-1), MMP-3, MMP-13, and TIMP-1 gene expression.

RESULTS

IL13 can prevent the release of collagen from bovine nasal cartilage in a dose dependent manner. This was accompanied by a concomitant decrease in measurable collagenolytic activity in the culture supernates and an increase in TIMP activity. Northern blot analysis showed that IL13 down regulated MMP-3 and MMP-13 levels but up regulated MMP-1 and TIMP-1 gene expression in bovine nasal chondrocytes at 24 hours.

CONCLUSION

This study showed for the first time that IL13 can block collagen release from resorbing cartilage in a similar manner to IL4. This is accompanied by a reduction in detectable collagenolytic activity, a decrease in MMP-3 and MMP-13 mRNA levels, and an up regulation of TIMP-1 expression.

Differential expression of matrix metalloproteinases and their tissue-derived inhibitors in cutaneous wound repair

Wound extracellular matrix is a key regulator of cell adhesion, migration, proliferation, and differentiation during cutaneous repair. The amount and organization of normal wound extracellular matrix are determined by a dynamic balance among overall matrix synthesis, deposition, and degradation. Matrix metalloproteinases (MMPs) are one family of structurally related enzymes that have the collective ability to degrade nearly all extracellular matrix components. The MMPs are broadly categorized into collagenases, gelatinases, stromelysins, and membrane-type MMPs by their substrate specificity. The aim of this study was to characterize the temporal changes in mRNA profiles for rat collagenase [matrix metalloproteinase-1 (MMP-1)], gelatinase A (MMP-2), matrilysin (MMP-7), gelatinase B (MMP-9), and membrane type 1-MMP (MT1-MMP), as well as tissue inhibitor of metalloproteinases-1 (TIMP-1), TIMP-2, and TIMP-3 during the inflammatory, granulation, and early remodeling phases of excisional skin repair. Eight full-thickness skin wounds were made on the backs of each rat (7-mm2 wounds; 16 rats; n = 128 wounds). Two animals at a time were reanesthetized, and all eight wounds on each animal were excised at 12 and 24 hours and at 2, 3, 5, 7, 10, and 14 days after injury. Six wounds from each animal were excised for RNA isolation, whereas two wounds were excised for histology. Controls consisted of nonwounded skin from identical locations in four animals. Total RNA from each time point was isolated and relative mRNA quantitation performed by using reduced-cycle reverse transcription-polymerase chain reaction. Correct polymerase chain reaction product amplification was confirmed by probing the blotted polymerase chain reaction product with a 32P-labeled oligonucleotide specific for a given MMP or TIMP. We demonstrated that the majority of MMP and TIMP mRNA induction and peak expression coincided temporally with the well-characterized inflammatory and granulation stages of repair. In conclusion, there is a distinct pattern of MMP and TIMP expression during normal excisional wound repair.

Molecular and mechanistic validation of delayed healing rat wounds as a model for human chronic wounds

The purpose of this study was to provide molecular and mechanistic evaluation of an ischemic wound model in rats to determine if it is a valid model for human chronic wounds. Compared to acute wounds, human chronic wounds contain markedly elevated levels of proinflammatory cytokines and matrix metalloproteinases, while matrix metalloproteinase inhibitors and growth factor activity are diminished. Accordingly, tissue from ischemic and normal rat wounds were analyzed for cytokine, proteases and growth factor levels. Dorsal full thickness punch wounds were created in rats using a reproducible template. The ischemic wound group (n = 10) had six uniformly placed wounds within a bipedicled dorsal flap. The control group (n = 10) had the same wounds created without elevation of a flap. On postwound days 3, 6 and 13 wounds were excised and analyzed. Protein levels for tumor necrosis factor-alpha were determined with a rat-specific enzyme-linked immunosorbent assay, while mRNA was determined by RNase protection assay. Matrix metalloproteinases and serine protease detection was done using gelatin and casein zymography, respectively. Significant delay in healing was achieved in the ischemic group: 50% healing for control wounds was at 7 days and 11 days for ischemic wounds (p < 0.001). No significant differences between wound groups were found for interleukin-1beta, and mRNA for tumor necrosis factor-alpha and interleukin-1beta. However, at day 13 ischemic wounds contained significantly more tumor necrosis factor-alpha than controls and normal skin (586 +/- 106 pg/biopsy vs. 79 +/- 7 pg/biopsy vs. 52 +/- 2 pg/biopsy; p < 0. 001). Zymography showed substantially greater quantities of matrix metalloproteinase-2, matrix metalloproteinase-9, and serine proteases in ischemic wounds. This model of delayed healing in rats shares many of the key biochemical, molecular and mechanistic characteristics found in human chronic wounds, namely elevated tumor necrosis factor-alpha and protease levels. As such, this model will likely prove to be useful in chronic wound research, particularly in developing novel therapeutics.

Analysis of the acute and chronic wound environments: the role of proteases and their inhibitors

To assess the differences in proteolytic activity of acute and chronic wound environments, wound fluids were collected from acute surgical wounds (22 samples) and chronic wounds (25 samples) of various etiologies, including mixed vessel disease ulcers, decubiti and diabetic foot ulcers. Matrix metalloproteinase (MMP) activity measured using the Azocoll assay was significantly elevated by 30 fold in chronic wounds (median 22.8 microg MMP Eq/ml) compared to acute wounds (median 0.76 microg MMP Eq/ml) (p < 0.001). The addition of the matrix metalloproteinase inhibitor Illomostat decreased the matrix metalloproteinase activity by approximately 90% in all samples, confirming that the majority of the activity measured was due to matrix metalloproteinases. Gelatin zymograms indicated predominantly elevated matrix metalloproteinase-9 with smaller elevations of matrix metalloproteinase-2. In addition tissue inhibitor of metalloproteinase-1 levels were analyzed in a small subset of acute and chronic wounds. When tissue inhibitor of metalloproteinase-1 levels were compared to protease levels there was an inverse correlation (p = 0.02, r = - 0.78). In vitro degradation of epidermal growth factor was measured by addition of 125I labelled epidermal growth factor to acute and chronic wound fluid samples. There was significantly higher degradation of epidermal growth factor in chronic wound fluid samples (mean 28.1%) compared to acute samples (mean 0.6%). This also correlated to the epidermal growth factor activity of these wound fluid samples (p < 0. 001, r = 0.64). Additionally, the levels of proteases were assayed in wound fluid collected from 15 venous leg ulcers during a nonhealing and healing phase using a unique model of chronic wound healing in humans. Patients with nonhealing venous leg ulcers were admitted to the hospital for bed rest and wound fluid samples were collected on admission (nonhealing phase) and after 2 weeks (healing phase) when the ulcers had begun to heal as evidenced by a reduction in size (median 12%). These data showed that the elevated levels of matrix metalloproteinase activity decreased significantly as healing occurs in chronic leg ulcers (p < 0.01). This parallels the processes observed in normally healing acute wounds. This data also supports the case for the addition of protease inhibitors in chronic wounds in conjunction with any treatments using growth factors.

Role of matrix metalloproteinases and their inhibition in cutaneous wound healing and allergic contact hypersensitivity

Normal wounds can heal by secondary intention (epidermal migration to cover a denuded surface) or by approximation of the wound edges (e.g., suturing). In healing by secondary intention, epidermis-derived MMPs are important. Keratinocyte migration begins within 3-6 hr post injury, as basal cells detach from underlying basal lamina and encounter a dermal substratum rich in type I collagen. Cell contact with type I collagen in vitro stimulates collagenase-1 expression, which is mediated by the alpha 2 beta 1 integrin, the major keratinocyte collagen-binding receptor. Collagenase-1 activity alone is necessary and sufficient for keratinocyte migration over a collagen subsurface. Stromelysins-1 and -2 are also found in the epidermis of normal acute wounds. Stromelysin-2 co-localizes with collagenase-1 and may facilitate cell migration over non-collagenous matrices of the dermis. In contrast, stromelysin-1 is expressed by keratinocytes behind the migrating front and which remain on basal lamina, i.e., the proliferative cell population. Studies with stromelysin-1-deficient mice that suggest this MMP plays a role in keratinocyte detachment from underlying basement membrane to initiate cell migration. In chronic ulcers, MMP levels are markedly elevated, in contrast to their precise temporal and spatial expression in acute wounds. Both collagenase-1 and stromelysin-1 are found in fibroblasts underlying the nonhealing epithelium, and stromelysin-1 expression is especially prominent. Two key questions underlie the use of MMP inhibitors and wound healing: (1) will these agents impair normal reepithelialization in wounds that heal by secondary intention; and (2) can MMP inhibitors be effective therapy for chronic ulcers? The answer to neither is known. Batimastat and marimastat appear not to interfere with normal wound healing, but only in sutured surgical wounds, a situation in which MMP expression has practically no role. We also show the first example of an in vivo immune response, contact hypersensitivity, which is dependent upon MMP activity. Using gene-deficient mice, we demonstrate that stromylysin-1 (MMP-3) is required for sensitization, whereas gelatinase B (MMP-9) is required for timely resolution of the reaction to antigenic challenge.

Aging differentially modulates the expression of collagen and collagenase in dermal fibroblasts

This study was conducted to investigate the effects of aging on collagen and collagenase expression by human dermal fibroblasts. To evaluate this effect, the expression of these ECM was determined and compared between either fetal and adult fibroblasts or dermal fibroblasts at various passages. A total of 13 cell strains, 8 fetal foreskin and 5 adult dermal fibroblasts, were grown to 80-90% confluency and their rates of cell proliferation and expression of mRNA for collagenase (MMP-1) and pro alpha1(I) chain of type I collagen was determined and compared. Fetal cells had a significantly higher rate of proliferation relative to adult fibroblasts evaluated within 10 days of culture. Northern analysis was used to evaluate the steady state levels of mRNA in these cells. The result of these experiments revealed a significantly greater expression of mRNA for collagenase (58.6 +/- 7.7 vs. 9.9 +/- 1.5, p < 0.05) in strains of adult fibroblasts. This was consistent with collagenase activity of conditioned medium derived from adult cells relative to fetal fibroblasts. However the expression of pro alpha1 (I) chain of type I collagen mRNA was not significantly (56.2 +/- 5.2 vs. 58.5 +/- 3.5) different between adult and fetal fibroblasts. This finding was confirmed by measuring total collagen production present in conditioned medium of these cells using hydroxyproline as an index for collagen production. The cellular response to IGF-1 and IFN-alpha2b as representatives of fibrogenic and anti-fibrogenic factors were also evaluated. When expression of collagenase was used as an indication for cellular response, the degree of this response to IGF-1 but not IFN-alpha2b was significantly greater in fetal relative to adult cells. Serial passage was also used as an in vitro model for aging fibroblasts and found a gradual reduction in pro alpha1(I) chain of type I collagen mRNA and hydroxyproline formation due to passaging. In conclusion, a slower rate of proliferation, a greater collagenase activity and expression of collagenase mRNA by aging fibroblasts could be some of the main reasons for attenuation of wound healing in elderly patients.

Epidermal expression of collagenase delays wound-healing in transgenic mice

A vital characteristic of skin is its ability for wound repair in response to injury. A transient elevation of matrix metalloproteinases (MMP) in the epidermal and dermal compartments of healing wounds implicates the MMP family of enzymes in the regulation of events important to injury repair. Transgenic mice expressing human interstitial collagenase (MMP-1) in the epidermis were used to perturb the regulation of this proteinase in order to examine the role of epidermal collagenase during wound healing. The relative healing potential of collagenase transgenic mice and wild-type littermates was assessed by measurements of the wound area during closure of full-thickness wounds. Transgenic mice exhibited a 2-3 d delay in the time required to reach 50% closure of 6 mm wounds. Histologic analysis of the transgenic wound bed revealed the retarded migration of the epithelium across the open wound. The results are consistent with the hypothesis that control of collagenase (MMP-1) expression is important for re-epithelialization during wound healing and indicate that collagenase regulation is critical to the kinetics of normal wound closure.

Tissue-engineered human skin substitutes developed from collagen-populated hydrated gels: clinical and fundamental applications

The field of tissue engineering has opened several avenues in biomedical sciences, through ongoing progress. Skin substitutes are currently optimised for clinical as well as fundamental applications. The paper reviews the development of collagen-populated hydrated gels for their eventual use as a therapeutic option for the treatment of burn patients or chronic wounds: tools for pharmacological and toxicological studies, and cutaneous models for in vitro studies. These skin substitutes are produced by culturing keratinocytes on a matured dermal equivalent composed of fibroblasts included in a collagen gel. New biotechnological approaches have been developed to prevent contraction (anchoring devices) and promote epithelial cell differentiation. The impact of dermo-epidermal interactions on the differentiation and organisation of bio-engineered skin tissues has been demonstrated with human skin cells. Human skin substitutes have been adapted for percutaneous absorption studies and toxicity assessment. The evolution of these human skin substitutes has been monitored in vivo in preclinical studies showing promising results. These substitutes could also serve as in vitro models for better understanding of the immunological response and healing mechanism in human skin. Thus, such human skin substitutes present various advantages and are leading to the development of other bio-engineered tissues, such as blood vessels, ligaments and bronchi.

Collagenase-1 complexes with alpha2-macroglobulin in the acute and chronic wound environments

The purpose of this study was to examine the appearance and activation of collagenase-1 (MMP-1) in the wound environment. We found that MMP-1 accumulates in the fluid phase of the burn wound environment within 2 d of injury and reaches maximal levels by day 4. Two forms of the enzyme were evident; one that corresponded to proMMP-1 and another that corresponded to a group of high molecular mass (approximately 200 kDa and >200 kDa doublet) MMP-1 containing complexes. ProMMP-1 and MMP-1 containing complexes also occurred in wound fluid from venous stasis ulcers, but neither was detected in mastectomy fluid or in plasma. Levels of the proteinase inhibitor alpha2-macroglobulin in burn fluid and chronic ulcer wound fluid were almost as high as in plasma, and the high molecular mass MMP-1 containing complexes in burn fluid appeared to result from binding between alpha2-macroglobulin and activated MMP-1. These observations provide direct evidence that active MMP-1 in the fluid phase of the wound environment becomes complexed to alpha2-macroglobulin.

Identification of proteinase 3 as the major caseinolytic activity in acute human wound fluid

Wound fluid contains several proteinases that are important in the repair process. In this study, we analyzed caseinolytic activity in wound fluid obtained from acute (burn) wounds. Caseinolytic activity in wound fluid increased markedly 2 d after injury and appeared on casein zymographs as a series of bands or a smear ranging from 30 to 100 kDa. Most of the enzyme activity was inhibited by the synthetic human neutrophil elastase inhibitor MDL 27,367 but not by the naturally occurring inhibitor of elastase, human secretory leukoproteinase inhibitor. Fractionation of wound fluid indicated that a single enzyme accounted for approximately 80% of the caseinolytic activity. This enzyme degraded the elastase substrate methoxysuccinyl-ala-ala-pro-val-p-nitroanilide at a slow rate. The above findings suggested that the enzyme responsible for caseinolytic activity might be proteinase 3, an elastase-related enzyme whose physiologic functions are poorly understood. Consistent with the above possibility, we found that monoclonal antibodies against proteinase 3 removed caseinolytic activity from wound fluid, and that purified proteinase 3 had a similar caseinolytic profile and inhibitor sensitivity to burn fluid.

Matrix metalloproteinase 9 level predicts optimal collagen deposition during early wound repair in humans

BACKGROUND

This study examined two matrix metalloproteinases (MMPs) and their association with deposition of collagen during wound repair.

METHODS

In 15 hernia wounds, wound fluid was collected using two Cellstick devices, which were implanted adjacent to two expanded polytetrafluoroethylene (ePTFE) tubes. MMP-2 and MMP-9 levels were analysed 24 and 48 h after operation using specific enzyme-linked immunosorbent assays, and collagen deposition in the ePTFE tubes was measured 10 days after operation as hydroxyproline.

RESULTS

The levels of both MMPs in wound fluid were increased compared with those of control serum, although MMP-9 decreased (P < 0.01) in the wounds 24-48 h after operation. The MMP-9 level at 24 h correlated inversely and specifically to deposited collagen measured as hydroxyproline (rs = -0.80, P < 0.01).

CONCLUSION

These results indicate that the level of MMP-9 in the early inflammatory phase can predict the amount of collagen deposited later in the wound healing process.

AP-1-mediated invasion requires increased expression of the hyaluronan receptor CD44

Fibroblasts transformed by Fos oncogenes display increased expression of a number of genes implicated in tumor cell invasion and metastasis. In contrast to normal 208F rat fibroblasts, Fos-transformed 208F fibroblasts are growth factor independent for invasion. We demonstrate that invasion of v-Fos- or epidermal growth factor (EGF)-transformed cells requires AP-1 activity. v-Fos-transformed cell invasion is inhibited by c-jun antisense oligonucleotides and by expression of a c-jun dominant negative mutant, TAM-67. EGF-induced invasion is inhibited by both c-fos and c-jun antisense oligonucleotides. CD44s, the standard form of a transmembrane receptor for hyaluronan, is implicated in tumor cell invasion and metastasis. We demonstrate that increased expression of CD44 in Fos- and EGF-transformed cells is dependent upon AP-1. CD44 antisense oligonucleotides reduce expression of CD44 in v-Fos- or EGF-transformed cells and inhibit invasion but not migration. Expression of a fusion protein between human CD44s and Aequorea victoria green fluorescent protein (GFP) in 208F cells complements the inhibition of invasion by the rat-specific CD44 antisense oligonucleotide. We further show that both v-Fos and EGF transformations result in a concentration of endogenous CD44 or exogenous CD44-GFP at the ends of pseudopodial cell extensions. These results support the hypothesis that one role of AP-1 in transformation is to activate a multigenic invasion program.

Effect of growth factors on matrix synthesis by ligament fibroblasts

Although it has been reported that several growth factors modulate soft-tissue healing, the specific effects of growth factors on protein synthesis during ligament healing have not been widely investigated. In this study, we examined the effects of basic and acidic fibroblast growth factors, transforming growth factor beta 1, and epidermal growth factor on collagen and noncollagenous protein synthesis by cultured fibroblasts from medial collateral ligament and anterior cruciate ligament in vitro. Uptake of tritiated proline was used to measure synthesis of collagen and noncollagenous protein, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis was used to analyze the type of collagens synthesized. Our data showed that transforming growth factor beta 1 increased both collagen and noncollagenous protein synthesis by medial collateral and anterior cruciate ligament fibroblasts on a dose-dependent basis. Collagen synthesis by cultured fibroblasts from the medial collateral and anterior cruciate ligaments was increased by treatment with transforming growth factor beta 1 by as much as approximately 1.5 times that of untreated controls. Although the response to transforming growth factor beta 1 by anterior cruciate ligament fibroblasts was equal to that by medial collateral ligament fibroblasts, the amounts of matrix proteins synthesized by anterior cruciate ligament fibroblasts were approximately half of that by medial collateral ligament fibroblasts. The increase was mostly in type-I collagen. Treatment of anterior cruciate ligament fibroblasts with epidermal growth factor increased collagen synthesis by approximately 25% but had little effect on medial collateral ligament fibroblasts. Neither basic nor acidic fibroblast growth factor increased either collagen or noncollagenous protein synthesis. These findings suggest that topical application of transforming growth factor beta 1, alone or in combination with epidermal growth factor, may have the potential to strengthen the ligament by increasing matrix synthesis during its remodeling and healing processes.

A comparative study of three occlusive dressings in the treatment of full-thickness wounds in pigs

BACKGROUND

Little objective information is available on the influence of occlusive dressings on the healing of cutaneous full-thickness wounds.

OBJECTIVE

Our purpose was to examine the effects of three occlusive dressings-two hydrocolloid dressings (Comfeel Ulcer Dressing, Coloplast A/S, Espergaerder, Denmark [hydrocolloid dressing A] and DuoDERM; ConvaTec, Princeton, N.J. [hydrocolloid dressing B]) and one polyurethane film dressing (OpSite, Smith & Nephew, Hull, U.K. [film dressing])-on tissue reactions, degree of inflammation, wound contraction, and epithelialization in full-thickness wounds in domestic pigs.

METHODS

Standardized 20 mm full-thickness punch biopsy wounds were treated for 10 days. Healing was assessed by light microscopy and by planimetry.

RESULTS

Material from both hydrocolloid dressings was phagocytosed as indicated by the presence of foam cells in the granulation tissue. Granulomatous tissue reactions around extracellular vacuoles were found in 10 of 12 hydrocolloid dressing B-treated wounds compared with one in hydrocolloid dressing A-treated wounds and in none of the 10 film dressing-treated wounds (p < 0.0001). Inflammation was significantly (p < 0.002) more pronounced in hydrocolloid dressing B-treated wounds. The extracellular vacuoles in the hydrocolloid dressing B group contained dressing material as demonstrated by Fourier transform infrared microscopy. There was a tendency (p < 0.07) towards a delayed entry into the contraction phase with hydrocolloid dressing B, but there was no significant difference in epithelialization between the three dressings.

CONCLUSION

Wound tissue reactions to different hydrocolloid dressings vary depending on composition. The tissue reactions had no significant effect on wound contraction or epithelialization.

Divergent patterns of matrix metalloproteinase activity during wound healing in ileum and colon of rats

BACKGROUND

Uncontrolled and increased extracellular matrix degradation during early anastomotic repair in the intestine may reduce wound strength increasing the risk of anastomotic dehiscence.

AIMS

To characterise the metalloproteinases present in intact and anastomosed ileum and colon to study their role in matrix degradation after surgery.

SUBJECTS

Tissue extracts of uninjured, and of anastomosed rat ileum and colon at postoperative days 1, 2, 3, 7, and 90, were used.

METHODS

Metalloproteinases were identified by gelatin and casein zymography. Aminophenylmercuric acetate (APMA) treatment was used to activate latent metalloproteinases.

RESULTS

Both uninjured ileum and colon contained a 60 and 67 kDa activity, but a 54 and 72 kDa gelatinase was present in ileum only, and a 51 kDa activity in colon only. APMA treatment converted the 60 kDa protease to 54 and 51 kDa forms and the 72 kDa protease to the 67 kDa form. These gelatinases may correspond to latent and active forms of MMP 1 and MMP 2, respectively. Additional metalloproteinases were observed after anastomotic construction. Both ileum and colon contained 95 and 230 kDa gelatinases, which were converted to 83 and 76 kDa forms by APMA. They may be the latent and active forms of MMP 9, respectively. Gelatinolytic activities of 25 and 28 kDa were only found in anastomosed ileum. Caseinolytic activities were only found in ileum extracts and those were most prominent at day 1, 2, and 3 after surgery.

CONCLUSIONS

The metalloproteinase pattern in ileum and colon differ considerably suggesting that matrix degradation after anastomotic construction may also vary.

The role of growth factors in wound healing

Growth factors have many activities that make them attractive agents for stimulating tissue repair. Growth factors attract cells into the wound, stimulate their proliferation, and have profound influence on extracellular matrix deposition. Since developing the ability to mass-produce these cytokines by recombinant techniques, hundreds of studies have demonstrated that growth factors can augment all aspects of tissue repair in normal and impaired healing models. After demonstrating that growth factors augment healing, investigators have started to detect and measure growth factors in wounds and have found that wounding initiates the expression of various growth factors. Impaired healing has also been linked to altered growth factor production. These findings have prompted great interest in the use of growth factors to augment clinical healing. Preliminary clinical trials have not produced the results expected. Growth factor treatment has occasionally led to statistically significant improvements in tissue repair, but whether the results are clinically significant can be debated. It appears that to be cost effective, clinical trials must focus on targeting growth factors for specific types of impaired healing. Although growth factors have not been the panacea that was originally expected, they have the potential for making significant clinical improvements when targeted for specific problem wounds.

Matrix metalloproteinases, gelatinase and collagenase, in chronic leg ulcers

Although extracellular proteolysis is a prerequisite for normal wound healing, uncontrolled proteolytic tissue destruction appears to be a pathogenic factor in non-healing wounds. The aim of our study was to compare the activities of the serine proteinases of polymorphonuclear origin, elastase and cathepsin G, and the metalloproteinases, gelatinase and collagenase, in chronic leg ulcer exudate (10 patients) and acute wound fluid (6 patients). Serine proteinase activities were low in leg ulcer exudates but very high in some but not all acute wound fluids. Total collagenase activity, measured as activity against type I collagen monitored by SDS-PAGE and densitometry, was higher in chronic leg ulcer exudate than in acute wound fluid and its degree of autoactivation was relatively high. Doxycycline inhibition studies suggested that the collagenase activity in chronic leg ulcer exudate was MMP-1 ("fibroblast-type") and not MMP-8 ("neutrophil-type"). Zymographic analysis of the gelatinolytic enzymes in acute wound fluid showed a progressive increase from the day of operation to postoperative day 5, but the degree of activity was lower than in chronic leg ulcer exudate and the low molecular mass activation products were faint. The leg ulcer gelatinase profiles were characterized by high expression of 92/82- and 72/62-kDa duplex bands and by the presence of low molecular mass activation products. Leg ulcer collagenase seems to be derived from mononuclear rather than polymorphonuclear cells, which are known to be involved in acute wound healing. In conclusion, the present study shows that gelatinase and collagenase, but not elastase and cathepsin G are found in chronic leg ulcer exudate.

Fibronectin degradation in chronic wounds depends on the relative levels of elastase, alpha1-proteinase inhibitor, and alpha2-macroglobulin

The goal of our studies was to learn about the mechanism of fibronectin degradation in chronic ulcers. We found that the appearance of fibronectin fragments in chronic ulcer wound fluid correlated with elevated levels of elastase and cleavage of the proteinase inhibitors alpha2-macroglobulin (alpha2-M) and alpha 1-proteinase inhibitor (alpha1-P1). Some wound fluid samples retained the capacity to degrade fibronectin in vitro. Degradation of fibronectin by these samples was blocked by specific inhibitors of neutrophil elastase but not by inhibitors of metalloproteinases. Addition of human neutrophil elastase to mastectomy fluid, an acute wound fluid, resulted in formation of alpha1-PI and alpha2-M complexes and cleavage products resembling those observed in chronic wound fluid. Moreover, degradation of fibronectin and processing of matrix metalloproteinase MMP-9 occurred under these conditions. Taken together, our findings suggest that elevated levels of neutrophil elastase are responsible for fibronectin degradation in the chronic wound environment.

Collagenase: a key enzyme in collagen turnover

The primary agents responsible for cartilage and bone destruction in joint diseases are active proteinases that degrade collagen and proteoglycan. All four main classes of proteolytic enzymes are involved in either the normal turnover of connective tissue or its pathological destruction. These proteinases are made by different cells found within the joints. Both extracellular and intracellular pathways exist and individual enzymes can be inhibited by specific proteinaceous inhibitors that block their activity. Recent research has implicated the matrix metalloproteinases (MMPs) in many of the processes involved in joint diseases. The metalloproteinases are capable of degrading all components of the extracellular matrix. This family of proteinases contains a group of at least three collagenases that are capable of degrading native fibrillar collagen. Collagen degradation within joint disease is recognized as the irreversible step in the destruction of cartilage that leads to a failure in joint function. The collagenases are the enzymes necessary to initiate collagen turnover in normal connective tissue turnover and in disease.

Metalloproteinase inhibitors and the prevention of connective tissue breakdown

The primary agents responsible for cartilage and bone destruction in joint diseases are active proteinases degrading collagen and proteoglycan. All four main classes of proteolytic enzymes are involved in either the normal turnover of connective tissue or its pathological destruction. These proteinases are made by different cells found within the joints. Both extracellular and intracellular pathways exist, and individual enzymes can be inhibited by specific proteinaceous inhibitors that block their activity. Recent research has implicated the matrix metalloproteinases in many of the processes involved in joint diseases. Conventional treatments do little to affect the underlying disease processes, and recently, the use of proteinase inhibitors has been suggested as a new therapeutic approach. A large variety of different synthetic approaches have been used and highly effective metalloproteinase inhibitors have been designed, synthesised and tested. These metalloproteinase inhibitors can prevent the destruction of animal cartilage in model systems and slow the progression of human tumours. Future patient trials will test the effectiveness of these compounds in vivo for the treatment of joint diseases.

Co-expression of tissue inhibitor and matrix metalloproteinase in myocardium

Matrix metalloproteinases (MMP) are present in the latent form in normal myocardium. To examine the stringent balance between MMP and tissue inhibitor of metalloproteinase (TIMP) and to determine whether MMP are secreted simultaneously and in co-ordination with their inhibitors, we analysed MMP and TIMP by immunological, isolation by gel-permeation and affinity chromatography, and enzymatic assays in tissues and extracts. Using antibodies to MMP-1 and TIMP-1, we found strong in situ staining of MMP-1 and TIMP-1 in tissues. The staining was uniform in the endo- and subendomyocardium as well as in the interstitial space. TIMP-1 was present wherever MMP-1 was localized. From the tissue extract, proteins were separated on a gel-filtration column (Sephacryl S-200) and analysed for MMP and TIMP activity by zymography as well as by using succinyl-Gly-Pro-Leu-Gly-Pro-4-amido-7-methyl coumarin (Suc-GPLGP-AMC) as a selective fluorogenic substrate for collagenase. TIMP and MMP were further purified on collagen-Sepharose affinity column. The results indicated that MMP activity was co-eluted with TIMP activity. MMP-1, MMP-2 and TIMP-1 were further analysed by Northern blot for mRNA levels in the heart, skin, lung, liver and kidney. Results suggested co-expression of MMP-1 and TIMP-1 at the transcription level in all tissues. The level of MMP-2 mRNA was specifically higher in the heart tissue, which suggests a role of MMP-2 in the integrity of cardiovascular structure. The study indicated that myocardium as well as other tissue have an endogenous inhibitory system, suggesting that the MMPs activity is co-ordinated by their inhibitors at both the gene and protein levels. Furthermore, MMP and TIMP were co-expressed and were tightly regulated in maintaining the architecture of the interstitial tissue.

Collagenase expression is rapidly induced in wound-edge keratinocytes after acute injury in human skin, persists during healing, and stops at re-epithelialization

Collagenolytic activity has been reported previously in association with wounds. We used in situ hybridization and immunohistochemistry to localize cellular sites of interstitial collagenase production in acute wounds in human skin at days 1, 2, 4, 6, 9, and 14 after wounding. In vivo, collagenase expression peaked in migrating basal keratinocytes at the wound edge at day 1, then gradually decreased and was undetectable at day 9 when healing was complete. To minimize the effects of crust formation and inflammation, we examined the healing of wounds made with a 3-mm punch in organ-cultured skin. In these in vitro wounds, re-epithelialization occurred by 5-7 d in 10% serum, although remodeling of the connective tissue was minimal. Collagenase expression showed a similar pattern as in the in vivo wounds; it was detected in migrating keratinocytes already 4-6 h after wounding, peaked at 12-24 h, gradually decreased during the next few days, and subsided upon re-epithelialization. In dermal fibroblasts, on the other hand, expression of collagenase started considerably later, after 5-7 d in culture, and persisted after complete re-epithelialization, indicating that collagenase is differentially regulated in different cell types. Our findings also show that collagenase induction in keratinocytes does not require inflammation and occurs as a rapid response to wounding, suggesting that interstitial collagenase is not only necessary for remodeling of the extracellular matrix, but may also have a role in initiating migration of keratinocytes in wound healing.

Tissue inhibitor of metalloproteinases-1 is decreased and activated gelatinases are increased in chronic wounds

The balance between matrix deposition and tissue turnover is fundamental in wound healing. It is likely that the balance between proteolytic enzymes and their inhibitors contributes to this balance. Matrix metalloproteinases are clearly important in tissue turnover, but their roles in wound healing are poorly understood. To investigate this, fluid from healing wounds resulting from mastectomies was collected from 1 h to 10 d post-surgery, and was analyzed for tissue inhibitor of metalloproteinases-1 concentrations. In all cases, tissue inhibitor of metalloproteinases-1 levels were initially comparable to those in serum, but increased rapidly to significantly higher levels within two days, with a tenfold average increase for five patients. On the other hand, zymography revealed that gelatinase A (72 kDa) levels increased moderately, whereas gelatinase B levels (92 kDa) decreased an average of twofold within 4 d. In contrast, fluid from chronic wounds had significantly more gelatinolytic activity, including lower-molecular-weight proteinase species that may represent activated or superactivated gelatinase fragments, as suggested by immunoprecipitation with specific antibodies. Tissue inhibitor of metalloproteinases-1 levels were lower in chronic than in healing wounds. These data may indicate that excess proteolysis in chronic wounds retards successful healing, and results from an imbalance of proteinase and inhibitors, as well as the presence of higher levels of activated metalloproteinases.

Gelatinase activity during wound healing

The two known mammalian gelatinases, 72- and 92-kDa gelatinase, are extracellular matrix metalloproteinases (MMPs) with a potential role in wound healing. The gelatinase activity as a function of wound age was analysed in tissue extracts of partial- and full-thickness wounds in the skin of pigs, using two assay systems. Total gelatinase activity, assessed using a 3H-labelled gelatin assay, was highest in the early healing phases and then decreased as healing proceeded in both wound types. Gelatin zymography, which distinguishes the activities of the two gelatinases, showed that the 92-kDa (MMP-9) gelatinase essentially followed the same pattern as that of total gelatinase activity, whereas the activity of the 72-kDa gelatinase (MMP-2) remained fairly stable, although it was higher than in uninjured skin, over the experimental period, irrespective of wound type. In conclusion, the two gelatinases appear to have different functions in the wound healing process. The 72-kDa gelatinase (MMP-2) is important during the prolonged remodelling phase, whereas the 92-kDa gelatinase (MMP-9) is linked to the epithelialization process and early repair events.

Metalloproteinase activation cascade after burn injury: a longitudinal analysis of the human wound environment

In this paper, we present a longitudinal study on metalloproteinases in wound-fluid samples collected from three patients with partial- to full-thickness burn wounds. Gelatin zymography showed that 92-kDa gelatinase (MMP-9) and its 225-kDa complex could be detected in burn fluid beginning as early as 4-8 h after injury. Marked increases in MMP-9 levels as well as activation of the proenzyme occurred between day 0 and day 2. The 72-kDa gelatinase (MMP-2) proenzyme was not detected until day 2 and activated enzyme did not appear until day 4. Stromelysin (MMP-3), both proenzyme and activated-enzyme forms, was first observed on day 4. Fluid-phase proteinase activity detected by azocoll degradation roughly corresponded with the level of stromelysin rather than the gelatinases. Our results provide evidence for a regulated metalloproteinase activation cascade following acute traumatic injury and demonstrate in vivo expression of metalloproteinase activity.

Wound repair in the context of extracellular matrix

Wound repair requires a continually evolving network of interactions among cells, cytokines and the extracellular matrix. Cell-surface integrins provide a mechanical connection between matrix components and the cytoskeleton, and integrins can transduce an astonishing variety of signals along pathways that may intercept the pathways triggered by cytokine receptors.

Localization of mRNAs representing interstitial collagenase, 72-kda gelatinase, and TIMP in healing porcine burn wounds

The process of wound healing sets in motion a complex and dynamic series of events, which includes the remodeling of the extracellular matrix. Degradation of matrix macromolecules is mediated through the actions of the matrix metalloproteinase family. Conversely, the actions of this enzyme family are regulated by tissue inhibitors of metalloproteinases (TIMPs). In this study, we have developed riboprobes derived from human cDNAs representing collagenase, 72-kDa gelatinase, and TIMP and have found them to be sufficiently specific and sensitive for use in in situ hybridization studies of porcine burn wounds. Expression of these mRNAs, although not seen in uninjured skin, was found to be a predictable and locally distinct event in wound repair. Transcripts for collagenase and TIMP but not 72-kDa gelatinase were detected at the resurfacing epithelial margin; label was also detected in and around follicular epithelium within the wound bed. Transcripts for both metalloenzymes and TIMP were found throughout the viable dermis and subcutaneous tissues underlying the wound bed. However, expression of 72-kDa gelatinase was most prominent in the superficial dermis adjacent to the resurfacing epidermis at the wound margin. Collagenase and TIMP transcripts were particularly prominent in a perivascular pattern in the dermis and in the connective tissue network surrounding adipocytes in the subcutaneous zone. Numerous cell types appeared to be involved, including keratinocytes, fibroblasts, macrophages, and endothelial cells. Future exploitation of this porcine thermal injury model is likely to provide information about the spatial and temporal patterns of matrix metalloproteinase and TIMP expression in cutaneous wound healing.

Are excessive granulation tissue formation and retarded wound contraction due to decreased collagenase activity in wounds in tight-skin mice?

Wound contraction is delayed in tight-skin mice but the mechanism(s) are unknown. The purpose of this study was to investigate collagenase levels and the formation of granulation tissue in experimental wounds in tight-skin mice. One full-thickness skin excision (20 x 20 mm) was made on the back of nine tight-skin and eight normal mice. Granulation tissue analyses were performed 7 days post-operatively. The collagenase activity was determined by the use of a radiolabelled telopeptide-free collagen substrate, and the amount of granulation tissue was determined gravimetrically. Wound contraction was delayed (P < 0.001) in tight-skin mice (mean 22%) compared with normal mice (mean 46%). The collagenase activity was decreased (P < 0.05) by 40%, whereas the quantity of granulation tissue was increased (P < 0.001) by 60% in the wounds of tight-skin mice. Decreased collagenase content may provide one explanation for the delayed contraction of full-thickness wounds in tight-skin mice. Furthermore, this animal would model may prove useful in the understanding of the pathogenesis, and in exploration of treatment, of excessive granulation tissue formation during wound healing.

Regulation of proteolytic activity in tissues

Degradation of tissue proteins is controlled by multiple means. These include regulation of the synthesis of proteinases, activation of the zymogen forms, the activity of the mature proteinase, and the degradation of these enzymes and the substrates. Mature proteinases can be controlled by pH, calcium ions, ATP, lipids and the formation of complexes with other proteinases, proteoglycans, and inhibitors.