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Magne B, Demers A, Savard É, Lemire-Rondeau M, Veillette N, Pruneau V, Guignard R, Morissette A, Larouche D, Auger FA, Germain L. Speeding up the Production of Clinical-Grade Skin Substitutes Using Off-the-shelf Decellularized Self-Assembled Dermal Matrices. Acta Biomater 2023:S1742-7061(23)00318-5. [PMID: 37285897 DOI: 10.1016/j.actbio.2023.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
Patients with deep and extensive wounds need urgent skin coverage to re-establish the cutaneous barrier that prevents life-threatening infections and dehydration. However, the current clinically-available skin substitutes intended for permanent coverage are limited in number, and a trade-off between production time and quality must be made. Here, we report the use of decellularized self-assembled dermal matrices to reduce by half the manufacturing process time of clinical-grade skin substitutes. These decellularized matrices can be stored for over 18 months and recellularized with patients' cells in order to generate skin substitutes that show outstanding histological and mechanical properties in vitro. Once grafted in mice, these substitutes persist over weeks with high graft take, few contraction events, and high stem cell content. These next-generation skin substitutes constitute a substantial advancement in the treatment of major burn patients, combining, for the first time, high functionality, rapid manufacturability and easy handling for surgeons and healthcare practitioners. Future clinical trials will be conducted to assess the advantages of these substitutes over existing treatments. STATEMENT OF SIGNIFICANCE: The number of patients in need for organ transplantation is ever-growing and there is a shortage in tissue and organ donors. In this study, we show for the first time that we can preserve decellularized self-assembled tissues and keep them in storage. Then, in only three weeks we can use them to produce bilayered skin substitutes that have properties very close to those of the native human skin. These findings therefore represent a major step forward in the field of tissue engineering and organ transplantation, paving the way toward a universal off-the-shelf biomaterial for tissue reconstruction and surgery that will be beneficial for many clinicians and patients.
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Affiliation(s)
- Brice Magne
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Anabelle Demers
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Étienne Savard
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Marika Lemire-Rondeau
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Noémie Veillette
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Virgile Pruneau
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Rina Guignard
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Amélie Morissette
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Danielle Larouche
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - François A Auger
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center
| | - Lucie Germain
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada.; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX; CHU de Québec - Université Laval Research Center.
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Changes in the Dermal Structure during Cultured Epidermal Autograft Engraftment Process. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e870. [PMID: 27757335 PMCID: PMC5055001 DOI: 10.1097/gox.0000000000000838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
The use of cultured epithelial autografts for the treatment of extensive burn wounds has become popular in recent years. We examined extensive burn wounds in 14 patients by using a combination of autograft and cultured epithelial autografts developed in Japan (JACE).
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De Schepper S, Boucneau JMA, Westbroek W, Mommaas M, Onderwater J, Messiaen L, Naeyaert JMAD, Lambert JLW. Neurofibromatosis type 1 protein and amyloid precursor protein interact in normal human melanocytes and colocalize with melanosomes. J Invest Dermatol 2006; 126:653-9. [PMID: 16374483 DOI: 10.1038/sj.jid.5700087] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The neurofibromatosis type 1 (NF1) gene product, neurofibromin, is known to interact with Ras, thereby negatively regulating its growth-promoting function. Although this is a well-established interaction, the discovery of other neurofibromin interacting partners could reveal new functional properties of this large protein. Using yeast two-hybrid analysis against a brain cDNA library, we identified a novel interaction between the amyloid precursor protein and the GTPase activating protein-related domain of neurofibromin. This interaction was further analyzed in human melanocytes and confirmed by immunoprecipitation and colocalization studies. In addition, we observed a colocalization of amyloid precursor protein and neurofibromin with melanosomes. Amyloid precursor protein has been proposed to function as a vesicle cargo receptor for the motor protein kinesin-1 in neurons. This colocalization of amyloid precursor protein and neurofibromin with melanosomes was lost in melanocytes obtained from normal skin of a NF1 patient. We suggest that a complex between amyloid precursor protein, neurofibromin, and melanosomes might be important in melanosome transport, which could shed a new light on the etiopathogenesis of pigment-cell-related manifestations in NF1.
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Affiliation(s)
- Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
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4
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Gharzi A, Reynolds AJ, Jahoda CAB. Plasticity of hair follicle dermal cells in wound healing and induction. Exp Dermatol 2003; 12:126-36. [PMID: 12702140 DOI: 10.1034/j.1600-0625.2003.00106.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The capacity of adult hair follicle dermal cells to participate in new follicle induction and regeneration, and to elicit responses from diverse epithelial partners, demonstrates a level of developmental promiscuity and influence far exceeding that of interfollicular fibroblasts. We have recently suggested that adult follicle dermal cells have extensive stem or progenitor cell activities, including an important role in skin dermal wound healing. Given that up to now tissue engineered skin equivalents have several deficiencies, including the absence of hair follicles, we investigated the capacity of follicle dermal cells to be incorporated into skin wounds; to form hair follicles in wound environments; and to create a hair follicle-derived skin equivalent. In our study, we implanted rat follicle dermal cells labelled with a vital dye into ear and body skin wounds. We found that they were incorporated into the new dermis in a manner similar to skin fibroblasts, but that lower follicle dermal sheath also assimilated into hair follicles. Using different combinations of follicle dermal cells and outer root sheath epithelial cells in punch biopsy wounds, we showed that new hair follicles were formed only with the inclusion of intact dermal papillae. Finally by combining follicle dermal sheath and outer root sheath cells in organotypic chambers, we created a skin equivalent with characteristic dermal and epidermal architecture and a normal basement membrane - the first skin to be produced entirely from hair follicle cells. These data support the hypothesis that follicle dermal cells may be important in wound healing and demonstrate their potential usefulness in human skin equivalents and skin substitutes. While we have made progress towards producing skin equivalents that contain follicles, we suggest that the failure of cultured dermal papilla cells to induce follicle formation in wounds illustrates the complex role the follicle dermis may play in skin. We believe that it demonstrates a genuine dichotomy of activity for follicle cells within skin.
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Affiliation(s)
- A Gharzi
- School of Biological and Biomedical Sciences, South Road, University of Durham, UK
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5
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Cho SH, Kim HT, Lee IJ, Kim MS, Park HJ. Influence of phonation on basement membrane zone recovery after phonomicrosurgery: a canine model. Ann Otol Rhinol Laryngol 2000; 109:658-66. [PMID: 10903048 DOI: 10.1177/000348940010900709] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The process of wound healing at the basement membrane zone of the vocal folds after phonomicrosurgery was investigated. The influence of phonation and the implied optimal period of voice rest were considered. Phonomicrosurgery was performed on both vocal folds of 20 adult dogs. In 10 dogs, the left recurrent laryngeal nerve was simultaneously resected to simulate iatrogenic voice rest; the remaining 10 dogs were allowed to phonate normally. The healing process of the vocal folds of each group was observed at 1, 2, 4, 8, and 12 weeks after surgery with immunohistochemical staining and transmission electron microscopy. In the voice rest group, the basement membrane was completely re-formed in 2 weeks, and the "cover" appeared completely rearranged by 8 weeks. The results of the phonation group were characterized by a delayed healing process and basement membrane changes. These results suggest that voice rest of at least 2 weeks after surgery may be beneficial and that vocal hygiene should be maintained for as long as 8 weeks.
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Affiliation(s)
- S H Cho
- Department of Otolaryngology-Head and Neck Surgery, St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
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Costa AMA, Peyrol S, Pôrto LC, Comparin JP, Foyatier JL, Desmoulière A. Mechanical forces induce scar remodeling. Study in non-pressure-treated versus pressure-treated hypertrophic scars. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 155:1671-9. [PMID: 10550323 PMCID: PMC1866977 DOI: 10.1016/s0002-9440(10)65482-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reparative process of second and third degree burns usually results in hypertrophic scar formation that can be treated by pressure. Although this method is efficient, its mechanisms of action are not known. In this work, we have studied the histological organization of hypertrophic scars submitted to pressure. Skin biopsies were performed 2 to 7 months after the onset of treatment in two adjacent regions of the scar, non-pressure- or pressure-treated and analyzed by immunohistochemistry and transmission electron microscopy for extracellular matrix organization and cellular morphology. In non-pressure-treated regions, fibrillin deposits did not present the classical candelabra-like pattern under epidermis and were reduced in dermis; in pressure-treated regions the amount was increased compared to non-pressure-treated regions but the organization was still disturbed. In non-pressure-treated regions, elastin was present in patch deposits; in pressure-treated regions elastin formed fibers, smaller than in normal dermis. Tenascin was present in the whole dermis in non-pressure-treated regions, whereas in pressure-treated regions it was observed only under epidermis and around vessels, as in normal skin. alpha-Smooth muscle actin-expressing myofibroblasts were absent in normal skin, present in large amounts in non-pressure-treated regions, and almost absent in pressure-treated regions. The disturbed ultrastructural organization of dermal-epidermal junction observed in non-pressure-treated regions disappeared after pressure therapy; typical features of apoptosis in fibroblastic cells and morphological aspects of collagen degradation were observed in pressure-treated regions. Our results show that, in hypertrophic scars, pressure therapy restores in part the extracellular matrix organization observed in normal scar and induces the disappearance of alpha-smooth muscle actin-expressing myofibroblasts, probably by apoptosis. We suggest that the pressure acts by accelerating the remission phase of the postburn reparative process.
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Affiliation(s)
- Andréa Monte Alto Costa
- Centre National de la Recherche Scientifique, Lyon, France; the Departamento de Histologia e Embriologia,†
| | - Simone Peyrol
- Faculté de Médecine Laënnec, Lyon, France; the Centre des Brûlés,§
| | - Luís Cristóvão Pôrto
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; the Service Commun de Microscopie Électronique,‡
| | - Jean-Pierre Comparin
- Chirurgie Réparatrice, Centre Hospitalier St. Joseph et St. Luc, Lyon, France; and the Groupe de Recherches pour l’Etude du Foie,¶
| | - Jean-Louis Foyatier
- Chirurgie Réparatrice, Centre Hospitalier St. Joseph et St. Luc, Lyon, France; and the Groupe de Recherches pour l’Etude du Foie,¶
| | - Alexis Desmoulière
- Centre National de la Recherche Scientifique, Lyon, France; the Departamento de Histologia e Embriologia,†
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7
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Takeda A, Kadoya K, Shioya N, Uchinuma E, Tsunenaga M, Amano S, Nishiyama T, Burgeson RE. Pretreatment of human keratinocyte sheets with laminin 5 improves their grafting efficiency. J Invest Dermatol 1999; 113:38-42. [PMID: 10417616 DOI: 10.1046/j.1523-1747.1999.00645.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laminin 5 is essential in epithelial attachment to stromal tissues, suggesting that it might improve keratinocyte attachment in a variety of clinical situations. In this study, we examined the effect of exogenous laminin 5 upon the efficiency of transplantation of keratinocyte sheets in animal models. Keratinocyte sheets were prepared according to the method of Rheinwald & Green (1975). Purified laminin 5 was added to the sheets of group 1 (1.0 microg per cm2), Dulbecco's modified Eagle's medium alone was added to group 2. The sheets were grafted to the panniculus carnosus of nude mice (BALB/C nu/nu) (n = 12) and nude rats (Fisher 344) (n = 15). The take rate was assessed by measurement of the area of surviving epithelium at 7 d postgrafting. Laminin 5 bound the keratinocyte sheets of group 1. At 7 d postgrafting, the area of epithelialization of group 1 was significantly larger than that of group 2. Immunohistochemistry staining showed that collagen IV, laminin 5, and collagen VII stained more strongly at the dermal-epidermal junction in group 1 than in group 2. Integrin chains alpha6 and beta4 were similar in both groups. Electron microscopy at day 3 after grafting, showed the lamina densa of group 1 to be more continuous than in group 2. Pretreatment of cultured human keratinocyte sheets with laminin 5 improved the extent of epithelial coverage and increased the rate of neobasement membrane formation. The results suggest that laminin 5 promotes epithelial attachment by increasing the rate of basement membrane assembly.
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Affiliation(s)
- A Takeda
- Plastic and Reconstructive Surgery, Kitasato University School of Medicine, Wound Healing Center, Kitasato University of Hospital, Sagihara, Japan
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8
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Denfeld RW, Tesmann JP, Dittmar H, Weiss JM, Schöpf E, Weltzien HU, Simon JC. Further Characterization of UVB Radiation Effects on Langerhans Cells: Altered Expression of the Costimulatory Molecules B7-1 and B7-2. Photochem Photobiol 1998. [DOI: 10.1111/j.1751-1097.1998.tb09093.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Breitkreutz D, Stark HJ, Mirancea N, Tomakidi P, Steinbauer H, Fusenig NE. Integrin and basement membrane normalization in mouse grafts of human keratinocytes--implications for epidermal homeostasis. Differentiation 1997; 61:195-209. [PMID: 9084138 DOI: 10.1046/j.1432-0436.1997.6130195.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Integrin patterns and formation of basement membrane (BM) were investigated in correlation to epidermal growth and differentiation during skin regeneration in human keratinocyte transplants on nude mice. Immuno-fluorescence and transmission electron microscopy (TEM) showed that different stages of tissue reconstruction were characterized by a sequence of coordinated events. Features of the initial tissue activation, with rapid keratinocyte proliferation around day 4, including cells in a suprabasal position, were: (1) a marked increase in and extended distribution of the integrin chains alpha 2, alpha 3, beta 1 and alpha 6, while beta 4 already showed a preferential basal location; (2) de novo expression of alpha 5 and alpha v; and (3) marked deposition of laminin-5 and nidogen but low levels of other BM components. Tissue normalization during the 2nd week, initiated by a drastic decrease in the number of proliferating cells after day 4, now strictly in basal position, was signified: by (1) orthotopic staining for basal-type keratins (K5, K14) together with a regular pericellular alpha 2 beta 1 and alpha 3 beta 1 distribution, (2) linear, balanced deposition of BM components (e.g. laminin-1, type IV collagen) and (3) colocalization of integrin alpha 6 beta 4 and bullous pemphigoid antigen. Simultaneously at 7 days hemidesmosomes and a defined BM had developed (TEM), becoming continuous at 14 days. This coincided with the regular distribution of suprabasal keratins (K1, K10) as well as intermediate (involucrin) and late differentiation markers (filaggrin, loricrin). Type-VII collagen deposition, still irregular at 14 days, became continuous at 22 days together with developing BM-anchoring fibrils indicating final tissue consolidation. This model mimics principal stages of epidermal wound healing in human skin and implies a linkage between BM assembly, integrin distribution and the compartment of proliferation competent cells, which in turn determines the onset of differentiation. Thus, apart from the balance of diffusible growth regulators, this positional control of keratinocytes, largely accomplished by integrin-matrix interactions, seems to be prerequisite to establishment and maintenance of tissue homeostasis.
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Affiliation(s)
- D Breitkreutz
- Division of Carcinogenesis and Differentiation, German Cancer Research Center (DKFZ), Heidelberg, Germany
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10
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Raghoebar GM, Tomson AM, Scholma J, Blaauw EH, Witjes MJ, Vissink A. Use of cultured mucosal grafts to cover defects caused by vestibuloplasty: an in vivo study. J Oral Maxillofac Surg 1995; 53:872-8; discussion 878-9. [PMID: 7629614 DOI: 10.1016/0278-2391(95)90271-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE In oral and maxillofacial surgery palatal mucosal grafts are routinely used to cover mucosal defects caused by vestibuloplasty. However, the quantity of palatal mucosa is a limiting factor in more extensive operations. This study investigated whether autologous cultured sheets of mucosa can serve as a dressing for these wounds. MATERIALS AND METHODS Punch biopsies (diameter, 4 mm) were taken from the hard palate of eight patients (five men, three women; mean age 43 years). Epithelial cells were enzymatically dissociated from these tissue specimens and grown in vitro in the presence of a fibroblast feeder layer. Within 3 weeks, a transplantable epithelial sheet of about 20 cm2 was obtained. The sheet was detached from the culture flask by enzyme treatment and fixed to a carrier of Vaseline (Cheeseborough Ponds Inc, Greenwich, CT) gauze. Using a split-mouth technique, the sheet was placed on half of a mucosal defect created by vestibuloplasty, while the other half of the defect was covered by a conventional split-thickness palatal graft. Both the cultured and conventional graft were held in place by the patient's relined denture fixed with perimandibular sutures. One week postsurgery, the denture and Vaseline gauze were removed. Three months after vestibuloplasty, biopsy specimens of each grafted site were taken and processed for light and transmission electron microscopy (LM, TEM). RESULTS Three months postsurgery, the grafted mucosa of both sites bore close resemblance to palatal mucosa. Both the cultured and split-thickness grafts were vascularized, did not evoke a homograft reaction, and showed a smooth graft/lip mucosal junction and minimal wound contraction. LM and TEM revealed that both types of grafts formed a fully differentiated keratinizing mucosa with a well-developed basement membrane and rete ridges, comparable with the histology and ultrastructure of palatal mucosa in situ. CONCLUSION It was concluded from this study that cultured mucosa can serve as a proper dressing for mucosal defects after vestibuloplasty.
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Affiliation(s)
- G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands
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Germain L, Guignard R, Rouabhia M, Auger FA. Early basement membrane formation following the grafting of cultured epidermal sheets detached with thermolysin or Dispase. Burns 1995; 21:175-80. [PMID: 7794497 DOI: 10.1016/0305-4179(95)80004-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The basement membrane zone is important for graft adhesion and stability. The aim of the present study was to visualize the regeneration of the basement membrane and determine the sequential appearance of its constituents in the early postgrafting period of cultured human epidermal sheets. A keratinocyte single cell suspension, devoid of dermal fibroblast contamination, was obtained from human skin by a two-step tissue digestion method with thermolysin and trypsin. After culturing, epidermal sheets were generated, detached enzymatically by incubating with thermolysin (for 20-30 min) or Dispase (for 45-60 min), and deposited on a muscular graft bed of athymic mice. Immunohistochemistry and ultrastructural analyses were performed on biopsies harvested 2, 4 and 21 days postgrafting. Bullous pemphigoid antigens and laminin were detected at the dermo-epidermal junction, showing an almost continuous line 2 days postgrafting. Type IV collagen was generally absent at this time, but it was detected 4 days postgrafting. Type VII collagen was labelled as a discontinuous line of increasing intensity from 2 to 21 days postgrafting. Ultrastructural analysis revealed hemidesmosomes and a discontinuous lamina densa 2 days postgrafting, and a complete basement membrane with a continuous lamina densa, hemidesmosomes and anchoring fibrils 21 days postgrafting. The sequence of appearance of major basement membrane components was similar for cultured sheets detached with thermolysin or Dispase. However, it differed from that of other wound healing models. Results are discussed in terms of the variable keratinocyte migration requirement between various wound healing models.
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Affiliation(s)
- L Germain
- Laboratoire des Grands Brûlés/LOEX, Hôpital du Saint-Sacrement, Sainte-Foy, Québec, Canada
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12
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Abstract
Cytokines are produced by a variety of cells and have numerous of overlapping activities. There is increasing evidence that cytokines play a crucial role in the pathogenesis of psoriasis and of other dermatologic diseases. This review summarizes current knowledge as to how the altered cytokine network is involved in the accumulation of inflammatory cells in lesional skin, and how the cytokines are involved in epidermal hyperproliferation. The actions of the most important therapeutic compounds, such as corticosteroids, dithranol, cyclosporine, retinoids, vitamin D3 analogues and ultraviolet radiation, on the cytokine system are also discussed. Consideration is given as to how the effects on the production of cytokines and/or cytokine receptors contribute to their therapeutic action.
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Affiliation(s)
- L Kemény
- Department of Dermatology, Albert Szent-Györgyi Medical University, Szeged, Hungary
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13
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Affiliation(s)
- T J Phillips
- Department of Dermatology, Boston University School of Medicine, MA 02118
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14
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Teepe RG, Burger A, Ponec M. Immunohistochemical studies on regeneration in cultured epidermal autografts used to treat full-thickness burn wounds. Clin Exp Dermatol 1994; 19:16-22. [PMID: 8313632 DOI: 10.1111/j.1365-2230.1994.tb01108.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The normal pattern of healing following culture grafting is not well-established. The present study describes the immunohistochemical expression of differentiation markers during various stages of wound healing after resurfacing full-thickness burn wounds with cultured epidermal autografts. For this purpose, biopsy specimens were obtained from six patients 6 days to 4.5 years after transplantation. A panel of monoclonal antibodies was used against various differentiation-specific protein markers, including cytokeratins, involucrin, transglutaminase and filaggrin. Findings from early and late biopsies were compared with site-matched normal skin and cultured epidermal sheets. The persistence of cytokeratins 6 and 16, and to a lesser extent, the abnormal distribution of involucrin up to 4.5 years after resurfacing burns with cultured autografts was observed. These findings confirm previous studies--that the newly formed epidermis after culture grafting remains in a hyperproliferative state for a long time, which may be caused by the absence of a modulating dermal factor. Our results suggest that keratinocyte maturation following culture autografting does not return to normal for at least 4.5 years after healing of full-thickness burn wounds.
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Affiliation(s)
- R G Teepe
- Department of Dermatology, University Hospital, Leiden, The Netherlands
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15
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McGrath JA, Schofield OM, Ishida-Yamamoto A, O'Grady A, Mayou BJ, Navsaria H, Leigh IM, Eady RA. Cultured keratinocyte allografts and wound healing in severe recessive dystrophic epidermolysis bullosa. J Am Acad Dermatol 1993; 29:407-19. [PMID: 8349857 DOI: 10.1016/0190-9622(93)70203-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients with recessive dystrophic epidermolysis bullosa (RDEB) frequently have painful erosions that are slow to heal. There is no definitive treatment; therefore any therapy that improves wound healing would be beneficial to these patients. OBJECTIVE Our purpose was to assess the effects of cultured allogeneic keratinocytes on wound healing in RDEB. METHODS Ten patients with RDEB and dermatome-induced superficial dermal wounds were studied. Cultured keratinocyte grafts were applied to part of the wound, with another part left ungrafted. Both sites were assessed clinically and microscopically, particularly with regard to basement membrane zone reconstitution. RESULTS Apart from minor differences in keratinocyte differentiation and a moderate analgesic effect induced by the graft, there were no other distinguishing findings in wound healing in the grafted and nongrafted sites. CONCLUSION There was little clinical benefit from cultured keratinocyte allografts in wound healing in RDEB. However, this study showed that RDEB keratinocytes have an inherent capacity to express some type VII collagen epitopes transiently during wound healing, although this was not associated with the detection of anchoring fibrils.
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Affiliation(s)
- J A McGrath
- Department of Cell Pathology, St. John's Institute of Dermatology, United Medical School, St. Thomas' Hospital, London, England
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16
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Carver N, Navsaria HA, Fryer P, Green CJ, Leigh IM. Restoration of basement membrane structure in pigs following keratinocyte autografting. BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:384-92. [PMID: 8369876 DOI: 10.1016/0007-1226(93)90044-c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The attachment of grafts of keratinocyte sheets is mediated in part by the presence and organisation of basement membrane components. The reappearance of basement membrane following keratinocyte autografting was examined in pigs. These studies showed that there was rapid expression of anchoring fibrils and hemidesmosomes, which reached normal numbers at 10 days. However, the length of hemidesmosomes did not reach normal size during the period of study. Weakness of attachment of keratinocyte autografted epidermis was found to lie between the basement membrane and the granulation tissue. This suggests that reported clinical problems with keratinocyte graft attachment may be mediated not only by delay in maturation of the basement membrane but also by its poor integration with collagen of the wound bed.
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Affiliation(s)
- N Carver
- RAFT Department of Research in Plastic Surgery, Mount Vernon Hospital NHS Trust, Northwood, UK
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Kangesu T, Navsaria HA, Manek S, Fryer PR, Leigh IM, Green CJ. Kerato-dermal grafts: the importance of dermis for the in vivo growth of cultured keratinocytes. BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:401-9. [PMID: 8369878 DOI: 10.1016/0007-1226(93)90046-e] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a porcine model, we studied the benefit of dermis for the growth of cultured autologous keratinocytes (CAK) on full-thickness wounds isolated within skin graft chambers. Kerato-dermal grafts were prepared in a two stage process using autologous de-epidermalised dermis (DED) and CAK (Group 1). Control wounds were prepared by grafting either CAK only (Group 2) or DED only (Group 3). The median epidermal cover of 34 wounds in Group 1 was 47% and was significantly greater (p < 0.001) than the epidermal cover of 12 wounds in Group 2 (4%) and 14 wounds in Group 3 (12%). The epidermis in Group 1 was durable whereas it was fragile in the control wounds. Histologically rête ridges were present at 2 weeks in Group 1, but not in the control wounds. These data indicate that a dermal wound bed significantly improves the in vivo growth of cultured keratinocytes.
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Affiliation(s)
- T Kangesu
- RAFT, Department of Research in Plastic Surgery, Mount Vernon Hospital NHS Trust, Northwood, Middx., UK
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