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Kwek MSY, Thangaveloo M, Madden LE, Phillips ARJ, Becker DL. Targeting Cx43 to Reduce the Severity of Pressure Ulcer Progression. Cells 2023; 12:2856. [PMID: 38132176 PMCID: PMC10741864 DOI: 10.3390/cells12242856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
In the skin, repeated incidents of ischemia followed by reperfusion can result in the breakdown of the skin and the formation of a pressure ulcer. Here we gently applied paired magnets to the backs of mice to cause ischemia for 1.5 h and then removed them to allow reperfusion. The sterile inflammatory response generated within 4 h causes a stage 1 pressure ulcer with an elevation of the gap junction protein Cx43 in the epidermis. If this process is repeated the insult will result in a more severe stage 2 pressure ulcer with a breakdown of the epidermis 2-3 days later. After a single pinch, the elevation of Cx43 in the epidermis is associated with the inflammatory response with an increased number of neutrophils, HMGB1 (marker of necrosis) and RIP3 (responsible for necroptosis). Delivering Cx43 specific antisense oligonucleotides sub-dermally after a single insult, was able to significantly reduce the elevation of epidermal Cx43 protein expression and reduce the number of neutrophils and prevent the elevation of HMGB1 and RIP3. In a double pinch model, the Cx43 antisense treatment was able to reduce the level of inflammation, necroptosis, and the extent of tissue damage and progression to an open wound. This approach may be useful in reducing the progression of stage 1 pressure ulcers to stage 2.
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Affiliation(s)
- Milton Sheng Yi Kwek
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| | - Leigh E. Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| | | | - David L. Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
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Kwek MSY, Thangaveloo M, Hui SLB, Madden LE, Phillips AR, Becker DL. Characterisation of an ischemia reperfusion model for the formation of a stage I pressure ulcer in mouse skin. J Tissue Viability 2021; 30:352-362. [PMID: 33875344 DOI: 10.1016/j.jtv.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/09/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Pairs of magnets were applied to the loose skin on the backs of mice in order to cause ischemia for periods of 1.5, 2, 2.5 and 3 h followed by reperfusion. We found 1.5 h of ischemia resulted in the most reliable outcome of blanched skin but no redness or skin breakdown. Histological analysis at 4 h of reperfusion showed, in the centre of the insult, condensed nuclei in the epidermis and sebaceous glands with a build up of neutrophils in the blood vessels, and a reduction in the number of fibroblasts. At 24 h, spongiosis was seen in the epidermis and pockets of neutrophils began to accumulate under it, as well as being scatted through the dermis. In the centre of the insult there was a loss of sebaceous gland nuclei and fibroblasts. Four days after the insult, spongiosis was reduced in the epidermis at the edge of the insult but enhanced in the centre and in hair follicles. Leukocytes were seen throughout the central dermis. At 8 days, spongiosis and epidermal thickness had reduced and fibroblasts were reappearing. However, blood vessels still had leukocytes lining the lumen. The gap junction protein connexin 43 was significantly elevated in the epidermis at 4 h and 24 h reperfusion. Ischemia of 1.5 h generates a sterile inflammatory reaction causing the loss of some cell types but leaving the epidermis intact reminiscent of a stage I pressure ulcer.
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Affiliation(s)
- Milton Sheng Yi Kwek
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | - Sophia Lim Beng Hui
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | - Leigh E Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore
| | | | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, 308232, Singapore.
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Lio DCS, Chia RN, Kwek MSY, Wiraja C, Madden LE, Chang H, Khadir SMA, Wang X, Becker DL, Xu C. Temporal pressure enhanced topical drug delivery through micropore formation. Sci Adv 2020; 6:eaaz6919. [PMID: 32523993 PMCID: PMC7259933 DOI: 10.1126/sciadv.aaz6919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/06/2020] [Indexed: 05/31/2023]
Abstract
Transdermal drug delivery uses chemical, physical, or biochemical enhancers to cross the skin barrier. However, existing platforms require high doses of chemical enhancers or sophisticated equipment, use fragile biomolecules, or are limited to a certain type of drug. Here, we report an innovative methodology based on temporal pressure to enhance the penetration of all kinds of drugs, from small molecules to proteins and nanoparticles (up to 500 nm). The creation of micropores (~3 μm2) on the epidermal layer through a temporal pressure treatment results in the elevated expression of gap junctions, and reduced expression of occludin tight junctions. A 1 min treatment of 0.28-MPa allows nanoparticles (up to 500 nm) and macromolecules (up to 20 kDa) to reach a depth of 430-μm into the dermal layer. Using, as an example, the delivery of insulin through topical application after the pressure treatment yields up to 80% drop in blood glucose in diabetic mice.
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Affiliation(s)
- Daniel Chin Shiuan Lio
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Nanyang Technological University, 62 Nanyang Drive, 637459, Singapore 637459, Singapore
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive Singapore 636921, Singapore
| | - Rui Ning Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive Singapore 636921, Singapore
| | - Milton Sheng Yi Kwek
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive Singapore 636921, Singapore
| | - Christian Wiraja
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Nanyang Technological University, 62 Nanyang Drive, 637459, Singapore 637459, Singapore
| | - Leigh Edward Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive Singapore 636921, Singapore
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 11 Mandalay Road, #17-01, Singapore 308232, Singapore
| | - Hao Chang
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Nanyang Technological University, 62 Nanyang Drive, 637459, Singapore 637459, Singapore
| | - S. Mohideen Abdul Khadir
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Nanyang Technological University, 62 Nanyang Drive, 637459, Singapore 637459, Singapore
| | - Xiaomeng Wang
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive Singapore 636921, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Proteos, 61 Biopolis Dr, Singapore 138673, Singapore
- Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower Level 6, Singapore 169856, Singapore
- Institute of Ophthalmology, University College London, 11-43 Bath Street, London EC1V 9EL, UK
| | - David L. Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive Singapore 636921, Singapore
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), 11 Mandalay Road, #17-01, Singapore 308232, Singapore
| | - Chenjie Xu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Nanyang Technological University, 62 Nanyang Drive, 637459, Singapore 637459, Singapore
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore
- National Dental Centre of Singapore, 5 Second Hospital Ave, Singapore 168938, Singapore
- Department of Biomedical Engineering, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong SAR, China
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