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Connective Tissue Formation in Wound Healing an Experimental Study

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Connective Tissue Formation in Wound Healing an Experimental Study View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Connective Tissue Formation in Wound Healing An experimental study Kaija Inkinen Fourth Department of Surgery Helsinki University Central Hospital and Division of Biochemistry Department of Biosciences University of Helsinki Finland Academic Dissertation To be presented, with the permission of the Faculty of Science, University of Helsinki, for public criticism, in the auditorium “Richard Faltin” of the Fourth Department of Surgery, Helsinki University Central Hospital, Helsinki, on September 11th, 2003, at 12 o’clock noon. Helsinki 2003 Supervised by Professor Juhani Ahonen Department of Surgery Helsinki University Central Hospital Helsinki, Finland Reviewed by Professor Jorma Keski-Oja Departments of Pathology and Virology Biomedicum and Haartman Institute University of Helsinki Helsinki, Finland and Docent Erkki Koivunen Department of Biosciences Division of Biochemistry University of Helsinki, Finland Opponent Docent Jouko Lohi Department of Pathology University of Helsinki Helsinki, Finland ISBN 952-91-6240-5 (paperback) ISBN 952-10-1313-3 (PDF) Yliopistopaino Helsinki 2003 CONTENTS ORIGINAL PUBLICATIONS 5 ABBREVIATION 6 ABSTRACT 7 INTRODUCTION 9 REVIEW OF THE LITERATURE 11 WOUND HEALING 11 Blood clot formation 12 Inflammation 12 Epithelialization 13 Neovascularization 13 Formation of Granulation Tissue 15 Matrix Remodeling 16 Viscose cellulose sponges as a wound healing model 17 EXTRACELLULAR MATRIX 18 Collagens 18 Structure and biosynthesis of collagens 21 Fibrillar collagens 22 The gene structure of the fibril-forming collagens 23 Regulation of collagen genes 25 Type I collagen 28 Type III collagen 28 Type V collagen 29 Cell and ECM interaction 31 DEGRADATION OF EXTRACELLULAR MATRIX 33 Matrix metalloproteinases 33 Gelatinases 35 Other MMPs 35 Regulation of MMP activity 38 The role of MMPs and TIMPs in wound healing 40 GROWTH FACTORS IN WOUND HEALING 41 TGF-β 41 PDGF 46 CTGF 48 OUTLINE OF THE PRESENT STUDIES 53 MATERIALS AND METHODS 54 Animals 54 Experimental wound healing model 54 Histological staining for collagens 54 Hemoglobin 54 Determination of total tissue collagen and DNA 55 Collagen extraction, identification, and quantitation 55 Extraction of metalloproteinases and gelatinolytic activity assay 56 Primary antibodies 56 Immunohistochemistry 57 In Situ hybridization 57 Analysis of mRNA 58 Probes 59 Preparation of rat probes for type V collagen and MMP-2 and -9 60 Statistical analysis 61 RESULTS 62 Sponge implants [ I and II ] 62 Interstitial collagens in granulation tissue [ I and II ] 63 MMP-2 and MMP-9 in granulation tissue [ III ] 65 Growth factors in granulation tissue [ IV ] 67 DISCUSSION 70 Type I, III and V collagens in wound healing 71 MMP-2 and MMP-9 in wound healing 73 CTGF, TGF-β and PDGF in wound healing 75 CONCLUSIONS 78 ACKNOWLEDGEMENTS 80 REFERENCES 82 ORIGINAL PUBLICATIONS This thesis is based on the following original publications, which are referred to in the text by the Roman numerals I-IV. I. Inkinen, K. Turakainen, H. Wolff, H. and Ahonen, J.: Cloning of cDNA for rat pro alpha1(V) collagen mRNA. Expression patterns of type I, type III and type V collagen genes in experimental granulation tissue. Connective Tissue Research. 40:209-220, 1999 II. Inkinen, K. Wolff, H. von Boguslawski, K. and Ahonen, J.: Type V Collagen in Experimental Granulation Tissue. Connective Tissue Research. 39:281-294, 1998 III. Inkinen, K. Turakainen, H. Wolff, H. Ravanti, L. Kähäri, VM. and Ahonen, J.: Expression and activity of matrix metalloproteinase-2 and -9 in experimental granulation tissue. Acta Pathologica, Microbiologica, et Immunologica Scandinavica.108:318-328, 2000 IV. Inkinen, K. Wolff, H. Lindroos, P. and Ahonen, J.: Connective tissue growth factor and its correlation to other growth factors in experimental granulation tissue. Connective Tissue Research. 44: 19-29, 2003 5 ABBREVIATION AP-1 activator protein-1 CCN Connective tissue growth factor/Cysteine-rich 61/Nephroblastoma over-expressed CTGF connective tissue growth factor ECM extracellular matrix EGF epidermal growth factor Egr-1 early growth response 1 FACIT fibril-associated collagens with interrupted triple helices FGF fibroblast growth factor GAPDH glyceraldehyde 3-phosphate dehydrogenase ICAM-1 intercellular adhesion molecule 1 IFN γ interferon γ IGF-1 insulin-like growth factor 1 IGF-BP insulin-like growth factor binding protein IL-1, -2, -4, -6 interleukin 1, 2, 4, 6 KGF keratinocyte growth factor LAP latency associated protein LTBP latent TGF-β binding protein MMP matrix metalloproteinase MT-MMP membrane-type matrix metalloproteinase MULTIPLEXIN proteins with multiple triple helix domains and interruptions NF-1 nuclear factor-1 PAGE polyacrylamide gel electrophoresis PARP proline and arginine rich peptide PCR polymerase chain reaction PDGF platelet-derived growth factor PDI protein disulfide isomerase PGE2 prostaglandin E2 SMC smooth muscle cell Sp-1 selective promoter factor 1 TbRE TGF-β-response element TGF-α transforming growth factor-α TGF-β transforming growth factor-β TIMP tissue inhibitor of metalloproteinases TNF-α tumor necrosis factor-α VC viscose cellulose VEGF vascular endothelial growth factor 6 ABSTRACT A tight balance between connective tissue synthesis and breakdown is required for extracellular matrix (ECM) deposition in normal wound healing. The formation of new and regenerating tissue requires the coordinated regulation of various genes, which encode both structural and regulatory molecules. In the present study, the spatial and temporal expression patterns of various key components in the connective tissue formation of normal wound healing were investigated. Type I, III and V collagens belong to the family of fibrillar collagens, which form the important structural component of connective tissue. In the present study, type V collagen, in relation to type I and III collagens, in the formation of new connective tissue was investigated. Type V collagen was actively synthesized by both macrophage and fibroblasts-like cells and its expression was seen at every time point but at a considerably lower level than with type I and III collagens. It had maximum expression level at two weeks, which coincides with the expression of myofibroblasts. At the protein level, its distribution was closely associated with the blood vessel walls, which suggests its association with angiogenesis. From the collagen degrading enzymes, gelatinases of the matrix metalloproteinases (MMP) family, MMP-2 and MMP-9 were investigated. In addition, the expression of MMP-14 and tissue inhibitor of matrix metalloproteinase 2 (TIMP), which are known to be important for the activation of latent MMP-2, were studied. Enzyme analyses revealed that latent MMP-2 was present during the whole period of the granulation formation, whereas active MMP-2 started increase after one week and stayed in high level during the whole period of experiment. MMP- 2 mRNA was expressed throughout the granulation formation and mostly in fibroblast-like cells. The MMP-14 gene was up-regulated during the first week of wound healing, which coincides with an increase in MMP-2 activation. In contrast, the TIMP-2 gene was constitutively expressed, as was the MMP-2 gene. Only after two months was the TIMP-2 mRNA level slightly higher than at other time points, implying the completion of the wound healing process. No active MMP-9 enzyme was found and latent MMP-9 was seen only during the first week of the healing process. Immunohistochemical staining revealed that the cells responsible for this MMP-9 were polymorphonuclear leukocytes and macrophages, which are probably invaders from the surrounding tissues and already have pro-enzyme in their granules. MMP-9 mRNA expression started to increase towards the end of the experiment but with no detectable concomitant enzymatic activity. This suggests that MMP-9 regulation occurs at the 7 post-transcriptional level. The most prominent cell types to express MMP-9 mRNA were macrophage-like cells. Connective tissue growth factor (CTGF) is downstream mediator of transforming growth factor-β (TGF-β) in fibroblasts. For the elucidation of its role in normal wound healing, its gene expression and protein localization, together with other fibrogenic growth factors, TGF- β1, and platelet-derived growth factors (PDGF), were studied. All these growth factors were found to be expressed throughout the wound healing process but CTGF had a more restricted expression pattern. CTGF mRNA had maximum expression at two weeks and the expressing cells were mostly fibroblasts, but in the early phase of wound healing also the blood vessel cells expressed CTGF at the gene and protein levels, suggesting that it is involved in angiogenesis. In conclusion, successful wound healing is accompanied by tightly scheduled expression of fibrillar collagens, matrix metalloproteinases and growth factors. The close association of type V collagen and CTGF in blood vessels during wound healing suggests their role in angiogenesis. MMP-2 is important during the prolonged remodeling phase, whereas the MMP- 9 gene is up-regulated when the granulation tissue matures. MMP-2 and MMP-9 might facilitate an essential event of wound healing, such as cell migration, angiogenesis and tissue remodeling. 8 INTRODUCTION The regulation of extracellular matrix (ECM) deposition is a key event in many physiological and pathological conditions. It is required for normal
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