Review Fibrocytes: a Unique Cell Population Implicated in Wound Healing
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CMLS, Cell. Mol. Life Sci. 60 (2003) 1342–1350 1420-682X/03/071342-09 DOI 10.1007/s00018-003-2328-0 CMLS Cellular and Molecular Life Sciences © Birkhäuser Verlag, Basel, 2003 Review Fibrocytes: a unique cell population implicated in wound healing C. N. Metz North Shore-LIJ Research Institute, 350 Community Drive, Manhasset, New York 11030 (USA), Fax: + 1 516 365 5090, e-mail: [email protected] Received 25 November 2002; received after revision 31 December 2002; accepted 16 January 2003 Abstract. Following tissue damage, host wound healing gin remains a mystery. A unique cell population, known ensues. This process requires an elaborate interplay be- as fibrocytes, has been identified and characterized. One tween numerous cell types which orchestrate a series of of the unique features of these blood-borne cells is their regulated and overlapping events. These events include ability to home to sites of tissue damage. This article re- the initiation of an antigen-specific host immune re- views the identification and characterization of fibro- sponse, blood vessel formation, as well as the production cytes, summarizes the potential role of fibrocytes in the of critical extracellular matrix molecules, cytokines and numerous steps of the wound-healing process and high- growth factors which mediate tissue repair and wound lights the potential role of fibrocytes in fibrotic disease closure. Connective tissue fibroblasts are considered es- pathogenesis. sential for successful wound healing; however, their ori- Key words. Tissue repair; fibrosis; tissue remodeling; TGFb; angiogenesis; antigen presentation. What are fibrocytes? wounds and scar tissues originate from the circulation or The discovery, isolation and initial characterization from the surrounding tissue areas, the concept that fi- of fibrocytes broblast-like cells found within the wound originate from the peripheral blood dates back almost 100 years (re- Wounds or tissue injuries caused by trauma, burns, in- viewed in [1]). Fibroblasts found at sites of tissue injury flammation, infection, and metabolic deficiencies result may originate from different sources depending on the in the physical disruption of the normal cellular architec- wound/injury type. For example, in minor wounds fi- ture of the tissue. In response to tissue injury, the host broblasts may migrate from surrounding undamaged tis- commences a repair process that is regulated by cellular, sue, whereas fibrocytes may be recruited to deep tissue humoral and connective tissue mediators. The cell types wounds where they differentiate into fibroblasts. implicated in the repair of tissue injury include plate- The investigations by Bucala and colleagues in the early lets, monocytes/macrophages, T lymphocytes, endothe- 1990s that led to the discovery of ‘fibrocytes’ were based lial cells and connective tissue fibroblasts. Connective on the hypothesis that specialized ‘fibroblast-like cells’ tissue fibroblasts found at the sites of tissue injury and in present in experimentally implanted wound chambers areas of tissue remodeling are believed to play an essen- originated from the circulation. This discovery led to the tial role in the healing process. Although it is unclear identification and initial characterization of a distinct whether these connective tissue fibroblasts found in population of blood-borne CD34+/Col I+ fibroblast-like cells that rapidly enter sites of tissue injury [2]. Termed * Corresponding author. fibrocytes, these cells comprise ~0.1–0.5% of nonery- CMLS, Cell. Mol. Life Sci. Vol. 60, 2003 Review Article 1343 throcytic cells in the peripheral blood (as determined by Table 1. Fibrocyte-associated surface markers. spot immunofluorescence staining using anti-CD34-rho- Marker type Reference damine and anti-col I-fluorescein 5 (6)-isothiocyanate (FITC) of blood cells following erythrocyte lysis) [2]. Fi- ECM markers brocytes can be isolated from buffy coats prepared from Collagen I (2–8)] blood and cultured ex vivo [2–4]. These crude fibrocyte Collagen III [2] Fibronectin [2] preparations obtained from human or mouse blood are Vimentin [2] grown in Dulbecco’s modified Eagle medium containing CD markers fetal calf serum, without the addition of other growth fac- CD11a (LFA-1) [2–3] tors. After 10–14 days of incubation, ex vivo cultured fi- CD11b (Mac 1) [2] brocytes display an adherent, spindle-shaped morphol- CD13 (pan myeloid antigen) [2] CD34 (hemopoetic stem cell antigen) [2] ogy. Fibrocytes are then purified from this crude prepara- CD45 (leukocyte common antigen) [2] tion (70–80% pure) following negative selection for CD54 (ICAM) [2] other immune cell types (B cells, T cells and monocytes) CD58 (LFA-3) [2] (see fig. 1). The resulting fibrocyte population (>95% pure CD80 (B7-1) [3] CD86 (B7-2) [2–3] based on collagen I and CD11b staining, or collagen I and + MHC-related markers CD34 staining) has been characterized based on expres- MHC class II [2–3] sion of (i) extracellular surface markers [including cluster HLA-DP [3] of differentiation (CD) antigens, major histocompatibility HLA-DQ [3] complex (MHC)-like molecules and extracellular matrix HLA-DR [3] protein markers] (table 1) and (ii) cytokine, chemokine and Chemokine receptors (ligands) CCR3 (MCP-3, MCP-5, RANTES, MIP1a, HCC-1) [4] growth factor expression patterns (table 2). CCR5 (MIP1a, MIP1b, RANTES) [4] Fibrocytes are a unique CD45+ cell population [2] They CCR7 (ELC, SLC) [4] are distinct from monocytes, (CD14–, esterase–, CD54–), CXCR4, fusin (SDF-1) [4] dendritic cells (CD10–, CD25–, CD38–), Langerhans cells (CD1a–), T lymphocytes (CD3–, TCR–, CD4–, CD25–), B cells (CD19–), fibroblasts (collagen I+, CD34+), epithe- Table2.Fibrocytes secrete chemokines, cytokines and growth fac- – – lial cells (cytokeratin ) and endothelial cells (vWF , tors implicated in wound repair. CD11b+). In addition, when examined by electron mi- croscopy, fibrocytes exhibit unique cytoplasmic exten- Factor Comments Ref. sions intermediate in size between microvilli and a chemokines pseudopodia which further differentiate fibrocytes from MIP1a constitutive; ≠ with TGF-b1 or IL-1b [8] blood-borne leukocytes [2]. MIP1b constitutive; ≠ with TGF-b1 or IL-1b [8] Fibrocytes expressing CD34, CD11b and collagen I (but MCP-1 constitutive; ≠ with TGF-b1 or IL-1b [8] not CD14, CD3 or CD10) found in the peripheral blood, b chemokines wound sites and areas of tissue remodeling should not be IL-8 constitutive; ≠ with TGF-b1 or IL-1b [8, 31] GROa constitutive; ≠ with TGF-b1 or IL-1b [8] confused with fibrocytes or fibroblast cultures which are Cytokines TNF-a with IL-1b stimulation [8] IL-6 with IL-1b or TNF stimulation [8] IL-10 with IL-1b or TNF stimulation [8] Obtain whole blood Growth Factors Angiogenin constitutive [31] Centrifugation over Ficoll-Paque CTGF constitutive [31] IGF-1 constitutive [31] M-CSF constitutive [8, 31] Isolate buffy coat, wash and perform low speed spin (remove platelets) PDGF constitutive [31] TGFb constitutive [8] Plate resultant PBMCs in DMEM 10% FBS Other MMP-9 Constitutive, active and latent [31] aSMA ≠ with TGF-b1 [4] Culture for 10–14 days (‘crude fibrocytes’) Immunomagnetic bead separation to isolate ‘fibrocytes’ Fibrocytes (CD 14–/CD11b+/collagen I+ or CD14–/CD34+/collagen I+) Figure 1. Schematic representation indicating the isolation and growth conditions for peripheral blood fibrocytes. Taken from [4]. 1344 C. N. Metz The role of fibrocytes in wound healing implicated in the amyloid fibrillogenesis described by that cultured peripheral blood fibrocytes require interac- Harris and colleagues [5]. Nor should they be confused tion with activated T cells to permit their early differenti- with ‘spiral ligament fibrocytes’ located within the ear. ation. The requirement for T cell interaction is similar to Spiral ligament fibrocytes are the cells which intercon- that reported for the differentiation of CD1a+ dendritic nect with basal cells of the stria vascularis via gap junc- cells [9]. Following their interaction with T cells, it is pro- tions and are postulated to play a critical role in main- posed that they migrate to the wound site (see fig. 2 and taining cochlear homeostasis [6–7]. Both of these cell below). Within the wound, these early-differentiated fi- types appear to be unrelated to the blood-borne fibrocytes brocytes might further interact with recruited T cells and implicated in wound healing. then fully differentiate into mature fibrocytes following exposure to transforming growth factor-b (TGFb, ex- pressed in early wounds). In response to TGF-b, it is pos- Ex vivo cultured peripheral fibrocytes originate from tulated that these mature fibrocytes express increased a CD14+ cells and differentiate into a cell population smooth muscle actin (aSMA) which provides a contrac- with wound-healing potential tile force for wound closure and produce collagen and other critical extracellular matrix molecules that promote The precise origin of peripheral blood fibrocytes has puz- wound healing (fig. 2). zled investigators since their discovery. Fibrocytes ex- press CD45 (leukocyte common antigen), a marker of bone marrow-derived cells (see table 1). Early studies us- Where are fibrocytes found? ing sex-mismatched, bone marrow chimeric mice to- gether with DNA amplification of the male-specific SRY Although initially identified as a blood-borne cell popu- gene showed that circulating fibrocytes in vivo arise from lation (CD34+, CD11b+ and/or collagen1+), fibrocytes radioresistant bone marrow progenitor cells or an uniden- have been localized