The wound fibroblast and macrophage. I: Wound cell population changes observed in tissue culture

Crosstalk between fibroblasts and immunocytes in fibrosis: From molecular mechanisms to clinical trials

BACKGROUND

The impact of fibroblasts on the immune system provides insight into the function of fibroblasts. In various tissue microenvironments, multiple fibroblast subtypes interact with immunocytes by secreting growth factors, cytokines, and chemokines, leading to wound healing, fibrosis, and escape of cancer immune surveillance. However, the specific mechanisms involved in the fibroblast-immunocyte interaction network have not yet been fully elucidated.

MAIN BODY AND CONCLUSION

Therefore, we systematically reviewed the molecular mechanisms of fibroblast-immunocyte interactions in fibrosis, from the history of cellular evolution and cell subtype divisions to the regulatory networks between fibroblasts and immunocytes. We also discuss how these communications function in different tissue and organ statuses, as well as potential therapies targeting the reciprocal fibroblast-immunocyte interplay in fibrosis. A comprehensive understanding of these functional cells under pathophysiological conditions and the mechanisms by which they communicate may lead to the development of effective and specific therapies targeting fibrosis.

Recommendations on Postoperative Activities After Abdominal Operations and Incisional Hernia Repair-A National and International Survey

Background: There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and there is significant variation in the literature on that question. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery. Materials and Methods: A national (German) and international survey of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results: A total of 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p = 0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p = 0.000). Conclusion: There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socioeconomic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.

HIF-1α controls palatal wound healing by regulating macrophage motility via S1P/S1P1 signaling axis

OBJECTIVES

To investigate the role of hypoxia-inducible factor 1α (HIF-1α) signaling, the expression profile of M1 and M2 macrophages, and the role of the sphingosine 1-phosphate (S1P)/S1P receptor system in palatal wound healing of heterozygous HIF-1α-deficient (HIF-1α HET) mice.

MATERIALS AND METHODS

HIF-1α HET and wild-type (WT) littermates underwent palatal tissue excision at the mid-hard palate. Histological analysis, immunostaining, real-time PCR, Western blotting (WB), and cellular migration assays were performed to analyze wound closure and macrophage infiltration.

RESULTS

DMOG pretreatment showed an acceleration of palatal wound closure in WT mice. In contrast, the delayed palatal wound closure was observed in HIF-1α HET mice with diminished production of Col1a1, MCP-1, and MIP-1α, compared with WT mice. Decreased infiltration of M1 macrophage (F4/80⁺ TNF-α⁺ , F4/80⁺ iNOS⁺ ) and M2 macrophage (F4/80⁺ Arginase-1⁺ , F4/80⁺ CD163⁺ ) was observed. The numbers of F4/80⁺ S1P₁ ⁺ macrophages of HIF-1α HET wounded tissues were significantly lower compared with WT tissues. S1P treatment of bone marrow macrophages (BMMs) significantly upregulated expression of S1P₁ in WT mice compared with HIF-1α HET. Phosphorylation of MAPK rapidly decreased in BMMs of HIF-1α HET mice than in BMMs of WT mice by S1P stimulation. Moreover, S1P enhanced HIF-1α expression via S1P₁ receptors to affect macrophage migration.

CONCLUSIONS

HIF-1α deficiency aggravates M1 and M2 macrophage infiltration and controls macrophage motility via S1P/S1P₁ signaling. These results suggest that HIF-1α signaling may contribute to the regulation of palatal wound healing.

Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice

Rationale

Hamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle–tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan.

Objective

We present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.

Wound healing in acutely injured fascia

Fascial healing following acute injury, such as that occurring during surgical procedures, is defined functionally. For example, failure of fascial healing following celiotomy is only identified when incisional hernias are diagnosed. Such hernias incur billions of dollars per year in medical costs. Despite the importance of fascial healing, there is a paucity of data regarding the quality such healing. In clinical settings, the quantification of fascial wound healing is limited to a binary state: either there is no clinically apparent functional deficit and full fascia healing is assumed, or an incisional hernia or other functional failure is visible and the fascia did not heal. There are no clinical methods to isolate and functionally test fascia in patients. Recent studies have revealed unexpected findings regarding the recovery of tensile strength, specific surgical methods that optimize fascial healing, and the potential impact of biological pharmaceuticals in eliminating fascial healing failure. However, much remains unknown about the biology of fascial healing.

Analysis of gene expression in the tumor-associated macrophage

INTRODUCTION

The tumor-associated macrophage (TAM) is at the front line of the host's defense against malignancy and provides an attractive target for immune-modulatory therapy. However, factors present within the tumor microenvironment can alter macrophage phenotype, preventing its cytotoxic activity and reducing its susceptibility to interferon-gamma and lipopolysaccharide-mediated stimulation.

METHODS

Macrophages were isolated from subcutaneous B16 melanoma tumors implanted in C57 BL/6 mice. Wound macrophages were harvested from subcutaneously-implanted PVA sponges, and resting peritoneal macrophages were harvested by peritoneal lavage. Gene expression was analyzed using an Atlas cDNA array (Clontech, Mountain View, CA).

RESULTS

TAM demonstrated a pattern of gene expression distinct from both wound and peritoneal macrophage. There is an increase in proliferation-associated genes and in genes encoding the ultrastructural proteins cofillin, zyxin, and vimentin more commonly associated with fibroblast-like cells. In addition, an observed decrease in expression of the CD14 gene, and increase in inhibitory pathways including osteopontin and its receptor CD44, the inositol 1,4,5-triphosphate receptor, and the receptors for interleukin-4 and granulocyte monocyte-colony stimulating factor could explain the resistance of TAM to lipopolysaccharide-mediated stimulation. There was also a significant decrease in the expression of the interferon-gamma second messenger, IRF-1.

CONCLUSIONS

This study has identified a number of pathways involved in the suppression of TAM function. Targeting of these pathways may allow for the generation of more effective immune-modulatory anti-neoplastic therapy.

Lactate Concentrations in Incisions Indicate Ischemic-like Conditions May Contribute to Postoperative Pain

The substances in wounds that cause incisional pain and hyperalgesia after surgery are poorly understood. We have developed and characterized rat models for incision-induced pain behaviors and measured increased tissue hydrogen ion concentration. Because lactate may facilitate nociceptor responses to low pH and contribute to ischemic pain mechanisms, we measured tissue lactate after incision of the plantar region of the hindpaw, gastrocnemius muscle, and paraspinal region in halothane anesthetized rats using in vivo microdialysis. Incisions were performed at 1 site (plantar, gastrocnemius, or paraspinal incision) in each rat. The corresponding contralateral side was used as the control. In anesthetized rats, a microdialysis fiber was passed into the incision and the control side. L-Lactate was measured using the lactate oxidase method. Tissue concentration was determined from postoperative day 0 to postoperative day 14 using the no net flux method. Lactate was increased on the day of hindpaw incision to 3.6 +/- 1.6 mmol/L compared with control (2.1 +/- .6 mmol/L) and remained increased through 7 days. In the gastrocnemius muscle, lactate was increased the day after incision (4.2 +/- 1.2 mmol/L vs 1.7 +/- .5 mmol/L) until postoperative day 7. On the day of the paraspinal incision, lactate was 3.4 +/- 1.1 mmol/L on the operated side and 2.2 +/- .6 mmol/L in the control side. Lactate remained increased through postoperative day 8 at the paraspinal incision. These experiments demonstrate that incision of the plantar hindpaw, the gastrocnemius muscle, and the paraspinal region increased tissue lactate concentration. The wound environment contains increased lactate at the same time that pH is decreased; lactate could potentially facilitate nociceptor activation by low pH and contribute to pain after surgery.

PERSPECTIVE

This study demonstrates that lactate is increased in wounds when pain behaviors and acid are increased. Lactate and low pH are present in incisions and indicate an ischemic pain mechanism that may contribute to postsurgical pain.

Hypoxia Regulates Macrophage Functions in Inflammation

The presence of areas of hypoxia is a prominent feature of various inflamed, diseased tissues, including malignant tumors, atherosclerotic plaques, myocardial infarcts, the synovia of joints with rheumatoid arthritis, healing wounds, and sites of bacterial infection. These areas form when the blood supply is occluded and/or unable to keep pace with the growth and/or infiltration of inflammatory cells in a given area. Macrophages are present in all tissues of the body where they normally assist in guarding against invading pathogens and regulate normal cell turnover and tissue remodeling. However, they are also known to accumulate in large numbers in such ischemic/hypoxic sites. Recent studies show that macrophages then respond rapidly to the hypoxia present by altering their expression of a wide array of genes. In the present study, we outline and compare the phenotypic responses of macrophages to hypoxia in different diseased states and the implications of these for their progression and treatment.

The origin and mode of fibroblast migration and proliferation in granulation tissue

The factors which regulate the properties of granulation tissue remain uncertain. The key cells in granulation tissue are fibroblasts and their role was investigated in rat skin excisional wounds. Full thickness wounds in 28 Hooded Lister rats were made and traced. On days 1 to 7, animals in groups of 4 received colchicine 1 mg/kg subcutaneously, 4 h before being killed. Wound sections were stained to locate and count mitotic cells. All wounds healed with a normal coefficient of contraction. The fibroblasts' mitotic indices (% of mitotic cells) were calculated. Dermis: 0.1% vs. 2.9% (control vs. test P < 0.001, paired t-test); fascia; 0.07% vs. 5.6% (control vs. test P < 0.001); granulation tissue: 9.7%. Granulation tissue fibroblasts come mainly from the adjacent fascia although the dermis may have an initial role. Once they are in the wound replication is extremely rapid. This study highlights for the first time the rapidity of fibroblastic migration and proliferation in excisional wounds, and suggests that future therapeutic interventions to control granulation tissue should consider these kinetics.

The effects of wound lavage solutions on canine fibroblasts: an in vitro study

OBJECTIVE

The purpose of this study was to determine the effects of phosphate-buffered saline (PBS), sterile tap water, normal saline, and Ringer's lactate on wound healing in an in vitro model.

STUDY DESIGN

The effects of PBS, sterile tap water, normal saline, and Ringer's lactate on a primary line of canine embryonic fibroblasts were determined.

ANIMALS OR SAMPLE POPULATION

A primary line of canine embryonic fibroblasts.

METHODS

The effects of the various lavage solutions were determined by (1) vital staining of the treated cells with a 0.5% trypan blue solution, (2) evaluation of the amount of lactate dehydrogenase released by the treated cells, and (3) cytopathologic evaluation of hematoxylin and eosin-stained monolayers of treated canine fibroblasts. The cells were exposed to the lavage treatments for the following time intervals: 0.5 minute, 1 minute, 2.5 minutes, 5 minutes, and 10 minutes. PBS was used as the control.

RESULTS

Sterile tap water significantly damaged canine fibroblasts at all time intervals (P = .05). This was attributed to the alkaline pH, hypotonicity, and presence of numerous cytotoxic trace elements in the tap water used. Cytotoxic effects were noted in fibroblasts after 10 minutes' exposure to normal saline; this may be because of the acidic pH of normal saline and lack of a buffering system. Ringer's lactate did not induce any significant fibroblast injury.

CONCLUSIONS

PBS and Ringer's lactate do not induce any significant fibroblast injury, whereas normal saline and sterile tap water cause mild and severe cytotoxic effects in vitro.

CLINICAL RELEVANCE

Further clinical investigation is indicated to establish whether Ringer's lactate is the wound lavage solution of choice compared with normal saline. Sterile tap water may cause considerable fibroblast injury.

[Cellular components in interstitial lung tissue in sudden infant death--immunohistochemical characterization]

Monoclonal antibodies against the Leucocyte Common Antigens LC and MAC-387 expressed by lymphocytes, mononuclear phagocytes and polymorphonuclears failed to mark the cells of the pulmonary interstitial connective tissue in cases of SIDS. Controls with interstitial pneumonia showed clearly marked inflammatory cells. Although focal proliferation of cells was frequently observed in the vicinity of distended lymphatics in SIDS cases, an inflammatory origin as in the cases of interstitial pneumonia could not be confirmed. A relationship between interstitial edema and a non-inflammatory proliferation of the cells is discussed.

Chlorhexidine diacetate and povidone-iodine cytotoxicity to canine embryonic fibroblasts and Staphylococcus aureus

Chlorhexidine diacetate and povidone-iodine were evaluated for fibroblast toxicity on a primary line of canine embryonic fibroblasts, and for bactericidal efficacy against Staphylococcus aureus. The cultured fibroblasts or S. aureus were exposed for 30 minutes to incremental dilutions of 0.5 and 0.0005% chlorhexidine diacetate, 5.0 to 0.05% povidone-iodine, or physiologic buffered saline as a control. To determine survival, fibroblasts were trypsinized and counted; S. aureus colonies were counted on brain-heart infusion agar. Survival for both groups was expressed by calculating the number of living cells in test dilutions as a percentage of the number in control cultures. Fibroblast survival occurred at chlorhexidine concentrations less than 0.013% and at povidone-iodine concentrations less than 0.5% (p less than 0.05). Significant S. aureus survival (p less than 0.05) was noted at chlorhexidine concentrations less than 0.05% and povidone-iodine concentrations less than 1.0%. These data showed that all bactericidal concentrations of chlorhexidine diacetate and povidone-iodine were lethal to canine embryonic fibroblasts in vitro, whereas non-lethal concentrations allowed significant bacterial survival.

Identification of a protein in sera of normal humans that inhibits fibroblast chemotactic and random migration in vitro

Normal human serum contains a 230,000 Mr protein that inhibits fibroblast chemotactic and random migration. This serum inhibitor of fibroblast migration (SIFM) is a heat-stable, trypsin-sensitive protein with a pI of 4.8 that reversibly inhibits the random and chemotactic migration of fibroblasts in vitro. Although SIFM effectively inhibits the chemotaxis of fibroblasts to interstitial collagens, fibronectin, lymphocyte-derived chemotactic factor for fibroblasts, and serum-derived chemotactic factor, it does not alter the chemotactic migration of human peripheral blood neutrophils or monocytes, and does not act as a cytotoxin to human dermal fibroblasts. The SIFM appears to act through a cell-directed mechanism to alter the fibroblast's ability to migrate. Serum inhibitor of fibroblast migration may function in vivo to modulate fibroblast migration under physiologic and pathologic conditions.

Wound healing properties of cimetidine in vitro

Cimetidine was one of a variety of drugs frequently given to surgical patients perioperatively tested for their effect on gap closure of wounded monolayers of human fascia cells in vitro. Cimetidine-treated cultures closed faster and had greater cell proliferation than controls. Closure of cimetidine-treated cultures occurred at six hours compared to ten hours in controls. Cimetidine concentrations of 1000 micrograms/ml resulted in 13.5 +/- 0.67 (SEM) X 10(4) cells/cm2 at six hours compared to 7.9 +/- 0.48 X 10(4) cells/cm2 in controls (p less than 0.05); the area covered by cells was 6.5 +/- 0.02 mm2 in treated cultures compared to 3.0 +/- 0.01 mm2 in controls (p less than 0.05). It is concluded that cimetidine stimulates fibroblast proliferation in vitro.

The wound fibroblast and macrophage. II: Their origin studied in a human after bone marrow transplantation

The origin of the wound fibroblast and macrophage was studied in a patient following bone marrow transplantation, using sex chromosome markers. Fibroblast-like cells emigrating from explants of a 5-day-old skin wound had the host karyotype, whereas macrophages had donor markers. These results suggest that the wound fibroblast in man is of local tissue origin, whereas wound macrophages are derived from haemopoietic tissue.