Connecting Wounds with Connexins

Staphylococcus aureus impairs cutaneous wound healing by activating the expression of a gap junction protein, connexin-43 in keratinocytes

Chronic wounds have been considered as major medical problems that may result in expensive healthcare. One of the common causes of chronic wounds is bacterial contamination that leads to persistent inflammation and unbalanced host cell immune responses. Among the bacterial strains that have been identified from chronic wounds, Staphylococcus aureus is the most common strain. We previously observed that S. aureus impaired mouse cutaneous wound healing by delaying re-epithelialization. Here, we investigated the mechanism of delayed re-epithelialization caused by S. aureus infection. With the presence of S. aureus exudate, the migration of in vitro cultured human keratinocytes was significantly inhibited and connexin-43 (Cx43) was upregulated. Inhibition of keratinocyte migration by S. aureus exudate disappeared in keratinocytes where the expression of Cx43 knocked down. Protein kinase phosphorylation array showed that phosphorylation of Akt-S473 was upregulated by S. aureus exudate. In vivo study of Cx43 in S. aureus-infected murine splinted cutaneous wound model showed upregulation of Cx43 in the migrating epithelial edge by S. aureus infection. Treatment with a PI3K/Akt inhibitor reduced Cx43 expression and overcame the wound closure impairment by S. aureus infection in the mouse model. This may contribute to the development of treatment to bacterium-infected wounds.

Cellular resolution of inflammation--catabasis

Controlled inflammation has become a central focus in chronic disease therapeutics. Exaggerated inflammation is a common factor that contributes to matrix destruction, cellular senescence, and nonhealing in a variety of disease processes. Efforts at controlling inflammation have traditionally concentrated on systemic antagonists to inflammation such as nonsteroidal anti-inflammatory agents. More recently, following increased appreciation of local biological cellular and molecular events occurring at the wound interface, efforts are being focused on local targeted approaches to catabasis, the resolution of inflammation. These efforts relate to the isolation and understanding of the mechanisms of actions of various "stop signal mediators." These lipoxins, resolvins, and protectins are produced and stimulated by cellular interactions in the blood stream, extracellular matrix, and in cells themselves. Transmission of these signals between cells and the extracellular matrix and between cells themselves occurs via a variety of mechanisms including through intracellular gap junctions, connexins, and cadherins. The existence of these mediators, signals, and channels of communication all provide new therapeutic options for achieving catabasis in a more defined and targeted fashion.

Connexins, a new target in wound treatment

Wound healing is a complex process requiring interaction between different cell types, each playing their part within the four main phases of wound healing. This process requires careful regulation, with communication between the different cell types via gap junction channels, which allow the passage of small molecules, including ions and second messengers, between cells. Gap junction protein (connexin) expression changes with the different stages of wound healing, playing important roles in regulating the process. The field of research looking into intercellular communication via gap junctions in skin and wound healing has shown encouraging results in experimental studies. As further developments and clinical studies are being carried out, practitioners should be introduced to this field, as a promising new wound treatment is currently in clinical trials. This paper aims to introduce practitioners to this field of study with a review of current available literature.

A model system to study Connexin 43 in the immune system

Connexin 43 (Cx43) is the predominant gap junction protein expressed in immune cells. Previous manuscripts have stated that gap junctions may play a role in antigen cross-presentation, dendritic cell maturation, T cell development, and regulatory T cell function. Many of these previous studies were performed in vitro. In vivo studies were not directly possible in adult mice because Cx43-/- mice die shortly after birth due to a cardiac malformation. To overcome these drawbacks, we have developed a mouse model that deletes Cx43 in the immune system while maintaining normal cardiac function. In our model, irradiated CD45.1+ wild-type mice were reconstituted with Cx43WT, Cx43+/-, or Cx43-/- hematopoietic fetal liver cells that were derived from CD45.2+ mice. The presence of CD45.2 allowed us to identify and track the donor cells following reconstitution. We determined that Cx43+/- and Cx43-/- hematopoietic cells were able to reconstitute irradiated mice as well as Cx43WT cells. Reconstitution was nearly 100% in the thymus and over 90% in the spleen. There appeared to be no difference in thymocyte development or in the ability of lymphocytes to transmigrate to peripheral lymphoid organs. However in response to inflammation, Cx43+/- radiation chimeras had increased peritoneal infiltration compared to Cx43WT and Cx43-/- groups. IgG responses were normal in all groups but the Cx43-/- reconstituted mice had an elevated IgM response. Our data suggests that Cx43 may not be involved in the normal development of the immune system but may regulate certain effector functions in vivo.

Abnormal connexin expression underlies delayed wound healing in diabetic skin

OBJECTIVE

Dynamically regulated expression of the gap junction protein connexin (Cx)43 plays pivotal roles in wound healing. Cx43 is normally downregulated and Cx26 upregulated in keratinocytes at the edge of the wound as they adopt a migratory phenotype. We have examined the dynamics of Cx expression during wound healing in diabetic rats, which is known to be slow.

RESEARCH DESIGN AND METHODS

We induced diabetes with streptozotocin and examined Cx expression and communication in intact and healing skin.

RESULTS

We found that diabetes decreased Cx43 and Cx26 protein and communication in the intact epidermis and increased Cx43 protein and communication in the intact dermis. Diabetes also altered the dynamic changes of Cxs associated with wound healing. Within 24 h, Cx43 was upregulated in a thickened bulb of keratinocytes at the wound edge (rather than downregulated as in controls, which formed a thin process of migratory cells). Cx43 decline was delayed until 48 h, when reepithelialization began. Although Cx26 was upregulated as normal after wounding in diabetic skin, its distribution at the wound edge was abnormal, being more widespread. Application of Cx43-specific antisense gel to diabetic wounds prevented the abnormal upregulation of Cx43 and doubled the rate of reepithelialization, which exceeded control levels.

CONCLUSIONS

Cx expression in diabetic skin is abnormal, as is the dynamic response of Cx43 to injury, which may underlie the delayed healing of diabetic wounds. Preventing the upregulation of Cx43 in diabetic wounds significantly improves the rate of healing and clearly has potential therapeutic value.