1
|
Reiche E, Keller PR, Soares V, Schuster CR, Rahmayanti S, Mroueh J, Mroueh V, Billaud M, Hu S, Hoover-Watson H, Lian CG, Tan Y, Doloff JC, Newell-Fugate AE, Coon D. Androgenic steroids induce pathologic scarring in a preclinical porcine model via dysfunctional extracellular matrix deposition. FASEB J 2024; 38:e23561. [PMID: 38530321 DOI: 10.1096/fj.202302144rrr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
Hypertrophic scarring is a major source of morbidity. Sex hormones are not classically considered modulators of scarring. However, based on increased frequency of hypertrophic scarring in patients on testosterone, we hypothesized that androgenic steroids induce abnormal scarring and developed a preclinical porcine model to explore these effects. Mini-swine underwent castration, received no testosterone (noT) or biweekly testosterone therapy (+T), and underwent excisional wounding. To create a delayed wound healing model, a subset of wounds were re-excised at 2 weeks. Scars from postoperative day 42 (POD42) and delayed wounds (POD28) were harvested 6 weeks after initial wounding for analysis via histology, bulk RNA-seq, and mechanical testing. Histologic analysis of scars from +T animals showed increased mean fibrosis area (16 mm2noT, 28 mm2+T; p = .007) and thickness (0.246 mm2noT, 0.406 mm2+T; p < .001) compared to noT. XX+T and XY+T scars had greater tensile burst strength (p = .024 and p = .013, respectively) compared to noT swine. Color deconvolution analysis revealed greater deposition of type I and type III collagen as well as increased collagen type I:III ratio in +T scars. Dermatopathologist histology scoring showed that +T exposure was associated with worse overall scarring (p < .05). Gene ontology analysis found that testosterone exposure was associated with upregulation of cellular metabolism and immune response gene sets, while testosterone upregulated pathways related to keratinization and laminin formation on pathway analysis. In conclusion, we developed a preclinical porcine model to study the effects of the sex hormone testosterone on scarring. Testosterone induces increased scar tissue deposition and appears to increase physical strength of scars via supraphysiologic deposition of collagen and other ECM factors. The increased burst strength seen in both XX and XY animals suggests that hormone administration has a strong influence on scar mechanical properties independent of chromosomal sex. Anti-androgen topical therapies may be a promising future area of research.
Collapse
Affiliation(s)
- Erik Reiche
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patrick R Keller
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vance Soares
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Calvin R Schuster
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Siti Rahmayanti
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Mroueh
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Vanessa Mroueh
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Billaud
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Hu
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Hunter Hoover-Watson
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yu Tan
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua C Doloff
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annie E Newell-Fugate
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas, USA
| | - Devin Coon
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Reiche E, Tan Y, Louis MR, Keller PR, Soares V, Schuster CR, Lu T, O’Brien Coon D. A Novel Mouse Model for Investigating the Effects of Gender-affirming Hormone Therapy on Surgical Healing. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4688. [PMID: 36467118 PMCID: PMC9708152 DOI: 10.1097/gox.0000000000004688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/05/2022] [Indexed: 06/13/2023]
Abstract
Wound healing problems are a major cause of morbidity for gender-affirming surgery (GAS) patients. Prior studies have shown sex differences in wound healing may exist. We hypothesized exogenous testosterone supplementation may impair post-GAS wound healing and developed a model to investigate this phenomenon. Mice were randomized by hormone regimen and gonadectomy (OVX). Gonadectomy or sham occurred on day 0 and mice were assigned to no testosterone (-T), mono- or bi-weekly (T/2T) testosterone groups. Dorsal splinted wounding occurred on day 14 and harvest on day 21. Serum testosterone levels were quantified with mass spectrometry. Tissue underwent analysis with planimetry, qPCR, ELISA, and immunofluorescence. Mean testosterone trough levels for bi-weekly regimen were higher compared to mono-weekly (397 versus 272 ng/dL; P = 0.027). At POD5, 2T injections led to 24.9% and 24.7% increases in mean wound size relative to SHAM and OVX/-T, respectively (P = 0.004; 0.001). Wounds in OVX/+2T mice demonstrated increased gene expression for inflammatory cytokines and macrophage marker F4/80 (P < 0.05). ELISA confirmed elevated wound TNFα levels (P < 0.05). Quantitative multiplex immunofluorescence with F4/80/NOS2/ARG1 showed significant increases in macrophage prevalence in OVX/+2T (P < 0.05). We developed a novel model of GAS hormonal milieu to study effects of exogenous testosterone on wound healing. Optimized twice-weekly dosing yielded serum levels comparable to clinical therapy. We showed exogenous testosterone administered to XX/OVX mice significantly impairs wound healing. A hyperinflammatory wound environment results in increased macrophage proliferation and elevated cytokines. Future efforts are directed toward mechanistic investigation and clinical validation.
Collapse
Affiliation(s)
- Erik Reiche
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Yu Tan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Matthew R. Louis
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Patrick R. Keller
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Vance Soares
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Calvin R. Schuster
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
| | - Tingying Lu
- The Department of Applied Mathematics and Statistics, Whiting School of Engineering, Johns Hopkins University, Baltimore, Md
| | - Devin O’Brien Coon
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Translational Tissue Engineering Center, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Md
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass
| |
Collapse
|
3
|
Jiang Y, Luo H, Zhao Z, Feng L. Estrogen Facilitates the Healing of Diabetic Wounds via Ameliorating the Function of Bone Marrow Mesenchymal Stem Cells. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We inted to elucidate the impacts of estrogen on the bone marrow-originated endothelial progenitor cells (BM-EPC) and mesenchymal stem cells (BM-MSC) as well as on diabetic wound healing. The skin injury models were established using the diabetic mice (db+/db+) and non-diabetic vector
mice and then treated with estrogen-based or placebo-based cream. On the 5th day following injury, BM cells were collected for quantification of EPCs and MSCs and colony-forming units along with analysis of wound healing rate and densities of blood vessels and scars following whole-body perfusion.
EPCs were identified through staining of VEGFR1 and CD34 by immunohistochemistrical analyses. In contrast to placebo, treatment with estrogen significantly intensified the colony formation of EPC and MSC, and further promoted the viability and proliferation potential of cells. Meanwhile, estrogen-treated
mice exhibited increased recruitment of EPC to the diabetic wounds along with increased vascular density. Additionally, on day 6 after injury, estrogen significantly accelerated wound healing, which was mediated by the enhanced collagen deposition through boosting MSC activation and differentiation,
resulting in elevated scar density. In conclusion, estrogen prompts wound healing of diabetic mice via ameliorating the function of BM-derived EPC and MSC, so as to accelerate the neovascularization at the sites of wounds in diabetic mice.
Collapse
Affiliation(s)
- Yan Jiang
- Department of Clinical Laboratory, The People’s Hospital of ChuXiong Yi Autonomous Prefecture, Chuxiong City, Chuxiong Yi Autonomous Prefecture, Yunnan Province, 675000, China
| | - Heng Luo
- Department of Ophthalmology, The People’s Hospital of ChuXiong Yi Autonomous Prefecture, Chuxiong City, Chuxiong Yi Autonomous Prefecture, Yunnan Province, 675000, China
| | - Zhengke Zhao
- Department of Teaching & Research, The People’s Hospital of ChuXiong Yi Autonomous Prefecture, Chuxiong City, Chuxiong Yi Autonomous Prefecture, Yunnan Province, 675000, China
| | - Lei Feng
- Department of Clinical Laboratory, The People’s Hospital of ChuXiong Yi Autonomous Prefecture, Chuxiong City, Chuxiong Yi Autonomous Prefecture, Yunnan Province, 675000, China
| |
Collapse
|
4
|
Shi H, Tsai KHY, Ma D, Wang X, Desai R, Parungao RJ, Hunt NJ, Cheng YY, Zhang H, Xu Y, Simanainen U, Tan Q, Cooper MS, Handelsman DJ, Maitz PK, Wang Y. Controlled dual release of dihydrotestosterone and flutamide from polycaprolactone electrospun scaffolds accelerate burn wound healing. FASEB J 2022; 36:e22310. [PMID: 35394674 PMCID: PMC9540550 DOI: 10.1096/fj.202101803r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
Abstract
Wound healing is a complex process involving multiple independent and overlapping sequential physiological mechanisms. In addition to cutaneous injury, a severe burn stimulates physiological derangements that induce a systemic hypermetabolic response resulting in impaired wound healing. Topical application of the anti‐androgen drug, flutamide accelerates cutaneous wound healing, whereas paradoxically systemic dihydrotestosterone (DHT) improves burn wound healing. We developed and characterized a PCL scaffold that is capable of controlled release of androgen (DHT) and anti‐androgen (F) individually or together. This study aims to investigate whether local modification of androgen actions has an impact on burn injury wound healing. In a full‐thickness burn wound healing, mouse model, DHT/F‐scaffold showed a significantly faster wound healing compared with F‐scaffold or DHT‐scaffold. Histology analysis confirmed that DHT/F‐scaffold exhibited higher re‐epithelization, cell proliferation, angiogenesis, and collagen deposition. Dual release of DHT and F from PCL scaffolds promoted cell proliferation of human keratinocytes and alters the keratinocyte cell cycle. Lastly, no adverse effects on androgen‐dependent organs, spleen and liver were observed. In conclusion, we demonstrated DHT plus F load PCL scaffolds accelerated burn wound healing when loading alone did not. These findings point to a complex role of androgens in burn wound healing and open novel therapeutic avenues for treating severe burn patients.
Collapse
Affiliation(s)
- Huaikai Shi
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia.,Asbestos Disease Research Institute, Concord Hospital, Sydney, Australia
| | - Kevin H-Y Tsai
- Adrenal Steroids Laboratory, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - Duncan Ma
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - Xiaosuo Wang
- Bosch Mass Spectrometry Facility, University of Sydney, Sydney, Australia
| | - Reena Desai
- Department of Andrology, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - Roxanne J Parungao
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - Nicholas J Hunt
- Biogerontology Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia.,Sydney Nano Institute, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Yuen Yee Cheng
- Asbestos Disease Research Institute, Concord Hospital, Sydney, Australia
| | - Hao Zhang
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ye Xu
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ulla Simanainen
- Department of Andrology, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - Qian Tan
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Mark S Cooper
- Adrenal Steroids Laboratory, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - David J Handelsman
- Department of Andrology, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia
| | - Peter K Maitz
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia.,Burns Unit, Concord Repatriation General Hospital, Concord, Australia
| | - Yiwei Wang
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia.,Jiangsu Provincial Engineering Research Centre of TCM External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
5
|
Gnyawali SC, Sinha M, El Masry MS, Wulff B, Ghatak S, Soto-Gonzalez F, Wilgus TA, Roy S, Sen CK. High resolution ultrasound imaging for repeated measure of wound tissue morphometry, biomechanics and hemodynamics under fetal, adult and diabetic conditions. PLoS One 2020; 15:e0241831. [PMID: 33227015 PMCID: PMC7682876 DOI: 10.1371/journal.pone.0241831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Non-invasive, repeated interrogation of the same wound is necessary to understand the tissue repair continuum. In this work, we sought to test the significance of non-invasive high-frequency high-resolution ultrasound technology for such interrogation. High-frequency high-resolution ultrasound imaging was employed to investigate wound healing under fetal and adult conditions. Quantitative tissue cellularity and elastic strain was obtained for visualization of unresolved inflammation using Vevo strain software. Hemodynamic properties of the blood flow in the artery supplying the wound-site were studied using color Doppler flow imaging. Non-invasive monitoring of fetal and adult wound healing provided unprecedented biomechanical and functional insight. Fetal wounds showed highly accelerated closure with transient perturbation of wound tissue cellularity. Fetal hemodynamics was unique in that sharp fall in arterial pulse pressure (APP) which was rapidly restored within 48h post-wounding. In adults, APP transiently increased post-wounding before returning to the pre-wounding levels by d10 post-wounding. The pattern of change in the elasticity of wound-edge tissue of diabetics was strikingly different. Severe strain acquired during the early inflammatory phase persisted with a slower recovery of elasticity compared to that of the non-diabetic group. Wound bed of adult diabetic mice (db/db) showed persistent hypercellularity compared to littermate controls (db/+) indicative of prolonged inflammation. Normal skin strain of db/+ and db/db were asynchronous. In db/db, severe strain acquired during the early inflammatory phase persisted with a slower recovery of elasticity compared to that of non-diabetics. This study showcases a versatile clinically relevant imaging platform suitable for real-time analyses of functional wound healing.
Collapse
Affiliation(s)
- Surya C. Gnyawali
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Mithun Sinha
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Mohamed S. El Masry
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Brian Wulff
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Subhadip Ghatak
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Fidel Soto-Gonzalez
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Traci A. Wilgus
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Sashwati Roy
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Chandan K. Sen
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| |
Collapse
|