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Zhu X, Yu G, Lv Y, Yang N, Zhao Y, Li F, Zhao J, Chen Z, Lai Y, Chen L, Wang X, Xiao J, Cai Y, Feng Y, Ding J, Gao W, Zhou K, Xu H. Neuregulin-1, a member of the epidermal growth factor family, mitigates STING-mediated pyroptosis and necroptosis in ischaemic flaps. BURNS & TRAUMA 2024; 12:tkae035. [PMID: 38855574 PMCID: PMC11162832 DOI: 10.1093/burnst/tkae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024]
Abstract
Background Ensuring the survival of the distal end of a random flap during hypoperfusion (ischaemia) is difficult in clinical practice. Effective prevention of programmed cell death is a potential strategy for inhibiting ischaemic flap necrosis. The activation of stimulator of interferon genes (STING) pathway promotes inflammation and leads to cell death. The epidermal growth factor family member neuregulin-1 (NRG1) reduces cell death by activating the protein kinase B (AKT) signalling pathway. Moreover, AKT signalling negatively regulates STING activity. We aimed to verify the efficacy of NRG1 injection in protecting against flap necrosis. Additionally, we investigated whether NRG1 effectively enhances ischemic flap survival by inhibiting pyroptosis and necroptosis through STING suppression. Methods A random-pattern skin flap model was generated on the backs of C57BL/6 mice. The skin flap survival area was determined. The blood supply and vascular network of the flap was assessed by laser Doppler blood flow analysis. Cluster of differentiation 34 immunohistochemistry (IHC) and haematoxylin and eosin (H&E) staining of the flap sections revealed microvessels. Transcriptome sequencing analysis revealed the mechanism by which NRG1 promotes the survival of ischaemic flaps. The levels of angiogenesis, oxidative stress, necroptosis, pyroptosis and indicators associated with signalling pathways in flaps were examined by IHC, immunofluorescence and Western blotting. Packaging adeno-associated virus (AAV) was used to activate STING in flaps. Results NRG1 promoted the survival of ischaemic flaps. An increased subcutaneous vascular network and neovascularization were found in ischaemic flaps after the application of NRG1. Transcriptomic gene ontology enrichment analysis and protein level detection indicated that necroptosis, pyroptosis and STING activity were reduced in the NRG1 group. The phosphorylation of AKT and forkhead box O3a (FOXO3a) were increased after NRG1 treatment. The increased expression of STING in flaps induced by AAV reversed the therapeutic effect of NRG1. The ability of NRG1 to phosphorylate AKT-FOXO3a, inhibit STING and promote flap survival was abolished after the application of the AKT inhibitor MK2206. Conclusions NRG1 inhibits pyroptosis and necroptosis by activating the AKT-FOXO3a signalling pathway to suppress STING activation and promote ischaemic flap survival.
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Affiliation(s)
- Xuwei Zhu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Gaoxiang Yu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Ya Lv
- The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou 325000, China
| | - Ningning Yang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Yinuo Zhao
- School of Pharmaceutical Science of Zhejiang Chinese Medical University, NO. 548 Binwen Road, Binjiang District, Hangzhou 310000, China
| | - Feida Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Jiayi Zhao
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Zhuliu Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Yingying Lai
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Liang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Jian Xiao
- Molecular Pharmacology Research Center, School of Pharmaceutical Science, Wenzhou Medical University, Chashan University Town, Ouhai District, Wenzhou, 325000, China
| | - Yuepiao Cai
- Molecular Pharmacology Research Center, School of Pharmaceutical Science, Wenzhou Medical University, Chashan University Town, Ouhai District, Wenzhou, 325000, China
| | | | - Jian Ding
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Weiyang Gao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Kailiang Zhou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
| | - Hui Xu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- Zhejiang Provincial Key Laboratory of Orthopaedics, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
- The Second Clinical Medical College of Wenzhou Medical University, No. 109 West Xueyuan Road, Lucheng District, Wenzhou 325027, China
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Zhang D, Liu C, Yuan Y, Yu Y, Qi B, Yu A. Monitoring angiogenesis in skin autografts using photoacoustic microscopy. JOURNAL OF BIOPHOTONICS 2024; 17:e202300317. [PMID: 37669433 DOI: 10.1002/jbio.202300317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Skin autografts have been broadly used to manage the skin and soft tissue defects. It is important for surgeons to assess the vitality of skin autografts via observing the angiogenesis. However, there is lack of reliable approach for giving the quantitative angiogenesis information on the skin autografts. Recently, photoacoustic microscopy imaging has attracted much attention based on its good performance in angiography. METHODS In this study, we aim to monitor angiogenesis in skin autografts via PAM, and further verify its clinical potential for the early prediction of skin autografts clinical outcome. RESULTS AND CONCLUSIONS The results indicate that PAM is a feasible, precise, high-resolution, noninvasive technique for the early prediction of necrosis of skin autografts via monitoring the angiogenesis, providing a promising tool for surgeons to use this surgical technology.
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Affiliation(s)
- Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Changjiang Liu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Yuan
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yifeng Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Yu Y, Wang Z, Gao S, Wu Y, Yu A, Wu F. Real-time visualization of skeletal muscle necrosis in mice and swine through NIR-II/I fluorescence imaging. JOURNAL OF BIOPHOTONICS 2024; 17:e202300225. [PMID: 37680010 DOI: 10.1002/jbio.202300225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
Avulsion often occurs in the limb due to heavy shearing forces which not only damage skeletal muscle but also main vessels, resulting in life-threatening muscle ischemia and necrosis. Defining muscle activity is vital for surgical repair. Currently, the color, capacity of blood, contractibility, and consistency (4C) are the primary principles for evaluating the activities of torn muscles. Based on clinical experiences, this standard turns out to be delayed diagnosis, which is not defined by specific parameters. Recently, near-infrared (NIR) fluorescence probes emitting within the second near-infrared window (NIR-II, 1000-1700 nm) have been widely used for non-invasive optical imaging because the tissue absorption and autofluorescence in the NIR-II region are negligible, thus allowing deeper penetration depths with micrometer-scale spatial resolution in vivo. As pathogenesis and development of muscle necrosis, necrosis-related protein may participate in this procedure. There is promising future for NIR-II to be used in evaluating muscle activity in avulsion. A new approach is developed based on experiments with mice and large animals (swine). Myoblasts were incubated with indocyanine green (ICG) to identify the necrosis muscles. The model of extremity damaged muscle was established for the real-time visualization and detection of developed necrosis muscle field under new equipment, both in balb/c mice (female) and long-haired swines. A visible NIR-II/I imaging system was first used in a large animal injured skeletal muscle-related model. Our NIR-II/I imaging system is suitable for evaluating the normal and injured skeletal muscle ICG cycle and pointing to the necrotic skeletal muscle tissue. NIR-II imaging is superior to NIR-I imaging in estimating skeletal muscle, best with 1100 nm filter. NIR-II fluorescence with 1100 nm filter is suitable for analyzing the progress of necrosis muscle tissue, leading to a new approach for intraoperative evaluation.
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Affiliation(s)
- Yifeng Yu
- Department of Orthopedics, Renmin Hospital, Wuhan University, Wuhan, China
| | - Zheng Wang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Siqi Gao
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yifan Wu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Fei Wu
- Department of Orthopedics, Renmin Hospital, Wuhan University, Wuhan, China
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Wu Y, Suo Y, Wang Z, Yu Y, Duan S, Liu H, Qi B, Jian C, Hu X, Zhang D, Yu A, Cheng Z. First clinical applications for the NIR-II imaging with ICG in microsurgery. Front Bioeng Biotechnol 2022; 10:1042546. [PMID: 36329697 PMCID: PMC9623121 DOI: 10.3389/fbioe.2022.1042546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022] Open
Abstract
In microsurgery, it is always difficult to accurately identify the blood supply with ease, such as vascular anastomosis, digit replantation, skin avulsion reconstruction and flap transplantation. Near-infrared window I (NIR-I, 700—900 nm) imaging has many clinical applications, whereas near-infrared window II (NIR-II, 1,000–1700 nm) imaging has emerged as a highly promising novel optical imaging modality and used in a few clinical fields recently, especially its penetration distance and noninvasive characteristics coincide with the needs of microsurgery. Therefore, a portable NIR-II imaging instrument and the Food and Drug Administration (FDA) approved indocyanine green (ICG) were used to improve the operation efficiency in microsurgery of 39 patients in this study. The anastomotic vessels and the salvaged distal limbs were clearly visualized after intravenous injection of ICG. The technique enabled identification of perforator vessels and estimation of perforator areas prior to the flap obtention and made it easier to monitor the prognosis. Overall, this study highlights the use of the portable NIR- II imaging with ICG as an operative evaluation tool can enhance the safety and accuracy of microsurgery.
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Affiliation(s)
- Yifan Wu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongkuan Suo
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Zheng Wang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yifeng Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shuang Duan
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Hongguang Liu
- Joint Laboratory for Molecular Medicine, Institute of Molecular Medicine, Northeastern University, Shenyang, Liaoning, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chao Jian
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiang Hu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dong Zhang
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Aixi Yu, ; Zhen Cheng,
| | - Zhen Cheng
- State Key Laboratory of Drug Research, Molecular Imaging Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai, Shandong, China
- *Correspondence: Aixi Yu, ; Zhen Cheng,
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