[New developments in skin reconstruction - cell cultures and skin substitutes plus review of the literature]. / Nouveautes Dans la Reconstruction Cutanee: Cultures de Cellules et Substituts Dermiques et Revue de la Litterature.

The management of patients with deep extensive burns remains a major challenge for reconstructive surgeons. This is especially true with the considerable progress that is currently being achieved in resuscitation procedures that permit the survival of patients with burns in over 90% of their body surface. Modern reconstruction techniques have had to innovate and become a complex surgery requiring a strategic plan involving materials and multiple surgical procedures tailored to each clinical situation. This type of care also requires the close and co-ordinated collaboration of several highly specialized teams. The survival rate and quality of life of these patients have thus much improved. We have likewise observed that the number of secondary complications such as contractures and scarring instabilities have also significantly decreased.

Quantitative assessment of cell viability and apoptosis in cultured epidermal autografts: application to burn therapy.

Cultured epidermal autografts (CEA) have been used in the treatment of burns for almost two decades but the clinical results are still inconsistent. In a group of 37 patients with extensive burn wounds admitted to the University Hospital of Lausanne, CEA take ranged between 10 and 100% with a mean of 65%. To investigate CEA efficacy in burns, twelve CEA preparations were tested for their biological properties with particular emphasis on the balance between cell viability and apoptosis. Apoptosis was evaluated by in situ end-labeling (TUNEL), detection of DNA fragments in CEA extracts and analysis of caspase-3 activity. All CEA samples displayed a high cell viability (> 90%) and a low apoptosis rate (< 6%). However, several biological parameters including the activity of transglutaminase showed wide interindividual variability suggesting that CEA therapeutic efficacy could be partly determined by intrinsic biological factors.

Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions.

A new culture model was developed to study the role of proliferation and apoptosis in the etiology of keloids. Fibroblasts were isolated from the superficial, central, and basal regions of six different keloid lesions by using Dulbecco's Modified Eagle Medium containing 10% fetal calf serum as a culture medium. The growth behavior of each fibroblast fraction was examined in short-term and long-term cultures, and the percentage of apoptotic cells was assessed by in situ end labeling of fragmented DNA. The fibroblasts obtained from the superficial and basal regions of keloid tissue showed population doubling times and saturation densities that were similar to those of age-matched normal fibroblasts. In contrast, the fibroblasts from the center of the keloid lesions showed significantly reduced doubling times (25.9 +/- 6.3 hours versus 43.5 +/- 6.3 hours for normal fibroblasts) and reached higher cell densities. In long-term culture, central keloid fibroblasts formed a stratified three-dimensional structure, contracted the self-produced extracellular matrix, and gave rise to nodular cell aggregates, mimicking the formation of keloid tissue. Apoptotic cells were detected in both normal and keloid-derived fibroblasts, but their numbers were twofold higher in normal cells compared with all keloid fibroblasts. To examine whether apoptosis mediates the therapeutic effect of ionizing radiation on keloids, the cells were exposed to gamma rays at a dose of 8 Gy. Under these conditions, a twofold increase in the population of apoptotic cells was detected. These results indicate that the balance between proliferation and apoptosis is impaired in keloid fibroblasts, which could be responsible for the formation of keloid tumors. The results also suggest that keloids contain at least two different fibroblast fractions that vary in growth behavior and extracellular matrix metabolism.

Co-regulation of melanin precursors and tyrosinase in human pigment cells: roles of cysteine and glutathione.

Glutathione (GSH) and cysteine (CysH) have both been implicated in the biogenesis of the pheomelanin precursor 5-S-cysteinyldopa (5-S-CD). However, recent studies have shown that only CysH is transported across the membrane of isolated melanosomes, and that the positive regulation of CysH in pigment cells leads to an increased production of 5-S-CD. In the present study, the question was examined as to whether melanin precursors and tyrosinase could be coregulated by cellular thiols. To address this issue, the levels of CysH and GSH were varied in normal melanocytes and melanoma cells using buthionine sulfoximine (BSO), an inhibitor of GSH biosynthesis. Treatment with 50-100 microM BSO decreased GSH levels to less than 10% of control, and increased CysH levels between two- and five-fold in both cell types. Concomitant with this, an increase in the ratio of 5-S-CD to DOPA and a decrease in the pigment content of the cells were observed. The decrease in cell pigmentation was associated with strong decreases in tyrosine hydroxylase activity and 14C-melanin production. Only melanoma cells showed a modified tyrosinase isozyme pattern on Western immunoblots in response to BSO, while the mRNA expression of tyrosinase and TRP-1 were unchanged in both cell types. These results suggest that the balance between CysH and GSH, which is partly determined by the rate of utilization of CysH for GSH biosynthesis, regulates not only the levels of 5-S-CD and DOPA but also the melanogenic activity of pigment cells. Since DOPA functions as a cofactor in the monophenolase reaction of tyrosinase, it is proposed that the ratio of 5-S-CD to DOPA may be an important factor in the regulation of tyrosinase activity in situ.

[Living epidermal and dermal substitutes for treatment of severely burned patients]. / Substituts épidermiques et dermo-épidermiques vivants pour le traitement des grands brûlés.

Epidermal and dermal cells can be multiplied in vitro using different techniques. Under particular conditions, the structure and the function of the original tissues are partly recreated. Autologous epidermal substitutes for wound coverage in deep burns are prepared in less than three weeks. Bilayered skin equivalents containing a dermal component are obtained by growing epidermal cells on a reconstructed dermal substitute or by juxtaposing stratified cultures of keratinocytes and fibroblasts. New technologies are required to optimise the nutrition of three-dimensional cultures of skin cells, which should lead to further progress in the area of skin reconstruction.

Insulin inhibits tyrosinase activity and 5-S-cysteinyldopa formation in human melanoma cells.

The effects of insulin on melanogenesis were examined in human Swift melanoma cells. When these cells were grown in a chemically defined culture medium containing insulin (5 microg/ml), they showed a low pigmentation in association with a high activity of glutathione peroxidase (GPO) and a low activity of tyrosinase. In Eagle's minimum essential medium supplemented with foetal calf serum (EMEM-FCS), the Swift cells showed an intense pigmentation in association with a low GPO activity and a high tyrosinase activity. Modulation of GPO activity with sodium selenite had no effect on melanogenesis variables. In contrast, addition of insulin (5 microg/ml) to the EMEM medium led to a marked decrease in tyrosinase activity (p<0.001) and to a concomitant reduction in the levels of 5-S-cysteinyldopa (p <0.01). These results indicate that insulin inhibits the formation of 5-S-cysteinyldopa and that of melanin via the inhibition of tyrosinase activity.

Efficacy of cultured epithelial autografts in pediatric burns and reconstructive surgery.

BACKGROUND: Cultured epithelial autografts are regularly used in burn patients, but they have not been tested in patients undergoing reconstructive surgery. The aim of this study was to analyze and compare the efficacy of cultured grafts in both burn and reconstructive surgery patients. METHODS: In six children with severe and massive burns, full-thickness areas were grafted with cultured grafts. In another six children with hypertrophic or hyperpigmented scars, or both, cultured grafts were used to cover defects resulting from scar excision or deep dermabrasion. RESULTS: In burn surgery the final cover rate averaged 60% (range, 0% to 100%). The functional and cosmetic results were good and at least equivalent to results after conventional grafting. Fragility, infection, and, in particular, mechanical instability of cultured grafts during the first weeks after transplantation were the main problems encountered. In reconstructive surgery the final cover rate was 100% in all patients. The functional and cosmetic results were very good and considered better than those obtained by using conventional grafting techniques. No major management problems were encountered. CONCLUSIONS: In massively burned children, cultured epithelial autografts represent an effective additional and potentially lifesaving method to conventional grafting. Questions remain regarding the use of this technique to treat less severe burns. For resurfacing-type scar revisions, cultured epithelial autografts yield excellent results that appear to be superior to those of conventional techniques.

Opposite regulation of tyrosinase and glutathione peroxidase by intracellular thiols in human melanoma cells.

Conditions of oxidative stress lead to down-regulation of glutathione (GSH) and glutathione peroxidase (GPO), which could be responsible for tyrosinase induction in pigment cells. To address this question, the effects of selective modulation of GSH metabolism on melanogenic parameters of slightly and highly melanized melanoma cells were examined. Under standard culture conditions (100 microM cystine, 100 microM tyrosine), the levels of GSH and the activities of glutathione reductase (GR) and GPO were found to be directly related to the pigmentation of melanoma cells. Exposure to 50 microM buthionine sulfoximine for 72 h decreased tyrosinase activity by 30-50% and GSH levels by more than 95%. In contrast, inhibition of GR activity with bis(chloroethyl)nitrosourea or stimulation of GPO activity with sodium selenite did not affect tyrosinase activity nor pigment formation in the melanoma cells tested. Since cysteine (CysH) is a precursor of the GSH tripeptide, the modulation of tyrosinase and GPO activity by the extracellular cystine concentration was also examined. When the cystine concentration was increased from 0 to 200 microM, a dose-dependent decrease in tyrosinase activity was associated with dose-dependent increases in GPO activity and in cell levels of CysH and GSH. The results indicate that cellular thiols coregulate the activities of tyrosinase and GPO in opposite directions. These interdependent processes could provide melanoma cells with protection against oxidative stress at low as well as at high thiol concentration.

Glutathione efflux associated with a low gamma-glutamyl transpeptidase activity in human melanoma cells.

The cellular concentration of reduced glutathione (GSH) modulates the sensitivity of human melanoma cells to alkylating drugs in vitro. To investigate whether the membrane-associated enzyme gamma-glutamyl transpeptidase (gamma-GTP) involved in GSH breakdown was expressed in melanoma cells, the enzymatic activity of gamma-GTP as well as the secretion of GSH were measured in human melanoma cells from four different cell lines (Me8, JUSO, GLL19, Swift). All the cells showed low gamma-GTP activities (0-1 mU/mg protein) and released GSH in culture supernatants at significant rates. After incubation for 24 h in growth medium containing 0.1 mmol/L cystine, the levels of GSH in supernatants ranged from 56 to 111 nmol GSH/mg protein. The GSH metabolism of melanoma cells was also evaluated by measuring the levels of the melanogenesis intermediate 5-S-cysteinyldopa under different experimental conditions. The results of these experiments suggest that melanoma cells have a low ability to metabolize the tripeptide GSH, which appears to be responsible for GSH secretion and accumulation in culture supernatants.

Cysteine-dependent 5-S-cysteinyldopa formation and its regulation by glutathione in normal epidermal melanocytes.

Recent evidence suggests that the melanogenesis intermediate 5-S-cysteinyldopa (5-S-CD) could display antioxidative activity. In the present study, the synthesis of 5-S-CD was examined in human epidermal melanocytes isolated from dark skin type VI (MT) and from white skin type III (GT). The MT melanocytes showed the higher melanin content and dopa oxidase activity. In addition, they produced eumelanin as shown by their ultrastructure, and the solubility and UV/visible absorption of the isolated pigment. Both MT and GT cells showed high levels of 5-S-CD (5.5-6.9 nmol/mg protein). 5-S-CD was also detected in culture supernatants from MT cells; the secretion rate was estimated to be 2.5 nmol/mg protein per 24 h. The role of cysteine and glutathione in 5-S-CD formation was investigated by exposing the melanocytes to the gamma-glutamylcysteine synthetase inhibitor L-buthionine sulfoximine (BSO). A strong reduction in glutathione levels (4-8% of the untreated controls) associated with an increase in cysteine levels (152-154%) was observed. In addition, BSO induced a moderate increase in the cellular levels of 5-S-CD (114-129%) and a decrease in dopa oxidase activity (75-83%). Our results indicate that the direct addition of cysteine to dopaquinone is the main source of 5-S-CD in human epidermal melanocytes. It is proposed that the synthesis of 5-S-CD is a mechanism regulating dopaquinone levels during pigment formation and/or a defence mechanism against oxidative stress.

Modulation of 5-S-cysteinyldopa formation by tyrosinase activity and intracellular thiols in human melanoma cells.

The catechol 5-S-cysteinyldopa (5-S-CD) is produced in large amounts in metastatic malignant melanoma. To further understand the mechanism of formation of 5-S-CD, we investigated the effects of thiol modulating agents and melanin precursors on human melanoma cells. Under standard culture conditions (0.1 mM cystine), the cell levels of 5-S-CD were highly correlated with the degree of melanization and the dopa oxidase activity of the four cell lines investigated (Me8, JUSO, GLL19, Swift). Inhibition of glutathione (GSH) biosynthesis with buthionine sulphoximine did not affect 5-S-CD levels in the low melanotic GL 19 cells. In contrast, the highly pigmented Swift cells showed a strong increase in the cell levels of cystine (CysH) and 5-S-CD. When the cystine concentration of the growth medium was increased to 0.2 mM, a similar situation of 5-S-CD synthesis caused by an increase in intracellular CysH levels was observed in the Swift cells. The GLL19 cells showed enhanced 5-S-CD formation in the presence of 0.1 mM L-dopa. This effect was associated with a fourfold increase in dopa oxidase activity. Our data clearly indicate that 5-S-CD is formed in human melanoma cells by a tyrosinase-dependent mechanism involving the addition of CysH to dopaquinone. Based on the enhancing effect of buthionine sulphoximine on 5-S-CD formation, it is proposed that GSH is not directly implicated in 5-S-CD formation, but regulates CysH levels via the enzyme gamma-glutamylcysteine synthetase.

Antifungal principles of Baccharis pedunculata.

Four compounds including a flavone, an acetylenic lactone, a prenylated coumarin, and a 3-methyl ether flavone were isolated from the dichloromethane leaf extract of Baccharis pedunculata (Mill.) Cabr. (Asteraceae). The latter three compounds were identified to be responsible for the antifungal activity against some human pathogenic and phytopathogenic fungi. The most active compound, lachnophyllum lactone, an acetylenic lactone, showed a very high toxicity (LD50 2 micrograms/ml) against human keratinocytes.

Abnormal keratin 1 and 10 cytoskeleton in cultured keratinocytes from epidermolytic hyperkeratosis caused by keratin 10 mutations.

Epidermolytic hyperkeratosis is caused by mutations of the differentiation-specific keratins K1 and K10. These mutations produce a weakened cytoskeleton that is prone to collapse resulting in cell fragility and lysis. In this study we have analyzed cultured keratinocytes from EHK patients bearing 10R-to-H and 15L-to-S mutations within the 1A segment of the K10 rod domain. Keratinocytes were grown submerged in serum-free medium and induced to differentiate by growing to confluence and increasing the Ca++ concentration in the medium. Cultures were either harvested for mRNA sequence analysis or subjected to immunofluorescence microscopy. Differentiating keratinocytes from these patients were found to express these K10 mutations in their mRNA. Moreover, these cells could be distinguished from normal keratinocytes by their aberrant morphology. EHK keratinocytes frequently exhibited a collapsed perinuclear network of K1/K10 filaments and sometimes peripheral granules of K1 and K10 aggregates, reminiscent of the cells of the suprabasal layers in these patients. This report documents the expression of mutant keratin 10 in cultured EHK keratinocytes.

Relationship between melanogenesis, glutathione levels and melphalan toxicity in human melanoma cells.

Resistance to alkylating agents has been correlated with cellular levels of reduced glutathione (GSH) and glutathione-S-transferase (GST). GSH is also involved in regulation of melanin synthesis. Therefore, we examined sensitivity to melphalan as a function of differentiation and GSH/GST levels in three human melanoma cell lines. The Me8 cell line, classified as undifferentiated on the basis of cell shape, absence of pigment, insignificant dopa oxidase activity and presence of inhibitors of dopa-melanin formation, showed the lowest GST activity among the cell lines investigated. GLL19 cells exhibited normal differentiation as indicated by the presence of dendrites, typical eumelanosomes, melanin granules and dopa oxidase activity. These cells showed the highest GSH content and the highest GST activity. The JUSO cell line showed incomplete differentiation, and its dopa oxidase and GST activities were intermediate between the Me8 and GLL19 cell lines. The sensitivity of melanoma cell lines to melphalan increased with their degree of differentiation; it was lowest for Me8, intermediate for JUSO and highest for GLL19. Dibutyryl cyclic AMP (dbcAMP) enhanced melphalan toxicity against Me8 cells. Depletion of intracellular GSH with buthionine sulphoximine (BSO) resulted in a three-fold increase in melphalan sensitivity in all three cell lines. Our results indicate that melphalan toxicity is related to cell differentiation and GSH status of melanoma cells. Based on the observed relationship between dopa oxidase, GSH/GST levels and drug toxicity, it is proposed that competition for the GSH pool between quinonoid melanin intermediates and melphalan could diminish drug conjugation and increase cytotoxicity.

Current concepts in pediatric burn care: management of burn wounds with cultured epidermal autografts.

Our experience with CEA is based on 21 patients operated on from 1986 to 1991. The areas covered with CEA measured 500 cm2 to 3160 cm2. At one setting no more than 40 sheets of 40 cm2 CEA have been transplanted. The take of CEA is over 75% when applied to dermis. The same holds true when covering "deepithelialised" skin homografts on immunosuppressed patients. Scar formation has not been a problem, and the overall results have been good.

Modulatory growth effects of 3T3 fibroblasts on cocultivated human melanoma cells.

Normal epidermal melanocytes are stimulated in vitro by fibroblast- and keratinocyte-derived growth factors. In this work, the paracrine responsiveness of human melanoma cells was investigated by cocultivation with growth-inhibited 3T3 fibroblasts. In short-term assays (3-4 days), melanoma cell growth was found to be improved if the cells were plated onto half-confluent 3T3 cell monolayers. In contrast, long-term cocultivation (greater than 7 days) resulted in significant growth inhibition of melanoma cells. These phenomena were not observed when melanoma cells were grown in 3T3 cell supernatants, which suggests a possible mediation by extracellular matrix components and/or by heterologous junctional communications.

Thermolysin treatment: a new method for dermo-epidermal separation.

The epidermis of superficial human skin samples could easily be separated from the dermis following incubation at +4 degrees C for 1 h in a solution containing 250-500 micrograms/ml thermolysin, a proteolytic enzyme hitherto mostly used for protein analysis. Light and electron microscopy revealed that the dermo-epidermal separation occurred at the basement membrane between the sites of bullous pemphigoid antigen and laminin and that the hemidesmosomes were selectively disrupted. The cohesion and morphology of the separated epidermis as well as the immunologic parameters investigated were not altered by this procedure. The clear cut dermo-epidermal separation produced by thermolysin treatment differed from the separation obtained with trypsin, which predominantly occurred between basal and suprabasal cells by disruption of desmosomes.