Human cell-conditioned media produced under embryonic-like conditions result in improved healing time after laser resurfacing.

BACKGROUND: Laser resurfacing procedures are continuing to grow in popularity as patients select less invasive procedures for rejuvenation of photo-damaged and aging skin. However, although physicians have begun exploring options to aid in postlaser healing, currently available treatments have little clinical evidence to support their use for wounded skin. METHODS: When grown under conditions of very low oxygen and suspension, a simulation of the embryonic environment, neonatal cells have been found to produce proteins and growth factors in types and quantities similar to those of fetal cells. The human cell-conditioned media (hCCM) produced by the cells was extracted and formulated into a gel to evaluate its efficacy in the healing of postlaser wounds. RESULTS: A split-face clinical evaluation of the material was performed, with 42 subjects undergoing combination ablative and nonablative laser procedures. Three concentrations of the hCCM were tested (× 0.1, × 1.0, × 10.0), and a dose-response trend was seen in the blinded physician evaluation, particularly in the assessment of crusting. In addition, transepidermal water loss readings showed a significant difference (p ≤ 0.05), indicating a more rapid return to normal skin barrier function with the active treatment. Histopathologic evaluation of subject biopsies showed reduced inflammation and a more normal epidermal appearance in the active treatment sites. CONCLUSIONS: The results of this clinical evaluation support the use of the soluble hCCM produced under embryonic-like conditions to accelerate wound healing after laser resurfacing procedures. The utility of the × 10 concentration appears to promote more rapid, scarless wound healing after resurfacing procedures and more normal skin recovery.

A noninvasive method for quantifying and distinguishing inflammatory skin reactions.

BACKGROUND: The ribonuclease protection assay (RPA) represents a technology that allows detection of small amounts of intact RNA. Recent progress in understanding cytokine networks in the skin suggests that measurements of cytokine mRNA levels could provide a method to distinguish various reactions such as irritant contact dermatitis and allergic contact dermatitis that can occur in the skin. OBJECTIVE: We attempted to differentiate and quantitate irritant and immunologic skin reactions by measuring mRNA levels. METHODS: We have used the technique of tape stripping human skin to remove superficial cell layers and have extracted RNA from these skin samples. This RNA was used for RPA analysis. RESULTS: By means of RPA analysis, we have demonstrated distinct cytokine profiles that appear to discriminate, for example, irritant from immunologic skin reactions. CONCLUSION: We have shown that multiple cytokine mRNA levels can be defined in these RNA samples obtained from the skin. This approach assesses not only the cytokine gene profiles, but at the same time may quantify the severity of common irritant versus allergic skin reactions.

The CTFA Evaluation of Alternatives Program: an evaluation of in vitro alternatives to the Draize primary eye irritation test. (Phase III) surfactant-based formulations.

The CTFA Evaluation of Alternatives Program is an evaluation of the relationship between data from the Draize primary eye irritation test and comparable data from a selection of promising in vitro eye irritation tests. In Phase III, data from the Draize test and 41 in vitro endpoints on 25 representative surfactant-based personal care formulations were compared. As in Phase I and Phase II, regression modelling of the relationship between maximum average Draize score (MAS) and in vitro endpoint was the primary approach adopted for evaluating in vitro assay performance. The degree of confidence in prediction of MAS for a given in vitro endpoint is quantified in terms of the relative widths of prediction intervals constructed about the fitted regression curve. Prediction intervals reflect not only the error attributed to the model but also the material-specific components of variation in both the Draize and the in vitro assays. Among the in vitro assays selected for regression modeling in Phase III, the relationship between MAS and in vitro score was relatively well defined. The prediction bounds on MAS were most narrow for materials at the lower or upper end of the effective irritation range (MAS = 0-45), where variability in MAS was smallest. This, the confidence with which the MAS of surfactant-based formulations is predicted is greatest when MAS approaches zero or when MAS approaches 45 (no comment is made on prediction of MAS > 45 since extrapolation beyond the range of observed data is not possible). No single in vitro endpoint was found to exhibit relative superiority with regard to prediction of MAS. Variability associated with Draize test outcome (e.g. in MAS values) must be considered in any future comparisons of in vivo and in vitro test results if the purpose is to predict in vivo response using in vitro data.

Cytokine mRNA expression in an in vitro human skin model, SKIN(2).

SKIN(2) ZK1300 is a three-dimensional human skin model consisting of multilayered dermal fibroblasts and well-differentiated epidermal keratinocyte layers, including a stratum corneum. To characterize this model better, constitutive levels of cytokine gene expression were determined. Reverse transcriptase-polymerase chain reaction (RT-PCR), followed by liquid hybridization to labelled internal probes, demonstrated that interleukin (IL)-1I, IL-1beta, IL-6, IL-8, IL-10, tumour necrosis factor (TNF)I, granulocyte macrophage-colony stimulating factor (GM-CSF), transforming growth factor (TGFbeta1) and IL-12 p35 mRNAs were constitutively expressed whereas IL-12 p40 was not. The contribution of the dermal component of this human skin model (Model ZK1100) was further characterized by determining constitutive cytokines expressed and their modulation by phorbol 12-myristate, 13-acetate (PMA). The dermal component, consisting of multilayered human dermal fibroblasts, constitutively expressed message for IL-1I, 1L-1beta, IL-6, IL-8, TGFbeta1, GM-CSF and IL-12 p35. Message was not detected for IL-10, TNFI or IL-12 p40. PMA treatment of the multilayered dermal fibroblasts increased steady-state mRNA levels of IL-1I, IL-1beta, IL-6, IL-8, GM-CSF and TGFbeta1, but did not induce IL-10, TNFI or IL-12 p40 expression at the dose and times tested. In summary, these studies demonstrate that the SKIN(2) three-dimensional human skin cultures, and their dermal component, constitutively express mRNA for an array of inflammatory and immunomodulatory cytokines, and that PMA exposure modulates mRNA levels of the dermal cytokines.

application of the human dermal model skin(2) ZK 1350 to phototoxicity and skin corrosivity testing.

The human three-dimensional in vitro model Skin(2) ZK 1350(TM) [Advanced Tissue Sciences (ATS), La Jolla, USA] was tested for two in vitro toxicology applications, prediction of phototoxicity and classification of skin corrosivity. For phototoxicity testing chemicals were applied topically for 1 or 24 hr followed by 30 min of irradiation with a non-irritating dose of UVA. Phototoxicity was assessed 24 hr later by comparing cytotoxicity of UVA-exposed and non-exposed tissue in the MTT assay. In a European EC/COLIPA in vitro phototoxicity validation trial with 20 test chemicals (11 phototoxic and nine non-phototoxic), the best result was obtained with the Skin(2) ZK 1350 assay in the 24-hr exposure protocol where nine of the 11 phototoxins were classified correctly both at ATS and ZEBET. 6-Methylcoumarin could only be identified as a phototoxin when applied through the medium to the dermis side of the skin model for 24 hr. All of the nine non-phototoxic chemicals were identified correctly with either 1- or 24-hr preincubation. To classify chemicals as corrosive to the skin with an in vitro assay, ZEBET and two other laboratories tested 50 chemicals under blind conditions in the Skin(2) ZK 1350 model within a European ECVAM validation trial. The results obtained with the ZK 1350 assay showed a satisfactory classification of skin corrosive/non-corrosive chemicals and a sufficient prediction of the three UN Packing Groups for corrosive chemicals. Predictions obtained at ZEBET with the Skin(2) ZK 1350 model (sensitivity: 64%, specificity: 76%; positive and negative predictive values: 68%) compared with a sensitivity of 81% and a specificity of 77% as mean values for the three laboratories testing the model.

Increases in human epidermal DR+CD1+, DR+CD1-CD36+, and DR-CD3+ cells in allergic versus irritant patch test responses.

In an attempt to differentiate an allergic patch test response from an irritant response, we evaluated by flow cytometry the percentages of various epidermal cell populations isolated from allergen and irritant-treated patch test sites. Nine allergic individuals were patch tested with various allergens (Rhus, dinitrochlorobenzene [DNCB], or nickel chloride) and a vehicle control for 48 h. Eight additional individuals were patch tested with irritating chemicals (sodium lauryl sulfate or nonanoic acid) and with a vehicle control for 48 h. Epidermal cells, isolated from suction blisters, were double labeled for CD1/HLA-DR, CD3/HLA-DR, or CD36/HLA-DR cell surface markers and analyzed by flow cytometry to determine the percentage of various cell populations. A mean increase of 0.91 +/- 0.3 in the percentage of DR+CD1+ Langerhans cells over the vehicle control patch test site was detected in allergen-positive patch test sites in allergic individuals, whereas a decrease of 0.19 +/- 0.2 in the percentage of DR+CD1+ Langerhans cells from the vehicle control patch test site was detected in irritant-treated patch test sites. Epidermal cells from allergen-positive patch test sites also exhibited an increase of 5.2 +/- 1.8 in percentage of DR+CD1- cells over the vehicle control patch test site compared to an increase change of 0.8 +/- 0.4 in epidermal cells isolated from irritant-treated patch test sites. We also found that DR+ cells that lacked the CD1 determinant expressed the macrophage/monocyte antigen CD36 (OKM5). Finally, a 2.3 +/- 0.8 increase in the percentage of DR-CD3+ cells over the vehicle control patch test site was observed in allergen-positive patch test sites compared to an increase of 0.2 +/- 0.2 observed in irritant-treated patch test sites. These results demonstrate a significant increase in DR+CD1+, DR+CD1-CD36+, and DR-CD3+ epidermal cells in allergen-positive patch test sites compared to irritant patch test sites.

Quantitative in vitro assessment of phototoxicity using a human skin model, Skin2.

The ability to accurately predict the phototoxic potential of personal and skin care products remains a key element in assessing the safety of premarketed products. To find a reliable in vitro alternative test for photoirritancy, the European Commission and the European Cosmetic Association are conducting a 3-year, European validation study. Based on the results of this study, an in vitro photoirritancy method will be selected for incorporation into new international guidelines for photoirritancy testing. As a part of this study, Skin2, a cultured human skin system, was used to evaluate the phototoxic potential of chemicals with known photoirritative properties. The Skin2 ZK1351, a 3-dimensional co-culture system, consists of dermal fibroblasts and a multilayered epidermis comprising differentiated keratinocytes. This product line has previously been used to evaluate the irritative potential of topically applied ingredients and products. In this study, various concentrations of the test chemicals were applied to the epidermal side of the Skin2 tissue for contact times of 1 h or 24 h and then the tissue was exposed to 2.9 J/cm2 of ultraviolet A (UVA) radiation. Treated but nonirradiated tissues were also assayed to predict the cytotoxic potential of the test chemicals, which could mask the phototoxic reaction. After exposure, the tissue substrates were rinsed free of test chemicals and allowed to recover for 24 h. Following this incubation, the MTT reduction assay was used to assess cytotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Solar simulator-induced herpes simplex labialis: use in evaluating treatment with acyclovir plus 348U87.

Models of UV radiation induced herpes labialis utilizing crude light sources have previously been used to examine the efficacy of antivirals. We sought to improve upon this model by using a solar simulator. Initial studies revealed that 13 of 34 (38%) subjects with a history of recurrent HSV labialis receiving three minimal erythema doses (MED's) of UV light developed herpes labialis. We next evaluated the effects of combined therapy with topical ACV and 348U87, a ribonucleotide reductase inhibitor, begun immediately after UV exposure for the prevention and treatment of herpes labialis. No significant reduction in the incidence or severity of herpes labialis was detected although the study was terminated after the interim analysis revealed no benefit, thus reducing the power to detect a difference. This lack of effect may be explained by the general poor efficacy of topical treatment for recurrent HSV infection. Further studies of ACV + 348U87 in vehicles that should increase the penetration and stability of the drugs are planned.

A three-dimensional in vitro model for the study of ocular cytotoxicity and irritancy.

A three-dimensional human tissue model has been developed in our laboratory and used as a substrate for assessing ocular cytotoxicity and irritancy potential. The full-thickness model is a co-culture of dermal fibroblasts and epithelial cells (keratinocytes). Metabolically and mitotically active fibroblasts are seeded onto medical-grade nylon mesh, where they attach and secrete collagen and extracellular matrix proteins. Then, keratinocytes are seeded onto the top of this submerged stromal tissue, and the tissue grows into a multilayered epithelium. Histological examination of this cellular co-culture system reveals a cellular organization similar to the rabbit/human cornea. The resulting substrate has been used effectively to study the effects of a variety of test compounds (surfactants, powders, creams) at diluted or full-strength concentrations in a time-course assay. The protocol mimics the way in which in vivo animal testing (Draize eye test) is performed. The treated tissue is assayed for cytotoxicity and irritancy (MTT and PGE(2), respectively) over a period of time. The high correlation (R > 0.81) of our in vitro data to existing animal eye data shows the potential usefulness of these tissue substrates as an in vitro alternative for evaluating the toxicity of test agents from diverse chemical classes.

Skin(2TM): An in vitro model to assess cutaneous immunotoxicity.

The skin serves as a complex barrier protecting the internal environment against external factors (e.g. bacteria, viruses, environmental toxins and UV light). For the epidermis to produce the most effective toxicological, immunological and biochemical barrier, the major cell types of the epidermis (i.e. keratinocytes) and in the dermis (i.e. fibroblasts) must function together in a dynamic integrated fashion. Furthermore, epidermal-dermal intercellular biochemical signals such as interleukins (IL), cytokines and other growth factors provide the skin with local homoeostatic signals to ensure the skin's immune integrity in response to a variety of environmental insults. Other investigators have shown that exposure of the skin to long-wave ultraviolet light (UVA) and mid-range ultraviolet light (UVB) can alter epidermal immune functions, including epidermal cytokine (e.g. IL-1, IL-6, TNF-alpha, IL-10 and GM-CSF) levels. The studies reported here use a co-culture system of dermal fibroblasts and well differentiated epidermal layers with an attached stratum corneum to form an in vitro human skin analogue. Baseline endogenous levels of IL-1alpha and tumour necrosis factor-alpha (TNF-alpha) were detected by using commercially available ELISA kits. The tissue substrates were exposed to UVA/UVB light (280-400 nm). The UV light was administered by a Dermsol 3 mercury halide solar simulator configured with filters to remove energy levels below 280 nm and above 410 nm. Skin tissue irradiated at 4J/cm(2) revealed a significant increase in IL-1alpha and TNF-alpha in comparison with non-UV irradiated tissue. Additional experiments revealed that the topical administration of indomethacin (0.1 to 10mg/ml) to the skin tissue ameliorated the up-regulation of these immune cytokines following UV irradiation. The use of such an in vitro co-culture system may provide researchers with a unique method to quantify mechanistically immunotoxicological events in the skin after exposure to ultraviolet light.

Product application technique alters the sun protection factor.

A number of factors may alter the efficacy of a sunscreen product being tested. Notably among these are (1) the source of ultraviolet (UV) radiation, (2) the filtration of the UV radiation source, (3) such environmental factors as swimming or sweating (4) and/or the amount of product applied. This is the first report in which the technique of product application itself is examined. We find that the act of rubbing the product into the skin appears also to remove product from the skin. In our study, different techniques of product application produced a 25% deviation in product sun protection factor. The variables associated with the application of sunscreening products are discussed.

Thy-1 and T-cell receptor antigen expression in mycosis fungoides and benign inflammatory dermatoses.

We have studied human Thy-1 and T-cell receptor (TCR) antigen expression in mycosis fungoides and benign inflammatory dermatoses. The study included 24 biopsy specimens from 21 patients with mycosis fungoides (nine patch stage from eight patients, 13 plaque stage from 11 patients, and two tumor stage from two patients), six specimens from five patients with premycotic parapsoriasis (pre-mycosis fungoides), three specimens from three patients with lichen planus, 11 specimens from 11 patients with lupus erythematosus, 13 specimens from 13 patients with dermatitis, six specimens from six patients with drug eruptions, nine normal skin specimens from nine subjects, and three specimens from three patients with small plaque (benign) parapsoriasis. Immunoperoxidase studies using the avidin-biotin complex technique on serial frozen sections were performed. Primary antibodies were anti-human Thy-1, anti-alpha heterodimer of the TCR, anti-beta heterodimer of the TCR, and anti-delta heterodimer of the TCR. An extensive dendritic network of Thy-1+ cells was seen in all cases of mycosis fungoides. Epidermotropic cells were Thy-1 negative, and Thy-1 was expressed perivascularly in normal individuals and patients as previously reported. Epidermal gamma/delta cells were seen only in mycosis fungoides, where up to 60% of the epidermal lymphocytes expressed this TCR. The increased numbers of Thy-1 and gamma/delta T cells in mycosis fungoides were statistically significant when compared with normal skin or benign inflammatory dermatoses. The role of these dendritic dermal Thy-1+ cells and epidermal gamma/delta T cells in mycosis fungoides is unclear. The significant numbers of these potentially immunomodulating cells that were seen suggest that they are involved in the pathogenesis of mycosis fungoides.

Alpha-melanocyte stimulating hormone modulates contact hypersensitivity responsiveness in C57/BL6 mice.

The neuropeptide alpha-melanocyte stimulating hormone (alpha-MSH) can act as an antagonist to interleukin 1 (IL-1) bioactivities such as inhibition of fever production, thymocyte proliferation, and inhibition of release of acute phase inflammatory molecules from the liver. In this report we have found that epicutaneous application of alpha-MSH suppresses both the sensitization and elicitation limbs of the cutaneous immune response (CIR) to potent contact sensitizers like dinitrofluorobenzene (DNFB) or oxazalone (OX) in mice. Further, the loss of contact hypersensitivity due to applications of alpha-MSH could be reconstituted by either intradermal or intravenous injections of epidermal thymocyte activating factor (ETAF)/interleukin-1. Topical application of alpha-MSH did not cause an alteration in Ia+ dendritic cells (i.e., Langerhans cells) but did produce a significant reduction in the expression of Thy1.2 marker on the Thyl+ dendritic epidermal cells (Thy1+DEC). It has no effects on the phenotypic expression of asialo GM-1 on these same cells. These observations suggest that alpha-MSH, a peptide classically isolated from the pituitary but found in many other tissues and cells of the body, may represent an additional biologic modifier than can modulate suppression of the contact hypersensitivity responses to various haptens. However, the mechanisms by which alpha-MSH or potentially other peptides found in the skin produce these suppressive effects have not been elucidated.

Multiple topical applications of arachidonic acid to mouse ears induce inflammatory and proliferative changes.

The response to daily topical applications of arachidonic acid (0.25-4 mg/ear/day) to the ears of outbred CD-1 mice was monitored. The first application produced erythema, extravasation of plasma proteins resulting in an increase in ear weight, and some neutrophil accumulation (detected histologically and quantified by myeloperoxidase content). The second application produced minimal edema but did cause erythema and a greater accumulation of neutrophils. Subsequent daily application caused erythema, neutrophil accumulation, and an increase in ear weight predominantly due to cell proliferation (epidermis and connective tissue). Daily applications of other unsaturated fatty acids did not match the response induced by arachidonic acid. Mast cell deficient mice (W/Wv) exhibited a smaller edema response to the first dose of arachidonic acid compared to either their wild-type controls or CD-1 mice. In addition, W/Wv mice exhibited a smaller ear weight increase and myeloperoxidase accumulation following eight daily doses of arachidonic acid. However, epidermal proliferation was similar in all the strains of mice tested. These data suggest that the edema caused by the first topical application of arachidonic acid is partly mast cell mediated. Mast cells also appear to be involved in the neutrophil infiltration induced by multiple topical applications, but not in the epidermal proliferation.

Immune studies in the depigmenting C57BL/Ler-vit/vit mice. An apparent isolated loss of contact hypersensitivity.

Vitiligo is a human disorder which destroys pigment cells in the skin, ears, eyes, and meningeal tissues and has often been associated with a variety of autoimmune disorders. The C57BL/Ler-vit/vit mouse is a mutant strain that exhibits a loss of epidermal pigment cells and a selective cell-mediated immune deficiency to epicutaneous-administered allergens. This observation is consistent with that observed in humans with vitiligo, who also exhibit loss of contact hypersensitivity (CHS), that appears to be associated with loss of pigment cells from the epidermis. Other cellular immune parameters such as delayed type hypersensitivity and antibody generation to both particulate and soluble Ag are normal or even hyperimmune in the vit/vit mice compared with congenic C57BL/6 controls. Cyclophosphamide treatment could reconstitute CHS responsiveness of the vit/vit mice to the allergen dinitrofluorobenzene. Further, this loss of CHS responsiveness to dinitrofluorobenzene could be restored with skin transplants from normal pigmented C57BL/6 mice to vit/vit mice. Normal C57BL/6 mice bearing white skin grafts from vit/vit mice did not contact sensitize. We suggest that this vit/vit mouse strain may serve as an excellent system to investigate various aspects of other contact hypersensitivity reactions as well as vitiligo.

Rapid induction of Thy-1 antigenic markers on keratinocytes and epidermal immune cells in the skin of mice following topical treatment with common preservatives used in topical medications and in foods.

Earlier experiments from our laboratory revealed that the medication most commonly used for depigmenting patients with vitiligo, monobenzyl ether of hydroquinone (MBEH), when applied to the skin of DBA/2 mice caused an increase in the population density (cells/mm2) of identifiable Ia+ and ATPase+ Langerhans cells. Further, this increase in Langerhans cell density could be correlated with an increase of contact hypersensitivity (CHS) reactivity to dinitrofluorobenzene (DNFB). The current experiments demonstrated that other compounds chemically similar to MBEH, such as butylated hydroxytoluene (BHT) and butylated hydroxyanisole (BHA), which are used as preservatives/antioxidants in many topical medications, cosmetics, food, and rubber products, can in five days significantly increase the population density of Thy-1+ dendritic epidermal cells. These compounds had no effects on Ia+ cells. This observation suggests that the Thy-1+ DEC cells may be more mobile and/or their surface markers may be readily expressed and are not a slowly mobile (trafficking) population of cells as suggested by the results of previous work. In addition, these parasubstituted phenolic compounds behaved like pertussis toxin and induced Thy-1 and Ia expression on keratinocytes. These changes in Thy-1 immune markers were not accompanied by functional alterations in the immune response to contact allergens as measured by the ear swelling technique.

Langerhans' cells in hair follicles of the depigmenting C57Bl/Ler-vit.vit mouse. A model for human vitiligo.

The C57Bl/Ler-vit.vit mouse grows a black pelage after birth. During successive hair molts, the fur loses its pigmentation. By 6 months of age, most of the fur of the animal is white. The epidermis of the ears and tail also loses its pigmentation. Histologic studies confirm that in the epidermis and hair follicles there is an absence of pigment cells identifiable by various histochemical or electron microscopic techniques. This mouse may be an excellent model in which to study the role of Langerhans' cells and the immune response in the pathogenesis of vitiligo, a study not easily done in humans. From results of prior studies, we postulated that if Langerhans' cells were involved in the destruction of melanocytes, they would be abnormal (either more or less numerous) in number during the active phase of depigmentation and normal in number after depigmentation was complete. To determine whether the Langerhans cell (Ia+/adenosine triphosphatase dendritic epidermal cell) might be involved in destruction of pigment cells, we quantified the number of Ia+ and adenosine triphosphatase dendritic cells in the hair follicles in skin from the ear, abdomen, back, and tail from male C57Bl/Ler-vit.vit mice while the fur and skin were depigmenting and after depigmentation was almost completed. We found that Langerhans' cells were normal in number during depigmentation and were most numerous after depigmentation. Previous studies indicate that Langerhans' cells in these mice are functionally defective and respond poorly to some contact allergens. From these morphologic and functional data, we conclude that Langerhans' cells probably are uninvolved in causing depigmentation in these mice. We also observed that the epithelium of hair follicles has a significantly higher (up to 1600/mm2) population density of Langerhans' cells than interfollicular skin.