构建含黑色素细胞组织工程皮肤的研究

目的 探讨运用组织工程方法构建含有黑色素细胞的组织工程皮肤。方法 以包皮组织作为细胞来源，采用消化法获得角朊细胞、成纤维细胞和黑色素细胞，在自行设计的组织工程皮肤培养系统构建组织工程皮肤。行Dopa染色、透射电镜和S-100免疫组织化学检测构建的皮肤中黑色素细胞的分布和状态。结果 构建的组织工程皮肤结构完整，细胞状态良好，Dopa染色、透射电镜和S-100免疫组织化学检测均显示含有大量黑色素细胞并处于良好状态。结论 构建了含黑色素细胞的组织工程皮肤，可用于下一步的动物实验和临床实验。     

Transplantation of acellular dermis and keratinocytes cultured on porous biodegradable microcarriers into full-thickness skin injuries on athymic rats

In search of an optimal transplantation regime for sufficient dermal and epidermal regeneration after a full-thickness skin injury, wounds on athymic rats were grafted with split-thickness skin grafts or acellular human dermis followed by transplantation with human keratinocytes either in single-cell suspension or cultured on porous biodegradable microcarriers. After 2 weeks, all wounds grafted with acellular human dermis showed a well organised and vascularised dermal component and reepithelialisation on the grafted dermal matrix was complete 21 days after transplantation with human keratinocytes. Wounds grafted with human keratinocytes seeded on biodegradable microcarriers or split-thickness skin grafts displayed over time (i.e. 16-21 days post-transplantation) a significantly thicker epithelial cell layer in comparison to wounds grafted with keratinocytes in single-cell suspensions or microcarriers not seeded with cells. Furthermore, measurements of dermal thickness in the closed wounds 21 days after grafting showed a significantly thicker and well organised neodermal component in wounds transplanted with keratinocytes seeded on microcarriers or split-thickness skin grafts compared to all other wounds. Positive immunostaining towards von Willebrand factor revealed the plausible proangiogenic effects of transplantation with keratinocytes seeded on microcarriers. Analysis of representative tissue sections after fluorescence in situ hybridisation visualised that grafted human keratinocytes were present in the epidermal layers covering the wounds 16 and 21 days after transplantation, strongly indicating preservation of cell viability. These results shows that the use of biodegradable microcarriers in the culture of autologous keratinocytes for treatment of full-thickness wounds not only facilitate the cultivation, transportation and transplantation processes but also enhances the dermal regeneration induced by a dermal scaffold which results in a clinical result that is significantly superior to the one obtained when keratinocytes are transplanted in a single-cell suspension.     

胎儿头皮毛囊内黑素细胞HMB-45和NKI/beteb的表达

目的：观察黑素细胞在胎儿头皮内的定位。方法：获取胎儿头皮（胎龄7月,畸形引产,死亡2h）,制备冰冻切片,分别用HMB-45和NKI/beteb抗体进行免疫荧光染色和免疫组化染色,激光共聚焦显微镜和倒置显微镜观察摄片。结果：NKI/beteb阳性细胞主要位于胎儿头皮的毛囊外根鞘隆突区,也见于毛球处、表皮基底部。HMB-45阳性细胞主要存在于毛球部、毛母质和表皮基底部,外根鞘区表达则阴性。结论：胎儿头皮毛囊内存在不同状态的黑素细胞,位于毛囊外根鞘隆突区的黑素细胞是黑素母细胞。     

Identification of hematopoietic cell populations from the dermal papillae of human hair follicles

Hematopoietic stem cell (HSC) activity has been identified from the hair follicles (HFs) in mice; however, it has not been identified in human HFs. We used immunohistochemistry and flow cytometry to identify cultured dermal papilla (DP) cells expressing CD45 to test for hematopoietic activity in colony-forming assays of granulocyte/macrophage hematopoietic progenitors (CFU-GM). Occasional CD45-positive cells were detected in cultured DP cells. After in vitro stimulation with IL-3, granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) for 7 days, about 1% of the cells were CD45-positive by flow cytometry analysis, an fifty-fold expansion in cell numbers. We further examined whether mesenchymal stem/progenitor cells reside in human dermal papillae. Cultured DP papilla cells incubated with monoclonal antibodies to remove the CD45 positive cells were induced into multilineage differentiation with the formation of CFU-GM. Our findings preliminarily indicate that human dermal papilla contain at least a CD45-positive hematopoietic cell population and a mesenchymal stem/progenitor cell population.     

Induction of hair follicle regeneration in rat ear by mi-croencapsulated human hair dermal papilla cells

Objective: To induce hair follicle regeneration in rat ear by microencapsulated dermal papillae (DP) cells.Methods: Intact dermal papillae were obtained from human scalp follicles which were digested with collagenase I. The human hair DP cells were encapsulated with alginate-polylysine-alginate (APA) by a high-voltage electric field droplet generator. The diameters of the DP cell microcapsules were optimized by regulating the voltage, the distance be-tween the needle head and the solution surface and the injection speed. Then DP cell microencapsulations were xenotransplanted into ears of 20 SD rats with a novel method. One rat was killed every week at the postoperative 2-12 weeks and the implantation sites were biopsied for histo-logical observation.Results: The DP cell microencapsulations were found in a group of round, smooth and transparent microcapsules under a phase-contrast microscope. The optimal combina-tion of parameters to obtain 0.4 mm DP cell microcapsules was voltage 7.0 kV, injection speed 55 mm/h, and distance 10mm. After 4-12 weeks, 18 of 20 DP cell microcapsule implan-tations had produced high-density hair. Histological obser-vation indicated that both large follicles and sebaceous gland structures were formed in the rat ear within 3-12 weeks.Conclusions: These findings show that the DP cell microencapsulation maintain the capacity for initiating the follicle regeneration and can be considered as a substitute for fresh isolated dermal papillae.     

Human skin preserved long-term in anhydric pulverized sodium chloride retains cell molecular structure and resumes function after transplantation

BACKGROUND: Human skin is needed to cover large areas of the body lost through burns, trauma, and extensive maxillofacial surgery. Contemporary methods of skin storage are limited by the period of preservation to a few days. Our previous findings showed that fixation and storage of human skin in anhydric sodium chloride at room temperature for weeks or months preserves its morphological and molecular structure. In this study, we examined whether skin grafts preserved in sodium chloride may be successfully transplanted. METHODS: Skin was harvested from lower limbs of patients during elective surgery, placed in containers with anhydric salt powder, and kept at 22 degrees C for 3 to 12 weeks. Desalination and rehydration took place before transplantation. Desalinated fragments were transplanted onto the dorsum of scid mice. RESULTS: All grafts were accepted by recipients. Three weeks after transplantation, keratinocytes synthesized keratins 10, 16, and 17 and expressed antigens specific for stem (p63) and transient (CD29) cells. Moreover, they proliferated vigorously, their basal layer cells incorporated bromdeoxyuridine and expressed proliferative cell nuclear antigen. Isolated from transplants and cultured in vitro, they remained viable and produced enzymes. Dermis retained its structure and expressed fibroblast-specific antigen. All graft cells remained human leukocyte antigen I. CONCLUSION: Human skin preserved in anhydric sodium chloride at room temperature for months can be successfully transplanted to scid mice. We propose the concept of "spore-like" keratinocyte stem cells to explain the long-term ex vivo survival of keratinocytes. The mechanism of survival of fibroblasts remains to be determined.     

毛乳头细胞诱导毛囊形成的研究

目的 探讨培养的毛乳头细胞在体内外条件下诱导毛囊形成的可能性。方法 采用酶消化法获得毛乳头细胞、真皮鞘细胞、毛囊上、下段及球部细胞，进行毛囊组织工程重建，或用游离细胞混合移植于棵鼠，组织学观察毛囊形成情况。结果 毛囊间表皮细胞、毛囊上段上皮细胞、下段上皮细胞和球部细胞在间质细胞凝胶上均可形成双层结构的组织工程皮肤，在真皮鞘细胞胶原凝胶上毛囊的上、下段上皮细胞形成了毛囊结构，移植于棵鼠后8周毛乳头细胞胶原凝胶诱导毛囊上、下段细胞形成了毛囊。低代毛乳头细胞与毛囊上皮细胞混合移植形成了数量较多、结构典型的毛囊，并有肉眼可见的毛发纤维产生。结论 毛囊的真皮成分细胞即毛乳头细胞、真皮鞘细胞在体内、外均具有诱导毛囊形成的能力，通过与毛囊上皮细胞之间的相互作用，可诱导毛囊形成。     

GMP-compliant culture of human hair follicle cells for encapsulation and transplantation

Human hair follicle cells, both bulge and dermal papilla cells, were isolated and cultured in a GMP cell factory, in order to obtain an in vitro hair follicle source for encapsulation end transplantation in alopecia regenerative cell therapy. An in vitro model, constituted by organotypic cultures of human skin sample, was set up to simulate the dermal-epidermal interaction between bulge cells and dermal papilla cells, evaluating the possible new follicles formation and the regenerative potentiality of these hair follicle cells. Both the bulge and dermal papilla cells show an excellent cellular proliferation as well as an abundant extracellular matrix production. The immunofluorescence investigation revealed the positivity of both cell lines to CK15 and CD200, whereas both cell lines were negative to CD71 and Oct-4. The pool of cultured bulge and dermal papilla cells was injected into the deep dermis; at day 28 of culture, some organized areas with a higher cell density can be observed: the cells self-organize into papilla-like lengthened aggregates. In samples in which the follicular cells have been seeded on the dermis surface, an epidermis-like homogeneous monolayer on the dermis surface can be seen, therefore showing a potentiality of these cells for epidermis regeneration. These data show the efficacy of a cellular isolation and amplification approach to obtain an in vitro human hair follicle regenerative source on industrial scale in a GMP cell factory. The results also proved an intrinsic potentiality of follicular cells to in vitro recreate the epidermis for tissue engineering purposes. Thus, it is feasible to produce bioengineered hair follicles in a GMP cell factory, for encapsulation and transplantation in alopecic patients.     

Culture of keratinocytes for transplantation without the need of feeder layer cells

Patients with large burn wounds have a limited amount of healthy donor skin. An alternative for the autologous skin graft is transplantation with autologous keratinocytes. Conventionally, the keratinocytes are cultured with mouse feeder layer cells in medium containing fetal calf serum (FCS) to obtain sufficient numbers of cells. These xenobiotic materials can be a potential risk for the patient. The aim of the present study was to investigate if keratinocytes could be expanded in culture without the need of a feeder layer and FCS. Keratinocytes were cultured on tissue culture plastic with or without collagen type IV coating in medium containing Ultroser G (serum substitute) and keratinocyte growth factor (KGF). An in vitro skin equivalent model was used to examine the capacity of these cells to form an epidermis. Keratinocytes in different passages (P2, P4, and P6) and freshly isolated cells were studied. Keratinocytes grown on collagen type IV were able to form an epidermis at higher passage numbers than cells grown in the absence of collagen type IV (P4 and P2, respectively). In both cases the reconstructed epidermis showed an increased expression of Ki-67, SKALP, involucrin, and keratin 17 compared to normal skin. Only 50,000 keratinocytes grown on collagen type IV in P4 were needed to form 1 cm2 epidermis, whereas 150,000 of freshly isolated keratinocytes were necessary. Using this culture technique sufficient numbers of keratinocytes, isolated from 1 cm2 skin, were obtained to cover 400 cm2 of wound surface in 2 weeks. The results show that keratinocytes can be cultured without the need of a fibroblast feeder layer and FCS and that these cells are still able to create a fully differentiated epidermis. This culture technique can be a valuable tool for the treatment of burn wounds and further development of tissue engineered skin.     

Role of hair papilla cells on induction and regeneration processes of hair follicles

Hair dermal papilla cells are specialized mesenchymal cells that exist in the dermal papilla located at the bottom of hair follicles. These cells play pivotal roles in hair formation, growth, and cycling. Hair follicle formation is usually directed by an aggregation of dermal mesenchymal cells, the origin of dermal papilla cells, in the embryonic skin. We noticed that cultured dermal papilla cells also have hair-forming activity and do not lose the activity even after long-term cultivation, if they are cultured with conditioned medium from keratinocytes obtained from the sole or with a medium containing fibroblast growth factor. The secreted factors from keratinocytes and fibroblast growth factor are, therefore, important for maintaining the cellular properties of dermal papilla cells. Even if the hair bulb, including the hair matrix and the dermal papilla, has been removed from vibrissal follicles in vivo, the new hair matrix and papilla can regenerate from the rest of the follicle, and eventually a hair shaft regrows. It has been reported that hair bulb regeneration does not occur when the lower half of a hair follicle is removed. However, new hair bulbs were formed in the remaining upper halves of vibrissal follicles if the amputated follicles had been implanted under the kidney capsule. The formed bulbs were small and pelage-type, not large vibrissa-type. Histological studies showed that the new dermal papillae were derived from dermal sheath cells surrounding upper follicular epidermis, and the new hair matrices were produced from the follicular epidermis. Moreover, the upper halves of vibrissal follicles reformed large vibrissa-type bulbs when they were associated with dermal papillae or cultured papilla cells and implanted in the kidney. Thus, dermal papilla cells and probably dermal sheath cells have the ability to induce and form hair bulbs under preferred environmental conditions. Attempts to identify the genes and proteins associated with hair-forming activity of dermal papilla cells have been carried out. We and other groups successfully isolated the molecules that were specifically expressed in dermal papilla cells. The nature of the hair-producing factors could be understood through the studies of these molecules.     

The Influence of Tissue Fluid/Lymph Cytokines and Growth Factors on Human Keratinocyte Proliferation and Differentiation

Cultured keratinocytes (KC) are needed for transplantation to the surface of large burn wounds and ulcers. They can be cultured in artificial media. However, the yield is always limited, viability is low, and proliferation and migration after grafting are slow. The question arose whether tissue fluid/lymph, which is a natural humoral environment for epidermal and dermal cells, contains cytokine(s) specifically regulating KC proliferation and could be used to culture large numbers of cells for transplantation. Culturing of skin keratinocytes in dermal tissue fluid/lymph containing keratinocyte growth factor, interleukin-1β, interleukin-6, tumor necrosis factor-α, and transforming growth factor-β revealed its strong stimulatory effect on the expression of p63 stem cell marker and proliferation but not differentiation of KC. Neutralizing these cytokines with antibodies resulted in decreased percentages of mitotic figures. None of the individual cytokines showed a dominant effect on proliferation. This observation suggests that either there may be other (so far undetected) specific cytokines or that the proliferation and differentiation of keratinocytes is an effect of the combined action of all investigated cytokines.     

Human De-epidermized Dermis as a Stem Cell Carrier

Recently several types of skin equivalents have been developed, consisting of differentiated keratinocytes cultured on various dermal substitutes. Different models of reconstructed human skin have been proposed, such as human and animal de-epidermized dermis, inert filters, collagen matrices, lyophilized collagen membranes populated with fibroblasts, and other models populated with melanocytes and/or Langerhans cells. These skin equivalents mimic native skin in vivo. They have provided information about dermal-epidermal interactions, cell-cell, and cell-matrix interactions; responses of dermal and epithelial cells to biological signals and pharmacological agents; as well as effects of drugs and growth factors on wound healing. Human allodermis from tissue banks has been used for clinical purposes, namely, as support for autologous keratinocyte cultures and as a potentially ideal scaffold for dermal replacement. This bioproduct is considered to be the most suitable clinical carrier for autologous fibroblasts and keratinocytes, as well as an useful experimental model to study angiogenesis and to stimulate vascularization in reconstructed human skin. Because it is human-derived, it is in our opinion the safest of all available types of skin equivalent. Having epidermal and dermal structures, it can be used in one-stage grafting procedures for wound closure.     

Effect of hyperbaric oxygen on human skin cells in culture and in human dermal and skin equivalents

A critical stage of cutaneous wound healing is the development and maturation of the epidermis. In the aged, and in certain pathologies, this repair process is compromised due to a variety of deficiencies, one of which is tissue oxygenation. Several phases of wound healing are dependent on adequate tissue oxygen levels, and hyperbaric oxygenation has been shown to transiently elevate these levels. The use of human cell monolayers, dermal equivalents and human skin equivalents provide excellent opportunities for studying wound healing using in vivo relevant models. The goal of this study was to examine the effect of hyperbaric oxygen on cell proliferation, differentiation, and matrix biosynthesis in monolayer cultures and epidermopoiesis in the developing skin equivalent. Normal human dermal fibroblasts, keratinocytes and melanocytes, dermal equivalents and skin equivalents were exposed to hyperbaric oxygen at pressures up to three atmospheres, for up to 10 consecutive daily treatments lasting 90 minutes each. Increase in fibroblast proliferation (cf., 30% at 1 atmosphere after 10 days treatment), was observed without a significant effect on proliferation of normal human melanocytes and glycosaminoglycan synthesis. Stimulation of collagen synthesis after two days of treatment was only significant at 1 atmosphere (about 20% increase) but this differential was not observed after 5 days of treatment. Hyperbaric oxygenation above 2 atmospheres, inhibited proliferation of fibroblasts and keratinocytes in cell monolayer cultures (e.g., a 10 day treatment at 3 atmospheres appeared cytostatic to keratinocytes). In contrast, hyperbaric treatment up to 3 atmospheres dramatically enhanced keratinocyte differentiation, and epidermopoiesis in the complete human skin equivalent. These results support the importance of hyperbaric oxygen therapy in wound healing, and should provide an insight into oxygen utilization during repair of peripheral human tissue. The results also show the utility of the human skin equivalent as a model for evaluation of parameters involved in wound healing.     

Giant tricholemmal squamous cell carcinoma with cranial infiltration

Tricholemmal squamous cell carcinoma is a rare variant of squamous cell carcinoma thought to follow a more benign course. The authors present the case of a 67-year-old man with a giant tricholemmal squamous cell carcinoma on his scalp. Further investigations demonstrated a skull destruction and cranial invasion. Curative treatment was impossible, but tumor mass reduction and wound closure by sandwich split-thickness skin mesh graft transplantation using a dermal template was performed. Problems of advanced squamous cell carcinoma on the scalp are discussed.     

毛乳头细胞和表皮细胞构建带附属器的组织工程皮肤

目的根据毛囊形成原理,以人毛乳头细胞和表皮细胞为种子细胞,构建带附属器的组织工程皮肤替代物。方法分实验组和对照组,实验组皮肤替代物真皮层接种人毛乳头细胞和表皮细胞;对照组真皮层不接种任何细胞。在裸鼠背部作一圆形全层皮肤缺损,将两组皮肤替代物气-液界面培养5 d后移植到裸鼠背部。观察创面愈合情况,并在移植后第4、6、8周取材,进行组织学观察。结果皮肤替代物移植后2周,实验组创面已完全愈合,移植后4周对照组创面才完全愈合,并且对照组创面收缩比实验组明显。移植后6周,实验组真皮层内见到毛囊样结构和皮脂腺结构,对照组未见毛囊样结构和皮脂腺样结构。结论将人的毛乳头细胞和表皮细胞共同种植在皮肤替代物的真皮层,可以构建出带附属器的组织工程皮肤替代物,这种替代物对创面的修复能力更强。     

Transplantation of chronic wounds with epidermal sheets derived from autologous hair follicles—the Leipzig experience

Background: An increasing number of chronic wounds in our society require strategies to improve wound healing and wound closure. One of several options is skin transplantation. In this article, we focus on the transplantation of tissue engineered autologous epidermal sheets derived from outer root sheath (ORS) cells of the patients' hair. Patients and Methods: Out of the stem cells of the ORS of anagen hair, autologous keratinocytes are cultured ex vivo in organotypic cultures to form a multilayered epidermal equivalent (EpiDex?, EuroDerm Biotech & Aesthetics, Stuttgart, Germany). These sheets are placed on the wound bed. Patients were observed twice a week in the first 2 weeks, then once weekly for 4 weeks, then every 4 weeks for up to 12 weeks after transplantation. A total of 23 patients with (n = 18) and without (n = 5) therapeutic improvement were analyzed retrospectively. We evaluated only the effect of a single transplantation in a selected ulcer per patient. Furthermore, a subgroup‐analysis for responder patients with an ulcer area < 25 cm² (n = 12) was performed. Results: In the responder patients (n = 18), a total wound reduction of 23% was observed. Patients (n = 12) with ulcer area < 25 cm² had an improvement of 64%. Complete wound closure in this subgroup after a single transplantation was achieved in 33 % (n = 4) cases. Conclusions: Autologous keratinocyte transplantation with EpiDex^? can be performed easily and safely in patients with chronic wounds with satisfying results. Our data suggest that patients with small ulcer area < 25 cm² might profit the most from this method.     

Effect of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) nanofiber matrices cocultured with hair follicular epithelial and dermal cells for biological wound dressing

Abstract:  We tested the effects on the early-stage wound healing of poly(3-hydroxybutyrate- co -3-hydroxyvalerate) (PHBV) nanofiber matrices cultured with hair follicular cells. PHBV only, PHBV/collagen, and PHBV/gelatin at a 7/3 weight ratio were produced by electrospinning, and their in vitro cell culture and in vivo wound healing as biological dressings were examined. In cell attachment and growth on matrices, dermal sheath (DS) cells attached to hydrophilic PHBV/collagen and PHBV/gelatin faster than hydrophobic PHBV at the early incubation stage (up to 6 h). From 6- to 24-h incubation, PHBV/collagen showed the best results in cell culture. Furthermore, PHBV/collagen cocultured for 3–5 days with DS and epithelial outer root sheath (ORS) cells expressed more extracellular materials, such as type I collagen, elastin, and α-smooth muscle actin, than cocultured PHBV with the same cells. However, there was no significant difference between PHBV and PHBV/collagen in the amounts of cytokeratin 8 expressed. Grafting of PHBV and PHBV/collagen matrices cocultured with ORS/DS cells for 3–5 days showed that PHBV promoted wound closure and re-epithelization more obviously than PHBV/collagen in both cocultured matrices and matrices alone. Cocultured matrices would heal wounds better than the corresponding matrices alone. Thus, PHBV cocultured with ORS/DS cells could be used as a cell-seeded biological dressing, thereby reducing preparation time as well as regenerating the epidermis efficiently during the early stage of wound healing.     

Phenotypical characterization of 6–21-week gestational age human dermis and epidermal cell isolation methods for in vitro studies on epidermal progenitors

Cell banked epidermal skin progenitor cells have the potential to provide an “off-the-freezer” product. Such cells may provide a skin donor area-independent cell-spray grafting therapy for the treatment of burns. We first characterized fetal skin samples of gestational ages ranging from 6 to 21 weeks. As the results suggest that the phenotypic differentiation occurs after 10 weeks, which may complicate follow-up in vitro studies, we developed and compared different cell isolation techniques for human fetal skin-derived epithelial cells from tissue ages 6 to 9 weeks. We initially screened seven methods of characterization, concluding that two methods warranted further investigation: incubating the epidermal tissue in Petri-dishes with culture medium for spontaneous cell outgrowth, and wiping the epidermal tissue onto a dry Petri-dish culture surface followed by adding culture medium. Non-controllable culture contamination with dermal cells was the reason for excluding the other five methods. The results suggest that epidermal cells can be isolated from tissue exhibiting a single homogeneous layer of CK15⁺ basal keratinocytes up to week 9. At later gestational ages, the ongoing skin differentiation results in a multi-layer basal structure and progenitors associated with the hair bulb would have to be considered. Spraying the resulting cells with a clinical spray device was successfully demonstrated in an in vitro model.     

Human keratinocyte stem cells survive for months in sodium chloride and can be successfully transplanted

Human skin fragments can be preserved in anhydric sodium chloride at room temperature for periods of weeks or months and successfully transplanted, retaining normal morphological structure. Skin fragments of 10 x 10 x 6 mm were harvested during elective vascular and orthopedic surgery of lower limbs, dried of blood, and placed in anhydric sodium chloride powder in tightly sealed containers. Prior to transplantation to scid mice, the specimens were desalinated and rehydrated. Specimens preserved for 1-6 months and harvested 3-4 weeks after transplantation revealed intensive incorporation of bromdeoxyuridine (BdUR) into basal keratinocytes (stem cells). They expressed p63 and CD29 (stem cells and transient cells antigens), proliferating cell nuclear antigen (PCNA), and cytokeratin 16 specific for proliferating keratinocytes. We conclude that human epidermal stem cells can survive in a dehydrated state in sodium chloride for months and after transplantation give rise to keratinocyte progenies. Skin fibroblasts and some resident immune cells can also survive.