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A bioengineered living cell construct activates metallothionein/zinc/MMP8 and inhibits TGF β to stimulate remodeling of fibrotic venous leg ulcers
Author(s) -
Stone Rivka C.,
Stojadinovic Olivera,
Sawaya Andrew P.,
Glinos George D.,
Lindley Linsey E.,
Pastar Irena,
Badiavas Evangelos,
TomicCanic Marjana
Publication year - 2019
Publication title -
wound repair and regeneration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.847
H-Index - 109
eISSN - 1524-475X
pISSN - 1067-1927
DOI - 10.1111/wrr.12778
Subject(s) - medicine , venous leg ulcer , wound healing , fibrosis , oncology , bioinformatics , immunology , surgery , biology
Venous leg ulcers (VLU) represent a major clinical unmet need, impairing quality of life for millions worldwide. The bioengineered bilayered living cell construct (BLCC) is the only FDA‐approved therapy demonstrating efficacy in healing chronic VLU, yet its in vivo mechanisms of action are not well understood. Previously, we reported a BLCC‐mediated acute wounding response at the ulcer edge; in this study we elucidated the BLCC‐specific effects on the epidermis‐free ulcer bed. We conducted a randomized controlled clinical trial ( ClinicalTrials.gov NCT01327937) enrolling 30 subjects with nonhealing VLUs, and performed genotyping, genomic profiling, and functional analysis on wound bed biopsies obtained at baseline and 1 week after treatment with BLCC plus compression or compression therapy (control). The VLU bed transcriptome featured processes of chronic inflammation and was strikingly enriched for fibrotic/fibrogenic pathways and gene networks. BLCC application decreased expression of profibrotic TGFß1 gene targets and increased levels of TGFß inhibitor decorin. Surprisingly, BLCC upregulated metallothioneins and fibroblast‐derived MMP8 collagenase, and promoted endogenous release of MMP‐activating zinc to stimulate antifibrotic remodeling, a novel mechanism of cutaneous wound healing. By activating a remodeling program in the quiescent VLU bed, BLCC application shifts nonhealing to healing phenotype. As VLU bed fibrosis correlates with poor clinical healing, findings from this study identify the chronic VLU as a fibrotic skin disease and are first to support the development and application of antifibrotic therapies as a successful treatment approach.