Controlled clinical study of deep partial-thickness burns treated with frozen cultured human allogeneic epidermal sheets.

Numerous studies, many uncontrolled, have suggested that the application of freshly prepared human allogeneic epidermal cultures promotes faster re-epithelialization of skin donor sites and deep partial-thickness burns. We describe the results of a study of deep partial-thickness burns treated with such cultures preserved in the frozen state. The study was controlled, side-by-side comparative, and randomized. Nine patients with deep partial-thickness burns and 2 patients with superficial partial-thickness burns were treated with the frozen cultures, with the use of adjacent wounds covered with petrolatum-coated gauze (Jelonet, Smith & Nephew Inc, Largo, Fla) as control wounds. The results showed that for the 2 superficial partial-thickness burns, the frozen cultures reduced healing time by 44%. For 5 of the patients with deep partial-thickness burns, the wounds treated with frozen cultures healed in a mean time of 5.6 days, whereas the control wounds healed in 12.2 days. More importantly, for the 4 other patients with deep partial-thickness burns, the wounds treated with the frozen cultures underwent complete re-epithelialization in a mean time of 4.2 days, but the control wounds were partially or mostly unhealed at up to 14 days. The results show that the frozen cultures not only accelerate the re-epithelialization of deep and superficial partial-thickness burns but also make it possible to heal such wounds that otherwise would not heal.

Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.

BACKGROUND: Skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. OBJECTIVE: To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. METHODS: We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. RESULTS: All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. CONCLUSION: The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.

Frozen human epidermal allogeneic cultures promote rapid healing of facial dermabrasion wounds.

BACKGROUND: Clinical studies have shown that cultured human epidermal allogenic sheets promote faster reepithelization of skin donor sites and deep partial-thickness wounds. OBJECTIVE: We describe the results of a controlled, clinical study of facial dermabrasion sites treated with a single application of frozen cultured human allogenic epidermal sheets that were thawed for 5-10 minutes at room temperature before application. METHODS: Ten patients with scars from acne or of other etiology underwent facial dermabrasion. One side of the face was treated with the frozen and thawed cultures, the other side was treated with standard dry dressing. RESULTS: The epidermal cultures promoted faster reepithelization of the wounds, with complete reepithelization in an average time of 4.6 days, whereas controls healed in an average of 7. 9 days. The reduction in healing time was 42% (P = 4.82 x 10(-7)). Pain was reduced in sites treated with the thawed cultures. CONCLUSION: Epidermal allogenic cultures, preserved by freezing, promoted significantly faster reepithelization and reduced pain intensity of dermabraded facial wounds, suggesting that they could be used routinely to improve the recovery from dermabrasion.

Functional domains of human growth hormone necessary for the adipogenic activity of hGH/hPL chimeric molecules.

Genetic analysis through construction of chimeric genes and their transfection in mammalian cells could provide a better understanding of biological functions of native or modified proteins, and would allow the design of new gene constructs encoding peptides that mimic or block ligand interaction with target tissues. To identify the hGH domains responsible for induction of adipose differentiation we constructed hGH/hPL chimeric molecules using homologous DNA mutagenesis, since hGH, but not human placental lactogen (hPL), promotes adipose differentiation in mouse 3T3-F442A cells. We assayed their adipogenic activity in an autocrine/paracrine biological model consisting of transiently transfected 3T3-F442A cells with the chimeric constructs. Plasmid DNAs carrying these constructs were transfected into growing 3T3-F442A cells, and cultures were further maintained for 7 days to differentiate into adipocytes. Secretion of transfected hGH/hPL chimeric proteins into the medium was in the range of 5-25 ng/ml. Adipogenic activity was a property only of those chimeric proteins that contained hGH exon III together with either hGH exon II or hGH IV. Our results also suggest that hGH binding site-2 is composed of two structural subdomains: subsite 2A encoded by exon II of hGH and subsite-2B encoded by exon IV. We also suggest that full adipogenic activity requires the presence of binding site-1 and any of the subsites of binding site-2. This simple autocrine/paracrine biological model of gene transfection allows the analysis of specific biological activity of products encoded by modified genes.

Frozen cultured sheets of human epidermal keratinocytes enhance healing of full-thickness wounds in mice.

Sheets of cultured allogeneic human keratinocytes have been used for the treatment of burns and chronic leg ulcers but there has been no animal assay for the therapeutic action of these cultures. In order to analyze the effects of frozen cultures of human keratinocytes on wound healing, we have developed such an assay based on the rate of repair of full-thickness skin wounds in immunocompetent NMR1 mice. Reepithelialization of the control wounds, originating from the murine epithelium at the edge of the wound, occurred at a constant rate of advance of 150 microm/day. When frozen cultured human epidermal sheets were thawed at room temperature for 5-10 min and applied to the surface of the wound, the murine epithelium advanced at 267 microm/day. Most wounds treated with frozen cultures completely healed after 10 days, whereas most control wounds required 16 days. The accelerated reepithelialization did not depend on the presence of proliferative human keratinocytes in the frozen cultures. The cultures also promoted early formation of granulation tissue and laminin deposition over the surface of the wound bed. This simple assay should permit quantitative analysis of the effects on healing exerted not only by cultured cells, but also by proteins and small molecules.

Cultivation of rabbit corneal epithelial cells in serum-free medium.

PURPOSE: To establish conditions for cultivation, serial growth, and normal differentiation of corneal epithelial cells in serum-free medium (SFM). METHODS: Rabbit corneal epithelial cells were co-cultured with lethally treated 3T3-cell feeder layers. Instead of serum, medium was supplemented with serum albumin, hormones, and other additives. Cell growth was quantitated spectrophotometrically with a new rhodamine-B staining protocol with a sensitivity range of 5 X 10(3) to 1 x 10(5) cells/cm2. Keratin expression was analyzed by immunostaining or sodium dodecyl sulfate-polyacrylamide gel electrophoresis of cell extracts. RESULTS: In SFM, without growth factors, cells grew no more than six to eight doublings, but when 10 ng/ml epidermal growth factor were added, serial transfer was possible, and epithelial cells grew to up to 18 to 20 doublings (three cell passages). Two cell colony types were seen: One type was composed of nonstratified proliferating cells, and the other of stratified cells expressing high levels of the differentiation-linked keratins K3 and K12. Confluent cultures formed a four- to five-layer stratified epithelium whose suprabasal cells were stained with anti-K12 antiserum. Acidic and basic fibroblast growth factors and epidermal growth factor reduced the expression of keratins K3 and K12. Transforming growth factor-alpha and epidermal growth factor led to the highest stimulation of cell proliferation. Limbal, peripheral, and central corneal epithelial cells showed similar clonal growth abilities, but colony size was larger for cells derived from limbal epithelium. CONCLUSIONS: These SFM conditions support the serial transfer, normal differentiation, and formation of typical corneal epithelium by cultured corneal epithelial cells and are useful in studying and assaying a variety of cytokines and compounds that modulate corneal epithelial cell proliferation and differentiation.

Cultivation, serial transfer, and differentiation of epidermal keratinocytes in serum-free medium.

We describe serum-free culture conditions for human epidermal keratinocytes using lethally treated 3T3 cells as feeder layers and normal Ca++ concentrations (1.2 mM), in a DMEM/F12-Ham nutrient mixture supplemented with several additives, and 10 mg/ml bovine serum albumin instead of animal serum. Keratinocytes were serially grown to 15-18 cell generations (4 subcultivations) and formed a stratified squamous epithelium that could be detached as a graftable epithelial sheet. EGF and TGF alpha significantly increased keratinocyte proliferation under these conditions; EGF reduced the expression of keratin K1, which is specific for stratified and terminally differentiated epidermal keratinocytes. In contrast with previous reports, the serum-free medium we describe here supports serial growth and normal differentiation of human epidermal keratinocytes, and the formation of graftable stratified epithelia; it also supports the assay of a variety of cytokines or compounds that modulate epidermal keratinocyte proliferation and differentiation.

Combined use of allograft and autograft epidermal cultures in therapy of burns.

Cultivation of human epidermal keratinocytes made possible the use of cultured autografts as part of the therapy of extensively burned patients. On the basis of our early results using banked cultured allografts and autografts, we developed an integral and combined burn therapy comprising banked cultured allografts for rapid healing of skin donor sites and deep partial-thickness burns, conventional split-thickness skin autografting, and when needed, cultured autografts for full-thickness burns. We compared hospital stay in 32 burn patients treated with the combined therapy and in 39 who were not treated with cultured epidermis. Three groups of patients were defined: 15 to 29 percent (n = 12), 30 to 49 percent (n = 10), and more than 49 percent (n = 10) burned body surface area. We found a 20 to 29 percent decrease in hospital stay in patients with up to 49 percent burned body surface area and a 46 percent reduction in patients suffering more extensive burns. Survival rate of extensively burned patients also was increased. We took advantage of the availability of banked cultured allografts for ambulatory treatment, without hospitalization, of pediatric patients with 5 to 20 percent burned body surface area. We show for the first time the use and benefits of this combined therapy.

Controlled clinical study of skin donor sites and deep partial-thickness burns treated with cultured epidermal allografts.

Two clinical studies in donor sites and deep partial-thickness burns treated with banked cultured human epidermal allografts are described. Ten burn patients were subjected to donor split-thickness skin harvesting. The study was controlled, side-by-side comparative, blind, and randomized. Banked cultured epidermal allografts promoted a faster reepithelialization of the wounds; they epithelialized in an average of 6.9 days, whereas controls healed in an average of 11.1 days, giving a reduction of 37.8 percent in time to heal (p < 0.005). Allografted sites were less erythematous as compared with controls (p < 0.01), with more tendency to normopigmentation. In the deep partial-thickness burns study, 10 patients with 18 burned wounds were treated. Wounds treated with cultured allografts showed complete reepithelialization in about 3 to 6 days. The two clinical studies showed that banked cultured epidermal allograft promotes a significantly faster epithelialization of donor sites and deep partial-thickness wounds. These results support the idea that cultured allografts should be used routinely to improve treatment of burn patients and reduce their therapy time.

A preadipose 3T3 cell variant highly sensitive to adipogenic factors and to human growth hormone.

We describe a new Swiss 3T3 preadipose clone, 3T3-F442A/C4, which shows higher sensitivity to serum adipogenic factors and to human growth hormone as compared to other 3T3 preadipose clones. The 3T3-F442A/C4 clone exhibited several characteristics different from the parental 3T3-F442A cells, mainly a high extent of adipose conversion under culture conditions that are non-adipogenic for the parental cells. The 3T3-F442A/C4 cells are not committed to undergo adipose differentiation, since they do not differentiate into adipocytes under serum-free or low-serum culture conditions, unless adipogenic factors or growth hormone are added into the culture medium. The 3T3-F442A/C4 cells showed 1.5- to 3.6-fold higher sensitivity to serum adipogenic factors and 5- to 6-fold higher sensitivity to human growth hormone as compared to the 3T3-F442A cells. The 3T3-F442A/C4 variant clone also differed from the parental clone by having a shorter population doubling time, an increased saturation density, and lower activity levels in some biochemical markers of adipose differentiation. On the other hand, the new variant clone has a similar proportion of cells susceptible to become adipocytes, and a similar response to insulin as compared to the parental cells. Our results show that the 3T3-F442A/C4 cells represent a new 3T3 preadipose clone that could be useful as a bioassay to evaluate growth hormone activity, as well as to purify and characterize hormones, adipogenic factors, and those compounds that affect mammalian adipogenesis.

Inhibition of 3T3 adipogenesis by retinoic acid is not mediated by cytoplasmic retinoic acid-binding protein.

Retinoic acid (RA) inhibits 3T3 adipogenesis in a dose-dependent and reversible manner, but its mechanism of action remains unknown. 3T3-F442A cell variants obtained by mutagenesis with nitrosoguanidine and/or selection with high RA concentrations showed different resistance to RA cytotoxicity and underwent adipose conversion of various extents when they were cultured in adipogenic conditions. Commitment to adipose differentiation was also inhibited by RA in these clones. Gel filtration chromatography showed the presence of a cytosolic RA-binding activity in the parental cells but not in three of the variant clones isolated. We demonstrate that cytoplasmic RA-binding activity is not essential for the inhibitory effects of the retinoid on 3T3 adipogenesis, or for resistance to RA cytotoxicity. Other mechanisms should be involved to explain the inhibition of adipose differentiation by RA.

HGH isoforms: cDNA expression, adipogenic activity and production in cell culture.

We have isolated, cloned and achieved functional expression of the cDNAs for both 22 kDa and 20 kDa human growth hormone (hGH) isoforms. A selective cDNA cloning strategy was used to preferentially and simultaneously obtain both hGH 22 kDa and hGH 20 kDa cDNAs. These were used to construct minigenes which were subcloned into two eukaryotic expression vectors and then introduced transiently in COS-7 cells and stably into CHO cells in culture. Transfection assays in COS-7 cells of both minigenes allowed the detection of the secreted hGH 22 kDa and hGH 20 kDa. These hGHs isoforms secreted into COS-7 medium were able to specifically promote differentiation of 3T3-F442A preadipocytes to adipose cells. Adipocyte differentiation was quantitated by Oil Red O triacylglycerol staining or glycerophosphate dehydrogenase activity. Furthermore, stable CHO cell lines have been derived that produce these hGH isoforms.

Quantitation of adipose conversion and triglycerides by staining intracytoplasmic lipids with Oil red O.

Cultured 3T3-F442A cells differentiate into adipocytes and accumulate lipid droplets in the cytoplasm. When fat cells are stained with Oil red O, the degree of staining seems to be proportional to the extent of cell differentiation. We report here a fast and simple method to quantitate the extent of adipose conversion by staining the accumulated lipid with Oil red O and determining the amount of extracted dye at 510 nm. The results show that Oil red O specifically stains triglycerides and cholesteryl oleate but no other lipids. This technique is a valuable tool for processing large numbers of cell cultures or samples in which adipose differentiation and/or accumulated triglycerides is to be quantitated.

Use of cultured human epidermal keratinocytes for allografting burns and conditions for temporary banking of the cultured allografts.

Five children who suffered burns clinically regarded as full skin thickness loss were grafted with cultured allogeneic skin from newborn prepuce. The wounds had remained open and infected without healing for about 20 days before the patients were received in the burn unit. To avoid losing surviving deep epidermal cells the wounds were débrided but not deeply excised and, a few days before allografting, they were washed with isodine solution and sterile water, and treated with silvadene cream application. All children received 76 cultured allografts of about 60 cm2 each. After allografting, the wounds were epithelized in 7-10 days and the allogeneic grafted skin began desquamation suggesting that the allograft did not 'take' permanently but was replaced by the newly formed skin. On the other hand, since allografting is an adequate therapy to provide early temporary coverage in extensively burned patients, we developed conditions for banking cultured skin to make it available for immediate use. The conditions described allow banking of the cultured grafts for 15-20 days with retention of clonal growth ability similar to that of unstored epithelia. The results show that cultured epidermal cells obtained from human newborn foreskin, when used as allografts for coverage of full skin or deep partial skin thickness burns, allow rapid epithelization of the burn wounds.

Cultivation of adult rat hepatocytes on 3T3 cells: expression of various liver differentiated functions.

Adult rat hepatocytes were maintained in culture for at least 1 month without losing the expression of their differentiated functions; they were cultured on lethally treated 3T3 fibroblasts inoculated at 35,000 cells/cm2 with medium containing 10-25 micrograms/ml hydrocortisone. Hepatocytes showed their typical morphology; they formed bile canaliculi, microvilli, and intercellular junctions with desmosomes and nexus; some formed structures that may resemble the perisinusoidal space of Disse. In addition, they showed DNA synthesis and expressed some liver-specific functions. They synthesized albumin and other proteins, which were exported to the culture medium. Like parenchymal liver cells in vivo, de novo fatty acid synthesis and esterification took place, and more than 80% of the lipids synthesized by the hepatocytes were secreted into the medium as triglycerides; they also showed cytochrome-P450 activity that was inducible with phenobarbital, suggesting that the hepatocytes have the capacity to metabolize drugs. These culture conditions allow the study of various hepatocyte differentiated functions, and they may provide the means to analyze the effect on liver of hormones, viruses and hepatotoxic chemicals and drugs; they may also indicate conditions adequate for serial growth of hepatocytes.

Intracytoplasmic triglyceride accumulation produced by dexamethasone in adult rat hepatocytes cultivated on 3T3 cells.

Glucocorticoids, such as hydrocortisone (HC) and dexamethasone (DEX), when administered to rats, induce lipid accumulation within hepatocytes (fatty liver). To investigate whether glucocorticoids can produce triglyceride (TG) accumulation as they do in vivo and the involved mechanisms, we have used primary cultures of rat hepatocytes which synthesized and secrete triglycerides into the culture medium. Hepatocytes cultivated on a feeder layer of lethally treated 3T3 cells were exposed for 2 weeks to micromolar concentrations of DEX. This glucocorticoid caused morphological alterations and cells accumulated lipid droplets in their cytoplasm; the TG content increased up to 6-fold in a concentration- and time-dependent manner. The removal of [14C]acetic or [14C]oleic acid from the culture medium was not altered in the cultures treated with 50 micrograms/ml DEX but the incorporation of [14C]acetic and [14C]oleic acid into TG in these cultures was about 13-fold and 60% higher than in non-treated cells, respectively. On the other hand, hepatocytes treated with 50 micrograms/ml DEX for 2 weeks showed a 16-fold decrease in TG release and 40% inhibition in protein export, whereas synthesis of total cellular proteins was not altered. Our results show that corticosteroids, such as DEX, caused lipid accumulation in liver cells through an increased synthesis and/or esterification of fatty acids, but mostly through a decrease in the secretion of TG.

Culture of proliferating and differentiating fat-storing cells in 3T3-conditioned medium.

There is growing evidence suggesting that hepatic fat-storing cells (FSC) or Ito cells have an important function in vitamin A storage and metabolism and in the synthesis of connective tissue components in normal liver and during fibrogenesis. The purified FSC acquire a fibroblastic morphology and their vitamin A content decreases in culture. We cultivated cells under in vitro conditions that allowed the expression of FSC morphological and functional characteristics for 3-4 weeks of primary culture. Cells were isolated from rat liver by the collagenase-perfusion method without further purification and cultured with 3T3-conditioned medium, which seemed to stimulate the selective proliferation of the FSC. After 8-10 days, round and stellate cells grew actively from a few precursor cells in the primary culture and were not subcultivated; the stellate cells had the ability to become round and vice versa and were highly motile. The cells had intracytoplasmic lipid droplets, a well developed rough endoplasmic reticulum, Golgi complex, numerous vesicles filled with electron-dense material, and extracellular matrix (ECM) components on their surface. Both stellate and round cells showed the presence of desmin by immunofluorescence and vitamin A autofluorescence, but lacked peroxidase activity. The culture conditions we describe allowed the selective proliferation of cells with morphological and functional characteristics of the FSC in the normal liver, raising the possibility of studying FSC proliferation and differentiation.

Thyroid hormone stimulates adipocyte differentiation of 3T3 cells.

Triiodothyronine added at 0.1 nM to 3T3-F442A cells cultured in adipogenic medium having endogenous hormone concentrations similar to those of hypothyroid serum stimulated adipose conversion; activities of both lipogenic enzymes, glycerophosphate dehydrogenase and malic enzyme, increased with hormone treatment. The number of adipocytes was also augmented by L-T3 addition but the number of fat cell clusters remained the same as compared to non-treated cultures, suggesting that thyroid hormone increased the number of adipocytes probably through stimulating selective multiplication of precursor adipose cells. Hormone addition to cells cultured with non-adipogenic medium did not promote conversion showing that L-T3 is not an adipogenic factor by itself. Triiodothyronine added at concentrations similar to those found in hyperthyroidism, from 10 nM up to 10 microM, also increased the proportion of adipocytes without changing the number of fat cell clusters, but they decreased the activity of both lipogenic enzymes and lipid accumulation in mature adipocytes. It can be concluded that during 3T3-F442A differentiation into adipocytes L-T3 increases the number of differentiated adipocytes and, at low concentrations, also enhances lipogenic enzyme activities, whereas at the hyperthyroid hormone levels these enzyme activities are significantly reduced, remaining at levels similar to those of cells cultured with hypothyroid medium. This cloned cell line seems to be a useful model to study thyroid hormone action at both molecular and cellular level.