The structure, function and accessibility of epidermal skin provide aunique opportunity to study the DNA damage response (DDR) of a normaltissue. The in vivo response can be examined in detail, at a molecularlevel, and further associated to the structural changes, observed at atissue level. We collected an extensive skin biopsy material frompatients undergoing fractionated radiotherapy for 5 to 7 weeks. Several end-points inthe DDR pathways were examined before, during and after the treatment. Quantification of DNA double strand break (DSB) signalling focirevealed a hypersensitivity to doses below 0.3Gy. Furthermore, aconsiderable amount of foci persisted between fractions. The low dosehypersensitivity was observed throughout the treatment and was alsoobserved for several key parameters further downstream in the DDR-pathway, such as p21-associated checkpoint activation, apoptosisinduction and reduction in basal keratinocyte density (BKD).Furthermore, for dose fractions above 1.0 Gy, a distinct acceleration inDDR was observed half way into treatment. This was manifested as anaccelerated loss of basal keratinocytes, mirrored by a simultaneousincrease in DSBs and p21 expression. Quantifications of mitotic events revealed a pronounced suppression ofmitosis throughout the treatment which was clearly low dosehypersensitive. Thus, no evidence of accelerated repopulation could beobserved for fraction doses ranging from 0.05 to 2Gy. Our results suggest that the keratinocyte response primarily isdetermined by checkpoints, which leads to pre-mitotic cell elimination by permanent growth arrest and apoptosis. A comparison between the epidermal and dermal sub-compartments revealsa consistent up-regulation of the DDR response during treatment. Adifference was however observed in the recovery phase after treatment,where miR-34a and p21 remain up-regulated in dermis more persistentlythan in epidermis. Our observations suggest that the recovery phaseafter treatment can provide important clues to understand clinicalobservations such as the early and late effects observed in normaltissues during fractionated radiotherapy.

Pacientes submetidos ao tratamento cirúrgico da obesidade mórbida apresentam perda ponderal acentuada e dismorfismo corporal e, com frequência, solicitam cirurgias plásticas visando um contorno corporal mais adequado. Os resultados dessas cirurgias plásticas são, em parte, limitados pela qualidade da pele resultante do grande emagrecimento. O presente estudo observacional teve como objetivo comparar fragmentos de pele da região epigástrica de 20 pacientes após perda ponderal acentuada consequente à cirurgia bariátrica com 20 pacientes portadores de obesidade mórbida, no sentido de analisar as alterações estruturais da pele como consequência do emagrecimento. A análise histomorfométrica foi realizada sobre o sistema colagênico através da metodologia Picrossírius/luz polarizada, e sobre o sistema elástico através da metodologia resorcinafucsina de Weigert. Foram observados, a redução das fibras colagênicas grossas (p=0,048); o aumento das fibras colagênicas finas (p=0,0085); e o aumento da densidade das fibras elásticas (p=0,0000009033) no grupo de pacientes emagrecidas. Não houve diferença entre os grupos quanto à média de idades (p=0,917) e quantidade total de fibras colágenas (p=0,3619). Os resultados evidenciaram as alterações estruturais da derme decorrentes do emagrecimento acentuado, demonstradas por meio do remodelamento colagênico, com a consequente redução das fibras espessas, organizadas, estruturadas e direcionadas em prol do aumento de fibras finas, desalinhadas e frouxamente dispostas, isso em associação ao aumento da elasticidade da pele. Isto explica cientificamente a já estabelecida percepção clínica das alterações cutâneas dos pacientes emagrecidos após cirurgias bariátricas, apresentando menor resistência e maior flacidez, quando comparadas ao período anterior ao emagrecimento / Post-bariatric patients develop body contour deformities and need plastic surgery procedures for reduction of excess skin and subcutaneous tissue. The results of these contouring procedures are typically limited by the poor quality of the skin. This observational study compared the epigastric skin of 20 post-bariatric with massive weight loss women with 20 women with morbid obesity through histomorphometric analysis of collagen fibers (picrosiriuspolarization) and elastic fibers (Weigert\'s resorcin-fuchsin). A reduction of thick collagen fibers (p=0.048), increase of thin collagen fibers (p=0.0085) and increase of the density of elastic fibers (p=0.0000009) were observed in the group of post-bariatric patients. There was no difference between the groups for mean age (p=0.917) and the total amount of collagen fibers (p=0.3619). These results represent structural changes in the dermis due to the massive weight loss once it demonstrates collagen modifications with reduction of thickness, organized and structured fibers, increase of thin, misaligned and disarranged fibers, and augmentation of the density of elastic fibers. This brings the scientific explanation for the established clinical perception that the skins of post-bariatric patients are less resistant and with more laxity when compared with what they were before the bariatric surgery

Wound healing is a complex process, in which a sequence of interrelated events at both the cell and tissue levels interact and contribute to the reduction in wound size. For diabetic patients, many of these processes are compromised, so that wound healing slows down and in some cases halts. In this thesis we develop a series of increasingly detailed mathematical models to describe and investigate healing of full thickness skin wounds. We begin by developing a time-dependent ordinary differential equation model. This phenomenological model focusses on the main processes contributing to closure of a full thickness wound: proliferation in the epidermis and growth and contraction in the dermis. Model simulations suggest that the relative contributions of growth and contraction to healing of the dermis are altered in diabetic wounds. We investigate further the balance between growth and contraction by developing a more detailed, spatially-resolved model using continuum mechanics. Due to the initial large retraction of the wound edge upon injury, we adopt a non-linear elastic framework. Morphoelasticity theory is applied, with the total deformation of the material decomposed into an addition of mass and an elastic response. We use the model to investigate how interactions between growth and stress influence dermal wound healing. The model reveals that contraction alone generates unrealistically high tension in the dermal tissue and, hence, volumetric growth must contribute to healing. We show that, in the simplified case of homogeneous growth, the tissue must grow anisotropically in order to reduce the size of the wound and we postulate mechanosensitive growth laws consistent with this result. After closure the surrounding tissue remodels, returning to its residually stressed state. We identify the steady state growth profile associated with this remodelled state. The model is used to predict the outcome of rewounding experiments as a method of quantifying the amount of stress in the tissue and the application of pressure treatments to control tissue synthesis. The thesis concludes with an extension to the spatially-resolved mechanical model to account for the effects of the biochemical environment. Partial differential equations describing the dynamics of fibroblasts and a regulating growth factor are coupled to equations for the tissue mechanics, described in the morphoelastic framework. By accounting for biomechanical and biochemical stimuli the model allows us to formulate mechanistic laws for growth and contraction. We explore how disruption of mechanical and chemical feedback can lead to abnormal wound healing and use the model to identify specific treatments for normalising healing in these cases.

Human skin has distinct lipid metabolism and production of bioactive lipid mediators that can be modulated by nutritional supplementation with omega-3 polyunsaturated fatty acids (n-3 PUFA), of which eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids exert anti-inflammatory effects. The aims of this project were to gain better understanding of their individual mechanisms in human epidermis and dermis. HaCaT keratinocytes, 46BR.1N fibroblasts, primary human epidermal keratinocytes and dermal fibroblasts were treated with EPA or DHA for 72h and then sham-irradiated or exposed to 15 mJ/cm2 ultraviolet radiation (UVR). Viability was measured by the MTT assay. The expression of cyclooxygenase-2 (COX-2), microsomal prostaglandin synthase-1 (mPGES-1) and 15-hydroxyprostaglandin dehydrogenase (15-PGDH) proteins was explored by western blotting. Human skin explants (n=4 donors) were cultured for 3 or 6 days and supplemented with EPA, DHA or vehicle. Culture media were collected to evaluate tissue damage and PUFA cytotoxicity (lactate dehydrogenase assay). Epidermal and dermal lipid profiles were assessed by gas chromatography and liquid chromatography coupled to tandem mass spectrometry. Primary keratinocytes were treated with fatty acids and various lipid mediators for 48h. Their effect was determined by the scratch assay and transepithelial electrical resistance. UVR upregulated COX-2 in HaCaT and primary epidermal keratinocytes, but did not affect mPGES-1 and 15-PGDH protein expression. UVR upregulated COX-2 and mPGES-1 in 46BR.1N fibroblasts but had no effect on 15-PGDH expression. The same UVR dose did not alter the expression of COX-2, mPGES-1 and 15-PGDH in primary dermal fibroblasts. Only EPA attenuated COX-2 expression in HaCaT and primary keratinocytes and either EPA or DHA had any effect in 46BR.1N and primary fibroblasts. Skin explants showed initial post-biopsy tissue damage. EPA and DHA supplementation augmented cellular levels of the corresponding fatty acids in both epidermis and dermis to a different extent. Increased uptake of DHA in the dermis was accompanied by reduced arachidonic acid levels. EPA treatment stimulated the production of PGE3 and various HEPE in epidermis, while DHA treatment caused high levels of HDHA species in dermis. N-3 PUFA and their derivatives delayed wound healing, cell migration and epidermal barrier permeability, while n-6 PUFA lipids showed the opposite effect. Overall, these findings suggest that EPA and DHA differently affect skin cells and skin, with EPA preference in epidermis and DHA in the dermis. These results highlight the importance of differential skin responses that could be important in skin health and disease.

Indiana University-Purdue University Indianapolis (IUPUI) / In the US, more than 1 million burn injuries are reported annually. About 45,000 injuries due to fires and burns result in hospitalization and ten percent of these result in death every year. Advances in burn treatment have led to a reduction in mortality rate over the last decades. Since more patients are surviving the initial resuscitation phase even with very large areas of skin being burned away, wound care has become increasingly important to ensure continued patient survival and improvement. While currently a common treatment for third degree burn wounds, skin grafts have several drawbacks. The availability of donor sites for autografts may be limited, especially in incidences of extensive skin loss. The rejection associated with the use of allografts and xenografts may render them inadequate or undesirable. Even if a suitable graft is found, poor retention due to infection, hematoma, and low vascularity at the recipient site are other drawbacks associated with the use of skin grafts as a primary treatment for severe burn wounds. As such, research has been done into alternative treatments, which include but are not limited to artificial skin, cell therapy, and growth factor application. We propose the delivery of adipose derived stem cells (ASC) in combination with endothelial progenitor cells (EC) via Integra Dermal Regenerative Template (DRT) to promote faster graft vascularization and thus faster healing of wounds. Integra DRT is an acellular skin substitute that consists of a dermal layer composed of bovine collagen and chondroitin-6-sulfate glycosaminoglycan, and an "epidermal" layer, which consists of silicone polymer. This silicone layer is removed after the collagen matrix is adequately vascularized (usually takes 2-3 weeks), and then a thin layer autograft is applied to the top of the neo-dermis. ASC are derived from the stromal-vascular fraction (SVF) of adipose tissue and are a readily available, pluripotent, mesenchymal cell known to promote angiogenesis. They are being explored as a treatment for a myriad of diseases and conditions, including wound healing. In combination with ECs, they form stable microvessel networks in vitro and in vivo. In our work, we found that ASC+EC form stable microvessel networks when cultured on Integra DRT. Also, ASC and ASC+EC conditioned media promoted both survival and migration of human epidermal keratinocytes compared to control medium. In a full thickness wound healing model, using healthy NSG mice, the ASC+EC case showed a significantly higher rate of wound closure compared to control. Based on best linear unbiased estimates (BLUE), the difference between the healing rates of ASC alone treatment and the Control treatment group is -0.45 +/- 0.22 mm²/day (p=0.041), which is not less than 0.025 and thus not statistically significant (Bonferroni Adjusted). However, the BLUE for the difference between the ASC+EC group and the Control group healing rates is -0.55 +/- 0.28 mm²/day (p = 0.017<0.025, Bonferroni Adjusted), which is statistically significant. Histology revealed a significantly higher number of vessels compared to control in both ASC alone and ASC+EC case. CD31 staining revealed the presence of human vessels in ASC+EC treatment scaffolds. We conclude that the combination of ASC and EC can be used to accelerate healing of full-thickness wounds when delivered to site of the wound via Integra. This result is especially compelling due to the fact that the mice used were all healthy. Thus our treatment shows an improvement in healing rate even compared to normal wound healing.