Bioengineered skin is a promising treatment for chronic skin wounds because of its ability to promptly promote wound healing at the injury site and to restore the skin’s epidermal and dermal structures and functions. Despite some level of clinical success, commercially available bioengineered skin substitutes are still limited by a high incidence of infection, a lack of mechanical integrity, and a slow rate of tissue ingrowth from the surrounding wound margin. To address these challenges, we propose to engineer novel polymer composite matrices for dermal regeneration. These matrices consist of two different electrospun polymer layers which create a composite matrix made up of a highly porous three-dimensional fibrous network. Each composite matrix contains a biodegradable electrospun “dermal” layer which acts as a scaffold for dermal cell ingrowth and tissue regeneration and a non-degradable electrospun “epidermal” layer that serves as a provisional barrier to protect the wound from environmental insult. To evaluate the success of our designs, we performed quantitative analyses of the physical properties of our electrospun scaffolds including fiber diameter and angle analyses and mechanical properties. We found our electrospun scaffolds are comprised of a random network of fibers ranging from approximately 0.2 – 5µm in diameter. They exhibit several mechanical properties that are similar to those measured in native skin tissue, including tangent elastic modulus and strain at failure. We have also found the proposed nanofibrous scaffolds to be capable of supporting normal human fibroblast attachment and migration. Our scaffolds show similar attachment to tissue culture polystyrene controls and better attachment than collagen-GAG sponge controls. The dermal layer of our scaffolds show fibroblast outgrowth rates between 185 - 206µm/day, which is similar to rates observed by others in collagen-GAG sponges and wounds. The promising findings from these in vitro studies warrant that our novel electrospun dermal regeneration matrix be further developed.

Bioengineered skin is a promising treatment for chronic skin wounds because of its ability to promptly promote wound healing at the injury site and to restore the skin’s epidermal and dermal structures and functions. Despite some level of clinical success, commercially available bioengineered skin substitutes are still limited by a high incidence of infection, a lack of mechanical integrity, and a slow rate of tissue ingrowth from the surrounding wound margin. To address these challenges, we propose to engineer novel polymer composite matrices for dermal regeneration. These matrices consist of two different electrospun polymer layers which create a composite matrix made up of a highly porous three-dimensional fibrous network. Each composite matrix contains a biodegradable electrospun “dermal” layer which acts as a scaffold for dermal cell ingrowth and tissue regeneration and a non-degradable electrospun “epidermal” layer that serves as a provisional barrier to protect the wound from environmental insult. To evaluate the success of our designs, we performed quantitative analyses of the physical properties of our electrospun scaffolds including fiber diameter and angle analyses and mechanical properties. We found our electrospun scaffolds are comprised of a random network of fibers ranging from approximately 0.2 – 5µm in diameter. They exhibit several mechanical properties that are similar to those measured in native skin tissue, including tangent elastic modulus and strain at failure. We have also found the proposed nanofibrous scaffolds to be capable of supporting normal human fibroblast attachment and migration. Our scaffolds show similar attachment to tissue culture polystyrene controls and better attachment than collagen-GAG sponge controls. The dermal layer of our scaffolds show fibroblast outgrowth rates between 185 - 206µm/day, which is similar to rates observed by others in collagen-GAG sponges and wounds. The promising findings from these in vitro studies warrant that our novel electrospun dermal regeneration matrix be further developed.

no / Significance: Epigenetic regulatory mechanisms are essential for epidermal homeostasis and contribute to the pathogenesis of many skin diseases, including skin cancer and psoriasis. However, while the epigenetic regulation of epidermal homeostasis is now becoming active area of research, the epigenetic mechanisms controlling the wound healing response remain relatively untouched. Recent Advances: Substantial progress achieved within the last two decades in understanding epigenetic mechanisms controlling gene expression allowed defining several levels, including covalent DNA and histone modifications, ATP-dependent and higher-order chromatin chromatin remodeling, as well as noncoding RNA- and microRNA-dependent regulation. Research pertained over the last few years suggests that epigenetic regulatory mechanisms play a pivotal role in the regulation of skin regeneration and control an execution of reparative gene expression programs in both skin epithelium and mesenchyme. Critical Issues: Epigenetic regulators appear to be inherently involved in the processes of skin repair, and are able to dynamically regulate keratinocyte proliferation, differentiation, and migration, together with influencing dermal regeneration and neoangiogenesis. This is achieved through a series of complex regulatory mechanisms that are able to both stimulate and repress gene activation to transiently alter cellular phenotype and behavior, and interact with growth factor activity. Future Directions: Understanding the molecular basis of epigenetic regulation is a priority as it represents potential therapeutic targets for the treatment of both acute and chronic skin conditions. Future research is, therefore, imperative to help distinguish epigenetic modulating drugs that can be used to improve wound healing.

The limited reparative capacity of the skin and the inadequacy of conventional treatments have necessitated the development of tissue engineered skin substitutes. Several substitutes, including Integra Dermal Regeneration Template, are finding increasingly widespread application in the treatment of acute and chronic wounds. To date, these substitutes are unable to fully recreate the functionality and aesthetics of skin prior to injury. This thesis applied an integrated approach combining solution preparation, material fabrication control and biological testing to investigate electrospun silk fibroin (SF) nano-microfibrous scaffolds as potential biomimetic skin substitutes. Further to this, the improvement of the existing Integra scaffold through the incorporation of hyaluronan (HA) was assessed. Through rheological analysis of regenerated SF solutions under shear and extensional deformation a concentration regime transition at 20 wt% SF was identified. Solutions with relaxation times under 0.001 seconds were found to be unsuitable for electrospinning. The incorporation of poly(ethylene oxide) (PEO) was found to significantly increase solution relaxation times and extensional viscosity, making them much more suitable for electrospinning. Solution viscoelastic properties were shown to directly influence electrospun fibre morphology, with increases in viscosity resulting in increases in fibre diameter under stable spinning conditions. The effects of electrospinning parameters on electrospun fibre morphologies were investigated using SF-PEO blended solutions. Increased electrical field, spinneret height and decreased flow rate were found to decrease fibre diameter. In vitro assessment of the attachment, spreading, proliferation, viability and gene expression of primary human dermal fibroblasts (PHDFs) and bone marrow-derived mesenchymal stem cells (BM-MSCs) was conducted. Both PHDFs and BM-MSCs attached and proliferated with greater rapidity on fibres of the smallest diameters (~250-300 nm) with proliferation decreasing as fibre size increased until fibre diameters reached ~1200 nm. Cells were observed to be spread, with multiple attachments between fibres in scaffolds composed of ~250-300 nm diameter fibres. Cells aligned themselves to single fibres in scaffolds composed of fibres greater than 1 micrometre. HA supplementation to Integra resulted in increased proliferation, viability and migration of PHDFs. In ex vivo cutaneous wound healing models, the invasion of Integra was enhanced when scaffolds were supplemented with HA, with increased matrix deposition observed. Optimal supplementation concentrations for in vitro and ex vivo increases in cell proliferation and migration were at 1.5 – 2 mg ml-1 HA. SF electrospun scaffolds facilitated epithelial migration in ex vivo artificial wounds, with the migratory epidermis more closely resembling the structures observed in vivo. Additional preliminary investigations into the efficacy of a paste-form of Integra, Integra Flowable Wound Matrix (IFWM) were performed ex vivo, with cell invasion comparable to the conventional scaffold format. The potential for the incorporation of viable PHDFs and BM-MSCs was also investigated and keratinocyte migration was enhanced in these scaffolds. The results in this thesis provide valuable optimisation information on the development of SF electrospun scaffolds for skin engineering. Additionally, the supplementation of Integra with HA may provide a simple and effective way to enhance the performance of the scaffold in vivo.

O surgimento das matrizes de regeneração dérmica nas duas últimas décadas permitiu um grande avanço no tratamento tanto das queimaduras agudas como das sequelas. No entanto, ainda há carência de informações sobre a relação entre os resultados clínicos e o que ocorre no tecido com cada tipo de matriz. O objetivo deste estudo foi avaliar prospectivamente os aspectos clínicos quanto à qualidade de pele, escala de Vancouver e POSAS, função e retração da área tratada e os aspectos histológicos na microscopia de luz e eletrônica, com o uso de duas matrizes de regeneração dérmica, ambas de colágeno bovino, uma de duas camadas, recoberta com lâmina de silicone e outra sem. Vinte e quatro pacientes, sorteados 12 em cada grupo, tiveram suas retrações cicatriciais secundárias à queimaduras tratadas em duas cirurgias, a primeira de liberação da retração e colocação da matriz e a segunda, colocação do auto enxerto de pele; em ambas as cirurgias foi utilizado o curativo de pressão negativa. As avaliações da escala de Vancouver e medidas da retração da área foram realizadas no pré-operatório, 1, 3, 6 e 12 meses e a escala de POSAS e avaliação funcional no pré-operatório e aos 12 meses. As biópsias foram colhidas no pré-operatório, no dia da colocação do enxerto de pele, 12 dias, 2, 6 e 12 meses após o enxerto. A avaliação clínica mostrou retração de todas as áreas tratadas, melhora da qualidade da pele e funcional em todos os pacientes. A matriz com silicone, mostrou superioridade dos resultados quanto a qualidade da pele, função e menor retração da área tratada. A análise histológica mostrou o crescimento de tecido conjuntivo denso idêntico ao tecido cicatricial original, sem diferenças entre as matrizes e que não se assemelha à derme normal. Também não foi observada diferença no diâmetro das fibrilas de colágeno do tecido neoformado, a pele normal e a cicatriz / The advent of dermal regenerate templates has fostered major advances in the treatment of acute burns and their sequelae, in the last two decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are still lacking. The goal of this study was to prospectively analyze the outcome of patients treated with two of the existing templates, followed by thin skin autograft. They are both made of bovine collagen, one includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template). Negative pressure therapy was applied post-surgically; patients were monitored for 12 months. Data on scar skin quality (Vancouver and POSAS evaluation scales), rate of joint mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical and ultrastructural levels. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The silicone-coupled template showed the best performance in all aspects. There was sub epidermal growth of dense connective tissue, indistinguishable from the original scars in both templates. The formation of tissue resembling normal dermis was not detected in any of the cases. Likewise, the ultrastructural analysis showed the same architecture of the connective tissue among the template scars and the original scar. No difference was detected when the collagen fibril diameters of the normal skin and of the scars (original and of the two templates) were compared

O surgimento das matrizes de regeneração dérmica nas duas últimas décadas permitiu um grande avanço no tratamento tanto das queimaduras agudas como das sequelas. No entanto, ainda há carência de informações sobre a relação entre os resultados clínicos e o que ocorre no tecido com cada tipo de matriz. O objetivo deste estudo foi avaliar prospectivamente os aspectos clínicos quanto à qualidade de pele, escala de Vancouver e POSAS, função e retração da área tratada e os aspectos histológicos na microscopia de luz e eletrônica, com o uso de duas matrizes de regeneração dérmica, ambas de colágeno bovino, uma de duas camadas, recoberta com lâmina de silicone e outra sem. Vinte e quatro pacientes, sorteados 12 em cada grupo, tiveram suas retrações cicatriciais secundárias à queimaduras tratadas em duas cirurgias, a primeira de liberação da retração e colocação da matriz e a segunda, colocação do auto enxerto de pele; em ambas as cirurgias foi utilizado o curativo de pressão negativa. As avaliações da escala de Vancouver e medidas da retração da área foram realizadas no pré-operatório, 1, 3, 6 e 12 meses e a escala de POSAS e avaliação funcional no pré-operatório e aos 12 meses. As biópsias foram colhidas no pré-operatório, no dia da colocação do enxerto de pele, 12 dias, 2, 6 e 12 meses após o enxerto. A avaliação clínica mostrou retração de todas as áreas tratadas, melhora da qualidade da pele e funcional em todos os pacientes. A matriz com silicone, mostrou superioridade dos resultados quanto a qualidade da pele, função e menor retração da área tratada. A análise histológica mostrou o crescimento de tecido conjuntivo denso idêntico ao tecido cicatricial original, sem diferenças entre as matrizes e que não se assemelha à derme normal. Também não foi observada diferença no diâmetro das fibrilas de colágeno do tecido neoformado, a pele normal e a cicatriz / The advent of dermal regenerate templates has fostered major advances in the treatment of acute burns and their sequelae, in the last two decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are still lacking. The goal of this study was to prospectively analyze the outcome of patients treated with two of the existing templates, followed by thin skin autograft. They are both made of bovine collagen, one includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template). Negative pressure therapy was applied post-surgically; patients were monitored for 12 months. Data on scar skin quality (Vancouver and POSAS evaluation scales), rate of joint mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical and ultrastructural levels. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The silicone-coupled template showed the best performance in all aspects. There was sub epidermal growth of dense connective tissue, indistinguishable from the original scars in both templates. The formation of tissue resembling normal dermis was not detected in any of the cases. Likewise, the ultrastructural analysis showed the same architecture of the connective tissue among the template scars and the original scar. No difference was detected when the collagen fibril diameters of the normal skin and of the scars (original and of the two templates) were compared