Substitut cutané produit par génie tissulaire : aspects reliés à l'allogénicité, la pigmentation et l'élastine

Authors: Goyer, Benjamin
Advisor: Germain, LucieProulx, Stéphanie
Abstract: Vast deep burns injuries are, by far, the worst trauma that a human being can experience. The time necessary for the coverage of thermal wounds with bandages, especially of a biological nature (e.g. cadaveric skin), at first temporary, and then permanently, influences the survival rate of patients. Over the years, numerous technologies were used to cover the skin wounds. Among them, we note split- and full-thickness skin grafts from a spared donor site, as well as cultured epithelial autografts (CEAs) and synthetic substitutes. However, these technologies showed some issues as the bioavailability of donor tissue or mechanical properties or biological activities. Indeed, it is the cellular and the extracellular matrix component that have a direct impact on the wound healing and on the longterm graft survival rate. In this way, new biologically active skin substitutes were developed. The most promising reconstructed skins to date are composed of an autologous epidermis associated with an extracellular matrix either allogeneic or xenogeneic or biosynthetic. However, the majority of these substitutes could only be used as temporary because of their immune inflammatory risk resulting from the presence of allogeneic or xenogeneic cells. Tissue-engineered technologies can be split in two approaches, either "Top-Down" or "Bottom-up". The most current as well as the most represented technology today is the "Top-Down" approach. Substitutes produced by this approach are based on structured artificial matrices developed via the major classes of biomaterials including (1) blood’s biopolymers such as fibrin, and components of the soft tissue such as collagen or fibronectin and (2) polysaccharides, as alginates, chitosan and glycosaminoglycan, including the hyaluronan. Alternatively, the "bottom-up" approach is based on the fibroblast’s capacity to synthesize and assemble their own extracellular matrix. In this field, the Laboratory of Organogenesis Experimental (LOEX) is a pioneer in a method of production of skin substitute called the "self-assembly" method. This method is based on the capacity of ascorbic acid to promote the extracellular matrix assembly secreted by fibroblasts. However, the histology and mechanical properties of these tissue-engineered skin substitutes, which are similar to native skin, (1) are quite long to produce, essentially because of the extracellular matrix assembly which takes twothird of the time of the whole production (2) lack of photoprotection, since pigment-producing cells called melanocytes are not added in the standard production and (3) the elastic fiber network, essential to insure their mechanical properties, is rudimentary. To address the identified problems, we designed a faster way to produce pigmented skin substitutes, integrating an elastic fiber network by tissue engineering according to the “self-assembly” method. To do so, we investigated the possibility of using an allogeneic reconstructed dermis associated with a syngeneic epidermis. This new method would allow eliminating two-third of the production time of the dermal part initially requested in the “on demand” production that was initially 100 % autologous. Estheticism and its functionality were evaluated by the addition of various densities of melanocytes during the epidermis reconstruction. Finally, at the same time, we addressed the weak presence of the elastic fiber network in our reconstructed skin. Indeed, we modified our production method to stimulate the elastogenesis process. More specifically, aldosterone, a mineralocorticoid hormone, and its competitive inhibitor, spironolactone, were added in the culture media during the skin substitute production in order to stimulate the insulin-like growth factor I (IGF-I) pathway and so the elastogenesis process. To conclude, my PhD project allowed to highlight: (1) the immunological tolerance of the allogeneic dermis with a long-term survival of their cellular components over the eight-week period, investigated in an immunocompetent murine model ; (2) that a minimal threshold of 200 melanocytes per mm2 in the epidermis reconstruction had the capacity to lead a homogeneous pigmentation after the transplant, as well as a photoprotection comparable to a 1500 melanocytes per mm2 density ; (3) that the addition of aldosterone and spironolactone increased the number of elastic fibers in our skin substitutes and improved the mechanical properties by the decrease of the shrinkage and the increase of the elasticity. Furthermore, the addition of melanocyte also increased the mechanical properties of the skin substitute. This positive impact on elastogenesis by melanocytes is poorly understood.
Document Type: Thèse de doctorat
Issue Date: 2017
Open Access Date: 28 September 2018
Grantor: Université Laval
Collection:Thèses et mémoires

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