1. Introduction
Cells used for cell therapy readily undergo cell death due to anoikis during injection [
1] and immediately after transplantation into damaged tissue [
2]. To overcome this challenge hindering efficacy of therapy cell sheet (CS) technology was developed by T. Okano as a delivery method using tissue engineering devoid of synthetic scaffolds or animal-based carrier materials [
3]. CS are minimal tissue constructs comprising of viable adherent cells bound by extracellular matrix (ECM) produced by these cells over time
in vitro. Besides ECM MSC sheets can also bear soluble growth factors, cytokines and extracellular vesicles trapped within matrix meshes [
4].
After transplantation within CS cells preserve their activity and retain at the site of application for a significant period of time ranging from days to weeks. Contrasting to widely used spheroids cells in CS have access to relatively evenly distributed nutrients and oxygen providing homogeneous conditions for all cellular elements [
5,
6].
CS from mesenchymal stem/stromal cells (MSC) of different tissue origin gained significant attention as a method for tissue engineering in regenerative medicine. Multipotency of MSC and rich ECM composition are properties that made MSC sheets a valuable utility to treat connective tissue defects (e.g., bone fractures, cartilage degeneration), mucosal ulcers, skin lesions and cardiac disease [
7]. Prospects of CS from MSC are beyond doubt yet certain practical challenges may limit widespread use of this technology.
One critical point is related to standardization of CS assembly that may take from 3 to 15 days to be obtained from harvested primary MSC. Heterogeneity of MSC features as well as donors’ features (age, sex, comorbidity) may affect the MSC properties and determine efficacy of CS assembly. Furthermore, human tissue material (bone marrow, subcutaneous or visceral fat) yields a heterogeneous pool of primary cells even when commercial reagents or GMP protocols of isolation and culture are used [
8]. Eventually, one may fail to obtain a ready-to-use CS within a specific time frame – e.g. by the day of planned surgery or as soon as possible in burn or emergency trauma patients. We failed to find published studies providing insights into feasibly evaluated determinants that impact CS assembly duration indicating a gap of knowledge that may be of importance for practical application of this approach.
4. Discussion
Present work was conceived to evaluate donor- and MSC-related features that impact duration of MSC sheet assembly. Comparative analysis of CS formation using parallel culture design (
Supplementary Figure S1) allowed to render several interesting conclusions on the subject and identify parameters that may determine the timing required to assembly a tissue-engineered construct.
Surprisingly, we found no correlation between CS assembly duration and basic donors’ characteristics (sex and age) suggesting that cells’ autonomous features retaining
in vitro impact assembly timing stronger that individual donor parameters (
Figure 2). Furthermore, this indicates that cultural conditions are sufficient to limit age-related impairments of MSC features (including proliferation rate and ECM deposition) at least in terms of efficacy of CS assembly on uncoated plastic surfaces.
Our previous data suggests active proliferation occurring at later terms of CS assembly (Days 9-12) so we expected that at early phase this would contribute to rapid formation of the construct [
10].A relationship between MSC proliferation (assessed as PDT) and CS assembly time seemed obvious, but our data revealed no significant correlation between the CS assembly duration and PDT (
Figure 1C). However, we were limited to PDT assessment during early-stage formation of dense monolayers which may not be relevant to later events. We suggest that transition to CS might impact the cell cycle leading to synchronization of the cell culture and modulation of division rate. Unfortunately, little is known on cell cycle changes in CS besides sporadic studies like one by Hirata et al which found a Rac1-dependent drop of proliferation and motility in sheets of keratinocytes [
16]. This gap of knowledge in regards to MSC properties warrants additional studies using cell cycle imaging during CS maturation after Days 5-6 since seeding.
We also found that that MSC with a short lag–phase period acquired morphology of a ready-for-use CS (
Figure 1D). This can be explained by the fact that MSCs with a substantial lag-phase take longer to adhere to plastic and accumulate solid and soluble components required to initiate mitosis. Thus, one may use assessment of lag-phase at early stages of CS assembly to receive a preliminary evaluation of expected assembly duration. Despite not being an obvious rate-limiting step, lag-phase seems a feasible parameter for evaluation at early stages of MSC culture.
Composition of ECM at early-stage MSC cultures was considered a potential predictive characteristic that might be of importance for structural formation of CS. We analyzed the major proteins that comprise interstitial matrix – collagen I and fibronectin (
Figure 3) and the basement membrane proteins - collagen IV and laminin (
Figure 4 and
Figure 5). Сollagen I is the most abundant protein in human body accounting > 25% of all body proteins while in skin its content exceeds 60% [
17]. In addition to type I collagen, high concentrations of fibronectin are also present in the ECM of connective tissues and stromal cells (including MSC) are one of major sources of mentioned components [
18]. Importantly, fibronectin plays an active regulatory role in the processes associated with active proliferation of connective tissue cells - fibroblasts and MSC
in vivo [
19].
Our findings indicate that collagen I and fibronectin contents in early-stage MSC cultures seem to have opposite correlative relation with duration of CS assembly with direct correlation for collagen I reaching statistical significance. Indeed, higher contents of collagen I in MSC monolayers correlated with longer CS assembly (
Figure 3). However, once we take into account our data in permeabilized monolayer cultures (
Figure 3A) we may find that collagen I and not fibronectin was deposited mainly inside MSC, but not as a structural component of CS. This partially explains results of correlative semi-quantitative analysis which was conducted by dot-ELISA in lysates and cannot discern between intra- and extracellular compartments detecting total collagen I in samples. However, this does not diminish importance of using collagen I contents in monolayer MSC as a predictive marker of long- or short-term CS assembly.
Interestingly, collagen I in CS had a distinct pattern of deposition and was mostly confined to areas of high cell density (visualized by DAPI) while fibronectin (
Figure 3A, “Cell sheet”) was evenly distributed over the entire construct. This demonstrates differential profiles of deposition for two crucial connective tissue ECM components which correlated with our findings in CS from immortalized adipose-derived MSC (ASC52telo, ATCC, USA) [
10].
Stiffness of ECM enriched by collagen I and fibronectin is often associated with mechanosensing-mediated transition of stromal cells to myofibroblasts [
20]. This phenomenon is pivotal for
in vivo wound healing due to vivid contractile ability of myofibroblasts mediated by their actin-cytoskeleton. Its remodeling has a landmark feature of high α-smooth muscle actin (α-SMA) contents and eventually leads to wound closure and precedes activation of reparative fibrosis [
21]. Nevertheless, in our study this ECM-mediated activation of transition to myofibroblasts might have played a role in CS contraction which we used as an objective event indicating completion of assembly. Our findings on α-SMA relative contents and prevalence of α-SMA-positive cells were in accordance with this assumption (
Figure 6A–C) yet no correlation was found between both mentioned parameters and CS assembly duration. Dramatic increase of α-SMA-positive cells in CS was observed and can be attributed both to MSC number increase and remodeling of cytoskeleton. Our previous findings suggest that ROCK-1/2 signaling axis is of pivotal importance for CS maturation and MSC differentiation fate yet understanding of how this relates to duration of assembly is yet to be established [
10].
Basement membrane proteins – collagen IV and laminin – were assessed as important components of basement membrane – a specialized ECM structure delimiting connective tissues from other cell types, providing differentiation and adhesion of cells, mechanical stability and elasticity preventing their rupture. In addition to their structural function, basement membranes provide a filter and barrier role for large molecules, and also controls cellular phenotype. Of two investigated proteins laminin provides sites for cell adhesion, and collagen IV stabilizes the entire basement membrane structure which functionally made them relevant objects influencing CS integrity and maturation. Furthermore, collagen IV and laminin bind each other via linker proteins – perlican and nidogen – which stresses their role as important structural elements of ECM.
Analysis of laminin contents revealed no correlation between its content and CS assembly duration (
Figure 4). Basically, this is explained by its intracellular deposition (in both monolayer and CS) with minor presence in extracellular space. Thus, its contribution to formation of CS from monolayer MSC was of minor impact while it may but may influence other processes – e.g., organization of the basement membrane upon contact of MSCs with endothelial cells which was observed in many co-culture studies. At the same time, character of correlation of collagen IV and duration of assembly (
Figure 5) we found was similar to collagen I despite its different roles in human body. While collagen I is an ubiquitous structural protein, collagen IV is confined exclusively to basement membranes [
22].
Generally, our findings on laminin and collagen IV indicate that their deposition within CS play a minor role in its formation as far as majority of both were deposited intracellularly and not visualized until permeabilization (
Figure 4 and
Figure 5). Nevertheless, its deposition may contribute to increase of MSC number as far as collagen IV enhances FAK-ERK signaling pathway associated with activation of MSC proliferation [
23].
Evaluation of fibroblast activation protein alpha (FAP-α) was conceived to find a correlative parameter that might define MSC transition to myofibroblasts and facilitate CS maturation. However, its contents in monolayer MSC did not correlate with duration of CS assembly (
Figure 6D). Its role is also attributed as a regulator of MSC migration functioning via modulation of RhoA GTPase activity while its peptidase activity is not essential for this and its inhibition did not influence migratory activity [
24]. In our work we were the first to assay FAP-α in ready-to-use CS from human MSC. Our data suggests that it was higher in CS that assembled rapidly (
Figure 6D) which suggests that in constructs that took less time for maturation increase of FAP-α occurs over time which was concordant with α -SMA increase in CS compared to monolayer. The mechanism of this regulatory circuit remains enigmatic yet effort is made to establish molecular pathways that connect ECM signaling and FAP-α expression in human MSC [
25]. Role of FAP-α peptidase activity in ECM turnover which is possible in CS may also contribute to packaging and deposition of mature matrix proteins [
26].
To conclude, our study is the first to investigate potential factors impacting CS assembly and suggests use of early-stage evaluation of ECM composition (collagen I, collagen IV) to assess the time required for completion of assembly. MSC lag-phase routine measurement can support results of ECM assays. Furthermore, we may stress that semi-quantitative dot-ELISA method is a feasible and cheap approach once data is normalized using DNA or total protein metrics. Despite descriptive nature and certain study limitations we believe that our results are of particular interest for practical use, since they may be useful for efficient selection of cellular material in the early stages of CS assembly. It may direct further potential standardization of protocols required for CS application in tissue engineering and regenerative medicine.