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  <MetaData>
    <Identifier>dgkh000109</Identifier>
    <ArticleType>Research Article</ArticleType>
    <TitleGroup>
      <Title language="en">Human skin equivalent as an alternative to animal testing </Title>
      <TitleTranslated language="de">&#196;quivalente menschlicher Haut als Alternative zum Tierversuch</TitleTranslated>
    </TitleGroup>
    <CreatorList>
      <Creator>
        <PersonNames>
          <Lastname>Mertsching</Lastname>
          <LastnameHeading>Mertsching</LastnameHeading>
          <Firstname>Heike</Firstname>
          <Initials>H</Initials>
        </PersonNames>
        <Address>
          <Affiliation>Fraunhofer Institute of Interfacial Engineering and Biotechnology, Department Cell Systems, Stuttgart, Germany</Affiliation>
        </Address>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Weimer</Lastname>
          <LastnameHeading>Weimer</LastnameHeading>
          <Firstname>Michaela</Firstname>
          <Initials>M</Initials>
        </PersonNames>
        <Address>Fraunhofer Institute of Interfacial Engineering and Biotechnology, Department Cell Systems, Nobelstrasse 12, 70569 Stuttgart, Germany<Affiliation>Fraunhofer Institute of Interfacial Engineering and Biotechnology, Department Cell Systems, Stuttgart, Germany</Affiliation></Address>
        <Email>weimer&#64;igb.fhg.de</Email>
        <Creatorrole corresponding="yes" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Kersen</Lastname>
          <LastnameHeading>Kersen</LastnameHeading>
          <Firstname>Silke</Firstname>
          <Initials>S</Initials>
        </PersonNames>
        <Address>
          <Affiliation>Fraunhofer Institute of Interfacial Engineering and Biotechnology, Department Cell Systems, Stuttgart, Germany</Affiliation>
        </Address>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
      <Creator>
        <PersonNames>
          <Lastname>Brunner</Lastname>
          <LastnameHeading>Brunner</LastnameHeading>
          <Firstname>Herwig</Firstname>
          <Initials>H</Initials>
        </PersonNames>
        <Address>
          <Affiliation>Fraunhofer Institute of Interfacial Engineering and Biotechnology, Department Cell Systems, Stuttgart, Germany</Affiliation>
        </Address>
        <Creatorrole corresponding="no" presenting="no">author</Creatorrole>
      </Creator>
    </CreatorList>
    <PublisherList>
      <Publisher>
        <Corporation>
          <Corporatename>German Medical Science GMS Publishing House</Corporatename>
        </Corporation>
        <Address>D&#252;sseldorf</Address>
      </Publisher>
    </PublisherList>
    <SubjectGroup>
      <SubjectheadingDDB>610</SubjectheadingDDB>
      <Keyword language="en">alternative testing</Keyword>
      <Keyword language="en">skin equivalent</Keyword>
      <Keyword language="en">permeation</Keyword>
    </SubjectGroup>
    <DatePublishedList>
      <DatePublished>20080311</DatePublished>
    </DatePublishedList>
    <Language>engl</Language>
    <SourceGroup>
      <Journal>
        <ISSN>1863-5245</ISSN>
        <Volume>3</Volume>
        <Issue>1</Issue>
        <JournalTitle>GMS Krankenhaushygiene Interdisziplin&#228;r</JournalTitle>
        <JournalTitleAbbr>GMS Krankenhaushyg Interdiszip</JournalTitleAbbr>
        <IssueTitle>Plasma Medicine - its perspective for wound therapy</IssueTitle>
      </Journal>
    </SourceGroup>
    <ArticleNo>11</ArticleNo>
  </MetaData>
  <OrigData>
    <Abstract language="de" linked="yes">
      <Pgraph>3-D-Haut&#228;quivalente sind physiologisch vergleichbar mit nat&#252;rlicher Haut und deshalb eine Alternative zum Tierversuch. Das hoch differenzierte in-vitro Modell menschlicher Haut wird zur Pr&#252;fung der Wirksamkeit und des Wirkungsmechanismus neuer Wirkstoffe eingesetzt. Es wird aus prim&#228;ren menschlichen Keratinozyten auf einem Kollagensubstrat, das menschliche dermale Fibroblasten enth&#228;lt, generiert und w&#228;chst an einer Luft-Wasser-Grenzschicht, die eine komplette epidermale Stratifikation und epidermal-dermale Interaktion gew&#228;hrleistet.</Pgraph>
      <Pgraph>Zuk&#252;nftiger Schwerpunkt ist die Etablierung verschiedener Testsysteme zum Studium der Wundheilung, der Melanomforschung und der Infektionsbiologie. Das Schl&#252;sselmerkmal des Hautmodells ist seine alternative Nutzbarkeit f&#252;r in-vivo-Studien; Spendergewebe k&#246;nnen auf die spezifische Fragestellung zugeschnitten werden und es sind multiple Analysen an mRNA und Proteinen m&#246;glich. </Pgraph>
      <Pgraph>Sowohl unter ethischen als auch unter &#246;konomischen Gesichtspunkten ergibt sich damit eine grundlegende Ver&#228;nderung in der Teststrategie der Pharmazeutischen Industrie im fr&#252;hen Entwicklungsstadium der Arzneimittelentwicklung mit erweiterten M&#246;glichkeiten zur Anwendung zellbasierter Assays. Das 3-D-Haut&#228;quivalent ist ferner zur Erfassung einer gro&#223;en Breite sog. Endpunkte geeignet wie Zellviabilit&#228;t, Freisetzung proinflammatorischer Mediatoren, Permeationsrate, Proliferation und biochemische Ver&#228;nderungen.</Pgraph>
    </Abstract>
    <Abstract language="en" linked="yes">
      <Pgraph>The 3-D skin equivalent can be viewed as physiologically comparable to the natural skin and therefore is a suitable alternative for animal testing. This highly differentiated in vitro human skin equivalent is used to assess the efficacy and mode of action of novel agents. This model is generated from primary human keratinocytes on a collagen substrate containing human dermal fibroblasts. It is grown at the air-liquid interface which allows full epidermal stratification and epidermal-dermal interactions to occur. </Pgraph>
      <Pgraph>Future emphasis is the establishment of different test systems to investigate wound healing, melanoma research and infection biology. Key features of this skin model are that it can be used as an alternative for <Mark2>in vivo</Mark2> studies, donor tissue can be tailored to the needs of the study and multiple analyses can be carried out at mRNA and protein level. </Pgraph>
      <Pgraph>Driven by both ethical and economical incentives, this has already resulted in a shift of the test strategies used by the Pharmaceutical Industry in the early drug development process as reflected by the increased demand for application of cell based assays. It is also a suitable model for testing a wide variety of endpoints including cell viability, the release of proinflammatory mediators, permeation rate, proliferation and biochemical changes.</Pgraph>
    </Abstract>
    <TextBlock linked="yes" name="Introduction">
      <MainHeadline>Introduction</MainHeadline>
      <Pgraph>Tissue engineering is an interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function. It offers the potential to create replacement structures from biodegradable scaffolds and autologous cells for reconstructive surgery. </Pgraph>
      <Pgraph>The living skin equivalent, a three-dimensional organotypic model, has been widely used to investigate many aspects of cutaneous biology. Reconstructed human skin equivalents are the models that most closely mimic normal human skin. They allow the topical application and skin irritancy testing of a great variety of products used in daily life. The major requirements for skin penetration screening are the presence of a competent skin barrier. In native skin the first barrier function is carried out by the outside layer of the skin, the <Mark2>stratum corneum</Mark2>. The second barrier is the basement membrane In studies with skin equivalent cultures, it has become evident that this two barrier function is affected. It is until now unclear whether nanoparticles will penetrate the skin. </Pgraph>
      <Pgraph>Some manufacturers of consumer products, particularly cosmetics, and perhaps in the future foodstuffs, may utilise the advantages derived from including particulate materials in nano size in these products to give improved or additional functionality. These nanoparticles will be free rather than fixed, although their reactivity (and thus toxicity) may be influenced by coatings. Basically cosmetic products is an area where nanoparticles of oxides of zinc, titanium and iron are being used, and where there are concerns that they might penetrate through the protective layers of the skin and cause reactions with UV light that result in damage to DNA in skin cells. And these corrosion causes in higher irritation potential of cosmetic products or in early skin aging.</Pgraph>
    </TextBlock>
    <TextBlock linked="yes" name="Methods">
      <MainHeadline>Methods</MainHeadline>
      <SubHeadline>Design of the basic 3-D skin model</SubHeadline>
      <Pgraph>The development of a skin model requires firstly the isolation and growth of dermal fibroblasts and epidermal keratinocytes from human bioptic tissues. This highly differentiated <Mark2>in vitro</Mark2> human skin equivalent model is used to assess the efficacy and mode of action of novel agents. The skin equivalent is generated from primary human keratinocytes on a collagen gel substrate containing human dermal fibroblasts. It is grown at the air-liquid interface which allows full epidermal stratification and epidermal-dermal interactions to occur. </Pgraph>
      <Pgraph>Figure 1 <ImgLink imgNo="1" imgType="figure"/> demonstrates the natural skin in comparison with the skin equivalent.</Pgraph>
      <Pgraph>Immunohistochemical staining for cell characterization was performed by use of the avidin-biotin-peroxidase technique. Keratinocytes were characterized by the expression of Keratin 10, 14, 19, Filaggrin and Involucrin. Streptavidin-peroxidase conjugate was applied, and final staining was performed with diaminobenzidine.</Pgraph>
    </TextBlock>
    <TextBlock linked="yes" name="Results and discussion">
      <MainHeadline>Results and discussion</MainHeadline>
      <Pgraph>We applied our skin equivalent in many different areas such as: </Pgraph>
      <Pgraph>
        <Mark1>1. Using the skin equivalent for </Mark1>
        <Mark1>
          <Mark2>in-vitro</Mark2>
        </Mark1>
        <Mark1> toxicity tests</Mark1>
      </Pgraph>
      <Pgraph>The irritation effect of different test substances was <TextGroup><PlainText>examined</PlainText></TextGroup> after topical application of the samples on the surface of the skin equivalent. A cell damage which can be attributed to the substance was photometrically quantified over the reduction from non toxic Tetrazolium salt to water-soluble Formazan (Figure 2 <ImgLink imgNo="2" imgType="figure"/>).</Pgraph>
      <Pgraph>
        <Mark1>2. Using the skin equivalent as an </Mark1>
        <Mark1>
          <Mark2>in-vitro</Mark2>
        </Mark1>
        <Mark1> tumor model</Mark1>
      </Pgraph>
      <Pgraph>The invasion of malignant cells in normal tissues is a fundamental characteristic for progressing and the formation of metastases. In order to simulate the invasion <Mark2>in vitro</Mark2>, different tumor cell lines are co-cultivated. Therefore it is possible to analyze the same influencing variables such as growth factors on the invasion behavior of tumors and to test possible therapeutics (e.g. inhibitors) (Figure 3 <ImgLink imgNo="3" imgType="figure"/>). </Pgraph>
      <Pgraph>
        <Mark1>3. Using the skin equivalent for testing </Mark1>
        <Mark1>
          <Mark2>in-vitro</Mark2>
        </Mark1>
        <Mark1> infection</Mark1>
      </Pgraph>
      <Pgraph>Infection of the reconstituted skin (A) with a clinical isolate of <Mark2>C. albicans</Mark2> (B) and an avirulent strain (C). The clinical strain penetrates the protective layer of keratinocytes and invades through the epithelial cell layers into the matrix, leading to disintegration of the model system after 48 h (B). The avirulent mutants do not form hyphae and show no ability to invade the tissue. <Mark2>Candida albicans</Mark2> was only detected on the tissue surface (C). The infection models can also be applied for drug screening <TextLink reference="1"></TextLink> (Figure 4 <ImgLink imgNo="4" imgType="figure"/>).</Pgraph>
      <Pgraph>
        <Mark1>4. Using the skin equivalent as an </Mark1>
        <Mark1>
          <Mark2>in-vitro</Mark2>
        </Mark1>
        <Mark1> wound healing model</Mark1>
      </Pgraph>
      <Pgraph>A wound could be initiated by mechanical effect of an Erb:YAG laser in the artificial skin. The defective region was activated by stimulated keratinocytes of the epidermis to refill the wound (Figure 5 <ImgLink imgNo="5" imgType="figure"/>). Parallel the IL-1&#945; expression was measured during the wound healing in the medium by ELISA (Figure 6 <ImgLink imgNo="6" imgType="figure"/>). Uninjured skin equivalents served as controls.</Pgraph>
      <Pgraph>By the physiological similarity with the natural skin the <TextGroup><PlainText>3-D</PlainText></TextGroup> human skin equivalent is suitable as a test system for: </Pgraph>
      <Pgraph>
        <UnorderedList>
          <ListItem level="1">determination of the irritation potential of different substances</ListItem>
          <ListItem level="1">pharmacological analysis (e.g. wound healing)</ListItem>
          <ListItem level="1">analysis of infection and invasion of different pathological microorganisms</ListItem>
          <ListItem level="1">target screening</ListItem>
          <ListItem level="1">immunological, histological and molecular-biological analysis</ListItem>
          <ListItem level="1">proof of efficacy and quality control</ListItem>
          <ListItem level="1">penetration- und permeation studies</ListItem>
          <ListItem level="1">development of bio-chips for tumor diagnostics or other skin diseases</ListItem>
          <ListItem level="1">development of medical devices, e.g. laser assisted diagnostic device for melanoma</ListItem>
        </UnorderedList>
      </Pgraph>
      <Pgraph>Pharmaceutical research is hampered by limited predictive value of routinely applied <Mark2>in vitro</Mark2> and <Mark2>in vivo</Mark2> drug screening models for clinical efficacy. In drug development, the common approach of pharmaceutical industry is to screen small-molecule libraries for function and toxicity in biochemical based or ligand binding high throughput essays <TextLink reference="2"></TextLink>. In general enzymes and 2-dimensional cell lines are used in those cell-based assays. The obtained results are of limited biological relevance, since the 2-dimensional cell systems do not adequately mimic the 3-dimensional environment in healthy and tumour tissues <TextLink reference="3"></TextLink>. </Pgraph>
      <Pgraph>This model offers the possibility to simulate physiological drug application and a human 3-D test system to established nanomaterials&#47;systems for cancer research&#47;therapy.</Pgraph>
    </TextBlock>
    <References linked="yes">
      <Reference refNo="1">
        <RefAuthor>Dieterich C</RefAuthor>
        <RefAuthor>Schandar M</RefAuthor>
        <RefAuthor>Noll M</RefAuthor>
        <RefAuthor>Johannes FJ</RefAuthor>
        <RefAuthor>Brunner H</RefAuthor>
        <RefAuthor>Graeve T</RefAuthor>
        <RefAuthor>Rupp S</RefAuthor>
        <RefTitle>In vitro reconstructed human epithelia reveal contributions of Candida albicans EFG1 and CPH1 to adhesion and invasion</RefTitle>
        <RefYear>2002</RefYear>
        <RefJournal>Microbiology</RefJournal>
        <RefPage>497-506</RefPage>
        <RefTotal>Dieterich C, Schandar M, Noll M, Johannes FJ, Brunner H, Graeve T, Rupp S. In vitro reconstructed human epithelia reveal contributions of Candida albicans EFG1 and CPH1 to adhesion and invasion. Microbiology. 2002:497-506.</RefTotal>
      </Reference>
      <Reference refNo="2">
        <RefAuthor>Sundberg SA</RefAuthor>
        <RefTitle>High-throughput and ultra- high-throughput screening: solution and cell based approaches</RefTitle>
        <RefYear>2000</RefYear>
        <RefJournal>Curr Opin Biotechnol</RefJournal>
        <RefPage>47-53</RefPage>
        <RefTotal>Sundberg SA. High-throughput and ultra- high-throughput screening: solution and cell based approaches. Curr Opin Biotechnol. 2000;11:47-53.</RefTotal>
      </Reference>
      <Reference refNo="3">
        <RefAuthor>Balis FM</RefAuthor>
        <RefTitle>Evolution of anticancer drug discovery and the role of cell-based screening</RefTitle>
        <RefYear>2002</RefYear>
        <RefJournal>J Nat Cancer Inst</RefJournal>
        <RefPage>78-9</RefPage>
        <RefTotal>Balis FM. Evolution of anticancer drug discovery and the role of cell-based screening. J Nat Cancer Inst. 2002;94:78-9.</RefTotal>
      </Reference>
    </References>
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          <Caption>
            <Pgraph>
              <Mark1>Figure 1: Histological cross section of human skin, and of the three dimensional skin equivalent with </Mark1>
              <Mark1>
                <Mark2>stratum corneum</Mark2>
              </Mark1>
            </Pgraph>
          </Caption>
        </Figure>
        <Figure format="png" height="171" width="559">
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          <Caption>
            <Pgraph>
              <Mark1>Figure 2: Histological cross section: control (A) after 20&#37; SDS-application for 2 sec (B), 30 sec (C) and 90 sec (D)</Mark1>
            </Pgraph>
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        </Figure>
        <Figure format="png" height="198" width="611">
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            <Pgraph>
              <Mark1>Figure 3: Different aggressive tumor cells on the 3-D skin equivalent</Mark1>
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        <Figure format="png" height="202" width="469">
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          <Caption>
            <Pgraph>
              <Mark1>Figure 4: Different strains of </Mark1>
              <Mark1>
                <Mark2>Candida albicans</Mark2>
              </Mark1>
              <Mark1> and their potential to penetrate the skin</Mark1>
            </Pgraph>
          </Caption>
        </Figure>
        <Figure format="png" height="194" width="585">
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          <Caption>
            <Pgraph>
              <Mark1>Figure 5: Wound healing process after injury with a laser</Mark1>
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          <Caption>
            <Pgraph>
              <Mark1>Figure 6: Analyzing of Interleukin 1&#945; in the supernatant of the medium during wound healing process</Mark1>
            </Pgraph>
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