Name: Visualizing Scar Development Using SCAD Assay - An Ex-situ Skin Scarring Assay (Video) | JoVE Journal
Uploaded: 2022-04-28T13:40:00.000+00:00
Duration: 7 min 40 s
Description: Learn the SCAD assay for visualizing scar development and fibroblast migration using skin-fascia explants. This ex-situ model enables high-throughput screening of therapeutic compounds to study wound healing mechanisms.

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5 minutes

We acknowledge all the co-authors of Jiang et al. 2020 for contributing to the development of SCAD methodology13. We thank Dr. Steffen Dietzel and the Bioimaging core facility at the Ludwig-Maximilans-Universit&#228;t for access to the Multiphoton system. Y.R. was supported by the Else-Kr&#246;ner-Fresenius-Stiftung (2016_A21), the European Research Council Consolidator Grant (ERC-CoG 819933), and the LEO Foundation (LF-OC-21-000835).

The model presented below provides a detailed step-by-step description of the generation of SCAD assay as briefly described in Jiang et al., 202013. SCAD sample preparations were performed after sacrificing the animals as per the international and the Government of Upper Bavaria guidelines. Animals were housed at the animal facility of the Helmholtz Centre Munich. The rooms were maintained with optimal humidity and constant temperature with a 12 h light cycle. Animals were supplied with food and water ad libitum.
1. SCAD tissue preparation
<ol>
	<li>Sacrifice newborn pups onpostnatal day 0 or day 1 (P0 or P1).</li>
	<li>Carefully excise at least 1.5 cm x 1.5 cm full-thickness dorsal back skin until the skeletal muscle layer using a sterile surgical scalpel.</li>
	<li>Peel the skin using sterile curved forceps, ensuring that the superficial fascia is intact with the underlying panniculus carnosus muscle.</li>
	<li>Wash the excised tissue with 50-100 mL of cold DMEM/F-12 media to remove contaminating blood.</li>
	<li>Wash once with Hanks&#39; Balanced Salt Solution (HBSS) to maintain tissue and cell viability.</li>
	<li>Place the skin upside down (superficial fascia on top) in a 10 cm Petri dish containing DMEM/F12 media.</li>
	<li>Using a disposable 2 mm biopsy punch, excise full-thickness round skin pieces, ensuring that superficial fascia is intact with underlying panniculus carnosus muscle until the epidermis to generate SCAD tissues.</li>
	<li>Prepare and fill 200 &#181;L of DMEM/F12 (without phenol red) complete media-DMEM/F12 media supplemented with 10% FBS, 1x GlutaMAX, 1x MEM non-essential amino acids, and 1x Penicillin/streptomycin into individual wells of a 96-well plate.</li>
	<li>Using sterile forceps, carefully transfer and fully submerge individual SCAD tissue upside down (fascia facing up) to the wells of a 96-well plate.</li>
	<li>Transfer the plate to a cell culture incubator maintained under standard conditions (37 &#176;C, 21%(v/v) oxygen, 5% (v/v) C02, and 95% humidity).</li>
</ol>
2. SCAD - Tissue culture
<ol>
	<li>Culture SCADs in an incubator for up to 5 days.</li>
	<li>On Day 2 and Day 4 of culture, replace the media with 200&#956;l&#160;of fresh pre-warmed DMEM/F12 complete media to ensure continued cell and tissue viability conditions. Replace treatment compounds during each media change. 
	NOTE: Ensure to leave 10 &#181;L of media in the well to avoid tissues sticking to the wells.</li>
	<li>Prepare SCADs for the following experiments: Live imaging (section 3), and Tissue Harvesting and 2D/3D immunofluorescence staining (section 4).</li>
</ol>
3. Live imaging of SCADs
<ol>
	<li>Prepare a minimum of 30 mL of 2%-3% (w/v) low melting agarose solution in PBS in a glass bottle by heating it in a microwave until boiling.</li>
	<li>Immediately transfer the bottle and cool the liquid agarose solution in a 40 &#176;C water bath.</li>
	<li>Transfer the SCAD tissue with fascia/Scar facing upward onto the center of a 35 mm dish.</li>
	<li>Embed the SCAD at room temperature (RT) by slowly transferring 40 &#176;C liquid agarose onto the 35 mm dish using a Pasteur pipette. Agarose polymerizes within 2 min.</li>
	<li>Add 2 mL of pre-warmed DMEM/F12 complete media (without phenol red indicator).</li>
	<li>Acquire time-lapse Images of day 0 SCADs up to 48 h using a confocal or a multiphoton microscope equipped with a suitable incubation system&#160;set to 37 &#176;C, 21% (v/v) oxygen, 5% (v/v) C02, and 95% humidity.</li>
</ol>
4. Tissue harvesting and 2D/3D immunofluorescence staining
<ol>
	<li>Wash the tissues at relevant time points by replacing the media with sterile PBS.</li>
	<li>Using sterile forceps, carefully transfer individual SCADs to 1.5 mL microcentrifuge tubes containing 500 &#181;L of 2% paraformaldehyde to fix the tissues overnight at 4 &#176;C.</li>
	<li>Wash the tissues three times with PBS and proceed with 2D/3D immunofluorescence staining.</li>
	<li>3D immunofluorescence staining
	<ol>
		<li>Permeabilize the tissues by incubating in a 1.5 mL microcentrifuge tube containing 500 &#181;L of PBS supplemented with 0.2% gelatin, 0.5% Triton-X100, and 0.01% Thimerosal (PBSGT)&#160;at RT for 24 h.</li>
		<li>Prepare an adequate amount of primary antibodies as per the manufacturer&#180;s instructions and incubate SCAD tissues in 150 &#181;L of PBSGT solution for 24 h at RT. 
		NOTE: If the optimal antibody concentration for immune fluorescence is not reported by the manufacturer, prior antibody titration needs to be performed on control tissues using varying concentrations (e.g., 1:50, 1:200, 1:500, 1:1000).</li>
		<li>Gently wash the SCADs three times with PBS to remove the unbound primary antibody.</li>
		<li>Incubate tissue with 1:1000 relevant Alexa Fluor secondary antibodies in PBS overnight at RT.</li>
		<li>Gently wash the tissue for 30 min in PBS three times to remove excess unbound secondary antibodies.</li>
		<li>Transfer the tissue onto a 35 mm glass-bottom dish for confocal or multiphoton imaging. 
		NOTE: When using water immersion objectives, embed the SCADs in 2 % low melting point agarose to immobilize the tissue to prevent drifting during image acquisition</li>
	</ol>
	</li>
	<li>2D immunofluorescence staining
	<ol>
		<li>Transfer the tissue to a cryo-mold and gently fill with optimal cutting temperature (OCT) compound to completely immerse the tissue.</li>
		<li>Gently adjust the orientation of the tissue, ensuring the absence of air bubbles to obtain a cross-section or a vertical section.</li>
		<li>Place the mold on dry ice for 20-30 min and incubate the block at -80 &#176;C overnight.</li>
		<li>Set the blade temperature to -25 &#176;C and specimen block temperature to -17 &#176;C. Prepare 6 &#181;m cryo-section using a cryostat, transfer the sections onto an adhesion slide, and store the slides in -20 &#176;C freezer.</li>
		<li>Rinse the slides three times in PBS and incubate&#160;the slides in 5% Bovine Serum Albumin (BSA) w/v in PBST (PBS supplemented with 0.05% Tween) for 1 h.</li>
		<li>Add an appropriate amount of primary antibody to 150&#956;l PGST, and incubate overnight at 4 &#176;C 
		NOTE: If the optimal antibody concentration for immune fluorescence is not reported by the manufacturer, prior antibody titration needs to be performed on control sections using varying concentrations (e.g., 1:50, 1:200, 1:500, 1:1000).</li>
		<li>Gently wash the sections three times with PBS to remove the unbound primary antibody.</li>
		<li>Incubate tissue with 1:1000 relevant Alexa Fluor secondary antibodies in PBS overnight at RT for 2 h.</li>
		<li>Gently wash the tissue for 5 min in PBS three times to remove excess unbound secondary antibodies.</li>
		<li>Mount the slides with a mounting medium containing DAPI and dry the slides in the dark at RT.</li>
		<li>Image the sections using a fluorescence microscope.</li>
	</ol>
	</li>
</ol>

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<li>Tripathi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Hypertrophic+scars+and+keloids%3A+a+review+and+current+treatment+modalities%5BTitle%5D)+AND+%22Biomedical+Dermatology%22%5BJournal%5D)">Hypertrophic scars and keloids: a review and current treatment modalities.</a> Biomedical Dermatology. 4, 11(2020).</li>
<li>Martin, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Wound+healing--Aiming+for+perfect+skin+regeneration%5BTitle%5D)+AND+%22Science%22%5BJournal%5D)">Wound healing--Aiming for perfect skin regeneration.</a> Science. 276 (5309), 75-81 (1997).</li>
<li>Correa-Gallegos, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Patch+repair+of+deep+wounds+by+mobilized+fascia%5BTitle%5D)+AND+%22Nature%22%5BJournal%5D)">Patch repair of deep wounds by mobilized fascia.</a> Nature. 576 (7786), 287-292 (2019).</li>
<li>Sen, C. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Human+wounds+and+its+burden%3A+An+updated+compendium+of+estimates%5BTitle%5D)+AND+%22Advances+in+Wound+Care%22%5BJournal%5D)">Human wounds and its burden: An updated compendium of estimates.</a> Advances in Wound Care. 8 (2), 39-48 (2019).</li>
<li>Rinkevich, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Identification+and+isolation+of+a+dermal+lineage+with+intrinsic+fibrogenic+potential%5BTitle%5D)+AND+%22Science%22%5BJournal%5D)">Identification and isolation of a dermal lineage with intrinsic fibrogenic potential.</a> Science. 348 (6232), 2151(2015).</li>
<li>Leavitt, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prrx1+fibroblasts+represent+a+pro-fibrotic+lineage+in+the+mouse+ventral+dermis%5BTitle%5D)+AND+%22Cell+Reports%22%5BJournal%5D)">Prrx1 fibroblasts represent a pro-fibrotic lineage in the mouse ventral dermis.</a> Cell Reports. 33 (6), 108356(2020).</li>
<li>Driskell, R. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Distinct+fibroblast+lineages+determine+dermal+architecture+in+skin+development+and+repair%5BTitle%5D)+AND+%22Nature%22%5BJournal%5D)">Distinct fibroblast lineages determine dermal architecture in skin development and repair.</a> Nature. 504 (7479), 277-281 (2013).</li>
<li>Walmsley, G. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Live+fibroblast+harvest+reveals+surface+marker+shift+in+vitro%5BTitle%5D)+AND+%22Tissue+Engineering.+Part+C%2C+Methods%22%5BJournal%5D)">Live fibroblast harvest reveals surface marker shift in vitro.</a> Tissue Engineering. Part C, Methods. 21 (3), 314-321 (2015).</li>
<li>Hakkinen, K. M., Harunaga, J. S., Doyle, A. D., Yamada, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Direct+comparisons+of+the+morphology%2C+migration%2C+cell+adhesions%2C+and+actin+cytoskeleton+of+fibroblasts+in+four+different+three-dimensional+extracellular+matrices%5BTitle%5D)+AND+%22Tissue+Engineering.+Part+A%22%5BJournal%5D)">Direct comparisons of the morphology, migration, cell adhesions, and actin cytoskeleton of fibroblasts in four different three-dimensional extracellular matrices.</a> Tissue Engineering. Part A. 17 (5-6), 713-724 (2011).</li>
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<li>Wan, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Connexin43+gap+junction+drives+fascia+mobilization+and+repair+of+deep+skin+wounds%5BTitle%5D)+AND+%22Matrix+Biology%3A+Journal+of+the+International+Society+for+Matrix+Biology%22%5BJournal%5D)">Connexin43 gap junction drives fascia mobilization and repair of deep skin wounds.</a> Matrix Biology: Journal of the International Society for Matrix Biology. 97, 58-71 (2021).</li>
<li>Molbay, M., Kolabas, Z. I., Todorov, M. I., Ohn, T. -L., Ertürk, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+guidebook+for+DISCO+tissue+clearing%5BTitle%5D)+AND+%22Molecular+Systems+Biology%22%5BJournal%5D)">A guidebook for DISCO tissue clearing.</a> Molecular Systems Biology. 17 (3), 9807(2021).</li>
<li>Ueda, H. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Tissue+clearing+and+its+applications+in+neuroscience%5BTitle%5D)+AND+%22Nature+Reviews+Neuroscience%22%5BJournal%5D)">Tissue clearing and its applications in neuroscience.</a> Nature Reviews Neuroscience. 21 (2), 61-79 (2020).</li>
<li>Ertürk, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Three-dimensional+imaging+of+solvent-cleared+organs+using+3DISCO%5BTitle%5D)+AND+%22Nature+Protocols%22%5BJournal%5D)">Three-dimensional imaging of solvent-cleared organs using 3DISCO.</a> Nature Protocols. 7 (11), 1983-1995 (2012).</li>
<li>Wilhelm, K. -P., Wilhelm, D., Bielfeldt, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Models+of+wound+healing%3A+an+emphasis+on+clinical+studies%5BTitle%5D)+AND+%22Skin+Research+and+Technology%3A+Official+Journal+of+International+Society+for+Bioengineering+and+the+Skin+%28ISBS%29+%5Band%5D+International+Society+for+Digital+Imaging+of+Skin+%28ISDIS%29+%5Band%5D+International+Society+for+Skin+Imaging+%28ISSI%29%22%5BJournal%5D)">Models of wound healing: an emphasis on clinical studies.</a> Skin Research and Technology: Official Journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI). 23 (1), 3-12 (2017).</li>
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All authors declare no competing interests.

Several models have already been developed to understand scar formation after injury. While a lot of advances have been rendered in this regard but, actual mechanisms are still not clear. In contrast to the previous technique, the SCAD model incorporates all cell types and cutaneous layers, thereby maintaining the complexity of native skin18,19. This methodology is capable of generating fundamental datasets that are important in understanding molecular mechanisms...

Wound healing is a process of restoration of breached wounds. Tissue injuries in invertebrates result in partial or complete regeneration. In contrast, mammals respond to deep injury by scarring, a process tailored to quickly seal wounds with dense plugs of matrix fibers that minimize the breached area and at the same time permanently deform the injured site1,2,3. Large skin burns or deep open wounds in mammals result in pathological phenotypes such as hypertrophic or keloid scars4,5. These exuberant scars cause a tremendous burden on clinical and global healthcare systems. In the US alone, scar management costs about $10 billion annually6,7. Therefore, the development of relevant methodologies are required to better understand the fundemental processes and mechanisms involved in scar formation.
In recent years, a wide range of studies in mice has revealed heterogeneous fibroblast populations with distinct functional potencies based on their origins in certain skin locations8,9,10. In back skin, Rinkevich et al., 2015, identified that a specific fibroblast population with an early embryonic expression of Engrailed-1 (En1), termed EPF (Engrailed positive fibroblast) contributes to cutaneous scarring upon wounding. Conversely,&#160; another fibroblast lineage with no history of engrailed expression, Engrailed negative fibroblast (ENF), does not contribute to scar formation8. Fate mapping of these En1 lineages using Cre-driven transgenic mouse lines crossed to fluorescence reporter mouse lines such as R26mTmG (En1Cre x R26mTmG) allows visualization of EPF and ENF populations.
Studying fibroblast migration in vivo over several days is limited by ethical and technical constraints. Furthermore, compound, viral and neutralizing antibody library screens to modulate pathways involved in scarring is technically challenging. Previously used in vitro or ex vivo models lack the ability to visualize fibroblast migration and scar formation in genuine skin microenvironments, uniformity in scar development, as well as tissue complexity that emulates in vivo skin environments11,12. To overcome the above limitations, we developed an ex vivo scarring assay termed SCAD (SCar-like tissue in A Dish)13,14. This simple assay can be performed by excising 2 mm full-thickness skin containing the epidermis, the dermis, and the subcutaneous fascia regions and culturing them in serum-supplemented DMSO media for up to 5 days. Scars generated from SCAD reliably replicate transcriptomic and proteomic hallmarks of in vivo scars. In addition, SCADs generated from relevant transgenic mouse lines (e.g., En1 mice) crossed with fluorescent reporter mouse lines allow the visualization of fibroblast migration dynamics and scar development at an unprecedented resolution. Furthermore, this model can be easily adapted for any high throughput applications (e.g., compound library, antibody library, or viral screening)13,14. In this article, we describe an optimized protocol to generate SCADs and subsequent downstream processing applications to study cellular and matrix dynamics in scar development.

<table><tbody><tr><td>10% Tween 20, Nonionic Detergent</td><td>Biorad Laboratories</td><td>1610781</td><td></td></tr><tr><td>Bovine serum albumin, Cold ethanol fract</td><td>Sigma</td><td>A4503-50G</td><td></td></tr><tr><td>DMEM/F-12, HEPES, no phenol red-500 mL</td><td>LIFE Technologies</td><td>11039021</td><td></td></tr><tr><td>DPBS, no calcium, no magnesium</td><td>Gibco</td><td>14190169</td><td></td></tr><tr><td>Epredia Cryostar NX70 Cryostat</td><td>Thermo Scientific</td><td></td><td></td></tr><tr><td>Epredia SuperFrost Plus Adhesion slides</td><td>Fisher scientific</td><td>J1800AMNZ</td><td>Adhesion slides</td></tr><tr><td>Fetal Bovine Serum, qualified, heat inactivated, E.U.-approved, South America Origin-500 mL</td><td>LIFE Technologies</td><td>&amp;nbsp;10500064</td><td></td></tr><tr><td>Fluoromount-G with DAPI</td><td>Life Technologies</td><td>00 4959 52</td><td>Mounting medium with DAPI</td></tr><tr><td>Forceps curved with fine points with guidepinstainless steel(tweezers)125 mm length</td><td>Fisher Scientific</td><td>12381369</td><td></td></tr><tr><td>Gelatin from porcine skin</td><td>Sigma</td><td>G2500-100G</td><td></td></tr><tr><td>GlutaMAX Supplement-100 mL</td><td>LIFE Technologies</td><td>35050038</td><td></td></tr><tr><td>HBSS, calcium, magnesium, no phenol red-500 mL</td><td>LIFE Technologies</td><td>14025092</td><td></td></tr><tr><td>Ibidi Gas incubation system for CO&lt;sub&gt;2&lt;/sub&gt; and O&lt;sub&gt;2&lt;/sub&gt;</td><td>Ibidi</td><td>11922</td><td></td></tr><tr><td>Ibidi Heating system</td><td>Ibidi</td><td>10915</td><td></td></tr><tr><td>Leica SP8 upright microscope - Multiphoton excitation 680&amp;ndash;1300 nm</td><td>Leica</td><td></td><td>Equipped with a 25x water-dipping objective (HC IRAPO L 25x/1.00&amp;thinsp;W) in combination with a tunable laser (Spectra-Physics, InSight DS&amp;thinsp;+&amp;thinsp;Single)</td></tr><tr><td>Non Essential Amino Acids</td><td>LIFE Technologies</td><td>11140035</td><td></td></tr><tr><td>NuSieve GTG Agarose ,25 g</td><td>Biozym /Lonza</td><td>859081</td><td></td></tr><tr><td>OCT Embedding Matrix</td><td>Carlroth</td><td>6478.1</td><td></td></tr><tr><td>Paraformaldehyde, 16% W/V AQ. 10 x10 mL</td><td>VWR International</td><td>43368.9M</td><td></td></tr><tr><td>Pen-Strep</td><td>Gibco</td><td>15140122</td><td></td></tr><tr><td>Stiefel Biopsy-Punch 2 mm</td><td>Stiefel</td><td>270130</td><td></td></tr><tr><td>Straight Sharp/Sharp Dissecting Scissors 11.4 cm</td><td>Fisher Scientific</td><td>15654444</td><td></td></tr><tr><td>Thimerosal Bioxtra, 97%&amp;ndash;101%</td><td>Sigma-Aldrich</td><td>T8784-1G</td><td></td></tr><tr><td>Zeiss Axioimager M2 upright microscope</td><td>Zeiss</td><td></td><td></td></tr></tbody></table>

visualizing scar development using scad assay - an ex-situ skin scarring assay

Visualizing Scar Development Using SCAD Assay - An Ex-situ Skin Scarring Assay

The mammalian global response to sealing deep tissue wounds is through scar formation and tissue contraction, mediated by specialized fascia fibroblasts. Despite the clinical significance of scar formation and impaired wound healing, our understanding of fascia fibroblast dynamics in wound healing is cursory due to the lack of relevant assays that enable direct visualization of fibroblast choreography and dynamics in complex environments such as in skin wounds. This paper presents a protocol to generate ex- situ skin scars using SCAD or &#34;SCar-like tissue in A Dish&#34; that emulate the complex environment of skin wounds. In this assay, 2 mm full-thickness skin is excised and cultured upside down in media for 5 days, during which scars and skin contractures develop uniformly. This methodology, coupled with fibroblast-lineage specific transgenic mouse models, enables visualization of individual fibroblast lineages across the entire wound repair process. Overall, this protocol aids&#160;researchers in understanding fundamental processes and mechanisms of wound repair,&#160;directly exploring the effects of modulators on wound healing outcomes.

Generation of SCADs can be separated into three essential steps: Harvesting back skin from P0-P1 mice, generating of full-thickness biopsy punches, and subsequent culture of individual scads up to 5 days in 96-well plates. As a readout, this assay can further be applied to analyze the spatial and temporal aspects of scarring. The spatial analysis utilizes 2D and 3D immune-labeling of tissues to study spatial localization of cellular and matrix components within developing scar tissue. Spatiotemporal studies allow visuali...

This protocol describes the generation of a skin-fascia explant termed "SCar like tissue in A Dish" or SCAD. This model allows unprecedented visualization of single fibroblasts during scar formation.

The mammalian global response to sealing deep tissue wounds is through scar formation and tissue contraction, mediated by specialized fascia fibroblasts. ...

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Visualizing Scar Development Using SCAD Assay - An Ex-situ Skin Scarring Assay

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