ARTICLE
Auteur(s) : Catherine Moali, David JS Hulmes
Institut de Biologie et Chimie des Protéines, CNRS/Université de
Lyon UMR 5086, 7 Passage du Vercors, Lyon, France
Tissue remodelling, the acquisition of new tissue architecture
resulting from the combined action of cells and their extracellular
matrix (ECM), is a feature of normal development and growth, as
well as pathological situations and tissue repair. In most tissues,
the amount of ECM equals or exceeds the cellular component and most
of the ECM is synthesized by mesenchymal cells (fibroblasts,
myofibroblasts and smooth muscle cells). Epithelial and endothelial
cells also contribute by synthesizing specialised ECM structures
such as basement membranes, which have both functional and
protective roles. Exactly how cells orchestrate the organisation of
the ECM remains largely unclear but extracellular and cell surface
proteases have clearly been identified as key players due to their
ability to synchronize matrix synthesis and degradation with the
activation and deactivation of growth factors and other
cytokines.
While normal tissue homeostasis depends on a controlled balance
between synthesis and degradation, loss of homeostasis in diseases
of the skin, cornea or internal organs can lead either to excessive
production (e.g. fibrosis, hypertrophic scarring) or excessive
destruction (e.g. arthritis, emphysema, chronic ulcers) of ECM.
Until recently, remodelling was regarded almost exclusively from
the destructive point of view with little attention being paid to
synthesis. This is explained by the intensive research for new
anti-tumoral agents and by the great expectations raised by
inhibitors of matrix metalloproteinases (MMPs). Even now, the
remodelling literature only rarely mentions proteases involved in
ECM synthesis and one major aspect of this review is to recognize
the importance of proteases such as tolloids and ADAMTSs in the
maturation of matrix components.
In recent years, using knock-out mice and novel tools such as
activity-based probes and high-throughput proteomics, researchers
have achieved real progress towards understanding the “protease
web” [1] which links proteases to other proteases, to their
substrates, their inhibitors and their various binding partners.
However, it remains a challenge to link substrates with
observations at the cellular or tissue level, and in vivo
extrapolation of processing events observed in vitro is made
difficult by the intrinsic complexity of the extracellular matrix.
Substrates can be masked by interaction partners, they can adopt
different conformations, or be physically entrapped or otherwise
inaccessible to proteases, due to spatial or temporal
separation.
In contrast to most other post-translational modifications,
proteolytic events are irreversible and therefore fine tuning of
protease activity is required to avoid tissue destruction. For all
types of extracellular proteases, inhibitors have been described,
either broad-spectrum, such as α2-macroglobulin [2], or more
specific to a protease family, such as TIMPs for MMPs. More
recently, mechanisms for enhancement of proteolytic activity have
also been described and, interestingly, these usually provide a
means to direct protease activity to particular substrates. Other
regulatory mechanisms following secretion include propeptide
removal, feedback loops involving processed substrates and control
of extracellular localisation.
In this review, we give examples of these various aspects and
present an overview of the properties and functions of the
extracellular and cell surface proteases (mainly serine proteases
and metalloproteases) involved in wound healing. This well known
case of tissue remodelling illustrates all the different functions
with which extracellular and cell surface proteases are known to be
involved: matrix protein synthesis and degradation; release of
cryptic bioactive fragments; regulation of growth factors and other
cytokines; and the control of cell adhesion, migration, apoptosis
and signalling.
Extracellular and cell surface proteases: old and new
players
The functional importance of proteases is demonstrated by the fact
that more than 2% of the genes present in the human genome consist
of proteases and protease inhibitors. These proteases are
classified according to their catalytic mechanism and to the
particular amino acid/cofactor responsible for water activation or
nucleophilic attack during hydrolysis. Among the 569 human
proteases [3], the most abundant are serine and threonine proteases
(176 proteins) and metalloproteases (194 proteins) but
cysteine and aspartate proteases also play major roles. In each
class, subfamilies can be identified according to their
localization: intracellular, extracellular or associated with the
cell surface. In this review, the focus will be on the
extracellular and cell surface associated proteases involved in
wound healing. These cluster into three main groups: serine
proteases (mainly proteases from the plasminogen/plasmin system),
cysteine proteases and lastly metalloproteases from the metzincin
superfamily, which are by far the most abundant (more than 80
members if MMPs, ADAM(TS)s, tolloids, meprins and pappalysins are
included). The key importance of plasmin and metzincins in skin
repair was clearly shown by Lund and co-workers [4] who
demonstrated that healing was significantly delayed in wounded mice
either deficient in plasminogen or treated with a broad-spectrum
metalloprotease inhibitor (galardin) but was completely blocked
when both effects were combined.
Each protease family could be the subject of an article in its
own right; here we present the main features of these enzymes and
refer the reader to the numerous reviews now available for more
detailed information.
Serine and cysteine proteases
In contrast to the metalloproteases that will be described below,
serine proteases do not form a homogeneous family with large
structural and regulatory differences. Most of the proteases found
in the blood circulation (mainly kallikreins [5, 6] and proteases
of the coagulation and complement cascades) are serine proteases
which can potentially impact remodelling processes such as
angiogenesis and wound healing. Also important are members of the
relatively new family of type II transmembrane serine proteases
(TTSPs; [7]) among which the matriptases play an important role in
wound healing through activation of pro-hepatocyte growth
factor/scatter factor [8]. Neutrophil elastase seems to play a
major role in the onset of inflammatory responses, especially in
the lung where, in the absence of tight regulation, changes in
neutrophil elastase activity can lead to excessive matrix
degradation (emphysema) or excessive matrix production (lung
fibrosis) [9]. Finally, we should mention two serine proteases
related to neutrophil elastase, also produced by inflammatory
cells, proteinase 3 and cathepsin G [10], as well as other members
of the cathepsin family which are better known but belong to the
class of the cysteine proteases (cathepsins B, K, L, S and V).
Cysteine cathepsins can degrade fibrillar collagens, elastin and
some other extracellular components in acidic pericellular
environments [11, 12]. These enzymes have been mainly associated
with cardiovascular diseases, cancer progression and bone
remodelling; their roles in wound healing remain relatively
elusive.
More broadly relevant in the wound healing context are proteases
from the plasmin system, which are not only responsible for fibrin
clot lysis [13] but can also participate in TGF-β activation [14,
15], cleave components of the extracellular matrix (laminin 332
[16], thrombospondin-1, fibronectin [17]) or activate other
proteases (especially MMPs) which will in turn degrade ECM. In
addition, as mentioned above, the crucial role of plasmin in tissue
repair has been demonstrated in mice deficient in plasminogen [4,
18].
Figure 1
illustrates the complex regulation of plasminogen conversion into
the active plasmin form [13]. Plasmin activation can be seen as a
paradigm for protease regulation with both enhancing and inhibiting
mechanisms both contributing to the fine tuning of protease
activity. The conversion of plasminogen to plasmin is mainly
carried out by two other serine proteases: tPA (tissue-type
plasminogen activator) and uPA (urokinase-type plasminogen
activator) with the latter being the most important for tissue
remodelling and the former for fibrin clot dissolution.
Several modulators of plasmin, tPA and uPA have been described
that, in some cases, can act in a substrate-specific manner. Such
substrate-specific regulation is frequently encountered with
proteases, but rarely with other types of enzymes. For example,
fibrin, the major plasmin substrate, binds both tPA and
plasminogen, thereby increasing tPA catalytic efficiency and
enhancing fibrinolysis [13]. In addition, uPA can be recruited and
activated more efficiently at the cell surface via a specific
receptor uPAR (uPA receptor). uPAR can then associate with a
variety of cell receptors, including integrins, and modulate cell
adhesion [19, 20]. Through a positive feedback loop, plasmin
cleaves tPA and uPA and the resulting two-chain plasminogen
activators are more active than the single chain proteases.
Finally, two inhibitors of the plasminogen activators (PAI-1 and
PAI-2) and inhibitors of plasmin (such as α2-plasmin inhibitor)
further regulate plasmin activation. This results in a complex
pathway of plasmin maturation, as described in figure 1, accounting for
the destructive potential associated with this protease.
Metalloproteases
Most extracellular metalloproteases belong to the metzincin
superfamily which is defined by a conserved zinc-binding motif
(HEXXHXXG/NXXH/D) and a methionine-containing turn near the active
site [21, 22]. This family is further divided into 6 different
subgroups: astacins which include tolloid proteinases and meprins,
matrixins (MMPs), adamalysins (ADAMs and ADAMTSs), pappalysins,
serralysins and leishmanolysins. With the exception of the last two
groups, all these families are involved in remodelling processes.
Matrix metalloproteases (MMPs)
MMPs are, without contest, the most well-known of all remodelling
enzymes and have been extensively studied in several contexts
(cancer, cardiovascular diseases, wound healing, bone remodelling,
pregnancy…) for the past 30 years. MMP activity is inherently
involved in remodelling since, in normal situations, these enzymes
are expressed at virtually undetectable levels with a few
exceptions such as MMP-7 which is constitutively expressed in
epithelial cells [23, 24]. Their expression becomes elevated when
there is a challenge to the system, such as wound healing and
disease [25].
The initial classification of the 23 human MMPs according to
their substrate specificity and functional characteristics
(collagenases, gelatinases, broad-specificity stromelysins,
membrane-bound MMPs…) has now given way to a simple numbering
scheme. While all MMPs have in common a signal peptide, a
propeptide and a catalytic domain, they differ by the possible
insertion of fibronectin-type II repeats in the catalytic domain
(MMPs-2 and -9), the presence of a haemopexin domain involved in
substrate recognition (in all MMPs except MMPs-7 and -26), an
additional transmembrane domain followed by a cytoplasmic tail
(MMPs-14, -15, -16 and 24) or a GPI anchor (MMPs-17 and -25) [26].
The propeptide is cleaved off either in the Golgi apparatus by
proteases from the furin-like proprotein convertase family or
pericellularly by plasmin, other MMPs or by autoproteolysis.
As a family, MMPs can cleave all extracellular matrix components
(collagens, elastin, proteoglycans and other structural
glycoproteins). They are also involved in growth factor activation
(e.g. TGF-β and VEGF: see below) and can modify cell-matrix and
cell-cell interactions in several ways (including matrix
degradation, shedding of syndecans and cadherins, and binding of
integrins and CD44) [27, 28]. After propeptide removal, MMP
activity is regulated by potent inhibitors of the TIMP family
(Tissue Inhibitors of MMPs 1-4) which have also been implicated in
a range of biological processes, grossly overlapping MMP functions
but with opposite effects: tumour metastasis, angiogenesis, wound
healing, cell differentiation and survival, inflammatory responses,
etc. TIMPs bind to the catalytic zinc ion of MMPs, thus blocking
access to the catalytic pocket. All MMPs can be inhibited by all
TIMPs but to variable extents [29]. The main structural and
regulatory features of this family are also summarized in figure 1.
ADAMs and ADAMTSs
The adamalysin family is the largest family of metalloproteases in
terms of numbers with 40 human ADAMs (A Disintegrin And
Metalloprotease) and 19 ADAMTSs (ADAMs with thrombospondin (TS)
motifs). Among the ADAMs, only 13 are predicted to be catalytically
active, and many have lost the ability to bind zinc, pointing to
additional, non-enzymatic roles, for example in cell adhesion.
ADAMs and ADAMTSs share some structural similarities (a catalytic
domain followed by a disintegrin domain and a cysteine-rich domain:
figure 1) but
major differences in their cellular localizations and substrate
specificities have led to divergent biological functions.
With a few exceptions, ADAM proteins remain attached to the
plasma membrane and the catalytic activity of the ADAMs that are
predicted to be active (8-10, 12, 15, 17, 19-21, 28, 30, 33) is
devoted to the shedding of the ectodomain of several transmembrane
proteins. They release diffusible factors, such as heparin-binding
EGF (HB-EGF) or TNF-α, from their membrane-anchored precursors.
They also cleave adhesion molecules (e.g. cadherins and CD44) to
disrupt adhesive contacts while shedding of signalling receptors
(e.g. the Notch receptor) leads to further intra-membrane
proteolysis and release of an intracellular domain which becomes a
signal transducer (see below). In the latter case, binding of a
substrate ligand, such as Delta in the case of the Notch receptor,
is often required to trigger proteolysis by ADAMs and permits very
strict regulation of the downstream signalling pathway. The ADAMs
that are proteolytically inactive can nevertheless play important
roles, especially in cell adhesion, via their disintegrin and
cysteine-rich domains. The disintegrin domains of several ADAMs,
for example, have been shown to bind to receptors of the integrin
family and thereby block their function. Furthermore, the
cysteine-rich domain can interact with ECM proteins such as
fibronectin and heparan-sulphate proteoglycans of the syndecan
family.
In contrast to the ADAMs, ADAMTSs are all secreted proteases and
are found either in soluble form or bound to the ECM. Their key
feature is a variable number of type 1 thrombospondin repeats (figure 1). They are
all supposedly active but six of the ADAMTS are orphans with no
known substrates. Other ADAMTSs tend to be much more specific than
the metalloproteases described so far and their main remodelling
functions can be classified into 3 overlapping groups [30]: (i) the
anti-angiogenic ADAMTSs (-1 and -8), this function being directly
mediated by their TS motifs or through the release of
anti-angiogenic factors such as thrombospondin fragments [31] (ii)
the aggrecanases (-1, -4, -5, -8, -9 and -15) which cleave aggrecan
and are the main players during joint degeneration and (iii) the
procollagen N-proteinases (-2, -3 and -14) which are involved in
processing of fibrillar collagen precursors.
For both ADAMs and ADAMTSs, propeptide removal is carried out by
proteases of the proprotein convertase family in the Golgi
apparatus. The only protein inhibitors that have been described so
far for ADAMs are the TIMPs but in contrast to the MMPs, not all
members of the family are inhibited by the four TIMPs and the
physiological consequences of this inhibition are not very well
documented. TIMP-3, which is unique among the TIMPs for its ability
to interact strongly with ECM, is also a potent inhibitor of the
catalytic domain of ADAM-10 and -17 [32, 33]. In the ADAMTS family,
full-length ADAMTS-4 and -5 have also been shown to be inhibited by
TIMP-3 [34]. Interestingly, TIMP-3 is not a good inhibitor of
ADAMTS-2 but this particular enzyme has been shown to be inhibited
by papilin [35], a protein found in the basement membrane which
contains the C-terminal, non catalytic domains of ADAMTSs. Finally,
ADAMTS-1-dependent cleavage of aggrecan seems to be enhanced by
fibulin-1 through simultaneous binding of both protease and
substrate [36].
For a more comprehensive overview of the members and roles of
both families, we recommend the recent reviews by Tousseyn
et al. and Edwards et al. on ADAMs [37, 38] and Porter
et al. on ADAMTSs [30].
Tolloids
Tolloid proteinases are also known as procollagen C-proteinases
(PCPs) or by the names of the four members of the family (BMP-1,
mTLD, mTLL-1 and mTLL-2). BMP-1 (bone morphogenetic protein-1) and
mTLD (mammalian tolloid) are splice variants of a single gene
whereas mTLL-1 and 2 (mammalian tolloid like-1 and -2) are the
products of two separate genes. Members of this family were
originally linked exclusively to collagen maturation as one of
their major roles is to cleave the C-terminal propeptides of
procollagens I, II and III, thereby triggering fibril formation.
However, a variety of new substrates have been discovered in the
past decade [39] and tolloids now appear as key players in various
biological functions ranging from embryogenesis and morphogenesis
to ECM biosynthesis. For example, they control dorso-ventral
patterning in the embryo through the cleavage of chordin, a growth
factor antagonist, as well as morphogenetic events such as muscle
growth and neural differentiation through the activation of GDF-8
and -11. It was also recently established that tolloids can cleave
latent TGF-β binding proteins (LTBPs) thereby releasing latent
TGF-β from the matrix and triggering TGF-β activation [40] (figure 2). In
addition, they process several partners involved in collagen
fibrillogenesis and participate in basement membrane assembly
through the processing of laminin 332 [41] and procollagen VII
[42]. Finally, tolloid proteinases probably also play a role in
angiogenesis with the recent discovery of substrates such as
endorepellin [43] and prolactin [44]. A unified view
suggesting that this family of proteases could act to synchronize
signalling pathways with ECM biosynthesis, a crucial requirement
during morphogenesis and tissue remodelling, is now emerging.
From a structural point of view, tolloid proteinases comprise a
catalytic domain of the astacin type and a variable number of CUB
and EGF domains (figure
1). Their propeptides are also removed by furin-like
proteases, as for some MMPs and almost all ADAM(TS)s. Tolloids are
soluble proteins which are regulated substrate-specific enhancers.
In addition, in Xenopus, it has been shown that the Sizzled protein
binds strongly to tolloids and inhibits cleavage of chordin [45],
suggesting that homologous secreted frizzled-related proteins might
play similar roles in mammals (though not supported by recent data,
[46]). Tolloids are also regulated by enhancer proteins which are
substrate-specific in that they specifically activate the cleavage
of only one type of substrate, for example procollagen C-proteinase
enhancers (PCPEs) in the case of the fibrillar procollagen
substrates [47] or twisted gastrulation and olfactomedin in the
case of chordin [48, 49].
Other metalloproteases
Two other families of metzincins are also slowly making their way
into the remodelling field: pappalysins and meprins. The best
studied member of the pappalysin family is PAPP-A
(Pregnancy-Associated Plasma Protein-A) which cleaves IGF binding
proteins 2, 4 and 5, thereby releasing sequestered IGF-I and II
with effects on cell proliferation, migration and differentiation.
Elevated levels of this protease are found in the circulation of
pregnant women and of patients with acute coronary syndromes.
PAPP-A also seems to play a role during wound healing with an
increased expression in the dermis and epidermis [50]. The
proteolytic activity of PAPP-A is inhibited, in an unusual and
probably irreversible manner, by the proform of eosinophil major
basic protein (pro-MBP), which forms a covalent 2:2
proteinase-inhibitor complex based on disulfide bonds [51].
Interestingly also, upon IGF binding, cleavage of IGFBP-2 and 4 is
enhanced many fold while cleavage of IGFBP-5 is slightly inhibited
[52].
Meprins, like tolloid enzymes, are proteases of the astacin
family [21], which, unlike tolloid proteases, are synthesised as
transmembrane proteins. They are expressed as two independent
subunits (α and β) which can assemble into hetero- or homo-dimers,
or higher oligomers in the case of meprin α, which can be released
from the plasma membrane by proteolytic shedding. Expression of
meprins has been reported mainly in the kidney, intestine and skin
but could increase during inflammatory conditions, cancer
progression and wound healing. In recent years, meprins have been
shown to cleave several ECM proteins (collagen IV, laminin 111,
nidogen-1, fibronectin), enzymes such as lysyl oxidases and
adhesion proteins such as cadherins but the discovery of
physiologically relevant substrates is still a matter of intense
research. The only endogenous inhibitor described so far for
meprins is mannan-binding lectin [53] but the primary regulatory
mechanism of meprins after propeptide removal seems to be targeting
to specific locations (e.g. apical membrane of polarized
cells).
Extracellular and cell surface proteases in wound
healing
The most common case of tissue remodelling, tissue repair, occurs
after various types of traumatic lesions (wounds, burns, surgery…).
Tissue repair is usually described as being divided into three
phases which partially overlap, while the entire process can take
several months.
During the first phase, haemostasis and inflammation, a
fibrin-rich provisional matrix is formed as a result of thrombin
and platelet activation. Fragments of coagulation factors,
activated complement components, growth factors and chemokines
released by damaged cells and activated platelets then recruit
inflammatory cells to the site of injury [54, 55]. Platelets, for
example, are major sources of TGF-β and PDGF. First to arrive are
the neutrophils, which cleanse the wound area by phagocytosis and
the release of antimicrobial substances (reactive oxygen species,
cationic peptides, eicosanoids) and proteases (neutrophil elastase,
cathepsin G, proteinase 3, uPA, MMPs-8 and -9) [56]. Migration of
neutrophils from the blood capillaries into the wound site involves
interactions with endothelial cell adhesion molecules such as
selectins and ICAMs. Subseqently, monocytes also infiltrate the
wound site, in response to growth factors (TGF-β, PDGF) and
chemokines (e.g. monocyte chemoattractant proteins or MCPs) where
they become activated and differentiate into mature tissue
macrophages. While both neutrophils and macrophages produce
pro-inflammatory mediators (TNF-α, interleukins-1 and -6),
macrophages also synthesize several growth factors (TGF-β, TGF-α,
bFGF, PDGF, VEGF) to stimulate the repair response.
In the second phase, re-epithelialisation and granulation tissue
formation, which commences soon after injury, keratinocytes use the
provisional fibrin-rich matrix to migrate and cover the wound area.
This requires the coordinated action of several growth factors and
cytokines, together with multiple proteases and adhesion proteins
involved in cell-cell and cell-matrix interactions. Important
growth factors involved in re-epithelialisation include members of
the EGF family (EGF, TGF-α, HB-EGF) and FGFs, which promote
keratinocyte proliferation, and TGF-β, which negatively regulates
this process [57]. Next, about 4 days after injury, fibroblasts are
also attracted to the wound area to initiate the formation of
granulation tissue, which includes a new extracellular matrix rich
in collagen III, fibronectin and proteoglycans. Cross-talk between
keratinocytes and fibroblasts plays an important role, notably in
the production of a new basement membrane, as well as in the
control of cell proliferation. Fibroblast proliferation is
stimulated by different growth factors (including PDGF, TGF-β,
CTGF, IGFs) some of which also promote the important process of
wound contraction by stimulating fibroblast differentiation into
myofibroblasts. In addition to the acquisition of a contractile
phenotype, these myofibroblasts also demonstrate an enhanced
ability to synthesize extracellular matrix. Finally, formation of
granulation tissue also requires new blood vessel formation,
angiogenesis, under the control of different growth factors
(notably VEGF) as well as anti-angiogenic factors released by
proteolysis (see below).
In the final phase of tissue repair, tissue remodelling, the
granulation tissue is progressively replaced by a more mature scar
tissue, where collagen I is the major component. Remodelling is a
lengthy process, which requires both synthesis and degradation of
ECM in order to recreate as closely as possible, but never
completely, the properties of the original tissue. At the end of
wound repair, myofibroblasts usually undergo apoptosis and are
replaced by normal fibroblasts. However, in certain pathologies,
excessive inflammation can lead to persistence of myofibroblasts
and excessive ECM synthesis, leading to hypertrophic scarring, or
complete failure to heal, as in chronic wounds (ulcers).
Proteases play numerous roles during the process of wound
healing (table 1). They are at work
during: haemostasis; regulation of the activities of growth
factors, chemokines and other cytokines; cell migration, signalling
and survival; angiogenesis; and synthesis and remodelling of the
extracellular matrix.
Haemostasis and inflammation
Upon injury, damage to the blood vessel wall exposes
sub-endothelial proteins, notably collagens, to which platelets
bind via specific glycoprotein receptors, resulting in platelet
activation and subsequent aggregation. Formation of the platelet
plug is stabilised by interaction with von Willebrand factor, which
itself is a substrate for ADAMTS-13 [30]. In addition, negative
regulation of aggregation occurs by proteolytic release from the
cell surface, or shedding, of platelet glycoprotein receptors by
ADAM-17/TACE [58]. The platelet plug is further stabilised by the
formation of a fibrin-rich network resulting from thrombin
activation, via the coagulation cascade, and subsequent maturation
of fibrinogen.
Circulating leukocytes then infiltrate into the wound area first
by attachment to the endothelial cells of the blood vessel wall
followed by extravasation into the surrounding tissue. This
involves tethering to specific cell adhesion molecules expressed on
the endothelial cells, notably E-selectin, ICAM-1 and VCAM-1, whose
expression is induced by inflammatory cytokines [59]. Subsequent
extravasation through the blood vessel wall requires additional
cell adhesion molecules such as PECAM-1 [60]. These processes are
under the control of multiple proteases (notably ADAMs-10 and -17)
through shedding of ICAM-1, VCAM-1 and PECAM-1 from endothelial
cells, as well as by shedding of L-selectin from neutrophils.
Finally, neutrophil infiltration into the wound site is facilitated
by secretion of the neutrophil collagenase MMP-8, probably through
collagen degradation but also through proteolytic modification of
chemotactic molecules [61, 62].
Migration of inflammatory cells into the wound site is actually
controlled by several chemokines, many of which are regulated by
the action of proteases [63, 64]. Protease activity can lead to
increased or decreased activity, either directly, by proteolytic
cleavage of the chemokine, or indirectly, by cleavage of
interaction partners or receptors. Particularly well studied are
the monocyte chemoattractant proteins (MCPs) which serve to attract
monocytes to the site of tissue injury. A number of MMPs have
been found to cleave short N-terminal fragments from different MCPs
leading to a loss of chemokine activity and the generation of
receptor antagonists [65]. Since these MMPs are produced by stromal
cells as a result of macrophage-derived inflammatory cytokines,
such activity could serve to dampen the inflammatory response.
Alternatively, other chemokines can be directly activated by
proteolytic activity, either by the processing of inactive
precursors (such as IL-8/CXCL8 activation by serine proteases,
cathepsin L or MMP-9) or by shedding of membrane-bound precursors
(such as CX3CL1/fractalkine by MMP-2 [66], ADAMs-10 and -17 [67]).
Furthermore, since IL-8 binds to the heparan sulphate chains of
cell surface syndecan-1, MMP-7 shedding of the IL-8/syndecan-1
complex can help establish local chemokine gradients at the wound
site [63].
Finally, ADAM-17/TACE also plays a key role in the regulation of
proinflammatory cytokines, both by the shedding of TNF-α from the
cell surface, as well as by the shedding of both TNF-α and IL-6
receptors [38]. Similarly, MMPs-7 and -12 may also release TNF-α
from macrophages, while MMPs-2,-3 and -9 are involved in the
activation and inactivation of IL-1β [63].
Table 1 Biological functions of extracellular and cell
surface proteases in tissue remodelling: substrates and proteases
involved. Compiled with the help of the CutDB proteolytic event
database (http://cutdb.burnham.org/), from where original
references can be obtained
|
Function
|
Substrates
|
Proteases involved
|
|
Matrix assembly
|
procollagens, prolysyl oxidases, osteoglycin, biglycan
|
tolloids, ADAMTSs
|
|
Matrix degradation
|
fibrillar collagens
|
MMPs
|
|
fibronectin, vitronectin
|
MMPs, kallikreins, plasmin, meprins, ADAMs
|
|
COMP, matrilin-3
|
ADAMTSs
|
|
tenascins, SPARC/osteonectin, osteopontin, thrombospondin
|
ADAMTSs, MMPs, plasmin, meprins, cathepsin G
|
|
aggrecan, brevican, versican
|
MMPs, ADAMTSs, plasmin
|
|
decorin, fibromodulin, lumican, biglycan, osteoglycin
|
MMPs, ADAMTSs
|
|
elastin, fibrillins, fibulin
|
MMPs
|
|
fibrinogen
|
plasmin, MMPs, kallikreins
|
|
laminins, nidogens, collagen IV, collagen XVIII
|
MMPs, kallikreins, cathepsin S, meprins, ADAMs, plasmin
|
|
Protease activation/inhibition
|
ProMMPs, plasminogen, meprins
|
MMPs, uPA, tPA, plasmin, kallikreins, autocatalysis
|
|
serpins, elafin, TIMP-1
|
MMPs, kallikreins, cathepsins, neutrophil elastase
|
|
PCPE-1
|
MMP-2
|
|
Release of bioactive fragments
|
collagen IV (tumstatin), collagens XV/XVIII (endostatins), perlecan
(endorepellin), plasmin (angiostatin), prolactin, growth hormone,
thrombospondin
|
MMPs, plasmin, cathepsins, tolloids, ADAMTS-1
|
|
Control of cell adhesion/migration
|
laminins, cadherin, L-selectin, ICAM-1, VCAM-1, PECAM-1, L1,
CD44
|
MMPs, tolloids, plasmin, neutrophil elastase, ADAMs, cathepsin
G
|
|
Release/activation/inactivation of growth factors, chemokines and
cytokines
|
TGF-β, TGF-α, TNF-α, IL-8 (CXCL8), IL-1β, CTGF, PDGF, VEGF,
monocyte chemoattractant proteins (CCLs-2,-7,-8,-13), HB-EGF, GDF8,
GDF11, IGFBPs, chordin, LTBP, CX3CL1; CCLs-5,-20,21;
CXCLs-1,-4,-5,-6,-9,-10,-16
|
MMPs, tolloids, plasmin, ADAMs, cathepsins, neutrophil elastase,
uPA
|
|
Shedding of cell surface receptors and other proteins
|
Estrogen receptor, TNF receptor, IL-6/IL-15 receptors, macrophage
colony stimulating factor receptor, NGF receptor, growth hormone
receptor, EGF receptor, FGF receptor, integrins, CXCR4, CD44, LRP8,
platelet glycoproteins, syndecans, transglutaminase 2, CD44,
collagen XVII
|
ADAMs, MMPs, neutrophil elastase, cathepsins
|
|
Cell survival
|
Fas-ligand, stromal cell derived factor-1 (CXCL12)
|
MMPs, cathespin G, neutrophil elastase
|
|
Cell signalling
|
Notch/delta, protease activated receptors
|
ADAMs, thrombin
|
Re-epithelialisation, angiogenesis and granulation tissue
formation
Re-epithelialisation, angiogenesis and granulation tissue formation
are also governed by the orchestrated action of numerous growth
factors as well as multiple proteases involved in growth factor
release from the matrix or from the cell surface, control of cell
signalling and modulation of cell-matrix and cell-cell
interactions. Different growth factors are involved in each step,
including TGF-α, HB-EGF and KGF in epithelial cell (keratinocyte)
proliferation and migration; bFGF, VEGF and TGF-β in angiogenesis;
and TGF-β, PDGF, CTGF and IGF in fibroblast proliferation and ECM
production; while other growth factors, such as HGF/SF, have more
general effects [8, 57].
Many of the examples described below show the importance of
proteolytic processing at the cell surface, not only for
transmembrane proteases (ADAMs, meprins, membrane type MMPs,
matriptases) but also for other proteases that are anchored to the
plasma membrane, either directly, through a GPI anchor
(MMPs-17,-25), or indirectly, in association with cell surface
receptors. Examples of the latter are binding of MMP-9 to the
hyaluronan receptor CD44 [68], MMP-2 to integrin
αvβ3, MMP-1 to integrin
α2β1 and MMP-7 to heparan sulphate
proteoglycans [63]. Such interactions serve to localise the site of
proteolysis, or protease activation, as well as to bring proteases
and their substrates in closer proximity.
Release of growth factors sequestered
in the extracellular matrix
One function of proteases is to mobilise growth factors, such as
VEGF, FGF, PDGF, CTGF and TGF-β, by release from matrix-bound
stores [27, 69, 70]. For example, angiogenic factors such as VEGF
and bFGF associate with heparan sulphate proteoglycans found in the
matrix and must be released to promote angiogenesis. MMP-9 is
thought to be the main enzyme involved in the release of VEGF [71]
but other mechanisms involving MMP-2 have been described [25, 72].
Interestingly, the released and matrix-bound forms of VEGF have
different properties, the former inducing endothelial cell
proliferation, the latter stimulating vascular sprouting and
branching [73]. MMP-2 can also unmask VEGF by cleaving inhibitory
partners such as pleiotrophin/HARP and CTGF [74]. Similarly, IGFs
are antagonized by six different IGF binding proteins that can be
cleaved by pappalysins, MMPs, cathepsins, kallikreins or other
serine proteases [75].
The activation of TGF-β has been extensively studied, and
several mechanisms, both proteolytic and non-proteolytic, have been
elucidated. TGF-β, (of which there are three variants β1, β2 and
β3), is secreted as a latent dimeric complex consisting of the
functional growth factor at the C-terminus and the latent prodomain
(called LAP or latency-associated peptide) at the N-terminus. TGF-
β is cleaved from its propeptide during secretion by furin-like
proteases and remains bound to LAP in a non-covalent manner. LAP
can also form disulphide bridges with latent TGF- β binding
proteins LTBPs-1, -3 or -4 [76] to produce LLC (large latent
complex). Because LTBPs have a strong affinity for several matrix
components, especially fibrillin-1 [77, 78], LLC is deposited
within the extracellular matrix, to which it is covalently bound by
transglutaminase cross-linking [79]. Release of the TGF-β/LAP
complex from the ECM requires proteolysis of the LTBP and this
processing was recently attributed to tolloids [40] (Fig.2). Subsequently,
active TGF-β can be released from the complex by another round of
proteolysis, this time under the control of plasmin [14] or MMPs-2,
-9 and -14, themselves possibly in association with integrins, to
which LAP also binds [68, 79, 80]. Conformational changes leading
to TGF-β activation in the absence of proteolytic activity have
also been demonstrated, the first being mediated by
thrombospondin-1 (TSP-1) which can bind to LAP associated with
TGF-β [81]. This interaction appears to induce a conformational
change in the prodomain which, while remaining bound to mature
TGF-β, leads to a loss of latency and hence TGF-β activation [82].
More recently, it has been shown that mechanical forces exerted by
myofibroblasts attached to an extracellular matrix substrate can
directly lead to TGF-β activation, through an LTBP-dependent but
non-proteolytic pathway [83]. With LAP bound to different types of
integrins via its RGD motif, cell shape change or movement can
distort the structure of the latent complex, thereby releasing
active TGF-β [79]. Interestingly, this mechanism only works when
cells remain bound to a relatively rigid substrate, in order to
provide sufficient mechanical traction, thereby demonstrating the
importance of the physical properties of the extracellular matrix
in growth factor activation.
Release of membrane-bound growth factors and control
of cell signalling
Growth factors can also be activated by proteolytic release, or
shedding, from the cell surface. For example, growth factors of the
EGF family, notably TGF-α and heparin binding (HB)-EGF have been
shown to play important roles in wound healing, particularly in
re-epithelialisation [57]. All EGF receptor ligands are synthesized
as membrane-anchored forms, which are activated by ectodomain
shedding from the cell surface. One of the best described examples
is the shedding of HB-EGF by ADAMs-9, -10, -12 or -17 [84]. HB-EGF
is expressed on the cell surface of keratinocytes and in the event
of injury, expression of ADAMs leads to shedding of the growth
factor and transient stimulation of the EGF receptor which is
required for keratinocyte migration. In addition, shedding of the
extracellular domain of HB-EGF also results in the release of a
C-terminal cytosolic fragment that can be translocated to the
nucleus where it associates with transcription factors involved in
cell cycle control [85].
In addition to growth factor activation, shedding also plays a
role in cell signalling. One of the best studied examples is the
Notch signalling pathway which is involved in a large panel of
developmental events and in several cancers [86] and was recently
shown to be directly involved in wound healing [87]. Thus, when
Notch signalling is blocked, delayed healing is observed, due to
changes in endothelial cell, keratinocyte and fibroblast migration.
Both the Notch receptor and its ligands (members of the Delta and
Jagged families) are transmembrane proteins with large
extracellular domains and as a consequence, interaction between
receptor and ligands is restricted to neighbouring cells. When a
ligand is bound to the Notch receptor, two sequential proteolytic
events are induced: the first cleavage is performed by ADAM-10 or
-17 resulting in the release of the Notch extracellular domain,
while the second cleavage occurs inside the membrane, by regulated
intracellular proteolysis or RIPping, and is due to the γ-secretase
complex [88]. The second cleavage promotes the translocation of the
Notch intracellular domain into the nucleus with subsequent
induction of transcriptional events.
Another example of the importance of proteases in cell
signalling has been described for the family of protease activated
receptors (PARs). These are transmembrane G-protein coupled
receptors in which cleavage of part of the extracellular domain
(usually by serine proteases) exposes a tethered ligand (part of
the polypeptide chain) which then interacts with the rest of the
molecule, thereby triggering intracellular signalling in an
irreversible manner. Activation of PARs by thrombin can have a
direct effect on the expression of profibrotic mediators such as
PDGF and CTGF [89], as well as TGF-β [90] and has been shown to be
involved in tissue fibrosis.
Modulation of cell-matrix and cell-cell
interactions
Both re-epithelialisation and angiogenesis involve several
proteolytically regulated steps, including cell migration through
the provisional matrix, and disruption/re-establishment of both
cell-cell and cell-matrix contacts. For example, epithelial
migration through the fibrin-rich matrix is in part due to
activation of serum-derived plasmin by up-regulation of uPA and its
receptor uPAR. Plasminogen-deficient mice show severely impaired
re-epithelialization in a skin wound model [91]. Similarly, laminin
332 (previously known as laminin 5) which connects basement
membranes to integrins and syndecans on the epithelial cell surface
can be cleaved by several proteases, including serine proteases,
MMPs and tolloid proteases. These proteolytic events generally
result in increased or decreased migration of epithelial cells,
depending on which chain is processed and at which site [92, 93].
With regard to cell-cell interactions, those mediated by
cadherins (E-cadherin in the case of keratinocytes or VE-cadherin
the case of endothelial cells) are also subject to protease
regulated shedding. Several proteases are potentially involved,
including MMPs-3,-7,-9,-12 and-14 [94, 95], ADAM-10 [96],
neutrophil elastase [97] and meprin-β [98]. Shedding of cadherins
can also result in translocation of membrane bound β-catenin to the
cell nucleus, thereby leading to changes in cell proliferation
[99].
Another effect of ECM proteolysis is to expose cryptic sites or
fragments (matricryptins) that change cell-matrix interactions
[100, 101]. For example, PDGF-stimulated vascular smooth muscle
cells migrate more rapidly on collagen I fragments generated by
collagenase activity than on intact collagen [102]. This is due to
changes in adhesion and migration mediated by a switch in integrin
recognition from α2β1 to
αvβ3. Similarly, MMP cleavage of basement
membrane collagen IV exposes a cryptic site associated with
increased angiogenesis coupled with decreased binding to integrin
α1β1 and increased binding to αvβ3 [103].
Further examples are the release of anti-angiogenic fragments from
pro-angiogenic molecules or even from proteases themselves,
including: (i) angiostatin from plasmin [104], (ii) anti-angiogenic
fragments from basement membrane components, including endostatin
from collagen XVIII, tumstatin, canstatin and arresten from
collagen IV and endorepellin from perlecan [43, 101], and (iii)
anti-angiogenic fragments from prolactin and growth hormone [44]
(figure 2).
Finally, in addition to their effects on cell proliferation,
signalling, adhesion and migration, extracellular proteases are
also known to influence programmed cell death, apoptosis [105].
Proteolytic disruption of cell-matrix interactions can lead to
apoptosis by the process of anoikis. Alternatively, apoptosis can
be induced by shedding of Fas ligand, or inhibited by release of
its “death” receptor Fas/CD95, both of which have been reported for
MMP-7 [24].
Matrix remodelling
In general, relatively little is known, in structural terms, about
how cells remodel their surrounding ECM. Clearly both mechanical as
well as biochemical mechanisms are involved, as shown for example
by the different signalling mechanisms involved in contracting
floating and restrained collagen gels [106], or by the inability of
TGF-β to induce myofibroblast differentiation unless tissues are
under mechanical stress [107]. The mechanical properties of tissues
such as skin are in turn largely determined by the composition and
organization of the ECM, itself regulated by proteolytic and
cross-linking enzymes. Matrix stiffness is a key factor in cell
migration; the matrix should be stiff enough to support cell
traction but not too stiff to avoid excess adhesion [108]. Cell
migration is usually, but not always, accompanied by proteolytic
activity, but interestingly recent observations show that the site
of proteolysis is behind the leading edge of the cell, thereby
allowing cells to attach to the matrix before it is degraded [109].
In this way, for example, ECM rigidity promotes increased
matrix-degrading activity of invasive cells at specialized
actin-rich protrusions called invadopodia or podosomes [110].
Granulation tissue formation involves the relatively rapid
deposition of fibrillar collagens (mainly collagen III),
fibronectin, proteoglycans and other proteins in a newly
synthesized ECM. The tolloids are the group of extracellular
proteases that have been most clearly linked to the process of ECM
assembly [39] (figure
2). Fibrillar collagens (types I, II, III, V and XI) are
synthesized in precursor form, with each molecule having both N-
and C-terminal propeptide extensions [111, 112]. The propeptides
help maintain solubility during synthesis of the procollagen
molecule and are removed either just before or shortly after
secretion into the ECM. In the case of the major fibrillagen
collagens (types I, II and III), the C-propeptides are removed by
tolloid proteases, while the N-propeptides are removed by members
of the ADAMTS family (types -2, -3 and -14). Following cleavage of
propeptides, mature collagen molecules can then spontaneously
assemble into fibrils. Proteolytic processing of procollagens V and
XI is more complicated, with tolloids also being involved in the
cleavage of N-propeptides and furin-like enzymes contributing to
C-terminal maturation [113]. Most collagen fibrils are usually
heterotypic in nature, i.e. composed of different collagen types,
for examples collagen I/III/V fibrils in skin or collagen II/XI
fibrils in cartilage, and it is known that such heterotypic
interactions play a role in the regulation of collagen fibril
diameter [111]. In addition, variations in the rates and extent of
processing between different collagen types, particularly in the
N-terminal regions, also contribute to diameter regulation.
Collagen fibril assembly is further regulated by interactions with
members of the small leucine rich proteoglycans (SLRPs, including
decorin, fibromodulin, biglycan, osteoglycin), among which biglycan
and osteoglycin have been shown to be cleaved by tolloid proteases
[114, 115]. In the case of osteoglycin, the tolloid-dependent
processing potentiates inhibition of collagen fibril assembly. Once
assembled, collagen fibrils are stabilised by the formation of
covalent crosslinks between neighbouring molecules, in a process
catalysed by cross-linking enzymes such as lysyl oxidases and
transglutaminases [116, 117]. Lysyl oxidases are themselves
synthesized in a precursor form, and can be activated by tolloid
protease cleavage of propeptides [118]. In addition, lysyl oxidases
also act on elastin fibres as well as in bFGF and TGF-β signalling
[119]. With regard to the basement membrane, tolloid proteases
regulate the assembly of anchoring filaments, involved in
stabilizing the dermal-epidermal junction, by propeptide cleavage
of the non-fibrillar procollagen VII [42], as well as incorporation
of laminin 332, by processing of the γ2 chain [41] (figure 2). Bearing in mind
that tolloid proteases also catalyze the first step of TGF-β
release from the matrix and that TGF-β increases the expression of
most matrix components, tolloid proteases appear therefore as major
hubs in the control of ECM assembly.
Conversion of granulation tissue into the mature form is a
process that can take several months and rarely results in the same
structural and functional properties as those of the original
tissue [54]. Remodelling requires the coordinated action of
numerous proteases involved in ECM degradation and synthesis
(essentially MMPs and ADAMTSs for the degradative part; table 1) as
well as in the control of cell proliferation, differentiation,
adhesion, migration and death, through the various mechanisms
described above. In adults, the end result of the remodelling phase
is often a scar [120] which reflects differences in the processes
of repair and regeneration, where the former has evolved as a means
to escape danger by rapid recovery of tissue integrity [121]. Scars
are characterized by dense bundles of mostly type I collagen
fibrils which appear to form during the process of wound
contraction and become oriented along lines of mechanical stress
[122, 123]. Wound contraction is thought to be due to the action of
fibroblasts remodelling the ECM, to which they are attached through
integrin receptors, either by tractional forces as they migrate
through the matrix or by contraction after having differentiated
into myofibroblasts [106, 124]. The process can be mimicked by
cells in collagen gels, where it has been shown that contraction
involves the synergistic effects of both α2β1
integrin and MMPs [125], the former mediating cell-matrix
interactions and the latter facilitating cell migration through the
matrix.
Conclusion
In this review, we have described the main families of proteases
involved in wound healing and have given an overview of their main
biological functions, all of which fall into one of the following
categories: ECM synthesis and degradation; release of cryptic
bioactive fragments; regulation of growth factors and cytokines;
control of cell adhesion, migration, apoptosis and signalling.
While the actors involved in the coordinated progression of the
wound healing process are known (proteases, growth factors, other
cytokines, matrix proteins and their fragments), much work remains
to be done to define all the possible interactions involved. Many
missing links remain between observations at the molecular and
tissue levels, thereby providing major obstacles in the way of a
more integrative picture of wound healing and other remodelling
processes. Fortunately however, new experimental approaches are
being developed that will certainly help to define the relevance of
specific proteolytic events in particular tissue contexts.
First, new imaging techniques are opening up new possibilities
for the direct visualisation of proteolytic activity and
remodelling both in vitro and in vivo. For example, visualisation
of proteolytic cell migration through collagen gels has been shown
to lead to re-organisation and alignment of collagen fibres [109].
Similarly, both large scale and local movements of ECM filaments,
the latter driven by cell migration, have been observed by
time-lapse imaging in developing embryos [126]. In addition, the
use of timer reporters has allowed specific molecules to be tracked
during morphogenetic changes, as for example during elastin
assembly [127]. Finally, both fluorescent and radioactively
labelled activity-based probes have been developed to directly
visualise sites of proteolytic activity in situ, as opposed to
antibody-based methods which usually do not distinguish between
precursor and active forms. Such probes are easily designed for
serine and cysteine proteases, for which numerous suicide
substrates are known, but probes targeting metalloproteases are
also under development with interesting results [128].
Also, the discovery of new protease substrates in cell-based
assays has gained in efficiency with the development of
quantitative proteomics and its application to proteases [1, 66].
Using iTRAQ (isobaric Tags for Relative and Absolute
Quantification) and SILAC (Stable Isotope Labelling by Amino-acids
in cell Culture) technologies, it is now possible, in one single
experiment, to identify a large proportion of the proteins (and
their fragments) found in a defined proteome and to quantify their
relative abundances in several biological contexts (typically in
the presence and absence of a protease).
Together with knock-out mice, these new developments should
contribute towards establishing the complex network of interactions
involved in each particular remodelling event and permit the use of
this knowledge to devise optimized therapeutic strategies.
Acknowledgements
We thank Daniel Kronenberg and Jean-Yves Exposito for helpful
comments on the manuscript. Original work from the authors’
laboratory was funded by grants from the European Commission
(NMP2-CT-2003-504017), the Fondation Coloplast, the Région
Rhône-Alpes, the Agence National de la Recherche, the Ligue Contre
le Cancer, the CNRS and the Université Claude Bernard Lyon 1.
Conflict of interest: none.
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