The authors are thankful to the nurses at the AMC that have facilitated the tissue collection. We would also like to acknowledge A.M.A. van der Laan for excellent technical support with the SHG and the two-photon imaging.

This protocol follows the LUMC and AMC guidelines of human research ethics committee.
1. Surgical Procedure and Tissue Collection
Note: Although various techniques for surgical excision of Dupuytren&#8217;s contracture exist, the current gold standard is the partial fasciectomy 15. Most patients are treated in the day-surgery clinic.
<ol>
	<li>Perform surgery under general or regional anesthesia according to patient&#39;s and anaesthesiologist&#39;s pre...

<ol>
	<li>Shih, B., Bayat, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scientific+understanding+and+clinical+management+of+Dupuytren+disease.">Scientific understanding and clinical management of Dupuytren disease.</a> Nat Rev Rheumatol. 6 (12), 715-726 (2010).</li><li>Bisson, M. A., McGrouther, D. A., Mudera, V., Grobbelaar, A. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+different+characteristics+of+Dupuytren's+disease+fibroblasts+derived+from+either+nodule+or+cord:+expression+of+&#945;-smooth+muscle+actin+and+the+response+to+stimulation+by+TGF-&#946;1.">The different characteristics of Dupuytren's disease fibroblasts derived from either nodule or cord: expression of &#945;-smooth muscle actin and the response to stimulation by TGF-&#946;1.</a> The Journal of Hand Surgery. 28 (4), 351-356 (2003).</li><li>Brickley-Parsons, D., Glimcher, M. J., Smith, R. J., Albin, R., Adams, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biochemical+changes+in+the+collagen+of+the+palmar+fascia+in+patients+with+Dupuytren's+disease.">Biochemical changes in the collagen of the palmar fascia in patients with Dupuytren's disease.</a> The Journal of Bone &amp; Joint Surgery. 63 (5), 787-797 (1981).</li><li>Berndt, A., Kosmehl, H., Katenkamp, D., Tauchmann, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Appearance+of+the+myofibroblastic+phenotype+in+Dupuytren's+disease+is+associated+with+a+fibronectin,+laminin,+collagen+type+IV+and+tenascin+extracellular+matrix.">Appearance of the myofibroblastic phenotype in Dupuytren's disease is associated with a fibronectin, laminin, collagen type IV and tenascin extracellular matrix.</a> Pathobiology. 62 (2), 55-58 (1994).</li><li>Karkampouna, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+ex+vivo+culture+method+for+the+study+of+Dupuytren's+disease:+effects+of+TGF&#946;+type+1+receptor+modulation+by+antisense+oligonucleotides.">Novel ex vivo culture method for the study of Dupuytren's disease: effects of TGF&#946; type 1 receptor modulation by antisense oligonucleotides.</a> Mol Ther Nucleic Acids. 3, e142 (2014).</li><li>Kruithof-de Julio, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Canonical+Wnt+signaling+regulates+Nkx3.1+expression+and+luminal+epithelial+differentiation+during+prostate+organogenesis.">Canonical Wnt signaling regulates Nkx3.1 expression and luminal epithelial differentiation during prostate organogenesis.</a> Developmental Dynamics. 242 (10), 1160-1171 (2013).</li><li>Krause, C., Kloen, P., ten Dijke, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Elevated+transforming+growth+factor+&#946;+and+mitogen-activated+protein+kinase+pathways+mediate+fibrotic+traits+of+Dupuytren's+disease+fibroblasts.">Elevated transforming growth factor &#946; and mitogen-activated protein kinase pathways mediate fibrotic traits of Dupuytren's disease fibroblasts.</a> Fibrogenesis &amp; Tissue Repair. 4 (1), 14 (2011).</li><li>Gorman, D. B., Wu, Y., Seney, S., Zhu, R. D., Gan, B. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wnt+expression+is+not+correlated+with+beta-catenin+dysregulation+in+Dupuytren's+Disease.">Wnt expression is not correlated with beta-catenin dysregulation in Dupuytren's Disease.</a> J Negat Results Biomed. 5, 13 (2006).</li><li>Streuli, C. H., Schmidhauser, C., Kobrin, M., Bissell, M. 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S., Karlsmark, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Models+for+use+in+wound+healing+research:+A+survey+focusing+on+in+vitro+and+in+vivo+adult+soft+tissue.">Models for use in wound healing research: A survey focusing on in vitro and in vivo adult soft tissue.</a> Wound Repair and Regeneration. 8 (2), 83-96 (2000).</li><li>Gudjonsson, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+and+tumor-derived+myoepithelial+cells+differ+in+their+ability+to+interact+with+luminal+breast+epithelial+cells+for+polarity+and+basement+membrane+deposition.">Normal and tumor-derived myoepithelial cells differ in their ability to interact with luminal breast epithelial cells for polarity and basement membrane deposition.</a> Journal of Cell Science. 115 (1), 39-50 (2002).</li><li>Xu, R., Boudreau, A., Bissell, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tissue+architecture+and+function:+dynamic+reciprocity+via+extra-+and+intra-cellular+matrices.">Tissue architecture and function: dynamic reciprocity via extra- and intra-cellular matrices.</a> Cancer and Metastasis Reviews. 28 (1-2), 167-176 (2009).</li><li>Jokinen, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integrin-mediated+cell+adhesion+to+type+I+collagen+fibrils.">Integrin-mediated cell adhesion to type I collagen fibrils.</a> Journal of Biological Chemistry. 279 (30), 31956-31963 (2004).</li><li>Au-Yong, I. T. H., Wildin, C. J., Dias, J. J., Page, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+common+practice+in+Dupuytren+surgery.">A review of common practice in Dupuytren surgery.</a> Techniques in Hand &amp; Upper Extremity Surgery. 9 (4), 178-187 (2005).</li><li>Deries, M., Collins, J. J. P., Duxson, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mammalian+myotome:+a+muscle+with+no+innervation.">The mammalian myotome: a muscle with no innervation.</a> Evolution &amp; Development. 10 (6), 746-755 (2008).</li><li>Deries, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extracellular+matrix+remodeling+accompanies+axial+muscle+development+and+morphogenesis+in+the+mouse.">Extracellular matrix remodeling accompanies axial muscle development and morphogenesis in the mouse.</a> Developmental Dynamics. 241 (2), 350-364 (2012).</li><li>Martins, G. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dynamic+3D+Cell+Rearrangements+Guided+by+a+Fibronectin+Matrix+Underlie+Somitogenesis.">Dynamic 3D Cell Rearrangements Guided by a Fibronectin Matrix Underlie Somitogenesis.</a> PLoS ONE. 4 (10), e7429 (2009).</li><li>Yokomizo, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Whole-mount+three-dimensional+imaging+of+internally+localized+immunostained+cells+within+mouse+embryos.">Whole-mount three-dimensional imaging of internally localized immunostained cells within mouse embryos.</a> Nat. Protocols. 7 (3), 421-431 (2012).</li><li>Karkampouna, S., de Julio, M. K. r. u. i. t. h. o. f. -. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fibrosis:+a+novel+approach+for+an+old+problem.">Fibrosis: a novel approach for an old problem.</a> Receptors &amp; Clinical Investigation. 1 (5), (2014).</li><li>Wolf, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Collagen-based+cell+migration+models+in+vitro+and+in+vivo.">Collagen-based cell migration models in vitro and in vivo.</a> Seminars in Cell &amp; Developmental Biology. 20 (8), 931-941 (2009).</li><li>Freund, I., Deutsch, M., Sprecher, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Connective+tissue+polarity.+Optical+second-harmonic+microscopy,+crossed-beam+summation,+and+small-angle+scattering+in+rat-tail+tendon.">Connective tissue polarity. 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The most critical steps of culturing ex vivo human connective tissue are the immediate use of the tissue after surgical removal to ensure viability; the tissue should remain in medium or saline solution at all times; maintain a sterile culture; transverse sections of tissue should have maximum 200 &#181;m thickness; set up of the ex vivo culture system is optimal when tissue is in contact with the medium but not fully submerged. Medium should be added only on the outside chamber of the transwell in a sm...

Dupuytren&#39;s disease (DD), a benign fibroproliferative disease causes permanent flexion of the fingers due to the formation of nodules and cords in the palm of the hand. Although the disease spread is particularly high among Caucasians of Northern Europe, the underlying genetic etiology of the disease remains unknown 1. The main characteristic of DD is the excess production of extracellular matrix (ECM) proteins (e.g., collagen), which form a tough fibrous tissue occupying the space between the tendons and skin of the palm of the hand and fingers, permanently disrupting the fine movements of the hand 2, 3. The recurrence of the disease suggests underlying genetic alterations as a cause of fibrosis 1, 4. An effective treatment could be to target directly the uncontrollable fibrotic mechanisms at the cellular and molecular level.
Our recent work on fibrosis has led us to the development of a novel 3D culture system that allows short-term culture of human fibrotic tissue with the potential of drug testing. This system has helped to overcome the limiting approach of 2D fibroblast cultures and to define a role for the partial down regulation, achieved by exon skipping, of TGF&#946; pathway activation in mediating fibrosis 5.
We have developed a method to culture ex vivo human resection specimens from DD patients to study the interaction between myofibroblasts and the surrounding ECM 5, 6. The study of DD connective tissue fibrosis as well as other fibrotic diseases relies on histopathological analysis of the excised surgical specimens, isolation of fibroblasts from the tissue and establishment of primary cultures or cell sorting procedures. These approaches are quite static since they do not permit exogenous manipulation of the disease properties or therapeutic intervention by the experimenter. In addition, primary cell cultures tend to adapt to the culture conditions and their gene expression properties differ essentially from the in vivo situation upon every passage, even during early passages (among passage 3 and 6) 7, 8. We have managed to maintain the waste surgical material in ex vivo culture conditions for a time period that allows study of the patient-specific characteristics and screening of anti-fibrotic or anti-inflammatory drug compounds.
The system is based on a nitrocellulose membrane that permits contact of the tissue with the medium but not with the plastic, thus, preventing the alteration of the tissue upon attachment, as previously observed when culturing DD fibroblasts as well as other cell types 9. No collagen gel or other ECM protein substrate is required, since the DD tissue itself produces large amounts of these proteins. This is advantageous for the maintenance of native ECM microenvironment and turnover since matrix substrates are important regulator of tissue architecture and function 10, 11. For instance, ECM proteins such as fibronectin, laminin and collagen, may influence front-rear polarity of fibroblasts as similarly shown for apical-basal polarity in epithelial cells 12, 13. Polarized cells have asymmetrical distribution of extracellular molecules which determines cell migration and gene expression, e.g., &#945;1&#946;1 integrin accessibility on the membrane affects cell adhesion to type I collagen14. Since a primary goal of this 3D model was to preserve the native microenvironment, no artificial ECM matrix substrate was used.
In brief: resection specimens are equally cut in a sterile environment and placed on nitrocellular membranes. If treatment administrated via injection is required the tissues are injected after they have been placed on the membrane. If treatment does not require to be administrated via injection then the compound is added to the culture media (Dulbecco&#8217;s Modified Eagle&#8217;s Medium (DMEM), with 1% fetal calf serum (FCS), 1% penicillin-streptomycin (P/S)). The cultures are maintained for a maximum of ten days after which the tissue is fixed in 4% paraformaldehyde (PFA), processed through 30% sucrose solution, embedded in O.C.T. compound and stored at -80 &#176;C, as previously described 5.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Dulbecco&#8217;s Modified Eagle&#8217;s Medium</td>
			<td>Invitrogen</td>
			<td>11965-084</td>
			<td></td>
		</tr>
		<tr>
			<td>fetal calf serum (FCS)</td>
			<td>Gibco</td>
			<td></td>
			<td>high glucose, heat inactivated</td>
		</tr>
		<tr>
			<td>penicillin-streptomycin</td>
			<td>Invitrogen</td>
			<td>15070-063</td>
			<td></td>
		</tr>
		<tr>
			<td>Cell culture inserts</td>
			<td>Millicell</td>
			<td>PIHA01250</td>
			<td>0.45um pore size, 12mm diameter</td>
		</tr>
		<tr>
			<td>anti-collagen type I</td>
			<td>Southern Biotech</td>
			<td>1310-08</td>
			<td></td>
		</tr>
		<tr>
			<td>anti- &#945; smooth muscle actin</td>
			<td>Sigma</td>
			<td>A2547</td>
			<td></td>
		</tr>
		<tr>
			<td>anti-collagen type III</td>
			<td>Southern Biotech</td>
			<td>1330-01</td>
			<td></td>
		</tr>
		<tr>
			<td>Alexa Fluor555 Donkey Anti-Mouse IgG (H+L)</td>
			<td>Invitrogen</td>
			<td>A-31570</td>
			<td></td>
		</tr>
		<tr>
			<td>Alexa Fluor 488 Donkey Anti-Goat IgG (H+L) Antibody</td>
			<td>Invitrogen</td>
			<td>A-11055</td>
			<td></td>
		</tr>
		<tr>
			<td>TOPRO-3</td>
			<td>Invitrogen</td>
			<td>T3605</td>
			<td></td>
		</tr>
		<tr>
			<td>methylsalicylate</td>
			<td>Sigma</td>
			<td>M6752</td>
			<td></td>
		</tr>
		<tr>
			<td>paraformaldehyde</td>
			<td>Sigma</td>
			<td>P6148</td>
			<td></td>
		</tr>
		<tr>
			<td>Tissue Tek OCT</td>
			<td>Sakura</td>
			<td>25608-930</td>
			<td></td>
		</tr>
		<tr>
			<td>Microsccope glass coverslips</td>
			<td>Menzel-Glaser</td>
			<td>BB024060A1</td>
			<td>24x60mm</td>
		</tr>
		<tr>
			<td>Microscope SuperFrost slides</td>
			<td>Menzel-Glaser</td>
			<td>AA00000102E</td>
			<td>76x26mm</td>
		</tr>
		<tr>
			<td>VECTASHIELD HardSet Mounting Medium</td>
			<td>Vector laboratories</td>
			<td>H-1400</td>
			<td></td>
		</tr>
		<tr>
			<td>Leica TCS SP5 II confocal microscope</td>
			<td>Leica Microsystems</td>
			<td></td>
			<td>Argon-488, 514 nm and HeNe-633 nm laser lines</td>
		</tr>
		<tr>
			<td>Zeiss 710 NLO upright confocal microscope</td>
			<td>Jena, Germany</td>
			<td></td>
			<td>equipped with femtosecond Spectra - Physics Deep See MP laser (Santa Clara, United States) using a Plan -Apochromat 20x/1.0 NA 
			water-immersion objective.</td>
		</tr>
	</tbody>
</table>

human dupuytren's ex vivo culture for the study of myofibroblasts and extracellular matrix interactions

Organ fibrosis or &#8220;scarring&#8221; is known to account for a high death toll due to the extensive amount of disorders and organs affected (from cirrhosis to cardiovascular diseases). There is no effective treatment and the in vitro tools available do not mimic the in vivo situation rendering the progress of the out of control wound healing process still enigmatic.
To date, 2D and 3D cultures of fibroblasts derived from DD patients are the main experimental models available. Primary cell cultures have many limitations; the fibroblasts derived from DD are altered by the culture conditions, lack cellular context and interactions, which are crucial for the development of fibrosis and weakly represent the derived tissue. Real-time PCR analysis of fibroblasts derived from control and DD samples show that little difference is detectable. 3D cultures of fibroblasts include addition of extracellular matrix that alters the native conditions of these cells. 
As a way to characterize the fibrotic, proliferative properties of these resection specimens we have developed a 3D culture system, using intact human resections of the nodule part of the cord. The system is based on transwell plates with an attached nitrocellulose membrane that allows contact of the tissue with the medium but not with the plastic, thus, preventing the alteration of the tissue. No collagen gel or other extracellular matrix protein substrate is required. The tissue resection specimens maintain their viability and proliferative properties for 7 days. This is the first &#8220;organ&#8221; culture system that allows human resection specimens from DD patients to be grown ex vivo and functionally tested, recapitulating the in vivo situation.

The method of ex vivo, 3D culture of connective tissue is an easy and robust set up system to understand the relation between ECM and other cell components constituting the DD tissue and potentially other types of fibrosis as well. Moreover this system allows a reliable method to test the effects of compounds on different cell types and their effects on the fibrotic load 20.
The steps from collection of surgical waste material derived from Dupuytren&#8217;s fibrosis, the as...

Watch this Scientific Journal Video about Human Dupuytren's Ex Vivo Culture for the Study of Myofibroblasts and Extracellular Matrix Interactions at JoVE.com

Human Dupuytren&#039;s Ex Vivo Culture for the Study of Myofibroblasts and Extracellular Matrix Interactions

Dupuytren&#8217;s disease (DD) is a fibroproliferative disease of the palm of the hand. Here, we present a protocol to culture resection specimens from DD in a three-dimensional (3D) culture system. Such short-term culture system allows preservation of the 3D structure and molecular properties of the fibrotic tissue.

Human Dupuytren's Ex Vivo Culture for the Study of Myofibroblasts and Extracellular Matrix Interactions

Organ fibrosis or &#8220;scarring&#8221; is known to account for a high death toll due to the extensive amount of disorders and organs affected (from ...

human-dupuytren-s-ex-vivo-culture-for-study-myofibroblasts

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JoVE Journal

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10.3K Views.  Leiden University Medical Center.  Malattia di Dupuytren (DD) è una malattia fibroproliferativa del palmo della mano. Qui vi presentiamo un protocollo per i campioni della cultura di resezione di DD in un tridimensionale (3D) sistema di coltura. Tale sistema di coltura a breve termine permette conservazione della struttura 3D e proprietà molecolari del tessuto fibrotico. 