Activation of hepatic stellate cells (HSCs) and subsequent uncontrolled accumulation of altered extracellular matrix (ECM) underpin liver fibrosis, a wound healing response to chronic injury, which can lead to organ failure and death. We sought to catalogue the components of fibrotic liver ECM to obtain insights into disease etiology and aid identification of new biomarkers. Cell-derived ECM was isolated from the HSC line LX-2, an in vitro model of liver fibrosis, and compared to ECM from human foreskin fibroblasts (HFFs) as a control. Mass spectrometry analyses of cell-derived ECMs identified, with ≥99% confidence, 61 structural ECM or secreted proteins (48 and 31 proteins for LX-2 and HFF, respectively). Gene ontology enrichment analysis confirmed the enrichment of ECM proteins, and hierarchical clustering coupled with protein-protein interaction network analysis revealed a subset of proteins enriched to fibrotic ECM, highlighting the existence of cell type-specific ECM niches. Thirty-six proteins were enriched to LX-2 ECM as compared to HFF ECM, of which Wnt-5a and CYR61 were validated by immunohistochemistry in human and murine fibrotic liver tissue. Future studies will determine if these and other components may play a role in the etiology of hepatic fibrosis, serve as novel disease biomarkers, or open up new avenues for drug discovery.
Activation of hepatic stellate cells (HSCs) and subsequent uncontrolled accumulation of altered extracellular matrix (ECM) underpin liver fibrosis, a wound healing response to chronic injury, which can lead to organ failure and death. We sought to catalogue the components of fibrotic liver ECM to obtain insights into disease etiology and aid identification of new biomarkers. Cell-derived ECM was isolated from the HSC line LX-2, an in vitro model of liver fibrosis, and compared to ECM from human foreskin fibroblasts (HFFs) as a control. Mass spectrometry analyses of cell-derived ECMs identified, with ≥99% confidence, 61 structural ECM or secreted proteins (48 and 31 proteins for LX-2 and HFF, respectively). Gene ontology enrichment analysis confirmed the enrichment of ECM proteins, and hierarchical clustering coupled with protein-protein interaction network analysis revealed a subset of proteins enriched to fibrotic ECM, highlighting the existence of cell type-specific ECM niches. Thirty-six proteins were enriched to LX-2 ECM as compared to HFF ECM, of which Wnt-5a and CYR61 were validated by immunohistochemistry in human and murinefibrotic liver tissue. Future studies will determine if these and other components may play a role in the etiology of hepatic fibrosis, serve as novel disease biomarkers, or open up new avenues for drug discovery.
Extracellular matrix (ECM) is a critical
component of the tissue
microenvironment.[1,2] Continuous ECM remodelling in
the setting of chronic injury leads to an excessive accumulation of
extracellular proteins, proteoglycans, and carbohydrates.[3−5] The resultant pathological state, termed fibrosis, is responsible
for the morbidity and mortality associated with organ failure in a
variety of chronic diseases that affect a wide range of organs, including
the liver, intestines, lungs, kidneys, eyes, heart, pancreas, and
skin. To date, no clinically proven therapeutic strategy exists to
reverse or prevent fibrosis. Elucidating the underlying mechanisms
responsible for abnormal ECM deposition is therefore an increasingly
pressing and important health challenge.Central to this challenge
is the need to characterize the qualitative
and quantitative changes in ECM protein composition that occur during
fibrotic progression and the effects these changes have on cell behavior.
In liver fibrosis, changes in ECM composition are driven by hepatic
stellate cells (HSCs), which upon chronic exposure to inflammatory
cues become activated and trans-differentiate into proliferative myofibroblast
cells.[6] Once activated, HSCs up-regulate
gene expression of ECM components, matrix-degrading enzymes, and their
respective inhibitors, which in turn results in matrix remodelling
and ECM accumulation at sites containing high densities of activated
HSCs.[6] The balance between ECM deposition
and remodelling determines whether fibrosis progresses or regresses.[7] In addition, there is increasing evidence that
key facets of HSC biology are regulated by the pericellular ECM. For
example, type I collagen, which is postulated to be the major component
of fibrosis, has been reported to enhance proliferation of HSCs in vitro,[7,8] whereas transfer of activated
HSCs from a type I collagen substrate to a basement membrane-like
matrix (Matrigel) can inhibit proliferation of HSCs as well as production
of fibrogenic proteins.[8,9] Furthermore, the regulation of
HSC behavior by the extracellular microenvironment is believed to
occur via integrin signaling.[9,10] Thus, an understanding
of the adhesion-dependent mechanisms that determine HSC behavior could
help uncover novel therapeutic targets.A large body of recent
work has concentrated on elucidating mechanisms
of fibrotic regression[11] and identifying
biomarkers of liver fibrosis.[12] We hypothesized
that a more detailed knowledge of the composition of fibrotic ECM
would inform both of these aims. Therefore, we employed SDS-PAGE separation
and mass spectrometry (GeLC–MS)-based proteomics to catalogue
the constituents of fibrotic ECM. Though proteomics has been used
to study liver fibrosis[13] and ECM changes
during transition from late-stage fibrosis to cancer,[14] no previous studies have focused exclusively on an enriched
liver ECM fraction, reflecting the fact that the ECM is a relatively
unexplored proteome.[15] A common approach
taken to aid the successful analysis of a subcellular compartment
using a mass spectrometry (MS)-based approach is the reduction of
sample complexity. We therefore implemented a strategy that enriched
for functionally relevant ECM[16] (which
has recently been employed upstream of MS analysis[17]), using the LX-2 cell line as a model of HSC-induced liver
fibrosis in vitro(18) and
dermal fibroblasts as a non-hepatic control. The resultant ECM catalogues
were interrogated using a variety of bioinformatic tools, and immunohistochemical
staining was used to validate potentially novel and interesting protein
targets. Using this approach, we identified two previously unreported
ECM proteins in fibrotic liver and provide evidence for the expression
of many other ECM proteins within fibrotic tissue.
Experimental Section
Antibodies
Antibodies used for Western blotting and
immunofluorescence were polyclonal rabbit immunoglobulin G (IgG) directed
against humanfibronectin (F3648; Sigma-Aldrich, Poole, U.K.) and
fibrillin (provided by C. Kielty, University of Manchester, U.K.).
Donkey anti-rabbitIgG conjugated to IRDye 800 (Rockland Immunochemicals,
Gilbertsville, PA) was used for Western blotting detection, and donkey
anti-rabbitIgG conjugated to an Alexa Fluor tag (Jackson ImmunoResearch
Laboratories, Inc., West Grove, PA) was used for immunofluorescence.
Antibodies used for immunohistochemistry were monoclonal rabbitIgG
directed against human and mouseWnt-5a (IMG-6075; Imgenex, San Deigo,
CA), polyclonal rabbitIgG directed against human and mouseCYR61
(Abnova, Taipei City, Taiwan) and polyclonal rabbitIgG directed against
humanfibulin-2 (Santa Cruz Biotechnology, Inc., Santa Cruz, CA).
Goat anti-rabbit or anti-mouse IgG1 conjugated to biotin were used
for immunohistochemical detection (ABC staining system, Santa Cruz
Biotechnology, Inc.).
Cell Culture
The activated humanHSC line LX-2[18] (provided by J. Iredale, Edinburgh University,
U.K.) and human foreskin fibroblasts (HFFs; provided by K. Clark,
University of Leicester, U.K.) were cultured in Dulbecco’s
minimal essential medium (DMEM; Sigma-Aldrich) supplemented with 10%
(v/v) fetal calf serum (FCS) and 2 mM l-glutamine. Cells
were maintained at 37 °C in a humidified 5% (v/v) CO2 atmosphere. To isolate HFFs, human neonatal foreskins were sourced
from the Cooperative Human Tissue Network. The foreskins were washed
and minced into small chunks (<1 mm). The tissue chunks were dispersed
in a cell culture dish containing DMEM supplemented with 50% (v/v)
FCS, 2 mM l-glutamine, penicillin–streptomycin, Fungizone,
and gentamicin. When cells migrated out of the tissue, FCS concentration
was reduced to 10% (v/v), and cells were then passaged at confluence
with trypsin/EDTA and cultured as described above.
Flow Cytometry
Details of flow cytometric analyses
are provided in the Supporting Information.
ECM Purification
To generate cell-derived matrices
(CDMs), 10 cm diameter cell culture dishes were coated with 0.2% (w/v)
sterile gelatin (Sigma-Aldrich) for 60 min at 37 °C. After equilibration
of gelatin-coated dishes with growth medium, primary fibroblasts (1
× 106 cells/mL) were plated onto dishes and cultured
for a range of times (from 5 to 14 days), changing the growth medium
every 3 days. To purify ECM, cells were removed using a modification
of a previously published protocol.[16] In
brief, growth medium was aspirated and cells were washed with PBS.
CDMs were denuded of cells by lysis with 20 mM NH4OH and
0.5% (v/v) Triton X-100 (Sigma-Aldrich) in PBS for 1 min at 37 °C,
followed by digestion with 10 μg/mL DNase I (Roche Diagnostics,
Burgess Hill, U.K.) for 60 min at 37 °C. CDMs were recovered
in reducing sample buffer [50 mM Tris-HCl, pH 6.8, 10% (w/v) glycerol,
4% (w/v) sodium dodecylsulfate (SDS), 0.004% (w/v) bromophenol blue,
8% (v/v) β-mercaptoethanol] by scraping (Greiner Bio-One GmbH,
Frickenhausen, Germany). Protein samples were resolved by SDS–polyacrylamide
gel electrophoresis (PAGE) and subjected to Western blotting, immunofluorescence
or MS as described below.
Western Blotting
Following SDS-PAGE, resolved proteins
were transferred to nitrocellulose membrane (Whatman, Maidstone, U.K.).
Membranes were blocked with casein blocking buffer (Sigma-Aldrich)
and probed with primary antibodies diluted in blocking buffer containing
0.05% (v/v) Tween 20. Membranes were washed with Tris-buffered saline
(10 mM Tris-HCl, pH 7.4, 150 mM NaCl) containing 0.05% (v/v) Tween
20 and incubated with species-specific fluorescent dye-conjugated
secondary antibodies diluted in blocking buffer containing 0.05% (v/v)
Tween 20. Membranes were washed in the dark and then scanned using
an Odyssey infrared imaging system (LI-COR Biosciences, Cambridge,
U.K.) to visualize bound antibodies.
Coomassie Blue Staining
Following SDS-PAGE, total protein
was visualized by incubating gels in Coomassie staining solution [0.025%
(w/v) Coomassie Brilliant Blue R-250, 10% (v/v) acetic acid, 25% (v/v)
propanol] for 60 min at room temperature. Gels were then destained
in 10% (v/v) acetic acid, washed with distilled H2O, and
scanned using the Odyssey imaging system.
GeLC–MS and data analysis
In-Gel Proteolytic Digestion
In-gel digestion with
trypsin was carried out as described by Shevchenko et al.[19] with adaptations for processing in 96-well plates
as described by Humphries et al.[20] Briefly,
following Coomassie Blue staining, gels were cut into 30 slices per
lane and chopped into ∼1 mm3 pieces, washed with
acetonitrile (ACN), reduced (10 mM dithiothreitol, 25 mM NH4HCO3), alkylated (55 mM iodoacetamide, 25 mM NH4HCO3), and digested with 12.5 ng/μL sequencing-grade
modified trypsin (Promega, Southampton, U.K.). Peptides were extracted
once with 20 mM NH4HCO3 and two times with 5%
(v/v) formic acid in 50% (v/v) ACN, and then concentrated to 20 μL
by vacuum centrifugation. Samples were stored at −20 °C
until analysis by liquid chromatography–tandem mass spectrometry
(LC–MS/MS).
LC–MS/MS Analysis
LC–MS/MS analysis was
performed using a nanoACQUITY UltraPerformance LC system (Waters,
Elstree, U.K.) coupled online to a 4000 Q TRAP triple-quadrupole linear
ion trap analyzer (Applied Biosystems, Framingham, MA, USA), as described
previously.[20] Samples (5 μL) were
concentrated and desalted on a Symmetry C18 preparative
column (20 mm length, 180 μm inner diameter, 5 μm particle
size, 100 Å pore size; Waters). Peptides were separated on an
ACQUITY UltraPerformance LC bridged ethyl hybrid C18 analytical
column (100 mm length, 75 μm inner diameter, 1.7 μm particle
size, 130 Å pore size; Waters) using a 40-min linear gradient
from 1% to 30% (v/v) ACN in 0.1% (v/v) formic acid at a flow rate
of 300 nL/min at 50 °C. The mass spectrometer was instructed
to acquire enhanced-resolution and product ion scans for peptides
with ion counts greater than 250,000 counts/s, with a precursor ion
mass-to-charge ratio (m/z) selection
window of m/z 400–1600. Information-dependent
acquisition (Analyst, version 1.4.1; Applied Biosystems) was used
to acquire tandem mass spectra over the range m/z 140–1400 for the two most intense peaks, which
were excluded for 12 s after two occurrences. Spectra were extracted,
charge-state deconvoluted and deisotoped using the default setting
of the Mascot Search script (mascot.dll, version 1.6b9; Matrix Science,
London, U.K.) as a plug-in for Analyst.Peak list files were
searched against a modified version of the IPI human database (version
3.34, release date second October 2007, containing 67,756 sequences)
containing 10 additional contaminant/reagent sequences of non-human
origin. Searches were submitted to an in-house Mascot server (version
2.2.03; Matrix Science).[21] Carbamidomethylation
of cysteine was set as a fixed modification and oxidation of methionine
was allowed as a variable modification. Only tryptic peptides were
considered, with one missed cleavage permitted. Monoisotopic precursor
mass values were used, and only doubly and triply charged precursor
ions were considered. Mass tolerances for precursor and fragment ions
were 1.5 and 0.5 Da, respectively.To validate the proteomic
data sets generated by GeLC–MS,
multiple database search engines and rigorous statistical algorithms
at both the peptide and protein level were employed.[22,23] To achieve this, data validation was performed using Scaffold (versions
Scaffold_2_06_00 and Scaffold_3.1.2; Proteome Software, Portland,
OR). Database search files generated by Mascot were imported into
Scaffold and further analyzed using the search engine X! Tandem (version
2007.01.01.1) implemented from within Scaffold. X! Tandem searches
were conducted against the same protein sequence database and using
the same search parameters as the associated Mascot search, except
that X! Tandem allowed S-carbamoylmethylcysteine
cyclization (pyro-carbamidomethylation of cysteine) or conversion
of glutamine or glutamic acid to 2-pyrrolidone-5-carboxylic acid at
N-termini as variable modifications by default. Peptide identifications
were accepted if they could be established with at least 90% probability
as determined by the PeptideProphet algorithm.[22] Protein identifications were accepted if they were assigned
at least two unique, validated peptides and could be established with
at least 99% probability as determined by the ProteinProphet algorithm.[23] These thresholds resulted in a protein false
discovery rate (FDR) of 0.1% as calculated by Scaffold. Proteins that
contained shared peptide matches were grouped in Scaffold to satisfy
the principle of parsimony, such that the minimum set of proteins
that adequately accounted for all identified peptide sequences was
described. Further data analysis allowing oxidation of either lysine
or proline as a variable modification in Mascot resulted in the identification
of additional peptides, which matched almost exclusively to collagens.
These peptides did not increase the number of proteins identified
or significantly alter the abundance of any detected protein and,
due to score suppression as a result of database searching with multiple
variable modifications, these data were not used further.MS
data were converted using PRIDE Converter (version 2.5.3)[24] and deposited in the PRIDE database (http://www.ebi.ac.uk/pride)[25] under accession numbers 22483–22488.
Quantification Using Spectral Counting
Label-free quantification
of relative protein abundance was performed by spectral counting[26−28] using all spectra matched to a peptide sequence. Relative protein
abundance was calculated on the basis of the unweighted spectral count
assigned to each identified protein by Scaffold. The unweighted spectral
count includes spectra matched to peptides shared between multiple
proteins if there is independent evidence that these proteins are
present. To normalize the data, spectral counts were expressed as
a percentage of the total number of spectra observed in the entire
sample. Mean normalized spectral counts were calculated using data
from three independent LX-2 and HFF ECM isolations. Due to the method
of protein normalization and to avoid overinterpretation of quantitative
comparisons, normalized spectral counts were only compared between
HFF and LX-2 for the same protein, and conclusions based on the stoichiometry
of components of the ECM within an individual sample were not made.
Gene Ontology (GO) Enrichment Analysis
Official gene
symbols were mapped to all protein identifications, and the LX-2 and
HFF data sets were analyzed using the online bioinformatic tools available
via the Database for Annotation, Visualization and Integrated Discovery
(DAVID; http://david.abcc.ncifcrf.gov/home.jsp).[29,30] For clarity, only top-level GO terms from the Cellular Component
and Biological Process domains, second-level GO terms from the Molecular
Function domain, and KEGG Pathway terms were considered. Furthermore,
only terms with enrichment value ≥1.5, Bonferroni-corrected P-value <0.05, EASE score (modified Fisher Exact P-value) <0.05, and at least two genes per term were
considered. The background data set for the analyses was the Homo sapiens genome, and the most relevant term relating
to ECM or cell adhesion is shown for each category.
Hierarchical Clustering Analysis
Agglomerative hierarchical
clustering using quantitative data (mean normalized spectral counts)
was performed with Cluster 3.0 (C Clustering Library, version 1.37).[31] Protein hits were hierarchically clustered on
the basis of uncentered Pearson correlation, and distances between
hits were computed using a complete-linkage matrix. Clustering results
were visualized using Java TreeView (version 1.1.1)[32] and MultiExperiment Viewer (version 4.1.01).[33]
Statistical Analysis of Relative Protein Abundance from MS Data
Sets
Statistical analysis of differential spectral count
data between samples was performed using QSpec (http://www.nesvilab.org/qspec.php/).[34] QSpec uses Bayes statistics to test
pairwise differences between spectral count data, which are modeled
as observations from a Poisson distribution. Differential relative
protein abundances with Bayes factors ≥10 and natural-logarithm-transformed
fold changes ≥1.5 were selected. These parameters were chosen
to provide a conservative FDR estimate of <5% in accordance with
the modeled data of Choi et al.[34] For this
data set, positive fold changes represent proteins enriched to LX-2,
negative fold changes represent proteins enriched to HFF, and values
are represented as ln(fold change).
Interaction Network Analysis
Protein–protein
interaction (PPI) network analysis was performed essentially as described
by Humphries et al.[20] The open-source platform
Cytoscape (version 2.6.0)[35] was used to
visualize protein–protein interaction networks. Proteins annotated
as part of the ECM or secreted in the UniProt Knowledgebase (http://www.uniprot.org/; 61 proteins in total) were selected
and mapped onto the human Protein Interaction Network Analysis interactome
(release date fourth March 2010; http://csbi.ltdk.helsinki.fi/pina/home.do),[36] which consists of protein–protein
interaction data integrated from six public curated databases. Interactions
from the ECM-directed protein–protein interaction database
MatrixDB[37] (http://matrixdb.ibcp.fr) were added manually. It was possible to map 57 of the 61 ECM or
secreted proteins onto this interactome. Proteins were assigned by
hierarchical clustering as either LX-2-enriched, HFF-enriched, or
shared LX-2 and HFF identifications. Clustering assignments were mapped
as an attribute onto each protein (node) of the networks and represented
visually by node color. Model layouts were constructed using the attribute
circle layout implemented in Cytoscape.
Immunofluorescence
Cells were plated onto glass-bottom
dishes (MatTek, Ashland, MA) coated with 0.2% (v/v) gelatin. LX-2
or HFF cells were grown for 11 days before preparing CDMs as described
above. After DNase I treatment, CDMs were fixed with 3% (w/v) paraformaldehyde
for 15 min and then incubated with the appropriate primary and secondary
Alexa Fluor antibody conjugates for 60 and 45 min, respectively. Images
were collected on a TCS SP5 AOBS inverted confocal (Leica Microsystems
GmbH, Wetzlar, Germany) using a 60×/0.50 Plan Fluotar objective.
The confocal settings were as follows: pinhole 1 airy unit, scan speed
1000 Hz unidirectional, format 1024 × 1024. Images were collected
using the following detection mirror settings: FITC, 494–530
nm; Texas red, 602–665 nm; using the 488 nm (20%) and 594 nm
(100%) laser lines for FITC and Texas red, respectively. When acquiring
three-dimensional optical stacks, the confocal software was used to
determine the optimal number of Z sections, and maximum intensity
projections are shown in the results. Images were analyzed and processed
using ImageJ (National Institutes of Health, Bethesda, MD) and Photoshop
CS (Adobe Systems, Inc., San Jose, CA).
Immunohistochemistry
Archived fibrotic human liver
tissue specimens obtained for the clinical staging of chronic hepatitis
C infection were used, following approval from the Brent Research
Ethics committee. All sections stained were graded as moderately fibrotic
(Ishak score 3 to 4), and sections from a total of three patients
for Wnt-5a and CYR61 were used. Archived murinefibrotic liver tissue
was kindly supplied by Q. Anstee (Imperial College London, U.K.).
C57BL/6J mice, aged 6–8 weeks old, were treated with carbon
tetrachloride (CCl4) diluted in a corn-oil vehicle and
administered by intraperitoneal injection on alternate week days for
a period of 4 weeks, in accordance with local ethical approval and
the Animal (Scientific Procedures) Act 1986. The dose of CCl4 administered was increased weekly in a stepwise fashion until a
maximum dose of 1 mL CCl4 per kilogram body weight was
reached after 3 weeks. At completion, animals were culled, and liver
tissue was collected. Liver sections from three mice treated with
CCl4 to induce liver fibrosis were stained for both CYR61
and Wnt-5a as described below.All sections were cut at 5 μm
from the corresponding formalin-fixed paraffin-embedded tissue blocks.
Sections were dewaxed using xylene and then rehydrated in ethanol
using a standard histological protocol. Sections were treated with
0.3% (v/v) hydrogen peroxide in methanol for 30 min to block endogenous
peroxidase activity and then washed with PBS. For human liver tissue
sections, antigen retrieval was performed by microwaving sections
in 10 mM citrate buffer, pH 6.0, for 10 min and then washing with
PBS. All sections were incubated with 1.5% (v/v) normal goat serum
(ABC Staining System; Santa Cruz Biotechnology, Inc.) for 60 min.
Sections were then incubated either overnight at 4 °C with anti-Wnt-5a
(1:50 dilution for murine sections; 1:100 dilution for human sections),
anti-CYR61 (1:100 dilution for murine sections), or anti-fibulin-2
(1:200 dilution for human sections), or for two hours at room temperature
with anti-CYR61 (1:200 dilution for human sections). Sections were
washed in PBS and incubated with a biotinylated goat anti-rabbit or
goat anti-mouse secondary antibody (1:200 dilution; ABC Staining System)
for 60 min and then washed again in PBS. Sections were incubated with
an avidin-conjugated biotinylated horseradish peroxidase (1:50 dilution;
ABC Staining System) for 30 min and then treated with 3,3′-diaminobenzidine
tetrahydrochloride for 2 min, counterstained using hematoxylin, dehydrated,
and mounted using a nonaqueous mounting medium, and coverslips were
applied. Control slides were incubated as described above, but with
the omission of the primary antibody. Slides were visualized using
an Olympus BX50 microscope (Olympus, Southend-on-Sea, U.K.) under
fixed lighting conditions, and images were captured using NIS-Elements
(Nikon, Surrey, U.K.).
Results
Preparation and Isolation of HSC-Derived ECM
To gain
insights into the etiology of liver fibrosis, we sought to catalogue
the composition of fibrotic liver ECM using GeLC–MS. Remodelling
of the ECM during liver fibrosis is driven by HSCs, and HSC–ECM
interactions regulate HSC activation, proliferation, survival, and
cell cycle.[7] Isolation of HSC-derived ECM
from the liver is, however, confounded by the variety and complexity
of tissue structures and contributing cell types. We therefore isolated
ECM produced by the HSC cell line LX-2 as an established in
vitro model of liver fibrosis.[7,18,38]As a further validation of the use of the LX-2
cell line, knowing that the integrin family of adhesion receptors
plays a key role in mediating ECM engagement and organization,[39] we determined the expression profile of integrins
on LX-2 cells by flow cytometry. Using a panel of anti-integrin antibodies,
we detected cell-surface expression of α1, α2, α5,
α6, αV, β1, β3, and β5 integrin subunits,
but not α3, α4, β6, or β8 (Supplementary Figure S1). This integrin expression profile
was similar to the previously reported expression of α1, α2,
α5, α6, αV, β1, β3, and β4 in
primary HSCs,[10,40,41] supporting the use of the LX-2 cell line as a model for investigating
liver matrix biology.We next performed experiments to optimize
the isolation of CDM
from LX-2 cells. We adapted a previously described ECM purification
method to isolate CDMs from LX-2 cells by the rapid removal of cellular
proteins after 5, 7, 11, or 14 days of culture.[16] The synthesis and organization of ECM increased with time,
and correspondingly higher levels of ECM were isolated at later time
points (Figure 1A). Western blotting analysis
of CDM for known components of fibrotic ECM revealed the presence
of fibronectin and fibrillin. Enrichment of fibronectin was maximal
at 11–14 days of culture, and enrichment of fibrillin was maximal
at day 11 (Figure 1B). Thus, for all further
analyses, we chose to isolate CDMs after 11 days of culture to coincide
with maximal recovery of fibronectin and fibrillin and to reduce the
potential impact of cell death that occurred as cells became highly
confluent.
Figure 1
Isolation and characterization of CDMs. CDMs were generated from
LX-2 cells after 5, 7, 11, or 14 days. (A,B) Proteins were solubilized,
separated by SDS-PAGE and stained with Coomassie Brilliant Blue (A)
or Western blotted for fibronectin or fibrillin (B). Mkr denotes the position of molecular mass standards. (C) CDMs from
LX-2 cells and HFFs were processed for immunofluorescence, stained
with anti-fibronectin (green) and anti-fibrillin antibodies (red),
and images were collected by confocal microscopy.
Isolation and characterization of CDMs. CDMs were generated from
LX-2 cells after 5, 7, 11, or 14 days. (A,B) Proteins were solubilized,
separated by SDS-PAGE and stained with Coomassie Brilliant Blue (A)
or Western blotted for fibronectin or fibrillin (B). Mkr denotes the position of molecular mass standards. (C) CDMs from
LX-2 cells and HFFs were processed for immunofluorescence, stained
with anti-fibronectin (green) and anti-fibrillin antibodies (red),
and images were collected by confocal microscopy.To characterize the isolated CDMs further, we performed
immunofluorescence
analyses of ECMs generated from LX-2 cells and compared them to HFFs
as a non-hepatic myofibroblast control. ECM from both cell types stained
positively for fibronectin (Figure 1C), revealing
extensive networks of interconnecting fibronectin bundles. By contrast,
immunofluorescence staining for fibrillin revealed cell type-specific
differences between the CDMs, with increased incorporation of fibrillin
into the ECM of LX-2 cells as compared to HFFs (Figure 1C). The staining of fibrillin in LX-2CDM frequently co-aligned
with that of fibronectin (Figure 1C), consistent
with the presence of known binding sites for fibrillin within fibronectin.[2] Moreover, the increased staining for fibrillin
in LX-2-derived ECM is consistent with the previously reported increase
in fibrillin within fibrotic liver.[42,43] Together,
these data support the use of purified LX-2CDM as an in vitro model to study ECM changes during liver fibrosis.
Proteomic Analysis of LX-2 and HFF CDMs
CDMs isolated
from LX-2 and HFF cells were analyzed by GeLC–MS. These experiments
identified 277 proteins with ≥99% confidence in LX-2- and HFF-derived
ECMs (Supplementary Tables S1 and S2).
Cell type-specific proteins and proteins common to both cell types
were identified (Figure 2A). Using the unbiased
annotation provided by the UniProt Knowledgebase (http://www.uniprot.org/), a total of 61 proteins (22%) were defined as secreted or part
of the ECM (Figure 2B). Thirty (49.2%) and
13 (21.3%) of these proteins were detected solely in LX-2 and HFFCDMs, respectively, and 18 (29.5%) proteins were detected in both
CDMs (Figure 2B). Importantly, a large number
of ECM components with well-defined roles in liver fibrosis were detected
in LX-2-derived ECM. GO enrichment analysis was carried out to provide
a global, unbiased assessment of the type and function of proteins
identified by GeLC–MS analyses of cell-derived ECMs (Supplementary Table S3). Proteins detected in
both LX-2- and HFF-derived ECM were enriched for identical GO terms
relating to ECM and adhesion from multiple ontology categories (Figure 2C). This finding indicates that the method for isolating
cell-derived ECM was effective and contrasts with the majority of
MS-based analyses of liver tissue or whole cells, which do not readily
detect ECM components.[13] Together, these
data indicate compositional differences in ECM and secreted proteins
found within the ECM derived from the LX-2 cell model of liver fibrosis
as compared to the non-fibrotic control.
Figure 2
Proteomic analysis of
LX-2 and HFF CDMs. (A,B) Venn diagrams display
numbers of proteins identified by GeLC–MS analyses of LX-2-
and HFF-derived ECM. In total, 277 proteins were identified (A), of
which 61 were defined as ECM or secreted using the UniProt Knowledgebase
(http://www.uniprot.org/) (B). Numbers indicate proteins
identified with ≥99% confidence and ≥2 unique peptides.
(C) GO enrichment analysis highlighting significantly enriched terms
related to adhesion and ECM. Bonferroni-corrected P-values are displayed, and the background data set for analysis was
the whole human genome.
Proteomic analysis of
LX-2 and HFFCDMs. (A,B) Venn diagrams display
numbers of proteins identified by GeLC–MS analyses of LX-2-
and HFF-derived ECM. In total, 277 proteins were identified (A), of
which 61 were defined as ECM or secreted using the UniProt Knowledgebase
(http://www.uniprot.org/) (B). Numbers indicate proteins
identified with ≥99% confidence and ≥2 unique peptides.
(C) GO enrichment analysis highlighting significantly enriched terms
related to adhesion and ECM. Bonferroni-corrected P-values are displayed, and the background data set for analysis was
the whole human genome.To identify patterns of relative distribution of
proteins in LX-2
and HFFCDMs, hierarchical clustering analysis was performed (Figure 3 and Supplementary Tables S4
and S5). On the basis of relative protein abundance, as measured
by spectral counting,[26−28] unbiased Pearson correlation identified three major
groups of proteins, which corresponded to clusters of proteins enriched
to HFFCDM (correlation = 0.89; Figure 3B),
LX-2CDM (correlation = 0.95; Figure 3C), or
both HFF and LX-2CDMs (correlation = 0.75; Figure 3D). On the basis of the assignment of proteins to clusters,
the ECM and secreted components were distributed as follows: 36 proteins
(59.0%) were enriched to LX-2CDM, 16 proteins (26.2%) were enriched
to HFFCDM, and 9 proteins (14.8%) were detected in both LX-2 and
HFFCDMs. This quantitative analysis indicated a number of additional
proteins that were either under-represented (Figure 3B) or over-represented (Figure 3C)
in the ECM derived from LX-2 cells. Furthermore, statistical analysis
using the QSpec method[34] identified proteins
that were significantly enriched in either LX-2 or HFFCDM (Figure 3B–D and Supplementary
Table S6). Importantly, a number of proteins previously characterized
as being up-regulated during liver fibrosis, such as fibrillin, nidogen,
and laminin,[44,45]were found in the LX-2-enriched
cluster and were significantly enriched (FDR ≤ 5%; Figure 3C). We therefore hypothesize that proteins with
differential expression patterns identified via these analyses may
reflect, or even direct, the mechanism of liver fibrosis.
Figure 3
Hierarchical
clustering of proteins identified by GeLC–MS
analysis of LX-2 and HFF CDMs. (A) Complete output of unsupervised
hierarchical clustering analysis of identified proteins. Quantitative
heat maps display mean spectral counts as a percentage of the total
number of spectra identified in each analysis. Associated dendrogram
displays hierarchical clustering on the basis of uncentered Pearson
correlation using complete linkage. Correlations at selected nodes
are indicated. (B–D) ECM and secreted proteins are shown with
gene names for HFF-enriched (blue vertical bar; B), LX-2-enriched
(red vertical bar; C), and HFF and LX-2 shared (gray vertical bar;
D) clusters. Asterisks (B–D) denote ECM and secreted proteins
with statistically significant differential abundance between LX-2
and HFF CDMs at 5% FDR (Bayes factor ≥10, natural-log-transformed
fold change ≥1.5).
Hierarchical
clustering of proteins identified by GeLC–MS
analysis of LX-2 and HFFCDMs. (A) Complete output of unsupervised
hierarchical clustering analysis of identified proteins. Quantitative
heat maps display mean spectral counts as a percentage of the total
number of spectra identified in each analysis. Associated dendrogram
displays hierarchical clustering on the basis of uncentered Pearson
correlation using complete linkage. Correlations at selected nodes
are indicated. (B–D) ECM and secreted proteins are shown with
gene names for HFF-enriched (blue vertical bar; B), LX-2-enriched
(red vertical bar; C), and HFF and LX-2 shared (gray vertical bar;
D) clusters. Asterisks (B–D) denote ECM and secreted proteins
with statistically significant differential abundance between LX-2
and HFFCDMs at 5% FDR (Bayes factor ≥10, natural-log-transformed
fold change ≥1.5).
LX-2- and HFF-Derived ECM Interaction Networks
To interrogate
the molecular organization of the isolated cell-derived ECM, PPI network
analysis was employed. To reduce the complexity of the networks, only
the ECM and secreted proteins identified by GeLC–MS were mapped
onto a human interactome. A total of 57 of the identified ECM and
secreted proteins were mapped, resulting in PPI networks of similar
size for both LX-2CDM (28 proteins) and HFFCDM (21 proteins; Figure 4). Proteins (nodes) in the resulting PPI networks
were colored according to the clusters they were assigned by hierarchical
clustering (LX-2-enriched, red; HFF-enriched, blue; LX-2 and HFF shared,
gray). Notably, the LX-2 network is largely formed from LX-2-enriched
proteins (17 of the 28 nodes are red), and the converse is true for
the HFF network (8 of the 21 nodes are blue), which suggests the existence
of cell type- and/or disease-specific ECM niches. In addition, this
analysis highlighted a larger number of components of the “basement
membrane toolkit” (laminins, type IV collagens, perlecan, and
nidogens[46]) incorporated into the LX-2
ECM network (10 proteins) in contrast to the HFF ECM network (2 proteins).
We speculate that this observation may reflect a characteristic compositional
and organizational change in the nature of fibrotic liver ECM. Furthermore,
although some components were found in both networks, they exhibited
different connectivities within each network. For example, fibulin-2
(FBLN2), a protein known to be up-regulated during liver fibrosis,[47−49] was the third most connected node within the LX-2-derived ECM network,
but only the 12th most connected in the HFF-derived ECM network. Thus,
it seems likely that both protein abundance and connectivity within
cell type-specific ECM niches may regulate the function of that tissue,
such as the development or progression of fibrosis in the liver.
Figure 4
Protein–protein
interaction network models for LX-2 and
HFF CDMs. (A,B) ECM and secreted proteins identified from LX-2-derived
(A) and HFF-derived (B) ECM were mapped onto a human interactome to
generate interaction network models. Protein identifications (nodes
labeled with gene names) are displayed as a degree-sorted circle (proteins
are ordered anticlockwise by descending number of binding partners
with the most connected protein at the top). Nodes are colored according
to their hierarchical clustering assignment to LX-2-enriched (red),
HFF-enriched (blue), or LX-2 and HFF shared (gray) clusters (vertical
colored bars in Figure 3). Proteins not incorporated
into the largest interconnected network are displayed below the respective
network.
Protein–protein
interaction network models for LX-2 and
HFFCDMs. (A,B) ECM and secreted proteins identified from LX-2-derived
(A) and HFF-derived (B) ECM were mapped onto a human interactome to
generate interaction network models. Protein identifications (nodes
labeled with gene names) are displayed as a degree-sorted circle (proteins
are ordered anticlockwise by descending number of binding partners
with the most connected protein at the top). Nodes are colored according
to their hierarchical clustering assignment to LX-2-enriched (red),
HFF-enriched (blue), or LX-2 and HFF shared (gray) clusters (vertical
colored bars in Figure 3). Proteins not incorporated
into the largest interconnected network are displayed below the respective
network.
Expression of Wnt-5a and CYR61 in Liver Fibrosis
As
a proof of principle, and to confirm the relevance of the proteins
identified by proteomic analysis of LX-2-derived ECM, immunohistochemical
staining of human and mousefibrotic liver tissue was performed (Figures 5, 6 and Supplementary Figures S2, S3, and S4). A number of proteins
identified in LX-2 or HFFCDMs were not incorporated into the PPI
networks visualized in Figure 4 due to the
lack of current knowledge of their interaction partners. Using spectral
counts as a measure of abundance, some of these proteins are likely
to represent abundant components of the ECM. In addition, a number
of the identified proteins were statistically enriched to LX-2CDM
and have intriguing links with fibrotic processes. For example, WNT5A mRNA levels have been shown to be up-regulated in
activated HSCs,[50] but differential protein
expression has not been reported. Also, CYR61 has been shown to trigger
senescence of dermal fibroblasts,[51] and
senescence of activated HSCs has been shown to limit liver fibrosis.[52] We therefore targeted Wnt-5a and CYR61 for validation
by immunohistochemical analysis and used fibulin-2 as a positive control.
Figure 5
Expression
of fibulin-2, Wnt-5a and CYR61 in human fibrotic liver
sections. (A–F) Representative images of histological sections
demonstrating immunohistochemical staining in human hepatitis C virus-induced
liver fibrosis. Fibulin-2 staining (A and B) was observed within fibrotic
areas. Wnt-5a (C and D) and CYR61 (E and F) staining was localized
to fibrotic septa in human liver tissue. Sections displayed are from
different individual patients. Control (G) indicates section stained
with the omission of the primary antibody. Images were acquired using
10× (A, C, E) and 20× (B, D, F, G) objectives.
Figure 6
Expression of Wnt-5a and CYR61 in mouse fibrotic liver
sections.
(A–D) Representative images of histological sections demonstrating
immunohistochemical staining in murine CCl4-induced liver
fibrosis. Wnt-5a (A and B) and CYR61 (C and D) both heavily stained
peri-fibrotic areas in murine liver tissue. Control (E) indicates
section stained with the omission of the primary antibody. Images
were acquired using 20× (A and C) and 40× (B,D, and E) objectives. Additional negative control tissue, in which
the primary antibody was omitted and normal murine liver tissue did
not stain positively for Wnt-5a or CYR61 is provided in Supplementary Figure S4.
Expression
of fibulin-2, Wnt-5a and CYR61 in humanfibrotic liver
sections. (A–F) Representative images of histological sections
demonstrating immunohistochemical staining in human hepatitis C virus-induced
liver fibrosis. Fibulin-2 staining (A and B) was observed within fibrotic
areas. Wnt-5a (C and D) and CYR61 (E and F) staining was localized
to fibrotic septa in human liver tissue. Sections displayed are from
different individual patients. Control (G) indicates section stained
with the omission of the primary antibody. Images were acquired using
10× (A, C, E) and 20× (B, D, F, G) objectives.Expression of Wnt-5a and CYR61 in mousefibrotic liver
sections.
(A–D) Representative images of histological sections demonstrating
immunohistochemical staining in murineCCl4-induced liver
fibrosis. Wnt-5a (A and B) and CYR61 (C and D) both heavily stained
peri-fibrotic areas in murine liver tissue. Control (E) indicates
section stained with the omission of the primary antibody. Images
were acquired using 20× (A and C) and 40× (B,D, and E) objectives. Additional negative control tissue, in which
the primary antibody was omitted and normal murine liver tissue did
not stain positively for Wnt-5a or CYR61 is provided in Supplementary Figure S4.As expected,[49] fibulin-2
staining was
localized to fibrotic areas in human hepatitis C virus-induced liver
fibrosis tissue sections (Figure 5A and B).
Positive staining for Wnt-5a (Figure 5C and
D) and CYR61 (Figure 5E and F) was also observed
in fibrotic septa from human hepatitis C virus-induced liver fibrosis
tissue sections. In addition, both Wnt-5a (Figure 6A and B) and CYR61 (Figure 6,C and
D) were found in peri-fibrotic areas in a murine model of liver fibrosis.
Taken together, these analyses show that Wnt-5a is expressed in fibrotic
areas of human tissue and perifibrotic areas of murine tissue, and
CYR61 is found in peri-fibrotic areas of human and murine tissue.
Collectively, these data confirm the identification of two novel components
of fibrotic liver ECM.
Discussion
The extracellular environment is a key regulator
of cell fate and
function.[53] Indeed, altering the composition
of the ECM has previously been shown to induce deactivation of HSCs.
In their activated forms, HSCs are postulated to drive fibrotic liver
disease, and so remodelling of the fibrotic matrix represents a potential
therapeutic strategy.[6,54] Antagonism of αVβ3
integrin receptor, for example, has been shown to block binding of
HSCs to ECM survival ligands, which induces HSC apoptosis and results
in remodelling of the surrounding ECM.[10] However, since relatively little is known about the constituents
of the fibrotic liver ECM, disruption of binding of all αVβ3
ligands would likely cause catastrophic effects upon a wide range
of cell-ECM interactions. Instead, more refined disease- and organ-specific
targets of fibrosis need to be identified. A first step toward this
goal is the holistic description of the constituents of the fibrotic
liver ECM. Our study confirms that such targets can be identified
using the GeLC–MS-based proteomics approach described here.
Furthermore, the predictive nature of these analyses allows us to
hypothesize that a number of the proteins we identified in this study
will make excellent candidates for further investigation into the
mechanisms, diagnosis, and treatment of fibrotic disease.As
this study of stellate cell ECM was a component of a program
to identify suitable therapeutic targets to inhibit liver fibrosis,
the control cell line was selected so that proteins or networks that
are specific to liver fibrogenesis could be identified in order to
avoid the potential adverse effects of systemic fibrogenesis inhibition.
Dermal fibroblasts were chosen as their use with the ECM enrichment
protocol has been established, resulting in the isolation of ECM that
had both structurally and functionally relevant composition.[55,56] We therefore anticipated a similarly functionally relevant LX-2
ECM to be isolated and characterized. Furthermore, the use of HFFs
permitted an organ-specific comparison to be made as it is well established
that liver fibrogenesis differs from general fibrosis (which is represented
here by HFFs). A direct comparison between quiescent and activated
HSCs was not possible due to technical limitations as freshly isolated
quiescent HSCs activate spontaneously in culture. An alternative approach
of inactivating HSCs by culturing cells on Matrigel[8,9] was
not used because Matrigel contamination of cell-derived ECM would
confound the MS analysis.It is important to note that a number
of the proteins identified
in this study have well reported links with fibrotic processes occurring
in both liver and other organs. For example, fibrillin, previously
implicated in the storage and activation of transforming growth factor-β
(TGF-β), is a known profibrotic cytokine that drives HSC activation
and secretion of ECM[57,58] and is up-regulated in both liver
fibrosis[42,43] and sclerosis.[59] Our analysis revealed significantly increased abundances of both
fibrillins 1 and 2 in the LX-2-derived ECM as compared to the control.
Similarly, plasminogen activator inhibitor 1 (PAI-1/SERPINE1), which
was up-regulated in LX-2-derived ECM, has been shown to be a profibrotic
matricellular protein with roles in cardiovascular and liver fibrotic
disease,[60] the knockout of which protects
against experimental liver fibrosis.[61] Other
proteins found in our study to be specifically up-regulated in LX-2-derived
ECM included LRRC17, a protein whose gene expression is increased
in Dupuytren’s disease (a fibrotic disorder affecting the hand,
characterized by abnormal proliferation of fibroblasts and their differentiation
into myofibroblasts[62]), and agrin, a proteoglycan
shown to stain specific regions of cirrhotic liver.[63] Indeed, screens for alterations in gene expression during
liver fibrosis have identified up-regulation of genes for gremlin,
TGF-β-induced protein ig-h3 (BIGH3) and insulin-like growth
factor-binding protein 5 (IGFBP-5),[50,64] the protein
products for all of which were overexpressed in LX-2-derived ECM.
The significance of this validation is revealed by consideration of
gremlin, which is a bone morphogenetic protein (Bmp) antagonist. Bmp
family members are known to play a role in liver homeostasis by blocking
TGF-β-related signaling pathways.[65] Bmp antagonists, such as gremlin, could therefore play a profibrotic
role by promoting TGF-β activity, and targeting their action
has been postulated as a potential therapy for liver and kidney fibrosis.[64] Thus, our GeLC–MS-based proteomics approach
adds a new level of selective refinement to previous global analytical
approaches, such as array-based gene expression studies, and identifies
biologically significant protein targets for potential downstream
investigations.In contrast to candidates overexpressed in LX-2CDM, proteins whose
expression was down-regulated in LX-2-derived ECM may also be important
for fibrotic progression. For example, elastin microfibril interfacer
1 (EMILIN-1) was absent from LX-2-derived ECM but robustly identified
in the control dermal ECM. This may have important consequences for
fibrosis as EMILIN-1 has been described as a negative regulator of
TGF-β signaling that prevents maturation of pro-TGF-β
by furin convertases, thereby regulating blood pressure homeostasis.[66] EMILIN-1 may thus have a wider role in fibrosis,
reinforcing the notion that proteins observed to be either up- or
down-regulated in liver ECM could have important roles in the mechanism
of fibrosis.Two novel fibrotic protein constituents identified
through this
study were also validated in fibrotic liver, namely, CYR61 and Wnt-5a.
CYR61 is a member of the CCN (cysteine-rich protein, connective tissue
growth factor, and nephroblastoma overexpressed gene) family of matricellular
proteins that typically signal through integrins to regulate a variety
of disease processes, including cancer, inflammation, and for connective
tissue growth factor (also known as CCN2) in particular, fibrosis.[67,68] CYR61 (also known as CCN1) has not previously been reported as a
constituent of fibrotic liver but is known to function as a ligand
for a variety of integrins expressed by HSCs.[68] Intriguingly, we detected by GeLC–MS increased abundance
of CYR61 in LX-2-derived ECM as compared to the control, and we were
able to validate this finding in both human and murinefibrotic liver
samples. Activation of cellular senescence could be an attractive
alternative antifibrotic therapy as senescence of activated HSCs has
been shown to limit liver fibrosis.[52] Indeed,
senescence of dermal fibroblasts has been shown to be triggered by
CYR61 signaling via integrin receptors.[51] The relationship between increased levels of CYR61 in fibrotic tissue
and its reported antifibrotic function requires further investigation
but may reflect tissue-specific differences in CYR61 function, altered
CYR61 signaling in fibrosis or a failed attempt by HSCs to activate
senescence, and down-regulate fibrosis, in response to profibrotic
insult.In a similar manner to CYR61, Wnt-5a was found to be
increased
in LX-2-derived ECM and fibrotic liver in vivo. In
a gene expression analysis of quiescent and activated rat HSCs, Wnt5a mRNA levels were up-regulated in activated HSCs,[50] although up-regulation of Wnt-5a protein expression
was not confirmed. We have therefore extended the findings of this
previous study,[50] and we describe here
the expression of Wnt-5a protein in both a murine model of liver fibrosis
and human fibrotic tissue. Wnt-5a is one member of a family of 19
secreted glycoproteins that play essential roles in many aspects of
embryonic patterning, cell specification, cell growth, and differentiation.[69,70] A role for Wnt-5a in fibrosis was suggested by its high expression
level in fibroblasts taken from patients with interstitial lung fibrosis.[71] Wnt-5a was postulated to act as a regulator
of fibroblast proliferation and to induce resistance to apoptosis,
as had previously been reported in human dermal fibroblasts.[72] These findings are consistent with the hypothesis
that Wnt-5a plays an analogous role in liver fibrosis by stimulating
proliferation and inhibiting apoptosis of HSCs. Alternatively, given
that the LX-2 cell line is an immortalized HSC line,[38] detection of Wnt-5a may reflect residual neoplastic characteristics
likely to remain present in such cells. The fact that expression of
Wnt-5a has also been reported to alter during progression from cirrhosis
to hepatocellular cancer[73] suggests a possible
molecular link between activated HSCs and hepatocellular carcinoma,
reflecting the well established clinical association. In this regard,
these data support the general notion that changes in hepatocellular
carcinoma ECM composition could be used to aid diagnosis or treatment[14] and suggest that altered expression of Wnt-5a
may represent an urgently required biomarker for early detection of
fibrosis and transition from late-stage fibrosis to cancer.[73] In either case, validation of these possibilities
is required using both primary derived HSCs and biopsy samples at
different stages of disease pathogenesis ranging from quiescence through
fibrosis to cancer. As CYR61 and Wnt-5a are both secreted matricellular
proteins up-regulated in liver fibrosis, they represent ideal candidates
as new type I, or direct, biomarkers for further evaluation.
Conclusions
In this study, the ECM proteins produced
by HSCs have been catalogued
using GeLC–MS-based proteomics coupled to an ECM-enrichment
strategy and an in vitro model of liver fibrosis.
Using this approach, the majority of all previously reported canonical
ECM protein constituents of humanfibrotic liver tissue were identified.[74] Furthermore, two novel components of fibrotic
liver tissue, CYR61 and Wnt-5a, have been identified and validated in vivo. These results confirm the biological and potential
clinical relevance of this new strategy. Understanding the molecular
changes underpinning the pathological process of fibrosis has been
an unmet challenge to investigators for decades. We propose that the
ECM protein cataloguing technique described here could present researchers
with a valuable tool to advance the field. Application of this strategy
to different in vitro disease models could therefore
significantly advance the identification of tissue- and disease state-specific
ECM proteins and provide the first step toward determining the mechanisms
underlying fibrosis and the identification of novel therapeutic targets
or biomarkers.
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