Cell non-autonomous functions of S100a4 drive fibrotic tendon healing

Abstract

Identification of pro-regenerative approaches to improve tendon healing is of critical importance given the diminished quality of life and physical function that accompanies the typical fibrotic response to tendon injury. S100a4 modulates fibrosis through tissue-type dependent mechanisms, and the role of S100a4 in fibrotic, scar-mediated tendon healing has not been established. In the present study we tested the hypothesis that inhibition of S100a4 improves tendon function following acute injury and surgical repair. We demonstrate cell non-autonomous functions of S100a4 as S100a4 haploinsufficiency promotes regenerative tendon healing, including decreased scar formation and improved mechanical properties. Moreover, inhibition of S100a4 via antagonism of its putative receptor, the Receptor for Advanced Glycation Endproducts (RAGE), also decreases scar formation. Mechanistically, knock-down of S100a4 decreases myofibroblast and macrophage content at the site of injury, with both cell populations being key drivers of fibrotic progression. In contrast, S100a4+ cell depletion displays time-dependent effects on scar formation, and consistent impairments in restoration of mechanical properties, indicating a critical role for these cells in re-establishing tendon strength after injury. Finally, we demonstrate, that S100a4-lineage cells become -SMA+ myofibroblasts, via loss of S100a4 expression. Using a combination of genetic mouse models, small molecule inhibitors and in vitro studies we have defined S100a4 as a novel, promising therapeutic candidate to improve tendon function after acute injury.