MOLECULAR TARGETS FOR THE TREATMENT OF WOUNDS, IN PARTICULAR CHRONIC WOUNDS

Abstract

The present invention relates to a therapeutic compound comprising: an agent that inhibits the activity of at least one gene selected from the group consisting of MAF, MEOX2, SIX2 and homologues thereof having at least 50% identity with said genes and/or an agent that enhances the activity of at least one gene selected from the group consisting of CREB5, E2F1, EGR2, HIC1, IRF7, JUN, MYC, SRF, STAT4, TCF4, FOXS1, GLI1, SOX9 and homologues thereof having at least 50% identity with said gene for use in the treatment of wounds, preferably chronic wounds.

Claims

1.-19. (canceled)

20. A method for treating wounds, preferably chronic wounds, in a subject in need thereof, comprising administering to said subject a therapeutic compound comprising: an agent that inhibits the activity of at least one gene selected from the group consisting of MEOX2, SIX2, and homologues thereof having at least 50% identity with said genes, and/or an agent that enhances the activity of at least one gene selected from the group consisting of CREB5, E2F1, EGR2, HIC1, IRF7, JUN, MYC, SRF, STAT4, GLI1, preferentially EGR2, STAT4 and homologues thereof having at least 50% identity with said gene.

21. The method according to claim 20 further comprising: an agent that inhibits the activity of PPARG or homologues thereof having at least 50% identity with PPARG; and/or an agent that enhances the activity of at least one gene selected from the group consisting of SMAD3, SMAD4 and homologues thereof having at least 50% identity with said genes.

22. The method according to claim 20 wherein said agent is selected from the group consisting of: anti-sense DNA or RNA, siRNA, shRNA, cDNA, TALENS or ribozymes, either naked or in the form of plasmid or viral vectors.

23. The method according to claim 20 wherein said agent is an inhibitor or enhancer of protein function.

24. The method according to claim 23 wherein said agent is selected from the group consisting of: a binding agent that binds, either reversibly or irreversibly, to inhibit protein function such as an antibody or a synthetic antagonist; or an agent that works upstream or downstream of the protein signaling mechanism to inhibit protein function.

25. The method according to claim 23 wherein said agent inhibits the activity of MEOX2 or SIX2; or wherein said agent enhances the activity of GLI1.

26. The method according to claim 23 wherein said agent is an agonist of GLI1.

27. The method according to claim 23, wherein said agent is Gant 61.

28. The method according to claim 20 wherein it is for treating mammalian wounds.

29. The method according to claim 20 wherein it is for treating chronic wounds chosen among: venous ulcers, diabetic ulcers, or pressure ulcers.

30. The method according to claim 20 wherein it is for treating human wounds.

31. The method according to claim 20 wherein the therapeutic compound is for topical application.

32. The method according to claim 20 wherein the therapeutic compound is for application to a medical device or impregnation of a medical device.

33. A pharmaceutical composition comprising a therapeutic compound comprising: an agent that inhibits the activity of at least one gene selected from the group consisting of MEOX2, SIX2, and homologues thereof having at least 50% identity with said genes, and/or an agent that enhances the activity of at least one gene selected from the group consisting of CREB5, E2F1, EGR2, HIC1, IRF7, JUN, MYC, SRF, STAT4, GLI1, preferentially EGR2, STAT4 and homologues thereof having at least 50% identity with said gene; and a pharmaceutically acceptable carrier.

34. A method for preparing a pharmaceutical composition according to claim 33 comprising combining said therapeutic compound with a pharmaceutically or veterinary acceptable carrier or vehicle.

35. The method according to claim 20, wherein the subject is mammalian.

36. A kit for treating a wound, preferably a chronic wound, wherein said kit comprises: (a) at least one therapeutic compound comprising: an agent that inhibits the activity of at least one gene selected from the group consisting of MEOX2, SIX2, and homologues thereof having at least 50% identity with said genes, and/or an agent that enhances the activity of at least one gene selected from the group consisting of CREB5, E2F1, EGR2, HIC1, IRF7, JUN, MYC, SRF, STAT4, GLI1, preferentially EGR2, STAT4 and homologues thereof having at least 50% identity with said gene; and (b) at least one dressing for applying to said wound.

37. A combination therapeutic for treating a wound, preferably a chronic wound, comprising: a) the pharmaceutical composition of claim 33; and b) at least one further therapeutic.

38. The method according to claim 20, wherein said agent modulates fibroblast and myofibroblast differentiation and/or activity.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0109] The legends of the figures are the following:

[0110] FIG. 1a: Schematic representation of the different treatments applied to the Normal Human Dermal Fibroblast (NHDF)

[0111] FIG. 1b: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR with the different treatments

[0112] FIG. 2a: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR. NHDFs were treated either with mock siRNA or siRNA directed against different mRNA (EGR2, SRF, HIC1, STAT4, TCF4, GLI1, JUN, IRF7, E2F1, MYC, CREB5, FOXS1, SOX9 or STAT1) and concomitantly subjected or not to TGF1 treatment. The RTqPCR were normalized with TUBB and the mock siRNA treated (TE) condition was set to one. The treatments of NHDFs with siRNA against SRF, HIC1 or STAT4 lead to extensive cell death (*): no analysis was possible.

[0113] FIG. 2b: Graphic representation of the percentage of differentiated cells as assessed by the percentage of alpha SMA positive cells after treatment of NHDFs as described in a). The treatments of NHDFs with siRNA against SRF, HIC1 or STAT4 lead to extensive cell death (*): no analysis was possible.

[0114] FIG. 2c: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR. Primary human dermal fibroblasts were treated either with mock siRNA or siRNA directed against different mRNA (PPARG, MAF, MEOX2, SIX2, STAT1 or USF2). The RTqPCR were normalized with TUBB and the mock siRNA treated (TE) condition was set to 1.

[0115] FIG. 2d: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR. NHDFs were treated either with mock siRNA or siRNA directed against different mRNA (PPARG, MAF, MEOX2, SIX2, STAT1 or USF2) and concomitantly treated either with CWF1 alone or in combination with TGF1. The RT-qPCR were normalized with TUBB and to the mock siRNA treated (TE) condition (set to 1 but not represented on this graph). To help in analyzing the effect of the different siRNA, the condition where the cells were treated with mock siRNA and TGF1 is added and represents the normal differentiation (light grey bar in the mock histogram).

[0116] FIG. 2e: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR. NHDFs were treated as depicted in d) except for the exudate treatment which was performed with a different exudate from a different patient suffering from chronic wound (CWF2).

[0117] FIG. 3a-l: short and long timing after TGF1 treatment for EGR2 (FIG. 3a), FOXS1 (FIG. 3j), SOX9 (FIG. 3b), SRF (FIG. 3f), STAT4 (FIG. 3h), TCF4 (FIG. 3c). MYC (FIG. 3k), JUN (FIG. 3g), IRF7 (FIG. 3e), E2F1 (FIG. 3i), CREB5 (FIG. 3d) and GLI1 (FIG. 3l). For each Factor, graphic representation of the mRNA levels after increasing time of treatment of the NHDF with TGF as assessed by RT-qPCR.

[0118] FIG. 4a-b: Key transcription factors in fibroblast to myofibroblast differentiation

[0119] FIG. 4a) Graphical explanation of the in silico gene network analysis

[0120] FIG. 4b) Table representing the different transcription factors identified by bioinformatical and network analysis.

[0121] FIG. 5a-d: short and long timing after TGF1 treatment for PPARG (FIG. 5a), MAF (FIG. 5d). MEOX2 (FIG. 5c) and SIX2 (FIG. 5b). For each Factor, graphic representation of the mRNA levels after increasing time of treatment of the NHDF with TGF as assessed by RT-qPCR.

[0122] FIG. 6a-l: Graphic representation of the TCF4 (FIG. 6a), EGR2 (FIG. 6b), SOX9 (FIG. 6c), STAT4 (FIG. 6d), FOXS1 (FIG. 6e), PPARG (FIG. 6f), MAF (FIG. 6g), MEOX2 (FIG. 6h), and SIX2 (FIG. 6i) mRNA levels after NHDF (donor A) treatment for 48 h (light grey) or 72 h (dark grey) either with mock siRNA or siRNA directed against different TF mRNA (SOX9, EGR2, TCF4, or FOXS1) and concomitantly treated with TGF-. For all graphs, the mock siRNA treated with TGF- (T+E) condition was set to 100% for each time of treatment (48 h and 72 h).

[0123] FIG. 7a-b: Schematic representation of the different treatments with drugs applied to the Normal Human Dermal Fibroblast (NHDF) with exsudates (FIG. 7a) or not (FIG. 7b).

[0124] FIG. 8a: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR of NHDFs treated by Trametinib.

[0125] FIG. 8b: Graphic representation of the SMA, PI16 and ACTC1 mRNA levels as assessed by RT-qPCR of NHDFs treated by Trametinib in the presence of exsudates.

[0126] FIG. 9a: Graphic representation of the SMA mRNA levels as assessed by RT-qPCR of NHDFs treated by Am580.

[0127] FIG. 9b: Graphic representation of the SMA, PI16 and ACTC1 mRNA levels as assessed by RT-qPCR of NHDFs treated by Am580 in the presence of exsudates.

[0128] FIG. 10: Graphic representation of the SMA, GLI1, SOX9 and MAF mRNA levels assessed by RT-qPCR of NHDFs treated by Gant 61.

[0129] FIG. 11 provides Table 1: identifying genes to be increased or decreased in order to treat wounds, non-healing or chronic wounds.

[0130] FIG. 12 provides Table 2: siRNA sequences for each target gene.

EXAMPLE

[0131] In response to a lesion, fibroblasts migrate into the wound where they differentiate into contractile myofibroblasts that will finally enter into apoptosis during the remodeling phase. This differentiation process can be studied ex-vivo in environmentally controlled tissue culture conditions, and therefore the timely controlled succession of different gene expression patterns can be addressed.

[0132] Materials and Methods

[0133] Establishment of an Ex Vivo Model of Chronic Wounds

[0134] Normal Dermal Fibroblast Cell Culture and Exudate Collection

[0135] NHDF, isolated from human explants, were purchased from Promocell. NHDF were cultivated in DMEM-F12 (Invitrogen), supplemented with 10% FCS (Invitrogen, 5 g/mL of insulin and 1 ng/mL of b-FGF (PromoKine)).

[0136] To collect exudates, two patients with mixed ulcers were recruited. For patient selection, it was decided to exclude any other comorbidity factor potentially involved in wound etiology: diabetes, peripheral arterial diseases, malnutrition. Exudates were collected from negative pressure therapy. All the exudates were centrifuged at 1,500g for 3 minutes to remove cell debris. The supernatant was filtered and stored at 80 C. until use. Aliquots were used to determine protein concentration according to BCA method (Sigma).

[0137] Establishment of an Ex Vivo Model of Chronic Wounds

[0138] For experiments, cells were deprived of insulin and b-FGF during 48 hours. Then, the cells were cultivated on collagen coated culture plates in DMEM-F12, supplemented with 10% FCS, 10 ng/mL of TGF-1 (Promocell) for 4 days. Four points were tested in order to appreciate the effect of exudate on fibroblast differentiation: untreated cells (TE), fibroblasts treated with TGF-1 (T+E), cells treated with exudate (TE+) and finally fibroblasts treated with TGF-0 and exudate at the same time (T+E+).

[0139] The efficiency of fibroblast differentiation was estimated by analyzing the expression of the myofibroblast marker alpha smooth muscle actin (SMA).

[0140] Western Blotting Assay

[0141] Total proteins were extracted by scratching the cells with lysis buffer (TRIS, NaCl, NP40, EDTA, IMDTT) and incubated 30 min in ice. To remove cell debris, the samples were centrifuged at 13,000g for 10 min at 4 C. and stored at 20 C. until use. Protein concentration was determined according to BCA method (Sigma). Equal amounts of total protein (20 g) were loaded to NuPAGE 10% BIS-Tris gel (Invitrogen), separated by migration at 150 V, and transferred to nitrocellulose membrane (Whatman) 1 hour at 30 V. Then, membranes were stained for SMA (Abcam) and tubulin (Abeam). Incubations were followed by secondary antibodies goat anti-rabbit IgG and goat anti-mouse IgG, respectively, conjugated with horseradish-peroxidase (HRP) (Promega). Signals were detected by ECL chemiluminescence using UptiLight HS WB Substrate (Uptima, Interchim). Bands were digitized with a scanner and the ratio between all bands density of the same blot was calculated by software (ImageJ 1.43u, 64-bit). Relative SMA expression was normalized to the respective value for tubulin.

[0142] Total RNA Sample Preparation

[0143] After four days of experiment, treated fibroblasts were lysed with TRIzol Reagent (Invitrogen) and stored at 80 C. Then RNA was purified using chloroform and precipitated by isopropanol. Total RNA was quantified on the NanoDrop 2000c Spectrophotometer (Thermo Scientific). Reverse transcription of 500 ng total RNA to cDNA was done with oligot dT (Invitrogen) using Superscript III RT (Invitrogen) and RNAse OUT (Invitrogen). The cDNA was store at 20 C.

[0144] Quantitative Real-Time RT-PCR

[0145] Quantitative real-time PCR (RT-qPCR) was done using 5 L of 1:20 diluted cDNA on the LightCycler480 system (Roche) using Maxima SYBR Green qPCR Master Mix (Fermentas). Forward and reverse primers for SMA were designed by Eurofins (MWG, SMA forward:CTGTTTTCCCATCCATTGTG (SEQ ID NO:9), SMA reverse: CCATGTTCTATCGGGTACTF (SEQ ID NO: 10)) and a 100 M stock was stored at 20 C. Forward and reverse primer pairs were used for each RT-qPCR reaction. The cycling conditions were as follows: an initial 95 C. for 10 minutes, followed by 45 cycles of 95 C. for 15 sec, 58 C. for 30 sec, 72 C. for 20 sec. LightCycler 480 SW 1.5 was used to evaluate the TM curves, to determine the Cp and to approximate the relative concentration for each amplification reaction.

[0146] siRNA Treatment

[0147] -Smooth Muscle Actin Immunofluorescence

[0148] Cells grown in collagen coated culture dishes, and treated as previously described, were fixed with 4% paraformaldehyde (PFA) in PBS for 15 minutes and permeabilized with 2.5% Triton X-100 (Euromedex, 2000-B) in PBS for 3 minutes. After saturation with 5% BSA in PBS, cells were stained for -SMA (Abeam, ab5694) and for DNA (DAPI). As secondary antibody, CyTM3 conjugated anti rabbit (GE Healthcare, PA43004) was used. Samples were observed with an oil immersion objective (Plan Fluor 40/1.30 Oil, Nikon) on a Nikon ECLIPSE Ti (Nikon). Digital images were taken with a digital camera (Cool SNAP HQ.sup.2, Photometries) and software (MetaMorf 7.5.4.0). To estimate the percentage of fibroblast differentiation due to the different treatments, the total number of cells per field was determined by the DAPI, and myofibroblasts, differentiated fibroblasts, were counted using the -SMA staining. Then, STUDENT (t-) and .sup.2 tests were realized to evaluate the differentially expression of SMA between the untreated fibroblasts (TE) and the treated ones.

[0149] mRNA Expression Analysis

[0150] Total RNA Sample Preparation and cDNA Synthesis

[0151] After four days of experiment, treated fibroblasts were detached with TRIzol Reagent (Invitrogen (Life Technologies), 15596-018) and stored at 80 C. Then RNA was purified using chloroform and precipitate by isopropanol. Total RNA was quantified on the NanoDrop 2000c Spectrophotometer (Thermo Scientific) and their quality was evaluated on the RNA Nano Chips (Agilent 2100 bioanalyzer, Agilent, 5067-1511). Reverse transcription of 500 ng total RNA to cDNA was done with oligot dT (Invitrogen (Life technologies), 18418-020) using Superscript III RT (Invitrogen (Life technologies), 18080-085) and RNAse OUT (Invitrogen (Life technologies), 10777-019). The cDNA was stored at 20 C. Only samples with a good bioanalyzer profile were used for qPCR analysis.

[0152] Network Analysis

[0153] In order to enlighten master regulators of fibroblast fate after each different treatment, the inventors performed a gene network analysis treating gene expression lists determined after mRNA seq deep sequencing analysis of the gene profile of TE with the gene profile of T+E, T+E+ and TE+1. In these analysis and based on the assumption that the decrease or increase of interconnected genes is of stronger significance than a significant Log FC, the inventors have used lists of genes selected only based on their P value and not on the value of their Log FC. The inventors have performed two types of analysis: an ingenuity upstream regulator analysis and a DIRE analysis. The Ingenuity upstream regulator analysis, given the particular profile of genes expression between two conditions, consists in selecting potential upstream regulators. The DIRE analysis is based on the selection of potential common regulatory elements between genes based on these elements conservation during evolution. From these identified elements, DIRE is able to provide a list of master regulators for a list of co-regulated genes. From those two analyses, and for each list analyzed, the inventors have selected Transcription Factors (TFs) expressed in at least one of the two conditions considered in the concerned list (i.e. number of sequencing his superior to twenty in at least one of the two conditions). Then, the inventors have deeply compared the two sets of analysis and decided to keep in the key regulators lists transcription factors belonging to both analyses. Because of possible bias in these two analyses the inventors also decided to rescue transcription factors belonging only to one analysis and not the other but presenting very interesting target genes pattern in one list or the other. Altogether, these genes networks analysis allowed proposing a list of TFs being key regulators in one or the other fibroblast fate.

[0154] For the chronic or non-healing wound model, chronic wound exudates were added to cell cultures (500 g/mL of total proteins of exudate). The experiments that were performed are depicted in FIG. 1a): cells were either not treated (TE), either treated with TGF alone (T+E), exudate alone (TE+) or TGF- and exudate (T+E+) for 4 days. The assays described previously were used to assess the level of differentiation. Chronic wound exudates decrease the expression of SMA (mRNA, FIG. 1b). This indicated that chronic wound exudates clearly inhibit fibroblast differentiation. This is correlated to the fact that in chronic wounds, non-functional fibroblasts, also called pseudo-senescent fibroblasts, are present.

[0155] Gene Expression Route Upon Fibroblast to Myofibroblast Differentiation

[0156] Identification of the main molecular targets implicated in fibroblast differentiation of human primary fibroblasts under normal and pathological conditions.

[0157] The inventors performed an in silico gene network analysis to enlighten putative upstream regulators of the different gene expression routes defined previously. This approach was original in the sense that the inventors used global gene network analysis to identify potential key regulators and the inventors did not take into account a change in these factors expression to select them. For example, the inventors used the DIRE program to identify evolutionary conserved potential regulatory elements in the different genes lists which allowed enlightening transcription factors that could potentially bind to these elements and thus regulate these sets of genes. Twenty-three transcription factors were selected out from this analysis.

[0158] To prioritize the extensive study of the different Transcription Factors (TFs), the inventors performed a time response study of TFs after the different fibroblast treatments. The inventors did a short-term (between 30 mn and 8 hours) and a long-term (between 8 hours and 96 hours) analysis of their changes in expression after the different treatments.

[0159] The inventors performed an exhaustive siRNA-based approach to study on one hand the role of these different factors in normal fibroblast to myofibroblast differentiation pathway and on the other hand, in the chronic-exudate-dependent non-differentiation cell fate.

[0160] The siRNA knock-down of fourteen of the potential key transcription factors identified therein inhibited the fibroblast to myofibroblast differentiation pathway as assessed by analyzing the SMA expression from TGF- and siRNA-treated NHDFs: GLI1, HIC1, TCF4, SOX9, STAT4 MYC, CREB5, IRF7, JUN, E2F1, EGR2, SRF, SMAD3, FOXS1 as their knockdown inhibitor myofibroblast differentiation to various extents (FIG. 2a-b). Very interestingly, except for SOX9, FOXS1 and EGR2, whose expression is strongly and rapidly up-regulated upon TGF treatment, the mRNA levels of the other factors is constant during the first day or so after TGF treatment and overall unchanged during the four days of differentiation (FIG. 3a-l). This indicates that the maintenance of their expression but not their over-expression is necessary for fibroblast to myofibroblast differentiation.

[0161] The siRNA knock-down of four other potential key transcription factors identified by the in silico analysis (MAF, SIX2, MEOX2 and PPARG) seemed to induce the fibroblast to myofibroblast differentiation in absence of TGF to the same extend as the one obtained with mock transfected cells treated with TGF. Even more interestingly the induction of myofibroblast differentiation was old true even in presence of chronic wound exudates and was very similar to the differentiation obtained in presence of TGF-only for mock transfected cells. In absence of these factors, the fibroblasts seemed able to bypass the exudate dominant action in order to differentiate into myofibroblasts. The inventors can also enlighten that, except for FOXS1, all these factors are slightly too strongly down regulated upon TGF treatment (FIG. 5) supporting that their down regulation could be necessary for differentiation.

[0162] Altogether these results showed that with knocking-down approaches the inventors were able either to reduce fibroblast to myofibroblast differentiation or to induce this differentiation even in a chronic wound context (FIG. 11, table 1).

[0163] An in silico gene network analysis allowed to identify potential key regulators of fibroblast cell fate either during differentiation into myofibroblast or in a context of chronic wounds. By knocking down approaches, the inventors found a strong effect on differentiation for nineteen factors. The strength of our analysis comes from the unbiased approach to look for evolutionary conserved common DNA element in the different lists of genes (via the DIRE program) and from there to identify putative upstream transcription regulators, rather than to look at differences in the expression levels of the transcription factors. It is very likely that the inventors would have missed those cell fate regulators by looking at their differential expression only.

[0164] By knocking-down approaches we identified transcription factors required for normal fibroblast to myofibroblast differentiation (FIG. 2a-e). The inventors used the SMA to follow myofibroblast differentiation as it is their best ex-vivo marker.

[0165] The inventors have also identified factors which seemed to play a role but maybe not as strongly as the ones described in the paragraph before as their knockdown leads to consistent but mild decrease of SMA expression. These factors are MYC, JUN, E2F1, IRF7 and CREB5.

[0166] Very interestingly, the inventors showed that the inactivation of some transcription factors leads to an increase of fibroblast differentiation per se. The invalidation of some of these factors could even increase fibroblast to myofibroblast differentiation in a chronic wound context.

[0167] The knocking down of PPARG mRNA leads to an increase of fibroblast to myofibroblast differentiation (FIG. 2c-d) even in the presence of chronic exudate.

[0168] FOXS1 belongs to the forkhead family of transcription factor often involved in developmental processes such as morphogenesis and differentiation. It has been shown that FOXS1 is of primary importance in the development of testicular vasculature. Moreover, FOXS1 was described as an early sensory neuronal marker. Here the inventors show that inactivation of FOXS1 leads to an increase of myofibroblast differentiation in absence of TGF.

[0169] MEOX2 has already been described as implicated in TGF pathway as it was identified as an important factor in cleft palate development in TGF3 knockout mice. Experiments in C2C12 myoblast cells showed that MEOX2 is also important for skeletal muscle development and differentiation. Here, the inventors showed that siRNA directed against MEOX2 lead to a bypass of the exudate effect by fibroblasts to be able to differentiate into myofibroblasts.

[0170] In T cells, it has been shown that MAF was responsible for inhibition of IL22 expression by neutralizing TGF. TGF and MAF have antagonist/opposite effects on IL21 expression in CD4(+) T cells. In the same connection, in this study, the inventors implicated MAF as an inhibitor of fibroblast to myofibroblast differentiation in absence or presence of exudate as its inactivation by siRNA leads to an increase of myofibroblast differentiation (FIG. 2c-d). On the contrary, during chondrocyte differentiation, a long form of MAF interacts and cooperates with SOX9 to activate downstream targets. This is another example of the differences between myofibroblast and chondrocyte differentiations.

[0171] SIX2 has been involved in maintaining pluripotency in kidney: in embryonal renal mesenchyme cells it is able to suppress differentiation and during kidney development it maintains the progenitor pool. Here, in dermal fibroblast, the invalidation of SIX2 leads to a bypass of the dominant exudate effect on TGF signaling (FIG. 2c-d).

[0172] Regulatory Interactions Between Key Transcription Factors During Fibroblast to Myofibroblast Differentiation

[0173] The expression of TCF4 mRNA was not modified after SOX9, EGR2 or FOXS1 knockdown (FIG. 6a-i) placing it at the top of the regulatory interaction network between these factors. On the contrary EGR2 expression was largely inhibited upon siRNA treatment against TCF4 and SOX9 but remained unchanged upon treatment against FOXS1 (FIG. 6a-i) placing it after TCF4 and SOX9 but before FOXS1 in the network. SOX9 mRNA remained largely unchanged upon TCF4 and FOXS1 knockdown. The inventors placed FOXS1 as a downstream target of SOX9. On the contrary SOX9 is upregulated upon EGR2 knockdown (FIG. 6a-i) The STAT4 mRNA is downregulated by TCF4, SOX9 and EGR2 knockdown (FIG. 6a-i) placing is as a downstream target of those TF whereas it remained unchanged upon FOXS1 siRNA treatment placing it beforehand. Consistently, FOXS1 mRNA is downregulated upon TCF4, SOX9 and EGR2 siRNA treatment (FIG. 6a-i) placing it at the end of this cascade. Globally, the PPARG, MAF and MEOX2 mRNA were upregulated upon siRNA treatment against TCF4, SOX9, EGR2 and FOXS1 (FIG. 6a-i) consistent with their role as antagonist in fibroblast differentiation, SIX2 mRNA level was unchanged upon EGR2 and FOXS1 knockdown (FIG. 6a-i) but upregulated in the same manner by TCF4 and SOX9 consistent with a close interconnection between these two TF and suggesting the existence of a balanced signal between the differentiation agonists SOX9 and TCF4 and the antagonist SIX2.

[0174] The identification of transcription factors able to bypass chronic wound exudates effect is of major importance in the chronic wound field as it gives new insight into targets that can be used in the treatment of chronic wounds such as leg ulcers. In this study, by focusing on fibroblast, by no mean the inventors tried to dissimulate the importance of other cells like neutrophils and macrophages in the skin healing process but the inventors willingly simplified the biological context to draw a clearer picture of the situation.

[0175] Effects of Drugs on the Fibroblast Differentiation

[0176] The inventors have tested several concentrations of drugs to define at least a range of optimal concentrations to observe an effect on the cells: in absence and in presence of TGF- the inventors expected to observe for some of the drugs either an increase of differentiation or an inhibition of differentiation.

[0177] For these tests, the inventors assessed the expression of different genes: SMA, PI16 (WO2013/144348) and ACTC1 (markers for differentiation, upregulated in myofibroblast cells versus fibroblasts), in presence or not of exsudates.

[0178] Trametinib

[0179] Very interestingly the inventors can see that in presence of Trametinib in between 1 to 4 nM an increase of the basal level of SMA is observed in non treated fibroblasts (FIG. 8a).

[0180] Interestingly Trametinib is able to increase the SMA myofibroblast marker even in presence of exudate, as well as on PI16 and ACTC1 expression (2 others genes shown to be upregulated upon differentiation) (FIG. 9b). Trametinib might be able to bypass the dominant negative effect of exudate on differentiation and thus could be of great therapeutic interest. Trametinib was described as a MAF antagonist gene so these results are in complete agreement with the siRNA experiments where it was shown that inhibiting MAF expression could launch differentiation.

[0181] Am580

[0182] Am580 used at 5 nM is able to increase differentiation in presence of TGF (FIG. 9a). Am580 is able to potentiate the TGF effect on the fibroblast and to increase differentiation as followed with 3 markers upregulated upon differentiation (SMA, PI16 and ACTC1). Moreover in presence of exudate Am580 is able to erase the negative effect of exudate on differentiation as shown with the increase of SMA and PI16, in the condition where TGFbeta, exudate and Am580 were added to the cells, in contrast with the same condition without Am580.

[0183] It has been shown that Am580 has an agonist effect on SOX9; these results confirmed the siRNA experiment as it is shown that inhibition of SOX9 (by siRNA treatment) leads to a complete inhibition of differentiation. Here it is shown that treating cells with an agonist of Sox9 gives the opposite effect.

[0184] Gant 61

[0185] Gant 61 used at 4 M is able to increase differentiation as shown by the upregulation of -SMA (FIG. 10). Surprisingly, Gant 61 is able upregulate the expression of GLI1, however it is reported that Gant61l is an GLI1 inhibitor (Stanton. Benjamin Z., et al., 2010. Small-molecule modulators of the Sonic Hedgehog signaling pathway. Molecular bioSystems. 6(1): 44-54.) Moreover, Gant 61 induced the increase of SOX9 mRNA and the decrease of MAF mRNA.