Abstract

Background Tissue expansion is a clinically established technique for addressing severe soft tissue defects and organ deformities. However, its advancement is limited by suboptimal efficiency and related complications. Elucidating the molecular and cellular mechanisms of skin regeneration during tissue expansion is therefore critical for enhancing therapeutic efficacy and minimizing adverse events. Angiotensin-converting enzyme 2 (ACE2) plays pivotal roles in tissue remodeling and regeneration. Our prior work identified ACE2 as mechanosensitive gene activated by mechanical stretch. Nevertheless, its regulatory mechanisms in epidermal regeneration during tissue expansion remain unclear. Methods HaCaT cells were treated with the ACE2 inhibitor MLN-4760, siRNA, and overexpression plasmids. Cell proliferation and migration were assessed by EdU assay and wound healing assay respectively. Transcriptomic sequencing was conducted to identify the differentially expressed genes (DEGs) after ACE2 knockdown in keratinocytes, which highlighted tenascin-C (TNC) as a critical DEG associated with epidermal regeneration. TNC silencing in HaCaT cells was analyzed via EdU and wound healing assays. In vivo, MLN-4760 was topically applied to the expanded rat skin, with epidermal regeneration assessed by H&E and PCNA immunofluorescence staining, while western blotting was used to evaluate the expression of proteins involved in TNC/PI3K/AKT/mTOR pathway. Results Both pharmacological inhibition and genetic knockdown of ACE2 enhanced the proliferation and migration of HaCaT cells, whereas ACE2 overexpression suppressed these activities. Mechanistically, ACE2 modulated cell behaviors and function through the TNC. In vivo, topical MLN-4760 application in a rat skin expansion model increased epidermal thickness, promoted keratinocyte proliferation, upregulated TNC expression, and activated PI3K/