title: The relationship of VEGF and PGE2 expression to extracellular matrix remodelling of the tenosynovium in the carpal tunnel syndrome.
abstract: Tenosynovial thickening within the confined space of the carpal tunnel is thought to be the cause of the carpal tunnel syndrome (CTS). However, little is known about the pathological mechanism of tenosynovial thickening. In this study, the role of prostaglandin E(2) (PGE(2)) and vascular endothelial growth factor (VEGF) (two representative molecules that can induce oedema by increasing vascular permeability) was analysed in CTS by using immunohistochemistry and enzyme-linked immunosorptive assay (ELISA). Expression of these molecules was compared with the patients' clinical histories and a temporary increase in production of these molecules was found in cells within the vessels and synovial lining during the intermediate phase of the syndrome when the histology of the tenosynovium changes from oedematous to fibrotic. Statistical analysis clearly demonstrated that there is a close correlation between the expression of PGE(2) and VEGF. Furthermore, immunohistochemical analysis with anti-proliferating cell nuclear antigen (PCNA) revealed that the area with distinct VEGF expression closely matched the area where endothelial cells, vascular smooth muscle cells, and synovial lining cells proliferate. In contrast, despite marked alteration in the extracellular matrix (ECM) component of the tenosynovium, the fibroblasts responsible for most ECM framework production do not proliferate during any phase of CTS. Histological analysis demonstrated that angiogenesis takes place only during the intermediate phase. Since clusters of capillaries and arterioles are often surrounded by type III collagen-rich, disorganized, degenerate connective tissue, which contains fewer fibroblasts than normal, angiogenesis appears to take place as a part of a regenerative reaction that results in fibrosis. These findings strongly indicate that both PGE(2) and VEGF are expressed in the tenosynovium in CTS during the intermediate phase and induce the histological changes seen in the tenosynovium.
authors.affiliation: Department of Orthopaedic Surgery, Mie University, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan. h-hirata@clin.medic.mie-u.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagakura
authors.forename: Masaya
authors.initials: M
authors.lastname: Tsujii
authors.forename: Akimasa
authors.initials: A
authors.lastname: Morita
authors.forename: Kohzo
authors.initials: K
authors.lastname: Fujisawa
authors.forename: Atsumasa
authors.initials: A
authors.lastname: Uchida
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D002455:Cell Division / Q000502:physiology; D003094:Collagen / Q000032:analysis; D015232:Dinoprostone / Q000032:analysis*; D018450:Disease Progression; D042783:Endothelial Cells / Q000473:pathology / Q000502:physiology; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005109:Extracellular Matrix / Q000473:pathology / Q000502:physiology*; D005260:Female; D005347:Fibroblasts / Q000502:physiology; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000473:pathology / Q000503:physiopathology; D009389:Neovascularization, Pathologic / Q000473:pathology / Q000503:physiopathology; D018809:Proliferating Cell Nuclear Antigen / Q000276:immunology; D013314:Stress, Mechanical; D013583:Synovial Membrane / Q000473:pathology / Q000503:physiopathology; D013710:Tendons / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis*
chemical_list: D018809:Proliferating Cell Nuclear Antigen; D042461:Vascular Endothelial Growth Factor A; D003094:Collagen; D015232:Dinoprostone