Expression of growth factors and growth factor receptor in non-healing and healing ischaemic ulceration.
OBJECTIVE
To characterise the histological and cytokinetic characteristics of purely ischaemic ulcers and the processes that underpin healing following successful revascularisation.


METHODS
Prospective observational study.


METHODS
Biopsies were taken immediately pre- and 6 weeks following successful revascularisation of solely ischaemic ulceration. They were evaluated for morphological differences using H&E staining for the platelet derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), TGFbeta receptorIII (TGFbetaRIII), transforming growth factor beta 1 and 3 (TGFbeta1 and TGFbeta3) and von Willebrand factor (vWF) expression using immunohistochemistry. Localisation and quantification of these growth factors and receptors was assessed systematically by three independent investigators who were blinded to the timing of biopsy.


RESULTS
Pre-operatively, small vessel vasculitis, necrosis and infection with a profuse neutrophil and macrophage infiltrate was observed in all samples. Post-operative biopsies revealed a proliferation of new capillaries in and around the ulcer edge and base. vWF staining confirmed an endothelial layer within these new vessels. Following successful revascularisation there was less infection and inflammation with minimal vasculitis. These newly formed capillaries had increased staining for TGFbeta3, PDGFR and TGFbetaRIII with staining for PDGFR also localised to dermal fibroblasts which were larger and more numerous. Accelerated epithelial cell proliferation was observed with detachment from the underlying dermis.


CONCLUSIONS
Healing of purely ischaemic ulcers is characterised by vasculogenesis associated with increased presence of the proangiogenic cytokines PDGF and TGFbeta3. These findings show promise for the use of growth factor manipulation to aid healing in ischaemic ulcers.
Murphy
M O
MO
Department of Vascular Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
Ghosh
J
J
Fulford
P
P
Khwaja
N
N
Halka
A T
AT
Carter
A
A
Turner
N J
NJ
Walker
M G
MG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000209:etiology / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017978:Receptors, Growth Factor / Q000378:metabolism*; D016212:Transforming Growth Factor beta / Q000378:metabolism*; D014945:Wound Healing / Q000502:physiology
D017978:Receptors, Growth Factor; D016212:Transforming Growth Factor beta