title: Inflammatory cytokine levels in chronic venous insufficiency ulcer tissue before and after compression therapy.
abstract: OBJECTIVE
  Elevated inflammatory cytokine levels have been implicated in the pathogenesis of non-healing chronic venous insufficiency (CVI) ulcers. The goal of this study was to determine the protein levels of a wide range of inflammatory cytokines in untreated CVI ulcer tissue before and after 4 weeks of high-strength compression therapy. These levels were compared to cytokines present in healthy tissue.
  
  
  METHODS
  Thirty limbs with untreated CVI and leg ulceration received therapy for 4 weeks with sustained high-compression bandaging at an ambulatory wound center. Biopsies were obtained from healthy and ulcerated tissue before and after therapy. A multiplexed protein assay was used to measure multiple cytokines in a single sample. Patients were designated as rapid or delayed healers based on ulcer surface area change.
  
  
  RESULTS
  The majority of pro-inflammatory cytokine protein levels were elevated in ulcer tissue compared to healthy tissue, and compression therapy significantly reduced these cytokines. TGF-beta1 was upregulated in ulcer tissue following compression therapy. Rapid healing ulcers had significantly higher levels of IL-1alpha, IL-1beta, IFN-gamma, IL-12p40, and granulocyte macrophage colony stimulating factor (GM-CSF) before compression therapy, and IL-1 Ra after therapy. IFN-gamma levels significantly decreased following therapy in the rapidly healing patients.
  
  
  CONCLUSIONS
  CVI ulcer healing is associated with a pro-inflammatory environment prior to treatment that reflects metabolically active peri-wound tissue that has the potential to heal. Treatment with compression therapy results in healing that is coupled with reduced pro-inflammatory cytokine levels and higher levels of the anti-inflammatory cytokine IL-1 Ra.
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Beidler
authors.forename: Christelle D
authors.initials: CD
authors.lastname: Douillet
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Berndt
authors.forename: Blair A
authors.initials: BA
authors.lastname: Keagy
authors.forename: Preston B
authors.initials: PB
authors.lastname: Rich
authors.forename: William A
authors.initials: WA
authors.lastname: Marston