title: Analysis of inflammatory cells and mediators in skin wound biopsies to determine wound age in living subjects in forensic medicine.
abstract: OBJECTIVE
  In forensic medicine it is important to determine the age of skin wounds in living subjects. The aim of this study was to assess whether analysis of inflammatory cells and inflammatory mediators in skin biopsies of wounds from living subjects could improve wound age determination.
  
  
  METHODS
  Biopsies (n=101), representing the superficial border area of a skin wound, were taken from skin injuries of known wound age (range: 4.5 hours to 25 days) of living subjects. All biopsies were analyzed for 3 inflammatory cell markers (MPO, CD45 and CD68) and 4 inflammatory mediators (MIP-1, IL-8, CML and vitronectin). For quantification, biopsies were subdivided in 4 different timeframes: 0.2-2 days, 2-4 days, 4-10 days and 10-25 days old wounds. Subsequently, a probability scoring system was developed.
  
  
  RESULTS
  MPO, CD45, MIP-1, IL-8 (inflammatory cell markers) and N(epsilon)-(carboxymethyl)lysine (CML) positivity were maximal in wounds of 0.2-2 days old and then decreased in time. Remarkably, CD45, CD68 and CML showed a minor but non-significant increase again in 10-25 days old wounds. MPO and CD68 positivity was significantly lower in 4-25 days old wounds compared to 0.2-4 days old wounds. MPO positivity was also significantly lower in 10-25 days old wounds compared to 0.2-10 days old wounds. For CD45, MIP-1, IL-8 and CML no significant differences between the age groups were found. In case of vitronectin positivity in the extravasate or when the number of MIP-1 or IL-8-positive cells was more than 10 cells/mm(2) the probability that a wound was more than 10 days old was 0%. A probability scoring system of all analyzed markers can be used to calculate individual wound age probabilities in biopsies of skin wounds of living subjects.
  
  
  CONCLUSIONS
  We have developed a probability scoring system of inflammatory cells and mediators that can be used to determine wound age in skin biopsies of living subjects.
authors.affiliation: Department of Pathology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Fronczek
authors.affiliation: Public Health Service Amsterdam, Department of Forensic Medicine, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
authors.forename: Ronald
authors.initials: R
authors.lastname: Lulf
authors.affiliation: Department of Pathology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; ICaR-VU, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: h.korkmaz@vumc.nl.
authors.forename: H Ibrahim
authors.initials: HI
authors.lastname: Korkmaz
authors.affiliation: Department of Epidemiology and Biostatistics, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Birgit I
authors.initials: BI
authors.lastname: Witte
authors.affiliation: Department of Pathology, Symbiant, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
authors.forename: Franklin R W
authors.initials: FR
authors.lastname: van de Goot
authors.affiliation: Department of Pathology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; ICaR-VU, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Pathology, Nederlands Forensisch Instituut (NFI), Laan van Ypenburg 6, 2490 GB The Hague, The Netherlands.
authors.forename: Mark P V
authors.initials: MP
authors.lastname: Begieneman
authors.affiliation: Department of Internal Medicine, Maastricht University, Minderbroedersberg 4, 6211 LK Maastricht, The Netherlands.
authors.forename: C G
authors.initials: CG
authors.lastname: Schalkwijk
authors.affiliation: Department of Pathology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; ICaR-VU, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Paul A J
authors.initials: PA
authors.lastname: Krijnen
authors.affiliation: Department of Pathology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rozendaal
authors.affiliation: Department of Pathology, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; ICaR-VU, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Cardiac Surgery, VU Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Hans W M
authors.initials: HW
authors.lastname: Niessen
authors.affiliation: Public Health Service Amsterdam, Department of Forensic Medicine, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
authors.forename: Udo J L
authors.initials: UJ
authors.lastname: Reijnders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D005260:Female; D049429:Forensic Pathology; D016179:Granulocyte Colony-Stimulating Factor / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007377:Interleukin-3 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D017493:Leukocyte Common Antigens / Q000378:metabolism; D008239:Lysine / Q000031:analogs & derivatives / Q000378:metabolism; D019402:Macrophage Inflammatory Proteins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011993:Recombinant Fusion Proteins / Q000378:metabolism; D012867:Skin / Q000293:injuries* / Q000378:metabolism* / Q000473:pathology; D013997:Time Factors; D019096:Vitronectin / Q000378:metabolism; D055815:Young Adult; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D016179:Granulocyte Colony-Stimulating Factor; D007377:Interleukin-3; D016209:Interleukin-8; D017493:Leukocyte Common Antigens; D008239:Lysine; D019402:Macrophage Inflammatory Proteins; D011993:Recombinant Fusion Proteins; D019096:Vitronectin; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C404145:myelopoietin; C048496:N(6)-carboxymethyllysine; C516769:PTPRC protein, human
keywords: Forensic; Immunohistochemistry; Immunology; Living subjects; Skin wounds; Wound age determination