title: Inhibited early immunologic response is associated with hypertrophic scarring.
abstract: This study aimed to examine changes in the inflammatory response in early hypertrophic compared to normal wound healing. The immune system is thought to be involved in hypertrophic scar formation. However, the exact mechanism and time of onset of the derailment remain unknown. In a prospective observational study, skin biopsies were taken directly postwounding and 3 hours later from patients who had elective cardiothoracic surgery. The skin biopsies were analysed for mRNA, proteins and cells involved in the early inflammatory phase of wound healing. The endpoint was scar outcome (hypertrophic (HTS) or normal (NTS)) at one year after surgery. There were significant differences between the NTS and HTS groups regarding the fold changes of mRNA expression of P-selectin during surgery. Postoperative skin concentrations of inflammatory proteins IL-6, IL-8 and CCL2 were significantly lower in the HTS compared to the NTS group. Also, a trend of higher pre-operative M2 macrophage numbers was observed in the HTS group. Neutrophil numbers increased equally during surgery in both groups. The increase of P-selectin mRNA in hypertrophic wound healing could affect leucocyte migration. The decreased concentrations of inflammatory proteins in hypertrophic wound healing indicate a reduced inflammatory response, which has consequences for the treatment of hypertrophic scarring during the early inflammatory phase. In a conclusion, alterations of wound healing associated with hypertrophic scarring are visible as early as 3 hours postwounding and include a reduced rather than increased inflammatory protein response.
authors.affiliation: Department of Plastic-, Reconstructive- and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Butzelaar
authors.affiliation: Department of Molecular Cell Biology and Immunology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Dennis P M
authors.initials: DP
authors.lastname: Schooneman
authors.affiliation: Department of Plastic-, Reconstructive- and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Ezgi A
authors.initials: EA
authors.lastname: Soykan
authors.affiliation: Department of Molecular Cell Biology and Immunology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: Talhout
authors.affiliation: Department of Plastic-, Reconstructive- and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.|Association of Dutch Burn Centers, Beverwijk, The Netherlands.
authors.forename: Magda M W
authors.initials: MM
authors.lastname: Ulrich
authors.affiliation: Department of Dermatology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Lenie J
authors.initials: LJ
authors.lastname: van den Broek
authors.affiliation: Department of Dermatology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: Gibbs
authors.affiliation: Department of Molecular Cell Biology and Immunology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Robert H J
authors.initials: RH
authors.lastname: Beelen
authors.affiliation: Department of Plastic-, Reconstructive- and Hand Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Aebele B
authors.initials: AB
authors.lastname: Mink van der Molen
authors.affiliation: Department of Plastic-, Reconstructive- and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands. fb.niessen@vumc.nl.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Niessen
mesh_terms: D002921:Cicatrix / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D006984:Hypertrophy / Q000276:immunology*; D020556:Neutrophil Infiltration; D011446:Prospective Studies
chemical_list: D016207:Cytokines
keywords: hypertrophic scar; immunology; inflammation; wound healing