Abstract
Hypertrophic scars represent a common complication in burn patients. In addition to cosmetic defects, they may cause serious sensory abnormalities such as pain and itching, severe dysfunction depending on the site, and emotional disorders such as anxiety and depression. The present study aimed to identify the molecular mechanisms underlying the use of extracorporeal shock wave therapy in keratinocytes. Keratinocytes derived from hypertrophic scar tissue were cultured and expression of proliferation markers (keratin 5 and 14), activation markers (keratin 6 and 17), differentiation markers (keratin 1, 10, and involucrin), apoptosis factors (Bax, Bcl2, and Caspase 14), and proliferation/differentiation regulators (p21 and p27) was investigated to compared with that of those in keratinocytes derived from normal skin tissue. Scar-derived keratinocytes were treated with extracorporeal shock waves under 1000 impulses at 0.1, 0.2, and 0.3 mJ/mm2. Shock waves altered the molecular pattern of proliferation, activation, differentiation, and apoptosis, as well as proliferation/ differentiation regulators, including Bax, Bcl2, ASK1, p21, p27, and Notch1. In summary, we show that extracorporeal shock wave therapy regulates the proliferation and differentiation of keratinocytes derived from hypertrophic scar to maintain normal epidermal integrity.
Highlights
Hypertrophic scars represent a common complication in burn patients
The expression of keratin 5 and 14 at mRNA and protein levels was no significant difference between hypertrophic scar keratinocytes (HTSKs) and Human normal keratinocytes (HNKs) (Figure S1A–D)
The expression of keratin 6 and 17 at mRNA and protein was markedly higher in HTSKs than that of those in HNKs (Fig. 1)
Summary
Hypertrophic scars represent a common complication in burn patients. In addition to cosmetic defects, they may cause serious sensory abnormalities such as pain and itching, severe dysfunction depending on the site, and emotional disorders such as anxiety and depression. Whereas the exact mechanism remains unknown, the phenomenon is characterized by the pathological proliferation of scar tissue caused by abnormal wound healing and scar maturation p rocesses[1] It is accompanied by excessive deposition of extracellular matrix, which increases scar thickness and decreases elasticity of the scar skin, and causes continuous scar pain and itching in burn patients[1,2]. Thicker scars in the joint area decrease the range of motion of the joint and become an important impediment to daily life movements and walking during the rehabilitation process[1] Various treatments, such as compression clothing, silicone gel, scar massage, laser treatment, intralesional injection, and surgical removal, are combined in clinical practice to treat hypertrophic scars in burn p atients[3]. The application of extracorporeal shock waves to treat hypertrophic scars resulting from burns has been limited to animal m odels[16]
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