Degreef Ilse, De Smet Luc, Sciot Raf, Cassiman Jean-Jacques, Tejpar Sabine
Orthopaedic Surgery Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Weligerveld 1, 3212, Pellenberg, Belgium.
Clin Orthop Relat Res. 2009 Mar;467(3):838-45. doi: 10.1007/s11999-008-0590-z. Epub 2008 Oct 29.
Recurrence of Dupuytren's contracture is common yet unpredictable, compromising surgical outcome. The alpha-smooth muscle actin-containing myofibroblast is the active contractile cellular component. Based on recent reports on beta-catenin accumulation in Dupuytren's disease, we investigated a possible relation with disease recurrence. We divided a collection of 143 nodules into those from patients with recurrent or nonrecurrent nodules and with a minimal 3-year followup. We randomly selected 12 and 11 samples of each group, respectively. We looked at Dupuytren's diathesis, immunohistologic staining for beta-catenin and alpha-smooth muscle actin, and Luck's histologic stages (zones). The expression of selected Wnt genes was examined with TaqMan PCR in separate histologic zones. All samples showed cytoplasmic and nuclear beta-catenin accumulation in myofibroblasts in involutional zones. The risk score of Abe et al. and Dupuytren's diathesis were greater in the recurrent group. Greater Wnt5a expression in the beta-catenin-accumulating involutional zone was seen. We conclude intracellular beta-catenin accumulation, possibly regulated by upstream Wnt signaling pathway activation and confined in myofibroblasts in the involutional zone of Dupuytren's diathesis, is unrelated to disease recurrence. Clinical parameters for Dupuytren's diathesis remain the best way to predict recurrence risk.
掌腱膜挛缩症的复发很常见但难以预测,会影响手术效果。含α-平滑肌肌动蛋白的肌成纤维细胞是活跃的收缩性细胞成分。基于近期有关β-连环蛋白在掌腱膜疾病中积聚的报道,我们研究了其与疾病复发的可能关系。我们将143个结节样本分为复发结节患者和非复发结节患者的样本,并进行了至少3年的随访。我们分别从每组中随机选取12个和11个样本。我们观察了掌腱膜素质、β-连环蛋白和α-平滑肌肌动蛋白的免疫组织化学染色以及拉克组织学分期(区域)。在不同的组织学区域用TaqMan PCR检测所选Wnt基因的表达。所有样本在 involutional区域的肌成纤维细胞中均显示出β-连环蛋白在细胞质和细胞核中的积聚。复发组中阿部等人的风险评分和掌腱膜素质更高。在β-连环蛋白积聚的 involutional区域观察到Wnt5a表达更高。我们得出结论,细胞内β-连环蛋白的积聚可能受上游Wnt信号通路激活的调节,并局限于掌腱膜素质 involutional区域的肌成纤维细胞中,与疾病复发无关。掌腱膜素质的临床参数仍然是预测复发风险的最佳方法。