Adhesion molecule expression in venous leg ulcers.

The final stage of chronic venous insufficiency (CVI) is ulceration. Several theories have been suggested to explain the skin changes and ulcerations. However, none of these can fully account for all the alterations which occur. Adhesion molecules are considered to play an important role in inflammatory reactions and in the process of wound healing. The aim of our study was to investigate the expression of intercellular adhesion molecule-1 (ICAM-1), endothelial leucocyte adhesion molecule-1 (ELAM-1), and vascular cellular adhesion molecule-1 (VCAM-1) in venous leg ulcers. Skin biopsies from 8 patients were taken from the surrounding skin of venous ulcers. ICAM-1 showed a weak to moderate expression on the endothelium of capillaries directly below the venous ulcer. A moderate expression of ICAM-1 was found on capillaries in the papillary dermis around the ulcus, similar to that of normal controls. A strong expression of ELAM-1 was only found on capillaries in the infiltrate directly under the ulcer. Some specimens also showed a moderate expression of ELAM-1 around the ulcus. Expression of VCAM-1 was subsequently found to be negative in all patients. The results suggest a disturbed inflammatory reaction in venous leg ulcers. In the area around the ulcer, where healing should initiate, the adhesion of monocytes and lymphocytes to the endothelium and the migration of these cells to the wound area were found to be insufficient.