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dc.contributor.authorKanapathy, Muholanen
dc.contributor.authorSimpson, R.en
dc.contributor.authorMadden, Leighen
dc.contributor.authorThrasivoulou, C.en
dc.contributor.authorMosahebi, A.en
dc.contributor.authorBecker, David Lawrenceen
dc.contributor.authorRichards, T.en
dc.identifier.citationKanapathy, M., Simpson, R., Madden, L., Thrasivoulou, C., Mosahebi, A., Becker, D. L., et al. (2018). Upregulation of epidermal gap junctional proteins in patients with venous disease. British Journal of Surgery, 105(1), 59-67.en
dc.description.abstractBackground Leg ulceration is a feared complication of venous insufficiency. It is not known whether varicose veins predispose skin to poor wound healing. The expression pattern of gap junctional protein connexin, a known marker of poor wound healing, was investigated across various stages of venous disease. Methods Patients undergoing intervention for varicose veins were assessed according to the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification of varicose veins. Paired 4‐mm punch biopsies were taken from above the ankle (pathological) and above the knee (control). Tissues were stained with haematoxylin and eosin, and for connexin 43, connexin 30 and connexin 26. Results Forty‐eight paired biopsies were taken (12 each for CEAP class C0, C2, C4 and C6). The pathological skin showed progressive epithelial hyperthickening, an increase in the number and depth of rete ridges, increased inflammation and loss of dermal architecture with disease progression from C4 onwards. The overall absolute connexin expression and mean connexin expression per cell in the pathological skin similarly increased across the CEAP classes from as early as C2. Increasing levels of connexin in control skin were also noted, indicating progression of the disease proximally. Connexin 43 expression showed the strongest positive correlation between pathological and control skin. Conclusion Connexins were overexpressed in patients with simple varicose veins, with a stepwise increased expression through venous eczema to ulceration. Connexin 43 is a potential biomarker for venous disease. This finding suggests that varicose veins predispose skin to poor wound healing.en
dc.format.extent19 p.en
dc.relation.ispartofseriesBritish Journal of Surgeryen
dc.rights© 2017 BJS Society Ltd (Published by John Wiley & Sons Ltd). This is the author created version of a work that has been peer reviewed and accepted for publication by British Journal of Surgery, BJS Society Ltd (Published by John Wiley & Sons Ltd). It incorporates referee’s comments but changes resulting from the publishing process, such as copyediting, structural formatting, may not be reflected in this document. The published version is available at: [].en
dc.subjectPathological Skinen
dc.titleUpregulation of epidermal gap junctional proteins in patients with venous diseaseen
dc.typeJournal Articleen
dc.contributor.schoolLee Kong Chian School of Medicine (LKCMedicine)en
dc.description.versionAccepted versionen
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