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- W2018685946 abstract "Sir:FigureDuring healing, wounds are painful or pruritic, and the resulting scar may be anesthetic or pruritic. Furthermore, tissues fail to heal normally if deprived of a nerve supply, leading to the observation that neuropeptides have dual purposes in wounds, both in sensory signaling and as mediators of healing. The sensory nervous system exerts a distally directed antidromic effect in addition to the conventional orthodromic response. Wounds are initially hyperinnervated during healing. During scar maturation, nerve density normalizes1 or becomes less than in controls. Although densities can be normal, the normal pattern of scar innervation is not reestablished (Fig. 1). Nerve end organs cannot regenerate, preventing restoration of normal sensation.Fig. 1: Immunohistochemical staining of (above) normal (unwounded) murine skin and (below) 42-day-old murine excisional wound for the pan-neuronal marker PGP9.5 in green. Red counterstain shows epidermis and hair follicles. Note the absence of hair follicles in the scar. Sensory end organs also fail to regenerate. (From Henderson J, Terenghi G, McGrouther DA, Ferguson MW. The reinnervation pattern of wounds and scars may explain their sensory symptoms. J Plast Reconstr Aesthet Surg. 2006;59:942–950.)The neurotransmitters calcitonin gene-related peptide and substance P are expressed by C fibers and are implicated in pain signaling. Calcitonin gene-related peptide is also found in Aδ fibers mediating pruritus. Substance P and calcitonin gene-related peptide contribute to the cutaneous response to injury. Nerve growth factor (NGF) is important in healing and sensory nerve development. Pruritic hypertrophic scars and experimental wounds contain more calcitonin gene-related peptide and substance P than normal skin. Although calcitonin gene-related peptide nerve fiber density returns to control levels in normotrophic scars, the increase in substance P–immunopositive fibers persists in mature scars.1 Substance P immunoreactivity is increased in pruritic skin grafts despite an overall decrease in graft innervation. Substance P is also elevated in psoriatic lesions and hypertrophic scars, whereas substance P–deficient mice show reduced allodynia and hyperalgesia. Calcitonin gene-related peptide fibers identified within human peroneal nerves stimulated electrically or with histamine cause pruritus. We suggest that calcitonin gene-related peptide levels could explain pain and pruritus during wound healing, and substance P might mediate the symptoms of mature scars. Neurotransmitters have multiple actions in mediating healing: substance P causes mast cell degranulation, inflammation, and keratinocyte proliferation. Substance P injection causes flare, wheal, and pruritus. Calcitonin gene-related peptide is a vasodilator and growth factor for various cells, showing synergy with substance P. Capsaicin stimulates substance P (and calcitonin gene-related peptide) release (causing a burning sensation) and then destroys small cutaneous neurons. This represents a useful pruritus treatment but can cause ulceration or poor healing. NGF−/− mice fail to develop normal cutaneous calcitonin gene-related peptide levels, and fail to respond to noxious stimuli. Cutaneous innervation and behavior are restored by transgenic NGF expression. NGF preferentially stimulates the growth of sensory neurons that express calcitonin gene-related peptide and substance P and is a growth factor for keratinocytes, fibroblasts, and endothelial cells. NGF accelerates healing in a variety of wound models. NGF is produced by keratinocytes, mast cells, injured tissue, and denervated skin. NGF administration causes cutaneous inflammation and sensitization. A recombinant NGF antagonist is being evaluated in clinical trials for the treatment of acute and chronic pain.2 The most promising future work follows the observation that fetuses can heal without scarring. Cytokine treatments including transforming growth factor-β3 reduce adult wound scarring.3,4 Studies of the developing cutaneous innervation may facilitate development of strategies to encourage regeneration of normal cutaneous neuronal anatomy. James Henderson, F.R.C.S.(Plast.) Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norfolk, United Kingdom Mark W. J. Ferguson, Ph.D. Renovo Ltd., Manchester, United Kingdom Giorgio Terenghi, Ph.D. Blond McIndoe Laboratories, University of Manchester, Manchester, United Kingdom DISCLOSURE Dr. Henderson was funded by Renovo, of which Dr. Ferguson is cofounder and chief executive officer. Renovo is conducting clinical trials of antiscarring agents." @default.
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- W2018685946 date "2012-01-01" @default.
- W2018685946 modified "2023-10-11" @default.
- W2018685946 title "The Feeling of Healing" @default.
- W2018685946 doi "https://doi.org/10.1097/prs.0b013e3182365fda" @default.
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