Elsevier

Surgery

Volume 131, Issue 3, March 2002, Pages 324-331
Surgery

Original Communications
Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia*,**

https://doi.org/10.1067/msy.2002.121376Get rights and content

Abstract

Background. Recent findings of an impaired protein ratio of type I to type III procollagen showed a disturbed collagen metabolism in incisional hernia development. We analyzed the type I and type III procollagen messenger RNA to investigate whether these findings represent the altered extracellular matrix or a primary defect at the transcriptional level. Methods. We examined cultured skin fibroblasts of patients with incisional or recurrent incisional hernia in comparison with those without any previous incision (control) and those with a skin scar without clinical appearance of a hernia (scar). Immunohistochemical detection of a lowered protein ratio of type I and type III collagen in the hernia skin tissue leads to mRNA expression analysis. The procollagen mRNA and the ratio of type I to type III procollagen mRNA are detected by reverse transcriptase-polymerase chain reaction and Northern blot analysis, the collagens type I and III by Western blot analysis. Results. Reverse transcriptase-polymerase chain reaction revealed an increase of type I procollagen mRNA in the incisional and recurrent hernia (0.90 ± 0.04 and 1.19 ± 0.04, respectively) compared with stable scar (0.54 ± 0.02) or healthy tissue (0.43 ± 0.01). The obvious rise of type III procollagen mRNA to 4.13 ± 0.04 for incisional, 6.02 ± 0.03 for recurrent hernia, 2.29 ± 0.04 for stable scar, and 1.72 ± 0.03 for the healthy tissue showed a significantly decreased ratio of type I to type III procollagen mRNA in the hernia patients as compared with the controls (P <.01). By Western blot analysis, an increase of type I and type III collagen protein and a significant rise in the corresponding ratio in the recurrent hernia group were detected. Conclusions. The altered synthesis of type I and type III collagen in cultured skin fibroblasts suggests a disorder of collagen metabolism, at least in patients with recurrent hernia. Hence, a basically impaired wound healing process is likely to contribute to the unsatisfactory results of incisional hernia repair. (Surgery 2002;131:324-31.)

Section snippets

Clinical specimens

From January to July 1999, a total of 22 patients participated in this study at the Department of Surgery. Informed consent was obtained from all patients.

Skin tissue samples were taken from the abdominal wall of healthy control patients with no previous skin incisions (n = 5; male 4, female 1; average age 61 years); from patients with a stable scar without any sign of herniation (n = 5; male 3, female 2; average age 58 years); from patients with an incisional hernia (n = 7; male 5, female 2;

Immunohistochemical analysis of collagen types I and III in tissue specimen

The immunostaining of the tissue with antibodies against collagen type I and type III showed a similar distribution in all groups. However, there is a slight increased staining for type III collagen in the group with recurrent incisional hernias. After Quantimet analysis, the resulting ratio of collagen I/III was found to be 0.62 ± 0.04 in the skin of the control group; 0.59 ± 0.01 in normal skin scars; 0.54 ± 0.02 in the skin of patients with incisional hernias; and 0.47 ± 0.01 in the skin of

Discussion

Collagen, as the principal component of the extracellular matrix, mainly consists of type I and type III collagen, which constitutes approximately 95% of all known 19 collagen types.8 Type I collagen, with its high tensile strength, is predominantly found in skin, bone, and fascia, whereas type III collagen is predominantly seen in blood vessels and parenchymatous organs. In healthy skin, type I and III collagen exist in a ratio of approximately 4:1.11 Type III collagen threads are thinner than

Conclusion

In the future, the investigation of the collagen gene expression and modulation in tissue of patients with an incisional hernia may help to define a population at risk. The incisional hernia has a known incidence of up to 20% and is the most frequent long-term complication after a laparotomy. Any development of a preventive therapeutic strategy would be of considerable socioeconomic relevance.

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    *

    Supported by the Federal Ministry of Education and Research (Germany) grant project 01KS9503/9 for the Interdisciplinary Center for Medical Research on Biomaterials and Implant Tissue-Interfaces, The Aachen University of Technology, the German Research Foundation (Kl 1320/2-1), and ETHICON, Norderstedt, Germany.

    **

    Reprint requests: Uwe Klinge, MD, Department of Surgery, The Technical University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.

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