Abstract：
UNASSIGNED: Complex regional pain syndrome (CRPS) presents postinjury with disproportionate pain and neuropathic, autonomic, motor symptoms, and skin texture affection. However, the origin of these multiplex changes is unclear. Skin biopsies offer a window to analyze the somatosensory and vascular system as well as skin trophicity with their protecting barriers. In previous studies, barrier-protective exosomal microRNAs were altered in CRPS. We here postulated that tissue architecture and barrier proteins are already altered at the beginning of CRPS. We analyzed ipsilateral and contralateral skin biopsies of 20 fully phenotyped early CRPS patients compared with 20 age- and sex-matched healthy controls. We established several automated unbiased methods to comprehensively analyze microvessels and somatosensory receptors as well as barrier proteins, including claudin-1, claudin-5, and claudin-19. Meissner corpuscles in the skin were bilaterally reduced in acute CRPS patients with some of them lacking these completely. The number of Merkel cells and the intraepidermal nerve fiber density were not different between the groups. Dermal papillary microvessels were bilaterally less abundant in CRPS, especially in patients with allodynia. Barrier proteins in keratinocytes, perineurium of dermal nerves, Schwann cells, and papillary microvessels were not affected in early CRPS. Bilateral changes in the tissue architecture in early CRPS might indicate a predisposition for CRPS that manifests after injury. Further studies should evaluate whether these changes might be used to identify risk patients for CRPS after trauma and as biomarkers for outcome.
摘要：
■复杂区域疼痛综合征（CRPS）在伤后表现为不成比例的疼痛和神经性，自主性,运动症状,和皮肤纹理的感情。然而,这些多重变化的起源尚不清楚.皮肤活检提供了一个窗口来分析体感和血管系统以及具有保护屏障的皮肤滋养。在以往的研究中,屏障保护性外泌体microRNAs在CRPS中发生了改变。我们在此假定在CRPS开始时组织结构和屏障蛋白已经改变。我们分析了20例完全表型的早期CRPS患者的同侧和对侧皮肤活检，并与20例年龄和性别匹配的健康对照进行了比较。我们建立了几种自动化的无偏方法来全面分析微血管和体感受体以及屏障蛋白，包括claudin-1，claudin-5和claudin-19。在急性CRPS患者中，皮肤中的Meissner小体双侧减少，其中一些完全缺乏。两组之间的默克尔细胞数量和表皮内神经纤维密度没有差异。CRPS中真皮乳头状微血管的双侧丰度较低，尤其是异常性疼痛患者。角质形成细胞中的屏障蛋白，皮肤神经的神经周，施万细胞，早期CRPS不影响乳头状微血管。早期CRPS组织结构的双侧变化可能表明损伤后表现出CRPS的倾向。进一步的研究应评估这些变化是否可用于确定创伤后CRPS的风险患者以及作为预后的生物标志物。
