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April 1997

Adhesion Molecule Expression and Endothelial Cell Activation in Cutaneous Leukocytoclastic Vasculitis: An Immunohistologic and Clinical Study in 42 Patients

Author Affiliations

From the Departments of Dermatology (Drs Sais, Jucglá, and Peyrí), Internal Medicine (Dr Vidaller), and Pathology (Dr Condom), Ciutat Sanitaria i Universitaria de Bellvitge, Universitat de Barcelona, Barcelona, Spain.

Arch Dermatol. 1997;133(4):443-450. doi:10.1001/archderm.1997.03890400041006

Objectives:  To investigate the sequential expression of adhesion molecules on endothelium and inflammatory cells in cutaneous leukocytoclastic vasculitis, and the relation of these adhesive molecules with clinical and histologic variables.

Design:  An immunohistochemical analysis (streptavidin-biotin-peroxidase technique) of 42 vasculitic lesions of up to 96 hours was performed using a panel of monoclonal antibodies specific for different adhesion molecules. Twenty normal skin samples and 3 perilesional specimens served as control samples. A clinical protocol was also performed, and patients were followed up for 1 to 5 years.

Setting:  A clinicopathologic research unit of a university hospital.

Patients:  Forty-two patients, 21 women and 21 men, aged 22 to 79 years, with cutaneous leukocytoclastic vasculitis.

Interventions:  Three skin biopsy specimens of vasculitic lesions from each patient were obtained for histopathologic examination on paraffin, direct immunofluorescence, and immunohistochemical analysis on cryostatic tissue sections.

Main Outcome Measures:  The histologic characteristics and the immunohistochemical-stained specimens were evaluated by 3 independent investigators, using a semiquantitative method.

Results:  Increased endothelial expression of very late activation antigen-1, HLA-DR, and intercellular adhesion molecule-1 was observed. The induction of E-selectin expression was more marked in recent lesions (P<.001) and correlated with the proportion of infiltrating neutrophils (P=.03). Endothelial expression of vascular cell adhesion molecule-1 was restricted to developed lesions. Most infiltrating cells were neutrophils expressing Mac-1. In 1 patient, lymphocyte function associated antigen-1 expression was also up-regulated. No significant increase in CD3, CD8, or CD71 immunoreactivity was found. An up-regulation of perivascular cells expressing HLA-DR and vascular cell adhesion molecule-1 was observed in vasculitic lesions. This cellular staining correlated with long-term evolution of the disease (P=.04).

Conclusions:  Adhesion molecules are sequentially up-regulated in cutaneous leukocytoclastic vasculitis. The results of this study support the possible involvement of E-selectin in mediating recruitment of neutrophils expressing Mac-1.Arch Dermatol. 1997;133:443-450

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