Plastic Surgery Research Council
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Presenter: Lily Daniali, MD
Co-Authors: Kimura M; Kim S; Cao X; Herbig U; Aviv A; Granick M
University of Medicine and Dentistry of New Jersey School of Medicine

Objective: Telomeres, tandem repeats of DNA capping chromosomes, undergo progressive shortening with each cell division in normal cells. The pathologic maintenance of telomere length by telomerase has been implicated in tumor cell immortality. While the pathogenesis of keloids is poorly understood, keloids similarly demonstrate unregulated, proliferative characteristic. In theory, as keloid formation is dependent on cell replication, telomeres should be shorter within keloid lesions than in normal skin. We examined this concept in this study.

Methods: We measured and compared telomere length by Southern blot analysis of terminal restriction fragments in keloids and adjacent normal skin of 16 individuals. When available, we also measured telomere length in blood leukocytes and subcutaneous fat. Finally, we performed intralesional measurement and mapping of telomere length within the keloid.

Results: Telomere length was highly variable between different study subjects (3 -3.5 kB) but highly correlated among tissues within the same individual (P < 0.005). The mean telomere length in subcutaneous fat, a non-proliferative tissue, 8.32 kb (95% CI: 7.84-8.81) was longer than that in skin, 7.29 kb (95% CI: 6.85-7.73), and blood, 7.05 kb (95% CI: 6.49-7.61), both highly proliferative tissues (P < .001). There was no difference in mean telomere length between skin and blood (P = .27). Mean telomere length was longer in keloids than in adjacent normal skin (P < 0.03). Keloids also displayed an intralesional length gradient, with the mean telomere length being shorter just below the epidermis and longer at the base of the lesion.

Conclusions: Despite the highly proliferative nature of keloid fibroblasts, telomere length in keloids is significantly longer than in normal adjacent tissue. Our findings suggest an early activation of telomerase, the reverse transcriptase that prevents telomere shortening during the early phase of keloid formation. The activation of telomerase may serve to maintain or even elongate telomere length within the keloid.

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