Trauma of Peripheral Innervation Impairs Content of Epidermal Langerhans Cells

Diagnostics, 2022 · DOI: 10.3390/diagnostics12030567 · Published: February 23, 2022

Spinal Cord Injury Neurology Dermatology

Simple Explanation

This study examines the impact of spinal cord injury (SCI) on Langerhans cells, which are immune cells in the skin. It looks at patients with lower motor neuron lesions (LMNSCI) and upper motor neuron lesions (UMNSCI). The researchers analyzed skin biopsies from the legs of patients before and after two years of electrical stimulation. The stimulation was either functional electrical stimulation for denervated muscles (h-bFES) or neuromuscular electrical stimulation (NMES). The results suggest that LMNSCI leads to an early decrease in immunoprotection in the skin, which can last for at least 10 years. Electrical stimulation can improve skin thickness, but it doesn't change the density of Langerhans cells.

Study Duration

2 years

Participants

13 LMNSCI patients and 3 UMNSCI patients

Evidence Level

Pilot case-study

Key Findings

1
Epidermal atrophy worsens with increasing years of LMNSCI.
2
Two years of skin electrostimulation reverses skin changes, producing a significant recovery of epidermis thickness, but not changes in Langerhans cells density.
3
LMNSCI induces an early decrease of immunoprotection that lasts at least 10 years.

Research Summary

This study evaluated Langerhans cells density and progression of epidermal atrophy in permanent spinal cord injury (SCI) patients suffering with either lower motor neuron lesions (LMNSCI) or upper motor neuron lesions (UMNSCI), both submitted to surface electrical stimulation. Linear regression analyses show that epidermal atrophy worsens with increasing years of LMNSCI and that 2 years of skin electrostimulation reverses skin changes, producing a signiﬁcant recovery of epidermis thickness, but not changes in Langerhans cells density. All together, these are original clinically relevant results suggesting a possible immuno-repression in epidermis of the permanently denervated patients.

Practical Implications

Counteracting Epidermal Atrophy

Electrical stimulation with anatomically shaped electrodes attached to the skin is clinically relevant to counteract epidermal atrophy in LMNSCI patients.

Understanding Immunosuppression

Permanent denervation induces an early decrease in epidermal immune protection that lasts at least 10 years after LMNSCI, suggesting potential for targeted immune therapies.

Guiding Rehabilitation Strategies

Functional electrical stimulation may not restore skin immunocompetence, highlighting the need for comprehensive strategies to address both muscle and skin health in SCI patients.

Study Limitations

1
Small sample size of UMNSCI patients.
2
The study design is a pilot case-study.
3
The clinical implications of the alteration in the content of Langerhans cells are unclear.

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