1
|
Wallace HJ, Cadby G, Melton PE, Wood FM, Falder S, Crowe MM, Martin LJ, Marlow K, Ward SV, Fear MW. Genetic influence on scar height and pliability after burn injury in individuals of European ancestry: A prospective cohort study. Burns 2018; 45:567-578. [PMID: 30595539 DOI: 10.1016/j.burns.2018.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic model adjusting for age, sex, number of surgical procedures and % total body surface area of burn in subjects of European ancestry. No individual genetic variants achieved the cut-off threshold of significance. Gene regions were analysed for spatially correlated single nucleotide polymorphisms and significant regions identified using comb-p software. This gene list was subject to gene pathway analysis to find which biological process terms were over-represented. Using this approach biological processes related to the nervous system and cell adhesion were the predominant gene pathways associated with both SH and SP. This study suggests genes associated with innervation may be important in scar fibrosis. Further studies using similar and larger datasets will be essential to validate these findings.
Collapse
Affiliation(s)
- Hilary J Wallace
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Phillip E Melton
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Science, Curtin University, Perth, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Sian Falder
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Margaret M Crowe
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Lisa J Martin
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Karen Marlow
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sarah V Ward
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| |
Collapse
|
2
|
Wallace HJ, Fear MW, Crowe MM, Martin LJ, Wood FM. Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study. Burns Trauma 2017; 5:19. [PMID: 28680887 PMCID: PMC5494810 DOI: 10.1186/s41038-017-0084-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/27/2017] [Indexed: 11/15/2022]
Abstract
Background There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type). Methods A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS). Results The overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (>1 mm) and 80.4% for children without raised scars (≤1 mm). After adjustment for other variables, each 1% increase in % total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8% (95% CI = 4.4–28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR = 11.621; 95% CI = 3.727–36.234) and multiple surgical procedures (OR = 11.521; 1.994–66.566). Conclusions Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.
Collapse
Affiliation(s)
- Hilary J Wallace
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia.,Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, M318, 35 Stirling Highway, Crawley, 6009 WA Australia
| | - Mark W Fear
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia
| | - Margaret M Crowe
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, WA Australia
| | - Lisa J Martin
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, WA Australia
| | - Fiona M Wood
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia.,Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, WA Australia
| |
Collapse
|