Vitamin D and Inflammatory Biomarkers during Wound-Healing

Objectives: Hypertrophic scars and keloids represent common undesirable consequences of wound-healing in which the pathogenesis continues on debate. It is known that a robust inflammatory mechanism is behind the formation of this abnormal fibrous wound-healing process. However, specific etiology, and pathophysiology remains unknown and treatment options ineffective[1]. Vitamin D is involved in proliferation, differentiation, and immunoregulation of cells and has shown to be a powerful anti-inflammatory agent[2]. Moreover, Vitamin D plays a role in terminal differentiation of epidermal cells that can affect wound healing[3,4]. The aim of this study is to evaluate vitamin D and inflammatory biomarkers plasma levels during wound-healing.

Materials and Methods: A prospective study was performed in patients (n=50) submitted to body contouring surgery, regarding the clinical evolution of the scars. Blood samples were collected before (t₀) and 3 to 5 days after surgery (t₅) corresponding to the inflammatory phase of wound healing.  Blood cell count, protein inflammatory biomarkers, vitamin D, vitamin A and vitamin E were quantified. Three months after surgery scars were evaluated and classified as normal or hypertrophic by two independent observers.

Results: In the end of the study 80% of patients developed a normal scar (control group, n=40) and 20% of patients presented hypertrophic scars (HT group, n=10). Patients in the HT group presented higher monocyte count (8.55% vs. 7.19%, p=0.036) and C-reactive protein levels (CRP: 6.12mg/L and 2.30mg/L, p=0.015) in t₀ comparing with the control group. In t₅, patients in the HT group, showed an decrease in neutrophil (53.97% vs 61,55%, p=0.0065) and increase in basophil (0.45% vs. 0.22%, p=0.0003) and lymphocyte count  (32.47% vs. 27.11%, p=0.037) compared with patients with normal scars (Fig.1).

Before surgery, Vitamin D plasma levels were found to be decreased by almost 50% (23.96ng/ml vs 13.33ng/mL, p=0.06) in patients that developed hypertrophic scars., in contrast no differences were found in vitamin E and vitamin A levels (Fig.2).

Conclusion: There is different systemic inflammatory profile response in patient during the formation of hypertrophic scars. Furthermore, vitamin D plasma levels are marked reduced in these patients. Considering the powerful anti-inflammatory effect of Vitamin D these findings could be related.