Decreased lymphatic vessel counts in patients with systemic sclerosis: Association with fingertip ulcers

Alfiya Akhmetshina, Jürgen Beer, Karin Zwerina, Matthias Englbrecht, Katrin Palumbo, Clara Dees, Nicole Reich, Jochen Zwerina, Gabriella Szucs, Johannes Gusinde, Tatiana Nevskaya, Oliver Distler, Dontscho Kerjaschki, Georg Schett, Jörg H.W. Distler

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16 Citations (Scopus)


Objective. Systemic sclerosis (SSc) is a connective tissue disease that is characterized by microvascular disease and tissue fibrosis. Progressive loss and irregular architecture of the small blood vessels are well characterized, but the potential involvement of the lymphatic vessel system has not been analyzed directly in SSc. This study was undertaken to assess whether the lymphatic vascular system is affected in SSc, and whether changes to the lymphatic vessels are associated with dystrophic changes and tissue damage in patients with SSc. Methods. Lymphatic endothelial cells in skin biopsy samples from patients with SSc and age- and sex-matched healthy volunteers were identified by staining for podoplanin and prox-1, both of which are specifically expressed in lymphatic endothelial cells but not in blood vascular endothelial cells. CD31 was used as a pan-endothelial cell marker. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney U, and Spearman's rank correlation tests. Results. The numbers of podoplanin- and prox-1-positive lymphatic vessels were significantly reduced in patients with SSc as compared with healthy individuals. The number of podoplanin-positive lymphatic precollector vessels was significantly lower in SSc patients with fingertip ulcers than in SSc patients without ulcers. Moreover, the number of lymphatic vessels correlated inversely with the number of fingertip ulcers at the time of biopsy and with the number of fingertip ulcers per year. The inverse correlation between lymphatic precollector vessel counts and fingertip ulcers remained significant after statistical adjustment for the blood vessel count, age, and modified Rodnan skin thickness score. Conclusion. These results demonstrate a severe reduction in the number of lymphatic capillaries and lymphatic precollector vessels in patients with SSc. Patients with decreased lymphatic vessel counts may be at particularly high risk of developing fingertip ulcers.

Original languageEnglish
Pages (from-to)1513-1522
Number of pages10
JournalArthritis and Rheumatism
Issue number5
Publication statusPublished - May 1 2010

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

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    Akhmetshina, A., Beer, J., Zwerina, K., Englbrecht, M., Palumbo, K., Dees, C., Reich, N., Zwerina, J., Szucs, G., Gusinde, J., Nevskaya, T., Distler, O., Kerjaschki, D., Schett, G., & Distler, J. H. W. (2010). Decreased lymphatic vessel counts in patients with systemic sclerosis: Association with fingertip ulcers. Arthritis and Rheumatism, 62(5), 1513-1522.