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Ghassan M. Saed, PhD; Daniel Ladin, MD; Jennifer Olson, BS; Xuefei Han, MS; Zizheng Hou, MD; David Fivenson, MD

Arch Dermatol. 1998;134:963-967.

Background  Keloids are the result of a dysregulated wound healing process. They are characterized by the formation of excess scar tissue that proliferates beyond the boundaries of the original wound. Somatic mutations of p53 have been implicated as causal events in up to 50% of all human malignancies. In addition, p53 has been shown to play an important role in controlling cell proliferation and apoptosis. We hypothesize that mutations in p53 can lead to a hyperproliferative state that can result in keloid formation.

Objective  To detect p53 DNA mutations in tissues and cultured fibroblasts from skin lesions of 7 patients with keloids.

Design  The polymerase chain reaction followed by single-strand conformational polymorphism analysis and direct DNA sequencing were used to detect p53 gene mutations.

Setting  The Department of Dermatology, Henry Ford Hospital, Detroit, Mich.

Patients  Seven patients with keloids seen for routine surgical excision of their lesions. Normal DNA specimens were obtained from buccal smears and healthy skin samples from these patients.

Results  Mutations in the p53 gene were identified in all patients by polymerase chain reaction followed by single-strand conformational polymorphism analysis and subsequently confirmed by DNA sequencing. A mutation in exon 5 resulting in amino acid substitution was found in 1 of the patients in keloid tissue and cultured keloid fibroblasts (codon 156, CGCCCC, arginineproline). Frameshift mutations in exons 5 and 6 caused by the insertion or deletion of a nucleotide at different positions were found in 6 patients with keloids in both keloid tissues and cultured fibroblasts. Mutations in exon 4 resulting in amino acid substitution were found in all patients in both keloid tissues and cultured fibroblasts (all in codon 72, CGCCCC, arginineproline). No p53 mutations were detected in buccal smears or cultured fibroblasts from healthy skin samples of any of the patients.

Conclusions  Focal mutations in p53 may increase cell proliferation and decrease cell death in the dysregulated growth patterns that have been clinically documented. An understanding of the pattern of all growth dysregulation related to keloids may lead to new therapeutic strategies.

From the Departments of Dermatology (Drs Saed and Fivenson and Mss Olson and Han) and Plastic Surgery (Drs Ladin and Hou), Henry Ford Hospital, Detroit, Mich.

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