Scleroderma skin biomechanics
Research type
Research Study
Full title
Structural, functional, mechanical and biochemical characteristics of the skin in patients with Scleroderma
IRAS ID
160515
Contact name
Riaz Akhtar
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
7 years, 11 months, 30 days
Research summary
Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterised by the clinical manifestation of scleroderma or ‘hard skin’. This project aims to better quantify the biomechanical properties of skin in SSc patients. Diagnosis of SSc is currently based on skin assessment using the semi-quantitative modified Rodnan skin score (mRSS) which is derived from clinical palpation of 17 anatomical areas. This clinical palpitation method of skin thickness is used as a surrogate measure of skin stiffness. More recently, an ultrasound-based technique, elastography has been utilised in some clinical studies. However, although the mRSS is considered a gold standard for assessment of SSc, the method is highly subjective and not able to discern discrete alterations in skin stiffness and/or disease progression. Similarly, although elastography is emerging as a useful in vivo technique, there are still unaddressed issues with regard to the semi-quantitative nature of the measurements. The proposal aims to use a novel in vitro technique, nanoindentation, to characterise tissue stiffness ex vivo using tissue obtained from 4 mm punch biopsies. Nanoindentation uses a rigid indenter to probe small volumes of tissues. Tissue stiffness from healthy controls will be compared with that from patients with SSc. Prior to taking punch biopsies from the tissue samples the patient’s mRSS will be recorded alongside skin elastography measurements. The ex vivo mechanical property data will be correlated with tissue histology. Hence, the specific objectives of this study are:
• To determine whether nanoindentation can differentiate between patients with normal skin and SSc (Primary Objective)
• To determine whether these novel ex vivo biomechanical properties of SSc relate to in vivo clinical methods used to assess skin stiffness, namely mRSS and elastography (Secondary Objective)
• To determine the relationship between ex vivo skin stiffness with skin histology (collagen content) (Secondary Objective)The data from this pilot study will aid in the development of a new medical device for measuring skin stiffness in scleroderma patients, in vivo.
REC name
Wales REC 7
REC reference
15/WA/0051
Date of REC Opinion
5 Feb 2015
REC opinion
Favourable Opinion