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Madison R. Mack, Gwen Wendelschafer-Crabb, Brian D. McAdams, Maria K

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1 Peripheral Neuro-Immune Pathology in Recessive Dystrophic Epidermolysis Bullosa 
Madison R. Mack, Gwen Wendelschafer-Crabb, Brian D. McAdams, Maria K. Hordinsky, William R. Kennedy, Jakub Tolar  Journal of Investigative Dermatology  Volume 135, Issue 4, Pages (April 2015) DOI: /jid Copyright © 2015 The Society for Investigative Dermatology, Inc Terms and Conditions

2 Figure 1 Recessive dystrophic epidermolysis bullosa (RDEB) patients have fewer epidermal nerve fibers (ENFs) and disorganized dermal nerve architecture. (a, b) To assess ENF density, ENFs were manually traced in 32 μm confocal image stacks of formalin-fixed skin sections stained with anti-protein gene product 9.5 (PGP9.5) rabbit antiserum and anti-collagen IV goat IgG. Slopes and intercepts within the 95% confidence interval of the linear regression were compared between groups to determine significance. Dotted lines indicate 95% confidence interval of the linear regression fit. (c) PGP9.5-stained skin sections were scored for nerve content in subepidermal neural plexus (SNP) score, where 0=normal, –1=½ normal levels, –2=14 normal levels, –3=< 14 normal levels, and 4 =no nerve. (d) × 20 Images of PGP9.5-positive nerves in the upper dermis and epidermis (scale bar=50 μm, arrows indicate SNP-associated nerves). (e) As another measure of the SNP region, total units of PGP9.5 immunofluorescence per square millimeter was quantified within the first 200 μm of dermis below the dermal–epidermal junction, plotted as mean ± SEM (n=6), and groups were compared by means of the t-test. Supplementary Materials online contain detailed methods. cap, capillary; DEJ, dermal–epidermal junction; ENFs, epidermal nerve fibers; SNP, subepidermal neural plexus. Journal of Investigative Dermatology  , DOI: ( /jid ) Copyright © 2015 The Society for Investigative Dermatology, Inc Terms and Conditions

3 Figure 2 Increased mast cell number and degranulation in recessive dystrophic epidermolysis bullosa (RDEB) patients. (a) Mast cells in RDEB and control skin were visualized by immunostaining with mouse anti-tryptase antiserum (Millipore, Billerica, MA) in 60 μm sections (scale bar=100 μm). (b) Mast cell density and (c) degranulation area were quantified in Neurolucida through automated object tracing, and groups were compared by means of the t-test. Error bars display the mean ± SEM. Supplementary Materials online contain detailed methods. Data from patients are color-coded in the same manner as for graphs (b, c). One patient (shown in red) had substantially more mast cells than any other individual and, to assess the data in the most conservative manner, has not been included in the t-test result shown (were the data point included P<0.001). Journal of Investigative Dermatology  , DOI: ( /jid ) Copyright © 2015 The Society for Investigative Dermatology, Inc Terms and Conditions


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