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The pathophysiology of this process remains unknown. Here, we demonstrate for the first time that mechanical stress applied to a healing wound is sufficient to produce hypertrophic scars in mice. The resulting scars are histopathologically identical to human hypertrophic scars and persist for more than six months following a brief (one\u2010week) period of augmented mechanical stress during the proliferative phase of wound healing. Resulting scars are structurally identical to human hypertrophic scars and showed dramatic increases in volume (20\u2010fold) and cellular density (20\u2010fold). The increased cellularity is accompanied by a four\u2010fold decrease in cellular apoptosis and increased activation of the prosurvival marker Akt. To clarify the importance of apoptosis in hypertrophic scar formation, we examine the effects of mechanical loading on cutaneous wounds of animals with altered pathways of cellular apoptosis. In p53\u2010null mice, with down\u2010regulated cellular apoptosis, we observe significantly greater scar hypertrophy and cellular density. Conversely, scar hypertrophy and cellular density are significantly reduced in proapoptotic\n                    <jats:italic>Bcl<\/jats:italic>\n                    II\u2010null mice. We conclude that mechanical loading early in the prolifer\u2010ative phase of wound healing produces hypertrophic scars by inhibiting cellular apoptosis through an Akt\u2010dependent mechanism.\u2014Aarabi S., Bhatt, K. A., Shi, Y., Paterno, J., Chang, E. I., Loh, S. A., Holmes, J. W., Longaker, M. T., Yee, H., Gurtner G. C. Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis.\n                    <jats:italic>FASEB J.<\/jats:italic>\n                    21, 3250\u20133261 (2007)\n                  <\/jats:p>","DOI":"10.1096\/fj.07-8218com","type":"journal-article","created":{"date-parts":[[2007,5,15]],"date-time":"2007-05-15T21:42:41Z","timestamp":1179265361000},"page":"3250-3261","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":474,"title":["Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis"],"prefix":"10.1096","volume":"21","author":[{"given":"Shahram","family":"Aarabi","sequence":"first","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirit A.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubin","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josemaria","family":"Paterno","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward I.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang A.","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey W.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Columbia University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Longaker","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herman","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Pathology New York University School of Medicine New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey C.","family":"Gurtner","sequence":"additional","affiliation":[{"name":"Department of Surgery Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,5,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.276.5309.75"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411006"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199710163371607"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200001000-00005"},{"key":"e_1_2_6_6_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/00004311-200007000-00009","article-title":"Airway management and respiratory care of the burn patient","volume":"38","author":"Sheridan R. 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