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The purpose of this investigation was to determine whether loss of neuronal control affects cellular and molecular homeostasis in the skin. Intact afflicted skin, wound edge of pressure ulcers, and control skin were analysed. Platelets, transforming growth factor\u2010<jats:bold><jats:italic>\u03b2<\/jats:italic><\/jats:bold>1, and activin A were identified by immunohistochemistry. Transforming growth factor\u2010<jats:bold><jats:italic>\u03b2<\/jats:italic><\/jats:bold>\u2010like activity was determined by bioassay, and gene expression by DNA microarray analysis or RT\u2010PCR. In afflicted skin, enhanced platelet extravasation was detected. Transforming growth factor\u2010<jats:bold><jats:italic>\u03b2<\/jats:italic><\/jats:bold>1 and activin A accumulated in the dermal\u2010epidermal junction zone. Transforming growth factor\u2010<jats:bold><jats:italic>\u03b2<\/jats:italic><\/jats:bold>\u2010like activity and activin A expression were increased in intact afflicted skin (compared to control skin) and were further enhanced in pressure ulcers. In vitro, activity was generated by fibroblast\u2010epithelial cell interactions, which also induced activin A. Thus, loss of neuronal control in spinal cord injury appears to trigger inappropriate wound healing processes in the patients' skin. Plasma leakage and increased transforming growth factor\u2010<jats:bold><jats:italic>\u03b2<\/jats:italic><\/jats:bold>\u2010like activity combined with shear forces potentially enhance the risk for pressure ulcer formation.<\/jats:p>","DOI":"10.1111\/iwj.13575","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T06:14:03Z","timestamp":1615875243000},"page":"728-737","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cellular and molecular changes that predispose skin in chronic spinal cord injury to pressure ulcer formation"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4642-1535","authenticated-orcid":false,"given":"Georg","family":"Brunner","sequence":"first","affiliation":[{"name":"Center for Spinal Cord Injuries Werner Wicker Hospital  Bad Wildungen Germany"},{"name":"Department of Cancer Research Skin Cancer Center Hornheide  M\u00fcnster 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