Author(s): Ogunewe Chidera M and Iwuamadi Ojiugo C*
Objective: Striae distensae constitute linear dermal scars that are accompanied by epidermal atrophy not yet associated with any significant medical problem, but can cause significant distress to its sufferers. The study aimed to analyze the relationship between antioxidants and total antioxidant capacity and Striae distensae in young female adults.
Materials and Methods: Using a random sampling technique, sixty (60) young adult females with Striae distensae (test samples) were selected and agematched with sixty (60) young adult females without Striae distensae, who served as the control group. Ten milliliters (10ml) of venous blood was collected from each participant, it was dispensed into plain containers and was allowed to cloth, and then centrifuged to obtain serum, which was stored at -20℃ before use. The antioxidant effect of the samples was studied using ABTS (2, 2,-azino-bis-3-ethyl benthiazoline-6-sulphonic acid) radical; cation decolorization assay. While the immunoglobulins were determined using the Elisa technique, data obtained were subjected to statistical analysis using SPSS 21, and the P<0.05 level of significance was adopted.
Results: The results reveal significantly lower serum levels of GPx(0.1588±0.0264), Catalase(0.4627±0.2608), TAC (10.12±2.186) and SOD (0.8897±0.20708) in young adult females with SD compared to controls with GPx (0.1819±0.474), Catalase (0.6535±0.3112), TAC (11.82±2.991) and SOD (1.0389±0.1994). There are also non-significant correlation of GPx with IgG (r = 0.054, p = 0.684), IgE (r = -0.189, p = 0.148) and IgM (r = 0.058, p = 0.661) as well as there are non-significant correlation of serum SOD with IgG (r = -0.221, p = 0.089), IgE (r = 0.018, p = 0.891) and IgM (r = 0.088, p = 0.504) in young adult females with SD. The results also reveal non-significant correlation of TAC with IgG (r = -0.143, p = 0.275), and IgM (r = -0.071, p = 0.589), IgE (r = 0.180, p = 0.170) and non-significant positive correlation of Catalase with IgG (r = 0.168, p = 0.200) and IgE (r = 0.062, p = 0.637), IgM (r = -0.147, p = 0.262) in young adult females with SD.
Conclusion: This study concludes that Striae distensae is associated with reduced activities of enzymatic antioxidants in young adult females.
Striae distensae (SD), also known as stretch mark is a common skin condition that is not yet associated with any significant medical problem but can cause significant distress to its sufferers. Striae distensae represent linear dermal scars that are accompanied by epidermal atrophy, as a natural result of the skin stretching, which may diminish over time but will not disappear completely. They are indented; reddened streaks that usually appear on the skin from rapid weight gain or weight change [1].
The classic anatomical sites affected include the abdomen and breast for pregnancy-related striae, the outer thighs or lumbosacral regions for adolescent boys, and the buttocks, thighs, upper arms, and breasts for adolescent girls [2,3]. Striae progress through three different stages of maturation: the acute stage is characterized by red and slightly raised striae rubrae, the sub-acute stage is characterized by purpuric stage, and the chronic stage is characterized by hypopigmented and atrophic striae albae [4]. Histological studies of mature striae reveal stretched collagen fibers aligned parallel to the skin surface, followed by subsequent loss of collagen and increased flattening of rete ridges [3].
Immunoglobulins (Igs) are glycoprotein molecules called antibodies (Abs), that are produced in response to foreign substances entering the living body-antigens or immunogens (viruses, bacteria, or toxins, etc.), binding them and forming antigen-antibody complexes resulting in antigen (Ag) elimination and protection of the body of the host. Igs are produced by the lymphocytes and are found in infractions of blood called gamma globulin [5]. Igs are synthesized with a molecular arrangement that fits the shape of molecules on the antigens or immunogens, to allow effective binding of the Abs. Igs binding to Ags helps to inactivate, weaken, or enhance the phagocytosis of Ags [6]. They act as a critical part of the immune response by specifically recognizing and binding to particular antigens, and aiding in their destruction [7]. The antibody immune response is highly complex and exceedingly specific. The various immunoglobulin classes and subclasses (isotypes) differ in their biological features, structure, target specificity, and distribution. Hence, the assessment of the immunoglobulin isotype can provide useful insight into complex humoral immune responses [8].
Glutathione peroxidase (GPx) is the general name of an enzyme family with peroxidase activity whose main biological role is to protect the organism from oxidative damage. The biochemical function of glutathione peroxidase is to reduce lipid hydroperoxides to their corresponding alcohols and to reduce free hydrogen peroxide to water [5]. Glutathione (GSH) is an antioxidant in plants, animals, fungi, and some bacteria and Archaea bacteria. Glutathione is capable of preventing damage to important cellular components caused by reactive oxygen species such as free radicals, peroxides, lipid peroxides, and heavy metals [9]. Catalase is an enzyme that brings about (catalyzes) the reaction by which hydrogen peroxide is decomposed to water and oxygen. Found extensively in organisms that live in the presence of oxygen, catalase prevents the accumulation of and protects cellular organelles and tissues from damage by peroxide, which is continuously produced by numerous metabolic reactions. Typical catalases comprise the most abundant group found in Eubacteria, Archaea bacteria, Protista, Fungi, Plantae, and Animalia, whereas catalase-peroxidases are not found in plants and animals and exhibit both catalatic and peroxidative activities [10].
It also has industrial uses to prevent certain contaminants in food as a disinfectant for contact lenses and as a cleansing agent in some other products. Commercial catalases also are used to break down hydrogen peroxide in wastewater. Superoxide dismutase (SOD) is an enzyme that alternately catalyzes the dismutation (or partitioning) of the superoxide (O_2) radical into ordinary molecular oxygen (O 2) and hydrogen peroxide (H2 O2). Superoxide is produced as a by-product of oxygen metabolism and, if not regulated, causes many types of cell damage [11].
Hydrogen peroxide is also damaging and is degraded by other enzymes such as catalase. Thus, SOD is an important antioxidant defense in nearly all living cells exposed to oxygen. One exception is Lactobacillus plantarum and related lactobacilli, which use a
SOD comprises a family of metalloproteins primarily classified into four groups: copper, zinc-containing SOD (Cu, Zn-SOD), manganese-containing SOD (Mn-SOD), iron-containing SOD (Fe-SOD), and nickel-containing SOD (Ni-SOD) [13]. This study aims to evaluate the serum levels of some immunoglobulins (IgG, IgE, and IgM), the correlation between serum IgM with IgG and IgE, and to determine and compare the body mass index of young adult females with striae distensae and control.
The pathogenesis of striae distensae is unknown but probably relates to changes in the components of the extracellular matrix, including fibrillin, elastin, and collagen. Elastic fiber is a primary target of the pathological process and the abnormalities extend as far as 3cm beyond the lesion into the normal skin [14]. It has been noted that striae are prevalent in cachetic states, such as tuberculosis, and typhoid, and after intense slimming diets. They may also be seen in anorexia nervosa [15].
Striae or “stretch marks” begin as reddish or purple lesions, which can appear anywhere on the body, but are most likely to appear in places where larger amounts of fat are stored; the most common places are the abdomen (especially near the navel), breasts, upper arms, underarms, back, thighs (both inner and outer), hips and buttocks. Over time, they tend to atrophy and lose pigmentation [16].
The affected areas appear empty and are soft to the touch. Stretch marks occur in the dermis, the resilient middle tissue layer that helps the skin retain its shape [17]. No stretch marks will form as long as there is support within the dermis; stretching plays a role in where the stretch marks occur and in what direction they run, however, there are several contributing factors to their formation. They can (but do not always) cause a burning itching sensation, as well as emotional distress. They pose no health risk in and of themselves, and do not compromise the body’s ability to function normally and repair itself; however, they are often considered a cosmetic nuisance [18].
The exact etiology remains controversial and this is partly due to variability in the clinical situations in which striae arises. They are the result of various physiologic states, including pregnancy, adrenocortical excess, and changes in the body habitus, as seen in rapid weight change [19]. Striae distensae affect skin that is subjected to continuous and progressive stretching; increased stress is placed on the connective tissue due to the increased size of various parts of the body. It occurs on the abdomen and the breast of pregnant women, on the shoulders of builders, in adolescents undergoing their growth, and in individuals who are overweight [20].
The period of subject enrollment, classification, sample collection, and laboratory determination of serum immunoglobulins (IgG,
IgE, IgM), and antioxidant enzymes (Glutathione peroxidase, catalase, and superoxide dismutase) lasted for three months.
Ten (10) milliliters of venous blood were collected from each participant. It was dispensed into a plain container to obtain serum. The samples were refrigerated at -20°C and analyzed within 1 week.
Reagents were commercially purchased and the manufacturer’s operational instruction was followed. Determination of Serum Human Immunoglobulin IgE, IgG, and IgMusing ELISA Kit as Modified by Melsin Medical Co., Limited [21]. To measure the concentration of IgE, IgG, and IgM in the sample, the ELISA kit includes a set of calibration standards. The calibration standards are assayed at the same time as the samples and allowed to produce a standard curve of Optical Density (O.D) versus IgE, IgG, and IgM concentrations. The concentration of IgE, IgG, and IgM in the samples was then determined by comparing the O.D. of the samples to the standard curve.
SOD was assayed according to the method of based on the inhibition of the formation of NADH-phenazine methosulphate- nitro blue tetrazolium formazon. The color formed at the end of the reaction was sampled into butanol and measured at 560mm [22].
Catalase activity was assayed following the method of where the UV absorption of hydrogen peroxide was measured at 240nm, and absorbance decreased when degraded by the enzyme catalase. From the decrease in absorbance, the enzyme activity was calculated [23].
The method proposed by was adopted for assaying the activity of glutathione peroxidase in the presence of the hydrogen donor pyrogallol, where peroxidase converted H 2 02 to H2 O and 02. The oxidation of pyrogallol to a colored product called purpurogalliwas followed spectro-photometrically at 430nm [24].
The antioxidant effect of the samples was studied using ABTS (2, 2,-azino-bis-3-ethyl benthiazoline-6-sulphonic acid) radical; cation decolorization assay according to the method of [25].
All data generated from this study was subjected to statistical analysis. The mean, standard deviation, students’ P-Test, and Pearson’s correlation were determined using SPSS version 21 Statistical Package software for Windows. Results were expressed as Mean± SD. The 5% (P<0.05) level of significance was adopted for significant findings.
The result in Table 1 showed that there were significantly lower serum levels of Glutathione peroxidase (0.1819±0.474), Catalase(0.4627±0.2608), TAC (10.12±2.186), and Superoxide Dismutase (0.8897±0.20708) in young adult females with SD compared with controls with p = 0.002, 0.001 and 0.000 for each case.
A greater percentage of SD subjects consider striae distensae as a medical disorder and it has caused some level of psychological distress to them. There were significantly lower serum levels of Superoxide Dismutase (SOD), Glutathione (GPX), Total antioxidant capacity (TAC), and Catalase compared with controls in each case. SOD catalyzes the dismutation of two superoxide anions into hydrogen peroxide and molecular oxygen [26]. The decreased level of SOD activity may be due to its high utilization to defend the cells from the injurious effects of superoxide radicals [27].
Catalase is recognized to be a secondary antioxidant enzyme in peroxidative defense that hydrolyzes hydrogen peroxide into water and oxygen. The low level of Catalase could be attributed to no feedback effect of hydrogen peroxide on mRNA expression [28,29]. Though several data suggested that oxidative stress and antioxidant imbalance could play a pivotal role in the pathogenesis of skin diseases, recent evidence has clarified that ROS generation activates both physiologic and pathologic mechanisms which are not peculiar to the skin but that should be considered general organism responses to pro-oxidant stimuli [30]. When free radicals are unable to steal an available electron from other atoms, they may start stealing them from our cells, ultimately causing a breakdown in the DNA of the skin, which can cause serious problems as “healthy” atoms are robbed of their electrons [31]. One of the most visible signs of free radical-induced damage is premature aging of the skin, as well as inflammation and irritation. The damage also appears on the skin in the form of wrinkles, sagging, dryness, dullness, and unwanted pigmentation, like age spots and broken blood vessels [32]. In defending the cells from the injurious effects of superoxide radicals, young adult females with low serum levels of antioxidants may be highly prone to SD. Extrinsic skin damage develops due to several factors: ionizing radiation, severe physical and psychological stress, alcohol intake, poor nutrition, overeating, environmental pollution, and exposure to UV radiation (UVR). UV-induced generation of ROS in the skin develops oxidative stress when their formation exceeds the antioxidant defense ability of the target cell. Acute exposure to UVR depletes the catalase activity in the skin and increases protein oxidation.
There was a non-significant correlation of TAC with Catalase, SOD, and Glutathione peroxidase. The SOD has a significant correlation with Catalase and a non-significant correlation with TAC and Glutathione in test samples.
A study on the same samples conducted by showed that serum levels of IgE, IgG, and IgM in young adult females with striae distensae were significantly lower compared with the controls in each case.SOD also has a non-significant correlation with IgG, IgE and IgM. This reveals that the serum level of SOD may not affect the levels of Catalase, TAC, and Glutathione peroxidase. IgG decreases while IgE and IgM increase as SOD increases and vice-versa in subjects. The TAC has a non-significant correlation with IgE, IgG, and IgM. This implies that serum levels of TAC may not affect the levels of IgE, IgG, and IgM in SD subjects. There was a non-significant correlation of Catalase with IgM, IgG, and IgE. This reveals that serum Catalase level may not influence the serum levels of IgM, IgG, and IgE in SD subjects. There was also a non-significant correlation of Glutathione peroxidase with IgE, IgG, and IgM. This reveals that serum levels of Glutathione peroxidase may not affect the levels of IgE, IgG, and IgM in SD subjects [33,34].
SD is associated with reduced activities of enzymatic antioxidants.
