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Denton CP, Wells AU, Coghlan JG. Major lung complications of systemic sclerosis. Nat Rev Rheumatol 2018; 14:511-527. [DOI: 10.1038/s41584-018-0062-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Stifano G, Christmann RB. Macrophage Involvement in Systemic Sclerosis: Do We Need More Evidence? Curr Rheumatol Rep 2015; 18:2. [DOI: 10.1007/s11926-015-0554-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Although scleroderma-associated interstitial lung disease (SSc-ILD) is a significant contributor to both morbidity and mortality, its pathogenesis is largely unclear. Pulmonary function tests and high-resolution computed tomographic scanning continue to be the most effective tools to screen for lung involvement and to monitor for disease progression. More research and better biomarkers are needed to identify patients most at risk for developing SSc-ILD as well as to recognize which of these patients will progress to more severe disease. Although immunosuppression remains the mainstay of treatment, antifibrotic agents may offer new avenues of treatment for patients with SSc-ILD in the future.
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Affiliation(s)
- Katherine Culp Silver
- Fellow, Adult & Pediatric Rheumatology, Medical University of South Carolina, Suite 816, Clinical Sciences Building, 96 Jonathan Lucas Street, Charleston, SC 29425, 843-792-3484
| | - Richard M. Silver
- Distinguished University Professor, Director, Division of Rheumatology & Immunology, Medical University of South Carolina, Suite 816, Clinical Sciences Building, 96 Jonathan Lucas Street, Charleston, SC 29425, 843-792-3484
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Shiwen X, Stratton R, Nikitorowicz-Buniak J, Ahmed-Abdi B, Ponticos M, Denton C, Abraham D, Takahashi A, Suki B, Layne MD, Lafyatis R, Smith BD. A Role of Myocardin Related Transcription Factor-A (MRTF-A) in Scleroderma Related Fibrosis. PLoS One 2015; 10:e0126015. [PMID: 25955164 PMCID: PMC4425676 DOI: 10.1371/journal.pone.0126015] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/27/2015] [Indexed: 02/07/2023] Open
Abstract
In scleroderma (systemic sclerosis, SSc), persistent activation of myofibroblast leads to severe skin and organ fibrosis resistant to therapy. Increased mechanical stiffness in the involved fibrotic tissues is a hallmark clinical feature and a cause of disabling symptoms. Myocardin Related Transcription Factor-A (MRTF-A) is a transcriptional co-activator that is sequestered in the cytoplasm and translocates to the nucleus under mechanical stress or growth factor stimulation. Our objective was to determine if MRTF-A is activated in the disease microenvironment to produce more extracellular matrix in progressive SSc. Immunohistochemistry studies demonstrate that nuclear translocation of MRTF-A in scleroderma tissues occurs in keratinocytes, endothelial cells, infiltrating inflammatory cells, and dermal fibroblasts, consistent with enhanced signaling in multiple cell lineages exposed to the stiff extracellular matrix. Inhibition of MRTF-A nuclear translocation or knockdown of MRTF-A synthesis abolishes the SSc myofibroblast enhanced basal contractility and synthesis of type I collagen and inhibits the matricellular profibrotic protein, connective tissue growth factor (CCN2/CTGF). In MRTF-A null mice, basal skin and lung stiffness was abnormally reduced and associated with altered fibrillar collagen. MRTF-A has a role in SSc fibrosis acting as a central regulator linking mechanical cues to adverse remodeling of the extracellular matrix.
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Affiliation(s)
- Xu Shiwen
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - Richard Stratton
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - Joanna Nikitorowicz-Buniak
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - Bahja Ahmed-Abdi
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - Markella Ponticos
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - Christopher Denton
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - David Abraham
- Centre for Rheumatology and Connective Tissue Diseases, University College London, Royal Free Campus, London, United Kingdom
| | - Ayuko Takahashi
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
| | - Matthew D. Layne
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Robert Lafyatis
- Rheumatology Department, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Barbara D. Smith
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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