Systemic sclerosis (SSc) is a connective tissue disorder of great clinical heterogeneity. Its pathophysiology remains unclear. Our aim was to evaluate the relative roles of reactive oxygen species (ROS) and of the immune system using an original model of SSc. BALB/c and immunodeficient BALB/c SCID mice were injected s.c. with prooxidative agents (hydroxyl radicals, hypochlorous acid, peroxynitrites, superoxide anions), bleomycin, or PBS everyday for 6 wk. Skin and lung fibrosis were assessed by histological and biochemical methods. Autoantibodies were detected by ELISA. The effects of mouse sera on H 2 O 2 production by endothelial cells and on fibroblast proliferation, and serum concentrations in advanced oxidation protein products (AOPP) were compared with sera from patients with limited or diffuse SSc. We observed that s.c. peroxynitrites induced skin fibrosis and serum anti-CENP-B Abs that characterize limited SSc, whereas hypochlorite or hydroxyl radicals induced cutaneous and lung fibrosis and anti-DNA topoisomerase 1 autoantibodies that characterize human diffuse SSc. Sera from hypochlorite-or hydroxyl radical-treated mice and of patients with diffuse SSc contained high levels of AOPP that triggered endothelial production of H 2 O 2 and fibroblast hyperproliferation. Oxidized topoisomerase 1 recapitulated the effects of whole serum AOPP. SCID mice developed an attenuated form of SSc, demonstrating the synergistic role of the immune system with AOPP in disease propagation. We demonstrate a direct role for ROS in SSc and show that the nature of the ROS dictates the form of SSc. Moreover, this demonstration is the first that shows the specific oxidation of an autoantigen directly participates in the pathogenesis of an autoimmune disease. The Journal of Immunology, 2009, 182: 5855-5864. S ystemic sclerosis (SSc)4 is a connective tissue disorder of unknown etiology characterized by vascular hyperreactivity, fibrosis of skin and visceral organs, and immunological alterations, including a distinct pattern of autoantibodies in the sera (1). The mechanisms that determine the clinical manifestations of the disease remain unclear (2). Several reports have suggested that reactive oxygen species (ROS) are involved in the pathogenesis of SSc (3-9). Indeed, skin fibroblasts from SSc patients spontaneously produce large amounts of ROS that trigger collagen synthesis (7, 10). In addition, autoantibodies found in SSc patients against the platelet-derived growth factor receptor expressed on fibroblasts also induce the production of ROS (11). Recently, we have demonstrated that sera from patients with SSc could induce not only the production of ROS by endothelial cells but also the hyperproliferation of fibroblasts (6).However, no direct proof for the involvement of oxidative stress in SSc pathogenesis has been brought forth to date. Moreover, the origin and nature of the oxidative stress remain to be elucidated. Environmental factors, and in particular silica dust, may be involved, which generate hydroxyl radicals (OH⅐) (12...

Systemic lupus erythematosus (SLE) is a systemic inflammatory autoimmune disease characterized by the involvement of multiple organs and an immune response against nuclear components. Although its pathogenesis remains poorly understood, type I interferon (IFN) and CD40 ligand (CD154) are known to contribute. Because platelets are involved in inflammatory processes and represent a major reservoir of CD154, we hypothesized that they participate in SLE pathogenesis. Here, we have shown that in SLE patients, platelets were activated by circulating immune complexes composed of autoantibodies bound to self-antigens through an Fc-gamma receptor IIa (CD32)-dependent mechanism. Further, platelet activation correlated with severity of the disease and activated platelets formed aggregates with antigen-presenting cells, including monocytes and plasmacytoid dendritic cells. In vitro, activated platelets enhanced IFN-alpha secretion by immune complex-stimulated plasmacytoid dendritic cells through a CD154-CD40 interaction. Finally, in lupus-prone mice, depletion of platelets or administration of the P2Y(12) receptor antagonist (clopidogrel) improved all measures of disease and overall survival; transfusion of activated platelets worsened the disease course. Together, these data identify platelet activation as an important contributor to SLE pathogenesis and suggest that this process and its sequelae may provide a new therapeutic target.

Objectives: To investigate the role of reactive oxygen species (ROS) in the development of the various patterns of systemic sclerosis (SSc) and the mechanisms of ROS production by endothelial cells and fibroblasts. Methods: Production of hydrogen peroxide (H 2 O 2 ), nitric oxide (NO) and cellular proliferation were determined following incubation of endothelial cells and fibroblasts with 56 SSc and 30 healthy sera. Correlations were established between those markers, the type and the severity of the clinical involvements, and the response to treatment. The factors leading to ROS production were determined. Results: H 2 O 2 production by endothelial cells and fibroblasts was higher after incubation with SSc sera than with normal sera (p,0.001) and with sera from SSc patients with severe complications than sera from other patients (p,0.05). Sera from patients with lung fibrosis triggered the proliferation of fibroblasts more than other SSc sera (p,0.001), whereas sera from patients with vascular complications exerted no proliferative effect on fibroblasts, but inhibited endothelial cell growth (p,0.05) and induced NO overproduction (p,0.05). Bosentan reduced NO release by 32%, whereas N-acetylcystein potentiated 5-fluorouracil (5FU) to inhibit fibroblast proliferation by 78%. Those serum-mediated effects did not involve antibodies but advanced oxidation protein products that selectively triggered cells to produce H 2 O 2 or NO. Conclusions: SSc sera induce the production of different types of ROS that selectively activate endothelial cells or fibroblasts, leading to vascular or fibrotic complications. Assaying serum-induced ROS production allows clinical activity of the disease to be followed and appropriate treatments to be selected.