Objective In systemic sclerosis (SSc) a persistent tissue repair process leads to progressive fibrosis of the skin and internal organs. The role of mesenchymal stem cells (MSCs), which characteristically initiate and regulate tissue repair, has not been fully evaluated. We sought to investigate whether dividing metakaryotic MSCs are present in SSc skin, and test whether exposure to the disease microenvironment activates MSCs leading to transdifferentation.
MethodsSkin biopsy material from recent onset diffuse SSc patients was examined by collagenase spread of 1mm thick surface-parallel sections, in order to identify metakarytoic dividing stem cells in each tissue plane. Adipose-derived MSCs from healthy controls were treated with dermal blister fluid from diffuse SSc patients, and profiled by next generation sequencing, or evaluated for phenotypic changes relevant to SSc. Differential responses of dermal fibroblasts were studied in parallel. Results MSC-like cells undergoing active metakaryotic division were identified in SSc but not control sections, most prominent in the deep dermis and adjacent to damaged microvessels, in both involved and clinically uninvolved skin. Furthermore, exposure to SSc blister fluid caused selective MSC activation, inducing a myofibroblast signature, whilst reducing signatures of vascular repair and adipogenesis and enhancing migration and contractility. Microenvironment factors implicated in inducing transdifferentiation include the pro-fibrotic growth factor TGFβ, presence of lactate and mechanosensing, whereas the microenvironment Th2 cytokine IL-31, enhanced osteogenic commitment (calcinosis). Conclusion Dividing MSC-like cells are present in the SSc disease microenvironment where multiple factors, likely acting in concert, promote transdifferentiation, leading to a complex and resistant disease state.