Because histopathological changes in the lungs of patients with systemic
sclerosis (SSc) are consistent with alveolar and vessel cell damage, we presume
that this interaction can be characterized by analyzing the expression of
proteins regulating nitric oxide (NO) and plasminogen activator inhibitor-1
(PAI-1) synthesis. To validate the importance of alveolar-vascular interactions
and to explore the quantitative relationship between these factors and other
clinical data, we studied these markers in 23 cases of SSc nonspecific
interstitial pneumonia (SSc-NSIP). We used immunohistochemistry and morphometry
to evaluate the amount of cells in alveolar septa and vessels staining for NO
synthase (NOS) and PAI-1, and the outcomes of our study were cellular and
fibrotic NSIP, pulmonary function tests, and survival time until death. General
linear model analysis demonstrated that staining for septal inducible NOS (iNOS)
related significantly to staining of septal cells for interleukin (IL)-4 and to
septal IL-13. In univariate analysis, higher levels of septal and vascular cells
staining for iNOS were associated with a smaller percentage of septal and
vascular cells expressing fibroblast growth factor and myofibroblast
proliferation, respectively. Multivariate Cox model analysis demonstrated that,
after controlling for SSc-NSIP histological patterns, just three variables were
significantly associated with survival time: septal iNOS (P=0.04), septal IL-13
(P=0.03), and septal basic fibroblast growth factor (bFGF; P=0.02). Augmented
NOS, IL-13, and bFGF in SSc-NSIP histological patterns suggest a possible
functional role for iNOS in SSc. In addition, the extent of iNOS, PAI-1, and
IL-4 staining in alveolar septa and vessels provides a possible independent
diagnostic measure for the degree of pulmonary dysfunction and fibrosis with an
impact on the survival of patients with SSc.