4.7 Review

The Microbiome in Systemic Sclerosis: Pathophysiology and Therapeutic Potential

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Current Concepts on the Pathogenesis of Systemic Sclerosis

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Summary: Systemic sclerosis (SSc) is a disease characterized by skin and internal organ fibrosis, vascular modifications, and autoimmunity. It predominantly affects women and has heterogeneous clinical presentations and courses. The pathogenesis involves genetic predisposition, environmental factors, and epigenetic modifications that lead to immune-inflammatory dysregulation and abnormal cell behavior. Myofibroblasts play a crucial role in the disease by promoting fibrosis and matrix deposition. Other cell types, such as pericytes, platelets, and keratinocytes, are also involved. T cell subsets and autoantibodies contribute to fibroblast and endothelial cell dysfunction. Recent studies have revealed heterogeneity in SSc cell differentiation and functional states. Understanding the heterogeneity and pathogenic mechanisms will aid in developing personalized therapeutic approaches.

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Plasma Metabolomic Profiling Reveals Four Possibly Disrupted Mechanisms in Systemic Sclerosis

Thomas Boegl et al.

Summary: A study analyzed the metabolomic profiles of plasma from systemic sclerosis (SSc) patients and identified four dysfunctional metabolic mechanisms associated with inflammation, vascular damage, fibrosis, and gut dysbiosis.

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Animal Models of Systemic Sclerosis: Using Nailfold Capillaroscopy as a Potential Tool to Evaluate Microcirculation and Microangiopathy: A Narrative Review

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Role of B-Cell in the Pathogenesis of Systemic Sclerosis

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Type 1 interferon activation in systemic sclerosis: a biomarker, a target or the culprit

Vishal Kakkar et al.

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Gut microbiome in systemic sclerosis: a potential therapeutic target

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Summary: This study investigated the prevalence and characteristics of small intestinal bacterial overgrowth (SIBO) in systemic sclerosis (SSc) patients, as well as the efficacy of rifaximin in treating SIBO in these patients. The results showed a higher prevalence of SIBO in SSc patients compared to the control group, and rifaximin treatment led to successful eradication of SIBO in a significant percentage of SSc patients.

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New Insights into Profibrotic Myofibroblast Formation in Systemic Sclerosis: When the Vascular Wall Becomes the Enemy

Eloisa Romano et al.

Summary: In systemic sclerosis (SSc), abnormalities in microvessel morphology evolve into a distinctive vasculopathy that progresses alongside tissue fibrosis orchestrated by myofibroblasts. The endothelial-to-mesenchymal transition (EndoMT) process may play a central role in the pathogenesis of SSc, contributing to both fibrotic vascular lesions and tissue fibrosis. A deeper understanding of the mechanisms underlying myofibroblast differentiation inside vessel walls provides the basis for targeted therapeutic strategies for SSc.

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Fecal microbiome differs between patients with systemic sclerosis with and without small intestinal bacterial overgrowth

Daniel Levin et al.

Summary: The study investigated the fecal microbiota of systemic sclerosis patients with and without small intestinal bacterial overgrowth, comparing them to healthy controls. Differences in microbial composition were observed between different groups, suggesting potential associations between specific bacterial taxa and clinical manifestations of systemic sclerosis. The findings indicate a potential role of altered microbiome in the development of systemic sclerosis, which warrants further investigation.

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Dysfunctional Keratinocytes Increase Dermal Inflammation in Systemic Sclerosis: Results From Studies Using Tissue-Engineered Scleroderma Epidermis

Barbara Russo et al.

Summary: Objective evidence suggests that keratinocyte-fibroblast interactions are abnormal in systemic sclerosis (SSc). This study found that SSc epidermal equivalents (EEs) exhibited aberrant differentiation and enhanced expression of activation markers, replicating the abnormalities seen in SSc epidermis. The dysregulation of genes from the homeobox family and increased metabolic and oxidative stress in SSc EEs may contribute to chronic inflammation and dermal fibrosis.

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Butyrate Improves Skin/Lung Fibrosis and Intestinal Dysbiosis in Bleomycin-Induced Mouse Models

Hee Jin Park et al.

Summary: The study found that butyrate has potential therapeutic effects in a mouse model of SSc and human dermal fibroblasts, by modulating intestinal microbiota, controlling macrophage differentiation, and inhibiting proinflammatory gene expression, thus improving fibrosis.

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Congruent microbiome signatures in fibrosis-prone autoimmune diseases: IgG4-related disease and systemic sclerosis

Damian R. Plichta et al.

Summary: The study analyzed the gut microbiomes of IgG4-RD and SSc patients, revealing distinct differences compared to healthy controls. There were significantly overabundant pathogenic bacteria and depleted beneficial bacteria in the patients, suggesting a potential role of gut microbiome in the pathophysiology of these diseases.

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Summary: Systemic sclerosis (SSc) is a disease characterized by immune dysregulation, vasculopathy, and fibrosis of multiple organs, with the gastrointestinal (GI) tract being the most commonly affected organ. Recent studies have found unique microbial taxa alterations in the GI microbiome of SSc patients compared to healthy controls (HC), with potential associations with disease manifestations and severity.

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B cells in systemic sclerosis: from pathophysiology to treatment

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A review and roadmap of the skin, lung and gut microbiota in systemic sclerosis

Shannon Teaw et al.

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TGFβ promotes low IL10-producing ILC2 with profibrotic ability involved in skin fibrosis in systemic sclerosis

Paoline Laurent et al.

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Oral Lactobacillus Species in Systemic Sclerosis

Daniela Melchiorre et al.

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