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T cells, B cells, and polarized immune response in the pathogenesis of fibrosis and systemic sclerosis

Chizzolini, Carlo

Current Opinion in Rheumatology: November 2008 - Volume 20 - Issue 6 - p 707–712
doi: 10.1097/BOR.0b013e32830c45ae
Raynaud phenomenon, scleroderma, overlap syndromes and other fibrosing syndromes: Edited by John Varga

Purpose of review A better comprehension of the interactions between cells of the adaptive immune system with fibroblasts and endothelial cells is required to understand abnormal extracellular matrix deposition, development of pathologic fibrosis, and vasculopathy.

Recent findings Skin T cells with high IL-4 production potential and peripheral blood T cells preferentially expressing chemokine receptors associated with Th2 functions are found in individuals with active systemic sclerosis. Animal models indicate that Th2 cells and IL-13 can induce muscular hypertrophy in pulmonary arterial vasculature. In bleomycin-induced fibrosis, B cells produce fibrogenic cytokines upon interaction of an endogenous ligand (hyaluronan) with toll-like receptor-4. In the sclerodermatous graft versus host model, the lack of tumor necrosis factor-production by CD4+ T cells is permissive for fibrosis development. Dermal fibrosis and capillary loss typical of systemic sclerosis can be reversible after high-dose immunosuppression and hematopoietic stem cell transplantation.

Summary Although immunosuppressive strategies to treat patients with systemic sclerosis and allied conditions are largely disappointing, thus indicating a permissive rather than causative role of immunoinflammatory events characteristic of the disease, new findings stress that cells of the adaptive immune system play important roles in assisting fibrogenesis and vascular abnormalities. This may help in identifying efficacious strategies aimed at their control.

Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland

Correspondence to Dr Carlo Chizzolini, MD, Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland Tel: +41 22 372 9370; fax: +41 22 372 9418; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.