r e v b r a s r e u m a t o l . 2016;56(4):285–286
w w w . r e u m a t o l o g i a . c o m . b r
REVISTA
BRASILEIRA
DE
REUMATOLOGIA
Editorial
The
search
for
new
biomarkers
in
systemic
sclerosis
A
busca
por
novos
biomarcadores
na
esclerose
sistêmica
Systemicsclerosis(SSc)isachronicautoimmunerheumatic diseasewithaheterogeneouscourse,whosefollow-up and treatmentremainchallenging.Inthiscontext,the identifica-tionofbiomarkersforassessingthediseaseactivity,therisk ofinvolvementofinternalorgans,andoftheirprognosisis extremelyimportant.
Inrecent years,there havebeen many advances inthe identification of serum biomarkers and of certain pheno-typesassociatedwithanincreasedriskofdevelopingcertain manifestationsuch as interstitial lung disease, pulmonary arterial hypertension, and renal sclerodermacrisis.1 Thus, thepresenceofanti-Scl70 antibodiesisassociatedwiththe diffusecutaneous clinical form and with a worse progno-sis. Serum KL-6, surfactant D protein, lysyl oxidase (LOX), tenascin-C,CXCL4,andCCL18seemtobepromising biomark-ersforassessing theseverity offibrosis ininterstitiallung diseasesassociatedwithSSc.2,3Ontheotherhand,thelevels ofnatriureticpeptides BNPand NT-proBNPhavebeenused as pulmonary arterial hypertension biomarkers.1 A recent study showed significantly higher serum levels of placen-talgrowthfactorandsolublereceptor1ofVEGFinpatients with pulmonary hypertension compared to SSc patients withoutpulmonaryhypertension, indicatingtheirpotential asbiomarkers forpulmonary hypertension.4 Despite these advances,furtherstudiesarerequiredinordertoidentifyand validatebiomarkersforpatientswithSSc.
In this issue, four studies evaluating different clinical and laboratory characteristics of patients with SSc were published.
Olewicz-Gawliketal.evaluatedtheserumlevelsofClara cellprotein(CC16) inpatientswith SSc.5 CC16is aprotein expressedintherespiratorytract,secretedbycellslocatedin thebronchialepithelium,whichhasanti-inflammatoryand anti-oxidantproperties.Althoughnodifferencewasfoundin serumlevelsofCC16betweenSScpatientsandcontrols,an
associationbetweenCC16levelsandamoreseverepulmonary involvementwasobserved.Theresultscorroboratethe find-ingsofapreviousstudy,whichfoundanassociationbetween levelsofCC16andlungactivityinsclerodermapatients,6and suggestthatCC16maybeapotentialserumbiomarkerinthe evaluationofinterstitiallungdisease.
Ontheotherhand,Sampaio-Barrosetal.founda signifi-cantcorrelationbetweenserumlevelsof25-hydroxyvitamin D(25OHD) andquality oflifeinpatientswithdiffuseSSc.7 These authorsalsofound anegativecorrelationbetweena higherdegreeofdevascularizationinnailfoldcapillaroscopy andlevelsofvitaminD,aswellasreducedlevelsofvitamin Dinpatientswithanti-Scl70antibodypositivity.Theseresults suggestthatserumlevelsofvitaminDcanbeusedas biomark-ersforworsequalityoflife.However,onecannotconcludethat thereductioninvitaminDlevelswouldbedirectlyrelatedtoa poorerqualityoflifeofthesepatients,orifsuchcorrelationis relatedtoamoreseverediseasesincetheauthorsassessed onlypatients withdiffuse disease.Onthe other hand, the findingsareconsistentwithmanystudiesdescribingahigh frequencyof25OHDdeficiencyinpatientswithSSc. Addition-ally,invitrostudiessuggestthatmultipleendogenousforms ofvitaminD3haveantifibroticpropertiesandmaybeafuture therapeutictargetinSSc.8
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rev bras reumatol.2016;56(4):285–286patientswithoutarthritis.There wasalsoahigh frequency ofradiographicchangescharacterizedbyjointspace narrow-ingand/orsubchondralboneerosion,suggestingthat,inthese patients,arthritiscandevelopmoreaggressively.
In summary, the studies published reveal the multiple facetsofSScandreinforcetheneedtofindreproducible,easily applicableinclinical practice,biomarkersinorder to iden-tifypatientsatriskofdevelopingmoreseriousmanifestations and,finally,foranearlytreatment.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
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topredictclinicalcourses.JDermatol.2016;43(1):29–38.
2. HantFN,Ludwicka-BradleyA,WangHJ,LiN,ElashoffR,
TashkinDP,etal.SurfactantproteinDandKL-6asserum
biomarkersofinterstitiallungdiseaseinpatientswith
scleroderma.JRheumatol.2009;36(4):773–80.
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ecomprometimentopulmonarempacientescomesclerose
sistêmica.RevBrasReumatol.2016;56:309–13.
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7.Sampaio-BarrosMM,TakayamaL,Sampaio-BarrosPD,Bonfá
E,PereiraRM.BaixosníveisséricosdevitaminaDna
esclerosesistêmicadifusa:correlac¸ãocompiorqualidadede
vidaealterac¸õescapilaroscópicasgraves.RevBrasReumatol.
2016;56:337–44.
8.PattanaikD,BrownM,PostlethwaiteBC,PostlethwaiteAE.
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2015;6:272.
9.HorimotoAM,SilveiraAFC,CostaIP.Autoimunidadefamilial
epoliautoimunidadeem60pacientesportadoresdeesclerose
sistêmicadaregiãoCentro-OestedoBrasil.RevBras
Reumatol.2016;56:314–22.
10.HorimotoAM,CostaIP.Sobreposic¸ãodeesclerosesistêmicae
artritereumatóide:umaentidadeclínicadistinta?RevBras
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CristianeKayser DisciplineofRheumatology,EscolaPaulistadeMedicina(EPM), UniversidadeFederaldeSãoPaulo(UNIFESP),SãoPaulo,SP,Brazil E-mail:[email protected]
2255-5021/©2016PublishedbyElsevierEditoraLtda.Thisis anopenaccessarticleundertheCCBY-NC-NDlicense
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
