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309. IT ISN’T PAIN PURE AND SIMPLE: EXPERIENCES OF PAIN AND DISCOMFORT IN PRIMARY SJÖGREN’S SYNDROME: A QUALITATIVE FOCUS GROUP STUDY

2017; Oxford University Press; Volume: 56; Issue: suppl_2 Linguagem: Inglês

10.1093/rheumatology/kex062.311

1462-0332

Katie L. Hackett, Vincent Deary, Katherine Deane, Julia L. Newton, Wan‐Fai Ng, Tim Rapley,

Salivary Gland Disorders and Functions

Background: Scleroderma (SSc) is characterized by pathological fibrosis.The mechanisms by which fibrosis occurs in SSc are not fully understood.Alternatively activated M2-like macrophages are associated with fibrosis.Therefore, there is interest in elucidating their role in SSc.M2 macrophages express mannose receptor CD206 and are known to secrete a number of soluble factors to establish a pro-fibrotic milieu when present in damaged tissues.Furthermore, we have shown adenosine tri-phosphate (ATP) concentration is increased in the skin of patients with SSc.Within the extracellular environment, ATP is a Damage-Associated Molecular Pattern (DAMP), binding the P2X class of purinergic receptors.Such mechanisms may contribute to SSc pathology.In this study, we explore the relationship of macrophage CD206 and P2X 7 expression to Rodnan Skin Score.The role of these cells in establishing fibrosis was also examined in vitro.Methods: 17 SSc patients and 9 controls were consented and their skin scores recorded.Macrophages were derived from peripheral blood mononuclear cells (PBMCs) and identified through CD14 expression by FACS.CD206 and P2X 7 co-expression was quantified.CD206 immunofluorescence of skin biopsies was also performed.Macrophages were co-cultured with 8 Â 10 4 and 2 Â 10 4 fibroblasts in a collagen matrix and within a monolayer respectively.Collagen gel contraction was quantified as a measure of fibrotic activity.CTGF and Collagen mRNA expression from gel matrices and cellular monolayers was quantified by qPCR.Blisters were created using established methods and blister fluid collected at 24 hours.Cellular infiltrates were analysed for CD14 and CD206/P2X 7 co-expression by FACS as with PBMCs.Results: CD206 and P2X 7 expression is higher on SSc PBMC-derived macrophages (mean fluorescence 776.1 SD ¼ 409.1, 724.4 SD ¼ 455.3) compared to healthy controls (mean fluorescence 632.2 SD ¼ 73.7, 472.9 SD ¼ 25.4).There is significant correlation of CD206 expression to P2X 7 expression (p < 0.001, r 2 ¼0.76) and CD206 expression is significantly correlated to Rodnan skin score (p < 0.05, r 2 ¼0.26).P2X 7 expression is positively correlated to skin score.Double positive P2X7 and CD206 cells were seen in a subgroup with higher skin scores.Fibroblasts co-cultured with macrophages showed increased CTGF and collagen mRNA by qPCR.CTGF mRNA was positively correlated with macrophage P2X7 (r 2 ¼0.23) and CD206 (r 2 ¼0.81) expression.Preliminary work suggests contraction of collagen discs in fibroblast and macrophage co-culture is increased with SSc macrophages compared to healthy controls.Conclusion: Data indicate a correlation between disease severity and CD206 expression by macrophages.Up-regulation of CTGF and Collagen expression in fibroblasts co-cultured with CD206 high macrophages suggests a role for these cells in pathogenic fibrosis.The coexpression of high levels of P2X7 with CD206 also indicates a possible role for the purinergic pathway in SSc fibrosis.Future work will examine the mechanism of macrophage-fibroblast cross-talk and investigate the effect of purinergic pathway inhibitors.