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強皮症における線維化とマスト細胞の関与

湯川宗之助1)、山岡邦宏1)、澤向範文1)、島尻正平2)、齋藤和義1)、笹栗靖之2)、田中良哉1)

1)産業医科大学医学部第一内科学講座
2)産業医科大学医学部第二病理学講座

強皮症(SSc)の皮膚線維化へのマスト細胞(MC)の関与は報告されているが、今回生検組織中のMCと皮膚・肺病態との関連性を検討した。SSc群 54例、non-SSc群 29例。皮膚組織は、MC同定にはtoluidine blue染色を用い、ナノデジタル病理、免疫組織染色、蛍光組織染色等で解析した。MCはSSc群で有意に線維化部位に一致して真皮で増加し、全身皮膚硬化スコアと相関した。MCの線維化組織での増加は、抗Scl-70抗体陽性群、及び、肺高血圧(PH)合併群で有意に認められ、mean PAP、max PGと正の相関を認めた。PH合併例では、肺動脈周囲に多数のMCを認め、SSc皮膚組織同様TGF-b1とPDGFを産生していた。以上より、SSc真皮にMCが多数存在し、局所でのTGF-b1やPDGF産生を介して皮膚硬化のみならず、PHの病態形成への関与を初めて示した。

Involvement of mast cells in fibrosis of scleroderma

Sonosuke Yukawa1), Kunihiro Yamaoka1), Norifumi Sawamukai1), Shohei Shimajiri2), Kazuyoshi Saito1), Yasuyuki Sasaguri2), Yoshiya Tanaka1)
1)The First Department of Internal Medicine, School of Medicine
2) The Department of Second Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Japan

To clarify the involvement of mast cell (MC) in human scleroderma pathology, we have evaluated skin biopsy specimens from SSc patients (54 cases). Number of MC (mast cells/mm2) in each specimen was detected by toluidine blue staining. Significantly increased number of MCs was observed in dermis of SSc compared with non-SSc, in concert with fibrosis. Increased number of MC correlated with Modified Rodnan Skin Thickness Score (MRSS) (p=0.012). In addition, patients positive for anti-Scl-70 antibody had higher MC number compared with negative patients. Surprisingly, MC was increased in cases with pulmonary hypertension (PH) and showed strong relation with mean pulmonary arterial pressure (mPAP) and max pressure gradient (PG) measured by cardiac ultrasound (r=0.607, r=0.687). Importantly, MC was also increased in pulmonary interstitium with PH and secreted TGF-b1 and PDGF which was identical with MC in dermis. In conclusion, MC was increased in dermis of SSc patients especially with PH, and its density was related with the severity of PH. In conclusion, we suggest the involvement of MC in the pathogenesis of SSc and advocate a novel concept of targeting MC for SSc therapy.

日本語サマリー

マスト細胞(MC)の強皮症(SSc)病態への関与を解明するために、SSc群 54例、non-SSc群 29例の皮膚組織を用いた。MCはSSc群で有意に多く、肺高血圧(PH)合併群で更に多数のMCを認め、mean PAP、max PGと強い正の相関を認めた。更にPH合併SSc肺組織には多数のMCを認め、SSc皮膚組織同様TGF-b1とPDGFを産生していた。マスト細胞制御によるSSc治療の可能性を提唱する。

英語サマリー

We have evaluated skin biopsy specimens at finger from SSc patients. Significantly increased number of mast cell (MC) was observed in skin specimens from SSc compared with non-SSc, and significantly increased number of MC was observed with higher Modified Rodnan Skin Thickness Score. In addition, patients positive for anti-Scl-70 antibody had higher MC number compared with negative. Surprisingly, MC was increased significantly in cases with pulmonary hypertension (PH), and showed strong relation with mean pulmonary arterial pressure and max PG measured by cardiac ultrasound. We suggest here the involvement of MC in the pathogenesis of skin fiblosis and PH in SSc.