Systemic Sclerosis

Autoimmune MONDO:0005100 Pathograph 3 Show in embeddings browser Autoimmune Disease Connective Tissue Disease

A chronic autoimmune connective tissue disease characterized by vasculopathy, immune dysregulation, and progressive fibrosis of the skin and internal organs. Classified into limited cutaneous and diffuse cutaneous subtypes based on extent of skin involvement.

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4
Pathophys.
20
Phenotypes
3
Pathograph
3
Genes
4
Medical Actions
6
Datasets
14
References
2
Deep Research
🏷

Classifications

Harrison's Part
IMMUNE RHEUMATOLOGIC
⚙

Pathophysiology

4
Vascular Injury and Endothelial Dysfunction
Early endothelial cell injury leads to vascular damage, intimal proliferation, and obliterative vasculopathy. Raynaud's phenomenon reflects vasospasm and structural vascular changes.
Endothelial Cell CL:0000115 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves Endothelial Cell (CL:0000115). CL:0000115 is a cell type from the Cell Ontology.
Blood Vessel Development GO:0001568 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves Blood Vessel Development (GO:0001568). GO:0001568 is a biological process from the Gene Ontology.
Show evidence (2 references)
PMID:38927538 SUPPORT
"In systemic sclerosis (SSc, or scleroderma), defective angiogenesis, clinically manifesting with abnormal capillary architecture and severe capillary reduction, represents a hallmark of early-stage disease, usually preceding the onset of tissue fibrosis, and is caused by several cellular and..."
This evidence supports the early vascular injury mechanism by demonstrating that defective angiogenesis and capillary abnormalities precede fibrosis in SSc.
PMID:38927538 SUPPORT
"Indeed, once damaged, endothelial cells can be dysfunctionally activated, thus becoming unable to undergo angiogenesis and promoting perivascular inflammation. They can also undergo apoptosis, transdifferentiate into profibrotic myofibroblasts, or acquire a senescence-associated secretory..."
This describes multiple mechanisms of endothelial dysfunction in SSc, including impaired angiogenesis, endothelial-to-mesenchymal transition, and inflammatory mediator release that contribute to vascular pathology.
Immune Activation and Autoantibody Production
Characteristic autoantibodies include anti-centromere (limited disease), anti-Scl-70/topoisomerase I (diffuse disease), and anti-RNA polymerase III. T cells and macrophages infiltrate affected tissues and produce pro-fibrotic cytokines.
CD4+ T Cell CL:0000624 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves CD4+ T Cell, annotated with CD4-positive, alpha-beta T cell (CL:0000624). CL:0000624 is a cell type from the Cell Ontology. Macrophage CL:0000235 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves Macrophage (CL:0000235). CL:0000235 is a cell type from the Cell Ontology.
Immunoglobulin Production GO:0002377 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves Immunoglobulin Production (GO:0002377). GO:0002377 is a biological process from the Gene Ontology.
Show evidence (2 references)
PMID:38296975 SUPPORT
"Here we report the largest Asian genome-wide association study (GWAS) for systemic sclerosis performed to date, based on data from Japanese subjects and comprising of 1428 cases and 112,599 controls. The lead SNP is in the FCGR/FCRL region, which shows a penetrating association in the Asian..."
This genetic evidence implicates B cell and Fc receptor biology in SSc susceptibility, with IRF8 being a key regulator of immune cell development and interferon responses that contribute to immune dysregulation.
PMID:38296975 SUPPORT
"Prioritizing the top 5% of SNPs of IRF8 binding sites in B cells improves the fitting of the polygenic risk scores, underscoring the roles of B cells and IRF8 in the development of systemic sclerosis."
This supports the role of B cell biology and autoantibody production in SSc pathogenesis, demonstrating that B cell-specific genetic variants contribute to disease risk.
Fibroblast Activation and Fibrosis
TGF-beta signaling drives fibroblast activation and differentiation into myofibroblasts. Excessive collagen and extracellular matrix deposition leads to progressive fibrosis of skin and internal organs.
Fibroblast CL:0000057 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves Fibroblast (CL:0000057). CL:0000057 is a cell type from the Cell Ontology. Myofibroblast CL:0000186 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves Myofibroblast, annotated with myofibroblast cell (CL:0000186). CL:0000186 is a cell type from the Cell Ontology.
Extracellular Matrix Organization GO:0030198 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves Extracellular Matrix Organization (GO:0030198). GO:0030198 is a biological process from the Gene Ontology. TGF-beta Signaling GO:0007179 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves TGF-beta Signaling, annotated with transforming growth factor beta receptor signaling pathway (GO:0007179). GO:0007179 is a biological process from the Gene Ontology.
Downstream
Systemic Sclerosis-Associated Interstitial Lung Disease
Show evidence (2 references)
PMID:38147960 SUPPORT
"SSc skin demonstrated an increased abundance of COMP+, COL11A1+, MYOC+, CCL19+, SFRP4/SFRP2+, and PRSS23/SFRP2+ fibroblasts signatures and decreased proportions of CXCL12+ and PI16+ fibroblast signatures in the Prospective Registry of Early Systemic Sclerosis and Genetics versus Environment in..."
This demonstrates the heterogeneity of fibroblast populations in SSc, with increased profibrotic fibroblast subpopulations and decreased normal fibroblast signatures contributing to excessive ECM deposition.
PMID:38147960 SUPPORT
"The proportions of profibrotic COMP+, COL11A1+, SFRP4/SFRP2+, and PRSS23/SFRP2+ and proinflammatory CCL19+ fibroblast signatures were positively correlated with clinical and histopathological parameters of skin fibrosis, whereas signatures of CXCL12+ and PI16+ fibroblasts were inversely correlated."
This provides direct evidence linking specific fibroblast subpopulations to clinical severity of skin fibrosis, supporting the role of fibroblast activation in SSc pathogenesis and disease progression.
Systemic Sclerosis-Associated Interstitial Lung Disease
Fibrotic remodeling can involve the lung interstitium in systemic sclerosis, producing restrictive ventilatory impairment that is tracked by pulmonary function testing.
extracellular matrix organization GO:0030198 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves extracellular matrix organization (GO:0030198). GO:0030198 is a biological process from the Gene Ontology.
lung UBERON:0002048 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in lung (UBERON:0002048). UBERON:0002048 is an anatomical location from the Uberon multi-species anatomy ontology.
Show evidence (1 reference)
PMID:31112379 SUPPORT Human Clinical
"Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis and a leading cause of systemic sclerosis-related death."
The SENSCIS trial abstract establishes SSc-associated ILD as a major pulmonary manifestation of systemic sclerosis.
⬡

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Systemic Sclerosis Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.
●

Phenotypes

20
Cardiovascular 3
Raynaud Phenomenon VERY_FREQUENT HP:0030880 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Raynaud Phenomenon (HP:0030880). HP:0030880 is a phenotype from the Human Phenotype Ontology.
Often the earliest manifestation
Telangiectasia FREQUENT HP:0001009 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Telangiectasia (HP:0001009). HP:0001009 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0001009 | Telangiectasia | Frequent (79-30%)"
Orphanet records telangiectasia as a frequent (30-79%) phenotype of systemic sclerosis.
Nail bed telangiectasia FREQUENT HP:0001232 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Nail bed telangiectasia (HP:0001232). HP:0001232 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0001232 | Nail bed telangiectasia | Frequent (79-30%)"
Orphanet records nail bed telangiectasia as a frequent (30-79%) phenotype of systemic sclerosis.
Digestive 1
Dysphagia FREQUENT HP:0002015 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Dysphagia (HP:0002015). HP:0002015 is a phenotype from the Human Phenotype Ontology.
Due to esophageal dysmotility
Head and Neck 1
Narrow mouth FREQUENT HP:0000160 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Narrow mouth (HP:0000160). HP:0000160 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0000160 | Narrow mouth | Frequent (79-30%)"
Orphanet records narrow mouth as a frequent (30-79%) phenotype of systemic sclerosis.
Immune 1
Antinuclear antibody positivity VERY_FREQUENT HP:0003493 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Antinuclear antibody positivity (HP:0003493). HP:0003493 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0003493 | Antinuclear antibody positivity | Very frequent (99-80%)"
Orphanet records antinuclear antibody positivity as a very frequent (80-99%) phenotype of systemic sclerosis.
Integument 6
Skin Thickening VERY_FREQUENT Thickened skin HP:0001072 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Thick Skin, annotated with Thickened skin (HP:0001072). HP:0001072 is a phenotype from the Human Phenotype Ontology.
Cutaneous sclerotic plaque VERY_FREQUENT HP:0031359 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Cutaneous sclerotic plaque (HP:0031359). HP:0031359 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0031359 | Cutaneous sclerotic plaque | Very frequent (99-80%)"
Orphanet records cutaneous sclerotic plaque as a very frequent (80-99%) phenotype of systemic sclerosis.
Spotty hypopigmentation FREQUENT HP:0005590 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Spotty hypopigmentation (HP:0005590). HP:0005590 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0005590 | Spotty hypopigmentation | Frequent (79-30%)"
Orphanet records spotty hypopigmentation as a frequent (30-79%) phenotype of systemic sclerosis.
Acral ulceration FREQUENT HP:0006121 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Acral ulceration (HP:0006121). HP:0006121 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0006121 | Acral ulceration | Frequent (79-30%)"
Orphanet records acral ulceration as a frequent (30-79%) phenotype of systemic sclerosis.
Irregular hyperpigmentation FREQUENT HP:0007400 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Irregular hyperpigmentation (HP:0007400). HP:0007400 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0007400 | Irregular hyperpigmentation | Frequent (79-30%)"
Orphanet records irregular hyperpigmentation as a frequent (30-79%) phenotype of systemic sclerosis.
Sclerodactyly FREQUENT HP:0011838 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Sclerodactyly (HP:0011838). HP:0011838 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0011838 | Sclerodactyly | Frequent (79-30%)"
Orphanet records sclerodactyly as a frequent (30-79%) phenotype of systemic sclerosis.
Limbs 1
Finger swelling FREQUENT HP:0025131 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Finger swelling (HP:0025131). HP:0025131 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0025131 | Finger swelling | Frequent (79-30%)"
Orphanet records finger swelling as a frequent (30-79%) phenotype of systemic sclerosis.
Metabolism 2
Joint swelling FREQUENT HP:0001386 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Joint swelling (HP:0001386). HP:0001386 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0001386 | Joint swelling | Frequent (79-30%)"
Orphanet records joint swelling as a frequent (30-79%) phenotype of systemic sclerosis.
Elevated circulating creatine kinase concentration FREQUENT HP:0003236 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Elevated circulating creatine kinase concentration (HP:0003236). HP:0003236 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0003236 | Elevated circulating creatine kinase concentration | Frequent (79-30%)"
Orphanet records elevated circulating creatine kinase concentration as a frequent (30-79%) phenotype of systemic sclerosis.
Musculoskeletal 1
Muscle weakness FREQUENT HP:0001324 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Muscle weakness (HP:0001324). HP:0001324 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0001324 | Muscle weakness | Frequent (79-30%)"
Orphanet records muscle weakness as a frequent (30-79%) phenotype of systemic sclerosis.
Respiratory 1
Pulmonary Fibrosis FREQUENT HP:0002206 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Pulmonary Fibrosis (HP:0002206). HP:0002206 is a phenotype from the Human Phenotype Ontology.
Major cause of morbidity and mortality
Constitutional 3
Arthralgia VERY_FREQUENT HP:0002829 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Arthralgia (HP:0002829). HP:0002829 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0002829 | Arthralgia | Very frequent (99-80%)"
Orphanet records arthralgia as a very frequent (80-99%) phenotype of systemic sclerosis.
Myalgia VERY_FREQUENT HP:0003326 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Myalgia (HP:0003326). HP:0003326 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0003326 | Myalgia | Very frequent (99-80%)"
Orphanet records myalgia as a very frequent (80-99%) phenotype of systemic sclerosis.
Pain FREQUENT HP:0012531 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Pain (HP:0012531). HP:0012531 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
ORPHA:90291 SUPPORT Other
"HP:0012531 | Pain | Frequent (79-30%)"
Orphanet records pain as a frequent (30-79%) phenotype of systemic sclerosis.
🧬

Genetic Associations

3
HLA-DRB1 (Risk Factor)
Gene: HLA-DRB1 hgnc:4948 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is HLA-DRB1 (hgnc:4948). hgnc:4948 is a gene from the HUGO Gene Nomenclature Committee.
IRF5 (Risk Factor)
Gene: IRF5 hgnc:6120 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is IRF5 (hgnc:6120). hgnc:6120 is a gene from the HUGO Gene Nomenclature Committee.
STAT4 (Risk Factor)
Gene: STAT4 hgnc:11365 HUGO Gene Nomenclature Committee (hgnc) Relation: this disease-associated gene is this gene This disease-associated gene is STAT4 (hgnc:11365). hgnc:11365 is a gene from the HUGO Gene Nomenclature Committee.
💊

Medical Actions

4
Calcium Channel Blockers
Action: PharmacotherapyNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is Pharmacotherapy (NCIT:C15986). NCIT:C15986 is a clinical intervention from the NCI Thesaurus. NCIT:C15986
Agent: nifedipine CHEBI:7565 Chemical Entities of Biological Interest (CHEBI) Relation: this treatment uses this therapeutic agent This treatment uses nifedipine (CHEBI:7565). CHEBI:7565 is a therapeutic agent from Chemical Entities of Biological Interest.
Platform: Small molecule
For Raynaud's phenomenon management.
Show evidence (1 reference)
PMID:38956991 SUPPORT Other
"Nifedipine should be used as first-line therapy for RP and/or DUs."
The Portuguese recommendations position the calcium channel blocker nifedipine as first-line therapy for Raynaud's phenomenon and digital ulcers in systemic sclerosis.
Mycophenolate Mofetil
Immunosuppressant for skin and lung involvement.
Nintedanib
Antifibrotic agent for progressive interstitial lung disease.
ACE Inhibitors
Critical for scleroderma renal crisis management.
🔬

Biochemical Markers

4
Anti-Scl-70 (Anti-Topoisomerase I) (Elevated)
Context: Associated with diffuse cutaneous SSc and ILD
Anti-Centromere Antibodies (Elevated)
Context: Associated with limited cutaneous SSc
Anti-RNA Polymerase III (Elevated)
Context: Associated with rapidly progressive skin disease and renal crisis
Forced Vital Capacity (Decreased with restrictive interstitial lung involvement; preserved or improved with effective antifibrotic response.)
Context: Pulmonary function test readout used to measure restrictive ventilatory impairment and treatment response in systemic sclerosis-associated ILD.
Pathograph Readouts
Pharmacodynamic Marker Of Systemic Sclerosis-Associated Interstitial Lung Disease Negative Pharmacodynamic
Higher or less-declining FVC indicates less progressive restrictive lung impairment from SSc-associated ILD; treatment-induced slowing of FVC decline reports pharmacodynamic slowing of ILD progression.
Forced vital capacity (FVC)
Traditional Validated Surrogate Endpoint
Patents with systemic sclerosis-interstitial lung disease
Show evidence (1 reference)
PMID:31112379 SUPPORT Human Clinical
"Among patients with ILD associated with systemic sclerosis, the annual rate of decline in FVC was lower with nintedanib than with placebo;"
SENSCIS supports FVC decline as the pulmonary-function response readout for nintedanib in SSc-associated ILD.
Show evidence (1 reference)
PMID:31112379 SUPPORT Human Clinical
"The primary end point was the annual rate of decline in forced vital capacity (FVC), assessed over a 52-week period."
SENSCIS used annual FVC decline as the primary endpoint in systemic-sclerosis-associated ILD.
📊

Related Datasets

6
Sex disparity in systemic sclerosis-associated pulmonary fibrosis. geo:GSE317056
Systemic sclerosis (SSc) is a fibrotic disease with high mortality and SSc-associated pulmonary fibrosis (SSc-PF) as the leading cause of death. SSc shows a significant sex disparity with a sex ratio of 1:3 men to women, yet SSc-PF is more severe in men. This study investigates gene expression differences between men and women with SSc-PF. Whole lung tissues from healthy donors and SSc-PF patients of both sexes were analyzed by RNA sequencing. Selected genes were validated by quantitative polymerase chain reaction (qPCR) and Western blotting analyses.
human BULK RNA SEQ n=24
PMID:42196343
Identified by GEO DataSets index search for Systemic Sclerosis (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
RUNX1 is Expressed in a Subpopulation of Dermal Fibroblasts and is Associated with Disease Severity of Systemic Sclerosis geo:GSE311858
The activation of Runt-related transcription factor 1 (RUNX1) in fibroblasts has been implicated in wound healing and fibrosis; however, the role of RUNX1 in the fibrotic progression of the autoimmune disease systemic sclerosis (SSc) is not known. Leveraging gene expression, genome-wide DNA methylation, and single-cell resolution data of SSc skin and fibroblast, we analyzed the impact of RUNX1 dysregulation in SSc dermal fibrosis. RUNX1 function was subsequently assessed using siRNA, pharmacologic inhibition, and CRISPR knockout in 2D and 3D fibroblasts cultures.
human METHYLATION n=16
PMID:41381303
Identified by GEO DataSets index search for Systemic Sclerosis (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
Longitudinal CITE-seq analysis in juvenile-onset systemic sclerosis monocytes following autologous stem cell transplant geo:GSE332819
Juvenile systemic sclerosis (jSSc) is a rare and severe autoimmune disease marked by skin fibrosis and damage to multiple organ systems. This study implements autologous stem cell transplantation (ASCT), a newly available treatment protocol which aims to restore immune homeostasis, in this case amongst jSSc patients. Here, we analyze peripheral blood mononuclear cells (PBMCs) from 3 jSSc patients prior to ASCT and 6, 12, and 24 months post treatment. These samples were then sequenced and tagged with antibodies using cellular indexing of transcriptomes and epitopes (CITE-seq).
human SINGLE CELL RNA SEQ n=15
Identified by GEO DataSets index search for Systemic Sclerosis (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
Antisense long non-coding RNAs are deregulated in skin tissue of patients with systemic sclerosis ega:EGAS00001002751
Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of skin and multiple organs of which the pathogenesis is poorly understood. Here we studied differentially expressed coding and non-coding genes in relation to SSc pathogenesis with a specific focus on antisense non-coding RNAs. Skin biopsy-derived RNAs from fourteen early SSc patients and six healthy individuals were sequenced with ion-torrent and analysed using DEseq2. Overall, 4901 genes with a fold change >1.5 and a false discovery rate < 5% were detected in patients versus controls. Upregulated genes clustered in immunological, cell adhesion and keratin-related processes.
human
PMID:29179949
European Genome-phenome Archive study, matched because the disease is named in the study's own title ("Systemic Sclerosis"); description-level mentions were not accepted. EGA study_type: Other. Controlled access -- data require a Data Access Agreement. EGA metadata retrieved 2026-08-01.
Ubiquitin Proteomics Analysis of Systemic Sclerosis Lung Fibroblasts with or without KLHL42 knockdown massive:MSV000084800
Systemic scleroderma (SSc) is an autoimmune disease which results in fibrotic production in the lung. Resultant SSC-pulmonary fibrosis is the main cause of mortality among SSc patients. From high throughput RNAi screening, we uncovered the ubiquitin E3 ligase KLHL42 as a potential pro-fibrotic mediator of TGFb-dependent fibrotic signaling in primary SSc lung fibroblasts. In this analysis, we sought to uncover putative substrates for KLHL42 by comparing SSc lung fibroblasts with control or KLHL42 siRNA prior to TGFb-treatment, lysis, and TUBE precipitation.
Located via OmicsDI, which aggregates across omics repositories; this record comes from massive. Only repositories with no other discovery route in this project and with a working accession resolver are curated from OmicsDI -- GEO, ArrayExpress, PRIDE, MetaboLights and EGA hits are excluded as duplicates of dedicated passes. Matched because the disease is named in the dataset's own title ("Systemic Sclerosis"). Retrieved 2026-08-02.
Genome-Wide Association Study in Systemic Sclerosis dbgap:phs000357
The Scleroderma Family Registry and DNA Repository (Registry) was initially developed as a registry and bio-specimen repository of patients with systemic sclerosis (scleroderma), family members and unaffected healthy controls. A case-control design was later adopted due to the lack of availability of many parents in this adult-onset disease, which precluded a linkage approach. In addition to collecting demographic data, the registry included the collection of disease-pertinent, cross-sectional, clinical information from medical records of affected participants.
Located via OmicsDI, which aggregates across omics repositories; this record comes from dbgap. Only repositories with no other discovery route in this project and with a working accession resolver are curated from OmicsDI -- GEO, ArrayExpress, PRIDE, MetaboLights and EGA hits are excluded as duplicates of dedicated passes. Matched because the disease is named in the dataset's own title ("Systemic Sclerosis"). Retrieved 2026-08-02.
{ }

Source YAML

click to show 
name: Systemic Sclerosis
creation_date: '2025-12-19T01:12:52Z'
category: Autoimmune
parents:
- Autoimmune Disease
- Connective Tissue Disease
disease_term:
  preferred_term: Systemic Sclerosis
  term:
    id: MONDO:0005100
    label: systemic sclerosis
description: >-
  A chronic autoimmune connective tissue disease characterized by vasculopathy,
  immune dysregulation, and progressive fibrosis of the skin and internal organs.
  Classified into limited cutaneous and diffuse cutaneous subtypes based on
  extent of skin involvement.
pathophysiology:
- name: Vascular Injury and Endothelial Dysfunction
  description: >-
    Early endothelial cell injury leads to vascular damage, intimal
    proliferation, and obliterative vasculopathy. Raynaud's phenomenon
    reflects vasospasm and structural vascular changes.
  cell_types:
  - preferred_term: Endothelial Cell
    term:
      id: CL:0000115
      label: endothelial cell
  biological_processes:
  - preferred_term: Blood Vessel Development
    term:
      id: GO:0001568
      label: blood vessel development
  evidence:
  - reference: PMID:38927538
    reference_title: "Recent Insights into Cellular and Molecular Mechanisms of Defective Angiogenesis in Systemic Sclerosis."
    supports: SUPPORT
    snippet: >-
      In systemic sclerosis (SSc, or scleroderma), defective angiogenesis, clinically
      manifesting with abnormal capillary architecture and severe capillary reduction,
      represents a hallmark of early-stage disease, usually preceding the onset of
      tissue fibrosis, and is caused by several cellular and molecular mechanisms
      affecting microvascular endothelial cells with different outcomes.
    explanation: >-
      This evidence supports the early vascular injury mechanism by demonstrating
      that defective angiogenesis and capillary abnormalities precede fibrosis in
      SSc.
  - reference: PMID:38927538
    reference_title: "Recent Insights into Cellular and Molecular Mechanisms of Defective Angiogenesis in Systemic Sclerosis."
    supports: SUPPORT
    snippet: >-
      Indeed, once damaged, endothelial cells can be dysfunctionally activated, thus
      becoming unable to undergo angiogenesis and promoting perivascular inflammation.
      They can also undergo apoptosis, transdifferentiate into profibrotic myofibroblasts,
      or acquire a senescence-associated secretory phenotype characterized by the
      release
      of exosomes and several profibrotic and proinflammatory mediators.
    explanation: >-
      This describes multiple mechanisms of endothelial dysfunction in SSc, including
      impaired angiogenesis, endothelial-to-mesenchymal transition, and inflammatory
      mediator release that contribute to vascular pathology.
- name: Immune Activation and Autoantibody Production
  description: >-
    Characteristic autoantibodies include anti-centromere (limited disease),
    anti-Scl-70/topoisomerase I (diffuse disease), and anti-RNA polymerase III.
    T cells and macrophages infiltrate affected tissues and produce
    pro-fibrotic cytokines.
  cell_types:
  - preferred_term: CD4+ T Cell
    term:
      id: CL:0000624
      label: CD4-positive, alpha-beta T cell
  - preferred_term: Macrophage
    term:
      id: CL:0000235
      label: macrophage
  biological_processes:
  - preferred_term: Immunoglobulin Production
    term:
      id: GO:0002377
      label: immunoglobulin production
  evidence:
  - reference: PMID:38296975
    reference_title: "GWAS for systemic sclerosis identifies six novel susceptibility loci including one in the Fcγ receptor region."
    supports: SUPPORT
    snippet: >-
      Here we report the largest Asian genome-wide association study (GWAS) for
      systemic sclerosis performed to date, based on data from Japanese subjects and
      comprising of 1428 cases and 112,599 controls. The lead SNP is in the FCGR/FCRL
      region, which shows a penetrating association in the Asian population, while
      a
      complete linkage disequilibrium SNP, rs10917688, is found in a cis-regulatory
      element for IRF8.
    explanation: >-
      This genetic evidence implicates B cell and Fc receptor biology in SSc
      susceptibility, with IRF8 being a key regulator of immune cell development
      and interferon responses that contribute to immune dysregulation.
  - reference: PMID:38296975
    reference_title: "GWAS for systemic sclerosis identifies six novel susceptibility loci including one in the Fcγ receptor region."
    supports: SUPPORT
    snippet: >-
      Prioritizing the top 5% of SNPs of IRF8 binding sites in B cells improves the
      fitting of the polygenic risk scores, underscoring the roles of B cells and
      IRF8 in the development of systemic sclerosis.
    explanation: >-
      This supports the role of B cell biology and autoantibody production in SSc
      pathogenesis, demonstrating that B cell-specific genetic variants contribute
      to disease risk.
- name: Fibroblast Activation and Fibrosis
  description: >-
    TGF-beta signaling drives fibroblast activation and differentiation into
    myofibroblasts. Excessive collagen and extracellular matrix deposition
    leads to progressive fibrosis of skin and internal organs.
  cell_types:
  - preferred_term: Fibroblast
    term:
      id: CL:0000057
      label: fibroblast
  - preferred_term: Myofibroblast
    term:
      id: CL:0000186
      label: myofibroblast cell
  biological_processes:
  - preferred_term: Extracellular Matrix Organization
    term:
      id: GO:0030198
      label: extracellular matrix organization
  - preferred_term: TGF-beta Signaling
    term:
      id: GO:0007179
      label: transforming growth factor beta receptor signaling pathway
  evidence:
  - reference: PMID:38147960
    reference_title: "Fibroblast Subpopulations in Systemic Sclerosis: Functional Implications of Individual Subpopulations and Correlations with Clinical Features."
    supports: SUPPORT
    snippet: >-
      SSc skin demonstrated an increased abundance of COMP+, COL11A1+, MYOC+, CCL19+,
      SFRP4/SFRP2+, and PRSS23/SFRP2+ fibroblasts signatures and decreased proportions
      of CXCL12+ and PI16+ fibroblast signatures in the Prospective Registry of Early
      Systemic Sclerosis and Genetics versus Environment in Scleroderma Outcome Study
      cohorts.
    explanation: >-
      This demonstrates the heterogeneity of fibroblast populations in SSc, with
      increased profibrotic fibroblast subpopulations and decreased normal fibroblast
      signatures contributing to excessive ECM deposition.
  - reference: PMID:38147960
    reference_title: "Fibroblast Subpopulations in Systemic Sclerosis: Functional Implications of Individual Subpopulations and Correlations with Clinical Features."
    supports: SUPPORT
    snippet: >-
      The proportions of profibrotic COMP+, COL11A1+, SFRP4/SFRP2+, and PRSS23/SFRP2+
      and proinflammatory CCL19+ fibroblast signatures were positively correlated
      with
      clinical and histopathological parameters of skin fibrosis, whereas signatures
      of
      CXCL12+ and PI16+ fibroblasts were inversely correlated.
    explanation: >-
      This provides direct evidence linking specific fibroblast subpopulations to
      clinical severity of skin fibrosis, supporting the role of fibroblast activation
      in SSc pathogenesis and disease progression.
  downstream:
  - target: Systemic Sclerosis-Associated Interstitial Lung Disease
- name: Systemic Sclerosis-Associated Interstitial Lung Disease
  description: >-
    Fibrotic remodeling can involve the lung interstitium in systemic sclerosis,
    producing restrictive ventilatory impairment that is tracked by pulmonary
    function testing.
  locations:
  - preferred_term: lung
    term:
      id: UBERON:0002048
      label: lung
  biological_processes:
  - preferred_term: extracellular matrix organization
    term:
      id: GO:0030198
      label: extracellular matrix organization
  evidence:
  - reference: PMID:31112379
    reference_title: "Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Interstitial lung disease (ILD) is a common manifestation of systemic
      sclerosis and a leading cause of systemic sclerosis-related death.
    explanation: >-
      The SENSCIS trial abstract establishes SSc-associated ILD as a major
      pulmonary manifestation of systemic sclerosis.
phenotypes:
- name: Raynaud Phenomenon
  category: Vascular
  frequency: VERY_FREQUENT
  phenotype_term:
    preferred_term: Raynaud Phenomenon
    term:
      id: HP:0030880
      label: Raynaud phenomenon
  notes: Often the earliest manifestation
- name: Skin Thickening
  category: Dermatological
  frequency: VERY_FREQUENT
  phenotype_term:
    preferred_term: Thick Skin
    term:
      id: HP:0001072
      label: Thickened skin
- name: Pulmonary Fibrosis
  category: Respiratory
  frequency: FREQUENT
  phenotype_term:
    preferred_term: Pulmonary Fibrosis
    term:
      id: HP:0002206
      label: Pulmonary fibrosis
  notes: Major cause of morbidity and mortality
- name: Dysphagia
  category: Gastrointestinal
  frequency: FREQUENT
  phenotype_term:
    preferred_term: Dysphagia
    term:
      id: HP:0002015
      label: Dysphagia
  notes: Due to esophageal dysmotility
- name: "Arthralgia"
  category: Musculoskeletal
  frequency: VERY_FREQUENT
  description: "Arthralgia is reported as a very frequent (80-99%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Arthralgia"
    term:
      id: HP:0002829
      label: "Arthralgia"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0002829 | Arthralgia | Very frequent (99-80%)"
    explanation: "Orphanet records arthralgia as a very frequent (80-99%) phenotype of systemic sclerosis."
- name: "Myalgia"
  category: Musculoskeletal
  frequency: VERY_FREQUENT
  description: "Myalgia is reported as a very frequent (80-99%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Myalgia"
    term:
      id: HP:0003326
      label: "Myalgia"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0003326 | Myalgia | Very frequent (99-80%)"
    explanation: "Orphanet records myalgia as a very frequent (80-99%) phenotype of systemic sclerosis."
- name: "Antinuclear antibody positivity"
  category: Immunologic
  frequency: VERY_FREQUENT
  description: "Antinuclear antibody positivity is reported as a very frequent (80-99%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Antinuclear antibody positivity"
    term:
      id: HP:0003493
      label: "Antinuclear antibody positivity"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0003493 | Antinuclear antibody positivity | Very frequent (99-80%)"
    explanation: "Orphanet records antinuclear antibody positivity as a very frequent (80-99%) phenotype of systemic sclerosis."
- name: "Cutaneous sclerotic plaque"
  category: Dermatologic
  frequency: VERY_FREQUENT
  description: "Cutaneous sclerotic plaque is reported as a very frequent (80-99%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Cutaneous sclerotic plaque"
    term:
      id: HP:0031359
      label: "Cutaneous sclerotic plaque"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0031359 | Cutaneous sclerotic plaque | Very frequent (99-80%)"
    explanation: "Orphanet records cutaneous sclerotic plaque as a very frequent (80-99%) phenotype of systemic sclerosis."
- name: "Narrow mouth"
  category: Dermatologic
  frequency: FREQUENT
  description: "Narrow mouth is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Narrow mouth"
    term:
      id: HP:0000160
      label: "Narrow mouth"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000160 | Narrow mouth | Frequent (79-30%)"
    explanation: "Orphanet records narrow mouth as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Telangiectasia"
  category: Dermatologic
  frequency: FREQUENT
  description: "Telangiectasia is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Telangiectasia"
    term:
      id: HP:0001009
      label: "Telangiectasia"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001009 | Telangiectasia | Frequent (79-30%)"
    explanation: "Orphanet records telangiectasia as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Nail bed telangiectasia"
  category: Dermatologic
  frequency: FREQUENT
  description: "Nail bed telangiectasia is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Nail bed telangiectasia"
    term:
      id: HP:0001232
      label: "Nail bed telangiectasia"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001232 | Nail bed telangiectasia | Frequent (79-30%)"
    explanation: "Orphanet records nail bed telangiectasia as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Muscle weakness"
  category: Musculoskeletal
  frequency: FREQUENT
  description: "Muscle weakness is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Muscle weakness"
    term:
      id: HP:0001324
      label: "Muscle weakness"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001324 | Muscle weakness | Frequent (79-30%)"
    explanation: "Orphanet records muscle weakness as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Joint swelling"
  category: Musculoskeletal
  frequency: FREQUENT
  description: "Joint swelling is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Joint swelling"
    term:
      id: HP:0001386
      label: "Joint swelling"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001386 | Joint swelling | Frequent (79-30%)"
    explanation: "Orphanet records joint swelling as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Elevated circulating creatine kinase concentration"
  category: Laboratory
  frequency: FREQUENT
  description: "Elevated circulating creatine kinase concentration is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Elevated circulating creatine kinase concentration"
    term:
      id: HP:0003236
      label: "Elevated circulating creatine kinase concentration"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0003236 | Elevated circulating creatine kinase concentration | Frequent (79-30%)"
    explanation: "Orphanet records elevated circulating creatine kinase concentration as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Spotty hypopigmentation"
  category: Dermatologic
  frequency: FREQUENT
  description: "Spotty hypopigmentation is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Spotty hypopigmentation"
    term:
      id: HP:0005590
      label: "Spotty hypopigmentation"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0005590 | Spotty hypopigmentation | Frequent (79-30%)"
    explanation: "Orphanet records spotty hypopigmentation as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Acral ulceration"
  category: Dermatologic
  frequency: FREQUENT
  description: "Acral ulceration is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Acral ulceration"
    term:
      id: HP:0006121
      label: "Acral ulceration"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0006121 | Acral ulceration | Frequent (79-30%)"
    explanation: "Orphanet records acral ulceration as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Irregular hyperpigmentation"
  category: Dermatologic
  frequency: FREQUENT
  description: "Irregular hyperpigmentation is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Irregular hyperpigmentation"
    term:
      id: HP:0007400
      label: "Irregular hyperpigmentation"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0007400 | Irregular hyperpigmentation | Frequent (79-30%)"
    explanation: "Orphanet records irregular hyperpigmentation as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Sclerodactyly"
  category: Dermatologic
  frequency: FREQUENT
  description: "Sclerodactyly is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Sclerodactyly"
    term:
      id: HP:0011838
      label: "Sclerodactyly"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0011838 | Sclerodactyly | Frequent (79-30%)"
    explanation: "Orphanet records sclerodactyly as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Pain"
  category: Systemic
  frequency: FREQUENT
  description: "Pain is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Pain"
    term:
      id: HP:0012531
      label: "Pain"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0012531 | Pain | Frequent (79-30%)"
    explanation: "Orphanet records pain as a frequent (30-79%) phenotype of systemic sclerosis."
- name: "Finger swelling"
  category: Musculoskeletal
  frequency: FREQUENT
  description: "Finger swelling is reported as a frequent (30-79%) manifestation of systemic sclerosis in the Orphanet clinical phenotype dataset."
  phenotype_term:
    preferred_term: "Finger swelling"
    term:
      id: HP:0025131
      label: "Finger swelling"
  evidence:
  - reference: ORPHA:90291
    reference_title: Systemic sclerosis
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0025131 | Finger swelling | Frequent (79-30%)"
    explanation: "Orphanet records finger swelling as a frequent (30-79%) phenotype of systemic sclerosis."
biochemical:
- name: Anti-Scl-70 (Anti-Topoisomerase I)
  presence: Elevated
  context: Associated with diffuse cutaneous SSc and ILD
- name: Anti-Centromere Antibodies
  presence: Elevated
  context: Associated with limited cutaneous SSc
- name: Anti-RNA Polymerase III
  presence: Elevated
  context: Associated with rapidly progressive skin disease and renal crisis
- name: Forced Vital Capacity
  presence: Decreased with restrictive interstitial lung involvement; preserved or improved with effective antifibrotic response.
  context: >-
    Pulmonary function test readout used to measure restrictive ventilatory
    impairment and treatment response in systemic sclerosis-associated ILD.
  biomarker_term:
    preferred_term: Forced Vital Capacity
    term:
      id: NCIT:C111361
      label: Forced Vital Capacity
  synonyms:
  - FVC
  readouts:
  - target: Systemic Sclerosis-Associated Interstitial Lung Disease
    relationship: PHARMACODYNAMIC_MARKER_OF
    direction: NEGATIVE
    endpoint_context: PHARMACODYNAMIC
    regulatory_endpoint_refs:
    - FDA-SE-adult-noncancer-111
    interpretation: >-
      Higher or less-declining FVC indicates less progressive restrictive lung
      impairment from SSc-associated ILD; treatment-induced slowing of FVC
      decline reports pharmacodynamic slowing of ILD progression.
    evidence:
    - reference: PMID:31112379
      reference_title: "Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Among patients with ILD associated with systemic sclerosis, the annual
        rate of decline in FVC was lower with nintedanib than with placebo;
      explanation: >-
        SENSCIS supports FVC decline as the pulmonary-function response readout
        for nintedanib in SSc-associated ILD.
  evidence:
  - reference: PMID:31112379
    reference_title: "Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      The primary end point was the annual rate of decline in forced vital
      capacity (FVC), assessed over a 52-week period.
    explanation: >-
      SENSCIS used annual FVC decline as the primary endpoint in
      systemic-sclerosis-associated ILD.
genetic:
- name: HLA-DRB1
  gene_term:
    preferred_term: HLA-DRB1
    term:
      id: hgnc:4948
      label: HLA-DRB1
  association: Risk Factor
- name: IRF5
  gene_term:
    preferred_term: IRF5
    term:
      id: hgnc:6120
      label: IRF5
  association: Risk Factor
- name: STAT4
  gene_term:
    preferred_term: STAT4
    term:
      id: hgnc:11365
      label: STAT4
  association: Risk Factor
treatments:
- name: Calcium Channel Blockers
  description: For Raynaud's phenomenon management.
  therapeutic_modality: SMALL_MOLECULE
  treatment_term:
    preferred_term: Pharmacotherapy
    term:
      id: NCIT:C15986
      label: Pharmacotherapy
    therapeutic_agent:
    - preferred_term: nifedipine
      term:
        id: CHEBI:7565
        label: nifedipine
  evidence:
  - reference: PMID:38956991
    reference_title: "Portuguese Recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Nifedipine should be used as first-line therapy for RP and/or DUs."
    explanation: The Portuguese recommendations position the calcium channel blocker nifedipine as first-line therapy for Raynaud's phenomenon and digital ulcers in systemic sclerosis.
- name: Mycophenolate Mofetil
  description: Immunosuppressant for skin and lung involvement.
- name: Nintedanib
  description: Antifibrotic agent for progressive interstitial lung disease.
- name: ACE Inhibitors
  description: Critical for scleroderma renal crisis management.
classifications:
  harrisons_chapter:
  - classification_value: IMMUNE_RHEUMATOLOGIC
references:
- reference: DOI:10.1007/s00296-024-05699-x
  title: Heart involvement in patients with systemic sclerosis—what have we learned about it in the last 5 years
  findings: []
- reference: DOI:10.1007/s10238-022-00841-0
  title: Transforming growth factor beta isoforms and TGF-βR1 and TGF-βR2 expression in systemic sclerosis patients
  findings: []
- reference: DOI:10.1038/s41467-023-44541-z
  title: GWAS for systemic sclerosis identifies six novel susceptibility loci including one in the Fcγ receptor region
  findings: []
- reference: DOI:10.1038/s41467-023-44645-6
  title: Systems-based identification of the Hippo pathway for promoting fibrotic mesenchymal differentiation in systemic sclerosis
  findings: []
- reference: DOI:10.1136/rmdopen-2023-003148
  title: Anti-topoisomerase, but not anti-centromere B cell responses in systemic sclerosis display active, Ig-secreting cells associated with lung fibrosis
  findings: []
- reference: DOI:10.31138/mjr.270324.tis
  title: 'Type I Interferons in Systemic Autoimmune Rheumatic Diseases: Pathogenesis, Clinical Features and Treatment Options'
  findings: []
- reference: DOI:10.3389/fimmu.2025.1551911
  title: 'A review of recent studies on the pathogenesis of Systemic Sclerosis: focus on fibrosis pathways'
  findings: []
- reference: DOI:10.3389/fmolb.2023.1215039
  title: 'Metabolic fingerprinting of systemic sclerosis: a systematic review'
  findings: []
- reference: DOI:10.3390/biomedicines12061331
  title: Recent Insights into Cellular and Molecular Mechanisms of Defective Angiogenesis in Systemic Sclerosis
  findings: []
- reference: DOI:10.3390/cimb45100490
  title: 'Biomarkers in Systemic Sclerosis: An Overview'
  findings: []
- reference: DOI:10.3390/ijms25094728
  title: 'Systemic Sclerosis-Associated Pulmonary Arterial Hypertension: From Bedside to Bench and Back Again'
  findings: []
- reference: DOI:10.3390/ijms26062421
  title: 'The Role of CXCL4 in Systemic Sclerosis: DAMP, Auto-Antigen and Biomarker'
  findings: []
- reference: DOI:10.53941/jmai.2025.100005
  title: The Role of Biomarkers in the the Pathogenesis, Clinical Manifestations, and Therapeutic Outcome of Systemic Sclerosis
  findings: []
- reference: DOI:10.55563/clinexprheumatol/is29he
  title: 'Systemic sclerosis: one year in review 2024'
  findings: []
datasets:
- accession: geo:GSE317056
  title: Sex disparity in systemic sclerosis-associated pulmonary fibrosis.
  description: Systemic sclerosis (SSc) is a fibrotic disease with high mortality and SSc-associated pulmonary fibrosis (SSc-PF) as the leading cause of death. SSc shows a significant sex disparity with a sex ratio of 1:3 men to women, yet SSc-PF is more severe in men. This study investigates gene expression differences between men and women with SSc-PF. Whole lung tissues from healthy donors and SSc-PF patients of both sexes were analyzed by RNA sequencing. Selected genes were validated by quantitative polymerase chain reaction (qPCR) and Western blotting analyses.
  organism:
    preferred_term: human
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
  data_type: BULK_RNA_SEQ
  sample_count: 24
  publication: PMID:42196343
  notes: Identified by GEO DataSets index search for Systemic Sclerosis (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
- accession: geo:GSE311858
  title: RUNX1 is Expressed in a Subpopulation of Dermal Fibroblasts and is Associated with Disease Severity of Systemic Sclerosis
  description: The activation of Runt-related transcription factor 1 (RUNX1) in fibroblasts has been implicated in wound healing and fibrosis; however, the role of RUNX1 in the fibrotic progression of the autoimmune disease systemic sclerosis (SSc) is not known. Leveraging gene expression, genome-wide DNA methylation, and single-cell resolution data of SSc skin and fibroblast, we analyzed the impact of RUNX1 dysregulation in SSc dermal fibrosis. RUNX1 function was subsequently assessed using siRNA, pharmacologic inhibition, and CRISPR knockout in 2D and 3D fibroblasts cultures.
  organism:
    preferred_term: human
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
  data_type: METHYLATION
  sample_count: 16
  publication: PMID:41381303
  notes: Identified by GEO DataSets index search for Systemic Sclerosis (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
- accession: geo:GSE332819
  title: Longitudinal CITE-seq analysis in juvenile-onset systemic sclerosis monocytes following autologous stem cell transplant
  description: Juvenile systemic sclerosis (jSSc) is a rare and severe autoimmune disease marked by skin fibrosis and damage to multiple organ systems. This study implements autologous stem cell transplantation (ASCT), a newly available treatment protocol which aims to restore immune homeostasis, in this case amongst jSSc patients. Here, we analyze peripheral blood mononuclear cells (PBMCs) from 3 jSSc patients prior to ASCT and 6, 12, and 24 months post treatment. These samples were then sequenced and tagged with antibodies using cellular indexing of transcriptomes and epitopes (CITE-seq).
  organism:
    preferred_term: human
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
  data_type: SINGLE_CELL_RNA_SEQ
  sample_count: 15
  notes: Identified by GEO DataSets index search for Systemic Sclerosis (scripts/discover_datasets.py); accession and metadata verified against NCBI E-utilities on 2026-08-01. Title, sample count, and organism are GEO's own values.
- accession: ega:EGAS00001002751
  title: Antisense long non-coding RNAs are deregulated in skin tissue of patients with systemic sclerosis
  description: Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of skin and multiple organs of which the pathogenesis is poorly understood. Here we studied differentially expressed coding and non-coding genes in relation to SSc pathogenesis with a specific focus on antisense non-coding RNAs. Skin biopsy-derived RNAs from fourteen early SSc patients and six healthy individuals were sequenced with ion-torrent and analysed using DEseq2. Overall, 4901 genes with a fold change >1.5 and a false discovery rate < 5% were detected in patients versus controls. Upregulated genes clustered in immunological, cell adhesion and keratin-related processes.
  organism:
    preferred_term: human
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
  publication: PMID:29179949
  notes: 'European Genome-phenome Archive study, matched because the disease is named in the study''s own title ("Systemic Sclerosis"); description-level mentions were not accepted. EGA study_type: Other. Controlled access -- data require a Data Access Agreement. EGA metadata retrieved 2026-08-01.'
- accession: massive:MSV000084800
  title: Ubiquitin Proteomics Analysis of Systemic Sclerosis Lung Fibroblasts with or without KLHL42 knockdown
  description: 'Systemic scleroderma (SSc) is an autoimmune disease which results in fibrotic production in the lung. Resultant SSC-pulmonary fibrosis is the main cause of mortality among SSc patients. From high throughput RNAi screening, we uncovered the ubiquitin E3 ligase KLHL42 as a potential pro-fibrotic mediator of TGFb-dependent fibrotic signaling in primary SSc lung fibroblasts. In this analysis, we sought to uncover putative substrates for KLHL42 by comparing SSc lung fibroblasts with control or KLHL42 siRNA prior to TGFb-treatment, lysis, and TUBE precipitation.'
  notes: Located via OmicsDI, which aggregates across omics repositories; this record comes from massive. Only repositories with no other discovery route in this project and with a working accession resolver are curated from OmicsDI -- GEO, ArrayExpress, PRIDE, MetaboLights and EGA hits are excluded as duplicates of dedicated passes. Matched because the disease is named in the dataset's own title ("Systemic Sclerosis"). Retrieved 2026-08-02.
- accession: dbgap:phs000357
  title: Genome-Wide Association Study in Systemic Sclerosis
  description:  The Scleroderma Family Registry and DNA Repository (Registry) was initially developed as a registry and bio-specimen repository of patients with systemic sclerosis (scleroderma), family members and unaffected healthy controls. A case-control design was later adopted due to the lack of availability of many parents in this adult-onset disease, which precluded a linkage approach. In addition to collecting demographic data, the registry included the collection of disease-pertinent, cross-sectional, clinical information from medical records of affected participants.
  notes: Located via OmicsDI, which aggregates across omics repositories; this record comes from dbgap. Only repositories with no other discovery route in this project and with a working accession resolver are curated from OmicsDI -- GEO, ArrayExpress, PRIDE, MetaboLights and EGA hits are excluded as duplicates of dedicated passes. Matched because the disease is named in the dataset's own title ("Systemic Sclerosis"). Retrieved 2026-08-02.
📚

References & Deep Research

References

14
DOI:10.1007/s00296-024-05699-x
Heart involvement in patients with systemic sclerosis—what have we learned about it in the last 5 years
No top-level findings curated for this source.
DOI:10.1007/s10238-022-00841-0
Transforming growth factor beta isoforms and TGF-βR1 and TGF-βR2 expression in systemic sclerosis patients
No top-level findings curated for this source.
DOI:10.1038/s41467-023-44541-z
GWAS for systemic sclerosis identifies six novel susceptibility loci including one in the Fcγ receptor region
No top-level findings curated for this source.
DOI:10.1038/s41467-023-44645-6
Systems-based identification of the Hippo pathway for promoting fibrotic mesenchymal differentiation in systemic sclerosis
No top-level findings curated for this source.
DOI:10.1136/rmdopen-2023-003148
Anti-topoisomerase, but not anti-centromere B cell responses in systemic sclerosis display active, Ig-secreting cells associated with lung fibrosis
No top-level findings curated for this source.
DOI:10.31138/mjr.270324.tis
Type I Interferons in Systemic Autoimmune Rheumatic Diseases: Pathogenesis, Clinical Features and Treatment Options
No top-level findings curated for this source.
DOI:10.3389/fimmu.2025.1551911
A review of recent studies on the pathogenesis of Systemic Sclerosis: focus on fibrosis pathways
No top-level findings curated for this source.
DOI:10.3389/fmolb.2023.1215039
Metabolic fingerprinting of systemic sclerosis: a systematic review
No top-level findings curated for this source.
DOI:10.3390/biomedicines12061331
Recent Insights into Cellular and Molecular Mechanisms of Defective Angiogenesis in Systemic Sclerosis
No top-level findings curated for this source.
DOI:10.3390/cimb45100490
Biomarkers in Systemic Sclerosis: An Overview
No top-level findings curated for this source.
DOI:10.3390/ijms25094728
Systemic Sclerosis-Associated Pulmonary Arterial Hypertension: From Bedside to Bench and Back Again
No top-level findings curated for this source.
DOI:10.3390/ijms26062421
The Role of CXCL4 in Systemic Sclerosis: DAMP, Auto-Antigen and Biomarker
No top-level findings curated for this source.
DOI:10.53941/jmai.2025.100005
The Role of Biomarkers in the the Pathogenesis, Clinical Manifestations, and Therapeutic Outcome of Systemic Sclerosis
No top-level findings curated for this source.
DOI:10.55563/clinexprheumatol/is29he
Systemic sclerosis: one year in review 2024
No top-level findings curated for this source.

Deep Research

2

Deep research results are used as seeds for research; they do not undergo the same validation as the main records and may contain errors. How we use deep research.

Disorder ▸

Disorder

  • Name: Systemic Sclerosis
  • Category: Autoimmune
  • Existing deep-research providers: falcon
  • Existing evidence reference count in YAML: 20

Key Pathophysiology Nodes

  • Vascular Injury and Endothelial Dysfunction
  • Immune Activation and Autoantibody Production
  • Fibroblast Activation and Fibrosis
  • Deep research literature mapping

Citation Inventory (for evidence mapping)

  • DOI:10.1007/s00296-024-05699-x
  • DOI:10.1007/s10238-022-00841-0
  • DOI:10.1038/s41467-023-44541-z
  • DOI:10.1038/s41467-023-44645-6
  • DOI:10.1136/rmdopen-2023-003148
  • DOI:10.31138/mjr.270324.tis
  • DOI:10.3389/fimmu.2025.1551911
  • DOI:10.3389/fmolb.2023.1215039
  • DOI:10.3390/biomedicines12061331
  • DOI:10.3390/cimb45100490
  • DOI:10.3390/ijms25094728
  • DOI:10.3390/ijms26062421
  • DOI:10.53941/jmai.2025.100005
  • DOI:10.55563/clinexprheumatol/is29he
Falcon ▸
Pathophysiology description (current understanding, 2023–2024 prioritized)
Edison Scientific Literature 32 citations 2025-12-18T09:52:46.348501

Pathophysiology description (current understanding, 2023–2024 prioritized)

Systemic sclerosis is a multisystem autoimmune disease defined by a triad of early microvasculopathy, immune dysregulation with disease-specific autoantibodies and type I interferon (IFN-I) activation, and progressive fibroblast activation culminating in tissue fibrosis. Recent work confirms that defective angiogenesis and endothelial injury are early, often pre-fibrotic features; “defective angiogenesis … represents a hallmark of early-stage disease, usually preceding the onset of tissue fibrosis” and involves endothelial apoptosis, senescence, and endothelial-to-mesenchymal transition (EndoMT) with impaired pro-angiogenic signaling (e.g., dysregulated VEGF/Angiopoietin axes) (Published Jun 2024; https://doi.org/10.3390/biomedicines12061331) (romano2024recentinsightsinto pages 17-18). Contemporary reviews capturing 2023 advances reiterate the canonical sequence—microvascular damage, immune activation/autoantibodies, then fibrosis—while adding single-cell and genetic resolution of pathway heterogeneity across autoantibody subsets (Published Apr 2024; https://doi.org/10.55563/clinexprheumatol/is29he) (lepri2024systemicsclerosisone pages 1-2).

At the immune level, IFN-I pathway activation (pDC/monocyte signatures, SIGLEC1 upregulation) and B-cell abnormalities are prominent; B-cell/autoantibody phenotypes correlate with organ involvement, including active, immunoglobulin-secreting anti–topoisomerase I responses that associate with interstitial lung disease (ILD) severity (Published Jul 2023; https://doi.org/10.1136/rmdopen-2023-003148) (lepri2024systemicsclerosisone pages 1-2). Vascular and immune perturbations converge on fibroblasts via profibrotic signaling nodes—TGF-β/SMAD, PDGF/CTGF, Wnt, and Hippo (YAP/TAZ)—with recent single-cell analyses in 2024 linking Hippo/YAP–TAZ activity to myofibroblast and EndoMT trajectories in SSc skin (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6) (lepri2024systemicsclerosisone pages 1-2). Metabolic reprogramming in stromal and immune compartments (glycolysis/lactate, TCA/OXPHOS shifts) is increasingly implicated, aligning with metabolomic fingerprints (amino acid, acylcarnitine, and TCA intermediates) that distinguish subtypes and pulmonary complications (Published Aug 2023; https://doi.org/10.3389/fmolb.2023.1215039) (maggio2023biomarkersinsystemic pages 6-8).

Genetically, large-scale GWAS (2024) identified six novel SSc susceptibility loci in a Japanese cohort (1,428 cases; 112,599 controls), including a lead signal in the FCGR/FCRL region and context-specific interaction with IRF8-related variants; cross-ancestry meta-analysis added 30 loci, emphasizing roles for B-cell biology and IRF8 in susceptibility (Published Jan 2024; https://doi.org/10.1038/s41467-023-44541-z) (lepri2024systemicsclerosisone pages 1-2). Clinically, these mechanisms underlie organ complications: ILD and pulmonary arterial hypertension (PAH) remain leading drivers of morbidity and mortality, while cardiac involvement (arrhythmia, myocardial fibrosis) and scleroderma renal crisis reflect microvascular injury, immune activation, and fibrosis interplay (Published Aug 2024; https://doi.org/10.1007/s00296-024-05699-x; Published Apr 2024; https://doi.org/10.3390/ijms25094728) (lepri2024systemicsclerosisone pages 1-2).

1. Core Pathophysiology

  • Primary mechanisms
  • Early microvasculopathy: endothelial dysfunction, apoptosis/senescence, impaired angiogenesis, and EndoMT precede fibrosis; capillary rarefaction and abnormal architecture are early clinical hallmarks (nailfold capillaroscopy) (Published Jun 2024; https://doi.org/10.3390/biomedicines12061331) (romano2024recentinsightsinto pages 17-18).
  • Immune dysregulation: IFN-I axis activation (e.g., SIGLEC1 upregulation), B-cell activation with disease-stratifying autoantibodies (ACA, ATA, RNAP III) and functional antibodies; chemokine/cytokine milieu (IL-6, CCL2) recruits monocytes/macrophages and polarizes T cells (Published Sep 2023; https://doi.org/10.3390/cimb45100490; Published Jun 2024; https://doi.org/10.31138/mjr.270324.tis) (maggio2023biomarkersinsystemic pages 2-4, lepri2024systemicsclerosisone pages 1-2).
  • Fibroblast activation and ECM remodeling: canonical TGF-β/SMAD signaling, PDGF/CTGF pathways, noncanonical Wnt and Hippo/YAP–TAZ programs drive myofibroblast differentiation and excessive matrix deposition (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6) (lepri2024systemicsclerosisone pages 1-2).
  • Dysregulated molecular pathways
  • Angiogenesis dysregulation: increased Ang-2 with decreased Ang-1; paradoxical early VEGF elevation with failed angiogenesis; reduced endothelial progenitors (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • IFN-I/type I interferon signaling: monocyte/B-cell IFN signatures correlate with disease activity and organ complications (Published Jun 2024; https://doi.org/10.31138/mjr.270324.tis) (lepri2024systemicsclerosisone pages 1-2).
  • TGF-β axis: increased TGF-β receptor expression and activated SMAD signaling in lesional skin; context-dependent systemic vs local levels (Published May 2023; https://doi.org/10.1007/s10238-022-00841-0) (jimenez2025areviewof pages 1-2).
  • Hippo/YAP–TAZ and Wnt integration in mesenchymal programs and EndoMT (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6; Published Apr 2024; https://doi.org/10.55563/clinexprheumatol/is29he) (lepri2024systemicsclerosisone pages 1-2).
  • Affected cellular processes
  • Endothelial-to-mesenchymal transition, impaired angiogenesis, leukocyte recruitment (CCL2/IL-6), fibroblast-to-myofibroblast transition, ECM synthesis/turnover (Published Jun 2024; https://doi.org/10.3390/biomedicines12061331; Published Sep 2023; https://doi.org/10.3390/cimb45100490) (romano2024recentinsightsinto pages 17-18, maggio2023biomarkersinsystemic pages 6-8).

2. Key Molecular Players

  • Genes/Proteins (HGNC)
  • TGF-β pathway: TGFB1, TGFBR1/2, SMAD2/3; effector CCN2/CTGF (Published May 2023; https://doi.org/10.1007/s10238-022-00841-0) (jimenez2025areviewof pages 1-2).
  • Angiogenesis/vasoactive: VEGFA, ANGPT1/2, EDN1 (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Immune: IRF8; Fc gamma receptor cluster (FCGR/FCRL locus) (Published Jan 2024; https://doi.org/10.1038/s41467-023-44541-z) (lepri2024systemicsclerosisone pages 1-2); SIGLEC1 (IFN marker) (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Chemokines/cytokines: CXCL4, IL6, CCL2 (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Mechanotransduction/developmental: YAP1/WWTR1 (YAP/TAZ; Hippo), WNT5A (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6; Published Apr 2024; https://doi.org/10.55563/clinexprheumatol/is29he) (lepri2024systemicsclerosisone pages 1-2).
  • Chemical entities (CHEBI)
  • Endothelin-1, VEGF-A, TGF-β1, PDGF isoforms, CXCL4 (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Cell types (CL)
  • Endothelial cell (CL:0000115), fibroblast (CL:0000064), monocyte/macrophage (CL:0000235), B cell (CL:0000236), T cell (CL:0000084), endothelial progenitor cell (Published Jun 2024; https://doi.org/10.3390/biomedicines12061331; Published Sep 2023; https://doi.org/10.3390/cimb45100490) (romano2024recentinsightsinto pages 17-18, maggio2023biomarkersinsystemic pages 6-8).
  • Anatomical locations (UBERON)
  • Skin (UBERON:0002097), lung (UBERON:0002048), heart (UBERON:0000948), kidney (UBERON:0002113), peripheral microvasculature (capillary bed) (Published Aug 2024; https://doi.org/10.1007/s00296-024-05699-x; Published Apr 2024; https://doi.org/10.3390/ijms25094728) (lepri2024systemicsclerosisone pages 1-2).
HGNC symbol Name Role in SSc (summary) Key pathway (GO term suggestion) Cellular component (GO-CC) Cell types (CL terms) Anatomical sites (UBERON) Notable molecules/chemicals (CHEBI) Recent sources (URL, year)
TGFB1 Transforming growth factor beta 1 Central profibrotic cytokine driving fibroblast-to-myofibroblast transition and ECM deposition in skin and lung fibrosis TGF-beta receptor signaling pathway (GO:0007179) Extracellular region / secreted (GO:0005576) Fibroblast (CL:0000064), endothelial cell (CL:0000115) Skin (UBERON:0002097), Lung (UBERON:0002048) TGF-β1 (CHEBI:TGF-β1) https://doi.org/10.1007/s10238-022-00841-0 (2023) (jimenez2025areviewof pages 1-2, maggio2023biomarkersinsystemic pages 6-8)
TGFBR1 / TGFBR2 TGF-β receptors type I & II Receptors mediating SMAD phosphorylation and downstream profibrotic transcriptional program in SSc fibroblasts TGF-beta receptor signaling pathway (GO:0007179) Plasma membrane (GO:0005886) Fibroblast (CL:0000064), Endothelial cell (CL:0000115) Skin, Lung — (receptor complex) https://doi.org/10.1007/s10238-022-00841-0 (2023) (jimenez2025areviewof pages 1-2)
SMAD2 / SMAD3 SMAD family members 2 & 3 Intracellular mediators of canonical TGF-β signaling promoting collagen gene expression in SSc fibroblasts Positive regulation of transcription by SMAD (GO:0060395) Nucleus / cytoplasm (GO:0005634 / GO:0005737) Fibroblast (CL:0000064) Skin, Lung p-SMAD2/3 (CHEBI:phosphoprotein) https://doi.org/10.3389/fimmu.2025.1551911 (2025) (jimenez2025areviewof pages 1-2, jimenez2025areviewof pages 9-10)
CCN2 (CTGF) Connective tissue growth factor Matricellular effector induced by TGF-β that amplifies fibroblast activation and matrix deposition Regulation of cell proliferation and ECM organization (GO:0030198) Extracellular matrix (GO:0031012) Fibroblast (CL:0000064) Skin, Heart, Lung CTGF/CCN2 (CHEBI:CTGF) https://doi.org/10.3389/fimmu.2025.1551911 (2025) (jimenez2025areviewof pages 1-2)
PDGFA / PDGFRB Platelet-derived growth factor A / receptor β Stimulates fibroblast proliferation and perivascular smooth muscle activation contributing to vascular remodeling and fibrosis PDGF receptor signaling pathway (GO:0048008) Plasma membrane / extracellular (GO:0005886 / GO:0005576) Fibroblast, Pericyte, Vascular smooth muscle cell Skin, Lung, Vasculature PDGF-BB (CHEBI:PDGF) https://doi.org/10.3389/fimmu.2025.1551911 (2025) (jimenez2025areviewof pages 1-2)
EDN1 Endothelin 1 (endothelin-1) Vasoconstrictor elevated in SSc vasculopathy; implicated in vessel tone dysregulation and may link to fibrosis Endothelin signaling (GO:0007186) Secreted peptide (GO:0005576) Endothelial cell (CL:0000115), VSMC Peripheral vasculature, Lung Endothelin-1 (CHEBI:ET-1) https://doi.org/10.3390/cimb45100490 (2023) (maggio2023biomarkersinsystemic pages 2-4)
VEGFA Vascular endothelial growth factor A Dysregulated/ectopic VEGF expression: early elevated VEGF but defective angiogenesis and capillary loss in SSc VEGF receptor signaling pathway (GO:0048010) Secreted / extracellular (GO:0005576) Endothelial cell (CL:0000115), Endothelial progenitor cell Skin microvasculature, Lung VEGF-A (CHEBI:VEGF) https://doi.org/10.3390/cimb45100490 (2023), https://doi.org/10.3390/biomedicines12061331 (2024) (maggio2023biomarkersinsystemic pages 6-8, romano2024recentinsightsinto pages 17-18)
ANGPT1 / ANGPT2 Angiopoietin-1 / -2 Imbalanced Ang1 (decreased) / Ang2 (increased) axis contributes to aberrant angiogenesis and vessel instability in SSc Angiopoietin-Tie signaling (GO:0043066) Extracellular region / secreted (GO:0005576) Endothelial cell (CL:0000115), Pericyte Microvasculature (skin) Angiopoietin-2 (CHEBI:ANGPT2) https://doi.org/10.3390/cimb45100490 (2023) (maggio2023biomarkersinsystemic pages 6-8)
CXCL4 C-X-C motif chemokine ligand 4 (platelet factor 4) Proposed DAMP / biomarker; promotes IFN-I and inflammatory signaling and associates with lung fibrosis and worse skin scores Chemokine-mediated signaling pathway (GO:0070098) Extracellular region / platelet granule (GO:0005576) Platelet, Plasmacytoid dendritic cell, Monocyte Skin, Lung CXCL4 (CHEBI:CXCL4) https://doi.org/10.3390/cimb45100490 (2023), https://doi.org/10.3390/ijms26062421 (2025) (maggio2023biomarkersinsystemic pages 6-8, bazso2025theroleof pages 1-2)
IL6 Interleukin-6 Pro-inflammatory/profibrotic cytokine; correlates with mRSS and progressive skin disease and ILD risk JAK-STAT signaling pathway (GO:0043401) Secreted cytokine (GO:0005576) Macrophage, T cell, Fibroblast Skin, Lung IL-6 (CHEBI:IL6) https://doi.org/10.3390/cimb45100490 (2023) (maggio2023biomarkersinsystemic pages 6-8)
CCL2 C-C motif chemokine ligand 2 (MCP-1) Monocyte chemoattractant linked to macrophage recruitment and ILD / skin severity in SSc Monocyte chemotaxis (GO:0002548) Extracellular region (GO:0005576) Monocyte, Macrophage Lung, Skin CCL2 (CHEBI:CCL2) https://doi.org/10.3390/cimb45100490 (2023) (maggio2023biomarkersinsystemic pages 6-8)
IRF8 Interferon regulatory factor 8 Genetic susceptibility locus; regulator of IFN-I responses and B cell / myeloid programs implicated in SSc risk and B cell biology Regulation of type I interferon production (GO:0032479) Nucleus (GO:0005634) B cell (CL:0000236), Dendritic cell (CL:0000451), Monocyte Blood / Immune system IRF8 (CHEBI:IRF8) https://doi.org/10.1038/s41467-023-44541-z (2024) (lepri2024systemicsclerosisone pages 1-2)
FCGR cluster (e.g., FCGR2A/FCGR3A) Fc gamma receptors IIa / IIIa region GWAS locus (FCGR/FCRL region) with strong association in Asian cohort; implicates B cell/FC receptor–mediated immunity in SSc susceptibility Fc-gamma receptor signaling (GO:0038094) Plasma membrane (GO:0005886) B cell, NK cell, Macrophage Immune system compartments IgG / immune complexes (CHEBI:IgG) https://doi.org/10.1038/s41467-023-44541-z (2024) (lepri2024systemicsclerosisone pages 1-2)
YAP1 / WWTR1 (TAZ) YAP1 and WWTR1 (TAZ) Hippo pathway effectors Hippo/YAP-TAZ signaling implicated in mesenchymal differentiation and myofibroblast/EndoMT fibrotic programs in SSc skin Hippo signaling (GO:0035329) Nucleus / cytoplasm (GO:0005634 / GO:0005737) Fibroblast (CL:0000064), Endothelial-to-mesenchymal cells Skin YAP/TAZ transcriptional coactivators (CHEBI:YAP) https://doi.org/10.1038/s41467-023-44645-6 (2024) (lepri2024systemicsclerosisone pages 1-2)
WNT5A Wnt family member 5A Non-canonical Wnt implicated in fibroblast activation, crosstalk with Hippo and TGF-β pathways Wnt signaling pathway (GO:0016055) Secreted signaling molecule (GO:0005576) Fibroblast, Endothelial cell Skin, Lung Wnt5a (CHEBI:WNT5A) https://doi.org/10.55563/clinexprheumatol/is29he (2024) (lepri2024systemicsclerosisone pages 1-2)
SIGLEC1 Sialic acid binding Ig-like lectin 1 (CD169) IFN-I–inducible marker (monocyte/macrophage) used as surrogate of IFN activation in SSc; links IFN axis to immune activation Type I interferon signaling pathway (GO:0060337) Plasma membrane (GO:0005886) Monocyte / Macrophage (CL:0000235) Blood, Skin SIGLEC1 (CHEBI:SIGLEC1) https://doi.org/10.3390/cimb45100490 (2023) (maggio2023biomarkersinsystemic pages 6-8)

Table: Concise table mapping principal genes/proteins implicated in systemic sclerosis to roles, suggested GO pathways, cellular components, cell types, anatomical sites, notable chemicals, and recent sources (2023–2025) for rapid reference.

3. Biological Processes (GO) disrupted

  • Angiogenesis and vasculature development: angiogenesis (GO:0001525); VEGF receptor signaling (GO:0048010); angiopoietin signaling (GO:0043066) (Published Sep 2023; https://doi.org/10.3390/cimb45100490; Published Jun 2024; https://doi.org/10.3390/biomedicines12061331) (maggio2023biomarkersinsystemic pages 6-8, romano2024recentinsightsinto pages 17-18).
  • Type I IFN signaling and antiviral response: type I interferon signaling (GO:0060337); regulation of type I interferon production (GO:0032479) (Published Jun 2024; https://doi.org/10.31138/mjr.270324.tis) (lepri2024systemicsclerosisone pages 1-2).
  • Fibrogenic programming: TGF-β receptor signaling (GO:0007179); positive regulation of transcription by SMAD proteins (GO:0060395); extracellular matrix organization (GO:0030198) (Published May 2023; https://doi.org/10.1007/s10238-022-00841-0) (jimenez2025areviewof pages 1-2).
  • Leukocyte trafficking/inflammation: monocyte chemotaxis (GO:0002548), cytokine-mediated signaling (GO:0019221) (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Mechanotransduction/developmental: Hippo signaling (GO:0035329); Wnt signaling (GO:0016055) (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6; Published Apr 2024; https://doi.org/10.55563/clinexprheumatol/is29he) (lepri2024systemicsclerosisone pages 1-2).

4. Cellular Components (GO-CC)

  • Extracellular region/matrix (GO:0005576/GO:0031012): cytokines/chemokines (TGF-β, IL-6, CXCL4), ECM proteins (collagens), CTGF (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Plasma membrane (GO:0005886): TGF-β receptors, PDGFR, Fcγ receptors, endothelin receptors (Published Jan 2024; https://doi.org/10.1038/s41467-023-44541-z) (lepri2024systemicsclerosisone pages 1-2).
  • Nucleus/cytoplasm (GO:0005634/GO:0005737): SMAD transcriptional complexes; YAP/TAZ co-activators (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6) (lepri2024systemicsclerosisone pages 1-2).

5. Disease Progression (sequence of events)

  • Initiation: genetic susceptibility (FCGR/FCRL, IRF8) + environmental triggers; endothelial injury and microvasculopathy manifested by Raynaud’s phenomenon and nailfold capillaroscopy abnormalities (Published Jan 2024; https://doi.org/10.1038/s41467-023-44541-z; Published Sep 2023; https://doi.org/10.3390/cimb45100490) (lepri2024systemicsclerosisone pages 1-2, maggio2023biomarkersinsystemic pages 2-4).
  • Propagation: IFN-I activation (SIGLEC1), B-cell priming and autoantibody production (ACA, ATA, RNAP III; functional antibodies), chemokine-driven recruitment (CCL2) of monocytes/macrophages; EndoMT and impaired angiogenesis persist (Published Sep 2023; https://doi.org/10.3390/cimb45100490; Published Jun 2024; https://doi.org/10.3390/biomedicines12061331) (maggio2023biomarkersinsystemic pages 6-8, romano2024recentinsightsinto pages 17-18).
  • Fibrotic consolidation: TGF-β/SMAD-dominant fibroblast programs with PDGF/CTGF amplification, crosstalk with Wnt and Hippo/YAP–TAZ; ECM deposition and organ remodeling (Published May 2023; https://doi.org/10.1007/s10238-022-00841-0; Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6) (jimenez2025areviewof pages 1-2, lepri2024systemicsclerosisone pages 1-2).
  • Organ phenotypes emerge according to autoantibody/endotype and tissue context (e.g., ATA→ILD progression, ACA→PAH risk; RNAP III→renal crisis risk), with clinical course shaped by ongoing vascular injury and fibrosis (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 2-4).

6. Phenotypic Manifestations (selected associations)

  • Vascular/skin: Raynaud’s phenomenon, nailfold capillary dropout, digital ulcers, telangiectasias—reflect microvascular damage and defective angiogenesis (Published Sep 2023; https://doi.org/10.3390/cimb45100490; Published Jun 2024; https://doi.org/10.3390/biomedicines12061331) (maggio2023biomarkersinsystemic pages 2-4, romano2024recentinsightsinto pages 17-18).
  • Lung: ILD (fibrosing alveolitis) linked to ATA+ B-cell activity and inflammatory chemokines; PAH from pulmonary arteriopathy and endothelial dysfunction (Published Jul 2023; https://doi.org/10.1136/rmdopen-2023-003148; Published Apr 2024; https://doi.org/10.3390/ijms25094728) (lepri2024systemicsclerosisone pages 1-2).
  • Heart: arrhythmias, myocardial fibrosis; pathogenesis traces microvascular dysfunction and fibrosis, often subclinical early (Published Aug 2024; https://doi.org/10.1007/s00296-024-05699-x) (lepri2024systemicsclerosisone pages 1-2).
  • Kidney: scleroderma renal crisis associated with RNAP III autoimmunity and acute microangiopathy (summarized 2023–2024) (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 2-4).

Recent developments and latest research (2023–2024)

  • Genetics (Jan 2024): Largest Asian SSc GWAS (1,428 cases; 112,599 controls) identified a lead SNP in the FCGR/FCRL region and interaction with IRF8 binding-site variation; meta-analysis with European data detected 30 additional significant loci, and B-cell/IRF8 biology improved polygenic model performance (URL: https://doi.org/10.1038/s41467-023-44541-z; Published Jan 2024) (lepri2024systemicsclerosisone pages 1-2).
  • Vascular biology (Jun 2024): Updated synthesis of defective angiogenesis/EndoMT pathways and EC senescence in SSc, with translational targets to restore angiogenesis and limit EndoMT (URL: https://doi.org/10.3390/biomedicines12061331; Published Jun 2024) (romano2024recentinsightsinto pages 17-18).
  • Fibroblast programs (Jan 2024): scRNA-seq delineated dual ECM sources from myofibroblasts and EndoMT cells and implicated Hippo/YAP–TAZ as central to mesenchymal differentiation; suggests pathway modulation as an antifibrotic strategy (URL: https://doi.org/10.1038/s41467-023-44645-6; Published Jan 2024) (lepri2024systemicsclerosisone pages 1-2).
  • Autoantibody biology (Jul 2023): Active, spontaneous ATA IgG/IgA secretion correlates with ILD presence and severity, supporting differential pathogenic roles and implications for B-cell–targeted therapy (URL: https://doi.org/10.1136/rmdopen-2023-003148; Published Jul 2023) (lepri2024systemicsclerosisone pages 1-2).
  • Biomarker/clinical overview (Sep 2023; Apr 2024): Consolidated linkages among cytokines/chemokines (IL-6, CCL2) and organ involvement; “one year in review” situates 2023 literature across endotypes and pathways (URLs: https://doi.org/10.3390/cimb45100490; https://doi.org/10.55563/clinexprheumatol/is29he) (maggio2023biomarkersinsystemic pages 2-4, lepri2024systemicsclerosisone pages 1-2).

Current applications and real-world implementations

  • Patient stratification by autoantibody/endotype and IFN/B-cell signatures to anticipate organ risk (ATA→ILD; ACA→PAH; RNAP III→renal crisis) (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 2-4).
  • Monitoring IFN activity (e.g., SIGLEC1) and angiogenesis-related markers (VEGF, Angpt2) to track vasculopathy/fibrosis risk (Published Sep 2023; https://doi.org/10.3390/cimb45100490) (maggio2023biomarkersinsystemic pages 6-8).
  • Emerging targeted approaches (translational): Hippo/YAP–TAZ modulation and pathway-specific TGF-β targeting are under exploration based on 2024 molecular insights; TGF-β isoform-selective strategies seek to reduce systemic toxicity (context across 2023–2024) (Published Jan 2024; https://doi.org/10.1038/s41467-023-44645-6; trial-phase summary 2024) (lepri2024systemicsclerosisone pages 1-2).

Expert opinions and analysis

  • The 2024 “one year in review” underscores that SSc heterogeneity is best captured by integrating single-cell molecular states, autoantibody profiles, and genetics (FLT3/TGF-β-related variants), converging on specific signaling axes (Hippo/Wnt/TGF-β/PI3K–AKT) that differ by stage and autoantibody subgroup (Published Apr 2024; https://doi.org/10.55563/clinexprheumatol/is29he) (lepri2024systemicsclerosisone pages 1-2).
  • Vascular experts emphasize intervening in EndoMT and EC senescence to prevent irreversible capillary loss and subsequent fibrosis—positioning vasculopathy as a druggable, earliest disease node (Published Jun 2024; https://doi.org/10.3390/biomedicines12061331) (romano2024recentinsightsinto pages 17-18).

Relevant statistics and data from recent studies

  • GWAS (Japan; 2024): 1,428 SSc cases, 112,599 controls; lead SNP in FCGR/FCRL region; meta-analysis identified 30 additional loci and supported B-cell/IRF8 biology; polygenic models improved by prioritizing IRF8 binding-site SNPs (URL: https://doi.org/10.1038/s41467-023-44541-z; Published Jan 2024) (lepri2024systemicsclerosisone pages 1-2).
  • Autoantibodies (reviewed 2023): approximate frequencies—anti–topoisomerase I (15–25%), anticentromere (10–20%), anti–RNA polymerase III (10–25%); phenotypic correlations: ATA→ILD, ACA→PAH/digital vasculopathy, RNAP III→rapid skin progression, renal crisis (URL: https://doi.org/10.3390/cimb45100490; Published Sep 2023) (maggio2023biomarkersinsystemic pages 2-4).
  • Vascular biomarker axes (2023): increased Ang-2 with decreased Ang-1; early VEGF elevation yet defective angiogenesis; SIGLEC1 upregulated with IFN activation (URL: https://doi.org/10.3390/cimb45100490; Published Sep 2023) (maggio2023biomarkersinsystemic pages 6-8).
  • B-cell activity and ILD (2023): spontaneous ATA IgG/IgA secretion higher in ILD and correlates with pulmonary fibrosis severity (URL: https://doi.org/10.1136/rmdopen-2023-003148; Published Jul 2023) (lepri2024systemicsclerosisone pages 1-2).

Evidence items (with PMIDs/URLs, publication dates; direct quotes where available)

  • “Defective angiogenesis … represents a hallmark of early-stage disease, usually preceding the onset of tissue fibrosis” (Biomedicines; Published Jun 2024; URL: https://doi.org/10.3390/biomedicines12061331) (romano2024recentinsightsinto pages 17-18).
  • “Systemic sclerosis … characterised by three main pathogenetic events represented by endothelial damage, inflammation with activation of the immune system … and finally fibrosis” (Clin Exp Rheumatol; Published Apr 2024; URL: https://doi.org/10.55563/clinexprheumatol/is29he) (lepri2024systemicsclerosisone pages 1-2).
  • “We report the largest Asian GWAS … comprising of 1428 cases and 112,599 controls … lead SNP is in the FCGR/FCRL region … meta-analysis … detects 30 additional significant loci … underscoring the roles of B cells and IRF8” (Nat Commun; Published Jan 2024; URL: https://doi.org/10.1038/s41467-023-44541-z) (lepri2024systemicsclerosisone pages 1-2).
  • “The ATA response … showed additional secretion of autoreactive IgA … The degree of spontaneous ATA-secretion was higher in patients with ILD … and correlated with the degree of pulmonary fibrosis” (RMD Open; Published Jul 2023; URL: https://doi.org/10.1136/rmdopen-2023-003148) (lepri2024systemicsclerosisone pages 1-2).
  • “The soluble levels of the three active TGF-β isoforms were lower in SSc patients than controls … In skin biopsies, TGF-β1, TGF-βR1, and TGF-βR2 expression levels were higher in SSc patients” (Clin Exp Med; Published May 2023; URL: https://doi.org/10.1007/s10238-022-00841-0) (jimenez2025areviewof pages 1-2).

Ontology-annotated knowledge base entry

  • Genes/proteins (HGNC) and pathways (GO): see embedded table for TGFB1, TGFBR1/2, SMAD2/3, CCN2, PDGF/PDGFR, EDN1, VEGFA, ANGPT1/2, CXCL4, IL6, CCL2, IRF8, FCGR locus, YAP1/WWTR1, WNT5A, SIGLEC1 with GO biological processes and GO-CC (romano2024recentinsightsinto pages 17-18, maggio2023biomarkersinsystemic pages 2-4, maggio2023biomarkersinsystemic pages 6-8, lepri2024systemicsclerosisone pages 1-2, jimenez2025areviewof pages 1-2).
  • Cell types (CL): endothelial cell (CL:0000115), fibroblast (CL:0000064), monocyte/macrophage (CL:0000235), B cell (CL:0000236), T cell (CL:0000084), endothelial progenitor cell (romano2024recentinsightsinto pages 17-18, maggio2023biomarkersinsystemic pages 6-8).
  • Anatomical locations (UBERON): skin (UBERON:0002097), lung (UBERON:0002048), heart (UBERON:0000948), kidney (UBERON:0002113), microvasculature (lepri2024systemicsclerosisone pages 1-2, romano2024recentinsightsinto pages 17-18).
  • Chemical entities (CHEBI): endothelin-1, VEGF-A, TGF-β1, PDGF, CXCL4 (maggio2023biomarkersinsystemic pages 6-8).
  • Phenotypes (HP; narrative associations): vascular (Raynaud’s, telangiectasias, digital ulcers), pulmonary (ILD, PAH), cardiac (arrhythmia, myocardial fibrosis), renal crisis; associations by autoantibody endotype (maggio2023biomarkersinsystemic pages 2-4, lepri2024systemicsclerosisone pages 1-2).

Notes on evidence strength and gaps

  • High-confidence nodes: vascular pathology (EndoMT/angiogenesis defects), IFN-I/B-cell autoimmunity, and TGF-β/SMAD-centered fibroblast activation are consistently supported by 2023–2024 sources (romano2024recentinsightsinto pages 17-18, lepri2024systemicsclerosisone pages 1-2, jimenez2025areviewof pages 1-2).
  • Genetics increasingly implicates B-cell/IRF8/FCGR biology; functional validation in primary tissues remains ongoing (lepri2024systemicsclerosisone pages 1-2).
  • Immunometabolism and metabolic fingerprints are promising but heterogeneous; targeted metabolomics and intervention studies are needed (maggio2023biomarkersinsystemic pages 6-8).

References

  1. (romano2024recentinsightsinto pages 17-18): Eloisa Romano, Irene Rosa, Bianca Saveria Fioretto, and Mirko Manetti. Recent insights into cellular and molecular mechanisms of defective angiogenesis in systemic sclerosis. Biomedicines, 12:1331, Jun 2024. URL: https://doi.org/10.3390/biomedicines12061331, doi:10.3390/biomedicines12061331. This article has 13 citations and is from a poor quality or predatory journal.

  2. (lepri2024systemicsclerosisone pages 1-2): Gemma Lepri, Marco Di Battista, Veronica Codullo, Francesco Bonomi, Antonello Sulis, Serena Guiducci, and Alessandra Della Rossa. Systemic sclerosis: one year in review 2024. Clinical and experimental rheumatology, Apr 2024. URL: https://doi.org/10.55563/clinexprheumatol/is29he, doi:10.55563/clinexprheumatol/is29he. This article has 25 citations and is from a peer-reviewed journal.

  3. (maggio2023biomarkersinsystemic pages 6-8): Giuseppe Di Maggio, Paola Confalonieri, Francesco Salton, Liliana Trotta, Luca Ruggero, Metka Kodric, Pietro Geri, Michael Hughes, Mattia Bellan, Michele Gilio, Selene Lerda, Elisa Baratella, Marco Confalonieri, Lucrezia Mondini, and Barbara Ruaro. Biomarkers in systemic sclerosis: an overview. Current Issues in Molecular Biology, 45:7775-7802, Sep 2023. URL: https://doi.org/10.3390/cimb45100490, doi:10.3390/cimb45100490. This article has 25 citations and is from a poor quality or predatory journal.

  4. (maggio2023biomarkersinsystemic pages 2-4): Giuseppe Di Maggio, Paola Confalonieri, Francesco Salton, Liliana Trotta, Luca Ruggero, Metka Kodric, Pietro Geri, Michael Hughes, Mattia Bellan, Michele Gilio, Selene Lerda, Elisa Baratella, Marco Confalonieri, Lucrezia Mondini, and Barbara Ruaro. Biomarkers in systemic sclerosis: an overview. Current Issues in Molecular Biology, 45:7775-7802, Sep 2023. URL: https://doi.org/10.3390/cimb45100490, doi:10.3390/cimb45100490. This article has 25 citations and is from a poor quality or predatory journal.

  5. (jimenez2025areviewof pages 1-2): Sergio A. Jimenez, Fabian A. Mendoza, and Sonsoles Piera-Velazquez. A review of recent studies on the pathogenesis of systemic sclerosis: focus on fibrosis pathways. Frontiers in Immunology, Apr 2025. URL: https://doi.org/10.3389/fimmu.2025.1551911, doi:10.3389/fimmu.2025.1551911. This article has 17 citations and is from a peer-reviewed journal.

  6. (jimenez2025areviewof pages 9-10): Sergio A. Jimenez, Fabian A. Mendoza, and Sonsoles Piera-Velazquez. A review of recent studies on the pathogenesis of systemic sclerosis: focus on fibrosis pathways. Frontiers in Immunology, Apr 2025. URL: https://doi.org/10.3389/fimmu.2025.1551911, doi:10.3389/fimmu.2025.1551911. This article has 17 citations and is from a peer-reviewed journal.

  7. (bazso2025theroleof pages 1-2): Anna Bazsó, Péter Szodoray, Yehuda Shoenfeld, and Emese Virág Kiss Med Dsci. The role of biomarkers in the the pathogenesis, clinical manifestations, and therapeutic outcome of systemic sclerosis. Journal of Mosaic of Autoimmunity, pages 5, Apr 2025. URL: https://doi.org/10.53941/jmai.2025.100005, doi:10.53941/jmai.2025.100005. This article has 0 citations.