Toward personalized medicine in scleroderma: Classification of scleroderma patients into stable "inflammatory" and "fibrotic" subgroups

Abstract

There is no universally agreed-upon treatment for the fibrosis of scleroderma. Recently, much information has been generated relating to the fundamental mechanisms underlying this disease. Partly based on these observations, both anti-inflammatory and anti-fibrotic agents have been considered as possible therapies. However, this information has not been successfully translated into clinical practice. In this issue, Pendergrass et al. use genome-wide expression profiling to provide valuable insights into scleroderma. Previously, the authors showed that morphea and limited scleroderma patients and a small subset of diffuse scleroderma (dSSc) patients express an inflammatory profile, whereas the majority of dSSc patients express a fibroproliferative profile. In the current study, the investigators show that the gene expression profile of these patients is fixed over time; i.e., in contrast to a previously held belief, the inflammatory patients do not go on to become fibrotic, and vice versa. These data suggest that expression profiling might be used to design clinical trials for scleroderma. The inflammatory patients might be treated with anti-inflammatory agents, whereas fibroproliferative patients might be treated with antifibrotic agents. © 2012 The Society for Investigative Dermatology.