Objective
We previously implicated the lipid mediator lysophosphatidic acid (LPA) in dermal fibrosis in systemic sclerosis (SSc). Here we identify the role of the LPA-producing enzyme autotaxin (ATX), and connect the ATX-LPA and IL-6 pathways in SSc.
Methods
We evaluated a novel ATX inhibitor, PAT-048, on fibrosis and IL-6 expression in the bleomycin (BLM) mouse model of dermal fibrosis. We utilized SSc patient and control dermal fibroblasts to evaluate LPA induction of IL-6, and IL-6 induction of ATX. We next evaluated whether LPA-induced ATX expression is dependent on IL-6, and whether baseline IL-6 expression in SSc fibroblasts is dependent on ATX. Finally, we compared ATX and IL-6 expression in SSc and healthy subject skin.
Results
PAT-048 markedly attenuated BLM-induced dermal fibrosis when initiated before or after fibrosis development. LPA stimulated human dermal fibroblast IL-6 expression, and IL-6 stimulated fibroblast ATX expression, connecting the ATX-LPA and IL-6 pathways in an amplification loop. IL-6 knockdown abrogated LPA-induced ATX expression in fibroblasts, and ATX inhibition attenuated IL-6 expression in fibroblasts and the skin of BLM-challenged mice. Both ATX and IL-6 expression were increased in SSc skin, and LPA-induced IL-6 levels and IL-6-induced ATX levels were increased in SSc fibroblasts compared to controls.
Conclusion
ATX is required for the development and maintenance of dermal fibrosis in the BLM model and enables two major mediators of SSc fibrogenesis, LPA and IL-6, to amplify each other’s production. Our results suggest that concurrent inhibition of these two pathways may be an effective therapeutic strategy for SSc fibrosis.