Introdução: A doença intersticial pulmonar (DIP) é uma forma de acometimento visceral grave pela esclerose sistêmica (ES), correspondendo na atualidade à principal causa de mortalidade pela doença. Atualmente, a tomografia computadorizada de alta resolução pulmonar (TCAR) é considerada o padrão-ouro no seu diagnóstico. Estudos recentes têm proposto diversos algoritmos clínicos para a predição diagnóstica e prognóstica da DIP-ES, objetivando ampliar sua detecção precoce e auxiliar na determinação de sua evolução e prognóstico. Objetivo: Testar os algoritmos clínicos propostos na literatura na predição diagnóstica e prognóstica na DIP-ES, estimar sua prevalência e avaliar a associação da extensão do acometimento pulmonar na TCAR com mortalidade em uma coorte de pacientes com ES. Métodos: Estudo de coorte prospectivo, incluindo 177 pacientes com ES recrutados no período de abril de 2000 a abril de 2009, avaliados através de entrevista, exame físico, exames laboratoriais, provas de função pulmonar e TCAR. Algoritmos clínicos (A, B e C), combinando dados da ausculta pulmonar, radiografia de tórax e capacidade vital forçada (CVF), foram aplicados para o diagnóstico de diferentes extensões da pneumopatia intersticial na TCAR. Curvas de Kaplan-Meier e Regressão de Cox uni e multivariada foram utilizadas para analisar a associação dos algoritmos e da extensão de DIP na TCAR com a mortalidade. Resultados: A prevalência estimada de DIP na TCAR do baseline foi de 57,1% e 79 pacientes (44,6%) morreram em uma mediana de 11,1 anos de seguimento. Para identificação de DIP com extensão ≥10 e ≥20% na TCAR, todos os algoritmos apresentaram uma alta sensibilidade (>89%) e um likelihoodratio negativo muito baixo (<0,16). Para fins prognósticos, sobrevida foi reduzida para todos os algoritmos, com destaque para o algoritmo C, o qual identifica DIP considerando a presença de crepitantes na ausculta pulmonar, alterações na radiografia de tórax ou CVF <80% (HR 3,47; IC 95% 1,62-7,42). Pacientes com doença extensa como proposto por Goh e Wells (extensão >20% na TCAR ou, em casos indeterminados, CVF <70%) apresentam uma significativa redução na sobrevida (HR 3,42; IC 95% 2,12-5,52). Sobrevida não foi diferente entre pacientes com extensão ≥10 ou ≥20% na TCAR e análise de mortalidade em 10 anos sugere que extensão >10% na TCAR apresenta uma boa capacidade preditiva para mortalidade, embora não haja um ponto de corte claro a partir do qual ocorra um maior incremento na mortalidade. Conclusão: Algoritmos clínicos apresentam uma alta sensibilidade e um likelihood ratio negativo muito baixo para o diagnóstico de extensões de DIP com relevância clínica e prognóstica (≥10 e ≥20%) e foram fortemente associados com mortalidade. Assim sendo, a utilização desses algoritmos pode evitar a necessidade de realização de TCAR em alguns casos. / Introduction: Interstitial lung disease (ILD) is a form of severe visceral involvement by systemic sclerosis (SSc) and currently is the primary cause of death by disease. Thoracic high-resolution computed tomography (HRCT) is considered the gold standard for diagnosis. Recent studies have proposed several clinical algorithms to predict the diagnosis of SSc-ILD, aiming to expand its early detection and estimate prognosis. Objective: To test the clinical algorithms to predict the presence and prognosis of SSc-ILD, to estimate the prevalence of SSc-ILD, and to evaluate the association of extent of ILD with mortality in a cohort of SSc patients. Methods: Prospective cohort study, including 177 SSc patients assessed by clinical evaluation, laboratory tests, pulmonary function tests, and HRCT. Clinical algorithms, combining lung auscultation, chest radiography and % predicted forced vital capacity (FVC), were applied for the diagnosis of different extents of ILD on HRCT. Univariate and multivariate Cox proportional models were used to analyze the association of algorithms and the extent of ILD on HRCT with the risk of death using hazard ratios (HR). Results: The prevalence of ILD was 57.1% on baseline HRCT and 79 patients died (44.6%) in a median follow-up of 11.1 years. For identification of ILD with extent ≥10 and ≥20% on HRCT, all algorithms presented a high sensitivity (>89%) and a very low negative likelihood ratio (<0.16). For prognosis, survival was decreased for all algorithms, especially the algorithm C (HR 3.47, 95% CI 1.62-7.42), which identified the presence of ILD based on crackles on lung auscultation, findings on chest X-ray or FVC <80%. Extensive disease as proposed by Goh and Wells (extent of ILD >20% on HRCT or, in indeterminate cases, FVC <70%) had a significantly higher risk of death (HR 3.42, 95% CI 2.12 to 5.52). Survival was not different between patients with extent of 10 or 20% of ILD on HRCT, and analysis of 10-year mortality suggested that a threshold of 10% may also have a good predictive value for mortality. However, there is no clear cutoff above which mortality is sharply increased. Conclusion: Clinical algorithms had a good diagnostic performance for extent of SSc-ILD on HRCT with clinical and prognostic relevance (≥10 and ≥20%), and were also strongly related to mortality. Therefore, they probably could be used to obviate the requirement of HRCT in some cases.

Orientador: Manoel Barros Bertolo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T17:57:00Z (GMT). No. of bitstreams: 1 DelRio_AnaPaulaToledo_M.pdf: 1151549 bytes, checksum: 2407595c8d19b5531c6d084bba4d3238 (MD5) Previous issue date: 2012 / Resumo: Introdução: A esclerose sistêmica (ES) é uma doença autoimune caracterizada por disfunção endotelial, vasculopatia obliterativa, fibrose cutânea e visceral. Trata-se de doença poligênica complexa que se manifesta em indivíduos geneticamente predispostos com exposição a fator ambiental ou outro precipitante e seu desenvolvimento depende da interação entre processos imunológicos, vasculares e fibróticos. Estudos genéticos prévios procuram correlacionar os alelos HLA classe I e II e as manifestações clínicas da doença. A fibrose pulmonar (FP) e a hipertensão arterial pulmonar (HAP) são, atualmente, os acometimentos com maior impacto prognóstico e as principais causas de óbito nos pacientes com ES. A expressão do autoanticorpo antitopoisomerase I (anti-Scl70) é um forte preditor de FP, associada à forma difusa e a HAP está relacionada ao anticorpo anticentrômero e à forma limitada da doença. Objetivos: O objetivo deste estudo foi avaliar a participação do HLA na expressão da doença e suas manifestações clínicas de pior prognóstico (FP e HAP) em pacientes com ES em uma população miscigenada. Métodos: Foram incluídos os pacientes com ES seguidos no ambulatório de Reumatologia da Universidade Estadual de Campinas (UNICAMP) de 2008 a 2011. Os dados clínicos foram obtidos através da análise dos prontuários. A genotipagem dos alelos Classe I e II foi realizada através da técnica de amplificação pela reação em cadeia da polimerase, utilizando seqüências específicas de primers. A análise estatística incluiu o teste exato de Fisher e o teste do qui-quadrado de Pearson. Foram considerados significativos valores de p ? 0,05. A razão de prevalência foi estimada pelo método delta. Resultados Cento e quarenta e um pacientes (120 mulheres e 21 homens) foram estudados, sendo 33,3% ES difusa, 62,4% ES limitada e 4,3% ES sine scleroderma. A FP foi considerada em 61 pacientes (43,3%), os alelos HLA-A*30 e DQB1*04 foram relacionados à suscetibilidade. No entanto, os alelos HLA-DRB1*01 e DQB1*05 foram relacionados à ausência desta manifestação. A HAP foi diagnosticada em 19 pacientes (13,5%) e teve associação com HLA-B*35 e C*04, enquanto o alelo C*03 pareceu ser protetor. Conclusões: Este estudo aponta para associação de alguns alelos do HLA classe I e II às manifestações clínicas de maior morbimortalidade na ES nesta série de casos. Estes achados não foram semelhantes aos encontrados previamente em outras populações, o que evidencia múltiplos padrões genéticos na ES / Abstract: Introduction: Systemic sclerosis (SSc) is an autoimmune disease characterized by endothelial dysfunction, occlusive vasculopathy, cutaneous and visceral fibrosis. This is a complex polygenic disease that manifests in genetically predisposed individuals with environmental or other precipitating factor exposure and its development depends on the interaction between immunological, vascular and fibrotic processes. Previous genetic studies aimed to correlate class I and II HLA and the clinical manifestations of the disease. Pulmonary fibrosis (PF) and pulmonary arterial hypertension (PAH) are currently the worse prognostic features and the main causes of death in patients with SSc. The presence of anti-topoisomerase I antibody (anti-Scl70) is a strong predictor of FP, associated with diffuse SSc and PAH is related to anticentromere and the limited form of the disease. Objectives: The aim of this study was to evaluate the HLA involvement in disease expression and poor prognostic clinical features, pulmonary fibrosis (PF) and pulmonary arterial hypertension (PAH), in patients diagnosed with systemic sclerosis (SSc) in a multiethnic population. Methods: SSc patients followed 2008-2011 were included and clinical data were obtained through records review. Molecular HLA typing was performed (PCR amplification technique using sequence of specific primers). Statistical analysis included Fisher's exact test and Pearson's corrected chi-square test. P values ? 0.05 were considered significant. The prevalence ratio was estimated by delta method. Results: One hundred forty-one patients (120 women and 21 men) were studied, 33,3% dcSSc, 62,4% lcSSc and 4,3% sine scleroderma. PF was present in 61 patients (43,3%), HLA-A*30 and DQB1*04 were related to susceptibility. However, HLA-DRB1*01 and DQB1*05 alleles were protective. PAH was diagnosed in 19 (13,5%) and had association with HLA-B*35 and C*04, whereas C*03 seemed to be protective. Conclusions: Our current study documents the association of some class I and II HLA alleles with the most severe clinical manifestations in a multiethnic case series. Our findings were not absolutely similar to the previous data in other populations / Mestrado / Clinica Medica / Mestra em Clínica Médica

Title: The effect of aerobic training in patients with systemic sclerosis - literature review Objective: Main aim of this diploma thesis is to evaluate the effect of aerobic training in individuals with systemic sclerosis, to assess whether aerobic training has an impact on quality of life of these patients, and find out which methods are used to assess aerobic fitness in these individuals. Furthermore, the work is focused on summarizing the existing knowledge about the disease itself. Methodics: Thesis is written in the form of a systematic review according to the specified methodological parameters. Results: Studies have shown that aerobic training or aerobic training in combination with resistant training has a positive effect on the aerobic capacity of individuals with systemic scleroderma, the trend to improve quality of life was found in all studies and the methods used to determine aerobic fitness in all studies were cardiopulmonary stress tests. In the case of three studies, a six-minute walk test was also evaluated, the results of which were determined in two studies as the primary values for determining the effectiveness of training. Keywords: systemic sclerosis, scleroderma, physical exercise, aerobic exercise, aerobic training

Hintergrund: Systemische Sklerose (SSc) ist eine seltene, progressive Bindegewebserkrankung mit derzeitig begrenztem Wissen über die Zusammenhänge zwischen klinischen Anzeichen, körperlichen Einschränkungen, Lebensqualität und depressiven Symptomen. Während die Prävalenz von Depressionen in der deutschen Allgemeinbevölkerung bei 8,5% (Stein et al., 2014) und in der polnischen Allgemeinbevölkerung bei 4,8% liegt (Hapke et al., 2019), schwankt sie bei Patienten mit SSc zwischen 23% und 46% (Matsuura et al., 2003; Müller et al., 2012, „Corrigenda“, 2022; Jewett et al., 2013; Kwakkenbos et al., 2013; Nguyen et al., 2014; Faezi et al., 2017; March et al., 2019). Dies legt nahe, dass eine Definition der Determinanten von Depression und Lebensqualität erforderlich ist. Hypothese: Das Ziel der Studie bestand darin, soziodemographische, klinische, psychologische und therapeutischen Parameter sowie die gesundheitsbezogene Lebensqualität, subjektiver Gesundheitszustand, Depressionsneigung, körperliche Einschränkungen, Schmerzen, Krankheitssymptome und -merkmale, subjektive und objektive Krankheitsaktivität von Patienten mit SSc mittels einer quantitativen Analyse zu erfassen und Abhängigkeiten untereinander darzulegen. Des Weiteren sollte geprüft werden, ob bei den untersuchten Patienten mit SSc eine höhere Prävalenz für Depressionsneigung, ein häufigeres Vorliegen von körperlichen Einschränkungen, verminderte gesundheitsbezogene Lebensqualität und verminderter subjektiver Gesundheitszustand im Vergleich zur allgemeinen Bevölkerung vorliegt und welche Einflussfaktoren diese beeinträchtigen. Die sich hieraus ergebenden Erkenntnisse könnten die zukünftige Behandlung von Patienten mit systemischer Sklerose wesentlich beeinflussen. Methoden: Es wurde eine Querschnittsanalyse von 79 Patienten in Dresden und 10 Patienten in Breslau zwischen 2016 und 2018 durchgeführt, sodass länderspezifische Charakteristika identifiziert und verglichen werden konnten. Darüber hinaus wurde eine Längsschnittanalyse von 33 Patienten aus Dresden mit Daten aus dem Jahr 2008 und aus 2018 ausgewertet, um den Verlauf der Parameter zu beurteilen. Mittels eines Patientenfragebogens wurden unter anderem soziodemographische Daten, Schmerzangaben, sowie subjektive Krankheitsschwere (PGA), körperliche Einschränkung durch die Erkrankung (HAQ), gesundheitsbezogene Lebensqualität (EQ-5D-3L), subjektiver Gesundheitszustand (EQ-5D-VAS) und Depressionsneigung (CES-D) erfasst. Mittels Arztfragebogen wurden unter anderem die Diagnoseform, Dauer der Erkrankung, Organbeteiligung, Symptome, Therapie und mittels EUSTAR-Score die Krankheitsaktivität erfasst. Die Datenanalyse erfolgte deskriptiv und explorativ. Kreuztabellen, Chi-Quadrat-Test und T-Test wurden für Berechnungen verwendet, die Pearson-Korrelation zur Messung von Abhängigkeiten und logistische Regressionsanalysen für kategorisierte Parameter. Ergebnisse: Da die limitierte kutane systemische Sklerose die häufigste Diagnose darstelle, waren vor allem muskulokutane Symptome führend. Bei den Breslauer Patienten zeigten sich zudem häufiger Lungen- und Ösophagusbeteiligungen, eine höhere Krankheitsaktivität sowie höhere subjektive Krankheitsschwere. Die Dresdner Patienten gaben hingegen stärkere Schmerzen an. Die körperlichen Einschränkungen durch die Erkrankung, gesundheitsbezogene Lebensqualität und subjektiver Gesundheitszustand waren bei den Breslauer Patienten ausgeprägter und die Depressionsneigung im Vergleich zu den Dresdner Patienten erhöht. Beide Kohorten zeigten im Vergleich zur durchschnittlichen Bevölkerung höhere Raten an Patienten mit Depressionsneigung, eine niedrigere gesundheitsbezogene Lebensqualität und einen schlechteren subjektiven Gesundheitszustand. Es konnten jeweils hochsignifikante Zusammenhänge zwischen gesundheitsbezogener Lebensqualität, subjektivem Gesundheitszustand, körperlichen Einschränkungen, Depressionsneigung und Schmerzen gezeigt werden. Bei den Dresdner SSc-Patienten konnten weitere signifikante Korrelation der körperlichen Einschränkung mit dem Vorliegen einer ausgeprägten Sklerodermie (mRSS>14) und eines schlechten subjektiven Gesundheitszustandes mit der Beteiligung des Kauorgans gezeigt werden. Es fanden sich weiterhin signifikante Korrelationen von Depressionsneigung bei den SSc-Patienten in Dresden mit pulmonaler Hypertonie, Dyspnoe sowie Muskelschwäche. Letzteres war auch bei den Breslauer SSc-Patienten feststellbar ebenso wie weitere signifikante Korrelationen zwischen der Depressionsneigung und Kontrakturen, Pits sowie erhöhter Erkrankungsaktivität (EUSTAR>3). In der Längsschnittstudie der 33 Dresdner SSc-Patienten zeigte sich eine signifikante Zunahme der Krankheitsaktivität, der Schmerzangabe, der körperlichen Einschränkung durch die Erkrankung sowie der Patientenzahl mit Depressionsneigung, wobei eine in 2008 festgestellte Depressionsneigung mit einer BMI-Zunahme über den Krankheitsverlauf einherging. Es wurde eine Zunahme der subjektiven Krankheitsschwere sowie eine Abnahme der gesundheitsbezogenen Lebensqualität und des subjektiven Gesundheitszustandes beobachtet. Schlussfolgerungen: Diese Studie zeigt, dass fast die Hälfte der SSc-Patienten unter Depressionsneigung litt, was etwa fünfmal mehr ist als der durchschnittliche Wert in der deutschen Allgemeinbevölkerung. Im Verlauf der Erkrankung nahmen die Depressionsneigung, Schmerzen und körperliche Einschränkungen zu. Die gesundheitsbezogene Lebensqualität und der Gesundheitszustand nahmen ab, was darauf hindeutet, dass eine frühzeitige Erkennung der Krankheit und eine präventive interdisziplinäre Behandlung der körperlichen und psychischen Symptome erforderlich sind.:1. Abbildungsverzeichnis IV-V 2. Tabellenverzeichnis VI 3. Abkürzungsverzeichnis VII-VIII 4. Einleitung 1-11 4.1 Medizinische Kenntnisse zur Systemischen Sklerose 1-9 4.1.1 Manifestation, Prävalenz, Inzidenz 1 4.1.2 Klassifikation und Symptomatik 2-4 4.1.3 Pathogenese 4-6 4.1.4 Diagnostik 6-7 4.1.5 Therapie 8-9 4.2 Systemische Sklerose und Depression 10-11 4.3 Ziele der Studie 11 5. Methoden 12-18 5.1 Allgemeine Voraussetzungen und Zustimmung der Ethikkommission 12 5.2 Studiendesign 12 5.3 Einschluss der Patienten 12-13 5.4 vorbestehende Daten 13 5.5 Daten weiterer Studienzentren 13 5.6 Methoden zur Datenerhebung 13-16 5.6.1 Patientenfragebogen 13-15 5.6.2 Arztfragebogen 16 5.7 Statistische Analyse 17-18 6.Ergebnisse 19-40 6.1 Allgemein 20 6.2 Längsschnittstudie Dresden 20-27 6.2.1 Soziodemographische Daten 20 6.2.2 Charakteristika der Erkrankung, Diagnostik und Therapie 20-22 6.2.3 Schmerzen und deren Verlauf 22-23 6.2.4 Subjektive Krankheitsschwere und deren Verlauf 23 6.2.5 Körperlichen Einschränkung und deren Verlauf 24 6.2.6 Gesundheitsbezogene Lebensqualität und deren Verlauf 24-25 6.2.7 Subjektiver Gesundheitszustand und dessen Verlauf 25 6.2.8 Depressive Symptome, BMI und deren Verlauf 25-27 6.3 Querschnittstudie Dresden 28-37 6.3.1 Soziodemographische Daten 28 6.3.2 Charakteristika der Erkrankung, Diagnostik und Therapie 28-29 6.3.3 Schmerzen 29-31 6.3.4 Subjektiven Krankheitsschwere 32 6.3.5 Körperlichen Einschränkung und deren Einflussfaktoren 32 6.3.6 Gesundheitsbezogene Lebensqualität und deren Einflussfaktoren 32-34 6.3.7 Subjektiver Gesundheitszustand und dessen Einflussfaktoren 34-35 6.3.8 Depressive Symptome und deren Einflussfaktoren 36-37 6.4 Querschnittstudie Breslau 38-40 6.4.1 Soziodemographische Daten 37-38 6.4.2 Charakteristika der Erkrankung, Diagnostik und Therapie 38 6.4.3 Schmerzen 38 6.4.4 Subjektive Krankheitsschwere 39 6.4.5 Körperlichen Einschränkung und deren Einflussfaktoren 39 6.4.6 Gesundheitsbezogene Lebensqualität und deren Einflussfaktoren 39 6.4.7 Subjektiver Gesundheitszustand und dessen Einflussfaktoren 39 6.4.8 Depressive Symptome und deren Einflussfaktoren 40 7.Diskussion 41-54 7.1 Allgemein 40 7.2 Längsschnittstudie Dresden 41-44 7.3 Querschnittstudie Dresden und Breslau 44-51 7.4 Stärken und Grenzen der Studie 52-53 7.5 Auswirkungen auf die klinische Praxis und die zukünftige Forschung 53 7.6 Weiterführende Überlegungen 53-54 8. Zusammenfassung 55-59 9. Literaturverzeichnis 60-70 10. Anhang 71-116 10.1 Abbildungen 70-83 10.2. Tabellen 84-116 11. Anlagen 117-122 11.1 Darstellung des Eigenanteils 117 11.2 Erklärung zur Eröffnung des Promotionsverfahrens 118-119 11.3 Erklärung über die Einhaltung der aktuellen gesetzlichen Vorgaben im Rahmen einer Dissertation 120 11.4 Curriculum vitae 121 11.5 Verzeichnis der wissenschaftlichen Veröffentlichungen 122 12. Danksagung 123

Recentemente, descobrimos que coelhos, Nova Zelândia, imunizados com colágeno tipo V humano mais adjuvante de Freund apresentavam fibrose e vasculite de órgãos normalmente afetados na esclerose sistêmica. Deste modo, nós estudamos o processo de fibrilogênese para identificar possíveis fatores envolvidos na alteração do remodelamento observado neste modelo de esclerodermia. Adicionalmente, fizemos uma comparação preliminar com pele humana obtida de pacientes com esclerodermia (n=3). Coelhos fêmeas, Nova Zelândia (n=14), foram imunizados subcutaneamente com duas doses de 1mg de colágeno V mais adjuvante completo de Freund, com intervalo de 30 dias, seguido de duas imunizações em adjuvante incompleto de Freund, via intramuscular, com intervalo de 15 dias. Os animais do grupo controle (n- 14) foram inoculados somente com adjuvante completo e incompleto de Freund, nas mesmas condições dos imunizados. Foram realizadas análises histológicas das peles dos animais e pacientes através da coloração com tricrômico de Masson e imunofluorescêcia, a fim de detectar fibras de colágeno e interação dos colágenos I, III e V. A análise da pele dos animais demonstrou depósito precoce de fibras de colágeno na derme após 7 dias da sensibilização, com aumento destes depósitos após 75 e 120 dias respectivamente. Depósito de colágeno na pele e atrofia de anexos foram mais intensos nos animais sacrificados em 120 dias e se correlacionaram com a quantidade aumentada de colágeno. Surpreendentemente, o colágeno V foi expresso em animais e pacientes, formando fibras densas e atípicas na derme. Sugerimos que esta expressão anômala de colágeno V, morfologicamente diferente, possa justificar o remodelamento observado na placa esclerodérmica / Recently, we discovered that New Zealand rabbits immunized with human type V collagen plus Freund`s adjuvant presented fibrosis and vasculitis of organs usually affected in systemic sclerosis. In this way, we studied the fibrillogenesis process regarding to identify any possible factor involved in altered remodeling observed in this scleroderma-like model. Additionally, we done a very preliminary comparison with human skins obtained from scleroderma patients (N=3). Female New Zealand rabbits (N=14) were immunized subcutaneously with two doses of 1mg collagen V plus complete Freunds adjuvant at a 30 days interval, followed by two additional intramuscular booster immunizations in incomplete Freunds adjuvant at a 15-day interval. Animals from control group (N=14), were only inoculated with complete and incomplete Freunds adjuvant given at same conditions of collagen type V group. Histological analysis of skins from animals and patients were done by Massons trichrome staining, and immunofluorescence method used to detect collagen fibers and interactions of types I, III and V collagen in the remodeling process. The analysis of animal skins showed precocious collagen fibril deposits in the dermis after 7 days of immunization and increase of this process in 75 and 120 days. Skin collagen deposit and atrophy of annexes were progressively more intense in late sacrificed animals and correlated with increased amount of collagen deposition. Surprisingly, type V collagen was over expressed both in animals and patients, forming dense and atypical collagen fibers in the dermis. We suggest that this anomalous expression of morphologically different type V collagen could justify the remodeling observed in scleroderma plaque

Introdução: Recentemente muitas são as funções atribuídas ao colágeno V em condições fisiológicas normais e em algumas doenças, como na esclerodermia. Esta proteína apresenta características estruturais singulares de regulação do diâmetro das fibrilas heterotípicas, e imunogenicidade, sendo capaz de desencadear uma resposta imune independente. Em descobertas recentes, desenvolvidas por nosso grupo, ficou evidenciado que o colágeno V apresenta histoarquitetura anômala, aumentando a sua imunoexpressão na pele e pulmão em estágios iniciais da doença, assim como, aumento do RNAm de suas cadeias, principalmente alfa2(V). Por esta razão e com o intuito de entender sobre os processos moleculares e ultraestruturais que correlacionam o COL V à fibrose na ES, a proposta do presente estudo foi realizar análise morfológica e ultraestrutural das cadeias, alfa1(V) e alfa2(V), da pele de pacientes com ES, assim como avaliar a influência do gene COL5A2 na fibrilogênese. Pacientes e Métodos: As análises foram desenvolvidas utilizando fragmento de pele obtidas de biópsia, tanto de pacientes como controles, sob aprovação do comitê de ética (CAPPesq 0331/10) e de acordo com Declaração de Helsinque. Participaram do estudo 7 pacientes (homens=3, mulheres=4) diagnosticados com ES há dois anos ou menos, e indivíduos voluntários saudáveis (n=7) utilizados como grupo controle. A biópsia das peles foi dividida para dois grupos de análises: estudos histológicos e cultura de fibroblastos; sob solução de formol a 10%, foram realizadas análises histomorfométricas [coloração de Hematoxilina e Eosina (H e E), Tricrômico de Masson, imunofluorescência (IM) para cadeias alfa1(V) e alfa2(V), e reconstrução tridimensional (Zeiss LSM 510 META/UV)], e em solução de glutaraldeído 2% para análise ultraestrutural (microscopia eletrônica de transmissão com imunomarcação com ouro coloidal). A quantificação das cadeias foi realizada por histomorfometria, através de análise de imagem utilizando o software Image Pro-Plus 6.0. Já a cultura de fibroblastos foi desenvolvida para avaliar: distribuição e perfil das cadeias alfa1(V) e alfa2(V) [reconstrução 3D (Zeiss LSM 510 META/UV)],expressão gênica COL5A1, COL5A2 e ITGA2 [qRT-PCR (Applied Biosystems)], e inibição temporária do gene COL5A2. Resultados: Na análise morfológica (H&E e Masson) observou-se modificação da histoarquitetura da pele dos pacientes, com espessamento e retificação da epiderme devido ao aumento na densidade das fibras colágenas, com projeções das papilas dérmicas em direção à derme papilar. Esse resultado foi confirmado na quantificação das cadeias (IM), evidenciado por perda acentuada da cadeia alfa1(V) na derme papilar [12,77 ± 1,344 vs 66,84± 3,36 (p < 0,0001)] e aumento significante da expressão da cadeias alfa1(V) e alfa2(V) na derme reticular alfa1(V) [7,657 ± 0,2133 vs 13,75 ± 0,958 ( p < 0,0001)] e alfa2(V) [5,072 ± 0,4117 vs 21,07 ± 0,790 (p=0,001)] dos pacientes quando comparados ao controle. Assim como visto na imunomarcação com ouro coloidal das cadeias do COLV, houve ausência de expressão linear da cadeia alfa1(V) na derme papilar, contrastando com a expressão da mesma na pele de controles, se contrapondo a forte imunoexpressão das cadeias alfa1(V) e alfa2(V) com uma maior evidência da cadeia alfa2(V) na região espessada pela junção lâmina basal e derme reticular. A reconstrução 3D em cultura de fibroblastos dérmicos demonstrou grande atividade das células de pacientes com ES, confirmado na expressão gênica dos COL5A1, COL5A2 e ITGA2, que se mostraram aumentados significantemente nos pacientes em relação ao controle. Por fim, após inibição do COL5A2 houve uma tendência ao aumento na expressão do COL5A1, e superexpressão da ITGA2. Conclusão: A alteração dérmica observada em pacientes com ES esta correlacionada com a modificação na distribuição das cadeias alfas do COLV, principalmente por perda acentuada da alfa1(V)3 homotrímera na derme papilar e superexpressão da alfa2(V) em capilares e vasos, interferindo na formação de matriz extracelular normal, sugerindo uma alteração pós traducional desta proteína, e que maiores estudos sobre a inibição da cadeia alfa2(V) são importantes para uma futura terapia gênica para atenuar os sintomas desencadeados nesta patologia / Introduction: Recently many functions are attributed to type V collagen in normal physiological conditions and in some diseases, such as scleroderma. This protein presents unique structural features for regulating the diameter of fibrils heterotypic and immunogenicity being capable of eliciting an immune response independent. In recent discoveries, developed by our group, it was evident that collagen V presents anomalous histoarchitecture, increasing the immunoexpression in the skin and lung in the early stages of the disease, as well as increased mRNA of his chains, mainly alpha2(V). For this reason and in order to understand the molecular and ultrastructural processes that correlate COL V fibrosis in SSc, the purpose of this study was to perform morphological and ultrastructural analysis of the chains alpha1(V) and alpha2(V) of the patient´s skin with ES, as well as to assess the influence of the COL5A2 gene in fibrillogenesis. Patients and Methods: The analyses were developed using skin fragment obtained from biopsy, both of patients and controls, under the approval of the ethics committee (CAPPesq 0331/10) and in accordance with the Declaration of Helsinki. The study included 7 patients (male = 3, female = 4) diagnosed with ES for two years or less, and healthy volunteers (n = 7) used as a control group. The biopsy of the skin was divided in two groups of analyzes: histological studies and cultured fibroblasts; Under formaldehyde solution 10%, histomorphometric analysis [staining with hematoxylin and eosin (H e E), Masson\'s trichrome, immunofluorescence (IM) to alpha1(V) and alpha2(V) chains, and three-dimensional reconstruction (Zeiss LSM 510 META were performed/UV), and in a solution of 2% glutaraldehyde for ultrastructural analysis (transmission electron microscopy with immunostaining with colloidal gold). Quantitation was performed by the chain histomorphometry by image analysis using Image Pro-Plus 6.0 software. Already a fibroblast culture was developed to assess: distribution and profile of the alpha1(V) and alpha2(V) chains, 3D reconstruction (Zeiss LSM 510 META / UV), gene expression of COL5A1, COL5A2 and ITGA2 [RT-qPCR (Applied Biosystems)], and temporary inhibition of the COL5A2 gene. Results: In the morphological analysis (H&E and Masson) was observed modification of histoarchitecture patient\'s skin, with thickening and rectification of the epidermis due to increased density of collagen fibers, with projections of dermal papillae toward the papillary dermis. This result was confirmed by quantification of the chains (IM), evidenced by marked loss of the alpha1(V) chain in the papillary dermis [12.77 ± 1.344 vs 66.84 ± 3.36 (p < 0.0001)] and significant increase in the expression of alpha1(V) and alpha2(V) chains, in the reticular dermis alpha1(V) chain [0.2133 ± 7.657 vs 0.958 ± 13.75 (p < 0.0001)] alfa2(V) chain [5.072 ± 0.4117 vs 21.07 ± 0.790 (p = 0.001)] of patients when compared to control. As seen in the immunostaining with colloidal gold chains of COLV, there was no linear expression of the alpha1(V) chain in the papillary dermis, contrasting with the same expression on the skin of controls, in contrast to strong immunoexpression of alpha1(V) and alpha2(V) chains, with a higher evidence of alpha2(V) chain in the junction region by a thickened basement membrane and reticular dermis. The 3D reconstruction of dermal fibroblasts in culture demonstrated large cell activity of patients with SSc, confirmed the gene expression of COL5A1, COL5A2 and ITGA2, which showed significantly increased in patients compared to control. Finally, after inhibition of COL5A2 there was a trend to increase in the expression of the COL5A1, and overexpression of ITGA2. Conclusion: The dermal alteration observed in SSc patients is correlated with the change in the distribution of the collagen alpha (V) chains, mainly by marked loss of alpha1(V)3 homotrimer the papillary dermis and overexpression of the alpha2(V) in capillaries and vessels, interfering with the normal extracellular matrix formation, suggesting a post-translational modification of this protein, and further studies on the inhibition of chain alpha2(V) are important for future gene therapy to attenuate the symptoms of this pathology triggered

Recentemente, descobrimos que coelhos, Nova Zelândia, imunizados com colágeno tipo V humano mais adjuvante de Freund apresentavam fibrose e vasculite de órgãos normalmente afetados na esclerose sistêmica. Deste modo, nós estudamos o processo de fibrilogênese para identificar possíveis fatores envolvidos na alteração do remodelamento observado neste modelo de esclerodermia. Adicionalmente, fizemos uma comparação preliminar com pele humana obtida de pacientes com esclerodermia (n=3). Coelhos fêmeas, Nova Zelândia (n=14), foram imunizados subcutaneamente com duas doses de 1mg de colágeno V mais adjuvante completo de Freund, com intervalo de 30 dias, seguido de duas imunizações em adjuvante incompleto de Freund, via intramuscular, com intervalo de 15 dias. Os animais do grupo controle (n- 14) foram inoculados somente com adjuvante completo e incompleto de Freund, nas mesmas condições dos imunizados. Foram realizadas análises histológicas das peles dos animais e pacientes através da coloração com tricrômico de Masson e imunofluorescêcia, a fim de detectar fibras de colágeno e interação dos colágenos I, III e V. A análise da pele dos animais demonstrou depósito precoce de fibras de colágeno na derme após 7 dias da sensibilização, com aumento destes depósitos após 75 e 120 dias respectivamente. Depósito de colágeno na pele e atrofia de anexos foram mais intensos nos animais sacrificados em 120 dias e se correlacionaram com a quantidade aumentada de colágeno. Surpreendentemente, o colágeno V foi expresso em animais e pacientes, formando fibras densas e atípicas na derme. Sugerimos que esta expressão anômala de colágeno V, morfologicamente diferente, possa justificar o remodelamento observado na placa esclerodérmica / Recently, we discovered that New Zealand rabbits immunized with human type V collagen plus Freund`s adjuvant presented fibrosis and vasculitis of organs usually affected in systemic sclerosis. In this way, we studied the fibrillogenesis process regarding to identify any possible factor involved in altered remodeling observed in this scleroderma-like model. Additionally, we done a very preliminary comparison with human skins obtained from scleroderma patients (N=3). Female New Zealand rabbits (N=14) were immunized subcutaneously with two doses of 1mg collagen V plus complete Freunds adjuvant at a 30 days interval, followed by two additional intramuscular booster immunizations in incomplete Freunds adjuvant at a 15-day interval. Animals from control group (N=14), were only inoculated with complete and incomplete Freunds adjuvant given at same conditions of collagen type V group. Histological analysis of skins from animals and patients were done by Massons trichrome staining, and immunofluorescence method used to detect collagen fibers and interactions of types I, III and V collagen in the remodeling process. The analysis of animal skins showed precocious collagen fibril deposits in the dermis after 7 days of immunization and increase of this process in 75 and 120 days. Skin collagen deposit and atrophy of annexes were progressively more intense in late sacrificed animals and correlated with increased amount of collagen deposition. Surprisingly, type V collagen was over expressed both in animals and patients, forming dense and atypical collagen fibers in the dermis. We suggest that this anomalous expression of morphologically different type V collagen could justify the remodeling observed in scleroderma plaque

Introdução: Recentemente muitas são as funções atribuídas ao colágeno V em condições fisiológicas normais e em algumas doenças, como na esclerodermia. Esta proteína apresenta características estruturais singulares de regulação do diâmetro das fibrilas heterotípicas, e imunogenicidade, sendo capaz de desencadear uma resposta imune independente. Em descobertas recentes, desenvolvidas por nosso grupo, ficou evidenciado que o colágeno V apresenta histoarquitetura anômala, aumentando a sua imunoexpressão na pele e pulmão em estágios iniciais da doença, assim como, aumento do RNAm de suas cadeias, principalmente alfa2(V). Por esta razão e com o intuito de entender sobre os processos moleculares e ultraestruturais que correlacionam o COL V à fibrose na ES, a proposta do presente estudo foi realizar análise morfológica e ultraestrutural das cadeias, alfa1(V) e alfa2(V), da pele de pacientes com ES, assim como avaliar a influência do gene COL5A2 na fibrilogênese. Pacientes e Métodos: As análises foram desenvolvidas utilizando fragmento de pele obtidas de biópsia, tanto de pacientes como controles, sob aprovação do comitê de ética (CAPPesq 0331/10) e de acordo com Declaração de Helsinque. Participaram do estudo 7 pacientes (homens=3, mulheres=4) diagnosticados com ES há dois anos ou menos, e indivíduos voluntários saudáveis (n=7) utilizados como grupo controle. A biópsia das peles foi dividida para dois grupos de análises: estudos histológicos e cultura de fibroblastos; sob solução de formol a 10%, foram realizadas análises histomorfométricas [coloração de Hematoxilina e Eosina (H e E), Tricrômico de Masson, imunofluorescência (IM) para cadeias alfa1(V) e alfa2(V), e reconstrução tridimensional (Zeiss LSM 510 META/UV)], e em solução de glutaraldeído 2% para análise ultraestrutural (microscopia eletrônica de transmissão com imunomarcação com ouro coloidal). A quantificação das cadeias foi realizada por histomorfometria, através de análise de imagem utilizando o software Image Pro-Plus 6.0. Já a cultura de fibroblastos foi desenvolvida para avaliar: distribuição e perfil das cadeias alfa1(V) e alfa2(V) [reconstrução 3D (Zeiss LSM 510 META/UV)],expressão gênica COL5A1, COL5A2 e ITGA2 [qRT-PCR (Applied Biosystems)], e inibição temporária do gene COL5A2. Resultados: Na análise morfológica (H&E e Masson) observou-se modificação da histoarquitetura da pele dos pacientes, com espessamento e retificação da epiderme devido ao aumento na densidade das fibras colágenas, com projeções das papilas dérmicas em direção à derme papilar. Esse resultado foi confirmado na quantificação das cadeias (IM), evidenciado por perda acentuada da cadeia alfa1(V) na derme papilar [12,77 ± 1,344 vs 66,84± 3,36 (p < 0,0001)] e aumento significante da expressão da cadeias alfa1(V) e alfa2(V) na derme reticular alfa1(V) [7,657 ± 0,2133 vs 13,75 ± 0,958 ( p < 0,0001)] e alfa2(V) [5,072 ± 0,4117 vs 21,07 ± 0,790 (p=0,001)] dos pacientes quando comparados ao controle. Assim como visto na imunomarcação com ouro coloidal das cadeias do COLV, houve ausência de expressão linear da cadeia alfa1(V) na derme papilar, contrastando com a expressão da mesma na pele de controles, se contrapondo a forte imunoexpressão das cadeias alfa1(V) e alfa2(V) com uma maior evidência da cadeia alfa2(V) na região espessada pela junção lâmina basal e derme reticular. A reconstrução 3D em cultura de fibroblastos dérmicos demonstrou grande atividade das células de pacientes com ES, confirmado na expressão gênica dos COL5A1, COL5A2 e ITGA2, que se mostraram aumentados significantemente nos pacientes em relação ao controle. Por fim, após inibição do COL5A2 houve uma tendência ao aumento na expressão do COL5A1, e superexpressão da ITGA2. Conclusão: A alteração dérmica observada em pacientes com ES esta correlacionada com a modificação na distribuição das cadeias alfas do COLV, principalmente por perda acentuada da alfa1(V)3 homotrímera na derme papilar e superexpressão da alfa2(V) em capilares e vasos, interferindo na formação de matriz extracelular normal, sugerindo uma alteração pós traducional desta proteína, e que maiores estudos sobre a inibição da cadeia alfa2(V) são importantes para uma futura terapia gênica para atenuar os sintomas desencadeados nesta patologia / Introduction: Recently many functions are attributed to type V collagen in normal physiological conditions and in some diseases, such as scleroderma. This protein presents unique structural features for regulating the diameter of fibrils heterotypic and immunogenicity being capable of eliciting an immune response independent. In recent discoveries, developed by our group, it was evident that collagen V presents anomalous histoarchitecture, increasing the immunoexpression in the skin and lung in the early stages of the disease, as well as increased mRNA of his chains, mainly alpha2(V). For this reason and in order to understand the molecular and ultrastructural processes that correlate COL V fibrosis in SSc, the purpose of this study was to perform morphological and ultrastructural analysis of the chains alpha1(V) and alpha2(V) of the patient´s skin with ES, as well as to assess the influence of the COL5A2 gene in fibrillogenesis. Patients and Methods: The analyses were developed using skin fragment obtained from biopsy, both of patients and controls, under the approval of the ethics committee (CAPPesq 0331/10) and in accordance with the Declaration of Helsinki. The study included 7 patients (male = 3, female = 4) diagnosed with ES for two years or less, and healthy volunteers (n = 7) used as a control group. The biopsy of the skin was divided in two groups of analyzes: histological studies and cultured fibroblasts; Under formaldehyde solution 10%, histomorphometric analysis [staining with hematoxylin and eosin (H e E), Masson\'s trichrome, immunofluorescence (IM) to alpha1(V) and alpha2(V) chains, and three-dimensional reconstruction (Zeiss LSM 510 META were performed/UV), and in a solution of 2% glutaraldehyde for ultrastructural analysis (transmission electron microscopy with immunostaining with colloidal gold). Quantitation was performed by the chain histomorphometry by image analysis using Image Pro-Plus 6.0 software. Already a fibroblast culture was developed to assess: distribution and profile of the alpha1(V) and alpha2(V) chains, 3D reconstruction (Zeiss LSM 510 META / UV), gene expression of COL5A1, COL5A2 and ITGA2 [RT-qPCR (Applied Biosystems)], and temporary inhibition of the COL5A2 gene. Results: In the morphological analysis (H&E and Masson) was observed modification of histoarchitecture patient\'s skin, with thickening and rectification of the epidermis due to increased density of collagen fibers, with projections of dermal papillae toward the papillary dermis. This result was confirmed by quantification of the chains (IM), evidenced by marked loss of the alpha1(V) chain in the papillary dermis [12.77 ± 1.344 vs 66.84 ± 3.36 (p < 0.0001)] and significant increase in the expression of alpha1(V) and alpha2(V) chains, in the reticular dermis alpha1(V) chain [0.2133 ± 7.657 vs 0.958 ± 13.75 (p < 0.0001)] alfa2(V) chain [5.072 ± 0.4117 vs 21.07 ± 0.790 (p = 0.001)] of patients when compared to control. As seen in the immunostaining with colloidal gold chains of COLV, there was no linear expression of the alpha1(V) chain in the papillary dermis, contrasting with the same expression on the skin of controls, in contrast to strong immunoexpression of alpha1(V) and alpha2(V) chains, with a higher evidence of alpha2(V) chain in the junction region by a thickened basement membrane and reticular dermis. The 3D reconstruction of dermal fibroblasts in culture demonstrated large cell activity of patients with SSc, confirmed the gene expression of COL5A1, COL5A2 and ITGA2, which showed significantly increased in patients compared to control. Finally, after inhibition of COL5A2 there was a trend to increase in the expression of the COL5A1, and overexpression of ITGA2. Conclusion: The dermal alteration observed in SSc patients is correlated with the change in the distribution of the collagen alpha (V) chains, mainly by marked loss of alpha1(V)3 homotrimer the papillary dermis and overexpression of the alpha2(V) in capillaries and vessels, interfering with the normal extracellular matrix formation, suggesting a post-translational modification of this protein, and further studies on the inhibition of chain alpha2(V) are important for future gene therapy to attenuate the symptoms of this pathology triggered

Gene transfer represents an important advance in the treatment of both genetic and acquired diseases. Topical gene therapy involves administration of the genetic material onto the surface of skin and mucosal membranes. Cationic gemini surfactants (m-s-m, where m represents the carbon atoms in the alkyl tail and s represents the carbon atoms in the spacer) are a novel category of delivery agents with especially high potential for polynucleotides. This is due to their structural versatility, ability to bind and condense DNA, and relatively low toxicity. <p>The objectives were to design, construct and characterize a cationic, non-viral gemini surfactant-based delivery system for an IFN-ã coding plasmid suitable for cutaneous gene therapy and to evaluate this novel therapeutic approach in a Tsk (tight-skin scleroderma) mouse model to determine its clinical feasibility. <p>The delivery systems were characterized by microscopy, dynamic light scattering (DLS), circular dichroism (CD) and small angle X-ray scattering (SAXS). <i>In vitro</i> gene expression was evaluated in PAM 212 keratinocyte culture. The extent of topical delivery of the plasmid using nanoparticle and nanoemulsion formulations was evaluated by measuring IFN-ã levels in CD1, IFN-ã-deficient and Tsk mice. The effect of transgene expression on collagen synthesis was evaluated in Tsk animals by real-time PCR.<p>The <i>in vitro</i> plasmidgeminilipid (PGL) system showed heterogeneous particle size (100-200 nm small particles and 300-600 nm aggregates). Electrostatic interactions between the DNA and PGL systems shifted the negative æ-potential of the DNA (-47 mV) to positive values (30-50 mV). At the same time, condensation of the DNA, and formation of Ø DNA was indicated by the increase of the overall negative signal in the CD spectra, due to the flattening of the 290 nm peak and shift of the 260 nm peak into the negative region in a structure-dependent manner. Lipid organization of the DNADOPE system, in the absence of gemini surfactants, shows hexagonal structure, while addition of gemini surfactant at +/- charge ratio of 10 caused lamellar phase organization. For short spacers (n=3-6), additional Pn3m cubic phase also appear to be present. <p><i> In vitro</i> transfection efficiency in the 12-n-12 series was found to be dependent on the length of the spacer between the two positively charged head groups, with the n=3 spacer showing the highest activity. The PGL systems with 12-3-12 and 12-4-12 led to significantly higher transgene expression compared to the other surfactants of the series. The transfection efficiency significantly correlated with the surface area occupied by one molecule (a). The effect of the tail length influenced the transfection efficiency, with longer tails being associated with higher protein expression. The highest <i>in vitro</i> transfection efficiency was recorded with the 18:1-3-18:1 surfactant (1.4±0.3 ng/5x10E4 cells). <p><i>In vivo</i>, high levels of IFN-ã expression were detected in the skin of animals treated with both nanoparticle (359±239 pg/cm2) and nanoemulsion (607±411 pg/cm2) formulations compared to topical naked DNA (136±125 pg/cm2). IFN-ã levels in the skin of animals injected with 5 ìg DNA were 256±130 pg/cm2. IFN-ã levels in the lymph nodes were higher for the nanoparticle formulation (433±456 pg/animal) compared to nanoemulsion (131±136 pg/animal) suggesting different delivery pathway of the two formulations.<p>IFN-ã expression was at high levels in the skin of Tsk mice after 4-day and 20-day treatments (472±171 and 345±276 pg/cm2). Both 4-day and 20-day treatments reduced the procollagen type I á1 mRNA levels for the topical treatment (64 and 70% reduction) and intradermal injection (58 and 72% reduction). Intercellular adhesion molecule-1 (ICAM-1) was upregulated by 50% in both topically treated and injected animals after 20-day treatment. <p>Here, it has been demonstrated that cationic gemini surfactant-based delivery systems are able to transfect epidermal cells <i>in vivo</i>, and the transgene IFN-ã expression is sufficient to cause significant reduction of collagen in an animal model of scleroderma. It has been shown for the first time that topical gene therapy is a feasible approach for the modulation of excessive collagen synthesis in scleroderma-affected skin.

Gene transfer represents an important advance in the treatment of both genetic and acquired diseases. Topical gene therapy involves administration of the genetic material onto the surface of skin and mucosal membranes. Cationic gemini surfactants (m-s-m, where m represents the carbon atoms in the alkyl tail and s represents the carbon atoms in the spacer) are a novel category of delivery agents with especially high potential for polynucleotides. This is due to their structural versatility, ability to bind and condense DNA, and relatively low toxicity. <p>The objectives were to design, construct and characterize a cationic, non-viral gemini surfactant-based delivery system for an IFN-ã coding plasmid suitable for cutaneous gene therapy and to evaluate this novel therapeutic approach in a Tsk (tight-skin scleroderma) mouse model to determine its clinical feasibility. <p>The delivery systems were characterized by microscopy, dynamic light scattering (DLS), circular dichroism (CD) and small angle X-ray scattering (SAXS). <i>In vitro</i> gene expression was evaluated in PAM 212 keratinocyte culture. The extent of topical delivery of the plasmid using nanoparticle and nanoemulsion formulations was evaluated by measuring IFN-ã levels in CD1, IFN-ã-deficient and Tsk mice. The effect of transgene expression on collagen synthesis was evaluated in Tsk animals by real-time PCR.<p>The <i>in vitro</i> plasmidgeminilipid (PGL) system showed heterogeneous particle size (100-200 nm small particles and 300-600 nm aggregates). Electrostatic interactions between the DNA and PGL systems shifted the negative æ-potential of the DNA (-47 mV) to positive values (30-50 mV). At the same time, condensation of the DNA, and formation of Ø DNA was indicated by the increase of the overall negative signal in the CD spectra, due to the flattening of the 290 nm peak and shift of the 260 nm peak into the negative region in a structure-dependent manner. Lipid organization of the DNADOPE system, in the absence of gemini surfactants, shows hexagonal structure, while addition of gemini surfactant at +/- charge ratio of 10 caused lamellar phase organization. For short spacers (n=3-6), additional Pn3m cubic phase also appear to be present. <p><i> In vitro</i> transfection efficiency in the 12-n-12 series was found to be dependent on the length of the spacer between the two positively charged head groups, with the n=3 spacer showing the highest activity. The PGL systems with 12-3-12 and 12-4-12 led to significantly higher transgene expression compared to the other surfactants of the series. The transfection efficiency significantly correlated with the surface area occupied by one molecule (a). The effect of the tail length influenced the transfection efficiency, with longer tails being associated with higher protein expression. The highest <i>in vitro</i> transfection efficiency was recorded with the 18:1-3-18:1 surfactant (1.4±0.3 ng/5x10E4 cells). <p><i>In vivo</i>, high levels of IFN-ã expression were detected in the skin of animals treated with both nanoparticle (359±239 pg/cm2) and nanoemulsion (607±411 pg/cm2) formulations compared to topical naked DNA (136±125 pg/cm2). IFN-ã levels in the skin of animals injected with 5 ìg DNA were 256±130 pg/cm2. IFN-ã levels in the lymph nodes were higher for the nanoparticle formulation (433±456 pg/animal) compared to nanoemulsion (131±136 pg/animal) suggesting different delivery pathway of the two formulations.<p>IFN-ã expression was at high levels in the skin of Tsk mice after 4-day and 20-day treatments (472±171 and 345±276 pg/cm2). Both 4-day and 20-day treatments reduced the procollagen type I á1 mRNA levels for the topical treatment (64 and 70% reduction) and intradermal injection (58 and 72% reduction). Intercellular adhesion molecule-1 (ICAM-1) was upregulated by 50% in both topically treated and injected animals after 20-day treatment. <p>Here, it has been demonstrated that cationic gemini surfactant-based delivery systems are able to transfect epidermal cells <i>in vivo</i>, and the transgene IFN-ã expression is sufficient to cause significant reduction of collagen in an animal model of scleroderma. It has been shown for the first time that topical gene therapy is a feasible approach for the modulation of excessive collagen synthesis in scleroderma-affected skin.