الفهرس 
Introduction
Aim of the studyOnly 14 pages are availabe for public view
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Abstract
SSc is a chronic debilitating autoimmune disease Its pathogenesis integrates autoimmunity, inflammation, vascular dysfunction as well as excessive fibrosis of skin and internal organs.
In this study, we evaluated OPG and RANKL as potential contributors to the vascular and inflammatory aspects of SSc disease process.
Serum samples from seventy SSc patients and 50 age and sex matched healthy controls were evaluated for levels of OPG, RANKL, IL-6, IL-17 and VEGF. OPG was significantly higher in SSc patients than in HCs, while RANKL was lower in SSc group than HCs but did not reach statistical difference. RANKL related significantly positively with the presence of skin ulcers. OPG also correlated significantly with skin ulcers presence and negatively with ulcer visual analogue scale (VAS) value. There was no significant relationship between OPG, RANKL and any of the markers of inflammation (Il-6, IL-17) orVascular dysfunction (VEGF). However, IL-6, IL-17 and VEGF correlated with clinical and outcome related variables which may aid in future development of a informative/predictive assay that reflects organ/system involvement.
The correlations of OPG and RANKL with skin ulcers are of special interest, as they represent two aspects of ulcer effects (ulcer presence and impact on quality of life). These findings are also consonant with basic research studies regarding the functional roles of OPG and RANKL on angiogenesis models, thus encouraging future research on SSc vascular models; these results may even have therapeutic implications
Although there was no significant relation between OPG, RANKL and Other inflammatory and vascular markers (IL-6, IL-17, VEGF), the immune assays of those markers were of benefit incorrelating with some important variables (i.e. pericardial effusion, DLCO, ejection fraction) that are reflected by those markers. IL-6 showed a significant relationship to breathing VAS, pt global and pericardial effusion.Thus, it appears that cardiopulmonary involvement as well as overall general condition are reflected to some extent by IL-6 elevation.IL-17 also significantly correlated with pericardial effusion and trended to relate to Breathing VAS. Furthermore, VEGF related significantly to breathing VAS, pt global and ejection fraction , in correlating negatively with DLCO, suggesting yet another possible relationship to cardiopulmonary involvement (i.e. as VEGF increase there is increase in Breathing VAS severity, overall Pt global interference with QOL, and decrease in DLCO which may be reflecting advanced ILD or PAH ) .
Conclusion: OPG and RANKL molecules are promising biomarkers for SSc related skin ulcers. Il-6, IL-17 and VEGF are potential biomarkers for organ system involvement. Further Longitudinal studies are warranted to better ascertain the relation between OPG/RANK/RANKL system with vascular and internal organ involvement.