Blood TSLP protein linked to greater risk of digital ulcers in SSc: Study
Higher protein levels may help predict who will develop finger, toe sores
Higher circulating levels of a protein called thymic stromal lymphopoietin, or TSLP, may be linked to a greater risk of digital ulcers — sores in the fingers and toes — in people with systemic sclerosis (SSc), also known as scleroderma, a study revealed.
These findings suggest that assessments of TSLP levels could be used to predict which patients may develop these painful sores.
“TSLP is higher in SSc [patients] with recurrent new DUs [digital ulcers],” the team wrote, noting their results showed “a high predictive value.”
The study, “Thymic stromal lymphopoietin and digital microvascular damage in systemic sclerosis patients: A pilot study,” was published in the journal Microvascular Research by a team of scientists in Italy.
Digital ulcers more likely in patients with high TSLP levels
Scleroderma occurs when the immune system mistakenly turns on connective tissue — the tissue that connects the body’s structures and helps hold them together. As a result, fibroblasts in connective tissue are triggered to produce excessive amounts of a protein called collagen, causing the skin and potentially internal organs to thicken and scar.
In SSc, accumulation of scar tissue can cause damage to small blood vessels and poor blood flow to the extremities. This often leads to painful digital ulcers, or breaks in the skin on the fingers, and sometimes the toes, that can interfere with daily activities and result in repeated visits to the doctor.
TSLP is a protein released by some cells in the body to initiate immune responses. This triggers an inflammatory response and the production of collagen by fibroblasts, which should help in tissue remodeling. In SSc, however, it may contribute to tissue thickening and scarring.
To learn more, the team of researchers watched for a link between higher levels of TSLP in the blood and the development of digital ulcers in a group of 75 people with SSc. These patients had a median age of 57 and a median disease duration of 17 years. The vast majority (85.3%) were women.
Slightly more than half — 39 or 52% — had diffuse SSc, a form of systemic scleroderma marked by extensive skin scarring and a higher risk for internal organ damage. The other 36 (48%) had limited SSc, which is usually milder and worsens at a slower pace.
TSLP might have a key role in digital microvascular [small blood vessel] damage of SSc patients. … Large and controlled studies are needed to confirm these preliminary data.
More than two-thirds (69.3%) had a history of digital ulcers. Their median levels of TSLP in the blood were higher than those of patients who had not developed digital ulcers (181.67 vs. 154.67 picograms per milliliter or pg/ml), the data showed.
The researchers also used a tool called capillaroscopic skin ulcer risk index (CSURI) to predict the likelihood of new digital ulcers developing. They found that patients with a CSURI equal to or greater than 2.96, which indicates a high risk for new digital ulcers, also had higher levels of TSLP.
When the researchers looked at how long patients stayed free from new digital ulcers, they observed that those with higher levels of TSLP were more likely to get new digital ulcers sooner than those with lower levels. Moreover, patients with a high CSURI were more than three times as likely to develop digital ulcers.
“TSLP might have a key role in digital microvascular [small blood vessel] damage of SSc patients,” the researchers concluded, noting that “large and controlled studies are needed to confirm these preliminary data.”
About the Author
