Is there a viral trigger for vascular manifestations in autoimmune diseases such as systemic sclerosis?
Systemic sclerosis (SSc) is a chronic fibrotic disease that affects the skin as well as internal organs. The exact aetiology remains unknown. An altered immune system as well as vascular changes are thought to be early factors in the pathogenesis of the disease, and it has been suggested that latent infection with human cytomegalovirus (HCMV) may also play a part [1]. Patients with SSc show a significantly higher prevalence of anti-HCMV antibodies compared with age and sex matched patients with rheumatoid arthritis or osteoarthritis [2]. A recent paper by Lunardi et al[3] found that HCMV was able to generate self-reactive antibodies in patients with SSc. These autoantibodies, which cross-reacted with the CMV late protein UL94, were able to induce endothelial cell apoptosis, probably through interaction with the integrin α3β1- and the α6β1-NAG-2 complex. Apoptosis of endothelial cells in turn is thought to be one of the earliest steps in the vascular pathology of SSc [4]. While these re
