Peroxisome proliferator- activated receptor γ: innate protection from excessive fibrogenesis and potential therapeutic target in systemic sclerosis

Purpose of review Progressive organ fibrosis and pulmonary arterial hypertension (PAH) are the leading causes of death in patients with systemic sclerosis (SSc). However, the pathogenesis and the link between these two processes remain obscure. A better understanding of these events is needed in order to facilitate the discovery and development of effective therapies for SSc. Recent findings Recent reports provide evidence that the orphan receptor peroxisome proliferator-activated receptor gamma (PPAR gamma), better known for its pivotal role in metabolism, has potent effects on inflammation, fibrogenesis and vascular remodeling and is important in the pathogenesis of fibrosis and PAH, and as a potential therapeutic target in SSc. The studies discussed in this review indicate that ligands of PPAR gamma potently modulate connective tissue turnover and suggest that aberrant expression or function of PPAR gamma is associated with, and very likely contributes to, the progression of pathological fibrosis and vascular remodeling. These observations are of particularly relevance because FDA-approved drugs of the thiazolidinedione class currently used for the treatment of obesity-associated type 2 diabetes activate PPAR gamma signaling. Moreover, novel PPAR gamma ligands with selective activity are under development or in clinical trials for inflammatory diseases, asthma, Alzheimer disease and cancer. Summary Drugs targeting the PPAR gamma pathway might be effective for the control of fibrosis as well as pathological vascular remodeling underlying PAH and, therefore, might have a therapeutic potential in SSc. A greater understanding of the mechanisms underlying the antifibrogenic and vascular remodeling activities of PPAR gamma ligands will be necessary in order to advance these drugs into clinical use.