Role of Smad Anchor for Receptor Activation (SARA) in skin fibrosis

Project: Research project

Project Details


Fibrosis is the hallmark of scleroderma (SSc), yet outcomes of former approaches targeting signals mediating fibrogenesis have rather been elusive. Targeting a precursor of myofibroblasts that accumulate and produce extracellular matrixes in healing wounds and fibrosing tissues is a novel concept. However, there are little myofibroblasts in healthy skin, and debates remain as to where those myofibroblasts come from, and how those progenitor cells are activated. Recent studies suggest that vascular pericytes that reside on the outer surface of small vessels and rather dormant in healthy conditions can be activated in early stage of fibrogenesis, become myofibroblasts and proliferate in the interstitium. However, contribution of pericytes in skin fibrosis is largely unknown. We previously reported that Smad Anchor for Receptor Activation (SARA) has a critical role for maintenance of cell phenotype and that loss of SARA results in transdifferntiation toward mesenchymal phenotype. SARA is highly expressed in normal skin. Analyses of the biopsy samples from our SSc cohort and an animal models for SSc revealed that SARA levels are downregulated in fibrotic skin. Data by us and other gene expression profile studies on database also show that SARA levels are low in skin, kidney and liver. We have generated a mouse that expresses SARA under the control of a promoter of choice using the Cre-lox technology. When SARA is expressed specifically in pericytes, fibrosis in skin, as well as in kidney and liver was significantly less severe and proliferation/infiltration of pericytes was greatly reduced. Interestingly, lung fibrosis was not protected by SARA overexpression, likely due to dominant role of alveolar epithelial cells not pericytes in lung fibrosis. Further, in a fly model of heart tube fibrosis, SARA overexpression protects and SARA knockdown suppresses the fibrosis. These data strongly suggest that SARA is an anti-fibrotic molecule and does so by preventing cellular phenotypic transdifferentiation and reduces numbers of myofibroblasts at multiple organs, including skin, and throughout species. However, a molecular mechanism by which SARA prevents pericyte differentiation, and its clinical relevance in SSc patients have not been studied. Here, we will; 1) take an unbiased approach to reveal genes that are differentially regulated in activated pericytes and SARA, 2) test whether the resulting candidate genes are involved in SARA-mediated cellular phenotype regulation in vitro, and 3) assess whether SARA levels in pericytes levels in skin of SSc patients associates with certain sub group of SSc and/or clinical severity and outcomes. Findings from the proposed study will lay the groundwork for future studies of novel targets for preventing and treating skin scarring. The PI has been studying general mechanisms for figrogenesis for over 2 decades, with a main focus on kidney, is rather new in the skin research. The co-Investigator, Dr. Varga and the PI have maintained a long-standing scientific relationship with a common interest in cellular and molecular mechanisms of fibrogenesis, and the present proposal marks the joining our expertise to address pathogenesis of SSc with a novel approach and uncover a novel therapeutic target.
Effective start/end date4/1/203/31/22


  • Ann & Robert H. Lurie Children's Hospital of Chicago (A20-0108-S001//March 10, 2021)
  • Scleroderma Foundation (A20-0108-S001//March 10, 2021)


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