THU0343 PU.1 INHIBITOR DB1976 CONTROLS FIBROBLAST POLARIZATION IN SYSTEMIC SCLEROSISAND LEADS TO REGRESSION OF FIBROSIS IN DIFFERENT MODELS OF ORGAN FIBROSIS
Authors: Thomas Wohlfahrt, Simon Rauber, Markus Luber, Alina Soare, Stefanie Weber, Alexandru-Emil Matei, Chih-Wei Chen, Emmanuel Karouzakis, Hans Kiener, Elena Pachera, Clara Dees, Alexander Kreuter, Astrid Juengel, Steffen Gay, Oliver Distler, Georg Schett, Jörg Distler, Andreas Ramming
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Persistent activation of fibroblast with excessive release of extracellular matrix is a hallmark of systemic sclerosis (SSc). Fibroblasts can either acquire a "pro-fibrotic" phenotype with excessive matrix production or a "pro-inflammatory" phenotype with releasing of matrix-degrading enzymes and subsequent tissue destruction. Despite these well-characterized phenotypic differences, the molecular mechanisms that drive polarization of fibroblasts into these two functionally opposing phenotypes remain enigmatic. <h3>Objectives</h3> We aimed to evaluate the transcriptional network that promotes the extracellular matrix-producing fibrotic fibroblast fate. <h3>Methods</h3> We investigated the transcriptional network that induces the profibrotic phenotype of fibroblasts by in silico and immunofluorescence analyses of human fibrotic skin, lung, liver and kidney, and performed functional assays to address the fibrogenic potential of fibroblasts in vitro and in several mouse models of systemic sclerosis. The heterocyclic diamidine DB1976 was used as new therapeutic compound to induce regression of fibrosis. <h3>Results</h3> We identified the ETS transcription factor PU.1 as molecular checkpoint for acquisition of a "pro-fibrotic" phenotype of fibroblasts. Our data demonstrate that expression of PU.1 is effectively silenced in fibroblasts during tissue homeostasis. When the epigenetic control of PU.1 is lost and PU.1 expression is induced, fibroblasts differentiate into a fibrotic phenotype that includes the transcription of numerous pro-fibrotic mediators. PU.1 polarized resting fibroblasts and even repolarized extracellular matrix-degrading inflammatory fibroblasts to an extracellular matrix-producing fibrotic phenotype. PU.1 is associated with a network of pro-fibrotic factors including members of the TEAD–HIPPO, canonical TGF-β–SMAD and AP1 signaling pathways. Other transcription factors with fibrotic abilities, such as SNAI2 and myocyte enhancer factor (MEF) 2, bind in close vicinity to PU.1-binding sites within the genome and contribute to the recruitment of the transcription machinery that drives the switch towards the fibrotic phenotype. PU.1 has a major coordinating role within this complex network of transcription factors in fibroblasts, as the inactivation of PU.1 alone is sufficient to prevent fibrotic polarization in vitro and in vivo. Finally, we investigated pharmacological targeting of PU.1 as a potential strategy to prevent uncontrolled fibrotic tissue remodelling. DB1976 showed anti-fibrotic effects in vivo in various fibrosis models and across several organs. Treatment with DB1976 not only prevented bleomycin-mediated skin fibrosis, but also induced regression of pre-established fibrosis, and was well tolerated. <h3>Conclusion</h3> These findings suggest that PU.1 inhibition may represent a novel and effective therapeutic approach to treat a wide range of fibrotic diseases. Inactivation of PU.1 effectively reverted the fibrotic phenotype of fibroblasts to a resting state and induced the regression of tissue fibrosis: <h3><b>Disclosure of Interests:</b></h3> Thomas Wohlfahrt: None declared, Simon Rauber: None declared, Markus Luber: None declared, Alina Soare: None declared, Stefanie Weber: None declared, Alexandru-Emil Matei: None declared, Chih-Wei Chen: None declared, Emmanuel Karouzakis: None declared, Hans Kiener: None declared, Elena Pachera: None declared, Clara Dees: None declared, Alexander Kreuter: None declared, Astrid Juengel: None declared, Steffen Gay: None declared, Oliver Distler Grant/research support from: Prof. Distler received research funding from Actelion, Bayer, Boehringer Ingelheim and Mitsubishi Tanabe to investigate potential treatments of scleroderma and its complications, Consultant for: Prof. Distler has/had consultancy relationship within the last 3 years with Actelion, AnaMar, Bayer, Boehringer Ingelheim, ChemomAb, espeRare foundation, Genentech/Roche, GSK, Inventiva, Italfarmaco, iQvia, Lilly, medac, MedImmune, Mitsubishi Tanabe Pharma, Pharmacyclics, Novartis, Pfizer, Sanofi, Serodapharm and UCB in the area of potential treatments of scleroderma and its complications. In addition, he had/has consultancy relationship within the last 3 years with A. Menarini, Amgen, Abbvie, GSK, Mepha, MSD, Pfizer and UCB in the field of arthritides and related disorders, Georg Schett: None declared, Jörg Distler: None declared, Andreas Ramming Grant/research support from: Novartis&nbsp;