Systemic sclerosis and determination of semaphorin 3A level in vascular involvement in systemic sclerosis

Objective: Semaphorin 3A is an immunomodulatory molecule and its level decreases in inflammatory and rheumatological diseases. Considering that it can be used as an early marker in distinguishing systemic sclerosis and systemic sclerosis with vascular involvement, due to its effects on angiogenesis, it is aimed to compare the semaphorin levels of healthy control group and systemic sclerosis patients. Materials and Methods: In this study, 21 patients aged 18-70 years who applied to Yıldırım Beyazıt University Faculty of Medicine-Ankara City Hospital Rheumatology Clinic with a history of renal crisis, digital ulcer and pulmonary arterial hypertension secondary to systemic sclerosis, digital ulcer, and 35 patients who did not develop digital ulcer, pulmonary arterial hypertension or renal crisis due to systemic sclerosis, were included. 31 healthy-patient volunteers who applied to the Internal Medicine-Rheumatology Outpatient Clinic, without systemic disease, without malignancy and autoimmune disease, without active thrombo-embolic disease, without a history of thrombosis, without chronic kidney disease, were included. Rheumatology outpatient epicrisis, re-evaluation notes, anamnesis and examination information obtained by interviewing the patients and data were compiled. Demographic information (age, gender), smoking habits, year of diagnosis, comorbidities, digital ulcer history, clinical findings (digital ulcer, sclerodactyly, Raynaud's phenomenon, calcinosis, arthritis, telangiectasia, cardiac involvement, gastrointestinal involvement, pulmonary involvement), serology autoantibodies, proteinuria levels, activity scores of the patient and control groups were determined and recorded. Semaphorin 3A level was measured by Enzyme Linked Immuno Sorbent Assay (ELISA) method. Results: A total of 56 systemic sclerosis patients, including 21 vascular patients with digital ulcer and pulmonary arterial hypertension and 35 non-vascular patients, and also 31 volunteers were included in the study. The mean serum semaphorin 3A level of 56 systemic sclerosis patients was 47.85 ng/ml (± 11.88), the serum semaphorin 3A level of the control group was 57.6 (± 19.81), the vascular group was 44.31 ng/ml ((± 5,87), and the non-vascular group was 49.96 ng/dl. According to these results, serum sema3A level of the patient group was found to be significantly lower than the control group (p 0.016). The serum sema3A level of the vascular group was found to be significantly lower than the control group (p= 0.01). The serum semaphorin 3A level (44.32 ng/ml) of patients with vascular systemic sclerosis was found to be statistically significantly lower than the serum semaphroin 3A level of patients with non-vascular systemic sclerosis (p= 0.04). There was no statistically significant difference between the Modified Rodnan Skin Score and Valentini activity indices of the patients and their semaphorin 3A, CRP, ESR and fibrinogen values. Conclusion: The semaphorin 3A level of all systemic sclerosis patients was lower than the control group. The semaphorin 3A level of systemic sclerosis patients in the vascular group was found to be statistically significantly lower than the control and non-vascular groups. The fact that the vascular group is lower than the non-vascular group suggests that semaphorin 3A is involved in the pathogenesis of vasculopathy and should be investigated for its use as a marker in this area. Keywords: Systemic Sclerosis, Scleroderma, Semaphorin 3A, Vascular, Vasculopathy