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- W2473119987 abstract "Sir: We read with great interest the article by Yun and colleagues.1 We congratulate the authors for their work, which may be a prelude to the clinical application of heat shock protein 90 (HSP90) inhibitors for keloid treatment. We would like to discuss this topic to add a further piece to the pathogenic “puzzle” underlying keloids formation and the authors’ findings. Toll-like receptor 4 (TLR4) is a transmembrane protein expressed by inflammatory cells, fibroblasts, and keratinocytes. It binds to exogenous ligands, such as lipopolysaccharide, and to endogenous ones, such as heat shock proteins and fibronectin. Physiologically, it plays a role as a biosensor of tissue damage and sterile inflammation to initiate tissue repair after injury. Nevertheless, TLR4 is overexpressed in pathologic fibroses, such as keloids,2 and increases transforming growth factor (TGF)-β signaling, responses, and fibroblast activation and proliferation.3 The interaction between HSP90 and TLR4 has recently been investigated in other tissues. Thuringer and colleagues found that HSP90 administration induced TLR4 activation. In contrast, specific inhibition of TLR4 expression suppressed extracellular HSP90-induced signaling and associated cell migration.4 Moreover, 17-allylaminodemethoxygeldanamycin (which is the same HSP90 inhibitor investigated by Yun et al.1) was found to block the proinflammatory TLR4 activation.5 Considered together, these findings provide consistent evidence of a close interaction between HSP90 and TLR4, with the first being a major cofactor in the onset of TLR4 intracellular pathways. In a stress condition, such as wound healing after surgery or trauma, the increase in HSP90 and the induction of TLR4 signaling may induce fibroblast activation, proliferation, and migration in addition to higher TGF-β production and responsiveness. As a consequence, a self-amplifying loop develops, sustaining both cellular proliferation and collagen overproduction. In their work, the authors found that 17-allylaminodemethoxygeldanamycin induces apoptosis and decreases cell migration/mobility of keloid fibroblasts. It would be interesting to assess collagen types I/III, fibronectin production, and TLR4 activation in the experimental group compared with the control group. HSP90 may act at different levels to promote cell proliferation and migration: we would like to encourage the authors to further investigate the role of HSP90 inhibition and its possible relationship with TLR4 signaling in future studies. Keloids still represent a major challenge for plastic surgeons. Thus, we appreciate this innovative article and are deeply interested in the translational application of the authors’ findings. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Francesco Segreto, M.D. Giovanni Francesco Marangi, M.D., Ph.D. Pierluigi Gigliofiorito, M.D. Francesca Briganti, M.S. Paolo Persichetti, M.D., Ph.D. Department of Plastic, Reconstructive and Aesthetic Surgery “Campus Bio-Medico di Roma” University Rome, Italy" @default.
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- W2473119987 date "2016-02-01" @default.
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- W2473119987 title "HSP90 and TLR4 Interplay in Keloids" @default.
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- W2473119987 doi "https://doi.org/10.1097/01.prs.0000475819.81154.81" @default.
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