388 A novel Abcc6 knockout rat model highlights the role of PPi in the pathogenesis of ectopic mineralization process in PXE Q Li, K van de Wetering, J Kingman, JP Sundberg and J Uitto 1 Thomas Jefferson University, Philadelphia, PA, 2 Netherlands Cancer Institute, Amsterdam, Netherlands and 3 The Jackson Laboratory, Bar Harbor, ME Pseudoxanthoma elasticum (PXE) is characterized by systemic connective tissue mineralization caused by loss-of-function mutations in the ABCC6 gene. The currently available Abcc6 mice represent a useful model system to study PXE pathophysiology and to explore potential treatment modalities. Abcc6 rats would, however, provide a more suitable model for metabolic studies and specifically unravel the role of PPi and Pi homeostasis in PXE. We have therefore generated Abcc6 rats using zinc finger nuclease (ZFN), targeting the first coding exon of Abcc6. Five germline transmission competent rats were identified that harbored deletions ranging from 10 to 23 bp surrounding the ZFN target site. These mutations were predicted to cause out-of-frame translation and induce a premature stop codon. Immunostaining of liver sections using a rat ABCC6 specific antibody showed plasma membrane expression in basolateral surface of hepatocytes in wild type rats and complete absence in the homozygous mutant rats. As a consequence of ABCC6 deficiency, complete necropsy of three mutant lines demonstrated ectopic mineralization in the muzzle skin, eyes, and arterial blood vessels in the knockout rats, features mimicking human PXE. Mineralization in the dermal sheath of vibrissae was also monitored by small animal CT scanning, which allows noninvasive evaluation of the mineralization process. Similar to human PXE patients, clinical chemistry did not reveal differences in serum calcium and phosphorus levels between wild type and Abcc6 rats. However, plasma PPi level was significantly reduced (<60%) in the Abcc6 rats as compared to wild type rats, leading to a significantly lower PPi/Pi ratio. Since PPi is physiologically a potent antimineralization factor, the results highlight the role of PPi in the context of the PPi/Pi ratio in the novel Abcc6 rat model due to loss-of-function of ABCC6, leading to ectopic mineralization in PXE. 389 Pirfenidone inhibits RDEB fibrosis and scarring J Cogan, K Yim, Y Hou, L Chao, V Gor, D Woodley and M Chen Dermatology, University of Southern California, Los Angeles, CA Patients with recessive dystrophic epidermolysis bullosa (RDEB) develop multiple skin wounds that heal with extensive scarring, contractures and mitten deformities. RDEB patients display increased pro-fibrotic TGF-b signaling, a distinct pro-fibrotic gene expression profile and elevated inflammation genes. So far, no specific pharmacological treatment is available for RDEB fibrosis. Among promising anti-fibrotic molecules, pirfenidone (PFD) has shown anti-fibrotic and anti-inflammatory activity in animal and cell models, and it is already being used clinically for the treatment of idiopathic pulmonary fibrosis. In this study, we evaluated the feasibility of using PFD to inhibit RDEB fibrosis using fibroblasts from RDEB patients and a RDEB mouse model. RDEB fibroblasts treated with PFD demonstrated reduced expression of multiple fibrosis markers [collagen I, connective tissue growth factor (CTGF), alpha smooth muscle actin (a-SMA), periostin, and tenascin C] by immunoblot analysis. By RT-PCR, PFD also reduced mRNA levels for fibrosis genes [tenascin-C, CTGF, periostin, TGF-b2, and aSMA] as well as IL-6, an inflammation gene known to stimulate fibrosis. In addition, PFD reduced the levels of pro-fibrogenic TGF-b in the media of RDEB fibroblasts as assessed by ELISA. Furthermore, PFD also reversed the characteristic RDEB cellular phenotype of collagen lattice hypercontractability. Lastly, using a RDEB mouse model featuring nail dystrophy and mitten deformities, PFD administered once daily subcutaneously for 4 weeks attenuated the onset of RDEB-associated fibrosis including mitten deformities and nail loss. It reduced in the skin of RDEB mice, their intrinsically elevated fibrosis markers [periostin, aSMA, fibronectin, collagen 1 and tenascin C] and pro-fibrogenic TGF-b and its downstream signaling [phospho-Smad2/3]. PFD also significantly reduced the number of cd11b-positive inflammatory cells in RDEB mice. These data demonstrate that PFD may be a non-invasive, safe and novel therapy for reducing RDEB fibrosis and scarring and improving the quality of life of RDEB patients.
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