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Toll\u2010like receptor 9 (TLR9) is implicated in autoimmunity and fibrosis; however, the expression, mechanism of action, and pathogenic role of TLR9 signaling in SSc remain uncharacterized. The aim of this study was to explore the expression, activity, and potential pathogenic role of TLR9 in the context of skin fibrosis in SSc and in mouse models of experimental fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Expression and localization of TLR9 were evaluated in SSc skin biopsy specimens and explanted skin fibroblasts. Fibrotic responses elicited by type A CpG oligonucleotide and mitochondrial DNA (mtDNA) were examined in human skin fibroblasts by a combination of real\u2010time quantitative polymerase chain reaction, Western blot analysis, transient transfection, immunofluorescence microscopy, and functional assays. Expression of TLR9 was examined in 2 distinct mouse models of experimental fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Skin biopsy specimens obtained from 2 independent cohorts of SSc patients showed up\u2010regulation of TLR9, and myofibroblasts were the major cellular source. Moreover, SSc skin biopsy specimens showed evidence of TLR9 pathway activation. CpG induced robust TLR9\u2010dependent fibrotic responses in explanted normal fibroblasts that could be blocked by bortezomib and were mediated through the action of endogenous TGF\u03b2. Mice with experimental fibrosis showed a time\u2010dependent increase in TLR9 localized primarily to myofibroblasts in the dermis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In isolated fibroblasts, TLR9 elicits fibrotic responses mediated via endogenous TGF\u03b2. In patients with SSc, mtDNA and other damage\u2010associated TLR9 ligands in the skin might trigger localized activation of TLR9 signaling, TGF\u03b2 production, and consequent fibroblast activation. Disrupting this fibrotic process with inhibitors targeting TLR9 or its downstream signaling pathways might therefore represent a novel approach to SSc therapy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.39655","type":"journal-article","created":{"date-parts":[[2016,3,6]],"date-time":"2016-03-06T02:39:41Z","timestamp":1457231981000},"page":"1989-2002","source":"Crossref","is-referenced-by-count":69,"title":["Toll\u2010like Receptor 9 Signaling Is Augmented in Systemic Sclerosis and Elicits Transforming Growth Factor \u03b2\u2013Dependent Fibroblast Activation"],"prefix":"10.1002","volume":"68","author":[{"given":"Feng","family":"Fang","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago  Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta Goncalves","family":"Marangoni","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago  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