Overexpression of Toll-like receptor 4 (TLR4)-complex genes in skin from diffuse cutaneous systemic sclerosis (dcSSc) patients. (A-C) Gene expression comparing dcSSc patients (SSc, n = 24, solid squares) to healthy controls (HC, n = 11, solid circles). Data are expressed as fold-change, normalized to mRNA expression by q-PCR, all expression normalized to one HC: TLR4 (A), CD14 (B) and Myeloid differentiation factor 2 (MD2) (C) show average SSc mRNA expression increased, respectively, by 2-fold (P <0.01); 2.4-fold (P <0.0001), and 1.8-fold (P <0.05). Bars show the mean ± standard error of the mean. In the dot plot, each data point represents a single skin sample. (D-F) Correlation between gene expression and change in skin score; change in skin score was calculated as the difference in the modified Rodnan skin score over 6 months (ΔMRSS). Correlation of ΔMRSS with: (D) TLR4 gene expression (r2 = 0.3, P = 0.02); (E) CD14 gene expression (r2 = 0.62, P = 0.0002); and (F) MD2 gene expression (r2 = 0.23, P = 0.04).