Relevant to our study, it was demonstrated that upregulation of endothelial Cathepsin B enzyme (CTSB) may contribute to the development of SSc vasculopathy, especially to digital ulcers, while reduced expression of CTSB in lesional dermal fibroblasts is likely to be associated with skin sclerosis in early dcSSc.29 The gene discussed is CTSB; the disease is systemic sclerosis.