SERPINE1 and systemic sclerosis: These results are significant since elevated PAI-1 has been shown to be elevated in skin lesions from SSc patients80,81 and its inhibition improved dermal inflammation and fibrosis in bleo treated mice.81 These findings suggest SIX1 as upstream from PAI-1 and as a mediator that predisposes adipocytes to a pro-fibrotic phenotype.