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Chen J, Bai T, Su J, Cong X, Lv L, Tong L, Yu H, Feng Y, Yu G. Salivary Gland Transplantation as a Promising Approach for Tear Film Restoration in Severe Dry Eye Disease. J Clin Med 2024; 13:521. [PMID: 38256655 PMCID: PMC10816601 DOI: 10.3390/jcm13020521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
With increased awareness of dry eye disease (DED), a multitude of therapeutic options have become available. Nevertheless, the treatment of severe DED remains difficult. In a patient whose DED is related to the loss of lacrimal function without severe destruction of the salivary glands, autologous transplantation of the latter as functioning exocrine tissue to rebuild a stable tear film is an attractive idea. All three major and minor salivary glands have been used for such transplantation. Due to the complications associated with and unfavorable prognosis of parotid duct and sublingual gland transplantation, surgeons now prefer to use the submandibular gland (SMG) for such procedures. The transplantation of the SMG not only has a high survival rate, but also improves dry eye symptoms and signs for more than 20 years post-surgery. The regulation of the secretion of the transplanted SMG is critical because the denervated SMG changes its mechanism of secretion. Innovative procedures have been developed to stimulate secretion in order to prevent the obstruction of the Wharton's duct and to decrease secretion when postoperative "epiphora" occurs. Among the minor salivary glands, the transplantation of the labial salivary glands is the most successful in the long-term. The measurement of the flow rates of minor salivary glands and donor-site selection are critical steps before surgery.
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Affiliation(s)
- Jiayi Chen
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Tianyi Bai
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Jiazeng Su
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xin Cong
- Key Laboratory of Molecular Cardiovascular Sciences, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Ministry of Education, Beijing 100191, China;
| | - Lan Lv
- Department of Ophthalmology, Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing 100730, China
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore 168751, Singapore;
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Eye-Academic Clinical Program, Duke-National University of Singapore, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Haozhe Yu
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Yun Feng
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Guangyan Yu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
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Møller-Hansen M, Utheim TP, Heegaard S. Surgical Procedures in the Treatment of Dry Eye Disease. J Ocul Pharmacol Ther 2023; 39:692-698. [PMID: 37566528 DOI: 10.1089/jop.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial disease affecting 5% to 50% in different populations. The most severe cases of DED are often caused by aqueous deficient dry eye disease (ADDE) due to lacrimal gland (LG) hypofunction. Many patients with severe ADDE do not experience adequate symptom relief from topical treatment, severely reducing their quality of life. The focus of this review is to describe the surgical interventions presently being used or investigated when topical treatment with eye drops is insufficient. The conventional surgical approach is to proceed to punctal occlusion or partial or total tarsorrhaphy. However, novel surgical procedures have been reported to have higher efficacy and patient satisfaction than conventional treatments. These procedures include amniotic membrane transplantation, transposition or transplantation of the salivary glands, and cell-based injections into the LG, each with strengths and weaknesses. Further development of these treatment modalities might prove pivotal in treating dry eye patients in the future.
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Affiliation(s)
- Michael Møller-Hansen
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tor Paaske Utheim
- Departmernt of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Singh S, Basu S, Geerling G. Salivary gland transplantation for dry eye disease: Indications, techniques, and outcomes. Ocul Surf 2022; 26:53-62. [DOI: 10.1016/j.jtos.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
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Jeffers J, Lucarelli K, Akella S, Setabutr P, Wojno TH, Aakalu V. Lacrimal gland botulinum toxin injection for epiphora management. Orbit 2022; 41:150-161. [PMID: 34396904 PMCID: PMC8844302 DOI: 10.1080/01676830.2021.1966810] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/05/2021] [Indexed: 05/17/2023]
Abstract
PURPOSE Epiphora remains an often difficult to manage ocular complaint for ophthalmologists in all subspecialties. This review seeks to examine the safety and efficacy of botulinum toxin injection for management of chronic epiphora. METHODS The authors conducted a Pubmed search for studies on the use of lacrimal and transplanted salivary gland botulinum toxin injections for the management of epiphora within the past 20 years. Studies included had a minimum of four glandular injections. RESULTS The authors identified 14 studies and divided them by indication for injection; either functional epiphora, non-functional epiphora, or mixed studies. Seven studies examined injections for cases of functional epiphora, four for non-functional epiphora, and four for mixed cases. The number of glandular injections reported ranged from 4 to 65. Side effects reported were limited to diplopia, eyelid or lacrimal gland hematoma, papillary conjunctivitis, dry eye, ptosis, and bleeding. CONCLUSIONS Glandular botulinum toxin injection should be considered as a viable treatment strategy for both functional and nonfunctional epiphora. From the studies reviewed, botulinum toxin injection was shown to be effective in both children and adults. Injection can be performed in the outpatient setting, is minimally invasive, technically easy to administer, has a favorable side effect profile, and good efficacy. Furthermore, repeat injections can be performed with similar efficacy.
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Affiliation(s)
- Johnathan Jeffers
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, USA
| | - Katherine Lucarelli
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, USA
| | - Sruti Akella
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, USA
| | - Pete Setabutr
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, USA
| | - Ted H. Wojno
- Department of Ophthalmology, Emory Eye Center, Atlanta, USA
| | - Vinay Aakalu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, USA
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丛 馨, 闵 赛, 吴 立, 蔡 志, 俞 光. [Role and mechanism of muscarinic acetylcholine receptor in the regulation of submandibular gland secretion]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:390-396. [PMID: 31209407 PMCID: PMC7439034 DOI: 10.19723/j.issn.1671-167x.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Indexed: 02/05/2023]
Abstract
Muscarinic acetylcholine receptors (mAChRs), including M1-M5 subtypes, are classic receptors in regulating water, ion, and solute transport in salivary gland. Our work focuses on the studies on the expression pattern and function of mAChR in the submandibular gland (SMG), and the underlying mechanism involved in the mAChR-regulated secretion, together with the effect of parasympathectomy on the salivary secretion. Microvascular autotransplantation of SMG into the temporal fossa provides a continuous and endogenous source of fluids, and is currently an effective method for treating severe keratoconjunctivitis sicca. By using RT-PCR, Western blotting, and immunofluorescence, our data demonstrated that the expression of M1 and M3 subtypes were decreased in latent period in rabbit SMG autotransplantation model, whereas carbachol stimulation promoted the salivary secretion, as well as M1 and M3 expressions. By contrast, mAChRs were hypersensitive in epiphora SMGs, whereas atropine gel and botulinum toxin A application significantly inhibited the hypersecretion in both animal models and patients. Furthermore, the possible intracellular signal molecules involved in the mAChR-modulated salivary secretion were explored. Activation of mAChR upregulated the expression of aquaporin 5 (AQP5), the main transporter that mediated water secretion through transcellular pathway, and led to AQP5 trafficking from lipid rafts to non-lipid microdomain. Extracellular signal-regulated kinase 1/2 (ERK1/2) was involved in the mAChR-regulated AQP5 content. mAChR activation also modulated the expression, distribution, and function of tight junction proteins, and increased paracellular permeability. ERK1/2/β-arrestin2/clathrin/ubiquitin signaling pathway was responsible for the mAChR-regulated downregulation of tight junction molecule claudin-4. Cytoskeleton filamentous actin (F-actin) was also involved in the distribution and barrier function of epithelial tight junctions. Besides, endothelial tight junctions were opened by mAChR agonist-evoked salivation in the mice. Furthermore, parasympathetic denervation increased resting salivary secretion in the long terminrats and minipigs. Taken together, our work demonstrated that mAChR regulated saliva secretion via transcellular and paracellular pathways in SMG epithelium as well as tight junction opening in SMG endothelium. Modulation of mAChR might be a promising strategy to ameliorate SMG dysfunction.
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Affiliation(s)
- 馨 丛
- 北京大学口腔医学院·口腔医院,唾液腺疾病研究中心, 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
- 京大学基础医学院生理学与病理生理学系,北京 100191Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - 赛南 闵
- 北京大学口腔医学院·口腔医院口腔颌面外科,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - 立玲 吴
- 北京大学口腔医学院·口腔医院,唾液腺疾病研究中心, 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081Center for Salivary Gland Diseases, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
- 京大学基础医学院生理学与病理生理学系,北京 100191Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - 志刚 蔡
- 北京大学口腔医学院·口腔医院口腔颌面外科,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - 光岩 俞
- 北京大学口腔医学院·口腔医院口腔颌面外科,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
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