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Kessal K, Liang H, Rabut G, Daull P, Garrigue JS, Docquier M, Melik Parsadaniantz S, Baudouin C, Brignole-Baudouin F. Conjunctival Inflammatory Gene Expression Profiling in Dry Eye Disease: Correlations With HLA-DRA and HLA-DRB1. Front Immunol 2018; 9:2271. [PMID: 30374345 PMCID: PMC6196257 DOI: 10.3389/fimmu.2018.02271] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/12/2018] [Indexed: 01/24/2023] Open
Abstract
Purpose: In several multicenter clinical trials, HLA-DR was found to be a potential biomarker of dry eye disease (DED)'s severity and prognosis. Given the fact that HLA-DR receptor is a heterodimer consisting in an alpha and a beta chain, we intended to investigate the correlation of inflammatory targets with the corresponding transcripts, HLA-DRA and HLA-DRB1, to characterize specific targets closely related to HLA-DR expressed in conjunctival cells from patients suffering from DED of various etiologies. Methods: A prospective study was conducted in 88 patients with different forms of DED. Ocular symptom scores, ocular-staining grades, tear breakup time (TBUT) and Schirmer test were evaluated. Superficial conjunctival cells were collected by impression cytology and total RNAs were extracted for analyses using the new NanoString® nCounter technology based on an inflammatory human code set containing 249 inflammatory genes. Results: Two hundred transcripts were reliably detected in conjunctival specimens at various levels ranging from 1 to 222,546 RNA copies. Overall, from the 88 samples, 21 target genes showed a highly significant correlation (R > 0.8) with HLA-DRA and HLA-DRB1, HLA-DRA and B1 presenting the highest correlation (R = 0.9). These selected targets belonged to eight family groups, namely interferon and interferon-stimulated genes, tumor necrosis factor superfamily and related factors, Toll-like receptors and related factors, complement system factors, chemokines/cytokines, the RIPK enzyme family, and transduction signals such as the STAT and MAPK families. Conclusions: We have identified a profile of 21 transcripts correlated with HLA-DR expression, suggesting closely regulated signaling pathways and possible direct or indirect interactions between them. The NanoString® nCounter technology in conjunctival imprints could constitute a reliable tool in the future for wider screening of inflammatory biomarkers in DED, usable in very small samples. Broader combinations of biomarkers associated with HLA-DR could be analyzed to develop new diagnostic approaches, identify tighter pathophysiological gene signatures and personalize DED therapies more efficiently.
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Affiliation(s)
- Karima Kessal
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Hong Liang
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Ghislaine Rabut
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | | | | | - Mylene Docquier
- iGE3 Genomics Platform University of Geneva, Geneva, Switzerland
| | | | - Christophe Baudouin
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, University of Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Françoise Brignole-Baudouin
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Paris Cité Université Paris Descartes, Faculté de Pharmacie de Paris, Paris, France
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Abstract
Allergic conjunctivitis (AC) can be divided into the primary form (caused by an allergic reaction occurring primarily in the conjunctivae) and the secondary form (induced by allergic reaction originating primarily in the nasal mucosa, where the released mediators can reach conjunctiva through the lacrimal system, the blood, the lymphatic network, or the neurogenic network). Patients with primary AC develop an immediate, late, or delayed conjunctival response (CR) during conjunctival provocation tests. Patients with secondary AC develop an immediate, late, or delayed type of secondary CR, induced by the nasal allergic reaction, due to the nasal allergen challenge. Various hypersensitivity mechanisms may be involved in the particular CR types. The secondarily induced AC and CRs can only be confirmed by nasal provocations tests, performed by rhinomanometry combined with recording of conjunctival signs. The existence of the primary and secondarily induced AC has an impact on treatment of this disorder.
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Pelikan Z. Seasonal and perennial allergic conjunctivitis: the possible role of nasal allergy. Clin Exp Ophthalmol 2009; 37:448-57. [PMID: 19624340 DOI: 10.1111/j.1442-9071.2009.02079.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a link between conjunctiva and nose. Nasal allergy is suspected to be involved in some cases of conjunctivitis. This work aims to investigate the possible role of nasal allergy in seasonal (SAC) and perennial (PAC) allergic conjunctivitis and the value of nasal challenges with allergens (nasal provocation tests [NPTs]) for the diagnostic procedures of the conjunctivitis. METHODS In 61 adults suffering from SAC or PAC with a positive history and skin tests, but responding insufficiently to the local treatment, 122 NPTs and 61 control nasal challenges with phosphate-buffered saline (PBS) were performed using rhinomanometry combined with recording of ocular response. In 16 control subjects suffering only from allergic rhinitis without a history of conjunctivitis, 16 positive NPTs were repeated and supplemented with registration of ocular features. RESULTS Of the 61 patients, 55 developed 103 positive nasal responses of various types (P < 0.01), 82 of which were accompanied by significant conjunctival response (P < 0.01) without any corneal involvement. No significant ocular responses were recorded during 61 control PBS challenges (P > 0.05) as well as during 16 challenges in control subjects (P > 0.1). CONCLUSIONS These results illustrate a possible involvement of nasal allergy in some patients with allergic conjunctivitis (SAC and PAC) and the value of the nasal challenges with allergen combined with registration of the ocular features in the diagnostic approach to these disorders.
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