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Hynnekleiv L, Magno M, Moschowits E, Tønseth KA, Vehof J, Utheim TP. A comparison between hyaluronic acid and other single ingredient eye drops for dry eye, a review. Acta Ophthalmol 2024; 102:25-37. [PMID: 37042308 DOI: 10.1111/aos.15675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/05/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
Dry eye disease (DED) is a highly prevalent and debilitating condition. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan that has a long history as a safe and effective DED treatment. HA is frequently used as a comparator when assessing other topical DED treatments. This study aims to summarise and critically evaluate the literature describing all isolated active ingredients that have been directly compared with HA in the treatment of DED. A literature search was conducted in Embase using Ovid on the 24th of August 2021 and in PubMed including MEDLINE on the 20th of September 2021. Twenty-three studies met the inclusion criteria, 21 of which were randomised controlled trials. Seventeen different ingredients representing six treatment categories were compared with HA treatment. Most measures showed no significant difference between treatments, suggesting either equivalency of treatments or that studies were underpowered. Only two ingredients were represented in more than two studies; carboxymethyl cellulose treatment appears equivalent to HA treatment, while Diquafosol treatment appears superior to HA treatment. Drop-frequency varied from one to eight drops daily. No single study explained the choice of drop frequency. Nine studies used a HA concentration of 0.1% which may be below therapeutic levels. Nine studies reported using preserved formulations, six of them with differences in preservatives between the compared groups. Thirteen studies were financially linked to industry. No major complications were reported. Studies were not designed to find differences in treatment effects for different types or severities of DED. HA is a good comparator treatment when assessing other DED treatments, although consensus after decades of use is still lacking for best choice of concentration, molecular weight and drop tonicity. Well-designed studies are needed to determine an evidence-based standard for HA treatment to be used as comparator.
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Affiliation(s)
- Leif Hynnekleiv
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
| | - Morten Magno
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emily Moschowits
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jelle Vehof
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
- Department of Ophthalmology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tor P Utheim
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Stavanger University Hospital, Oslo, Norway
- Department of Quality and Health Technology, The Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Oral Biology, Faculty of dentistry, University of Oslo, Oslo, Norway
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
- Department of Research and Development, Oslo Metropolitan University, Oslo, Norway
- The Norwegian dry eye clinic, Oslo, Norway
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Flessa CM, Zampeli E, Evangelopoulos ME, Natsis V, Bodewes ILA, Huijser E, Versnel MA, Moutsopoulos HM, Mavragani CP. Genetic Variants of the BAFF Gene and Risk of Fatigue Among Patients With Primary Sjögren's Syndrome. Front Immunol 2022; 13:836824. [PMID: 35371038 PMCID: PMC8964489 DOI: 10.3389/fimmu.2022.836824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background/Purpose Primary Sjögren's Syndrome (SS) is characterized by B lymphocyte hyperactivity with B cell activating factor (BAFF) acting as an important regulator. Single Nucleotide Polymorphisms (SNPs) of the BAFF gene have been implicated in the pathogenesis of several autoimmune diseases characterized by heightened fatigue levels, including primary SS. We aimed to explore potential associations between BAFF SNPs and fatigue status of primary SS patients. Methods Fatigue status was assessed in 199 consecutive primary SS patients (Greek cohort) using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale. Clinical, histological, laboratory, psychometric and personality data were also collected. DNA extracted from peripheral blood of all patients underwent evaluation for the presence of five BAFF SNPs (rs9514827, rs1041569, rs9514828, rs1224141, rs12583006) by PCR. To confirm our findings, an independent replicative cohort of 62 primary SS patients (Dutch cohort) was implemented. Finally, 52 multiple sclerosis (MS) patients were served as disease controls (MS cohort). Analysis of BAFF SNPs in association with fatigue levels was performed by the online platforms SNPStats and SHEsis and the SPSS 26 and Graph Pad Prism 8.00 software. Results TT genotype of the rs9514828 BAFF polymorphism was significantly less frequent in the fatigued primary SS patients of the Greek cohort compared to the non-fatigued (14.1% vs 33.3%). The corresponding ORs [95%CI] in the dominant and overdominant models were 0.33 [0.15-0.72], p=0.003 and 0.42 [0.23-0.78], p=0.005 respectively. The association remained significant after adjustment for the variables contributing to fatigue in the univariate analysis (OR [95% CI]: 0.3 [0.1-0.9], p=0.026). Accordingly, in the Dutch cohort, there was a trend of lower mental fatigue among patients carrying the TT rs9514828 BAFF genotype compared to their CC counterparts (4.1 ± 2.4 vs 6.0 ± 2.2 respectively, p=0.06). The rs9514828 BAFF SNP was not significantly associated with fatigue in the MS cohort. Conclusions We report a novel association between genetic makeup and primary SS-associated fatigue with the rs9514828 TT genotype decreasing the likelihood of fatigue development among these patients. These findings need validation in multi-center studies.
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Affiliation(s)
- Christina-Maria Flessa
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria-Eleftheria Evangelopoulos
- 1st Department of Neurology, Multiple Sclerosis and Demyelinating Disease Unit, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilis Natsis
- 1st Department of Neurology, Multiple Sclerosis and Demyelinating Disease Unit, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Iris L A Bodewes
- Department of Immunology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Erika Huijser
- Department of Immunology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marjan A Versnel
- Department of Immunology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Clio P Mavragani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Fourth Department of Internal Medicine, Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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3
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Doaré E, Héry-Arnaud G, Devauchelle-Pensec V, Alegria GC. Healthy Patients Are Not the Best Controls for Microbiome-Based Clinical Studies: Example of Sjögren's Syndrome in a Systematic Review. Front Immunol 2021; 12:699011. [PMID: 34394092 PMCID: PMC8358393 DOI: 10.3389/fimmu.2021.699011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction It has been hypothesized that gut and oral dysbiosis may contribute to the development of primary Sjögren's syndrome (pSS). The aim of this systematic review was to assemble available data regarding the oral and gut microbiota in pSS and to compare them to data from healthy individuals and patients with dry symptoms without a diagnosis of Sjögren's syndrome or lupus disease to identify dysbiosis and discuss the results. Methodology Using the PRISMA guidelines, we systematically reviewed studies that compared the oral and gut microbiota of Sjögren's patients and controls. The PubMed database and Google Scholar were searched. Results Two-hundred and eighty-nine studies were found, and 18 studies were included: 13 referred to the oral microbiota, 4 referred to the gut microbiota, and 1 referred to both anatomical sites. The most frequent controls were healthy volunteers and patients with sicca symptoms. The most common analysis method used was 16S-targeted metagenomics. The results were mostly heterogeneous, and the results regarding diversity were not always in accordance. Dysbiosis in pSS was not confirmed, and reduced salivary secretion seems to explain more microbial changes than the underlying disease. Conclusion These heterogeneous results might be explained by the lack of a standardized methodology at each step of the process and highlight the need for guidelines. Our review provides evidence that sicca patients seem to be more relevant than healthy subjects as a control group.
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Affiliation(s)
- Elise Doaré
- Rheumatology Department, Reference Centre of Rare Autoimmune Diseases, Cavale Blanche Hospital and Brest University, INSERM UMR 1227, Brest, France
| | - Geneviève Héry-Arnaud
- UMR1078, Génétique, Génomique Fonctionnelle Et Biotechnologies, INSERM, Université de Brest, EFS, IBSAM, Brest, France.,Centre Brestois d'Analyse du Microbiote, Hôpital La Cavale Blanche, CHRU de Brest, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, Reference Centre of Rare Autoimmune Diseases, Cavale Blanche Hospital and Brest University, INSERM UMR 1227, Brest, France
| | - Guillermo Carvajal Alegria
- Rheumatology Department, Reference Centre of Rare Autoimmune Diseases, Cavale Blanche Hospital and Brest University, INSERM UMR 1227, Brest, France
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Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview. ACTA ACUST UNITED AC 2021; 57:medicina57030271. [PMID: 33809659 PMCID: PMC8002330 DOI: 10.3390/medicina57030271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease.
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Kamal Y, Kandil M, Eissa M, Yousef R, Elsaadany B. Probiotics as a prophylaxis to prevent oral candidiasis in patients with Sjogren's syndrome: a double-blinded, placebo-controlled, randomized trial. Rheumatol Int 2020; 40:873-879. [PMID: 32219478 DOI: 10.1007/s00296-020-04558-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
Patients with Sjögren's syndrome are at a higher risk to develop oral candidiasis than the general population. As antifungals have many side-effects, new approaches are needed to address this problem. This randomized controlled study aimed to evaluate the short-term efficacy of probiotics in the reduction of oral candidal growth in patients with SS. Thirty-two Sjogren's syndrome patients were randomly allocated in two groups receiving either Probiotics or placebo capsules twice a day for 5 weeks. The strains included in the probiotic capsule were Lactobacillus acidophilus, Lactobacillus bulgaricus, Streptococcus thermophilus and Bifidobacteriumbifidum. Oral rinse solution samples were collected and candidal levels were determined (CFU/mL) at baseline and after the 5-week experimental period. Pain, erythema and angular cheilitis were also assessed at baseline and after 2, 4 and 5-week. In the probiotic group, there was a statistically significant reduction of the candidal load from baseline to the 5th week respectively. However, the change in candidal load at the same time in the placebo group was not statistically significant. The tested probiotic product may represent an unconventional method to reduce candidal colonization, to prevent oral candidosis in patients with Sjogren's syndrome.Clinical trials registration ID NCT03840538 (https://clinicaltrials.gov/show/NCT03840538).
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Affiliation(s)
- Yasmine Kamal
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Mahmoud Kandil
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham Yousef
- Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Basma Elsaadany
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
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Cortes-Troncoso J, Jang SI, Perez P, Hidalgo J, Ikeuchi T, Greenwell-Wild T, Warner BM, Moutsopoulos NM, Alevizos I. T cell exosome-derived miR-142-3p impairs glandular cell function in Sjögren's syndrome. JCI Insight 2020; 5:133497. [PMID: 32376798 DOI: 10.1172/jci.insight.133497] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects exocrine salivary and lacrimal glands. Local inflammation in the glands is thought to trigger glandular dysfunction and symptoms of dryness. However, the mechanisms underlying these processes are incompletely understood. Our work suggests T cell exosome-derived miR-142-3p as a pathogenic driver of immunopathology in SS. We first document miR-142-3p expression in the salivary glands of patients with SS, both in epithelial gland cells and within T cells of the inflammatory infiltrate, but not in healthy volunteers. Next, we show that activated T cells secreted exosomes containing miR-142-3p, which transferred into glandular cells. Finally, we uncover a functional role of miR-142-3p-containing exosomes in glandular cell dysfunction. We find that miR-142-3p targets key elements of intracellular Ca2+ signaling and cAMP production - sarco(endo)plasmic reticulum Ca2+ ATPase 2b (SERCA2B), ryanodine receptor 2 (RyR2), and adenylate cyclase 9 (AC9) - leading to restricted cAMP production, altered calcium signaling, and decreased protein production from salivary gland cells. Our work provides evidence for a functional role of the miR-142-3p in SS pathogenesis and promotes the concept that T cell activation may directly impair epithelial cell function through secretion of miRNA-containing exosomes.
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Affiliation(s)
- Juan Cortes-Troncoso
- Sjögren's Syndrome and Salivary Gland Dysfunction Unit.,Oral Immunity and Inflammation Section, and
| | - Shyh-Ing Jang
- Sjögren's Syndrome and Salivary Gland Dysfunction Unit
| | - Paola Perez
- Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research (NIDCR), NIH, Bethesda, Maryland, USA
| | - Jorge Hidalgo
- Program of Physiology and Biophysics, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
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Cinoku II, Mavragani CP, Moutsopoulos HM. Atherosclerosis: Beyond the lipid storage hypothesis. The role of autoimmunity. Eur J Clin Invest 2020; 50:e13195. [PMID: 31868918 DOI: 10.1111/eci.13195] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022]
Abstract
Atherosclerosis has long been considered as a lipid storage disease. Recent data suggest that autoimmune mechanisms seem to be involved in the pathophysiology of atherosclerosis. The presence of activated endothelial vascular cells, neutrophils, macrophages, T and to a lesser extent B cells in atherosclerotic plaques, together with the proinflammatory cytokine burden suggest mobilization of both innate and adaptive immune pathways in atherosclerosis pathobiology. The development of antibodies to oxidized low-density lipoprotein (ox-LDL), the experimental induction of atherosclerosis either via the transfer of T cells or immunization with autoantigens such as β2 glycoprotein Ι (β2-GPI) and heat shock proteins (HSP) further support the autoimmune nature of atherosclerosis. However, classical immunosuppressive and immune-modulatory drugs, successfully used in the therapy of autoimmune rheumatic diseases have shown limited benefits so far in the treatment of atherosclerosis.
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Affiliation(s)
- Ilir I Cinoku
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos M Moutsopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Academy of Athens, Athens, Greece
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Mavragani CP, Moutsopoulos HM. Sjögren's syndrome: Old and new therapeutic targets. J Autoimmun 2019; 110:102364. [PMID: 31831255 DOI: 10.1016/j.jaut.2019.102364] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 02/09/2023]
Abstract
Sjögren's syndrome (SS) is a prototype autoimmune disease characterized by oral and ocular mucosal dryness following chronic inflammation of salivary and lachrymal glands, respectively. Profound B cell hyperactivity along with systemic manifestations including fatigue, musculoskeletal complaints, features related to hepatic, pulmonary, renal and nervous system involvement, as well as lymphoma development can be also present. Despite that activation of both innate and adaptive immune pathways has been long well documented in SS pathogenesis, systemic immunosuppression in SS, in contrast to other autoimmune diseases, has been largely inefficacious. Biological agents previously implemented in successful therapeutic outcomes in rheumatoid arthritis (RA), such as anti-TNF agents, anakinra, tocilizumab and rituximab failed to reach primary outcomes in randomized double-blind controlled trials in the context of SS. Abatacept and belimumab, already licensed for the treatment of RA and lupus respectively, as well combination regimens of both rituximab and belimumab hold some promise in alleviation of SS-specific complaints, but data from large controlled trials are awaited. Recent advances in dissecting the molecular pathways underlying SS pathogenesis led to an expanding number of novel biological compounds directed towards type I interferon system, antigen presentation, costimulatory pathways, B and T cell activation, as well as germinal center formation. While targeting of cathepsin-S (Petesicatib), inducible costimulator of T cells ligand (prezalumab), and lymphotoxin beta receptor (baminercept) failed to fulfil the primary outcome measures, preliminary results from two randomized placebo controlled trials on CD40 blockade (Iscalimab) and B-cell activating factor receptor (Ianalumab) inhibition resulted in significant reduction of SS disease activity, with a favorable so far safety profile. Results from administration of other kinase inhibitors, a transmembrane activator and calcium-modulator and cytophilin ligand interactor TACI fusion protein (RC18), as well as low dose recombinant interleukin-2 to expand T-regulatory cells are currently awaited.
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Affiliation(s)
- Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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9
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Risk factors for caries development in primary Sjogren syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:117-122. [DOI: 10.1016/j.oooo.2019.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 01/21/2023]
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10
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Vivino FB, Bunya VY, Massaro-Giordano G, Johr CR, Giattino SL, Schorpion A, Shafer B, Peck A, Sivils K, Rasmussen A, Chiorini JA, He J, Ambrus JL. Sjogren's syndrome: An update on disease pathogenesis, clinical manifestations and treatment. Clin Immunol 2019; 203:81-121. [PMID: 31022578 DOI: 10.1016/j.clim.2019.04.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Frederick B Vivino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Vatinee Y Bunya
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Giacomina Massaro-Giordano
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Chadwick R Johr
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Stephanie L Giattino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Annemarie Schorpion
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Brian Shafer
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Ammon Peck
- Department of Infectious Diseases and Immunology, University of Florida College of Veterinary Medicine, PO Box 100125, Gainesville, FL 32610, USA.
| | - Kathy Sivils
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - John A Chiorini
- NIH, Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research, Building 10, Room 1n113, 10 Center DR Msc 1190, Bethesda, MD 20892-1190, USA.
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - Julian L Ambrus
- Division of Allergy, Immunology and Rheumatology, SUNY at Buffalo School of Medicine, 100 High Street, Buffalo, NY 14203, USA.
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Lee CP, Hsu PY, Su CC. Increased prevalence of Sjogren's syndrome in where soils contain high levels of chromium. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 657:1121-1126. [PMID: 30677879 DOI: 10.1016/j.scitotenv.2018.12.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 05/25/2023]
Abstract
Previously, we showed that farm soil levels of chromium were strongly correlated with people's serum chromium levels and an increase (3.6 fold) in both the incidence and prevalence of sicca syndrome in areas where farm soil chromium was high. Because Sjogren's syndrome (SS) is the major disease causing a dry mouth and dry eyes, we aimed in the study to investigate whether these areas with high soil chromium have a high SS prevalence. We used a database from the authority in charge of catastrophic illness certificates. Heavy metal concentrations in farm soils were retrieved from nationwide surveys. We used spatial regression models to study the relationships between the SS prevalence and soil metal concentrations. There were 11,220 people, 1165 men and 10,055 women who received a SS certificate from 2000 to 2011. The SS prevalence was 31 per 105 people, 5.59 for men and 55.01 for women. The highest SS prevalence in Taiwan (53 per 105) was located in an area where farm soils contain the highest amounts of chromium. In contrast, other types of heavy metal did not show such a strong association. In conclusion, the SS prevalence is significantly increased in areas where soils contain high levels of chromium. Chromium is likely a risk for SS.
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Affiliation(s)
- Chien-Pang Lee
- Department of Maritime Information and Technology, National Kaohsiung University of Science and Technology, Kaohsiung City, Taiwan
| | - Peng-Yang Hsu
- Section of Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Che-Chun Su
- Section of Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
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Bone Morphogenetic Protein 6 Inhibits the Immunomodulatory Property of BMMSCs via Id1 in Sjögren's Syndrome. Stem Cells Int 2018; 2018:9837035. [PMID: 30174696 PMCID: PMC6098892 DOI: 10.1155/2018/9837035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/19/2018] [Indexed: 12/29/2022] Open
Abstract
Mesenchymal stem cells (MSCs) treatment has emerged as a promising approach for treating Sjögren's syndrome (SS). Impaired immunoregulatory activities of bone marrow mesenchymal stem cells (BMMSCs) are found in both SS patients and animal models, and the underlying mechanism is poorly understood. Increased expression of BMP6 is reported to be related to SS. The aim herein was to determine the effects of BMP6 on BMMSCs function. BMMSCs were isolated from SS patients and NOD mice and showed a high level of BMP6 expression. The effects of BMP6 on BMMSCs function were investigated using in vitro BMMSCs differentiation and in vitro and in vivo T cell proliferation and polarization assays. BMP6 increased osteogenic differentiation of BMMSCs and inhibited the immunomodulatory properties of BMMSCs. BMP6 enhanced T cell proliferation and Th1/Th17 differentiation in a T cell-BMMSC coculture system. Mechanistically, BMP6 downregulated PGE2 and upregulated IFN-gamma via Id1 (inhibitor of DNA-binding protein 1). Neutralizing BMP6 and knockdown of Id1 could restore the BMMSCs immunosuppressive function both in vitro and in vivo. The present results suggest a novel role of Id1 in BMP-mediated MSCs function, which may contribute to a better understanding of the mechanism of action of MSCs in treating autoimmune diseases.
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Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by lymphocytic and plasmacytic infiltration of the exocrine glands. Tubulointerstitial nephritis (TIN) is the most common type of renal involvement in pSS. However, clinically significant renal involvement is uncommon. Granulomatous interstitial nephritis (GIN) is a rare histopathological entity characterized by the presence of granulomas against a background of interstitial inflammation. GIN is not a typical and commonly seen form of TIN in pSS. Herein, we report on a patient who was concurrently diagnosed with pSS and GIN and was treated successfully with rituximab (RTX). pSS should be considered in the differential diagnosis of GIN, and RTX may be a good option in the treatment of this patient group.
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Chao WC, Lin CH, Liao TL, Chen YM, Hsu CY, Chen JP, Chen DY, Chen HH. The risk of nontuberculous mycobacterial infection in patients with Sjögren's syndrome: a nationwide, population-based cohort study. BMC Infect Dis 2017; 17:796. [PMID: 29282007 PMCID: PMC5745909 DOI: 10.1186/s12879-017-2930-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacterial (NTM) infection in immunocompromized patients is currently a growing health concern, and we aimed to examine the relative risk of NTM infection in patients with Sjögren's syndrome (SS) compared with that in non-SS individuals. METHODS We used the 2003-2012 Taiwanese National Health Insurance Research Database to identify 6554 incident SS cases during 2007-2012 and selected 98,310 non-SS controls matched (1:15) for age, gender, and the year of first SS diagnosis date after excluding those who had rheumatoid arthritis or systemic lupus erythematosus. RESULTS We identified four NTM-infected patients in the SS group (three in the first year) and nine in the non-SS group (three in the first year). SS patients had a higher incidence rate of NTM infection than that in non-SS individuals (IRR, 7.56; 95% CI, 2.33-24.55), especially during the first year (IRR, 16.05; 95% CI, 3.24-79.51). After adjusting for potential confounders, the risk of NTM infection was not increased in SS patients during the entire follow-up period or during the first year, but the risk increased in SS patients treated with immunosuppressants during the entire follow-up period (HR, 17.77; 95% CI, 4.53-69.61), especially during the first year (HR, 33.33; 95% CI, 4.37-254.23). CONCLUSION An increased risk of NTM infection was found in SS patients treated with immunosuppressants during the first year after SS diagnosis.
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Affiliation(s)
- Wen-Cheng Chao
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.,Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Business Administration, National Changhua University of Education, Changhua, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiann-Yi Hsu
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
| | - Jun-Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan
| | - Der-Yuan Chen
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.,Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan. .,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan. .,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. .,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
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15
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Demarchi J, Papasidero S, Medina MA, Klajn D, Chaparro Del Moral R, Rillo O, Martiré V, Crespo G, Secco A, Catalan Pellet A, Amitrano C, Crow C, Asnal C, Pucci P, Caeiro F, Benzanquen N, Pirola JP, Mayer M, Zazzetti F, Velez S, Barreira J, Tamborenea N, Santiago L, Raiti L. Primary Sjögren's syndrome: Extraglandular manifestations and hydroxychloroquine therapy. Clin Rheumatol 2017; 36:2455-2460. [PMID: 28913747 DOI: 10.1007/s10067-017-3822-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 12/25/2022]
Abstract
The use of hydroxychloroquine (HCQ) in Primary Sjögren's Syndrome (pSS) has been assessed in different studies over the last years, with conflicting results regarding its efficacy in sicca syndrome and extraglandular manifestations (EGM). The goal of this study was to compare the incidence rate of EGM in pSS patients with and without HCQ therapy.We performed a multicenter retrospective study, including patients with pSS (European classification criteria) with at least 1 year of follow-up. Subjects with concomitant fibromyalgia, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Demographics and pSS characteristics were recorded. The EGM were defined by EULAR-SS disease activity index (ESSDAI). Patients were divided into two groups according to their use or not of HCQ therapy. We evaluated the use of HCQ and its relationship to EGM. HCQ therapy was defined as the continuous use of the drug for at least 3 months. A descriptive analysis of demographics and pSS characteristics was performed. We compared the incidence of EGM between groups defined by HCQ therapy using chi2 test or Fisher's exact test. A total of 221 patients were included (97.3% women), mean age, 55.7 years (SD 14). Mean age at diagnosis, 48.8 years (SD 15); median disease duration, 60 months (IQR 35-84). One hundred and seventy patients (77%) received HCQ. About half of the patients had at least one EGM during the course of the disease, 20% of them developed an EGM before the onset of the sicca syndrome and 26% simultaneously with dryness symptom. Overall, EGM were less frequent in those on HCQ therapy (36.5% vs 63.5%, p < 0.001). Considering each EGM individually, the following manifestations were more frequent in the non-treated group: arthritis (p < 0.001), fatigue (p < 0.001), purpura (p = 0.01), Raynaud phenomenon (p = 0.003), and hypergammaglobulinemia (p = 0.006). Immunosuppressive treatment was indicated on 28 patients (12.7%), 13 of which were receiving also HCQ. The first reason for those treatments was the presence of arthritis in 12/28 patients (42.8%), and the drug used in all the cases was methotrexate. Only three patients required immunosuppressive therapy with cyclophosphamide, due to the presence of glomerulonephritis, vasculitis, and interstitial lung disease. None of the patients received biologic therapy. The lower incidence of EGM was observed in patients on HCQ therapy supports its efficacy in pSS. However, further large scale prospective studies are needed to confirm these findings.
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Affiliation(s)
- J Demarchi
- Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina.
| | - S Papasidero
- Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina
| | - M A Medina
- Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina
| | - D Klajn
- Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina
| | | | - O Rillo
- Hospital General de Agudos Dr. E. Tornú, Buenos Aires, Argentina
| | - V Martiré
- Hospital B. Rivadavia, Buenos Aires, Argentina
| | - G Crespo
- Hospital B. Rivadavia, Buenos Aires, Argentina
| | - A Secco
- Hospital B. Rivadavia, Buenos Aires, Argentina
| | | | - C Amitrano
- Hospital Alemán, Buenos Aires, Argentina
| | - C Crow
- Hospital Alemán, Buenos Aires, Argentina
| | - C Asnal
- Hospital Alemán, Buenos Aires, Argentina
| | - P Pucci
- Hospital Alemán, Buenos Aires, Argentina
| | - F Caeiro
- Hospital Privado de Córdoba, Córdoba, Argentina
| | | | - J P Pirola
- Hospital Privado de Córdoba, Córdoba, Argentina
| | - M Mayer
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - F Zazzetti
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - S Velez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - J Barreira
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - N Tamborenea
- Organización Médica de Investigación (OMI), Buenos Aires, Argentina
| | - L Santiago
- Organización Médica de Investigación (OMI), Buenos Aires, Argentina
| | - L Raiti
- Clínica Bessone, Buenos Aires, Argentina
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16
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Giacomelli R, Afeltra A, Alunno A, Baldini C, Bartoloni-Bocci E, Berardicurti O, Carubbi F, Cauli A, Cervera R, Ciccia F, Cipriani P, Conti F, De Vita S, Di Benedetto P, Doria A, Drosos AA, Favalli EG, Gandolfo S, Gatto M, Grembiale RD, Liakouli V, Lories R, Lubrano E, Lunardi C, Margiotta DPE, Massaro L, Meroni P, Minniti A, Navarini L, Pendolino M, Perosa F, Pers JO, Prete M, Priori R, Puppo F, Quartuccio L, Ruffatti A, Ruscitti P, Russo B, Sarzi-Puttini P, Shoenfeld Y, Somarakis GA, Spinelli FR, Tinazzi E, Triolo G, Ursini F, Valentini G, Valesini G, Vettori S, Vitali C, Tzioufas AG. International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)? Autoimmun Rev 2017; 16:911-924. [DOI: 10.1016/j.autrev.2017.07.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 02/06/2023]
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17
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Chang CC, Chang YS, Wang SH, Lin SY, Chen YH, Chen JH. Primary Sjogren's syndrome and the risk of acute pancreatitis: a nationwide cohort study. BMJ Open 2017; 7:e014807. [PMID: 28801391 PMCID: PMC5724124 DOI: 10.1136/bmjopen-2016-014807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Studies on the risk of acute pancreatitis in patients with primary Sjogren's syndrome (pSS) are limited. We evaluated the effects of pSS on the risk of acute pancreatitis in a nationwide, population-based cohort in Taiwan. STUDY DESIGN Population-based retrospective cohort study. SETTING We studied the claims data of the >97% Taiwan population from 2002 to 2012. PARTICIPANTS We identified 9468 patients with pSS by using the catastrophic illness registry of the National Health Insurance Database in Taiwan. We also selected 37 872 controls that were randomly frequency matched by age (in 5 year bands), sex and index year from the general population. PRIMARY OUTCOME MEASURE We analysed the risk of acute pancreatitis by using Cox proportional hazards regression models including sex, age and comorbidities. RESULTS From 23.74 million people in the cohort, 9468 patients with pSS (87% women, mean age=55.6 years) and 37 872 controls were followed-up for 4.64 and 4.74 years, respectively. A total of 44 cases of acute pancreatitis were identified in the pSS cohort versus 105 cases in the non-pSS cohort. Multivariate Cox regression analysis indicated that the incidence rate of acute pancreatitis was significantly higher in the pSS cohort than in the non-pSS cohort (adjusted HR (aHR) 1.48, 95% CI 1.03 to 2.12). Cyclophosphamide use increased the risk of acute pancreatitis (aHR 5.27, 95% CI 1.16 to 23.86). By contrast, hydroxychloroquine reduced the risk of acute pancreatitis (aHR 0.23, 95% CI 0.09 to 0.55). CONCLUSION This nationwide, retrospective cohort study demonstrated that the risk of acute pancreatitis was significantly higher in patients with pSS than in the general population.
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Affiliation(s)
- Chi-Ching Chang
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Hung Wang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shyr-Yi Lin
- Department of Primary Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsuan Chen
- Biostatistics Centre College of Management, Taipei Medical University, Taipei, Taiwan
| | - Jin Hua Chen
- Biostatistics Centre College of Management, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
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18
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Kim M, Kim HS, Na KS. Correlation between Tear Osmolarity and Other Ocular Surface Parameters in Primary Sjögren's Syndrome. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:25-31. [PMID: 28243020 PMCID: PMC5327171 DOI: 10.3341/kjo.2017.31.1.25] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To investigate the relationships between tear osmolarity and other ocular surface parameters and to determine the diagnostic value of tear osmolarity in primary Sjögren's syndrome (SS) using tear film break-up time, Schirmer I test, and cornea/conjunctiva staining. METHODS We included 310 eyes of 155 patients diagnosed with dry eye disease (39 primary SS and 116 non-Sjögren dry eye disease) at Seoul St. Mary's Hospital from August 2010 to January 2015. All subjects completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent ocular examinations including tear osmolarity (TearLab Osmolarity System), Schirmer I test, slit lamp examination for tear film break-up time, and corneal and conjunctival fluorescein staining. We used the mean value of both eyes for all parameters. Fluorescein staining was assessed using the Sjögren's International Collaborative Clinical Alliance ocular staining score (OSS). RESULTS In primary SS patients (n = 39), the mean subject age was 52.5 ± 11.9 years, and 94.9% of the subjects were women. Mean tear osmolarity in SS was 311.1 ± 16.4 mOsm/L, with 16 (41.0%) subjects having values ≥316 mOsm/L. In SS, there was a positive correlation between mean tear osmolarity and OSDI score (ρ = 0.405, p = 0.011) and OSS (ρ = 0.592, p < 0.001). There was a negative correlation between mean tear osmolarity and the Schirmer I test (ρ = -0.625, p < 0.001). There was no significant correlation between mean tear osmolarity and tear film break-up time in SS (ρ = 0.110, p = 0.505). CONCLUSIONS Tear osmolarity measurements using the TearLab Osmolarity System can reflect both symptom severity (OSDI) and objective signs (Schirmer test and OSS) in SS.
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Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Sun Na
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Zhang Q, Wang X, Chen H, Shen B. Sjögren's syndrome is associated with negatively variable impacts on domains of health-related quality of life: evidence from Short Form 36 questionnaire and a meta-analysis. Patient Prefer Adherence 2017; 11:905-911. [PMID: 28546741 PMCID: PMC5436777 DOI: 10.2147/ppa.s132751] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this article was to systematically review the literature to identify the impact of primary Sjögren's syndrome (pSS) on specific health-related quality of life (HRQoL) domains. METHODS A meta-analysis was performed, and the related articles were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine, and Web of Science databases and in reference lists of articles and systematic reviews. Score of the Short Form 36 (SF-36) questionnaire was used as the outcome measurement, and mean differences (MD) with 95% confidence intervals (CIs) were calculated. RESULTS Seven studies were included, comprising 521 patients with pSS and 9,916 healthy controls. The SF-36 questionnaire score of each domain (physical function, role physical [RP] function, emotional role function, vitality, mental health, social function, body pain, general health, physical component scale, mental component scale) was lower in patients with pSS than in healthy controls, especially the score in the dimension of RP function. CONCLUSION This meta-analysis showed that patients had lower pSS score in each dimension of the SF-36, mostly in the RP function. This demonstrated that targeted interventions should be carried out to improve the HRQoL of pSS patients.
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Affiliation(s)
- Qiuxiang Zhang
- Department of Nursing, The Second Affiliated Hospital of Nantong University
- School of Nursing, Nantong University
| | - Xulin Wang
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Haoyang Chen
- Department of Nursing, The Second Affiliated Hospital of Nantong University
- School of Nursing, Nantong University
| | - Biyu Shen
- Department of Nursing, The Second Affiliated Hospital of Nantong University
- Correspondence: Biyu Shen, Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People’s Republic of China, Tel/fax +86 513 8506 1318, Email
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20
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Lee J, Koh JH, Kwok SK, Park SH. Translation and Validation of a Korean Version of the Xerostomia Inventory in Patients with Primary Sjögren's Syndrome. J Korean Med Sci 2016; 31:724-8. [PMID: 27134493 PMCID: PMC4835597 DOI: 10.3346/jkms.2016.31.5.724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/16/2016] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to generate and validate a cross-culturally adapted Korean version of the xerostomia inventory (XI), an 11-item questionnaire designed to measure the severity of xerostomia. The original English version of the XI was translated into Korean according to the guidelines for cross-cultural adaptation of health-related quality-of-life measures. Among a prospective cohort of primary Sjögren's syndrome (pSS) in Korea, 194 patients were analyzed. Internal consistency was evaluated by using Cronbach's alpha, and test-retest reliability was obtained by using an intraclass correlation coefficient (ICC) analysis. Construct validity was investigated by performing a correlation analysis between XI total score and salivary flow rate (SFR). Cronbach's alpha for internal consistency was 0.868, and the ICC for test-retest reliability ranged from 0.48 to 0.827, with a median value of 0.72. Moderate negative correlations between XI score and stimulated SFR, unstimulated SFR, and differential (stimulated minus unstimulated) SFR were observed (Spearman's rho, ρ = -0.515, -0.447, and -0.482, respectively; P < 0.001). The correlation analysis between the visual analogue scale (VAS) score of overall dryness and SFR indicated a smaller ρ value (-0.235 [P = 0.006], -0.243 [P = 0.002], and -0.252 [P = 0.003], respectively), which supports that XI more accurately reflects the degree of xerostomia in the pSS patients. In conclusion, the Korean version of the XI is a reliable tool to estimate the severity of xerostomia in patients with pSS.
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Affiliation(s)
- Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
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Li H, Sun X, Zhang J, Sun Y, Huo R, Li H, Zhai T, Shen B, Zhang M, Li N. Paeoniflorin ameliorates symptoms of experimental Sjogren's syndrome associated with down-regulating Cyr61 expression. Int Immunopharmacol 2016; 30:27-35. [DOI: 10.1016/j.intimp.2015.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/31/2015] [Accepted: 11/18/2015] [Indexed: 11/25/2022]
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22
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Santiago ML, Seisdedos MR, Garcia Salinas RN, Catalán Pellet A, Villalón L, Secco A. Utilidad de los anticuerpos y de la biopsia de glándula salival menor en el estudio del complejo sicca en la práctica diaria. ACTA ACUST UNITED AC 2015; 11:156-60. [DOI: 10.1016/j.reuma.2014.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/02/2014] [Accepted: 06/06/2014] [Indexed: 10/24/2022]
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23
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Peric T, Markovic D, Petrovic B, Radojevic V, Todorovic T, Radicevic BA, Heinemann RJ, Susic G, Popadic AP, Spiric VT. Efficacy of pastes containing CPP-ACP and CPP-ACFP in patients with Sjögren’s syndrome. Clin Oral Investig 2015; 19:2153-65. [DOI: 10.1007/s00784-015-1444-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/25/2015] [Indexed: 11/27/2022]
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Madero-Visbal R, Milas Z. The role of parotidectomy in Sjögren's syndrome. Oral Maxillofac Surg Clin North Am 2014; 26:83-90. [PMID: 24287196 DOI: 10.1016/j.coms.2013.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sjögren's syndrome, a chronic and progressive autoimmune disorder mainly characterized by xerophthalmia, xerostomia, and parotid enlargement, is primarily managed medically, but some patients will require surgical management. Patients with Sjögren's syndrome have an increased risk of non-Hodgkin lymphoma. Superficial parotidectomy is indicated for diagnostic purposes and can be therapeutic in limited circumstances. Surgical indications for parotidectomy in Sjögren's syndrome include recurrent parotitis refractory to medical management; salivary gland malignancy; and severe, refractory pain. Surgical complications include transient or permanent facial nerve injury, post-operative pain, persistent inflammation of remnant parotid tissue, Frey syndrome, and facial scarring.
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Affiliation(s)
- Rafael Madero-Visbal
- MD Anderson Cancer Center, Orlando, 1400 S Orange Avenue, Orlando, FL 32806, USA
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25
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Sjögren's syndrome: A forty-year scientific journey. J Autoimmun 2014; 51:1-9. [DOI: 10.1016/j.jaut.2014.01.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/01/2014] [Indexed: 12/16/2022]
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26
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New advances in the classification, pathogenesis and treatment of Sjogren's syndrome. Curr Opin Rheumatol 2014; 25:623-9. [PMID: 23846338 DOI: 10.1097/bor.0b013e328363eaa5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW In the current review, we summarize the newly proposed classification criteria for Sjogren's syndrome, recent findings of Sjogren's syndrome pathogenesis and the latest achievements in disease management. RECENT FINDINGS A new set of Sjogren's syndrome classification criteria has been recently proposed by an expert consensus panel of the American College of Rheumatology-Sjögren's International Collaborative Clinical Alliance. Recent findings reveal new aspects in the activation of innate and adaptive immune pathways and novel animal models - highly reminiscent of human Sjogren's syndrome-are described. Of particular note, apoptosis of epithelial cells as a result of deficient IκBζ, previously shown to be a modulator of NFκB activity, has been suggested as a central pathogenetic event. Mechanistic data on anti-B-cell therapies, gene transfer approaches aimed to restore secretory function, as well mesenchymal stem cell transplantation in mice and humans are also discussed. SUMMARY Over the last year, a new set of classification criteria for Sjogren's syndrome has been suggested, new Sjogren's syndrome-like animal models have been described and significant progress has been made in understanding the activation of innate and adaptive immune responses. New therapeutic approaches have been also implemented with variable success.
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27
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Affiliation(s)
- Clio P Mavragani
- Departments of Physiology (Mavragani) and Pathophysiology (Moutsopoulos), Faculty of Medicine, University of Athens, Athens, Greece
| | - Haralampos M Moutsopoulos
- Departments of Physiology (Mavragani) and Pathophysiology (Moutsopoulos), Faculty of Medicine, University of Athens, Athens, Greece
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28
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Napeñas JJ, Rouleau TS. Oral Complications of Sjögren's Syndrome. Oral Maxillofac Surg Clin North Am 2014; 26:55-62. [DOI: 10.1016/j.coms.2013.09.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Motta D, Yamasaki L, Sanches O, Giuffrida R, Cândido E, Pereira C, Góes J, Rocha T, Silva DA, Silva M, Basso K, Andrade S. Comparação entre dois protocolos de tratamento de ceratoconjuntivite seca experimentalmente induzida em coelhos. ARQ BRAS MED VET ZOO 2014. [DOI: 10.1590/s0102-09352014000100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi avaliar e comparar a eficácia de dois protocolos de tratamento de ceratoconjuntivite seca (CCS) experimentalmente induzida em coelhos: uma formulação oftálmica tópica composta por álcool polivinílico 1,4%, adicionado com acetilcisteína 10% e pilocarpina 1% (AAP), e outro protocolo com o uso do óleo de semente de linhaça (OL) tópico em forma de colírio, durante 12 semanas. Foram utilizados 15 coelhos machos, adultos, da raça Nova Zelândia, alocados aleatoriamente em três grupos: grupo C (controle), grupo AAP (formulação oftálmica) e grupo L (OL tópica). Os animais foram avaliados semanalmente pelo teste lacrimal de Schirmer, teste de fluoresceína e teste de Rosa Bengala; uma vez por mês, pelo exame de citologia esfoliativa ocular; ao final do experimento, pela análise histopatológica da córnea e conjuntiva. Os resultados demonstraram que houve um aumento maior na produção lacrimal quando utilizada a formulação oftálmica, e uma resolução mais rápida das úlceras de córnea, bem como diminuição no número de células desvitalizadas quando utilizado o óleo de semente de linhaça, além de aumento no número de células caliciformes em ambos os grupos de tratamento. A associação desses dois protocolos pode ser no futuro uma alternativa no tratamento da CCS.
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Ramos-Casals M, Brito-Zerón P. New approaches in Sjögren’s syndrome therapy. Expert Rev Clin Immunol 2014; 3:195-204. [DOI: 10.1586/1744666x.3.2.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Komai K, Shiozawa K, Tanaka Y, Yoshihara R, Tanaka C, Sakai H, Yamane T, Murata M, Tsumiyama K, Hashiramoto A, Shiozawa S. Sjögren’s syndrome patients presenting with hypergammaglobulinemia are relatively unresponsive to cevimeline treatment. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0176-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nakayamada S, Saito K, Umehara H, Ogawa N, Sumida T, Ito S, Minota S, Nara H, Kondo H, Okada J, Mimori T, Yoshifuji H, Sano H, Hashimoto N, Sugai S, Tanaka Y. Efficacy and safety of mizoribine for the treatment of Sjögren's syndrome: a multicenter open-label clinical trial. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0627-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jensen DH, Oliveri RS, Trojahn Kølle SF, Fischer-Nielsen A, Specht L, Bardow A, Buchwald C. Mesenchymal stem cell therapy for salivary gland dysfunction and xerostomia: a systematic review of preclinical studies. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:335-342.e1. [PMID: 24528792 DOI: 10.1016/j.oooo.2013.11.496] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/27/2013] [Accepted: 11/14/2013] [Indexed: 12/14/2022]
Abstract
The most severe forms of xerostomia and salivary gland dysfunction, as well as a severely reduced quality of life, are seen in Sjögren syndrome (SS) and after radiotherapy for head and neck cancer. For both conditions, no effective regenerative therapies yet exist. Thus, the aim of this article was to assess, through systematic review, the potential benefit of mesenchymal stem cell (MSC) therapy in radiation-induced and SS-related salivary gland dysfunction and xerostomia. We searched PubMed/MEDLINE, Embase, Web of Science, the Cochrane Database of Systematic Reviews, the World Health Organization Clinical Trials Registry Platform, and Google Scholar. We identified 6 separate study comparisons eligible for inclusion. Owing to the limited number of studies, we conclude that more randomized, adequately powered clinical trials are needed to validate the potential beneficial effect of MSCs on salivary gland dysfunction and xerostomia. Nonetheless, the preliminary studies identified in the present review were encouraging for further research.
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Affiliation(s)
- David Hebbelstrup Jensen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Roberto Stefan Oliveri
- Cell Therapy Facility, Blood Bank, Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stig-Frederik Trojahn Kølle
- Department of Plastic Surgery, Breast Surgery & Burns, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne Fischer-Nielsen
- Cell Therapy Facility, Blood Bank, Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Allan Bardow
- Department of Oral Medicine, School of Dentistry, University of Copenhagen, Copenhagen, Denmark
| | - Christian Buchwald
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ansari H, Weinberg L, Spencer N. Toxic epitheliopathy from a single application of preservative free oxybuprocaine (0.4%) in a patient with Sjogren's syndrome. BMJ Case Rep 2013; 2013:bcr2013010487. [PMID: 24038291 PMCID: PMC3794119 DOI: 10.1136/bcr-2013-010487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Topical ocular anaesthetic agents are frequently used for ophthalmic diagnosis and surgery. While corneal complications following long-term use or misuse of local anaesthetic solutions have been described, toxic epitheliopathy after a single application of six drops of preservative free oxybuprocaine is rare. In order to increase the awareness of this ocular complication, we report such a case in a patient with Sjogren's syndrome who presented for elective cataract surgery. We outline the mechanisms proposed to explain the ocular toxic effects of oxybuprocaine and discuss the management principles in preventing this complication in the context of Sjogren's syndrome.
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Affiliation(s)
- Humaira Ansari
- Department of Medicine, The Northern Hospital, Epping, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Narelle Spencer
- Department of Ophthalmology, Austin Hospital, Heidelberg, Victoria, Australia
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Cho HJ, Yoo JJ, Yun CY, Kang EH, Lee HJ, Hyon JY, Song YW, Lee YJ. The EULAR Sjogren's syndrome patient reported index as an independent determinant of health-related quality of life in primary Sjogren's syndrome patients: in comparison with non-Sjogren's sicca patients. Rheumatology (Oxford) 2013; 52:2208-17. [DOI: 10.1093/rheumatology/ket270] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Martinez Sanchez LM, Cardona Velez J, Vargas Grisales N, Rojas Londoño J, Rodríguez Gázquez MDLÁ. Perfil clínico y epidemiológico de pacientes con síndrome de Sjögren concomitante a artritis reumatoide. MEDUNAB 2013. [DOI: 10.29375/01237047.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
El Síndrome de Sjögren es una enfermedad crónica autoinmune en la cual se ven alteradas las glándulas mucosas del organismo, caracterizada principalmente por sequedad oral (xerostomía) y ocular (xeroftalmia). Objetivo. Describir el perfil clínico y epidemiológico de pacientes con Sjögren concomitante a Artritis Reumatoide en una Clínica privada de la ciudad de Medellín-Colombia. 2005- 2010. Metodología. Estudio descriptivo del tipo de series clínicas en el que se estudiaron las historias clínicas de los pacientes atendidos por Sjögren concomitante a Artritis Reumatoide en una clínica privada de Medellín-Colombia. Para el análisis estadístico se utilizó el programa SPSS, a las variables cuantitativas se les calculó el promedio y la desviación estándar, además de los valores mínimo y máximo, y a las variables cualitativas se les estimó proporciones. Resultados. Se estudiaron 23 pacientes los cuales tenían una edad mediana de 55 años y 91.3% eran del sexo femenino. Los síntomas más frecuentemente reportados fueron la xerostomía y la xeroftalmia con un 69.6% y 56.5% respectivamente. Los métodos más empleados para el diagnóstico fueron el Factor Reumatoideo (78.3%) y los anticuerpos antinucleares (69.6%), mientras que los principales medicamentos empleados fueron la cloroquina y la Prednisolona (cada uno con 52.2%). Conclusión. Sjögren concomitante a Artritis fue encontrado más comúnmente en el sexo femenino. Las manifestaciones clínicas más frecuentes fueron la xerostomía y xeroftalmia y la mediana del tiempo de diagnóstico fue de 61 meses. Es necesario seguir ahondando en el tema para caracterizar mejor aquellos pacientes con Sjögren y otra enfermedad inmunológica de base.
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Mays JW, Sarmadi M, Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract 2013; 12:265-82. [PMID: 23040353 DOI: 10.1016/s1532-3382(12)70051-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Systemic autoimmune and inflammatory diseases often manifest oral lesions in their earliest stages, and early diagnosis, which may be spurred by a dental examination, is key for improved outcomes. After systemic diagnosis, oral lesions benefit from specialized care by dentists in collaboration with the medical team. This review aims to educate dental clinicians about the most relevant systemic autoimmune and inflammatory conditions with accompanying oral lesions, their implications for health, and management strategies supported by the biomedical literature and clinical experience. Ulcerative conditions including Behcet and Crohn diseases are discussed, along with rheumatic conditions including Sjögren syndrome, lupus erythematosus, and rheumatoid arthritis. EVIDENCE ACQUISITION Evidence was accumulated through PubMed searches using pertinent keywords for each subsection. References were reviewed and original publications examined to verify the accuracy of the information. We focused on evidence included in current reviews and randomized trials. Recommendations were supported by multiple studies and consensus expert opinion. EVIDENCE SYNTHESIS Disease phenotypes described and clinical recommendations were synthesized from best-quality evidence available for each disease. Efforts were made to describe evidence selection within each disease section. CONCLUSIONS Dentists play an important role in the early detection and multidisciplinary medical management of complex autoimmune diseases. It is important to recognize prevalent medical and dental issues and special needs of patients with autoimmune conditions. The management of many inflammatory conditions is similar, and often begins with the use of topical steroids, analgesics, and antimicrobial treatments, in addition to careful attention to oral hygiene and appropriate fluoride usage. In this brief review, we aim to discuss the presentation/prevalence, diagnosis, and treatment of oral manifestations encountered in autoimmune, autoinflammatory and systemic chronic inflammatory diseases. Systemic autoimmune conditions are estimated to affect 5% to 8% of Americans.(1) Oral manifestations are encountered with high frequency, and are often the first clinical signs or symptoms of the general disease. Optimal management of complex autoimmune diseases requires a multidisciplinary medical team including dentists to care for lesions of the oral cavity. The dental practitioner may be asked to play a primary role in the diagnosis of such conditions and to participate with other health professionals working together to achieve effective clinical management. To aid in this process, we discuss in this article the current general knowledge of systemic autoimmune conditions that present with prevalent oral manifestations. The focus is on the diagnosis and management of the oral component of each disease. Importantly, whereas the etiology and pathogenesis and systemic clinical presentation may vary, presentation in the oral cavity is often similar and many conditions involve oral ulcerations. For this reason, we discuss the differential diagnosis and management of the most common oral ulcerations in a general section and subsequently address individual conditions that present with oral ulcerations. Similarly, treatment of various autoimmune/inflammatory oral conditions is often common and involves modulation or suppression of the immune response locally and/or systemically and will be therefore addressed in a common section as well as individually for each disease when unique treatment regimens are recommended. We present here our general treatment recommendations based on clinical experience and literature review; however, it is critical that good clinical judgment and specifics of an individual case should determine the appropriate dental/oral medicine intervention for a specific patient.
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Affiliation(s)
- Jacqueline W Mays
- Clinical Research Core, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
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Choi HN, Choe JY, Kim SH, Kim SK, Ryoo HM, Park SH. Remission of Lymphocytic Interstitial Pneumonia in Sjögren's Syndrome after Autologous Peripheral Blood Stem Cell Transplantation. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Han Na Choi
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Si Hye Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Kyu Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Abstract
Systemic disorders with possible involvement of the nervous system include a variety of diseases with presumed inflammatory and autoimmune pathomechanisms, among them Behçet disease, sarcoidosis, systemic lupus erythematosus, juvenile idiopathic arthritis, scleroderma, and Sjögren syndrome. This disease group encompasses systemic inflammatory disorders with a genetically defined dysregulation of the innate immune system as well as systemic autoimmune disorders characterized by alterations of the adaptive immunity such as autoantibodies and autoreactive T cells. Although more commonly diagnosed in adults, all of these diseases can manifest in childhood and some as early as infancy. Neurological involvement may represent the initial manifestation, and nearly every neurological symptom can be caused by inflammatory/autoimmune diseases. In a child with (sub)acute onset of otherwise unexplained neurological findings, consideration of inflammatory/autoimmune disorders may be of crucial therapeutic and prognostic importance. In the absence of disease-specific clinical features, the initial diagnostic workup is broad. Basic blood tests include inflammatory markers and autoantibodies. Cerebral magnetic resonance imaging and a lumbar puncture with measurement of opening pressure as well as cerebrospinal fluid analysis are indicated in most patients with central nervous system (CNS) involvement. Skin, muscle, or organ biopsies (e.g., renal) may provide additional information. Especially in patients with isolated CNS involvement, a brain biopsy may be indicated. Timely recognition and treatment of CNS inflammation may improve or even reverse clinical symptoms and prevent secondary brain injury.
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Affiliation(s)
- Daniela Pohl
- Department of Neurology, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada.
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Denniston AK, Gayed M, Carruthers D, Gordon C, Murray PI. Rheumatic Disease. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khandelwal D, Bhattacharya S, Khadgawat R, Kaur S, Tandon N, Ammini AC. Hypokalemic paralysis as a presenting manifestation of primary Sjögren's syndrome: A report of two cases. Indian J Endocrinol Metab 2012; 16:853-5. [PMID: 23087883 PMCID: PMC3475923 DOI: 10.4103/2230-8210.100684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease characterized by a progressive lymphocytic infiltration of the exocrine glands with varying degrees of systemic involvement. Overt or latent renal tubular acidosis (RTA), caused by tubulointerstitial nephropathy, is a common extraglandular manifestation of pSS. Hypokalemic paralysis is a well known, albeit rare complication of severe distal RTA from any cause. Cases of pSS manifesting for the first time as hypokalemic paralysis caused by distal RTA have been rarely reported. We herein present our experience of two cases, who presented to us for evaluation of hypokalemic paralysis and on work up found evidence of distal RTA, which on further work up found to be secondary to pSS. A high index of suspicion for pSS should be kept in all patients with hypokalemic paralysis.
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Affiliation(s)
- Deepak Khandelwal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Saptarshi Bhattacharya
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Satbir Kaur
- Department of Clinical Immunology and Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ariachery C. Ammini
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Lida Santiago M, Seisdedos MR, García Salinas RN, Secco A, Marino Claverie L, Techera L, Takashima L, Aicardi P, Sandi Rosales MA, Knobel E, Magri SJ, Catalán Pellet AC. Frecuencia de complicaciones y rédito de la biopsia de glándula salival menor. ACTA ACUST UNITED AC 2012; 8:255-8. [DOI: 10.1016/j.reuma.2012.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 03/18/2012] [Accepted: 03/22/2012] [Indexed: 11/29/2022]
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Pavlakis P, Alexopoulos H, Kosmidis M, Mamali I, Moutsopoulos H, Tzioufas A, Dalakas M. Peripheral neuropathies in Sjögren’s syndrome: A critical update on clinical features and pathogenetic mechanisms. J Autoimmun 2012; 39:27-33. [DOI: 10.1016/j.jaut.2012.01.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/07/2012] [Indexed: 10/14/2022]
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Systemic lupus erythematosus with Sjögren syndrome compared to systemic lupus erythematosus alone: a meta-analysis. J Clin Rheumatol 2012; 18:28-32. [PMID: 22157271 DOI: 10.1097/rhu.0b013e31823ecbdf] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study aimed to compare the difference of the clinical and laboratory features of the patients between the combined systemic lupus erythematosus (SLE) and Sjögren syndrome (SLE-SS) and SLE only. MATERIALS AND METHODS A systematic literature search was performed to identify the articles as to SLE with SS between 1970 and May 2011. The demographics, pertinent clinical, and laboratory data were extracted from 6 publications, and a meta-analysis was performed. The pooled odds ratios and 95% confidence interval were computed for the variability of these parameters between SLE-SS and SLE. RESULTS A total of 6 studies were included, consisting of 2489 patients with SLE and 444 with SLE-SS, and the estimated prevalence of the latter was 17.8%. Patients with SLE-SS were older and more often had associated oral ulcers and arthritis. In contrast, proteinuria (odds ratio = 1.77; 95% confidence interval, 1.39-2.25; P < 0.0001) was more common in SLE alone than SLE-SS, and central nervous system involvement tended to be more common. Anti-double-stranded DNA antibodies were equally prevalent in both groups. Anti-SSA/Ro and anti-SSB/La antibodies were more frequent, and anti-Sm and anti-cardiolipin antibodies were less prevalent in SLE-SS than SLE alone. CONCLUSIONS There are significant variances in certain clinical and laboratory aspects between SLE-SS and SLE. This combined disease of SLE-SS has distinct features with relatively less major internal organ involvement but has more specific autoantibody profile and favorable clinical outcome.
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Hauk V, Calafat M, Larocca L, Fraccaroli L, Grasso E, Ramhorst R, Leirós CP. Vasoactive intestinal peptide/vasoactive intestinal peptide receptor relative expression in salivary glands as one endogenous modulator of acinar cell apoptosis in a murine model of Sjögren's syndrome. Clin Exp Immunol 2012; 166:309-16. [PMID: 22059987 DOI: 10.1111/j.1365-2249.2011.04478.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by a progressive oral and ocular dryness that correlates poorly with the autoimmune damage of the glands. It has been proposed that a loss of homeostatic equilibrium in the glands is partly responsible for salivary dysfunction with acinar cells involved actively in the pathogenesis of SS. The non-obese diabetic (NOD) mouse model of Sjögren's syndrome develops secretory dysfunction and early loss of glandular homeostatic mechanisms, with mild infiltration of the glands. Based on the vasodilator, prosecretory and trophic effects of the vasoactive intestinal peptide (VIP) on acini as well as its anti-inflammatory properties we hypothesized that the local expression of VIP/vasoactive intestinal peptide receptor (VPAC) system in salivary glands could have a role in acinar cell apoptosis and macrophage function thus influencing gland homeostasis. Here we show a progressive decline of VIP expression in submandibular glands of NOD mice with no changes in VPAC receptor expression compared with normal mice. The deep loss of endogenous VIP was associated with a loss of acinar cells through apoptotic mechanisms that could be induced further by tumour necrosis factor (TNF)-α and reversed by VIP through a cyclic adenosine-5'-monophosphate (cAMP)/protein kinase A (PKA)-mediated pathway. The clearance of apoptotic acinar cells by macrophages was impaired for NOD macrophages but a shift from inflammatory to regulatory phenotype was induced in macrophages during phagocytosis of apoptotic acinar cells. These results support that the decline in endogenous VIP/VPAC local levels might influence the survival/apoptosis intracellular set point in NOD acinar cells and their clearance, thus contributing to gland homeostasis loss.
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Affiliation(s)
- V Hauk
- Laboratorio de Inmunofarmacología. Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
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von Geldern G, McPharlin T, Becker K. Immune mediated diseases and immune modulation in the neurocritical care unit. Neurotherapeutics 2012; 9:99-123. [PMID: 22161307 PMCID: PMC3271148 DOI: 10.1007/s13311-011-0096-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This chapter will review the spectrum of immune-mediated diseases that affect the nervous system and may result in an admission to the neurological intensive care unit. Immunomodulatory strategies to treat acute exacerbations of neurological diseases caused by aberrant immune responses are discussed, but strategies for long-term immunosuppression are not presented. The recommendations for therapeutic intervention are based on a synthesis of the literature, and include recommendations by the Cochrane Collaborative, the American Academy of Neurology, and other key organizations. References from recent publications are provided for the disorders and therapies in which randomized clinical trials and large evidenced-based reviews do not exist. The chapter concludes with a brief review of the mechanisms of action, dosing, and side effects of commonly used immunosuppressive strategies in the neurocritical care unit.
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Affiliation(s)
- Gloria von Geldern
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Thomas McPharlin
- University of Washington School of Pharmacy, Seattle, WA 98104 USA
| | - Kyra Becker
- Department of Neurology, University of Washington School of Medicine, Seattle, WA 98104 USA
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Khandelwal D, Bhattacharya S, Gadodia A, Khadgawat R, Tandon N, Ammini AC. Metabolic bone disease as a presenting manifestation of primary Sjögren's syndrome: Three cases and review of literature. Indian J Endocrinol Metab 2011; 15:341-345. [PMID: 22029009 PMCID: PMC3193787 DOI: 10.4103/2230-8210.85599] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease characterized by a progressive lymphocytic infiltration of the exocrine glands with varying degrees of systemic involvement. Chronic inflammation compromises the glands' function that leads to dry symptoms in the mouth/eyes. Renal involvement is a well recognized extraglandular manifestation of pSS. Metabolic bone disease (MBD), however, rarely occurs as the primary manifestation of a renal tubule disorder due to pSS. To the best of our knowledge there are only 6 reported cases of metabolic bone disease as the primary manifestation of pSS to date. Four of these had distal renal tubular acidosis (RTA), and 2 had a combined picture of distal and proximal tubular dysfunction. We herein present our experience of 3 cases who presented to us with a clinical picture suggestive of MBD. While investigating these patients, we found evidence of RTA, which was found to be secondary to pSS.
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Affiliation(s)
- Deepak Khandelwal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Saptarshi Bhattacharya
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Gadodia
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - A. C. Ammini
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Alard JE, Hillion S, Guillevin L, Saraux A, Pers JO, Youinou P, Jamin C. Autoantibodies to endothelial cell surface ATP synthase, the endogenous receptor for hsp60, might play a pathogenic role in vasculatides. PLoS One 2011; 6:e14654. [PMID: 21326874 PMCID: PMC3034716 DOI: 10.1371/journal.pone.0014654] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 01/13/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heat shock protein (hsp) 60 that provides "danger signal" binds to the surface of resting endothelial cells (EC) but its receptor has not yet been characterized. In mitochondria, hsp60 specifically associates with adenosine triphosphate (ATP) synthase. We therefore examined the possible interaction between hsp60 and ATP synthase on EC surface. METHODOLOGY/PRINCIPAL FINDINGS Using Far Western blot approach, co-immunoprecipitation studies and surface plasmon resonance analyses, we demonstrated that hsp60 binds to the β-subunit of ATP synthase. As a cell surface-expressed molecule, ATP synthase is potentially targeted by anti-EC-antibodies (AECAs) found in the sera of patients suffering vasculitides. Based on enzyme-linked immunosorbent assay and Western blotting techniques with F1-ATP synthase as substrate, we established the presence of anti-ATP synthase antibodies at higher frequency in patients with primary vasculitides (group I) compared with secondary vasculitides (group II). Anti-ATP synthase reactivity from group I patients was restricted to the β-subunit of ATP synthase, whereas those from group II was directed to the α-, β- and γ-subunits. Cell surface ATP synthase regulates intracellular pH (pHi). In low extracellular pH medium, we detected abnormal decreased of EC pHi in the presence of anti-ATP synthase antibodies, irrespective of their fine reactivities. Interestingly, soluble hsp60 abrogated the anti-ATP synthase-induced pHi down-regulation. CONCLUSIONS/SIGNIFICANCE Our results indicate that ATP synthase is targeted by AECAs on the surface of EC that induce intracellular acidification. Such pathogenic effect in vasculitides can be modulated by hsp60 binding on ATP synthase which preserves ATP synthase activity.
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Affiliation(s)
- Jean-Eric Alard
- EA2216 “Immunology and Pathology” and IFR 148 ScInBioS, Université de Brest and Université Européenne de Bretagne, Brest, France
| | - Sophie Hillion
- EA2216 “Immunology and Pathology” and IFR 148 ScInBioS, Université de Brest and Université Européenne de Bretagne, Brest, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Alain Saraux
- EA2216 “Immunology and Pathology” and IFR 148 ScInBioS, Université de Brest and Université Européenne de Bretagne, Brest, France
- Centre Hospitalier Universitaire, Brest, France
| | - Jacques-Olivier Pers
- EA2216 “Immunology and Pathology” and IFR 148 ScInBioS, Université de Brest and Université Européenne de Bretagne, Brest, France
- Centre Hospitalier Universitaire, Brest, France
| | - Pierre Youinou
- EA2216 “Immunology and Pathology” and IFR 148 ScInBioS, Université de Brest and Université Européenne de Bretagne, Brest, France
- Centre Hospitalier Universitaire, Brest, France
| | - Christophe Jamin
- EA2216 “Immunology and Pathology” and IFR 148 ScInBioS, Université de Brest and Université Européenne de Bretagne, Brest, France
- Centre Hospitalier Universitaire, Brest, France
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