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Muñoz-Ortiz J, Reyes-Guanes J, Zapata-Bravo E, Mora-Muñoz L, Reyes-Hurtado JA, Tierradentro-García LO, Rojas-Carabali W, Gómez-Suarez M, de-la-Torre A. Ocular adverse events from pharmacological treatment in patients with multiple sclerosis-A systematic review of the literature. Syst Rev 2021; 10:280. [PMID: 34711264 PMCID: PMC8554884 DOI: 10.1186/s13643-021-01782-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/28/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to review the scientific evidence and describe the ocular treatment-emergent adverse events (TEAEs) related to pharmacological treatment in patients with multiple sclerosis. METHODS A systematic review of literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines in the MEDLINE, LILACS, EMBASE, and COCHRANE databases. Articles were filtered based on title and abstract considering the selection criteria and subsequently filtered by full-text reading. The resulting articles were evaluated using the Joanna Briggs Institute Quality Tools. Study characteristics and results were extracted and presented in structured tables to conduct a narrative synthesis. RESULTS A total of 2852 published articles were extracted using our strategy. After removing duplicates, 2841 articles were screened based on title and abstract, 102 articles were evaluated using quality tools, and 69 articles were filtered by full-text reading. Through this search strategy, 60 articles met all the inclusion criteria and seven articles, through a search update conducted in the same manner, were included. This resulted in 67 articles meeting the inclusion criteria, of which 11 were experimental and 56 were observational. The therapies related to ocular TEAEs were alemtuzumab, amantadine, fingolimod, steroids, CTLA-4 Ig, estriol, interferon β, natalizumab, hyperbaric oxygen, rituximab, siponimod, teriflunomide, and tovaxin. Fingolimod and siponimod were commonly associated with macular edema, interferon β was associated with retinopathy, alemtuzumab was associated with thyroid eye disease, amantadine was associated with corneal edema, and steroids were associated with acute retinal necrosis. Opportunistic infections were also found, and there was one life-threatening case. CONCLUSIONS Our search revealed different methodological assessments of the topic. However, longitudinal studies regarding ocular TEAEs related to multiple sclerosis therapy are necessary to provide evidence-based recommendations, especially in understudied regions such as Latin America and Africa. Physicians should monitor ocular symptoms in patients being treated for multiple sclerosis and consider an interdisciplinary approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020106886.
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Affiliation(s)
- Juliana Muñoz-Ortiz
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia.,Escuela Barraquer Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Estefanía Zapata-Bravo
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Laura Mora-Muñoz
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Juan Antonio Reyes-Hurtado
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Luis Octavio Tierradentro-García
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia
| | - Marcela Gómez-Suarez
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología del Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group "NeURos", Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia.
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Masi G, Annunziata P. Sjögren's syndrome and multiple sclerosis: Two sides of the same coin? Autoimmun Rev 2016; 15:457-61. [PMID: 26827908 DOI: 10.1016/j.autrev.2016.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/21/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Gianni Masi
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Pasquale Annunziata
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
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Tovey MG, Lallemand C. Immunogenicity and other problems associated with the use of biopharmaceuticals. Ther Adv Drug Saf 2014; 2:113-28. [PMID: 25083207 DOI: 10.1177/2042098611406318] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Biopharmaceuticals are used widely for the treatment of cancer, chronic viral hepatitis, inflammatory, and autoimmune diseases. Biopharmaceuticals such as interferons are well tolerated for the most part with the most common adverse events observed being 'flu-like' symptoms that resolve rapidly after initial treatment. Prolonged treatment is associated, however, with more serious adverse events including leucopenia, thrombocytopenia, and neuropsychiatric effects, which may necessitate dose reduction or even cessation of treatment in some patients. Recombinant growth factors, such as erythropoietin (EPO), granulocyte colony-stimulating factor, or granulocyte macrophage colony-stimulating factor, are for the most part well tolerated, although severe complications have been reported in patients with cancer or chronic kidney disease treated with EPO. Similarly, treatment of patients with cancer with high doses of interleukin-2 is associated with significant toxicity. Treatment of chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis, and Crohn's disease, with antitumor necrosis factor-alpha monoclonal antibodies is associated with an increased risk of granulomatous infections and, in particular, tuberculosis. The monoclonal antibody, natalizumab, that targets alpha4 integrins is effective in the treatment of multiple sclerosis but is associated with the activation of JC virus and development of progressive multifocal leukoencephalopathy. Repeated administration of recombinant proteins can cause a break in immune tolerance in some patients resulting in the production of a polyclonal antibody response that can adversely affect pharmacokinetics and clinical response. In addition, neutralizing antibodies that cross react with nonredundant essential proteins such as EPO can cause severe autoimmune reactions.
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Affiliation(s)
- Michael G Tovey
- Laboratory of Viral Oncology, FRE3238 CNRS, Institut André Lwoff, 7 rue Guy Moquet, 94801 Villejuif, France
| | - Christophe Lallemand
- Laboratory of Viral Oncology, FRE3238 CNRS, Institut André Lwoff, 94801 Villejuif, France
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Erhamamcı S, Horasanlı B, Aktaş A. Assessment of the effect of interferon-beta1a therapy on thyroid and salivary gland functions in patients with multiple sclerosis using quantitative salivary gland scintigraphy. Mol Imaging Radionucl Ther 2014; 23:43-7. [PMID: 24963444 PMCID: PMC4067875 DOI: 10.4274/mirt.53825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/13/2014] [Indexed: 01/22/2023] Open
Abstract
Objective: Interferon-beta (IFN-β) is widely used in patients with multiple sclerosis (MS), a demyelinating disease of the central nervous system. High incidence of thyroid dysfunction has been reported after administration of IFN-β in MS patients. The aim of this study was to assess the effect of IFN-β1a therapy on simultaneous thyroid and salivary gland function in patients with MS using quantitative salivary gland scintigraphy (QSGS). Methods: Fifteen relapsing-remitting (RR) MS patients treated with IFN-β1a and two control groups consisting of 15 untreated RRMS patients and 20 healthy age and sex-matched individuals were included in the study. The functional status of the salivary and thyroid glands was analysed with the QSGS and laboratory tests, including thyroid function and thyroid antibody. After intravenous administration of 150 MBq Tc-99m pertechnetate, dynamic study was performed for 25 minutes. Salivary gland secretion was stimulated with oral lemon juice at 15 minutes. At the end of dynamic study, a static image in the same projection was taken. Uptake ratios at 12-14 min (UR%) and stimulated excretion fraction (EF%) of each parotid and submandibular gland were calculated automatically from SGS. Thyroid uptake ratio (TUR) of thyroid gland was calculated from the static image. Results: All MS patients treated and untreated with IFN-β1a, and healthy individuals were euthyroid. Anti-thyroid peroxidase antibody (anti-TPO) was detected in 4 out of 15 MS patients (26.6%) treated with IFN-β1a. There was no significant differences in the UR, EF and TUR values among MS patients treated and untreated with IFN-β1a, and healthy controls (p>0.05). Although the TUR values in MS patients treated with IFN-β1a were less than those of the both control group, the difference was not statistically significant (p>0.05). Conclusion: IFN-β1a therapy was demonstrated to have no effect on thyroid and salivary gland functions using QSGS in patients with MS. Thyroid and salivary gland functions were also found to remain unchanged in untreated MS patients.
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Affiliation(s)
- Seval Erhamamcı
- Başkent University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Bahriye Horasanlı
- Başkent University Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Ayşe Aktaş
- Başkent University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
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Li H, Ice JA, Lessard CJ, Sivils KL. Interferons in Sjögren's Syndrome: Genes, Mechanisms, and Effects. Front Immunol 2013; 4:290. [PMID: 24062752 PMCID: PMC3778845 DOI: 10.3389/fimmu.2013.00290] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/04/2013] [Indexed: 01/25/2023] Open
Abstract
Sjögren’s syndrome (SS) is a common, progressive autoimmune exocrinopathy distinguished by dry eyes and mouth and affects ∼0.7% of the European population. Overexpression of transcripts induced by interferons (IFN), termed as an “IFN signature,” has been found in SS patients. Four microarray studies have been published in SS that identified dysregulated genes within type I IFN signaling in either salivary glands or peripheral blood of SS patients. The mechanism of this type I IFN activation is still obscure, but several possible explanations have been proposed, including virus infection-initiated and immune complex-initiated type I IFN production by plasmacytoid dendritic cells. Genetic predisposition to increased type I IFN signaling is supported by candidate gene studies showing evidence for association of variants within IFN-related genes. Once activated, IFN signaling may contribute to numerous aspects of SS pathophysiology, including lymphocyte infiltration into exocrine glands, autoantibody production, and glandular cell apoptosis. Thus, dysregulation of IFN pathways is an important feature that can be potentially used as a serum biomarker for diagnosis and targeting of new treatments in this complex autoimmune disease.
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Affiliation(s)
- He Li
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation , Oklahoma City, OK , USA ; Department of Pathology, University of Oklahoma Health Sciences Center , Oklahoma City, OK , USA
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Annunziata P, De Santi L, Di Rezze S, Millefiorini E, Capello E, Mancardi G, De Riz M, Scarpini E, Vecchio R, Patti F. Clinical features of Sjogren's syndrome in patients with multiple sclerosis. Acta Neurol Scand 2011; 124:109-14. [PMID: 20809902 DOI: 10.1111/j.1600-0404.2010.01428.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the frequency of clinical features of Sjogren's syndrome (SS) in patients with multiple sclerosis (MS) receiving treatment with disease-modifying drugs (DMDs) or naïve to treatment and the possible association with clinical, cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) parameters. METHODS A multicentre cross-sectional observational study was designed, based on a structured neurologist-administered questionnaire to 440 patients. RESULTS Twenty-eight of 230 (12%) patients receiving treatment with DMDs (DMDs(+)) and 14 of 210 (6.6%) treatment-naïve patients (DMDs(-) ) showed clinical features of SS. Four primary SS were diagnosed, two of which were DMDs(+) and two were DMDs(-) . Sicca symptoms were significantly associated with higher EDSS scores (P = 0.018), a low frequency of gadolinium-enhanced MRI-positive lesions (P = 0.018) and cerebral disturbances (P = 0.001). CONCLUSIONS Screening for the clinical features of SS should be performed in patients with MS both receiving treatment with immunomodulatory drugs and without therapy.
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Affiliation(s)
- P Annunziata
- Department of Neurological, Neurosurgical and Behavioural Sciences, University of Siena, Siena, Italy.
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Massara A, Bonazza S, Castellino G, Caniatti L, Trotta F, Borrelli M, Feggi L, Govoni M. Central nervous system involvement in Sjögren's syndrome: unusual, but not unremarkable--clinical, serological characteristics and outcomes in a large cohort of Italian patients. Rheumatology (Oxford) 2010; 49:1540-9. [PMID: 20444860 DOI: 10.1093/rheumatology/keq111] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To perform an observational retrospective cross-sectional case-control study to evaluate prevalence, clinical patterns and outcomes of CNS involvement in a large cohort of primary SS (pSS) patients. METHODS A total of 424 pSS patients, diagnosed according to the 2002 criteria proposed by the American-European Consensus Group, were checked for CNS involvement after exclusion of secondary causes. Demographic, clinical, seroimmunological data were compared between patients with and without CNS involvement. Neuroimaging data were also analysed. RESULTS CNS involvement was detected in 25 (5.8%) patients (24 females and 1 male) both at disease onset (52%) and later (48%) with a mean latency after diagnosis of 7 years. Diffuse (40%), focal/multifocal (36%), multiple sclerosis (MS)-like disease (20%) and isolated optic neuritis (4%) were the most common CNS clinical pictures. Disease duration, lung involvement and decreased C(4) were associated with CNS involvement, while articular manifestations were more frequently observed in patients without neurological complications. Most cases had an acute, often recurrent course with spontaneous remission or only mild neurological impairment. CONCLUSIONS CNS involvement represents a rare but not negligible complication of pSS, which may occur with a bimodal temporal pattern, both at onset and later, prompting attention in the differential diagnosis of apparently isolated neurological syndromes. Lung involvement emerged as the strongest risk factor for CNS involvement with a relative risk of 7.9, along with disease duration and decreased C(4).
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Affiliation(s)
- Alfonso Massara
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Safety, Tolerability, and Immunogenicity of Interferons. Pharmaceuticals (Basel) 2010; 3:1162-1186. [PMID: 27713294 PMCID: PMC4034027 DOI: 10.3390/ph3041162] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/03/2010] [Accepted: 04/12/2010] [Indexed: 02/08/2023] Open
Abstract
Interferons (IFNs) are class II cytokines that are key components of the innate immune response to virus infection. Three IFN sub-families, type I, II, and III IFNs have been identified in man, Recombinant analogues of type I IFNs, in particular IFNα2 and IFNβ1, have found wide application for the treatment of chronic viral hepatitis and remitting relapsing multiple sclerosis respectively. Type II IFN, or IFN gamma, is used principally for the treatment of chronic granulomatous disease, while the recently discovered type III IFNs, also known as IFN lambda or IL-28/29, are currently being evaluated for the treatment of chronic viral hepatitis. IFNs are in general well tolerated and the most common adverse events observed with IFNα or IFNβ therapy are “flu-like” symptoms such as fever, headache, chills, and myalgia. Prolonged treatment is associated with more serious adverse events including leucopenia, thrombocytopenia, increased hepatic transaminases, and neuropsychiatric effects. Type I IFNs bind to high-affinity cell surface receptors, composed of two transmembrane polypeptides IFNAR1 and IFNAR2, resulting in activation of the Janus kinases Jak1 and Tyk2, phosphorylation and activation of the latent cytoplasmic signal transducers and activators of transcription (STAT1) and STAT2, formation of a transcription complex together with IRF9, and activation of a specific set of genes that encode the effector molecules responsible for mediating the biological activities of type I IFNs. Systemic administration of type I IFN results in activation of IFN receptors present on essentially all types of nucleated cells, including neurons and hematopoietic stem cells, in addition to target cells. This may well explain the wide spectrum of IFN associated toxicities. Recent reports suggest that certain polymorphisms in type I IFN signaling molecules are associated with IFN-induced neutropenia and thrombocytopenia in patients with chronic hepatitis C. IFNγ binds to a cell-surface receptor composed of two transmembrane polypeptides IFGR1 and IFGR2 resulting in activation of the Janus kinases Jak1 and Jak2, phosphorylation of STAT1, formation of STAT1 homodimers, and activation of a specific set of genes that encode the effector molecules responsible for mediating its biological activity. In common with type I IFNs, IFNγ receptors are ubiquitous and a number of the genes activated by IFNγ are also activated by type I IFNs that may well account for a spectrum of toxicities similar to that associated with type I IFNs including “flu-like” symptoms, neutropenia, thrombocytopenia, and increased hepatic transaminases. Although type III IFNs share the major components of the signal transduction pathway and activate a similar set of IFN-stimulated genes (ISGs) as type I IFNs, distribution of the IFNλ receptor is restricted to certain cell types suggesting that IFNλ therapy may be associated with a reduced spectrum of toxicities relative to type I or type II IFNs. Repeated administration of recombinant IFNs can cause in a break in immune tolerance to self-antigens in some patients resulting in the production of neutralizing antibodies (NABs) to the recombinant protein homologue. Appearance of NABs is associated with reduced pharmacokinetics, pharmacodynamics, and a reduced clinical response. The lack of cross-neutralization of IFNβ by anti-IFNα NABs and vice versa, undoubtedly accounts for the apparent lack of toxicity associated with the presence of anti-IFN NABs with the exception of relatively mild infusion/injection reactions.
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Min JH, Kim HJ, Kim BJ, Lee KW, Sunwoo IN, Kim SM, Kim BJ, Kim SH, Park MS, Waters P, Vincent A, Sung JJ, Lee KH. Brain abnormalities in Sjogren syndrome with recurrent CNS manifestations: association with neuromyelitis optica. Mult Scler 2009; 15:1069-76. [DOI: 10.1177/1352458509106228] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and objectives Optic neuritis or longitudinally extensive myelitis in Sjogren syndrome (SS) suggests a neuromyelitis optica spectrum disorder (NMOSD). However, brain abnormalities of SS remain to be elucidated for the association with neuromyelitis optica (NMO). Methods Twelve primary SS patients (all women, 42 ± 13.2 years) who had recurrent central nervous system (CNS) manifestations with brain involvement were retrospectively identified. Brain MRI, and neurologic and serologic findings were analyzed with the measurement of anti-aquaporin-4 antibody (AQP4-Ab). Results All patients showed brain lesions characteristic of NMO as follows: 1) the involved sites adjacent to the third and fourth ventricles and in the posterior limb of the internal capsule, 2) unique configurations, such as the longitudinal course from the internal capsule to the midbrain, large cerebral or cerebellar lesions over 3 cm, and cavity-like formations. AQP4-Ab was positive in six of eight patients tested, and all the seropositive patients showed lesions with increased diffusion, suggestive of vasogenic edema. Four patients met the revised criteria of NMO, and nine had features of NMOSDs. Of the remaining three patients showing only brain involvement, one had AQP4-Ab. Conclusions This study demonstrates that SS patients with recurrent CNS involvement have brain abnormalities characteristic of NMO and AQP4-Ab in Korea. The presence of AQP4-Ab in one SS patient with only brain involvement may suggest that the coexistence of NMO should be explored in SS patients with recurrent CNS manifestations, even without optic neuritis or myelitis.
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Affiliation(s)
- JH Min
- Department of Neurology, Myongji Hospital, Kwandong University College of Medicine, South Korea
| | - HJ Kim
- Department of Neurology, National Cancer Center, South Korea
| | - BJ Kim
- Department of Neurology, Korea University Medical Center, South Korea
| | - KW Lee
- Department of Neurology, Seoul National University College of Medicine, South Korea
| | - IN Sunwoo
- Department of Neurology, Severance Hospital, Yonsei College of Medicine, South Korea
| | - SM Kim
- Department of Neurology, Severance Hospital, Yonsei College of Medicine, South Korea
| | - BJ Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | - SH Kim
- Department of Neurology, Hanyang University Hospital, South Korea
| | - MS Park
- Department of Neurology, Chonnam National University Hospital, South Korea
| | - P Waters
- Department of Clinical Neurology, Neuroscience group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
| | - A Vincent
- Department of Clinical Neurology, Neuroscience group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
| | - JJ Sung
- Department of Neurology, Seoul National University College of Medicine, South Korea
| | - KH Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
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Deshmukh US, Nandula SR, Thimmalapura PR, Scindia YM, Bagavant H. Activation of innate immune responses through Toll-like receptor 3 causes a rapid loss of salivary gland function. J Oral Pathol Med 2009; 38:42-7. [PMID: 19192049 DOI: 10.1111/j.1600-0714.2008.00700.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have demonstrated the expression of Toll-like receptor 3 (TLR3) in salivary glands and epithelial cell lines derived from Sjögren's syndrome (SS) patients. As viral infections are considered to be a trigger for SS, in this study we investigated whether in vivo engagement of TLR3 affects salivary gland function. METHODS Female New Zealand Black/WF1 mice were repeatedly injected with polyinosinic:polycytidylic acid [poly(I:C)]. TLR3 expression within submandibular glands was studied using immunohistochemistry. RNA levels of inflammatory cytokines in the submandibular glands were determined by real time polymerase chain reaction. Pilocarpine induced saliva volume was used as an index of glandular function. RESULTS Immunohistochemical analysis of submandibular glands showed TLR3 expression in epithelium of serous and mucous acini, granular convoluted tubules, and ducts. Poly(I:C) treatment rapidly up-regulated the mRNA levels of type I interferon (IFN) and inflammatory cytokines in the submandibular glands. One week after treatment, the saliva volumes in poly(I:C) treated mice were significantly reduced in comparison with the phosphate-buffered saline (PBS) treated mice. Hematoxylin and eosin staining showed that salivary gland histology was normal and lymphocytic foci were not detected. Glandular function recovered after poly(I:C) treatment was stopped. CONCLUSIONS Our results demonstrate that engagement of TLR3 within the salivary glands results in a rapid loss of glandular function. This phenomenon is associated with the production of type I IFN and inflammatory cytokines in the salivary glands. Restoration of glandular function suggests that for viral etiology of SS, a chronic infection of salivary glands might be necessary.
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Affiliation(s)
- Umesh S Deshmukh
- Division of Rheumatology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, VA 22908, USA.
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