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Chen J, Bai T, Su J, Cong X, Lv L, Tong L, Yu H, Feng Y, Yu G. Salivary Gland Transplantation as a Promising Approach for Tear Film Restoration in Severe Dry Eye Disease. J Clin Med 2024; 13:521. [PMID: 38256655 PMCID: PMC10816601 DOI: 10.3390/jcm13020521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
With increased awareness of dry eye disease (DED), a multitude of therapeutic options have become available. Nevertheless, the treatment of severe DED remains difficult. In a patient whose DED is related to the loss of lacrimal function without severe destruction of the salivary glands, autologous transplantation of the latter as functioning exocrine tissue to rebuild a stable tear film is an attractive idea. All three major and minor salivary glands have been used for such transplantation. Due to the complications associated with and unfavorable prognosis of parotid duct and sublingual gland transplantation, surgeons now prefer to use the submandibular gland (SMG) for such procedures. The transplantation of the SMG not only has a high survival rate, but also improves dry eye symptoms and signs for more than 20 years post-surgery. The regulation of the secretion of the transplanted SMG is critical because the denervated SMG changes its mechanism of secretion. Innovative procedures have been developed to stimulate secretion in order to prevent the obstruction of the Wharton's duct and to decrease secretion when postoperative "epiphora" occurs. Among the minor salivary glands, the transplantation of the labial salivary glands is the most successful in the long-term. The measurement of the flow rates of minor salivary glands and donor-site selection are critical steps before surgery.
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Affiliation(s)
- Jiayi Chen
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Tianyi Bai
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Jiazeng Su
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xin Cong
- Key Laboratory of Molecular Cardiovascular Sciences, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Ministry of Education, Beijing 100191, China;
| | - Lan Lv
- Department of Ophthalmology, Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing 100730, China
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore 168751, Singapore;
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Eye-Academic Clinical Program, Duke-National University of Singapore, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Haozhe Yu
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Yun Feng
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Guangyan Yu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
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Pabois O, Avila-Sierra A, Ramaioli M, Mu M, Message Y, You KM, Liamas E, Kew B, Durga K, Doherty L, Sarkar A. Benchmarking of a microgel-reinforced hydrogel-based aqueous lubricant against commercial saliva substitutes. Sci Rep 2023; 13:19833. [PMID: 37985688 PMCID: PMC10662424 DOI: 10.1038/s41598-023-46108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
Xerostomia, the subjective sensation of 'dry mouth' affecting at least 1 in 10 adults, predominantly elders, increases life-threatening infections, adversely impacting nutritional status and quality of life. A patented, microgel-reinforced hydrogel-based aqueous lubricant, prepared using either dairy or plant-based proteins, has been demonstrated to offer substantially enhanced lubricity comparable to real human saliva in in vitro experiments. Herein, we present the benchmarking of in vitro lubrication performance of this aqueous lubricant, both in its dairy and vegan formulation against a range of widely available and employed commercial saliva substitutes, latter classified based on their shear rheology into "liquids", "viscous liquids" and "gels", and also had varying extensional properties. Strikingly, the fabricated dairy-based aqueous lubricant offers up to 41-99% more effective boundary lubrication against liquids and viscous liquids, irrespective of topography of the tested dry mouth-mimicking tribological surfaces. Such high lubricity of the fabricated lubricants might be attributed to their limited real-time desorption (7%) from a dry-mouth mimicking hydrophobic surface unlike the tested commercial products including gels (23-58% desorption). This comprehensive benchmarking study therefore paves the way for employing these microgel-based aqueous lubricant formulations as a novel topical platform for dry mouth therapy.
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Affiliation(s)
- Olivia Pabois
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Marco Ramaioli
- INRAE, AgroParisTech, UMR SayFood, Université Paris-Saclay, 91120, Palaiseau, France
| | - Mingduo Mu
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Yasmin Message
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Kwan-Mo You
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Evangelos Liamas
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
- Unilever Research & Development Port Sunlight Laboratory, Bebington, CH63 3JW, UK
| | - Ben Kew
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Kalpana Durga
- Vitrition UK Ltd, Liversedge, WF15 6RA, UK
- ADM Protexin Ltd, Lopen Head, TA13 5JH, UK
| | | | - Anwesha Sarkar
- Food Colloids and Bioprocessing Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK.
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Assy Z, van Santen JS, Brand HS, Bikker FJ. Use and efficacy of dry-mouth interventions in Sjögren's disease patients and possible association with perceived oral dryness and patients' discomfort. Clin Oral Investig 2023; 27:5529-5537. [PMID: 37507599 PMCID: PMC10492750 DOI: 10.1007/s00784-023-05172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES Sjögren's disease (SjD) patients use various interventions to relief their oral dryness. However, the use and efficacy of these interventions have only partially been evaluated. The present study aims to investigate whether there is an association between the perceived oral dryness and discomfort of SjD patients and their use of specific interventions. MATERIALS AND METHODS A cross-sectional study was performed among SjD patients, who completed several questionnaires to assess the severity of their oral dryness and an inventory of dry-mouth interventions. The perceived efficacy of each intervention was reported on a 5-point Likert-scale. RESULTS The questionnaires were returned by 92 SjD patients. For relief of oral dryness, they mostly used "eating fruit", "drinking tea", "moistening the lips", "drinking water, and "drinking small volumes" (> 50%). Three interventions had a frequency of use ranging from 2-6 times/day, whereas, "drinking water" and "drinking small volumes" showed higher frequencies (> 14). The highest overall efficacy (≥ 3.5) was reported for "chewing gum" and "using a mouth gel". Furthermore, various dry-mouth interventions showed significant associations with oral dryness scores and/or patients' discomfort. For example, "drinking small volumes" and "using XyliMelts" were associated with the Bother Index score. CONCLUSION Great variation was found in the use of dry-mouth interventions by the participants and the severity of the oral dryness and/or patients' discomfort seemed to affect their choice of intervention. Notably, the mostly used interventions did not show the highest reported efficacy. CLINICAL RELEVANCE These findings might help SjD patients and clinicians in their choice of effective dry-mouth interventions.
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Affiliation(s)
- Z Assy
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
| | - J S van Santen
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - H S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - F J Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Zeng W, Zhou X, Yu S, Liu R, Quek CWN, Yu H, Tay RYK, Lin X, Feng Y. The Future of Targeted Treatment of Primary Sjögren's Syndrome: A Focus on Extra-Glandular Pathology. Int J Mol Sci 2022; 23:ijms232214135. [PMID: 36430611 PMCID: PMC9694487 DOI: 10.3390/ijms232214135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease defined by exocrine gland hypofunction resulting in dry eyes and dry mouth. Despite increasing interest in biological therapies for pSS, achieving FDA-approval has been challenging due to numerous complications in the trials. The current literature lacks insight into a molecular-target-based approach to the development of biological therapies. This review focuses on novel research in newly defined drug targets and the latest clinical trials for pSS treatment. A literature search was conducted on ClinicalTrials.gov using the search term "Primary Sjögren's syndrome". Articles published in English between 2000 and 2021 were included. Our findings revealed potential targets for pSS treatment in clinical trials and the most recent advances in understanding the molecular mechanisms underlying the pathogenesis of pSS. A prominent gap in current trials is in overlooking the treatment of extraglandular symptoms such as fatigue, depression, and anxiety, which are present in most patients with pSS. Based on dryness and these symptom-directed therapies, emerging biological agents targeting inflammatory cytokines, signal pathways, and immune reaction have been studied and their efficacy and safety have been proven. Novel therapies may complement existing non-pharmacological methods of alleviating symptoms of pSS. Better grading systems that add extraglandular symptoms to gauge disease activity and severity should be created. The future of pSS therapies may lie in gene, stem-cell, and tissue-engineering therapies.
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Affiliation(s)
- Weizhen Zeng
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Xinyao Zhou
- Department of Rheumatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijng 100053, China
| | - Sulan Yu
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ruihua Liu
- Department of Rheumatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijng 100053, China
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Haozhe Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Xiang Lin
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: (X.L.); (Y.F.)
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (X.L.); (Y.F.)
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Assy Z, Brand HS, Bots CP, Bikker FJ. The relationship between the severity of oral dryness and the use of dry-mouth interventions by various subgroups of dry-mouth patients. Clin Oral Investig 2022. [PMID: 35006295 DOI: 10.1007/s00784-021-04292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/10/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Dry-mouth patients use different interventions to relieve their oral dryness. As recent studies showed that various subgroups of dry-mouth patients perceived different intra-oral regions as most dry, the present study investigated whether the use of dry-mouth interventions by various subgroups of dry-mouth patients was related to the perceived oral dryness as well as salivary flow rate. MATERIALS AND METHODS Xerostomia Inventory (XI) scores, Regional Oral Dryness Score (RODI) scores and used dry-mouth interventions were extracted from the medical records of 528 patients visiting a saliva clinic. Based on their medical history, they were allocated into 6 subgroups. RESULTS The subgroups of dry-mouth patients used a wide range of interventions to relieve their oral dryness. Sjögren's syndrome patients used most interventions more frequently than patients with oral dryness due to use of a limited number of medications and controls. Patients using medications showed associations between the total XI score and dry-mouth interventions aimed at the entire mouth. In medication using patients and controls, the locally applied intervention "using mouth gel" was associated with RODI scores of the anterior tongue. CONCLUSION The use of dry-mouth interventions was associated with dry-mouth feelings. Use of interventions aimed to relieve dryness of the entire mouth was significantly associated with total XI score, while locally applied interventions were significantly associated with the severity of dryness at specific intra-oral regions, the anterior tongue in particular. CLINICAL RELEVANCE The results will help clinicians to advise dry-mouth patients about the most suitable interventions for relief of oral dryness complaints.
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Assy Z, Bikker FJ, Mashhour E, Asadi M, Brand HS. Preferences of Sjögren's syndrome patients regarding potential new saliva substitutes. Clin Oral Investig 2022; 26:6245-6252. [PMID: 35688954 PMCID: PMC9525427 DOI: 10.1007/s00784-022-04576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sjögren's syndrome (SS) patients should be involved in the development of new saliva substitutes at an early stage. The purpose of the current study was to explore the preferences of these patients regarding various product characteristics of potential new saliva substitutes. MATERIAL AND METHOD A questionnaire was distributed among SS patients. They could anonymously indicate their preferences for saliva substitute characteristics using 5-point Likert scales. RESULTS Fifty-nine SS patients filled in the questionnaire. According to their opinion, the most ideal saliva substitute has a thin-watery consistency with a neutral flavour that should be applied as a spray. Patients demand a prolonged alleviation of dry mouth complaints and neutralization of harmful bacteria. The patients mainly object against the presence of artificial sweeteners and alcohol in saliva substitutes, but have limited objections against the presence of vegetable-based ingredients and natural enzymes. Major objections were against the potential side effects "bitter taste" and "discoloration of teeth". Age and severity of xerostomia affected desire of flavours. Younger patients preferred menthol flavour, while respondents with severe xerostomia preferred the use of "neutral flavours" significantly more. CONCLUSION The most ideal saliva substitute has thin-watery consistency in spray form with a neutral flavour and providing long alleviation of dry mouth complaints. Besides, it should not contain artificial sweeteners or alcohol, and should not have a bitter taste or cause discoloration of the teeth. CLINICAL RELEVANCE Investigating the opinion of SS patients provides tailoured insights into their preference, which may contribute to the development of more effective saliva substitutes.
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Affiliation(s)
- Zainab Assy
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, the Netherlands
| | - Floris J. Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, the Netherlands
| | - Esra Mashhour
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, the Netherlands
| | - Mina Asadi
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, the Netherlands
| | - Henk S. Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, the Netherlands
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