Th1 predominance and perforin expression in minor salivary glands from patients with primary Sjögren's syndrome

Objectives of this study were to examine the cytokine and perforin mRNA expression in minor salivary glands from patients with primary Sjögren's syndrome (pSS), searching for possible correlation with clinical parameters and to identify the dominant cytokine pattern in the different groups. Oral mucosa biopsy samples from 42 pSS patients were studied. Total RNA was analysed by normalized RT-PCR using oligo-dT as the RT primer and IL-2, IFN-gamma, IL-12, IL-18, IL-4, IL-10, TGF-beta, TNF-alpha and perforin-specific primers for amplification. Results were analysed taking into account: (1) biopsy grade I to IV (Chisholm's classification); (2) diagnosis of either definite pSS (n=30) or probable pSS (n=12), following the European classification criteria (ECC), and (3) length of disease evolution from the beginning of symptoms to the time of biopsy, using an arbitrary cut-off point of 12 months. This studied showed that Th1-related cytokines (IL-2, IFN-gamma, IL-12, IL-18, TNF-alpha) and perforin were present in most samples. IL-4 (Th2) was totally absent but other Th2 and regulatory cytokines (IL-10, TGF-beta) were detected in the majority of samples. No significant differences were found between definite and probable pSS nor between grades II, III, IV and fibrous tissue biopsies. A statistically significant increase of IL-2 (P=0.012) and IFN-gamma (P=0.019) was observed in samples from patients with longer disease evolution, whereas the two Th1-inducer cytokines IL-12 and IL-18 were equally and highly expressed in all samples. In conclusion, a predominant Th1 pattern of cytokines was observed in all pSS samples, irrespective of biopsy classification. In addition, a significant increase of Th1 cytokine expression frequency was associated with longer disease evolution.

[Immunohistochemical study of inflammatory infiltrates in minor salivary glands in Sjögren's syndrome and other autoimmune diseases]

BACKGROUND

A study of the phenotype, activation and adhesive cells factors and cytokines in minor salivary glands in patients with primary Sjögren's syndrome (pSS), secondary Sjögren's syndrome (sSS) and autoimmune diseases (AD) without Sjögren's syndrome.

PATIENTS AND METHODS

We have studied the minor salivary glands in 30 patients with pSS, 30 patients with sSS, 19 patients with AD without SS and 18 controls, using immunohistochemical techniques to analyze the molecular expression of CD3, CD4, CD8, CD20, CD25, CD14, CD56, CD11a, CDw50 (ICAM-3), HLA-DR, IL-1, TNF-alpha and IFN-gamma in lymphocytic infiltration and epithelial cells.

RESULTS

Phenotype features were similar in patients with pSS and sSS, except that CD20+ lymphocyte expression was significantly higher in the sSS group (p = 0.023). The patients affected by AD without SS had activated lymphocytes in minor salivary glands in a similar manner to patients affected by pSS and sSS. No significant differences were found in HLA-DR expression in epithelial cells. We found unusual CD25 expression in epithelial cells in patients with SS but not in patients with AD without SS. The differences between pSS and sSS are related to SS theoretical time development and to immunosuppressive treatments.

CONCLUSIONS

The immunohistochemical pattern of minor salivary glands is similar in patients with pSS and sSS. Patients with AD are likely to develop immunological changes in minor salivary glands attributable to activated lymphocytes.

High prevalence of subclinical Sjögren's syndrome features in patients with autoimmune thyroid disease

OBJECTIVE

To determine the prevalence of keratoconjunctivitis sicca and xerostomia related to Sjögren's syndrome (SS) in asymptomatic patients with diagnosed autoimmune thyroid diseases (AITD); and to investigate whether the immunopathologies of sialadenitis observed in AITD associated SS and primary SS are similar.

METHODS

One hundred seventy-six patients diagnosed with AITD (88 with Graves' disease, 40 Hashimoto's thyroiditis, 48 primary myxedema) were tested for keratoconjunctivitis sicca (Schirmer's test and rose bengal staining) and for xerostomia (salivary scintigraphy and labial salivary gland biopsy). Immunohistopathological studies were performed on cryostat sections of bucal mucosa biopsies using antibodies to CD3, CD4, CD8, CD20, CD14, CD25, LFA-1, ICAM-3 HLA class II, tumor necrosis factor-alpha, interleukin 1, and interferon-gamma.

RESULTS

Nineteen of 52 (37%) patients with AITD fulfilled the criteria for xerostomia and 39/170 (23%) for keratoconjunctivitis sicca. Features of SS were diagnosed in 43 of 176 (24%) patients with AITD, with similar prevalence in Graves' (20%). Hashimoto's thyroiditis (27%), and primary myxedema (29%). In AITD associated SS, infiltrating lymphocytes were mainly CD3+ T lymphocytes, with a CD4/CD8 ratio of 2:1. In most patients infiltrating lymphocytes expressed activation markers, HLA class II molecules, and interleukin 2 receptor (CD25). In some patients HLA class II was inappropriately expressed in the epithelial gland cells.

CONCLUSION

The finding that a third of patients with AITD have SS features confirms that AITD and SS are mutually associated. Together with the similarity of immunopathology of sialadenitis in AITD associated SS in primary SS, this supports the theory that SS and AITD are 2 autoimmune diseases closely related pathogenetically.