Conjunctival T-cell subpopulations in Sjögren's and non-Sjögren's patients with dry eye.

TLDR

The study examined conjunctival inflammation in Sjögren’s and non‑Sjögren’s dry‑eye patients and proposes evaluating anti‑inflammatory therapies for keratoconjunctivitis sicca. Conjunctival biopsies from 15 SS‑KCS and 15 NS‑KCS patients were immunohistochemically stained for CD3, CD4, CD8, HLA‑DR, HLA‑DQ, and ICAM‑1, with cell counts performed by two masked observers. Both groups displayed similar lymphocytic infiltration and elevated immune‑activation markers, indicating that T‑cell‑driven inflammation may underlie KCS symptoms more than previously recognized.

Abstract

To examine the conjunctiva of patients with Sjögren's syndrome keratoconjunctivitis sicca (SS-KCS) and non-Sjögren's keratoconjunctivitis sicca (NS-KCS) for evidence of immune-based inflammation.Conjunctival biopsy specimens were obtained from 15 patients with SS-KCS and 15 with NS-KCS. Immunohistochemistry was performed on frozen sections to characterize and quantify T-cell subtypes (CD3, CD4, and CD8) and markers of immune activation (major histocompatibility complex [MHC] class II: HLA-DR, HLA-DQ) and inflammation (intercellular adhesion molecule [ICAM]-1). The numbers of cells positive for each marker were counted by two masked observers and averaged.Conjunctival biopsy specimens from patients with SS-KCS or NS-KCS revealed lymphocytic infiltration and increased immunoreactivity for the markers of inflammation and immune activation. The extent of cellular immunoreactivity did not differ significantly between SS-KCS and NS-KCS tissue samples.The authors' findings indicate that patients with SS-KCS or NS-KCS have conjunctival inflammation manifested by inflammatory cell infiltrates and upregulation of expression in markers of immune activation. Clinical symptoms of KCS may be more dependent on T-cell activation and resultant inflammation than previously believed. In addition to tear substitutes, anti-inflammatory therapeutics should be investigated for the treatment of KCS.