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Françoise Brignole, Pierre-Jean Pisella, Marie Goldschild, Magda De Saint Jean, Alain Goguel, Christophe Baudouin; Flow Cytometric Analysis of Inflammatory Markers in Conjunctival Epithelial Cells of Patients with Dry Eyes. Invest. Ophthalmol. Vis. Sci. 2000;41(6):1356-1363.
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purpose. To investigate in impression cytology (IC) specimens the expression of
inflammatory and apoptosis-related markers by conjunctival epithelial
cells from patients with dry eye as a rationale for treatment with
methods. Immunologic anomalies were identified at baseline, before treatment
with the masked medication, in a homogeneous series of patients with
dry eye syndrome, who were enrolled in a large European multicenter
clinical trial (Cyclosporin A Dry Eye Study; Allergan, Irvine, CA). IC
specimens were collected in 243 patients with moderate to severe
keratoconjunctivitis sicca (KCS), with or without Sjögren’s
syndrome (SS). Fifty normal subjects were separately examined to
provide normal control values. Specimens were analyzed in a masked
manner by flow cytometry, using antibodies directed to markers of the
immune system and/or apoptotic pathway: HLA DR, CD40, CD40 ligand, Fas,
and APO2.7. Levels of expression were quantified, and results were
compared with those obtained in the 50 normal patients.
results. One hundred sixty-nine specimens were successfully interpreted at
baseline, including 41% from patients with SS. A highly significant
increase of HLA DR expression by conjunctival cells was found in
KCS-affected eyes compared with normal eyes, which did not express this
marker or did so very weakly. HLA DR expression in eyes with SS was
significantly higher than in KCS-affected eyes without SS. Fas and
APO2.7 were found at low levels in all normal and KCS-affected eyes.
CD40 and CD40 ligand expressions were significantly increased in eyes
with KCS compared with normal eyes. HLA DR, CD40 and Fas were found at
significantly higher levels in the SS group than in the non-SS group.
conclusions. Conjunctival cells from patients with dry eye with moderate to severe
KCS, with or without SS, overexpress inflammatory and apoptosis-related
markers. Whether inflammation is a primary phenomenon in KCS or is the
consequence of repetitive abrasion of the ocular surface after tear
film deficiency remains to be determined. These data, nevertheless,
support the use of immunomodulatory and/or anti-inflammatory drugs in
the treatment of patients with KCS.
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