Assessment of ocular surface during graft versus host disease. Clinical and biological assessment of clinical score such as Schirmer 1, Schirmer 2, BUT and patient subjective discomfort, and biological peptide secretion of HLA–DR, MUC5AC and TFF1

Abstract

Abstract: : Purpose:Chronic Graft Versus Host Disease (GVHD) is a well known cause of ocular surface disorders including dry eye symptoms. Ocular surface disorder after bone marrow transplantation (BMT) without GVHD diagnosed by the hematologist has even been described. Epidemiological studies of ocular surface symptoms after BMT are common, but clinical and biological assessments of signs occurring during BMT are uncommon. Trefoil Factor 1 (TFF1) belongs to the trefoil factor family, which are typical secretory products of mucous epithelia. TFF1 is involved in gastric wound healing and acts in concert with MUC5AC. We assessed the clinical signs, inflammatory markers and mucous markers in GVHD due to BMT. Methods:We performed clinical ocular surface examinations in 14 healthy volunteers and in 11 patients (who underwent BMT for 6 months at least). Schirmer 1, Schirmer 2, BUT, fluorescein and lissamine green impregnation and slit lamp examinations were performed. Answers to questions, derived from an ocular surface quality of life questionnaire were collected during the examination. Impression cytology specimens were used to assess the expression of TFF1 peptide, MUC5AC, and HLA–DR peptide by flow cytometry. Results:We found statistically significantly lower scores for Schirmer 1 (p=0.0085), Schirmer 2 (p<0.0001) and BUT (p=0.0007) in patients after BMT than in healthy volunteers. The ocular surface quality of life score was statistically affected in patients after bone marrow transplantation (p=0.049), with more symptoms (p=0.011) and higher discomfort scores (p=0.035). We found a statistically significant higher expression of HLA–DR (p<0.0001) and TFF1 (p=0.001) in patients after BMT whatever the GVHD status. A lower expression of MUC5AC was found only in patients after BMT suffering from extensive chronic GVHD. Conclusions:Clinical and biological changes in patients after bone marrow transplantation do not seem to depend on clinical chronic GVHD status. Inflammation and TFF1 expression are higher. The MUC5AC rate is unchanged, except in extensive chronic GVHD where it is lower.

Keywords: conjunctiva • inflammation • flow cytometry