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C Baudouin, PJ Pisella, C Blondin, M De Saint Jean, F Brignole; Expression of Inflammatory, Apoptotic, and Mucin Markers in Keratoconjunctivitis Sicca . Invest. Ophthalmol. Vis. Sci. 2002;43(13):63.
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Purpose: To investigate the expression of the immune- or apoptosis-related markers HLA-DR, IL-6, IL-8, IL-10 and APO2.7, and the mucin MUC5AC in conjunctival epithelial cells, from patients with moderate to severe keratoconjunctivitis sicca (KCS), and with or without Sjogren's syndrome. Method: Patients (n=49) who were included in a prospective European multicenter trial (Cyclosporine Dry Eye Study AGN503, Allergan) provided impression cytology (IC) samples at baseline. Using a defined quantification technique (Qifikit, Dako), IC specimens were processed and analyzed in a masked fashion, using specific antibodies in conjunction with flow cytometry. Results: HLA-DR and APO2.7 expression, as assessed by the percentage of positive conjunctival cells and level of expression, was greater at baseline in KCS patients compared with expression in a normal (non-KCS) reference population. In addition, there was a significant (p<0.001) correlation between the levels of HLA-DR and APO2.7, both in terms of the percentage and levels of expression. In contrast however, MUC5AC expression was low (5.3% +/- [SD 5.8] goblet cell number) and negatively correlated with HLA-DR and APO2.7 expression (p<0.01). IL-6 was overexpressed at baseline, while IL-8 and IL-10 were negative. Conclusions: Conjunctival epithelial cells from dry eye patients with moderate to severe KCS strongly overexpress the class II antigen HLA-DR, and the apoptotic marker, APO2.7; however, their expression is negatively correlated with conjunctival mucus cell density. These data provide a rationale for the use of cyclosporin A as an immunomodulatory agent for the treatment of patients with dry eye.
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