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Omer Iqbal; The roles of IL-13 and Granulysin in the pathogenesis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4872.
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Stevens Johnson Syndrome and Toxic Epidermal Necrolysis are rare, most often drug-induced severe cutaneous adverse reactions and have a high mortality rate. In the severe cases, they are followed by many complications involving different organs, which lead to multi-organ failure and death. One of the major complications is that it can lead to visual impairment and corneal blindness. The pathogenesis of the disease is not fully understood. This study will be focused on the expression of granulysin and IL-13 in the skin and blood of patients with SJS/TEN as studied by immunohistochemistry and ELISA techniques. The levels of IL-13 and granulysin will be correlated later with the degree of ocular surface disease in these patients by referring to the patient charts. Cell culture studies will also be performed challenging the human corneal epithelial cells with TNFα and determining the expression of IL-13 and granulysin.
Under a current, Loyola IRB approved protocol, 12 collected and archived unstained slides of skin from biopsy confirmed SJS/TEN patients will be used for this study. Ten skin biopsy slides of non-SJS/TEN patients (Lichen Planus) were used as a control group. Human Corneal Epithelial Cells (HCEC, Courtesy Professor Valtink from Germany) were cultured in Basal F99 medium. Cells were exposed to TNF-α at final concentration of 0, 1, 10, and 100 ng/ml and the expression of IL-13 and granulysin was studied by immunofluorescence microscopy.
IL-13 and granulysin image intensities showed a statistically significant difference p<.0001 between control (908) and SJS patient pool (1855) using Kruskai.walls nonparumetric ANOVA. Challenging the human corneal epithelial cells with TNFα, showed a concentration-dependent increase in the expression of IL-13 and granulysin. When the cells were challenged with the plasma of patients with SJS and TEN, the TEN plasma showed a relatively increased expression of IL-13 and granulysin. Than SJS plasma compared to the normal human plasma.
Increased expressions of IL-13 and granulysin were observed in skin biopsy samples of SJS/TEN patients. The expression of granulysin was relatively lower than the expression of IL-13. Similar results were observed in the cell culture study. Blockade of IL-13 and granulysin may potentially be used as a new therapeutic strategy in the management of SJS/TEN.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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