title: A significant role of stromal fibroblasts in rapidly progressive dry eye in patients with chronic GVHD.
abstract: OBJECTIVE
  To elucidate histopathologic features of the lacrimal gland in chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation.
  
  
  METHODS
  Lacrimal gland specimens from five patients who had dry eye as part of the symptoms of chronic GVHD were examined by immunohistochemistry and transmission electron microscopy. Lacrimal gland specimens from five patients with Sjögren's syndrome (SS) were used as control samples.
  
  
  RESULTS
  Lymphocytes, predominantly T cells, were found primarily in the periductal areas of the lacrimal gland from patients with chronic GVHD, whereas B cells were the dominant infiltrating cells in the acinar areas of the lacrimal gland from patients with SS. Notable findings in the lacrimal gland from patients with chronic GVHD were marked fibrosis of the glandular interstitium and an increase in the number of CD34(+) stromal fibroblasts. These findings were more prominent in patients with severe dry eye than in those with mild dry eye. Electron microscopic observations of the lacrimal gland from patients with chronic GVHD revealed that stromal fibroblasts were attached to various inflammatory cells, especially T cells, through primitive or rudimentary contacts. In addition, the presence of a well-developed rough endoplasmic reticulum in the fibroblasts and newly synthesized collagen fibrils in the extracellular matrix indicated an active production of extracellular matrix components. Electron micrographs revealed multilayered and thickened basal laminae of blood vessels, ducts, and lobules in the lacrimal gland of patients with chronic GVHD; however, these observations were infrequently observed in the lacrimal glands of patients with SS.
  
  
  CONCLUSIONS
  The results suggest substantial differences in the lacrimal gland histopathology of patients with chronic GVHD and SS. In addition, it is likely that stromal fibroblasts are actively involved in the pathogenic process of chronic GVHD in the lacrimal gland by producing excessive extracellular matrix components.
authors.affiliation: Departments of Ophthalmology and. Diagnostic Pathology, Institute for Advanced Medical Research, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ogawa
authors.forename: K
authors.initials: K
authors.lastname: Yamazaki
authors.forename: M
authors.initials: M
authors.lastname: Kuwana
authors.forename: Y
authors.initials: Y
authors.lastname: Mashima
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Ishida
authors.forename: I
authors.initials: I
authors.lastname: Toda
authors.forename: Y
authors.initials: Y
authors.lastname: Oguchi
authors.forename: K
authors.initials: K
authors.lastname: Tsubota
authors.forename: S
authors.initials: S
authors.lastname: Okamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Kawakami
mesh_terms: D000328:Adult; D018952:Antigens, CD34 / Q000378:metabolism; D001402:B-Lymphocytes / Q000473:pathology; D001706:Biopsy; D002908:Chronic Disease; D018450:Disease Progression; D015352:Dry Eye Syndromes / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005347:Fibroblasts / Q000378:metabolism / Q000648:ultrastructure; D005355:Fibrosis; D006086:Graft vs Host Disease / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007124:Immunoenzyme Techniques; D007765:Lacrimal Apparatus / Q000378:metabolism / Q000473:pathology*; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000473:pathology; D014184:Transplantation, Homologous
chemical_list: D018952:Antigens, CD34