Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye.
OBJECTIVE
We have recently discovered that women with primary and secondary Sjögren's syndrome are androgen-deficient. We hypothesize that this hormone insufficiency contributes to the meibomian gland dysfunction, tear film instability, and evaporative dry eye that are characteristic of this autoimmune disorder. If our hypothesis is correct, we predict: (1) that androgens regulate meibomian gland function, control the quality and/or quantity of lipids produced by this tissue, and promote the formation of the tear film's lipid layer; and (2) that androgen deficiency, due to an attenuation in androgen synthesis (e.g., during Sjögren's syndrome, menopause, aging, complete androgen-insensitivity syndrome [CAIS] and anti-androgen use), will lead to meibomian gland dysfunction and evaporative dry eye. The following studies were designed to test these predictions.


METHODS
Experimental procedures included clinical studies, animal models, and histological, biochemical, molecular biological, and biomedical engineering techniques.


RESULTS
Our results demonstrate that: (1) androgens regulate the meibomian gland. This tissue contains androgen receptor mRNA, androgen receptor protein within acinar epithelial cell nuclei, and Types 1 and 2 5alpha-reductase mRNAs. Moreover, androgens appear to modulate lipid production and gene expression in mouse and/or rabbit meibomian glands; and (2) androgen deficiency may lead to meibomian gland dysfunction, altered lipid profiles in meibomian gland secretions, tear film instability, and evaporative dry eye. Thus, we have found that anti-androgen therapy in men is associated with meibomian gland disease, a decreased tear film breakup time, and functional dry eye. Furthermore, we have discovered that androgen receptor dysfunction in women with CAIS is associated with meibomian gland changes and a significant increase in the signs and symptoms of dry eye. Of interest, we have also found that androgen deficiency is associated with significant and striking alterations in the neutral and polar lipid patterns of human meibomian gland secretions.


CONCLUSIONS
Our findings show that the meibomian gland is an androgen target organ and that androgen deficiency may promote meibomian gland dysfunction and evaporative dry eye. Overall, these results support our hypothesis that androgen deficiency may be an important etiologic factor in the pathogenesis of evaporative dry eye in women with Sjögren's syndrome.
Schepens Eye Research Institute, Boston, Massachusetts 02114, USA. sullivan@vision.eri.harvard.edu
David A
DA
Sullivan
Benjamin D
BD
Sullivan
James E
JE
Evans
Frank
F
Schirra
Hiroko
H
Yamagami
Meng
M
Liu
Stephen M
SM
Richards
Tomo
T
Suzuki
Debra A
DA
Schaumberg
Rose M
RM
Sullivan
M Reza
MR
Dana
D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase / Q000096:biosynthesis / Q000235:genetics; D000375:Aging / Q000502:physiology; D000728:Androgens / Q000172:deficiency* / Q000502:physiology; D000818:Animals; D001327:Autoimmune Diseases / Q000150:complications / Q000503:physiopathology; D055598:Chemical Phenomena; D002627:Chemistry, Physical; D015352:Dry Eye Syndromes / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D004790:Enzyme Induction; D004847:Epithelial Cells / Q000187:drug effects / Q000378:metabolism; D005260:Female; D006801:Humans; D050356:Lipid Metabolism; D008537:Meibomian Glands / Q000503:physiopathology*; D051379:Mice; D017698:Postmenopause / Q000502:physiology; D012333:RNA, Messenger / Q000096:biosynthesis / Q000235:genetics; D011817:Rabbits; D011944:Receptors, Androgen / Q000096:biosynthesis / Q000235:genetics / Q000502:physiology; D012727:Sex Characteristics; D012859:Sjogren's Syndrome / Q000150:complications / Q000503:physiopathology; D013666:Tears / Q000737:chemistry; D013739:Testosterone / Q000494:pharmacology / Q000627:therapeutic use; D017155:Wettability
D000728:Androgens; D012333:RNA, Messenger; D011944:Receptors, Androgen; D013739:Testosterone; D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase