title: Conjunctival HLA-DR and CD8 expression detected by impression cytology in ocular graft versus host disease.
abstract: OBJECTIVE
  To assess the expression of human leucocyte antigen (HLA)-DR in epithelial cells and cluster of differentiation (CD8)-positive lymphocytes as possible markers of chronic ocular graft versus host disease (cGvHD) after hematological stem cell transplantation (HSCT).
  
  
  METHODS
  Twenty-seven consecutive patients with dry-eye symptoms following HSCT (24 [89%] with peripheral blood stem cell transplantation and 3 [11%] with bone marrow transplants; 17 [63%] familiar allogenic grafts) and 19 age-matched controls were included. Conjunctival impression cytology specimens were stained for HLA-DR, cytokeratin 19, and CD8. Oxford grading scale, blinking frequency, Schirmer test, tear film break-up time (TBUT), and Ocular Surface Disease Index (OSDI) were also recorded. Wilcoxon nonparametric testing was used to compare controls and HSCT recipients and to assess HSCT recipient subgroups with and without clinical cGVHD.
  
  
  RESULTS
  Eighteen patients showed clinical signs of ocular cGVHD. TBUT and Schirmer test scores were significantly lower in patients, while Oxford grades and OSDI were significantly higher than in controls. Epithelial HLA-DR expression was generally higher in HSCT recipients than in controls, but it did not correlate with ocular cGVHD status. CD8-positive lymphocytes were identified in five patients with ocular cGvHD and one control.
  
  
  CONCLUSIONS
  A strong HLA-DR expression as detected by impression cytology appears to indicate a general HSCT response and fails to predict ocular cGVHD. However, the detection of CD8-positive lymphocytes using impression cytology was frequently associated with ocular cGvHD. Our data warrant further evaluation of CD8 expression in impression cytology, along with comparison to conjunctival biopsies and brush cytology, as impression cytology may offer a less invasive strategy for assessing cGVHD status.
authors.affiliation: University Eye Hospital, Albert-Ludwig-University, Freiburg, Germany. philipp.eberwein@uniklinik-freiburg.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Eberwein
authors.forename: Susanne
authors.initials: S
authors.lastname: Issleib
authors.forename: Daniel
authors.initials: D
authors.lastname: Böhringer
authors.forename: Hans
authors.initials: H
authors.lastname: Mittelviefhaus
authors.forename: Johannes
authors.initials: J
authors.lastname: Schwartzkopff
authors.forename: Juergen
authors.initials: J
authors.lastname: Finke
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
mesh_terms: D000328:Adult; D016827:CD8 Antigens / Q000378:metabolism*; D016022:Case-Control Studies; D003228:Conjunctiva / Q000378:metabolism* / Q000473:pathology*; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D005455:Fluorescent Antibody Technique; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology* / Q000473:pathology*; D006684:HLA-DR Antigens / Q000378:metabolism*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D016827:CD8 Antigens; D006684:HLA-DR Antigens