title: Clinical and Molecular Inflammatory Response in Sjögren Syndrome-Associated Dry Eye Patients Under Desiccating Stress.
abstract: OBJECTIVE
  To evaluate the response of the lacrimal function unit in Sjögren syndrome (SS)-associated dry eye patients exposed to 2 simulated daily life environmental conditions.
  
  
  METHODS
  Prospective crossover pilot study.
  
  
  METHODS
  Fourteen female SS dry eye patients were exposed for 2 hours to a controlled normal condition (23 C, 45% relative humidity, and air flow 0.10 m/s) and a controlled adverse condition that simulates desiccating stress (23 C, 5% relative humidity, and air flow 0.10 m/s). The following dry eye tests were performed before and after the exposure: tear osmolarity, phenol red thread test, conjunctival hyperemia, fluorescein tear break-up time, corneal fluorescein staining, conjunctival lissamine green staining, and Schirmer test. Levels of 16 molecules were analyzed in tears by multiplex immunobead analysis.
  
  
  RESULTS
  Clinical evaluation showed lacrimal functional unit impairment after the desiccating stress: significantly increased tear osmolarity (315.7 ± 3.0 vs 327.7 ± 5.1 mOsm/L, P = .03), conjunctival hyperemia (1.3 ± 0.1 vs 1.6 ± 0.1, P = .05), and corneal staining in temporal (3.5 ± 0.5 vs 4.7 ± 0.4, P = .01) and nasal (3.6 ± 0.5 vs 4.5 ± 0.5, P = .04) areas. Tear concentrations increased for interleukin-1 receptor antagonist (16 557.1 ± 4047.8 vs 31 895.3 ± 5916.5 pg/mL, P = .01), interleukin-6 (63.8 ± 20.2 vs 111.5 ± 29.6 pg/mL, P = .02), interleukin-8 (2196.1 ± 737.9 vs 3753.2 ± 1106.0 pg/mL, P = .03), and matrix metalloproteinase-9 (101 515.6 ± 37 088.4 vs 145 867.1 ± 41 651.5 pg/mL, P = .03). After the simulated normal condition, only a significant increase in nasal corneal staining (2.9 ± 0.5 vs 3.6 ± 0.5, P = .03) was observed.
  
  
  CONCLUSIONS
  Even a short exposure to a desiccating environment can produce a significant deterioration of the lacrimal function unit in female SS dry eye patients. The often unnoticed exposure to these conditions during daily life may increase inflammatory activity rapidly, triggering an ocular surface deterioration.
authors.affiliation: Instituto de Oftalmobiología Aplicada, Universidad de Valladolid, Valladolid, Spain; Visión I+D, SL, Valladolid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: López-Miguel
authors.affiliation: Instituto de Oftalmobiología Aplicada, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Tesón
authors.affiliation: Instituto de Oftalmobiología Aplicada, Universidad de Valladolid, Valladolid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Martín-Montañez
authors.affiliation: Instituto de Oftalmobiología Aplicada, Universidad de Valladolid, Valladolid, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine, Valladolid, Spain.
authors.forename: Amalia
authors.initials: A
authors.lastname: Enríquez-de-Salamanca
authors.affiliation: Allergan Inc, Irvine, California.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Stern
authors.affiliation: Instituto de Oftalmobiología Aplicada, Universidad de Valladolid, Valladolid, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine, Valladolid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: González-García
authors.affiliation: Instituto de Oftalmobiología Aplicada, Universidad de Valladolid, Valladolid, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine, Valladolid, Spain. Electronic address: calonge@ioba.med.uva.es.
authors.forename: Margarita
authors.initials: M
authors.lastname: Calonge
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D015352:Dry Eye Syndromes / Q000378:metabolism / Q000503:physiopathology; D004780:Environment, Controlled; D005136:Eye Proteins / Q000378:metabolism; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D006813:Humidity; D053590:Interleukin 1 Receptor Antagonist Protein / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D007766:Lacrimal Apparatus Diseases / Q000378:metabolism* / Q000503:physiopathology; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008875:Middle Aged; D009994:Osmolar Concentration; D010865:Pilot Projects; D011446:Prospective Studies; D012859:Sjogren's Syndrome / Q000378:metabolism* / Q000503:physiopathology; D013194:Staining and Labeling / Q000379:methods; D013312:Stress, Physiological; D013666:Tears / Q000737:chemistry / Q000378:metabolism
chemical_list: C508606:CXCL8 protein, human; D005136:Eye Proteins; C508600:IL6 protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D016209:Interleukin-8; C042434:tear proteins; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9