title: Mechanisms and New Strategies for Primary Sjögren's Syndrome.
abstract: Primary Sjögren's syndrome (SS) is a common chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly salivary and lacrimal, resulting in oral and ocular dryness, although virtually any organ system can be affected. SS-related systemic manifestations are classified as either related to the presence of periepithelial infiltrates in exocrine and parenchymal organs or resulting from immunocomplex deposition due to B cell hyperactivity with increased risk for B cell lymphoma development. Activation of both innate and adaptive immune pathways contributes to disease pathogenesis, with prominent interferon (IFN) signatures identified in both peripheral blood and affected salivary gland tissues. Recently, LINE-1 genomic repeat elements have been proposed as potential triggers of type I IFN pathway activation in SS through activation of Toll-like receptor-dependent and -independent pathways. In view of the increasingly appreciated variability of SS, elucidation of distinct operating pathways in relation to diverse clinical phenotypes and selection of the optimal therapeutic intervention remain major challenges. Inhibition of cathepsin S molecules, blockade of costimulation through administration of abatacept and inhibitors of B7-related molecules and CD40, blockade of B cell function and B cell survival factors, and disruption of the formation of ectopic germinal centers are considered the main therapeutic targets. Well-controlled multicenter clinical trials are ongoing and data are awaited.
authors.affiliation: Department of Physiology, School of Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece; email: kmauragan@med.uoa.gr.
authors.forename: Clio P
authors.initials: CP
authors.lastname: Mavragani
mesh_terms: D056704:Adaptive Immunity; D000818:Animals; D017951:Antigen Presentation; D053264:B-Cell Activating Factor / Q000378:metabolism; D053265:B-Cell Activation Factor Receptor / Q000378:metabolism; D001402:B-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000276:immunology / Q000378:metabolism*; D018858:Germinal Center / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate; D007372:Interferons / Q000276:immunology / Q000378:metabolism; D008213:Lymphocyte Activation; D008212:Lymphocyte Depletion; D010950:Plasma Cells; D011947:Receptors, Antigen, B-Cell / Q000378:metabolism; D015398:Signal Transduction; D012859:Sjogren's Syndrome / Q000235:genetics / Q000276:immunology*
chemical_list: D053264:B-Cell Activating Factor; D053265:B-Cell Activation Factor Receptor; D016207:Cytokines; D011947:Receptors, Antigen, B-Cell; C505719:TNFSF13B protein, human; D007372:Interferons
keywords: B cell activation; BAFF; autoimmunity; germinal center formation; interferon pathways