Lymphocytic infiltration of the lacrimal gland and ocular surface in autoimmune diseases such as Sjögren's syndrome (SS) causes an aqueous-deficient dry eye that is associated with significant morbidity. Previous studies from our laboratory and others have established autoimmune regulator (Aire)-deficient mice as a useful model to examine exocrinopathy and ocular surface disease associated with SS. Consistent with human SS, autoreactive CD4(+) T cells play an indispensible role in the development of exocrine and ocular surface disease in Aire knockout mice. We report that in addition to CD4(+) T cells, a large number of macrophages infiltrate the corneal stroma, limbus, and lacrimal glands of diseased mice. Adoptive transfer of autoreactive CD4(+) T cells from Aire knockout mice led to local infiltration of macrophages and ocular surface damage in immunodeficient recipients. Depletion of local macrophages, through subconjunctival injection of clodronate liposome, attenuated lissamine green staining and improved ocular phenotype. Alternatively, systemic depletion of macrophages had no effect on ocular phenotype but led to significant improvements in lacrimal gland exocrinopathy and tear secretion. Our results suggested that autoreactive CD4(+) T cells provoked macrophage infiltration to the eye and lacrimal gland, where they played a functional role in directing the development of autoimmune dry eye.

Purpose. Squamous metaplasia occurs in ocular surface diseases like Sjögren’s syndrome (SS). It is a phenotypic change whereby epithelial cells initiate synthesis of squamous cell-specific proteins such as small proline-rich protein 1B (SPRR1B) that result in pathologic keratin formation on the ocular surface. The authors hypothesized that inflammation is a key inducer of pathologic keratinization and that SPRR1B represents an analytical biomarker for the study of the molecular mechanisms. methods. Real-time quantitative RT-PCR and immunohistochemistry were used to examine SPRR1B mRNA and protein in two different mouse models of dry eye and patients with SS. Adoptive transfer of mature lymphocytes from mice lacking the autoimmune regulator (aire) gene was performed to examine the role of inflammation as an inducer of squamous metaplasia. SPRR1B expression in response to several cytokines was examined in vitro, whereas the expression of cytokines IL1β and IFNγ was quantified in ocular tissues of aire-deficient mice and patients with SS. results. SPRR1B was increased across the ocular surface of mice with both desiccating stress and autoimmune-mediated, aqueous-deficient dry eye and in patients with SS. Adoptive transfer of CD4⁺ T cells from aire-deficient mice to immunodeficient recipients caused advanced ocular surface keratinization. IL1α, IL1β, IL6, IFNγ, and TNFα induced SPRR1B expression in vitro and the local expression of IL1β and IFNγ was elevated in ocular tissues of patients with SS and aire-deficient mice. conclusions. SPRR1B is a valid biomarker for the study of the molecular mechanisms of squamous metaplasia. There is a definitive link between inflammation and squamous metaplasia in autoimmune-mediated dry eye disease, with IL1β and IFNγ likely acting as key participants.

Purpose. Lacritin is a tear glycoprotein with prosecretory, prosurvival, and mitogenic properties. We examined lacritin levels in the tears of Sjögren's syndrome (SS) patients and explored the therapeutic potential of topical lacritin for the treatment of keratoconjunctivitis sicca. Methods. Tears from healthy controls (n = 14) and SS patients (n = 15) were assayed for lacritin using a C-terminal antibody. In a paired-eye study, autoimmune regulator (Aire) knockout (KO) mice (n = 7) were treated three times daily for 21 days with 10 μL of 4 μM lacritin (left eye) or vehicle (PBS) control (right eye). Tear secretion and ocular surface integrity were assessed at baseline and after treatment. Immunohistochemical staining of CD4+ T cells, cytokeratin-10 (K10), and cytokeratin-12 (K12) expression in the cornea and CD4+ T cell infiltration in the lacrimal glands were assessed. Results. Lacritin monomer (421.8 ± 65.3 ng [SS] vs. 655.8 ± 118.9 ng [controls]; P = 0.05) and C-terminal fragment protein (125 ± 34.1 ng [SS] vs. 399.5 ± 84.3 ng [controls]; P = 0.008) per 100 μL of tear eluate were significantly lower in SS patients. In Aire KO mice treated with lacritin, tear secretion increased by 46% (13.0 ± 3.5 mm vs. 8.9 ± 2.9 mm; P = 0.01) and lissamine green staining score significantly decreased relative to baseline (−0.417 ± 0.06 vs. 0.125 ± 0.07; P = 0.02). Expression of K10 but not K12 in the cornea was significantly decreased in lacritin-treated eyes. Focal CD4+ T cell infiltration of the lacrimal glands was significantly reduced on the lacritin-treated side versus the untreated side. Conclusions. Lacritin is significantly reduced in the tears of SS patients. Topically administered lacritin has therapeutic potential for the treatment of aqueous-deficient dry eye disease.

Purpose.: The cornified envelope protein small proline-rich protein 1B (SPRR1B) is a biomarker for squamous metaplasia. Proinflammatory cytokines IL-1β and IFN-γ are potent inducers of ocular surface keratinization and SPRR1B expression. Here the molecular mechanisms controlling SPRR1B gene expression in response to IL-1β and IFN-γ are elucidated. Methods.: A 3-kb fragment of the SPRR1B gene 5′-flanking region was amplified from human chromosome 1, sequentially deleted, and cloned into a luciferase vector. Constructs were transiently transfected into human corneal epithelial cells, and activity was assessed in response to IL-1β, IFN-γ, or basal medium. Functional cis-elements responding to IL-1β and IFN-γ were characterized by site-directed mutagenesis and gel mobility shift assay. Effects of mitogen-activated protein kinases p38, ERK, and JNK were assessed using inhibitors and dominant-negative mutants. Results were validated by real-time RT-PCR. Results.: The first 620 bp of the SPRR1B 5′-flanking region regulated constitutive expression and increased promoter activity in response to IL-1β and IFN-γ. Corresponding cis-elements for IL-1β and IFN-γ were bound by cAMP response element binding protein (CREB) and zinc-finger E-box binding homeobox 1 (ZEB1), respectively. Inhibition of p38 abolished the stimulatory effects of IL-1β and IFN-γ on SPRR1B, whereas inhibition of JNK and ERK had no effect. Dominant-negative mutants targeting p38α and p38β2 blocked cytokine-induced SPRR1B promoter activity and mRNA expression. Conclusions.: SPRR1B is upregulated by the proinflammatory cytokines IL-1β and IFN-γ via p38 MAPK-mediated signaling pathways that lead to the activation of transcription factors CREB and ZEB1, respectively. These results identify key intracellular signaling intermediates involved in the pathogenesis of immune-mediated ocular surface squamous metaplasia.

Adherens junctions (AJs) containing epithelial cadherin (E‐cad) bound to p120‐catenin (p120ctn) and β‐catenin (β‐ctn) play a crucial role in regulating cell–cell adhesion. Cigarette smoke abrogates cell–cell adhesion between epithelial cells by disrupting E‐cad, a hallmark of epithelial–mesenchymal transition (EMT), yet the underlying mechanism remains unknown. We used an organotypic culture of primary human bronchial epithelial (HBE) cells treated with smoke‐concentrated medium (Smk) to establish an essential role for the interaction between p120ctn and the cytoplasmic tail of MUC1 (MUC1‐CT) in regulating E‐cad disruption. Within the first 4 h of smoke exposure, apical MUC1‐CT repositioned to the basolateral membrane of pseudo‐stratified HBE cells, where it interacted with p120ctn. A time‐dependent increase in MUC1‐CT/p120ctn complexes occurred in conjunction with a time‐dependent dissociation of p120ctn/E‐cad/β‐ctn complexes, as well as the coordinated degradation of p120ctn and E‐cad. Interestingly, Smk induced a similar interaction between MUC1‐CT and β‐ctn, but this occurred 44 h after MUC1‐CT's initial interaction with p120ctn, and well after the AJs were destroyed. Blocking MUC1‐CT's interaction with p120ctn using a MUC1‐CT dominant‐negative peptide, PMIP, successfully abolished Smk's disruptive effects on AJs and recovered apical‐basolateral polarity of HBE cells. The MUC1‐CT/p120ctn interaction was highly dependent on EGFR/Src/Jnk‐mediated tyrosine phosphorylation (TyrP) of MUC1‐CT. Accordingly, EGFR, Src or Jnk inhibitors (AG1478, PP2, SP600125, respectively) abrogated Smk‐induced MUC1‐CT‐TyrP, MUC1‐CT/p120ctn interaction, AJ disruption, and loss of cellular polarity. Our work identified MUC1‐CT and p120ctn as important regulators of epithelial polarity and cell‐cell adhesion during a smoke‐induced EMT‐like process. Novel therapeutics designed to inhibit MUC1‐CT/p120ctn complex formation may prevent EMT in the smoker's airway. Copyright © 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.