A Preliminary Study On Th17 Cell-related Cytokines Levels In Tear Samples Of Systemic Lupus Erythematosus Or Primary Sjogren’s Syndrome Patient With Dry Eye Disease

【Background】Autoimmune disease is involving immune dysfunction and causing multiple organs damages,Primary Sjogren’s Syndrome（PSS）and Systemic Lupus Erythematosus（SLE）are the most common autoimmune diseases with higher incidence.The usual clinical symptoms are damages accrued in connective tissue such as skin,mucous membranes,and glands.The corneal,conjunctival,and lacrimal gland tissues of the eye structures and functions are also can be damaged due to immune dysfunctions and resulting in dry eye disease（DED）with a blindness risk if the symptoms development to a serious situation.A number of studies have been conducted to investigate the pathogenesis of autoimmune diseases leading to dry eye disease,but it has not been fully clarified.A research report pointed out T cell infiltration is existed in the lacrimal gland of dry eye disease patients.IL-17,TNF-α,IL-21 and IL-22 levels are up-regulated in the tear samples of dry eye disease patients with PSS caused by Th17-cell related cytokines secretions and the reason may be related to the differentiation of primitive T cells into Th17 cells in the eye.In addition,clinical experience can be observed that some patients with SLE also have clinical symptoms of dry eye disease.Studies using tear samples from patients with SLE dry eye disease are rare,and the results of studies using blood samples also show that TNF-αand IL-6 levels is up-regulated in blood samples of SLE patients with dry eye diseases.【Objective】Because the components contained in tears may be different from blood,this study determined the expression of Th17 cell-related cytokines in tear samples of SLE or PSS patients with dry eye disease,including IL-1β,IL-2,IL-4,IFN-γ,IL 6,IL-8,IL-17F,TNF-α,IL-21,IL-22 and IL-23 to provide valuable information for the subsequent exploration of its pathogenesis and discovery of new potential therapeutic targets.【Methods】The Liquid suspension chip system（Luminex 200）was used to detect the concentration of Th17 cell-related factors in tear samples of normal healthy people（control group,n=30 people）,patients with simple dry eye disease（SDE group,n=13people）,SLE patients with dry eye disease（SLEA^-group with negative anti-SSA antibody,n=13 people）,SLE patients with dry eye disease（SLEA⁺group with positive anti-SSA antibody,n=17 people）,PSS patients with dry eye disease and positive anti-SSA antibody（PSS group,n=18 people）.And 4 ocular surface examinations for patients with dry eye symptoms,including ocular surface disease index（OSDI）,tear secretion test（Sirmer I Test,SIT）,tear uptime（Break Up Time,BUT）,corneal fluorescein stain（Cornea Fluorescein Staining,CFS）,and compare with concentration of Th17 cell-related factors in the tears of the subjects in each group and the results of these 4 ocular surface examinations.【Results】The SIT and BUT results of the SLEA^-and SLEA⁺groups were lower than those of the normal group（P<0.001）.The SIT and BUT results of the SLEA^-and SLEA⁺groups were lower than those of the SDE group（P<0.05）.Compared with the SLEA⁺group,the SIT,BUT,CFS,OSDI results of the SLEA^-group present no statistically significant difference（P>0.05）.Compared with the PSSA⁺group,the results of SIT,BUT,CFS,and OSDI in the SLEA^-and SLEA⁺groups present no statistically significant difference（P>0.05）.The serum anti-SSA antibody titers in patients with SLE dry eye disease and PSS dry eye disease were not significantly correlated with the results of SIT,BUT,CFS,OSDI（P>0.05）.The levels of IL-1βand IL-17F in tear samples of SLEA^-/+patients with dry eye disease were higher than those in the normal group,but the difference was not statistically significant.The levels of IL-6,IL-8,TNF-αand IL-21 in tear samples of SLEA^-/+patients with dry eye disease were higher than those in the normal group（P<0.01）.The levels of IL-2,IL-4,IL-22,IL-23,and IFN-γin tear samples of SLEA^-/+patients with dry eye disease were lower than those in the normal group（P<0.05）.【Conclusion】The 4 ocular surface examinations results of SLEA^-/+patients with dry eye disease are similar to PSSA⁺patients with dry eye disease,but the expression of some cytokines in their tears is not the same.The abnormal regulation of Th17 cell pathway may be related to the dry eye disease occurrence in SLEA^-/+and PSSA⁺patients.