Exploring Immune Cell Signatures in Autoimmunity and Ocular Surface Stress

Status: Recruiting
Location: See location...
Intervention Type: Other
Study Type: Observational

Ocular surface disease, especially dry eye and scleritis, commonly affects patients with autoimmune diseases. Ocular surface immune cells are increased in autoimmune disease; however the full subset of immune cells activated is unknown. Recent experimental studies show that dendritic cells and T cells in the cornea are critically associated with corneal nerve innervation. Corneal confocal microscopy (CCM) allows rapid non-invasive in vivo imaging of dendritic cells and corneal nerves. The investigators propose to investigate how ocular surface health, conjunctival immune cells and corneal nerve/dendritic cell morphology interact in 3 rheumatological conditions: Sjogren's syndrome (SS), Rheumatoid arthritis (RA), Systemic lupus erythematosus (SLE). The preliminary flow cytometric studies show that various immune cells (eg: T cells, B cells, and dendritic cells) can be quantified using minimally invasive impression membranes (Eyeprim). Clinically, the research team is experienced in measuring features of ocular surface inflammation (conjunctival redness, tear breakup times) with Oculus keratograph5M. The investigators also aim to harvest conjunctival immune cells using impression cytology and quantify specific cell types with flow cytometry. Corneal nerve morphology and dendritic cell density and distribution will be assessed using CCM; in collaboration with the group who have pioneered this technique. The investigator anticipate that alterations in corneal nerve and dendritic cell parameters will correlate with immune activation/inflammation, deterioration of tear function and increased systemic severity of the rheumatological disease. In addition, the investigators hypothesize that the lower the corneal nerve density, the higher the number of corneal dendritic cells and conjunctival inflammatory cells. Studying these relationships may allow a better mechanistic understanding of local corneal and systemic immune activation and the development of a non-invasive ophthalmic surrogate marker of dendritic cell activation and nerve fibre loss to aid earlier diagnosis, risk stratification and the development of new therapies in autoimmune patients with severe dry eye.

Participation Requirements
Sex: All
Minimum Age: 21
Maximum Age: 99
Healthy Volunteers: Accepts Healthy Volunteers

⁃ Recruitment inclusion criteria for Systemic diseases participants:

• Clinically diagnosed with Primary Sjogren's Syndrome, Rheumatoid Arthritis or Systemic Lupus Erythematosus.

⁃ Recruitment inclusion criteria for controls:

⁃ NO Dry eye or severe Meibomian Gland Disease

⁃ NO current or recent (< 6 months) conjunctivitis, keratitis, uveitis or other inflammatory condition affecting eye

⁃ NO recent ocular surgery or LASIK (< 6 months)

⁃ Frequency of dry eye symptoms is < once/week (burning, tearing, itching, foreign body sensation, transient blurring improved by blinking)

⁃ NO contact lens wear for the past 1 week

⁃ NO systemic conditions of Diabetes Mellitus, Rheumatoid Arthritis, Systemic Lupus Erythematosus

⁃ Bulbar redness is < 1.5 grading

Other Locations
Cynthia Boo
Time Frame
Start Date: May 2016
Estimated Completion Date: December 2022
Target number of participants: 160
Collaborators: SingHealth Translational Immunology and Inflammation Centre, TTSH Eye Clinic
Leads: Singapore National Eye Centre

This content was sourced from clinicaltrials.gov

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