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Translational Research in Sjögren’s Syndrome

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Translational Oral Health Research

Abstract

Sjögren’s syndrome (SS) is an autoimmune inflammatory disorder of the exocrine glands, particularly affecting lacrimal and salivary glands. Hallmark symptoms are dry mouth and dry eye, often in conjunction with general symptoms, such as malaise and fatigue. Lymphomas could develop in 5–10% of the patients. As SS is a rather complex syndrome with many features, the one patient being diagnosed with SS may suffer from a different complex of complaints than another SS patient and may thus be in need of a different treatment approach. To better classify SS patients and to personalize their treatment, many clinicians and researchers are currently working on efforts (1) to refine classification of SS patients, (2) to ease the diagnostic work-up of SS, and (3) to better understand the etiopathogenesis of SS. Latter knowledge is essential to understand the course of the disease. This way clinicians will be able to identify patients who are at risk of developing SS or lymphomas; can intervene at an early stage of the disease to prevent damage to, e.g., the glands; as well as can personalize treatment with, e.g., biologicals. In this chapter, current major achievements are discussed, and promising new directions are indicated.

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References

  1. Quin B, Wang J, Yang Z, Yang M, Ma N, Huang F, et al. Epidemiology of primary Sjögren’s syndrome: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74:1983–9.

    Article  Google Scholar 

  2. Lendrem D, Howard Tripp N, Mariette X, et al. Rethinking primary Sjögren’s Syndrome: stratification by clinical phenotypes to improve understanding of disease pathogenesis, trial design, clinical management and prospective health gains? Arthritis Rheumatol. 2016;68:abstract 3031.

    Google Scholar 

  3. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8.

    Article  Google Scholar 

  4. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H, et al. American College of Rheumatology classification criteria for Sjögren’s syndrome: a data-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken). 2012;64:475–87.

    Article  Google Scholar 

  5. Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76:9–16.

    Article  Google Scholar 

  6. Vissink A, Bootsma H. Connective tissue diseases: refining the classification criteria for primary Sjögren syndrome. Nat Rev Rheumatol. 2017;13:10–2.

    Article  Google Scholar 

  7. Jousse-Joulin S, Nowak E, Cornec D, Brown J, Carr A, Carotti M, et al. Salivary gland ultrasound abnormalities in primary Sjögren’s syndrome: consensual US-SG core items definition and reliability. RMD Open. 2017;3(1):e000364.

    Article  Google Scholar 

  8. Mossel E, Delli K, van Nimwegen JF, Stel AJ, Kroese FGM, Spijkervet FKL, et al. Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjögren’s syndrome. Ann Rheum Dis. 2017. https://doi.org/10.1136/annrheumdis-2017-211250. pii: annrheumdis-2017-211250. [Epub ahead of print]

  9. Hocevar A, Ambrozic A, Rozman B, Kveder T, Tomsic M. Ultrasonographic changes of major salivary glands in primary Sjögren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford). 2005;44:768–72.

    Article  Google Scholar 

  10. Delli K, Arends S, van Nimwegen JF, Dijkstra PU, Stel AJ, Spijkervet FKL, et al. Ultrasound of the major salivary glands is a reliable imaging technique in patients with clinically suspected primary Sjögren’s syndrome. Ultraschall Med. 2017;38:1–8.

    Article  Google Scholar 

  11. Goules AV, Tzioufas AG. Primary Sjögren’s syndrome: clinical phenotypes, outcome and the development of biomarkers. Immunol Res. 2017;65:331–4.

    Article  Google Scholar 

  12. Baldini C, Gallo A, Perez P, Mosca M, Alevizos I, Bombardieri S. Saliva as an ideal milieu for emerging diagnostic approaches in primary Sjögren’s syndrome. Clin Exp Rheumatol. 2012;30:785–90.

    PubMed  Google Scholar 

  13. Kroese FG, Bootsma H. Biomarkers: new biomarker for Sjögren’s syndrome—time to treat patients. Nat Rev Rheumatol. 2013;9:570–2.

    Article  Google Scholar 

  14. Winthrop KL, Strand V, van der Heijde DM, Mease PJ, Crow MK, Weinblatt M, et al. The unmet need in rheumatology: reports from the targeted therapies meeting 2016. Clin Exp Rheumatol. 2016;34(4 Suppl 98):69–76.

    PubMed  Google Scholar 

  15. Jonsson R, Theander E, Sjostrom B, Brokstad K, Henriksson G. Autoantibodies present before symptom onset in primary Sjögren syndrome. JAMA. 2013;310:1854–5.

    Article  Google Scholar 

  16. Theander E, Jonsson R, Sjostrom B, Brokstad K, Olsson P, Henriksson G. Prediction of Sjögren’s syndrome years before diagnosis and identification of patients with early onset and severe disease course by autoantibody profiling. Arthritis Rheumatol. 2015;67:2427–36.

    Article  Google Scholar 

  17. Baldini C, Cecchettini A, Gallo A, Bombardieri S. Updates on Sjögren’s syndrome: from proteomics to protein biomarkers. Expert Rev Proteomics. 2017;14:491–8.

    Article  Google Scholar 

  18. Ramos-Casals M, Brito-Zeron P, Solans R, Camps MT, Casanovas A, Sopena B, et al. Systemic involvement in primary Sjögren’s syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology (Oxford). 2014;53:321–31.

    Article  Google Scholar 

  19. Tzioufas AG, Costello R, Manoussakis MN, Papadopoulos NM, Moutsopoulos HM. Cryoglobulinemia in primary Sjögren’s syndrome: a monoclonal process. Scand J Rheumatol Suppl. 1986;61:111–3.

    PubMed  Google Scholar 

  20. Quartuccio L, Isola M, Baldini C, Priori R, Bartoloni E, Carubbi F, et al. Clinical and biological differences between cryoglobulinaemic and hypergammaglobulinaemic purpura in primary Sjögren’s syndrome: results of a large multicentre study. Scand J Rheumatol. 2015;44:36–41.

    Article  Google Scholar 

  21. Nocturne G, Virone A, Ng WF, Le Guern V, Hachulla E, Cornec D, et al. Rheumatoid factor and disease activity are independent predictors of lymphoma in primary Sjögren’s syndrome. Arthritis Rheumatol. 2016;68:977–85.

    Article  Google Scholar 

  22. Quartuccio L, Baldini C, Bombardieri S, Priori R, Valesini G, Bartoloni E, et al. The need to target mucosa-associated lymphoid tissue for preventing lymphoma in rheumatoid factor-positive patients with Sjögren’s syndrome: comment on the article by nocturne et al. Arthritis Rheumatol. 2016;68:1318–9.

    PubMed  Google Scholar 

  23. Theander E, Vasaitis L, Baecklund E, Nordmark G, Warfvinge G, Liedholm R, et al. Lymphoid organisation in labial salivary gland biopsies is a possible predictor for the development of malignant lymphoma in primary Sjögren’s syndrome. Ann Rheum Dis. 2011;70:1363–8.

    Article  Google Scholar 

  24. Haacke EA, van der Vegt B, Vissink A, Spijkervet FKL, Bootsma H, Kroese FGM. Germinal centres in diagnostic labial gland biopsies of patients with primary Sjögren’s syndrome are not predictive for parotid MALT lymphoma development. Ann Rheum Dis. 2017. https://doi.org/10.1136/annrheumdis-2017-211290. pii: annrheumdis-2017-211290. [Epub ahead of print]

  25. Pollard RP, Pijpe J, Bootsma H, Spijkervet FK, Kluin PM, Roodenburg JL, et al. Treatment of mucosa-associated lymphoid tissue lymphoma in Sjögren’s syndrome: a retrospective clinical study. J Rheumatol. 2011;38:2198–208.

    Article  Google Scholar 

  26. Daniels TE. Labial salivary gland biopsy in Sjögren’s syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. 1984;27:147–56.

    Article  Google Scholar 

  27. Pijpe J, Kalk WW, van der Wal JE, Vissink A, Kluin PM, Roodenburg JL, et al. Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjögren’s syndrome. Rheumatology (Oxford). 2007;46:335–41.

    Article  Google Scholar 

  28. Delli K, Haacke EA, Ihrler S, van der Vegt B, Vissink A, Bootsma H, et al. Need for consensus guidelines to standardise the assessment of germinal centres and other histopathological parameters in salivary gland tissue of patients with primary Sjögren’s syndrome. Ann Rheum Dis. 2016;75:e32.

    Article  Google Scholar 

  29. Reksten TR, Johnsen SJ, Jonsson MV, Omdal R, Brun JG, Theander E, et al. Genetic associations to germinal centre formation in primary Sjögren’s syndrome. Ann Rheum Dis. 2014;73:1253–8.

    Article  Google Scholar 

  30. Haacke EA, Bootsma H, Spijkervet FKL, Visser A, Vissink A, Kluin PM, Kroese FGM. FcRL4+ B-cells in salivary glands of primary Sjögren’s syndrome patients. J Autoimmun. 2017;81:90–8.

    Article  Google Scholar 

  31. Delli K, Haacke EA, Kroese FG, Pollard RP, Ihrler S, van der Vegt B, et al. In primary Sjögren’s syndrome high absolute numbers and proportions of B cells in parotid glands predict responsiveness to rituximab as defined by ESSDAI, but not by SSRI. Ann Rheum Dis. 2016;e34:75.

    Google Scholar 

  32. Delli K, Haacke EA, Kroese FG, Pollard RP, Ihrler S, van der Vegt B, Vissink A, et al. Towards personalised treatment in primary Sjögren’s syndrome: baseline parotid histopathology predicts responsiveness to rituximab treatment. Ann Rheum Dis. 2016;75:1933–8.

    Article  Google Scholar 

  33. Fisher BA, Jonsson R, Daniels T, Bombardieri M, Brown RM, Morgan P, et al. Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren’s syndrome. Ann Rheum Dis. 2017;76:1161–8.

    Article  Google Scholar 

  34. Tavoni AG, Baldini C, Bencivelli W, Cavazzini L, Covelli M, De Vita S, et al. Minor salivary gland biopsy and Sjögren’s syndrome: comparative analysis of biopsies among different Italian rheumatologic centers. Clin Exp Rheumatol. 2012;30:929–33.

    PubMed  Google Scholar 

  35. Haacke EA, van der Vegt B, Vissink A, Spijkervet FKL, Bootsma H, FGM K. Standardisation of the detection of germinal centres in salivary gland biopsies of patients with primary Sjögren’s syndrome is needed to assess their clinical relevance. Ann Rheum Dis. 2017. https://doi.org/10.1136/annrheumdis-2017-212164. pii: annrheumdis-2017-212164. [Epub ahead of print]

  36. Mavragani CP, Crow MK. Mechanisms and new strategies for primary Sjögren’s syndrome. Annu Rev Med. 2017;68:331–43.

    Article  Google Scholar 

  37. Mavragani CP, Crow MK. Activation of the type I interferon pathway in primary Sjögren’s syndrome. J Autoimmun. 2010;35:225–31.

    Article  Google Scholar 

  38. Kimoto O, Sawada J, Shimoyama K, Suzuki D, Nakamura S, Hayashi H, et al. Activation of the interferon pathway in peripheral blood of patients with Sjögren’s syndrome. J Rheumatol. 2011;38:310–6.

    Article  Google Scholar 

  39. Nguyen CQ, Peck AB. The interferon-signature of Sjögren’s syndrome: how unique biomarkers can identify underlying inflammatory and immunopathological mechanisms of specific diseases. Front Immunol. 2013;4:142.

    Article  Google Scholar 

  40. Maria NI, Brkic Z, Waris M, van Helden-Meeuwsen CG, Heezen K, van de Merwe JP, et al. MxA as a clinically applicable biomarker for identifying systemic interferon type I in primary Sjögren’s syndrome. Ann Rheum Dis. 2014;73:1052–9.

    Article  Google Scholar 

  41. Hall JC, Baer AN, Shah AA, Criswell LA, Shiboski CH, Rosen A, et al. Molecular subsetting of interferon pathways in Sjögren’s syndrome. Arthritis Rheumatol. 2015;67:2437–46.

    Article  Google Scholar 

  42. Kroese FG, Verstappen GM, de Leeuw K, Bootsma H. Sjögren’s syndrome, should we sign? Expert Rev Clin Immunol. 2016;12:365–7.

    Article  Google Scholar 

  43. Mariette X, Roux S, Zhang J, Bengoufa D, Lavie F, Zhou T, et al. The level of BLyS (BAFF) correlates with the titre of autoantibodies in human Sjögren’s syndrome. Ann Rheum Dis. 2003;62:168–71.

    Article  Google Scholar 

  44. Pers JO, Lahiri A, Tobon GJ, Youinou P. Pathophysiological cytokine network in primary Sjögren’s syndrome. Presse Med. 2012;41(9 Pt 2):e467–74.

    Article  Google Scholar 

  45. Cornec D, Jousse-Joulin S, Costa S, Marhadour T, Marcorelles P, Berthelot JM, et al. High-grade salivary-gland involvement, assessed by histology or ultrasonography, is associated with a poor response to a single rituximab course in primary Sjögren’s syndrome: data from the TEARS randomized trial. PLoS One. 2016;11:e0162787.

    Article  Google Scholar 

  46. Corneth OBJ, Verstappen GMP, Paulissen SMJ, de Bruijn MJW, Rip J, Lukkes M, et al. Enhanced Bruton’s tyrosine kinase activity in peripheral blood B lymphocytes from patients with autoimmune disease. Arthritis Rheumatol. 2017;69:1313–24.

    Article  Google Scholar 

  47. De Vita S, Quartuccio L, Seror R, Salvin S, Ravaud P, Fabris M, et al. Efficacy and safety of belimumab given for 12 months in primary Sjögren’s syndrome: the BELISS open-label phase II study. Rheumatology (Oxford). 2015;54:2249–56.

    Google Scholar 

  48. Delaleu N, Mydel P, Kwee I, Brun JG, Jonsson MV, Jonsson R. High fidelity between saliva proteomics and the biologic state of salivary glands defines biomarker signatures for primary Sjögren’s syndrome. Arthritis Rheumatol. 2015;67:1084–95.

    Article  Google Scholar 

  49. Ryu OH, Atkinson JC, Hoehn GT, Illei GG, Hart TC. Identification of parotid salivary biomarkers in Sjögren’s syndrome by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry and two-dimensional difference gel electrophoresis. Rheumatology (Oxford). 2006;45:1077–86.

    Article  Google Scholar 

  50. Hu S, Gao K, Pollard R, Arellano-Garcia M, Zhou H, Zhang L, et al. Preclinical validation of salivary biomarkers for primary Sjögren’s syndrome. Arthritis Care Res (Hoboken). 2010;62:1633–8.

    Article  Google Scholar 

  51. Alevizos I, Alexander S, Turner RJ, Illei GG. MicroRNA expression profiles as biomarkers of minor salivary gland inflammation and dysfunction in Sjögren’s syndrome. Arthritis Rheum. 2011;63:535–44.

    Article  Google Scholar 

  52. Delaleu N, Mydel P, Brun JG, Jonsson MV, Alimonti A, Jonsson R. Sjögren’s syndrome patients with ectopic germinal centers present with a distinct salivary proteome. Rheumatology (Oxford). 2016;55:1127–37.

    Article  Google Scholar 

  53. Sun HY, Lv AK, Yao H. Relationship of miRNA-146a to primary Sjögren’s syndrome and to systemic lupus erythematosus: a meta-analysis. Rheumatol Int. 2017;37:1311–6.

    Article  Google Scholar 

  54. Tandon M, Perez P, Burbelo PD, Calkins C, Alevizos I. Laser microdissection coupled with RNA-seq reveal cell-type and disease-specific markers in the salivary gland of Sjögren’s syndrome patients. Clin Exp Rheumatol. 2017;35:777–85.

    PubMed  Google Scholar 

  55. Kroese FG, Abdulahad WH, Haacke E, Bos NA, Vissink A, Bootsma H. B-cell hyperactivity in primary Sjögren’s syndrome. Expert Rev Clin Immunol. 2014;10:483–99.

    Article  Google Scholar 

  56. Verstappen GM, Meiners PM, Corneth OBJ, Visser A, Arends S, Abdulahad WH, et al. Attenuation of follicular helper T cell-dependent B cell hyperactivity by abatacept treatment in primary Sjögren’s syndrome. Arthritis Rheumatol. 2017;69:1850–61.

    Article  Google Scholar 

  57. Van Nimwegen JF, Moerman RV, Sillevis Smitt N, Brouwer E, Bootsma H, Vissink A. Safety of treatments for primary Sjögren’s syndrome. Expert Opin Drug Saf. 2016;15:513–24.

    Article  Google Scholar 

  58. Devauchelle-Pensec V, Mariette X, Jousse-Joulin S, Berthelot JM, Perdriger A, Puéchal X, et al. Treatment of primary Sjögren syndrome with rituximab: a randomized trial. Ann Intern Med. 2014;160:233–42.

    Article  Google Scholar 

  59. Bowman S, Everett CC, O’Dweyer JL, Emery P, Pitzalis C, Ng WF, et al. Randomized controlled trial and cost-effectiveness analysis in treating fatigue and oral dryness in primary Sjögren’s syndrome. Arthritis Rheumatol. 2017;69:1440–50.

    Article  Google Scholar 

  60. Bootsma H, Kroese FGM, Vissink A. Editorial: rituximab in the treatment of Sjögren’s syndrome: is it the right or wrong drug? Arthritis Rheumatol. 2017;69:1346–9.

    Article  Google Scholar 

  61. Cornec D, Devauchelle-Pensec V, Mariette X, Jousse-Joulin S, Berthelot JM, Perdriger A, et al. Development of the Sjögren’s syndrome responder index, a data-driven composite endpoint for assessing treatment efficacy. Rheumatology. 2015;54:1699–708.

    Article  Google Scholar 

  62. Meiners PM, Vissink A, Kroese FG, Spijkervet FK, Smitt-Kamminga NS, Abdulahad WH, et al. Abatacept treatment reduces disease activity in early primary Sjögren’s syndrome (open-label proof of concept ASAP study). Ann Rheum Dis. 2014;73:1393–6.

    Article  Google Scholar 

  63. Pollard RP, Abdulahad WH, Vissink A, Hamza N, Burgerhof JG, Meijer JM, et al. Serum levels of BAFF, but not APRIL, are increased after rituximab treatment in patients with primary Sjogren’s syndrome: data from a placebo-controlled clinical trial. Ann Rheum Dis. 2013;72:146–8.

    Article  Google Scholar 

  64. Oni C, Mitchell S, James K, Ng WF, Griffiths B, Hindmarsh V, Price E, Pease CT, Emery P, Lanyon P, Jones A, Bombardieri M, Sutcliffe N, Pitzalis C, Hunter J, Gupta M, McLaren J, Cooper A, Regan M, Giles I, Isenberg D, Saravanan V, Coady D, Dasgupta B, McHugh N, Young-Min S, Moots R, Gendi N, Akil M, Barone F, Fisher B, Rauz S, Richards A, Bowman SJ. Eligibility for clinical trials in primary Sjögren’s syndrome: lessons from the UK Primary Sjögren’s Syndrome Registry. Rheumatology (Oxford). 2017;56(12):2255.

    Google Scholar 

  65. Pollard RP, Abdulahad WH, Bootsma H, Meiners PM, Spijkervet FK, Huitema MG, et al. Predominantly proinflammatory cytokines decrease after B cell depletion therapy in patients with primary Sjogren’s syndrome. Ann Rheum Dis. 2013;72:2048–50.

    Article  Google Scholar 

  66. Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch Intern Med. 2005;165:2337–44.

    Article  Google Scholar 

  67. Theander E, Henriksson G, Ljungberg O, Mandl T, Manthorpe R, Jacobsson LT. Lymphoma and other malignancies in primary Sjögren’s syndrome: a cohort study on cancer incidence and lymphoma predictors. Ann Rheum Dis. 2006;65:796–803.

    Article  Google Scholar 

  68. Voulgarelis M, Skopouli FN. Clinical, immunologic, and molecular factors predicting lymphoma development in Sjögren’s syndrome patients. Clin Rev Allergy Immunol. 2007;32:265–74.

    Article  Google Scholar 

  69. Brito-Zerón P, Kostov B, Fraile G, Caravia-Durán D, Maure B, Rascón FJ, et al. SS Study Group GEAS-SEMI. Characterization and risk estimate of cancer in patients with primary Sjögren syndrome. J Hematol Oncol. 2017;10:90.

    Article  Google Scholar 

  70. Hjelmervik TO, Petersen K, Jonassen I, Jonsson R, Bolstad AI. Gene expression profiling of minor salivary glands clearly distinguishes primary Sjögren’s syndrome patients from healthy control subjects. Arthritis Rheum. 2005;52:1534–44.

    Article  Google Scholar 

  71. Gottenberg JE, Cagnard N, Lucchesi C, Letourneur F, Mistou S, Lazure T, et al. Activation of IFN pathways and plasmacytoid dendritic cell recruitment in target organs of primary Sjögren’s syndrome. Proc Natl Acad Sci U S A. 2006;103:2770–5.

    Article  Google Scholar 

  72. Wildenberg ME, van Helden-Meeuwsen CG, van de Merwe JP, Drexhage HA, Versnel MA. Systemic increase in type I interferon activity in Sjögren’s syndrome: a putative role for plasmacytoid dendritic cells. Eur J Immunol. 2008;38:2024–33.

    Article  Google Scholar 

  73. Igoe A, Scofield RH. Autoimmunity and infection in Sjögren’s syndrome. Curr Opin Rheumatol. 2013;25:480–7.

    Article  Google Scholar 

  74. Inoue H, Mishima K, Yamamoto-Yoshida S, Ushikoshi-Nakayama R, Nakagawa Y, Yamamoto K, et al. Aryl hydrocarbon receptor-mediated induction of EBV reactivation as a risk factor for Sjögren’s syndrome. J Immunol. 2012;188:4654–62.

    Article  Google Scholar 

  75. Szyszko EA, Brokstad KA, Oijordsbakken G, Jonsson MV, Jonsson R, Skarstein K. Salivary glands of primary Sjögren’s syndrome patients express factors vital for plasma cell survival. Arthritis Res Ther. 2011;13(1):R2.

    Article  Google Scholar 

  76. Amft N, Curnow SJ, Scheel-Toellner D, Devadas A, Oates J, Crocker J, et al. Ectopic expression of the B cell-attracting chemokine BCA-1 (CXCL13) on endothelial cells and within lymphoid follicles contributes to the establishment of germinal center-like structures in Sjögren’s syndrome. Arthritis Rheum. 2001;44:2633–41.

    Article  Google Scholar 

  77. Barone F, Bombardieri M, Manzo A, Blades MC, Morgan PR, Challacombe SJ, et al. Association of CXCL13 and CCL21 expression with the progressive organization of lymphoid-like structures in Sjögren’s syndrome. Arthritis Rheum. 2005;52:1773–84.

    Article  Google Scholar 

  78. Barone F, Bombardieri M, Rosado MM, Morgan PR, Challacombe SJ, De Vita S, et al. CXCL13, CCL21, and CXCL12 expression in salivary glands of patients with Sjögren’s syndrome and MALT lymphoma: association with reactive and malignant areas of lymphoid organization. J Immunol. 2008;180:5130–40.

    Article  Google Scholar 

  79. Jonsson MV, Skarstein K, Jonsson R, Brun JG. Serological implications of germinal center-like structures in primary Sjögren’s syndrome. J Rheumatol. 2007;34:2044–9.

    PubMed  Google Scholar 

  80. Risselada AP, Kruize AA, Goldschmeding R, Lafeber FP, Bijlsma JW, van Roon JA. The prognostic value of routinely performed minor salivary gland assessments in primary Sjögren’s syndrome. Ann Rheum Dis. 2014;73:1537–40.

    Article  Google Scholar 

  81. Risselada AP, Looije MF, Kruize AA, Bijlsma JW, van Roon JA. The role of ectopic germinal centers in the immunopathology of primary Sjögren’s syndrome: a systematic review. Semin Arthritis Rheum. 2013;42:368–76.

    Article  Google Scholar 

  82. Routsias JG, Goules JD, Charalampakis G, Tzima S, Papageorgiou A, Voulgarelis M. Malignant lymphoma in primary Sjögren’s syndrome: an update on the pathogenesis and treatment. Semin Arthritis Rheum. 2013;43:178–86.

    Article  Google Scholar 

  83. Routsias JG, Tzioufas AG. Autoimmune response and target autoantigens in Sjögren’s syndrome. Eur J Clin Investig. 2010;40:1026–36.

    Article  Google Scholar 

  84. Routsias JG, Tzioufas AG. B-cell epitopes of the intracellular autoantigens Ro/SSA and La/SSB: tools to study the regulation of the autoimmune response. J Autoimmun. 2010;35:256–64.

    Article  Google Scholar 

  85. Tzioufas AG, Kapsogeorgou EK, Moutsopoulos HM. Pathogenesis of Sjögren’s syndrome: what we know and what we should learn. J Autoimmun. 2012;39:4–8.

    Article  Google Scholar 

  86. Lund FE. Cytokine-producing B lymphocytes-key regulators of immunity. Curr Opin Immunol. 2008;20:332–8.

    Article  Google Scholar 

  87. Fillatreau S. Cytokine-producing B cells as regulators of pathogenic and protective immune responses. Ann Rheum Dis. 2013;72(Suppl 2):ii80–4.

    Article  Google Scholar 

  88. Furuzawa-Carballeda J, Hernandez-Molina G, Lima G, Rivera-Vicencio Y, Ferez-Blando K, Llorente L. Peripheral regulatory cells immunophenotyping in primary Sjögren’s syndrome: a cross-sectional study. Arthritis Res Ther. 2013;15:R68.

    Article  Google Scholar 

  89. Puri KD, Di Paolo JA, Gold MR. B-cell receptor signaling inhibitors for treatment of autoimmune inflammatory diseases and B-cell malignancies. Int Rev Immunol. 2013;32:397–427.

    Article  Google Scholar 

  90. Moerman RV, Arends S, Meiners PM, Brouwer E, Spijkervet FK, Kroese FG, et al. EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) is sensitive to show efficacy of rituximab treatment in a randomised controlled trial. Ann Rheum Dis. 2014;73:472–4.

    Article  Google Scholar 

  91. Seror R, Bootsma H, Saraux A, Bowman SJ, Theander E, Brun JG, et al. Defining disease activity states and clinically meaningful improvement in primary Sjögren’s syndrome with EULAR primary Sjögren’s syndrome disease activity (ESSDAI) and patient-reported indexes (ESSPRI). Ann Rheum Dis. 2016;75:382–9.

    Article  Google Scholar 

  92. Seror R, Meiners P, Baron G, Bootsma H, Bowman SJ, Vitali C, et al. Development of the ClinESSDAI: a clinical score without biological domain. A tool for biological studies. Ann Rheum Dis. 2016;75:1945–50.

    Article  Google Scholar 

  93. Quartuccio L, Baldini C, Bartoloni E, Priori R, Carubbi F, Alunno A, et al. Correlation between ESSDAI and ClinESSDAI in a real-life cohort of patients with Sjögren’s syndrome. Clin Exp Rheumatol. 2017;35:546–7.

    PubMed  Google Scholar 

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Vissink, A., Spijkervet, F.K.L., Kroese, F.G.M., Bootsma, H. (2018). Translational Research in Sjögren’s Syndrome. In: Meurman, J. (eds) Translational Oral Health Research. Springer, Cham. https://doi.org/10.1007/978-3-319-78205-8_10

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