Background: A 2015 survey in Taiwan revealed that the prevalence of Dry Eye Syndrome
(DES) is 4.87%, with 4.8% of these cases likely to develop into Sjögren's Syndrome (SJS).
An American study indicated that 11.6% of DES cases could be diagnosed as SJS, and SJS
patients showed significantly more severe conjunctival and corneal staining, Schirmer's
test results, clinical symptoms, anti-nuclear antibody, and rheumatoid factor compared to
non-SJS patients. Various autoimmune diseases (such as SJS, SLE, RA, SSc, AS, etc.) also
affect the severity of dry eye symptoms. Recent studies have employed exosome proteomics
to investigate cell-to-cell communication, molecular mechanisms of diseases, and the
development of new diagnostic markers and therapeutic targets. While these studies have
significant research value for understanding disease mechanisms, diagnosis, and
treatment, few have specifically focused on the impact of exosome proteomics in SJS and
DES.
Objective: By analyzing the differential proteins in exosomes, this study aims to
understand the pathological mechanisms of SJS and DES, identify potential diagnostic and
therapeutic methods, and advance the diagnosis and treatment of these diseases.
Methods: This study will develope on previous research projects conducted at Taipei
Veterans General Hospital (TBDESJS，V112C-190) and the National Science and Technology
Council (ACUDES). TBDESJS focused on evaluating the use of a herbal tea TBDESJS for
relieving dry eye and mouth symptoms in DES and SJS patients, and ACUDES explored the
immediate and long-term effects of acupuncture on treating dry eye and mouth symptoms in
DES and SJS patients by using the GB20 (Fengchi) and BL2 (Zanzhu) acupuncture points.
TBDESJS Study: Included 30 DES patients, 60 SJS patients, and 10 healthy controls
(NHC) to evaluate the efficacy of the Traditional Chinese Medicine (TCM) herbal tea
in improving dry eye and mouth symptoms.
ACUDES Study: Included 50 DES patients, 50 SJS patients, and 20 NHC to evaluate the
efficacy of acupuncture GB20 and BL2 in improving dry eye and mouth symptoms.
The study will further analyze the remaining samples from these two projects with consent
from the participants (45 SJS, 28 DES, and 10 NHC from TBDESJS; 47 SJS, 40 DES, and 20
NHC from ACUDES). In total, 92 SJS, 68 DES, and 30 NHC participants will be included. We
will select 40 participants with significant therapeutic improvement from the ACUDES
study and 40 from the TBDESJS study for pre- and post-treatment comparison, along with 20
NHC participants, total 100 subjects and 180 person-times.
Additionally, we will perform comprehensive cross-analyses incorporating whole-genome
genotyping, cytokines, Schirmer's test, tear breakup time, TCM constitution scale, OSDI,
ESSPRI, PSQI, FIRST, TCM pulse diagnosis, TCM tongue diagnosis, and TCM heart rate
variability measurements. This will help us understand the potential pathways by which
the TBDESJS and ACUDESJS regulate immunity, aiming for future clinical applications in
SJS and DES patients, ultimately achieving the goal of Holistic Health Care.
Expected Outcomes:
Purify exosomes from the plasma of SJS and DES patients, identify differential
proteins between healthy individuals and patients, and investigate the roles of
these proteins in immune cell regulation and their potential as diagnostic tools.
Analyze the differential proteins in plasma exosomes of SJS and DES patients before
and after treatment with the TBDESJS and ACUDES to explore their therapeutic
mechanisms.
Explore the possible pharmacological mechanisms of the TBDESJS and ACUDES.