January 6, 2015

Dr. Susan J. Henly, PhD, RN, FAAN Nursing Research, EditorSchool of Nursing6-151B Weaver-Densford HallUniversity of MinnesotaMinneapolis, MN 55455

Dear Dr. Henly,

We read the article published in the Nov/Dec 2014 issue of Nursing Research, titled “Assessing the immune status critically ill trauma patients by flow cytometry” (Kuethe et al., 2014). The authors described the importance of analysis of different cells in patients of intensive care unit (ICU), by flow cytometry technique, where the immune system is susceptible to nosocomial infections that cause mortality on ICU in the world (Markwartet al., 2014). Certainly flow cytometry has the ability to identify cell subtypes by morphological phenotype (shape and size) or by surface antigens in autoimmune diseases such as primary Sjögren´s syndrome (pSS). Flow cytometry could be an important noninvasive tool for diagnosis and progression of primary Sjögren´s syndrome (Cornec et al., 2014; Roberts et al., 2010).

Primary Sjögren's syndrome is an autoimmune disease that affects exocrine glands. Xerostomia and xerophthalmia are their main signs; the primary Sjögren´s syndrome diagnosis is established by European-Americans criteria (Vitali et al., 2002) and the Sjögren’s Syndrome Disease Activity and Sjögren’s Syndrome Disease Damage Indexes. Laboratory l tests are also used. Lymphocytic infiltrate is analyzed in minor salivary gland biopsy (Ramos-Casals et al., 2005). Because various studies have reported increased apoptosis —characterized by lymphocytic infiltrate in minor salivary glands (Ramos-Casals et al., 2005; Sanz, 2008)—in primary Sjögren’s Syndrome patients , flow cytometry could be used in diagnosis and prognosis by analyzing different molecules associated in apoptotic pathways in peripheral blood of primary Sjögren’s Syndrome patients or patients with other autoimmune diseases (Alunno et al., 2014; Cornec et al., 2014; Roberts et al., 2010). These markers could be measured over time to determine the disease progression of patients with different treatments. Nursing scientists could use flow cytometry to study associations with clinical parameters, treatment and markers in pSS or in other autoimmune diseases.

Sincerely,

Ana Lilia Fletes Rayas, PhD, NDProfessor Universidad de Guadalajara. Centro Universitario de Ciencias de la Salud. Departamento de Enfermería Clínica Integral Aplicada. Licenciatura en Enfermería SemiescolarizadaCoordinador de Investigación en Enfermería del O.P.D. Instituto Jalisciense de Cancerología

José de Jesús López Jiménez, PhD, MC, Pharmaceutical Chemistry

ProfessorUniversidad de Guadalajara. Centro Universitario de Ciencias de la Salud. Departamento de Enfermería Clínica Integral Aplicada. Licenciatura en Enfermería SemiescolarizadaResearch Technician. Centro de Investigación Biomédica de Occidente. Instituto Mexicano del Seguro Social

References

Alunno, A., Carubbi, F., Bistoni, O., Caterbi, S., Bartoloni, E., Bigerna, B., …Gerli, R. (2014). CD4(-)CD8(-) T-cells in primary Sjögren's syndrome: Association with the extent of glandular involvement. Journal of Autoimmunity, 51, 38-43.

Barrera-Martínez, L. A., Drago-Serrano, M.,E., Pérez-Ramos, J., Zamoras, A. C., Sainz-Espuñez, T. R., & Mendoza-Pérez, F. (2004). Flow cytometry: link between basic research and clinical application. Journal of the National Institute of Respiratory Diseases of Mexico, 17(1), 42-55.

Cornec, D., Saraux, A., Pers, J. O., Jousse-Joulin, S., Marhadour, T., Roguedas-Contios, A. M., Genestet, S., Renaudineau, Y., & Devauchelle-Pensec, V. (2014) Diagnostic accuracy of blood B-cell subset profiling and autoimmunity markers in Sjögren’s syndrome. Arthritis Research and Therapy, 6(1), R15. 

Kuethe, J. W., Mintz-Cole, R., Johnson, B. L. III, Midura, E. F., Caldwell, C. C., Schneider, B. S. (2014). Assessing the immune status of criticall ill trauma patients using flow cytometry. Nursing Research, 63, 426-434.

Markwart, R., Condotta, S. A., Requardt, R. P., Borken, F., Schubert, K., Weigel, C., Bauer, M., …Rubio, I. (2014) Immunosuppression after sepsis: Systemic inflammation and sepsis induce a loss of naïve T-cells but no enduring cell-autonomous defects in T-cell function. PLoS ONE, 9(12). Retrieved from http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0115094

Ramos-Casals, M., & Font, J. (2005). Primary Sjögren´s syndrome: Current emergent aetiopathogenic concepts. Reumathology, 44:1354-1367.

Roberts, M., Maguire, C., Rosenberg, A., Coca, A., Anolik, J. H., & Sanz, I. (2010). B-cell profiling using multi-color flow cytometry as biomarker of disease progression in primary Sjogren's syndrome (pSS) [abstract]. Arthritis and Rheumatology, 62 (10):1886.

Sanz, A. B., Santamaría, B., Ruiz-Ortega, M., Egido, J., & Ortiz, A. (2008). Mechanism of renal apoptosis in health and disease. Journal of the American Society of Nephrology, 19, 1634-1642.

Vitali, C., Bombardieri, S., Jonsson, R., Moutsopoulos, H. M., Alexander, E. L., Carsons, S. E., …Weisman, M. H. (2002). Classification criteria for Sjogen's syndrome: A revised version of the European criteria proposed by the American-European consensus group. Annals of Rheumatic Diseases , 61, 554-558.