Scientist Hits on Possible Sjogren’s Remedy

Walking in the Sahara desert and sticking your head in the sand--with eyes open: That’s how people describe the painful and disabling symptoms of a puzzling inflammatory condition called Sjogren’s syndrome.

Affecting millions of Americans, Sjogren’s is a condition that leaves the eyes and mouth painfully dry and gritty. Scientists suspect that it is an autoimmune disorder affecting all the body’s moisture-producing glands. The inflammation targets connective tissue, and without moisture, especially in the eye, patients can experience severe ulceration of the cornea and subsequent visual loss. Problems in other organs of the body can lead to severe joint pain and fatigue.

Now, a scientist working on a hunch has found what seems like a surprisingly simple solution, a treatment that reverses the dryness and restores moisture to the eye.

David Sullivan of the Schepens Eye Research Institute in Boston has been studying hormonal regulation of the eye and found that androgens such as testosterone play an important role in Sjogren’s. And merely placing a topical film of testosterone on the eye seems to reverse or suppress the inflammatory process.

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There has been little attention to Sjogren’s, despite an estimate that 2 million to 4 million people, primarily women, are affected by this condition. With virtually no medicines to offer patients, doctors have sent people home with artificial teardrops that help moisten the eyes. Others wear goggles that act like humidity chambers. Most receive little benefit from either treatment.

The gritty Sahara environment of the eye has been Sullivan’s focus. To understand Sjogren’s, it’s important to focus on the outer film of the eye. Three layers make up this film: a mucous sheet composed of hundreds of thousands of cells; a watery layer--the lacrimal gland that contains antibodies to protect against infections; and an oily, outer layer called the meibomian. People with Sjogren’s can lack enough water in the lacrimal gland. But the majority of patients suffer from an inflammation in the meibomian layer, and the immune system response to this inflammation disrupts the normal activity of this tissue layer.

Knowing that estrogen has been linked to autoimmune disorders and that testosterone has been shown to suppress the same process, Sullivan thought he had a good lead to follow. He was right. He found that administering testosterone suppressed the inflammation in the gland. And as he suspected, correcting the hormone deficiency and suppressing the inflammatory process reversed the eye damage.

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Women make about two-thirds the level of androgens that males do, which may explain why the condition appears more often in females. The condition generally comes on the heels of menopause, which is precisely when estrogen and androgen levels drop, Sullivan explains. The meibomian gland is regulated by androgens. When androgens are put back into the eye, the meibomian layer functions normally, and the eyes are moistened and pain-free.

A pharmaceutical company is now testing Sullivan’s treatment in Phase 1 clinical studies. The same company--Allergan of Irvine--also just completed the final phases of human testing of cyclosporine A eyedrops. This medicine is used after transplantation to prevent the body from rejecting the donor organ. On the same principle, the medicine prevents or corrects the underlying autoimmune disorder. Last year, the Food and Drug Administration approved the first treatment for dry mouth, a medicine called Salagen that stimulates saliva.

“There’s been a frustration that doctors can’t do anything for these patients,” said Alexis Stegemann, executive director of the Sjogren’s Syndrome Foundation based in Jericho, N.Y. The foundation has 7,300 members, and publishes a newsletter called Moisture Seekers. For more information, access the foundation’s Web site at https://www.sjogrens.com or call (800) 475-6473.