January 6, 2015
Dr. Susan J. Henly, PhD, RN, FAAN
Nursing Research, Editor
School of Nursing
6-151B Weaver-Densford Hall
University of Minnesota
Minneapolis, 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, ND
Professor
Universidad de Guadalajara. Centro Universitario de Ciencias de la Salud. Departamento de
Enfermería Clínica Integral Aplicada. Licenciatura en Enfermería Semiescolarizada
Coordinador de Investigación en Enfermería del O.P.D. Instituto Jalisciense de Cancerología
José de Jesús López Jiménez, PhD, MC, Pharmaceutical Chemistry
Professor
Universidad de Guadalajara. Centro Universitario de Ciencias de la Salud. Departamento de
Enfermería Clínica Integral Aplicada. Licenciatura en Enfermería Semiescolarizada
Research 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), 4255.
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, 16341642.
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.