Salivary transforming growth factor alpha in patients with Sjögren's syndrome and reflux laryngitis

Braz J Otorhinolaryngol. 2014;80(6):462---469 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Salivary transforming growth factor alpha in patients with Sjögren’s syndrome and reflux laryngitis夽 Marco Antonio dos Anjos Corvo a,b,∗ , Claudia Alessandra Eckley a,b , Luis Vicente Rizzo c,d , Luiz Roberto Sardinha c,d , Tomas Navarro Rodriguez e,f , Ivo Bussoloti Filho a,b a Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil Department of Otorhinolaryngology, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil c Department of Immunology, Universidade de São Paulo (USP), São Paulo, SP, Brazil d Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, SP, Brazil e Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil f School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil b Received 8 April 2013; accepted 24 May 2014 Available online 27 August 2014 KEYWORDS Xerostomia; Laryngopharyngeal reflux; Sjögren’s syndrome; Saliva; Epidermal growth factor; Transforming growth factor alpha Abstract Introduction: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren’s syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren’s syndrome and laryngopharyngeal reflux. Objective: To compare the salivary transforming growth factor alpha levels of patients with Sjögren’s syndrome and laryngopharyngeal reflux to those of healthy controls. Methods: This is a prospective controlled study. Twelve patients with Sjögren’s syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. Results: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. 夽 Please cite this article as: Corvo MA, Eckley CA, Rizzo LV, Sardinha LR, Rodriguez TN, Bussoloti Filho I. Salivary transforming growth factor alpha in patients with Sjögren’s syndrome and reflux laryngitis. Braz J Otorhinolaryngol. 2014;80:462---9. ∗ Corresponding author. E-mail: (M.A.A. Corvo). http://dx.doi.org/10.1016/j.bjorl.2014.08.006 1808-8694/© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved. Salivary transforming growth factor alpha in patients 463 Conclusion: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren’s syndrome and laryngopharyngeal reflux when compared to the control group. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved. PALAVRAS-CHAVE Xerostomia; Refluxo laringofaríngeo; Síndrome de Sjögren; Saliva; Fator de crescimento epidérmico; Fator transformador de crescimento alfa Estudo da concentração salivar do fator transformador de crescimento alfa em indivíduos com Síndrome de Sjögren e refluxo laringofaríngeo Resumo Introdução: A saliva exerce influência primordial na homeostase do sistema digestório, pelos seus componentes inorgânicos e pelos fatores de crescimento. Indivíduos com síndrome de Sjögren (SS) apresentam maior incidência da doença do refluxo gastroesofágico (DRGE) e do refluxo laringofaríngeo (RLF). Concentrações salivares diminuídas do fator transformador de crescimento-alfa (TGF-␣) foram observadas em doentes dispépticos, porém não há estudos em populações com SS e RLF. Objetivo: Comparar concentrações salivares do TGF-␣; de indivíduos com SS e RLF a de controles saudáveis. Método: Trata-se de um estudo prospectivo controlado. Doze pacientes com SS e RLF e 11 indivíduos controles saudáveis tiveram amostras salivares espontâneas e estimuladas coletadas para estabelecer concentração de TGF-␣. Resultados: A concentração salivar de TGF-␣; foi estatisticamente maior no grupo estudo para ambas amostras. Este aumento foi confirmado nos sete indivíduos do grupo estudo que não apresentavam esofagite erosiva quando comparados ao grupo controle, porém não houve diferença estatística da concentração de TGF-␣; entre pacientes do grupo estudo que apresentavam esofagite erosiva em comparação ao grupo controle. Conclusão: A concentração salivar de TGF-␣; foi estatisticamente maior no grupo de indivíduos com SS e RLF, sem esofagite erosiva. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados. Introduction Saliva performs multiple roles in the digestive system homeostasis.1---6 Examples of its actions include the enzymatic digestion of food; formation of the food bolus; facilitation of mastication, swallowing, and speech; lubrication of mucous membranes; and maintenance of dental health, oral mucosa, and the digestive system. Changes that interfere with the content of saliva may therefore compromise the integrity of this delicate balance and generate consequences in the oral cavity, pharynx, and esophagus.1,2,4,6,7 More than 99% of saliva consists of water, with less than 1% solid elements, mostly proteins and salts.6 The inorganic compounds of saliva are represented mainly by bicarbonate ions, calcium, and phosphate.4,5,8---12 In turn, the organic composition is represented by a series of proteins called growth factors, whose biological action is based on the replication and repair of the epithelium of the digestive system.13 Due to their influence on the protective mechanisms of the digestive system during homeostasis from daily aggressive factors, the most important growth factors in saliva are the family of epidermal growth factors, which comprise epidermal growth factor (EGF) and also transforming growth factor --- fraction alpha (TGF-␣).14 Salivary TGF-␣ is a potent mitogenic 50-amino acid polypeptide, whose healing properties are based on its capacity to stimulate DNA synthesis of epithelial cells, with neoangiogenesis and tissue regeneration induction after local injury.15 The literature states that salivary TGF-␣ exerts its influence on the digestive system by helping to maintain an appropriate pre-epithelial defense barrier, through interaction with other salivary components such as EGF, mucins, and salivary prostaglandins.2,5,6,16 Even though the protective characteristics of TGF-␣ on the gastric mucosa have been demonstrated,5 there are no data avai (...truncated)