Increased intestinal permeability in primary Sjögren's syndrome and multiple sclerosis

Bitte Sjöström; Anders Bredberg; Thomas Mandl; Lucía Alonso-Magdalena; Bodil Ohlsson; Shahram Lavasani; Mehrnaz Nouri; Gunnel Henriksson

doi:10.1016/j.jtauto.2021.100082

Increased intestinal permeability in primary Sjögren's syndrome and multiple sclerosis

J Transl Autoimmun. 2021 Jan 6:4:100082. doi: 10.1016/j.jtauto.2021.100082. eCollection 2021.

Authors

Bitte Sjöström¹, Anders Bredberg¹, Thomas Mandl^{2

3}, Lucía Alonso-Magdalena^{4

5}, Bodil Ohlsson^{6

7}, Shahram Lavasani^{8

9}, Mehrnaz Nouri^{8

10}, Gunnel Henriksson^{1

11}

Affiliations

¹ Department of Laboratory Medicine, Medical Microbiology, Lund University, Lund, Sweden.
² Department of Rheumatology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
³ Department of Clinical Sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.
⁴ Department of Neurology, Skåne University Hospital, Malmö/Lund, Lund University, Sweden.
⁵ Department of Clinical Sciences, Malmö, Neurology, Lund University, Sweden.
⁶ Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
⁷ Department of Clinical Sciences, Malmö, Lund University, Sweden.
⁸ Department of Biology, Lund University, Lund, Sweden.
⁹ ImmuneBiotech AB, Medicon Village, Lund, Sweden.
¹⁰ Department of Clinical Sciences, Clinical Research Centre, Surgery Research Unit, Lund University, Malmö, Sweden.
¹¹ Department of Clinical Microbiology, Skåne University Hospital, Lund, Sweden.

Abstract

There is increasing evidence suggesting a role of intestinal dysfunction in a number of autoimmune diseases. Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease with a documented increased level of intestinal inflammation, whereas multiple sclerosis (MS) is an organ-specific autoimmune disease known to exhibit increased intestinal permeability. In this study we determine to what extent intestinal inflammation, analysed by a faecal calprotectin ELISA, is accompanied by altered intestinal wall permeability, as measured by a lactulose and mannitol intestinal absorption assay. Intestinal permeability was increased in both pSS and MS patients, while faecal calprotectin was elevated in pSS but normal in MS. Our findings suggest different mechanisms mediating a leaky gut in these two diseases: in pSS there is autoimmune attack directly on the intestinal wall; in MS, with autoimmunity being limited to the CNS, it may be due to a disturbed CNS regulation of enteric nerve function.

Keywords: Faecal calprotectin; Intestinal permeability; Lactulose/mannitol ratio; Multiple sclerosis; Primary Sjögren’s syndrome.