Imaging Activated-T-Lymphocytes in the Salivary Glands of Patients with Sjogren's Syndrome by Tc-99m-Interleukin-2: Diagnostic and Therapeutic Implications

Background: Sjogren's syndrome (SS) is a progressive autoimmune disease characterized by local mononuclear cell infiltration of the salivary and lachrymal glands. Labial biopsy demonstrates local infiltration by Th1 cells that produce pro-inflammatory cytokines, such as interleukin-2 (IL2). The aim of this study was to assess the utility of Tc-99m-labelled-IL2 (Tc-99m-IL2) in evaluating in vivo the extent and severity of lympho-mononuclear cell infiltration in the salivary glands of patients with SS. Methods: We investigated 48 patients with primary SS and 27 control subjects using Tc-99m-IL2 scintigraphy. Furthermore, in a subgroup of 30 patients, we also performed Tc-99m-pertechnetate scintigraphy ((TcO4-)-Tc-99m) for evaluation of the salivary gland function. Results: Tc-99m-IL2 uptake in the salivary glands of SS patients was higher than in the control subjects (1.30 +/- 0.16 vs. 0.83 +/- 0.08 for parotids and 1.36 +/- 0.15 vs. 1.16 +/- 0.07 for submandibular glands; p < 0.0001). The salivary gland uptake of Tc-99m-IL2 in patients with a longer history of disease was lower compared with the recently diagnosed patients. A significant direct correlation was found between the uptake of Tc-99m-IL2 and histology. Conclusions: Tc-99m-IL2 scintigraphy showed that the degree of lymphocytic infiltration of major salivary glands is variable in patients with different disease durations. Patients with a high Tc-99m-IL2 uptake could be efficiently treated with immuno-modulatory drugs and the efficacy of treatment could be followed-up by Tc-99m-IL2 scintigraphy.