Research on Sjögren’s syndrome
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Since the early nineties research on Sjögren’s syndrome has been central at the Broegelmann resarch laboratory and the Department of rheumatology, in close cooperation with Oral pathology at the Department of pathology and the Department of clinical dentistry. Good collaboration with the rheumatology clinic and high degree of patient participation, often over several years, has been detrimental to study different aspects of the disease, and to link research findings to the patients’ symptoms and signs. Through a collaboration in the Nordic countries and Europe, patients in the Vestland county can take part in the clinical study NECESSITY, investigating new treatments of Sjögren’s syndrome.
Sjögren’s syndrome is an autoimmune disease mainly affecting 40-60 years old women. To date, setting the diagnosis Sjögren’s syndrome remains challenging, especially in early stages of the disease. Several of the clinical signs manifest rather late in the disease progress, and most of the knowledge is focused on fully developed disease and chronic inflammation. The early Sjögren research in Bergen started with trying to find out what caused the chronic inflammation, by analyzing blood samples for previous herpes infections. We have also used animal models to map early stages of the disease development.
To understand how the disease arises we have tried to find hereditary factors (genetic markers). Genetic studies are resource intensive, both with regards to patient material and to laboratory equipment, and through several years we have been part of a major, international collaboration. Ten years ago, together with researchers from Oklahoma, USA, we were able to present the first genetic markers (12 candidate genes) for Sjögren’s syndrome, and recently another 10 candidate genes were discovered.
In autoimmune diseases the body makes antibodies against self. Many of the patients with Sjögren’s syndrome have antibodies against Ro/SSA and La/SSB, often detected during the clinical examinations at diagnosis. In collaboration with researchers in Sweden we found that these antibodies in fact can be detected in blood samples long before clinical symptoms develop, and several years prior to diagnosis. The discovery was possible due to access to a serum bank with samples from more than 625.000 women, among these 29 who had Sjögren’s syndrome. We have also showed that patients with antibodies against Ro/SSA and La/SSB seem to have a different clinical disease pattern than patients that do not have these autoantibodies. As such, anti-Ro/SSA and anti-La/SSB are biomarkers for Sjögren’s syndrome, that both suggest possible disease, as well as say something about the severity of the disease.
Signal substances that regulate immune cells and inflammation are often elevated during infections and chronic inflammation. We were the first to describe that an important signal substance (interferon) that usually targets viruses, is an important biomarker for active disease in patients with Sjögren’s syndrome.
Local production of anti-Ro/SSA and anti-La/SSB autoantibodies in the salivary glands, was first described in a study from Bergen. The formation of autoantibodies and chronic inflammatory lesions in the salivary glands indicates an active role for the salivary gland tissue in driving the inflammatory disease. In later studies, we have also determined that adipose tissue in the glands seem to enhance the local inflammation.
Over the last 30 years we have made important findings by using blood-, saliva and tissue samples from our patients with Sjögren’s syndrome. This has inspired us to follow our patient cohort over several years, for instance by salivary gland ultrasonography. The Sjögren group in Bergen has an extensive collaboration in Norway, Scandinavia, Europe, the United States and Brazil. Our combined efforts contribute to the future, targeted treatment of the disease. In 2015 we gathered around 300 Sjögren researchers in Bergen, for the 13th International symposium on Sjögren’s syndrome. In the following symposia in Washington, DC (2018) and Rome, Italy (2022) researchers from Bergen participated with both scientific and professional contributions.
The Sjögren research at the University of Bergen has been founded by the Broegelmann foundation, the Western Norway regional health authority (Helse Vest), the Research council of Norway, the European union, Trond Mohn, as well as other contributors. Together with persevering patients and committed clinicians our research projects can contribute to new knowledge about Sjögren's syndrome!
