Current Concepts: MouseModels of Sjogren’s Syndrome
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Title: Current Concepts: MouseModels of Sjogren’s Syndrome
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Creator: Nguyen, Cuong Q.
Lavoie, Tegan N.
Lee, Byung Ha
Publisher: Hindawi Publishing Corporation
Publication Date: 2011
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Journal of Biomedicine and Biotechnology
Volume 2011, Article ID 549107, 14 pages

Review Article

Current Concepts: Mouse Models of Sj6gren*s Syndrome

Tegan N. Lavoie/ Byiing Ha Lee/ and Ciioeg Q. Nguyen^'^"'''^

Department of Oral Biology, College of Dentistry, University ofFL, P. O. Box 100424, 1600 SW Archer Road,
Gainesville, FL 32610, USA
^ Center for Orphan Autoimmune Disorders, College of Dentistry, University of Florida, P.O. Box 100424, 1600 SW Archer Road,
Gainesville, FL 32610, USA
^Eli andEdytheL. Broad Institute, 7 Cambridge Center, Cambridge, MA 02142, USA
'^ Department of Chemical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-545,
Cambridge, MA 02139, USA

Correspondence should be addressed to Cuong Q. Nguyen,

Received 16 September 2010; Accepted 10 November 2010

Academic PMitor: Andrea Vecchione

Copyright 2011 Tegan N. Lavoieetal. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly

Sjogren's syndrome (SjS) is a complex chronic autoimmune disease of unknown etiology which primarily targets the exocrine
glands, resulting in eventual loss of secretory function. The disease can present as either primary SjS or secondary SjS, the latter
of which occurs concomitantly with another autoimmune disease such as rheumatoid arthritis, systemic lupus erythematosus,
scleroderma, or primary biliary cirrhosis. Current advancements in therapeutic prevention and treatment for SjS are impeded
by lack of understanding in the pathophysiological and clinical progression of the disease. Development of appropriate mouse
models for both primary and secondary SjS is needed in order to advance knowledge of this disease. This paper details important
features, advantages, and pitfalls of current animal models of SjS, including spontaneous, transgenic, knockout, immunization, and
transplantation chimera mouse models, and emphasizes the need for a better model in representing the human SjS phenotype.
1. Introduction

Sjogren's syndrome (SjS) is a systemic chronic autoimmune
disease that targets the exocrine glands, predominantly the
salivary glands and lacrimal glands, resulting in xerostomia
(dry month) and keratoconjunctivitis sicca (dry eyes) [1].
The disease also presents with systemic manifestations
involving the destruction of the thyroid gland [2], lungs
[3], liver [4], and kidneys [5]. The National Arthritis Data
Workgroup using the Olmsted County, MN and 2005 US
population prevalence estimates from the Census Bureau has
estimated that the prevalence of primary SjS (pSjS) in the
USA approaches 1.3 million with a range of 0.4-3.1 million
of the approximate 214.8 million population, with a female-
to-male ratio of about 9:1, indicating a probable correlation
between disease development and sex hormones [6]. SjS can
exist in one of two forms, either primary or secondary [7].
pSjS affects salivary and/or lacrimal glands in the absence of
other rheumatic diseases, while its more common secondary
form occurs in the presence of other rheumatic diseases,
such as systemic lupus erythematosus (SLE) [8], rheumatoid
arthritis (RA) [9], scleroderma [10], and primary biliary
cirrhosis [11]. The degree of glandular destruction is related
to the progressive development of lymphocytic infiltrations
which are composed primarily of CD4+ and CD8^ T cells
[12], B cells [13], macrophages, and dendritic cells [14].
According to the revised European-American Consensus
Group criteria, diagnosis of SjS includes signs of ocular and
oral dryness, detection of infiltrating lymphocytes within
minor salivary glands with quantification determined by
histopathological evaluation, and the presence in serum of
autoantibodies, specifically anti-SSA/Ro, anti-SSB/La, and
antinuclear antibodies (ANA) [15]. Recently, considerable
interest has focused attention on serological evaluations
showing the presence of rheumatoid factor (RF), elevated
immunoglobulin levels (hypergammaglobulinemia), anti~a-
fodrin, and the presence of antibodies to the muscarinic

Journal of Biomedicine and Biotechnology
acetylcholine receptors, especially the type 3 receptor (M3R)
which could impair secretory function [16-24].
The precise etiology of SjS remains elusive; however, a
number of possible theories have been postulated. Envi-
ronmental triggers including exposure to Epstein-Barr virus
[25], hepatitis C virus [26], and retroviruses including both
human T-cell l)'mphocytic virus type I (HTLV-1) [27] and
human endogenous retrovirus (HERV-K113) [28], may ini-
tiate epithelial cell activation and a prolonged inflammatory
response in genetically predisposed individuals, resulting
in systemic autoimmunity. Other hypotheses, including
epithelial/acinar cell apoptosis, emergence of autoreactive
T cells, eftect of autoantibodies and neurological dys-
function, could consequently contribute to various aspects
of SjS pathogenesis [29]. The challenge of attempting to
understand the mechanism of human SjS pathogenesis is
the inability to learn the biological and immunological
occurrence prior to overt clinical signs. End-stage disease is
often the only parameter which is used to characterize the
entire disease process. As a result, it remains difficult to grasp
and understand the disease development. Therefore, animal
models for SjS would permit the investigation of the full
spectrum of possible etiologies from prior to during and after
disease development.
An ideal SjS mouse model should fulfill a range of
common characteristics present in human SjS, including
etiological, clinical, histological, serological, and immimo-
biological features as detailed in Table 1. Furthermore,
different models will represent SjS in either its primary or
secondary form, as demonstrated in Table 2 which clarifies
the relevance of each mouse model. This paper will provide
a comprehensive examination of many animal models of SjS
that mimic fully or various pathological aspects of human

2. Spontaneous Mouse Models for Sjogren's

2.1. Nonobese Diabetic Mice. The nonobese diabetic (NOD)
inbred strain of mice were developed from a cataract-prone
subline (CTS) derived from outbred ICR mice [33]. The
NOD strain is not cataract-prone, however, and is most
commonly used as a model for human Type 1 insulin-
dependent diabetes mellitus (IDDM or TlD) due to 1)111-
phocytic infiltrations (insulitis) which cause the destruction
of pancreatic islets. Onset of diabetes in highly inbred NOD
mice occurs between 90 and 120 days, with an incidence of
60-80% in females and 20-30% in males by 210 days [34].
Spontaneous onset of diabetes in NOD mice presents with
hyperglycemia, hypercholesterolemia, glycosuria, ketonuria,
pol)airia, polydipsia, and polyphagia, all common clinical
features of human IDDM. While insulitis develops by 4
weeks (wks) of age, lymphocytic infiltrations in the salivary
and lacrimal glands occur at approximately 12-16 wks of
age with corresponding loss of secretory function by 20 wks
old [35, 36]. At the onset of SjS-like disease, various signa-
ture autoantibodies can also be detected, specifically, anti-
SSA/Ro, anti-SSB/La and anti-muscarinic receptor type III
(M3R) which has been demonstrated to directly contribute
to the secretory dysfunction in this animal model and SjS
The NOD mouse model has provided important insight
into the genetics of human SjS. The development of TlD in
the NOD mouse is controlled by more than 18 chromosomal
regions [37]. Early studies involving replacement of individ-
ual insulin-dependent diabetes {idd) susceptibility intervals
such as Idd3, IddS, Iddl3, Iddl, and Idd9 had minimal efiiect
on the development of autoimmune exocrinopathy or SjS-
like disease. Both Idd3 and IddS are required for development
of salivary and lacrimal dysfunction [38]. When both
NOD-derived genetic regions were introduced to the SjS
nonsusceptible C57BL/6 strain by crossing C57BL/6.NODc3
mice carrying Idd3 (Autoimmune exocrinopathy 1 (Aeclj)
locus and C57BL/6.NODci t mice carrying IddS {Aec2) locus,
the C57BL/6.NOD(:3.NODcit or C57BL/6.NOD-AeciAec2
mouse strain was produced which is homozygous for both
IddS and IddS chromosomal intervals [39]. This double
congenic strain fully recapitulated the SjS-like disease pro-
cess, exhibiting pathophysiological changes at early age,
followed by l)'iiiphoc)'tic infiltrations of the salivary and
lacrimal glands at 12-16 wks of age, then accompanied
by the production of autoantibodies to nuclear antigens
(SSA/Ro, SSB/La) and M3R in the absence of TlD. The
l)'mphoc)'tic foci (LF) consisted mainly of CD4* and CD8*
T cells, as well as B lymphocytes with associated loss of
saUva production by 20 wks of age. Due to the presence
of T cells and sporadic numbers of dendritic cells and
macrophages within infiltrates, an increase in the levels of
proinflammatory cytokines such as interleukin-17 (IL-17),
IL-22, and IL-23 was also detected locally and systemically.
Similar observations are observed in human SjS patients
A recombinant inbred line, known as C57BL/6.NOD-
AeclRlAec2, was developed to define smaller genetic regions
that contain those genes necessary to induce autoimmune
exocrinopathy by narrowing the Aecl region [41]. The
genetic region of Aecl locus was shortened from a 48.5 cm
segment to a centromeric piece spanning 19.2 cm. The
resultant strain exhibited more rapid SjS-like disease in
males, with males developing salivary gland infiltrations
at 10 wks of age compared to 19 wks in females. Females
presented with more severe sialadenitis and larger infil-
trations in the submandibular gland by 22 wks; however,
they exhibited no dacryoadenitis whereas males exliibited
significantly high levels of dacryoadenitis. Furthermore, a
homogeneous nuclear ANA pattern was apparent in males
as early as 5 wks of age but not until 10 wks in females. Both
sexes demonstrated a significant loss of saliva flow rate (35-
40%) beginning at 5 wks of age, but only males displayed a
loss of lacrimal gland secretory function. The lack of lacrimal
gland dysfunction in females may be attributed to the loss of
a necessary gene on the shortened Aecl locus which could
regulate the sex dimorphism presented in SjS.
Interestingly, the major histocompatibility complex
(MHC) genes have little or no relation to the development
of SjS in the NOD mouse. For example, the MHC class
II region, when replaced from A^^ to A^' locus in NOD

Journal of Biomedicine and Biotechnology
Table 1: Important criterion for an ideal primary SjS mouse model.
Unknown (possible viral exposure)
Keratoconjunctivitis sicca
Polyclonal lymphocytic infiltrations in the salivary and lacrimal glands
Lymphocytic focus, > 50 mononuclear cells/mm^ (CD4+ > CDS^)
Monoclonal B cell proliferation
Progressive destruction of the acinar and ductal cells
Anti-SSA/Ro and anti-SSB/La autoantibodies
Anti-a- fodrin autoantibody
Rheumatoid factor
Antinuclear antibodies
Anti-type 3 acetylcholine muscarinic receptor
Additional organ involvement
Heart, blood vessels, lungs, liver, pancreas, stomach, kidneys, bladder, thyroid gland (secondary SjS)
Diminished apoptosis of lymphocytes
Abnormal MHC expression, H2+-glandular ductal epithelium
Epithelial cell expression of Fas/FasL
9 :1 female: male ratio
Disease presents in absence of other rheumatic diseases
Table 2: Primary and secondary SjS mouse models.
Type of SjS
Mouse Model
Secondary to
CAII immunization
ID3 K.O.
Ar K.O.
Ro immunization
HTLV-1 tax Tg
TGF-/J1 K.O.
IL-6Tg IL-lOTg
Autoimmune diabetes
Autoimmune thyroiditis
SLE [31]
PBC [321SLE/Neuropathy
K.O.: knockout; Tg: transgenic; SLE: systemic kipus erylhernalosus; RA:
rheumatoid arthritis; PBC: primary biliary cirrhosis; IBS: inflaiumatory
bowel disease.
mice, prevented the development of TlD, but the onset of
SS-like disease remained unaffected [42]. Also, the NOD.H
2^''^ strain presents with exocrine gland infiltrations and
compromised saliva flow without symptoms of TlD due to
the replacement of the A^ allele with I-A^, but continues
to develop spontaneous thyroiditis at a low occurrence (5%)
[43, 44]. The NOD.B10-H2^ strain also demonstrates an
SjS-like phenotype with inflammatory infiltrations in the
exocrine glands without the occurrence of TlD due to the
replacement of the diabetogenic MHC locus with the MHC
locus of C57BL/10 strain that is nonsusceptible to TlD
[45, 46]. As a result, the NOD and NOD-derived animal
models have been critical in elucidating the genetic basis of
SjS development.
2.2. NZB/\V PI Mice. The first mouse model for sponta-
neous SjS was the NZB/W Fl hybrid described in 1968
[47]. By crossing the first filial generation New Zealand
black (NZB) mouse with the New Zealand white (NZW)
mouse, the NZB/W Fl hybrid was produced, which spon-
taneously developed disease characteristic of SjS and SLE
[48]. Mononuclear cell infiltrations were present in both
salivary and lacrimal glands by 4 months of age, with more
severe lesions in the lacrimal glands of females. Epithelial
cell nodules were also present, as well as edematous changes,
necrosis, and connective tissue replacement of parenchyma.
The primary composition of infiltrations was T cells with
lower numbers of B cells [49]. Hypergammaglobulinemia,
pulmonary vasculitis, nuclear autoantibodies, reduced com-
plement levels, and circulating immune complexes were also
presented in this mouse model [50].
2.3. MRL/lpr Mice. The MRL//pr mouse was developed with
a genetic mutation of the lymphoproliferation {Ipr) gene
on chromosome 19 which encodes the structural gene for
the Fas antigen [51]. The MRL-lpr/lpr mouse spontaneously
develops disease similar to SLE [52] and RA [53], charac-
terized by splenomegaly, arthritis, glomerulonephritis, and

Journal of Biomedicine and Biotechnology

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massive lymphadenopathy [54]. This model develops an SjS-
like phenotype beginning at 2 months of age with the onset of
inflammatory infiltrations within the submandibular glands,
followed by a less severe inflammation in the parotid and
sublingual glands. Although an early report suggested that
MRL mice do not synthesize anti-SSA/Ro and anti-SSB/La
auto-antibodies [55], more recent reports indicate that
nearly 30% of mice develop anti-52 KDa SSA/Ro antibodies,
6% develop anti-60 KDa SSA/Ro antibodies, and 6% develop
anti-SSB/La antibodies, but not SSA/Ro [56]. Due to the
defect in the Fas antigen which controls apoptosis, the
MRL//pr mice develop aggressive autoimmune l)'mphopro-
liferation contributed by the autoreactive Ipr T cells which
have escaped thymic selection [51].

2.4. NFS/sld Mice. The NFS/s/ii mouse bears a mutation in
the sublingual gland differentiation arrest (sld) gene which
affects acinar cell differentiation into mucous-secreting cells
in the subhngual gland [57]. At three days of age, the NFS/sW
mice are thymectomized without any prior immunization;
these mice develop a spontaneous pSjS-like disease [58].
Severe inflammatory infiltrations develop after 4 wks of
age in both salivary and lacrimal glands that are composed
mainly of CD3^ and CD4+ T cells with a lesser number of
CD8' T cells and B220* B cells. No inflammatory lesions
are present in other organs, nor in nonthymectomized mice.
Female mice develop a more severe diseased phenotype.
NFS/sW mice which developed infiltrations in the glands
had significant levels of IgG autoantibodies in sera. The
organ-specific 120-kilodalton a-fodrin autoantigen which
has high sequence homology with the human cytoskeleton
protein a-fodrin was found within the sahvary glands of
NFS/s/d mutant mice, indicating a potential role in the
development of sialadenitis and dacryoadenitis [59]. The
early accumulation of a-fodrin within the salivary glands
may lead to the observed loss of secretory function by 18 wks;
however, this is most likely due to aging rather than SjS-like
disease phenotype [60].

2.S. IQI/jic Mice. The IQI//; mouse is an inbred strain
established from the Imprinting Control Region (ICR)
mouse strain similar to NOD. These mice produce antinucle-
olar autoantibody in response to mercuric chloride exposure
[61]. The strain is marked by an increase in the number
of B cells within the th)'mus of aged females, as well as
the presence of mononuclear cell infiltrations within the
salivary and lacrimal glands. The major composition of
inflammatory infiltrations is reportedly B220' B cells, with
a lesser numbers of CD4^ T cells. Concomitantly, acinar
cell destruction is observed around large foci. However,
small foci consist primarily of CD4* cells, indicating that
B cells continuously invade the affected organs as the
disease progresses. Sialadenitis is present in 80% of female
mice with lesions beginning at 6 months of age, and one-
third of the animals produce speckled-type IgG antinuclear
autoantibody by 15 months of age. Neither anti-SSA/Ro
nor anti-SSB/La autoantibodies were detected. Expression
of MHC class II antigen is apparent in the ductal epithelial
cells surrounding LF. Additionally, lymphocytic infiltrations
are also observed in the pancreas, kidneys, and lungs as the
IQI//ic mice aged [62]. Enhanced expression of kallikrein-
13 (Klk-13) has been detected in salivary glands, suggesting
that Klk-13 may be a candidate autoantigen in SjS that
could contribute to the development of sialadenitis due to
increased T cell response to organs expressing Klk-13 [63].
2.6. Aly/aly Mice. The aly/aly mouse possesses the homozy-
gous autosomal recessive mutation alymphoplasia (aly) gene,
resulting in loss of lymph nodes and Peyer's patches [64].
Subsequently, aly/aly mice readily accept allogenic skin grafts
and demonstrate impaired response to T cell-dependent
antigens due to absence of germinal center formation. These
mice spontaneously develop an SjS-like phenotype by 14 wks
of age, with worsening disease as they aged, presenting with
chronic salivary and lacrimal gland inflammation as well
as inflammation of the exocrine glands of the pancreas.
Both lung and exocrine gland infiltrations are apparent, with
infiltrating cells being primarily CD4+CD8" T cells. Both
salivary and lacrimal glands demonstrate lymphoc)'tic accu-
mulation within periductal areas spanning to the lobules,
and lacrimal glands show significant degeneration of acinar
cells surrounding infiltrations. Tissue damage is minor or
absent in salivary glands of aged mice, and the liver shows
mild lymphoid cell infiltration. No autoantibodies to self-
antigens or nuclear components are apparent, likely due to
extreme defects in humoral immunity.

3. Transgenic Mouse Models

3.1. HTLV~1 Tax Transgenic (Tg) Mice. Human T-cell
leukemia virus 1 (HTLV-1) is a retrovirus involved in
adult T-cell leukemia as well as in the pathogenesis of
autoimmune diseases such as SjS, RA, and possibly multiple
sclerosis (MS) [65]. Transgenic mice containing the HTLV-
1 tax gene under the control of the viral long terminal
repeat (LTR) acquires an autoimmune phenotype which
targeted the exocrine glands [27]. At early age, HTLV-1
tax transgenic mice have rapid proliferation of epithelial
cells with subsequent ductal proliferation, causing distortion
of the salivary gland architecture. Lymphocytic infiltrations
were observed juxtapose to epithelial cells in the salivary
and lacrimal glands. However, lacrimal glands develop less
severe infiltrations with onset occurring much later than in
the salivary glands. Massive LF develop between 6-8 months
of age with subsequent destruction of acinar tissues. The
degree of destruction corresponds with the level of tax gene
expression in the ductal epithelium, suggesting that HTLV-
1 may be tropic for ductal epithelial cells in the exocrine
glands. Therefore, it is postulated that HTLV-1 may trigger
the viral induction of inflammatory lesions via initiation of
proliferation and lymphocytic infiltrations. However, disease
etiology in this mouse model is likely different from that in
human pSjS in which lymphocytic infiltration occurs before
proliferation of ductal cells.

Journal of Biomedicine and Biotechnology
3.2. Cytokine Overexpression Models

3.2.1. IL~6 Transgenic Mice. Interleukin-6 is a cj'tokine that
influences the immune response, participating in autoim-
mune disease development and pathogenesis of liver disease.
Using a murine graft-versus-host reaction (GVHR) model
with MHC class II disparity, the amount of autoimmune-
like lesions were examined to observe a difference in
transgenic mice with high IL-6 concentrations. The GVHR
IL~6 transgenic mice had increased IL-6 serum levels and
antimitochondrial antibodies (AMA), larger spleen indexes,
and weakened autoimmune-like lesions of the liver, pancreas,
and salivary glands when compared to controls. There is a
discrepancy between AMA titers and histological features in
IL~6 Tg mice, indicating that AMA production may be a
result of polyclonal activation of B cells upon stimulation by
IL-6. Results indicate IL-6 may influence the pathogenesis of
SjS [32].

,3.2.2. IL~10 Transgenic Mice. Interleukin-10 (IL-10) is a
cytokine that may contribute to inflammation and patho-
genesis in various autoimmune diseases, due to its function
in regulating the proliferation and differentiation of B cells
and in enhancing MHC class II antigen expression [66]. IL-
10 has also been shown to induce expression of cell adhesion
molecules on endothelial cells and to trigger apoptotic cell
death [ 67]. IL-10 Tg mice were generated by using the human
salivary amylase promoter to regulate IL-10 gene expression
[68]. Elevated expression levels of IL-10 are observed in
the salivary and lacrimal glands. Histological examination
confirmed the presence of inflammatory lesions within
the exocrine glands in 8 wks old mice, with concomitant
decreased salivary and lacrimal fluid secretion. Staining of
lymphocytic infiltrates demonstrated that the cell population
was predominantly CD4' with a lesser portion (<10%) of
CD8* cells. No sex differences were evident. By 20 wks of
age, no significant difference was observed between IgGl
levels in wild-type control and transgenic mice and no
autoantibodies were detected. Interestingly, CD4* T cells in
IL-10 Tg mice expressed FasL, suggesting that IL-10 may
play a part in FasL activation of nonspecific bystander T
cells, which coincides with Fas/FasL-mediated apoptosis in
the destruction of acinar tissue.

3.2.3. IL-12 Transgenic Mice. Interleukin-12 (IL-12) is
a heterodimeric cytokine produced mainly by activated
macrophages, dendritic cells, and granulocj'tes which func-
tions in the activation of NK cells and induces CD4* T cell
differentiation from a ThO to ThI cell phenotype [69, 70].
IL-12 SJL transgenic mice were made by expressing IL-12
p70 under the transcriptional control of the thyroglobulin
promoter, resulting in IL-12 overexpression in the thyroid
organ [69]. Histopathological analysis showed an increase in
mononuclear infiltrates within salivary and lacrimal glands
when compared with wild-type mice. LF consist primarily
of B220^ B lymphocytes with a lesser amount of CD4+ T
lymphocytes. Subsequently, the Tg mice develop hyposecre-
tory function in the exocrine glands. Sex-dependent growth
retardation was observed in female, but not male mice,
suggesting a sex-specific effect of IL-12 overexpression [70].
A significant decrease in saliva flow rate was evident in both
sexes; however, in males the decrease was age dependent
while in females the change was neither age nor gene dose
dependent. Increased levels of ANA were observed at 13 wks,
and age-dependent increase in anti-SSB/La autoantibody was
also presented; however, no significant difference in anti-
SSA/Ro autoantibody was seen when compared with wild-
type controls. Morphological changes included an increase in
acinar cell volume and a decrease in cell number per acinus in
the salivary glands [70]. This mouse model tends to develop
autoimmune thyroid disease, indicating the IL-12 Tg mouse
is a candidate animal model for secondary SjS [69].

3.2.4. IL-14a Transgenic Mice. Interleukin-14a (IL-14a) is
a cytokine produced mainly by T cells and acts as a
B cell growth factor [71]. Increased levels of IL-14a are
present in the peripheral blood leukocytes of both pSjS
and secondary SjS patients with SLE [72]. IL-14a Tg mice
develop hypergammaglobulinemia involving IgG, IgA, and
IgM autoantibodies, parotid gland lymphocytic infiltrations,
deposits of IgM in the kidneys, and mild renal disease.
These features are characteristic of human SjS, but also
reflect a SLE-like phenotype [73]. Development of large B
cell lymphomas in aged LL-14a Tg mice occurs as a result
of dysregulation of IL-14a which regulates B lymphocyte
growth, a common clinical manifestation in both SjS and SLE
patients [73]. IL-14a Tg mice also demonstrate enhanced
antibody responses to vaccinations with T-independent and
T-dependent antigens. Decreased saliva secretion occurs
prior to l)'mphoc)'tic infiltrations of the salivary glands.
Tear flow has not been fully defined, although lymphocytic
infiltrations do occur in the lacrimal glands. Less than 25%
of IL-14a Tg mice test positive for anti-SSA/Ro and anti-
SSB/La which are detected at 12 months of age in the salivary
glands, suggesting that other autoantibodies may contribute
to the initial phase of SjS development which remains to be
determined [72].

3.2.S. BAFP Transgenic Mice. B-cell activating factor (BAFF)
is a ligand in the tumor necrosis factor (TNF) family
which acts as a powerful modulator of B cell activity [74].
BAFF is produced by myeloid cells and acts to induce
the polyclonal maturation of resting immature B cells to
resting mature B cells without stimulating proliferation
[75]. Several autoimmune diseases, including SLE and SjS,
have increased blood levels of BAFF, and neutralization of
BAFF results in disease prevention [76]. Mice transgenic
for BAFF develop an SLE phenotype, presenting with
hyperproliferation of B lymphocytes and elevated levels
of RF and anti-DNA autoantibodies [77]. As the BAFF
Tg mice age, they develop a secondary SjS-like phenotype
by 13 months of age with reduced saliva flow, presenting
with enlarged salivary glands and corresponding B220+ cells
lymphocytic infiltrations with destruction of ductal and
acinar cells [78]. Keratoconjunctivitis was not apparent and
no sex dimorphism in disease development was observed.

Journal of Biomedicine and Biotechnology
BAFF Tg mice also had severe hypergammaglobulinemia
with high levels of immunoglobulins, specifically IgG, IgM,
IgA, and IgE isotypes; however, neither anti-SSA/Ro or anti-
SSB/La autoantibodies were detected [79]. Summarized data
for spontaneous and transgenic mouse models is presented
in Table 3.

4. Knockout (KO) Mouse Models

4.1. Id3^''^ Knockout Mice. Inhibitor of differentiation 3 (Id3)
is a nuclear protein which inhibits the DNA binding of
basic-helix-loop-helix (bHLH) transcription factors and is
involved in both negative and positive regulations of cell
growth and differentiation [80]. Id3 is also influential in
TCR-mediated T cell selection during T cell development
[81]. Id3 null mutants develop lymphocytic infiltrations
within the salivary and lacrimal glands by 2 months of age,
corresponding with a loss in secretory function. Infiltrations
are composed mainly of CD4' and CD8' T cells and
B220+ B cells [82]. Both autoantibodies, anti-SSA/Ro and
anti-SSB/La, were shown to be present at significant levels
after 1 year of age [82]. Notably, infiltrations were not
observed in nonexocrine organs. In this model, neonatal 3
day thymectomization or genetic ablation of T cells resulted
in an improvement in disease condition, implying that
autoimmune T cells are of thymic origin. B cells were
observed to behave in cooperation with T cells in the
suppression of exocrine function.

4.2. PI3K Knockout Mice. The phosphoinositide 3-kinase
(PI3K) enzymes produce 3-phosphorylated phosphoinosi-
tides which function as second messengers downstream of
multiple receptor types [83]. To create a null mutant for
PI3K, a strain with a floxed allele of PikSrl and a null
allele of Pik3r2 was crossed with Lck-Cre transgenic mice,
producing the rlAT/r2n strain [84]. The resulting knockout
mouse develops an SjS-like autoimmunity, with lymphocytic
infiltration of the lacrimal glands and acinar cell atrophy
and destruction. Infiltrations in the lacrimal glands consist
primarily of CD4+ T cells with a lesser portions of CD8+
T cells and B220^ B cells. Infiltrations also occur within
the lungs, liver, and intestines, with no inflammation in the
kidney, supporting a primary SjS disease.

4.3. TGP-[5l Knockout Mice. The multifunctional cytokine,
transforming growth factor beta 1 (TGF-/31), is produced
mainly by lymphocytes, macrophages, and dendritic cells
and is involved in immunoregulation, embryonic develop-
ment, hematopoiesis, wound healing, fibrosis, and tumorge-
nesis [85-89]. Homozygous mutants of the TCP -jil gene
experience a rapid onset of severe systemic inflammation
which predominantly targets the salivary glands, eyes, heart,
skeletal muscle, lungs, liver, stomach, pancreas, and brain
[90]. Inflammatory infiltrates vary in cellular compositions
across the spectrum of affected organs, from primarily
lymphocytic in the brain to primarily neutrophilic in the
stomach. Salivary gland infiltrations appear at 1 wk of age
and increase in severity with age [91]. Mononuclear lympho-
cytic infiltration in the salivary gland causes rapid atrophy
of acinar tissues and high deposition levels of IgG, TNF-
a, IFN-y, IL-l/J, IL-4, IL-6, and IL-10 in the lesions. Saliva
production is significantly affected in TGP-jil KO mice when
compared to wild-type controls. Peripheral blood analysis of
TGP- jil KO mice revealed the presence of anti-ssDNA, anti-
dsDNA, ANA, and glomerular immune complex deposits
[88]. TGF-/J1 also affects thjinocytes differentiation by inhi-
bition of precursor CD4"CD8'' thjinocytes differentiation
into mature CD4^CD8+ thymocytes.

4.4. Thrombospondin-1-Deficient Mice. Thrombospondin-1
(TSP-1) is a matricellular protein which regulates both in
vitro and in vivo activation of latent TGF-/^ [92, 93]. Relying
on the precise pathogenic effect that TGF-/J exerts on the
autoimmune process of SjS, a TSP-1 deficient mouse strain
was created; however, the deficient mice presented with less
severe inflammation when compared with the TGF-j3 KO
mouse [94]. Inflammatory infiltrates within the lacrimal
glands were first observed at 24 wks of age, consisting
primarily of CD4' T cells with a lesser amount of CD8*
T cells. TSjP-I-deficient mice also demonstrate reduced eye
size which occasionally leads to complete closure and loss of
eyes. Damage to the corneal epithelial barrier is apparent,
occurring in conjunction with corneal edema in aged
mice. Both anti-SSA/Ro and anti-SSB/La autoantibodies are
detected at elevated levels in the sera, and a significant loss
of lacrimal gland secretory function is evident. A twofold
increase in IL-17A^ cells was observed in splenocytes, and
increased apoptosis and transcriptional levels of IL-6 and
IFN-)' were seen in the lacrimal glands of 8-week- old mice.
Also, a considerable increase in IL-17A+CD4+ peripheral
T cells was apparent in 24 wks old TSP-J-deficient mice,
concurrent with reduced levels of IFN-y. Currently, it is
unknown whether this mouse model develops sialadenitis
and secretory dysfunction in the salivary glands.

4.S. Aromatase-Deficient Mice. The aromatase gene con-
trols activation of estrogen production [95]. To determine
whether estrogen levels may contribute to SjS disease
pathogenesis, an aromatase knock-out (ArKO) mouse model
was constructed [96]. Male and female ArKO mice over 12
months old present with mild splenomegaly, lymphadenopa-
thy, and hypercellularity in the bone marrow, with no
apparent lymphocytic infiltrations occurring within the
lungs and liver. Peripheral blood analysis revealed a 1.5- to
2-fold increase in leukocyte population with a significant
increase in the number of B220^ B lymphocytes, but no
change in the number of T cell antigen receptor-j8+ T cells.
Mild proteinuria and massive lymphocyte infiltration within
the kidneys suggest renal dysfunction in the ArKO mice. In
aged ArKO mice (12-17 months), enlarged salivary glands
with massive lymphocytic infiltrations were observed, with
severe acinar tissue destruction. The major composition
of lymphocytic infiltrations was B220^ B lymphocytes. A
significant increase in B220* cells was also observed in
the lymphoid tissues. Sera analysis revealed the presence of

Journal of Biomedicine and Biotechnology
anti-a-fodrin autoantibodies, and analysis of infiltrates in
salivary glands showed evidence of proteolytic fragments of
a-fodrin, indicative of tissue destruction often present in
pSjS. The ArKO mice were negative for ANA and manifested
long-term estrogen deprivation resulting in autoimmune
exocrinopathy and occasionally renal failure.

5. Immunization Mouse Models

S.l. Carbonic Anhydrase II Immunization. Frequently, anti-
bodies to carbonic anhydrase II (CAII), a basic zinc met-
alloenzyme involved in the catalysis of a reversible hydra-
tion of carbon dioxide, are characteristic of autoimmune
pancreatitis [97, 98]. However, recent findings suggest their
presence in other autoimmune diseases such as SjS as well
as connective tissue diseases [99]. Autoimmune sialadenitis
was induced in PL/J(JJ-2") mice by immunization with
human carbonic anhydrase II (CAII) [ 100]. Mice immunized
with CAII developed an increase in the size and focus score
in the salivary and lacrimal glands. In addition the ani-
mals manifested disintegration and atrophy of surrounding
acinar cells [100]. A small percentage of CAII-immunized
mice demonstrated smaller LF within the pancreas and
kidney, similar to human SjS patients who develop chronic
pancreatitis and renal tubular acidosis [100, 101]. Serum
antibody reactive to CAII has been reported in several
autoimmune diseases, including SjS, chronic pancreatitis
(CP), and autoimmune cholangitis [102]. However, no
prohferative responses of peripheral blood mononuclear cells
(PBMC) to CAII were observed, indicating CAII is probably
not a key target antigen for the immune response in the
origination and development of SjS and CP [103].

S.2. Ro Immunization. Anti-SSA/Ro autoantibody is present
at a significantly high level in patients with severe autoim-
mune diseases and serves as a standard diagnostic biomarker
for SjS and SLE [104]. BALB/c mice immunized with short
peptides from the 60-kDA Ro (SSA) antigen, known to
induce epitope spreading, develop an immune response to
the Ro/La ribonucleoprotein particle [105]. Ro immunized
mice present with lymphocytic infiltrations within the
salivary glands composed primarily of CD4+ (45%) and
CD8+ (18%) T cells and CD 19+ (35%) B lymphocytes, con-
current with a significant decrease in saliva flow rate [105].
Intermolecular epitopes spreading can be prevented by oral
administration of the Ro 60 autoantigen to Ro immunized
mice, inhibiting salivary gland l^iiiphocytic infiltrations and
increasing salivary flow rate; however, epitope spreading is
indicative of minimal tolerance to Ro and La in the B cell
and T cell compartments [106-110]. This model however
requires repeated immunizations with Ro peptide emulsified
in Freund's adjuvant over the course of several wks, with
disease development not occurring until 4 months, raising
the issue of a completely different etiological scenario than is
seen in human SjS patients [111]. The role of anti-SSA/Ro is
not well understood in either SjS mouse models or in human
SjS patients; therefore, further study is needed to examine the
pathogenic role of Ro antigen.
6. Infection Mouse Models

6.1. Murine Cytomegalovirus. Environmental triggers have
been postulated to be capable of inducing autoimmu-
nity in genetically predisposed individuals. Several viruses
including Epstein-Barr virus (EBV), hepatitis C virus, and
cytomegalovirus (CMV) have been associated with the devel-
opment of SjS. Frequently, individuals who are immuno-
compromised develop sialadenitis upon CMV infection
due to viral replication which occurs primarily within the
ductal epithelium of the salivary glands [112]. In mice,
however, murine CMV (MCMV) instead replicates within
the serous acinar epithelial cells of the submandibular
gland [113-115]. Salivary gland infection in mice produces
an extended inflammatory immune response which leads
to epithelial cell death and regeneration [116]. Four dif-
ferent strains of mice (C57BL/6 [B6]-f/H-, Fas-deficient
m-lpr/lpr, TNFRI-deficient B6-m/ri''0, and B6-m/ri ''-
Ipr/lpr) infected with murine CMV (MCMV) were shown
to manifest certain phenotypes of SjS-like disease [117].
For instance. Fas-deficient B6-lpr/lpr mice infected with
murine CMV (MCMV) developed anti-Ro and anti-La
autoantibodies and persistent severe lymphocytic infiltra-
tions within the salivary glands that remained 100 days
postinfection even after viral clearance. Neither C57BL/6
[B6]--!-/-+- nor TNFRI-deficient B6-m/r'' mice infected with
MCMV had inflammation in the salivary glands at 100 days
postinfection, although infiltrations were observed in both
strains at 28 days postinfection. In MCMV-infected B6-
tnfrl ^-lpr/lpr mice, identical salivary gland inflammation
to MCMV^-infected B6-lpr/lpr mice was observed at 28 days,
and no inflammation was apparent in uninfected B6-lpr/lpr
controls. All mice developed sialadenitis by 28 days which
was still present at 100 days postinfection.
Autoimmune-prone NZM2328 mice infected with
MCMV are also capable of recapitulating certain phenotypes
of SjS-like disease [118]. Infected female NZM2328 mice
have severe chronic l)'iiiphocytic infiltrations in the exocrine
glands composed of CD4' T cells and B220* B cells. Severe
local inflammations coincide with presence of organ-
targeted autoantibodies against glandular antigens as well
as reduced saliva volumes. Anti-Ro/SSA or anti-La/SSB
is not detected in virus-infected animals. However, both
infected male NZM2328 mice and female B6-lpr mice have
significantly less severe glandular infiltrations. Interestingly,
animal models of MCMV-induced SjS only require a single
exposure to the virus which could serve as an ideal animal
model examining the early phase of human SjS development.

7. Transplantation Chimeras

Autoimmunity resembling a SjS phenotype can be induced
in hybrid mice upon transplantation of leukocytes from a
parental strain to nonirradiated Fl recipients, generating
a chronic graft-versus-host reaction (GVHR) [119-121].
Haematopoietic transplantation chimeras were produced
by transplantation of spleen cells from BALB/c donors to
nonirradiated F|-hybrids of BALB/c and CBA/H-T6 mice
[122]. Both male and female chimeras were shown to

Journal of Biomedicine and Biotechnology
subsequently develop a SjS-like phenotype with enlarged
lymph nodes and nodulated contorted spleens at 7 months
after transplantation. Males manifested a more severe disease
phenotype found in the lymph nodes and spleen when
compared to both female chimeras and wild type controls.
Sera were negative for autoantibodies against DNA, but
positive ANA with a nucleolar pattern was observed in most
chimeric mice. Raised levels of albumin in the urine of both
males and females were found, with higher levels in males.
Kidneys in both sexes demonstrated lymphocyte "cuffs" with
plasma cells surrounding the vessels and no IgG, IgA, or
IgM deposits were found in glomeruli. Mononuclear cell
infiltrates were apparent in both the salivary and lacrimal
glands of male and female chimeras with no difference in
severity between sexes. The spleens showed ordinary size and
distribution of red pulp, but diminished or absent white
pulp. The rim of lymphocytes was absent, and cells were
enlarged within the germinal centers. The nodules in the
spleen indicate that donor spleen colony-forming units have
invaded the recipient spleen, resulting in competition with
lymphohaematopoietic cells [122]. Therefore, it is likely that
transplantation leads to both acute and chronic GVHR.
The chimeric animals showed the absence of typical clinical
phenotypes of SjS, including splenomegaly, hepatomegaly,
high albuminuria, anti-dsDNA autoantibodies, ascites for-
mation, and immune complex glomerulonephritis [122].
Summarized data for knockout, immunization, infection,
and transplantation chimera mouse models is presented in
Table 4.
8. Conclusion and Future Directions

As demonstrated by the vast range of available mouse
models, SjS is a highly complex disease whose etiology is still
not well understood. It is likely that SjS pathogenesis involves
an intricate relationship between genetics and environmen-
tal factors which can provoke both innate and adaptive
immunity, hormone secretion, and the autonomic nervous
system into triggering the initiation and progression of the
disease. Animal models demonstrate a variety of potential
pathologies for the disease, ranging from overproduction
of inflammatory cytokines to exposure by exocrine gland-
targeting viruses. Therefore, these animal models provide a
useful tool in observing the different stages in the glandular
pathophysiological abnormality to the loss of immune toler-
ance and eventually to the onset of overt or clinical disease. In
addition, they can serve as great tools in designing diagnoses,
as well as in prevention and treatment therapies. Each mouse
model possesses its own advantages, as well as pitfalls, and no
ideal model for the study of SjS currently exists. Spontaneous
models naturally develop SjS and appear most similar to the
human SjS disease, but still have their drawbacks. Knock-out
animal models can also be useful, allowing observation of
the importance a particular protein, regulatory mechanism,
or cell type has in disease development, leading to improved
treatment options. However, no SjS mouse model fulfills all
of the necessary characteristics of the human disease, and
such discrepancies may cause progress in the field to come
to a standstill. A better model is needed.

Cuong Q. Nguyen is supported in part by PHS Grants
K99DE018958 and R21AI081952, and funds from the Center
for Orphan Autoimmune Disorders at University of Florida
and the Sjogren's Syndrome Foundation. The authors would
like to thank Dr. Ammon B. Peck for helpful suggestions
and editorial support. Publication of this article was funded
in part by the University of Florida Open-Access publishing

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