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1 From the Departments of Anatomy, 3 Urology, and 4 Dermatology, Christian Albrecht University of Kiel, Germany; and the 2 Department of Ophthalmology, University Hospital Eppendorf, Hamburg, Germany.
PURPOSE. To determine the expression and production of antimicrobial peptides by mucosal cells of the lacrimal passage in healthy and pathologic states.
METHODS. Detection of bactericidal-permeability–increasing protein (BPI),
heparin-binding protein (CAP37), human cationic antimicrobial protein
(LL-37), human 
-defensin 5 (HD5), human -defensin 6 (HD6), human
ß-defensin 1 (HBD-1), and human ß-defensin 2 (HBD-2) was performed
by reverse transcription–polymerase chain reaction (RT-PCR).
Intracellular deposition of lysozyme, lactoferrin, secretory
phospholipase A2, human neutrophil defensins (HNP-1, -2,
and -3), human ß-defensin 1 (HBD-1), and human ß-defensin 2 (HBD-2)
was analyzed immunohistochemically. Samples were obtained from 15
patients by surgery and from 10 cadavers.
RESULTS. RT-PCR revealed BPI, CAP37, and HBD-1 mRNA in samples of healthy
nasolacrimal duct epithelium. Additionally, HBD-2 mRNA was detected in
epithelial samples from patients with dacryocystitis. Messenger RNAs
for LL-37 and -defensin 5 and 6 were absent in all samples
investigated. Immunohistochemistry revealed lysozyme, lactoferrin,
secretory phospholipase A2, and HNP-1, -2, and -3 to be
present in all samples, whereas HBD-1 was present only in some of the
healthy and inflamed samples. Immunoreactive HBD-2 peptide was visible
only in some of the inflamed samples.
CONCLUSIONS. The data suggest that the human efferent tear ducts produce a broad spectrum of antimicrobial peptides. Under inflammatory conditions, changes in the expression pattern occurred, revealing induction of the human inducible defensin HBD-2 and in some cases downregulation of HBD-1 and CAP37. Antimicrobial peptides have a therapeutic potential in dacryocystitis, in that they have a broad spectrum of antimicrobial activity and accelerate epithelial healing. However, caution is appropriate, because defensins also promote fibrin formation and cell proliferation, which are key elements in scarring processes, such as dacryostenosis.
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