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. 2022 May 5;17(5):e0266137. doi: 10.1371/journal.pone.0266137

Dental follicle mesenchymal stem cells ameliorated glandular dysfunction in Sjögren’s syndrome murine model

Deniz Genç 1,2,*, Osman Bulut 3, Burcu Günaydin 4, Mizgin Göksu 5, Mert Düzgün 5, Yelda Dere 6, Serhat Sezgin 7, Akın Aladağ 7, Aziz Bülbül 3
Editor: Gianpaolo Papaccio8
PMCID: PMC9070867  PMID: 35511824

Abstract

Objective

Dental mesenchymal stem cells (MSCs) are potential for use in tissue regeneration in inflammatory diseases due to their rapid proliferating, multilineage differentiation, and strong anti-inflammatory features. In the present study, immunoregulatory and glandular tissue regeneration effects of the dental follicle (DF)MSCs in Sjögren’s Syndrome (SS) were investigated.

Methods

Dental follicle (DF) tissues were obtained from healthy individuals during tooth extraction, tissues were digested enzymatically and DFMSCs were cultured until the third passage. DFMSCs were labeled with Quantum dot 655 for cell tracking analysis. The induction of the SS mouse model was performed by the injection of Ro60-273-289 peptide intraperitoneally. DFMSCs were injected intraperitoneally, or into submandibular, or lacrimal glands. Splenocytes were analyzed for intracellular cytokine (IFN-γ, IL-17, IL-10) secretion in T helper cells, lymphocyte proliferation, and B lymphocyte subsets. Histologic analysis was done for submandibular and lacrimal glands with hematoxylin-eosin staining for morphologic examination.

Results

The systemic injection of DFMSCs significantly reduced intracellular IFN-γ and IL-17 secreting CD4+ T cells in splenocytes (p<0.05), and decreased inflammatory cell deposits and fibrosis in the glandular tissues. DFMSCs differentiated to glandular epithelial cells in submandibular and lacrimal injections with a significant reduction in lymphocytic foci. The results showed that few amounts of DFMSCs were deposited in glandular tissues when applied intraperitoneally, while high amounts of DFMSCs were located in glandular tissues and differentiated to glandular epithelial cells when applied locally in SS murine model.

Conclusion

DFMSCs have the potential for the regulation of Th1, Th17, and Treg balance in SS, and ameliorate glandular dysfunction. DFMSCs can be a beneficial therapeutic application for SS.

Introduction

Sjögren’s Syndrome (SS) is a systemic autoimmune disease in which lymphocytic infiltration of salivary and lachrymal glands generally leads to xerostomia and xerophthalmia, and systemic complications develop in one-third of patients [1]. T helper 1 (Th1), Th17, and B cells have been reported to be involved in the pathogenesis of SS [2]. SS can be classified as; i) primary Sjögren’s syndrome (pSS) that occurs in the absence of another underlying rheumatic disorder, and ii) secondary Sjögren’s syndrome (sSS) that is associated with another underlying rheumatic disease, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or scleroderma [3]. Current treatment of SS is carried out with biological agents and traditional disease-modifying drugs, but it is still difficult due to the complex pathogenesis of the disease and side effects of conventional drugs [4]. Therefore, it is crucial to develop new treatment approaches that target inflammatory responses and contribute to tissue regeneration in the treatment of SS disease.

Mesenchymal stem cells (MSCs) are adult multipotent cells originating from mesodermal and ectodermal lineages, which have the capacity of self-renewal and can differentiate into osteoblasts, adipocytes, and chondrocytes [5]. MSCs can be isolated from many adult tissues such as bone marrow, adipose tissue, umbilical cord, and dental tissues. Among them, dental MSCs are potent candidates for the treatment of inflammatory diseases due to an easily accessible source, easy to isolate, rapidly proliferating in the culture, multipotent differentiation ability, and high immunomodulatory effects [6]. However, there are limited studies on the effects of MSCs in the treatment of SS, and the effects of dental MSCs on lymphocyte phenotype, immunoregulation, and tissue regeneration in SS disease remain to be elucidated.

In the present study, we investigated the immunomodulatory and regenerative effects of DFMSCs on the glandular tissues of the murine model of SS by injecting them intraperitoneally or into the submandibular or lacrimal glands.

Materials and method

In this study, the ethical approval was obtained from The Muğla Sıtkı Koçman University Animals Ethics Committee (24/07/2020.01) for animal studies and Muğla Sıtkı Koçman University Clinical Ethical Committee (08/08/2019.06) for collection of human dental tissues.

Animals and study groups

Fifty 6–8 weeks old male Balb-c mice were purchased from the Experimental Animal Center of the Muğla Sıtkı Koçman University. Mice were housed in animal cages at the same center, and all experiments were approved by the ethics committee for experimental animals. The total sample size for the study is determined with G-power analysis, and calculated as n = 50 for the comparison of 5 groups including SS, Control, and dental-MSCs treatment groups when the effect size is 0.55, α-error is 0.05, power is 0.85 calculated by F tests [7]. Groups were determined as following; Group 1: Control group (n = 10), Group 2: SS Model (n = 10), Group 3a: intraperitoneal DFMSCs treatment group (n = 10), Group 3b: submandibular DFMSCs treatment group (n = 10), Group 3c: lacrimal DFMSCs treatment group (n = 10). Animals were sacrificed 28 days after treatment protocols. Experimental design is given in S1 Fig.

Sjögren’s syndrome experimental model

The induction of the SS murine model was performed as previously described [8]. In brief, Ro60-273-289 peptide with sequence LQEMPLTALLRNLGKMT was purchased from Biosynthesis, USA. The intraperitoneal injection was done with 50 μg of Ro60 peptide emulsified in 100 μL of Freuds’ complete adjuvant (FCA) on day 1. The following immunizations were carried out on days 14, 36, 63, and 119 of the protocol with 50 μg Ro60 peptide in 100 μL of incomplete Freuds’ adjuvant (iFA) per mouse. Control animals were immunized with FCA or iFA.

Isolation and characterization of dental MSCs

Dental follicle tissues were obtained from 6 healthy subjects aged between 19–25 years, who applied to the Muğla Sıtkı Koçman University Dental Hospital for wisdom tooth extraction. Written consent was obtained from all participants according to the ethical guidelines. Dental tissues were mechanically and enzymatically digested as described previously [9]. In brief, dental tissues were cut into 0.5–1 mm pieces with a scalpel. The collagenase type I solution was used (3mg/mL in PBS) for the enzymatic digestion of tissues, at 37°C for 45 minutes. After the incubation period, cells were washed with 5 mL of DMEM supplemented with 10% FBS and centrifuged at 1500 rpm for 5 minutes. The remaining pellet was suspended in 5 mL DMEM supplemented with 10% FBS and 1% Penicillin/Streptomycin (100 U/mL) and cultured in a T25 flask until reaching 80–90% confluence. Dental MSCs in the third passage were analyzed for the positive cell surface markers of CD29, CD73, CD90, and CD105, and negative cell surface markers of CD14, CD34, and HLA-DR by staining the cells with anti-CD73 (APC), anti-CD90 (PerCp), anti-CD105 (FITC), anti-CD14 (PE), anti-CD34 (APC), anti-CD45 (PerCp), anti-HLA-DR (FITC) antibodies. All antibodies were purchased from BD Biosciences, US. Analysis was performed via flow cytometry (BD Accuri C6 Plus, BD Biosciences, US). The data was recorded as mean fluorescence intensity (MFI).

Fluorescence labeling of dental MSCs

Dental MSCs were labeled with Quantum Dot 655 kit (Thermofisher, US) for homing analysis of MSCs in the murine model. Qdot labeling was performed as described in the manufacturer’s protocol. In brief, component A and component B in the kit were mixed and incubated in the dark at room temperature for 5 minutes. 1x106 cells suspended in 100 μL of DMEM transferred into component A and B vial, vortexed for 30 seconds, and incubated for 60 minutes at 37°C in the dark chamber. Labeled cells were used within 2 hours for the treatment groups.

Treatment of SS model mice with DFMSCs

The injections of DFMSCs were done with three injection ways as described before [10–12] with some modifications as follows; I) İntraperitoneal injection: 1x106 cells suspended in 0.5 mL of PBS was injected intraperitoneally with a 28-gauge needle [10]. II) Submandibular gland injection: 1x106 cells suspended in 0.1 mL PBS, and injected in the submandibular gland below the throat line of the mouse with a 29-gauge needle [11]. III) Lacrimal gland injection: 1x106 cells suspended in 20 μL PBS was injected in the extra orbital lacrimal gland through the front of the ear line with a 27-gauge needle [12]. All injections were done on day 126. Animals were sacrificed on the 28th day after DFMSCs treatment, on day 154th of the experimental protocol.

Saliva and tears flow rate

Mouse saliva was collected according to a previous study [13]. Saliva and tears secretion was stimulated with an intraperitoneal injection of 0.05 mg of pilocarpine/100 g body weight. Total saliva was obtained from the oral cavity over 10 minutes using capillary tubes. Tears were collected for 10 seconds with a cotton thread containing phenol red at 5–10 minutes following the injection of pilocarpine hydrochloride [14]. The saliva and tears secretion rate measurement was done on days 126 and 154. The data for saliva flow rate was represented as microliters (μL)/10 minutes, and the data for tears rate was recorded as mm/10 seconds.

Lymphocyte proliferation analysis

To evaluate the immunosuppressive effect of DFMSCs we carried out a proliferation analysis for lymphocytes, by staining splenocytes with Carboxyfluorescein succinimidyl ester (CFSE), as described before [15]. For the analysis of lymphocyte proliferation, 5 μM of CFSE (Thermofisher, US) was used to stain every 1x106 cells in 1 mL PBS. The cell suspension was incubated in the dark at room temperature for 5 minutes, then mixed with 5 mL of cRPMI (RPMI 1640 + 10% FBS + 1% penicillin/streptomycin) and centrifuged at 2000 rpm for 5 minutes. After centrifugation, the supernatant was discarded, the remaining cells were suspended with cRPMI (5x105 cells/500 μL), and stimulated with anti-CD3 and anti-CD28 for specific T lymphocyte responses for 72 hours. Separately, B lymphocytes were stimulated with lipopolysaccharide (LPS) (1 μg/mL) for 6 days for the analysis of B cell proliferation rate. At the end of the culture period, the cells were stained either with anti-CD3 (APC), anti-CD4 (PE) to gate T lymphocytes or with anti-CD3 (APC) and anti-CD19 (PerCp) to gate B lymphocytes for 30 minutes at +4°C, and CD3+CD4+ T cells or CD19+ B cells were gated in the flow cytometry analysis and analyzed for CFSE signaling in the FL-1 channel. All antibodies were purchased from BD Biosciences, US. The data was recorded as a percentage (%) in the selected lymphocyte population. The gating strategy is shown in S2 Fig.

Immunophenotyping analysis

The spleens were removed through an incision from each of the mice after sacrification on day 154. As described before, the immunophenotyping analysis for Th1, Th2, Th17, and T regulatory (Treg) cells from splenocytes were done [16]. The spleens were cut into small pieces about 0.5 mm in diameter with a scalpel. Cells arising from the spleen were washed with 10 mL of RPMI 1640 medium, filtered through a 70 μm nylon filter, and then centrifuged at 200xg for 10 minutes. The cell pellet was counted by a hemocytometer, and 1x106 cells/mL were stimulated with anti-CD3 and anti-CD28 (1 μg/ml) at 37°C in a humidified 5% CO2 atmosphere for 72 hours. After the culture period splenocytes were analyzed for intracellular cytokine secretions. In brief, cells were washed twice with phosphate buffer solution (PBS) and centrifuged at 200xg for 5 minutes. The remaining pellet was stained with anti-mouse-CD3 and anti-mouse-CD4 to gate Th cells. Then, the cells permeabilized with a permeabilization solution for 40 minutes. The permeabilized cells were then stained with anti-IFNγ, anti-IL4, anti-IL17, or anti-IL10 antibodies for intracellular cytokine detection via flow cytometry (Accuri C6 Plus, BD Biosciences, US). B lymphocyte subsets were analyzed for plasma B cells and naïve B cell populations with the stimulation of lipopolysaccharide (LPS) (1 μg/mL) for 6 days. CD19+IgD-CD27+CD38+ cells were analyzed for plasma B lymphocytes. CD19+CD27-IgD+ cells were analyzed for naïve B lymphocytes. Cells were stained with anti-mouse-CD19 (APC), anti-mouse-CD27 (PE), anti-mouse-CD38 (FITC), anti-IgD (PerCp). FoxP3 expressing CD4+ T cells were also analyzed for T regulatory cell frequency. The splenocytes (1x106 cells/mL) were stimulated with anti-CD3 and anti-CD28 (10 μg/ml) at 37°C in a humidified 5% CO2 atmosphere for 72 hours. After the culture period, cells were stained with anti-mouse-CD4 (FITC), anti-mouse-CD25 (APC) antibodies for cell surface markers. Cells were permeabilized and stained with anti-mouse-FoxP3 (PE) antibodies for the intracellular expression of FoxP3. All antibodies were purchased from BD Biosciences, US. The data was represented as the percentage (%) of the cells. The gating strategy is shown in S2 Fig.

Detection of secreted cytokine levels

The cytokine levels were measured in the culture supernatants of splenocytes, and in the collected saliva and tears as described before [9,17,18], with some modifications. In brief, the isolated splenocytes were suspended in RPMI 1640 medium supplemented with 10%FBS and 1%penicillin/streptomycin (100 U/ml,100μg/mL) and were stimulated with anti-CD3 and anti-CD28 at 37°C in a humidified 5%CO2 chamber for 72 hours. After the culture period, the supernatant was collected and 50 μL of each of the samples was incubated with microbeads for 2 hours. The saliva samples (50 μL) were directly incubated with the microbeads for 2 hours. Tear cytokine concentrations were measured from the collected 4–5 μL of tear samples. The samples were diluted 1 in 8.333 in a final volume of 25 μL and a total of 1μL of each capture bead. Levels of IFN-γ, IL-17 and IL-10 were determined using a Cytometric Bead Array (CBA) Human Th1/Th2/Th17 kit (BD Biosciences, San Diego, CA, USA) according to the manufacturer’s instructions. The data were given as pg/ml.

Homing and differentiation analysis of DFMSCs

The glandular samples were divided into two parts. One of the parts was subjected to histochemical analysis and the second part of the tissues was analyzed for α-smooth muscle actin (α-SMA) within Qdot labeled cells to determine the differentiation of DFMSCs to glandular epithelial cells. We analyzed homing of DFMSCs applied with intraperitoneal, submandibular, and lacrimal injections on the 7th day and 28th day after injection in the submandibular and lacrimal gland tissues as described previously [19]. Fresh glandular tissues were sent immediately to the pathology laboratory for the frozen section. An adjacent tissue block was fixed in 10% neutral buffered formalin and paraffin-embedded. Frozen sections were freshly studied by Leica CM-1860 UV. Sections were stained with anti-smooth muscle actin (α-SMA) and DAPI antibodies to detect Qdot labeled cells in the glandular tissue. The images were scanned by a fluorescent microscope (Nikon TS-2 FL Trinocular Inverted Microscope 5.9 Megapixel Head DS-Fi3, Japan). Antibodies were purchased from Abcam, US.

The differentiation of DFMSCs was analyzed by staining the glandular epithelial cells with anti-α-SMA antibody within Qdot labeled cells via flow cytometry. The tissue digestion was performed as described before [20]. Fresh tissue samples were cut into 0.5–1 mm pieces and enzymatically digested with 2 mL of DMEM low glucose supplemented with 3mg/ml collagenase type I, 2.4 U/mL dispase solution, 8 U/mL DNAse type I solution, and 6 mM CaCl2 at 37°C for 90 minutes. The enzymatic activation was blocked with DMEM supplemented with 15%FBS and washed twice with the same medium. The samples were centrifuged at 1,242 x g for 5 minutes. The cell pellet was stained with anti-α-SMA (FITC) antibody and analyzed via flow cytometry. The epithelial differentiation of dental MSCs was determined by analyzing the double-positive cell population of α-SMA (FL-1 channel) and Qdot (FL-3 channel). The data was represented as the percentage (%) of the cells.

Histopathologic analysis

Glandular tissues were fixed in 10% buffered formalin at room temperature for 24 hours. Then glandular tissues were embedded in paraffin and serially sectioned into 4–5 μm thick paraffin sections. The sections were stained with hematoxylin-eosin (Bio Optica, Italy) using standard protocols. Sections were observed under the light microscope (Olympus BX46, Japan). The focus score in the gland was determined by the number of lymphocytic foci [21].

Statistical analysis

Differences between groups were analyzed using the GraphPad Prism 9.0 version (GraphPad Software, Inc., CA, USA). Data were given as mean (Mean) ± standard deviation (SD) (minimum-maximum) values in each group. In detail, the secreted cytokine levels were in pg/mL and given as mean±SD. Flow cytometry analysis for cytokine secreting cells, and B lymphocyte subsets were presented as percentage (%) of cell populations. Graphical presentation and statistical analysis were calculated using GraphPad Prism 8 software (Graphpad Software Inc., USA). Comparison of the data of more than two groups was done by one-way ANOVA test. Histopathologic data were analyzed by the Mann-Whitney U test. An unpaired Student’s t-test was used to compare cytokine levels between groups. P <0.05 values were considered statistically significant and p<0.01-p<0.001 values were considered as highly statistically significant.

Results

Characterization of DFMSCs

DF-MSCs showed MSCs characteristics in the third passage with the high expressions of positive markers of CD73 (DFMSCs: 96.3±0.9%), CD90 (DFMSCs: 96.7±1.0%) CD105 (DFMSCs: 95.6±0.4%). Dental MSCs lack the expression of CD14, CD34, CD45 and HLA-DR as negative markers (S3 Fig).

The systemic application of DFMSCs suppressed peripheral IFN-γ and IL-17 secreting T lymphocytes and reduced symptoms in a murine model of SS

We compared the immunomodulatory effect of intraperitoneal, submandibular and lacrimal injections of DFMSCs in a mouse model of SS by analyzing lymphocyte proliferative responses, and T and B lymphocyte phenotypes within splenocytes. Total lymphocytes were gated from the SSC-FSC area of flow cytometry and analyzed for CD3+CD4+ T lymphocytes proliferation. The cytokine secreting cells were analyzed for CD4+IFNγ+ or CD4+IL17+ or CD4+IL10+ cells for Th1, Th17, or IL-10 secreting T cells, respectively. CD19+ B cells were analyzed for plasma and naïve B lymphocyte subsets to determine the modulatory effects of DFMSCs in the spleen mononuclear cells of the SS murine model. We also measured saliva and tears secretion rate in SS murine model before and after the DFMSCs treatment and compared the data within application days and groups.

CD3+CD4+ T lymphocyte proliferation rate was significantly high in SS mice (Group 2) (46.1±9.3%) compared to control group (Group 1) (9.6±2.2%) (p<0.001). The intraperitoneally injected DFMSCs (Group 3a) significantly decreased CD3+CD4+ T lymphocyte proliferation rate (19.7±7.6%) compared to Group 2 (p<0.01). Submandibular and lacrimal injections of DFMSCs tended to decrease the lymphoproliferative responses of CD3+CD4+ T lymphocytes (39.9±8.1% and 43.7±6.8%, respectively) compared to Group 2, but no significant difference was observed (p>0.05). CD19+ B lymphocyte proliferation rate was significantly high in SS mice (Group 2) (45.3±16.8%) compared to the control group (Group 1) (10.1±4.3%) (p<0.001). The intraperitoneally injected DFMSCs (Group 3a) significantly decreased CD19+ B lymphocyte proliferation rate (24.1±9.3%) compared to Group 2 (p<0.01). Submandibular and lacrimal injections of DFMSCs did not significantly change the lymphoproliferative responses of CD19+ B lymphocytes (46.9±12.9% and 53.3±17.9%, respectively) compared to Group 2 (p>0.05) Fig 1.

Fig 1. Lymphocyte proliferation analysis in the splenocytes.

Fig 1

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CD3+CD4+ T lymphocyte proliferation rate was significantly high in SS mice (Group 2) compared to the control group (Group 1) (p<0.001). The intraperitoneally injected DFMSCs (Group 3a) significantly decreased CD3+CD4+ T lymphocyte proliferation rate compared to Group 2 (p<0.01). Submandibular and lacrimal injections of DFMSCs tended to decrease the lymphoproliferative responses of CD3+CD4+ T lymphocytes compared to Group 2, but no significant difference was observed (p>0.05). CD19+ B lymphocyte proliferation rate was significantly high in SS mice (Group 2) compared to the control group (Group 1) (p<0.001). The intraperitoneal injection of DFMSCs (Group 3a) significantly decreased CD19+ B lymphocyte proliferation rate compared to Group 2 (p<0.01). Submandibular and lacrimal injections of DFMSCs did not significantly change the lymphoproliferative responses of CD19+ B lymphocytes compared to Group 2 (p>0.05).

CD4+CD25+FoxP3+ T regulatory cell frequency was notably low in Group 2 (8.3±1.1%) compared to Group 1 (14.2±0.8%) (p<0.01). The intraperitoneal injection of DFMSCs significantly enhanced CD4+CD25+FoxP3+ T regulatory cell ratio (13.8±4.7%) when compared with Group 2 (p<0.01). The CD4+CD25+FoxP3+ T regulatory cell ratio in the intraperitoneal injected DFMSCs group (Group 3a) was close to Group 1, and no significant difference was observed between the two groups (p>0.05). The submandibular and lacrimal injections of DFMSCs did not significantly change CD4+CD25+FoxP3+ T regulatory cell frequency (9.1±0.6% and 8.7±0.9%) compared to Group 2 (p>0.05 and p>0.05, respectively) Fig 2.

Fig 2. FoxP3 expressing T regulatory cell frequency.

Fig 2

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The intraperitoneal injection of DFMSCs significantly enhanced CD4+CD25+FoxP3+ T regulatory cell ratio compared to Group 2 (p<0.01). FoxP3 expressing CD4+CD25+ T regulatory cell ratio in intraperitoneal injected DFMSCs group (Group 3a) was close to Group 1, and no significant difference was observed between two groups (p>0.05). The submandibular and lacrimal injections of DFMSCs did not significantly change CD4+CD25+FoxP3+ T regulatory cell frequency compared to Group 2 (p>0.05 and p>0.05, respectively).

CD4+IFN-γ+ T cell ratio in the splenocytes was significantly high in Group 2 (6.8±0.7%) compared to Group 1 (1.6±0.4%) (p<0.001). The intraperitoneal injection of DFMSCs significantly reduced CD4+IFN-γ+ T cell ratio (2.4±0.5%) compared to Group 2 (p<0.001). The submandibular and lacrimal injected DFMSCs tended to decrease CD4+IFN-γ+ T cell ratio (6.2±0.4% and 6.7±0.6%) in the splenocytes, but no significant difference was observed when compared with Group 2 (p>0.05 and p>0.05). CD4+IL-17+ T cell ratio was significantly high in Group 2 (3.8±0.7%) compared to Group 1 (0.9±0.4%) (p<0.001). The intraperitoneal and submandibular injection of DFMSCs significantly reduced CD4+IL-17+ T cell ratio (1.4±0.6% and 2.0±0.3%, respectively) compared to Group 2 (p<0.001 and p<0.005, respectively). The lacrimal injected DFMSCs tended to decrease CD4+IL-17+ T cell ratio (3.5±0.3%) in the splenocytes, but no significant difference was observed when compared with Group 2 (p>0.05). CD4+IL-10+ T cell ratio was significantly low in Group 2 (2.2±0.3%) compared to Group 1 (3.4±0.8%) (p<0.05). The intraperitoneal injection of DFMSCs significantly increased CD4+IL-10+ T cell ratio in Group 3a (5.2±0.6%) compared to Group 2 (p<0.01), but no significant difference was observed in submandibular and lacrimal injected DFMSCs (2.7±0.5% and 2.3±0.8%, respectively) when compared with Group 2 (p>0.05 and p>0.05, respectively) Fig 3.

Fig 3. Cytokine secreting CD4+T lymphocyte ratio.

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The intraperitoneal injection of DFMSCs significantly reduced the CD4+IFN-γ+ T cell ratio compared to Group 2 (p<0.001). The submandibular and lacrimal injections of DFMSCs tended to decrease the CD4+IFN-γ+ T cell ratio (6.2±0.4% and 6.7±0.6%) in the splenocytes, but no significant difference was observed when compared with Group 2 (p>0.05 and p>0.05). The intraperitoneal and submandibular injections of DFMSCs significantly reduced the CD4+IL-17+ T cell ratio compared to Group 2 (p<0.001 and p<0.005, respectively). The lacrimal injected DFMSCs tended to decrease CD4+IL-17+ T cell ratio in the splenocytes, but no significant difference was observed when compared with Group 2 (p>0.05). The intraperitoneal injection of DFMSCs significantly increased CD4+IL-10+ T cell ratio in Group 3a compared to Group 2 (p<0.01), but no significant difference was observed in submandibular and lacrimal injected DFMSCs when compared with Group 2 (p>0.05 and p>0.05, respectively).

The secreted cytokine levels in the culture supernatants of splenocytes were analyzed via flow cytometry. IFN-γ and IL-17 levels were significantly high in Group 2 (IFN-γ: 38.1±10.8 pg/mL, IL-17: 279.2±63.2 pg/mL) compared to Group 1 (IFN-γ: 21.3±7.1 pg/mL, IL-17: 199.8±23.4 pg/mL) (p<0.05 and p<0.01, respectively). IL-10 levels were significantly low in Group 2 (15.4±4.2 pg/mL) compared to Group 1 (21.8±9.7 pg/mL) (p<0.05). Intraperitoneal injection of DFMSCs significantly increased IL-10 levels in Group 3a (32.3±9.8 pg/mL) (p<0.01), and significantly decreased the secreted IFN-γ and IL-17 levels (15.9±4.2 pg/mL and 203.7±19.2 pg/mL, respectively) compared to Group 2 (p<0.01 and p<0.01, respectively). Submandibular and lacrimal injections of DFMSCs did not significantly change the secreted IFN-γ (36.9±11.6 pg/mL and 34.7±7.8 pg/mL) (p>0.05 and p>0.05, respectively), IL-17 (265.2±57.4 pg/mL and 271.9±41.5 pg/mL) (p>0.05 and p>0.05, respectively), and IL-10 levels (12.8±3.5 pg/mL and 10.1±3.2 pg/mL) when compared with Group 2 (p>0.05 and p>0.05, respectively) Fig 4A.

Fig 4. The secreted cytokine levels in the culture supernatant of splenocytes, saliva, and tears.

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(a) The cytokine levels in the culture supernatants of splenocytes. Intraperitoneal injection of DFMSCs significantly increased IL-10 levels in Group 3a (p<0.01), and significantly decreased the secreted IFN-γ and IL-17 levels compared to Group 2 (p<0.01 and p<0.01, respectively). Submandibular and lacrimal injections of DFMSCs did not significantly change the secreted IFN-γ (p>0.05 and p>0.05, respectively), IL-17 (p>0.05 and p>0.05, respectively), and IL-10 levels when compared with Group 2 (p>0.05 and p>0.05, respectively). (b) The cytokine levels in saliva. Intraperitoneal injection of DFMSCs significantly increased IL-10 levels in Group 3a (p<0.05), and significantly decreased the secreted IFN-γ and IL-17 levels compared to Group 2 (p<0.05 and p<0.05, respectively). Submandibular injection of DFMSCs significantly decreased the secreted IFN-γ and IL-17 levels in the saliva compared to Group 2 (p<0.01 and p<0.05, respectively). Submandibular injection of DFMSCs significantly increased IL-10 levels in the saliva compared to Group 2 (p<0.05). (c) The cytokine levels in tears. Intraperitoneal injection of DFMSCs significantly increased IL-10 levels in Group 3a (p<0.05), and significantly decreased the secreted IFN-γ and IL-17 levels compared to Group 2 (p<0.01 and p<0.01, respectively). Lacrimal injection of DFMSCs significantly decreased the secreted IFN-γ and IL-17 levels in the tears compared to Group 2 (p<0.05 and p<0.01, respectively). Lacrimal injection of DFMSCs significantly increased IL-10 levels in the saliva compared to Group 2 (p<0.05).

The secreted IFN-γ and IL-17 levels in the saliva were significantly high in Group 2 (IFN-γ: 16.2±6.3 pg/mL, IL-17: 19.8±5.7 pg/mL) compared to Group 1 (IFN-γ: 8.2±2.1 pg/mL, IL-17: 2.9±1.2 pg/mL) (p<0.01 and p<0.001, respectively). There was no significant difference between Group1 (11.7±3.9 pg/mL) and Group 2 (10.8±1.7 pg/mL) in IL-10 levels in the saliva (p>0.05). Intraperitoneal injection of DFMSCs significantly increased IL-10 levels in Group 3a (16.5±3.8 pg/mL) (p<0.05), and significantly decreased the secreted IFN-γ and IL-17 levels (11.3±2.1 pg/mL and 12.1±2.4 pg/mL, respectively) compared to Group 2 (p<0.05 and p<0.05, respectively). Submandibular injection of DFMSCs significantly decreased the secreted IFN-γ and IL-17 levels in the saliva (8.3±1.9 pg/mL and 9.6±0.5 pg/mL, respectively) compared to Group 2 (p<0.01 and p<0.05, respectively). Submandibular injection of DFMSCs significantly increased IL-10 levels in the saliva (14.2±3.6 pg/mL) compared to Group 2 (p<0.05) Fig 4B.

The secreted IFN-γ and IL-17 levels in the tears were significantly high in Group 2 (IFN-γ: 19.1±8.2 pg/mL, IL-17: 21.8±6.7 pg/mL) compared to Group 1 (IFN-γ: 11.9±3.1 pg/mL, IL-17: 4.8±1.1 pg/mL) (p<0.01 and p<0.001, respectively). There was no significant difference between Group1 (12.3±3.6 pg/mL) and Group 2 (11.6±2.1 pg/mL) in IL-10 levels in the tears (p>0.05). Intraperitoneal injection of DFMSCs significantly increased IL-10 levels in Group 3a (17.1±4.3 pg/mL) (p<0.05), and significantly decreased the secreted IFN-γ and IL-17 levels (12.1±2.6 pg/mL and 11.9±2.1 pg/mL, respectively) compared to Group 2 (p<0.01 and p<0.01, respectively). Lacrimal injection of DFMSCs significantly decreased the secreted IFN-γ and IL-17 levels in the tears (14.6±3.9 pg/mL and 12.3±4.2 pg/mL, respectively) compared to Group 2 (p<0.05 and p<0.01, respectively). Lacrimal injection of DFMSCs significantly increased IL-10 levels in the saliva (13.4±4.6 pg/mL) compared to Group 2 (p<0.05) Fig 4C.

The saliva flow rate was significantly low in Group 2 compared to Group 1 on day 126 (Group 1: 307±39 μL, Group 2: 143±47 μL, p<0.01) and on day 154 (Group 1: 301±54 μL, Group 2: 158±32 μL, p<0.01). The intraperitoneal injection of DFMSCs significantly increased the saliva flow rate in Group 3a (247±35 μL) compared to Group 2 on day 154 (p<0.05) and increased the saliva flow rate in Group 3a on day 154 compared to day 126 (141±28 μL) (p<0.05). The lacrimal injection of DFMSCs in Group 3c did not significantly change the saliva flow rate in SS mice when compared with Group 2 on day 154 (137±23 μL) (p>0.05). The tears secretion rate was significantly low in Group 2 compared to Group 1 on day 126 (Group 1: 2.8±0.5 mm/10 seconds, Group 2: 1.4±0.6 mm/10 seconds), and on day 154 (Group 1: 2.8±0.4 mm/10 seconds, Group 2: 1.5±0.6 mm/10 seconds) (p<0.01). The intraperitoneal injection of DFMSCs significantly increased tears rate in Group 3a (2.2±0.5 mm/10 seconds) compared to Group 2 on day 154 (p<0.05), and increased the tears rate in Group 3b on day 154 compared to day 126 (1.9±0.3 mm/10 seconds) (p<0.05) Fig 5.

Fig 5. Saliva and tears flow rate.

Fig 5

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The intraperitoneal injection of DFMSCs significantly increased the saliva flow rate in Group 3a compared to Group 2 on day 154 (p<0.05) and increased the saliva flow rate in Group 3a on day 154 compared to day 126 (p<0.05). The lacrimal injection of DFMSCs in Group 3c did not significantly change the saliva flow rate in SS mice when compared with Group 2 on day 154 (p>0.05). The intraperitoneal injection of DFMSCs significantly increased tears rate in Group 3a compared to Group 2 on day 154 (p<0.05), and increased the tears rate in Group 3b on day 154 compared to day 126 (p<0.05).

The ratio of CD19+IgD+CD27+ naïve B lymphocytes in the splenocytes were significantly low in Group 2 (19.9±5.8%) compared to Group 1 (27.2±4.9%) (p<0.05). Intraperitoneal injection of DFMSCs significantly increased the ratio of CD19+IgD+CD27+ naïve B lymphocytes in Group 3a (24.1±3.9%) compared to Group 2 (p<0.05). CD19+IgD-CD38+CD27+ plasma cell ratio was significantly high in Group 2 (3.6±1.2%) compared to Group 1 (0.6±0.4%) (p<0.01). Intraperitoneal injection of DFMSCs significantly decreased the ratio of CD19+IgD-CD38+CD27+ plasma cells in Group 3a (1.9±0.7%) compared to Group 2 (p<0.05). Submandibular and lacrimal injections of DFMSCs did not significantly changed CD19+IgD+CD27+ (Submandibular: 17.5±4.1%, Lacrimal: 18.2±2.9%) and CD19+IgD-CD38+CD27+ cell ratio (Submandibular: 3.5±1.0%, Lacrimal: 3.4±0.8%) in Group 3b and Group 3c when compared with Group 2 (p>0.05) Fig 6.

Fig 6. Flow cytometry analysis of plasma and naïve B cell subsets in the splenocytes.

Fig 6

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Intraperitoneal injection of DFMSCs significantly increased the ratio of CD19+IgD+CD27+ naïve B lymphocytes in Group 3a compared to Group 2 (p<0.05). CD19+IgD-CD38+CD27+ plasma cell ratio was significantly high in Group 2 compared to Group 1 (p<0.01). Intraperitoneal injection of DFMSCs significantly decreased the ratio of CD19+IgD-CD38+CD27+ plasma cells in Group 3a compared to Group 2 (p<0.05). Submandibular and lacrimal injections of DFMSCs did not significantly change CD19+IgD+CD27+ and CD19+IgD-CD38+CD27+ cell ratio in Group 3b and Group 3c when compared with Group 2 (p>0.05).

DFMSCs administered by intraperitoneal injection in SS mice migrated to submandibular and lacrimal glands in low amounts

The glandular tissues were analyzed for the migration and homing of DFMSCs after intraperitoneal, submandibular, and lacrimal injections at the 7th day and 28th days. The Qdot labeled cells in the tissue samples were analyzed by a fluorescent microscope. Results showed that Qdot labeled DFMSCs were located in submandibular and lacrimal glands within 7 days when injected locally. Intraperitoneally injected DFMSCs migrated preferentially to submandibular glands in the first 7 days and permanently localized as foci in the exocrine gland for up to 28 days Fig 7.

Fig 7. Homing of DFMSCs in submandibular and lacrimal glands in SS mouse model.

Fig 7

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Quantum dot 655 (Qdot-655) labeled cells were analyzed with a fluorescence microscope in the glandular tissues of the SS murine model on the 7th and 28th days after intraperitoneal, and local injections of DFMSCs. Qdot labeled DFMSCs were located in submandibular and lacrimal glands within 7 days when injected locally. Intraperitoneally injected DFMSCs migrated preferentially to submandibular glands in the first 7 days and localized as foci in the exocrine gland for up to 28 days.

Locally applied DFMSCs highly differentiated into glandular epithelial cells

The differentiation of Qdot labeled DFMSCs was analyzed by staining the glandular epithelial cells with α-SMA antibody. Qdot labeled cells were analyzed within glandular epithelial cells by a fluorescent microscope. Submandibular and lacrimal injections of DFMSCs showed high differentiation into glandular epithelial cells on day 28 compared to the intraperitoneally injected DFMSCs. The data demonstrated that intraperitoneally injected DFMSCs act by regulating lymphocyte responses, not by differentiation into glandular epithelial cells in the SS mouse model Fig 8A.

Fig 8. The differentiation analysis of DFMSCs into epithelial lineage in glandular tissues.

Fig 8

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(a) The fluorescent microscope images of glandular tissues. Glandular tissues were stained with α-SMA (FITC) and DAPI, and analyzed for Quantum dot 655 (Qdot-655) labeled cells. Submandibular and lacrimal injections of DFMSCs showed high differentiation into glandular epithelial cells on day 28 compared to the intraperitoneally injected DFMSCs. (b) Flow cytometry analysis for α-SMA stained cells within Qdot-655 labeled cells. The submandibular and lacrimal injections of DFMSCs highly express α-SMA in submandibular and lacrimal glands of SS mouse model compared to intraperitoneal injections (p<0.001 and p<0.001, respectively).

Intraperitoneal, submandibular and lacrimal injected Qdot labeled DFMSCs were analyzed for α-SMA signaling via flow cytometry. The cells were analyzed in a double positive area for Qdot labeled cells (DFMSCs) in the FL-3 channel and α-SMA (FITC) in the FL-1 channel to determine DFMSCs expressing the epithelial marker. Results showed that submandibular and lacrimal injections of DFMSCs highly express α-SMA in submandibular (12.5±2.1%) and lacrimal (10.1±1.8%) glands of SS mouse model compared to intraperitoneal injections (Submandibular: 1.2±0.7%, Lacrimal: 0.9±0.4%) (p<0.001 and p<0.001, respectively) Fig 8B.

DFMSCs reduced lymphocytic infiltration and fibrosis in glandular tissues

In the present study, we analyzed lymphocytic infiltration and tissue integrity by staining the sections with a hematoxylin-eosin stain. Glandular tissues of SS mice showed high amounts of lymphocytic foci (Focus score >1) (number of lymphocytic foci in submandibular glands (mean±SEM): 4.6±0.5) (number of lymphocytic foci in lacrimal glands (mean±SEM): 3.4±0.6) compared to control subjects (Focus score <1) (number of lymphocytic foci in submandibular glands (mean±SEM): 0.2±0.8) (number of lymphocytic foci in lacrimal glands (mean±SEM): 0.4±0.6) (p<0.001). Also, tissue destruction and fibrosis in submandibular and lacrimal glands in Group 2 were observed in the glandular sections. DFMSCs reduced lymphocytic infiltrates in submandibular glands (number of lymphocytic foci (mean±SEM): 1.2±0.6) (p<0.01) and lacrimal glands (number of lymphocytic foci (mean±SEM): 0.8±0.4) (p<0.05), and ameliorated tissue destruction when applied intraperitoneally. Submandibular or lacrimal injection of DFMSCs significantly reduced lymphocytic infiltration and fibrosis in submandibular (number of lymphocytic foci (mean±SEM): 1.6±0.7) (p<0.05) or lacrimal glands (number of lymphocytic foci (mean±SEM): 1.4±0.5) (p<0.05) Fig 9.

Fig 9. Histopathological analysis of glandular tissues.

Fig 9

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(a) Hematoxylin-eosin staining of submandibular and (b) lacrimal glands. The statistical analysis of lymphocytic foci of glandular tissues. Submandibular and lacrimal glands of SS mice showed high amounts of lymphocytic foci (Focus score >1) compared to control subjects (Focus score <1) (p<0.001). The lymphocytic foci were shown with green arrows. Tissue destruction and fibrosis in submandibular and lacrimal glands in Group 2 were observed in the glandular sections (yellow arrows). DFMSCs significantly reduced lymphocytic infiltrates in submandibular glands (p<0.01) and in lacrimal glands (p<0.05), and ameliorated tissue destruction when applied intraperitoneally. Submandibular or lacrimal injection of DFMSCs significantly reduced lymphocytic infiltration and fibrosis in submandibular (p<0.05) or lacrimal glands (p<0.05).

Discussion

Sjögren’s syndrome (SS) is an autoimmune disease characterized by the destruction of the exocrine glands and lymphocyte infiltrates in the salivary and lacrimal glands [22]. Due to the potent immunomodulatory and regenerative effects, MSCs have been investigated in several autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Crohn’s disease [23]. The studies demonstrated that MSCs exert modulatory effects on both innate and adaptive immune cells, by inhibiting the activation and plasticity of immune cells [24]. In the present study, we investigated the immunomodulatory and regenerative effects of DFMSCs, which can be isolated at a high amount in a culture condition and has strong anti-inflammatory and potent regenerative effects, on the SS murine model by systemic and local applications. We found that DFMSCs down-regulate immune responses reduce lymphocytic infiltration when administered by systemic injection, and can differentiate into glandular epithelial cells when administered into glandular tissue.

Previous studies have shown that bone marrow-derived MSCs upregulate the immunosuppressive effect of myeloid-derived suppressor cells by transforming the growth factor-b (TGF-β)/Smad pathway. In addition, PGE2 production by MSCs increases Foxp3+ T regulatory cell frequency [25–29]. However, given the complexity of pSS and the diverse immunosuppressive mechanisms of MSCs isolated from different tissues, uncovering new sources of MSCs that may have higher immunosuppressive capacity will contribute to the expansion of cellular therapy options [30]. In the present study, we demonstrated that systemic administration of DFMSCs strongly regulates Th1 and Th17 responses in splenocytes by enhancing the frequency of T regulatory cells and up-regulating IL-10 secreting CD4+ T cells, and by down-regulating plasma B cells in the favor of naïve B cells. The systemic injection also reduced lymphocytic infiltrate and tissue destruction in glandular tissues. After local injection, DFMSCs differentiated into glandular epithelial cells in submandibular and lacrimal glands and reduced lymphocytic foci in glandular tissues. The improvement of SS manifestations was observed mainly in the systemic injection of DFMSCs, while a slight recovery was observed in local injections. Consistent with previous studies, the results of this study showed that local application of DFMSCs promotes regeneration in damaged glandular tissue and systemic administration of DFMSCs reduces immune responses in both exocrine glands and the periphery.

In this study, it was shown that intraperitoneal injection of DFMSCs down-regulated lymphoproliferative responses in splenic CD4+T and CD19+B cells, but failed to inhibit the proliferative responses of splenocytes at local injections. MSCs can suppress T-cell proliferation by secreting anti-inflammatory mediators such as transforming growth factor β1 (TGFβ1) and hepatocyte growth factor (HGF) [31,32]. To determine the regulatory effects of DFMSCs on the inflammatory mediators we further investigated the cytokine secretion in the splenocytes, saliva, tears, and splenic T and B lymphocyte subsets in the SS murine model.

Studies to date have demonstrated that IFN-γ and IL-17 are dominant cytokines found in the exocrine glands of SS patients and animal models of SS by enhancing T regulatory (Treg) and IL-10 secreting cells [33–41]. In this study, it was observed that systemic administration of DFMSCs suppressed the secretion of IFN and IL-17 cytokines in both splenocytes, saliva, and tears, by increasing the frequency of FoxP3-expressing T-regulatory cells (Treg) and the proportion of IL-10-producing lymphocytes. However, locally injected DFMSCs did not significantly change the amount of inflammatory cytokines. The data suggest that systemic administration of DFMSCs promotes peripheral tolerance in the favor of regulatory T lymphocyte phenotype.

Autoreactive antibody-producing plasma B cells are other cell types that are important in the pathogenesis of SS [42]. It is known that MSCs can suppress B cell proliferation and differentiation into plasma cells via IL-1Ra signaling, and can inhibit IgM production by B cells [43–45]. In the present study, the results showed that intraperitoneal injection of DFMSCs resulted in a significant reduction in the plasma B cell population in favor of naive B cells. However, no significant difference was observed in the ratio of naïve and plasma B cells in splenocytes of the SS mouse model with local injections of DFMSCs. These results suggest that locally administered DFMSCs may have a potent role in damaged tissue rather than peripheral immune responses.

In previous studies, it has been reported that high levels of IFN-γ, IL-17, IL-1RA, IL-4, and IL-2 were observed in tears of SS patients when compared with non-SS patients with sicca symptoms [35,46]. In the present study, we showed that local administration of DFMSCs into submandibular and lacrimal glands have also been effective in suppressing inflammatory cytokines in the saliva or tears that play a crucial role in the pathogenesis of SS, by enhancing IL-10 levels. Compatible with these results, the frequency of IFN-γ secreting Th1 cells and IL-17 secreting Th17 cells in the splenocytes strongly reduced with intraperitoneal administration of DFMSCs with the increased frequency of IL-10 secreting CD4+ T lymphocytes, while no significant difference was observed in the IFN-γ, IL-17 or IL-10 secreting cells in the splenocytes with the local administration of DFMSCs.

Histopathologic findings in SS include focal lymphocytic infiltrates in the exocrine glands. The infiltrate contains CD4+ Th cells, B cells, and plasma cells leading to glandular dysfunction that manifests as dry eyes and dry mouth [47–50]. We evaluated the symptomatic findings to determine the therapeutic efficacy of DFMSCs on SS. The flow rate of saliva and tears notably increased with systemic and local injections of DFMSCs. When evaluated together with the cytokine levels in saliva and tears, it is thought that DFMSCs may have a regenerative effect on the damaged tissue due to the suppression of inflammatory responses in exocrine glands with locally applied DFMSCs.

The results of this study demonstrated that DFMSCs can migrate to exocrine glands when administered intraperitoneally. It has been observed that locally applied DFMSCs are permanently located in the exocrine glands. We, therefore, investigated the regenerative effects of DFMSCs with systemic and local administration by evaluating homing and differentiation ability of DFMSCs. It was observed that DFMSCs administered by intraperitoneal injection migrated to the exocrine tissue in the first 7 days and were localized as foci in the exocrine gland on the 28th day. It was demonstrated that locally injected DFMSCs were distributed in the exocrine glands in large numbers and permanently localized until the 28th day. After observing homing of DFMSCs, we performed histologically and flow cytometry analysis for the differentiation ability of Qdot labeled DFMSCs by staining tissue samples with α-SMA as an epithelial marker. The results indicated the differentiation ability of DFMSCs into glandular epithelial cells with local injections in the SS murine model. Previous studies demonstrated that human umbilical cord MSCs adapt to an epithelial phenotype when co-cultured with human salivary gland biopsies of SS patients, and bone marrow-derived MSCs showed epithelial differentiation potential when cultured in the conditioned media with keratinocyte growth factor, epidermal growth factor, hepatocyte growth factor, and insulin-like growth factor, which indicate that MSCs can differentiate into epithelial lineage under appropriate conditions [51,52]. In this study, we demonstrated the ability of DFMSCs to differentiate into an epithelial phenotype in a murine model of SS for the first time.

In this study, DFMSCs was shown to be an alternative to cell-based therapies by demonstrating their regulatory effects on T and B lymphocyte responses in SS. While DFMSCs substantially target peripheral immune responses when applied systemically, they prefer differentiating to epithelial cells when applied locally. The underlying mechanism of epithelial differentiation potential of DFMSCs in SS should be further investigated.

Conclusion

In conclusion, we demonstrated the immunomodulatory effects of DFMSCs on T and B lymphocyte responses in a murine model of SS. In addition, DFMSCs have the potential to differentiate into glandular epithelial cells in the SS when applied locally. DFMSCs may be a potent candidate in cellular therapy options for SS.

Supporting information

S1 Fig. Study design.

The SS murine model was performed with the intraperitoneal injection of 50 μg of Ro60 peptide emulsified in 100 μL of Freuds’ complete adjuvant (FCA) on day 1. The following immunizations were carried out on days 14, 36, 63, and 119 with 50 μg Ro60 peptide. DFMSCs are administered by intraperitoneal, submandibular, or lacrimal injections.

(TIF)

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S2 Fig. Gating strategy for flow cytometry analysis.

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S3 Fig. Characterization of DFMSCs.

DFMSCs expressed positive markers (CD73, CD90, and CD105) over 95%, and lack the expressions of negative markers (CD14, CD34, and HLA-DR).

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Click here for additional data file. (1.1MB, tif)
S1 Raw data

(DOCX)

Click here for additional data file. (29.3KB, docx)

Data Availability

The anonymized data are freely accessible via DataverseNL using the following DOI: https://doi.org/10.34894/LZKWBR.

Funding Statement

This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

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Decision Letter 0

Gianpaolo Papaccio

27 Jan 2022

PONE-D-21-36398DENTAL FOLLICLE MESENCHYMAL STEM CELLS AMELIORATED GLANDULAR DYSFUNCTION IN SJÖGRENS’ SYNDROME MURINE MODELPLOS ONE

Dear Dr. Genç,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

This manuscript has been carefully evaluated by two experts in the field. It is of interest pending some alterations that are needed, as specified by each referee.The Authors must amen the manuscript following all the reviewers criticisms and highlight in the new text all the changes in red.A point to point rebuttal letter to all the points raised is also needed.

Please submit your revised manuscript by Mar 13 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Gianpaolo Papaccio, M.D., Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.

If you are reporting a retrospective study of medical records or archived samples, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information.

3. Thank you for stating the following financial disclosure:

 “This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178.”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

4. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178. We thank to Rüştü Kuşcu for his skillful assistance.“

“This study is funded by XXXXXXXX with the Project number of 120S178. We thank to XXXXXX for his skillful assistance.”

We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In the present study, the Authors investigated the effect of dental follicle (DF)MSCs in regeneration of glandular tissue in Sjögren’s Syndrome (SS) mouse model.

Although the manuscript is good, some issues need to be addressed.

- The figure 7 is out of focus and must be changed.

- Pages 11 and 12: add the name of university and hospital and change the “XXXXXX”.

- The Discussion section is too long (n#6 pages), dispersive and chaotic. Reduce it focusing on results, limits and novelties of work.

Reviewer #2: In the present study authors investigated the modulatory and regenerative effects of dental follicle mesenchymal stem cells (DFMSCs) in Sjögren’s Syndrome (SS) mouse model. DFMSCs were injected intraperitoneally, or into submandibular, or lacrimal glands. The immunomodulatory effect was investigated by assessing of intracellular cytokine (IFN-g, IL-17, IL-10) secretion in spleen-derived T helper cells, lymphocyte proliferation and B lymphocyte subsets. The regenerative capability was evaluated by Histologic analysis and flow cytometry of submandibular and lacrimal glands.

The improvement of SS manifestations was observed mainly in systemic injection of DFMSCs, while slight recovery was observed in local injections.

The manuscript is well written and the study is interesting. However, some revisions are needed before the paper can be published:

- In materials and method section, the name of dental hospital is missing.

- Scale bars are missing in Figures 7,8,9

- Histological images need to be improved.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2022 May 5;17(5):e0266137. doi: 10.1371/journal.pone.0266137.r002

Author response to Decision Letter 0

1 Feb 2022

To The Editor-in-Chief,

We thank the reviewers for their valuable contributions to our study. We revised the manuscript as per reviewers’ comments and explained it in detail below. We changed the figure files in “tif.” file format.

Best regards,

Deniz GENÇ

Corresponding author

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Response: We edited the manuscript according to the Journal Requirements.

2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.

Response: We included the ethics statements in the Methods section and online submission.

If you are reporting a retrospective study of medical records or archived samples, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information.

Response: The present study is not a retrospective study.

3. Thank you for stating the following financial disclosure:

“This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178.”

Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

Response: We thank to the Editorial Board.

4. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178. We thank to Rüştü Kuşcu for his skillful assistance.“

“This study is funded by XXXXXXXX with the Project number of 120S178. We thank to XXXXXX for his skillful assistance.”

We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

Response: We thank to the Editorial Board. We removed the Acknowledgements Section, the funding information has been stated as “This study is funded by THE SCIENTIFIC AND TECHNOLOGICAL RESEARCH COUNCIL OF TURKEY (TUBITAK) with the Project number of 120S178. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” in the funding information section.

5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

Response: The ethics statement is included in the Methods section.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Response: We thank the reviewers.

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Response: We thank the reviewers.

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Response: We thank the reviewers.

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

Response: We thank the reviewers. English editing has been done.

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: In the present study, the Authors investigated the effect of dental follicle (DF)MSCs in regeneration of glandular tissue in Sjögren’s Syndrome (SS) mouse model.

Although the manuscript is good, some issues need to be addressed.

- The figure 7 is out of focus and must be changed.

- Pages 11 and 12: add the name of university and hospital and change the “XXXXXX”.

- The Discussion section is too long (n#6 pages), dispersive and chaotic. Reduce it focusing on results, limits and novelties of work.

Response 1: Figure 7 was obtained from a fluorescent microscope (Nikon TS-2 FL Trinocular Inverted Microscope 5.9 Megapixel Head DS-Fi3, Japan). The image resolution of the device was 5.9 Megapixels, therefore it cannot be focused by a device further. But, the format of the figures was changed to “tif.” files to increase the resolution of the images.

Response 2: The name of the university and hospital has been mentioned in the main text as “Muğla Sıtkı Koçman University”.

Response 3: The discussion section has been reduced focusing on the results.

Reviewer #2: In the present study authors investigated the modulatory and regenerative effects of dental follicle mesenchymal stem cells (DFMSCs) in Sjögren’s Syndrome (SS) mouse model. DFMSCs were injected intraperitoneally, or into submandibular, or lacrimal glands. The immunomodulatory effect was investigated by assessing of intracellular cytokine (IFN-g, IL-17, IL-10) secretion in spleen-derived T helper cells, lymphocyte proliferation and B lymphocyte subsets. The regenerative capability was evaluated by Histologic analysis and flow cytometry of submandibular and lacrimal glands.

The improvement of SS manifestations was observed mainly in systemic injection of DFMSCs, while slight recovery was observed in local injections.

The manuscript is well written and the study is interesting. However, some revisions are needed before the paper can be published:

- In materials and method section, the name of dental hospital is missing.

- Scale bars are missing in Figures 7,8,9

- Histological images need to be improved.

Response 1: The name of the university and hospital has been mentioned in the main text as “Muğla Sıtkı Koçman University”.

Response 2: The scale bars are added in Figures 7, 8, and 9.

Response 3: Histological images in Figures 7 and 8 were obtained from a fluorescent microscope (Nikon TS-2 FL Trinocular Inverted Microscope 5.9 Megapixel Head DS-Fi3, Japan). The image resolution of the device was 5.9 Megapixels, therefore it cannot be focused by a device further. We focused the images by changing the file format from “jpeg.” To “tif.”. Histological images in Figure 9 were obtained by a light microscope (Olympus BX46, Japan). The format of the figures was changed to “tif.” files to increase the resolution of the images.

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file. (16.4KB, docx)

Decision Letter 1

Gianpaolo Papaccio

2 Mar 2022

PONE-D-21-36398R1DENTAL FOLLICLE MESENCHYMAL STEM CELLS AMELIORATED GLANDULAR DYSFUNCTION IN SJÖGREN'S SYNDROME MURINE MODELPLOS ONE

Dear Dr. Genç,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

The Authors did not correctly answer to the concerns of a reviewer. They only deleted some sentences.It is important and needed to follow in details all criticisms raised by the referee and highlight in red colour all the amendments.This is the last round and chance they have, therefore they must pay all the attention needed.

==============================

Please submit your revised manuscript by Apr 16 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Gianpaolo Papaccio, M.D., Ph.D.

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: (No Response)

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: (No Response)

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: (No Response)

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: (No Response)

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The Authors have partially answered all my previous concerns. The Discussion section remains too long. The Authors have only deleted some sentences. They must modify the discussion as previously requested.

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2022 May 5;17(5):e0266137. doi: 10.1371/journal.pone.0266137.r004

Author response to Decision Letter 1

9 Mar 2022

To The Editor-in-Chief,

We thank the reviewers for their valuable contribution to our study. We corrected and revised the article as per reviewers’ comments.

Best regards,

Deniz GENÇ

Corresponding Author

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

Response: We thank the reviewers.

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Reviewer #1: Yes

Reviewer #2: (No Response)

Response: We thank the reviewers.

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Reviewer #1: Yes

Reviewer #2: (No Response)

Response: We thank the reviewers.

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Reviewer #1: Yes

Reviewer #2: (No Response)

Response: We thank the reviewers.

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Reviewer #1: No

Reviewer #2: (No Response)

Response: We thank the reviewers. The language editing was done.

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The Authors have partially answered all my previous concerns. The Discussion section remains too long. The Authors have only deleted some sentences. They must modify the discussion as previously requested.

Response: The discussion section is revised by focusing on the main results of the study. Most of the discussions made in comparison with previous studies have been shortened in line with the main results of our study. In the discussion section, the findings of our study were highlighted and revised.

Reviewer #2: (No Response)

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Reviewer #1: No

Reviewer #2: No

Attachment

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Decision Letter 2

Gianpaolo Papaccio

15 Mar 2022

DENTAL FOLLICLE MESENCHYMAL STEM CELLS AMELIORATED GLANDULAR DYSFUNCTION IN SJÖGREN'S SYNDROME MURINE MODEL

PONE-D-21-36398R2

Dear Dr. Genç,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Academic Editor

PLOS ONE

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Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

**********

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Acceptance letter

Gianpaolo Papaccio

25 Apr 2022

PONE-D-21-36398R2

Dental follicle mesenchymal stem cells ameliorated glandular dysfunction in Sjögren’s syndrome murine model

Dear Dr. Genç:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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on behalf of

Prof. Gianpaolo Papaccio

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 Fig. Study design.

    The SS murine model was performed with the intraperitoneal injection of 50 μg of Ro60 peptide emulsified in 100 μL of Freuds’ complete adjuvant (FCA) on day 1. The following immunizations were carried out on days 14, 36, 63, and 119 with 50 μg Ro60 peptide. DFMSCs are administered by intraperitoneal, submandibular, or lacrimal injections.

    (TIF)

    Click here for additional data file. (319KB, tif)
    S2 Fig. Gating strategy for flow cytometry analysis.

    (TIF)

    Click here for additional data file. (2.3MB, tif)
    S3 Fig. Characterization of DFMSCs.

    DFMSCs expressed positive markers (CD73, CD90, and CD105) over 95%, and lack the expressions of negative markers (CD14, CD34, and HLA-DR).

    (TIF)

    Click here for additional data file. (1.1MB, tif)
    S1 Raw data

    (DOCX)

    Click here for additional data file. (29.3KB, docx)
    Attachment

    Submitted filename: Response to Reviewers.docx

    Click here for additional data file. (16.4KB, docx)
    Attachment

    Submitted filename: Response to Reviewers.docx

    Click here for additional data file. (13.7KB, docx)

    Data Availability Statement

    The anonymized data are freely accessible via DataverseNL using the following DOI: https://doi.org/10.34894/LZKWBR.

    Articles from PLOS ONE are provided here courtesy of PLOS

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