is important for B-cell development, antibody production by B cells, germinal centre formation, interleukin-12 (IL-12) production, CD8+ T cell effector function and optimal T cell-dependent antibody responses . We hypothesized that CD40L might undergo epigenetic deregulation in pSS via putative X-inactivation escape. We enrolled 26 women (age 56 ± 15.4 years) fulfilling the American European Consensus Group for pSS  and 22 healthy control women (age 41 ± 14.6 years) who did not have Maraviroc cell line autoimmune or infectious diseases. Sixteen of 26 pSS women were gone through menopause versus 3 of 22 female controls. Among the 26 patients with pSS, 76% tested positive for anti-SSA antibodies and/or anti-SSB antibodies; 9 patients showed extra-glandular involvement: active synovitis or inflammatory arthralgia (n = 5), renal involvement (n = 1), autoimmune cytopenia
and myositis (n = 1), purpura (n = 1), or lung involvement (n = 1). One patient had mucosa-associated lymphoid-tissue (MALT) gastric lymphoma. Ten patients received hydroxychloroquine, 4 methotrexate and none more potent immunosuppressive drugs. All patients underwent the same clinical, biological and immunological screening. To classify patients with active and non-active disease, we used 2 arbitrary Fludarabine cut-offs (5 or 7) of the EULAR Sjogren’s Syndrome Disease Selleckchem Doxorubicin Activity Index (ESSDAI) . The study was approved by the local ethics committee, and informed consent was obtained from all subjects. Peripheral blood mononuclear cells (PBMCs) from blood samples for all subjects
were isolated by density-gradient centrifugation. CD4+ T cells were isolated by positive selection (Miltenyi Biotec, Paris). The purity of CD4+ T cells was >96% in all experiments. After CD4+ T cell isolation, cells were analysed ex vivo at 4 h after polyclonal activation with 5 ng/ml phorbolmyristate acetate (PMA) (Sigma-Aldrich, Saint Quentin Fallavier, France) and 500 ng/ml ionomycin (Sigma-Aldrich) and after 4 days of culture and activation with phytohemagglutinin A (PHA, 5 μg/l) (Sigma-Aldrich) and interleukin2 (IL-2, 20 UI/ml) (Roche Diagnostics, Meylan, France), respectively. After 4 days of culture, cells were again stimulated with PMA and ionomycin to induce CD40L expression. A freshly prepared demethylating agent [5-azacytidineC (5-AzaC), 1 μm; Sigma-Aldrich] was added at day 1 of culture and then every day until day 3. The cell medium consisted of RPMI 1640 glutamax Gibco supplemented with 10% SVF, penicillin (100 U/ml), streptomycin (100 μg/ml), buffer HEPES 10 mm, pyruvate of sodium 1 mm and amino acids (Invitrogen, Saint-Aubin, France).