Background: Canine keratoconjunctivitis sicca (cKCS) is an inflammatory eye condition related to a deficiency in the\ntear aqueous fraction. Etiopathogenesis of such disease is substantially multifactorial, combining the individual genetic\nbackground with environmental factors that contribute to the process of immunological tolerance disruption and, as a\nconsequence, to the emergence of autoimmunity disease. In this occurrence, it is of relevance the role of the\nphysiological immune-dysregulation that results in immune-mediated processes at the basis of cKCS. Current\ntherapies for this ocular disease rely on immunosuppressive treatments. Clinical response to treatment frequently\nvaries from poor to good, depending on the clinical-pathological status of eyes at diagnosis and on individual\nresponse to therapy. In the light of the variability of clinical response to therapies, we evaluated the use of an antiinflammatory/\nantioxidant nutraceutical diet with potential immune-modulating activity as a therapeutical adjuvant in\ncKCS pharmacological treatment. Such combination was administered to a cohort of dogs affected by cKCS in which\nthe only immunosuppressive treatment resulted poorly responsive or ineffective in controlling the ocular symptoms.\nResults: Fifty dogs of different breeds affected by immune-mediated cKCS were equally distributed and randomly\nassigned to receive either a standard diet (control, n = 25) or the nutraceutical diet (treatment group, n = 25) both\ncombined with standard immunosuppressive therapy over a 60 days period. An overall significant improvement\nof all clinical parameters (tear production, conjunctival inflammation, corneal keratinization, corneal pigment\ndensity and mucus discharge) and the lack of food-related adverse reactions were observed in the treatment\ngroup (p < 0.0001).\nConclusions: Our results showed that the association of traditional immune-suppressive therapy with the antioxidant/\nanti-inflammatory properties of the nutraceutical diet resulted in a significant amelioration of clinical signs and\nsymptoms in cKCS. The beneficial effects, likely due to the presence of supplemented nutraceuticals in the diet,\nappeared to specifically reduce the immune-mediated ocular symptoms in those cKCS-affected dogs that were poorly\nresponsive or unresponsive to classical immunosuppressive drugs. These data suggest that metabolic changes could\naffect the immune response orchestration in a model of immune-mediated ocular disease, as represented by cKCS.
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