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Differences in conjunctival gene expression profiles between Ethiopians with trachomatous trichiasis (with [TTI] or without [TT] inflammation) and controls (C) were investigated to identify relevant host responses. Tarsal conjunctival swab samples were collected for RNA isolation and<jats:italic>C. trachomatis<\/jats:italic>PCR. Transcriptome-wide microarray experiments were conducted on 42 samples (TTI,<jats:italic>n<\/jats:italic>= 13; TT,<jats:italic>n<\/jats:italic>= 15; C,<jats:italic>n<\/jats:italic>=14). Specific results were confirmed by using multiplex quantitative reverse transcription-PCR for 16 mRNA targets in an independent collection of case-control samples: 386 case-control pairs (TTI,<jats:italic>n<\/jats:italic>= 244; TT,<jats:italic>n<\/jats:italic>= 142; C,<jats:italic>n<\/jats:italic>= 386). The gene expression profiles of cases were consistent with squamous metaplasia (keratins, SPRR), proinflammatory cytokine production (<jats:italic>IL1<\/jats:italic>\u03b2,<jats:italic>CXCL5<\/jats:italic>, and<jats:italic>S100A7<\/jats:italic>), and tissue remodeling (<jats:italic>MMP7<\/jats:italic>,<jats:italic>MMP9<\/jats:italic>,<jats:italic>MMP12<\/jats:italic>, and<jats:italic>HAS3<\/jats:italic>). There was no difference in the level of<jats:italic>IFN<\/jats:italic>\u03b3 between cases and controls. However, cases had increased<jats:italic>INDO<\/jats:italic>,<jats:italic>NOS2A<\/jats:italic>, and<jats:italic>IL13RA2<\/jats:italic>and reduced<jats:italic>IL13<\/jats:italic>.<jats:italic>C. trachomatis<\/jats:italic>was detected in 1\/772. Cases show evidence of ongoing inflammation and tissue remodeling, which were more marked where clinical inflammation was also present. Significantly, these processes appear to be active in the absence of current<jats:italic>C. trachomatis<\/jats:italic>infection. There was limited evidence of a T<jats:sub>H<\/jats:sub>1 response (<jats:italic>INDO<\/jats:italic>and<jats:italic>NOS2A<\/jats:italic>) and no association between a T<jats:sub>H<\/jats:sub>2 response and cases. The epithelium appears to be actively involved in late cicatricial stages of trachoma through the production of proinflammatory factors (<jats:italic>IL1<\/jats:italic>\u03b2,<jats:italic>CXCL5<\/jats:italic>, and<jats:italic>S100A7<\/jats:italic>). Longitudinal studies are needed to investigate which etiological factors and pathways are associated with progressive scarring and whether simply controlling chlamydial infection will halt progression in people with established cicatricial disease.<\/jats:p>","DOI":"10.1128\/iai.00888-10","type":"journal-article","created":{"date-parts":[[2010,10,12]],"date-time":"2010-10-12T04:59:31Z","timestamp":1286859571000},"page":"499-511","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":58,"title":["Conjunctival Transcriptome in Scarring Trachoma"],"prefix":"10.1128","volume":"79","author":[{"given":"Matthew J.","family":"Burton","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saul N.","family":"Rajak","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"The Carter Center, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Bauer","sequence":"additional","affiliation":[{"name":"Cambridge Genomic Services, Department of Pathology, Cambridge University, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen A.","family":"Weiss","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonda B.","family":"Tolbert","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Shoo","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esmail","family":"Habtamu","sequence":"additional","affiliation":[{"name":"The Carter Center, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alphaxard","family":"Manjurano","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Emerson","sequence":"additional","affiliation":[{"name":"The Carter Center, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C. 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