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Affiliation(s)
- James T Rosenbaum
- Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health & Science University , Portland , OR , USA.,Legacy Devers Eye Institute , Portland , OR , USA
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Gill T, Brooks SR, Rosenbaum JT, Asquith M, Colbert RA. Novel Inter-omic Analysis Reveals Relationships Between Diverse Gut Microbiota and Host Immune Dysregulation in HLA-B27-Induced Experimental Spondyloarthritis. Arthritis Rheumatol 2019; 71:1849-1857. [PMID: 31216122 DOI: 10.1002/art.41018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To define inflammation-related host-microbe interactions in experimental spondyloarthritis (SpA) using novel inter-omic approaches. METHODS The relative frequency of gut microbes was determined by 16S ribosomal RNA (rRNA) gene sequencing, and gene expression using RNA-Seq of host tissue. HLA-B27/human β2 -microglobulin-transgenic (HLA-B27-transgenic) and wild-type rats from dark agouti, Lewis, and Fischer backgrounds were used. Inter-omic analyses using Cytoscape were employed to identify relevant relationships. PICRUSt was used to predict microbial functions based on known metagenomic profiles. RESULTS Inter-omic analysis revealed several gut microbes that were strongly associated with dysregulated cytokines driving inflammatory response pathways, such as interleukin-17 (IL-17), IL-23, IL-17, IL-1, interferon-γ (IFNγ), and tumor necrosis factor (TNF). Many microbes were uniquely associated with inflammation in Lewis or Fischer rats, and one was relevant on both backgrounds. Several microbes that were strongly correlated with immune dysregulation were not differentially abundant in HLA-B27-transgenic compared to wild-type controls. A multi-omic network analysis revealed non-overlapping clusters of microbes in Lewis and Fischer rats that were strongly linked to overlapping dysregulated immune/inflammatory genes. Prevotella, Clostridiales, and Blautia were important in Lewis rats, while Akkermansia muciniphila and members of the Lachnospiraceae family dominated in Fischer rats. Inflammation-associated metabolic pathway perturbation (e.g., butanoate, propanoate, lipopolysaccharide, and steroid biosynthesis) was also predicted from both backgrounds. CONCLUSION Inter-omic and network analysis of gut microbes and the host immune response in experimental SpA provides an unprecedented view of organisms strongly linked to dysregulated IL-23, IL-17, IL-1, IFNγ, and TNF. Functional similarities between these organisms may explain why animals of different genetic backgrounds exhibit common patterns of immune dysregulation, possibly through perturbation of similar metabolic pathways. These results highlight the power of linking analyses of gut microbiota with the host immune response to gain insights into the role of dysbiotic microbes in SpA beyond taxonomic profiling.
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Affiliation(s)
- Tejpal Gill
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Stephen R Brooks
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - James T Rosenbaum
- Oregon Health and Science University and Legacy Devers Eye Institute, Portland
| | | | - Robert A Colbert
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Han YS, Rivera-Grana E, Salek S, Rosenbaum JT. Distinguishing Uveitis Secondary to Sarcoidosis From Idiopathic Disease: Cardiac Implications. JAMA Ophthalmol 2019; 136:109-115. [PMID: 29327057 DOI: 10.1001/jamaophthalmol.2017.5466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Idiopathic disease is the most frequent diagnosis in a uveitis clinic. The need to distinguish sarcoidosis from idiopathic uveitis is controversial. However, cardiac involvement in sarcoidosis can be life-threatening. Objective To report a series of patients with uveitis and cardiac sarcoidosis to illustrate the importance of categorizing the causes of uveitis. Design, Setting, and Participants This retrospective observational case series reviewed the medical records of 249 patients with uveitis who were referred to the Casey Eye Institute between July 1, 2008, and February 28, 2017. Main Outcomes and Measures We describe patients who initially received a diagnosis of idiopathic uveitis but subsequently received a diagnosis of sarcoidosis. Clinical data, including ophthalmologic findings, were collected. We summarized the number of patients who initially presented with idiopathic uveitis, the number of patients who recived a classification of idiopathic uveitis after evaluation, the number of patients who underwent chest computed tomography or an electrocardiogram, and the number of patients with ocular sarcoidosis. Results Of 33 patients with sarcoidosis, 21 (63.6%) were women and the mean (SD) age was 53.5 (13.8) years. Of 249 patients, the referring diagnosis was idiopathic uveitis for 179 (72%). After history, examination, and laboratory testing, 127 (51%) were still considered to have idiopathic disease. Fifty-three of the 179 patients (30%) with idiopathic disease underwent chest computed tomography scanning. A diagnosis of presumed sarcoidosis, usually on the basis of a chest computed tomography scan, was made in 19 patients (36.2%). As 14 patients (5.6%) were previously known to have sarcoidosis, 33 patients (13.3%) were evaluated with definite or presumed ocular sarcoidosis. We obtained electrocardiograms as a screen for cardiac sarcoidosis on 14 (42.4%) of these patients. Nine patients with abnormal electrocardiogram results were referred to cardiologists. Four of the 19 patients (21.1%) who were referred for idiopathic uveitis but subsequently received a diagnosis of presumed sarcoidosis were found to have episodes of ventricular tachycardia that required implantable cardiac defibrillators. Distinguishing ocular sarcoidosis from idiopathic uveitis had potentially life-saving implications for these patients. Conclusions and Relevance The present case series shows the potential utility of distinguishing sarcoidosis-associated uveitis from idiopathic uveitis. We suggest that patients older than 40 years with a history of idiopathic uveitis be evaluated with chest computed tomography and an electrocardiogram if sarcoidosis is suggested on ophthalmic examination.
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Affiliation(s)
- Yong Seop Han
- Casey Eye Institute, Oregon Health & Science University, Portland.,Department of Ophthalmology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Gyeongnam 52727, South Korea
| | | | - Sherveen Salek
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland.,Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland.,Legacy Devers Eye Institute, Portland, Oregon
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Rosenbaum JT, Pisenti L, Park Y, Howard RA. Insight into the Quality of Life of Patients with Ankylosing Spondylitis: Real-World Data from a US-Based Life Impact Survey. Rheumatol Ther 2019; 6:353-367. [PMID: 31111433 PMCID: PMC6702589 DOI: 10.1007/s40744-019-0160-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We aim to assess the real-world, US patient-reported impact of ankylosing spondylitis (AS) on quality of life (QOL) across physical, discomfort, social, and emotional domains. METHODS Demographic and QOL data were collected from a random sample of patients associated with the Spondylitis Association of America (SAA) from July to December 2017. QOL measures were based on the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) questionnaire. The survey evaluated AS impact on the physical domain on the day of survey participation and impact on the discomfort, social, and emotional domains within the week before participation. A 3:1 (male to female) weighting was performed to reflect the reported prevalence of AS in US adults. RESULTS Of 820 respondents who completed the survey, 716 self-reported receiving an AS diagnosis from their doctor and were included in this analysis (mean age, 55.5 years; 46.9% male). The mean total EASi-QoL score was 28.9 (weighted); overall, 33.7%, 31.7%, and 34.7% of respondents, respectively, reported a low (EASi-QoL score 0-17), a medium (18-35), and a high (≥ 36) impact of AS on QOL. The physical domain was most impacted; 41.9% of respondents had an EASi-QoL score ≥ 10 (weighted). Women were significantly more likely than men to report a high impact of AS on all QOL domains. Biologic users reported an impact on QOL comparable with the impact on QOL of nonsteroidal anti-inflammatory drug use. AS also impacted lifestyle characteristics, including career choice and sports participation. CONCLUSION AS negatively impacted all QOL domains analyzed. The incorporation of subjective measures of disease into disease evaluation should be considered. FUNDING Novartis Pharmaceuticals Corporation and UCB, Inc. Plain language summary available for this article.
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Affiliation(s)
- James T Rosenbaum
- Oregon Health & Science University, Portland, OR, USA.
- Legacy Devers Eye Institute, Portland, OR, USA.
| | | | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Abstract
Acute anterior uveitis (AAU) and the spondyloarthritis (SpA) subtypes ankylosing spondylitis, reactive arthritis and psoriatic arthritis are among the inflammatory diseases affected by the biology of the intestinal microbiome. In this Review, the relationship between AAU, SpA and the microbiome is discussed, with a focus on the major SpA risk gene HLA-B*27 and how it is associated with both intestinal tolerance and the loss of ocular immune privilege that can accompany AAU. We provide four potential mechanisms to account for how dysbiosis, barrier function and immune response contribute to the development of ocular inflammation and the pathogenesis of AAU. Finally, potential therapeutic avenues to target the microbiota for the clinical management of AAU and SpA are outlined.
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Affiliation(s)
- James T Rosenbaum
- Departments of Ophthalmology, Medicine and Cell Biology, Oregon Health and Science University, Portland, OR, USA.,Legacy Devers Eye Institute, Portland, OR, USA
| | - Mark Asquith
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
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Asquith M, Sternes PR, Costello ME, Karstens L, Diamond S, Martin TM, Li Z, Marshall MS, Spector TD, le Cao KA, Rosenbaum JT, Brown MA. HLA Alleles Associated With Risk of Ankylosing Spondylitis and Rheumatoid Arthritis Influence the Gut Microbiome. Arthritis Rheumatol 2019; 71:1642-1650. [PMID: 31038287 DOI: 10.1002/art.40917] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/25/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE HLA alleles affect susceptibility to more than 100 diseases, but the mechanisms that account for these genotype-disease associations are largely unknown. HLA alleles strongly influence predisposition to ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Both AS and RA patients have discrete intestinal and fecal microbiome signatures. Whether these changes are the cause or consequence of the diseases themselves is unclear. To distinguish these possibilities, we examined the effect of HLA-B27 and HLA-DRB1 RA risk alleles on the composition of the intestinal microbiome in healthy individuals. METHODS Five hundred sixty-eight stool and biopsy samples from 6 intestinal sites were collected from 107 healthy unrelated subjects, and stool samples were collected from 696 twin pairs from the TwinsUK cohort. Microbiome profiling was performed using sequencing of the 16S ribosomal RNA bacterial marker gene. All subjects were genotyped using the Illumina CoreExome SNP microarray, and HLA genotypes were imputed from these data. RESULTS Associations were observed between the overall microbial composition and both the HLA-B27 genotype and the HLA-DRB1 RA risk allele (P = 0.0002 and P = 0.00001, respectively). These associations were replicated using the stool samples from the TwinsUK cohort (P = 0.023 and P = 0.033, respectively). CONCLUSION This study shows that the changes in intestinal microbiome composition seen in AS and RA are at least partially due to effects of HLA-B27 and HLA-DRB1 on the gut microbiome. These findings support the hypothesis that HLA alleles operate to cause or increase the risk of these diseases through interaction with the intestinal microbiome and suggest that therapies targeting the microbiome may be effective in preventing or treating these diseases.
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Affiliation(s)
| | - Peter R Sternes
- Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | | | | | - Zhixiu Li
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mhairi S Marshall
- Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland
| | - Matthew A Brown
- Queensland University of Technology, Brisbane, Queensland, Australia
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Kopplin LJ, Munk M, Baynham J, Rosenbaum JT, Suhler EB, Biggee K, Goldstein DA, Lin P. Association of Fundus Autofluorescence Findings and Outer Retinal Lesions on Optical Coherence Tomography With Visual Acuity in Birdshot Chorioretinopathy. ACTA ACUST UNITED AC 2019; 3:235-241. [PMID: 34263097 DOI: 10.1177/2474126419850746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This article investigates the optical coherence tomography (OCT) and fundus autofluorescence imaging findings in birdshot chorioretinopathy (BSCR) and their association with visual acuity (VA). Methods In a retrospective, cross-sectional study, we evaluated OCT images for changes in retinal structure including cystoid macular edema (CME), epiretinal membrane, and outer retinal lesions. We assessed autofluorescence images for hypoautofluorescent and hyperautofluorescent changes and noted the distribution of the lesions. Demographic data and VA at the time of imaging were also collected. Associations between OCT and autofluorescence findings and logarithm of the minimum angle of resolution VA were tested using linear regression. Results We conducted a chart review of 80 eyes from 40 patients with BSCR. Outer retinal lesions were found on OCT in 28 of 80 eyes (35%) and disruption of the outer segment ellipsoid zone (EZ) occurred in 23 eyes (28.7%). Macular hypoautofluorescent lesions were more common than hyperautofluorescent lesions, present in 58.8% and 13% of eyes, respectively. The presence of outer retinal lesions on OCT was significantly associated with reduced VA (P = .006) as was EZ disruption (P = .003). These associations remained significant after accounting for the presence of macular edema. There was a trend toward association of macular hypoautofluorescent lesions with decreased vision, although it was not statistically significant (P = .17). Conclusions The association of outer retinal lesions with decreased VA suggests a mechanism of central vision loss that is distinct from CME and may provide an additional objective finding to monitor disease activity in BSCR patients.
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Affiliation(s)
- Laura J Kopplin
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin Eye Institute, Milwaukee, WI, USA
| | - Marion Munk
- Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Eric B Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.,Portland Veterans Affairs Health Care System, Portland, OR, USA
| | | | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University, Chicago, IL, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
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Janowitz C, Nakamura YK, Metea C, Gligor A, Yu W, Karstens L, Rosenbaum JT, Asquith M, Lin P. Disruption of Intestinal Homeostasis and Intestinal Microbiota During Experimental Autoimmune Uveitis. Invest Ophthalmol Vis Sci 2019; 60:420-429. [PMID: 30695094 PMCID: PMC6353239 DOI: 10.1167/iovs.18-24813] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose We determine the changes in intestinal microbiota and/or disruptions in intestinal homeostasis during uveitis. Methods Experimental autoimmune uveitis (EAU) was induced in B10.RIII mice with coadministration of interphotoreceptor retinoid-binding protein peptide (IRBP) and killed mycobacterial antigen (MTB) as an adjuvant. Using 16S rRNA gene sequencing, we looked at intestinal microbial differences during the course of uveitis, as well as intestinal morphologic changes, changes in intestinal permeability by FITC-dextran leakage, antimicrobial peptide expression in the gastrointstinal tract, and T lymphocyte prevalence before and at peak intraocular inflammation. Results We demonstrate that increased intestinal permeability and antimicrobial peptide expression in the intestinal tract coincide in timing with increased effector T cells in the mesenteric lymph nodes, during the early stages of uveitis, before peak inflammation. Morphologic changes in the intestine were most prominent during this phase, but also occurred with adjuvant MTB alone, whereas increased intestinal permeability was found only in IRBP-immunized mice that develop uveitis. We also demonstrate that the intestinal microbiota were altered during the course of uveitis, and that some of these changes are specific to uveitic animals, whereas others are influenced by adjuvant MTB alone. Intestinal permeability peaked at 2 weeks, coincident with an increase in intestinal bacterial strain differences, peak lipocalin production, and peak uveitis. Conclusions An intestinal dysbiosis accompanies a disruption in intestinal homeostasis in autoimmune uveitis, although adjuvant MTB alone promotes intestinal disruption as well. This may indicate a novel axis for future therapeutic targeting experimentally or clinically.
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Affiliation(s)
- Cathleen Janowitz
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Yukiko K Nakamura
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Christina Metea
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Abigail Gligor
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - William Yu
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Lisa Karstens
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States.,Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States.,Devers Eye Institute, Portland, Oregon, United States
| | - Mark Asquith
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
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Abstract
PURPOSE OF REVIEW The intestinal microbiome is thought to play a role in the pathogenesis of inflammatory bowel disease (IBD). There are many shared clinical manifestations between IBD and spondyloarthritis (SpA), of which the most common are peripheral arthritis and uveitis. Clinical overlap along with similar genetics between these diseases suggests a possible shared pathogenetic mechanism, which might center on the intestinal microbiota. In this review, we discuss the available evidence that SpA is a microbiome-driven disease and indicate how SpA-associated uveitis could be tied to gut dysbiosis. We conclude by discussing different treatment paradigms targeting the intestinal microbiome for SpA. RECENT FINDINGS Recent studies support the growing evidence of the intestinal microbiome as a crucial player in SpA disease pathogenesis. There is emerging evidence that the gut microbiome may play a causative role in uveitis. SUMMARY The field is beginning to discover a new level of understanding how the intestinal microbiome is involved in SpA. Treatment methods to alter intestinal microbiota to treat SpA-related diseases are still in its infancy.
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Affiliation(s)
- Rene Y Choi
- Department of Ophthalmology, Casey Eye Institute
| | - Mark Asquith
- Division of Arthritis and Rheumatic Diseases, Department of Ophthalmology, Oregon Health and Science University
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute.,Division of Arthritis and Rheumatic Diseases, Department of Ophthalmology, Oregon Health and Science University.,Legacy Devers Eye Institute, Portland, Oregon, USA
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60
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Affiliation(s)
- James T Rosenbaum
- From the Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and Legacy Devers Eye Institute - both in Portland (J.T.R.); and the Department of Ophthalmology, Ophthalmic Consultants of Boston (L.M.R.), the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Harvard Medical School - all in Boston
| | - Lana M Rifkin
- From the Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and Legacy Devers Eye Institute - both in Portland (J.T.R.); and the Department of Ophthalmology, Ophthalmic Consultants of Boston (L.M.R.), the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Harvard Medical School - all in Boston
| | - Karen A Buch
- From the Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and Legacy Devers Eye Institute - both in Portland (J.T.R.); and the Department of Ophthalmology, Ophthalmic Consultants of Boston (L.M.R.), the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Harvard Medical School - all in Boston
| | - Miriam B Barshak
- From the Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and Legacy Devers Eye Institute - both in Portland (J.T.R.); and the Department of Ophthalmology, Ophthalmic Consultants of Boston (L.M.R.), the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Harvard Medical School - all in Boston
| | - Mai P Hoang
- From the Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and Legacy Devers Eye Institute - both in Portland (J.T.R.); and the Department of Ophthalmology, Ophthalmic Consultants of Boston (L.M.R.), the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Radiology (K.A.B.), Medicine (M.B.B.), and Pathology (M.P.H.), Harvard Medical School - all in Boston
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61
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Affiliation(s)
- Akshay S Thomas
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.,Tennessee Retina, Nashville, TN, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.,Legacy Devers Eye Institute, Portland, OR, USA
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Choi RY, Rivera-Grana E, Rosenbaum JT. Reclassifying Idiopathic Uveitis: Lessons From a Tertiary Uveitis Center. Am J Ophthalmol 2019; 198:193-199. [PMID: 30352197 DOI: 10.1016/j.ajo.2018.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Idiopathic uveitis is frequently the most common diagnosis in series from uveitis clinics. This study sought to determine the percentage of patients initially diagnosed as idiopathic, noninfectious uveitis referred to a tertiary uveitis center who were subsequently found to have an identifiable cause of uveitis. DESIGN Retrospective case series. METHODS We performed a computerized database analysis of 179 consecutive patients who were referred to our practice with the diagnosis of idiopathic, noninfectious uveitis between 2008 and 2016. Patients were evaluated by a thorough history and ophthalmic examination with selected laboratory testing targeted by clues from the history and examination. Standardization of Uveitis Nomenclature (SUN) criteria were used to better assess different types of uveitis. RESULTS Fifty-two out of 179 (29.0%) patients initially diagnosed with idiopathic uveitis were subsequently diagnosed with an underlying condition. Among patients referred with a diagnosis of idiopathic disease, female patients were most commonly affected (121/179; 67.6%). Among subsequent diagnoses, sarcoidosis was the most common (19/52 or 36.5%), followed by HLA-B27-associated uveitis (11/52, 21.1%), infectious uveitis (6/52, 11.5%), tubulointerstitial nephritis with uveitis (6/52, 11.5%), and juvenile idiopathic uveitis (4/52, 7.7%). Other diagnosable conditions included Behçet disease, multifocal choroiditis, panuveitis, Crohn disease, multiple sclerosis, and relapsing polychondritis. An underlying condition was not found in 127 of 179 (70.9%) patients. CONCLUSIONS We report that 29% of patients referred to our tertiary uveitis center diagnosed as "idiopathic" had an associated identifiable cause. Identifying an underlying condition associated with uveitis could be potentially lifesaving for some illnesses (eg, sarcoidosis with cardiac involvement) and is critical to management (eg, infection). Although we were able to use limited testing to classify many patients who had been previously incorrectly labeled with idiopathic uveitis, idiopathic uveitis remains the most common diagnosis in our uveitis clinic.
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Friedman MA, Choi D, Planck SR, Rosenbaum JT, Sibley CH. Gene Expression Pathways across Multiple Tissues in Antineutrophil Cytoplasmic Antibody-associated Vasculitis Reveal Core Pathways of Disease Pathology. J Rheumatol 2019; 46:609-615. [PMID: 30647166 DOI: 10.3899/jrheum.180455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify commonalities in gene expression data across all antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) tissues thus far characterized. METHODS Gene expression data were collected from the 3 AAV tissues thus far characterized (orbit, peripheral leukocytes, and sinus brushings). These data were analyzed to identify commonly expressed genes and disease pathways. The pathways data were adjusted for multiple comparisons using a combined local false discovery rate, which estimates the probability of a false discovery of a given pathway in all 3 tissues analyzed. RESULTS Only 4 genes were upregulated in all 3 tissues - IL1RN, TLR2, SLC11A1, and MMP9. After multiple comparison adjustments, the network pathway analysis revealed 28 pathways associated with all 3 tissues. The most strongly associated pathway for all 3 tissues was the neutrophil degranulation pathway [multidimensional local false discovery (md-locfdr) = 1.05 × 10-12], followed by the osteoclast differentiation (md-locfdr = 3.8 × 10-05), cell surface interactions at the vascular wall (md-locfdr = 4.2 × 10-04), signaling by interleukins (md-locfdr = 6.1 × 10-04), and phagosome (md-locfdr = 0.003) pathways. There were no downregulated genes or pathways common to all 3 tissues. CONCLUSION This analysis identified individual genes and pathways of disease common to all AAV tissues thus far characterized. The use of a network pathway analysis allowed us to identify pathologic mechanisms that were not readily apparent in the commonly expressed genes alone. Many of these pathways are consistent with current theories about infectious drivers and the crossroads of innate and adaptive immune mechanisms. In addition, this analysis highlights novel pathways, such as vessel wall interactions and platelet activation, which require further investigation.
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Affiliation(s)
- Marcia A Friedman
- From the Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU (Portland State University) School of Public Health, Oregon Health & Science University (OHSU), Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea; Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA. .,M.A. Friedman, MD, Instructor of Medicine, Department of Medicine, OHSU; D. Choi, PhD, Professor, Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU School of Public Health, and the Graduate School of Dentistry, Kyung Hee University; S.R. Planck, PhD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU; J.T. Rosenbaum, MD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU, and Devers Eye Institute, Legacy Health Systems; C.H. Sibley, MD, Assistant Professor of Medicine, Department of Medicine, OHSU.
| | - Dongseok Choi
- From the Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU (Portland State University) School of Public Health, Oregon Health & Science University (OHSU), Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea; Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA.,M.A. Friedman, MD, Instructor of Medicine, Department of Medicine, OHSU; D. Choi, PhD, Professor, Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU School of Public Health, and the Graduate School of Dentistry, Kyung Hee University; S.R. Planck, PhD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU; J.T. Rosenbaum, MD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU, and Devers Eye Institute, Legacy Health Systems; C.H. Sibley, MD, Assistant Professor of Medicine, Department of Medicine, OHSU
| | - Stephen R Planck
- From the Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU (Portland State University) School of Public Health, Oregon Health & Science University (OHSU), Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea; Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA.,M.A. Friedman, MD, Instructor of Medicine, Department of Medicine, OHSU; D. Choi, PhD, Professor, Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU School of Public Health, and the Graduate School of Dentistry, Kyung Hee University; S.R. Planck, PhD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU; J.T. Rosenbaum, MD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU, and Devers Eye Institute, Legacy Health Systems; C.H. Sibley, MD, Assistant Professor of Medicine, Department of Medicine, OHSU
| | - James T Rosenbaum
- From the Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU (Portland State University) School of Public Health, Oregon Health & Science University (OHSU), Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea; Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA.,M.A. Friedman, MD, Instructor of Medicine, Department of Medicine, OHSU; D. Choi, PhD, Professor, Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU School of Public Health, and the Graduate School of Dentistry, Kyung Hee University; S.R. Planck, PhD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU; J.T. Rosenbaum, MD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU, and Devers Eye Institute, Legacy Health Systems; C.H. Sibley, MD, Assistant Professor of Medicine, Department of Medicine, OHSU
| | - Cailin H Sibley
- From the Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU (Portland State University) School of Public Health, Oregon Health & Science University (OHSU), Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea; Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA.,M.A. Friedman, MD, Instructor of Medicine, Department of Medicine, OHSU; D. Choi, PhD, Professor, Department of Medicine, and the Casey Eye Institute, and the OHSU-PSU School of Public Health, and the Graduate School of Dentistry, Kyung Hee University; S.R. Planck, PhD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU; J.T. Rosenbaum, MD, Professor of Ophthalmology, Department of Medicine, and Casey Eye Institute, OHSU, and Devers Eye Institute, Legacy Health Systems; C.H. Sibley, MD, Assistant Professor of Medicine, Department of Medicine, OHSU
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Abraham RS, Albanesi C, Alevizos I, Anguita J, Antiochos B, Aranow C, Atkinson JP, Austin HA, Babu S, Ballow MC, Balow JE, Belmont JW, Berek C, Beukelman T, Bhavsar T, Bird JA, Blutt SE, Boguniewicz M, Bonamichi-Santos R, Boisson B, Borzova E, Boyaka PN, Boyce J, Browne SK, Burks W, Bustamante J, Calder VL, Campbell M, Cardones ARG, Casanova JL, Castells M, Cavacini LA, Chan ES, Chaplin DD, Chatham WW, Chen ES, Chinen J, Christopher-Stine L, Ciancanelli M, Cope AP, Corry DB, Crea F, Cron RQ, Cuellar-Rodriguez JM, Dalakas MC, Dann SM, Diamond B, Du TW, Dupuis-Boisson S, Eagar TN, Elmets CA, Erkan D, Fanning L, Fikrig E, Flego D, Fleisher TA, Fonacier L, Fontenot AP, Freeman AF, Frew AJ, Fujihashi K, Gadina M, Gatt ME, Gershwin ME, Gillespie SL, Goronzy JJ, Goswami S, Grattan CE, Greenspan NS, Gupta S, Gustafson CE, Hall RP, Hamilton RG, Harrington LE, Harrison LC, Hasni SA, Helbling A, Hester J, Holland SM, Hourcade D, Huntington ND, Hwangpo T, Imboden JB, Issa F, Izraeli S, Jaffe ES, Jalkanen S, Jones S, Jouanguy E, Kabbani S, Kaufmann SH, Kheradmand F, Kohn DB, Korngold R, Kovalszki A, Kuhns DB, Kulkarni H, Kuo CY, Lahouti A, Landgren CO, Laurence A, Lee JS, Lemière C, Leung DY, Levinson AI, Levy O, Lewis DE, Lin P, Linkermann A, Liuzzo G, Lockshin MD, Lord AK, Lozier JN, Luong A, Luqmani R, Mackay M, Maltzman JS, Mannon PJ, Manns MP, Martin JG, Maynard CL, McCash S, McDonald DR, Melby PC, Miller SD, Mitchell AL, Mohd-Zaki A, Mold C, Moller DR, Monos DS, Mueller SN, Mulders-Manders CM, Mulligan MJ, Müller UR, Munshi PN, Murata K, Murphy PM, Navasa N, Noel P, Notarangelo LD, Nussbaum RL, Nutman TB, Nutt SL, Oliveira JB, Ortel TL, O'Shea JJ, Pai SY, Pandit L, Paul ME, Pearce SH, Pedicino D, Peterson EJ, Picard C, Pittaluga S, Priel DL, Puck J, Puel A, Radbruch A, Reece ST, Reveille JD, Rich RR, Roifman CM, Rosen A, Rosenbaum JT, Rosenzweig SD, Rouse BT, Rowley SD, Sakaguchi S, Salmi M, Sant AJ, Satola SW, Saw V, Schechter MC, Schroeder HW, Segal BM, Selmi C, Shankar S, Sharma A, Sharma P, Shearer WT, Siegel RM, Simon A, Smith GP, Stephens DS, Stephens R, Straumann A, Teos LY, Timares L, Tonnus W, Torres RM, Uzel G, van der Hilst JC, van der Meer JW, Varga J, Vyas JM, Waldman M, Weiser P, Weller PF, Weyand CM, Wigley FM, Winchester RJ, Wing JB, Wood KJ, Wu X, Xu H, Yee C, Zhang SY. List of Contributors. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chauhan K, Scaife S, Rosenbaum JT. Uveitis and health disparities: results from the National Inpatient Sample. Br J Ophthalmol 2018; 103:1301-1305. [PMID: 30578244 DOI: 10.1136/bjophthalmol-2018-312048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/24/2018] [Accepted: 11/05/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE Health disparities exist when the prevalence or outcome of the disease are influenced by age, race, sex or income. Health disparities are prevalent in autoimmune diseases. However, there is a lack of national US data regarding health disparities in uveitis. The primary aim of our study is to evaluate health disparities for uveitis in the USA. METHODS We performed a retrospective, observational, cross-sectional study to ascertain health disparities for uveitis and its complications in the USA using the National Inpatient Sample (NIS) for the years 2002-2013. We used the International Classification of Disease, ninth revision, codes to identify uveitis cases and ocular complications. Uveitis was divided into total, infectious and non-infectious uveitis. We collected information on age, sex, race, income quartile and ocular complications. We preformed statistical analysis using SAS V.9.4. A logistic regression model was used to predict the odds of developing uveitis and its complications. RESULTS There were a total of 94 143 978 discharges including 15 296 total uveitis, 4538 infectious and 10 758 non-infectious uveitis patients. Compared with the total NIS population, patients with uveitis were younger (mean age 45±18 vs 48±28 years, p value ≤0.0001, African-Americans (23% vs 10%, p value ≤0.0001), in the lowest income quartile (<$38 999; 29% vs 26%, p value ≤0.0001) and were insured by Medicaid (25% vs 20%, p value ≤0.0001). CONCLUSION African-American patients have a higher prevalence of uveitis. Patients insured by Medicare and Medicaid have more frequent ocular complications. This knowledge may guide future research on disparity and shape healthcare decision making.
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Affiliation(s)
- Krati Chauhan
- Division of Rheumatology, Southern Illinois University - School of Medicine, Springfield, Illinois, USA
| | - Steven Scaife
- Center for Clinical Research, Southern Illinois University - School of Medicine, Springfield, Illinois, USA
| | - James T Rosenbaum
- Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University-School of Medicine, Portland, Oregon, USA.,Department of Ophthalmology, Legacy Devers Eye Institute, Portland, Oregon, USA
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Rosenbaum JT, Dick AD. The Eyes Have it: A Rheumatologist's View of Uveitis. Arthritis Rheumatol 2018; 70:1533-1543. [PMID: 29790291 DOI: 10.1002/art.40568] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/17/2018] [Indexed: 12/18/2022]
Abstract
Uveitis is defined as intraocular inflammation. It is an extraarticular manifestation of many forms of joint disease, which include spondyloarthritis, juvenile idiopathic arthritis, and Behçet's disease. Rheumatologists may be asked to consult on the ophthalmologic care of patients with uveitis in order to identify an associated systemic illness. Diagnoses such as spondyloarthritis, sarcoidosis, and interstitial nephritis with uveitis are frequently overlooked by referring ophthalmologists. Alternatively, rheumatologists may be asked to help manage the patient's immunosuppression, including biologic therapy, which can be required to treat a subset of patients with uveitis. This review is intended to provide rheumatologists with the necessary information to facilitate collaboration in the comanagement of patients with uveitis.
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Affiliation(s)
- James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
| | - Andrew D Dick
- University College London, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, London, UK, and University of Bristol, Bristol Eye Hospital, Bristol, UK
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Choi RY, Lauer A, Rosenbaum JT. Molecular diagnosis and ocular imaging of varicella zoster virus associated neuroretinitis. Am J Ophthalmol Case Rep 2018; 11:146-148. [PMID: 30094392 PMCID: PMC6072656 DOI: 10.1016/j.ajoc.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To report a case of varicella zoster virus associated neuroretinitis confirmed via polymerase chain reaction analysis of ocular fluid. Observations A 30-year-old man presented with a 1-week history of decreased vision in his left eye and ulcerative skin lesions above his left eyebrow. On exam, he had clinical findings consistent with neuroretinitis characterized by optic disc edema and formation of a macular star. Polymerase chain reaction analysis of aqueous fluid was positive for varicella zoster virus. He was treated with oral valacyclovir with excellent resolution of his symptoms and clinical findings. Conclusions and importance Varicella zoster virus is a rare cause of neuroretinitis. We report for the first time a case of varicella zoster virus associated neuroretinitis confirmed by polymerase chain reaction analysis of ocular fluid. Molecular testing of ocular tissue may lead to a definitive diagnosis.
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Affiliation(s)
- Rene Y. Choi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Andreas Lauer
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - James T. Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Legacy Health System, Portland, OR, USA
- Corresponding author. Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, 3375 SW Terwilliger Blvd, 4th floor, Portland, OR, 97239, USA. Tel.: +1 503 494 5023; fax: +1 503 494 6875.
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Dick AD, Rosenbaum JT. Reply. Ophthalmology 2018; 125:e54. [PMID: 30032799 DOI: 10.1016/j.ophtha.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Andrew D Dick
- Ophthalmology, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, United Kingdom.
| | - James T Rosenbaum
- Legacy Devers Eye Institute, Portland, Oregon; Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Departments of Medicine and Cell Biology, Oregon Health & Science University, Portland, Oregon
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Affiliation(s)
- James T Rosenbaum
- From Oregon Health and Science University and the Legacy Devers Eye Institute, Portland (J.T.R.); and New York University Medical Center, New York (G.J.S.)
| | - Gregg J Silverman
- From Oregon Health and Science University and the Legacy Devers Eye Institute, Portland (J.T.R.); and New York University Medical Center, New York (G.J.S.)
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Laurence M, Asquith M, Rosenbaum JT. Spondyloarthritis, Acute Anterior Uveitis, and Fungi: Updating the Catterall-King Hypothesis. Front Med (Lausanne) 2018; 5:80. [PMID: 29675414 PMCID: PMC5895656 DOI: 10.3389/fmed.2018.00080] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/09/2018] [Indexed: 12/12/2022] Open
Abstract
Spondyloarthritis is a common type of arthritis which affects mostly adults. It consists of idiopathic chronic inflammation of the spine, joints, eyes, skin, gut, and prostate. Inflammation is often asymptomatic, especially in the gut and prostate. The HLA-B*27 allele group, which presents intracellular peptides to CD8+ T cells, is by far the strongest risk factor for spondyloarthritis. The precise mechanisms and antigens remain unknown. In 1959, Catterall and King advanced a novel hypothesis explaining the etiology of spondyloarthritis: an as-yet-unrecognized sexually acquired microbe would be causing all spondyloarthritis types, including acute anterior uveitis. Recent studies suggest an unrecognized sexually acquired fungal infection may be involved in prostate cancer and perhaps multiple sclerosis. This warrants reanalyzing the Catterall-King hypothesis based on the current literature. In the last decade, many links between spondyloarthritis and fungal infections have been found. Antibodies against the fungal cell wall component mannan are elevated in spondyloarthritis. Functional polymorphisms in genes regulating the innate immune response against fungi have been associated with spondyloarthritis (CARD9 and IL23R). Psoriasis and inflammatory bowel disease, two common comorbidities of spondyloarthritis, are both strongly associated with fungi. Evidence reviewed here lends credence to the Catterall-King hypothesis and implicates a common fungal etiology in prostate cancer, benign prostatic hyperplasia, multiple sclerosis, psoriasis, inflammatory bowel disease, and spondyloarthritis. However, the evidence available at this time is insufficient to definitely confirm this hypothesis. Future studies investigating the microbiome in relation to these conditions should screen specimens for fungi in addition to bacteria. Future clinical studies of spondyloarthritis should consider antifungals which are effective in psoriasis and multiple sclerosis, such as dimethyl fumarate and nystatin.
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Affiliation(s)
| | - Mark Asquith
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, United States
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, United States.,Department of Medicine, Oregon Health and Science University, Portland, OR, United States.,Department of Cell Biology, Oregon Health and Science University, Portland, OR, United States.,Legacy Devers Eye Institute, Portland, OR, United States
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Gill T, Asquith M, Brooks SR, Rosenbaum JT, Colbert RA. Effects of HLA-B27 on Gut Microbiota in Experimental Spondyloarthritis Implicate an Ecological Model of Dysbiosis. Arthritis Rheumatol 2018; 70:555-565. [PMID: 29287307 DOI: 10.1002/art.40405] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/19/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether HLA-B27-mediated experimental spondyloarthritis (SpA) is associated with a common gut microbial signature, in order to identify potential drivers of pathogenesis. METHODS The effects of HLA-B27 on 3 genetic backgrounds, dark agouti (DA), Lewis, and Fischer, were compared, using wild-type littermates and HLA-B7-transgenic Lewis rats as controls. Cecum and colon tissue specimens or contents were collected from the rats at 2, 3-4, and 6-8 months of age, and histologic analysis was performed to assess inflammation, RNA sequencing was used to determine gene expression differences, and 16S ribosomal RNA gene sequencing was used to determine microbiota differences. RESULTS Both HLA-B27-transgenic Lewis rats and HLA-B27-transgenic Fischer rats developed gut inflammation, while DA rats were resistant to the effects of HLA-B27, and HLA-B7-transgenic rats were not affected. Immune dysregulation was similar in affected Lewis and Fischer rats and was dominated by activation of interleukin-23 (IL-23)/IL-17, interferon, tumor necrosis factor, and IL-1 cytokines and pathways in the colon and cecum, while DA rats exhibited low-level cytokine dysregulation without inflammation. Gut microbial changes in HLA-B27-transgenic rats were strikingly divergent on the 3 different host genetic backgrounds, including different patterns of dysbiosis in HLA-B27-transgenic Lewis and HLA-B27-transgenic Fischer rat strains, with some overlap. Interestingly, DA rats lacked segmented filamentous bacteria that promote CD4+ Th17 cell development, which may explain their resistance to disease. CONCLUSION The effects of HLA-B27 on gut microbiota and dysbiosis in SpA are highly dependent on the host genetic background and/or environment, despite convergence of dysregulated immune pathways. These results implicate an ecological model of dysbiosis, with the effects of multiple microbes contributing to the aberrant immune response, rather than a single or small number of microbes driving pathogenesis.
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Affiliation(s)
- Tejpal Gill
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Stephen R Brooks
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - James T Rosenbaum
- Legacy Devers Eye Institute and Oregon Health and Science University, Portland
| | - Robert A Colbert
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Jabs DA, Dick A, Doucette JT, Gupta A, Lightman S, McCluskey P, Okada AA, Palestine AG, Rosenbaum JT, Saleem SM, Thorne J, Trusko B. Interobserver Agreement Among Uveitis Experts on Uveitic Diagnoses: The Standardization of Uveitis Nomenclature Experience. Am J Ophthalmol 2018; 186:19-24. [PMID: 29122577 DOI: 10.1016/j.ajo.2017.10.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the interobserver agreement among uveitis experts on the diagnosis of the specific uveitic disease. DESIGN Interobserver agreement analysis. METHODS Five committees, each comprised of 9 individuals and working in parallel, reviewed cases from a preliminary database of 25 uveitic diseases, collected by disease, and voted independently online whether the case was the disease in question or not. The agreement statistic, κ, was calculated for the 36 pairwise comparisons for each disease, and a mean κ was calculated for each disease. After the independent online voting, committee consensus conference calls, using nominal group techniques, reviewed all cases not achieving supermajority agreement (>75%) on the diagnosis in the online voting to attempt to arrive at a supermajority agreement. RESULTS A total of 5766 cases for the 25 diseases were evaluated. The overall mean κ for the entire project was 0.39, with disease-specific variation ranging from 0.23 to 0.79. After the formalized consensus conference calls to address cases that did not achieve supermajority agreement in the online voting, supermajority agreement overall was reached on approximately 99% of cases, with disease-specific variation ranging from 96% to 100%. CONCLUSIONS Agreement among uveitis experts on diagnosis is moderate at best but can be improved by discussion among them. These data suggest the need for validated and widely used classification criteria in the field of uveitis.
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Dick AD, Rosenbaum JT, Al-Dhibi HA, Belfort R, Brézin AP, Chee SP, Davis JL, Ramanan AV, Sonoda KH, Carreño E, Nascimento H, Salah S, Salek S, Siak J, Steeples L. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology 2018; 125:757-773. [PMID: 29310963 DOI: 10.1016/j.ophtha.2017.11.017] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/06/2017] [Accepted: 11/08/2017] [Indexed: 12/14/2022] Open
Abstract
TOPIC An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. CLINICAL RELEVANCE The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. METHODS An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. RESULTS In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. CONCLUSIONS Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.
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Affiliation(s)
- Andrew D Dick
- Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, United Kingdom.
| | - James T Rosenbaum
- Legacy Devers Eye Institute, Portland, Oregon; Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Departments of Medicine and Cell Biology, Oregon Health & Science University, Portland, Oregon
| | - Hassan A Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil
| | - Antoine P Brézin
- Service d'ophtalmologie, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Soon Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Ophthalmology & Visual Sciences Academic Clinical Program, Singapore, Republic of Singapore
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Athimalaipet V Ramanan
- Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; Pediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ester Carreño
- Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Sawsen Salah
- Service d'ophtalmologie, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Sherveen Salek
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jay Siak
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Ophthalmology & Visual Sciences Academic Clinical Program, Singapore, Republic of Singapore
| | - Laura Steeples
- Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Manchester Royal Eye Hospital, Central Manchester University Hospitals, and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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Salek SS, Pradeep A, Guly C, Ramanan AV, Rosenbaum JT. Uveitis and Juvenile Psoriatic Arthritis or Psoriasis. Am J Ophthalmol 2018; 185:68-74. [PMID: 29101009 DOI: 10.1016/j.ajo.2017.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE To describe the phenotype of the uveitis that accompanies juvenile psoriatic arthritis or psoriasis. DESIGN Observational case series. METHODS Setting: Two university-based referral clinics: 1 in England, 1 in the United States. STUDY POPULATION Five children with uveitis and psoriatic arthritis and 1 with uveitis and psoriasis Observational Procedure: Retrospective chart review. MAIN OUTCOME MEASURES Demographics of subjects such as age and sex; description of ocular and joint disease; surgical and other complications; medical treatment. RESULTS Five of the 6 children in this series had the onset of disease at or before age 6 (P = .0008 compared to expected age of onset for psoriatic arthritis in childhood). All children in this series had an inadequate response to topical corticosteroids. Most of the children were treated with systemic corticosteroids for many months, yet all of them went on to require methotrexate. Therapy with systemic methotrexate did not suffice, as all the patients also required some form of biologic therapy. Five of 6 had surgeries such as vitrectomy, cataract extraction, or a procedure for glaucoma control. CONCLUSIONS The observations suggest that the uveitis that accompanies juvenile psoriatic arthritis might be a distinct disease that is particularly severe when its onset affects children aged 6 years or younger.
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Affiliation(s)
- Sherveen S Salek
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Archana Pradeep
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Catherine Guly
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon.
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Irizarry FJ, Kopplin LJ, Salek SS, Adamus G, Saleh M, Biggee K, Lin P, Rosenbaum JT. Recovery of outer retinal laminations on optical coherence tomography after treatment of cancer associated retinopathy. Am J Ophthalmol Case Rep 2017; 8:11-13. [PMID: 29260107 PMCID: PMC5731551 DOI: 10.1016/j.ajoc.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/27/2017] [Accepted: 08/29/2017] [Indexed: 10/31/2022] Open
Abstract
Purpose To report novel optical coherence tomography findings in a case of anti-α-enolase cancer associated retinopathy. Observations An elderly female presented with bilateral decreased vision and a recent diagnosis of ovarian carcinoma. Optical coherence tomography demonstrated bilateral loss of outer retinal structures and macular edema. Serum testing found antibodies against α-enolase and 82-84 kDa proteins. Outer retinal structures showed recovery, macular edema resolved and repeat anti-retinal antibody testing became negative following cancer therapy and topical difluprednate treatment. Conclusions and importance Cancer associated retinopathy is a paraneoplastic disease that results in damage to retinal structures through an autoimmune response. The damage is generally considered to be irreversible; however, in rare cases, such as observed here, retinal structures may demonstrate recovery after treatment.
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Affiliation(s)
- Francisco J Irizarry
- Ponce Health Science University, 388 Zona Ind. Reparada 2, Ponce 00716, Puerto Rico
| | - Laura J Kopplin
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239, USA
| | - Sherveen S Salek
- Emory Eye Center, 1365 B Clifton Road NE, Atlanta, GA 30322, USA
| | - Grazyna Adamus
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239, USA
| | - Mohamed Saleh
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239, USA
| | - Kristin Biggee
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239, USA
| | - Phoebe Lin
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239, USA.,Legacy Devers Eye Institute, 1040 NW 22nd Avenue, Portland, OR 97210, USA
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Rosenbaum JT, Choi D, Harrington CA, Wilson DJ, Grossniklaus HE, Sibley CH, Salek SS, Ng JD, Dailey RA, Steele EA, Hayek B, Craven CM, Edward DP, Maktabi AMY, Al Hussain H, White VA, Dolman PJ, Czyz CN, Foster JA, Harris GJ, Bee YS, Tse DT, Alabiad CR, Dubovy SR, Kazim M, Selva D, Yeatts RP, Korn BS, Kikkawa DO, Silkiss RZ, Sivak-Callcott JA, Stauffer P, Planck SR. Gene Expression Profiling and Heterogeneity of Nonspecific Orbital Inflammation Affecting the Lacrimal Gland. JAMA Ophthalmol 2017; 135:1156-1162. [PMID: 28975236 DOI: 10.1001/jamaophthalmol.2017.3458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Although a variety of well-characterized diseases, such as sarcoidosis and granulomatosis with polyangiitis, affect the lacrimal gland, many patients with dacryoadenitis are diagnosed as having nonspecific orbital inflammation (NSOI) on the basis of histology and systemic disease evaluation. The ability to further classify the disease in these patients should facilitate selection of effective therapies. Objective To test the a priori hypothesis that gene expression profiles would complement clinical and histopathologic evaluations in identifying well-characterized diseases and in subdividing NSOI into clinically relevant groups. Design, Setting, and Participants In this cohort study, gene expression levels in biopsy specimens of inflamed and control lacrimal glands were measured with microarrays. Stained sections of the same biopsy specimens were used for evaluation of histopathology. Tissue samples of patients were obtained from oculoplastic surgeons at 7 international centers representing 4 countries (United States, Saudi Arabia, Canada, and Taiwan). Gene expression analysis was done at Oregon Health & Science University. Participants were 48 patients, including 3 with granulomatosis with polyangiitis, 28 with NSOI, 7 with sarcoidosis, 4 with thyroid eye disease, and 6 healthy controls. The study dates were March 2012 to April 2017. Main Outcomes and Measures The primary outcome was subdivision of biopsy specimens based on gene expression of a published list of approximately 40 differentially expressed transcripts in blood, lacrimal gland, and orbital adipose tissue from patients with sarcoidosis. Stained sections were evaluated for inflammation (none, mild, moderate, or marked), granulomas, nodules, or fibrosis by 2 independent ocular pathologists masked to the clinical diagnosis. Results Among 48 patients (mean [SD] age, 41.6 [19.0] years; 32 [67%] female), the mclust algorithm segregated the biopsy specimens into 4 subsets, with the differences illustrated by a heat map and multidimensional scaling plots. Most of the sarcoidosis biopsy specimens were in subset 1, which had the highest granuloma score. Three NSOI biopsy specimens in subset 1 had no apparent granulomas. Thirty-two percent (9 of 28) of the NSOI biopsy specimens could not be distinguished from biopsy specimens of healthy controls in subset 4, while other examples of NSOI tended to group with gene expression resembling granulomatosis with polyangiitis or thyroid eye disease. The 4 subsets could also be partially differentiated by their fibrosis, granulomas, and inflammation pathology scores but not their lymphoid nodule scores. Conclusions and Relevance Gene expression profiling discloses clear heterogeneity among patients with lacrimal inflammatory disease. Comparison of the expression profiles suggests that a subset of patients with nonspecific dacryoadenitis might have a limited form of sarcoidosis, while other patients with NSOI cannot be distinguished from healthy controls.
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Affiliation(s)
- James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland.,Devers Eye Institute, Legacy Health System, Portland, Oregon.,Department of Medicine, Oregon Health & Science University, Portland
| | - Dongseok Choi
- Casey Eye Institute, Oregon Health & Science University, Portland.,Oregon Health and Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | | | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland
| | | | - Cailin H Sibley
- Department of Medicine, Oregon Health & Science University, Portland
| | - Sherveen S Salek
- Casey Eye Institute, Oregon Health & Science University, Portland.,Devers Eye Institute, Legacy Health System, Portland, Oregon
| | - John D Ng
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Roger A Dailey
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Eric A Steele
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Brent Hayek
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | | | - Deepak P Edward
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hailah Al Hussain
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Valerie A White
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig N Czyz
- Department of Ophthalmology, Ohio University, Columbus.,Ophthalmic Surgeons and Consultants of Ohio, Columbus
| | - Jill A Foster
- Ophthalmic Surgeons and Consultants of Ohio, Columbus.,Department of Ophthalmology, The Ohio State University, Columbus
| | - Gerald J Harris
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee
| | - Youn-Shen Bee
- Department of Ophthalmology, Kaohsiung Veteran's General Hospital, Kaohsiung City, Taiwan
| | - David T Tse
- Department of Ophthalmology, University of Miami, Miami, Florida
| | | | - Sander R Dubovy
- Department of Ophthalmology, University of Miami, Miami, Florida
| | - Michael Kazim
- Department of Ophthalmology, Columbia University, New York, New York
| | - Dinesh Selva
- Ophthalmology Network, Royal Adelaide Hospital, Adelaide, Australia
| | - R Patrick Yeatts
- Department of Ophthalmology, Wake Forest University, Winston-Salem, North Carolina
| | - Bobby S Korn
- Department of Ophthalmology, University of California, San Diego
| | - Don O Kikkawa
- Department of Ophthalmology, University of California, San Diego
| | | | | | - Patrick Stauffer
- Casey Eye Institute, Oregon Health & Science University, Portland
| | - Stephen R Planck
- Casey Eye Institute, Oregon Health & Science University, Portland.,Devers Eye Institute, Legacy Health System, Portland, Oregon.,Department of Medicine, Oregon Health & Science University, Portland
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Thomas AS, Redd T, Campbell JP, Palejwala NV, Baynham JT, Suhler EB, Rosenbaum JT, Lin P. The Impact and Implication of Peripheral Vascular Leakage on Ultra-Widefield Fluorescein Angiography in Uveitis. Ocul Immunol Inflamm 2017; 27:349-355. [PMID: 29035614 DOI: 10.1080/09273948.2017.1367406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: To study if peripheral vascular leakage (PVL) on ultra-widefield fluorescein angiography (UWFFA) prognosticates complications of uveitis or necessitates treatment augmentation. Methods: Retrospective cohort study of uveitis patients imaged with UWFFA and ≥1 yr of follow-up. Results: We included 73 eyes of 42 patients with uveitis. There was no difference in baseline, intermediate, final visual acuity (p = 0.47-0.95) or rates of cystoid macular edema (CME) (p = 0.37-0.87) in eyes with PVL vs. those without. Eyes with PVL receiving baseline treatment augmentation were more likely to have baseline CME but were not more likely to have impaired visual acuity at final follow-up. PVL was independently associated with treatment augmentation on generalized estimating equation analysis with multivariable linear regression (OR: 4.39, p = 0.015). Conclusions: PVL did not confer an increased risk of impaired VA or CME at ≥1 yr follow-up but was possibly an independent driver of treatment augmentation.
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Affiliation(s)
- Akshay S Thomas
- a Department of Ophthalmology , Duke University Eye Center , Durham , North Carolina , USA
| | - Travis Redd
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA
| | - John P Campbell
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA
| | | | | | - Eric B Suhler
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA.,e Portland Veteran's Affairs Medical Center , Portland , Oregon , USA
| | - James T Rosenbaum
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA.,f Devers Eye Institute , Portland , Oregon , USA
| | - Phoebe Lin
- b Department of Ophthalmology, Casey Eye Institute , Oregon Health and Science University , Portland , Oregon , USA
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78
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Affiliation(s)
- James T Rosenbaum
- From the Legacy Devers Eye Institute and Oregon Health and Science University, Portland
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79
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Asquith M, Davin S, Stauffer P, Michell C, Janowitz C, Lin P, Ensign-Lewis J, Kinchen JM, Koop DR, Rosenbaum JT. Intestinal Metabolites Are Profoundly Altered in the Context of HLA-B27 Expression and Functionally Modulate Disease in a Rat Model of Spondyloarthritis. Arthritis Rheumatol 2017; 69:1984-1995. [PMID: 28622455 PMCID: PMC5623151 DOI: 10.1002/art.40183] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 06/13/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE HLA-B27-associated spondyloarthritides are associated with an altered intestinal microbiota and bowel inflammation. We undertook this study to identify HLA-B27-dependent changes in both host and microbial metabolites in the HLA-B27/β2 -microglobulin (β2 m)-transgenic rat and to determine whether microbiota-derived metabolites could impact disease in this major model of spondyloarthritis. METHODS Cecal contents were collected from Fischer 344 33-3 HLA-B27/β2 m-transgenic rats and wild-type controls at 6 weeks (before disease) and 16 weeks (with active bowel inflammation). Metabolomic profiling was performed by high-throughput gas and liquid chromatography-based mass spectrometry. HLA-B27/β2 m-transgenic rats were treated with the microbial metabolites propionate or butyrate in drinking water for 10 weeks, and disease activity was subsequently assessed. RESULTS Our screen identified 582 metabolites, of which more than half were significantly altered by HLA-B27 expression at 16 weeks. Both microbial and host metabolites were altered, with multiple pathways affected, including those for amino acid, carbohydrate, xenobiotic, and medium-chain fatty acid metabolism. Differences were even observed at 6 weeks, with up-regulation of histidine, tyrosine, spermidine, N-acetylmuramate, and glycerate in HLA-B27/β2 m-transgenic rats. Administration of the short-chain fatty acid propionate significantly attenuated HLA-B27-associated inflammatory disease, although this was not associated with increased FoxP3+ T cell induction or with altered expression of the immunomodulatory cytokines interleukin-10 (IL-10) or IL-33 or of the tight junction protein zonula occludens 1. HLA-B27 expression was also associated with altered host expression of messenger RNA for the microbial metabolite receptors free fatty acid receptor 2 (FFAR2), FFAR3, and niacin receptor 1. CONCLUSION HLA-B27 expression profoundly impacts the intestinal metabolome, with changes evident in rats even at age 6 weeks. Critically, we demonstrate that a microbial metabolite, propionate, attenuates development of HLA-B27-associated inflammatory disease. These and other microbiota-derived bioactive mediators may provide novel treatment modalities in HLA-B27-associated spondyloarthritides.
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Affiliation(s)
- Mark Asquith
- Oregon Health and Science University, Division of Arthritis and
Rheumatic Diseases, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
| | - Sean Davin
- Oregon Health and Science University, Division of Arthritis and
Rheumatic Diseases, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
| | - Patrick Stauffer
- Oregon Health and Science University, Division of Arthritis and
Rheumatic Diseases, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
| | - Claire Michell
- Oregon Health and Science University, Division of Arthritis and
Rheumatic Diseases, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
| | - Cathleen Janowitz
- Oregon Health and Science University, Division of Arthritis and
Rheumatic Diseases, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
| | - Phoebe Lin
- Oregon Health and Science University, Casey Eye Institute, Portland,
OR, USA, 97239
| | - Joe Ensign-Lewis
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic
Center Blvd, Philadelphia, PA, USA, 19104
| | | | - Dennis R Koop
- Oregon Health and Science University, Department of Physiology and
Pharmacology, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
| | - James T. Rosenbaum
- Oregon Health and Science University, Division of Arthritis and
Rheumatic Diseases, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
- Oregon Health and Science University, Department of Physiology and
Pharmacology, 3181 SW Sam Jackson Park Rd, Portland, OR, USA, 97239
- Devers Eye Institute, 1040 Nw 22nd Ave, Suite 200, Portland, OR,
USA, 97210
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Abstract
PURPOSE OF REVIEW Ocular involvement in sarcoidosis is present in up to 80% of patients and is frequently manifested before diagnosis of the underlying systemic disease. Considering the therapeutic consequences, early diagnosis of the underlying disease is advantageous in patients presenting with ocular inflammation. There are several ocular findings suggestive of underlying sarcoidosis, such as granulomatous keratic precipitates, iris nodules, cells in the vitreous humor known as snowballs and snowbanks, and retinal periphlebitis. High suspicion is crucial for the diagnosis of sarcoidosis. This review on ocular sarcoidosis will mainly focus on new diagnostic and treatment modalities. RECENT FINDINGS Recent studies found possible new diagnostic indicators for the diagnosis of ocular sarcoidosis which include not only serum profiles but also vitreous sample analysis. Ophthalmologic imaging techniques have improved to investigate the ocular structure in detail. Results from recent uveitis clinical trials have included sarcoidosis as an underlying cause and have reported positive results. SUMMARY The diagnosis of ocular sarcoidosis can be challenging in some cases. High suspicion is important to diagnose ocular sarcoidosis with various laboratory and ophthalmic tools. There are many possible options for the treatment of ocular sarcoidosis including various biologic agents.
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Affiliation(s)
- Sungjae Yang
- Department of Ophthalmology, Gangneung Asan Hospital, Ulsan University, Gangneung. Korea
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Sherveen Salek
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
- Legacy Devers Eye Institute, 1040 NW 22nd Ave, Suite 200, Portland, OR 97210, USA
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Rudwaleit M, Rosenbaum JT, Landewé R, Marzo-Ortega H, Sieper J, van der Heijde D, Davies O, Bartz H, Hoepken B, Nurminen T, Deodhar A. Observed Incidence of Uveitis Following Certolizumab Pegol Treatment in Patients With Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2017; 68:838-44. [PMID: 26815944 PMCID: PMC5089650 DOI: 10.1002/acr.22848] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/07/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022]
Abstract
Objective Axial spondyloarthritis (axial SpA) is characterized by inflammation of the spine and sacroiliac joints and can also affect extraarticular sites, with the most common manifestation being uveitis. Here we report the incidence of uveitis flares in axial SpA patients from the RAPID‐axSpA trial, including ankylosing spondylitis (AS) and nonradiographic (nr) axial SpA. Methods The RAPID‐axSpA (NCT01087762) trial is double‐blind and placebo‐controlled to week 24, dose‐blind to week 48, and open‐label to week 204. Patients were randomized to certolizumab pegol (CZP) or placebo. Placebo patients entering the dose‐blind phase were re‐randomized to CZP. Uveitis events were recorded on extraarticular manifestation or adverse event forms. Events were analyzed in patients with/without history of uveitis, and rates reported per 100 patient‐years. Results At baseline, 38 of 218 CZP‐randomized patients (17.4%) and 31 of 107 placebo‐randomized patients (29.0%) had past uveitis history. During the 24‐week double‐blind phase, the rate of uveitis flares was lower in CZP (3.0 [95% confidence interval (95% CI) 0.6–8.8] per 100 patient‐years) than in placebo (10.3 [95% CI 2.8–26.3] per 100 patient‐years). All cases observed during the 24‐week double‐blind phase were in patients with a history of uveitis; in these patients, rates were similarly lower for CZP (17.1 [95% CI 3.5–50.1] per 100 patient‐years) than placebo (38.5 [95% CI 10.5–98.5] per 100 patient‐years). Rates of uveitis flares remained low up to week 96 (4.9 [95% CI 3.2–7.4] per 100 patient‐years) and were similar between AS (4.4 [95% CI 2.3–7.7] per 100 patient‐years) and nr‐axial SpA (5.6 [95% CI 2.9–9.8] per 100 patient‐years). Conclusion The rate of uveitis flares was lower for axial SpA patients treated with CZP than placebo during the randomized controlled phase. Incidence of uveitis flares remained low to week 96 and was comparable to rates reported for AS patients receiving other anti–tumor necrosis factor antibodies.
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Affiliation(s)
| | - J T Rosenbaum
- Devers Eye Institute, Legacy Health System, Portland, Oregon, and Oregon Health & Science University, Portland
| | - R Landewé
- Academic Medical Center, Amsterdam and Atrium Medical Center, Heerlen, the Netherlands
| | - H Marzo-Ortega
- Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - J Sieper
- University Hospital Charité, Berlin, Germany
| | | | | | - H Bartz
- UCB Pharma, Monheim, Germany
| | | | | | - A Deodhar
- Oregon Health & Science University, Portland
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Asquith MJ, Stauffer P, Davin S, Mitchell C, Lin P, Rosenbaum JT. Perturbed Mucosal Immunity and Dysbiosis Accompany Clinical Disease in a Rat Model of Spondyloarthritis. Arthritis Rheumatol 2017; 68:2151-62. [PMID: 26992013 DOI: 10.1002/art.39681] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/10/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The HLA-B27/β2 -microglobulin (β2 m)-transgenic (Tg) rat is a leading model of B27-associated spondyloarthritis (SpA), and the disease is dependent on the presence of intestinal bacteria. Previous studies have shown that adult HLA-B27/β2 m-Tg rats have an altered intestinal microbiota. This study sought to better define the age-dependent changes to both mucosal immune function and dysbiosis in this rat model of SpA. METHODS Intestinal contents were collected from wild-type and HLA-B27/β2 m-Tg rats postweaning (ages 3 and 6 weeks), at disease onset (age 10 weeks), and after the establishment of disease (ages ≥16 weeks). The microbial community structure was determined by 16S ribosomal RNA sequencing and quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Mucosal and systemic Th1, Th17, and Treg cell responses were analyzed by flow cytometry, as was the frequency of IgA-coated intestinal bacteria. Intestinal expression of inflammatory cytokines and antimicrobial peptides (AMPs) was determined by qRT-PCR. RESULTS An inflammatory cytokine signature and elevated AMP expression during the postweaning period preceded the development of clinical bowel inflammation and dysbiosis in HLA-B27/β2 m-Tg rats. An early and sustained expansion of the Th17 cell pool was specifically observed in the cecal and colonic mucosa of HLA-B27/β2 m-Tg rats. Strongly elevated intestinal colonization of Akkermansia muciniphila and an increased frequency of IgA-coated fecal bacteria were significantly associated with expression of HLA-B27 and arthritis development. CONCLUSION HLA-B27/β2 m expression in this rat model renders the host hyperresponsive to microbial antigens from infancy. Early activation of innate immunity and expansion of a mucosal Th17 signature are soon followed by dysbiosis in HLA-B27/β2 m-Tg animals. The pathologic processes of perturbed mucosal immunity and dysbiosis strongly merit further study in both prediseased and diseased populations of patients with SpA.
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Affiliation(s)
| | | | - Sean Davin
- Oregon Health & Science University, Portland
| | | | - Phoebe Lin
- Oregon Health & Science University and Casey Eye Institute, Portland
| | - James T Rosenbaum
- Oregon Health & Science University, Casey Eye Institute, and Devers Eye Institute, Portland
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Nakamura YK, Metea C, Karstens L, Asquith M, Gruner H, Moscibrocki C, Lee I, Brislawn CJ, Jansson JK, Rosenbaum JT, Lin P. Gut Microbial Alterations Associated With Protection From Autoimmune Uveitis. Invest Ophthalmol Vis Sci 2017; 57:3747-58. [PMID: 27415793 PMCID: PMC4960998 DOI: 10.1167/iovs.16-19733] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the contribution of the gut microbiota to the pathogenesis of uveitis. Methods Experimental autoimmune uveitis (EAU) in B10.RIII mice was induced using interphotoreceptor binding protein peptide. Mice were treated with oral or intraperitoneal (IP) antibiotics. Effector (Teff) and regulatory (Treg) T lymphocytes were identified using flow cytometry; 16S rRNA gene sequencing and qPCR were performed on gastrointestinal (GI) contents. Results Broad-spectrum (four antibiotics given simultaneously) oral, but not IP, antibiotics reduced mean uveitis clinical scores significantly compared with water-treated animals (0.5 vs. 3.0, P < 0.0001 for oral; 3.4 vs. 3.4, P > 0.99 for IP). Both oral metronidazole (P = 0.02) and vancomycin (P < 0.0001) alone decreased inflammation, whereas neomycin (P = 0.7) and ampicillin (P = 0.4) did not change mean uveitis scores. Oral broad-spectrum antibiotics increased Tregs in the GI lamina propria of EAU animals at 1 week, and in extraintestinal lymphoid tissues later, whereas Teff and inflammatory cytokines were reduced. 16S sequencing of GI contents revealed altered microbiota in immunized mice compared with nonimmunized mice, and microbial diversity clustering in EAU mice treated with uveitis-protective antibiotics. Experimental autoimmune uveitis mice also demonstrated gut microbial diversity clustering associated with clinical score severity. Conclusions Oral antibiotics modulate the severity of inducible EAU by increasing Tregs in the gut and extraintestinal tissues, as well as decreasing effector T cells and cytokines. 16S sequencing suggests that there may be protective and, conversely, potentially uveitogenic, gut microbiota. These findings may lead to a better understanding of how uveitis can be treated or prevented by modulating the gut microbiome.
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Affiliation(s)
- Yukiko K Nakamura
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States
| | - Christina Metea
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States
| | - Lisa Karstens
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Mark Asquith
- Division of Rheumatology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Henry Gruner
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States
| | - Cathleen Moscibrocki
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States
| | - Iris Lee
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States
| | - Colin J Brislawn
- Pacific Northwest National Laboratory, Richland, Washington, United States
| | - Janet K Jansson
- Pacific Northwest National Laboratory, Richland, Washington, United States
| | - James T Rosenbaum
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States 3Division of Rheumatology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States 5Devers Eye Institute, Portland, Oregon, Uni
| | - Phoebe Lin
- Casey Eye Institute Oregon Health and Science University, Portland, Oregon, United States
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Lim LL, Xie J, Chua CC, Wong T, Hoang LT, Becker MD, Suhler EB, Rosenbaum JT, Mackensen F. In Vivo Laser Confocal Microscopy Using the HRT-Rostock Cornea Module: Diversity and Diagnostic Implications in Patients with Uveitis. Ocul Immunol Inflamm 2017; 26:900-909. [PMID: 28562149 DOI: 10.1080/09273948.2017.1298818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Keratic precipitates (KP) are a common feature of uveitis. We prospectively examined KP with the Heidelberg Retinal Tomograph II confocal laser scanning microscope and Rostock Corneal Module (HRT-RCM) to explore their diagnostic implications. METHODS Prospective, observational, multicenter study. HRT-RCM images were classified by two masked observers. RESULTS 120 scans on 120 eyes from 110 subjects were included. The majority (N = 93) had non-infectious uveitis. Sixty eyes had active disease at scanning. Eight KP morphologies were defined. Agreement between the two masked graders was high (Kappa value across all categories = 0.81). Cluster and nodular KP were associated with active infectious uveitis (p < 0.01): patients with cluster KP (odds ratio [OR] = 3.03, 95% confidence interval [CI]: 1.43, 6.45) and nodular KP (OR = 3.89, 95% CI: 1.42, 10.65) were more likely to have infectious uveitis than those without. CONCLUSIONS Laser confocal microscopy of KP may have a role in determining between infectious and non-infectious uveitis.
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Affiliation(s)
- Lyndell L Lim
- a Ophthalmology , Oregon Health & Science University , Portland , Oregon , USA.,b Centre for Eye Research Australia , University of Melbourne , Melbourne , Australia
| | - Jing Xie
- b Centre for Eye Research Australia , University of Melbourne , Melbourne , Australia
| | - Chyn C Chua
- b Centre for Eye Research Australia , University of Melbourne , Melbourne , Australia
| | - Tiffany Wong
- a Ophthalmology , Oregon Health & Science University , Portland , Oregon , USA
| | - Lani T Hoang
- a Ophthalmology , Oregon Health & Science University , Portland , Oregon , USA
| | - Matthias D Becker
- c Ophthalmology , Interdisciplinary Uveitis Center , Heidelberg , Germany.,d Department of Ophthalmology , Triemli Hospital , Zurich , Switzerland
| | - Eric B Suhler
- a Ophthalmology , Oregon Health & Science University , Portland , Oregon , USA.,e Portland Veteran's Affairs Medical Center , Portland , Oregon , USA
| | - James T Rosenbaum
- a Ophthalmology , Oregon Health & Science University , Portland , Oregon , USA.,f Legacy Devers Eye Institute , Portland , Oregon , USA
| | - Friederike Mackensen
- a Ophthalmology , Oregon Health & Science University , Portland , Oregon , USA.,c Ophthalmology , Interdisciplinary Uveitis Center , Heidelberg , Germany
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Daniel E, Pistilli M, Kothari S, Khachatryan N, Kaçmaz RO, Gangaputra SS, Sen HN, Suhler EB, Thorne JE, Foster CS, Jabs DA, Nussenblatt RB, Rosenbaum JT, Levy-Clarke GA, Bhatt NP, Kempen JH. Risk of Ocular Hypertension in Adults with Noninfectious Uveitis. Ophthalmology 2017; 124:1196-1208. [PMID: 28433444 DOI: 10.1016/j.ophtha.2017.03.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the risk and risk factors for ocular hypertension (OHT) in adults with noninfectious uveitis. DESIGN Retrospective, multicenter, cohort study. PARTICIPANTS Patients aged ≥18 years with noninfectious uveitis seen between 1979 and 2007 at 5 tertiary uveitis clinics. METHODS Demographic, ocular, and treatment data were extracted from medical records of uveitis cases. MAIN OUTCOME MEASURES Prevalent and incident OHT with intraocular pressures (IOPs) of ≥21 mmHg, ≥30 mmHg, and increase of ≥10 mmHg from documented IOP recordings (or use of treatment for OHT). RESULTS Among 5270 uveitic eyes of 3308 patients followed for OHT, the mean annual incidence rates for OHT ≥21 mmHg and OHT ≥30 mmHg are 14.4% (95% confidence interval [CI], 13.4-15.5) and 5.1% (95% CI, 4.7-5.6) per year, respectively. Statistically significant risk factors for incident OHT ≥30 mmHg included systemic hypertension (adjusted hazard ratio [aHR], 1.29); worse presenting visual acuity (≤20/200 vs. ≥20/40, aHR, 1.47); pars plana vitrectomy (aHR, 1.87); history of OHT in the other eye: IOP ≥21 mmHg (aHR, 2.68), ≥30 mmHg (aHR, 4.86) and prior/current use of IOP-lowering drops or surgery in the other eye (aHR, 4.17); anterior chamber cells: 1+ (aHR, 1.43) and ≥2+ (aHR, 1.59) vs. none; epiretinal membrane (aHR, 1.25); peripheral anterior synechiae (aHR, 1.81); current use of prednisone >7.5 mg/day (aHR, 1.86); periocular corticosteroids in the last 3 months (aHR, 2.23); current topical corticosteroid use [≥8×/day vs. none] (aHR, 2.58); and prior use of fluocinolone acetonide implants (aHR, 9.75). Bilateral uveitis (aHR, 0.69) and previous hypotony (aHR, 0.43) were associated with statistically significantly lower risk of OHT. CONCLUSIONS Ocular hypertension is sufficiently common in eyes treated for uveitis that surveillance for OHT is essential at all visits for all cases. Patients with 1 or more of the several risk factors identified are at particularly high risk and must be carefully managed. Modifiable risk factors, such as use of corticosteroids, suggest opportunities to reduce OHT risk within the constraints of the overriding need to control the primary ocular inflammatory disease.
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Affiliation(s)
- Ebenezer Daniel
- Scheie Eye Institute, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maxwell Pistilli
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srishti Kothari
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Naira Khachatryan
- Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
| | - R Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, England, United Kingdom
| | - Sapna S Gangaputra
- Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - James T Rosenbaum
- Department of Ophthalmology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nirali P Bhatt
- Scheie Eye Institute, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Discovery Eye Center, MyungSung Christian Medical Center, Addis Ababa, Ethiopia
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Miloslavsky EM, Naden RP, Bijlsma JWJ, Brogan PA, Brown ES, Brunetta P, Buttgereit F, Choi HK, DiCaire JF, Gelfand JM, Heaney LG, Lightstone L, Lu N, Murrell DF, Petri M, Rosenbaum JT, Saag KS, Urowitz MB, Winthrop KL, Stone JH. Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis. Ann Rheum Dis 2017; 76:543-546. [PMID: 27474764 DOI: 10.1136/annrheumdis-2016-210002] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/11/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To develop a Glucocorticoid Toxicity Index (GTI) to assess glucocorticoid (GC)-related morbidity and GC-sparing ability of other therapies. METHODS Nineteen experts on GC use and outcome measures from 11 subspecialties participated. Ten experts were from the USA; nine from Canada, Europe or Australia. Group consensus methods and multicriteria decision analysis (MCDA) were used. A Composite GTI and Specific List comprise the overall GTI. The Composite GTI reflects toxicity likely to change during a clinical trial. The Composite GTI toxicities occur commonly, vary with GC exposure, and are weighted and scored. Relative weights for items in the Composite GTI were derived by group consensus and MCDA. The Specific List is designed to capture GC toxicity not included in the Composite GTI. The Composite GTI was evaluated by application to paper cases by the investigators and an external group of 17 subspecialists. RESULTS Thirty-one toxicity items were included in the Composite GTI and 23 in the Specific List. Composite GTI evaluation showed high inter-rater agreement (investigators κ 0.88, external raters κ 0.90). To assess the degree to which the Composite GTI corresponds to expert clinical judgement, participants ranked 15 cases by clinical judgement in order of highest to lowest GC toxicity. Expert rankings were then compared with case ranking by the Composite GTI, yielding excellent agreement (investigators weighted κ 0.87, external raters weighted κ 0.77). CONCLUSIONS We describe the development and initial evaluation of a comprehensive instrument for the assessment of GC toxicity.
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Affiliation(s)
- Eli M Miloslavsky
- Rheumatology, Allergy and Immunology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ray P Naden
- Maternal-Fetal Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Paul A Brogan
- Institute of Child Health, University College London, UCL Inst of Child Health, London, UK
| | - E Sherwood Brown
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Paul Brunetta
- Late Stage Immunology Product Development, Genentech, Inc., South San Francisco, USA
| | - Frank Buttgereit
- Department of Rheumatology and Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Hyon K Choi
- Department of Rheumatology, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Liz Lightstone
- Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, Imperial College London, London, UK
| | - Na Lu
- Department of Rheumatology, Massachusetts General Hospital, Boston, USA
| | - Dedee F Murrell
- University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Petri
- Department of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Kenneth S Saag
- UAB Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Murray B Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, Canada
| | | | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Rheumatology Clinic, Boston, Massachusetts, USA
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88
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Sen HN, Belfort R, Chan CC, Lee RW, Rosenbaum JT, Holland GN. Obituary. Am J Ophthalmol 2016. [DOI: 10.1016/j.ajo.2016.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Karstens L, Asquith M, Davin S, Stauffer P, Fair D, Gregory WT, Rosenbaum JT, McWeeney SK, Nardos R. Does the Urinary Microbiome Play a Role in Urgency Urinary Incontinence and Its Severity? Front Cell Infect Microbiol 2016; 6:78. [PMID: 27512653 PMCID: PMC4961701 DOI: 10.3389/fcimb.2016.00078] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Traditionally, the urinary tract has been thought to be sterile in the absence of a clinically identifiable infection. However, recent evidence suggests that the urinary tract harbors a variety of bacterial species, known collectively as the urinary microbiome, even when clinical cultures are negative. Whether these bacteria promote urinary health or contribute to urinary tract disease remains unknown. Emerging evidence indicates that a shift in the urinary microbiome may play an important role in urgency urinary incontinence (UUI). The goal of this prospective pilot study was to determine how the urinary microbiome is different between women with and without UUI. We also sought to identify if characteristics of the urinary microbiome are associated with UUI severity. METHODS We collected urine from clinically well-characterized women with UUI (n = 10) and normal bladder function (n = 10) using a transurethral catheter to avoid bacterial contamination from external tissue. To characterize the resident microbial community, we amplified the bacterial 16S rRNA gene by PCR and performed sequencing using Illumina MiSeq. Sequences were processed using the workflow package QIIME. We identified bacteria that had differential relative abundance between UUI and controls using DESeq2 to fit generalized linear models based on the negative binomial distribution. We also identified relationships between the diversity of the urinary microbiome and severity of UUI symptoms with Pearson's correlation coefficient. RESULTS We successfully extracted and sequenced bacterial DNA from 95% of the urine samples and identified that there is a polymicrobial community in the female bladder in both healthy controls and women with UUI. We found the relative abundance of 14 bacteria significantly differed between control and UUI samples. Furthermore, we established that an increase in UUI symptom severity is associated with a decrease in microbial diversity in women with UUI. CONCLUSIONS Our study provides further characterization of the urinary microbiome in both healthy controls and extensively phenotyped women with UUI. Our results also suggest that the urinary microbiome may play an important role in the pathophysiology of UUI and that the loss of microbial diversity may be associated with clinical severity.
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Affiliation(s)
- Lisa Karstens
- Division of Bioinformatics and Computational Biology, Oregon Health and Science UniversityPortland, OR, USA
- Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA
| | - Mark Asquith
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
| | - Sean Davin
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
| | - Patrick Stauffer
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
| | - Damien Fair
- Department of Behavioral Neuroscience, Oregon Health and Science UniversityPortland, OR, USA
- Department of Psychiatry, Oregon Health and Science UniversityPortland, OR, USA
- Advanced Imaging Research Center, Oregon Health and Science UniversityPortland, OR, USA
| | - W. Thomas Gregory
- Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA
| | - James T. Rosenbaum
- Division of Arthritis and Rheumatology, Oregon Health and Science UniversityPortland, OR, USA
- Devers Eye Institute, Oregon Health and Science UniversityPortland, OR, USA
| | - Shannon K. McWeeney
- Division of Bioinformatics and Computational Biology, Oregon Health and Science UniversityPortland, OR, USA
| | - Rahel Nardos
- Division of Urogynecology, Oregon Health and Science UniversityPortland, OR, USA
- Kaiser PermanenteClackamas, OR, USA
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Rosenbaum JT. The Fellow and the Professor Revisited. JAMA Ophthalmol 2016; 134:727. [PMID: 27258322 DOI: 10.1001/jamaophthalmol.2016.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James T Rosenbaum
- Oregon Health & Sciences University, Portland2Legacy Devers Eye Institute, Portland
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Abstract
Sarcoidosis is one of the leading causes of inflammatory eye disease. Ocular sarcoidosis can involve any part of the eye and its adnexal tissues and may cause uveitis, episcleritis/scleritis, eyelid abnormalities, conjunctival granuloma, optic neuropathy, lacrimal gland enlargement, and orbital inflammation. Glaucoma and cataract can be complications from inflammation itself or adverse effects from therapy. Ophthalmic manifestations can be isolated or associated with other organ involvement. Patients with ocular sarcoidosis can present with a wide range of clinical presentations and severity. Multidisciplinary approaches are required to achieve the best treatment outcomes for both ocular and systemic manifestations.
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Affiliation(s)
- Sirichai Pasadhika
- Vitreoretinal and Uveitis Service, Legacy Devers Eye Institute, 1040 Northwest 22nd Avenue Suite 168, Portland, OR 97210, USA.
| | - James T Rosenbaum
- Legacy Devers Eye Institute, 1040 Northwest 22nd Avenue Suite 168, Portland, OR 97210, USA
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Rosenbaum JT, Mount GR, Youssef J, Lin P. New Perspectives in Rheumatology: Avoiding Antimalarial Toxicity. Arthritis Rheumatol 2016; 68:1805-9. [PMID: 27111663 DOI: 10.1002/art.39719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/07/2016] [Indexed: 11/11/2022]
Abstract
This report inaugurates New Perspectives in Rheumatology, a series of authoritative articles that focus on recent scientific and clinical developments and their potential to reshape rheumatology practice. Anticipated topics include the implementation of new guidelines and emerging information from clinical and translational research. Richard J. Bucala, MD, PhDEditor-in-ChiefRobert Terkeltaub, MDCo-Editor and Review Article Editor.
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Affiliation(s)
- James T Rosenbaum
- Oregon Health & Sciences University and Legacy Devers Eye Institute, Portland
| | | | | | - Phoebe Lin
- Oregon Health & Sciences University, Portland
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Abstract
Anterior uveitis is far more common than intermediate, posterior or panuveitis. About 50% of patients with acute anterior uveitis are HLA B27+. Those who are HLA B27+ are highly likely to have associated back, joint, or tendon disease. The majority of patients with acute anterior uveitis and inflammatory low back pain are suffering from axial spondyloarthritis and radiographic evidence for abnormal sacroiliac joints is not required to make this diagnosis. Received 12 October 2015; revised 31 January 2016; accepted 16 February 2016; published online 12 April 2016.
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Affiliation(s)
- James T Rosenbaum
- a Casey Eye Institute , Oregon Health & Science University , Portland , Oregon , USA.,b Legacy Devers Eye Institute , Portland , Oregon , USA
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Holbrook JT, Sugar EA, Burke AE, Vitale AT, Thorne JE, Davis JL, Jabs DA, Jaffe GJ, Branchaud B, Hahn P, Koreen L, Lad E(NM, Lin P, Martel JN, (Shah) Serrano N, Skalak C, Vajzovic L, Baer C, Bryant J, Chavala S, Cusick M, Day S, Dayani P, Ehlers J, Kesen M, Lee A, Melamud A, Qureshi JA, Scott AW, See RF, Shuler RK, Wood M, Yeh S, Fernandes A, Gibbs D, Leef D, Martin DF, Srivastava S, Dunn JP, Begum H, Boring J, Brotherson KL, Burkholder B, Butler NJ, Cain D, Cook MA, Emmert D, Graul JR, Herring M, Laing A, Leung TG, Mahon MC, Moradi A, Nwankwo A, Ostheimer TL, Reed T, Arnold E, Barnabie PM, Belair ML, Bolton SG, Brodine JB, Brown DM, Brune LM, Galor A, Gan T, Jacobowitz A, Kapoor M, Kedhar S, Kim S, Leder HA, Livingston AG, Morton Y, Nolan K, Peters GB, Soto P, Stevenson R, Tarver-Carr M, Wang Y, Foster CS, Anesi SD, Linda Bruner, Ceron O, Hinkle DM, Persons N, Wentworth B, Acevedo S, Anzaar F, Cesca T, Contero A, Fitzpatrick K, Goronga F, Johnson J, Lebron KQ, Marvell D, Morgan C, Patel N, Pinto J, Siddique SS, Sprague J, Yilmaz T, Sen HN, Bono M, Cunningham D, Hayes D, Koutsandreas D, Nussenblatt RB, Sherry PR, Short GL, Smith W, Temple A, Bamji A, Coleman H, Davuluri G, Faia L, Gottlieb C, Jirawuthiworavong GV, Lew JC, Mercer R, Obiyor D, Perry CH, Potapova N, Weichel E, Wroblewski KJ, Yeh S, Latkany PA, Coonan C, Honda A, Lorenzo-Latkany M, Masini R, Morell S, Nguyen A, Badamo J, Boyd KM, Enos M, Gallardo J, Jarczynski J, Lee JY, McGrosky M, Nour A, Sanchez M, Steinberg K, Stawell RJ, Breayley L, D'Sylva C, Glatz E, Hodgson L, Lim L, Ling C, McIntosh R, Morrison (Ewing) J, Newton A, Sanmugasundram S, Smallwood R, Zamir E, Hunt N, Jones L, Koukouras I, Williams S, Merrill PT, Carns D, Richine L, Voskuil-Marre DL, Woo K, Gaynes B, Giannoulis C, Hulvey P, Kernbauer E, Khan HS, Levine SJ, Toennessen S, Tonner E, Wang RC, Aguado H, Arceneaux S, Duignan K, Fish GE, Hesse N, Jaramillo D, Mackens M, Arnwine J, Callanan D, Cummings K, Gray K, Howden S, Mutz K, Sanchez B, Lightman S, Ismetova F, Prytherch A, Seguin-Greenstein S, Tomkins O, Bar A, Edwards K, Joshi L, Moraji J, Samy A, Stubbs T, Taylor S, Towler H, Tronnberg R, Holland GN, Almanzor RD, Castellanos J, Hubschman JP, Johiro AK, Kukuyev A, Levinson RD, McCannel CA, Ransome SS, Gonzales CR, Gupta A, Kalyani PS, Kapamajian MA, Kappel PJ, Arcinue C, Chuang J, Barteselli G, Currie G, Mendoza V, Powell D, Clark T, Cochran DE, Freeman WR, Hedaya J, Kemper T, Kozak I, LeMoine JM, Loughran ME, Magana L, Mojana F, Morrison V, Nguyen V, Oster SF, Acharya N, Clay D, Lee S, Lew M, Margolis TP, Stewart J, Wong IG, Brown D, Khouri CM, Goldstein DA, Birnbaum A, Degillio A, Rosa GDL, Ramirez C, Simjanowski E, Skelly M, Castro-Malek AL, Crooke CE, Huntley M, Nash K, Niec M, Pyatetsky D, Ramirez M, Rozenbajgier Z, Tessler HH, Davis JL, Albini TA, Chin M, Castaño D, Elizondo A, Ho M, Kovach JL, Lin RCS, Mandelcorn E, Nguyen JKD, Pacini A, Pineda S, Pinto DA, Rebimbas J, Stepien KE, Teran C, Elner SG, Bernard H, Fournier L, Godsey L, Goings L, Hackel R, Hesselgrave M, Jayasundera KT, Prusak R, Titus P, Bergeron M, Blosser R, Brown R, Chrisman-McClure C, Gothrup JR, Saxe SJ, Sizemore D, Kempen JH, Berger J, Drossner S, DuPont JC, Maguire AM, Petner J, Engelhard S, Hopkins T, McCall D, McRay M, Will D, Xu W, Lo J, Salvo R, Windsor E, Weeney L, Pavan PR, Albritton K, Leto J, Madow B, Mayor L, Pautler SE, Saxon W, Soto J, Goldstein B, Klukoff A, Lambright L, McDonald K, Ortiz M, Scymanky S, Szalay DD, Rao N, Davis T, Douglass J, Linton J, Padilla M, Ramos S, Aguirre A, Chong L, Cisneros L, Corona E, Eliott D, Fawzi A, Garcia J, Khurana R, Lim J, Mead R, Tsai JH, Vitale A, Bernstein PS, Carlstrom B, Gilman J, Hanseen S, Morris P, Ramirez D, Wegner K, Sheppard JD, Anthony B, Casper A, Felix-Kent L, Fernandez J, Johnson T, Scoper SV, Cole RD, Crawford N, Franklin L, Hamelin K, Martin J, Marx R, Schultz G, Webb J, Yeager P, Kim RY, Benz MS, Brown DM, Chen E, Fish RH, Kegley E, Shawver L, Wong TP, De La Garza R, Friday (Hay) S, Mutz K, Rao PK, Adcock E, Apte RS, Baladenski A, Curtis R, Gould S, Hebden A, Kambarian J, Meyer C, Pistorius S, Quinn M, Rathert G, Blinder KJ, Hartz A, Light P, Shah GK, VanGelder R, Jabs DA, Altaweel MM, Kempen JH, Kurinij N, Jabs DA, Almanzor RD, Altaweel MM, Brown D, Dunn JP, Holland GN, Kempen JH, Kim RY, Kurinij N, Prusakowski N, Thorne JE, Bolton SG, Brune LM, Clark T, Gilman J, Hubbard L, Martin DF, Nussenblatt RB, Wittes J, Barlow WE, Hochberg M, Lyon AT, Palestine AG, Simon LS, Altaweel MM, Kurinij N, Rosenbaum JT, Smith H, Kempen JH, Jaffe GJ, Davis J, Dunn JP, Martin DF, Thorne J, Vitale A, Thorne JE, Acharya NR, Kempen JH, Latkany PA, Vitale AT, Nussenblatt RB, VanGelder R, Almanzor RD, Boring JA, Gibbs D, Lee S, Prusakowski N, Thorne JE, Alexander J, Ng WP, Friedman DS, Adler A, Alexander J, Burke A, Katz J, Kempen JH, Prusakowski N, Reed S, Ansari H, Cohen N, Modak S, Ng WP, Sugar EA, Burke AE, Drye LT, Van Natta ML, Frick K, Katz J, Louis TA, Modak S, Shade D, Jabs DA, Pascual K, Slutsky-Sanon JS, Glomp C, Nieves MA, Stevens M, Allen A, Hilal Y, Holbrook JT, Abreu F, Burke A, Casper AS, Drye LT, Ewing C, Friedman DS, Hart A, Lears A, Li S, Meinert J, Morrison V, Nowakowski D, Prusakowski N, Reyes G, Shade DM, Smith J, Steuernagle K, Van Natta M, Venugopal V, Yu T, Adler A, Alexander J, Boring J, Chen P, Cohen N, Collins K, Dodge J, Frick KD, Jackson R, Jimenez C, Katz J, Landers A, Livingston H, Louis TA, Meinert CL, Modak S, Ng WP, Rayapudi S, Shen W, Shiflett C, Smith R, Tieman A, Tonascia JA, Zheng R, Altaweel MM, Allan J, Benz WK, Domalpally A, Johnson KA, Myers DJ, Pak JW, Reed S, Reimers JL, Christianson DJ, Chambers G, Fleischli MA, Freund J, Glander KE, Goulding A, Gama V, Gangaputra S, Hafford D, Harris SE, Hubbard LD, Joyce JM, Kruse CN, Nagle L, Remm A, Padden-Lechten GE, Pohlman A, Shaw RA, Sivesind P, Thayer D, Treichel E, Warren KJ, Watson SM, Webster MK, White JK, Wilhelmson T, Zhang G. Dissociations of the Fluocinolone Acetonide Implant: The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. Am J Ophthalmol 2016; 164:29-36. [PMID: 26748056 DOI: 10.1016/j.ajo.2015.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial. DESIGN Randomized clinical trial with extended follow-up. METHODS Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically related. RESULTS A total of 250 eyes (146 patients) had at least 1 implant placed. Median follow-up time after implant placement was 6 years (range 0.5-9.2 years). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval [CI]: 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity ≥5 letters temporally related to the dissociation. Thirty-nine implant removal surgeries were performed, 33 with replacement. Twelve dissociations were noted during implant removal surgeries in 10 participants (26%, 95% CI 15%-48%); 5 of these eyes had a decline in visual acuity ≥5 letters after surgery. The time from implant placement to removal surgery was longer for the surgeries at which dissociated implants were identified than for those without one (5.7 vs 3.7 years, P < .001). Overall, visual acuity declined 15 or more letters from pre-implant values in 22% of affected eyes; declines were frequently associated with complications of uveitis or its treatment. CONCLUSION There is an increasing risk of dissociation of Retisert implants during follow-up; the risk is greater with removal/exchange surgeries, but the risk of both spontaneous and surgically related events increases with longevity of the implants. In 22% of affected eyes visual acuity declined by 15 letters. In the context of eyes with moderate to severe uveitis for years, this rate is not unexpected.
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Kempen JH, Gewaily DY, Newcomb CW, Liesegang TL, Kaçmaz RO, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Foster CS, Jabs DA, Payal A, Fitzgerald TD. Remission of Intermediate Uveitis: Incidence and Predictive Factors. Am J Ophthalmol 2016; 164:110-7.e2. [PMID: 26772874 DOI: 10.1016/j.ajo.2015.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the incidence of remission among patients with intermediate uveitis; to identify factors potentially predictive of remission. DESIGN Retrospective cohort study. METHODS Involved eyes of patients with primary noninfectious intermediate uveitis at 4 academic ocular inflammation subspecialty practices, followed sufficiently long to meet the remission outcome definition, were studied retrospectively by standardized chart review data. Remission of intermediate uveitis was defined as a lack of inflammatory activity at ≥2 visits spanning ≥90 days in the absence of any corticosteroid or immunosuppressant medications. Factors potentially predictive of intermediate uveitis remission were evaluated using survival analysis. RESULTS Among 849 eyes (of 510 patients) with intermediate uveitis followed over 1934 eye-years, the incidence of intermediate uveitis remission was 8.6/100 eye-years (95% confidence interval [CI], 7.4-10.1). Factors predictive of disease remission included prior pars plana vitrectomy (PPV) (hazard ratio [HR] [vs no PPV] = 2.39; 95% CI, 1.42-4.00), diagnosis of intermediate uveitis within the last year (HR [vs diagnosis >5 years ago] =3.82; 95% CI, 1.91-7.63), age ≥45 years (HR [vs age <45 years] = 1.79; 95% CI, 1.03-3.11), female sex (HR = 1.61; 95% CI, 1.04-2.49), and Hispanic race/ethnicity (HR [vs white race] = 2.81; 95% CI, 1.23-6.41). Presence/absence of a systemic inflammatory disease, laterality of uveitis, and smoking status were not associated with differential incidence. CONCLUSIONS Our results suggest that intermediate uveitis is a chronic disease with an overall low rate of remission. Recently diagnosed patients and older, female, and Hispanic patients were more likely to remit. With regard to management, pars plana vitrectomy was associated with increased probability of remission.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Dina Y Gewaily
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Deglin and Greene Retinal Center, Wynnewood, Pennsylvania
| | - Craig W Newcomb
- Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - R Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Allergan, Inc, Dublin, Ireland
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Tampa Bay Uveitis Center, Tampa, Florida
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abhishek Payal
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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96
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Durrani K, Kempen JH, Ying GS, Kacmaz RO, Artornsombudh P, Rosenbaum JT, Suhler EB, Thorne JE, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Foster CS, Systemic Immunosuppressive Therapy For Eye Diseases Site Research Group. Adalimumab for Ocular Inflammation. Ocul Immunol Inflamm 2016; 25:405-412. [PMID: 27003323 DOI: 10.3109/09273948.2015.1134581] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory diseases. METHODS Characteristics of patients treated with adalimumab were abstracted in a standardized chart review. Main outcomes measured were control of inflammation, corticosteroid-sparing effect, and visual acuity. RESULTS In total, 32 patients with ocular inflammation were treated with adalimumab. The most common ophthalmic diagnoses were anterior uveitis, occurring in 15 patients (47%), and scleritis, occurring in 9 patients (28%). At 6 months of therapy, among 15 eyes with active inflammation, 7 (47%) became completely inactive, and oral prednisone was reduced to ≤10 mg/day in 2 of 4 patients (50%). On average, visual acuity decreased by 0.13 lines during the first 6 months of treatment. Adalimumab was discontinued because of lack of effectiveness in four patients within 6 months. CONCLUSIONS Adalimumab was moderately effective in controlling inflammation in a group of highly pre-treated cases of ocular inflammatory disease.
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Affiliation(s)
- Khayyam Durrani
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
| | - John H Kempen
- c Center for Preventive Ophthalmology and Biostatistics.,d Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology , Perelman School of Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | | | - R Oktay Kacmaz
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
| | - Pichaporn Artornsombudh
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,c Center for Preventive Ophthalmology and Biostatistics
| | - James T Rosenbaum
- e Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,f Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA
| | - Eric B Suhler
- e Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,f Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA.,g Portland Veteran's Affairs Medical Center , Portland , Oregon , USA
| | - Jennifer E Thorne
- h Department of Ophthalmology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,i Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Douglas A Jabs
- i Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA.,j Department of Ophthalmology , Icahn School of Medicine at Mount Sinai , New York , New York , USA.,k Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Grace A Levy-Clarke
- l Laboratory of Immunology, National Eye Institute , Bethesda , Maryland , USA
| | | | - C Stephen Foster
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
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97
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Abstract
The microbiome is strongly implicated in a broad spectrum of immune-mediated diseases. Data support the concept that HLA molecules shape the microbiome. We provide hypotheses to reconcile how HLA-B27 might affect the microbiome and in turn predispose to acute anterior uveitis. These theories include bacterial translocation, antigenic mimicry, and dysbiosis leading to alterations in regulatory and effector T-cell subsets. Received 31 October 2015; revised 7 January 2016; accepted 8 January 2016; published online 22 March 2016.
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Affiliation(s)
- James T Rosenbaum
- a Legacy Devers Eye Institute , Portland , Oregon , USA.,b Casey Eye Institute , Oregon Health & Science University , Portland , Oregon , USA.,c Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA
| | - Phoebe Lin
- b Casey Eye Institute , Oregon Health & Science University , Portland , Oregon , USA
| | - Mark Asquith
- c Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA
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98
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Lin W, Beardsley RM, Skalet AH, Wilson DJ, Rosenbaum JT, Lin P. Bilateral Idiopathic Solitary Granuloma of the Uveal Tract: Diagnosis and Treatment. ACTA ACUST UNITED AC 2016; 4. [PMID: 26779545 DOI: 10.4172/2324-8599.1000166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present a case of sequential bilateral idiopathic solitary granuloma of the uveal tract in a 51 year-old woman, who underwent enucleation in one eye due to complications of this condition, but was then successfully treated in the contralateral eye with anti-tumor necrosis-alpha therapy followed shortly by intraocular steroids and a steroid-releasing implant. Her visual acuity at its worst was 20/200 due to vitreous haze and cystoid macular edema, but then stabilized after successful treatment with a final visual acuity of 20/25 in her only seeing eye at 1 year follow-up. This represents the first known biopsy-proven case of bilateral idiopathic solitary granuloma, which additionally, has responded favorably to treatment.
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Affiliation(s)
| | | | | | | | - James T Rosenbaum
- Devers Eye Institute-Legacy Health System, Portland, OR, USA; Casey Eye Institute-OHSU, Portland, OR, USA
| | - Phoebe Lin
- Casey Eye Institute-OHSU, Portland, OR, USA
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99
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100
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Rosenbaum JT, Sibley CH, Choi D, Harrington CA, Planck SR. Molecular diagnosis: Implications for ophthalmology. Prog Retin Eye Res 2015; 50:25-33. [PMID: 26608807 DOI: 10.1016/j.preteyeres.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 12/21/2022]
Abstract
The effort to subdivide diseases and to individualize therapies based on characteristics of the patient has been labeled precision medicine. Jameson and Longo define precision medicine as "treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations" (Jameson and Longo, 2015). We illustrate how molecular diagnosis can be applied to orbital inflammatory disease to achieve the goals of precision medicine.
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Affiliation(s)
- James T Rosenbaum
- Devers Eye Institute, Legacy Health Systems, 1040 NW 22nd Avenue, Portland, OR 97210, USA; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Cailin H Sibley
- Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Dongseok Choi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA; OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Stephen R Planck
- Devers Eye Institute, Legacy Health Systems, 1040 NW 22nd Avenue, Portland, OR 97210, USA; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
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