In-vivo diagnostic measurements of ocular inflammation

PURPOSE OF REVIEW

The diagnosis of allergic conjunctival inflammation is usually made on the basis of clinical signs and symptoms; however, in-vivo and in-vitro tests are indicated when patient management requires identification of the specific allergic sensitization. The purpose of this review is to describe recent and less recent methods to assess ocular allergic inflammation.

RECENT FINDINGS

In the non-active phase of the disease, the specific conjunctival provocation test can be used to identify local sensitivities to allergens. Although not highly specific, total IgE in tears may be measured with a simple local test by inserting a paper strip in the lower meniscus. Limited tear volume prohibits the use of specific IgE tests. The measurement of tear-specific inflammatory markers, such as eosinophil cationic protein, IL-4, IL-5 and eotaxin, may also be useful for the diagnosis of ocular allergy. Multiple cytokine assays of tear samples and new imaging techniques are exciting advances that might provide the in-vivo diagnosis of ocular surface inflammation.

SUMMARY

Whereas chronic, severe ocular allergic conditions have uniquely diagnostic signs and symptoms, the most common diseases, seasonal and perennial allergic conjunctivitis, have no specific pathognomonic signs. The diagnostic measurements of local inflammation may help in the management of ocular allergy.

[Development of an antigen detection dot blot assay for the diagnosis of human onchocerciasis based on the biotin-avidin binding system]

The development of a highly sensitive and specific diagnostic test is of urgent need for the field assessment of human onchocerciasis and for monitoring the success of control programs. We report here the development and evaluation of a Dot blot Immunobinding Assay (DIA-BA) based on the biotin-avidin binding system, for the detection of O. volvulus specific antigens in body fluids. Specific antibodies were produced by immunizing rabbits with the O. volvulus recombinant antigen Oncho-C71 and labelled with biotin. The biotinylated probes were then used to detect O. volvulus specific antigens initially blotted onto a nitrocellulose membrane. The smallest amount of blotted antigens detectable by the new test is 0.5ng, 1ng, 1ng and 2ng respectively in urine, dermal fluid, tears and serum samples. Out of 456 onchocerciasis endemic subjects examined, 98.4%, 96.5%, 90.8% and 75.0% were positive by the DIA-BA test on urine, dermal fluid, tears and serum respectively The test was most sensitive (100%) when used on urine and least (54.76%) when used on serum from skin snip positive subjects. The specificity of the test, determined amongst non-exposed individuals, was 100% on all but for dermal fluid samples (97.5%). Also, the color intensities on the blot were observed to positively correlate (r = 0.8 on urine) with the skin microfilaria loads on the individuals. We conclude that DIA-BA test could be very useful for mass diagnosis of prepatent, of low and high level infections due to O. volvulus.

Brain-derived neurotrophic factor selectively enhances allergen-specific IgE production

We studied the effect of brain-derived neurotrophic factor (BDNF) on in vitro Japanese cedar pollen (JCP)-specific IgE production by mononuclear cells from atopic keratoconjunctivitis patients with JCP allergy. BDNF enhanced JCP-specific IgE production in a dose-dependent fashion in cultures of mononuclear cells stimulated with JCP, and maximal enhancement was achieved at 10 ng/ml. In contrast, BDNF had no effect on JCP-specific IgA or IgG4 production. On the other hand, other neurotrophins, NGF, NT-3, or NGF failed to enhance JCP-specific IgE production. Moreover, anti-BDNF mAb specifically blocked BDNF-induced enhancement of JCP-specific IgE production. Study for cytokine production revealed that BDNF decreased production of Th1 cytokines, IFN-gamma and IL-12, while it had no effect on production of TH2 cytokines, IL-4, IL-10 and IL-13, in cultures of mononuclear cells stimulated with JCP. These results indicate that BDNF relatively skews cytokine pattern toward Th2 type. Collectively, BDNF may increase allergen-specific IgE production, which may in turn aggravate allergic symptoms.

A comparison of methods of inducing lachrymation and tear collection in chickens for detection of virus-specific immuoglobulins after infection with infectious bronchitis virus

Four-week-old specific-pathogen-free chickens were infected with virulent infectious bronchitis virus Massachusetts strain M41 via the ocular-nasal route. At weekly intervals up to 3 weeks post-infection, excess lachrymation was induced either by placing sodium chloride (salt) crystals on the eyes or by intramuscular injection of carbachol. Tears were collected using micropipettes or on filter paper. Levels of virus-specific immunoglobulin (Ig)A and IgG were similar, irrespective of the method of tear induction. When tears were collected using filter papers, IgG was detected in eluted samples but at significantly lower levels than in those collected by pipette. Collection of IgA in this way was even less productive, and only trace amounts were detected. Possible reasons for these discrepancies have been discussed.

Quantitative analysis of antigen specific IgE in tears in comparison to serum samples

We determined pollen specific IgE in tears and compared these results to the concentration of specific IgE in serum samples. We obtained tears (using Schirmer strips) and serum samples from subjects with Japanese cedar (Cryptomeria japonica) pollinosis, and tested for C. japonica pollen specific IgE using a quantitative ELISA. Time kinetic analyses through the pollen season showed that specific IgE levels in tears were found to increase earlier than those in sera and reached their maximum at the end of or after the pollen season, from March to early June. In the C. japonica pollen free season, July to December, the specific IgE levels in tears decreased, although the serum levels remained relatively high. These results indicate that the quantitative assay for specific IgE in tears might be useful to identify specific eye allergens.

[Antibodies to retinal S antigen in the tear and serum as an indicator of the nature of a course of endogenous uveitis in children]

Antibodies (IgM and IgG) to retinal S antigen were studied by enzyme immunoassay in the tear (n = 135) and blood serum (n = 221) samples taken from 45 children with chronic endogenous uveitis during a follow-up (for 6 months to 5 years). The studies have confirmed the early evidence that detection of serum autoantibodies may be used for the diagnosis of autoimmune and infectious-and-autoimmune uveitis, the verification and prediction of renal alterations, risks for lesions in the second eye in unilateral uveitis and prerecurrence in bilateral uveitis. Criteria for detecting antibodies to lacrimal S antigen were developed. Its has been ascertained that it is expedient to use this procedure as a method for controlling the efficiency of treatment in uveitis involving the posterior parts of the eye, confirming, and predicting the risk for involvement of the retina into an inflammatory process, detecting trends for development of chronic forms of both bilateral and unilateral uveitis. Simultaneous accumulation of IgM and/or IgG antibodies in the lacrimal fluid and serum, as well as imbalance, i.e. a prolonged enhancement of only local or only systemic response to S antigen (of both classes), are prognostically unfavorable.

Development and evaluation of an antigen detection dipstick assay for the diagnosis of human onchocerciasis

To improve on the diagnosis of onchocerciasis, especially light infections, we developed and evaluated an oncho-dipstick test based on the detection of Onchocerca volvulus specific antigens in urine and tears. The test was able to detect as little as 25 ng/ml of parasite specific antigens in samples and took as little as 3 h. Evaluation of the assay on 456 residents of an onchocerciasis hyperendermic area in Cameroon resulted in 408 (89.5%) positives in urine and 374 (82%) positives in tears. The prevalence of onchocerciasis in the study area, as determined by Rapid Epidemiological Mapping of Onchocerciasis (REMO) and skin snip methods, was 52 and 36.8%, respectively. The sensitivity of the oncho-dipstick assay was 100% in urine and 92% in tears; its specificity was 100% in both. Concordance between urine and tear test results from the same individuals was 87%. The test strips were sufficiently reactive when left at room temperature for up to 8 months. The test would be useful for laboratory diagnosis of onchocerciasis in low transmission zones and to ascertain successful treatment of patients in experimental drug studies.

Local and systemic humoral immune response during acute and chronic Acanthamoeba keratitis in rabbits

PURPOSE

To study local and systemic antibody responses during the course of acute and chronic Acanthamoeba keratitis in a rabbit model. The role of secretory IgA (sIgA) in innate and adaptive immunity is investigated.

METHODS

Acanthamoeba keratitis was induced by intrastromal injection of live trophozoites in rabbits with and without prior oral immunization with aqueous Acanthamoeba antigen. The severity score of the ensuing keratitis was followed. Anti-Acanthamoeba antibodies in tears and sera were determined before infection and on a weekly basis postinfection for 6 weeks. The role of mucosal IgA as a link between the innate and adaptive immunity to Acanthamoeba was evaluated.

RESULTS

Acanthamoeba keratitis was significantly milder in animals infected after oral immunization than in naïve animals. Mucosal sIgA bound Acanthamoeba in a concentration-dependent, mannose-mediated manner. It significantly inhibited Acanthamoeba binding to rabbit corneal epithelium in vitro and in vivo. Anti-Acanthamoeba IgA significantly influenced amoebic lysis by neutrophils.

CONCLUSIONS

Mucosal IgA protects the external ocular surface by virtue of anti-adhesin properties displayed by the mannosylated residues on the heavy chains of IgA molecule (innate immunity) as well as specific antigen-binding sites (adaptive immunity). Immune IgA also augmented neutrophil-mediated amoebic lysis (adaptive immunity).

Tear cytokines in acute and chronic ocular allergic inflammation

PURPOSE OF REVIEW

Elevated levels of inflammatory cytokines have been reported in tears from ocular allergic disease states. The purpose of this review is to assimilate recent research contrasting tear cytokine concentrations in non-allergic subjects versus subjects with acute (seasonal allergic conjunctivitis) and chronic (giant papillary conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis) ocular allergic inflammation to discover whether the cytokine profiles could provide useful insight into disease mechanisms and therapeutic targets.

RECENT FINDINGS

Recent studies have revealed distinct differences in the cytokine/chemokine concentrations in tears between the various manifestations of ocular allergy. The acute (seasonal allergic conjunctivitis) and iatrogenic (giant papillary conjunctivitis) forms of ocular allergic inflammation are characterized by an overall lack of significant cytokine changes in tears compared with chronic disease (vernal keratoconjunctivitis, atopic keratoconjunctivitis). Chronic ocular allergic inflammation produces increased concentrations of T helper 1 and 2, and proinflammatory cytokines as well as chemokines. However, vernal and atopic keratoconjunctivitis portray distinct differences in the patterns of tear cytokines/chemokines expressed.

SUMMARY

The plethora of increased cytokines and chemokines in vernal and atopic keratoconjunctivitis compared with non-allergic, seasonal allergic conjunctivitis and giant papillary conjunctivitis provides a new perspective into the complex inflammatory processes occurring on the ocular surface in chronic disease. The ability to measure multiple cytokines in tears, combined with knowledge obtained from in-vitro analysis of the individual and combined effects of these cytokines on various conjunctival cells (i.e. mast cells, epithelial cells, fibroblasts) has facilitated further understanding of specific processes contributing to maintenance of inflammation and progression of vision-threatening disease and paved the way toward new therapeutic targets.

Lacrimal secretory IgA in active posterior uveitis induced by Toxoplasma gondii

It is quite difficult to diagnose active toxoplasmosis in patients with ocular toxoplasmosis. Active posterior uveitis presumably due to Toxoplasma gondii infection (APUPT) is seldom produced during a prime-infection; hence most patients do not show high IgM antibodies. High levels of IgA have been described in active toxoplasmosis. The purpose of this study was to investigate possible association between APUPT and the specific anti-parasite sIgA in tears. The study was carried out as case-control. Tears of 25 clinically confirmed APUPT patients and 50 healthy control subjects were analyzed. All were IgG seropositive. Specific sIgA was determined by ELISA assay using T. gondii RH strain crude extract. Anti-T. gondii sIgA was found in 84% of the cases and in 22% of the control subjects. The intensity of the reaction was higher in APUPT cases (P = 0.007). There was strong association between APUPT patients and lacrimal sIgA (odds-ratio 18.61, P = 0.0001). ELISA test sensitivity was 84% and specificity 78%. Our data suggest that anti-T.gondii secretory IgA found in tears may become an important marker for active ocular toxoplasmosis.

The Staphylococcal Superantigen-Like Protein 7 Binds IgA and Complement C5 and Inhibits IgA-FcαRI Binding and Serum Killing of Bacteria

The staphylococcal superantigen-like proteins (SSLs) are close relatives of the superantigens but are coded for by a separate gene cluster within a 19-kb region of the pathogenicity island SaPIn2. rSSL7 (formally known as SET1) bound with high affinity (K(D), 1.1 nM) to the monomeric form of human IgA1 and IgA2 plus serum IgA from primate, pig, rat, and horse. SSL7 also bound the secretory form of IgA found in milk from human, cow, and sheep, and inhibited IgA binding to cell surface FcalphaRI (CD89) and to a soluble form of the FcalphaRI protein. In addition to IgA, SSL7 bound complement factor C5 from human (K(D), 18 nM), primate, sheep, pig, and rabbit serum, and inhibited complement-mediated hemolysis and serum killing of a Gram-negative organism Escherichia coli. SSL7 is a superantigen-like protein secreted from Staphylococcus aureus that blocks IgA-FcR interactions and inhibits complement, leading to increased survival of a sensitive bacterium in blood.

[Immunological aspects of tear fluid]

The eye is linked to the common mucosal immune system. This system play the part in preservation of the ocular surface. Tear fluid contains pro and anty-inflammatory factors such as lactoferrin, plasmin, immunoglobulins, and a lot of cytokines (interleukins, GM-CSF, TGF alfa and beta). The cornea is immunologicaly preferred, as a result of lack of resident lymphoreticular cells.

Prevention of naturally occurring infectious bovine keratoconjunctivitis with a recombinant cytotoxin-ISCOM matrix adjuvanted vaccine

The efficacy of a recombinant Moraxella bovis cytotoxin subunit vaccine to prevent naturally occurring infectious bovine keratoconjunctivitis (IBK) was evaluated in a randomized, blinded, controlled field trial. Ninety-three cross bred beef calves were vaccinated with either saline, ISCOM matrix (adjuvant control), or a recombinant M. bovis cytotoxin carboxy terminus peptide plus ISCOM matrix and boostered 21 days later. Ocular examinations were performed once weekly for 20 weeks. At week 12, the cumulative proportion of calves with ulcerated eyes in the recombinant vaccine group was significantly lower than in the saline control group. Throughout the 20 week trial, the cumulative proportion of ulcerated calves remained lowest in the recombinant vaccine group. By week 7, nonulcerated calves in the recombinant vaccine group had significantly higher changes in serum neutralizing titers and cytotoxin specific to total IgG ratios in serum and tears as compared to calves in the control groups. The trend for a reduced cumulative proportion of IBK in the vaccinated calves over the 20 week trial suggests that a recombinant M. bovis cytotoxin vaccine may be beneficial in helping to prevent naturally occurring IBK.

Detection of secretory IgM in tears during rhino-conjunctivitis

BACKGROUND

With various methods, secretory immunoglobulin M (sIgM) was assessed in tears of patients with rhino-conjunctivitis.

METHODS

Tears were analyzed by microimmunoelectrophoresis (MIE), size-exclusion high-pressure liquid chromatography (SE-HPLC), sodium dodecyl sulphate (SDS) electrophoresis and isoelectric focusing.

RESULTS

Only very small traces of serum IgM could be found in tears of healthy volunteers. MIE showed that tear sIgM is different from serum IgM. The former migrates in the direction of the anode, while serum IgM migrates to the cathode. The SDS electropherogram of a number of patients showed an additional strong band of the sIgM mu-chain of approximately 68 kDa, after rhino-conjunctivitis. SE-HPLC showed two additional peaks for these patients, at 10.97 min and at 12.94 min, which were attributed to tear sIgM. The former peak consists of a complex of four sIgM molecules. One year later the chromatograms of the former rhino-conjunctivitis patients did not show any peak of sIgM in SE-HPLC.

CONCLUSIONS

Serum IgM of a molecular weight (MW) 970 kDa appears only in normal tears at very low concentrations, as a result of transudation from the serum. In contrast, sIgM is synthesized during rhino-conjunctivitis in high concentrations in the human lacrimal glands and the conjunctiva. These increased levels of tear sIgM are due to stimuli for specific protein synthesis.

[Results of examination of the local immunity in demodectic blepharoconjunctivitis]

Described in the paper are the results of examination of the local immunity in patients with demodectic blepharoconjunctivitis (DBC). Demodicosis of the eyes was established to develop in impairments of the local immunity described by a lower level of IL-4 in lacrimal fluid, a lower relative quantity of CD3+ cells, and a higher relative count of CD16+-lymphocytes infiltrating the eyelid-conjunctiva epithelium. The age-related immunodeficiency manifested as a decreased relative number of CD3+ and CD4+-lymphocytes infiltrating the eyelid-conjunctiva epithelium provokes a higher invasion of ticks and an increased morbidity of demodicosis among elderly people. DBC, when complicated by episcleritis or keratitis, is accompanied by a higher IgE level in lacrimal fluid and a decreased ratio of IgE/IL-4, which matters in prognostication and pathogenetic substantiation of DBC therapy.

Immunogenicity of recombinant Omp31 from Brucella melitensis in rams and serum bactericidal activity against B. ovis

Detergent-extracted recombinant Omp31 (rOmp31 extract) from Brucella melitensis produced in Escherichia coli was previously identified as a protective immunogen against B. ovis in mice. In this study, we evaluated the immunogenicity of rOmp31extract in rams. This immunogen was emulsified in an oil adjuvant and administered three times with 4 and 8 weeks intervals. Antibody response was measured in serum by whole B. ovis ELISA. Specific antibodies to purified rOmp31 (pET-Omp31) were detected by Western blotting and indirect ELISA. In addition, isotype specific antibodies were measured in tears. Serum bactericidal activity against B. ovis in the presence of complement was measured in vitro. Cellular immune response was explored by intradermal testing with purified rOmp31. Immunization with rOmp31 extract induced IgG specific antibodies in serum able to bind to whole B. ovis cells. Furthermore, strong inhibition in a competitive ELISA (with an Omp31-specific monoclonal antibody) suggested that a proportion of Omp31-specific antibodies were directed against a loop containing a protective epitope. Serum antibodies killed efficiently B. ovis in vitro in the presence of either guinea pig or ovine serum. Tears had both IgG and IgA antibodies to equivalent titers. Finally, immunized rams showed skin reactivity to Omp31. These data demonstrate that B. melitensis Omp31, a protective antigen identified in the mouse model, induces antibody and cellular immune mechanisms in sheep.

[Immunologic peculiarities of uveitis concurrent with systemic pathologies]

Immunologic examinations were performed in 111 patients with uveitis concurrent with a variety of systemic pathologies, including 85 males and 26 females, mean age--32.4 +/- 5.8. A higher IL-6 content in blood serum (BS) and in lachrymal fluid (LF) was detected in all patients. The IL-4 content was lower in uveitis associated with ankylosing spondylitis and with Reuter's disease, whereas, it was higher in juvenile rheumatoid arthritis. The systemic immunity changes were related with the hemostasis impairments in the phagocytic, humoral and cellular chains: an enhanced functional activity of phagocyte cells, a lower absolute quantity of T-lymphocytes, a higher count of B-cells, a reduced concentration of IgM and of circulating immune complexes (CIC), and a diminished general hemolytic activity of the complement in BS. A reduced concentration of the secretory fraction of IgA, IgG and IgM concurrent with higher concentrations of IgA, C3- and C4 complement components, CIC and of lysozyme activity in LF was detected in the local immunity system.

No apparent association between periocular and ocular microcolonization and the degree of inflammation in patients with atopic keratoconjunctivitis

BACKGROUND

The cause of the chronic inflammation in atopic keratoconjunctivitis (AKC), the ocular manifestation of atopic eczema/dermatitis syndrome, is largely unknown.

OBJECTIVE

To investigate the possibility that microorganisms may be important in the inflammatory activity in AKC.

METHODS

Fifteen patients with AKC participated in the study. The presence of aerobic bacteria and fungi was related to the severity of clinical signs, the numbers of inflammatory cells in tears and conjunctival biopsies, and the concentration of various cytokines in tears. In addition, serological evidence for IgE sensitization to Staphylococcus aureus B antigen and Malassezia sympodialis antigen was investigated. Twelve healthy subjects were included for control purposes.

RESULTS

The patients exhibited moderate clinical signs of AKC. No relation was found between the severity of AKC and the presence of microorganisms, despite the fact that S. aureus was frequently isolated. AKC patients showed significantly higher levels of IFN-gamma, TNF-alpha (tumour necrosis factor-alpha), IL-2, IL-4, IL-5 and IL-10 than controls. An association was found between conjunctival signs and the levels of all cytokines except IL-5.

CONCLUSION

We found no evidence to suggest that periocular and ocular microcolonization are related to inflammatory parameters in AKC. However, confirmation of the present results in a longitudinal study with repeated clinical examinations and samplings in the same individual is required before the contribution of S. aureus to on-going inflammation in AKC can be dismissed.

Anti-Ro/SSA and anti-La/SSB autoantibodies in the tear fluid of patients with Sjögren's syndrome

PURPOSE

To investigate the presence of anti-Ro/SSA and anti-La/SSB antibodies in the tear fluid and serum of patients with Sjögren's syndrome and to evaluate the association of these autoantibodies with the severity of keratoconjunctivitis sicca.

METHODS

Tear fluid and serum were obtained from 28 patients with Sjögren's syndrome and 17 age matched normal control subjects. Evaluation of tear fluid and sera anti-Ro/SSA and anti-La/SSB levels was done by using a quantitative enzyme linked immunosorbent assay kit designed for the quantitative measurement of IgG class autoantibodies directed against highly purified SSA and SSB antigens. Tear function and ocular surface were evaluated by Schirmer I test, tear break up time, and rose bengal staining. Dry eye symptom scores were recorded.

RESULTS

Increased levels of anti-Ro/SSA and anti-La/SSB antibodies were detected in sera of 57.1% and 50% of SS patients, respectively. Six patients had increased levels of anti-Ro/SSA in the tear fluid, in one case anti-Ro/SSA being detected in tear fluid when it was negative in serum. Ten patients had positive anti-La/SSB titres in tear fluid and in four of these patients, anti-La/SSB titres were not elevated in serum. A positive correlation was observed between serum and tear fluid titres of anti-Ro/SSA (r = 0.43, p = 0.02), but not of anti-La/SSB. Serum anti-Ro/SSA and anti-La/SSB concentrations correlated positively with dry eye symptom scores (r = 0.42, p = 0.02 and r = 0.48, p = 0.01, respectively) and negatively correlated with Schirmer I test scores (r = -0.39, p = 0.04 and r = -0.40, p = 0.03, respectively). Significant correlations were found between tear anti-La/SSB concentrations and dry eye symptom score (r = 0.56, p = 0.02) and also rose bengal staining scores of the ocular surface (r = 0.44, p = 0.02).

CONCLUSION

This study shows that autoantibodies against Ro/SSA and La/SSB antigens are present in the tear fluid of some patients with SS and their presence in serum or tear fluid is associated with the severity of keratoconjunctivitis sicca. Additional measurement of tear fluid levels of anti-Ro/SSA and anti-La/SSB may serve as a valuable diagnostic indicator of SS.

[A study of total IgE in inflammatory pathologies of the eye anterior segment]

The paper contains data on comparative research of the IgE content in blood serum and lachrymal fluid in patients with ophthalmoherpes and with other inflammatory diseases of the eye. A higher IgE level was found in blood serum and lachrymal fluid in cases of ophthalmoherpes as well as in lachrymal fluid in cases of allergic, Chlamydia and fungus diseases of the eye. The data obtained can be used in the diagnostics of allergic eye diseases as well as in elaborating complex treatment methods for herpetic, Chlamydia and fungus lesions of the anterior eye segment. A detection of the local allergenic effect of acaricide drugs exerted on the conjunctiva and eyelids makes it obligatory to consider the above fact while treating patients with demodectic blepharoconjunctivitis.

Systemic and ocular antibody responses to inactivated acute hemorrhagic conjunctivitis (AHC) virus; enterovirus 70 (EV70)

PURPOSE

Evaluate the immune response in rabbits injected with EV70, the agent of acute hemorrhagic conjunctivitis (AHC) and AHC associated neuropathy.

METHODS

Rabbits were injected intramuscularly with uv-light inactivated EV70 isolate J670/71. Neutralizing activity against EV70 was quantified in serum and tear samples and the immunoglobulin (Ig) classes of the neutralizing activity in serum identified by sucrose gradient ultra-centrifugation. Adjuvant muramyl dipeptide (MDP) was applied topically to assess the role of ocular inflammation on levels of neutralizing antibody, proteins and Ig in tears. The protective effects of human and rabbit sera and interferon-alpha (IFN-alpha) against EV70 were compared in human conjunctival and lens cells.

RESULTS

Sera collected at 6 and 13 d contained 19S IgM anti-EV70 neutralizing antibody, while serum collected 21 d post injection contained 19S IgM and 7S IgG anti-EV70 neutralizing antibody. Low titers of anti-EV70 activity (< or =30 U/ml) were detected in tears of seropositive rabbits. MDP induction of conjunctivitis in seropositive rabbits increased tear IgG concentration (3-fold) and anti-EV70 neutralizing antibody titers (> or =10-fold). The protective effect of the rabbit and human sera against EV70 infection in conjunctival, but not lens epithelial cells, was enhanced by the addition of IFN-alpha.

CONCLUSIONS

Immunization with uv-light inactivated EV70 elicits a classical humoral immune response in rabbits. The protective activity of serum in EV70-infected human conjunctival cells, but not lens cells, was increased by IFN-alpha. Adjuvant MDP-induced conjunctivitis, increased blood-conjunctival barrier (BCB) permeability and anti-EV70 neutralizing activity in tear of seropositive rabbits. The results suggest immunization with inactivated EV70 could provide systemic as well as ocular protection during natural EV70 infection.

[Immunological phenomenons in the pathology of the tear film. Is cyclosporine the turn point in the Sjögren's syndrome treatment? Preliminary report]

PURPOSE

The purpose of this study is to examine the new way in the casual treatment, resulting in the normalization of immunological processes on the ocular surface.

MATERIAL AND METHODS

5 patients (4 women and 1 men with mean age of 55.5 years, range 45 to 59 years) with Sjögren's syndrome--type dry eye, were included in the study. Patients received topically 0.05% cyclosporine, ophthalmic emulsion twice a day for a 6 months. The severity of patients complaints was evaluated according to the Dr. Mann Pharma/Bausch & Lomb's record.

RESULTS

Schirmer test II values, and lyzamine green staining scores, were evaluated priori to treatment and 6 months after the start. At the beginning of the study (day 0) the Schirmer test II values ranged from 1 to 5 mm (mean--2.2 mm). Break-up-time ranged from 3 to 6 sec (mean--4.8 sec). In all of 5 cases lyzamine green staining scores were 9. On month 6th, all of 5 patients had significant differences, compared to their baseline measurements in term of above mentioned parameters. The Schirmer test II values ranged from 8 to 12 mm (mean--10.3 mm). Break-up-time ranged from 9 to 13 sec (mean--11.2 sec), lyzamine green staining scores ranged from 2 to 3 points (mean--2.7).

CONCLUSIONS

0.05% cyclosporine, ophthalmic emulsion had a beneficial effect both on the subjective and objective clinical parameters of dry eye patients. The final conclusions must be supported by more cases.

Evaluation of staphylococcal enterotoxin-specific IgE antibody in tears in allergic keratoconjunctival disorders

PURPOSE

To investigate the presence of staphylococcal enterotoxin A (SEA) and B (SEB)-specific IgE antibodies in tears from patients with allergic conjunctival disorders.

METHODS

The study included 8 eyes of 4 patients with perennial allergic conjunctivitis (PAC), 14 eyes of 7 patients with vernal keratoconjunctivitis (VKC), 12 eyes of 6 patients with atopic keratoconjunctivitis (AKC), and 10 eyes of 10 healthy volunteers as controls. Tears were sampled by the method of the Schirmer test I. Sampled tears were eluted and SEA- and SEB-specific IgE antibodies were analyzed by the AlaSTAT-IMMULIZE method.

RESULTS

SEA-specific IgE antibodies in tears were positive in 9 of 14 eyes in VKC patients and in 1 of 12 eyes in AKC patients. SEB-specific IgE antibodies in tears were positive in 7 of 14 eyes in VKC patients and in 2 of 12 eyes in AKC patients. Values for antibodies were higher in patients with severe clinical findings. However, all the cases in the normal control and the PAC groups were negative for both antibodies.

CONCLUSION

Our data strongly suggested that staphylococcal enterotoxin may cause type I allergy, and may be an exacerbating factor for vernal keratoconjunctivitis and atopic keratoconjunctivitis.

[Rhinoconjunctivitis: importance of a local diagnosis?]

Diagnosis of allergic rhinoconjunctivitis, particularly in chronic forms, remains sometimes difficult. Systemic tests such as skin or blood tests may be not sufficient to assess local sensitization. Local tests are needed, performed from nasal secretion or tears. Measurement of total IgE in the local secretions of 41 patients suffering from rhinoconjunctivitis show that diagnosis contribution was upgraded from 61 to 88%. Very interestingly, in some cases, local tests were the only argument for allergy.