Evaluation of Ia expression in rat ocular tissues following inoculation with interferon-gamma

Immune responses to retinal gene therapy using adeno-associated viral vectors - Implications for treatment success and safety

Recombinant adeno-associated virus (AAV) is the leading vector for gene therapy in the retina. As non-pathogenic, non-integrating, replication deficient vector, the recombinant virus efficiently transduces all key retinal cell populations. Successful testing of AAV vectors in clinical trials of inherited retinal diseases led to the recent approval of voretigene neparvovec (Luxturna) for the treatment of RPE65 mutation-associated retinal dystrophies. However, studies applying AAV-mediated retinal gene therapy independently reported intraocular inflammation and/or loss of efficacy after initial functional improvements. Both observations might be explained by targeted removal of transduced cells via anti-viral defence mechanisms. AAV has been shown to activate innate pattern recognition receptors (PRRs) such as toll-like receptor (TLR)-2 and TLR-9 resulting in the release of inflammatory cytokines and type I interferons. The vector can also induce capsid-specific and transgene-specific T cell responses and neutralizing anti-AAV antibodies which both limit the therapeutic effect. However, the target organ of retinal gene therapy, the eye, is known as an immune-privileged site. It is characterized by suppression of inflammation and promotion of immune tolerance which might prevent AAV-induced immune responses. This review evaluates AAV-related immune responses, toxicity and inflammation in studies of retinal gene therapy, identifies influencing variables of these responses and discusses potential strategies to modulate immune reactions to AAV vectors to increase the safety and efficacy of ocular gene therapy.

The RPE Cell and the Immune System

The RPE cell plays a pivotal role in retinal immunity. In fact, the RPE cell orchestrates both innate and adaptive immunity and contains a plethora of factors to regulate the immune response. Many immunoregulatory activities of the RPE cell are accomplished through cytokine production, toll-like receptor (TLR) activation, complement regulation and antigen presentation. The RPE cells immune regulatory network plays an essential role in retinal immunity and autoimmunity, retinal infections and in a variety of retinal degenerative disorders. Understanding the immune regulatory properties of this cell may provide additional clues to disease mechanisms that may lead to future treatments for many human retinal diseases.

Tunicamycin-induced Endoplasmic Reticulum Stress Upregulates the Expression of Pentraxin 3 in Human Retinal Pigment Epithelial Cells

PURPOSE

To investigate the production of long pentraxin 3 (PTX3) in response to tunicamycin-induced endoplasmic reticulum (ER) stress and its role in ER stress-associated cell death, PTX3 expression was evaluated in the human retinal pigment epithelial cell line, ARPE-19.

METHODS

PTX3 production in ARPE-19 cells was analyzed in the absence or presence of tunicamycin treatment by enzyme-linked immunosorbent assay. PTX3 protein and mRNA levels were estimated using western blot analysis and real-time reverse transcription-polymerase chain reaction, respectively. Protein and mRNA levels of CCAAT-enhancer-binding protein homologous protein (CHOP) and ARPE-19 cell viability were measured in the presence of tunicamycin-induced ER stress in control or PTX3 small hairpin RNA (shRNA)-transfected ARPE-19 cells.

RESULTS

The protein and mRNA levels of PTX3 were found to be significantly increased by tunicamycin treatment. PTX3 production was significantly decreased in inositol-requiring enzyme 1α shRNA-transfected ARPE-19 cells compared to control shRNA-transfected cells. Furthermore, pretreatment with the NF-κB inhibitor abolished tunicamycin-induced PTX3 production. Decreased cell viability and prolonged protein and mRNA expression of CHOP were observed under tunicamycin-induced ER stress in PTX3 shRNA transfected ARPE-19 cells.

CONCLUSIONS

These results suggest that PTX3 production increased in the presence of tunicamycin-induced ER stress. Therefore, PTX3 could be an important protector of ER stress-induced cell death in human retinal pigment epithelial cells. Inositol-requiring enzyme 1α and the NF-κB signaling pathway may serve as potential targets for regulation of PTX3 expression in the retina. Therefore, their role in PTX3 expression needs to be further investigated.

CD73 expression in RPE cells is associated with the suppression of conventional CD4 cell proliferation

CD73 is intensively involved in the regulation of immune responses through the conversion of pro-inflammatory ATP to immunosuppressive adenosine. Herein, we clarified whether cells in the retina express CD73 and participate in the regulation of inflammatory eye diseases such as experimental autoimmune uveitis (EAU). First, immunofluorescence staining was performed to compare the distribution of CD73(+) cells in the retinas of EAU-induced and normal B10RIII mice. The results revealed that a layer of cells in the normal retina that was consistent with the location of retinal pigment epithelial (RPE) cells strongly expressing CD73, and the expression was markedly reduced in the presence of EAU. Thereafter, EAU was also induced in C57BL/6 mice by active immunization or adoptive transfer. CD73 expression in isolated RPE cells was assessed by real-time RT-PCR and western blotting, and the catalytic abilities of the cells to convert AMP to adenosine were determined using HPLC analyses. Compared to the normal control, significantly decreased CD73 expression and AMP catalytic ability were found in the RPE cells isolated from inflamed eyes. CD73 expression and activity were also studied in cultured RPE cells treated with different stimuli, such as Toll-like receptor ligands and cytokines. Highly varied functional CD73 expression was observed in RPE cells through cytokines or Toll-like receptor agonist treatments. Finally, whether RPE cells could regulate the immune response, particularly the proliferation of CD4 cells, through surface-expressed CD73 was determined using a two-chamber assay. The robust inhibition of conventional T-cell proliferation was uniquely observed when CD73(+) RPE cells in the upper chamber were in the presence of AMP. To further confirm the function of CD73 in RPE cells, Cd73(-/-) RPE cells were isolated, and CD73-rescued control cells were constructed. CD73(+)Cd73(-/-) RPE, not Cd73(-/-) RPE, significantly suppressed interacted CD4 cells proliferation and cytokine production. Taken together, these data suggest that naive RPE cells suppressed the immune response through their high expression of CD73. The expression of CD73 in RPE cells could be regulated through many factors, and down-regulated CD73 expression attenuated the suppressive effect of RPE on the proliferation of conventional CD4 cells.

Immune regulation in the retina

Immune reactivity in the retina can be critically important in inflammation and infections, but regulation of this response is essential. The retinal pigment epithelial (RPE), a unique retinal cell, displays a number of essential functions to support the health of the retina. In this review, we highlight how the RPE cell plays a pivotal role in immune defense. The RPE cell orchestrates both innate and adaptive immunity since it expresses TLRs, complement components, MHC class I and II molecules, and serves as an antigen presenting cell. Moreover, both of these immune responses result in the production of a plethora of cytokines, mainly proinflammatory. In order to counteract these inflammatory factors and silence unwanted immune reactivity, the RPE cell also generates suppressive molecules. Recently, chronic immune reactivity has been implicated in a number of retinal diseases, such as age-related macular degeneration (AMD). Current evidence suggests that the generation of excessive retinal inflammation may be the consequence of a loss of RPE immunosuppressive factors. Herein, we summarize the varied interactions of the RPE cell with the immune response and highlight how the RPE cell survives and participates in this dynamic environment.

CD4 T-cell suppression by cells from Toxoplasma gondii-infected retinas is mediated by surface protein PD-L1

In the inflamed retina, CD4(+) T cells can cause retinal damage when they are not properly regulated. Since tissue expression of major histocompatibility complex (MHC) class II and costimulatory molecules is a key mechanism for regulating effector T cells, we tested the hypothesis that upregulation of these proteins in the retina contributes to the regulation of CD4 T cells. Here we report that in retinas infected with the protozoan parasite Toxoplasma gondii, MHC class II is upregulated on infiltrating leukocytes as well as on resident retinal cells, including photoreceptors. Flow cytometric analysis indicated that B7 costimulatory family members (CD80, CD86, ICOS-L, and programmed death ligand 2 [PD-L2]) were not expressed on class II(+) cells. In contrast, PD-L1 (also named B7-H1 or CD274) was expressed on the majority of both hematopoietic and resident retinal MHC class II-expressing cells. Retinal cells from Toxoplasma-infected animals were able to suppress T-cell activation in a PD-L1-dependent manner. Finally, we demonstrate that the expression of MHC class II and PD-L1 was critically dependent on gamma interferon (IFN-gamma) expression. These data suggest that retinal MHC class II and PD-L1 expression is a novel mechanism by which the retina protects itself from CD4 T-cell-mediated immune damage in ocular toxoplasmosis and other types of retinal immune responses.

Major histocompatibility complex molecules on parenchymal cells of the target organ protect against autoimmune disease

Parenchymal cells of the autoimmune organ may only express major histocompatibility complex (MHC) molecules during the disease process. In this paper, we hypothesize that the appearance of MHC molecules on parenchymal cells may augment the activation of invading autoreactive T cells and either exacerbate or suppress local inflammation. It is speculated that like many biological responses this is a two-edge sword - namely, the expression of modest levels of MHC molecules may inhibit the activation of invading T cells, whereas overexpression of these molecules may promote activation of autoimmune T cells, enhancing the inflammatory cascade, thus leading to tissue damage.

Cytokines and chemokines in uveitis: is there a correlation with clinical phenotype?

Uveitis is a general term for intraocular inflammation and includes a large number of clinical phenotypes. As a group of disorders, it is responsible for 10% of all registered blind patients under the age of 65 years. Immune-mediated uveitis may be associated with a systemic disease or may be localized to the eye. The pro-inflammatory cytokines interleukin (IL)-1beta, IL-2, IL-6, interferon-gamma and tumor necrosis factor-alpha have all been detected within the ocular fluids or tissues in the inflamed eye together with others, such as IL-4, IL-5, IL-10 and transforming growth factor-beta. The chemokines IL-8, monocyte chemoattractant protein-1, macrophage inflammatory protein (MIP)-1alpha, MIP-1beta and fractalkine are also thought to be involved in the associated inflammatory response. There have been a number of studies in recent years investigating cytokine profiles in different forms of uveitis with a view to determining what cytokines are important in the inflamed eye. This review attempts to present the current state of knowledge from in vitro and in vivo research on the inflammatory cytokines in intraocular inflammatory diseases.

Cytokines in immunotherapy of experimental uveitis

A better understanding of the basic mechanisms of uveitis and of the role of cytokines in experimental ocular inflammation autoimmune diseases should allow us to define new approaches for therapy. Modulation of the cytokine network by either blocking cytokine activity or administration of regulatory Th2 cytokines has shown its efficacy in several experimental autoimmune diseases including uveitis. However, cytokines present pleiotropic activities and thus may exert different effects depending on the autoimmune diseases, making interventions on their production complex. Anti-cytokine therapy or a combination of anti-cytokine drugs, antibodies, and cytokine gene therapy to synergize the therapeutical effects of other treatments appear to be of interest. Improvements in drug delivery and in biotechnology will also allow us to elaborate new and safe immunomodulatory strategies.

Basic pathogenic mechanisms operating in experimental models of acute anterior uveitis

Acute anterior uveitis is a recurrent inflammatory disease of the eye that occurs commonly, is distressing for the patient, and may have potentially blinding sequelae. The pathogenesis of the disease is poorly understood, and anti-inflammatory treatment is consequently non-specific and may be associated with significant complications. Animal models are a possible key to a better understanding of this disease. In one model, rats and mice develop a relatively short-lived anterior uveal inflammation almost immediately after systemic injection of bacterial endotoxin. Accumulating evidence suggests that cytokine production by resident uveal macrophages initiates endotoxin-induced uveitis which is characterized by an infiltration of neutrophils and mononuclear cells. A second model displays features in keeping with a delayed-type hypersensitivity immune response. Experimental melanin-induced uveitis is an acute recurrent uveitis with delayed onset but extended duration, observed when rats are immunized with bovine ocular melanin. Both animal models have clinical features in common with acute anterior uveitis, although experimental melanin-induced uveitis appears to mimic the human disease more closely. Novel treatment options to target implicated inflammatory cells and molecules are currently under consideration.

Influence of viral infection on expression of cell surface antigens in human retinal pigment epithelial cells

BACKGROUND

Subacute viral infection is known to change the phenotype of infected cells, thereby causing immune-mediated tissue damage. The aim of this study was to investigate the expression of different cell surface molecules on human retinal pigment epithelial cells (RPEC) following viral infection, with special emphasis on those having immune-regulatory functions.

METHODS

Cultured RPEC were infected with cytomegalovirus (CMV), coxsackie-virus B3 (CVB) or herpes simplex virus type I (HSV). Double-staining fluorescence technique was used for visualization of virus infection and cell surface markers in the same cells by laser microscopy.

RESULTS

CMV downregulated MHC class I antigens on RPEC, whereas CVB and HSV did not alter MHC class I antigen expression. No induction of class II antigens was observed in RPEC infected with CVB, HSV or CMV. The intercellular adhesion molecule ICAM-1 (CD54) was strongly expressed in uninfected RPEC, and a slight increase was observed after virus infection. Vascular cell adhesion molecule 1 (VCAM-1) was expressed in low amounts in both uninfected and infected RPEC. No expression of intercellular adhesion molecule 2 (ICAM-2), E-selectin ELAM-1 or lymphocyte-function-associated antigen 1 (LFA-1) was observed on RPEC before or after virus infection.

CONCLUSION

Downmodulation of immune-regulating cell surface antigens has been suggested to provide a means of long-term survival of viruses in the infected cell, favoring establishment of persistent infection. Our observation in cultured human RPEC indicates that this mechanism might indeed contribute to the development of disease affecting retinal tissue.

Mucosal tolerance to experimental autoimmune myasthenia gravis is associated with down-regulation of AChR-specific IFN-gamma-expressing Th1-like cells and up-regulation of TGF-beta mRNA in mononuclear cells

Oral and nasal administration of nicotinic acetylcholine receptor (AChR) to Lewis rats prior to myasthenogenic immunization with AChR and complete Freund's adjuvant (CFA) resulted in prevention or marked decrease of the severity of experimental autoimmune myasthenia gravis (EAMG) and suppression of AChR-specific B-cell responses and of AChR-reactive T-cell function. To examine the involvement of immunoregulatory cytokines and the underlying mechanisms involved in tolerance induction, in situ hybridization with radiolabeled cDNA oligonucleotide proves was adopted to enumerate mononuclear cells (MNC) expressing mRNA for the proinflammatory cytokine interferon-gamma (IFN-gamma), the B cell-stimulating interleukin-4 (IL-4), and the immunosuppressive transforming growth factor-beta (TGF-beta). Popliteal and inguinal lymph nodes from EAMG rats contained elevated numbers of AChR-reactive IFN-gamma, IL-4, and TGF-beta mRNA-expressing cells, compared to control rats receiving PBS orally or nasally and injected with CFA only. Oral and nasal tolerance was accompanied by decreased numbers of AChR-reactive IFN-gamma and IL-4 mRNA-expressing cells and strong up-regulation of TGF-beta mRNA-positive cells in lymphoid organs when compared to nontolerized EAMG control rats. The results suggest that IFN-gamma and IL-4 are central effector molecules in the development of EAMG and that TGF-beta plays an important role in tolerance induction to EAMG.

The influence of penetrating keratoplasty and cyclosporin A therapy on MHC class II (Ia)-positive cells in the rat iris and choroid

BACKGROUND

The presence of Ia-positive cells (MHC class II equivalent) has been previously reported in the iris and choroid of various species. They have been reported to have both round and dendritic morphologies; the latter may represent classic dendritic cells, potent antigen-presenting cells (APCs). It is possible that the dendritic-like cells play a important role in (auto)immune processes of uveal and other ocular tissues. Using the flat or whole mount technique, the distribution of Ia-positive cells in the rat iris and choroid was investigated following penetrating keratoplasty (PKP) and following treatment with cyclosporin A (CsA).

METHODS

Lewis (LW) rats received corneal buttons from Lewis-Brown Norway (LW-BN) donors and were randomly assigned to the following groups: (i) operated, untreated (n = 24); (ii) operated, CsA-treated (10 mg/kg i.m.; n = 22). Controls were groups (iii) normal LW rats (n = 13); (iv) unoperated, CsA-treated (16 days' treatment; n = 8); (v) anterior perforation of the anterior chamber (n = 3); (vi) eight corneal sutures only (n = 4); (vii) syngeneic operated (LW to LW; n = 4). Animals of groups (i) and (ii) were killed on the 5th, 9th and 13th postoperative days and on appearance of the corneal rejection (group i, day 13; group ii, day 16). Both eyes were enucleated, immediately fixed, and iris-choroid flat mounts were examined for Ia-positive cells using APAAP immunohistochemistry.

RESULTS

In the normal Lewis rat iris, scattered Ia-positive cells of both nondendritic and dendritic morphology were observed. CsA treatment in the unoperated rat did not result in a significant decrease in the percentage of dendritic cells in the iris or choroid. Anterior chamber perforation, the placement of sutures in the cornea and syngeneic PKP resulted in a moderate increase in iris Ia-positive cells. Allogeneic transplantation resulted in a large increase in both types of Ia-positive cells, particularly on day 13 with corneal rejection. In group ii, an initial decrease in Ia-positive cells until day 13 was observed; upon rejection (day 16), the histological picture was similar to that of untreated animals. Alterations in the operated choroid were also apparent following CsA treatment.

CONCLUSION

Corneal transplantation in the Lewis rat results in an increase in Ia-positive cells in the iris; CsA therapy can delay but not prevent this reaction. Changes in choroidal Ia-positive cells following PKP were not apparent, their numbers being affected only by CsA treatment following grafting.

Immunohistochemical and cytokine analysis of eyes from rats with adjuvant arthritis

Adjuvant induced arthritis in the rat is an animal model of juvenile chronic arthritis (JCA). An anterior uveitis may also develop in this model which closely resembles that seen in association with JCA in the human. Female Lewis rats (150-225 g) were injected intradermally with either Freund's complete adjuvant (FCA, n=5) or Freund's incomplete adjuvant (FIA, n=5). Eyes were examined by slit-lamp biomicroscopy every two days, and the animals sacrificed 21 days post-immunisation. Aqueous humour and serum interleukin-6 (IL-6) levels were determined using the B(9) bioassay, and serial tissue sections of the globes were stained with a variety of monoclonal antibodies. In the FCA group, arthritis was detected in two rats, but no rats from either group developed clinical uveitis. Immunohistochemical analysis revealed greater numbers of macrophages and MHC class II+ve cells in the irises and ciliary bodies of FCA treated rats than were seen in the FIA group. No other cellular infiltrate was detected. Serum IL-6 levels were greater in the FCA group (range 6-122 U/ml, median 42) than the FIA group (range 2-27, median 3) (p=0.018), the highest values seen in the two rats which developed arthritis (100, 122 U/ml). In the aqueous of both groups, IL-6 levels were <5 U/ml, and albumin levels were not significantly different (FCA median=2.0 mg/ml, FIA median=1.8). The authors″ results suggest that in the adjuvant induced arthritis model, infiltration with macrophages and MHC class II+ve cells occurs in the absence of clinical uveitis.

Activated T lymphocytes in epiretinal membranes from eyes of patients with proliferative diabetic retinopathy

BACKGROUND

To investigate the potential contribution of immune-mediated processes to the development of proliferative diabetic retinopathy (PDR), an immunohistochemical study was undertaken to characterize the infiltrating immune cells in epiretinal membranes from the eyes of patients with PDR.

METHODS

A total of 18 PDR epiretinal membrane specimens obtained surgically from pars plana vitrectomy were studied by using a panel of monoclonal antibodies against T lymphocytes (CD4 and CD8), interleukin-2 (IL-2) and interleukin-2 receptors (IL-2R).

RESULTS

Twelve of 18 specimens (67%) contained CD4-positive cells and 13 of 18 (73%) contained CD8-positive cells. IL-2 was found in 12 of 18 samples (67%), of which 11 also contained CD4-positive cells, and IL-2R was detected in 10 of 18 membranes (56%), of which 9 contained CD4-positive cells and released IL-2. Most of the IL-2R-positive membranes were from type I diabetic patients, 40% of them from patients younger than 40 years.

CONCLUSION

Our study demonstrated the involvement of activated immune cells and release of lymphokine(s) in more than half of the diabetic epiretinal membranes tested and revealed that the processes of immune responses and the biological effects of lymphokine(s) may play an important part in the development of epiretinal membranes of PDR, especially in young-onset and type I diabetes.

Ectopic expression of gamma interferon in the eye protects transgenic mice from intraocular herpes simplex virus type 1 infections

Transgenic (rho gamma) mice provide a model for studying the influence of gamma interferon (IFN-gamma) produced in the eye on ocular and cerebral viral infection. To establish this model, we injected BALB/c- and C57BL/6-derived transgenic and nontransgenic mice of different ages intravitreally with herpes simplex virus type 1 (HSV-1) strain F. Eye and brain tissues of these mice were assessed for pathological and immunocytochemical changes. HSV-1 infection induced severe retinitis of the injected eyes and infection of the brain in all mice. In transgenic mice inoculated with HSV-1, the left, nontreated eyes were protected from retinitis, whereas nontransgenic mice developed bilateral retinitis. Additional intravitreal injection of IFN-gamma with the virus protected the noninoculated eyes of nontransgenic mice. Three-week-old nontransgenic mice died from HSV-1 infection, whereas transgenic mice of the same age and nontransgenic mice intravitreally treated with IFN-gamma survived. Ocular IFN-gamma production increased the extent of inflammation in transgenic mice but did not have a significant influence on the growth of HSV-1 until day 3 after inoculation and did not influence the neuroinvasion of this virus. Thus, the effects of IFN-gamma were not caused by an early block of viral replication. Possible mechanisms of IFN-gamma action include activation of the immune response, alteration of the properties of the virus, and direct protection of neurons.

Corneal endothelial cells block T cell proliferation, but not T cell activation or responsiveness to exogenous IL-2

We previously reported that Ia+ monolayers of LEW rat corneal endothelial (CE) cells were unable to stimulate proliferation of MHC compatible T cell lines or IL-2 release from hybridomas, and inhibited [3H]-thymidine incorporation when added to conventional lymphocyte proliferation assays. Our purpose was to further analyze the mechanism of the inhibitory activity of CE cells on T lymphocyte activation. Mitogen-induced proliferative responses of splenocytes were found to be as susceptible to inhibition by CE cells as previously reported for antigen-specific activation of T cell lines. Antigen presenting cell (APC) antigen pulsing experiments showed that CE cells did not inhibit antigen processing. Flow cytometry and microscopic observation of the co-cultures revealed that T cells became activated in the presence of antigen, APC and CE cells, exhibiting morphologic changes of blast cell formation, although they did not divide unless given exogenous IL-2. However, if T cells were preactivated in the absence of CE cells, they were no longer susceptible to inhibition if subsequently transferred into CE cell-conditioned medium or onto CE cells. Evidence for an inhibitory factor in CE cell culture supernatant was revealed by two approaches: 1) addition of conditioned medium from CE cell cultures led to inhibition of lymphocyte proliferation assays, and 2) split-well assays also demonstrated the existence of a cell-free immunosuppressive factor produced by the CE cells. However, the inhibition mediated by supernatant alone was less potent than that by direct T cell contact with CE cells, implying that cell-cell interaction contributed to the inhibition. Indomethacin, a prostaglandin synthetase inhibitor, did not reverse CE cell-mediated inhibition. Neutralizing antibodies to TGF-beta 1 and 2 did not reverse the inhibition by CE cells. In summary, T cells received activation signals from APC in the presence of CE cells, but proliferation was inhibited unless exogenous lymphokine was added.

Clinical and immunohistochemical correlation of herpetic keratitis with the expression of HLA-DR antigen

The corneal buttons after corneal graft of 22 patients with herpetic keratitis were studied (16 male, 6 female; 7-87 years of age). Ten still had active inflammation, while 12 had stabilized by the time of the study. Different degrees of neovascularization were observed in 19 cases. HLA-DR antigen was detected in the corneal epithelium in 7 of 22 cases (32%), in the corneal stroma in 17 of 22 cases (77%), and in the endothelium in 9 cases (41%) by using the immunohistochemical technique. The expression of HLA-DR antigen was more common and more marked in active herpetic keratitis (90%) and in neovascularized corneas (84%). The frequency and density of HLA-DR expression in perforating corneal ulcers were no higher than in other cases, but anterior synechia was accompanied by strong expression of HLA-DR antigen in the corneas. The expression of HLA-DR antigen was not only detected in the peripheral, but also in the central area of the specimens. The cells expressing HLA-DR antigen in corneas were mainly corneal cells. The results showed a close relationship between HSV-keratitis and the expression of HLA-DR antigen, which may be induced during the clinical course of the disease. The expression of HLA-DR might be one of the factors in the recurrent onset of the disease and a significant sign of the prognosis of corneal transplantation for these patients.

Immunopathological findings in conjunctival cells using immunofluorescence staining of impression cytology specimens

The conventional technique of impression cytology provides a non-invasive method for the evaluation of conjunctival epithelium alterations. Using indirect immunofluorescence procedures two inflammatory markers, class II MHC antigens HLA DR and the receptor to IgE (CD23), were sought in impression cytology specimens obtained from 80 patients. In normal subjects conjunctival epithelial cells did not show any reactivity. Only scattered dendritic cells were found to express class II antigens but not the receptor to IgE. In contrast patients with chronic conjunctivitis of various aetiologies, mainly infectious or allergic, had 40-100% of brightly positive conjunctival cells for one or both antigens. In these cases epithelial cells and goblet cells reacted similarly. Twenty four eyes in 12 patients with idiopathic dry eye syndrome disclosed results similar to those from normal conjunctival specimens. However 18 other specimens from patients suffering from idiopathic tear deficiency but undergoing multiple substitutive treatments for dry eye had moderate to strong positivity for HLA DR and/or the receptor to IgE (20-100% of cells). As these results were independent of the degree of squamous metaplasia the expression of these membrane markers may reflect local inflammation in addition to tear deficiency, possibly due to sensitisation to the eye drops used. These immunocytological techniques thus provide useful methods of investigating conjunctival inflammation and allergy. They may constitute valuable aid in the diagnosis and appropriate treatment of ocular surface disorders.

Interferon-gamma induces the expression of major histocompatibility antigens by human retinal glial cells

Retinal glial cells normally do not express major histocompatibility (MHC) molecules. However, the expression of MHC antigens by retinal glial cells under certain pathological conditions suggests that these cells may play a role in immune responses of the retina. At present, the identity of molecules that may regulate the expression of class I and class II MHC antigens by retinal glial cells has not been established. Since interferon-gamma (IFN-gamma) induces MHC antigens in a variety of cell types, we examined the effect of this lymphocyte product on class I and class II antigen expression by human retinal glial cells in culture. Glial cells derived from post-mortem donor eyes were exposed to recombinant human IFN-gamma. Cells with MHC class I or class II antigens were detected with the use of specific monoclonal antibodies that were labeled directly or indirectly with fluorescent probes. Fluorescence of labeled cells was assayed by flow cytometry. Exposure to IFN-gamma increased the expression of class I and class II antigens by the retinal glial cells. Double labeling studies showed that 90% of the glial cells induced to express class II antigens also had class I antigens. Overall, the results show that IFN-gamma can regulate the expression of MHC molecules by human retina glial cells in culture. These findings are consistent with the concept that glia may play a role in immunological disorders affecting the retina.

Immune privilege and suppression of immunogenic inflammation in the anterior chamber of the eye

Immunologic privilege of the anterior chamber has been associated with the capacity to induce a unique form of deviant systemic immunity after anterior chamber (AC) immunization. However, the capacity of privilege to suppress expression of immunity in the AC has not been examined. We studied the ability of the AC to sustain immunogenic inflammation after direct antigen challenge (delayed hypersensitivity-DH) in C57BL/6 mice primed to M tuberculosis (MT) antigens. Compared to subcutaneous and subconjunctival sites where primed mice demonstrated vigorous and significant DH, the anterior chambers of these mice failed to develop signs of inflammation unless toxic doses of antigen were injected. In an attempt to promote intraocular DH, the AC's of MT-primed mice were pre-treated with subinflammatory intracameral injections of IFN-gamma, a cytokine that antagonizes TGF-beta, recruits antigen presenting cells (APC) from the blood and activates resident APC precursors. It was observed that AC injection of IFN-gamma, followed 3 days later by AC challenge with 200 ng of MT, resulted in severe intraocular inflammation only in primed (but not naive) mice. We conclude that the normal mouse AC resists DH unless its immunosuppressive microenvironment is abolished, as in these experiments by IFN-gamma. We propose that impaired expression of cell-mediated immunity is an important component of immune privilege of the AC.

Immunohistologic study of epiretinal membranes in proliferative vitreoretinopathy

We performed an immunohistologic study on 11 specimens of epiretinal membranes surgically obtained from patients who had rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Immunostaining procedures were used to identify immunoglobulin and complement deposits, to visualize class II antigen expression by proliferating cells, and to determine eventual infiltration by cells of the immune system. Diffuse deposits of IgG, IgA, IgE, C1q, C3c, and C3d were found in epiretinal membranes, whereas numerous cells, including glial or pigmented epithelial cells, expressed HLA-DR and HLA-DQ antigens. Some macrophages and B or T8 lymphocytes were identified. These results suggest activation of the immune system during the course of proliferative vitreoretinopathy. Class II antigen expression could be dependent upon growth-promoting factors and interferon gamma and could play a crucial role in this immune reaction, which resulted in immunoglobulin deposition and activation of complement. However, the eventual role of immune phenomena in the extension of proliferative processes remains to be determined.