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Vergouwen DPC, Ten Berge JC, Boukhrissi S, Rothova A, Schreurs MWJ. Clinical Relevance of Autoantibodies and Inflammatory Parameters in Non-infectious Scleritis. Ocul Immunol Inflamm 2022; 30:1859-1865. [PMID: 34464233 DOI: 10.1080/09273948.2021.1966050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Scleritis is a potentially blinding disorder, with highly unpredictable course and outcome. We analyzed the prevalence and clinical relevance of autoantibodies and inflammatory parameters in non-infectious scleritis. METHODS Retrospective analysis of laboratory findings in all consecutive patients at the department of Ophthalmology of the Erasmus MC with non-infectious scleritis. RESULTS We included 81 patients with non-infectious scleritis. A systemic autoimmune disease was present in 46%. Positive anti-nuclear antibodies were found in 30%, anti-neutrophil cytoplasmic antibodies were positive in 19%, and the presence of rheumatoid factor was shown in 17%. The aforementioned autoantibodies, as well as inflammatory parameters, failed to show prognostic clinical value. In contrast, anti-citrullinated peptide antibodies (ACPA), found in 9% of scleritis patients, were significantly associated with the development of scleral necrosis (P = .01). CONCLUSIONS The presence of ACPA in patients with non-infectious scleritis was associated with the development of scleral necrosis.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - S Boukhrissi
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M W J Schreurs
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Vergouwen DPC, Rothova A, Berge JCT, Verdijk RM, van Laar JAM, Vingerling JR, Schreurs MWJ. Current insights in the pathogenesis of scleritis. Exp Eye Res 2020; 197:108078. [PMID: 32504648 DOI: 10.1016/j.exer.2020.108078] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
Scleritis is a sight-threatening inflammation characterized by severe pain and redness of the eye. It can cause blindness by severe complications like scleral and corneal necrosis, keratitis, and uveitis. The pathogenesis of scleritis is largely unknown due to a combination of the rarity of the disease, the little available human tissue-based research material, and the lack of animal models. The immune system is assumed to play a crucial role in the pathogenesis of scleritis. Multiple clues indicate probable antigenic stimuli in scleritis, and the involvement of matrix metalloproteinases in the destruction of scleral tissue. In this article we review the current insights into the pathogenesis of scleritis, and we suggest new hypotheses by implementing knowledge of systemic autoimmune disease pathogenesis. Understanding the pathogenesis of scleritis is crucial to improve the clinical management, as well as to find novel treatment modalities.
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Affiliation(s)
- D P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - A Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J C Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R M Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A M van Laar
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Section Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J R Vingerling
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M W J Schreurs
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Otasevic L, Zlatanovic G, Stanojevic-Paovic A, Miljkovic-Selimovic B, Dinic M, Djordjevic-Jocic J, Stankovic A. Helicobacter pylori: an underestimated factor in acute anterior uveitis and spondyloarthropathies? Ophthalmologica 2007; 221:6-13. [PMID: 17183194 DOI: 10.1159/000096515] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 02/09/2006] [Indexed: 01/13/2023]
Abstract
Acute anterior uveitis (AAU) is the most common form of intraocular inflammation, but its aetiology is still unclear. Fifty percent of AAU patients are HLA-B27-positive, and half of these also have spondyloarthropathies (SpA). Numerous serological studies have shown elevated levels of serum antibodies to various Gram-negative bacteria in HLA-B27-positive AAU and SpA patients. Antigenic similarities between these bacteria and host components (HLA-B27) have already been shown. Still, the mechanism underlying these diseases has not been clarified. Among the Gram-negative bacteria, Helicobacter pylori has not been screened in AAU patients. The purpose of our study was to see if this common human pathogen somehow interferes with AAU. In addition Chlamydia trachomatis, Yersinia enterocolitica 03 and 09, Salmonella sp. and Proteus OX19 were also examined. A total of 60 patients consisting of 4 groups (15 patients with AAU, 15 with SpA, 15 with AAU+SpA and 15 healthy control persons) were examined. A high percentage of the serological results of all investigated bacteria was positive: 80% in the AAU, 93.3% in the SpA and 100% in the AAU+SpA group, while it amounted to 66.7% in the control group (p < 0.05). H. pylori showed the highest percentage of positivity in all 3 patient groups (66.7% in the AAU, 73.3% in the SpA and 80% in the AAU+SpA group). In contrast, 26.7% of the controls were anti-H.-pylori-positive, thus showing a statistically significant difference between the patients and the control group (p < 0.05). HLA-B27/B7-CREG positivity was detected in 53.3% of the AAU, 66.7% of the SpA and 93.3% of the AAU+SpA patients and in none of the controls. Our results suggest that H. pylori might be a candidate participating in the development of AAU and SpA. They also support the theory of genetic (HLA-B27) and exogenous factors (Gram-negative bacteria) as probable background of these diseases.
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Affiliation(s)
- Ljiljana Otasevic
- Clinic of Ophthalmology, University Clinical Centre Nis, Nis, Serbia and Montenegro.
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Trevisani VF, Mattos KT, Esteves RF, Olialves SM, Andrade LE. Autoantibodies specificity in acute anterior uveitis according to the presence of the HLA-B27 allele. Ocul Immunol Inflamm 2001; 9:231-42. [PMID: 11935433 DOI: 10.1076/ocii.9.4.231.3952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To study HLA-B27(+) and HLA-B27(-) patients with AAU with respect to the frequency and specificity of organ-specific and non-organ-specific autoantibodies. METHODS Fifty-seven consecutive patients with AAU were subjected to ophthalmologic and rheumatologic evaluation as well as to autoantibody determination: antinuclear antibodies (ANA), rheumatoid factor (RF), anticardiolipin, anti-smooth muscle, and anti-parietal cell antibodies, and immunoblot for antibodies to HeLa cells and to bovine iris extract. HLA-B27 was determined by a microlymphocytotoxicity assay. Statistical analysis employed chi-square test, Fisher's exact test, and McNemar test. RESULTS Thirty-four patients had the HLA-B27 allele (B27(+)/AAU) and 23 did not (B27(-)/AAU). ANA, RF, anticardiolipin, and anti-parietal cell antibodies appeared in low frequency. No patient presented anti-smooth muscle antibody. Immunoblot showed a high frequency of antibodies to HeLa cell proteins in B27(-)/AAU patients with predominant reactivity at 46 kDa and 56 kDa. In contrast, sera from B27(+)/AAU patients reacted poorly against HeLa cell antigens. Immunoblot with bovine iris extract showed a significant frequency of antibodies in both groups, with a predominant response to antigens with an estimated mobility of 35, 52, and 54 kDa. CONCLUSION Antibodies specific to iris antigens were equally frequent in both acute uveitis groups, whereas non-organ-specific autoantibodies, especially those to HeLa cell proteins, were far less frequent in B27(+)/AAU than in B27(-)/AAU patients.
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Affiliation(s)
- V F Trevisani
- Rheumatology and Ophthalmology Divisions, São Paulo Federal University, São Paulo, SP, Brazil.
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Romero-Piffiguer MD, Ferrero M, Iribarren P, Gea S, Ontivero S, Luna JD, Muiño JC, Bevolo G, Juárez CP. Inflammatory arthritic process, iridocyclitis and immune response to articular and ocular antigens in Wistar rats injected with T. gondii trophozoites. J Autoimmun 1999; 12:199-208. [PMID: 10222029 DOI: 10.1006/jaut.1998.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study deals with the potential role of T. gondii in inducing an arthritic inflammatory process. Wistar rats were injected subcutaneously (sc) into the right footpad with viable T. gondii trophozoites emulsified in incomplete Freund's adjuvant (IFA). The control group was injected with IFA. All parasite-injected animals developed a local inflammatory process characterized by hind limb swelling and marked restriction of ankle motility approximately 25 days after injection. Histopathogical studies of the joints, carried out 90 days after injection, revealed intense mononuclear infiltration, proliferation of granulation tissue, giant cells and necrosis in the synovia of 90% of T. gondii-injected rats. Strikingly, 40% (4/10) of the parasite-injected animals developed iridocyclitis, which was characterized by intense mononuclear infiltration around the iris-ciliary microvasculature in two animals and a slightly pronounced infiltrate of polymorphonuclear and mononuclear cells in two other animals. Antibodies to soluble T. gondii antigens (STAg) were detected in all parasite-injected rats. Antibodies against articular and ocular antigens such as proteoglycans, type II collagen, retinal S antigen and iris antigens were detected by ELISA in 40, 80, 70 and 70% of T. gondii -injected animals, respectively. Control animals injected with IFA failed to develop any articular or ocular process or humoral immune response. The present study demonstrated that footpad sc injection of Wistar rats with viable T. gondii trophozoites was able to induce a localized inflammatory arthritic process which, in some of the animals, was accompanied by iridocyclitis and immune response against articular and ocular components.
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Sahly H, Podschun R, Kekow J, Nölle B, Gross WL, Ullmann U. Humoral immune response to Klebsiella capsular polysaccharides in HLA-B27-positive patients with acute anterior uveitis and ankylosing spondylitis. Autoimmunity 1999; 28:209-15. [PMID: 9892502 DOI: 10.3109/08916939808995368] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Klebsiella is suggested to trigger ankylosing spondylitis (AS) and acute anterior uveitis (AAU) in HLA-B27-positive individuals. Previous investigations showed an increased antibody response to the Klebsiella capsular types K26, K36, and K50 in sera from HLA-B27-positive AS patients. In the present study the prevalence and titers of antibodies against Klebsiella capsular antigens were measured by means of an ELISA in 32 sera from HLA-B27-positive AAU patients either with (n = 10) or without AS (n = 22) and compared with sera from HLA-B27-negative AS-patients (n = 13). Sera from either HLA-B27-positive (n = 45) or negative (n = 40) healthy individuals served as control. Sera from HLA-B27-positive AAU with or without AS showed significantly higher antibody prevalence and IgG-titers against capsular antigens of the Klebsiella serotypes K26, K36, and K50 when compared with sera from HLA-B27-negative AS patients or with healthy controls. These results might be taken to indicate the predominance of these serotypes in the HLA-B27-associated AS and AAU.
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Affiliation(s)
- H Sahly
- Department of Medical Microbiology and Virology, University of Kiel, Germany.
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Bañares A, Hernández-García C, Fernández-Gutiérrez B, Jover JA. Eye involvement in the spondyloarthropathies. Rheum Dis Clin North Am 1998; 24:771-84, ix. [PMID: 9891710 DOI: 10.1016/s0889-857x(05)70041-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Eye inflammation, especially uveitis, is a prominent feature of spondyloarthropathies. Uveitis associated with ankylosing spondylitis and Reiter's syndrome usually is a unilateral acute anterior uveitis with a high tendency to recur sometimes in the contralateral eye. Uveitis associated with undifferentiated spondyloarthropathy, inflammatory bowel disease, and psoriasis may be less characteristic in its presentation, with a higher tendency to posterior pole involvement, bilaterality, and chronicity. Although acute anterior uveitis is grouped into the spectrum of human leukocyte antigen B27-related disease, other genetic and environmental factors including infections by gram-negative bacteria and gut inflammation can play a role in its pathogenesis. The prognosis of uveitis usually is excellent with topical treatment, and only those with posterior pole involvement or a high tendency to recur or to chronicity might benefit from immunosuppressive therapy.
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Affiliation(s)
- A Bañares
- Service of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
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Aihara Y, Shimizu C, Fujiwara Y, Yokota S. Acute anterior uveitis in a child with HLA-B60 after Salmonella enteritis associated with the transient appearance of auto-antibody. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1996; 38:286-7. [PMID: 8741325 DOI: 10.1111/j.1442-200x.1996.tb03489.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A Japanese girl with HLA-B60, but not B27, who developed acute anterior uveitis after Salmonella enteritis is described. There was no evidence of arthritis or urethritis during this episode. This is the first report that acute anterior uveitis after Salmonella enteritis was associated with the transient appearance of auto-antibody in the serum at an early period.
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Affiliation(s)
- Y Aihara
- Department of Pediatrics, Urafune Hospital of Yokohama City, University School of Medicine, Japan
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Abstract
Acute anterior uveitis (AAU) or iritis is an inflammatory disorder of the anterior structures of the eye that may be associated with a number of disease entities. A significant proportion of patients will have no evidence of an underlying disorder and are labeled as idiopathic. Within this group approximately 50% will possess the human leukocyte antigen, HLA-B27, and some will have an associated spondyloarthropathy such as ankylosing spondylitis or Reiter's syndrome. Nevertheless, a number of HLA-B27-positive patients have no apparent underlying rheumatic disorder. The potential interplay of HLA-B27 and certain infective agents in the pathogenesis of AAU is discussed with particular reference to Yersinia species. Presentation of a uveitogenic peptide, similar to the arthritogenic peptide model in spondyloarthropathies, may be a mechanism involved in the development of AAU. Experimental models in animals have increased our understanding of the roles of retinal proteins and bacterial peptides, as well as T cells and cytokines, in the pathogenesis of uveitis. As in animal models of arthritis, certain retinal peptides (in conjunction with adjuvant therapy) can induce uveitis in animals. The treatment of isolated AAU usually involves topical medication and the prognosis is good. Occasional cases, especially those associated with systemic disorders, may require the addition of systemic corticosteroids or other immunosuppressive medications.
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Dick AD. Experimental approaches to specific immunotherapies in autoimmune disease: future treatment of endogenous posterior uveitis? Br J Ophthalmol 1995; 79:81-8. [PMID: 7880799 PMCID: PMC505026 DOI: 10.1136/bjo.79.1.81] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A D Dick
- Centenary Institute of Cancer Medicine and Cell Biology, Sydney, Australia
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Monowarul Islam SM, Numaga J, Mitsui H, Maeda H. Immunology of AAU in AS patients. IMMUNOLOGY TODAY 1994; 15:595. [PMID: 7710528 DOI: 10.1016/0167-5699(94)90223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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