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Nussenblatt RB, Calogero D, Buchen SY, Leder HA, Goodkin M, Eydelman MB. Rabbit intraocular reactivity to endotoxin measured by slit-lamp biomicroscopy and laser flare photometry. Ophthalmology 2012; 119:e19-23. [PMID: 22578448 DOI: 10.1016/j.ophtha.2012.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 02/29/2012] [Accepted: 04/05/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the ocular reactivity of the rabbit to an intracameral injection of a dispersive ophthalmic viscosurgical device (OVD) containing various levels of bacterial endotoxin using slit-lamp biomicroscopy and laser flare photometry. DESIGN Experimental, randomized, masked animal study. PARTICIPANTS Thirty Dutch-Belted rabbits. METHODS The rabbits were randomized into 6 groups to receive 0.05 ml of a hydroxypropyl methylcellulose-based dispersive OVD to which had been added one of 5 different doses of bacterial endotoxin ranging from 0.02 to 1.4 endotoxin units (EUs) or a vehicle control to both eyes. The eyes were evaluated for anterior segment inflammation at baseline and 3, 6, 9, 24, 48, and 72 hours after injection using slit-lamp biomicroscopy and laser flare photometry. MAIN OUTCOME MEASURES Corneal clarity and anterior chamber (AC) inflammation. RESULTS All the corneas remained clear throughout the study. Anterior chamber cells were seen at 6, 9, and 24 hours in 60% to 100% of the eyes intracamerally injected with endotoxin-containing OVD, and the response declined rapidly after 24 hours. A dose-response effect was seen between the concentration of endotoxin and the AC cell response. The aqueous flare response in eyes injected with the 2 highest doses of endotoxin was significantly greater (P<0.05) than that of controls. The amounts of fibrin observed in the AC were random, with no apparent dose-response effect seen. The flare values as obtained by laser flare photometry were consistent with the slit-lamp biomicroscopy flare findings up to grade 3+. However, the increase in laser flare value seemed to level off in eyes with more than 3+ flare. Neither measure of flare correlated with endotoxin level. CONCLUSIONS Among the parameters evaluated in this study, the AC cell response, evaluated by slit-lamp biomicroscopy and graded using a standard grading system, was found to be the most reliable indicator of the amount of endotoxin in the dispersive OVD. The use of laser flare photometry alone does not seem to be useful in detecting an ocular response to endotoxin contamination in OVDs.
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Yeh S, Fahle G, Forooghian F, Faia LJ, Weichel ED, Stout JT, Flaxel CJ, Lauer AK, Sen HN, Nussenblatt RB. Polymerase chain reaction-based ganciclovir resistance testing of ocular fluids for cytomegalovirus retinitis. ACTA ACUST UNITED AC 2012; 130:113-5. [PMID: 22232481 DOI: 10.1001/archophthalmol.2011.380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Liu B, Chan CC, Nussenblatt RB. Application of small molecules/macromolecules in ocular inflammatory diseases. Antiinflamm Antiallergy Agents Med Chem 2012; 11:113-120. [PMID: 22934741 DOI: 10.2174/187152312803305713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 06/01/2023]
Abstract
Macrobiomolecular treatments for ocular inflammatory diseases have been described in a previous review. This article mainly discusses the application of small molecules in uveitis therapy, which includes corticosteroids, salicylic acid (aspirin), metabolite analogs, and anti-oxidative agents. Additionally, we update recent advances in peptide and nucleic acid related therapies, and focus mainly on the calcineurin inhibitor, cyclosporine, oral tolerant retinal proteins/peptides, gene therapy and ribonucleic acid interference strategies. We classify these immunomodulatory agents by their molecular signatures and highlight the molecular structure and mechanisms of function. These developments in understanding molecular mechanisms of the diseases, with the advent of new technologies, advance current therapeutic approaches. The future direction is to tailor treatments to individual patients in order to provide the safest and most effective therapies for ocular inflammatory diseases.
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Rizzo LV, Vallochi AL, Belfort R, Holland GN, Nussenblatt RB. Authors' response. Br J Ophthalmol 2011. [DOI: 10.1136/bjophthalmol-2011-301237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dagur PK, Biancotto A, Wei L, Sen HN, Yao M, Strober W, Nussenblatt RB, McCoy JP. MCAM-expressing CD4(+) T cells in peripheral blood secrete IL-17A and are significantly elevated in inflammatory autoimmune diseases. J Autoimmun 2011; 37:319-27. [PMID: 21959269 PMCID: PMC3223259 DOI: 10.1016/j.jaut.2011.09.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 11/21/2022]
Abstract
Th17 cells are a subset of CD4(+) T cells characterized by production of IL-17 and are known to be key participants in inflammatory reactions and various autoimmune diseases. In this study we found that a subset of human CD4(+) T cells expressing MCAM (CD146) have higher mRNA levels of RORC2, IL-23R, IL-26, IL-22, IL-17A, but not IFN-γ, compared to CD4(+) T cell not expressing CD146. Upon TCR stimulation with CD3/CD28, CD4(+)CD146(+) T cells secrete significantly more IL-17A, IL-6, and IL-8 than do CD4(+)CD146(-) T cells. Low frequencies of CD4(+)CD146(+) T cells are found in the circulation of healthy adults, but the frequency of these cells is significantly increased in the circulation of patients with inflammatory autoimmune diseases including Behcet's, sarcoidosis and Crohn's disease. Patterns of gene expression and cytokine secretion in these cells are similar in healthy and disease groups. In Crohn's disease, the increase in CD4(+)CD146(+) cells in the circulation correlates with disease severity scores. These data indicate that expression of CD146 on CD4(+) T cells identifies a population of committed human Th17 cells. It is likely the expression of CD146, an endothelial adhesion molecule, facilitates adherence and migration of Th17 cells through the endothelium to sites of inflammation.
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Grunwald L, Newcomb CW, Daniel E, Kaçmaz RO, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Suhler EB, Thorne JE, Foster CS, Kempen JH. Risk of relapse in primary acute anterior uveitis. Ophthalmology 2011; 118:1911-5. [PMID: 21680024 PMCID: PMC3179829 DOI: 10.1016/j.ophtha.2011.02.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 01/04/2011] [Accepted: 02/25/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the risk of and risk factors for a second episode (relapse) among patients with remitted primary anterior uveitis. DESIGN Retrospective cohort study. PARTICIPANTS Patients with primary anterior uveitis presenting to 1 of 4 academic ocular inflammation subspecialty practices achieving remission of the primary episode within 90 days of initial uveitis diagnosis. METHODS Data were obtained by standardized chart review. MAIN OUTCOME MEASURES Time to relapse of anterior uveitis and risk factors for relapse. RESULTS We included 102 patients with a first episode of anterior uveitis who were seen within 90 days of first-ever uveitis onset and followed for 165 person-years after achieving remission of the initial episode. Most patients were female (60%) and white (78%). Forty patients had a recurrence of anterior uveitis. The incidence of relapse was 24% per person-year (95% confidence interval [CI], 17%-33%). At 1.5 years after remission, 61% (95% CI, 48%-71%) were still in remission. Younger adults had significantly higher relapse risk than middle-aged adults (hazard ratio [18- to 35-year-old persons vs. 35- to 55-year-old persons], 2.7; 95% CI, 1.3-6.0). CONCLUSIONS Our results suggest that many patients with remitted primary anterior uveitis presenting for tertiary uveitis care will relapse. Age in the young adult range was associated with higher risk of relapse. Given the high relapse risk, management of patients with primary anterior uveitis should include an explicit plan for detecting and managing relapses. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Furusato E, Shen D, Cao X, Furusato B, Nussenblatt RB, Rushing EJ, Chan CC. Inflammatory cytokine and chemokine expression in sympathetic ophthalmia: a pilot study. Histol Histopathol 2011; 26:1145-51. [PMID: 21751146 PMCID: PMC3140018 DOI: 10.14670/hh-26.1145] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sympathetic ophthalmia is a bilateral uveitis that develops after penetrating injury to one eye. This study aimed to identify the inflammatory cellular sub-phenotypes and expression of pertinent inflammatory cytokines/chemokines in sympathetic ophthalmia (SO). Dalen-Fuchs nodules (DFN), granulomas, and non-granulomatous foci of inflammation were micro-dissected from 15 cases. RNA was extracted, and quantitative PCR was performed to measure IL-17, IL-18, IL-23, IFN-γ, CCL19, CXCL11, CCL17, and CCL22 transcripts. Immunohistochemical methods were used to characterize CD3, CD4, CD8, CD20, CD68, and CD163 expression. Non-granulomatous lymphocytes were predominantly CD3-positive and expressed more IFN-γ than cells within granulomas, consistent with Th1 cells. In contrast, granulomas and DFN contained mainly CD68+, CD163+/- and expressed more IL-17, IL-18, IL-23, CCL19, and CXCL11 than non-granulomatous cells. Our data indicate for the first time that M1 macrophages are the predominant inflammatory cells within granulomas and DFN of SO. We further observed high levels of IL-17 within granulomas and the presence of Th1 and M1 cells.
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Faia LJ, Sen HN, Li Z, Yeh S, Wroblewski KJ, Nussenblatt RB. Treatment of inflammatory macular edema with humanized anti-CD11a antibody therapy. Invest Ophthalmol Vis Sci 2011; 52:6919-24. [PMID: 21498606 DOI: 10.1167/iovs.10-5896] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of treating macular edema, secondary to noninfectious uveitis, with a humanized anti-CD11a antibody. METHODS Six patients received weekly subcutaneous treatments for 16 weeks according to this open-label, prospective, noncomparative phase I/II trial. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were compared to baseline. Adverse events were recorded and assessed. Blood was sampled to assess the levels of CD56(bright) regulatory NK cells before initiation and after termination of the study. RESULTS No serious adverse events were reported by the patients. Patients' ages ranged from 22 to 82 years. Mean BCVA improvements were 6.7 ± 6.9 ETDRS letters in the worse eye and 1.7 ± 5.2 letters in the better eye. Mean CMT reductions were 128 ± 105 μm in the worse eye and 57 ± 68 μm in the better eye. Anti-CD11a antibody treatments resulted in an increase in the CD56(bright) regulatory NK cell population in the peripheral blood of the patients. CONCLUSIONS Anti-CD11a treatment improved visual function, reduced macular thickness, and increased the level of CD56(bright) regulatory NK cells in patients with uveitic macular edema refractory to other immunosuppressive medications. Targeting CD11a may be beneficial in treating other causes of macular edema.
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Hu M, Liu B, Jawad S, Ling D, Casady M, Wei L, Nussenblatt RB. C5a contributes to intraocular inflammation by affecting retinal pigment epithelial cells and immune cells. Br J Ophthalmol 2011; 95:1738-44. [PMID: 21873312 DOI: 10.1136/bjophthalmol-2011-300235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The complement activation molecule C5a has been found in the eye and is implicated in the pathogenesis of ocular inflammatory diseases. In this study, the authors sought to investigate C5a's effects on human retinal pigment epithelial (RPE) cells and peripheral blood mononuclear cells (PBMCs), and on the interaction between RPE cells and PBMCs. METHODS Arising retinal pigment epithelia cell line-19 and PBMCs isolated from healthy donors were used in this study. Western blot, real-time PCR and cell surface receptor staining were used to detect C5a receptor expression. Real-time PCR was used to detect cytokine mRNA expression. A thiazolyl blue tetrazolium bromide assay was used to detect cell viability. Cells were stained with Annexin V and 7-aminoactinomycin D for an apoptosis assay. Cell proliferation was measured using a tritiated thymidine incorporation assay. RESULTS C5a receptors were present on RPE cells, and receptor expression was increased by pro-inflammatory cytokines. C5a suppressed RPE cells' production of transforming growth factor β2, an important immunosuppressive agent in the eye. In addition, the viability of RPE cells was decreased in the presence of C5a, and this effect was not due to apoptosis. C5a increased proliferation of PBMCs and upregulated their production of pro-inflammatory cytokines. Finally, C5a decreased RPE cells' ability to suppress immune cell proliferation. CONCLUSION The results provide a direct link between complement activation and intraocular inflammation. This line of information may help to understand the mechanism of the pathogenesis of intraocular inflammatory diseases. Moreover, the authors show that a close, reciprocal interaction between the innate immune system and the adaptive immune system may be involved in the development of such diseases.
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Mattapallil MJ, Silver PB, Mattapallil JJ, Horai R, Karabekian Z, McDowell JH, Chan CC, James EA, Kwok WW, Sen HN, Nussenblatt RB, David CS, Caspi RR. Uveitis-associated epitopes of retinal antigens are pathogenic in the humanized mouse model of uveitis and identify autoaggressive T cells. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2011; 187:1977-85. [PMID: 21765017 PMCID: PMC3150271 DOI: 10.4049/jimmunol.1101247] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Noninfectious uveitis is a leading cause of blindness and thought to involve autoimmune T cell responses to retinal proteins (e.g., retinal arrestin [soluble-Ag (S-Ag)]). There are no known biomarkers for the disease. Susceptibility is associated with HLA, but little is known about susceptible class II alleles or the potentially pathogenic epitopes that they present. Using a humanized HLA-transgenic mouse model of S-Ag-induced autoimmune uveitis, we identified several susceptible and resistant alleles of HLA-DR and -DQ genes and defined pathogenic epitopes of S-Ag presented by the susceptible alleles. The sequences of these epitopes overlap with some previously identified peptides of S-Ag ("M" and "N"), known to elicit memory responses in lymphocytes of uveitis patients. HLA-DR-restricted, S-Ag-specific CD4(+) T cells could be detected in blood and draining lymph nodes of uveitic mice with HLA class II tetramers and transferred the disease to healthy mice. Importantly, tetramer-positive cells were detected in peripheral blood of a uveitis patient. To our knowledge, these findings provide the first tangible evidence that an autoimmune response to retina is causally involved in pathogenesis of human uveitis, demonstrating the feasibility of identifying and isolating retinal Ag-specific T cells from uveitis patients and may facilitate their development as biomarkers for the disease.
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Liu B, Wei L, Meyerle C, Tuo J, Sen HN, Li Z, Chakrabarty S, Agron E, Chan CC, Klein ML, Chew E, Ferris F, Nussenblatt RB. Complement component C5a promotes expression of IL-22 and IL-17 from human T cells and its implication in age-related macular degeneration. J Transl Med 2011; 9:1-12. [PMID: 21762495 PMCID: PMC3154861 DOI: 10.1186/1479-5876-9-111] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 07/15/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Age related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly populations worldwide. Inflammation, among many factors, has been suggested to play an important role in AMD pathogenesis. Recent studies have demonstrated a strong genetic association between AMD and complement factor H (CFH), the down-regulatory factor of complement activation. Elevated levels of complement activating molecules including complement component 5a (C5a) have been found in the serum of AMD patients. Our aim is to study whether C5a can impact human T cells and its implication in AMD. METHODS Human peripheral blood mononuclear cells (PBMCs) were isolated from the blood of exudative form of AMD patients using a Ficoll gradient centrifugation protocol. Intracellular staining and enzyme-linked immunosorbent assays were used to measure protein expression. Apoptotic cells were detected by staining of cells with the annexin-V and TUNEL technology and analyzed by a FACS Caliber flow cytometer. SNP genotyping was analyzed by TaqMan genotyping assay using the Real-time PCR system 7500. RESULTS We show that C5a promotes interleukin (IL)-22 and IL-17 expression by human CD4+ T cells. This effect is dependent on B7, IL-1β and IL-6 expression from monocytes. We have also found that C5a could protect human CD4+ cells from undergoing apoptosis. Importantly, consistent with a role of C5a in promoting IL-22 and IL-17 expression, significant elevation in IL-22 and IL-17 levels was found in AMD patients as compared to non-AMD controls. CONCLUSIONS Our results support the notion that C5a may be one of the factors contributing to the elevated serum IL-22 and IL-17 levels in AMD patients. The possible involvement of IL-22 and IL-17 in the inflammation that contributes to AMD may herald a new approach to treat AMD.
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Abstract
INTRODUCTION Uveitis is a challenging disease covering both infectious and noninfectious conditions. The current treatment strategies are hampered by the paucity of randomized controlled trials and trials comparing the efficacy of different agents. AREAS COVERED This review describes the current and future treatments of uveitis. A literature search was performed in PUBMED from 1965 to 2010 on drugs treating ocular inflammation with emphasis placed on more recent, larger studies. Readers should gain a basic understanding of current treatment strategies beginning with corticosteroids and transitioning to steroid sparing agents. Steroid sparing agents include antimetabolites such as methotrexate, azathioprine and mycophenolate mofetil; calcineurin inhibitors which include cyclosporine, tacrolimus; alkylating agents which include cyclophosphamide and chlorambucil; and biologics which include the TNF-α inhibitors infliximab, adalimumab and etanercept and daclizumab, IFN-α(2a) and rituximab. EXPERT OPINION Newer agents are typically formulated from existing drugs or developed based on new advances in immunology. Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects.
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Abbott RL, Adrean SD, Al-Muammar A, Akhtar J, Alfonso EC, Allen RC, Almond MC, Alvarenga L, Alward WLM, Ambrósio R, Anwar M, Azar DT, Ball JL, Barney NP, Bartow RM, Baum J, Belin MW, Bell JH, Benetz BA, Berbos Z, Beuerman RW, Bhasin AK, Bhat PV, Biber JM, Bidros M, Birnbaum AD, Bouchard CS, Bradley JC, Brandt JD, Brasington RD, Brilakis HS, Burkat CN, Calatayud M, Cameron JD, Campos M, Carpel EF, Cavanagh HD, Chan C, Chang RI, Chang BH, Chern KC, Ching S, Chodosh J, Choo PH, Chung G, Ciolino JB, Clayton JA, Cohen EJ, Comyn O, Cortina MS, Cowden JW, Croasdale CR, Davidson RS, Davis EA, Daya SM, Freitas DD, DeMill DL, de Oliveira LA, de Smet MD, de Sousa LB, Djalilian AR, Dohlman CH, Donnenfeld ED, Dortzbach RK, Driebe WT, Dunn SP, Eagle RC, Edelstein SL, Eiferman RA, Eliason JA, Farid M, Faulkner WJ, Feder RS, Feiz V, Feng MT, Fingert JH, Florakis GJ, Fontana L, Forster RK, Foster CS, Foster FS, Foulks GN, Friedlander MH, Fukuda M, Galor A, Gan TJ, Garg P, Garg S, Glasser DB, Goins KM, Goldstein DA, Gottlieb C, Grimmett MR, Gris O, Groos EB, Gruzensky WD, Güell JL, Gupta PK, Hamill MB, Hammersmith KM, Hamrah P, Hannush SB, Hardten DR, Harrison A, Heck EL, Heidemann DG, Herman DC, Heur JM, Hodge WG, Hoffman CJ, Holland EJ, Holland GN, Honig MA, Hood CT, Hoskins EN, Huang AJW, Huang D, Hui JI, Iuorno JD, Jackson WB, Jakobiec FA, Jeng BH, Jester JV, Jordan DR, Kaiura TL, Karp CL, Katz DG, Kaufman SC, Kersten RC, Khachikian SS, Kim JH, Kim JY, Kim SK, Kim T, Kirkness CM, Klyce SD, Koch DD, Kowalski RP, Krachmer JH, Laibson PR, Lane SS, Lass JH, Lee WB, Lee OA, Lemp MA, Lenhart PD, Li Y, Liesegang TJ, Lim MC, Lin LK, Lin MP, Lindquist TD, Lindstrom RL, Litoff D, Liu C, Lowder CY, Lubniewski AJ, McGee HT, McLean IW, Macsai MS, Manero F, Mannis MJ, Mantopoulos D, Martinez CE, Mártonyi CL, Mashor RS, Mathers WD, Mehta MN, Meisler DM, Mian SI, Miller D, Miller CA, Montoya M, Morral M, Moyes AL, Murphy ML, Nassiri N, Neff KD, Nelson JD, Nerad JA, Netto MV, Newton CJ, Nijm LM, Nishida T, Noble BA, Nordlund ML, Nussenblatt RB, O'Day DG, Ongkosuwito JV, Oxford KW, Palay DA, Palmon FE, Paranjpe DR, Parikh M, Park DH, Park DJJ, Parsons MR, Pavlin CJ, Pearlstein ES, Perry A, Petroll WM, Pfister DR, Pfister RR, Pflugfelder SC, Price FW, Price MO, Probst LE, Purcell JJ, Pyott AAE, Raizman MB, Raju LV, Randleman JB, Rao GN, Rapuano CJ, Reilly CD, de Candelaria Renesto A, Rezende RA, Robertson DM, Rootman DS, Rothman JS, Rubinfeld RS, Sadowsky AE, Saika S, Sakhalkar MV, Salz JJ, Sangwan VS, Scarpi M, Scharf BH, Schmidt G, Schmitt A, Schmitt FP, Schteingart MT, Schwab IR, Schwam BL, Schwartz GS, Sen HN, Shapiro MB, Shimmura S, Singal N, Skeens HM, Skolnick CA, Slomovic AR, Smith JA, Snyder ME, Solomon R, Soukiasian SH, Srinivasan S, Stamler JF, Steinert RF, Stoller GL, Streeten BW, Stulting RD, Sugar A, Sugar J, Tan D, Tauber J, Terry MA, Tessler HH, Torrabadella M, Traboulsi EI, Trattler WB, Tsai JH, Tse DT, Tu EY, Ursea R, Vaddavalli PK, Van Meter WS, Varley GA, Vasaiwala R, Verachtert AJ, Verdier DD, Vieira AC, Virasch VV, Wang L, Waring GO, Waring GO, Warner MA, Warrian KJ, Webster GF, Weikert MP, Weisenthal RW, Weiss JS, Wichiensin P, Wilhelmus KR, Wilson SE, Woodward MA, Yee RW, Yoo S. Contributors. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sen HN, Sangave AA, Goldstein DA, Suhler EB, Cunningham D, Vitale S, Nussenblatt RB. A standardized grading system for scleritis. Ophthalmology 2010; 118:768-71. [PMID: 21093921 DOI: 10.1016/j.ophtha.2010.08.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 08/11/2010] [Accepted: 08/12/2010] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study evaluated the performance of a standardized grading system for scleritis using standard digital photographs. DESIGN Cross-sectional interobserver agreement study. PARTICIPANTS Photo archives from the National Eye Institute. METHODS Three uveitis specialists from 3 different centers graded 79 randomly arranged images of the sclera with various degrees of inflammation. Grading was done using standard screen resolution (1024×768 pixels) on a 0 to 4+ scale in 2 sessions: (1) without using reference photographs and (2) with reference to a set of standard photographs (proposed grading system). The graders were masked to the order of images, and the order of images was randomized. Interobserver agreement in grading the severity of inflammation with and without the use of grading system was evaluated. MAIN OUTCOME MEASURES Interobserver agreement. RESULTS The proposed grading system for assessing activity in scleritis demonstrated a good interobserver agreement. Interobserver agreement (pooled κ) was poor (0.289) without photographic guidance and improved substantially when the "grading system" with standardized photographs was used (κ = 0.603). CONCLUSIONS This system of standardized images for scleritis grading provides significantly more consistent grading of scleral inflammation in this study and has clear applications in clinical settings and clinical research.
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Mahdi N, Faia LJ, Goodwin J, Nussenblatt RB, Sen HN. A case of autoimmune retinopathy associated with thyroid carcinoma. Ocul Immunol Inflamm 2010; 18:322-3. [PMID: 20662664 DOI: 10.3109/09273941003802379] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report a case of autoimmune retinopathy (AIR) associated with a thyroid carcinoma. DESIGN Case report. METHOD A 51-year-old Caucasian woman presented with a rapid decline in vision. Initial visual field and immunohistochemical testing revealed autoimmune retinopathy without an apparent underlying malignancy. Conventional local and systemic immunosuppressive therapies failed to halt the progression. RESULTS Rituximab treatments were initiated and a slowing of visual loss was seen. Continued surveillance for malignancy revealed a thyroid adenoma, and later a thyroidectomy revealed a thyroid carcinoma. CONCLUSIONS This report highlights the unique presentation of AIR associated with a thyroid carcinoma, the need for continued surveillance for malignancy in cases of AIR, and the possible new use of rituximab for the treatment of AIR.
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Nussenblatt RB, Byrnes G, Sen HN, Yeh S, Faia L, Meyerle C, Wroblewski K, Li Z, Liu B, Chew E, Sherry PR, Friedman P, Gill F, Ferris F. A randomized pilot study of systemic immunosuppression in the treatment of age-related macular degeneration with choroidal neovascularization. Retina 2010; 30:1579-87. [PMID: 20847709 PMCID: PMC3174007 DOI: 10.1097/iae.0b013e3181e7978e] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Age-related macular degeneration remains the leading cause of irreversible blindness in the United States and the developed world. Intravitreal injections of anti–vascular endothelial growth factor (VEGF) medications have become standard of care for the treatment of the wet form of the disease. Recent reports have demonstrated an association with various immune factors. We aimed to investigate the effect of immunosuppressive therapy in the clinical course of the wet form of the disease. We compared anti-VEGF therapy plus one of three systemic immunosuppressive therapies versus anti-VEGF therapy alone for recurrent choroidal neovascularization associated with age-related macular degeneration. METHODS This was a pilot, Phase I/II, prospective, randomized, unmasked, single-center trial. Patients with subretinal exudation secondary to recurrent choroidal neovascularization associated with age-related macular degeneration were included in the study. Patients were randomized to 1 of 3 systemic arms immunosuppressive agents (daclizumab, rapamycin, or infliximab) for 6 months plus intraocular anti-VEGF therapy if indicated, compared with a group who received only anti-VEGF therapy if indicated. RESULTS The number of anti-VEGF injections per group, visual acuity, retinal thickness, and safety measures were assessed in all groups. Thirteen patients were randomized; comparing anti-VEGF injections before and during the study, a decrease in the number of injections from 0.73 injections per month to 0.42 for daclizumab and from 0.67 to 0.34 for sirolimus was seen, while no apparent decrease was seen for either infliximab or observation. Visual acuities were maintained in all groups. CONCLUSION These preliminary data suggest that some immunosuppressive agents given systemically can alter the clinical course of the wet form of the disease and support the notion that more definitive clinical trials of immune mediation of age-related macular degeneration are indicated.
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Forooghian F, Cukras C, Meyerle CB, Nussenblatt RB, Gottlieb CC, Chew EY, Wong WT. Gallium scintigraphy in the investigation of retinal inflammatory vasculopathy. Acta Ophthalmol 2010; 88:e291-2. [PMID: 19878127 DOI: 10.1111/j.1755-3768.2009.01725.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saligan LN, Levy-Clarke G, Wu T, Faia LJ, Wroblewski K, Yeh S, Nussenblatt RB, Sen HN. Quality of life in sarcoidosis: comparing the impact of ocular and non-ocular involvement of the disease. Ophthalmic Epidemiol 2010; 17:217-24. [PMID: 20642344 DOI: 10.3109/09286586.2010.483754] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare the differences in vision and health-related quality of life (HRQOL) of individuals with ocular and non-ocular sarcoidosis; and to examine the impact of specific demographic and clinical factors on the noted differences. METHODS A cross-sectional study using non-randomized prospective cohort was conducted at the National Eye Institute (protocol number: 06-EI-0239, NCT00379275) from August 31, 2006 until November 15, 2007. Each participant completed vision and HRQOL questionnaires, the Sarcoidosis Health Questionnaire (SHQ) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ), along with a demographic/environmental exposure survey. Clinical data were collected through an ophthalmic exam as part of the research protocol. RESULTS The study enrolled 75 biopsy-proven and 20 clinically presumed sarcoidosis participants which were divided into two cohorts, ocular (N = 60) and non-ocular groups (N = 35). The ocular group had significantly lower (P < 0.01) total NEI-VFQ scores compared to the non-ocular group. Multiple linear regression analysis showed that participants with ocular sarcoidosis who had an annual household income of < $50,000 (P < 0.01) had significantly lower total SHQ scores while participants with ocular sarcoidosis whose visual acuity was 20/100 or worse had significantly lower total NEI-VFQ scores (P = 0.03). CONCLUSIONS Ocular involvement impacts both overall and vision-related quality of life among sarcoidosis patients. Lower economic status appears to have a significant impact on the quality of life of sarcoidosis patients. Assessment of visual function and general health status provide pertinent information for individuals with sarcoidosis and should be included in their care to assess burden of their disease on their quality of life.
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Nussenblatt RB, Bielekova B, Childs R, Krensky A, Strober W, Trinchieri G. National Institutes of Health Center for Human Immunology Conference, September 2009. Ann N Y Acad Sci 2010; 1200 Suppl 1:E1-23. [PMID: 20633145 DOI: 10.1111/j.1749-6632.2010.05682.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although studies of the laboratory mouse model have laid the groundwork for our rich understanding of immunobiology, they have fallen short in deciphering human disease and providing much needed therapeutic modalities. Indeed, bench-to-bedside approaches have not been a particularly effective means of developing translational research.(1) Recently, a symposium was held at the National Institutes of Health (NIH) entitled "Meeting the Human Immunology Challenge," highlighting the opportunities for the new Intramural NIH Center for Human Immunology, Autoimmunity, and Inflammation (http://www.nhlbi.nih.gov/resources/chi/); among other things it has become clear that a broader definition of the human immune spectrum in health and disease is needed. The human immunology meeting was held in the Clinical Center of the National Institutes of Health, Bethesda, Maryland, on September 3 and 4, 2009.
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Galor A, Feuer W, Kempen JH, Kaçmaz RO, Liesegang TL, Suhler EB, Foster CS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Thorne JE. Adverse effects of smoking on patients with ocular inflammation. Br J Ophthalmol 2010; 94:848-53. [PMID: 20606023 DOI: 10.1136/bjo.2009.174466] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in patients with ocular inflammation. METHODS A retrospective cohort study of patients with ocular inflammation who were followed longitudinally and had smoking information available in the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study database. RESULTS Among 2676 patients with active ocular inflammation, smokers were more likely to have bilateral ocular disease and poorer visual acuity on presentation compared with non-smokers and previous smokers. In a multivariate analysis, there was no statistically significant difference in the time to disease quiescence between groups. However, the median time to recurrence of ocular inflammation was statistically significantly longer for non-smokers (9.4 months) and for previous smokers (10.7 months) than for current smokers (7.8 months) (p=0.02). The RR of ocular inflammation recurrence was higher for smokers than for non-smokers (adjusted HR=1.19, 95% CI 1.03 to 1.37) and tended towards significance in previous smokers (adjusted HR=1.11, 95% CI 0.93 to 1.35). CONCLUSIONS Smoking was associated with an increased likelihood of bilateral ocular inflammation and reduced vision upon presentation, and an increased risk of recurrence compared with not smoking. These results suggest that patients with ocular inflammation should be counselled to stop smoking as part of routine management.
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Yeh S, Li Z, Sen HN, Lim WK, Gill F, Perkins K, Rao VK, Nussenblatt RB. Scleritis and multiple systemic autoimmune manifestations in chronic natural killer cell lymphocytosis associated with elevated TCRalpha/beta+CD3+CD4-CD8- double-negative T cells. Br J Ophthalmol 2010; 94:748-52. [PMID: 20508050 DOI: 10.1136/bjo.2009.171264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Chronic natural killer lymphocytosis (CNKL) has been associated with systemic autoimmunity; however, its association with scleritis or ocular autoimmunity has not been characterised. The natural killer (NK) cell function and immunophenotype of a patient with CNKL who developed bilateral scleritis and multiple systemic autoimmune findings were evaluated. METHODS The ophthalmic records of a patient with CNKL and scleritis were reviewed over a 6-year period. Flow cytometry was performed to evaluate T cell, NK and B cell populations. NK cellular functions (ie, NK cytotoxicity and cytokine/chemokine production following interleukin 2 (IL2) stimulation) were evaluated. RESULTS A 56-year-old woman with vitiligo, psoriatic arthritis, thyroiditis, erythema nodosum, bilateral anterior scleritis and Sjogren syndrome was managed with multiple immunosuppressive medications, including prednisone, mycophenolate mofetil and methotrexate. Flow cytometry showed a persistent elevation of CD56(+)CD3(-) NK cells greater than 40%, which was consistent with CNKL. NK cell cytotoxicity assay identified a deficiency of K562 cell lysis in the patient (1.46 mean-fold greater in control vs patient). NK cytokine/chemokine production following IL2 stimulation was also deficient (2.5-32.5-fold greater in control). Cytokines/chemokines assessed included pro-inflammatory (interferon gamma, tumor necrosis factor alpha, IL1, monocyte chemotactic protein 1) and immunoregulatory cytokines (IL4, IL5 and IL10). An abnormal elevation of TCRalpha/beta(+) CD3(+)CD4(-)CD8(-) T cells suggestive of autoimmune lymphoproliferative syndrome was observed; however, apoptosis dysfunction was not found. CONCLUSION The association of increased but dysfunctional NK cells in the context of multiple systemic and ocular manifestations suggests a role of NK cells in the pathogenesis of our patient's disease. Further studies regarding NK cell dysfunction and ocular autoimmunity are needed.
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Yeh S, Weichel ED, Faia LJ, Albini TA, Wroblewski KK, Stetler-Stevenson M, Ruiz P, Sen HN, Chan CC, Nussenblatt RB. 25-Gauge transconjunctival sutureless vitrectomy for the diagnosis of intraocular lymphoma. Br J Ophthalmol 2010; 94:633-8. [PMID: 20447965 DOI: 10.1136/bjo.2009.167940] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Diagnostic pars plana vitrectomy is a useful technique in the diagnosis of intraocular lymphoma (IOL); however, the role of transconjunctival sutureless vitrectomy (TSV) has not been fully explored for this indication. The purpose of this study was to review our experience with 25-gauge TSV for the diagnosis of IOL. METHODS Patients who underwent 25-gauge TSV for the diagnosis of IOL (primary, secondary or recurrent) from two tertiary referral centres were reviewed. Demographic data and underlying medical conditions were reviewed. Preoperative and postoperative visual acuities (VA) and ophthalmic examination data were assessed. Cytopathology, flow cytometry, cytokine and gene rearrangement studies were assessed. RESULTS Twelve patients underwent 25-gauge diagnostic TSV with a median follow-up time of 37 weeks. B-cell or T-cell IOL was diagnosed based on cytology in 3/12 patients (25%, 95% CI 8.9 to 53.2%) and in eight patients (67%, 95% CI 39.1 to 86.1%) using adjunctive diagnostic testing. VA stabilised or improved in 11 eyes (92%). Mean VA improved from 20/95 to 20/66 (p=0.055, paired t test). CONCLUSIONS 25-Gauge TSV is safe and effective for obtaining vitreous specimens for the evaluation of IOL. The availability of expert ophthalmic pathological consultation, flow cytometry, cytokine evaluation and gene rearrangement studies were essential to the diagnosis.
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Nussenblatt RB, Meinert CL. The status of clinical trials: cause for concern. J Transl Med 2010; 8:65. [PMID: 20609234 PMCID: PMC2907327 DOI: 10.1186/1479-5876-8-65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/07/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Americans see clinical research as important, with over 15 million American residents participating in NIH-sponsored studies in 2008 and growing yearly. METHODS Documents reporting NIH supported Clinical Research projects were reviewed. RESULTS When compared with other studies, the number of interventional Phase III and Phase IV trials have decreased from 20% to 4.4% from 1994-2008. CONCLUSIONS This finding most likely has occurred for several reasons. One reason is that the physician lacks an infrastructure for designing and carrying out trials. This lack is because of an absence of a coordinated effort to train clinical trialists. It is clear that the Nation needs a more purposeful approach to developing and maintaining the infrastructure for designing and conducting clinical trials. Building it de novo trial by trial is profoundly inefficient, to say nothing about time consuming and error prone.
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Silveira C, Vallochi AL, Rodrigues da Silva U, Muccioli C, Holland GN, Nussenblatt RB, Belfort R, Rizzo LV. Toxoplasma gondii in the peripheral blood of patients with acute and chronic toxoplasmosis. Br J Ophthalmol 2010; 95:396-400. [PMID: 20601663 DOI: 10.1136/bjo.2008.148205] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Toxoplasmic retinochoroiditis may recur months or years after the primary infection. Rupture of dormant cysts in the retina is the accepted hypothesis to explain recurrence. Here, the authors present evidence supporting the presence of Toxoplasma gondii in the peripheral blood of immunocompetent patients. METHODS Direct observation by light microscopy and by immunofluorescence assay was performed, and results were confirmed by PCR amplification of parasite DNA. RESULTS The authors studied 20 patients from Erechim, Brazil, including acute infected patients, patients with recurrent active toxoplasmic retinochoroiditis, patients with old toxoplasmic retinal scars, and patients with circulating IgG antibodies against T gondii and absence of ocular lesions. Blood samples were analysed, and T gondii was found in the blood of acutely and chronically infected patients regardless of toxoplasmic retinochoroiditis. CONCLUSIONS The results indicate that the parasite may circulate in the blood of immunocompetent individuals and that parasitaemia could be associated with the reactivation of the ocular disease.
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Yeh S, Nussenblatt RB, Levy-Clarke GA. Emerging biologics in the treatment of uveitis. Expert Rev Clin Immunol 2010; 3:781-96. [PMID: 20477028 DOI: 10.1586/1744666x.3.5.781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pathogenic mechanisms underlying uveitis syndromes continue to be evaluated using animal models and in the clinical setting. As the complex interactions between ocular immune cells, proinflammatory cytokines, chemokines and cellular adhesion molecules are uncovered, targeted therapies directed against these immune mediators will continue to be developed. Traditional immunosuppressive medications, such as corticosteroids and steroid-sparing immunomodulatory agents, have demonstrated efficacy in the treatment of uveitic syndromes, but side effects and drug toxicities often limit the use of these medications. The biologic agents, a newer class of medications, target specific immune pathways and have demonstrated efficacy in rheumatologic, dermatologic and neurologic conditions. Biologic therapies (e.g., TNF-alpha inhibitors and IL-2 receptor inhibitor) targeting ocular immune cell surface receptors, cytokines and chemokines continue to be developed and have shown promise in the treatment of uveitis and ocular inflammatory diseases. Clinical and basic aspects of monoclonal antibody therapy for uveitis are presented in this review. Additional studies are needed to further evaluate the role of monoclonal antibodies in the therapeutic armamentarium for uveitis.
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