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Fukuda K, Ishida W, Tanaka H, Harada Y, Fukushima A. Inhibition by rebamipide of cytokine-induced or lipopolysaccharide-induced chemokine synthesis in human corneal fibroblasts. Br J Ophthalmol 2014; 98:1751-5. [PMID: 25138760 DOI: 10.1136/bjophthalmol-2014-305425] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The dry-eye drug rebamipide has mucin secretagogue activity in and anti-inflammatory effects on corneal epithelial cells. Corneal stromal fibroblasts (transdifferentiated keratocytes) function as immune modulators in the pathogenesis of chronic ocular allergic inflammation and in innate immune responses at the ocular surface. The possible anti-inflammatory effects of rebamipide on human corneal stromal fibroblasts were examined. METHODS Serum-deprived cells were incubated for 1 h with rebamipide and then for various times in the additional absence or presence of cytokines or bacterial lipopolysaccharide (LPS). The release of chemokines into culture supernatants was determined with ELISAs. The intracellular abundance of chemokine mRNAs was quantitated by reverse transcription and real-time PCR analysis. Degradation of the nuclear factor κB (NFκB) inhibitor IκBα was detected by immunoblot analysis. RESULTS Rebamipide suppressed the release of interleukin (IL)-8 and the upregulation of IL-8 mRNA induced by tumour necrosis factor α (TNF-α) or LPS in corneal fibroblasts. It also inhibited eotaxin-1 (CCL-11) expression at the protein and mRNA levels induced by the combination of TNF-α and IL-4. In addition, rebamipide attenuated the degradation of IκBα induced by TNF-α or LPS. CONCLUSIONS Rebamipide inhibited the synthesis of chemokines by corneal fibroblasts in association with suppression of NFκB signalling. Rebamipide may therefore prove effective for the treatment of corneal stromal inflammation associated with allergy or bacterial infection.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Nankoku City, Kochi, Japan
| | - Waka Ishida
- Department of Ophthalmology and Visual Science, Kochi Medical School, Nankoku City, Kochi, Japan
| | - Hiroshi Tanaka
- Machida Hospital, Kochi City, Kochi, Japan Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Kochi Medical School, Nankoku City, Kochi, Japan
| | - Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Nankoku City, Kochi, Japan
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García-Posadas L, Contreras-Ruiz L, Arranz-Valsero I, López-García A, Calonge M, Diebold Y. CD44 and RHAMM hyaluronan receptors in human ocular surface inflammation. Graefes Arch Clin Exp Ophthalmol 2014; 252:1289-95. [PMID: 24916930 DOI: 10.1007/s00417-014-2686-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 02/27/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND CD44 and RHAMM hyaluronan (HA) receptors have been studied in several systemic diseases such as osteoarthritis and cancer. However, not too much is known about their role in ocular surface disorders. The purpose of this research was to determine if CD44 and RHAMM are implicated in human ocular surface inflammation. METHODS Upper tarsal conjunctival epithelial samples from patients with active ocular surface inflammation (n = 17) and healthy controls (n = 14) were recovered by brush cytology. Patients were evaluated by an ophthalmologist and classified in different groups according to the etiology (immune atopic diseases or immune non-atopic diseases) and inflammation intensity (mild/moderate or severe). CD44, RHAMM, and p53 mRNAs were measured using real-time PCR. RESULTS CD44, RHAMM, and p53 mRNAs were detected in all samples. In immune atopic diseases, higher levels of CD44 and RHAMM mRNAs were present, reaching a 300 % increase for RHAMM in severe inflammation (p < 0.001). In contrast, in immune non-atopic diseases, the HA receptors were downregulated. CD44 tended to decrease up to 30 % in severe patients (p = 0.06), and RHAMM decreased 40 % in severe inflammation (p = 0.021). CONCLUSIONS RHAMM may be implicated in severe ocular surface inflammation affecting the upper tarsal conjunctiva.
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Affiliation(s)
- Laura García-Posadas
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
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Vichyanond P, Pacharn P, Pleyer U, Leonardi A. Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes. Pediatr Allergy Immunol 2014; 25:314-22. [PMID: 24438133 DOI: 10.1111/pai.12197] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is an unusually severe sight-threatening allergic eye disease, occurring mainly in children. Conventional therapy for allergic conjunctivitis is generally not adequate for VKC. Pediatricians and allergists are often not familiar with the severe clinical symptoms and signs of VKC. As untreated VKC can lead to permanent visual loss, pediatric allergists should be aware of the management and therapeutic options for this disease to allow patients to enter clinical remission with the least side effects and sequelae. Children with VKC present with severe ocular symptoms, that is, severe eye itching and irritation, constant tearing, red eye, eye discharge, and photophobia. On examination, giant papillae are frequently observed on the upper tarsal conjunctiva (cobblestoning appearance), with some developing gelatinous infiltrations around the limbus surrounding the cornea (Horner-Trantas dot). Conjunctival injections are mostly severe with thick mucus ropy discharge. Eosinophils are the predominant cells found in the tears and eye discharge. Common therapies include topical antihistamines and dual-acting agents, such as lodoxamide and olopatadine. These are infrequently sufficient and topical corticosteroids are often required for the treatment of flare ups. Ocular surface remodeling leads to severe suffering and complications, such as corneal ulcers/scars. Other complications include side effects from chronic topical steroids use, such as increased intraocular pressure, glaucoma, cataract and infections. Alternative therapies for VKC include immunomodulators, such as cyclosporine A and tacrolimus. Surgery is reserved for those with complications and should be handled by ophthalmologists with special expertise. Newer research on the pathogenesis of VKC is reviewed in this article. Vernal keratoconjunctivitis is a very important allergic eye disease in children. Complications and remodeling changes are unique and can lead to blindness. Understanding of pathogenesis of VKC may lead to better therapy for these unfortunate patients.
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Affiliation(s)
- Pakit Vichyanond
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Leonardi A, Hall A. Mechanisms of corneal allergic reaction: new options for treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.10.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mantelli F, Calder VL, Bonini S. The Anti-Inflammatory Effects of Therapies for Ocular Allergy. J Ocul Pharmacol Ther 2013; 29:786-93. [DOI: 10.1089/jop.2013.0161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Stefano Bonini
- Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, Italy
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Nebbioso M, Zicari AM, Lollobrigida V, Marenco M, Duse M. Assessment of Corneal Alterations by Confocal Microscopy in Vernal Keratoconjunctivitis. Semin Ophthalmol 2013; 30:40-3. [DOI: 10.3109/08820538.2013.821508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Namba H, Narumi M, Sugano A, Murata I, Suzuki T, Yamakawa M, Yamashita H. Pathological findings of pemphigus vulgaris showing giant cobblestone-like conjunctival papillae. Case Rep Ophthalmol 2013; 4:114-21. [PMID: 24163678 PMCID: PMC3806711 DOI: 10.1159/000355374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe the pathophysiological findings of a patient with pemphigus vulgaris (PV) showing giant conjunctival papillae. Methods A 64-year-old man who had mucosal-dominant PV with giant conjunctival papillae, resembling those of vernal keratoconjunctivitis (VKC), underwent an ophthalmological workup. The clinical and pathological findings were investigated. Results Ophthalmic interventions were unable to provide the desired beneficial effects, and multiple excisions were necessary to remove the proliferative conjunctival lesions. Histopathological investigations of the excised tissues demonstrated acantholysis and a subconjunctival infiltration with numerous inflammatory cells such as lymphocytes, plasma cells, and neutrophils. However, in contrast to typical VKC, mast cells and eosinophils were rarely found in the subconjunctival tissues. Direct immunofluorescent staining showed a significant deposition of immunoglobulin G and complement component 3 in the epithelial intercellular substance, consistent with mucosal-dominant PV. Then, the patient was hospitalized because of oral erosion exacerbation and malnutrition. Because of the patient's declining general condition, we administered an increasing dose of a systemic steroid with an intravenous immunoglobulin, after which his ocular lesions and symptoms improved. Conclusions The histological conjunctival papilla findings were quite different from those of VKC papillae. If PV causes a lesion in a patient, systemic immunosuppression might be more effective than topical ophthalmic treatment because of overall immunological involvement.
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Affiliation(s)
- Hiroyuki Namba
- Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine, Yamagata City, Japan
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Abstract
Vernal keratoconjunctivitis (VKC) is a relatively rare, chronic form of ocular allergy that can potentially cause severe visual complications. Affecting mainly children and young adults, it is an IgE- and T cell-mediated disease, leading to a chronic inflammation in which eosinophil, lymphocyte and structural cell activation are involved. Treatment of VKC requires a multiple approach that includes conservative measures and pharmacologic treatment. Patients and parents should be made aware of the long duration of disease, its chronic evolution and possible complications. Treatment should be based on the duration and frequency of symptoms and the severity of corneal involvement. Mast cell stabilizers and antihistamines have been proven to be effective for the treatment of mild to moderate forms of VKC. In the most severe cases, topical steroids can be used as rescue medication to reduce conjunctival and corneal inflammation. Immunomodulators that have been investigated for VKC treatment include topical ocular preparations of cyclosporine A and tacrolimus. Topical cyclosporine A has been proven to be effective in the long-term treatment of VKC, significantly improving signs and symptoms without significant side effects.
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Abstract
PURPOSE OF REVIEW Successful treatment of allergic eye disease depends on understanding the pathophysiology of ocular allergy. Thus, in this review, recent experimental and clinical research that has provided significant information about the immunopathology of allergic eye disease will be discussed. RECENT FINDINGS Recently, role of various cells, cytokines and chemokines has been scrutinized in the immunopathogenesis of ocular allergy. In this respect, current research highlights contribution of special molecules and cells in the development and clinical features of immunoglobulin E (IgE) and T-cell-mediated eye allergies. SUMMARY Recent findings in molecular immunology of ocular allergy, which comprise complex inflammatory conditions of the conjunctiva, have enabled us to better understand the pathophysiology of these diseases and have aided in the potential development of new therapeutic agents.
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Baiula M, Bedini A, Carbonari G, Dattoli SD, Spampinato S. Therapeutic targeting of eosinophil adhesion and accumulation in allergic conjunctivitis. Front Pharmacol 2012; 3:203. [PMID: 23271999 PMCID: PMC3530033 DOI: 10.3389/fphar.2012.00203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/07/2012] [Indexed: 12/27/2022] Open
Abstract
Considerable evidence indicates that eosinophils are important effectors of ocular allergy. Increased worldwide prevalence of allergic eye pathologies has stimulated the identification of novel drug targets, including eosinophils and adhesion molecules. Accumulation of eosinophils in the eye is a key event in the onset and maintenance of allergic inflammation and is mediated by different adhesion molecules. Antihistamines with multiple mechanisms of action can be effective during the early and late phases of allergic conjunctivitis by blocking the interaction between β(1) integrins and vascular cell adhesion molecule (VCAM)-1. Small molecule antagonists that target key elements in the process of eosinophil recruitment have been identified and reinforce the validity of α(4)β(1) integrin as a therapeutic target. Glucocorticoids are among the most effective drugs for ocular allergy, but their use is limited by adverse effects. Novel dissociated glucocorticoids can prevent eosinophil accumulation and induce apoptosis of eosinophils, making them promising candidates for ophthalmic drugs. This article reviews recent understanding of the role of adhesion molecules in eosinophil recruitment in the inflamed conjunctiva along with effective treatments for allergic conjunctivitis.
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Affiliation(s)
- Monica Baiula
- Department of Pharmacy and Biotechnology, University of BolognaBologna, Italy
| | - Andrea Bedini
- Department of Pharmacy and Biotechnology, University of BolognaBologna, Italy
| | - Gioia Carbonari
- Department of Pharmacy and Biotechnology, University of BolognaBologna, Italy
| | | | - Santi Spampinato
- Department of Pharmacy and Biotechnology, University of BolognaBologna, Italy
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Leonardi A, Bogacka E, Fauquert JL, Kowalski ML, Groblewska A, Jedrzejczak-Czechowicz M, Doan S, Marmouz F, Demoly P, Delgado L. Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy 2012; 67:1327-37. [PMID: 22947083 DOI: 10.1111/all.12009] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 12/28/2022]
Abstract
Ocular allergy includes several clinically different conditions that can be considered as hypersensitivity disorders of the ocular surface. The classification of these conditions is complex, and their epidemiology has not been adequately studied because of the lack of unequivocal nomenclature. Ocular allergy symptoms are often, but not always, associated with other allergic manifestations, mostly rhinitis. However, specific ocular allergic diseases need to be recognized and managed by a team that includes both an ophthalmologist and an allergist. The diagnosis of ocular allergy is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when the identification of the specific allergic sensitization is required for patient management. The aims of this Task Force Report are (i) to unify the nomenclature and classification of ocular allergy, by combining the ophthalmology and allergy Allergic Rhinitis and its Impact on Asthma criteria; (ii) to describe current methods of diagnosis; (iii) to summarize the therapeutic options for the management of ocular allergic inflammation.
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Affiliation(s)
- A. Leonardi
- Department of Neuroscience; Ophthalmology Unit; University of Padua; Padua; Italy
| | - E. Bogacka
- Department of Internal Medicine, Allergy and Geriatrics; Medical Academy of Wrocław; Wrocław; Poland
| | - J. L. Fauquert
- Unité d'Allergologie de l'enfant; CHU Estaing; Clermont-Ferrand; France
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Łódź; Poland
| | - A. Groblewska
- Department of Ophthalmology; Polish Mother's Memorial Hospital; Łódź; Poland
| | | | - S. Doan
- Hopital Bichat and Fondation A. de Rothschild; Paris; France
| | - F. Marmouz
- Pole sanitaire du Vexin; Pontoise; France
| | - P. Demoly
- Inserm U454 - IFR3; hôpital Arnaud-de-Villeneuve; Montpellier; France
| | - L. Delgado
- Faculty of Medicine; Department of Immunology; University of Porto; Porto; Portugal
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Leonardi A, Lazzarini D, Bortolotti M, Piliego F, Midena E, Fregona I. Corneal Confocal Microscopy in Patients with Vernal Keratoconjunctivitis. Ophthalmology 2012; 119:509-15. [DOI: 10.1016/j.ophtha.2011.09.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/23/2011] [Accepted: 09/09/2011] [Indexed: 10/14/2022] Open
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Fukuda K, Nishida T, Fukushima A. Synergistic induction of eotaxin and VCAM-1 expression in human corneal fibroblasts by staphylococcal peptidoglycan and either IL-4 or IL-13. Allergol Int 2011; 60:355-63. [PMID: 21502805 DOI: 10.2332/allergolint.10-oa-0247] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 12/21/2010] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Common features of allergic or atopic ocular and skin diseases are the participation of Th2 lymphocytes and eosinophils and colonization by Staphylococcus aureus. To examine the role of interaction between Th2 cells and bacterial infection in tissue eosinophilia, we determined the effects of Th2 cytokines and peptidoglycan derived from the cell wall of S. aureus on corneal fibroblasts. METHODS Chemokine concentrations and the cell surface expression of adhesion molecules were determined by ELISAs, and chemokine and adhesion molecule mRNAs were quantitated by real-time PCR analysis. Signaling by the transcription factor NF-κB was evaluated by immunoblot and immunofluorescence analyses as well as by assay of DNA binding activity. RESULTS Among Th2 cytokines tested, only interleukin (IL)-4 and IL-13 induced a low level of eotaxin release by corneal fibroblasts, as did peptidoglycan. However, the combination of peptidoglycan and either IL-4 or IL-13 induced a marked synergistic increase both in eotaxin release (without affecting that of IL-8) and in the abundance of eotaxin mRNA. The combination of peptidoglycan and IL-4 or IL-13 also synergistically increased the surface expression of VCAM-1, but not that of ICAM-1. Peptidoglycan activated NF-κB in corneal fibroblasts, and inhibitors of NF-κB attenuated eotaxin release induced by peptidoglycan alone or in combination with IL-4 or IL-13. CONCLUSIONS Interaction of innate and adaptive immunity, as manifested by synergistic stimulation of eotaxin and VCAM-1 expression in corneal fibroblasts by peptidoglycan and Th2 cytokines, may play an important role in tissue eosinophilia associated with ocular allergy.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Japan. k.fukuda@kochi−u.ac.jp
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Ueta M, Sotozono C, Kinoshita S. Expression of interleukin-4 receptor α in human corneal epithelial cells. Jpn J Ophthalmol 2011; 55:405-410. [PMID: 21617960 DOI: 10.1007/s10384-011-0030-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 01/12/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE We previously reported that human conjunctival epithelial cells expressed functioning interleukin-4 receptor α (IL-4Rα). In this study, we investigated whether human corneal epithelial cells also express functioning IL-4Rα. METHODS The presence of IL-4Rα mRNA and protein in human corneal epithelium was examined by reverse-transcriptase polymerase chain reaction (RT-PCR) and immunohistology, respectively. The cell surface expression of IL-4Rα and the transcripts upregulated upon IL-4Rα ligand (IL-4 or IL-13) stimulation were examined by flow cytometry and quantitative RT-PCR, respectively, using immortalized human corneal-limbal epithelial (HCLE) cells. RESULTS The mRNA and protein of IL-4Rα were detected in human corneal epithelium. Flow cytometry analysis showed the cell surface expression of IL-4Rα protein. Quantitative RT-PCR assay of HCLE cells showed the upregulation of the transcripts tumor necrosis factor alpha-induced protein 6 (TNFAIP6), RAS guanyl-releasing protein 1 (RASGRP1), carbonic anhydrase II (CA2), cytokine-inducible SH2-containing protein (CISH), hyaluronan synthase 3 (HAS3), calpain 14 (CAPN14), endothelin receptor type A (EDNRA), cathepsin C (CTSC), and lecithin retinol acyltransferase (LRAT) as well as human conjunctival epithelial cells. CONCLUSION Human corneal epithelial cells expressed functioning IL-4Rα, and stimulation of its ligands, IL-4 and IL-13, could induce the expression of various genes, e.g., antiinflammatory molecule genes such as TNFAIP6 and CISH and cellular differentiation and proliferation-related molecule genes such as RASGRP1, HAS3, EDNRA, and LRAT.
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Affiliation(s)
- Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan. .,Research Center for Inflammation and Regenerative Medicine, Faculty of Life and Medical Sciences, Doshisha University, Kyoto, Japan.
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan
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Chigbu DI, Sandrasekaramudaly-Brown S. Ocular surface disease: a case of vernal keratoconjunctivitis. Cont Lens Anterior Eye 2010; 34:39-44. [PMID: 20971677 DOI: 10.1016/j.clae.2010.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 11/16/2022]
Abstract
Vernal keratoconjunctivitis (VKC) is a recurrent, chronic allergic inflammation of the ocular surface associated with remodeling of the cornea and conjunctiva, with a potential to adversely affect the patient's vision and quality of life. It affects mainly children and young adults. The purpose of this interventional case report is to present a typical case of limbal VKC, which was unresponsive to antiallergic treatment alone. A 5-year-old boy, who was previously unsuccessful with conventional anti-allergic therapy alone, presented with clinicopathological features pathognomonic of limbal VKC. The patient was successfully managed with a combination of palliative, anti-allergic and anti-inflammatory therapy. Prophylaxis with an anti-allergic pharmaceutical agent was initiated for long term use to prevent the release of allergic mediators. This case highlights the importance of prescribing the most appropriate pharmaceutical medication for VKC since conjunctival fibroproliferative lesions are often resistant to anti-allergy therapy. Allergic inflammatory mediators are responsible for the fibroproliferative changes of the conjunctiva and corneal lesions in VKC. Thus, it is crucial to prescribe the most appropriate pharmaceutical medication that will prevent the release of allergic inflammatory mediators, control the allergic inflammatory cascade and prevent ocular surface damage. The fine points of this case are presented with a review of applicable literature.
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Affiliation(s)
- DeGaulle I Chigbu
- Pennsylvania College of Optometry at Salus University, 8360 Old York Road, Elkins Park, PA 19027, USA.
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Fukuda K, Yamada N, Nishida T. Case report of restoration of the corneal epithelium in a patient with atopic keratoconjunctivitis resulting in amelioration of ocular allergic inflammation. Allergol Int 2010; 59:309-312. [PMID: 20657166 DOI: 10.2332/allergolint.10-cr-0185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 03/15/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Atopic and vernal keratoconjunctivitis are severe types of ocular allergic disease characterized not only by conjunctival inflammation but also by corneal involvement. In vitro studies have suggested that breakdown of corneal epithelial barrier function and subsequent activation of stromal fibroblasts may amplify ocular allergic inflammation. CASE SUMMARY A 27-year-old man with atopic dermatitis developed atopic keratoconjunctivitis including corneal ulcer with plaque deposition in his right eye. Conjunctival inflammation in the right eye was resistant to topical steroid therapy. Surgical removal of corneal plaque and administration of autologous fibronectin eyedrops resulted not only in resurfacing of the corneal epithelium but also in amelioration of conjunctival inflammation. DISCUSSION This case suggests that loss of corneal epithelial integrity likely exacerbates conjunctival allergic inflammation and that restoration or maintenance of the barrier function of the corneal epithelium may be one of the important targets for the treatment of severe ocular allergic diseases.
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MESH Headings
- Administration, Topical
- Adult
- Cell Proliferation/drug effects
- Conjunctivitis, Allergic/complications
- Conjunctivitis, Allergic/immunology
- Conjunctivitis, Allergic/pathology
- Conjunctivitis, Allergic/physiopathology
- Conjunctivitis, Allergic/therapy
- Corneal Ulcer
- Dermatitis, Atopic/complications
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/pathology
- Dermatitis, Atopic/physiopathology
- Dermatitis, Atopic/therapy
- Epithelium, Corneal/drug effects
- Epithelium, Corneal/growth & development
- Epithelium, Corneal/pathology
- Eye/blood supply
- Eye/immunology
- Eye/pathology
- Fibronectins/administration & dosage
- Humans
- Inflammation
- Male
- Morphogenesis/drug effects
- Recovery of Function
- Vision, Ocular/drug effects
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.; Present address: Department of Ophthalmology, Kochi Medical School, Kochi, Japan..
| | - Naoyuki Yamada
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Teruo Nishida
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Enríquez-de-Salamanca A, Calonge M. Cytokines and chemokines in immune-based ocular surface inflammation. Expert Rev Clin Immunol 2010; 4:457-67. [PMID: 20477574 DOI: 10.1586/1744666x.4.4.457] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Altered levels of several cytokines and chemokines have been found in different types of inflammatory ocular surface diseases, such as allergy or dry-eye syndrome. It has also been demonstrated that epithelial cells play a key role in the persistence and even initiation of chronic mucosal inflammation. The recent development of 'multiplex detection' technologies has facilitated the identification of specific patterns of expression of these molecules in some ocular immune-based inflammatory disorders. Analysis of these molecules in tissues, cells (in vivo and in vitro) and tears has revealed that not only inflammatory cells but also epithelial and fibroblast resident cells are sources of these molecules. The purpose of this review is to summarize recent studies in this field.
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Affiliation(s)
- Amalia Enríquez-de-Salamanca
- IOBA (Institute of Applied Opthalmobiology), Ocular Surface Group, Campus Miguel Delibes, University of Valladolid, Valladolid, Spain.
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Leonardi A, Quintieri L. Olopatadine: a drug for allergic conjunctivitis targeting the mast cell. Expert Opin Pharmacother 2010; 11:969-81. [DOI: 10.1517/14656561003694643] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fukuda K, Nishida T. Reciprocal interaction of the conjunctiva and cornea in ocular allergy. J Allergy Clin Immunol 2010; 125:493-496.e2. [DOI: 10.1016/j.jaci.2009.10.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 10/20/2009] [Accepted: 10/23/2009] [Indexed: 10/19/2022]
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Fukuda K, Ohbayashi M, Morohoshi K, Zhang L, Liu FT, Ono SJ. Critical role of IgE-dependent mast cell activation in a murine model of allergic conjunctivitis. J Allergy Clin Immunol 2009; 124:827-33.e2. [DOI: 10.1016/j.jaci.2009.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 06/04/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
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Nochez Y, Denoyer A, Pisella PJ. La ciclosporine A à 0,05 % dans les troubles chroniques sévères de la surface oculaire. Can J Ophthalmol 2009. [DOI: 10.3129/i09-117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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75
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Leonardi A, Sathe S, Bortolotti M, Beaton A, Sack R. Cytokines, matrix metalloproteases, angiogenic and growth factors in tears of normal subjects and vernal keratoconjunctivitis patients. Allergy 2009; 64:710-7. [PMID: 19220217 DOI: 10.1111/j.1398-9995.2008.01858.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND To detect the presence of multiple mediators and growth factors in tears of vernal keratoconjunctivitis (VKC) patients with active disease using stationary phase antibody arrays. METHODS Tears were collected from 12 normal subjects (CT) and 24 active VKC patients. Tears were centrifuged and successively probed using three microwell plate arrays specific for: (i) cytokines: interleukin (IL)-2, IL-4, IL-5, IL-8, IL-10, IL-12, IL-13, interferon-gamma and tumour necrosis factor-alpha; (ii) growth factors: basic fibroblast growth factor (bFGF), platelet-derived growth factor, thrombopoietin, angiopoietin-2, vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), keratocyte growth factor, tissue inhibitor of metalloprotease (TIMP)-1 and heparin-binding epithelial growth factor (HB-EGF) and (iii) matrix metalloprotease (MMP)-1, MMP-2, MMP-3, MMP-8, MMP-9, MMP-10, MMP-13, TIMP-1 and TIMP-2. RESULTS Interleukin-8 signals were detected in all CT and highly detected in all VKC samples. The Th2-type cytokines, IL-4, IL-5 and IL-10 were detected only in tears of VKC patients. Signals for bFGF, HB-EGF, VEGF and HGF were detected in 41-87% of VKC samples and in few CT samples. Only TIMP-1 and TIMP-2 were found in all normal and patient tear samples, whereas MMP-1, MMP-2, MMP-3, MMP-9 and MMP-10 were highly present in all VKC samples. CONCLUSIONS Stationary phase antibody array methodology was useful for the screening of various cytokines, growth factors and MMPs in tears. These analyses identified in tears of VKC patients previously unreported factors including MMP-3 and MMP-10 and multiple proteases, growth factors and cytokines, which may all play an important role in the pathogenesis of conjunctival inflammation.
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Affiliation(s)
- A Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
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76
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Balato A, Unutmaz D, Gaspari AA. Natural killer T cells: an unconventional T-cell subset with diverse effector and regulatory functions. J Invest Dermatol 2009; 129:1628-42. [PMID: 19262602 DOI: 10.1038/jid.2009.30] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Natural killer T (NKT) cells are a unique subset of lymphocytes that express NK cell markers such as CD161 and CD94, as well as a T-cell receptor (TCR) alpha/beta, with a restricted repertoire, which distinguishes them from NK cells, which lack a TCR. In contrast to conventional T-lymphocytes, the TCR of NKT cells does not interact with that of peptide antigens presented by classical major histocompatibility complex-encoded class I or II molecules. Instead, this TCR recognizes glycolipids presented by CD1d, a non-classical antigen-presenting molecule. The rapid response of NKT cells to their cognate antigens is characteristic of an innate immune response, and allows the polarizing cytokines (IFN-gamma and/or IL-4) to regulate adaptive immunity. NKT cells have been found to be critical in the immune response against viral infections and malaria, as well as in tumor immunity, and certain autoimmune diseases. NKT cells have been assessed to represent the "trait d'union" between innate and adaptive immunity. They play an active role in skin diseases, such as contact sensitivity, which have been implicated in UV-induced immunosuppression and psoriasis. Thus, NKT-cells are emerging as an important subset of lymphocytes, with a protective role in host defense and a pathogenic role in certain immune-mediated disease states.
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Affiliation(s)
- Anna Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
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78
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Abstract
The eye represents an ideal and frequent site for the allergic reactions. The term 'allergic conjunctivitis' refers to a collection of disorders that affect the lid, conjunctiva and/or cornea. Even though the diagnosis is essentially clinical, local tests such as cytology, conjunctival provocation and tear mediator analysis can be performed. The immunoglobulin E (IgE)-mediated mechanism does not explain completely the severity and the clinical course of chronic allergic ocular diseases such as vernal (VKC) and atopic keratoconjunctivitis (AKC), which are probably also related to T cell-mediated responses, massive eosinophil attraction and activation and non-specific hypersensitivity. An altered balance between T helper type 1 (Th1) and Th2 cells and between Th1- and Th2-types of cytokines is thought to be responsible of the development of ocular allergic disorders. New findings suggest that a wide range of cytokines, chemokines, proteases and growth factors are involved by complex interwoven interactions rather than distinct and parallel pathways. In addition, several non-specific enzymatic systems may be activated during acute and chronic allergic inflammation, thus contributing to the complex pathogenesis of the disease. Current drug treatment for ocular allergy targets the key mechanisms involved in the development of clinical disease: mast cells with mast cell stabilizers, histamine with histamine receptor antagonists and inflammation with corticosteroids, severe inflammation with immunomodulators. None of these agents lacks side effects and none abolishes signs and symptoms completely. New therapeutic strategies are still needed to respond to the complex pathogenesis of severe forms of ocular allergy such as VKC and AKC.
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Affiliation(s)
- A Leonardi
- Ophthalmology Unit, Department of Neuroscience, University of Padova, Padova, Italy.
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79
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Enríquez-de-Salamanca A, Calder V, Gao J, Galatowicz G, García-Vázquez C, Fernández I, Stern ME, Diebold Y, Calonge M. Cytokine responses by conjunctival epithelial cells: an in vitro model of ocular inflammation. Cytokine 2008; 44:160-7. [PMID: 18760623 DOI: 10.1016/j.cyto.2008.07.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 07/16/2008] [Accepted: 07/18/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We examined the differential secretion of cytokines by a conjunctival epithelial cell line in response to proinflammatory cytokines to identify the potential contributions during ocular surface inflammation. METHODS A conjunctival epithelial cell line was exposed to IFN-gamma, TNF-alpha, IL-4, or IL-13, and cytokine production was determined in supernatants at different times after exposure. Cell apoptosis was measured by flow cytometry. RESULTS TNF-alpha induced the greatest effect on cytokine secretion, which was time-dependent. TNF-alpha-stimulated secretion of IL-12p40 was significantly increased by 30 min; GM-CSF, MCP-1, IL-6, IL-7, IL-8, and RANTES were significantly increased by 2 h, and IFN-gamma and IL-1alpha by 24 h. After 48 h, TNF-alpha also induced a significant increase in IL-1beta, IL-3, and IP-10 secretion. IFN-gamma significantly enhanced IP-10 and RANTES secretion after 48 h of exposure. Following IL-4 treatment there was a significant increase in eotaxin-1 after 24h, and IL-12p40 and IL-3 after 48 h. IL-13 significantly increased the secretion of eotaxin-1 after 24 h, and IL-8 after 48 h. CONCLUSION Our results suggest that conjunctival epithelial cells are an important source of cytokines and chemokines that are regulated by proinflammatory cytokines and may play an important role in ocular surface inflammation.
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Affiliation(s)
- Amalia Enríquez-de-Salamanca
- IOBA (Institute of Applied Ophthalmobiology)-Ocular Surface Group, University of Valladolid, Campus Miguel Delibes, Valladolid E-47011, Spain.
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80
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Leonardi A, De Dominicis C, Motterle L. Immunopathogenesis of ocular allergy: a schematic approach to different clinical entities. Curr Opin Allergy Clin Immunol 2007; 7:429-35. [PMID: 17873584 DOI: 10.1097/aci.0b013e3282ef8674] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The immunopathogenesis of ocular allergic disorders is generally related to the specific immunoglobulin E-mediated mast cell activation and the following cascade of inflammatory mediators. Seasonal and perennial allergic conjunctivitis, however, are the only ocular diseases to involve solely type I hypersensitivity. The other main forms, vernal and atopic keratoconjunctivitis, have a more complex immunological basis and a chronic inflammatory component. Involvement of inflammatory cells, particularly eosinophils and T cells, cytokines and proteases can lead to more serious corneal damage with vision-threatening potential. RECENT FINDINGS Experimental allergic conjunctival models and clinical research studies have shown that T helper type 2-related mechanisms are definitely involved in the sensitization phase of ocular allergy, however, both T helper type 1 and type 2 cytokines are overexpressed in the active disease, contributing to the development of ocular inflammation. SUMMARY A review of the recent literature allows us to better understand the mechanisms involved in the development of ocular allergy and to guide us toward a more schematic approach, which could possibly be useful in forming a new classification, standardizing clinical phases and individuating new treatment targets.
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Affiliation(s)
- Andrea Leonardi
- Ophthalmology Unit, Department of Neuroscience, University of Padua, Italy.
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81
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Abstract
PURPOSE OF REVIEW The purpose of this article is to summarize the clinical presentations associated with the classification of ocular allergy. This article also serves to summarize recent findings of pathophysiological mechanisms associated with ocular allergy and to highlight recently improved diagnostic methods for ocular allergic inflammation. RECENT FINDINGS The term allergic conjunctivitis may not sufficiently describe all forms of allergic eye disease, thus a new classification system is desirable, preferably derived from the varied pathophysiological mechanisms operating in the different forms of ocular allergy. Recent published material has further characterized the roles that inflammatory and structural cells have in ocular allergic inflammation. Improved diagnostic methods have also been developed to assess the underlying causes of ocular allergy. SUMMARY The underlying immune responses of ocular allergies are complex, indicating the critical need to understand the pathophysiology behind these diseases. Extensive research over the past several years has provided valuable insight into understanding the pathophysiology associated with the different forms of allergic conjunctivitis. Further clarification of the mechanisms associated with different forms of ocular allergy is essential for improved methods of classification, diagnosis, and treatment.
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Affiliation(s)
- Marcus G Hodges
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland 20852, USA
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82
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Current World Literature. Curr Opin Allergy Clin Immunol 2007; 7:454-5. [PMID: 17873589 DOI: 10.1097/aci.0b013e3282f0cf23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leonardi A. New drug treatments for ocular allergies. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.3.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fukushima A, Sumi T, Fukuda K, Yamaguchi T, Kumagai N, Nishida T, Ueno H. Modulation of murine experimental allergic conjunctivitis by treatment with α-galactosylceramide. Immunol Lett 2006; 107:32-40. [PMID: 16930723 DOI: 10.1016/j.imlet.2006.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/27/2006] [Accepted: 07/13/2006] [Indexed: 01/21/2023]
Abstract
When mice are treated with alpha-galactosylceramide (alpha-GalCer), NKT cells are activated and suppress the development of experimental airway inflammation. This suppressive effect is believed to be mediated by the upregulation of IFN-gamma. Here, we investigated whether alpha-GalCer treatment can also modulate the development of experimental allergic conjunctivitis (EC). EC was induced in wild-type and IFN-gamma-deficient Balb/c mice by active immunization with ragweed (RW) followed by challenge with RW in eye drops. The mice were intraperitoneally injected with alpha-GalCer or vehicle at the time of immunization or before RW challenge. Twenty-four hours after RW challenge, conjunctivas, spleens and sera were harvested for histological analysis, flow cytometric, proliferation and cytokine assays, and measurement of immunoglobulin levels, respectively. Treatment with alpha-GalCer at the time of the EC-priming immunization significantly increased Th2 responses and markedly upregulated the severity of the EC. However, treatment with alpha-GalCer just before the Ag challenge that triggers EC in primed animals significantly suppressed the disease. This was associated with an increased frequency of CD4(+)CD25(+) cells, which express Foxp3, in the spleen. alpha-GalCer treatment just prior to Ag challenge also suppressed the development of EC in IFN-gamma-deficient mice, and we found apoptosis and anergy are unlikely to play a major role in the mechanism by which pre-challenge alpha-GalCer treatment suppresses EC. These data suggest that NKT cells can play a downregulatory role in the development of EC and that alpha-GalCer may be useful for treating allergic conjunctivitis.
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Affiliation(s)
- Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kohasu, Nankoku-City 783-8505, Japan.
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Fukushima A, Sumi T, Fukuda K, Kumagai N, Nishida T, Yagita H, Ueno H. Interleukin 10 and transforming growth factor beta contribute to the development of experimentally induced allergic conjunctivitis in mice during the effector phase. Br J Ophthalmol 2006; 90:1535-41. [PMID: 16914468 PMCID: PMC1857521 DOI: 10.1136/bjo.2006.100180] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate the involvement of interleukin (IL)10 and transforming growth factor (TGF) beta in the development of experimentally induced allergic conjunctivitis in mice. METHODS Balb/c mice were actively sensitised with ragweed in alum, and then challenged with ragweed in eye drops after 10 days. 24 h later, the conjunctivas, spleens and blood were collected for histological and cytokine expression analyses, proliferation and cytokine production assays and measurement of immunoglobulin (Ig) levels. Mice developing experimentally induced allergic conjunctivitis were injected intraperitoneally with 200 microg of anti-IL10 or anti-TGF beta antibodies at 0, 2, 4, 6 and 8 days (induction phase treatment) or 500 microg of antibodies 2 h before ragweed challenge (effector phase treatment). Normal rat IgG was used for control injections. RESULTS Treatment with either anti-IL10 or anti-TGF beta antibodies during the induction phase did not affect eosinophil infiltration into the conjunctiva. By contrast, treatment with either antibody during the effector phase suppressed infiltration. During the effector phase, treatment with anti-TGF beta antibody, but not the anti-IL10 antibody, markedly up regulated proliferation and Th2 cytokine production by splenocytes. IL1alpha levels in the conjunctiva were reduced after treatment with either antibody; in addition, eotaxin and tumour necrosis factor alpha levels were reduced after treatment with antibody to TGF beta. CONCLUSIONS IL10 and TGF beta do not have immunosuppressive roles in the development of experimentally induced allergic conjunctivitis. Rather, they augment the infiltration of eosinophils into the conjunctiva during the effector phase of experimentally induced allergic conjunctivitis.
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Affiliation(s)
- A Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kohasu, Nankoku, Japan.
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86
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Fukuda K, Kumagai N, Fujitsu Y, Nishida T. Fibroblasts as local immune modulators in ocular allergic disease. Allergol Int 2006; 55:121-9. [PMID: 17075248 DOI: 10.2332/allergolint.55.121] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Indexed: 11/20/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC), a severe form of ocular allergic disease, is characterized by the formation of giant papillae at the upper tarsal conjunctiva and corneal lesions that threaten vision. Recent evidence indicates that resident fibroblasts function as immune modulators in the pathogenesis of the chronic allergic inflammation associated with VKC. The T helper 2 (Th2) cell-derived cytokines interleukin (IL)-4 and IL-13 stimulate the migration and proliferation of conjunctival fibroblasts as well as protecting these cells from apoptotic cell death, effects that likely underlie the hyperplasia of fibroblasts that contributes to the formation of giant papillae. Conjunctival fibroblasts also synthesize extracellular matrix proteins and tissue inhibitors of metalloproteinases as well as down-regulate the expression of matrix metalloproteinases in response to these cytokines, effects that likely contribute to the excessive deposition of extracellular matrix that is characteristic of giant papillae. Stimulation of fibroblasts in the corneal stroma with the combination of a proinflammatory cytokine and either IL-4 or IL-13 results in up-regulation of the expression of the chemokine eotaxin and thymus- and activation-regulated chemokine as well as of vascular cell adhesion molecule-1, which together mediate the infiltration and activation of eosinophils and Th2 cells. Fibroblasts therefore appear to play a central role in the induction and amplification of ocular allergic inflammation and the consequent development of giant papillae and corneal disorders in individuals with VKC. Fibroblasts and fibroblast-derived factors thus represent new and potentially important therapeutic targets for treatment of the giant papillae and corneal disorders associated with VKC.
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Affiliation(s)
- Ken Fukuda
- Department of Ocular Pathophysiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
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