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Mavris N, Jaouni T, Amer R. Subretinal Fibrosis Developing 10 Years After First Presentation with Chronic Ocular Sarcoidosis in a Child. Ocul Immunol Inflamm 2024:1-4. [PMID: 38865486 DOI: 10.1080/09273948.2024.2363481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To provide a comprehensive overview of the diagnostic and therapeutic journey of a pediatric patient with persistent sarcoid-associated panuveitis over a 10-year period, who ultimately developed bilateral macular subretinal fibrosis and visual loss. METHODS Retrospective case report. RESULTS The patient was diagnosed with sarcoidosis after undergoing a transbronchial biopsy. She was followed up because of granulomatous panuveitis, multifocal choroiditis, and papillitis bilaterally. She maintained a stable condition, and visual acuity was 0.3 RE and 0.5 LE. Immunomodulatory therapy included prednisone, methotrexate, and adalimumab. The patient was lost to follow-up for 20 months because of the COVID-19 pandemic. She was represented with active uveitis and was not responding to TNF-ɑ inhibitors (adalimumab and infliximab). Ultimately, the patient's intraocular inflammation was successfully controlled by using intravitreal steroids (Triamcinolone and Fluocinolone acetonide implant). However, the visual outcome was guarded because of bilateral subretinal fibrosis. CONCLUSION 10% of patients with sarcoidosis-associated uveitis risk blindness in one eye. The index case progressed to sight-robbing bilateral subretinal fibrosis, a rare complication of ocular sarcoidosis despite a combination of conventional and biologic anti-inflammatory therapies. There is a pressing need to develop new treatment agents for refractory non-infectious uveitis.
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Affiliation(s)
- Neofytos Mavris
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Tarek Jaouni
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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2
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De Man V, Bataillie S, Cassiman C, Sels L, Schauwvlieghe PP. Ophthalmological and Neurological Findings in Patients with Idiopathic Uveitis Associated with Retinal Vasculitis and the Relation with the HLA DR15 Allele. Ocul Immunol Inflamm 2024:1-7. [PMID: 38648262 DOI: 10.1080/09273948.2024.2316759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 02/05/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE In 15 patients with idiopathic uveitis associated with retinal vasculitis, HLA DRB1 gene testing was performed to detect a possible association. 11 patients tested positive and 4 negative for the HLA DRB1 × 15 allele. The presence of the HLA DRB1 × 15 haplotype might be associated with a higher susceptibility to develop Multiple Sclerosis (MS). METHODS In this case series, we describe the ophthalmological and neurological findings in 10 HLA DR15-positive patients and 4 HLA DR15-negative patients that had neurological workup, including Magnetic Resonance Imaging (MRI) of the brain. RESULTS All patients had granulomatous ocular inflammation with either panuveitis or intermediate uveitis. MRI of the brain showed white matter lesions in 13 patients (9/10 and 4/4 respectively) of which 4 patients were eventually diagnosed with MS (3/10 and 1/4 respectively). CONCLUSION Although the majority of tested patients was carrying at least one HLA DRB1-15 allele, there was no difference in ophthalmological and neurological findings in both groups.
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Affiliation(s)
- Vincent De Man
- Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Lise Sels
- Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Long-Term Follow-up of Patients With Uveitis Treated With Adalimumab: Response Rates and Reasons for Discontinuation of Therapy. Am J Ophthalmol 2022; 240:194-204. [PMID: 35314190 DOI: 10.1016/j.ajo.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the effectiveness and reasons for discontinuation including the side effect profiles of adalimumab in a real-world setting. DESIGN Retrospective clinical cohort study. METHODS A medical chart review of clinical practice in 2 tertiary eye care services in Rotterdam, the Netherlands, was performed Data were collected from May 1, 2004, through September 1, 2020. Patients with noninfectious uveitis treated with adalimumab (n = 341; 633 affected eyes) were included. The primary outcome was the effectiveness of adalimumab, measured by the number of patients achieving inactive disease, remission, and relapse-free survival. The secondary outcomes were the reasons for discontinuation, including side effects, and the number of patients who developed antibodies. RESULTS In total, 341 patients were treated with adalimumab between May 2004 and September 2020. The uveitis recurrence-free survival interval was 3.4 years (range, 0-13 years). Adalimumab had an acceptable side effect profile. A total of 178 patients achieved inactive disease while continuing adalimumab, and 51 patients maintained remission after discontinuing adalimumab. Reasons for discontinuation of adalimumab were no response, relapse, or reasons unrelated to the effectiveness of treatment. Adalimumab antibodies were present in 40 of 115 patients (35%). Antibodies were associated with lower adalimumab levels, and antibodies were observed more often in patients on adalimumab monotherapy (P < .01). CONCLUSIONS Adalimumab is effective for patients with noninfectious uveitis, with an acceptable side effect profile. Although relapses can occur, the majority of the patients achieved inactive disease or remission after cessation of adalimumab, without other systemic immunosuppressive medication.
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Gupta S, Shyamsundar K, Agrawal M, Vichare N, Biswas J. Current Knowledge of Biologics in Treatment of Noninfectious Uveitis. J Ocul Pharmacol Ther 2022; 38:203-222. [DOI: 10.1089/jop.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Simple Gupta
- Department of Ophthalmology, Command Hospital, Pune, India
| | - K. Shyamsundar
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Mohini Agrawal
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Nitin Vichare
- Department of Ophthalmology, Command Hospital, Pune, India
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Netralaya, Chennai, India
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Casselman P, Cassiman C, Casteels I, Schauwvlieghe P. Insights into multiple sclerosis-associated uveitis: a scoping review. Acta Ophthalmol 2021; 99:592-603. [PMID: 33326162 DOI: 10.1111/aos.14697] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE This paper is a scoping review of research on multiple sclerosis (MS)-associated uveitis to determine its epidemiology, pathophysiology, clinical features and treatment. METHODS A comprehensive search of the medical databases MEDLINE (PubMed), EMBASE, Web of Science and Cochrane was carried out on 25 November 2019, to identify papers published between 1980 and 2019 that focus on patients with MS-associated uveitis. RESULTS Based on large cohort studies (n ≥ 1000), the prevalence of uveitis in patients with MS is estimated to be 0.53-1.34% (mean = 0.83%), and MS is diagnosed in 0.52-3.20% (mean = 1.30%) of patients with uveitis. The condition is most frequent among middle-aged women. Patients usually complain of floaters and/or blurred vision, with bilateral intermediate uveitis (with retinal vasculitis) as the most frequent ophthalmological finding. Both MS and intermediate uveitis are associated with HLA-DRB1*15:01 and IL-2RA gene polymorphism rs2104286 A > G, suggesting a common genetic background. T cells, and possibly B cells, play an important role in both autoimmune disorders. Multiple sclerosis (MS)-related uveitis is classically treated as non-infectious uveitis, with corticosteroids as the first treatment step. Other treatments include immunosuppressants, cryotherapy, laser photocoagulation and vitrectomy. These treatment options have a limited, if any, effect on the course of MS and can be complicated by side-effects. As treatment strategies for MS have increased in the last decade, it would be interesting to evaluate the efficacy of these new treatments during the course of uveitis. Moreover, the correlation between retinal periphlebitis and MS could be established more accurately with the recently developed techniques of wide-field fluorescein angiography in a large cohort of MS patients. CONCLUSION MS-associated uveitis is a rare, highly discussed pathology about which much is still unknown. Large epidemiological studies and extrapolation of new MS treatments to this condition are warranted.
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Affiliation(s)
| | | | - Ingele Casteels
- Department of Ophthalmology University Hospitals Leuven Leuven Belgium
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Signaling mechanisms of growth hormone-releasing hormone receptor in LPS-induced acute ocular inflammation. Proc Natl Acad Sci U S A 2020; 117:6067-6074. [PMID: 32123064 DOI: 10.1073/pnas.1904532117] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ocular inflammation is a major cause of visual impairment attributed to dysregulation of the immune system. Previously, we have shown that the receptor for growth-hormone-releasing hormone (GHRH-R) affects multiple inflammatory processes. To clarify the pathological roles of GHRH-R in acute ocular inflammation, we investigated the inflammatory cascades mediated by this receptor. In human ciliary epithelial cells, the NF-κB subunit p65 was phosphorylated in response to stimulation with lipopolysaccharide (LPS), resulting in transcriptional up-regulation of GHRH-R. Bioinformatics analysis and coimmunoprecipitation showed that GHRH-R had a direct interaction with JAK2. JAK2, but not JAK1, JAK3, and TYK2, was elevated in ciliary body and iris after treatment with LPS in a rat model of endotoxin-induced uveitis. This elevation augmented the phosphorylation of STAT3 and production of proinflammatory factors, including IL-6, IL-17A, COX2, and iNOS. In explants of iris and ciliary body, the GHRH-R antagonist, MIA-602, suppressed phosphorylation of STAT3 and attenuated expression of downstream proinflammatory factors after LPS treatment. A similar suppression of STAT3 phosphorylation was observed in human ciliary epithelial cells. In vivo studies showed that blocking of the GHRH-R/JAK2/STAT3 axis with the JAK inhibitor Ruxolitinib alleviated partially the LPS-induced acute ocular inflammation by reducing inflammatory cells and protein leakage in the aqueous humor and by repressing expression of STAT3 target genes in rat ciliary body and iris and in human ciliary epithelial cells. Our findings indicate a functional role of the GHRH-R/JAK2/STAT3-signaling axis in acute anterior uveitis and suggest a therapeutic strategy based on treatment with antagonists targeting this signaling pathway.
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Abstract
Inflammatory intraocular eye diseases, grouped under the term uveitis are blinding conditions, believed to be mediated by pathogenic autoimmune processes that overcome the protective mechanisms of the immune privilege status of the eye. An animal model for these diseases, named experimental autoimmune uveitis (EAU), is induced by initiation of immunity against ocular-specific antigens, or it develops spontaneously in mice with T-cells that transgenically express TCR specific to the target eye antigen(s). T-Cells specific to ocular antigens are generated in the thymus and their majority are eliminated by exposure to their target antigen expressed in this organ. T-cells that escape this negative selection acquire pathogenicity by their activation with the target antigen. In spontaneous EAU, the microbiota play crucial roles in the acquisition of pathogenicity by providing both antigenic stimulation, by molecules that mimic the target ocular antigen, and an additional stimulation that allows invasion of tissues that harbor the target antigen. The pathogenic process is physiologically inhibited by the peripheral tolerance, composed of antigen-specific T-regulatory (Treg) lymphocytes. Deleting the Tregs enhances the ocular inflammation, whereas adoptively transferring them suppresses the pathogenic response. Potential usage of Treg cells for suppression of autoimmune diseases in humans is under intensive investigation.
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Affiliation(s)
- Igal Gery
- Laboratory of Immunology, National Eye Institute, Bethesda, MD, United States
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Lin FL, Ho JD, Cheng YW, Chiou GCY, Yen JL, Chang HM, Lee TH, Hsiao G. Theissenolactone C Exhibited Ocular Protection of Endotoxin-Induced Uveitis by Attenuating Ocular Inflammatory Responses and Glial Activation. Front Pharmacol 2018; 9:326. [PMID: 29686615 PMCID: PMC5900795 DOI: 10.3389/fphar.2018.00326] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to investigate the effects of a natural component, theissenolactone C (LC53), on the ocular inflammation of experimental endotoxin-induced uveitis (EIU) and its related mechanisms in microglia. Evaluation of the severity of anterior uveitis indicated that LC53 treatment significantly decreased iridal hyperemia and restored the clinical scores. Additionally, the deficient retina functions of electroretinography were improved by LC53. LC53 significantly reduced levels of tumor necrosis factor (TNF)-α, monocyte chemoattractant protein-1, protein leakage and activation of matrix metalloproteinases in the anterior section during EIU. Moreover, LC53 treatment decreased the oxidative stress as well as neuroinflammatory reactivities of GFAP and Iba-1 in the posterior section. Furthermore, LC53 decreased the phosphorylation of p65, expression of HSP90, Bax, and cleaved-caspase-3 in EIU. According to the microglia studies, LC53 significantly abrogated the productions of TNF-α, PGE2, NO and ROS, as well as inducible NO synthase and cyclooxygenase-2 expression in LPS-stimulated microglial BV2 cells. The microglial activation of IKKβ, p65 phosphorylation and nuclear phosphorylated p65 translocation were strongly attenuated by LC53. On the other hand, LC53 exhibited the inhibitory effects on JNK and ERK MAPKs activation. Our findings indicated that LC53 exerted the ocular-protective effect through its inhibition on neuroinflammation, glial activation, and apoptosis in EIU, suggesting a therapeutic potential with down-regulation of the NF-κB signaling for uveitis and retinal inflammatory diseases.
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Affiliation(s)
- Fan-Li Lin
- Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jau-Der Ho
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Wen Cheng
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - George C Y Chiou
- Department of Neuroscience and Experimental Therapeutics and Institute of Ocular Pharmacology, College of Medicine, Texas A&M Health Science Center, College Station, TX, United States
| | - Jing-Lun Yen
- Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Ming Chang
- Department of Anatomy, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzong-Huei Lee
- Institute of Fisheries Science, National Taiwan University, Taipei, Taiwan
| | - George Hsiao
- Graduate Institute of Medical Sciences and Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program for the Clinical Drug Discovery from Botanical Herbs, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Diedrichs-Möhring M, Niesik S, Priglinger CS, Thurau SR, Obermayr F, Sperl S, Wildner G. Intraocular DHODH-inhibitor PP-001 suppresses relapsing experimental uveitis and cytokine production of human lymphocytes, but not of RPE cells. J Neuroinflammation 2018; 15:54. [PMID: 29467002 PMCID: PMC5822610 DOI: 10.1186/s12974-018-1088-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/02/2018] [Indexed: 01/02/2023] Open
Abstract
Background Uveitis is a potentially blinding inflammatory disease of the inner eye with a high unmet need for new therapeutic interventions. Here, we wanted to investigate the suppressive effect of the intraocular application of the small molecule dihydroorotate dehydrogenase (DHODH)-inhibitor PP-001 on experimental relapsing rat uveitis and furthermore determine its effect on proliferation and cytokine secretion of human peripheral blood lymphocytes (PBL) and human retinal pigment epithelial (RPE) cells in vitro. Methods Spontaneously relapsing uveitis was induced in rats by immunization with interphotoreceptor retinoid-binding protein (IRBP) peptide R14. PP-001 was injected intravitreally after resolution of the primary disease to investigate further relapses. Proliferation and metabolic activity of phytohemagglutinin (PHA)-stimulated human peripheral lymphocytes with and without PP-001 and cytokine secretion were determined by XTT assay and bioplex bead assay. The RPE cell line ARPE-19 as well as primary human RPE cells treated with PP-001 or anti-vascular endothelial growth factor (VEGF) antibody bevacizumab were also investigated for metabolic activity and cytokine/chemokine secretion. Results Injection of PP-001 into rat eyes reduced the number of relapses by 70%, from 20 relapses (57% of the rats affected) in the control group to 6 relapses (33% of the rats) in the treatment group. In human PBL cultures, PP-001 reduced the proliferation in a dose-dependent manner. The secretion of several cytokines such as IL-17, IFN-γ, and VEGF was suppressed by PP-001, as previously observed with rat T cells in the experimental autoimmune uveitis (EAU) model. In contrast, human RPE cells were not affected by PP-001, while the anti-VEGF antibody bevacizumab severely impaired the secretion of various cytokines including VEGF. Conclusions For the first time, intravitreal injection of PP-001 demonstrated an effective, but transient reduction of relapses in the rat EAU model. In vitro PP-001 suppressed proliferation and cytokine/chemokine secretion of human lymphocytes, while neither human RPE cell line ARPE-19 nor primary RPE cells were affected.
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Affiliation(s)
- Maria Diedrichs-Möhring
- Section of Immunobiology, Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Sandy Niesik
- Section of Immunobiology, Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstr. 8, 80336, Munich, Germany.,Division Virus-associated carcinogenesis (F170), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Claudia S Priglinger
- Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Stephan R Thurau
- Section of Immunobiology, Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Franz Obermayr
- Panoptes Pharma GmbH, Reisnerstr. 34/1, 1030, Vienna, Austria
| | - Stefan Sperl
- Panoptes Pharma GmbH, Reisnerstr. 34/1, 1030, Vienna, Austria
| | - Gerhild Wildner
- Section of Immunobiology, Department of Ophthalmology, University Hospital, LMU Munich, Mathildenstr. 8, 80336, Munich, Germany.
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Leitlinie Nr. 24b der DOG und BVA. Ophthalmologe 2017; 114:1122-1134. [DOI: 10.1007/s00347-017-0582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wakefield D, McCluskey P, Wildner G, Thurau S, Carr G, Chee SP, Forrester J, Dick A, Hudson B, Lightman S, Smith J, Tugal-Tutkun I. Inflammatory eye disease: Pre-treatment assessment of patients prior to commencing immunosuppressive and biologic therapy: Recommendations from an expert committee. Autoimmun Rev 2017; 16:213-222. [PMID: 28137477 DOI: 10.1016/j.autrev.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022]
Abstract
AIM To outline recommendations from an expert committee on the assessment and investigation of patients with severe inflammatory eye disease commencing immunosuppressive and/or biologic therapy. METHOD The approach to assessment is based on the clinical experience of an expert committee and a review of the literature with regard to corticosteroids, immunosuppressive drug and biologic therapy and other adjunct therapy in the management of patients with severe sight-threatening inflammatory eye disease. CONCLUSION We recommend a careful assessment and consultative approach by ophthalmologists or physicians experienced in the use of immunosuppressive agents for all patients commencing immunosuppressive and/or biologic therapy for sight threatening inflammatory eye disease with the aim of preventing infection, cardiovascular, metabolic and bone disease and reducing iatrogenic side effects.
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Affiliation(s)
- Denis Wakefield
- University of New South Wales, Faculty of Medicine, Kensington, Australia.
| | - Peter McCluskey
- Save Sight Institute, Sydney Eye Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gerhild Wildner
- Section of Immunobiology, Department of Ophthalmology, Clinic of the University of Munich, Munich, Germany
| | - Stephan Thurau
- Section of Immunobiology, Department of Ophthalmology, Clinic of the University of Munich, Munich, Germany
| | - Gregory Carr
- Manly Hospital, North Shore Private Hospital, St Leonards, NSW, Australia
| | - Soon-Phaik Chee
- Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Department of Ophthalmology, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore National Eye Centre, Ocular Inflammation and Immunology Department, Singapore
| | - John Forrester
- The Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Andrew Dick
- UCL-Institute of Ophthalmology, London, UK; School of Clinical Science, University of Bristol, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital, London, UK
| | - Bernard Hudson
- Department of Microbiology & Infectious Diseases, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia
| | - Susan Lightman
- UCL/Institute of Ophthalmology, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Justine Smith
- Eye & Vision Health, Flinders University School of Medicine, Adelaide, Australia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Tappeiner C, Mesquida M, Adán A, Anton J, Ramanan AV, Carreno E, Mackensen F, Kotaniemi K, de Boer JH, Bou R, de Vicuña CG, Heiligenhaus A. Evidence for Tocilizumab as a Treatment Option in Refractory Uveitis Associated with Juvenile Idiopathic Arthritis. J Rheumatol 2016; 43:2183-2188. [DOI: 10.3899/jrheum.160231] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 12/14/2022]
Abstract
Objective.To report on experience using the anti-interleukin 6 receptor antibody tocilizumab (TCZ) to treat severe and therapy-refractory uveitis associated with juvenile idiopathic arthritis (JIA).Methods.Retrospective data were gathered from patients with JIA receiving TCZ treatment for uveitis. JIA and related uveitis data (disease onset, activity, structural complications, and topical and systemic antiinflammatory treatment) were evaluated at the start of TCZ (baseline) and every 3 months during TCZ therapy.Results.A total of 17 patients (14 women) with active uveitis were included (mean age 15.3 ± 6.9 yrs, mean followup time 8.5 mos). In all patients, uveitis had been refractory to previous topical and systemic corticosteroids, methotrexate (MTX), and other synthetic and biological disease-modifying antirheumatic drugs, including ≥ 1 tumor necrosis factor-α (TNF-α) inhibitor. Uveitis inactivity was achieved in 10 patients after a mean of 5.7 months of TCZ treatment (in 3 of them, it recurred during followup) and persisted in the remaining 7 patients. By using TCZ, systemic corticosteroids or immunosuppressives could be spared in 7 patients. Macular edema was present in 5 patients at baseline and improved in all of them under TCZ treatment. Arthritis was active in 11 patients at the initial and in 6 at the final followup visit.Conclusion.TCZ appears to represent a therapeutic option for severe JIA-associated uveitis that has been refractory to MTX and TNF-α inhibitors in selected patients. The present data indicate that inflammatory macular edema responds well to TCZ in patients with JIA-associated uveitis.
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Kyei S, Koffuor GA, Ramkissoon P, Ameyaw EO, Asiamah EA. Anti-inflammatory effect of Heliotropium indicum Linn on lipopolysaccharide-induced uveitis in New Zealand white rabbits. Int J Ophthalmol 2016; 9:528-35. [PMID: 27162723 DOI: 10.18240/ijo.2016.04.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/14/2016] [Indexed: 01/19/2023] Open
Abstract
AIM To investigate the anti-inflammatory effect of an aqueous whole plant extract of Heliotropium indicum (HIE) on endotoxin-induced uveitis in New Zealand white rabbits. METHODS Clinical signs of uveitis including flares, iris hyperemia and miosis, were sought for and scored in 1.0 mg/kg lipopolysaccharide (LPS) -induced uveitic rabbits treated orally with HIE (30-300 mg/kg), prednisolone (30 mg/kg), or normal saline (10 mL/kg). The number of polymorphonuclear neutrophils infiltrating, the protein concentration, as well as levels of tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2), and monocyte chemmoattrant protein-1 (MCP-1) in the aqueous humor after the various treatments were also determined. A histopathological study of the anterior uveal was performed. RESULTS The extract and prednisolone-treatment significantly reduced (P≤0.001) both the clinical scores of inflammation (1.0-1.8 compared to 4.40±0.40 in the normal saline-treated rabbits) and inflammatory cells infiltration. The level of protein, and the concentrations of TNF-α, PGE2 and MCP-1 in the aqueous humor were also significantly reduced (P≤0.001). Histopathological studies showed normal uveal morphology in the HIE and prednisolone-treated rabbits while normal saline-treated rabbits showed marked infiltration of inflammatory cells. CONCLUSION The HIE exhibits anti-inflammatory effect on LPS-induced uveitis possibly by reducing the production of pro-inflammatory mediators.
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Affiliation(s)
- Samuel Kyei
- Discipline of Optometry, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa; Department of Optometry, School of Allied Health Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
| | - George Asumeng Koffuor
- Discipline of Optometry, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa; Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, Kumasi, Ghana
| | - Paul Ramkissoon
- Discipline of Optometry, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa
| | - Elvis Ofori Ameyaw
- Department of Biomedical and Forensic Sciences, School of Allied Health Science, University of Cape Coast, PMB, Cape Coast, Ghana
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Salazar-Méndez R, Yilmaz T, Cordero-Coma M. Moving forward in uveitis therapy: preclinical to phase II clinical trial drug development. Expert Opin Investig Drugs 2015; 25:195-214. [DOI: 10.1517/13543784.2016.1128893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Palmou-Fontana N, Navarro EJ, Melero OM, Palacios SL. Red eyes presenting with a fistulous lesion in the left lower extremity: a case report. J Med Case Rep 2015; 9:206. [PMID: 26361972 PMCID: PMC4567779 DOI: 10.1186/s13256-015-0661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/23/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Very few cases of scar sarcoidosis affecting the eyes and bone together have been reported in the last few years. Case presentation We report a case of a 49-year-old Spanish man with recurrent bilateral granulomatous uveitis and a fistulous nodular lesion in the left pre-tibial region (scar granuloma) on the site of an 8-year-old scar. He presented with bilateral hilar adenopathies and elevation of inflammatory markers and angiotensin-converting enzyme. A histologically confirmed sarcoid of the tibia with a radiologic appearance unusual for long tubular bone involvement was observed. He also had bilateral ophthalmologic involvement. Conclusions Sarcoidosis is a disease of unknown cause histologically characterized by non-caseating granulomas that can involve any organ or tissue. Osseous sarcoidosis is a relatively rare presentation. However, on the basis of cases reported in the literature, sarcoid lesions on bones are generally asymptomatic. Biologic agents are considered an alternative therapy for sarcoidosis resistant to conventional treatment.
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Takayama K, Tanaka A, Ishikawa S, Mochizuki M, Takeuchi M. Comparison between Outcomes of Vitrectomy in Granulomatous and Nongranulomatous Uveitis. Ophthalmologica 2015; 235:18-25. [DOI: 10.1159/000441255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022]
Abstract
Purpose: The aim of this study was to compare the outcomes of vitrectomy in granulomatous uveitis and nongranulomatous uveitis insufficiently managed by immunosuppressive therapy. Methods: Thirty-eight eyes with granulomatous uveitis and 17 eyes with nongranulomatous uveitis that underwent vitrectomy for ocular complications between July 2006 and August 2012 were reviewed retrospectively. Visual acuity and ocular inflammation scores before and 6 months after surgery were compared. Patients treated with vitrectomy alone and those in whom vitrectomy was combined with phacoemulsification were analyzed separately. Results: The mean visual acuity improved significantly both in granulomatous and nongranulomatous uveitis. In granulomatous uveitis, the mean inflammation scores decreased significantly both in the anterior segment and in the posterior segment. In nongranulomatous uveitis, the mean inflammation score in the posterior segment decreased significantly, although it did not change in the anterior segment. Conclusion: Vitrectomy was effective for treating ocular complications both in granulomatous uveitis and nongranulomatous uveitis, with favorable outcomes of improved visual acuity and decreased uveitis activity.
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Agarwal A, Afridi R, Hassan M, Sadiq MA, Sepah YJ, Do DV, Nguyen QD. Novel Therapies in Development for Diabetic Macular Edema. Curr Diab Rep 2015; 15:75. [PMID: 26294336 DOI: 10.1007/s11892-015-0652-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetic macular edema (DME) secondary to diabetic retinopathy (DR) is a major cause for functional visual loss in the developed world. Laser photocoagulation has been used for decades in the treatment of DME. However, the advent of anti-vascular endothelial growth factor (anti-VEGF) has revolutionized the treatment of DME. Three important anti-VEGF agents whose efficacy has been well established via phase III clinical trials include ranibizumab, bevacizumab, and aflibercept. However, even in the era of anti-VEGF therapies, there are some challenges that retina specialists have to confront in managing patients with DME. These include the need for frequent treatment and an unpredictable response to therapy. There is evidence to suggest that pathways other than the VEGF pathway may be playing a role in the development of DME. Thus, extensive research is focused on development of novel agents that target these pathways. This review focuses on novel therapeutic agents in development, which may be used as a monotherapy or in combination with anti-VEGF agents, for the management of DME in the future.
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Affiliation(s)
- Aniruddha Agarwal
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
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Effects of subconjunctival tocilizumab versus bevacizumab in treatment of corneal neovascularization in rabbits. Cornea 2015; 33:1088-94. [PMID: 25119962 DOI: 10.1097/ico.0000000000000220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to compare the antiangiogenic effects of subconjunctival application of bevacizumab and tocilizumab on the regression of corneal neovascularization (NV) in rabbits. METHODS Corneal neovascularization was induced in 48 eyes of 24 rabbits. Seven days after suture placement, the rabbits were divided into 4 groups of 6 rabbits each and treated subconjunctivally with 0.1 mL balanced salt solution (group 1), 0.1 mL tocilizumab (0.25 mg per 0.1 mL and 2.5 mg per 0.1 mL, groups 2 and 3), or 0.1 mL bevacizumab (2.5 mg per 0.1 mL) (group 4). Digital photographs of the eyes were obtained and the surface areas of corneal neovascularization were measured on days 7 and 14 after subconjunctival injections. On days 7 and 14, 3 rabbits were randomly chosen and the eyes were extracted. Half of the corneal specimens were analyzed histopathologically, and the other half were used to measure the concentrations of vascular endothelial growth factor (VEGF) and IL-6 using a multiplex bead assay, and the levels were compared with those of the controls. RESULTS The surface areas of induced corneal neovascularization were significantly smaller in groups 3 and 4 (2.5 mg of tocilizumab and 2.5 mg of bevacizumab) compared with the control group on days 7 and 14 (P < 0.05). Group 2 did not show significant difference from the control group on days 7 and 14. There were no differences observed in the reduced neovascularization areas in groups 3 and 4 on days 7 and 14. The concentrations of VEGF in groups 3 and 4 were significantly lower than in the control group, and IL-6 mRNA levels were significantly lower in group 3 than in the other groups (P < 0.001) on days 7 and 14. Immunohistochemical analysis confirmed the reduced expression of VEGF in all 3 experimental groups compared with the control group. CONCLUSIONS An antiangiogenic effect was observed after subconjunctival injection of 2.5 mg tocilizumab to an extent similar to that seen with 2.5 mg bevacizumab, which indicates that subconjunctival application of tocilizumab is effective for the inhibition of corneal neovascularization.
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Uvéites et biothérapies. Rev Med Interne 2015; 36:107-16. [DOI: 10.1016/j.revmed.2014.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 02/16/2014] [Accepted: 07/28/2014] [Indexed: 12/25/2022]
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Qin YJ, Chu KO, Yip YWY, Li WY, Yang YP, Chan KP, Ren JL, Chan SO, Pang CP. Green tea extract treatment alleviates ocular inflammation in a rat model of endotoxin-induced uveitis. PLoS One 2014; 9:e103995. [PMID: 25093862 PMCID: PMC4122397 DOI: 10.1371/journal.pone.0103995] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/06/2014] [Indexed: 12/14/2022] Open
Abstract
Green tea extract (GTE) ingested by rats exerted anti-oxidative activities in various ocular tissues as shown in our previous studies. The present work investigated anti-inflammatory effects of GTE on endotoxin-induced uveitis (EIU). EIU was generated in adult rats by a footpad injection of 1 mg/kg lipopolysaccharide (LPS). Oral administration of GTE (550 mg/kg) was given one, two or four times after LPS injection. Twenty-four hours later, LPS produced severe hyperemia and edema in the iris. Immunocytochemical examinations showed an accumulation of infiltrating cells in the aqueous humor that were immunopositive for cluster of differentiation 43 (CD43) and CD68, markers for leucocytes and macrophages, respectively. Analyses of the aqueous humor showed an increase in pro-inflammatory mediators including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1). GTE treatments improved the clinical manifestations and reduced infiltrating cells and protein exudation in the aqueous humor, which were not observed under half dose of GTE (275 mg/kg). The number of CD68 positive macrophages residing in the iris and ciliary was also reduced. GTE suppressed production of TNF-α, IL-6 and MCP-1 in the aqueous humor, which was associated with a down-regulation of LPS receptor complex subunits, Toll-like receptor 4 (TLR-4) and CD14, and suppression of nuclear factor-kappa Bp65 (NF-κBp65) in the iris and ciliary body. Our findings show that GTE is a potent anti-inflammatory agent against the inflammation of EIU, and suggest a potential use in treatment of acute uveitis.
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Affiliation(s)
- Yong Jie Qin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Kai On Chu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Yolanda Wong Ying Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Wai Ying Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Ya Ping Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Kwok Ping Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jia Lin Ren
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sun On Chan
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail: (CPP); (SOC)
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- * E-mail: (CPP); (SOC)
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Zhao X, Toyooka T, Ibuki Y. Silver ions enhance UVB-induced phosphorylation of histone H2AX. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2014; 55:556-565. [PMID: 24838775 DOI: 10.1002/em.21875] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
Silver (Ag) is used in a wide range of industries including healthcare, food, cosmetics, and environmental industries due to its antibacterial properties. The rapidly expanding use of Ag has raised issues concerning its toxicity in humans. However, studies investigating the effects of Ag on humans are very limited, and the combined effects of Ag and other environmental factors have not yet been determined. Ultraviolet (UV) radiation in sunlight is the most prominent and ubiquitous physical stressor in our natural environment. In this study, we investigated the genotoxic potential of combined exposure to Ag(+) (AgNO3) and UVB in the human keratinocyte cell line, HaCaT, by measuring the generation of phosphorylated histone H2AX, which is currently attracting attention as a biomarker for the detection of genotoxic insults. We found that the generation of γ-H2AX was synergistically enhanced when cells were coexposed to Ag(+) and UVB. Furthermore, we showed that the enhanced generation of γ-H2AX could be attributed to the increased formation of UVB-induced cyclobutane pyrimidine dimers and (6-4) photoproducts. These lesions, if not repaired properly, are the major causal factor for skin carcinogenesis. Our results provide an important insight into influence of Ag on the genotoxic potency of sunlight.
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Affiliation(s)
- Xiaoxu Zhao
- Graduate Division of Nutritional and Environmental Sciences, University of Shizuoka, Shizuoka-Shi, Shizuoka, Japan
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Immunopathogenesis of ocular Behçet's disease. J Immunol Res 2014; 2014:653539. [PMID: 25061613 PMCID: PMC4100451 DOI: 10.1155/2014/653539] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/10/2014] [Indexed: 12/12/2022] Open
Abstract
Behçet's disease (BD) is a chronic recurrent systemic inflammatory disorder of unknown etiology characterized by oral and genital ulcerations, skin lesions, and uveitis. The ocular involvement of BD, or Behçet's uveitis (BU), is characterized by panuveitis or posterior uveitis with occlusive retinal vasculitis and tends to be more recurrent and sight threatening than other endogenous autoimmune uveitides, despite aggressive immunosuppression. Although pathogenesis of BD is unclear, researches have revealed that immunological aberrations may be the cornerstone of BD development. General hypothesis of BD pathogenesis is that inflammatory response is initiated by infectious agents or autoantigens in patients with predisposing genetic factors and perpetuated by both innate and acquired immunity. In addition, a network of immune mediators plays a substantial role in the inflammatory cascade. Recently, we found that the immunopathogenesis of BU is distinct from other autoimmune uveitides regarding intraocular effector cell profiles, maturation markers of dendritic cells, and the cytokine/chemokine environment. In addition, accumulating evidence indicates the involvement of Th17 cells in BD and BU. Recent studies on genetics and biologics therapies in refractory BU also support the immunological association with the pathogenesis of BU. In this review, we provide an overview of novel findings regarding the immunopathogenesis of BU.
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Semeraro F, Arcidiacono B, Nascimbeni G, Angi M, Parolini B, Costagliola C. Anti-TNF therapy for juvenile idiopathic arthritis-related uveitis. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:341-8. [PMID: 24711694 PMCID: PMC3969254 DOI: 10.2147/dddt.s54207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Juvenile idiopathic arthritis-related uveitis is the most common type of uveitis in childhood and one of the main causes of visual impairment in children. The introduction of biological treatment has widened the range of therapeutic options for children with uveitis refractory to standard nonbiologic immunosuppressants. Data from clinical trials suggest that both adalimumab and infliximab have demonstrated effectiveness and safety in open-label studies, although no large, randomized, controlled trials have been reported so far. The role of etanercept in treating juvenile idiopathic arthritis-related uveitis is not yet well defined. In our experience, anti-tumor necrosis factor therapy has been shown to be more effective than steroids and/or methotrexate in treating uveitis. Up to now, tumor necrosis factor blocking compounds have been reserved for the treatment of the most severe cases of refractory uveitis, and larger prospective clinical trials are required in order to better assess the safety of these new compounds.
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Affiliation(s)
- Francesco Semeraro
- Eye Clinic, Department of Neurological Sciences and Vision, University of Brescia, Brescia, Italy
| | | | - Giuseppe Nascimbeni
- Eye Clinic, Department of Neurological Sciences and Vision, University of Brescia, Brescia, Italy
| | - Martina Angi
- Eye Clinic, Department of Neurological Sciences and Vision, University of Brescia, Brescia, Italy
| | | | - Ciro Costagliola
- Eye Clinic, Department of Health Sciences, University of Molise, Campobasso, Italy
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Mérida S, Sancho-Tello M, Navea A, Almansa I, Muriach M, Bosch-Morell F. An anti-interleukin-2 receptor drug attenuates T- helper 1 lymphocytes-mediated inflammation in an acute model of endotoxin-induced uveitis. PLoS One 2014; 9:e90216. [PMID: 24595020 PMCID: PMC3940780 DOI: 10.1371/journal.pone.0090216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/26/2014] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the anti-inflammatory efficacy of Daclizumab, an anti-interleukin-2 receptor drug, in an experimental uveitis model upon a subcutaneous injection of lipopolysaccharide into Lewis rats, a valuable model for ocular acute inflammatory processes. The integrity of the blood-aqueous barrier was assessed 24 h after endotoxin-induced uveitis by evaluating two parameters: cell count and protein concentration in aqueous humors. The histopathology of all the ocular structures (cornea, lens, sclera, choroid, retina, uvea, and anterior and posterior chambers) was also considered. Enzyme-linked immunosorbent assays of the aqueous humor samples were performed to quantify the levels of the different chemokine and cytokine proteins. Similarly, a biochemical analysis of oxidative stress-related markers was also assessed. The inflammation observed in the anterior chamber of the eyes when Daclizumab was administered with endotoxin was largely prevented since the aqueous humor protein concentration substantially lowered concomitantly with a significant reduction in the uveal and vitreous histopathological grading. Th1 lymphocytes-related cytokines, such as Interleukin-2 and Interferon-γ, also significantly reduced with related anti-oxidant systems recovery. Daclizumab treatment in endotoxin-induced uveitis reduced Th1 lymphocytes-related cytokines, such as Interleukin-2 and Interferon gamma, by about 60–70% and presented a preventive role in endotoxin-induced oxidative stress. This antioxidant protective effect of Daclizumab may be related to several of the observed Daclizumab effects in our study, including IL-6 cytokine regulatory properties and a substantial concomitant drop in INFγ. Concurrently, Daclizumab treatment triggered a significant reduction in both the uveal histopathological grading and protein concentration in aqueous humors, but not in cellular infiltration.
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Affiliation(s)
- Salvador Mérida
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Amparo Navea
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, Spain
| | - Inmaculada Almansa
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - María Muriach
- Unidad Predepartamental de Medicina, Universitat Jaume I, Castellón de la Plana, Spain
| | - Francisco Bosch-Morell
- Instituto de Ciencias Biomédicas, Universidad CEU Cardenal Herrera, Valencia, Spain
- Oftalmología Médica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Valencia, Spain
- * E-mail:
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Dastiridou A, Kalogeropoulos C, Brazitikos P, Symeonidis C, Androudi S. New biologic-response modifiers in ocular inflammatory disease: beyond anti-TNF treatment. Expert Rev Clin Pharmacol 2014; 5:543-55. [DOI: 10.1586/ecp.12.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sepah YJ, Michelle EH, Metcalf B, Khwaja A, Channa R, Ibrahim M, Hatef E, Heo J, Hee JL, Rentiya ZS, Do DV, Nguyen QD. Voclosporin: a potentially promising therapeutic agent for noninfectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.11.19] [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: 11/08/2022]
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Kruh JN, Yang P, Suelves AM, Foster CS. Infliximab for the treatment of refractory noninfectious Uveitis: a study of 88 patients with long-term follow-up. Ophthalmology 2013; 121:358-364. [PMID: 24011995 DOI: 10.1016/j.ophtha.2013.07.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To establish the safety and efficacy of infliximab for the treatment of refractory noninfectious uveitis. DESIGN Retrospective, interventional, noncomparative cohort study. PARTICIPANTS Eighty-eight patients from a single-center private practice. METHODS Patients with chronic, recalcitrant uveitis treated with infliximab (Remicade; Janssen Biotech, Inc., Titusville, NJ) were identified through an electronic medical record database. All charts were reviewed for sex, diagnosis, location of inflammation, presence of vasculitis, prior immunomodulatory treatments, duration of infliximab treatment, dose received, secondary side effects, and other medications continued while receiving treatment with infliximab. MAIN OUTCOME MEASURES The primary outcome measures were the rate of remission, time to remission, relapse rate, failure rate, and patient tolerance. Additional analysis aimed to identity risk factors that would predict a higher success rate of infliximab to treat various types of noninfectious uveitis. RESULTS Of the 72 patients (81.8%) who achieved clinical remission while being treated with infliximab, 42 (58.3%) required additional immunomodulatory medications. At 7, 18.1, and 44.7 weeks, 25%, 50%, and 75% of patients, respectively, achieved clinical remission off all corticosteroids. Thirty-two patients (36.4%) experienced at least 1 side effect while on infliximab therapy, and 17 patients (19.3%) discontinued treatment secondary to 1 or more intolerable side effects. The most common adverse effects were skin rash (9.1%) and fatigue (8%). Factors associated with a higher chance to achieve clinical remission were nonidiopathic uveitis (P < 0.001), intermediate or panuveitis (P < 0.001), absence of vasculitis (P < 0.001), and a starting dose ≥5 mg/kg (P < 0.011). CONCLUSIONS Infliximab induces a high rate of complete clinical remission in recalcitrant uveitis and is well tolerated by most patients.
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Affiliation(s)
- Jonathan N Kruh
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts
| | - Paul Yang
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts
| | - Ana M Suelves
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Abstract
Alemtuzumab (Campath®, MabCampath®, Genzyme) is an IgG1k anti-CD52 humanized monoclonal antibody (mAb) that was first licensed in March 2001 by FDA. EMEA granted its approval in July 2001 and Health Canada in November 2005. The initial indication was limited to B-CLL previously treated and resistant to alkylating agents. Starting from 2007, alemtuzumab was approved also as first-line therapy of B-CLL. So far, it has been experienced in over 60 countries.
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Biotherapies in inflammatory ocular disorders: Interferons, immunoglobulins, monoclonal antibodies. Autoimmun Rev 2013; 12:774-83. [DOI: 10.1016/j.autrev.2013.02.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 02/18/2013] [Indexed: 12/12/2022]
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Vadlapudi AD, Patel A, Cholkar K, Mitra AK. Recent Patents on Emerging Therapeutics for the Treatment of Glaucoma, Age Related Macular Degeneration and Uveitis. RECENT PATENTS ON BIOMEDICAL ENGINEERING 2012; 5:83-101. [PMID: 25414810 PMCID: PMC4235159 DOI: 10.2174/1874764711205010083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advancements in the field and rising interest among pharmaceutical researchers have led to the development of new molecules with enhanced therapeutic activity. Design of new drugs which can target a particular pathway and/or explore novel targets is of immense interest to ocular pharmacologists worldwide. Delivery of suitable pharmacologically active agents at proper dose (within the therapeutic window) to the target tissues without any toxicity to the healthy ocular tissues still remain an elusive task. Moreover, the presence of static and dynamic barriers to drug absorption including the corneal epithelium (lipophilic), corneal and scleral stroma (hydrophilic), conjunctival lymphatics, choroidal vasculature and the blood-ocular barriers also pose a significant challenge for achieving therapeutic drug concentrations at the target site. Although many agents are currently available, new compounds are being introduced for treating various ocular diseases. Deeper understanding of the etiology and complex mechanisms associated with the disease condition would aid in the development of potential therapeutic candidates. Novel small molecules as well as complex biotechnology derived macromolecules with superior efficacy, safety and tolerability are being developed. Therefore, this review article provides an overview of existing drugs, treatment options, advances in emerging therapeutics and related recent patents for the treatment of ocular disorders such as glaucoma, age related macular degeneration (AMD) and uveitis.
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Affiliation(s)
- Aswani Dutt Vadlapudi
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
| | - Ashaben Patel
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
| | - Kishore Cholkar
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
| | - Ashim K. Mitra
- Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO 64108-2718, USA
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Cunningham ET. Surveying uveitis specialists-a call for consensus. J Ophthalmic Inflamm Infect 2012; 2:61-3. [PMID: 22454249 PMCID: PMC3345051 DOI: 10.1007/s12348-012-0061-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 01/30/2012] [Indexed: 12/14/2022] Open
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Cunningham ET, Goldstein DA, Zierhut M. Uveitis Treatment Trials—A Cross-study Perspective. Ocul Immunol Inflamm 2012; 20:63-7. [PMID: 22360435 DOI: 10.3109/09273948.2012.661297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Van Praet L, Van den Bosch F, Mielants H, Elewaut D. Mucosal Inflammation in Spondylarthritides: Past, Present, and Future. Curr Rheumatol Rep 2011; 13:409-15. [DOI: 10.1007/s11926-011-0198-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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