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Cox JT, Minkus CL, Li A, Han S, Liu R, Shah P, Stanwyck LK, Rizzo JF, Sobrin L. Autoimmune Retinopathy: Intravenous Immunoglobulin Treatment versus Natural History. Ophthalmol Retina 2024; 8:609-611. [PMID: 38428458 DOI: 10.1016/j.oret.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Jacob T Cox
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Caroline L Minkus
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Park Nicollet Clinic, St. Louis Park, Minnesota
| | - Ashley Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Samuel Han
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Renee Liu
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Priya Shah
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Lynn K Stanwyck
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
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Gougoulakis LS, Rothermundt C, Flynn MC, Jörger M, Todorova MG. Electrodiagnostic Biomarkers in Paraneoplastic Retinopathy. Klin Monbl Augenheilkd 2024; 241:510-524. [PMID: 38653300 DOI: 10.1055/a-2227-3970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Paraneoplastic retinopathy (PNR) is a rapid-onset photoreceptor and post-photoreceptor dysfunction triggered by a cross-reaction between antigens expressed by the underlying tumour and retinal proteins. The present study aims to determine the electrodiagnostic biomarkers that support the diagnosis of PNR and evaluate the effect of treatment. METHODS A retrospective observational case-controlled study including 25 patients with suspected PNR, of which 11 patients were diagnosed with PNR. The presence of PNR was confirmed based on clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, optical coherence tomography, fluorescein angiography, retinal vessel oximetry, colour test, full-field electroretinogram (ffERG), on-/off ERG, S-cone ERG, and multifocal ERG (mfERG). The relationships between the clinical symptomatology and the effect of therapy were evaluated. RESULTS All PNR patients (Nr: 11) presented with subjective symptoms of newly reported central vision or visual field deterioration. Posterior segment findings showed a severe patchy-like retinal atrophy, attenuation of the retinal vessels, and a waxy optic disc. Optical coherence tomography revealed a discontinued ISe line, and multiple hyperreflective foci. Retinal vessel oxygen saturation was increased. Multifocal ERG revealed reduced central and paracentral responses and ffERG severely attenuated scotopic-, photopic-, on-/off- and S-cone responses. The colour vision test revealed a tritan-tetartan-weakness. Two of the PNR patients underwent rituximab therapy with no further progression and even recovery of electrodiagnostic responses.In 1 nPNR (non-paraneoplastic retinopathy) patient (total Nr: 14) pseudoxanthoma elasticum-related retinopathy was the reason for impaired vision. In 3 of 13 patients with bronchopulmonary cancer a MEK- and FGFR-inhibitor- drug toxicity was the reason for the visual deterioration. CONCLUSION Careful investigation for signs of central and/or peripheral visual field deterioration must be performed in the presence of history of a co-existing malignancy. The possibility of PNR should be taken into account. The electrodiagnostic biomarkers, suggested in this study, may help to promptly recognise PNR and also to evaluate the effect of implemented therapy.
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Affiliation(s)
| | - Christian Rothermundt
- Clinic of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Switzerland
| | - Marie-Claire Flynn
- Clinic of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Switzerland
| | - Markus Jörger
- Clinic of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Switzerland
| | - Margarita G Todorova
- Department of Ophthalmology, Cantonal Hospital St. Gallen, Switzerland
- Department of Ophthalmology, University of Zürich, Switzerland
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Heng JS, Kim JM, Jones DK, Stoessel KM, Weiss SA, Sznol M, Kluger HM, Walter SD, Silverstein NA, Pointdujour-Lim R. Autoimmune retinopathy with associated anti-retinal antibodies as a potential immune-related adverse event associated with immunotherapy in patients with advanced cutaneous melanoma: case series and systematic review. BMJ Open Ophthalmol 2022; 7:e000889. [PMID: 35047671 PMCID: PMC8724805 DOI: 10.1136/bmjophth-2021-000889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To demonstrate the spectrum of autoimmune retinopathy (AIR) associated with immunotherapy for advanced cutaneous melanoma. METHODS AND ANALYSIS Retrospective chart review on patients with advanced cutaneous melanoma who developed AIR after initiating immunotherapy. Complete ophthalmic examination and relevant ancillary testing were performed on each patient. The presence of AIR-associated anti-retinal antibodies was confirmed by western blot and/or immunohistochemical staining. Ophthalmic and systemic outcomes after treatment for AIR were followed over time. A systematic review of AIR associated with immunotherapy for cutaneous or non-ocular mucosal melanoma was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Case 1 developed photopsia and nyctalopia with electroretinographic findings characteristic for melanoma-associated retinopathy 1 week after initiating ipilimumab/nivolumab immunotherapy. Case 2 experienced new severe bilateral visual field loss associated with anti-retinal and anti-optic nerve antibodies while on maintenance nivolumab immunotherapy. Case 3 developed decreased visual acuity due to acute exudative polymorphous vitelliform maculopathy within 2 weeks of initiating ipilimumab/nivolumab immunotherapy. All patients had concurrent extraocular immune-related adverse events in addition to the presence of anti-retinal antibodies on serological testing. 14 published cases of AIR associated with immunotherapy for cutaneous or non-ocular mucosal melanoma were identified and reviewed. CONCLUSIONS Immune checkpoint inhibition can trigger the development of AIR with varied clinical manifestations in patients with advanced cutaneous melanoma. This study highlights the need for close monitoring in cutaneous melanoma patients receiving immunotherapy who develop new visual symptoms with or without funduscopic changes, as well as the potential role for screening of patients prior to initiating immunotherapy.
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Affiliation(s)
- Jacob S Heng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jenna M Kim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - D Kyle Jones
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Stoessel
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah A Weiss
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mario Sznol
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Harriet M Kluger
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott D Walter
- Retina Consultants, P.C, Hartford, Connecticut, USA
- Hartford HealthCare Cancer Institute, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
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Dutta Majumder P, Marchese A, Pichi F, Garg I, Agarwal A. An update on autoimmune retinopathy. Indian J Ophthalmol 2021; 68:1829-1837. [PMID: 32823399 PMCID: PMC7690499 DOI: 10.4103/ijo.ijo_786_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Autoimmune retinopathy (AIR) refers to a group of rare autoimmune retinal degenerative diseases presumably caused by cross-reactivity of serum autoantibodies against retinal antigens. The pathogenesis of AIR remains largely presumptive and there are a significant number of antiretinal antibodies that have been detected in association with AIR. The diagnosis of AIR is largely based on the demonstration of antiretinal antibodies in the serum along with suggestive clinical features and ancillary investigations. A high index of suspicion along with early diagnosis and treatment may play a critical role to lower the risk of irreversible immunological damage to the retinal cells in these patients. A multi-disciplinary approach for complete management and evaluation is helpful in such conditions. Various therapeutic options have been described for the treatment of AIR, though there is no consensus on standard treatment protocol.
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Affiliation(s)
| | - Alessandro Marchese
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Itika Garg
- Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Khaddour K, Khanna S, Ansstas M, Jakhar I, Dahiya S, Council L, Ansstas G. Normalization of electroretinogram and symptom resolution of melanoma-associated retinopathy with negative autoantibodies after treatment with programmed death-1 (PD-1) inhibitors for metastatic melanoma. Cancer Immunol Immunother 2021; 70:2497-2502. [PMID: 33544215 PMCID: PMC8360886 DOI: 10.1007/s00262-021-02875-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/25/2021] [Indexed: 12/16/2022]
Abstract
Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome that involves the production of autoantibodies which can cross-react with retinal epitopes leading to visual symptoms. Autoantibodies can target intracellular proteins, and only a few are directed against membrane proteins. This discrepancy in autoantibody-protein target can translate into different immune responses (T-cell mediated vs B-cell mediated). Historically, treatment of MAR has focused on surgical reduction or immunosuppressive medication, mainly glucocorticoids. However, tumor resection is not relevant in metastatic melanoma in which MAR is mostly encountered. Moreover, the use of glucocorticoids can reduce the efficacy of immunotherapy. We report the first case to our knowledge with subjective resolution of visual symptoms and objective evidence of normalization of electroretinogram of MAR with undetectable autoantibodies after administration of programmed death-1 (PD-1) inhibitor (pembrolizumab) without the use of surgical reduction or systemic immunosuppression. This case highlights the potential improvement and resolution of negative autoantibody MAR with the use of PD-1 inhibitors and emphasizes the importance of multidisciplinary approach and team discussion to avoid interventions that can decrease immunotherapy-mediated anti-tumor effect.
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Affiliation(s)
- Karam Khaddour
- Division of Medical Oncology, Washington University in Saint Louis, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA
| | - Sangeeta Khanna
- Department of Ophthalmology and Neurology, Saint Louis University, St Louis, MO, USA
| | - Michael Ansstas
- Allergy and Immunology, Barnes Jewish Christian Health Care, Saint Louis, MO, USA
| | | | - Sonika Dahiya
- Division of Neuropathology, Department of Pathology and Immunology, Washington University in Saint Louis, Saint Louis, USA
| | - Laurin Council
- Division of Dermatology, Washington University in Saint Louis, Saint Louis, USA
| | - George Ansstas
- Division of Medical Oncology, Washington University in Saint Louis, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, Saint Louis, MO, USA.
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Nintedanib and a bi-specific anti-VEGF/Ang2 nanobody selectively prevent brain metastases of lung adenocarcinoma cells. Clin Exp Metastasis 2020; 37:637-648. [PMID: 32918638 PMCID: PMC7666285 DOI: 10.1007/s10585-020-10055-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/06/2020] [Indexed: 02/07/2023]
Abstract
Brain metastases (BM) are an ever-increasing challenge in oncology, threatening quality of life and survival of many cancer patients. The majority of BM originate from lung adenocarcinoma, and stage III patients have a risk of 40–50% to develop BM in the first years of disease onset. As therapeutic options are limited, prevention of their occurrence is an attractive concept. Here we investigated whether Nintedanib (BIBF 1120), a tyrosine kinase inhibitor (TKI) targeting the VEGF pathway approved for lung adenocarcinoma, and the dual anti-VEGF-A/Ang2 nanobody BI836880 have the potential to prevent BM formation. A mouse model of brain metastasis from lung adenocarcinoma was used in which tumor cells were injected intracardially. Metastases formation occurred inside and outside of the brain and was followed by MRI, IVIS, and immunohistochemistry. BM were reduced in volume and number by both Nintedanib and the dual anti-VEGF-A/Ang2 nanobody, which translated into improved survival. Both compounds were able to normalize cerebral blood vessels at the site of brain metastatic lesions. Extracranial metastases, however, were not reduced, and meningeal metastases only partially. Interestingly, unspecific control IgG also lead to brain vessel normalization and reduction of brain and meningeal metastases. This data indicates a brain-specific group effect of antiangiogenic compounds with respect to metastasis prevention, most likely by preventing an early angiogenic switch. Thus, Nintedanib and BI836880 are promising candidates for future BM preventive study concepts in lung adenocarcinoma patients.
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Karatsai E, Robson AG, Taylor SRJ. Outcomes Associated With Sustained-Release Intraocular Fluocinolone Implants in a Case of Melanoma-Associated Retinopathy Treated Without Systemic Immunosuppression. JAMA Ophthalmol 2020; 137:564-567. [PMID: 30896772 DOI: 10.1001/jamaophthalmol.2019.0284] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome in which antiretinal antibodies crossreact with retinal ON-bipolar cells, resulting in night blindness and progressive visual field loss. Current therapeutic options include cytoreductive surgery in combination with immunoglobulin, corticosteroids, or plasmapheresis, but their effectiveness is limited and may be contraindicated, given the possible protective role of circulating autoantibodies against metastatic spread. We report 3-year follow-up of the first case (to our knowledge) of MAR treated with intravitreal long-acting steroid implants. Objective To report on a patient with MAR who was treated with intravitreal fluocinolone acetonide implants in the absence of systemic immunosuppression. Design, Setting, and Participants This is a 3-year follow-up of a 73-year-old woman with a history of surgical excision of a malignant melanoma of the left pinna who presented with visual symptoms of shimmering and nyctalopia. Fundus examination, fundus autofluorescence, and optical coherence tomography were normal, with no evidence of cystoid macular edema. Automated perimetry showed a reduction in visual field and full-field electroretinography (ERG) demonstrated findings consistent with generalized ON-bipolar cell dysfunction, typical of MAR. The patient was treated with bilateral fluocinolone acetonide intravitreal implants. Main Outcomes and Measures Visual acuity, visual field, and electroretinography testing for 3 years after treatment. Results Visual fields improved in this 73-year-old patient from 20/30 (Snellen measured as 6/9) OD and 20/16 (6/5) OS at baseline to 20/20 OU within 1 week of treatment. Detailed electroretinography monitoring indicated characteristic abnormalities that partly resolved after treatment, consistent with improved inner retinal ON-bipolar cell function. Bilateral cataracts developed approximately 2 years after injection; cataract surgery was performed uneventfully. At 3 years posttreatment, the patient remained visually stable and in systemic disease remission, with best-corrected visual acuity remaining at 20/20 OU. Conclusions and Relevance We report what is, to our knowledge, the first case of MAR treated with intravitreal slow-release corticosteroid implants, which shows improvements in visual symptoms, visual fields, and retinal function. Sustained-release intraocular steroid implants may offer an effective and safe alternative to systemic immunosuppression in MAR, although results from 1 case should be generalized with abundant caution.
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Affiliation(s)
| | - Anthony G Robson
- Moorfields Eye Hospital, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Simon R J Taylor
- Royal Surrey County Hospital, Guildford, United Kingdom.,University of Surrey, Guildford, United Kingdom
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Ramos-Ruperto L, Busca-Arenzana C, Boto-de Los Bueis A, Schlincker A, Arnalich-Fernández F, Robles-Marhuenda Á. Cancer-Associated Retinopathy and Treatment with Intravenous Immunoglobulin Therapy. A Seldom Used Approach? Ocul Immunol Inflamm 2019; 29:399-402. [PMID: 31710513 DOI: 10.1080/09273948.2019.1681471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a case of cancer-associated retinophaty (CAR) treated with intravenous immunoglobulin (IGIV) and review the use of IGIV in the treatment of CARMethods: Case report: A 68-year-old woman, former smoker, presented with bilateral subacute decreased visual acuity with 1 month of evolution, without other symptoms. Clinical examination revealed retinal atrophy and a mild vitritis component. Treatment with corticosteroid and IGIV was initiated empirically with the stabilization of visual loss. Anti-recoverin antibodies tested positive and a small cell lung carcinoma was diagnosed. In a review of the literature, we found that only 12 cases of patients treated with intravenous immunoglobulins have been reported.Conclusions: the early use of IVIG could contribute to an improvement and/or stabilization of visual symptoms in this patient group due to its rapid effect and lower profile of adverse effects when administered with chemotherapy.
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Affiliation(s)
- Luis Ramos-Ruperto
- Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
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Xu Q, Zhang Z, Chen Z, Zhang B, Zhao C, Zhang Y, Zhao C, Deng X, Zhou Y, Wu Y, Gu J. Nonspecific immunoglobulin G is effective in preventing and treating cancer in mice. Cancer Manag Res 2019; 11:2073-2085. [PMID: 30881131 PMCID: PMC6410752 DOI: 10.2147/cmar.s188172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous accidental findings showed that administration of immunoglobulin G (IgG) in treating autoimmune diseases was able to inhibit cancers that happened to grow in these patients. However, such treatment has not been used to treat cancer patients clinically. The mechanism and optimal dosages of this treatment have not been established. Subsequent animal experiments confirmed this effect, but all previous studies in animal models used human IgG which was heterogeneous to the animal hosts and therefore could adversely interfere with the results. MATERIALS AND METHODS We tested different dosages of mouse IgG in treating and preventing three syngeneic cancer types (melanoma, colon cancer, and breast cancer) in three immune potent mouse models. The expression of Ki67, CD34, VEGF, MMPs, and cytokines in tumor tissues were examined with immunohistochemistry or quantitative real-time PCR to evaluate tumor proliferation, vascularization, metastasis, and proinflammatory response in the tumor microenvironment. RESULTS We found that low-dose IgG could effectively inhibit cancer progression, regulate tumor vessel normalization, and prolong survival. Administration of IgG before cancer cell inoculation could also prevent the development of cancer. In addition, IgG caused changes in a number of cytokines and skewed macrophage polarization toward M1-like phenotype, characterized by proinflammatory activity and inhibition of proliferation of cancer cells. CONCLUSION Our findings suggest that nonspecific IgG at low dosages could be a promising candidate for cancer prevention and treatment.
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Affiliation(s)
- Qian Xu
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Zaiping Zhang
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Zhiming Chen
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Biying Zhang
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Chanyuan Zhao
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Yimin Zhang
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Conghui Zhao
- Department of Pathology, Beijing University Health Science Center, Beijing 100083, China,
| | - Xiaodong Deng
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Yao Zhou
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Yanyun Wu
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
| | - Jiang Gu
- Provincial Key Laboratory of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou 515041, Guangdong, China,
- Department of Pathology, Beijing University Health Science Center, Beijing 100083, China,
- Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu Jinjiang Hospital for Maternal and Child Health Care, Chengdu 610066, Sichuan, China,
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Adamus G. Impact of Autoantibodies against Glycolytic Enzymes on Pathogenicity of Autoimmune Retinopathy and Other Autoimmune Disorders. Front Immunol 2017; 8:505. [PMID: 28503176 PMCID: PMC5408022 DOI: 10.3389/fimmu.2017.00505] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/12/2017] [Indexed: 12/20/2022] Open
Abstract
Autoantibodies (AAbs) against glycolytic enzymes: aldolase, α-enolase, glyceraldehyde-3-phosphate dehydrogenase, and pyruvate kinase are prevalent in sera of patients with blinding retinal diseases, such as paraneoplastic [cancer-associated retinopathy (CAR)] and non-paraneoplastic autoimmune retinopathies, as well as in many other autoimmune diseases. CAR is a degenerative disease of the retina characterized by sudden vision loss in patients with cancer and serum anti-retinal AAbs. In this review, we discuss the widespread serum presence of anti-glycolytic enzyme AAbs and their significance in autoimmune diseases. There are multiple mechanisms responsible for antibody generation, including the innate anti-microbial response, anti-tumor response, or autoimmune response against released self-antigens from damaged, inflamed tissue. AAbs against enolase, GADPH, and aldolase exist in a single patient in elevated titers, suggesting their participation in pathogenicity. The lack of restriction of AAbs to one disease may be related to an increased expression of glycolytic enzymes in various metabolically active tissues that triggers an autoimmune response and generation of AAbs with the same specificity in several chronic and autoimmune conditions. In CAR, the importance of serum anti-glycolytic enzyme AAbs had been previously dismissed, but the retina may be without pathological consequence until a failure of the blood–retinal barrier function, which would then allow pathogenic AAbs access to their retinal targets, ultimately leading to damaging effects.
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Affiliation(s)
- Grazyna Adamus
- School of Medicine, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
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Komáromy AM, Abrams KL, Heckenlively JR, Lundy SK, Maggs DJ, Leeth CM, MohanKumar PS, Petersen‐Jones SM, Serreze DV, Woerdt A. Sudden acquired retinal degeneration syndrome (SARDS) – a review and proposed strategies toward a better understanding of pathogenesis, early diagnosis, and therapy. Vet Ophthalmol 2015; 19:319-31. [DOI: 10.1111/vop.12291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- András M. Komáromy
- College of Veterinary Medicine Michigan State University 736 Wilson Road East Lansing MI 48824 USA
- School of Veterinary Medicine University of Pennsylvania 3900 Delancey Street Philadelphia PA 19104 USA
| | | | - John R. Heckenlively
- Kellogg Eye Center University of Michigan 1000 Wall Street Ann Arbor MI 48105 USA
| | - Steven K. Lundy
- Division of Rheumatology Department of Internal Medicine University of Michigan 300 North Ingalls Building Ann Arbor MI 48109 USA
| | - David J. Maggs
- Department of Surgical and Radiological Sciences School of Veterinary Medicine University of California‐Davis 1 Shields Avenue Davis CA 95616 USA
| | - Caroline M. Leeth
- Department of Animal and Poultry Sciences College of Agriculture and Life Sciences 175 West Campus Drive, MC 0306, 3280 Litton Reaves Hall Virginia Tech Blacksburg VA 24061 USA
| | - Puliyur S. MohanKumar
- Department of Pathobiology and Diagnostic Investigation College of Veterinary Medicine Michigan State University East Lansing MI 48824 USA
| | - Simon M. Petersen‐Jones
- College of Veterinary Medicine Michigan State University 736 Wilson Road East Lansing MI 48824 USA
| | | | - Alexandra Woerdt
- The Animal Medical Center 510 East 62nd Street New York NY 10065 USA
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Dalal MD, Morgans CW, Duvoisin RM, Gamboa EA, Jeffrey BG, Garg SJ, Chan CC, Sen HN. Diagnosis of occult melanoma using transient receptor potential melastatin 1 (TRPM1) autoantibody testing: a novel approach. Ophthalmology 2013; 120:2560-2564. [PMID: 24053997 DOI: 10.1016/j.ophtha.2013.07.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the first case of melanoma-associated retinopathy (MAR) and underlying occult melanoma diagnosed based on the presence of serum transient receptor potential melastatin 1 (TRPM1) autoantibodies. DESIGN Interventional case report with basic science correlation. PARTICIPANTS One patient with MAR. INTERVENTION Testing for the presence of serum TRPM1 autoantibodies. MAIN OUTCOME MEASURES Diagnosis of an occult melanoma involving the axillary lymph nodes (unknown primary site) and MAR based on the presence of TRPM1 autoantibodies in the patient's serum. RESULTS The patient's clinical exam was remarkable for mild intraocular inflammation in both eyes and retinal hemorrhages with an apparent choroidal neovascularization in the left eye, which was confirmed by fluorescein angiography and indocyanine green angiography testing. Humphrey visual field 30-2 SITA-fast (Humphrey Visual Field Analyzer, Carl Zeiss Meditec, Inc, Dublin, CA) demonstrated diffuse depression in both eyes out of proportion to the clinical exams, prompting electroretinography testing that revealed an electronegative response. Dark-adapted thresholds were markedly elevated and mediated by cones. Due to concern for MAR, a systemic work-up for melanoma was performed by the primary care physician that was unrevealing. Given our continued clinical suspicion for MAR, the patient's serum was sent for evaluation for TRPM1 autoantibodies. The patient's serum applied to normal human retina exhibited positivity in the inner nuclear layer. Application of the patient's serum to wild-type and TRPM1 knockout mouse retina revealed strongly labeled bipolar cells in the wild-type retina, but not in the TRPM1 knockout retina, indicating TRPM1-dependent immunoreactivity. The antigen was confirmed as TRPM1 by labeling of TRPM1-transfected human embryonic kidney 293 cells. Additional systemic work-up prompted by this finding resulted in identification of an occult metastatic melanoma involving the axillary lymph nodes with an unknown primary site. The patient underwent surgical excision of the occult melanoma without evidence of other sites of metastases. He also received intravenous immunoglobulin therapy and his vision has stabilized. CONCLUSIONS This is the first reported case of a melanoma-associated retinopathy diagnosed utilizing the innovative approach of testing for serum TRPM1 autoantibodies.
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Affiliation(s)
- Monica D Dalal
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine W Morgans
- Department of Physiology and Pharmacology, Oregon Health and Sciences University, Portland, Oregon
| | - Robert M Duvoisin
- Department of Physiology and Pharmacology, Oregon Health and Sciences University, Portland, Oregon
| | - Elizabeth A Gamboa
- Department of Physiology and Pharmacology, Oregon Health and Sciences University, Portland, Oregon
| | - Brett G Jeffrey
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Sunir J Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Institute, Philadelphia, Pennsylvania
| | - Chi-Chao Chan
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Audemard A, de Raucourt S, Miocque S, Comoz F, Giraud JM, Dreno B, Bienvenu B, Rogerie MJ, Dompmartin A. Melanoma-associated retinopathy treated with ipilimumab therapy. Dermatology 2013; 227:146-9. [PMID: 24051549 DOI: 10.1159/000353408] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/02/2013] [Indexed: 11/19/2022] Open
Abstract
Melanoma-associated retinopathy (MAR) is a rare autoimmune syndrome in patients with melanoma characterized by visual disorders. MAR is induced by the degeneration of bipolar cells of the retina and the presence of serum autoantibodies against retina proteins. Ipilimumab, an anti-cytotoxic T lymphocyte-associated antigen 4 antibody, improves survival in previously treated patients with metastatic melanoma, but is responsible for a spectrum of immune-related adverse events. Administration of ipilimumab to patients with autoimmune diseases (such as MAR or vitiligo) is actually not recommended. We report a patient presenting with MAR occurring during a melanoma relapse. Surgery and chemotherapy had no effect on visual acuity and melanoma increased. In the absence of alternative antitumoral treatment, we focused on the vital prognosis and treated the patient with ipilimumab. Two years after the treatment the patient is free from new metastasis but has presented with exacerbation of vitiligo and MAR. In the very rare case of melanoma with autoimmune disease without a therapy option, ipilimumab could be discussed, taking into account the fact that it can be effective on tumor burden but can also increase autoimmunity.
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Affiliation(s)
- A Audemard
- Department of Internal Medicine, Caen, France
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16
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Rahimy E, Sarraf D. Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management. Surv Ophthalmol 2013; 58:430-58. [DOI: 10.1016/j.survophthal.2012.09.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/27/2012] [Accepted: 12/04/2012] [Indexed: 12/29/2022]
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17
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Nakano S, Kanamori A, Nakamura M, Mizukawa K, Negi A. Paraneoplastic optic neuropathy associated with cerebellar choroid meningioma. Eye (Lond) 2013; 27:1220-1. [PMID: 23846372 DOI: 10.1038/eye.2013.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- S Nakano
- Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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Stead RE, Fox MA, Staples E, Lim CS. Delayed presentation of melanoma-associated retinopathy and subsequent resolution with cytoreduction surgery. Doc Ophthalmol 2013; 127:165-71. [PMID: 23794161 DOI: 10.1007/s10633-013-9398-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/10/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND To present a case of melanoma-associated retinopathy (MAR) which manifested 26 months prior to a formal diagnosis of melanoma. METHODS Case report. RESULTS A 72-year-old female presented with bilateral continuous photopsia consistent with MAR of 7-months duration. At this point, visual function appeared normal with the exception of mildly impaired colour vision (10/17 Ishihara plates). The flash electroretinographic (ERG) revealed extinguished rod responses, a normal a-wave and reduced b-wave (electronegative ERG) on the maximal combined response, absent oscillatory potentials and broadened a-wave trough on the cone response. Multifocal ERG (mfERG) responses were delayed and demonstrated atypical morphology. Nineteen months after the initial presentation, her visual symptoms had progressed significantly with constant debilitating photopsia in combination with 13 kg weight loss. Biopsy of a now evident left axillary mass demonstrated a metastatic high-grade malignant melanoma. No primary was detected, and an axillary lymph node clearance was undertaken. Subsequently, visual symptoms resolved with corresponding improvement in the ERG over the next 18 months. Rod responses recovered such that the amplitude was at the lower limit of normal and the mfERG response delay lessened. Unfortunately, the melanoma recurred and the patient passed away 6 months later. Visual symptoms did not recur. CONCLUSION We present a case which demonstrates MAR may precede the formal diagnosis of melanoma by up to 26 months. The potential for improvement in the rod visual function persists over a period of years with normalisation of an electronegative waveform. In this case, cytoreductive surgery resulted in complete resolution of the MAR, which did not return even with a recurrence of the tumour.
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Affiliation(s)
- Richard E Stead
- Department of Ophthalmology, Queens Medical Centre, Nottingham University NHS Trust, Nottingham, NG7 2UH, UK,
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19
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Lin CJ, Chen SN, Hwang JF, Tseng CC, Li KH. Nonparaneoplastic autoimmune retinopathy presenting with peripheral retinal vasoocclusion: case report. Retin Cases Brief Rep 2013; 7:41-45. [PMID: 25390519 DOI: 10.1097/icb.0b013e3182618d55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of nonparaneoplastic autoimmune retinopathy presenting with severe peripheral retinal vasoocclusion. METHODS Interventional case report. CASE REPORT A 44-year-old woman complained of blurred vision and photopsia in both eyes. She has no history of cancer or autoimmune disease. Best-corrected visual acuity was 20/40 in the left eye and 20/30 in the right eye. Constriction of the visual field sparing central vision was found. Fluorescein angiography revealed severe peripheral retinal vasoocclusion, panretinal degeneration, and cystoid macular edema. Optical coherence tomography demonstrated intraretinal fluid. Electroretinography showed decreased amplitude of a- and b-waves in both scotopic and photopic tests. The implicit time was generally within normal limits. The amplitude of flicker response was also diminished. Multifocal electroretinography showed declined signal all over the macular region. Systemic workup including whole body positron emission tomography/computed tomography for cancer screening showed negative results. Only antirecoverin antibody was positive. Under the impression of nonparaneoplastic autoimmune retinopathy, systemic and local immunosuppressive therapy was given and showed improvement. CONCLUSION Nonparaneoplastic autoimmune retinopathies are uncommon retinal degenerations with visual loss associated with unique clinical symptoms and findings and with serum antiretinal autoantibodies. Severe peripheral retinal vasoocclusion was not reported. Early detection and timely treatment with immunosuppression could result in clinical improvement.
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Affiliation(s)
- Chun-Ju Lin
- *Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan †School of Medicine, Chung Shan Medical University, Taichung, Taiwan ‡Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
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20
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Recovery of visual function in patient with melanoma-associated retinopathy treated with surgical resection and interferon-beta. Doc Ophthalmol 2012. [DOI: 10.1007/s10633-012-9313-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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21
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Affiliation(s)
- Phoebe Lin
- Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710, USA
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22
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Abstract
OPINION STATEMENT Melanoma-associated retinopathy is a rare paraneoplastic disorder that is challenging to diagnose and even more difficult to treat. Because of the rarity of the disease, therapy is based on analysis of case series and case reports. Based on evidence from these reports, first-line therapy is cytoreduction of metastatic disease through metastasectomy, chemotherapy, and radiation. This can be combined with intravenous immunoglobulin. For refractory visual symptoms, additional therapies include systemic corticosteroids and plasmapheresis, but the success of these strategies has been limited. Because of the rarity of the disorder, new therapies should be evaluated and reported in the literature to expand our clinical understanding of this autoimmune disease.
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Affiliation(s)
- Steven F Powell
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, MMC 480, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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23
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Ko AC, Hernandez J, Brinton JP, Faidley EA, Mugge SA, Mets MB, Kardon RH, Folk JC, Mullins RF, Stone EM. Anti-γ-enolase autoimmune retinopathy manifesting in early childhood. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2010; 128:1590-5. [PMID: 21149784 PMCID: PMC3258021 DOI: 10.1001/archophthalmol.2010.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the clinical, molecular, and serologic findings of a case in which autoimmune retinopathy and early-onset heritable retinal degeneration were both considered in the differential diagnosis. METHODS A 3-year-old girl had clinical findings suggestive of a childhood-onset retinal degeneration. Samples of DNA and serum were collected. The coding regions of 11 genes associated with Leber congenital amaurosis were sequenced. The patient's serum reactivity to soluble and insoluble fractions of human retinal protein was compared with that of healthy control subjects (n = 32), patients with inflammatory eye disease (n = 80), and patients with molecularly confirmed retinal degenerations (n = 11). Two-dimensional gel electrophoresis and mass spectrometry were used to identify a protein that corresponded to a reactive band on Western blot. RESULTS No plausible disease-causing mutations were identified in any of the retinal disease genes tested. However, the patient's serum showed reactivity to a single retinal antigen of approximately 47 kDa. Two-dimensional gel electrophoresis and mass spectrometry revealed the major reactive species to be neuron-specific enolase (NSE). Autoantibodies targeting NSE were not observed in any healthy control subjects or patients with inflammatory eye disease. However, anti-NSE activity was found in 1 child with molecularly confirmed Leber congenital amaurosis. CONCLUSION This patient's clinical and laboratory findings coupled with the recently discovered role of anti-NSE antibodies in canine autoimmune retinopathy suggest that autoantibodies targeting NSE are involved in the pathogenesis of her disease. CLINICAL RELEVANCE Infection or inflammation within the retina early in life may lead to an autoimmune phenocopy of early-onset inherited retinal degeneration.
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Affiliation(s)
- Audrey C. Ko
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | - Jasmine Hernandez
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | - Jason P. Brinton
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | - Elizabeth A. Faidley
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | - Sarah A. Mugge
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | | | - Randy H. Kardon
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
- VA Medical Center, Iowa City, IA 52246
| | - James C. Folk
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | - Robert F. Mullins
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
| | - Edwin M. Stone
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA
- The Howard Hughes Medical Institute, Chevy Chase, MD
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Kivity S, Katz U, Daniel N, Nussinovitch U, Papageorgiou N, Shoenfeld Y. Evidence for the use of intravenous immunoglobulins--a review of the literature. Clin Rev Allergy Immunol 2010; 38:201-69. [PMID: 19590986 PMCID: PMC7101816 DOI: 10.1007/s12016-009-8155-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intravenous immunoglobulins (IVIg) were first introduced in the middle of the twentieth century for the treatment of primary immunodeficiencies. In 1981, Paul Imbach noticed an improvement of immune-mediated thrombocytopenia, in patients receiving IVIg for immunodeficiencies. This opened a new era for the treatment of autoimmune conditions with IVIg. Since then, IVIg has become an important treatment option in a wide spectrum of diseases, including autoimmune and acute inflammatory conditions, most of them off-label (not included in the US Food and Drug Administration recommendation). A panel of immunologists and internists with experience in IVIg therapy reviewed the medical literature for published data concerning treatment with IVIg. The quality of evidence was assessed, and a summary of the available relevant literature in each disease was given. To our knowledge, this is the first all-inclusive comprehensive review, developed to assist the clinician when considering the use of IVIg in autoimmune diseases, immune deficiencies, and other conditions.
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Affiliation(s)
- Shaye Kivity
- Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
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