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van Romunde SHM, Vergouwen DPC, Iacovello D, Roelen DL, Verdijk RM, Ten Berge JCEM, Pertile G, Schreurs MWJ, van Meurs JC. Destructive inflammatory reaction after an autologous retinal pigment epithelium and choroid transplantation: no detection of an auto-immune response. J Ophthalmic Inflamm Infect 2022; 12:27. [PMID: 36018390 PMCID: PMC9418395 DOI: 10.1186/s12348-022-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Five patients who underwent uncomplicated retinal pigment epithelium (RPE)-choroid transplantation for neovascular age-related macular degeneration developed a destructive inflammatory reaction causing subretinal fluid accumulation and extensive RPE atrophy in the graft. We hypothesized that this inflammation could be caused by an auto-immune response against the graft, resulting in circulating auto-antibodies. The aim of our study was to examine a potential autoimmune origin, which would allow a more targeted therapy approach. Methods Five above-mentioned patients and four control groups of five patients each were included: 1) after uncomplicated RPE-choroid transplantation, 2) after full macular translocation, 3) treated with anti-vascular endothelial growth factor, and 4) healthy controls. Histopathology of rejected graft tissue was performed using standard procedures. Presence of RPE-choroid autoantibodies in serum was examined by indirect immunofluorescence and Western blot, and human leukocyte antigen (HLA) typing was performed. Results Histopathological examination of an explanted graft showed infiltration of T-lymphocytes and macrophages in the choroid and RPE, and an increased number of B-cell lymphocytes were found in the choroid. Indirect immunofluorescence showed weak RPE-choroid autoantibody immunoreactivity in three patients of different groups. Western blot did not show specific RPE-choroid autoantibody immunoreactivity and no difference of HLA genotypes between the groups was found. Conclusions Although local mononuclear inflammatory cell infiltration and a high number of B-lymphocytes were observed in an explanted graft, we did not detect serological evidence of an autoimmune origin of the postoperative inflammation using direct immunofluorescence and Western Blot. Alternatively, the graft failure may have been caused by local innate inflammation, triggered by breakdown of tolerance. Based on our current findings of this small study group, we have no rationale to pursue therapies targeted towards autoreactive graft failure. More research is needed to confirm our findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12348-022-00305-2.
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Affiliation(s)
- Saskia H M van Romunde
- Department of Vitreoretinal surgery, Rotterdam Eye Hospital, Schiedamse Vest 180 - 3011BH, Rotterdam, the Netherlands.
| | - Daphne P C Vergouwen
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Daniela Iacovello
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria, Viale Rizzardi, 437024, Negrar, Italy
| | - Dave L Roelen
- Department of Immunology, Leiden Universitary Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Robert M Verdijk
- Department of Vitreoretinal surgery, Rotterdam Eye Hospital, Schiedamse Vest 180 - 3011BH, Rotterdam, the Netherlands.,Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, University Medical Center, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.,Department of Pathology, Leiden Universitary Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Josianne C E M Ten Berge
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Grazia Pertile
- Department of Ophthalmology, IRCCS Sacro Cuore Don Calabria, Viale Rizzardi, 437024, Negrar, Italy
| | - Marco W J Schreurs
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Jan C van Meurs
- Department of Vitreoretinal surgery, Rotterdam Eye Hospital, Schiedamse Vest 180 - 3011BH, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
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De Sutter C, Schauwvlieghe PP, Ruys J, Cosemans I, Depla J, Van Laere S, Veckeneer M. Occurrence of macular neovascularization after RPE-choroid translocation surgery to treat complicated AMD: incidence, management and outcome. Ophthalmologica 2021; 245:69-79. [PMID: 34530427 DOI: 10.1159/000519519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Charlotte De Sutter
- Department of Ophthalmology, University Hospital Brussels, Free University Brussels, Brussels, Belgium
| | | | - Joke Ruys
- Department of Ophthalmology, ZNA Middelheim, Antwerp, Belgium
| | - Ine Cosemans
- Department of Ophthalmology, ZNA Middelheim, Antwerp, Belgium
| | - Jozef Depla
- Department of Ophthalmology, ZNA Middelheim, Antwerp, Belgium
| | - Sven Van Laere
- Interfaculty Center Data Processing & Statistics, Free University Brussels, Brussels, Belgium
| | - Marc Veckeneer
- Department of Ophthalmology, ZNA Middelheim, Antwerp, Belgium
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