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Ozcifci G, Aydin T, Atli Z, Balkan II, Tabak F, Oztas M, Ozguler Y, Ugurlu S, Hatemi G, Melikoglu M, Fresko I, Hamuryudan V, Seyahi E. The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behçet's syndrome. Rheumatol Int 2022; 42:101-113. [PMID: 34825278 PMCID: PMC8614218 DOI: 10.1007/s00296-021-05056-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/13/2021] [Indexed: 12/28/2022]
Abstract
Initial case series of small number of patients at the beginning of the pandemic reported a rather guarded prognosis for Behçet's syndrome (BS) patients infected with SARS-CoV-2. In this prospective study, we describe the incidence, clinical characteristics, disease course, management, and outcome in a large cohort of BS patients with laboratory-confirmed infection of SARS-CoV-2. We defined a cohort of 1047 registered BS patients who were aged between 16 and 60 years and seen routinely before the pandemic at the multidisciplinary outpatient clinic. We followed prospectively this cohort from beginning of April 2020 until the end of April 2021. During 13 months of follow-up, of the 1047 (599 M/448 F) patients, 592 (56.5%) were tested for SARS-CoV-2 PCR at least once and 215 (20.5%; 95% CI 0.18-0.23) were tested positive. We observed 2 peaks which took place in December 2020 and April 2021. Of the 215 PCR positive patients, complete information was available in 214. Of these 214, 14 (6.5%) were asymptomatic for COVID-19. In the remaining, the most common symptoms were anosmia, fatigue, fever, arthralgia, and headache. A total of 40 (18.7%) had lung involvement, 25 (11.7%) were hospitalized, 1 was admitted to the intensive care unit while none died. Favipiravir was the most prescribed drug (74.3%), followed by colchicine (40.2%), and hydroxychloroquine (20.1%) in the treatment of COVID-19. After COVID-19, 5 patients (2.3%) were given supplemental O2 and 31 (14.5%) antiaggregant or anticoagulants. During COVID-19, of the 214 PCR positive patients, 116 (54.2%) decreased the dose of their immunosuppressives or stopped taking completely; 36 (16.8%) experienced a BS flare which was mostly oral ulcers (10.3%). None of the patients reported a thrombotic event. A total of 93 (43.5%) patients reported BS flares after a median 45 days of COVID-19 infection and this was found to be significantly associated with immunosuppressive drug discontinuation. Multiple regression analysis adjusted for age and gender indicated that smoking and using interferon-alpha decreased the likelihood of getting COVID-19. The incidence and severity of COVID-19 did not differ between those who were using colchicine or not. The cumulative incidence of COVID-19 in this prospectively followed cohort of BS patients was almost two folds of that estimated for the general population living in Istanbul, Turkey, however, the clinical outcome of COVID-19 was not severe and there was no mortality. The protective effect of smoking and interferon deserves further investigation. On the other hand, colchicine did not have any positive or negative effect against COVID-19. Significant number of patients flared after COVID-19, however, this was significantly associated with immunosuppressive discontinuation during the infection. Contrary to our previous observations, COVID-19 did not seem to exacerbate thrombotic events during or after the infection.
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Affiliation(s)
- Guzin Ozcifci
- Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tahacan Aydin
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Atli
- Department of Accounting and Taxation, Sinop University, Sinop, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Oztas
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310 Turkey
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Yalçindag N, Köse HC. Comparison of the Treatment Results for Behçet Uveitis in Patients Treated with Infliximab and Interferon. Ocul Immunol Inflamm 2019; 28:305-314. [PMID: 31268743 DOI: 10.1080/09273948.2019.1606256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To compare the efficacy and safety of infliximab and interferon in patients with refractory Behçet uveitis.Methods: Medical records of 20 patients treated with infliximab (IFX) and 33 patients treated with interferon (IFN) were retrospectively analyzed by evaluating the number of uveitis attacks, visual acuity and ocular inflammation at 6 and 12 months after initiation of treatment.Results: Mean duration of treatment was 22 ± 18 months in IFX group and 30.3 ± 22.5 months in IFN group. Sixteen patients of IFX group (80%) and 28 patients of IFN group (85%) achieved remission. In both groups, the mean best-corrected visual acuity and all inflammatory parameters improved. In terms of these parameters, there was no significant difference between the two groups.Conclusion: Infliximab and interferon improve control of ocular inflammation and efficiently decrease the relapse rate. Our results determined no significant difference between two agents in controlling intraocular inflammation.
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Affiliation(s)
- Nilüfer Yalçindag
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Helin Ceren Köse
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Afarid M, Azimi A, Malekzadeh M. Evaluation of serum interferons in patients with age-related macular degeneration. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:24. [PMID: 31007694 PMCID: PMC6450131 DOI: 10.4103/jrms.jrms_363_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/16/2018] [Accepted: 12/25/2018] [Indexed: 12/15/2022]
Abstract
Background: Environmental, genetic, and immunological factors may play a role in the pathogenesis of age-related macular degeneration (AMD). In an attempt to better understand the pathogenesis of AMD, in this study, we evaluated the serum interferon (IFN) levels in patients with AMD and compared it with persons without AMD. Materials and Methods: In this case–control study, 42 patients with AMD and 42 healthy individuals (without AMD) were enrolled as the case and control groups, respectively. The two groups were matched regarding their age and sex. We classified the case group as dry-type and wet-type AMD. Blood samples were obtained and the serum was collected and frozen at −20°C. Alpha-, beta-, and gamma-IFN levels were measured using the sandwich ELISA method and compared between and within the groups. Results: The mean beta IFN levels in both case and control groups were 46.88 ± 27.25 pg/ml and 34.90 ± 18.81 pg/ml (P = 0.021), respectively. Regarding gamma and alpha IFN, the serum levels were not detectable in most of the patients and no significant difference was detected between the case and control groups. Conclusion: We found that serum beta IFN levels are higher in patients with AMD. This finding may have diagnostic, therapeutic, and prognostic value in AMD patients and can be a beginning for further evaluation.
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Affiliation(s)
- Mehrdad Afarid
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Azimi
- Department of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahyar Malekzadeh
- School of Medicine, Shiraz Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, Iran
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Celiker H, Kazokoglu H, Direskeneli H. Factors Affecting Relapse and Remission in Behçet's Uveitis Treated with Interferon Alpha2a. J Ocul Pharmacol Ther 2018; 35:58-65. [PMID: 30359208 DOI: 10.1089/jop.2018.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate factors affecting relapse and remission in patients with Behçet uveitis (BU) in the context of using the interferon alpha2a (IFNα2a) therapy. METHODS Clinical records were reviewed of 32 patients (totaling 54 eyes) presenting with severe BU who had been treated with IFNα2a therapy. Factors influencing relapsing-remitting course of BU during IFNα2a therapy and after the cessation of the agent were evaluated. Possible affecting factors of recurrence were age, gender, duration of the Behçet disease, time elapsed before starting the drug, number of relapses before the starting of IFNα2a, laterality, and presence of panuveitis. RESULTS Thirty patients (93.7%) responded to IFNα2a therapy. Annual attack rate before and after IFNα2a treatment was determined to be 4.03 ± 3.19 (attack per year) and 0.58 ± 1.07, respectively (P < 0.001). In univariable statistical evaluation, women tended to have a lower relapse risk than men. Multivariable analyses showed that age was the major factor determining relapse rate, while the effect of gender was not statistically significant (P = 0.196). The other probable influencing factors were not found to be statistically significant (P > 0.05). Increase in visual acuity observed during last examination compared to initial examination was determined to be statistically significant (P = 0.018). CONCLUSIONS Even if the female gender was evaluated as a good prognostic factor in univariable analyses, it was not assessed as an effective prognostic factor in multivariable analyses. Being aged may be regarded a good prognostic factor on the relapsing-remitting course of patients with BU who were treated with IFNα2a therapy.
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Affiliation(s)
- Hande Celiker
- 1 Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haluk Kazokoglu
- 1 Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- 2 Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
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Abstract
Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA)-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded – central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative groups, as the relative rarity of the condition makes it difficult for one center to accumulate enough patients for worthwhile studies. Nevertheless, results obtained with newer therapies, such as biological agents directed against particular cytokines or cell-surface receptors, demonstrate ever improving control of the inflammation in refractory cases, providing hope that the outlook for visual function in this condition can only improve.
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Affiliation(s)
- Victor Menezo
- Institut Catala de Retina, Barcelona, Spain ; Department of Ophthalmology, Provincial Hospital Consortium Castellon, Castello, Spain
| | - Simon Rj Taylor
- Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK ; Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Mesquida M, Molins B, Llorenç V, Hernández MV, Espinosa G, Dick AD, Adán A. Current and future treatments for Behçet's uveitis: road to remission. Int Ophthalmol 2013; 34:365-81. [PMID: 23729309 DOI: 10.1007/s10792-013-9788-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/02/2013] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is a multisystem inflammatory disorder of uncertain origin, although it remains defined within the spectrum of systemic immune-mediated vasculitic disorders and also represents a spectrum of putative autoimmune disease. Major symptoms include oral aphthous ulcers, genital ulcerations, skin lesions, and ocular lesions. Despite afflicting many systems, ocular complications of BD are some of the more devastating for the patient and their quality of life. Eye involvement, which affects 60-80 % of BD patients, is characterized in its more severe form by posterior or panuveitis including occlusive retinal vasculitis. While pathogenesis of BD remains complex, association with Class I MHC (HLA-B*51) predisposing to inflammation with engagement of the innate-immune system (neutrophils, NK cells), and perpetuated by the adaptive T cell responses against infectious- and/or auto-antigens. Despite the choice of conventional immunosuppressive therapies available, only recently with the advent of biologic therapy has visual prognosis and outcomes been substantially and favorably altered. For example, both interferon-α (IFN-α) and tumour necrosis factor (TNF)-α antagonists deliver promising results and for the first time improve prognosis. With IFN-α therapy, durable remissions of uveitis can be achieved and lead to drug-free remission. Similarly, anti-TNF therapy with infliximab is reported to be rapidly effective in inducing and maintaining remission. Most recently, rising evidence reports on the use of adalimumab, etanercept, and golimumab, while use of anti-interleukin (IL)-1 agents (anakinra, canakinumab, gevokizumab), IL-6 blockers (tocilizumab), and rituximab (depleting anti-CD20 antibody) is also increasing. The aim of this review is to provide evidence for the role of conventional therapies combined with evidence for advantages and disadvantages of biologic therapies in the treatment of ocular BD. Although randomized controlled trials remain sparse, evidence remains strong and enticing that biologic agents are invaluable for the treatment of sight-threatening Behçet's uveitis and makes it an exciting time for Behçet's specialists worldwide.
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Affiliation(s)
- Marina Mesquida
- Ophthalmology Department, Hospital Clinic of Barcelona, University of Barcelona, Sabino de Arana, 1, 08028, Barcelona, Spain,
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7
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Abstract
Relapsing ocular involvement is one of the major manifestations in Behçet disease (BD). When ocular BD is left untreated, it often results in blindness in <5 years. Combining systemic corticosteroids with cyclosporine A and other conventional immune modulating agents has been the only choice for treatment. More recently, the introduction of 'biologics' seems to be an effective therapy in patients affected with BD, especially in those with ocular disease. Our purpose was to survey the current knowledge regarding the biological therapeutic approaches for Behçet uveitis. We focused on the most commonly used biological agents: 'tumor necrosis factor-alpha antagonists' and 'interferon alpha'. We attempted to compare the effectiveness of these two biologicals and tried to balance on the pros and cons of these agents in clinical practice. The impressive efficacy of both approaches in sight-threatening BD argues for their expanding role. Earlier introduction of these agents in the course of disease may prevent irreversible structural damage and may result in improved long-term prognosis.
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Affiliation(s)
- Dicle Hazirolan
- Department of Ophthalmology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
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Tian L, Lei B, Shao J, Wei L, Kijlstra A, Yang P. AAV2-mediated combined subretinal delivery of IFN-α and IL-4 reduces the severity of experimental autoimmune uveoretinitis. PLoS One 2012; 7:e37995. [PMID: 22685550 PMCID: PMC3369876 DOI: 10.1371/journal.pone.0037995] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 05/01/2012] [Indexed: 11/19/2022] Open
Abstract
We previously showed that adeno-associated virus 2 (AAV2) mediated subretinal delivery of human interferon-alpha (IFN-α) could effectively inhibit experimental autoimmune uveoretinitis (EAU). In this study we investigated whether subretinal injection of both AVV2.IFN-α and AAV2.IL-4 had a stronger inhibition on EAU activity. B10RIII mice were subretinally injected with AAV2.IFN-α alone (1.5×107 vg), AAV2.IL-4 alone (3.55×107 vg), and AAV2.IFN-α combined with AAV2.IL-4. PBS, AAV2 vector encoding green fluorescent protein (AAV2.GFP) (5×107 vg) was subretinally injected as a control. IFN-α and IL-4 were effectively expressed in the eyes from three weeks to three months following subretinal injection of AAV2 vectors either alone or following combined administration and significantly attenuated EAU activity clinically and histopathologically. AAV2.IL-4 showed a better therapeutic effect as compared to AAV2.IFN-α. The combination of AAV2.IL-4 and AAV2.IFN-α was not significantly different as compared to AAV2.IL-4 alone. There was no difference concerning DTH (delayed-type hypersensitivity) reaction, lymphocyte proliferation and IL-17 production among the investigated treatment groups, suggesting that local retinal gene delivery did not affect the systemic immune response.
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Affiliation(s)
- Lichun Tian
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People’s Republic of China
- Guangzhou Institute of Respiratory Diseases, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Bo Lei
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Ju Shao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Lin Wei
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Aize Kijlstra
- Eye Research Institute Maastricht, Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, People’s Republic of China
- * E-mail:
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Taylor SRJ, Singh J, Menezo V, Wakefield D, McCluskey P, Lightman S. Behçet disease: visual prognosis and factors influencing the development of visual loss. Am J Ophthalmol 2011; 152:1059-66. [PMID: 21872204 DOI: 10.1016/j.ajo.2011.05.032] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/19/2011] [Accepted: 05/24/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the visual prognosis of patients with ocular Behçet disease and to determine factors predictive of visual loss and severe visual loss. DESIGN Retrospective case series. METHODS One hundred seventy-five eyes of 107 patients diagnosed with ocular Behçet disease were included. The main outcome measures were visual loss (best-corrected visual acuity, worse than 20/40) and severe visual loss (best-corrected visual acuity, 20/200 or worse). RESULTS The mean duration of follow-up was 6.5 years. Presenting visual acuity was worse than 20/40 in 50% of eyes and 20/200 or worse in 21% of eyes; approximately one third of this was reversible with treatment. The most common cause of irreversible severe visual loss was ischemic maculopathy. At 10 years, there was a 39% risk of visual loss and a 24% risk of severe visual loss, the latter figure being reduced to 13% if patients with irreversible visual loss at presentation were excluded. After controlling for potentially confounding variables, male sex, unilateral disease, and left eye involvement all were statistically significant risk factors for severe visual loss at 5 and 10 years. Patients who were treated with biologic agents were less likely to have severe visual loss in either eye at both 5 and 10 years. CONCLUSIONS Many patients with ocular Behçet disease still have irreversible visual loss at presentation. However, the visual prognosis is otherwise improved, with a 10-year risk of severe visual loss of 13% in this cohort. The use of biologic agents is associated with a lower risk of severe visual loss at 5 and 10 years.
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Affiliation(s)
- Simon R J Taylor
- Institute of Ophthalmology, University College London, United Kingdom.
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Tian L, Yang P, Lei B, Shao J, Wang C, Xiang Q, Wei L, Peng Z, Kijlstra A. AAV2-mediated subretinal gene transfer of hIFN-α attenuates experimental autoimmune uveoretinitis in mice. PLoS One 2011; 6:e19542. [PMID: 21611186 PMCID: PMC3096632 DOI: 10.1371/journal.pone.0019542] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 03/31/2011] [Indexed: 11/18/2022] Open
Abstract
Background Recent reports show that gene therapy may provide a long-term, safe and
effective intervention for human diseases. In this study, we investigated
the effectiveness of adeno-associated virus 2 (AAV2) based human
interferon-alpha (hIFN-α) gene therapy in experimental autoimmune
uveoretinitis (EAU), a classic model for human uveitis. Methodology/Principal Findings An AAV2 vector harboring the hIFN-α gene (AAV2.hIFN-α) was
subretinally injected into B10RIII mice at two doses
(1.5×106 vg, 1.5×108 vg). AAV2 vector
encoding green fluorescent protein (AAV2.GFP) was used as a control
(5×108 vg). The expression of hIFN-α in homogenized
eyes and serum was detected by ELISA three weeks after injection. The
biodistribution of vector DNA in the injected eyes, contralateral eyes and
distant organs was determined by PCR. EAU was induced by immunization with
IRBP161–180 three weeks following vector injections,
and evaluated clinically and pathologically. IRBP-specific proliferation and
IL-17 expression of lymphocytes from the spleen and lymph nodes were assayed
to test the influence of the subretinal delivery of AAV2.hIFN-α on the
systemic immune response. hIFN-α was effectively expressed in the eyes
from three weeks to three months following subretinal injection of
AAV2.hIFN-α vector. DNA of AAV2.GFP was observed only in the injected
eyes, but not in the distant organs or contralateral eyes. Subretinal
injection of both doses significantly attenuated EAU activity clinically and
histologically. For the lower dose, there was no difference concerning
lymphocyte proliferation and IL-17 production among the AAV2.hIFN-α,
AAV2.GFP and PBS injected mice. However, the higher dose of AAV2.hIFN-α
significantly suppressed lymphocyte proliferation and IL-17 production. Conclusions/Significance Subretinal delivery of AAV2.hIFN-α lead to an effective expression within
the eye for at least three months and significantly attenuated EAU activity.
AAV2.hIFN-α was shown to inhibit the systemic IRBP-specific immune
response.
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Affiliation(s)
- Lichun Tian
- Zhongshan Ophthalmic Center, Sun Yat-sen
University, Guangzhou, People's Republic of China
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
- * E-mail:
| | - Bo Lei
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Ju Shao
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Chaokui Wang
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Qin Xiang
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Lin Wei
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Zhougui Peng
- The First Affiliated Hospital of Chongqing
Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye
Institute, Chongqing, People's Republic of China
| | - Aize Kijlstra
- Eye Research Institute Maastricht, Department
of Ophthalmology, University Hospital Maastricht, Maastricht, The
Netherlands
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Anti-inflammatory treatment of uveitis with biologicals: new treatment options that reflect pathogenetic knowledge of the disease. Graefes Arch Clin Exp Ophthalmol 2010; 248:1531-51. [PMID: 20737162 DOI: 10.1007/s00417-010-1485-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 07/09/2010] [Accepted: 07/26/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endogenous uveitis is a sight-threatening disease. In addition to corticosteroids, immunosuppressive agents are commonly used to treat patients with severe course. Immunosuppressive drugs act nonspecifically, rather than providing a specific interaction with the critical pathogenetic pathways of uveitis. Better knowledge of the basic mechanisms underlying uveitis and of the molecules that are important for regulating inflammation has helped to create new and more specific treatment approaches. Biological therapy for inflammatory diseases employs substances that interfere with specific molecules or pathways induced in the body during the inflammatory process. METHODS This review gives an overview on molecules that play a critical role in the pathogenetic process of uveitis, as has been observed in patients or the respective animal models, and summarizes the current experience with biologicals for the treatment of uveitis refractive to conventional immunosuppressives.
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Lyon F, Gale RP, Lightman S. Recent developments in the treatment of uveitis: an update. Expert Opin Investig Drugs 2010; 18:609-16. [PMID: 19388878 DOI: 10.1517/14728220902852570] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of complex uveitis is often based around the use of oral corticosteroids. To spare the side effects of corticosteroids, second-line oral immunosuppressant drugs are used. Newer systemic immunosuppressive drugs, including biologics, and locally delivered treatments are being evaluated. This article reviews current conventional treatments, discusses their limitations and evaluates newer treatment strategies. Current theories about the pathogenesis of uveitis and potential targets for treatment are discussed in this context. We are still in search of a low-risk, where possible, locally delivered and targeted treatment for uveitis.
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Affiliation(s)
- Fiona Lyon
- Academic Unit of Ophthalmology, York Hospital, Wigginton Road, York YO318HE, UK
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Mackensen F, Max R, Becker MD. Interferons and their potential in the treatment of ocular inflammation. Clin Ophthalmol 2009; 3:559-66. [PMID: 19898628 PMCID: PMC2770867 DOI: 10.2147/opth.s3308] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Indexed: 12/31/2022] Open
Abstract
Since their discovery in the 1950s interferons have been the scope of investigation in many diseases as therapeutic as well as pathogenetic factors. We know they have immune stimulatory and immune regulatory effects. This apparently counter-intuitive mechanism can be summarized as immunomodulatory action and seems to be very effective in a number of ocular inflammatory diseases. We review the current knowledge of interferons in immunity and autoimmunity and show their use in clinical ophthalmologic practice.
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Affiliation(s)
- Friederike Mackensen
- Interdisciplinary Uveitis Center, Dept. of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany.
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