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Kalogeropoulos D, Kanavaros P, Vartholomatos G, Moussa G, Kalogeropoulos C. Cytokines in Immune-mediated "Non-infectious" Uveitis. Klin Monbl Augenheilkd 2023. [PMID: 38134911 DOI: 10.1055/a-2202-8704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Uveitis is a significant cause of ocular morbidity and accounts for approximately 5 - 10% of visual impairments worldwide, particularly among the working-age population. Infections are the cause of ~ 50% cases of uveitis, but it has been suggested that infection might also be implicated in the pathogenesis of immune-mediated "non-infectious" uveitis. There is growing evidence that cytokines (i.e., interleukins, interferons, etc.) are key mediators of immune-mediated "non-infectious" uveitis. For example, activation of the interleukin-23/interleukin-17 signalling pathway is involved in immune-mediated "non-infectious" uveitis. Studies in animal models have been important in investigating the role of cytokines in uveitis. Recent studies of clinical samples from patients with uveitis have allowed the measurement of a considerable array of cytokines even from very small sample volumes (e.g., aqueous and vitreous humour). The identification of complex patterns of cytokines may contribute to a better understanding of their potential pathogenetic role in uveitis as well as to an improved diagnostic and therapeutic approach to treat these potentially blinding pathologies. This review provides further insights into the putative pathobiological role of cytokines in immune-mediated "non-infectious" uveitis.
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Affiliation(s)
| | - Panagiotis Kanavaros
- Anatomy-Histology-Embryology, University of Ioannina, Faculty of Medicine, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University General Hospital of Ioannina, Greece
| | - George Moussa
- Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, United Kingdom of Great Britain and Northern Ireland
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Alafaleq M, Freund R, Penet MA, Fardeau C, Isnard-Bagnis C, Tezenas du Montcel S, Deray G, LE Hoang P, Bodaghi B, Tostivint I. Ciclosporin A in bilateral auto-immune chronic posterior uveitis associated with macular oedema: a Long-term Observational Safety and Efficacy Study. Eye (Lond) 2022; 36:2144-2150. [PMID: 34718340 PMCID: PMC9581979 DOI: 10.1038/s41433-021-01829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE A non-interventional, longitudinal, retrospective follow-up study to assess CsA-induced nephrotoxicity (IN) and its reversibility after withdrawal in patients exhibiting a bilateral chronic posterior uveitis (CPU) associated with cystoid macular oedema (CMO) in at least one eye. Data from medical records between 1986 and 2013. METHODS Primary outcome was the renal tolerance during and after CsA treatment assessed by plasma creatinine concentration and glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology (CKD-Epi) formula. Secondary outcomes were CsA through concentration, occurrence of cancers and ophthalmologic efficacy assessed by three parameters including CMO, vitreous inflammation, and best-corrected visual acuity BVCA changes. RESULTS One hundred forty-three patients were followed for renal tolerance. Underlying diseases were Birdshot retinochoroiditis (n = 67), Behçet disease (n = 9), probable sarcoidosis (n = 23), sympathetic ophthalmia (n = 3), idiopathic (n = 41). After CsA discontinuation in 115 patients (mean treatment duration of 5.9 ± 3.8 years) mean plasma creatinine concentration was 82.2 ± 14.2 µmol/L versus 82.1 ± 14.1 µmol/L at baseline, mean GFR was 79.4 ± 13.9 mL/min versus 82.5 ± 14.3 mL/min at baseline, with no significant difference (respectively p = 0.91 and p = 0.09). Blood pressure did not significantly change during follow-up. CMO was completely resorbed in at least one eye, in 70.8% patients (n = 72) at 6 months, in 71.4% patients (n = 49) at 10 years and in 54.2% patients (n = 24) at 20 years. BCVA did not statistically change over time. CONCLUSION Early and long-term monitoring of renal tolerance and dual adjustment of CsA doses in inflammatory stages of CPU were associated with reversible CsA IN. CsA could be effective in the treatment of CMO in CPU patients.
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Affiliation(s)
- Munirah Alafaleq
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France.
- Ophthalmology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Romain Freund
- Department of Biostatistics, Public Health and Medical Information, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Marie-Aude Penet
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Christine Fardeau
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France
| | - Corinne Isnard-Bagnis
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Sophie Tezenas du Montcel
- INSERM, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Gilbert Deray
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France
| | - Phuc LE Hoang
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, Reference Center for Rare Diseases, AP-HP, Pitié Salpêtrière - Charles Foix University Hospitals, Sorbonne University, 75013, Paris, France
| | - Isabelle Tostivint
- Nephrology Department, AP-HP, Pitié-Salpêtrière -Charles Foix University Hospitals, University of Sorbonne, F75013, Paris, France.
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Alsaddi MA, Hondeghem K, Schauwvlieghe PP. Relapse of Birdshot Uveitis after Stopping Immunosuppressive Treatment and Starting Immune Checkpoint Inhibitors for Lung Cancer. Case Rep Ophthalmol 2022; 13:910-915. [PMID: 36466056 PMCID: PMC9710432 DOI: 10.1159/000526636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 07/03/2024] Open
Abstract
A 56-year-old Caucasian woman with birdshot uveitis had to stop immunosuppressive treatment with adalimumab due to metastatic squamous lung carcinoma. She was subsequently treated with chemotherapy and pembrolizumab, an immune checkpoint inhibitor (ICI). After stopping adalimumab and starting pembrolizumab, the patient had an inflammatory relapse of birdshot uveitis with macular oedema. Birdshot uveitis is triggered by an unknown antigen presented on the HLA-A29 molecule which activates cytotoxic T-cells. Although immunosuppressive therapy effectively stabilizes birdshot uveitis, it might induce a higher risk of developing cancer. Treatment with ICIs, on the other hand, might exacerbate birdshot uveitis by increasing anti-tumoural immune reaction and inducing off-target autoimmunity.
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da Fonsêca MLG, Vianna RNG, Rocha ACH, Casella AMB, Cialdini A, Muccioli C, da Costa DS, Lucena DR, Vasconcelos-Santos DV, Morizot E, Castro E, Rodriguez EEC, Diligenti FT, Porto FBO, Nascimento H, Yanamoto JH, Oréfice JL, Muralha LRP, Carneiro LB, Finamor LPS, Frazão MAM, Motta M, Nobrega MJ, Zajdenweber ME, Moraes RT, Meirelles RL, Lemos SR, de Araújo WF. Birdshot retinochoroiditis in Brazil: a multicenter review of 40 patients. Int J Retina Vitreous 2022; 8:5. [PMID: 34996521 PMCID: PMC8740347 DOI: 10.1186/s40942-021-00353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Birdshot retinochoroiditis (BRC) is a rare and chronic bilateral uveitis mostly found in Caucasians. As few data are available about the clinical course of BRC in Hispanic patients, we aimed to report the clinical findings and the evolution of BRC in Brazilian patients. Methods This retrospective cohort multicenter nationwide study was performed by analyzing the records of patients with BRC diagnoses from Brazilian ophthalmological centers from April 1995 to May 2020. Results Forty patients (80 eyes) with a diagnosis of BRC were evaluated. The mean age was 53 years, and there was no sex predominance. All tested patients (34/40) were positive for HLA-A29. The diagnosis of BRC was made following the Levinson et al. criteria, and all ancillary tests were performed to exclude differential diagnoses. Clinical signs and symptoms, such as complications and treatment, were described. Conclusions BRC evolution in Brazilian patients seems to have some peculiarities that diverge from the published literature available about Caucasians, as AS inflammation is higher in this population.
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Affiliation(s)
- Maria Luisa Gois da Fonsêca
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil.
| | - Raul N G Vianna
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil
| | - Anna C H Rocha
- Retina and Vitreous Service, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Antonio M B Casella
- Retina and Vitreous Service, Londrina State University (UEL), Londrina, PR, Brazil
| | - Arnaldo Cialdini
- Retina and Vitreous Service, Brazilian Center for Eye Surgery (CBCO), Goiânia, GO, Brazil
| | - Cristina Muccioli
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Daniela S da Costa
- Retina and Vitreous Service, Federal Hospital of State Servers (SERVIDORES), Rio de Janeiro, RJ, Brazil
| | - Daniel R Lucena
- Retina and Vitreous Service, Escola Cearence de Oftalmologia, Fortaleza, CE, Brazil
| | | | - Eduardo Morizot
- Retina and Vitreous Service, Botafogo Polyclinic, Rio de Janeiro, RJ, Brazil
| | - Elaine Castro
- Retina and Vitreous Service, Federal Fluminense University (UFF), Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033900, Brazil
| | - Ever E C Rodriguez
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Felipe T Diligenti
- Retina and Vitreous Service, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Heloisa Nascimento
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Joyce H Yanamoto
- Ophthalmology Department, Hospital das Clínicas, HCFMUSP (USP), São Paulo, SP, Brazil
| | | | | | | | - Luciana P S Finamor
- Retina and Vitreous Service, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria A M Frazão
- Department of Ophthalmology, "Santa Casa"of São Paulo, São Paulo, SP, Brazil
| | - Mario Motta
- Retina and Vitreous Service, Federal University of the State of the Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Mario J Nobrega
- Retina and Vitreous Service, Hospital de Olhos Sadalla Amin Ghanem, Joinville, SC, Brazil
| | | | - Remo T Moraes
- Brazilian Institute of Ophthalmology (IBOL), Rio de Janeiro, RJ, Brazil
| | - Rodrigo L Meirelles
- Ophthalmology Department, Hospital das Clínicas, HCFMUSP (USP), São Paulo, SP, Brazil
| | - Sidney R Lemos
- Retina and Vitreous Service, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Cheng SK, Thompson I, Okeagu C, Sen HN. CHOROIDAL LESIONS UNRESPONSIVE TO FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT IN BIRDSHOT CHORIORETINOPATHY. Retin Cases Brief Rep 2022; 16:56-58. [PMID: 31688672 PMCID: PMC7190444 DOI: 10.1097/icb.0000000000000909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To report the persistence of choroidal lesions despite fluocinolone acetonide intravitreal implants and their resolution with oral prednisone treatment. METHODS Retrospective chart review of a birdshot chorioretinopathy patient at a tertiary referral clinic. RESULTS Indocyanine angiography revealed resolution of choroidal lesions with oral prednisone and recurrence after discontinuation of oral prednisone. CONCLUSION Choroidal lesions responded to oral prednisone despite bilateral active fluocinolone acetonide intravitreal implant in a birdshot chorioretinopathy patient.
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Affiliation(s)
- Shuk Kei Cheng
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Ian Thompson
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Chinwenwa Okeagu
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - H. Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD
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Minos E, Barry RJ, Southworth S, Folkard A, Murray PI, Duker JS, Keane PA, Denniston AK. Birdshot chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment. Orphanet J Rare Dis 2016; 11:61. [PMID: 27175923 PMCID: PMC4866419 DOI: 10.1186/s13023-016-0429-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/17/2016] [Indexed: 11/15/2022] Open
Abstract
Birdshot chorioretinopathy (BCR) is a rare form of chronic, bilateral, posterior uveitis with a distinctive clinical phenotype, and a strong association with HLA-A29. It predominantly affects people in middle age. Given its rarity, patients often encounter delays in diagnosis leading to delays in adequate treatment, and thus risking significant visual loss. Recent advances have helped increase our understanding of the underlying autoimmune mechanisms involved in disease pathogenesis, and new diagnostic approaches such as multimodality imaging have improved our ability to both diagnose and monitor disease activity. Whilst traditional immunosuppressants may be effective in BCR, increased understanding of immune pathways is enabling development of newer treatment modalities, offering the potential for targeted modulation of immune mediators. In this review, we will discuss current understanding of BCR and explore recent developments in diagnosis, monitoring and treatment of this disease. Synonyms for BCR: Birdshot chorioretinopathy, Birdshot retinochoroiditis, Birdshot retino-choroidopathy, Vitiliginous choroiditis. Orphanet number: ORPHA179 OMIM: 605808.
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Affiliation(s)
- Evangelos Minos
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert J Barry
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, West Midlands, B15 2WB, UK
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sue Southworth
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birdshot Uveitis Society, London, UK
| | | | - Philip I Murray
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, West Midlands, B15 2WB, UK
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, West Midlands, B15 2WB, UK.
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK.
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