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Kempen JH, Newcomb CW, Washington TL, Foster CS, Sobrin L, Thorne JE, Jabs DA, Suhler EB, Rosenbaum JT, Sen HN, Levy-Clarke GA, Nussenblatt RB, Bhatt NP, Lowder CY, Goldstein DA, Leiderman YI, Acharya NR, Holland GN, Read RW, Dunn JP, Dreger KA, Artornsombudh P, Begum HA, Fitzgerald TD, Kothari S, Payal AR, Daniel E, Gangaputra SS, Kaçmaz RO, Liesegang TL, Pujari SS, Khachatryan N, Maghsoudlou A, Suga HK, Pak CM, Helzlsouer KJ, Buchanich JM. Use of Immunosuppression and the Risk of Subsequent Overall or Cancer Mortality. Ophthalmology 2023; 130:1258-1268. [PMID: 37499954 PMCID: PMC10811288 DOI: 10.1016/j.ophtha.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To determine the incidence of all-cause and cancer mortality (CM) in association with immunosuppression. DESIGN Retrospective cohort study at ocular inflammatory disease (OID) subspecialty centers. We harvested exposure and covariate data retrospectively from clinic inception (earliest in 1979) through 2010 inclusive. Then we ascertained overall and cancer-specific mortalities by National Death Index linkage. We constructed separate Cox models to evaluate overall and CM for each class of immunosuppressant and for each individual immunosuppressant compared with person-time unexposed to any immunosuppression. PARTICIPANTS Patients with noninfectious OID, excluding those with human immunodeficiency infection or preexisting cancer. METHODS Tumor necrosis factor (TNF) inhibitors (mostly infliximab, adalimumab, and etanercept); antimetabolites (methotrexate, mycophenolate mofetil, azathioprine); calcineurin inhibitors (cyclosporine); and alkylating agents (cyclophosphamide) were given when clinically indicated in this noninterventional cohort study. MAIN OUTCOME MEASURES Overall mortality and CM. RESULTS Over 187 151 person-years (median follow-up 10.0 years), during which 15 938 patients were at risk for mortality, we observed 1970 deaths, 435 due to cancer. Both patients unexposed to immunosuppressants (standardized mortality ratio [SMR] = 0.95, 95% confidence interval [CI], 0.90-1.01) and those exposed to immunosuppressants but free of systemic inflammatory diseases (SIDs) (SMR = 1.04, 95% CI, 0.95-1.14) had similar mortality risk to the US population. Comparing patients exposed to TNF inhibitors, antimetabolites, calcineurin inhibitors, and alkylating agents with patients not exposed to any of these, we found that overall mortality (adjusted hazard ratio [aHR] = 0.88, 0.89, 0.90, 1.11) and CM (aHR = 1.25, 0.89, 0.86, 1.23) were not significantly increased. These results were stable in sensitivity analyses whether excluding or including patients with SID, across 0-, 3-, or 5-year lags and across quartiles of immunosuppressant dose and duration. CONCLUSIONS Our results, in a cohort where the indication for treatment was proven unassociated with mortality risk, found that commonly used immunosuppressants-especially the antimetabolites methotrexate, mycophenolate mofetil, and azathioprine; the TNF inhibitors adalimumab and infliximab, and cyclosporine-were not associated with increased overall and CM over a median cohort follow-up of 10.0 years. These results suggest the safety of these agents with respect to overall and CM for patients treated with immunosuppression for a wide range of inflammatory diseases. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Sight for Souls, Bellevue, Washington; MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
| | - Craig W Newcomb
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terri L Washington
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
| | - Lucia Sobrin
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Department of Ophthalmology, George Washington University, Washington, District of Columbia; Janssen Retina Global Clinical Development, Princeton, New Jersey
| | - Grace A Levy-Clarke
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, West Virginia
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Nirali P Bhatt
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Careen Y Lowder
- Cole Eye Institute, Department of Ophthalmology, Cleveland Clinic, Cleveland, Ohio
| | - Debra A Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yannek I Leiderman
- Illinois Eye & Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Nisha R Acharya
- F.I. Proctor Foundation, Department of Ophthalmology, University of California San Francisco School of Medicine, San Francisco, California
| | - Gary N Holland
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Russell W Read
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - James P Dunn
- Mid-Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kurt A Dreger
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pichaporn Artornsombudh
- Department of Ophthalmology, Somdech Phra Pinkloa Hospital, Royal Thai Navy, Bangkok, Thailand; Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Hosne A Begum
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srishti Kothari
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ebenezer Daniel
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sapna S Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Siddharth S Pujari
- Siddharth Netralaya Superspecialty Eye Hospital, Belgaum, Karnataka, India
| | - Naira Khachatryan
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hilkiah K Suga
- MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Clara M Pak
- MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia; University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Kathy J Helzlsouer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanine M Buchanich
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
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2
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Papaliodis GN, Rosner BA, Dreger KA, Fitzgerald TD, Artornsombudh P, Kothari S, Gangaputra SS, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Jabs DA, Pak CM, Ying GS, Kempen JH. Incidence of and Risk Factors for Cataract in Anterior Uveitis. Am J Ophthalmol 2023; 254:221-232. [PMID: 37414328 PMCID: PMC10528977 DOI: 10.1016/j.ajo.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To estimate the incidence/risk factors for cataract in noninfectious anterior uveitis. DESIGN Retrospective multicenter cohort study (6 US tertiary uveitis sites, 1978-2010). METHODS Data were harvested by trained expert reviewers, using protocol-driven review of experts' charts. We studied cataract incidence-newly reduced visual acuity worse than 20/40 attributed to cataract; or incident cataract surgery-in 3923 eyes of 2567 patients with anterior uveitis. RESULTS Cataract developed in 507 eyes (54/1000 eye-years, 95% CI 49-59). Time-updated risk factors associated with cataract included older age (≥65 vs <18 years: adjusted hazard ratio [aHR] 5.04, 95% CI 3.04-8.33), higher anterior chamber cell grade (P(trend)=0.001), prior incisional glaucoma surgery (aHR 1.86, 95% CI 1.10-3.14), band keratopathy (aHR 2.23, 95% CI 1.47-3.37), posterior synechiae (aHR 3.71, 95% CI 2.83-4.87), and elevated intraocular pressure ≥30 vs 6-20 mm Hg (aHR 2.57, 95% CI 1.38-4.77). Primary acute (aHR 0.59, 95% CI 0.30-1.15) and recurrent acute (aHR 0.74, 95% CI 0.55-0.98) had lower cataract risk than chronic anterior uveitis. Higher-dose prednisolone acetate 1%-equivalent use (≥2 drops/day) was associated with >2-fold higher cataract risk in eyes with anterior chamber cell grades 0.5+ or lower but was not associated with higher cataract risk in the presence of anterior chamber cells of grade 1+ or higher. CONCLUSIONS Cataract complicates anterior uveitis in ∼5.4/100 eye-years. Several fixed and modifiable risk factors were identified, yielding a point system to guide cataract risk minimization. Topical corticosteroids only were associated with increased cataract risk when anterior chamber cells were absent or minimally present, suggesting their use to treat active inflammation (which itself is cataractogenic) does not cause a net increase in cataract incidence.
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Affiliation(s)
- George N Papaliodis
- From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (G.N.P., J.H.K.), Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School (G.N.P., C.S.F., J.H.K.), Boston, Massachusetts, USA.
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (B.A.R.), Boston, Massachusetts, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health (B.A.R.), Boston, Massachusetts, USA
| | - Kurt A Dreger
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health (K.A.D.), Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins School of Medicine (K.A.D., J.E.T., D.A.J.), Baltimore, Maryland, USA
| | - Tonetta D Fitzgerald
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA
| | - Pichaporn Artornsombudh
- Massachusetts Eye Research and Surgery Institution (P.A., S.K., C.S.F.), Waltham, Massachusetts, USA; Department of Ophthalmology, Somdech Phra Pinklao Hospital, Royal Thai Navy (P.A.), Bangkok, Thailand;; Department of Ophthalmology, King Chulalongkorn Memorial Hospital (P.A.), Bangkok, Thailand
| | - Srishti Kothari
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution (P.A., S.K., C.S.F.), Waltham, Massachusetts, USA
| | - Sapna S Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center (S.S.G.), Nashville, Tennessee, USA
| | - Grace A Levy-Clarke
- Department of Ophthalmology and Visual Sciences, West Virginia University (G.A.L.-C.), Morgantown, West Virginia, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health (R.B.N., H.N.S.), Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University (J.T.R., E.B.S.), Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University (J.T.R.), Portland, Oregon, USA; Legacy Devers Eye Institute (J.T.R.), Portland, Oregon, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health (R.B.N., H.N.S.), Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University (J.T.R., E.B.S.), Portland, Oregon, USA; Portland Veteran's Affairs Medical Center (E.B.S.), Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, Johns Hopkins School of Medicine (K.A.D., J.E.T., D.A.J.), Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (J.E.T., D.A.J.), Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Department of Ophthalmology, Harvard Medical School (G.N.P., C.S.F., J.H.K.), Boston, Massachusetts, USA; Massachusetts Eye Research and Surgery Institution (P.A., S.K., C.S.F.), Waltham, Massachusetts, USA
| | - Douglas A Jabs
- Department of Ophthalmology, Johns Hopkins School of Medicine (K.A.D., J.E.T., D.A.J.), Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (J.E.T., D.A.J.), Baltimore, Maryland, USA
| | - Clara M Pak
- University of Rochester School of Medicine & Dentistry (C.M.P.), Rochester, New York, USA; MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical School (J.H.K., C.M.P.), Addis Ababa, Ethiopia
| | - Gui-Shuang Ying
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA
| | - John H Kempen
- From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (G.N.P., J.H.K.), Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School (G.N.P., C.S.F., J.H.K.), Boston, Massachusetts, USA; MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical School (J.H.K., C.M.P.), Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine (J.H.K.), Addis Ababa, Ethiopia.
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3
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Kempen JH, Pistilli M, Begum H, Fitzgerald TD, Liesegang TL, Payal A, Zebardast N, Bhatt NP, Foster CS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE. Remission of Non-Infectious Anterior Scleritis: Incidence and Predictive Factors. Am J Ophthalmol 2021; 223:377-395. [PMID: 30951689 DOI: 10.1016/j.ajo.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 02/18/2019] [Accepted: 03/20/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess how often non-infectious anterior scleritis remits and identify predictive factors. METHODS Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. RESULTS During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. CONCLUSIONS Our results suggest scleritis remission occurs more slowly in anterior scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance scleritis remission (as suggested here) are needed.
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4
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Pistilli M, Gangaputra SS, Pujari SS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Begum H, Fitzgerald TD, Dreger KA, Kempen JH. Contemporaneous Risk Factors for Visual Acuity in Non-Infectious Uveitis. Ocul Immunol Inflamm 2021; 29:1056-1063. [PMID: 33621148 DOI: 10.1080/09273948.2020.1828493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We evaluated the associations of clinical and demographic characteristics with visual acuity (VA) with over 5 years in a subspecialty noninfectious uveitis population. METHODS Retrospective data from 5,530 noninfectious uveitis patients were abstracted by expert reviewers, and contemporaneous associations of VA with demographic and clinical factors were modeled. RESULTS Patients were a median of 41 years old, 65% female, and 73% white. Eyes diagnosed ≥5 years prior to cohort entry had worse VA (-1.2 lines) than those diagnosed <6 months prior, and eyes with cataract surgery performed prior to entry had worse VA (-5.9 lines) than those performed during follow-up. Vitreous haze (-4.2 lines for 3+ vs quiet), hypotony (-2.5 lines for ≤5 mm Hg vs 6-23 mm Hg), and CNV (-1.8 lines) all were strongly associated with reduced VA. CONCLUSION Factors associated with reduced VA included well-known structural complications, and lack of subspecialty care during cataract surgery.
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Affiliation(s)
- Maxwell Pistilli
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sapna S Gangaputra
- Department of Ophthalmology and Vision Sciences, Vanderbilt Eye Institute, Nashville, Tennessee, USA
| | | | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA.,Tampa Bay Uveitis Center, Tampa, Florida, USA
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,Portland Veteran's Affairs Medical Center, Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hosne Begum
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kurt A Dreger
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,MCM Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia, USA
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5
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Pistilli M, Joffe MM, Gangaputra SS, Pujari SS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Begum H, Fitzgerald TD, Dreger KA, Altaweel MM, Holbrook JT, Kempen JH. Visual Acuity Outcome over Time in Non-Infectious Uveitis. Ocul Immunol Inflamm 2019; 29:1064-1071. [PMID: 31821051 DOI: 10.1080/09273948.2019.1687733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: We evaluated visual acuity (VA) over 5 years in a subspecialty noninfectious uveitis population.Methods: Retrospective data from 5,530 noninfectious uveitis patients with anterior, intermediate, posterior or panuveitis were abstracted by expert reviewers. Mean VA was calculated using inverse probability of censoring weighting to account for losses to follow-up.Results: Patients were a median of 41 years old, 65% female, and 73% white. Initial mean VA was worse among panuveitis (20/84) than posterior (20/64), intermediate (20/47), and anterior (20/37) uveitides. On average, mean VA improved by 0.62, 0.51, 0.37, and 0.26 logMAR-equivalent lines over 2 years, respectively (each P < .001), then remained stable, except posterior uveitis mean VA worsened to initial levels.Conclusion: Mean VA of uveitic eyes improved and, typically, improvement was sustained under uveitis subspecialty care. Because VA tends to improve under tertiary care, mean VA change appears a better outcome for clinical studies than time-to-loss of VA.
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Affiliation(s)
- Maxwell Pistilli
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,The Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Marshall M Joffe
- The Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sapna S Gangaputra
- Department of Ophthalmology and Vision Sciences, Vanderbilt Eye Institute, Nashville, TN, USA
| | | | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Departments of Ophthalmology and Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory of Immunology, National Eye Institute, Bethesda, MD, USA
| | - Grace A Levy-Clarke
- Tampa Bay Uveitis Center, Tampa, FL, USA.,Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, MD, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,Ophthalmology Service, Portland Veteran's Affairs Medical Center, Portland, OR, USA
| | - Jennifer E Thorne
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirali P Bhatt
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Hosne Begum
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tonetta D Fitzgerald
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Kurt A Dreger
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael M Altaweel
- The Fundus Photograph Reading Center, University of Wisconsin School of Medicine, Madison, WI, USA.,Department of Ophthalmology and Vision Sciences, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Janet T Holbrook
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Clinical Trials and Synthesis, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,MCM Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
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6
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Gangaputra SS, Newcomb CW, Joffe MM, Dreger K, Begum H, Artornsombudh P, Pujari SS, Daniel E, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Jabs DA, Nussenblatt RB, Rosenbaum JT, Levy-Clarke GA, Kempen JH. Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases. Am J Ophthalmol 2019; 208:68-75. [PMID: 31344346 DOI: 10.1016/j.ajo.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases. DESIGN Retrospective analysis of cohort study data. METHODS Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained via medical record review. The study included 352 patients who were taking single-agent immunosuppression with MTX or MMF at 4 tertiary uveitis clinics. Marginal structural models (MSM)-derived statistical weighting created a virtual population with covariates and censoring patterns balanced across alternative treatments. With this methodological approach, the results estimate what would have happened had none of the patients stopped their treatment. Survival analysis with stabilized MSM-derived weights simulated a clinical trial comparing MMF vs MTX for noninfectious inflammatory eye disorders. The primary outcome was complete control of inflammation on prednisone ≤10 mg/day, sustained for ≥30 days. RESULTS The time to success was shorter (more favorable) for MMF than MTX (hazard ratio = 0.68, 95% confidence interval: 0.46-0.99). Adjusting for covariates, the proportion achieving success was higher at every point in time for MMF than MTX from 2 to 8 months, then converges at 9 months. The onset of corticosteroid-sparing success took more than 3 months for most patients in both groups. Outcomes of treatment (MMF vs MTX) were similar across all anatomic sites of inflammation. The incidence of stopping therapy for toxicity was similar in both groups. CONCLUSIONS Our results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.
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Affiliation(s)
- Sapna S Gangaputra
- Vanderbilt Eye Institute, Nashville, Tennessee, USA; Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marshall M Joffe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kurt Dreger
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hosne Begum
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pichaporn Artornsombudh
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Somdech Phra Pinkloa Hospital, Royal Thai Navy, Bangkok, Thailand; Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Siddharth S Pujari
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Siddharth Netralaya, Belgaum, Karnataka, India
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA; Portland Veteran's Affairs Medical Center, Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Departments of Ophthalmology and Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Portland, Oregon, USA
| | | | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; MCM Eye Unit/Ophthalmology, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
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Stansky E, Biancotto A, Dagur PK, Gangaputra S, Chaigne-Delalande B, Nussenblatt RB, Sen HN, McCoy JP. B Cell Anomalies in Autoimmune Retinopathy (AIR). Invest Ophthalmol Vis Sci 2017; 58:3600-3607. [PMID: 28715846 PMCID: PMC5516566 DOI: 10.1167/iovs.17-21704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Autoimmune retinopathy (AIR) is a retinopathy associated with unexplained vision loss presumably linked to circulating antiretinal antibodies; currently, however, there are no standardized criteria regarding the diagnosis, treatment strategy, or pathogenesis of this disease. The importance of B-lymphocyte immunophenotyping in the classification of AIR is unknown. Methods We utilized 15-color multiparametric flow cytometry to identify aberrations in B cell subsets that may contribute to the pathophysiology of AIR. Luminex cytokine analysis was also performed on plasma samples from AIR patients. Results Significant differences in AIR patients compared to individuals with other inflammatory conditions or healthy donors were found in the B cell memory compartment, including an increase in naïve B cells and a decrease in switched and unswitched memory B cells, which correlated with alterations in immunoglobulin secretion. Conclusions These findings suggest that the maturation process of B cells may be impaired and that B cell immunophenotyping may help in understanding disease process in AIR.
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Affiliation(s)
- Elena Stansky
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Angélique Biancotto
- Center for Human Immunology, National Institutes of Health, Bethesda, Maryland, United States
| | - Pradeep K Dagur
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Sapna Gangaputra
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Benjamin Chaigne-Delalande
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - J Philip McCoy
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
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8
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Knickelbein JE, Liu B, Arakelyan A, Zicari S, Hannes S, Chen P, Li Z, Grivel JC, Chaigne-Delalande B, Sen HN, Margolis L, Nussenblatt RB. Modulation of Immune Responses by Extracellular Vesicles From Retinal Pigment Epithelium. Invest Ophthalmol Vis Sci 2017; 57:4101-7. [PMID: 27537259 PMCID: PMC4991022 DOI: 10.1167/iovs.15-18353] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Extracellular vesicles (EV), such as exosomes, are important mediators of intercellular communication and have been implicated in modulation of the immune system. We investigated if EV released from retinal pigment epithelium (RPE) modulate immune responses in vitro. Methods Extracellular vesicles were isolated from ARPE-19 cultures stimulated or not with the inflammatory cytokines IL-1β, IFN-γ, and TNF-α. Isolated EV were characterized by nanoparticle flow and Western blot analyses. Retinal pigment epithelium–derived EV were cultured with human peripheral blood mononuclear cells, which were assayed for T-cell proliferation by 3H-thymidine incorporation. Retinal pigment epithelium–derived EV were also independently cultured with enriched lymphocytes or monocytes. Cell phenotype and cell death were evaluated by flow cytometric analysis. Cytokine levels were assayed in culture supernatants by multiplex bead analysis. Results The concentration of ARPE-derived EV from cytokine-stimulated cultures was slightly higher than from nonstimulated cultures. The size of EV was approximately 100 nm in both groups. Extracellular vesicles from both nonstimulated and cytokine-stimulated ARPE-19 significantly inhibited T-cell proliferation without affecting T-cell viability. Culture of EV from nonstimulated ARPE-19 with undifferentiated human monocytes induced an immunoregulatory phenotype with a significantly higher percentage of CD14++CD16+ monocytes and upregulation of TGF-β1. Culture of EV from cytokine-stimulated ARPE-19 cells with human monocytes induced upregulation of several proinflammatory cytokines and monocyte death. Conclusions Retinal pigment epithelium cells constitutively secrete EV in the size range of exosomes, with increased release from RPE cells stimulated with inflammatory cytokines. Extracellular vesicles from both nonstimulated and cytokine-stimulated RPE inhibited T-cell stimulation. Extracellular vesicles from nonstimulated ARPE-19 cells promoted an immunoregulatory CD14++CD16+ phenotype in human monocytes, while EV from cytokine-stimulated ARPE-19 cells caused human monocyte death. These findings suggest that RPE cells use EV to induce a downregulatory immune environment under homeostatic conditions. In an inflammatory milieu, RPE-derived EV may mitigate a potentially harmful inflammatory response through killing of monocytes.
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Affiliation(s)
- Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Baoying Liu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Anush Arakelyan
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Sonia Zicari
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Susan Hannes
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Ping Chen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Zhiyu Li
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Jean-Charles Grivel
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States 2Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Benjamin Chaigne-Delalande
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Leonid Margolis
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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Abstract
Introduction Non-infectious uveitis encompasses a group of inflammatory eye diseases that can cause irreversible vision loss if left untreated or undertreated. In cases requiring stemic treatment, a step-wise treatment approach is often employed starting with corticosteroids for severe active disease, followed by initiation of steroid-sparing therapies to maintain inflammatory control and avoid the abundant complications of long-term corticosteroid use. Areas covered We review the current high-quality evidence comparing the efficacy of various systemic steroid-sparing agents in the treatment of non-infectious uveitis. For studies to be included, they had to have a prospective, randomized, comparative design or a retrospective design including at least 100 patients. Expert commentary Given the rarity of uveitis and the heterogeneity of uveitic diseases, there are few randomized controlled studies that directly compare the relative efficacy of the various steroid-sparing immunosuppressive agents. Therefore, current treatment strategies are based mainly on data from observational series.
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Affiliation(s)
| | - Meredith Kim
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Elvira Argon
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | | | - Nida H Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD
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10
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Daniel E, Pistilli M, Kothari S, Khachatryan N, Kaçmaz RO, Gangaputra SS, Sen HN, Suhler EB, Thorne JE, Foster CS, Jabs DA, Nussenblatt RB, Rosenbaum JT, Levy-Clarke GA, Bhatt NP, Kempen JH. Risk of Ocular Hypertension in Adults with Noninfectious Uveitis. Ophthalmology 2017; 124:1196-1208. [PMID: 28433444 DOI: 10.1016/j.ophtha.2017.03.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the risk and risk factors for ocular hypertension (OHT) in adults with noninfectious uveitis. DESIGN Retrospective, multicenter, cohort study. PARTICIPANTS Patients aged ≥18 years with noninfectious uveitis seen between 1979 and 2007 at 5 tertiary uveitis clinics. METHODS Demographic, ocular, and treatment data were extracted from medical records of uveitis cases. MAIN OUTCOME MEASURES Prevalent and incident OHT with intraocular pressures (IOPs) of ≥21 mmHg, ≥30 mmHg, and increase of ≥10 mmHg from documented IOP recordings (or use of treatment for OHT). RESULTS Among 5270 uveitic eyes of 3308 patients followed for OHT, the mean annual incidence rates for OHT ≥21 mmHg and OHT ≥30 mmHg are 14.4% (95% confidence interval [CI], 13.4-15.5) and 5.1% (95% CI, 4.7-5.6) per year, respectively. Statistically significant risk factors for incident OHT ≥30 mmHg included systemic hypertension (adjusted hazard ratio [aHR], 1.29); worse presenting visual acuity (≤20/200 vs. ≥20/40, aHR, 1.47); pars plana vitrectomy (aHR, 1.87); history of OHT in the other eye: IOP ≥21 mmHg (aHR, 2.68), ≥30 mmHg (aHR, 4.86) and prior/current use of IOP-lowering drops or surgery in the other eye (aHR, 4.17); anterior chamber cells: 1+ (aHR, 1.43) and ≥2+ (aHR, 1.59) vs. none; epiretinal membrane (aHR, 1.25); peripheral anterior synechiae (aHR, 1.81); current use of prednisone >7.5 mg/day (aHR, 1.86); periocular corticosteroids in the last 3 months (aHR, 2.23); current topical corticosteroid use [≥8×/day vs. none] (aHR, 2.58); and prior use of fluocinolone acetonide implants (aHR, 9.75). Bilateral uveitis (aHR, 0.69) and previous hypotony (aHR, 0.43) were associated with statistically significantly lower risk of OHT. CONCLUSIONS Ocular hypertension is sufficiently common in eyes treated for uveitis that surveillance for OHT is essential at all visits for all cases. Patients with 1 or more of the several risk factors identified are at particularly high risk and must be carefully managed. Modifiable risk factors, such as use of corticosteroids, suggest opportunities to reduce OHT risk within the constraints of the overriding need to control the primary ocular inflammatory disease.
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Affiliation(s)
- Ebenezer Daniel
- Scheie Eye Institute, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maxwell Pistilli
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srishti Kothari
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Naira Khachatryan
- Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
| | - R Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, England, United Kingdom
| | - Sapna S Gangaputra
- Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, The Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - James T Rosenbaum
- Department of Ophthalmology, Department of Medicine, Oregon Health and Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Nirali P Bhatt
- Scheie Eye Institute, Philadelphia, Pennsylvania; Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Discovery Eye Center, MyungSung Christian Medical Center, Addis Ababa, Ethiopia
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11
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Kuo DE, Wei MM, Armbrust KR, Knickelbein JE, Yeung IYL, Nussenblatt RB, Chan CC, Sen HN. Gradient Boosted Decision Tree Classification of Endophthalmitis Versus Uveitis and Lymphoma from Aqueous and Vitreous IL-6 and IL-10 Levels. J Ocul Pharmacol Ther 2017; 33:319-324. [PMID: 28157416 DOI: 10.1089/jop.2016.0132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To investigate the effectiveness of gradient boosting to classify endophthalmitis versus uveitis and lymphoma by intraocular cytokine levels. METHOD Patient diagnoses and aqueous and vitreous levels of interleukin (IL)-6 and IL-10 were retrospectively extracted from a National Eye Institute Histopathology Core database and compared by Kruskal-Wallis and post hoc Dunn tests. A gradient-boosted decision tree classifier was trained to differentiate endophthalmitis versus uveitis and lymphoma from vitreous IL-6 and IL-10, vitreous IL-6 only, and aqueous IL-6 only data sets; and was tested with 80-20 train-test split and 3-fold cross-validation of the training set. RESULTS Seven endophthalmitis, 29 lymphoma, and 49 uveitis patients were included. IL-6 was higher in endophthalmitis than uveitis (P = 0.0713 aqueous, 0.0014 vitreous) and lymphoma (P = 0.0032 aqueous, 0.0001 vitreous). IL-10 was significantly higher in lymphoma than uveitis (P = 0.0017 aqueous, 0.0014 vitreous). Three-fold cross validation demonstrated 95% ± 5%, 95% ± 4%, and 97% ± 5% predictive accuracy for vitreous IL-6 and IL-10, vitreous IL-6 only, and aqueous IL-6 only data sets. Upon validation with the testing set, vitreous IL-6 and IL-10 and aqueous IL-6 only data sets achieved 100% predictive accuracy and vitreous IL-6 only data achieved 93% predictive accuracy with 100% sensitivity, 92% specificity, and an area under the receiver operating characteristic curve (ROC/AUC) of 96%. CONCLUSIONS With limited sample size, gradient boosting can differentiate endophthalmitis from uveitis and lymphoma by IL-6 and IL-10 with high sensitivity and specificity; however, a larger cohort is needed for further validation.
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Affiliation(s)
- David E Kuo
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland.,2 University of California , San Diego, School of Medicine, San Diego, California
| | - Maggie M Wei
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland.,3 Georgetown University , School of Medicine, Washington, District of Columbia
| | - Karen R Armbrust
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
| | - Jared E Knickelbein
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
| | - Ian Y L Yeung
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland.,4 Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert B Nussenblatt
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
| | - Chi-Chao Chan
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
| | - Hatice Nida Sen
- 1 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
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Abstract
PURPOSE Panax Notoginseng, a traditional Chinese medicine, is known as an anti-inflammatory herb. However, the molecular mechanism by which it controls helper T cell mediated immune responses is largely unknown. METHODS Naive CD4+ T cells isolated from healthy donors, patients with Behcet's disease, and C57BL/6 mice were polarized into Th1, Th17, and Treg cells. Proliferation and cytokine expression were measured in these cells with the presence or absence of Panax Notoginseng saponins (PNS). Genomewide expression profiles of Th1, Th17, and Treg cells were assessed using Affymetrix microarray analysis. RESULTS We found that PNS control the proliferation and differentiation of Th17 cells by globally downregulating the expression of inflammatory cytokines and cell cycle genes. CONCLUSIONS These findings demonstrated that PNS function as an anti-inflammatory agent through directly targeting Th17 cell mediated immune response.
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Affiliation(s)
- Jia-Ru Wei
- 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China .,2 Guangdong Province Key Laboratory of Brain Function and Disease, Sun Yat-sen University , Guangzhou, China
| | - Xiaofeng Wen
- 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China .,2 Guangdong Province Key Laboratory of Brain Function and Disease, Sun Yat-sen University , Guangzhou, China
| | - Paul W Bible
- 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Zhiyu Li
- 3 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
| | - Robert B Nussenblatt
- 3 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
| | - Lai Wei
- 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China .,2 Guangdong Province Key Laboratory of Brain Function and Disease, Sun Yat-sen University , Guangzhou, China .,3 Laboratory of Immunology, National Eye Institute, National Institutes of Health , Bethesda, Maryland
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13
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Knickelbein JE, Tucker WR, Bhatt N, Armbrust K, Valent D, Obiyor D, Nussenblatt RB, Sen HN. Gevokizumab in the Treatment of Autoimmune Non-necrotizing Anterior Scleritis: Results of a Phase I/II Clinical Trial. Am J Ophthalmol 2016; 172:104-110. [PMID: 27663070 DOI: 10.1016/j.ajo.2016.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the safety and potential efficacy of gevokizumab, an anti-interleukin 1β (IL-1β) monoclonal antibody, in the treatment of active, noninfectious, non-necrotizing anterior scleritis. DESIGN Phase 1/2, open label, nonrandomized, prospective, single-arm pilot trial. METHODS Eight patients with active, noninfectious, non-necrotizing anterior scleritis with a scleral inflammatory grade of +1 to +3 in at least 1 eye were enrolled. In 1 patient both eyes were enrolled, for a total of 9 eyes (4 eyes with +1, 1 eye with +2, and 4 eyes with +3). Patients received 1 subcutaneous injection of 60 mg gevokizumab at baseline and then every 4 weeks for 12 weeks. Complete physical and ocular examinations were performed at each visit. The primary outcome was at least a 2-step reduction or reduction to grade 0 in scleral inflammation on a 0 to +4 scale according to a standardized photographic scleritis grading system by 16 weeks in the study eye compared to baseline. Secondary outcomes included changes in visual acuity, intraocular pressure, and trends in scleral grading. Participants who met the primary outcome were eligible to continue in the study for up to 52 weeks and received additional gevokizumab injections every 4 weeks until week 36, followed by 2 safety visits at weeks 40 and 52. RESULTS Seven eyes from 7 patients met the primary outcome within a median time of 2 weeks following the first gevokizumab injection. No definitive changes in visual acuity or intraocular pressure were identified. There were no serious adverse events related to the study drug. A total of 43 adverse effects were reported, with 93% described as mild, 95% as nonocular, and only 14% deemed possibly caused by the investigational treatment. CONCLUSIONS The results of this small study suggest that blockage of IL-1β using gevokizumab may be beneficial in treating active, noninfectious anterior scleritis and that gevokizumab is well tolerated. Larger randomized trials are warranted to assess the true efficacy of gevokizumab in the treatment of non-necrotizing anterior scleritis.
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Affiliation(s)
| | - William R Tucker
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Nirali Bhatt
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Karen Armbrust
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - David Valent
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Dominic Obiyor
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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14
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Fox AR, Gordon LK, Heckenlively JR, Davis JL, Goldstein DA, Lowder CY, Nussenblatt RB, Butler NJ, Dalal M, Jayasundera T, Smith WM, Lee RW, Adamus G, Chan CC, Hooks JJ, Morgans CW, Detrick B, Sen HN. Reply. Am J Ophthalmol 2016; 170:242-243. [PMID: 27566926 DOI: 10.1016/j.ajo.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
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15
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Chen P, Urzua CA, Knickelbein JE, Kim JS, Li Z, Hannes S, Kuo D, Chaigne-Delalande B, Armbrust K, Tucker W, Liu B, Agrón E, Sen HN, Nussenblatt RB. Elevated CD1c+ Myeloid Dendritic Cell Proportions Associate With Clinical Activity and Predict Disease Reactivation in Noninfectious Uveitis. Invest Ophthalmol Vis Sci 2016; 57:1765-72. [PMID: 27070110 PMCID: PMC4849533 DOI: 10.1167/iovs.15-18357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To test the association between elevated proportions of CD1c+ myeloid dendritic cells (mDCs) and disease activation/reactivation in noninfectious uveitis. METHODS Noninfectious uveitis patients (n = 89) and healthy controls (n = 111) were recruited. The proportion of CD1c+ mDCs in the total dendritic cell (DC) population of peripheral blood was measured by flow cytometry (CD1c+ mDCs gated on Lineage 1+HLADR+ DCs). Disease activity was assessed per Standardization of Uveitis Nomenclature criteria. Uveitis reactivation was ascribed to clinically quiescent patients who developed reactivation of intraocular inflammation within 6 months. RESULTS The proportions of CD1c+ mDCs were increased in noninfectious uveitis patients, especially in active disease, compared to healthy controls. This CD1c+ mDC elevation was not associated with underlying systemic diseases, anatomic locations of uveitis, medications, or demographic factors. Longitudinal data showed that the dynamics of CD1c+ mDC levels were correlated with disease activity. The average proportion of CD1c+ mDCs in active uveitis patients was 60% so we set this as the cutoff between high and low CD1c+ mDC levels. Although 74% of quiescent patients had low proportions of CD1c+ mDCs, 26% still had high proportions. Quiescent patients with high CD1c+ mDC proportions showed increased risk of disease reactivation, compared to quiescent patients with low CD1c+ mDC proportions. CONCLUSIONS Increased proportions of CD1c+ mDCs were associated with clinical activity, and quiescent patients with elevated CD1c+ mDCs were more likely to undergo reactivation. This suggests that CD1c+ mDC proportion may be a potential biomarker for assessing clinical activation and reactivation in noninfectious uveitis.
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Affiliation(s)
- Ping Chen
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Cristhian A Urzua
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States 2Department of Ophthalmology, Universidad de Chile, Santiago, Chile
| | - Jared E Knickelbein
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Jane S Kim
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States 3School of Medicine, University of California San Diego, La Jolla, California, United States
| | - Zhiyu Li
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Susan Hannes
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - David Kuo
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States 3School of Medicine, University of California San Diego, La Jolla, California, United States
| | - Benjamin Chaigne-Delalande
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Karen Armbrust
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - William Tucker
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Baoying Liu
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Elvira Agrón
- Division of Epidemiology and Clinical Application, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - H Nida Sen
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert B Nussenblatt
- Laboratory of Immunology National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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Fox AR, Gordon LK, Heckenlively JR, Davis JL, Goldstein DA, Lowder CY, Nussenblatt RB, Butler NJ, Dalal M, Jayasundera T, Smith WM, Lee RW, Adamus G, Chan CC, Hooks JJ, Morgans CW, Detrick B, Sen HN. Consensus on the Diagnosis and Management of Nonparaneoplastic Autoimmune Retinopathy Using a Modified Delphi Approach. Am J Ophthalmol 2016; 168:183-190. [PMID: 27210277 DOI: 10.1016/j.ajo.2016.05.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop diagnostic criteria for nonparaneoplastic autoimmune retinopathy (AIR) through expert panel consensus and to examine treatment patterns among clinical experts. DESIGN Modified Delphi process. METHODS A survey of uveitis specialists in the American Uveitis Society, a face-to-face meeting (AIR Workshop) held at the National Eye Institute, and 2 iterations of expert panel surveys were used in a modified Delphi process. The expert panel consisted of 17 experts, including uveitis specialists and researchers with expertise in antiretinal antibody detection. Supermajority consensus was used and defined as 75% of experts in agreement. RESULTS There was unanimous agreement among experts regarding the categorization of autoimmune retinopathies as nonparaneoplastic and paraneoplastic, including cancer-associated retinopathy and melanoma-associated retinopathy. Diagnostic criteria and tests essential to the diagnosis of nonparaneoplastic AIR and multiple supportive criteria reached consensus. For treatment, experts agreed that corticosteroids and conventional immunosuppressives should be used (prescribed) as first- or second-line treatments, though a consensus agreed that biologics and intravenous immunoglobulin were considered appropriate in the treatment of nonparaneoplastic AIR patients regardless of the stage of disease. Experts agreed that more evidence is needed to treat nonparaneoplastic AIR patients with long-term immunomodulatory therapy and that there is enough equipoise to justify randomized, placebo-controlled trials to determine if nonparaneoplastic AIR patients should be treated with long-term immunomodulatory therapy. Regarding antiretinal antibody detection, consensus agreed that a standardized assay system is needed to detect serum antiretinal antibodies. Consensus agreed that an ideal assay should have a 2-tier design and that Western blot and immunohistochemistry should be the methods used to identify antiretinal antibodies. CONCLUSIONS Consensus was achieved using a modified Delphi process to develop diagnostic criteria for nonparaneoplastic AIR. There is enough equipoise to justify randomized, placebo-controlled trials to determine whether patients with nonparaneoplastic AIR should be treated with long-term immunomodulatory therapy. Efforts to develop a standardized 2-tier assay system for the detection of antiretinal antibodies have been initiated as a result of this study.
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Knickelbein JE, Wei M, Nussenblatt RB, Sen HN. Retinal Pigment Epithelium Tear after Immunosuppressive Treatment for Sarcoidosis-related Choroidal Granuloma. Ocul Immunol Inflamm 2016; 25:820-824. [PMID: 27379730 DOI: 10.1080/09273948.2016.1180402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the formation of a retinal pigment epithelial (RPE) tear following immunosuppressive treatment of a large choroidal granuloma in a patient with sarcoidosis-related panuveitis. METHODS A 25-year-old woman presented with bilateral sarcoidosis-related panuveitis and optic disc edema in both eyes with a large choroidal granuloma temporal to the fovea in the left eye. High-dose oral prednisone therapy was given. RESULTS High-dose oral prednisone therapy produced improvement in her panuveitis with reduction in size of the left choroidal granuloma. An RPE tear overlying the flattening choroidal granuloma developed by 3 weeks of treatment. CONCLUSIONS Treatment of choroidal granuloma with rapid reduction in size may result in an RPE tear.
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Affiliation(s)
- Jared E Knickelbein
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - Maggie Wei
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - Robert B Nussenblatt
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - H Nida Sen
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
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Dardik R, Livnat T, Halpert G, Jawad S, Nisgav Y, Azar-Avivi S, Liu B, Nussenblatt RB, Weinberger D, Sredni B. The small tellurium-based compound SAS suppresses inflammation in human retinal pigment epithelium. Mol Vis 2016; 22:548-62. [PMID: 27293373 PMCID: PMC4889158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 05/26/2016] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Pathological angiogenesis and chronic inflammation greatly contribute to the development of choroidal neovascularization (CNV) in chorioretinal diseases involving abnormal contact between retinal pigment epithelial (RPE) and endothelial cells (ECs), associated with Bruch's membrane rupture. We explored the ability of the small organotellurium compound octa-O-bis-(R,R)-tartarate ditellurane (SAS) to mitigate inflammatory processes in human RPE cells. METHODS Cell adhesion assays and analyses of gene and protein expression were used to examine the effect of SAS on ARPE-19 cells or primary human RPE cells that were grown alone or in an RPE-EC co-culture. RESULTS Adhesion assays showed that SAS inhibited αv integrins expressed on RPE cells. Co-cultures of RPE cells with ECs significantly reduced the gene expression of PEDF, as compared to RPE cells cultured alone. Both SAS and the anti-αvβ3 antibody LM609 significantly enhanced the production of PEDF at both mRNA and protein levels in RPE cells. RPE cells co-cultured with EC exhibited increased gene expression of CXCL5, COX1, MMP2, IGF1, and IL8, all of which are involved in both angiogenesis and inflammation. The enhanced expression of these genes was greatly suppressed by SAS, but interestingly, remained unaffected by LM609. Zymography assay showed that SAS reduced the level of MMP-2 activity in RPE cells. We also found that SAS significantly suppressed IL-1β-induced IL-6 expression and secretion from RPE cells by reducing the protein levels of phospho-IkappaBalpha (pIκBα). CONCLUSIONS Our results suggest that SAS is a promising anti-inflammatory agent in RPE cells, and may be an effective therapeutic approach for controlling chorioretinal diseases.
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Affiliation(s)
- Rima Dardik
- Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel,Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Tami Livnat
- Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Gilad Halpert
- C.A.I.R. Institute, The Safdié AIDS and Immunology Research Center, The Mina & Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan 52900, Israel
| | - Shayma Jawad
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Yael Nisgav
- Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Shirley Azar-Avivi
- Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Baoying Liu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Robert B. Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Dov Weinberger
- Laboratory of Eye Research, Felsenstein Medical Research Center, Petach Tikva, Israel,Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Sredni
- C.A.I.R. Institute, The Safdié AIDS and Immunology Research Center, The Mina & Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan 52900, Israel
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Ucar D, Kim JS, Bishop RJ, Nussenblatt RB, Rao VK, Sen HN. Ocular Inflammatory Disorders in Autoimmune Lymphoproliferative Syndrome (ALPS). Ocul Immunol Inflamm 2016; 25:703-709. [PMID: 27229379 DOI: 10.1080/09273948.2016.1175637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To describe inflammatory ocular findings in patients with autoimmune lymphoproliferative syndrome (ALPS). METHODS A retrospective review of medical records for ALPS patients seen at the National Eye Institute between 2003 and 2013. RESULTS A total of 29 ALPS patients previously referred for ocular or visual symptoms or with a history of prolonged corticosteroid use, were identified. Mean age was 20 years (range: 4-66 years). The majority were male (n = 21, 72.4%) and Caucasian (n = 24, 82.8%). Ten (34.5%) had abnormal ocular findings, the most common of which was an ocular inflammatory disorder (n = 4, 13.8%). Uveitis was seen in two patients with ALPS-FAS and one with ALPS-U, all of whom required long-term systemic immunosuppression. One patient with ALPS-FAS had a history of optic neuritis. CONCLUSIONS ALPS can have intraocular inflammatory manifestations that require routine follow-up to ensure appropriate and timely treatment of intraocular disease. Long-term immunosuppression may be needed for patients with ALPS-associated uveitis.
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Affiliation(s)
- Didar Ucar
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA.,b Department of Ophthalmology , Cerrahpasa Medical School, University of Istanbul , Istanbul , Turkey
| | - Jane S Kim
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA.,c University of California, San Diego, School of Medicine , La Jolla , California , USA
| | - Rachel J Bishop
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - Robert B Nussenblatt
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - V Koneti Rao
- d National Institute of Allergy and Infectious Diseases, National Institute of Health , Bethesda , Maryland , USA
| | - H Nida Sen
- a National Eye Institute, National Institutes of Health , Bethesda , Maryland , USA
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Fox AR, Chew EY, Meyerle C, Vitale S, Ferris FL, Nussenblatt RB, Sen HN. Age-related macular degeneration in patients with uveitis. Br J Ophthalmol 2016; 101:342-347. [PMID: 27154918 DOI: 10.1136/bjophthalmol-2016-308587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/09/2016] [Accepted: 04/14/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the prevalence of large drusen in a uveitis clinic population. DESIGN Retrospective, cohort study. METHODS Patients with primary, non-infectious uveitis 55 years or older who were seen at the National Eye Institute of the National Institutes of Health from 2004 through August 2013 were reviewed using electronic medical records and photographic databases. Patients were classified as having age-related macular degeneration (AMD) if either eye had large drusen, geographic atrophy or neovascular AMD according to definitions used by the Eye Diseases Prevalence Research Group (EDPRG). The expected number of cases and standardised mortality ratio (SMR) for large drusen were estimated based on EDPRG estimates. RESULTS We identified 177 patients aged ≥55 years as having primary non-infectious uveitis; 170 (96.0%) had gradable fundus photos. Average age was 65.0±7.5 years (range 55-87), and 87 were non-Hispanic white, 66 non-Hispanic black, 6 Hispanic white and 11 of other race/ethnicity. Large drusen were identified in four patients (2.4%; 95% CI 0.6 to 6.0). No patients were identified to have late AMD. In the uveitis cohort, the SMR for cases of large drusen, which was adjusted for age, was calculated to be 0.32 (95% CI 0.12 to 0.70) for the whole cohort, 0.28 (95% CI 0.09 to 0.79) for non-Hispanic whites and 0.46 (95% CI 0.14 to 1.29) for non-Hispanic blacks. CONCLUSIONS Large drusen prevalence among patients with uveitis ≥55 years of age appears less than the prevalence in the general US population after accounting for differences in age distribution, especially for non-Hispanic whites. Although the racial and gender distribution in this study population is not directly representative of the general US population, results of this study suggest possible sparing of patients with uveitis from AMD. A larger systematic study with greater power would be needed to confirm these findings.
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Affiliation(s)
- Austin R Fox
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Catherine Meyerle
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Holbrook JT, Sugar EA, Burke AE, Vitale AT, Thorne JE, Davis JL, Jabs DA, Jaffe GJ, Branchaud B, Hahn P, Koreen L, Lad E(NM, Lin P, Martel JN, (Shah) Serrano N, Skalak C, Vajzovic L, Baer C, Bryant J, Chavala S, Cusick M, Day S, Dayani P, Ehlers J, Kesen M, Lee A, Melamud A, Qureshi JA, Scott AW, See RF, Shuler RK, Wood M, Yeh S, Fernandes A, Gibbs D, Leef D, Martin DF, Srivastava S, Dunn JP, Begum H, Boring J, Brotherson KL, Burkholder B, Butler NJ, Cain D, Cook MA, Emmert D, Graul JR, Herring M, Laing A, Leung TG, Mahon MC, Moradi A, Nwankwo A, Ostheimer TL, Reed T, Arnold E, Barnabie PM, Belair ML, Bolton SG, Brodine JB, Brown DM, Brune LM, Galor A, Gan T, Jacobowitz A, Kapoor M, Kedhar S, Kim S, Leder HA, Livingston AG, Morton Y, Nolan K, Peters GB, Soto P, Stevenson R, Tarver-Carr M, Wang Y, Foster CS, Anesi SD, Linda Bruner, Ceron O, Hinkle DM, Persons N, Wentworth B, Acevedo S, Anzaar F, Cesca T, Contero A, Fitzpatrick K, Goronga F, Johnson J, Lebron KQ, Marvell D, Morgan C, Patel N, Pinto J, Siddique SS, Sprague J, Yilmaz T, Sen HN, Bono M, Cunningham D, Hayes D, Koutsandreas D, Nussenblatt RB, Sherry PR, Short GL, Smith W, Temple A, Bamji A, Coleman H, Davuluri G, Faia L, Gottlieb C, Jirawuthiworavong GV, Lew JC, Mercer R, Obiyor D, Perry CH, Potapova N, Weichel E, Wroblewski KJ, Yeh S, Latkany PA, Coonan C, Honda A, Lorenzo-Latkany M, Masini R, Morell S, Nguyen A, Badamo J, Boyd KM, Enos M, Gallardo J, Jarczynski J, Lee JY, McGrosky M, Nour A, Sanchez M, Steinberg K, Stawell RJ, Breayley L, D'Sylva C, Glatz E, Hodgson L, Lim L, Ling C, McIntosh R, Morrison (Ewing) J, Newton A, Sanmugasundram S, Smallwood R, Zamir E, Hunt N, Jones L, Koukouras I, Williams S, Merrill PT, Carns D, Richine L, Voskuil-Marre DL, Woo K, Gaynes B, Giannoulis C, Hulvey P, Kernbauer E, Khan HS, Levine SJ, Toennessen S, Tonner E, Wang RC, Aguado H, Arceneaux S, Duignan K, Fish GE, Hesse N, Jaramillo D, Mackens M, Arnwine J, Callanan D, Cummings K, Gray K, Howden S, Mutz K, Sanchez B, Lightman S, Ismetova F, Prytherch A, Seguin-Greenstein S, Tomkins O, Bar A, Edwards K, Joshi L, Moraji J, Samy A, Stubbs T, Taylor S, Towler H, Tronnberg R, Holland GN, Almanzor RD, Castellanos J, Hubschman JP, Johiro AK, Kukuyev A, Levinson RD, McCannel CA, Ransome SS, Gonzales CR, Gupta A, Kalyani PS, Kapamajian MA, Kappel PJ, Arcinue C, Chuang J, Barteselli G, Currie G, Mendoza V, Powell D, Clark T, Cochran DE, Freeman WR, Hedaya J, Kemper T, Kozak I, LeMoine JM, Loughran ME, Magana L, Mojana F, Morrison V, Nguyen V, Oster SF, Acharya N, Clay D, Lee S, Lew M, Margolis TP, Stewart J, Wong IG, Brown D, Khouri CM, Goldstein DA, Birnbaum A, Degillio A, Rosa GDL, Ramirez C, Simjanowski E, Skelly M, Castro-Malek AL, Crooke CE, Huntley M, Nash K, Niec M, Pyatetsky D, Ramirez M, Rozenbajgier Z, Tessler HH, Davis JL, Albini TA, Chin M, Castaño D, Elizondo A, Ho M, Kovach JL, Lin RCS, Mandelcorn E, Nguyen JKD, Pacini A, Pineda S, Pinto DA, Rebimbas J, Stepien KE, Teran C, Elner SG, Bernard H, Fournier L, Godsey L, Goings L, Hackel R, Hesselgrave M, Jayasundera KT, Prusak R, Titus P, Bergeron M, Blosser R, Brown R, Chrisman-McClure C, Gothrup JR, Saxe SJ, Sizemore D, Kempen JH, Berger J, Drossner S, DuPont JC, Maguire AM, Petner J, Engelhard S, Hopkins T, McCall D, McRay M, Will D, Xu W, Lo J, Salvo R, Windsor E, Weeney L, Pavan PR, Albritton K, Leto J, Madow B, Mayor L, Pautler SE, Saxon W, Soto J, Goldstein B, Klukoff A, Lambright L, McDonald K, Ortiz M, Scymanky S, Szalay DD, Rao N, Davis T, Douglass J, Linton J, Padilla M, Ramos S, Aguirre A, Chong L, Cisneros L, Corona E, Eliott D, Fawzi A, Garcia J, Khurana R, Lim J, Mead R, Tsai JH, Vitale A, Bernstein PS, Carlstrom B, Gilman J, Hanseen S, Morris P, Ramirez D, Wegner K, Sheppard JD, Anthony B, Casper A, Felix-Kent L, Fernandez J, Johnson T, Scoper SV, Cole RD, Crawford N, Franklin L, Hamelin K, Martin J, Marx R, Schultz G, Webb J, Yeager P, Kim RY, Benz MS, Brown DM, Chen E, Fish RH, Kegley E, Shawver L, Wong TP, De La Garza R, Friday (Hay) S, Mutz K, Rao PK, Adcock E, Apte RS, Baladenski A, Curtis R, Gould S, Hebden A, Kambarian J, Meyer C, Pistorius S, Quinn M, Rathert G, Blinder KJ, Hartz A, Light P, Shah GK, VanGelder R, Jabs DA, Altaweel MM, Kempen JH, Kurinij N, Jabs DA, Almanzor RD, Altaweel MM, Brown D, Dunn JP, Holland GN, Kempen JH, Kim RY, Kurinij N, Prusakowski N, Thorne JE, Bolton SG, Brune LM, Clark T, Gilman J, Hubbard L, Martin DF, Nussenblatt RB, Wittes J, Barlow WE, Hochberg M, Lyon AT, Palestine AG, Simon LS, Altaweel MM, Kurinij N, Rosenbaum JT, Smith H, Kempen JH, Jaffe GJ, Davis J, Dunn JP, Martin DF, Thorne J, Vitale A, Thorne JE, Acharya NR, Kempen JH, Latkany PA, Vitale AT, Nussenblatt RB, VanGelder R, Almanzor RD, Boring JA, Gibbs D, Lee S, Prusakowski N, Thorne JE, Alexander J, Ng WP, Friedman DS, Adler A, Alexander J, Burke A, Katz J, Kempen JH, Prusakowski N, Reed S, Ansari H, Cohen N, Modak S, Ng WP, Sugar EA, Burke AE, Drye LT, Van Natta ML, Frick K, Katz J, Louis TA, Modak S, Shade D, Jabs DA, Pascual K, Slutsky-Sanon JS, Glomp C, Nieves MA, Stevens M, Allen A, Hilal Y, Holbrook JT, Abreu F, Burke A, Casper AS, Drye LT, Ewing C, Friedman DS, Hart A, Lears A, Li S, Meinert J, Morrison V, Nowakowski D, Prusakowski N, Reyes G, Shade DM, Smith J, Steuernagle K, Van Natta M, Venugopal V, Yu T, Adler A, Alexander J, Boring J, Chen P, Cohen N, Collins K, Dodge J, Frick KD, Jackson R, Jimenez C, Katz J, Landers A, Livingston H, Louis TA, Meinert CL, Modak S, Ng WP, Rayapudi S, Shen W, Shiflett C, Smith R, Tieman A, Tonascia JA, Zheng R, Altaweel MM, Allan J, Benz WK, Domalpally A, Johnson KA, Myers DJ, Pak JW, Reed S, Reimers JL, Christianson DJ, Chambers G, Fleischli MA, Freund J, Glander KE, Goulding A, Gama V, Gangaputra S, Hafford D, Harris SE, Hubbard LD, Joyce JM, Kruse CN, Nagle L, Remm A, Padden-Lechten GE, Pohlman A, Shaw RA, Sivesind P, Thayer D, Treichel E, Warren KJ, Watson SM, Webster MK, White JK, Wilhelmson T, Zhang G. Dissociations of the Fluocinolone Acetonide Implant: The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. Am J Ophthalmol 2016; 164:29-36. [PMID: 26748056 DOI: 10.1016/j.ajo.2015.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial. DESIGN Randomized clinical trial with extended follow-up. METHODS Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically related. RESULTS A total of 250 eyes (146 patients) had at least 1 implant placed. Median follow-up time after implant placement was 6 years (range 0.5-9.2 years). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval [CI]: 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity ≥5 letters temporally related to the dissociation. Thirty-nine implant removal surgeries were performed, 33 with replacement. Twelve dissociations were noted during implant removal surgeries in 10 participants (26%, 95% CI 15%-48%); 5 of these eyes had a decline in visual acuity ≥5 letters after surgery. The time from implant placement to removal surgery was longer for the surgeries at which dissociated implants were identified than for those without one (5.7 vs 3.7 years, P < .001). Overall, visual acuity declined 15 or more letters from pre-implant values in 22% of affected eyes; declines were frequently associated with complications of uveitis or its treatment. CONCLUSION There is an increasing risk of dissociation of Retisert implants during follow-up; the risk is greater with removal/exchange surgeries, but the risk of both spontaneous and surgically related events increases with longevity of the implants. In 22% of affected eyes visual acuity declined by 15 letters. In the context of eyes with moderate to severe uveitis for years, this rate is not unexpected.
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Kim JS, Knickelbein JE, Jaworski L, Kaushal P, Vitale S, Nussenblatt RB, Sen HN. Enhanced Depth Imaging Optical Coherence Tomography in Uveitis: An Intravisit and Interobserver Reproducibility Study. Am J Ophthalmol 2016; 164:49-56. [PMID: 26829594 DOI: 10.1016/j.ajo.2016.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/18/2016] [Accepted: 01/24/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the intravisit and interobserver reproducibility of subfoveal choroidal thickness (SFCT) measurements in patients with noninfectious uveitis. DESIGN Reliability analysis. METHODS Two consecutive enhanced depth imaging optical coherence tomography (EDI-OCT) scans were obtained at a single clinic visit for 97 uveitic eyes from patients ≥16 years of age with noninfectious anterior (n = 10), intermediate (n = 11), posterior (n = 26), and panuveitis (n = 13) at the National Eye Institute. SFCT was manually measured by 2 ophthalmologists using manufacturer's software. Intravisit and interobserver reproducibility of SFCT measurements were assessed by using the Bland-Altman method to determine the estimate of bias (mean difference in SFCT measurements), 95% limits of agreement, and coefficients of repeatability. The reproducibility of these measurements was also compared between groups by anatomic location and clinical activity. RESULTS Of 97 eyes, 65 (67.0%) were clinically quiet, 18 (18.6%) were minimally active, and 14 (14.4%) were active at the time the scans were obtained. Manual SFCT measurements were reproducible within 32.4 ± 3.8 μm between sessions for the same observer and 51.4 ± 8.5 μm between observers for the same session. Coefficients of repeatability did not differ significantly by anatomic location or disease activity. CONCLUSIONS Manual SFCT measurements obtained by EDI-OCT are reproducible in uveitis patients, with coefficients of repeatability that are nearly comparable to those published for normal eyes. This study provides guidance for using manual SFCT measurements in clinical practice, but further studies are still needed to determine their utility in clinical trials.
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Affiliation(s)
- Jane S Kim
- University of California, San Diego, School of Medicine, La Jolla, California; Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Laurence Jaworski
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Padmini Kaushal
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Susan Vitale
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert B Nussenblatt
- 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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Kempen JH, Gewaily DY, Newcomb CW, Liesegang TL, Kaçmaz RO, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Foster CS, Jabs DA, Payal A, Fitzgerald TD. Remission of Intermediate Uveitis: Incidence and Predictive Factors. Am J Ophthalmol 2016; 164:110-7.e2. [PMID: 26772874 DOI: 10.1016/j.ajo.2015.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the incidence of remission among patients with intermediate uveitis; to identify factors potentially predictive of remission. DESIGN Retrospective cohort study. METHODS Involved eyes of patients with primary noninfectious intermediate uveitis at 4 academic ocular inflammation subspecialty practices, followed sufficiently long to meet the remission outcome definition, were studied retrospectively by standardized chart review data. Remission of intermediate uveitis was defined as a lack of inflammatory activity at ≥2 visits spanning ≥90 days in the absence of any corticosteroid or immunosuppressant medications. Factors potentially predictive of intermediate uveitis remission were evaluated using survival analysis. RESULTS Among 849 eyes (of 510 patients) with intermediate uveitis followed over 1934 eye-years, the incidence of intermediate uveitis remission was 8.6/100 eye-years (95% confidence interval [CI], 7.4-10.1). Factors predictive of disease remission included prior pars plana vitrectomy (PPV) (hazard ratio [HR] [vs no PPV] = 2.39; 95% CI, 1.42-4.00), diagnosis of intermediate uveitis within the last year (HR [vs diagnosis >5 years ago] =3.82; 95% CI, 1.91-7.63), age ≥45 years (HR [vs age <45 years] = 1.79; 95% CI, 1.03-3.11), female sex (HR = 1.61; 95% CI, 1.04-2.49), and Hispanic race/ethnicity (HR [vs white race] = 2.81; 95% CI, 1.23-6.41). Presence/absence of a systemic inflammatory disease, laterality of uveitis, and smoking status were not associated with differential incidence. CONCLUSIONS Our results suggest that intermediate uveitis is a chronic disease with an overall low rate of remission. Recently diagnosed patients and older, female, and Hispanic patients were more likely to remit. With regard to management, pars plana vitrectomy was associated with increased probability of remission.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Dina Y Gewaily
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Deglin and Greene Retinal Center, Wynnewood, Pennsylvania
| | - Craig W Newcomb
- Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - R Oktay Kaçmaz
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Allergan, Inc, Dublin, Ireland
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Tampa Bay Uveitis Center, Tampa, Florida
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Abhishek Payal
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Oregon Health & Science University, Portland, Oregon; Portland Veterans' Affairs Medical Center, Portland, Oregon
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ouyang H, Goldberg JL, Chen S, Li W, Xu GT, Li W, Zhang K, Nussenblatt RB, Liu Y, Xie T, Chan CC, Zack DJ. Ocular Stem Cell Research from Basic Science to Clinical Application: A Report from Zhongshan Ophthalmic Center Ocular Stem Cell Symposium. Int J Mol Sci 2016; 17:415. [PMID: 27102165 PMCID: PMC4813266 DOI: 10.3390/ijms17030415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 12/16/2022] Open
Abstract
Stem cells hold promise for treating a wide variety of diseases, including degenerative disorders of the eye. The eye is an ideal organ for stem cell therapy because of its relative immunological privilege, surgical accessibility, and its being a self-contained system. The eye also has many potential target diseases amenable to stem cell-based treatment, such as corneal limbal stem cell deficiency, glaucoma, age-related macular degeneration (AMD), and retinitis pigmentosa (RP). Among them, AMD and glaucoma are the two most common diseases, affecting over 200 million people worldwide. Recent results on the clinical trial of retinal pigment epithelial (RPE) cells from human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs) in treating dry AMD and Stargardt’s disease in the US, Japan, England, and China have generated great excitement and hope. This marks the beginning of the ocular stem cell therapy era. The recent Zhongshan Ophthalmic Center Ocular Stem Cell Symposium discussed the potential applications of various stem cell types in stem cell-based therapies, drug discoveries and tissue engineering for treating ocular diseases.
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Affiliation(s)
- Hong Ouyang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
| | - Jeffrey L Goldberg
- Department of Ophthalmology, Stanford University, Palo Alto, CA 94303, USA.
| | - Shuyi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
| | - Wei Li
- Unit on Retinal Neurophysiology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Guo-Tong Xu
- Department of Ophthalmology, Tongji University, Shanghai 200092, China.
| | - Wei Li
- Department of Ophthalmology, Xiamen University, Xiamen 361005, China.
| | - Kang Zhang
- Department of Ophthalmology, University of California San Diego, San Diego, CA 92093, USA.
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
| | - Ting Xie
- Stowers Institute for Medical Research, Kansas City, MO 64110, USA.
| | - Chi-Chao Chan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Donald J Zack
- Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, MD 21231, USA.
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25
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Durrani K, Kempen JH, Ying GS, Kacmaz RO, Artornsombudh P, Rosenbaum JT, Suhler EB, Thorne JE, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Foster CS, Systemic Immunosuppressive Therapy For Eye Diseases Site Research Group. Adalimumab for Ocular Inflammation. Ocul Immunol Inflamm 2016; 25:405-412. [PMID: 27003323 DOI: 10.3109/09273948.2015.1134581] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory diseases. METHODS Characteristics of patients treated with adalimumab were abstracted in a standardized chart review. Main outcomes measured were control of inflammation, corticosteroid-sparing effect, and visual acuity. RESULTS In total, 32 patients with ocular inflammation were treated with adalimumab. The most common ophthalmic diagnoses were anterior uveitis, occurring in 15 patients (47%), and scleritis, occurring in 9 patients (28%). At 6 months of therapy, among 15 eyes with active inflammation, 7 (47%) became completely inactive, and oral prednisone was reduced to ≤10 mg/day in 2 of 4 patients (50%). On average, visual acuity decreased by 0.13 lines during the first 6 months of treatment. Adalimumab was discontinued because of lack of effectiveness in four patients within 6 months. CONCLUSIONS Adalimumab was moderately effective in controlling inflammation in a group of highly pre-treated cases of ocular inflammatory disease.
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Affiliation(s)
- Khayyam Durrani
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
| | - John H Kempen
- c Center for Preventive Ophthalmology and Biostatistics.,d Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology , Perelman School of Medicine, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | | | - R Oktay Kacmaz
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA
| | - Pichaporn Artornsombudh
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,c Center for Preventive Ophthalmology and Biostatistics
| | - James T Rosenbaum
- e Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,f Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA
| | - Eric B Suhler
- e Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,f Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA.,g Portland Veteran's Affairs Medical Center , Portland , Oregon , USA
| | - Jennifer E Thorne
- h Department of Ophthalmology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,i Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Douglas A Jabs
- i Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA.,j Department of Ophthalmology , Icahn School of Medicine at Mount Sinai , New York , New York , USA.,k Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Grace A Levy-Clarke
- l Laboratory of Immunology, National Eye Institute , Bethesda , Maryland , USA
| | | | - C Stephen Foster
- a Massachusetts Eye Research & Surgery Institution and Ocular Immunology and Uveitis Foundation , Waltham , Massachusetts , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , Massachusetts , USA
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Finak G, Langweiler M, Jaimes M, Malek M, Taghiyar J, Korin Y, Raddassi K, Devine L, Obermoser G, Pekalski ML, Pontikos N, Diaz A, Heck S, Villanova F, Terrazzini N, Kern F, Qian Y, Stanton R, Wang K, Brandes A, Ramey J, Aghaeepour N, Mosmann T, Scheuermann RH, Reed E, Palucka K, Pascual V, Blomberg BB, Nestle F, Nussenblatt RB, Brinkman RR, Gottardo R, Maecker H, McCoy JP. Standardizing Flow Cytometry Immunophenotyping Analysis from the Human ImmunoPhenotyping Consortium. Sci Rep 2016; 6:20686. [PMID: 26861911 PMCID: PMC4748244 DOI: 10.1038/srep20686] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/05/2016] [Indexed: 01/21/2023] Open
Abstract
Standardization of immunophenotyping requires careful attention to reagents, sample handling, instrument setup, and data analysis, and is essential for successful cross-study and cross-center comparison of data. Experts developed five standardized, eight-color panels for identification of major immune cell subsets in peripheral blood. These were produced as pre-configured, lyophilized, reagents in 96-well plates. We present the results of a coordinated analysis of samples across nine laboratories using these panels with standardized operating procedures (SOPs). Manual gating was performed by each site and by a central site. Automated gating algorithms were developed and tested by the FlowCAP consortium. Centralized manual gating can reduce cross-center variability, and we sought to determine whether automated methods could streamline and standardize the analysis. Within-site variability was low in all experiments, but cross-site variability was lower when central analysis was performed in comparison with site-specific analysis. It was also lower for clearly defined cell subsets than those based on dim markers and for rare populations. Automated gating was able to match the performance of central manual analysis for all tested panels, exhibiting little to no bias and comparable variability. Standardized staining, data collection, and automated gating can increase power, reduce variability, and streamline analysis for immunophenotyping.
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Affiliation(s)
- Greg Finak
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, 98109, WA
| | - Marc Langweiler
- Hematology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Mehrnoush Malek
- Terry Fox Laboratory , British Columbia Cancer Agency, V3J 4W6, Canada
| | - Jafar Taghiyar
- Terry Fox Laboratory , British Columbia Cancer Agency, V3J 4W6, Canada
| | - Yael Korin
- UCLA Pathology and Laboratory Medicine, Los Angeles, CA
| | | | - Lesley Devine
- Dept of Neurology, Yale School of Medicine, New Haven, CT
| | | | - Marcin L. Pekalski
- University of Cambridge, JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, Cambridge, UK
| | - Nikolas Pontikos
- University of Cambridge, JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, Cambridge, UK
| | - Alain Diaz
- Dept Microbiology & Immunology, University of Miami Miller School of Medicine, Miami, FL
| | - Susanne Heck
- Guys and St Thomas Hospital, Guy’s Hospital, London, UK
| | | | - Nadia Terrazzini
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN2 4GJ, United Kingdom
| | - Florian Kern
- Brighton and Sussex Medical School, Division of Medicine, Brighton, BN1 9PS, United Kingdom
| | - Yu Qian
- Department of Informatics, J. Craig Venter Institute, La Jolla, 92037, CA
| | - Rick Stanton
- Department of Informatics, J. Craig Venter Institute, La Jolla, 92037, CA
| | - Kui Wang
- School of Mathematics and Physics, University of Queensland, Brisbane, Australia
| | - Aaron Brandes
- The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - John Ramey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, 98109, WA
| | - Nima Aghaeepour
- Terry Fox Laboratory , British Columbia Cancer Agency, V3J 4W6, Canada
- Baxter Laboratory in Stem Cell Biology, Stanford University, Stanford, California, 94305, USA
| | - Tim Mosmann
- Hematology Branch, National Institutes of Health, Bethesda, Maryland, USA
- University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, 14642, NY
| | | | - Elaine Reed
- UCLA Pathology and Laboratory Medicine, Los Angeles, CA
| | | | | | - Bonnie B. Blomberg
- Dept Microbiology & Immunology, University of Miami Miller School of Medicine, Miami, FL
| | - Frank Nestle
- Guys and St Thomas Hospital, Guy’s Hospital, London, UK
| | - Robert B. Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ryan Remy Brinkman
- Terry Fox Laboratory , British Columbia Cancer Agency, V3J 4W6, Canada
- Department of Medical Genetics, University of British Columbia, Canada
| | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, 98109, WA
| | - Holden Maecker
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, 94305, CA
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27
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Hosokawa K, Muranski P, Feng X, Townsley DM, Liu B, Knickelbein J, Keyvanfar K, Dumitriu B, Ito S, Kajigaya S, Taylor JG, Kaplan MJ, Nussenblatt RB, Barrett AJ, O'Shea J, Young NS. Memory Stem T Cells in Autoimmune Disease: High Frequency of Circulating CD8+ Memory Stem Cells in Acquired Aplastic Anemia. J Immunol 2016; 196:1568-78. [PMID: 26764034 DOI: 10.4049/jimmunol.1501739] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
Abstract
Memory stem T cells (TSCMs) constitute a long-lived, self-renewing lymphocyte population essential for the maintenance of functional immunity. Hallmarks of autoimmune disease pathogenesis are abnormal CD4(+) and CD8(+) T cell activation. We investigated the TSCM subset in 55, 34, 43, and 5 patients with acquired aplastic anemia (AA), autoimmune uveitis, systemic lupus erythematosus, and sickle cell disease, respectively, as well as in 41 age-matched healthy controls. CD8(+) TSCM frequency was significantly increased in AA compared with healthy controls. An increased CD8(+) TSCM frequency at diagnosis was associated with responsiveness to immunosuppressive therapy, and an elevated CD8(+) TSCM population after immunosuppressive therapy correlated with treatment failure or relapse in AA patients. IFN-γ and IL-2 production was significantly increased in various CD8(+) and CD4(+) T cell subsets in AA patients, including CD8(+) and CD4(+) TSCMs. CD8(+) TSCM frequency was also increased in patients with autoimmune uveitis or sickle cell disease. A positive correlation between CD4(+) and CD8(+) TSCM frequencies was found in AA, autoimmune uveitis, and systemic lupus erythematosus. Evaluation of PD-1, CD160, and CD244 expression revealed that TSCMs were less exhausted compared with other types of memory T cells. Our results suggest that the CD8(+) TSCM subset is a novel biomarker and a potential therapeutic target for AA.
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Affiliation(s)
- Kohei Hosokawa
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892;
| | - Pawel Muranski
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Danielle M Townsley
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Baoying Liu
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Jared Knickelbein
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Keyvan Keyvanfar
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Bogdan Dumitriu
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Sawa Ito
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Sachiko Kajigaya
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - James G Taylor
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892; and
| | - Robert B Nussenblatt
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - A John Barrett
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - John O'Shea
- Molecular Immunology and Inflammation Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
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28
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Zarranz-Ventura J, Keane PA, Sim DA, Llorens V, Tufail A, Sadda SR, Dick AD, Lee RW, Pavesio C, Denniston AK, Adan A, Adán A, Aslam T, Denniston AK, Dick AD, Karampelas M, Keane PA, Lee RW, Murray PI, Nussenblatt RB, Pavesio CE, Sadda SR, Sen HN, Sim DA, Tufail A, Zarranz-Ventura J. Evaluation of Objective Vitritis Grading Method Using Optical Coherence Tomography: Influence of Phakic Status and Previous Vitrectomy. Am J Ophthalmol 2016; 161:172-80.e1-4. [PMID: 26476212 DOI: 10.1016/j.ajo.2015.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate a proposed method for objective measurement of vitreous inflammation using a spectral-domain optical coherence tomography (SD OCT) device in a large cohort of uveitis eyes, including pseudophakic eyes and vitrectomized eyes. DESIGN Retrospective, observational cohort study. METHODS One hundred five uveitis eyes (105 patients) with different vitreous haze score grades according to standardized protocols and corresponding SD OCT images (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, California, USA) were included. Clinical data recorded included phakic status, previous vitreoretinal surgery, and anterior chamber (AC) cells and flare. SD OCT images were analyzed using custom software that provided absolute measurements of vitreous (VIT) and retinal pigment epithelium (RPE) signal intensities, which were compared to generate a relative optical density ratio with arbitrary units (VIT/RPE-relative intensity) and compared to VHS. RESULTS VIT/RPE-relative intensity showed a significant positive correlation with vitreous haze score (r = 0.535, P < .001) that remained significant after adjusting for factors governing media clarity, such as AC cells, AC flare, and phakic status (R(2)-adjusted = 0.424, P < .001). Significant differences were also observed between the different vitreous haze score groups (P < .001). Preliminary observation did not observe differences in VIT/RPE-relative intensity values between phakic and pseudophakic eyes (0.3522 vs 0.3577, P = .48) and between nonvitrectomized and vitrectomized eyes (0.3540 vs 0.3580, P = .52), overall and respectively for each vitreous haze score subgroup. CONCLUSIONS VIT/RPE-relative intensity values provide objective measurements of vitreous inflammation employing an SD OCT device. Phakic status and previous vitrectomy surgery do not appear to influence these values, although these preliminary findings need validation in future studies.
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Abstract
Uveitis encompasses a spectrum of diseases whose common feature is intraocular inflammation, which may be infectious or noninfectious in etiology (Nussenblatt and Whitcup 2010). Infectious causes of uveitis are typically treated with appropriate antimicrobial therapy and will not be discussed in this chapter. Noninfectious uveitides are thought have an autoimmune component to their etiology and are thus treated with anti-inflammatory agents.
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Affiliation(s)
- Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Karen R Armbrust
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Meredith Kim
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bldg 10 Room 10N109, 10 Center Drive, Bethesda, MD, 20892, USA.
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Denniston AK, Holland GN, Kidess A, Nussenblatt RB, Okada AA, Rosenbaum JT, Dick AD. Heterogeneity of primary outcome measures used in clinical trials of treatments for intermediate, posterior, and panuveitis. Orphanet J Rare Dis 2015; 10:97. [PMID: 26286265 PMCID: PMC4545540 DOI: 10.1186/s13023-015-0318-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/06/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Uveitis describes a heterogeneous group of conditions characterized by intraocular inflammation. Since most of the sight-threatening forms of uveitis are individually rare, there has been an increasing tendency for clinical trials to group distinct uveitis syndromes together despite clear variations in phenotype which may reflect real aetiological and pathogenetic differences. Furthermore this grouping of distinct syndromes, and the range of manifestations within each uveitis syndrome, leads to a wide range of possible outcome measures. In this study we wished to review the degree of consensus or otherwise in the choice of primary outcome measures for registered clinical trials related to uveitis. METHODS Systematic review of data provided in clinical trial registries describing clinical trials dealing with medical treatment of intermediate, posterior, or panuveitis through 01 October 2013. We reviewed 15 on-line clinical trial registries approved by the International Committee of Medical Journal Editors. We identified all that met the following inclusion criteria: prospective, interventional design; target populations with intermediate, posterior or panuveitis; and one or more pre-specified outcome measures that were related to uveitis. Primary outcome measures were classified in terms of type (efficacy or safety or both; single, composite, or multiple); dimension (disease activity, disease damage, measured or patient-reported visual function); and domain (the specific study variable being measured). RESULTS Of 195 registered uveitis studies, we identified 104 clinical trials that met inclusion criteria. There were 14 different domains used as primary outcome measures. Among clinical trials that utilized primary outcome measures of treatment efficacy (n = 94), 70 (74 %) used a measure of disease activity (vitreous haze in 40/70 [57 %]; macular oedema in 19/70 [27 %]) and 49 (70 %) used a measure of visual function (visual acuity in all cases). Multiple primary outcome measures were used in 23 (22 %) of 104 clinical trials. With regard to quality, in 12 (12 %) of 104 clinical trials, outcome measures were poorly defined. No clinical trial utilized a patient-reported study variable as primary outcome measure. CONCLUSIONS This systematic review highlights the heterogeneity of outcome measures used in recent clinical trials for intermediate, posterior, and panuveitis. Current designs prioritize clinician-observed measures of disease activity and measurement of visual function as outcome measures. This apparent lack of consensus regarding outcome measures for the study of uveitis is a concern, as it prevents comparison of studies and meta-analyses, and weakens the evidence available to stake-holders, from patients to clinicians to regulators, regarding the efficacy and value of a given treatment.
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Affiliation(s)
- Alastair K Denniston
- Institute of Translational Medicine, Birmingham Health Partners, University of Birmingham, Birmingham, UK.
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Gary N Holland
- UCLA Stein Eye Institute and the Department of Ophthalmology, Ocular Inflammatory Disease Center, David Geffen School of Medicine at UCLA, 100 Stein Plaza, UCLA, Los Angeles, CA, 90095-7000, USA
| | - Andrej Kidess
- Institute of Translational Medicine, Birmingham Health Partners, University of Birmingham, Birmingham, UK
| | | | - Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, USA Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Andrew D Dick
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Academic Unit of Ophthalmology, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Knickelbein JE, Jaworski L, Hasan J, Kaushal P, Sen HN, Nussenblatt RB. Therapeutic options for the treatment of non-infectious uveitis. Expert Review of Ophthalmology 2015. [DOI: 10.1586/17469899.2015.1047826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Grigg ME, Dubey JP, Nussenblatt RB. Ocular toxoplasmosis: lessons from Brazil. Am J Ophthalmol 2015; 159:999-1001. [PMID: 25956461 DOI: 10.1016/j.ajo.2015.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
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Chen P, Denniston AK, Hirani S, Hannes S, Nussenblatt RB. Role of dendritic cell subsets in immunity and their contribution to noninfectious uveitis. Surv Ophthalmol 2015; 60:242-9. [PMID: 25749202 PMCID: PMC4404222 DOI: 10.1016/j.survophthal.2015.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 11/17/2022]
Abstract
Dendritic cells (DCs) are a heterogeneous population. Murine DCs consist of conventional DCs (cDCs) and plasmacytoid DCs (pDCs). In humans, the analogous populations are myeloid DCs (mDCs) and pDCs. Though distinct in phenotypes and functions, studies have shown that these DC subsets may interact or "crosstalk" during immune responses. For example, cDCs may facilitate pDC maturation, and pDCs may enhance antigen presentation of cDCs in certain pathogenic conditions or even take on a cDC phenotype themselves. The role of DCs in noninfectious uveitis has been studied primarily in the experimental autoimmune uveitis mouse model and to a more limited extent in patients. Recent evidence shows that the number, phenotype, and function of DC subsets are altered in this disease. We provide an overview of selected recent developments of pDCs and cDCs/mDCs, with special attention to their interaction and the dual roles of DC subsets in noninfectious uveitis.
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Affiliation(s)
- Ping Chen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sima Hirani
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Hannes
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Liu B, Dhanda A, Hirani S, Williams EL, Sen HN, Martinez Estrada F, Ling D, Thompson I, Casady M, Li Z, Si H, Tucker W, Wei L, Jawad S, Sura A, Dailey J, Hannes S, Chen P, Chien JL, Gordon S, Lee RWJ, Nussenblatt RB. CD14++CD16+ Monocytes Are Enriched by Glucocorticoid Treatment and Are Functionally Attenuated in Driving Effector T Cell Responses. J Immunol 2015; 194:5150-60. [PMID: 25911752 DOI: 10.4049/jimmunol.1402409] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/30/2015] [Indexed: 12/16/2022]
Abstract
Human peripheral monocytes have been categorized into three subsets based on differential expression levels of CD14 and CD16. However, the factors that influence the distribution of monocyte subsets and the roles that each subset plays in autoimmunity are not well studied. In this study, we show that circulating monocytes from patients with autoimmune uveitis exhibit a skewed phenotype toward intermediate CD14(++)CD16(+) cells, and that this is associated with glucocorticoid therapy. We further demonstrate that CD14(++)CD16(+) monocytes from patients and healthy control donors share a similar cell-surface marker and gene expression profile. Comparison of the effects of intermediate CD14(++)CD16(+) monocytes with classical CD14(++)CD16(-) and nonclassical CD14(+)CD16(++) monocytes revealed that the intermediate CD14(++)CD16(+) subset had an attenuated capacity to promote both naive CD4(+) T cell proliferation and polarization into a Th1 phenotype, and memory CD4(+) T cell proliferation and IL-17 expression. Furthermore, CD14(++)CD16(+) cells inhibit CD4(+) T cell proliferation induced by other monocyte subsets and enhance CD4(+) T regulatory cell IL-10 expression. These data demonstrate the impact of glucocorticoids on monocyte phenotype in the context of autoimmune disease and the differential effects of monocyte subsets on effector T cell responses.
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Affiliation(s)
- Baoying Liu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Ashwin Dhanda
- School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, United Kingdom; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London EC1V 2PD, United Kingdom; and
| | - Sima Hirani
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Emily L Williams
- School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, United Kingdom; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London EC1V 2PD, United Kingdom; and
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | | | - Diamond Ling
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Ian Thompson
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Megan Casady
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Zhiyu Li
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Han Si
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - William Tucker
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Lai Wei
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Shayma Jawad
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Amol Sura
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Jennifer Dailey
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Susan Hannes
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Ping Chen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Jason L Chien
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892
| | - Siamon Gordon
- Sir William Dunn School of Pathology, University of Oxford, Oxford OX1 3RE, United Kingdom
| | - Richard W J Lee
- School of Clinical Sciences, University of Bristol, Bristol BS8 1TD, United Kingdom; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London EC1V 2PD, United Kingdom; and
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892;
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Nussenblatt RB, Palestine AG. Ciclosporin (Sandimmun) therapy: experience in the treatment of pars planitis and present therapeutic guidelines. Dev Ophthalmol 2015; 23:177-84. [PMID: 1730354 DOI: 10.1159/000429649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- R B Nussenblatt
- Laboratory of Immunology, National Eye Institute, Bethesda, Md
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Affiliation(s)
- J L Davis
- Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Fla
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Nussenblatt RB, Davis JL, Palestine AG. Chorioretinal biopsy for diagnostic purposes in cases of intraocular inflammatory disease. Dev Ophthalmol 2015; 23:133-8. [PMID: 1730345 DOI: 10.1159/000429641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- R B Nussenblatt
- Laboratory of Immunology, National Eye Institute, Bethesda, Md
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Affiliation(s)
- J L Davis
- Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Fla
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Affiliation(s)
- J L Davis
- Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Fla
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Chen P, Denniston A, Hannes S, Tucker W, Wei L, Liu B, Xiao T, Hirani S, Li Z, Jawad S, Si H, Lee RWJ, Sen HN, Nussenblatt RB. Increased CD1c+ mDC1 with mature phenotype regulated by TNFα-p38 MAPK in autoimmune ocular inflammatory disease. Clin Immunol 2015; 158:35-46. [PMID: 25784146 DOI: 10.1016/j.clim.2015.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 02/04/2015] [Accepted: 03/03/2015] [Indexed: 01/01/2023]
Abstract
In this study we investigated the role of blood CD1c(+) myeloid dendritic cells 1 (mDC1), a key mDC subtype, in patients with autoimmune uveitis. We observed a significant increase of blood CD1c(+) mDC1 in uveitis patients. The increased CD1c(+) mDC1 exhibited high HLADR expression and less antigen uptake. CD1c(+) mDC1 were divided into two subpopulations. CD1c(hi) mDC1 subpopulation showed less antigen uptake and higher HLADR expression compared to CD1c(lo) mDC1 subpopulation. Importantly, the CD1c(hi) mDC1 subpopulation was increased in uveitis patients. In vitro, mature monocyte-derived dendritic cells (MoDCs), characterized by lower levels of antigen uptake, induced more CD4(+)CD62L(-) T helper cell proliferation. The mature phenotype and function of CD1c(+) mDC1 were regulated by TNFα via a p38 MAPK-dependent pathway. These data show that alterations in the systemic immune response are involved in the pathogenesis of autoimmune uveitis and invite the therapeutic possibility of attenuating uveitis by manipulating blood CD1c(+) mDC1.
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Affiliation(s)
- Ping Chen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alastair Denniston
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Edgbaston, Birmingham B15 2WB, UK; Centre for Translational Inflammation Research, University of Birmingham, UK
| | - Susan Hannes
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - William Tucker
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lai Wei
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Baoying Liu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tiaojiang Xiao
- Laboratory of Molecular Biology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sima Hirani
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Zhiyu Li
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shayma Jawad
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Han Si
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard W J Lee
- Department of Clinical Sciences, University of Bristol, Bristol, UK
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Chen P, Tucker W, Hannes S, Liu B, Si H, Gupta A, Lee RWJ, Sen HN, Nussenblatt RB. Levels of blood CD1c+ mDC1 and CD1chi mDC1 subpopulation reflect disease activity in noninfectious uveitis. Invest Ophthalmol Vis Sci 2014; 56:346-52. [PMID: 25515573 DOI: 10.1167/iovs.14-15416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Myeloid dendritic cells (mDCs) play an important role in autoimmune diseases. However, the role of blood CD1c(+) myeloid dendritic cells 1 (mDC1s), the subset of human blood mDCs, is not well understood in noninfectious uveitis. METHODS Fresh peripheral blood samples from human noninfectious uveitis patients (n = 32) and healthy controls (HCs) (n = 64) were stained with FITC-Lineage 1 (Lin1), PERCP-HLADR, and PE-CD1c antibodies. The levels of mDC1 were quantified by using flow cytometric analysis. Longitudinal data from patients (n = 16) were analyzed to correlate the levels of mDC1 with disease activity. RESULTS Blood CD1c(+) mDC1 and its subpopulation, CD1c(hi) mDC1, were increased in uveitis patients compared with HCs. Longitudinal data demonstrated that both the CD1c(+) mDC1 and CD1c(hi) mDC1 subpopulation reflected a dynamic change in clinical uveitis activity: CD1c expression was increased in active uveitis but decreased when uveitis became inactive. CONCLUSIONS Given these observations, an alteration in blood CD1c(+) mDC1 and the CD1c(hi) mDC1 subpopulation could be a potential biomarker to monitor clinical uveitis activity within patients.
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Affiliation(s)
- Ping Chen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - William Tucker
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Susan Hannes
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Baoying Liu
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Han Si
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Ankur Gupta
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Richard W J Lee
- Department of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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Sen HN, Vitale S, Gangaputra SS, Nussenblatt RB, Liesegang TL, Levy-Clarke GA, Rosenbaum JT, Suhler EB, Thorne JE, Foster CS, Jabs DA, Kempen JH. Periocular corticosteroid injections in uveitis: effects and complications. Ophthalmology 2014; 121:2275-86. [PMID: 25017415 DOI: 10.1016/j.ophtha.2014.05.021] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/21/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. DESIGN Multicenter, retrospective cohort study. PARTICIPANTS A total of 914 patients (1192 eyes) who had received ≥ 1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. METHODS Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. MAIN OUTCOME MEASURES Control of inflammation, improvement of visual acuity (VA) to ≥ 20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery. RESULTS Among 914 patients (1192 eyes) who received ≥ 1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤ 6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥ 20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥ 20/40. By 12 months, the cumulative incidence of ≥ 1 visits with an intraocular pressure of ≥ 24 mmHg and ≥ 30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥ 20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2). CONCLUSIONS Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.
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Affiliation(s)
- H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
| | - Susan Vitale
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Sapna S Gangaputra
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Tampa Bay Uveitis Center, Tampa, Florida
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Veterans' Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John H Kempen
- Department of Ophthalmology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Nussenblatt RB, Lee RW, Chew E, Wei L, Liu B, Sen HN, Dick AD, Ferris FL. Immune responses in age-related macular degeneration and a possible long-term therapeutic strategy for prevention. Am J Ophthalmol 2014; 158:5-11.e2. [PMID: 24709810 DOI: 10.1016/j.ajo.2014.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe the immune alterations associated with age-related macular degeneration (AMD); and, based on these findings, to offer an approach to possibly prevent the expression of late disease. DESIGN Perspective. METHODS Review of the existing literature dealing with epidemiology, models, and immunologic findings in patients. RESULTS Significant genetic associations have been identified and reported, but environmentally induced (including epigenetic) changes are also an important consideration. Immune alterations include a strong interleukin 17 family signature as well as marked expression of these molecules in the eye. Oxidative stress as well as other homeostatic altering mechanisms occur throughout life. With this immune dysregulation there is a rationale for considering immunotherapy. Indeed, immunotherapy has been shown to affect the late stages of AMD. CONCLUSION Immune dysregulation appears to be an underlying alteration in AMD, as in other diseases thought to be degenerative and attributable to aging. Para-inflammation and immunosenescence may importantly contribute to the development of disease. The role of complement factor H still needs to be better defined, but in light of its association with ocular inflammatory conditions such as sarcoidosis, it does not appear to be unique to AMD but rather may be a marker for retinal pigment epithelium function. With the strong interleukin 17 family signature and the need to treat early on in the disease process, oral tolerance may be considered to prevent disease progression.
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Wu W, Jin M, Wang Y, Liu B, Shen D, Chen P, Hannes S, Li Z, Hirani S, Jawad S, Sen HN, Chan CC, Nussenblatt RB, Wei L. Overexpression of IL-17RC associated with ocular sarcoidosis. J Transl Med 2014; 12:152. [PMID: 24885153 PMCID: PMC4059456 DOI: 10.1186/1479-5876-12-152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/14/2014] [Indexed: 12/04/2022] Open
Abstract
Background Sarcoidosis is a chronic inflammatory disease with a systemic granulomatous disorder affecting multiple organs including the eye. Both CD4+ T cell and macrophage have been linked to the pathogenesis of the disease. Methods The expression of IL-17RC was measured using FACS,immunohistochemistry and real-time PCR. Serum level of IL-17 was detected using ELISA. Results An elevated expression of IL-17RC on CD8+ T cells in peripheral blood was found in patients with ocular sarcoidosis as compared to healthy controls. Interestingly, we found a significant increase in the serum level of IL-17 in patients with ocular sarcoidosis as compared to healthy controls, which may be responsible for the induction of IL-17RC on CD8+ cells. In addition, IL-17RC appeared only in the retinal tissue of the patient with clinically active sarcoidosis. Conclusions Our results suggested a potential involvement of IL-17RC+CD8+ T cells in pathogenesis of ocular sarcoidosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Lee RW, Nicholson LB, Sen HN, Chan CC, Wei L, Nussenblatt RB, Dick AD. Autoimmune and autoinflammatory mechanisms in uveitis. Semin Immunopathol 2014; 36:581-94. [PMID: 24858699 PMCID: PMC4186974 DOI: 10.1007/s00281-014-0433-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/13/2014] [Indexed: 12/12/2022]
Abstract
The eye, as currently viewed, is neither immunologically ignorant nor sequestered from the systemic environment. The eye utilises distinct immunoregulatory mechanisms to preserve tissue and cellular function in the face of immune-mediated insult; clinically, inflammation following such an insult is termed uveitis. The intra-ocular inflammation in uveitis may be clinically obvious as a result of infection (e.g. toxoplasma, herpes), but in the main infection, if any, remains covert. We now recognise that healthy tissues including the retina have regulatory mechanisms imparted by control of myeloid cells through receptors (e.g. CD200R) and soluble inhibitory factors (e.g. alpha-MSH), regulation of the blood retinal barrier, and active immune surveillance. Once homoeostasis has been disrupted and inflammation ensues, the mechanisms to regulate inflammation, including T cell apoptosis, generation of Treg cells, and myeloid cell suppression in situ, are less successful. Why inflammation becomes persistent remains unknown, but extrapolating from animal models, possibilities include differential trafficking of T cells from the retina, residency of CD8+ T cells, and alterations of myeloid cell phenotype and function. Translating lessons learned from animal models to humans has been helped by system biology approaches and informatics, which suggest that diseased animals and people share similar changes in T cell phenotypes and monocyte function to date. Together the data infer a possible cryptic infectious drive in uveitis that unlocks and drives persistent autoimmune responses, or promotes further innate immune responses. Thus there may be many mechanisms in common with those observed in autoinflammatory disorders.
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Affiliation(s)
- Richard W Lee
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University Hospitals Bristol NHS, Foundation Trust, and University of Bristol, Bristol, UK
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Keane PA, Karampelas M, Sim DA, Sadda SR, Tufail A, Sen HN, Nussenblatt RB, Dick AD, Lee RW, Murray PI, Pavesio CE, Denniston AK. Objective measurement of vitreous inflammation using optical coherence tomography. Ophthalmology 2014; 121:1706-14. [PMID: 24835759 DOI: 10.1016/j.ophtha.2014.03.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/04/2014] [Accepted: 03/07/2014] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To obtain measurements of vitreous signal intensity from optical coherence tomography (OCT) image sets in patients with uveitis, with the aim of developing an objective, quantitative marker of inflammatory activity in patients with this disease. DESIGN Retrospective, observational case-control series. PARTICIPANTS Thirty patients (30 eyes) with vitreous haze secondary to intermediate, posterior, or panuveitis; 12 patients (12 eyes) with uveitis but without evidence of vitreous haze; and 18 patients (18 eyes) without intraocular inflammation or vitreoretinal disease. METHODS Clinical and demographic characteristics were recorded, including visual acuity (VA), diagnosis, and anatomic type of uveitis. In each eye, the anterior chamber (AC) was graded for cellular activity and flare according to standardized protocols. The presence and severity of vitreous haze were classified according to the National Eye Institute system. Spectral-domain OCT images were analyzed using custom software. This software provided an "absolute" measurement of vitreous signal intensity, which was then compared with that of the retinal pigment epithelium (RPE), generating an optical density ratio with arbitrary units ("VIT/RPE-Relative Intensity"). MAIN OUTCOME MEASURES Correlation between clinical vitreous haze scores and OCT-derived measurements of vitreous signal intensity. RESULTS The VIT/RPE-Relative Intensity was significantly higher in uveitic eyes with known vitreous haze (0.150) than in uveitic eyes without haze or in healthy controls (0.0767, P = 0.0001). The VIT/RPE-Relative Intensity showed a significant, positive correlation with clinical vitreous haze scores (r = 0.566, P = 0.0001). Other ocular characteristics significantly associated with VIT/RPE-Relative Intensity included VA (r = 0.573, P = 0.0001), AC cells (r = 0.613, P = 0.0001), and AC flare (r = 0.385, P = 0.003). Measurement of VIT/RPE-Relative Intensity showed a good degree of intergrader reproducibility (95% limits of agreement, -0.019 to 0.016). CONCLUSIONS These results provide preliminary evidence that OCT-derived measurements of vitreous signal intensity may be useful as an outcome measure in patients with uveitis. If validated in future studies, such measures may serve as an objective, quantitative disease activity end point, with the potential to improve the "signal:noise" ratio of clinical trials in this area, thus enabling smaller studies for the same power. The incorporation of automated vitreous analysis in commercial OCT systems may, in turn, facilitate monitoring and re-treatment of patients with uveitis in clinical practice.
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Affiliation(s)
- Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Michael Karampelas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Hinchingbrooke Hospital, Hinchingbrooke Health Care NHS Trust, Huntingdon, United Kingdom
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Srinivas R Sadda
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Adnan Tufail
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Andrew D Dick
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Richard W Lee
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Philip I Murray
- Academic Unit of Ophthalmology, University of Birmingham, Birmingham, United Kingdom; Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
| | - Carlos E Pavesio
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alastair K Denniston
- Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom; Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
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Grange LK, Kouchouk A, Dalal MD, Vitale S, Nussenblatt RB, Chan CC, Sen HN. Neoplastic masquerade syndromes in patients with uveitis. Am J Ophthalmol 2014; 157:526-31. [PMID: 24211361 DOI: 10.1016/j.ajo.2013.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE To identify the demographic and clinical characteristics, along with the frequency, of neoplastic masquerade syndromes in a tertiary uveitis clinic. DESIGN A retrospective observational cohort. METHODS Demographic and clinical data on all patients presenting to the National Eye Institute (NEI) with uveitis between 2004 and 2012 were used to compare neoplastic masquerade syndromes and uveitis. RESULTS A total of 853 patients presenting with uveitis were identified. Of these, 21 (2.5%) were diagnosed with neoplastic masquerade syndromes. The average age at presentation of masquerade syndrome patients was 57 years (median, 55; range, 38-78); for uveitis, 42 years (median, 43; range, 3-98) (P = 0.0003). There were 48% females in the masquerade syndromes group, compared with 59% females in the uveitis group. African American patients represented 9% of the masquerade syndrome patients and 36% of uveitis patients (P = 0.01). Mean worse eye visual acuity was 0.89 (20/160) in neoplastic masquerade syndromes, and 0.66 (20/100) in the uveitis group (P = 0.21). Of masquerade syndrome patients, 90% had posterior inflammation, compared with 63% of uveitis patients (P = 0.006). Of those with masquerade syndromes, 48% of patients had unilateral disease, compared with 27% of the uveitis patients (P = 0.04). CONCLUSIONS Patients with neoplastic masquerade syndromes were more likely to be older, male, or non-African American and to have posterior segment inflammation and unilateral disease. Patients with masquerade syndromes also had worse visual acuity than did uveitis patients. These differences in clinical characteristics may help to raise the suspicion for neoplastic masquerade syndromes.
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Dagur PK, Biancotto A, Stansky E, Sen HN, Nussenblatt RB, McCoy JP. Secretion of interleukin-17 by CD8+ T cells expressing CD146 (MCAM). Clin Immunol 2014; 152:36-47. [PMID: 24681356 DOI: 10.1016/j.clim.2014.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 12/21/2022]
Abstract
Interleukin-17 (IL-17) has been associated with the pathogenesis of numerous autoimmune diseases. CD4+ T cells secreting IL-17 are termed Th17 cells. CD8+ T cells, designated Tc17 cells, are also capable of secreting IL-17. Here we describe a population of Tc17 cells characterized by the expression of surface CD146, an endothelial adhesion molecule. These cells display signatures of a human Tc17 genotype and phenotype. Circulating CD8+CD146+ T cells are present in low levels in healthy adults. Elevations in CD8+CD146+ T cells are found in Behcet's disease and birdshot retinochoroidopathy, which have been reported to have HLA class I associations. Sarcoidosis does not have a class I association and displays an increase in CD4+ CD146+ T cells but not in CD8+CD146+ T cells. CD146 on these cells may facilitate their ability to bind to, and migrate through, endothelium, as has been reported for CD4+CD146+ T cells.
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Affiliation(s)
- Pradeep K Dagur
- Hematology Branch, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA
| | - Angélique Biancotto
- Center for Human Immunology, Autoimmunity and Inflammation, NIH, Bethesda, MD 20892, USA
| | - Elena Stansky
- Hematology Branch, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA
| | - H Nida Sen
- Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Robert B Nussenblatt
- Center for Human Immunology, Autoimmunity and Inflammation, NIH, Bethesda, MD 20892, USA; Clinical Immunology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - J Philip McCoy
- Hematology Branch, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA; Center for Human Immunology, Autoimmunity and Inflammation, NIH, Bethesda, MD 20892, USA.
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Grange L, Dalal M, Nussenblatt RB, Sen HN. Autoimmune retinopathy. Am J Ophthalmol 2014; 157:266-272.e1. [PMID: 24315290 DOI: 10.1016/j.ajo.2013.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE To provide a detailed review of current clinical guidelines for the diagnosis, work-up and treatment of autoimmune retinopathy and to preview briefly possible future therapies. DESIGN Perspective based on literature review and clinical expertise. METHODS Interpretation of current literature, relying on the authors' clinical experience. RESULTS Autoimmune retinopathy is a rare immunologic disease characterized by the presence of circulating antiretinal antibodies along with electroretinographic and visual field abnormalities. An ophthalmic examination can be normal or show minimal findings. The diagnosis of autoimmune retinopathy is made difficult by diagnostic criteria that are both limited and nonstandardized. Currently, the diagnosis is made based on the demonstration of serum antiretinal antibodies and the presence of clinical manifestations (including abnormal electroretinographic findings). The mere presence of these antibodies is not diagnostic. Lack of an accepted gold standard for antiretinal antibodies detection and poor interlaboratory concordance make the diagnosis challenging. There are anecdotal reports of immunosuppressive therapy in autoimmune retinopathy; however, the response to treatment is variable, with more favorable results achieved in paraneoplastic retinopathy, particularly cancer-associated retinopathy, with a combination of chemotherapy and immunosuppression. Whether an earlier attempt to treat nonparaneoplastic autoimmune retinopathy would be more beneficial is unknown. Early treatment attempts are limited by lack of sensitive and specific assays and definitive clinical criteria. CONCLUSIONS Little is known about the clinical course, prognosis and treatment of autoimmune retinopathy. Additional studies should examine the specificity and pathogenicity of antiretinal antibodies and screen for biomarkers, and they should be conducted concurrently with studies seeking to identify appropriate treatment.
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