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Immunoassay of Serum Alpha-1 Antitrypsinlevel

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Immunoassay of Serum Alpha-1 Antitrypsinlevel Br J Ophthalmol: first published as 10.1136/bjo.68.4.242 on 1 April 1984. Downloaded from British Journal ofOphthalmology, 1984, 68, 242-244 Immunoassay of serum alpha-1 antitrypsin level in uveitis A. K. GUPTA AND G. S. SARIN From Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India SUMMARY The serum alpha-1 antitrypsin level was measured in 60 patients with endogenous uveitis, 27 patients with phacoallergic endophthalmitis, 12 patients with phacolytic glaucoma, and 58 healthy subjects. Thirty-four patients with endogenous uveitis were also followed up for 6 months after treatment, and the serum alpha-1 antitrypsin level was measured again. There was a significant rise in the serum alpha-1 antitrypsin level in cases of endogenous uveitis and phaco- allergic endophthalmitis but no alteration in cases of phacolytic glaucoma. Among the patients with endogenous uveitis the level was significantly raised in cases of anterior uveitis, but there was no change in cases of posterior uveitis. A significant rise was seen only in cases of acute anterior uveitis but not in chronic anterior uveitis. The serum alpha-1 antitrypsin level was unaltered in endogenous uveitis despite clinical improvement. Inflammatory diseases of the eye may lead to severe glaucoma were studied for the immunoassay of serum impairment of vision and even complete loss ofocular alpha-i antitrypsin level. The control group function because of the development of secondary comprised 58 healthy subjects who had no evidence glaucoma, complicated cataract, cyclitic membrane, of ocular or systemic disease and attended the Eye http://bjo.bmj.com/ secondary retinal detachment, and phthisis bulbi.' Centre mainly for the purpose of refraction. The Lens proteases liquefy the lens cortex to such a diagnosis of uveitis was established by detailed degree that lens material may escape through the clinical examination, slit-lamp biomicroscopy, and capsule. Alpha-1 antitrypsin, a glycoprotein, is the direct and indirect ophthalmoscopy. Cases of uveitis, major nonspecific protease inhibitor, synthesised by associated with hypermature cataract, exposure of hepatocytes.2 Serum alpha-1 antitrypsin (alpha-1 lens matter into aqueous humour following trauma, antiprotease) is frequently increased in malignancy,3 needling, or extracapsular extraction were on September 23, 2021 by guest. Protected copyright. acute infections,4 corticosteroid therapy,' rheuma- categorised as phacoallergic endophthalmitis toid arthritis,' pregnancy,7 oral contraceptive clinically. They showed lid oedema, ciliary con- administration,8 oestrogen therapy,9 sarcoidosis,"' gestion, ins oedema, posterior synechiae, and and leprosy." Serum immunoglobulins have been numerous large keratic precipitates. reported to be altered in uveitis.'2-'4 There is good The age and sex distribution of all the subjects is evidence that alpha-I antitrypsin is involved in the given in Table 1. The sera samples were stored at regulation of the immune system.'-5 In the present -20°C until assayed. The alpha-I antitrypsin level in study the serum alpha-1 antitrypsin levels have been serum was measured by a single radial immuno- evaluated in patients with uveitis and the effect of diffusion technique using monospecific goat anti- therapy on its level have also been studied. serum against human alpha-1 antitrypsin and the reference standard obtained from Meloy Labora- Material and methods tories, Virginia, USA. " The alpha-I antitrypsin level was calculated from the calibration curve constructed Sixty patients with endogenous uveitis, 27 with phaco- by incorporating 3 known concentrations ofreference allergic endophthalmitis, and 12 with phacolytic standard. Thirty-four patients with endogenous uveitis were Correspondence to Dr A. K. Gupta, VI/6 Maulana Azad Medical followed up for 6 months after treatment consisting College Campus, Kotla Road, New Delhi 110 002, India. of local and systemic steroids, oral phenylbutazone, 242 Br J Ophthalmol: first published as 10.1136/bjo.68.4.242 on 1 April 1984. Downloaded from Immunoassay of serum alpha-i antitrypsin level in uveitis 243 Table 1 Age and sex distribution in healthy subjects and diseased states Age in years Sex Total no. of subjects 10-20 21-40 41-60 61 and Mean±SD Male Female over Healthy subjects 3 37 16 2 34-6±10-2 36 22 58 Endogenous uveitis 4 34 19 3 35-8±12-4 34 26 60 Phacoallergic endophthalmitis () 6 11 10 57-1±18-2 19 8 27 Phacolytic glaucoma 0 0 11 1 56-8±3-0 8 4 12 mydriatics, and cycloplegics. A repeat measurement Table 2 Serum alpha-I antitrypsin level in healthy of serum alpha-1 antitrypsin level was done on subjects and diseased states patients with endogenous uveitis after clinical improvement. No. of Alpha-I subjects antitrypsin Results level (mg/dl) Healthy subjects 58 199-9±54-9 The serum alpha-I antitrypsin levels in the Endogenous uveitis 6() 233-2±56.0 healthy Phacoallergic endophthalmitis 27 241-8±64.3 subjects and in the patients with uveitis are given in Phacolytic glaucoma 12 187-4±49-6 Table 2. A significant rise in the level was observed in endogenous uveitis (p<0-001) and phacoallergic Si conversion: mg/dixO-01 =g/1. endophthalmitis (p<0001). However, there was no significant change (p>05) in its level in phacolytic Table 3 Serum alpha-I antitrypsin level in different glaucoma in comparison with the level in healthy subgroups ofendogenous uveitis patients subjects. Table 3 shows the serum alpha-1 antitrypsin level in the different subgroups ofendogenous uveitis. No. of Alpha-i The serum alpha-I antitrypsin level was raised in the subjects antitrypsin subgroup of anterior uveitis (p<0-001). However, in level (mg/dl) http://bjo.bmj.com/ the subgroup of posterior uveitis there was no signifi- Anterior uveitis 46 239-5±55 4 cant change (p>0-3). The patients with anterior Acute 29 241-8±57-6 uveitis were further subdivided into acute anterior Chronic 17 220-2±46-6 and chronic anterior uveitis (Table 3). The serum Posterior uveitis 14 221-8±63-1 alpha-1 antitrypsin level was significantly increased in Si conversion: mg/dlx-01 =g/l. acute anterior uveitis (p<0.001) but unaltered (p>0-2) in chronic anterior uveitis in comparison with the level in healthy subjects. 266.4 mg/dl.'9 In Western series, however, the serum on September 23, 2021 by guest. Protected copyright. Table 4 shows the comparative serum alpha-1 anti- alpha-1 antitrypsin level has been reported to vary trypsin levels in patients with endogenous uveitis prior between 180 and 400 mg/dl.2'-22 (SI conversion: to treatment and after the treatment when there was mg/dl x0101 =g/l.) clinical improvement. No significant change was seen There is a remarkable elevation of the serum in its level after treatment in any group. alpha-1 antitrypsin level in endogenous uveitis and phacoallergic endophthalmitis. The rise in the level Discussion of serum alpha-1 antitrypsin was significant in acute anterior uveitis. However, cases of posterior uveitis Several proteolytic enzymes are liberated in human and chronic anterior uveitis did not show any signifi- serum during bacterial infections.'7 The action of cant alteration in its level. The elevated serum alpha- these proteases is modulated by various protease 1 antitrypsin level in patients with endogenous uveitis inhibitors like alpha-I antitrypsin, alpha-1 anti- did not show any appreciable fall in spite of the chymotrypsin, interalpha trypsin inhibitor, clinical improvement. This could be explained by the antithrombin-2, C-1 inactivator, and alpha-2 fact that these patients were on systemic cortico- macroglobulin.'8 steroids, which are known to increase the serum The serum alpha-i antitrypsin level in the healthy alpha-1 antitrypsin level,5 or it might be due to the subjects (199-9 mg/dl) is lower than the values persistence of subclinical activity of endogenous reported elsewhere from India, being 225 mg/dl" and uveitis. It has been reported that there is no signifi- Br J Ophthalmol: first published as 10.1136/bjo.68.4.242 on 1 April 1984. Downloaded from 244 A. K. Gupta and G. S. Sarin Table 4 Serum alpha-I antitrypsin level in endogenous 5 Faarvang HJ, Lauritsen OS. Relationship between serum con- uveitis patients before and after therapy centration and urinary output of trypsin inhibitor after cortisone administration. ScandJ Clin Lab Invest 1963; 15: 483-90. No. of Alpha-i antitrypsin level p Value 6 Cleve H, Behrend T. Quantitative immunological determination subjects (mg/dl) of alpha-I acid glycoprotein and alpha-I antitrypsin in the sera of patients with rheumatoid arthritis. Z Rheumatol 1966; 25: Before After 278-83. therapy therapy 7 Ganrot PO, Bjerre B. Alpha-I antitrypsin and alpha-2 macro- globulin concentration in serum during pregnancy. Acta Obstet Antcrior uveitis 25 233(0±45-( 226-8±41- 1 >0-7 GynecolScand 1967; 46: 126-37. Acutc 16 239-5±47-5 227-5±37-8 >0-5 8 Laurell CB. Alpha-I antitrypsin deficiency and liver disease. In: Chronic 9 221-4±40(0 225-6±488- >0-9 Read AE ed. Modern trends in gastroenterology. 5th ed. London: Postcrior uvcitis 9 220-0±33-6 218-3±45-9 >0-95 Butterworth, 1975: 134. Total no. of paticnts 34 229-6±42-2 224-5±41-9 >0-7 9 SchumacherGFB, Pearl MJ. Alpha antitrypsin in cervical mucus. Fertil Steril 1968; 19: 91-9. 10 Young C Jr, Headings VE, Bose S, Harden KA, Crockett ED Jr, SI convcrsion: mg/dlxO-l =g/l. Hackney RL Jr. Alpha- I antitrypsin level in sarcoidosis: relation- ship to disease activity. Chest 1973; 64: 39-45. cant association of the 11 Agarwal SK, Saha K. Serum alpha-I antitrypsin in various forms alpha-I antitrypsin phenotype of leprosy.
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