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Immune Responses to Retinal Autoantigens and Peptides in Equine Recurrent Uveitis

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Immune Responses to Retinal Autoantigens and Peptides in Equine Recurrent Uveitis Immune Responses to Retinal Autoantigens and Peptides in Equine Recurrent Uveitis Cornelia A. Deeg,1 Bernd Kaspers,1 Hartmut Gerhards,2 Stephan R. Thurau,3 Bettina Wollanke,2 and Gerhild Wildner3 5 PURPOSE. To test the hypothesis that autoimmune mechanisms unclear. Research has focused on the identification of infec- are involved in horses in which equine recurrent uveitis (ERU) tious agents that may induce uveitis, such as bacteria, viruses, develops spontaneously. or parasites, especially on a possible role for Leptospira inter- 6–8 METHODS. Material obtained from horses treated for spontane- rogans as an initiating agent in this process. However, the ous disease by therapeutic routine vitrectomy was analyzed for concept of an infectious factor that exclusively induces and total IgG content and IgG specific for S-Antigen (S-Ag) and maintains the disease is not sufficient to explain certain aspects interphotoreceptor retinoid-binding protein (IRBP). The cellu- of the clinical course and therapeutic approaches. Because of the recurrence of inflammation,5 the positive effect of cortico- lar infiltrate of the vitreous was analyzed by differential counts 2 of cytospin preparations and flow cytometry using equine steroids, and the insufficient therapeutic success of antibiot- lymphocyte-specific antibodies. Antigen-specific proliferation ics, the concept has emerged that the disease is immune assays were performed comparing peripheral blood lympho- mediated. Therefore, ERU is of high value for studying uveitis, because horses represent the only species besides humans in cytes (PBLs) with vitreal lymphocytes by stimulation with S-Ag 9 and several S-Ag– and IRBP-derived peptides. which recurrent uveitis develops spontaneously. Only a lim- ited number of experiments have been designed to examine RESULTS. The total IgG content of specimens from horses with the immunologic reactions of diseased horses. Immunohisto- ERU was very high with great variability among the investi- chemical studies have demonstrated a predominance of T cells gated samples (11.5 Ϯ 8.0 mg). Autoantibodies to S-Ag or IRBP in the inflammatory cellular infiltrates and an increase of major or both were found in 72% of vitreous specimens from horses 8 histocompatibility complex (MHC) class II expression on reti- with uveitis. The leukocyte infiltrates (up to 2 ϫ 10 cells per nal pigment epithelial cells.10 Recently, we have established sample) were dominated by lymphocytes (Ͼ90%) in most pars plana vitrectomy as a therapeutic approach in ERU,4 and cases (22/32). Flow cytometry showed that more than 50% of ϩ this has enabled us to gain inflammatory cells from eyes with these cells were CD4 T cells. In vitro stimulation of vitreal uveitis. The goal of our study was to further investigate the lymphocytes, but not of PBL, showed a strong proliferative underlying immunopathogenic mechanisms in ERU, providing response to peptides derived from S-Ag or IRBP in 9 of 12 evidence that the disease is autoimmune mediated with useful patients. and unique properties in comparison with all other uveitis CONCLUSIONS. In the eyes of horses with ERU, IgG antibodies models. and autoreactive T cells specific for retinal antigens were detected. These results strongly support the hypothesis that ERU is an autoimmune-mediated disease and is highly similar to METHODS recurrent uveitis in humans in both clinical and immunologic parameters. (Invest Ophthalmol Vis Sci. 2001;42:393–398) Patients Sixty-four horses with clinical signs of ERU underwent therapeutic pars quine recurrent uveitis (ERU) is a spontaneous disease plana vitrectomy according to the method described by Werry and Eaffecting up to 15% of horses.1 The disease is characterized Gerhards.4 All patients had at least two uveitic episodes, and ERU was by repeated episodes of intraocular inflammation, and many diagnosed according to clinical criteria, as described.11 Clinical signs of corresponding clinical and pathologic features are similar to intraocular inflammation including aqueous flare, synechiae, vitreitis, recurrent uveitis in humans.2 Clinical findings include blepha- pigment deposition on the anterior lens surface, retinal detachment, rospasm, photophobia, miosis, and pain in the acute phase.3 and cataract. The horses were treated with topical atropine a few days The recurrences vary in phase and severity, with a tendency to before surgery. Neither immunosuppressive therapy nor corticoste- increase in severity. Vision loss or blindness is the result of the roids were applied, because horses undergo surgery only in the quies- inflammatory process that leads to synechiae, cataract forma- cent stages of the disease.3 Physical examination included intraocular tion, retinal detachment, or phthisis bulbi.4 Blind horses have pressure measurement, slit lamp examination, and direct ophthalmos- to be euthanatized for ethical reasons and cause large eco- copy with dilated pupil. Because the donors of specimens are not nomic losses in the equine industry. Although ERU has been experimental but companion animals and were brought to the Depart- known for centuries and occurs worldwide, the cause remains ment of Equine Surgery in the need of medical help, these studies could not include histologic analysis of the eyes. Enucleation of uveitic eyes is performed rarely, because vitrectomy has been successfully established for horses as a routine treatment for progressive stages From the 1Institute of Animal Physiology, the 2Department for Equine Surgery, and the 3Section of Immunobiology, Department of of ERU. Ophthalmology, Ludwig-Maximilians University, Munich, Germany. Supported by Deutsche Forschungsgemeinschaft Grant DE Sample Collection 719/1-1. All animals were managed in accordance with the ARVO Statement for Submitted for publication July 5, 2000; revised September 5 and October 3, 2000; accepted October 16, 2000. Use of Animals in Ophthalmic and Vision Research. Depending on Commercial relationships policy: P. sample size and numbers of collected cells, specimens were used for Corresponding author: Cornelia A. Deeg, Institute of Animal Phys- one or several of the analytical procedures, to determine the type of iology, Ludwig-Maximilians University, Veterina¨rstrasse 13, 80539 Mu- inflammation and the humoral and cellular immune responses to reti- nich, Germany. [email protected] nal antigens. Heparinized blood for in vitro proliferation assays and Investigative Ophthalmology & Visual Science, February 2001, Vol. 42, No. 2 Copyright © Association for Research in Vision and Ophthalmology 393 Downloaded from jov.arvojournals.org on 09/29/2021 394 Deeg et al. IOVS, February 2001, Vol. 42, No. 2 serum were collected before ocular surgery. Vitreous samples were 118717), PI 536 (IRBP; aa 536-54917), and B27PD (HLA-B; aa 125-13815). obtained during pars plana vitrectomy and assayed immediately. Vitre- Peripheral blood lymphocytes (PBLs) were obtained from heparinized ous was diluted with 200 ml sterile balanced salt solution (BSS) during blood samples by Ficoll density gradient centrifugation (Pharmacia, surgery. BSS is routinely used to replace removed vitreous. Control Freiburg, Germany). Cells were washed three times and resuspended vitreous was immediately collected and processed after death from in RPMI 1640 medium (Life Technologies, Karlsruhe, Germany) sup- eyes of euthanatized horses without ocular disease. Control blood plemented with 2 mM L-glutamine (Biochrom, Berlin, Germany), 100 samples were obtained from horses without ocular disease. U/ml penicillin (Biochrom), 100 ␮g/ml streptomycin (Biochrom), and 10% fetal calf serum (ICN Biochemicals, Meckenheim, Germany). Preparation of Cells from Vitreous Vitreal lymphocyte preparations with more than 90% lymphocytes and Flow Cytometry (as assessed by cytospin preparations) were assayed for their antigen- specific proliferation only when more than 1 ϫ 106 cells were recov- Vitreous humor was filtered through a stainless steel sieve before 5 ered from the vitreous. PBLs (5 ϫ 10 cells per well) and vitreous cells analysis. Cells were pelleted by centrifugation at 4°C for 20 minutes at 4 (1 ϫ 10 cells per well) were cultured as triplicates in flat-bottomed 750g. The supernatant was stored at Ϫ20°C until use, and the cell microtiter plates (Nunc) in the presence of antigens for 5 days in pellet was resuspended in RPMI and subsequently analyzed. Differen- humidified atmosphere at 37°C with 5% CO2. Subsequently, cells were tial counts were obtained from Wright-stained cytospin preparations, labeled with 2 ␮Ci [3H]thymidine per well for 18 hours and harvested and the remaining cells were phenotyped by flow cytometry. In 100 ␮l at day 6 (Amersham, Braunschweig, Germany). [3H]thymidine incor- fluorescence buffer (phosphate-buffered saline [PBS] with 1% bovine poration was measured by scintillation counting. The results are pre- serum albumin [BSA], 0.01% sodium azide; Sigma, Deisenhofen, Ger- 6 sented as stimulation index (SI; mean counts per minute [cpm] of many) 1 ϫ 10 cells were incubated for 30 minutes at 4°C with 10 ␮l triplicates with antigen/mean cpm of triplicates without antigen). of monoclonal mouse anti-equine antibodies directed against the fol- lowing markers: CD4 (clone CVS4), CD8 (CVS 21), and clone CVS1 to Statistical Methods detect B cells (all from Biozol/Serotec, Eching, Germany). Cells were subsequently washed three times with fluorescence buffer and stained The statistical significance of differences between groups was evalu- with fluorescein-isothiocyanate (FITC)–conjugated
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