Article

Eye (1997) 11, 213–216; doi: 10.1038/eye.1997.54

Mechanisms of inflammatory response in sympathetic ophthalmia and VKH syndrome

Narsing A Rao1

1A. Ray Irvine, Jr, Ophthalmic Pathology Laboratory, Doheny Eye Institute, University of Southern California, School of Medicine, Los Angeles, California, USA

Correspondence: Narsing A. Rao, MD, Doheny Eye Institute, 1450 San Pablo Street DVRC-211, Los Angeles, CA 90033-1088, USA

Top

Abstract

Although the inciting events in the pathogenesis of sympathetic ophthalmia and Vogt–Koyanagi–Harada (VKH) syndrome are different, these two forms of bilateral granulomatous uveitis share several clinical, histopathological and immunohistochemical features, including their association with HLA types and in their in vitro T-cell response to retinal antigens. These clinical and immunopathological features indicate that there is an underlying T-cell-mediated autoimmunity to uveal/retinal antigens in the development of these forms of uveitis. Both forms exhibit preservation of the choriocapillaris and retina despite extensive inflammatory cell infiltration in the choroid. Recent experimental studies suggest that this preservation of choriocapillaris could be the result of anti-inflammatory products secreted by the retinal pigment epithelium, including transforming growth factor-beta and a novel protein called retinal pigment epithelial protective protein that is known to suppress the phagocyte generation of superoxide. Such suppression of the oxidant release in the choroidal inflammation could help protect the uvea from necrotic change and preserve the choriocapillaris from inflammatory cell infiltration.

Keywords:

Sympathetic ophthalmia; Vogt–Koyanagi–Harada syndrome; Granulomatous uveitis; Oxygen free radicals; Retinal pigment epithelium; Protective protein

Top

References

  1. Davis JL, Mittal KK, Freidlin V, Mellow SR, Optican DC, Palestine AG, Nussenblatt RB. HLA associations and ancestry in Vogt-Koyanagi-Harada disease and sympathetic ophthalmia. Ophthalmology 1990;97:1137–42. | PubMed | ISI |
  2. Moorthy RS, Inomata H, Rao NA. Vogt-Koyanagi-Harada syndrome. Surv Ophthalmol 1995;39:265–92. | Article | PubMed | ISI | ChemPort |
  3. Rao NA, Marak GE Jr. Sympathetic ophthalmia simulating Vogt-Koyanagi-Harada's disease: clinicopathologic study of four cases. Jpn J Ophthalmol 1983;27:506–11. | PubMed | ChemPort |
  4. Goto H, Rao NA. Sympathetic ophthalmia and Vogt-Koyanagi-Harada syndrome. Int Ophthalmol Clin 1990;30:279–85. | Article | PubMed | ISI |
  5. Sakamoto T, Murata T, Inomata H. Class II major histocompatibility complex on melanocytes of Vogt-Koyanagi-Harada disease. Arch Ophthalmol 1991;109:1270–4. | PubMed | ISI |
  6. Kuppner MC, Liversidge J, McKillop-Smith S, Lumsden L, Forrester JV. Adhesion molecule expression in acute and fibrotic sympathetic ophthalmia. Curr Eye Res 1993;12:923–34. | Article | PubMed | ISI |
  7. Inomata H, Sakamoto T. Immunohistochemical studies of Vogt-Koyanagi-Harada disease with sunset sky fundus. Curr Eye Res 1990;9(Suppl):35–40.
  8. Rao NA, Wong VG. Aetiology of sympathetic ophthalmitis. Trans Ophthalmol Soc UK 1981;101:357–60. | PubMed |
  9. Cooke A. Autoimmunity update. Immunologist 1995;3:241–3.
  10. deSmet MD, Yamamoto JH, Mochizuki M, Gery I, Singh VK, Shinohara T, et al. Cellular immune responses of patients with uveitis to retinal antigens and their fragments. Am J Ophthalmol 1990;110:135–42. | PubMed | ISI | ChemPort |
  11. Boros DL. The role of cytokines in the formation of the schistosome egg granuloma. Immunobiology 1994;191:441–50. | PubMed | ISI |
  12. Rao NA, Patchett R, Fernandez MA, Sevanian A, Kunkel SL, Marak GE Jr. Treatment of experimental granulomatous uveitis by lipoxygenase and cyclooxygenase inhibitors. Arch Ophthalmol 1987;105:413–5. | PubMed | ISI |
  13. Kunkel SL, Chensue SW, Mounton C, et al. Role of lipoxygenase products in murine pulmonary granuloma formation. J Clin Invest 1984;74:514–24. | Article | PubMed | ISI |
  14. Rao NA. Role of oxygen free radicals in retinal damage associated with experimental uveitis. Trans Am Ophthalmol Soc 1990;88:797–850. | PubMed |
  15. Goto H, Wu GS, Gritz DC, Atalla LR, Rao NA. Chemotactic activity of the peroxidized retinal lipid membrane in experimental autoimmune uveitis. Curr Eye Res 1991;10:1009–14. | Article | PubMed | ISI |
  16. Wu GS, Rao NA. A novel retinal pigment epithelial protein suppresses neutrophil Superoxide generation. I. Characterisation of the suppressive factor. Exp Eye Res 1996;63:713–25. | Article | PubMed | ISI |
  17. Rao NA, Thaete LG, Delmage JM, Sevanian A. Superoxide dismutase in ocular structures. Invest Ophthalmol Vis Sci 1985;26:1778–81. | PubMed | ISI |
  18. Wu GS, Swiderek KM, Rao NA. A novel retinal pigment epithelial protein suppresses neutrophil super-oxide generation II. Purification and microsequencing analysis. Exp Eye Res 1996;63:727–37. | Article | PubMed | ISI |
  19. Einer VM, Strieter RM, Einer SG, Baggiolini M, Lindley I, Kunkel SL. Neutrophil chemotactic factor (IL-8) gene expression by cytokine-treated retinal pigment epithelial cells. Am J Pathol 1990;136:745–50. | PubMed | ISI | ChemPort |
  20. Planck SR, Dang TT, Graves D, Tara D, Ansel JC, Rosenbaum JT. Retinal pigment epithelial cells secrete interleukin-6 in response to interleukin-1. Invest Ophthalmol Vis Sci 1992;33:78–82. | PubMed | ISI | ChemPort |

Extra navigation

.

natureevents

ADVERTISEMENT